The liver is a busy organ
The liver is a large, reddish-brown organ on the right side of the body just below your rib cage. It sits above the gallbladder (the organ that stores bile to help digest fatty foods) and next to the pancreas (responsible for converting foods into energy) and intestines. On average, a liver weighs three pounds and, in combination with other nearby organs, supports the absorption and digestion of every nutrient we consume.
The liver plays a large role, working with the intestines, in filtering blood coming from the digestive tract before it is pumped to the rest of your body. It also produces the bile that is stored in the gall bladder and released into the intestines in response to food. The liver is the site where most systemic detoxification occurs, including taking natural substances from the blood, like hormones and cholesterol, as well as non-natural substances, such as medications like statins and antibiotics. Because it is a major regulator of plasma glucose and ammonia levels – two molecules that cross the blood-brain barrier – your liver is also essential for optimal function of your brain.
The liver synthesizes proteins that, with the help of vitamin K, are essential for blood clotting. It also helps package and clear damaged red blood cells from circulation.
What makes the liver unique?
In addition to its complex functionality, the liver is a unique organ because it can regenerate itself. The portal vein connects blood circulation from the intestines to the spleen, pancreas, and the liver. And because the liver is located so closely to the intestines, it receives a fresh supply of nutrients from the foods you eat.
Liver cells, called hepatocytes, are also unique in their own way. Not like other cells in the body, hepatocytes provide a biochemical defense against toxic chemicals from the foods or drinks we consume, at the same time they are reprocessing absorbed dietary nutrients.1)
What damages the liver – risk factors for a less than healthy liver
Everyday foods, medications, and lifestyle habits can affect your liver health.
- Alcohol consumption. Frequent and chronic alcohol consumption, defined as more than two alcoholic beverages daily, puts one at risk for liver damage. Alcoholic hepatitis, which is inflammation that causes liver degeneration, can further develop into cirrhosis and might even be fatal.
- Fat accumulation. Carrying extra body fat and not metabolizing the carbohydrates you are eating can add to the risk for liver problems. Excess body fat that is either stored in the fat cells or traveling in the bloodstream can be toxic to the liver, resulting in what is formally called non-alcoholic fatty liver disease (or more commonly referred to as fatty liver). With changes in diet and lifestyle, fat accumulation in the liver can be reversed, but if this becomes a chronic issue, it can be a serious health concern. Fatty liver presents the most common risk to good liver health in the United States.
- Exposure to certain chemicals and toxins. Environmental exposure to toxins is everywhere. Anything that comes in contact with your body, particularly your skin, lungs, and mouth, can be of concern. Read labels, avoid breathing in smog or smoke, and be aware of exposures in your workplace.
- Medications. A large percentage of the prescription and non-prescription medications you take pass through your liver. Work with your health-care professional or pharmacist to identify potential side effects of medications you are taking. The top medications that can cause liver damage include:2)
- Acetaminophen (Tylenol®) – OTC for pain relief
- Amoxicillin/clavulanate (Augmentin®) – antibiotic
- Diclofenac – prescription non-steroidal anti-inflammatory
- Amiodarone – medication for atrial fibrillation
- Allopurinol (Zylopirim®) – gout treatment
- Anti-seizure medications – several in this group (Dilantin®, carbamazepine)
- Parasites, viruses, or bacteria. You can pick up these organisms from any exposed orifice on your skin or body, or through blood, semen, or other fluids from infected individuals. Some foods can be culprits too, like undercooked meat or raw fish. There is a potential from tattoos also. Any of these types of microbes can cause infection and inflammation in the liver, restricting its functionality and perhaps causing scarring or damage.
- Genetics. Some individuals are born with genes that require special attention to be paid to the liver. For example, hemochromatosis affects one in every 200 people. In this condition, iron build-up in the blood can cause liver damage. This and other genetic problems should be addressed by a health-care practitioner.
What can you do to keep your liver healthy?
To maintain good liver health, start by recognizing your daily habits and how the habits affect the health of your liver.
- Reduce alcohol intake. If you drink alcohol regularly, then discontinue or reduce its intake; stay below the daily 1-2 drinks recommended limit. Start replacing alcohol consumption with plenty of water to maintain hydration and help flush your system.
- Minimize inflammation. Avoid exposure to environmental toxins as much as possible. Minimize or eliminate inflammatory foods that can tax your liver such as fried foods, desserts and other simple carbs, and high fructose corn syrup. Eat plenty of foods that have ingredients that help minimize inflammation, like fiber and other nutrients from cruciferous and green leafy vegetables, healthy omega-3 fatty acids from fish and nuts,3 and antioxidants and vitamins from berries. Use anti-inflammatory spices like turmeric, ginger, and cinnamon. Cinnamon also helps metabolize extra sugar you have floating around in your bloodstream before it can be converted to fat (triglycerides).
- Maintain a healthy body weight. Keeping a body fat amount appropriate for your bone structure will help you maintain a normal level of fats in your blood and minimize the accumulation of fats deposited in your liver. Regular exercise combined with a good diet and proper sleep are also crucial to maintaining a healthy weight through your adult years.
How do you know if you have liver issues or even liver disease?
First, if you have any of the symptoms listed below, then be sure to contact your health-care professional right away. A blood test showing elevated liver enzymes is often the first sign something is amiss. In that case, a further diagnosis, like ultrasound, is needed to gather more information. The symptoms cited below are typically seen in more advanced liver disease or in an acute infectious disease like hepatitis and require medical intervention.
- Tenderness or discomfort. Abdominal discomfort can range from uncomfortable to severe; i.e., anywhere from a stabbing sensation to almost unnoticeable. Nevertheless, liver insult is typically accompanied by some swelling that might indicate your liver is inflamed.
- Swollen abdomen. This kind of swelling can be caused by too many blood proteins accumulating in the portal vein, which can result in high blood pressure and fluid accumulation as a result of liver cirrhosis, scarring, and hardening of the liver.
- Yellowing skin or eyes. Jaundice is the classic sign of liver disease. Bilirubin is a yellow pigment that is naturally released from red blood cells when they break down about every 90 days. With a healthy liver, bilirubin is cleared from the blood and made into bile to be stored in the gallbladder. In the case of an unhealthy liver, the pigment remains in the blood, accumulating and depositing close to the skin surface where it is noticeable. As liver function improves, the yellowing reverses.
- Itchy skin. Liver disease can cause itchy skin that doesn’t go away with lotions or creams. It is believed to be due to accumulation of substances in the blood, although the exact cause is still being investigated. It is most common in liver diseases that involve bile duct inflammation.
- Nausea, loss of appetite, and weight loss. When your liver can’t rid itself of toxins, the buildup can affect your GI tract and the communication between your gut and brain. The inability and/or lack of desire to eat can be signs that your body is telling you not to put anything more inside until you can properly digest, absorb, and excrete the nutrients it needs.
- Changes in urine or stool. Urine becomes darker and stool is pale or even white; black tarry stools is observed in advanced liver disease.
- Michalopoulos G. Liver regeneration. J Cell Physiol 2007;213(2):286-300.
- The 10 worst medications for your liver. https://www.goodrx.com/blog/the-ten-worst-medications-for-your-liver/ [Accessed 5.14.19]
- Scorletti E, Byrne C. Omega-3 fatty acids, hepatic lipid metabolism, and nonalcoholic fatty liver disease. Annu Rev Nutr 2013;33:231-248.