The liver is our largest internal organ
and plays a central role in the maintenance of our entire body. Dietary
proteins, fats and carbohydrates are synthesized and broken down, and
cholesterol and triglycerides are regulated, by the liver. The liver is
the primary site for activation, clearance, detoxification and excretion
of most medications, drugs, and toxins that enter our body. Because the
liver is the primary depot of all the junk we take in, it is
particularly important we avoid toxic substances, like drugs and poisons
– alcohol being the most common example of both.
Chronic liver disease is the tenth
leading cause of death in the United States – resulting in about 25,000
deaths per year. Fortunately, for most us looking for salvation after
years of abuse of our bodies, the liver has a tremendous capacity to
regenerate itself, even after serious injuries. Even though you may not
have thought much about it up until now because the liver is hidden deep
inside your body, it is time to bring proper “liver care” to the
forefront of your attention.
High-Carbohydrate, Liver-Friendly Foods
The time-honored diet for all liver
ailments has been a high-carbohydrate, low-fat, low-protein diet.
During my medical school training, more than 30 years ago, I recall
prescribing this kind of diet for patients with all kinds of liver
illnesses from acute hepatitis to chronic liver failure. Carbohydrates
are the energy sources most easily utilized by the liver; in addition, a
high-carbohydrate diet limits the intake of proteins, which can be toxic
to the body.1
Carbohydrate fuels burn cleanly into carbon dioxide and water, without
leaving behind toxic remnants of metabolism, like the nitrogen left
behind when burning protein for fuel. Carbohydrates also increase the
production of insulin, which helps remove potentially toxic proteins
from the body.
Dietary protein can cause a person with
liver failure to become very ill, when amino acids and other
protein-breakdown-products accumulate. The results of the build-up of
these substances can be encephalopathy (mental dysfunction) and hepatic
coma. Vegetable protein is more easily tolerated by a person with
impaired liver function.2
In fact, people with severe liver disease have been effectively treated
by a diet which substitutes animal protein with vegetable protein as a
single therapy – relieving encephalopathy and hepatic coma.
Obesity encourages the progression of
liver disease to a chronic, often fatal, condition, known as cirrhosis.3
There is also evidence that carbohydrate intake has a protective effect
on the risk of cirrhosis, whereas saturated fat intake significantly
increases the risk associated with alcohol consumption.4,5
Therefore, for many reasons, a low-fat, high-carbohydrate, plant-protein
vegetarian diet would be the best diet for all persons with liver
disease – as well as anyone wanting to keep the liver healthy.
Fatty Liver Disease
Simple accumulation of fats within the
liver tissue, commonly referred to as “fatty infiltration of the liver”
and medically termed “non-alcoholic steatohepatitis,” is caused by
eating an unhealthy diet. This fatty liver disease can lead to serious
consequences, including inflammation, scar tissue formation (fibrosis),
and cirrhosis. At autopsy, from 6% to 11% of livers of Americans show
moderate to severe accumulation of fat. This condition is more commonly
seen in people who are alcoholic, obese, have diabetes and/or elevated
triglycerides (hypertriglyceridemia). About 75% of people with this
condition are women, and between 70% and 100% are obese. Fatty
infiltration of the liver is usually discovered when routine blood tests
reveal elevation of one or more of the “liver enzymes” known as
alanine aminotransferase (ALT)
and gamma glutamyl transferase (GGT). Exclusion of other causes
for the elevation of these liver enzymes, such as heavy alcohol intake
and viral hepatis, must be made before a diagnosis of non-alcoholic
steatohepatitis is made. The higher the levels of elevated liver
enzymes, the more likely damage to the liver on direct examination will
be seen. About half of the patients complain of fatigue and/or upper
abdominal discomfort – the other half has no symptoms. Liver
enlargement is sometimes detected on physical examination.
High fat and oil consumption are
associated with an elevation in liver enzymes.6
Most importantly, a change in diet and exercise regime that results in a
10 to 15 pound weight loss is a very effective means of healing the
liver – this is seen by improvement of the liver enzymes and
disappearance of fat from the liver tissues on direct examination of the
liver tissues after a biopsy.7
Many other studies have confirmed that this potentially serious liver
condition can be cured with a change in diet and accompanying weight
Hepatitis, meaning inflammation of the
liver, is usually due to a virus infection, but can also be caused by
medications and other chemical toxins. Viral hepatitis is commonly
classified as A, B, and C, as well as by other letters. These viruses
are spread by close contact with infected people or their body fluids
(saliva, blood, and semen). Hepatitis B and C are most often associated
with illicit drug use, blood transfusions, and sexual contact.
Fortunately, there are effective vaccines for hepatitis A and B, which
greatly reduce your chances of infection. All of our family members
have been immunized against both forms of viral hepatitis – this
decision was made partly because we frequently travel worldwide to
places of higher risk.
Once infected, the body provides a
defense that attempts to eliminate the virus. However, in some cases
this fails and the infection becomes chronic. For example, between 75
to 80 percent of people infected with hepatitis C go on to a chronic
form where the virus persists – as a result, more than 25 percent
develop cirrhosis within 40 years. Chronic infections by hepatitis B
and hepatitis C viruses are major risk factors for most primary liver
cancer cases worldwide.
Therapy for Infectious Hepatitis
I have had people chronically infected
with viral hepatitis tell me that after a change to a low-fat, pure
vegetarian diet they were able to rid themselves of the virus. (I cannot
substantiate this with scientific research, but it makes sense that a
healthier body would be better able to mount an effective attack against
any foreign invader.)
There are herbal treatments for chronic
hepatitis that are almost side-effect free and highly effective. For
example, one of the earliest and most encouraging reports was published
in 1988 in the Lancet.11
In this preliminary study,
22 of 37 (59%) of chronically infected patients who were treated with a
preparation of the plant Phyllanthus amarus for 30 days lost hepatitis B
surface antigen when tested 15-20 days after the end of the treatment;
compared with only 1 of 23 (4%) placebo-treated controls (the antigen is
the protein coat of the virus and its presence is a strong indication of
continued infection). Some subjects had been followed for up to 9 months
and in no case did evidence of chronic virus infection return. There
were no serious adverse effects from the treatment. Several more recent
reviews of the effectiveness of this herb have come to similar
conclusions about its effectiveness.12,13
Other herbal treatments of herb
combinations have also been reported to be effective, such as the
Chinese “Jianpi Wenshen recipe” and the Japanese herbal medicine
With such a gloomy future for people
with this progressive liver disease, it is a wonder that everyone with
chronic hepatitis doesn’t at least try the herbal approach, with its low
cost and absence of serious adverse effects. Unfortunately, the
nonprofit nature of these remedies reduces the likelihood that patients
and their doctors will know about them.
Doctors and patients “do” know about
drug therapies. The best standard medical therapies for chronic
hepatitis are with drugs known as interferon and ribavirin – they offer
about a 40 percent chance of eliminating the chronic infection. The
costs are high (48 weeks of interferon/ribavirin combination therapy
should cost approximately $10,000), and the side effects are often
Drugs and Toxins
Commonly used medications with known
liver toxicity include NSAID (Advil, Motrin, etc.), including the new
Cox-2 inhibitors (like Celebrex and Vioxx), other pain-killers
(Tylenol), cholesterol-lowering drugs (like Mevacor, Zocor, Lipitor and
niacin), diabetic medications (Precose, Actos, Avandia, and
sulfonylureas), estrogens, anabolic steroids, antibiotics, antifungals,
anticonvulsants, antidepressants, antiarthritic (methotrexate), acne (Accutane),
vitamin A (retinol) and many other medications (see the Physicians’ Desk
Reference – PDR – for a partial
list). Obviously, the best prevention is avoidance of these substances
– and the easiest way to avoid medication exposure is to stay healthy
with a good diet and exercise habits.
Alcohol is the most common toxin known
to cause severe liver disease. Everyone knows this and prevention is
obviously the safest course.
There are other important dietary
sources of liver toxins that cause damage as serious as liver cancer.
Nitrosamines found in preserved meats, such as luncheon meats and hot
dogs, are suspected of causing liver cancer; as are aflatoxins, found in
moldy grain and peanut products. The solvent, carbon tetrachloride, can
cause fatal liver disease. There are also low levels of environmental
contaminants produced by industry that are potentially toxic to the
liver. The best way to avoid this variety of chemical intake is to eat
low on the food chain – in other words to eat low-fat, plant foods.
Liver Tonics – Milk Thistle
Herbal treatments have been widely used
for many forms of liver disease, such as hepatitis caused by viruses and
toxins, fatty liver, alcoholic cirrhosis, and radiation toxicity. The
most commonly used herb is milk thistle. It has shown to be effective
in mushroom poisoning, alcoholic liver disease, and viral hepatitis. It
appears to protect the liver cells against a variety of toxins, as well
as helping to detoxify the liver and promote regeneration of liver
Other herbs, including Picrorhiza kurroa, Curcuma longa (turmeric),
Camellia sinensis (green tea), and Glycyrrhiza glabra (licorice), have
also been found to be helpful for a variety of liver conditions.17,18
Because of their low cost, and relatively few side effects (compared to
traditional medical treatments), these treatments should be considered
for many acute and chronic liver conditions after carefully weighing the
benefits and risks.
Ten Ways to a Healthy Liver:
1) Minimize Alcohol Consumption
2) Prevent Fatty Infiltration of the
Liver by Staying Trim
3) Avoid Medications by Staying
4) Eat a High-Carbohydrate, Low-Fat,
Plant-Food Diet and Exercise to Stay Trim and Healthy
5) Minimize Protein Intake with Liver
Disease (Use Vegetable Protein)
6) Reduce Your Risk of Viral Infection
by Reducing Exposure
7) Immunize Yourself against Hepatitis
A and B
8) Avoid Environmental Chemicals,
9) Treat Hepatitis with Phyllanthus
10) Treat Other Chronic Liver
Conditions with Milk Thistle
1) Ilan Y. A balanced 5:1
carbohydrate:protein diet: a new method for supplementing protein to
patients with chronic liver disease. J Gastroenterol Hepatol.
2) Uribe M. Treatment of chronic
portal--systemic encephalopathy with vegetable and animal protein diets.
A controlled crossover study. Dig Dis Sci. 1982
3) Day CP. Who gets alcoholic liver
disease: nature or nurture? J R Coll Physicians Lond. 2000
4) Corrao G. Interaction between
dietary pattern and alcohol intake on the risk of liver cirrhosis. The
Provincial Group for the Study of Chronic Liver Disease. Rev
Epidemiol Sante Publique. 1995;43(1):7-17.
5) Corrao G. Exploring the role of
diet in modifying the effect of known disease determinants: application
to risk factors of liver cirrhosis. Am J Epidemiol. 1995 Dec
6) Deems RO. Relationship between
liver biochemical tests and dietary intake in patients with liver
disease. J Clin Gastroenterol. 1994 Jun;18(4):304-8.
7) Ueno T. Therapeutic effects of
restricted diet and exercise in obese patients with fatty liver. J
Hepatol. 1997 Jul;27(1):103-7.
8) Eriksson S. Nonalcoholic
steatohepatitis in obesity: a reversible condition.
Acta Med Scand. 1986;220(1):83-8.
9) Drenick EJ. Effect on hepatic
morphology of treatment of obesity by fasting, reducing diets and
small-bowel bypass. N Engl J Med. 1970 Apr 9;282(15):829-34.
10) Vajro P. Persistent
hyperaminotransferasemia resolving after weight reduction in obese
children. J Pediatr. 1994 Aug;125(2):239-41.
11) Thyagarajan SP. Effect of
Phyllanthus amarus on chronic carriers of hepatitis B virus. Lancet.
1988 Oct 1;2(8614):764-6.
12) Calixto JB. A review of the plants
of the genus Phyllanthus: their chemistry, pharmacology, and therapeutic
potential. Med Res Rev. 1998 Jul;18(4):225-58.
13) Liu J. Genus Phyllanthus for
chronic hepatitis B virus infection: a systematic review.
J Viral Hepat. 2001 Sep;8(5):358-66.
14) Liu JP. Chinese medicinal herbs
for asymptomatic carriers of hepatitis B virus infection. Cochrane
Database Syst Rev. 2001;(2):CD002231.
15) Yamashiki M. Effects of the
Japanese herbal medicine "Sho-saiko-to" (TJ-9) on in vitro
interleukin-10 production by peripheral blood mononuclear cells of
patients with chronic hepatitis C. Hepatology. 1997
16) Ferenci P. Randomized controlled
trial of silymarin treatment in patients with cirrhosis of the liver. J
Hepatol. 1989 Jul;9(1):105-13.
17) Luper S. A review of plants used
in the treatment of liver disease: part 1.
Altern Med Rev. 1998 Dec;3(6):410-21.
18) Luper S. A review of plants used
in the treatment of liver disease: part two.
Altern Med Rev. 1999 Jun;4(3):178-88.
© 2002 John
McDougall All Rights Reserved