The liver is a wonderfully resilient and complex organ that nurtures and protects your body day in and day out. It helps neutralise and dispose of toxins, feeds your body the energy it needs to function, fights off viruses and infections, regulates sex hormones, cholesterol levels and vitamin and mineral supplies in your body. And that’s only some of its more than 500 functions.
The liver is the only organ that can regenerate itself, thus making it possible for one person to donate part of their liver to another person.
By learning more about your liver and how you can keep it healthy, you may actually help reduce your risk of developing not only liver disease but also other health conditions including diabetes and heart disease.
To give an idea of the liver’s critical roles, here is a partial list of its functions:
Cleanses blood
– Metabolising alcohol and other drugs and chemicals,
– Neutralising and destroying poisonous substances.
Regulates the supply of body fuel
– Producing, storing and supplying quick energy (glucose) to keep the mind alert and the body active,
– Producing, storing and exporting fat.
Manufactures many essential body proteins involved in
– Transporting substances in the blood,
– Clotting of blood,
– Providing resistance to infection.
Regulates the balance of many hormones
– Sex hormones,
– Thyroid hormones,
– Cortisone and other adrenal hormones.
Regulates body cholesterol
– Produces cholesterol, excretes and converts it to other essential substances.
Regulates the supply of essential vitamins and minerals such as iron and copper.
Produces bile which eliminates toxic substances from the body and aids digestion.
Top tips for a healthy liver
1) Reduce alcohol
We are often told that too much alcohol is bad for us, and you may have wondered when sipping a glass of wine or beer how alcohol affects your liver. Your liver can cope with drinking a small amount of alcohol. However, the liver can only handle a certain amount of alcohol at any given time, so if you drink more than the liver can deal with by drinking too quickly, or drinking too much over a short period of time, the liver cells (hepatocytes) struggle to process it.
When alcohol reaches the liver, it produces a toxic enzyme called acetaldehyde which can damage liver cells and cause permanent scarring, in addition to other organs such as the stomach lining causing gastritis or peptic ulcer disease.
If you continue to drink excessively, either through binge drinking or by having multiple drinks on a daily basis, the consequences include destruction of liver cells, a build-up of fat deposits in your liver (fatty liver), or liver inflammation (alcoholic hepatitis), permanent scarring (cirrhosis) or even liver cancer.
Guidelines for low-risk weekly alcohol consumption suggest up to 11 standard drinks in a week for women, and up to 17 standard drinks in a week for men. Drinking no more than six standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion. Drinking more than six standard drinks on any one occasion is regarded as binge drinking.
Remember it is the amount of alcohol – not the type – is what matters. AskAboutAlcohol.ie is a HSE website that provides dedicated information about alcohol risk and offers support and guidance to anyone who wants to cut back on their drinking. Keep in mind that alcohol can have varying effects on you depending on: age, gender, mental health, drug use and medical conditions, so balance a glass of your preferred alcoholic beverage with some thought about the associated risks.
2) Maintain a healthy weight
Research has demonstrated that more than 70 per cent of Irish over-50s are either overweight or obese. Of those classed as obese, approximately 30 per cent will have fatty liver disease or non-alcohol fatty liver disease (NAFLD), putting them at high risk of liver scarring (cirrhosis), liver failure and liver cancer.
Recently published research from Bristol University examined outcomes from more than 4,000 young people enrolled in a longitudinal study called Children of the 90s, which was set up to follow the lives and health of children born in 1991 and 1992 in Avon, England. All of them had been given an ultrasound at the age of 18, which revealed that 2.5 per cent had NAFLD.
Five years later, a newer kind of scan called transient elastography or fibroscan detected that over 20 per cent had fatty deposits on the liver, or steatosis, indicating non-alcoholic fatty liver disease. Half of those were classified as severe. The scans also found that 2.4 per cent had fibrosis – scarring on the liver. The vast majority of the young people with NAFLD were overweight, with a BMI of over 25. Among people with the largest amount of fatty liver deposits, 60 per cent were obese.
If you carry any excess weight around your middle, it can cause insulin resistance which often leads to fatty liver disease. Measure your middle and keep it at a healthy circumference. Men should maintain a waist of less than 102cm (40 inches) and women, less than 88cm (35 inches). Exercising and eating a diet that’s low in fat and high in fibre, vitamins, antioxidants and minerals will help you maintain a healthy weight and liver.
Doing any physical activity is better than doing none. If you currently do no physical activity, start by doing some, and gradually build up to the recommended amount. Guidelines recommend 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity each week. Aim to start with a brisk 30-minute walk each day.
3) Avoid fad diets
Fad diets that make your weight yoyo can put excessive stress on your liver. Avoid any products that promise large amounts of weight loss in an unrealistically short period of time. Aim to lose weight at a healthy rate of ½kg-1kg per week. Liver cleansing and detox diets should also be avoided. Contrary to popular belief, no particular diet is liver cleansing, but a healthy diet improves wellbeing.
4) Have a regular MOT
– A blood test is the best way to keep a keen eye on the levels of cholesterol and glucose in your blood – all of which are associated with fatty liver disease. Too much glucose can be an indication that you have impaired glucose tolerance or diabetes – in both cases you'll need to carefully control your blood sugar levels through diet, medications and/or weight loss. Seventy per cent of people living with Type 2 diabetes (T2DM) develop NAFLD yet three quarters of T2DM patients with NAFLD have normal liver function tests. In this condition, blood tests are not sufficient to diagnose NAFLD and further tests such as fibroscan are advisable.
– Have you ever experimented with intravenous drugs? Did you have a blood transfusion, or organ transplant prior to 1992? If so, make sure you get tested for hepatitis C.
– Do you complain of chronic fatigue? Check your iron levels (serum ferritin). Haemochromatosis is a genetic condition very common in Irish people that causes slow gradual iron accumulation in the liver and other organs. Once diagnosed, treatment is very simple and regular ferritin blood checks can help to keep the condition under control.
– Practice safer sex and protect yourself from hepatitis B. Unlike hepatitis B, hepatitis C is not classified as a sexually transmissible infection, but if there is a chance of blood to blood contact, you should practice safer sex.
– Less commonly, toothbrushes, razors and other personal care items can also transmit hepatitis B or C, so don't borrow, or share yours with anyone. Household contacts of people living with chronic hepatitis B should be offered the hepatitis B vaccine. There is no vaccine for hepatitis C.
– If you currently use intravenous drugs, don't share needles. Take advantage of a needle exchange programme.
– Body art, piercings, and tattoos are all forms of self-expression. However, inadequately sterilised tools, reused needles or contaminated inks could expose you to hepatitis B or C infections. Because piercing and tattoo equipment can come into contact with blood, it is important to ensure your service provider takes the proper infection control precautions between clients.
5) Be aware of drug safety
With easy access to health information via the internet, you may be tempted to self-diagnose and treat your own health problems. But by not consulting a doctor, you may be putting yourself at risk for potentially hazardous side effects that can result when certain medications and/or supplements are combined. As the main organ that detoxifies most drugs, herbal remedies and vitamins, the liver is vulnerable to the toxic consequences of self-medicating.
In recent years, herbal remedies such as kava have made headlines for their harmful effects on the liver, yet it is only one of many herbal remedies that can cause liver toxicity. There have also been concerns about the potential for accidental overdosing with paracetamol when several products containing this drug (ie cold remedies and pain medication) are taken at the same time.
People may not realise that any medication – herbal or pharmaceutical – undergoes important chemical changes when processed by the liver. While the original product might not be considered harmful, the resulting byproducts may be toxic to the liver. Also, the interaction of one medication with other medications, or when combined with alcohol, may cause complications for otherwise healthy people. Those who already have liver problems have to be especially careful and may not be able to take even the most ordinary over-the-counter remedies to treat common ailments like headaches or colds.
Always consult your doctor or pharmacist before taking new medication.
– Prof Suzanne Norris is consultant hepatologist & gastroenterologist, St James’s Hospital and Liver Wellness, Dublin and professor of hepatology and gastroenterology, Trinity College, Dublin.
