Learning to Love your Liver

What is the liver?

The liver is remarkable, and plays a valuable role in the function of almost every organ system in the body. As one of the most important organs, it has the unique ability to partially regenerate itself after surgical removal or damage. However, in severe situations, such as liver scarring (also called fibrosis) or repeated damage from chronic alcohol or drug abuse, the ability to regenerate is impeded.

The liver is made up of tiny cells called ‘hepatocytes’, blood circulates through the liver carrying nutrients, medication, and also toxic substances, and the liver acts as a ‘filter’ altering toxins and waste to be efficiently removed from the body. The liver’s ability to filter and detoxify plays a crucial role in maintaining our overall health.

Our liver works very hard for us around the clock to keep us healthy. To put it into perspective, approximately 1350 ml of blood moves through the liver each minute which works out to be approximately 1944 Litres of blood every 24 hours! (1). In this article, I will share with you the importance of maintaining a healthy liver, delving into its various functions and the critical role it plays in our well-being. We will also discuss subtle signs and symptoms that may indicate an unhappy liver, as well as more severe symptoms associated with liver damage. Finally, I will offer you some guidance on how to support your liver through healthy dietary and lifestyle choices, ensuring it’s optimal function.

Why should you care about your liver?

The liver is well-known for its role in removing alcohol and drugs from our body, and while that is an important job, it also performs numerous other essential functions for us everyday. Here are some key reasons to care about your liver health:

1. It keeps us energised: The liver helps energise our body by maintaining blood sugar levels, converting substances like amino acids into sugar, breaking down proteins into amino acids, and transforming fats into energy. For those following a ketogenic diet,  or who regularly practise fasting, or prolonged exercise, a healthy liver is vital for efficiently producing ketones for energy.

2. Storage of vitamins and minerals: The liver stores essential vitamins and minerals such as Vitamin A, Vitamin D, Vitamin B12, Vitamin K, iron, and copper. These nutrients can be stored for several months or even years. That is why when someone is eating a very nutrient depleted diet, they may not start showing signs of deficiency for months or even years.

3. Detoxification: Have you ever considered doing a ‘detox’ cleanse, well supporting your liver is one of the wonderful ways you can support your body's natural detoxification systems all year round! The liver helps remove drugs, alcohol, environmental chemicals, and waste products from your body by altering these substances for safe removal from the body.

4. Weight loss support: Part of how the liver detoxifies substances from our body is through phase 1, 2, and 3 detoxification pathways. When the liver lacks the necessary resources to carry out these processes or become overwhelmed by the volume of toxins, it ingeniously protects the body by encapsulating these harmful substances within fat cells (also called adipose tissue) to prevent them from circulating in the bloodstream and causing damage. During a weight loss journey, these toxins are released again, prompting the liver to manage them once more (3). This is why it’s essential to support your liver while attempting to lose weight. Rather than aiming for rapid weight loss, which can burden your liver, it’s preferable to pursue a slow, steady, and sustainable approach, allowing your liver to safely process what it needs to. This can also help explain why some individuals experience a weight loss ‘plateau’ where certain areas of adipose tissue remain stubbornly resistant. In such cases, it could be that the liver requires additional support to perform its functions effectively.

5. Keeps skin looking healthy: The liver contributes to healthy, supple skin by helping with the absorption and storage of fat-soluble nutrients and playing a role in hormone regulation.

6. Immune system support: The liver contains ‘Kupffer cells’ that remove bacteria, viruses, and other harmful substances from the blood acting as an immune defence.

7. Cholesterol production: Cholesterol has a bad reputation, but it is actually a very important substance in our body for the membrane structure of cells, hormone synthesis, nerve function, and bile production. The liver plays an essential role in producing cholesterol. 

8. Blood clotting: The liver creates substances needed for blood clotting, which prevents excessive bleeding after injury or during surgery.

9. Reducing menstrual symptoms: the liver plays a crucial role in hormone regulation and metabolism, including the breakdown and elimination of excess estrogen from the body. Supporting your liver ensures the maintenance of hormonal balance, and can reduce common menstrual symptoms such as bloating, fluid retention, mood swings, heavy bleeding, and cramping.

What a list! And this isn’t even everything that the liver does. These are some amazing reasons that you should take the health of your liver seriously and do what you can to keep it happy.

Subtle signs your liver may be unhappy

These signs are not diagnostic but they may be indicative that your liver needs some extra love and attention:

• Feeling tired and lethargic all the time

• Feeling that coffee, alcohol, or other substances take a lot longer for you to ‘get out of your system’ than most people

• Discomfort, pain, or bloating in your upper abdominal area

• Feeling nauseous after eating fat containing foods

• Getting a headache or feeling sick when you encounter strong smells such as perfume or chemicals

• Frequent headaches

• Digestive problems such as bloating, irregular bowel movements, indigestion, diarrhoea

• Yellowing of the whites of your eyes, your skin, your fingernails, or toenails

• Brain fog, memory and confusion

• Itching hands and feet, especially when you lay down for bed at night

• Fluid retention

• Floating stools

More severe signs your liver may be damaged

If you are concerned about your liver in any way it’s very important to seek help from a medical professional, here are some more significant signs that you liver may need help:

• Severe jaundice, yellowing of the skin and eyes

• Fluid buildup (ascites) around the abdominal area causing swelling and discomfort

• Fluid buildup (edema) in the legs, ankles, or feet

• Vomiting blood

• Dark urine

• Pale or clay-coloured stools

• Spider like blood vessels on the face, upper chest, or arms

• Easily bruising or bleeding

• Loss of appetite, nausea, or vomiting

• Weight loss and muscle wasting

• Severe abdominal pain

Showing more love to your liver through your diet

Now that we understand more about the remarkable work that the liver does for us, let’s talk about how we can love and support our liver’s on a day to day basis starting with our diet:

1. Avoid heavily processed foods: Aim to consume whole foods as much as possible such as fruits, vegetables, unprocessed meat, fish, nuts, seeds, and whole grains. Limit your intake of artificial sweeteners, preservatives, colours, flavours, and unfamiliar ingredients. Most modern convenience foods put quite a burden on our liver, that is now dealing with so many foreign substances on a daily basis.

2. Adopt a low-glycemic index diet: Choose foods and eating habits that don’t cause high blood sugar spikes, which can increase the risk of insulin resistance and diabetes. High sugar consumption can also contribute to non-alcoholic fatty liver disease (NAFLD), which is now one of the most prevalent diseases in the world. In Australia it is estimated that 1 in 3 people have a fatty liver! (20). Wow! Some basic tips to a low-GI diet is to avoid sugary drink, simple carbs like white bread, pasta, and opt for whole grain and wholemeal options. Incorporate healthy fats, proteins, whole fruits, and vegetables into your meals.

3. Eat cruciferous vegetables every day: Cruciferous vegetables are high in substances that support liver detoxification. This includes vegetables such as broccoli, kale, Brussel's sprouts, broccoli sprouts, cabbage, and cauliflower.

4. Eat plenty of sulphur rich foods: A few examples of sulphur rich foods includes eggs, onion, and garlic

5. Eat enough fibre: Maintaining regular bowel movements is crucial for liver health. The liver stores waste products in bile within the gallbladder, which is then excreted into the digestive tract and bound by fibre for efficient elimination through bowel movements. Constipation can have various causes, so if increasing fibre doesn’t resolve it, consult with a healthcare professional.

6. Stay hydrated: Drinking plenty of water maintains bowel regularity and ensures your liver can function most effectively.

7. Include healthy fats in your diet: Don’t be afraid of healthy fats in your diet. Healthy fats are essential for health and should not be demonised or feared. In order for your gallbladder to properly empty itself, there needs to be adequate fat in the meal you’ve eaten to stimulate the gallbladder to contract (2). Consistently eating a low or no fat diet can impede gallbladder function and therefore negatively affect the liver. However, if you have gallbladder issues or are missing a gallbladder, consult a healthcare professional for personalised advice on fat intake. Some healthy fat sources include nuts, seeds, avocados, olives, olive oil, fatty fish, grass-fed meat, grass-fed ghee, goat’s butter, goat’s cheese.

8. Enjoy bitter foods: Foods such as rocket, dandelion root, and lemon water support digestion and liver function.

9. Eat an abundance of antioxidant rich foods and drinks: antioxidant rich foods include berries, rosemary, green tea, artichokes, dark chocolate, nuts and seeds, spices such as turmeric, ginger, and cinnamon.

10. Enjoy good quality coffee: coffee has been shown to protect against non-alcoholic fatty liver disease. An example of good quality coffee is organic, freshly ground beans. Try to avoid sweetener. Black coffee or just a dash of milk is preferred.

Lifestyle tips for supporting your liver

1. Limit alcohol and drug use: excessive alcohol and drug consumption can damage the liver. If you choose to drink alcohol occasionally, consider the following tips to minimize its impact on your liver:

• Pace yourself

• Drink a large glass of water between each alcoholic beverage

• Eat something nutritious before consuming alcohol

• Avoid binge drinking

• Choose drinks that don’t spike your blood sugar, such as dry wines, spirits with sugar free mixers, or Japanese sake. Keep in mind that moderation is key.

• Take breaks between drinking sessions, reserving alcohol for special occasions instead of daily or weekly consumption.

2. Reduce exposure to chemicals and environmental pollutants: This includes cleaning products, skincare items, and air pollution. Since exposure to chemicals has drastically increased over the past century, reducing contact can lesson the burden on your liver. Here are some tips:

• Switch to natural cleaning products or make your own homemade cleaning products

• Choose natural-based skincare and makeup products

• Use natural deodorant, perfume and fragrances containing essential oils

• Prioritise organic fruits and vegetables or use a produce wash to remove pesticide residue. Another tip is to focus on the 'dirty dozen' and 'clean 15' list (google it for more info)

• Drink filtered water to reduce exposure to harmful substances

4. Exercise regularly: As a minimum, aim for at least 30 minutes of strenuous exercise 2-3 times a week to improve liver function.

5. Quit smoking and vaping: Cigarettes and vaping can negatively affect liver health as they introduce harmful substances that the liver must process and detoxify. Smoking and vaping can cause oxidative stress, impair liver function, weaken immune response, and increase the risk of liver diseases.

6. Practise safe sex: Use protection and engage in regular testing to reduce the risk of exposure to viral hepatitis. Discuss testing with new sexual partners before engaging in sexual activities.

7. Prioritise relaxation and stress management: stress can negatively impact liver health. Schedule daily or at least weekly moments to relax and unwind. Consider activities such as yin yoga, taking a bath, reading, spending time with loved ones, doing things that make you laugh, spending time in nature, etc.

Herbal medicines that support the liver

Naturopaths have some fabulous herbal medicines in their toolbox to support the liver. These herbs are usually prescribed in highly concentrated tincture extracts. However you should always consult with a Naturopathic practitioner or your prescribing doctor to ensure they are suitable to your unique needs before taking them. Some examples of herbs include:

• St. Mary's Thistle (Silybum marianum): This herb exhibits hepatoprotective (liver protective), antifibrotic (prevents liver fibrosis/scarring), promotes liver regeneration, acts as a powerful liver antioxidant, and choleretic (promotes the secretion of bile) actions (4). A study done involving 52 obese men who were diagnosed with NAFLD, were given St. Mary's Thistle extract for 2 months. The results showed a significant reduction in aminotransferase (a liver enzyme) without any specific side effects (5).

• Dandelion Root (Taraxacum officinale): Dandelion root exhibits hepatoprotective (liver protective), bitter (improves digestion), choleretic (promotes secretion of bile) and antioxidant actions (6, 7, 8). Studies in human and animal research has found dandelion root to be useful in preventing and treating liver diseases such as NAFLD, and alcoholic-induced liver damage (9).

• Globe artichoke (Cynara scolymus): Artichoke has been shown to exhibit bitter, anti-obesity, antioxidant, choleretic (promotes secretion of bile) actions (10, 11). Research has shown that Globe artichoke significantly reduces liver enzymes, especially among people with NAFLD (12)

• Turmeric (Curcuma longa): turmeric exhibits hepatoprotective (liver protecting), antioxidant, and anti-inflammatory actions. Turmeric has been shown to protect the liver against damage from ingesting heavy metals and reduce the replication of hepatitis B virus (13). Curcumin, a compound found in turmeric, has been shown to protect the liver from damage, reduce fat accumulation, and prevent inflammation in studies using animal models of non-alcoholic steatohepatitis (NASH), potentially by activating a specific protein (Nrf2) and blocking the activity of harmful molecules (HMGB1-NF-κB) (14).  Curcumin has also been shown to help protect the liver from various types of oxidative stress and damage by improving antioxidant levels and reducing inflammation in numerous studies, suggesting it may have potential therapeutic uses for liver health (14).

• Rosemary (Rosmarinus officinale): Rosemary exhibits antioxidant and hepatoprotective (liver protective) effects against alcoholic liver disease (15). Rosemary is also able to induce phase 2 liver detoxification (16).

• Schisandra (Schisandra chinensis): schisandra supports liver health by protecting against toxins, promoting liver regeneration, and enhancing antioxidant activity; these effects have been demonstrated in various studies (17, 18, 19)

In conclusion, keeping our liver happy keeps our body happy. Looking after your liver is very important for overall health and wellbeing. If you would like some specific naturopathic advice on caring for your liver and your overall health consider booking in a naturopathic appointment with me. I hope this article has helped you learn to love and appreciate your liver more.

References

1. Guyton & Hall (2011). Guyton and Hall Textbook of Medical Physiology. Elsevier https://www.healthdirect.gov.au/fatty-liver#:~:text=About%201%20in%203%20Australians,have%20high%20blood%20pressure

2. Froehlich, F., Gonvers, J. J., & Fried, M. (1995). Role of nutrient fat and cholecystokinin in regulation of gallbladder emptying in man. Digestive Diseases and Science, 40, 529-533. https://link.springer.com/article/10.1007/BF02064362

3. Jackson, E, Shoemaker, R., Larian, N. & Cassis, L. (2018). Adipose tissue as a site of toxic accumulation. Comp Physiol, 7(4), 1085-1135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101675/

4. Abenavoli, L., Izzo, A. A., Milic, N., Cicala, C., Santini, A., & Capasso, R. (2018). Milk thistle (Silybum marianum): A concise overview on its chemistry, pharmacological and nutraceutical uses in liver diseases. Phytotherapy Research. https://doi.org/10.1002/ptr.6171

5. Mirhashemi, S. H., Hakakzadeh, A., Yeganeh, F. E., Oshidari, B., & Rezaee, S. P. (2022). Effect of 8 weeks milk thistle powder (silymarin extract) supplementation on fatty liver disease in patients candidates for bariatric surgery. Metabol Open, 14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149185/

6. Pfingstgraf, I. O., Taulescu, M, Pop, R. M., Orasan, R., ... Parvu, A. E.. (2021). Protective effects of Taraxacum officinale L. (Dandelion) root extract in eperimental acute on chronic liver failure. Antioxidants, 10(504). https://doi.org/10.3390/antiox10040504

7. Wirngo, F. E., Lambert, M. N., & Jeppeson, P. B. (2016). The physiological effects of dandelion (Taraxacum officinale) in type 2 diabetes. The Review of Diabetic Studies, 13(2-3), 113-131. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553762/#:~:text=It%20has%20several%20beneficial%20properties,%2Dinduced%20diabetes%20%5B127%5D.

8. Mahboubi, M. & Mahboubi, M. (2020). Hepatoprotection by dandelion (Taraxacum officinale) and mechanisms. Asian Pacific Journal of Tropical Biomedicine, 10(1), 1-10. https://apjtb.org/article.asp?issn=2221-1691;year=2020;volume=10;issue=1;spage=1;epage=10;aulast=Mahboubi

9. Napoli, A. D. & Zucchetti, P. (2021). A comprehensive review of the benefits of Taraxacum officinale on human health. Bulletin of the National Research Centre, 45(110). https://bnrc.springeropen.com/articles/10.1186/s42269-021-00567-1

10. Mahboubi, M. (2018). Cynara scolymus (artichoke) and it efficacy in management of obesity. Bulletin of Faculty of Pharmacy, 56(2), 115-120. https://www.sciencedirect.com/science/article/pii/S1110093118300346#:~:text=scolymus%20inhibits%20the%20digestive%20enzymes,in%20preclinical%20and%20clinical%20studies.

11. Gebhardt, R. (2005). Choleretic and anticholestatic activities of flavonoids of artichoke (Cynara cardunculus L. Subsp. scolymus (L.) hayek). Acta Hortic, 681, 429-436. https://doi.org/10.17660/ActaHortic.2005.681.60

12. Moradi, S., Shokri-Mashhadi, N., Saraf-Bank, S., Mohammadi, H., Zobeiri, M., Clark, C. C. T., & Rouhani, M. H. (2021). The effects of Cynara scolymus L. supplementation on liver enzymes: A systematic review and meta-analysis. The International Journal of Clinical Practice. https://onlinelibrary.wiley.com/doi/abs/10.1111/ijcp.14726

13. Tun, B. T., Nham, D. T., Hai, N. T., & Thu, D. K. (2019). Curcuma longa, the polyphenolic curcumin compound and pharmacological effects on liver. Dietary Interventions in Liver Disease, 125-164. https://doi.org/10.1016/b978-0-12-814466-4.00010-0

14. Farzaei, M. H., Zobeiri, M., Parvizi, F., El-Senduny, F. F., ... Abdollahi, M. (2018). Curcumin in liver diseases: A systematic review of the cellular mechanisms of oxidative stress and clinical perspective. Nutrients, 10(7). 855. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073929/

15. Martinez-Rodrigues, L., Gutierrez-Hernandez, J., Reyes-Estrada, A. ... Lopez, A. (2019). Hepatoprotective, antihyperlipidemic and radical scavenging activitiy of hawthorn (Crataegus oxycantha) and rosemary (Rosemarinus officinalis) on alcoholic liver disease. Alternative Therapies in Health & medicine, 25(4), 54-63. https://web.p.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=10786791&AN=137351663&h=cIMUpLRR9bydGFVMulfVy4om0xrNXSnH9cMA8%2bgdKcD1i68RSaM%2bYeZ1q9gOpazuGFFqdh9TUAoS2wdTVha5kw%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d10786791%26AN%3d137351663

16. Petiwala, S. M., & Johnson, J. J. (2013). Diterpenes from rosemary (Rosmarinus officinalis): Defining their potential for anti-cancer activity. Cancer Letters, 367(2), 93-102. https://doi.org/10.1016/j.canlet.2015.07.001

17. Panossian, A., & Wikman, G. (2008). Pharmacology of Schisandra chinensis Bail.: An overview of Russian research and uses in medicine. Journal of Ethnopharmacology, 118(2), 183-212. https://doi.org/10.1016/j.jep.2008.04.020

18. Liu, G. T. (2010). Pharmacological actions and clinical use of fructus schizandrae. Chinese Medical Journal, 100(10), 791-795.

19. Chiu, P. Y., Luk, K. F., Leung, H. Y., Ng, K. M., Ko, K. M. (2013). Schisandrin B stereoisomers protect against hypoxia/reoxygenation-induced apoptosis and inhibit associated changes in Ca2+-induced mitochondrial permeability transition and mitochondrial membrane potential in H9c2 cardiomyocytes. Life Sciences, 92(3), 145-150. https://doi.org/10.1016/j.lfs.2012.11.012

20. Adams, L. A., Roberts, S. K., Strasser, S. I., Mahady, s. E., Powell, E., Estes, C., Razavi, H., & George, J. (2020). Nonalcoholic fatty liver disease burden: Australia, 2019-2030. Journal of Gastroenterology and Hepatology, 35(9), 1628-1635. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540570/