Remember from prior blogs, that fibrosis forms first as long strings that associate over time and are eventually arranged into a very stable triple helix that is zipped together by vitamin C. There are many kinds of collagen in your body and they have different characteristics depending on their specific chemistry. The progress of cirrhosis is determined by how that collagen forms and matures.
As a way to think of it, collagen is a cousin to the plastics that are everywhere in your everyday life. They are polymers which are large groups of similar molecules that link together. Like many collagens in the body, those in the liver are flexible and stretchy, think skin as an example, when they are formed. It is the nature of many polymers to take some time to "cook", that is to form the structure and then to cross connect to other molecules nearby. They attach to each other in dense mats which leads to the kind of tissue you see in a scar in your skin. It is basically a "mat" of fibers. As those mats get thicker and stronger they begin to destroy function in your liver and we call that cirrhosis.
Did you ever wonder why you hear about enlarged livers but end stage liver disease is characterized by a hard shrunken liver? Why would that be? Here the triple helix becomes the star. Over time the helix winds tighter and as a consequence shortens. If you heat human collagen much of it will shrink by as much as 20%. Imagine billions of tiny helical ropes getting shorter and killing liver cells trapped between them. We don't heat a human body, of course, but time is a good substitute for heat, and that explains how things continue to change in the liver even if the original cause is removed.
So why do you care? Fighting fibrosis is a continuous process. There is no quick solution but how might you manage the process? Think about sports teams, or yoga as examples. They work at stretching and manipulation of tissues. Their goals are to keep the various tissues working and staying flexible. In their case muscles and tendons. They try not to allow their collagen to shorten and harden and lose functionality. Could that idea apply to the collagen in the liver?
You will be told that there is nothing you can do about cirrhosis but the truth is more nuanced than that. You are also told that exercise is good for you. We hear that about everything so that message tends to get lost but lets take a walk through the liver. Since it is a flexible organ it responds to blood flow. If activity causes more blood to flow into the liver it flexes and adjusts to allow that extra blood to make it through. Conceptually exercise is similar to a yoga pose that stretches your liver.
If you regularly stretch those triple helix in your liver you can slow down their shrinkage. A fully mature and locked in helix will likely ignore you but those not yet stabilized can be affected by manipulation. Is this a cure? certainly not, but today our goal is to not die before effective treatments can be developed. We know those are coming. Not soon, but every day in the battle against the loss of liver function is important and consistency is vital. So when your doc says exercise, it really isn't just a good suggestion, it is a prescription for a treatment that can prolong your life.
I promise no more lectures on collagen.
In case you missed them here are links to the two earlier discussions
If you would like to find more information about collagen here is a link to a broader discussion.