The Liver - Savior from Our Own Abuses
From the McDougall Newsletter
The liver is our largest internal organ and plays a central role in the maintenance of our entire body. Dietary proteins, fats and carbohydrates are synthesized and broken down, and cholesterol and triglycerides are regulated, by the liver. The liver is the primary site for activation, clearance, detoxification and excretion of most medications, drugs, and toxins that enter our body. Because the liver is the primary depot of all the junk we take in, it is particularly important we avoid toxic substances, like drugs and poisons – alcohol being the most common example of both.
Chronic liver disease is the tenth leading cause of death in the United States – resulting in about 25,000 deaths per year. Fortunately, for most us looking for salvation after years of abuse of our bodies, the liver has a tremendous capacity to regenerate itself, even after serious injuries. Even though you may not have thought much about it up until now because the liver is hidden deep inside your body, it is time to bring proper “liver care” to the forefront of your attention.
High-Carbohydrate, Liver-Friendly Foods
The time-honored diet for all liver ailments has been a high-carbohydrate, low-fat, low-protein diet. During my medical school training, more than 30 years ago, I recall prescribing this kind of diet for patients with all kinds of liver illnesses from acute hepatitis to chronic liver failure. Carbohydrates are the energy sources most easily utilized by the liver; in addition, a high-carbohydrate diet limits the intake of proteins, which can be toxic to the body.1 Carbohydrate fuels burn cleanly into carbon dioxide and water, without leaving behind toxic remnants of metabolism, like the nitrogen left behind when burning protein for fuel. Carbohydrates also increase the production of insulin, which helps remove potentially toxic proteins from the body.
Dietary protein can cause a person with liver failure to become very ill, when amino acids and other protein-breakdown-products accumulate. The results of the build-up of these substances can be encephalopathy (mental dysfunction) and hepatic coma. Vegetable protein is more easily tolerated by a person with impaired liver function.2 In fact, people with severe liver disease have been effectively treated by a diet which substitutes animal protein with vegetable protein as a single therapy – relieving encephalopathy and hepatic coma.
Obesity encourages the progression of liver disease to a chronic, often fatal, condition, known as cirrhosis.3There is also evidence that carbohydrate intake has a protective effect on the risk of cirrhosis, whereas saturated fat intake significantly increases the risk associated with alcohol consumption.4,5Therefore, for many reasons, a low-fat, high-carbohydrate, plant-protein vegetarian diet would be the best diet for all persons with liver disease – as well as anyone wanting to keep the liver healthy.
Fatty Liver Disease
Simple accumulation of fats within the liver tissue, commonly referred to as “fatty infiltration of the liver” and medically termed “non-alcoholic steatohepatitis,” is caused by eating an unhealthy diet. This fatty liver disease can lead to serious consequences, including inflammation, scar tissue formation (fibrosis), and cirrhosis. At autopsy, from 6% to 11% of livers of Americans show moderate to severe accumulation of fat. This condition is more commonly seen in people who are alcoholic, obese, have diabetes and/or elevated triglycerides (hypertriglyceridemia). About 75% of people with this condition are women, and between 70% and 100% are obese. Fatty infiltration of the liver is usually discovered when routine blood tests reveal elevation of one or more of the “liver enzymes” known as alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT). Exclusion of other causes for the elevation of these liver enzymes, such as heavy alcohol intake and viral hepatis, must be made before a diagnosis of non-alcoholic steatohepatitis is made. The higher the levels of elevated liver enzymes, the more likely damage to the liver on direct examination will be seen. About half of the patients complain of fatigue and/or upper abdominal discomfort – the other half has no symptoms. Liver enlargement is sometimes detected on physical examination.
High fat and oil consumption are associated with an elevation in liver enzymes.6 Most importantly, a change in diet and exercise regime that results in a 10 to 15 pound weight loss is a very effective means of healing the liver – this is seen by improvement of the liver enzymes and disappearance of fat from the liver tissues on direct examination of the liver tissues after a biopsy.7Many other studies have confirmed that this potentially serious liver condition can be cured with a change in diet and accompanying weight loss.8-10
Hepatitis, meaning inflammation of the liver, is usually due to a virus infection, but can also be caused by medications and other chemical toxins. Viral hepatitis is commonly classified as A, B, and C, as well as by other letters. These viruses are spread by close contact with infected people or their body fluids (saliva, blood, and semen). Hepatitis B and C are most often associated with illicit drug use, blood transfusions, and sexual contact. Fortunately, there are effective vaccines for hepatitis A and B, which greatly reduce your chances of infection. All of our family members have been immunized against both forms of viral hepatitis – this decision was made partly because we frequently travel worldwide to places of higher risk.
Once infected, the body provides a defense that attempts to eliminate the virus. However, in some cases this fails and the infection becomes chronic. For example, between 75 to 80 percent of people infected with hepatitis C go on to a chronic form where the virus persists – as a result, more than 25 percent develop cirrhosis within 40 years. Chronic infections by hepatitis B and hepatitis C viruses are major risk factors for most primary liver cancer cases worldwide.
Therapy for Infectious Hepatitis
I have had people chronically infected with viral hepatitis tell me that after a change to a low-fat, pure vegetarian diet they were able to rid themselves of the virus. (I cannot substantiate this with scientific research, but it makes sense that a healthier body would be better able to mount an effective attack against any foreign invader.)
There are herbal treatments for chronic hepatitis that are almost side-effect free and highly effective. For example, one of the earliest and most encouraging reports was published in 1988 in the Lancet.11 In this preliminary study, 22 of 37 (59%) of chronically infected patients who were treated with a preparation of the plant Phyllanthus amarus for 30 days lost hepatitis B surface antigen when tested 15-20 days after the end of the treatment; compared with only 1 of 23 (4%) placebo-treated controls (the antigen is the protein coat of the virus and its presence is a strong indication of continued infection). Some subjects had been followed for up to 9 months and in no case did evidence of chronic virus infection return. There were no serious adverse effects from the treatment. Several more recent reviews of the effectiveness of this herb have come to similar conclusions about its effectiveness.12,13
Other herbal treatments of herb combinations have also been reported to be effective, such as the Chinese “Jianpi Wenshen recipe” and the Japanese herbal medicine "Sho-saiko-to."14,15
With such a gloomy future for people with this progressive liver disease, it is a wonder that everyone with chronic hepatitis doesn’t at least try the herbal approach, with its low cost and absence of serious adverse effects. Unfortunately, the nonprofit nature of these remedies reduces the likelihood that patients and their doctors will know about them.
Doctors and patients “do” know about drug therapies. The best standard medical therapies for chronic hepatitis are with drugs known as interferon and ribavirin – they offer about a 40 percent chance of eliminating the chronic infection. The costs are high (48 weeks of interferon/ribavirin combination therapy should cost approximately $10,000), and the side effects are often serious.
Drugs and Toxins
Commonly used medications with known liver toxicity include NSAID (Advil, Motrin, etc.), including the new Cox-2 inhibitors (like Celebrex and Vioxx), other pain-killers (Tylenol), cholesterol-lowering drugs (like Mevacor, Zocor, Lipitor and niacin), diabetic medications (Precose, Actos, Avandia, and sulfonylureas), estrogens, anabolic steroids, antibiotics, antifungals, anticonvulsants, antidepressants, antiarthritic (methotrexate), acne (Accutane), vitamin A (retinol) and many other medications (see the Physicians’ Desk Reference – PDR – for a partial list). Obviously, the best prevention is avoidance of these substances – and the easiest way to avoid medication exposure is to stay healthy with a good diet and exercise habits.
Alcohol is the most common toxin known to cause severe liver disease. Everyone knows this and prevention is obviously the safest course.
There are other important dietary sources of liver toxins that cause damage as serious as liver cancer. Nitrosamines found in preserved meats, such as luncheon meats and hot dogs, are suspected of causing liver cancer; as are aflatoxins, found in moldy grain and peanut products. The solvent, carbon tetrachloride, can cause fatal liver disease. There are also low levels of environmental contaminants produced by industry that are potentially toxic to the liver. The best way to avoid this variety of chemical intake is to eat low on the food chain – in other words to eat low-fat, plant foods.
Liver Tonics – Milk Thistle
Herbal treatments have been widely used for many forms of liver disease, such as hepatitis caused by viruses and toxins, fatty liver, alcoholic cirrhosis, and radiation toxicity. The most commonly used herb is milk thistle. It has shown to be effective in mushroom poisoning, alcoholic liver disease, and viral hepatitis. It appears to protect the liver cells against a variety of toxins, as well as helping to detoxify the liver and promote regeneration of liver cells.16,17Other herbs, including Picrorhiza kurroa, Curcuma longa (turmeric), Camellia sinensis (green tea), and Glycyrrhiza glabra (licorice), have also been found to be helpful for a variety of liver conditions.17,18Because of their low cost, and relatively few side effects (compared to traditional medical treatments), these treatments should be considered for many acute and chronic liver conditions after carefully weighing the benefits and risks.
Ten Ways to a Healthy Liver:
1) Minimize Alcohol Consumption
2) Prevent Fatty Infiltration of the Liver by Staying Trim
3) Avoid Medications by Staying Healthy
4) Eat a High-Carbohydrate, Low-Fat, Plant-Food Diet and Exercise to Stay Trim and Healthy
5) Minimize Protein Intake with Liver Disease (Use Vegetable Protein)
6) Reduce Your Risk of Viral Infection by Reducing Exposure
7) Immunize Yourself against Hepatitis A and B
8) Avoid Environmental Chemicals, Including Aflatoxins
9) Treat Hepatitis with Phyllanthus Amarus
10) Treat Other Chronic Liver Conditions with Milk Thistle
1) Ilan Y. A balanced 5:1 carbohydrate:protein diet: a new method for supplementing protein to patients with chronic liver disease. J Gastroenterol Hepatol. 2000 Dec;15(12):1436-41.
2) Uribe M. Treatment of chronic portal--systemic encephalopathy with vegetable and animal protein diets. A controlled crossover study. Dig Dis Sci. 1982 Dec;27(12):1109-16.
3) Day CP. Who gets alcoholic liver disease: nature or nurture? J R Coll Physicians Lond. 2000 Nov-Dec;34(6):557-62.
4) Corrao G. Interaction between dietary pattern and alcohol intake on the risk of liver cirrhosis. The Provincial Group for the Study of Chronic Liver Disease. Rev Epidemiol Sante Publique.1995;43(1):7-17.
5) Corrao G. Exploring the role of diet in modifying the effect of known disease determinants: application to risk factors of liver cirrhosis. Am J Epidemiol. 1995 Dec 1;142(11):1136-46.
6) Deems RO. Relationship between liver biochemical tests and dietary intake in patients with liver disease. J Clin Gastroenterol. 1994 Jun;18(4):304-8.
7) Ueno T. Therapeutic effects of restricted diet and exercise in obese patients with fatty liver.J Hepatol. 1997 Jul;27(1):103-7.
8) Eriksson S. Nonalcoholic steatohepatitis in obesity: a reversible condition.
Acta Med Scand. 1986;220(1):83-8.
9) Drenick EJ. Effect on hepatic morphology of treatment of obesity by fasting, reducing diets and small-bowel bypass. N Engl J Med. 1970 Apr 9;282(15):829-34.
10) Vajro P. Persistent hyperaminotransferasemia resolving after weight reduction in obese children. J Pediatr. 1994 Aug;125(2):239-41.
11) Thyagarajan SP. Effect of Phyllanthus amarus on chronic carriers of hepatitis B virus.Lancet. 1988 Oct 1;2(8614):764-6.
12) Calixto JB. A review of the plants of the genus Phyllanthus: their chemistry, pharmacology, and therapeutic potential. Med Res Rev. 1998 Jul;18(4):225-58.
13) Liu J. Genus Phyllanthus for chronic hepatitis B virus infection: a systematic review.
J Viral Hepat. 2001 Sep;8(5):358-66.
14) Liu JP. Chinese medicinal herbs for asymptomatic carriers of hepatitis B virus infection. Cochrane Database Syst Rev. 2001;(2):CD002231.
15) Yamashiki M. Effects of the Japanese herbal medicine "Sho-saiko-to" (TJ-9) on in vitro interleukin-10 production by peripheral blood mononuclear cells of patients with chronic hepatitis C. Hepatology. 1997 Jun;25(6):1390-7.
16) Ferenci P. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol. 1989 Jul;9(1):105-13.
17) Luper S. A review of plants used in the treatment of liver disease: part 1.
Altern Med Rev. 1998 Dec;3(6):410-21.
18) Luper S. A review of plants used in the treatment of liver disease: part two.
Altern Med Rev. 1999 Jun;4(3):178-88.