THE PROBLEM: The real liver experts don’t offer effective diet advice

(click here for a pdf with all the science references)

Currently, the experts who treat liver disease, (the specialists of AASLD), do not officially recommend any specific diet for liver health. The reason is because there are not enough well-designed dietary clinical trials focused specifically on the liver to give the organ experts confidence to make official dietary recommendations. This creates a serious dilemma. As patients we don’t have that luxury. We must make choices. We must live every day making food decisions and hope that our diet is a healthy one even if the experts can’t help us. No wonder we see endless variety in dietary advice and “experts” of all persuasions.

OUR GOAL: Design a diet strategy that minimizes the liver workload

With a bit of time, even things like the COVID virus are accommodated by our fears and broader concerns bubble back up.  One of the challenges faced by a lot of people with serious chronic illness is that they are alone physically or emotionally.

As I think about these past weeks and staying at home I realize that I am so very fortunate. My wife Rosemary makes my days in isolation a joy rather than a burden but I see messages in our patient forums that break my heart from people who are literally dying deaths of despair.  If you are well enough, reach out to those you know who are lonely. Chronic illness is difficult enough without having to do it alone.

Click the picture below for a link to a bit of fun on the subject of introspection. Many of you are old enough to remember this but it may be meaningful to our younger folks as well. (The picture isn't related, I just like it)

This is what you will find here:

• Non-technical explanation of how your body actually works
• How the liver develops disease over time
• Why fats are a critical source of fuel for your cells
• How the liver manages triglycerides
• How the course of fatty liver disease depends on triglycerides and carbohydrates
• How the kind of dietary fat you use matters
• Information by a liver patient for liver patients
• Information about diet based upon bio-chemistry not fads

We are a nonprofit foundation and we do not represent anyone but the patient. If you are looking for advice on supplements or quick fixes this is not the place for you. We offer extensive information about the body in general, the liver specifically, and we recommend lifestyle strategies that have worked for me specifically and which I believe are valuable for anyone concerned about liver health to be familiar with.

Since you are on my mailing list you know about NASH, unlike most of the people.  We had the 2019 version of NASHday on the 12th and  as I think about how that event went I am struck by the fact that as a health outreach it was unusual.

I'll explain why but first, the punchline, NASHday was about people's lives and not about money.

We have every kind of "DAY" that you can think of.  Every cause has a day or a month, some peg to hang the cause on and to focus attention. Just as an example, these are the top five unofficial holidays according to toptenz.net.

1.      Black Day.

2.      Autistic Pride Day.

3.      International Free Hugs Day.

4.      Monkey Day.

5.      Record Store Day.

It is very early and we don't know a lot yet but Intercept Pharmaceuticals has just released results of their Phase 3 test of Obeticholic Acid as a possible treatment for NASH.

This is a major step for us as patients.  We all know the story.  The doc says sadly, "You have cirrhosis, I'm sorry we have no treatment".  This is a refrain we see retold thousands of times here at the Foundation and it is the path I have personally traveled. I've written that we are on the brink of a new day when we will have options.  This is the dawning of that day.

http://ir.interceptpharma.com/news-releases/news-release-details/intercept-announces-positive-topline-results-pivotal-phase-3

Click here if you would like to see a short video of how liver disease develops.

Where is your liver

A large, complex, triangular-shaped solid organ, the liver is located in the upper right abdomen, just below the diaphragm and behind the ribs, extending across the midline to the left side. It is the largest and heaviest internal organ, weighing about 1.5 kilograms. The liver is the only organ with two blood supplies: the hepatic artery, which brings blood from the heart, and the hepatic portal vein, which brings all the blood from the intestines. Blood leaves the liver through the hepatic veins. At a microscopic level, the liver is composed of individually functioning units called lobules, containing areas with blood vessels, ducts, and intervening cords of liver cells (hepatocytes).

How does your liver affect digestion?

The hepatocytes, liver cells, manufacture bile, a yellow or green alkaline fluid, containing bile salts. This synthesizing and secreting function of the hepatocytes means that the liver is also a gland. Bile travels from the liver cells through a network of ducts to the gallbladder for storage and concentration – to as much as five times its original potency. During a meal, the gallbladder releases bile into the small intestine to assist with digestion and absorption of dietary fats. Bile also contains bicarbonate ions, which help neutralize acid carried from the stomach to the small intestine. Bile salts originating from the liver aid in converting vitamin D into its active form, which is necessary for calcium utilization. This organ is also pivotal in absorption of other fat-soluble vitamins.

What are the liver's metabolic functions?

Metabolism refers to the complex biochemical processes and reactions that take place in the human body. Carbohydrate, fat, and protein metabolism all require inputs from the liver, which stores glucose (derived from carbohydrates) when it is abundant, and through communication with pancreas releases it when needed, thereby ensuring a steady energy supply for the body. The liver also converts fats into an energy source for the body. This organ is the site for breakdown of protein into amino acids, as well as conversion of amino acids to glucose, fats, and proteins. Finally, the liver is responsible for the synthesis of cholesterol and regulation of cholesterol levels.

How does your liver affect blood clotting?

Bleeding within the body activates a complex system of plasma proteins, called coagulation factors, which promote blood clot formation. The liver is responsible for producing most of these coagulation factors. Some of these factors require vitamin K for synthesis, and the liver produces the bile salts essential for intestinal absorption of this fat-soluble vitamin. Uncontrolled bleeding may occur if the clotting factors are not produced or if vitamin K is not absorbed.

What other proteins does your liver make?

The liver produces most of the proteins found in blood. Albumin is a major protein made by the liver that plays an important role in regulating blood volume and distribution of fluids in the body. One possible result of liver dysfunction is low albumin levels, which can lead to abnormal fluid retention causing swollen legs and abdominal distension. The liver also produces ferritin (a protein used to store iron in the body) as well as proteins that bind to hormones, lipoproteins involved in cholesterol transport, and acute phase proteins involved in inflammation and infection.

What are the hormonal functions of your liver?

The liver has many key functions associated with hormones in the body. For example, the liver is involved in the chemical conversion of thyroid hormone into its most active form. Thyroid hormone is responsible for modulating the body’s metabolic rate, the speed at which complex biochemical processes and reactions take place. In addition, the liver secretes IGF-1, a hormone that promotes cell growth. Angiotensinogen is another hormone produced by the liver. This hormone is part of a complex system that regulates sodium and potassium levels in the kidneys and is involved in blood pressure control. In addition, the liver regulates hormone levels by breaking down and removing these chemical messengers from the body when they are no longer needed.

What is your liver’s role in breaking down unwanted substances?

Together with the spleen, the liver helps to degrade old red blood cells into breakdown products, such as bilirubin and other bile pigments. The liver extracts these products from the blood for elimination via urine and stool. When the liver fails to function properly, bilirubin may accumulate in the body and result in a yellow appearance of the skin and eyes, known as jaundice. The liver also plays a large role in detoxifying and breaking down toxic poisons, drugs, alcohol, and waste products. In patients with liver failure, these unwanted substances tend to accumulate in the body and potentially lead to toxicities.

The liver, an amazing organ!

A strong, working liver is vital for human health. This remarkable, hard-working organ and gland is responsible for a host of essential bodily functions, comprising critical roles in digestion and nutrient absorption, complex metabolic functions, protein production, and hormonal production and regulation. Moreover, it is the primary organ involved in the breakdown of every toxic substance your body encounters, whether you ingest, inject, touch, breathe, or otherwise come into contact with it, preventing accumulation of waste products.

Some Liver Facts!

• The liver can regenerate itself! As long as at least 25% of the healthy liver remains, it can become whole again.
• Not only is it the largest gland in the body, the liver is the most complex in function.
• We all know that alcohol consumption takes its toll on the liver, but did you know that cigarette smoking is bad for your liver too?
• A healthy liver filters about 1.7 litres of blood per minute.
• It contains 300 billion specialized cells.
• It can produce as much as one litre of bile per day. The body reabsorbs most of the bile salts at the terminal ileum and regularly sends them directly back to the liver for reuse.
• During pregnancy, the liver increases in size and weight to accommodate the changing metabolic demands and hormonal balance of the mother.
• At any given moment, the liver holds about 13% of the body’s blood supply.
• More than 500 vital functions take place in the liver.
• A healthy human liver holds about a two-year store of Vitamin A.
• Although attempted in 1963, the first successful whole human liver transplant occurred in 1967.
• In 1989, surgeons transplanted a portion of a living adult’s liver into a child, resulting in both donor and recipient having normal liver function. Since that time, adult-to-adult living donations occur with a portion of the donor’s liver replacing the entire liver of the recipient. Over time, both livers grow into complete organs. Although amazing, this procedure still carries some risks.
• At this time there is no medical treatment for liver failure other than transplant but an improved diet and the avoidance of harmful substances can halt and at times even reverse liver damage.

There is a lot of dietary advice but a good place to start is here

Hopefully you clicked on the picture to hear the very short quote from Shakespeare.  Sometimes I can't resist a bit of drama.

Since you have an interest in liver disease, I wanted to let you know that we have reached a real milestone in the development of the foundation.  We intend to help change the way liver disease, particularly NASH, is managed and to save the lives of millions who do not know today that they are at risk.

In every battle there are moments which mark the end of an era. They portend the beginning of something new and a time when tiny things can sprout and grow to a vast scale. Sometimes analogy man gets loose in my mind and I apologize in advance, but I'm drawn to the stories of things that speak to universal truths. Did you know that the biggest living thing on earth, the giant redwood, grows from one of the smallest tree seeds? The Wellness League may be that tiny seed that just grows.

I recently wrote about my view that for the first time a cirrhosis patient could look forward to real medical therapies.  A few folks felt that I was planting false hopes and that such miracles weren't going to happen.  In light of that, I thought I might provide a broader view of the situation today.

Some of you are old enough to remember that not so long ago Hep C was unknown.  We called the illness non A non B hepatitis. Today we have a cure. A miracle perhaps but also a lesson.

This information is primarily for physicians but may be of value to some of our patients. As a patient, it is important to know that the interpretation of a Fibroscan score is not simple.  The meaning of a test depends upon what caused the liver damage as we can see in this scoring guide.

In light of this, it is important that a qualified physician makes the interpretation of your test results.  Some of the guidance available for physicians is found in these documents.

Fibroscan Physician Interpretation Training

Fibroscan Clinical Publications