Your liver is amazing.
Unlike some organs, your liver is a true multi-tasker. Every second, of every day, your liver is hard at work keeping you alive. In fact, your liver performs over 500 functions that are vital to life. Not many organs can boast a resume like that!
We ask a lot of our livers; often with little attention to what it’s doing for us or what it needs to be its best.
Given how much it does, it can run into trouble when it can’t optimally perform some of those 500 tasks. It’s susceptible to attacks on several fronts: viruses, toxic substances, contaminants, diseases, poor nutrition, certain medications and more.
Sadly, many are unaware of the status of their liver health because there are few, if any symptoms until there is significant issues. On the one hand, your liver is a real trooper and can take a lot. On the other hand though, because it doesn’t complain, you might not intervene as early as your should and/or could.
Luckily, diet and nutrition are fundamental to a healthy liver plan.
What is the liver?
Your liver weighs just over 1 kg. It’s a beast when it comes to its job. It helps to digest everything you eat and drink, repackages it, and sends it back out for your body to use. It’s your body’s second largest organ next to your skin, and is your largest solid organ. All this, in about the size of a football.
It’s also the master detoxifying organ. Detoxification is one of the main functions of your liver, along with your kidneys and other organs. Everything you eat, drink, breath in or rub on your skin gets absorbed. And all of this is ultimately processed by your liver. Anything that is needed and helpful is kept, anything that isn’t, is excreted.
Unlike muscles that don’t require that much blood unless they’re being exercised, the liver has a lot of blood flowing through it. About 13% (780 ml or 27 ounces or 5.4 cups) of your total blood supply is in the liver at any given time.
What does the liver do?
Your liver does a dizzyingly impressive variety of functions. Some of these include:
It cleanses your blood
Some people get nervous with the word ‘cleanse’ and ‘detox’ given the amount of exaggerated claims on the web. But the reality is, your liver does clean your blood.
It converts harmful compounds like alcohol, illicit drugs, medications, and environmental chemicals and toxins etc. into a form that can be excreted (1, 2). It also neutralizes and destroys poisonous substances.
Regulates your fuel supply
The liver stores some of the carbohydrate you eat as glycogen. When you need energy in between meals, and over night, it releases some of the stored carbohydrate into the blood stream (blood sugar or glucose).
Your body uses this as fuel to help keep you going. It fuels your brain, muscles and more (3). Your liver also processes, stores and releases fat for energy too (4).
Produces proteins that your body uses
These proteins help to transport substances in your blood like iron, calcium, thyroid hormone and more. The liver also produces an important protein called albumin which maintains water balance in your body. Other proteins help to clot your blood and fight infections (5).
Oversees the balance of hormones
These various hormones are released into your blood stream by various glands but someone has to keep things organized. Enter your liver; it keeps tabs on your sex hormones, thyroid hormones, cortisol and other adrenal hormones and so much more.
Regulates your body’s cholesterol
Producing cholesterol, excreting it and converting it to other essential substances like vitamin D, testosterone, estrogen is another main job of your liver (6).
Produces bile
Bile is like dish washing detergent; it helps to emulsify dietary fats which supports their absorption during digestion. This helps your body absorb the fat-soluble vitamins A, D, E and K, and other dietary compounds like the carotenoids. But, your liver is smart. It takes the toxins it needs to excrete and piggybacks them onto bile.
Bile, and the toxins it carries, are ultimately excreted in stool. Fiber helps to bind more bile, and therefore toxins, so getting more fiber in your diet does help with detoxification (7, 8).
What diseases can develop in the liver?
There are easily 26 different liver diseases that I could list here but many of them are super rare. More common liver diseases are:
- Autoimmune hepatitis
- Cirrhosis
- Hemochromatosis
- Hepatitis A, B & C
- NASH (non-alcoholic steatohepatitis)
- NAFLD (non-alcoholic fatty liver disease)
- Alcoholic steatohepatitis & fatty liver
- Liver cancer
Fatty liver
One of the most common liver disorders is fatty liver. About 25-30% of those in Western countries have it.
Fatty liver, or hepatic steatosis, is a term that describes the buildup of fat in the liver. We all have small amounts of fat in our liver, but too much can become a health problem. When the liver contains more than 5% fat, early stage fatty liver disease is diagnosed.
In mild forms, fatty liver can be a reversible condition that typically improves with lifestyle modifications such as diet changes, avoiding/limiting alcohol, weight loss, and increased physical activity. The problem is, most of the time, fatty liver has no symptoms. This is true with a lot of other liver health issues. Only when damage is fairly advanced do symptoms of fatty liver rear their head.
Fatty liver becomes harmful when the condition progresses. As fat accumulates, it starts to damage the liver tissue. The resulting liver inflammation (steatohepatitis) can lead to liver scarring, cirrhosis [severe scarring], liver cancer, and/or end-stage liver disease.
What are the symptoms of liver problems?
Liver failure symptoms need to be taken seriously. Because the symptoms are somewhat vague and could be related to other health issues, be sure to seek out medical advice as soon as you can.
Many conditions begin as flu-like symptoms and progress to more severe signs of liver problems, such as jaundice and dark-colored urine.
Early symptoms of liver disease include:
- Fatigue
- Loss of appetite
- Nausea and/or vomiting
- Joint pain
- Stomach discomfort or pain
- Abnormal blood vessels on the skin (spider angiomas)
- Itchy skin
- Weakness
More serious symptoms include:
- Yellowing of the skin and eyes (jaundice)
- Confusion and difficulty thinking clearly
- Abdominal swelling (ascities)
- Swelling of the legs (edema)
- Impotence
- Gynecomastia (when males start to develop breast tissue)
- Enlarged liver (hepatomegaly)
- Dark urine
- Pale-colored stools
If you’re experiencing any of the symptoms mentioned above, see your doctor immediately.
Liver inflammation symptoms
Liver inflammation can be acute (elevated liver enzymes ALT, AST and ALP)) or chronic. Low grade liver inflammation symptoms are rarely to never felt. You may have ‘normal’ liver enzymes levels but can still be experiencing background damage to your liver if you are overburdening it.
This is a very common assumption in those with alcohol use disorder. Normal enzyme levels give the false impression that there isn’t any damage and that damage isn’t/hasn’t occurred. The analogy I use is with skin burns and sun-related skin damage. You can go your whole life without a sunburn and still have photo damage down the road.
Also, if your background diet is low in the very nutrients that protect your liver and that are need to support its normal detoxification process, collateral damage will occur. It might not show up for years, but it’s there in the background.
How to keep your liver healthy
If you’re wondering how to improve liver health, you might be pleased to know that much of it is easily within your control. Like any organ, your liver needs to be nourished and pampered in order to maintain its structure and function, so diet quality counts. Also, diet supports your liver’s main role in detoxification. Diet DOES support ‘detox’.
Decreasing your risk for communicable liver disease where possible (vaccinations, Hep A, B etc) is another important step. Also, don’t underestimated the impact of everyday over-the-counter (OTC) medications. These can be problematic too. Acetaminophen is the leading cause of liver damage and needs to be taken wisely (9, 10). Acetaminophen is found in over 400 OTC products.
[epq-quote align=”align-center”]Each year, about 4,500 hospitalizations in Canada occur due to acetaminophen overdose, and about 16 per cent of these are accidental according to Health Canada[/epq-quote]
And yes, alcohol intake is one of the biggest factors in determining your liver health. Alcohol is broken down into a highly toxic compound called acetylaldehyde, and then eventually acetate. (11, 12, 13). Drinking ‘guidelines’ are based on amounts assessed with population data where the suggested limit doesn’t appear to lead to increased morbidity (disease) or mortality (death). In the end, the less alcohol consumed, the better your liver health.
Exploring Alcohols Effects On Liver Function
What can be considered excessive alcohol consumption? More than 2 drinks per day for women and 3 drinks per day for men (14). Note, alcohol and acetaminophen is one of the worst combinations for your liver…this mix should be avoided at all costs.
Best diet for liver health
It’s true, poor dietary choices and a high toxin burden will negatively affect your liver health but can a juice cleanse or elixir do anything that a nutrient-dense diet can’t?
The answer is NO!
It begs the question: are we really detoxing/cleansing or nourishing? There is no one single food, powder, pill or juice that will ramp up what your liver is already doing anymore than what a nutritious diet based on whole foods [yes both plant and animal], along with appropriate supplementation when needed, can do.
When people go on ‘detoxes’ they automatically eliminate the crap and eat more wholesome foods, you do the math. You can’t excrete more toxins in any clinically meaningful way with a cleanse. You can however, support your liver by nourishing it with the necessary nutrients it needs while not overburdening it with excessive alcohol, drugs or unwarranted medications.
It’s true, consumers, and some self-stylized health gurus, love the terms detox and and cleanses. While the terms are used casually, they have no real meaning. The best ‘detox’ diet you can choose is a healthy diet based on wholesome, nutrient-dense foods.
While not an absolute list, some big hitters when it comes to liver-loving foods are:
Coffee
Reduces inflammation, helps to increase glutathione, reduces the risk for cirrhosis, fatty liver & liver cancer (15, 16, 17, 18).
Tea (green, black, white)
Improves blood markers of liver health, reduces fatty liver, lowers risk for liver cancer (19, 20, 21).
Grapefruit
Reduces inflammation and protects liver cells with the polyphenols naringenin and naringin (22, 23).
Fish and seafood
Lowers inflammation, reduces the risk for fatty liver (24).
Berries
Lots of polyphenols support liver health overall and prevent oxidation and damage to liver cells, and supports Nrf2 (22).
Tomatoes and tomato products: may reduce inflammation, prevent and reduce NAFLD (23, 24).
Nuts
In a word, vitamin E (tocopherols and tocotrienols) and nut-based phytonutrients. Antioxidant, Nrf2 inducer (19, 25)
Leafy green vegetables
Contain inorganic nitrates which may prevent fatty liver, and lutein reduces inflammation and oxidative stress (26, 27, 28).
Beets and beet juice
Beets contain nitrates and betalains which help to reduce oxidative stress and inflammation. In animal studies, beets have been shown to induce detoxification enzymes (29, 30, 31, 32).
Cruciferous vegetables
These veggies contain compounds that help the liver to detoxify and neutralize toxins and like many phytonutrients, induce detoxification enzymes (33, 34, 35).
Olive oil
Polyphenols in olive oil helps to reduce inflammation, improve insulin sensitivity [reduce fatty liver & insulin resistance], and lower elevated liver enzymes (19, 36, 37).
Eggs
Have lots of B vitamins, as well as, vitamin A which is needed for the liver to function optimally. Eggs are also one of the best sources of choline which protects against fatty liver and supports liver health in general (38, 39, 40, 41).
Dark orange vegetables
The big players here are alpha & beta carotene, cryptoxanthin and falcarinol. They may play an important role in preventing oxidative stress and inflammation, both of which play a major role in liver cell damage (42, 43)
Onions, garlic, shallots
Tthese vegetables contain compounds which have been show to reduce liver inflammation, protect liver cells from toxic agents and since they contain sulfur, help to support glutathione production (44, 45, 46).
Ginger
Aa potent anti-inflammatory, ginger has been shown to lower elevated liver enzymes and protect against the toxic effects of xenobiotic compounds (47, 48).
Plants Consumption and Liver Health
What foods cleanse your liver?
This is a hot button item. According to the natural medicine world, unless you’re on a ‘cleanse’ you’re accumulating toxins. The only way to purge yourself of these accumulated toxins is to do a detox. Of course this is verifiably wrong. You are detoxifying 24/7; have been since the day you were born and will be until the day you die.
Your liver is detoxifying all the time. It prepares toxins for excretion by one of two main routes: stool or urine. Other toxins are lost with each breath, some are sloughed of as you shed skin, and you sweat out toxins daily.
The confusion around detoxing is the suggestion that it’s something you have to do or that you can turn on or off . You don’t and you can’t. But, the reality is, your liver needs an almost innumerable amount of nutrients to support all phases of detoxification:
- Phase I Cytochrome P450 enzymes
- Phase II Conjugation enzymes
- Nrf2
- Metallothionein
If you’re not getting enough of these crucial nutrients, then detoxification efficiency can suffer. This is true with any organ or system that isn’t getting the nutrients it needs to function optimally, the liver is not different. Layer on the extra burden of having to detoxify things like Tylenol, alcohol, industrial solvents, air pollution or household cleaners and it can take it’s toll.
Research does support the role of various nutrients, phytonutrients and botanical compounds in supporting and increasing the activity (“inducers”) of the detoxification phases above (49, 50, 51). For example, broccoli, green tea, curcumin, grapefruit, blueberries, kale, coffee etc do support detox (52, 53, 54, 55). This is of course code for “minimally-processed, nutrient-dense, whole-foods” approach.
But supplements have been examined too (51, 57, 58, 60). Researchers in this field refer to 5 superstars in particular for liver health. These include dandelion, gluathione, alpha lipoic acid, choline and milk thistle (61, 62, 63, 64, 65).
Not to be out done is NAC (N-Acetyl Cysteine), it’s no shrinking violet when it comes to liver support and healing. In fact, it’s the very thing doctors give patients in the emergency room who have acetaminophen poisoning (66, 67, 68). An IV of NAC literally brings people back from the brink of death by increasing glutathione production – amazing!
Any foods bad for liver health?
- Alcohol
- Deep fried foods
- Foods high in added/refined sugar
- Highly processed foods with a lot of sodium
- Processed foods with trans fat
- Red meat [if you’re at risk for hemocromatosis)
How does the liver regenerate?
The liver is truly an amazing organ in that it has the capacity to regenerate. The liver commonly repairs itself by rebuilding new liver cells when the old ones are damaged. This means that after an injury or surgery to remove tissue, the liver tissue can grow back to a certain extent.
The liver starts growing back by having the existing cells enlarge. Then, new liver cells start to multiply. However, when there’s repeated damage to the liver, permanent scarring takes place. This condition is called cirrhosis.
In my experience working in addictions, virtually everyone I’ve met, knows this. But they and I know, when it comes to human psychology, knowing this fact tends to lead to rationalization. “Hey, my liver can take it because it will regenerate”. This is true – to a point, everything has a limit.
Bottom line
Your liver is an impressive organ that performs a huge amount of essential functions. It tirelessly works day and night to keep you healthy, without even having to think about it.
While it’s a superstar of sorts, it’s not invincible and is susceptible to damage if you don’t treat it right.
Therefore, it makes sense to do what you can to protect it.
By nourishing it with a healthy diet, including the foods listed above, you can help to lower your risk of liver diseases while supporting its inherent detoxification process.
By incorporating these foods, and if you choose, targeted supplementation, you can be confident that your liver will always be there for you.
Doug Cook RDN is a Toronto based integrative and functional nutritionist and dietitian with a focus on digestive, gut, and mental health. Follow me on Facebook, Instagram and Twitter.