Detoxification

Your liver — the detoxification specialist

by Marcelle Pick, OB/GYN NP

• How does the liver function when you eat?
• What happens when something goes wrong with liver detox?
• Fatty liver — and other liver problems
• Knowing more about your liver function
• How to support the liver and its ability to detoxify

Your liver is the foundation of your body’s ability to detoxify. The largest solid organ in your body, your liver is situated on the right side within your rib-cage. This powerhouse organ has some spectacular skills, including the astonishing ability to heal and regenerate itself. It’s the main metabolic “clearinghouse” for both naturally-produced chemicals and foreign or toxic molecules that invade your body.

The liver is in charge of over 500 separate functions. Here are some of the big ones:

Blood and lymph cleansing

The liver acts as a big, porous filter, continually receiving both blood and lymph, the clear fluid that carries wastes and poisons away from your cells. The liver screens out impurities and metabolic waste products, then channels these vital fluids back into your bloodstream and lymphatic circulation.

Digestion

When food enters your digestive tract, the liver produces hormones and enzymes necessary for processing and metabolism. These break down, recycle, and synthesize carbohydrates, proteins, and fats, which your body uses as fuel and for other key actions. For example, the liver creates bile specifically to break down dietary fats. Bile is stored mostly in the gallbladder, which sits next to the liver. The liver also synthesizes albumin, the most abundant blood plasma protein, which transports hormones and drugs and helps balance blood pH.

Detoxification

Your liver is always working to detoxify the chemicals it encounters — toxins, foreign substances, and excess hormones, including thyroxine (thyroid hormone), cortisol, estrogen, and aldosterone (affects blood pressure). Excess hormones can cause many different health problems and symptoms.

Hormone production

One of the liver’s major biochemical functions is to manage certain hormones and turn them into more active forms (vitamin D) or less reactive forms (estrogen). The liver also manufactures blood-clotting chemicals such as fibrinogen, hormones that help control blood pressure and flow, and growth factors.

Chemical energy storehouse

The multitasking liver serves as a holding area for glycogen, used for on-demand energy between meals. This sugar storage regulates the amount of sugar, or glucose, in your blood and — critically — in your brain. The liver also holds mineral and vitamin reserves, including A, D, B12, iron and copper, and keeps ready certain active cells used by your immune system.

Cholesterol

This waxy steroid is produced and recycled by your liver and excreted into the digestive tract in bile. Cholesterol makes cell membranes permeable and is a building block for sex hormones. About half of it is reabsorbed into the bloodstream via the small intestine. Triglycerides are also made in the liver in response to the insulin your pancreas secretes.

Regeneration

Incredibly, your liver is the only organ that has the ability to regenerate itself if large amounts of hepatic (relating to the liver) tissue are lost. I have a patient who had a hepatic cyst removed, along with about 20% of her liver. Shockingly — but wonderfully — within just eight weeks, her missing liver tissue had entirely regenerated. Other research bears this out, showing that even if you lose most of your liver, the remaining 25–30% can grow back into an entire working organ. So even under challenging conditions, your liver can become healthy again.

How does the liver function when you eat?

As you chew and swallow your first bite of a meal, your liver and other organs are signaled to produce the digestive enzymes needed to break the food down into smaller, more manageable nutrient particles for absorption as they move along the GI tract. Your liver handles different types of food in various ways:

• Carbohydrates are broken down into the simple sugar glucose, which crosses into the bloodstream and serves as your cells’ main energy source. When the blood reaches the liver for filtration, excess glucose is converted and stored as glycogen. Under fasting conditions, the liver can convert glycogen back into glucose for instant energy. It can also synthesize glucose from lactic acid and amino acids. Carbs also cause your pancreas to secrete the hormone insulin, which triggers your liver to produce triglycerides. Triglycerides are a form of blood fat, a major source of energy, and the most common type of fat in your body.
• Fats are processed in the digestive tract with bile, and absorbed through the gut into the bloodstream. The liver produces and regulates fat levels, as cholesterol and triglycerides, in the blood. For up to eight hours after eating, dietary cholesterol and triglycerides are taken up into the bloodstream and recycled by the liver. Between meals, the liver continues producing these molecules for delivery to the cells. But, as most of us know, overproduction of cholesterol or triglycerides can cause a cascade of health problems.
• Proteins are broken down in the stomach and small intestine into amino acids and other compounds, some of which are converted into enzymes by the liver. The enzymes and carrier molecules are responsible for converting ammonia, an extremely toxic byproduct of protein breakdown, into urea. The kidneys can then efficiently transfer urea into the urine, which is how the body rids itself of the excess nitrogen waste produced by protein metabolism.

In a perfect world, you would eat only healthy, whole foods and drink only pure liquids, and your liver would hum along, synthesizing nutrients and processing waste products without a hitch. But in reality, you ingest, absorb, and inhale many harmful substances regularly, both purposefully and by accident.

Your liver identifies many substances as poisonous, including drugs, alcohol, solvents, external chemicals, and heavy metals. It works to detoxify and/or filter out these and other poisons, and is remarkably effective at doing so — most of the time.

The processes of healthy detoxification

In general, your liver tries to turn the harmful substances it encounters into molecules that can be dissolved in water, so they can be easily eliminated. Using “biotransformation,” your liver changes their chemical structure, reducing their reactivity until they are able to be flushed by your kidneys and excreted. This conversion requires an assortment of nutrients, amino acids, and enzymes to break down and make different drugs, hormones, and toxins less fat-soluble. It diffuses their bioactivity and makes them less dangerous to your system.

Even as you sip a single glass of wine, your liver begins to detoxify the alcohol it contains. If you consume too much alcohol, or any other toxin, too quickly, your liver just can’t keep up, and the toxins will reenter your bloodstream.

Detoxification of many harmful substances requires more than one step. These two phases must operate in balance for the natural detoxification process to be successfully completed.

Phase I

Sometimes called functionalization, the first stage of detox modifies toxins using straightforward processes like oxidation, hydrolysis, and reduction, to convert and deactivate substances, and to make them more water-soluble. They may be excreted at this stage, but substances can still be highly reactive, or possibly even more poisonous at this in-between stage. The liver then engages in more complex efforts to neutralize a toxin.

Phase II

The second stage of detox is conjugation, a process which uses more involved reactions such as methylation and sulphation to defuse toxins.

These two phases must operate in balance for the natural detoxification process to be successfully completed. The latter part of both phase I and phase II is excretion, or removal of poisons from the body as stool or urine.

What happens when something goes wrong with liver detox?

If the liver cannot keep up with its detoxifying duties, toxins, poisons, and heavy metals may end up being deposited in your tissues and fat cells. This type of bioaccumulation can also occur when your liver does not have the array of raw materials and nutrients it needs to perform its detox maneuvers.

When reactive chemicals and heavy metals are stored — either in the liver or other tissue — it can give rise to disease and physical symptoms. And if a stored substance is very toxic, your risk of being poisoned skyrockets. Stored heavy metals in particular are known to affect the brain (as neurotoxins) and can cause cognitive dysfunction. Certain hormones in excess and other endocrine disruptors tip your hormonal scales and interfere with cellular communication, leading to a range of obvious and not-so-obvious health issues.

Sometimes, there is a problem in the liver itself that may reduce the amount and flow of bile. This is sometimes called liver “congestion” or sluggishness, though tests may not indicate dysfunction. There can also be a decline in enzyme production as we age which slows down the liver, but poor diet, lack of exercise, and certain diseases can cause the same problem.

Fatty liver — and other liver problems

Many health experts believe that one of the emerging threats to overall health is the increase in incidence of fatty liver — where the liver becomes more than 10% fat by weight. Fat molecules can build up in the liver as a result of insulin resistance, diabetes, obesity, alcohol abuse, malnutrition, and surprisingly, rapid weight loss.

Fatty liver also occurs when you over-consume certain fats — you may have watched this happen in the movie Supersize Me, when filmmaker Morgan Spurlock ate nothing but fast food for an entire month. Happily, his liver returned to normal eventually, after he returned to eating a healthier diet.

Hormonal changes at menopause, and aging itself, can also contribute to a fatty liver. Currently, it’s estimated that at least 20% of the general population — and a staggering 75% of obese people — have nonalcoholic fatty liver disease (NAFLD).

You can foster a healthy liver by trying to resolve any digestive issues and imbalances. When you clear up any GI troubles, your liver function will improve exponentially. Other key steps include lowering your triglycerides, losing weight safely, avoiding alcohol, controlling diabetes, eating a balanced diet (with low glycemic-load meals and healthy fats), and exercising. While there is no established medical treatment for fatty liver, we know that the condition can resolve, though following a detoxifying diet is a prerequisite for that to occur. Once your liver gets the right “information” in the form of proper nutrition, it can heal itself under many circumstances.

Most of us know that extended alcohol abuse can destroy liver function and tissue, but so can poisoning or injury, as well as certain genetic characteristics, or polymorphisms. But sometimes the cause of liver dysfunction is unknown.

Knowing more about your liver function

When there is a problem, conventional medical tests can help determine if a person has liver damage or dysfunction. These tests can only identify a condition like liver failure or some of type of major abnormality. Conventional providers screen for the “big” things like hepatitis or alcoholism, but if your tests come back “normal,” they might tell you everything is fine, when it really isn’t.

Practitioners of functional medicine use a series of “compound challenge tests” to evaluate a person’s ability to detoxify. These techniques look for markers of detoxification, and sometimes for remainders of the toxins themselves. They can also reveal even slight changes in enzyme levels and may help pinpoint an imbalance between phase I and phase II detox. You may have good function during phase I that falls off during phase II, leaving you in a highly toxic state. Or you may have low detox ability in both phases — a sign that you can’t detox fast enough to meet your system’s needs.

If I have a patient who doesn’t feel well and has specific symptoms, such as extreme sensitivity or reaction to fragrances or common chemicals, it tells me we need to investigate what else is going on. I try to identify which toxins and health conditions are likely risk factors for a patient and use this information to develop effective treatment protocols. But if any tests reveal abnormal liver enzymes, it’s a signal that she should have a full work-up and medical evaluation to find out what’s behind these abnormalities.

How to support the liver and its ability to detoxify

Your diet is the single most important element for liver health, so we encourage you to eat healthy, organic, low-glycemic foods, including lots of plant foods and adequate protein. Drink plenty of water, of course, and choose filtered, spring, or mineral water. Regular aerobic exercise is important too.

Avoiding exposure to toxins is advised whenever possible. This includes limiting alcohol intake and taking only the prescribed dosage of prescription medication, vitamins, minerals, or supplements. The jury is still out on vaccinations against hepatitis A and B, but if you have an elevated risk for hepatitis, talk to a functional medicine practitioner about your options.

The health of your entire body is dependent on good liver function. Here are some liver-supporting practices and supplements:

Related to this article:

References & further reading your liver

 

Original Publication Date: 08/24/2009
Last Modified: 02/16/2010
Principal Author: Marcelle Pick, OB/GYN NP