Is Your Liver Happy

Here we are a month into 2019 and what we knew about health last year remains pretty much the same.  For the large majority of people we find a “health lane” and stick to it. For one person that may look like high-activity levels 5-6 days of “training” per week, a Whole 30 eating protocol, 5-day work week at the office, and the occasional cocktail outing with friends. On the other end of the spectrum person “x” eats mostly vegetarian, engages in yoga once a week, prefers snuggling with their cat, and enjoys church activities.  

People tend to find their comfort zone and begin habit building from a young age. In many cases adopting practices and ideas from their parents and peer groups. Cue the “my mom and dad had this or that issue, must be my genetic cards,”

However we choose to behave it is altering our bodies and physiology at a cellular level. In some ways, and much like our current healthcare system, these behaviors feel uncoupled from our health trajectories. This is because while some activities (injuries, sleep, caloric consumption, food choice, activity levels etc.) have short-term effects the long-term patterns result in ramifications that trickle out over 5 -20 years before we realize their full effect. Often times it’s very difficult to rule out early stage pathology or disease barring an invasive diagnostic test.

Overtime the body gives back, adapts, based on what has been required of it. As a student of the musculoskeletal system the research is quite clear when it comes to how quickly the neuromuscular complex can refashion itself. The Center for Healthy Aging and the Department of Biomedical Sciences at the University of Copenhagen concluded that it takes two weeks for a young person not using a leg to lose 1/3 of their muscle strength and mass leaving them on par with a person who is 40-50 years their senior.  

Inactivity does not discriminate and affects both young and old. What is more interesting is that after 2 weeks of immobilization participants cycle trained 3-4 times per week for six weeks. This was not enough for them to regain their muscle strength unless they included weight training.

This example demonstrates how quickly the body adapts to inactivity and results in rapid muscle loss.  The real kicker is that it will take you three times the amount of time to regain the lost muscle mass.

 Let’s look at a few examples of disease that require a period of 10-20 years before the disease has fully developed and spill over into other organ systems.  Most people don’t realize that cirrhosis of the liver and the deposition of connective tissue (scarring and fibrosis) requires about 80 grams of ethanol daily for 10- 20 years.  For those wondering what’s 80 grams - there is roughly 14 grams of ethanol in a 12 oz beer.  

More importantly, non-alcoholic fatty liver disease or NAFLD parallels that of obesity and has steadily risen over the last 30 years. NAFLD is projected to become the leading cause of liver related morbidity and mortality within 20 years and a leading indication for liver transplantation in the next few years.

Some researchers are calling diabetes a disease of the liver first. The liver is an important organ especially for energy metabolism and storage. The development of Type 2 Diabetes takes around 5-10 years in adults and can take much less time in children. These are 2 examples of long-term metabolic disorders. Atherosclerosis (think plaque and eventual heart attack) would be another example of inter-related long term metabolic stress that leads to maladaptive changes to an individual’s physiology.

Nutrition in the broader context of caloric intake

If you overload the system with continued doses of  “fuel” whether alcoholic beverages, sugar, or fat/protein for that matter, eventually the body will be unable to effectively process, detoxify and utilize these energy sources. A fatty liver is a signal that it is unable to burn fuel appropriately. A healthy liver ranges from 1-3 % fat and once it is at 5% normal function is on the line.

Judging by the statistics, if you’re an American, chances are you may stand to shed a few pounds. This tradeoff, excessive pounds for improved function, will increase your overall health and longevity. I’ve heard firsthand from patients, friends and family how difficult it can be to shed some weight and how to track progress when the scale seems to stall. Even exercise has its limits if your liver is struggling. Exercise is not a game changer for healthy weight loss as much as it is for maintaining a healthy weight. 

Most of us aren’t having routine blood work that looks at our liver enzymes, and even if you are by the time they are elevated your liver has been under insult for a while. The only way to rule out fatty liver is with a biopsy. Dr. Alan Christianson shares an interesting statistic: in situations where healthy individuals are undergoing testing to provide liver tissue donation 40.2% were found to have fatty liver disease. These are individuals with otherwise healthy blood markers.

Height to waist ratio

How do I know if my liver is strained or how it is handling the cumulative energy load? One of the most important metrics is your waist circumference. Your waist should be less than ½ your height. If it’s larger you may be more likely to have higher triglycerides, lower HDL cholesterol, higher LDL particle size, elevated inflammatory markers, elevated blood pressure, and higher fasting glucose.

If you want to quantify your risk of fatty liver disease Dr. Christianson has a built a calculator (because, as we know, short of a biopsy every other marker is inherently imperfect).

Fatty Liver Index

All you need are some results and some measurements:

The measurements you need:

  • Weight in pounds

  • Height in inches

  • Waist circumference in inches

The blood test results you will need:

  • Fasting triglycerides

  • Fasting GGT

Unlike your car, your liver doesn’t want to be “topped off” at every meal.  Whenever we eat above and beyond our basal fuel requirements metabolic processes result in elevated free radicals and inflammatory compounds. Energy production is a “dirty process” metabolically speaking and requires the liver to run it’s detoxification pathways.

 Trust me, the body is not trying to carry trapped fat around our midsection. If you give the liver no choice and subject it to fuel overload this will result in high density fat storage, high blood glucose aka pre-diabetes/diabetes type 2, suppressed metabolism, and increased levels of pro-inflammatory adipokines.

In addition to eating nutrient dense meats, dairy, fruits and vegetables, do I take any evidence-based supplements for liver health?

Liver specific support

  • N- Acetyl-L - Cysteine: can raise the liver’s protective glutathione

  • Milk thistle: shown to protect liver cells and safeguard it from cell death

  •  Alpha lipoic acid, Taurine, and Betaine Anhydrous  

  • Dandelion tea to enhance bowel secretion and liver function