Liver Detoxification /
Support Requirement

Liver Detoxification / Support Requirement: Overview

Hampered detoxification processes can result in a condition labeled by many naturopathic and nutrition-oriented physicians as the "congested" or "sluggish" liver, or the more recently coined "impaired hepatic detoxification".  Standard liver enzyme blood tests may or may not be elevated in such cases.

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The capacity of the liver to detoxify any given compound is determined not only by the inherent toxicity of the compound but also by the available supply of nutrients and endogenous molecules required for Phase I and II reactions, by any pre-existing liver disease which may be present and by the total load of all toxins to which it is exposed.

Causes and Development

Impaired liver function can result from intrahepatic problems caused by exposure to food additives, solvents (cleaning materials, formaldehyde, toluene, benzene, etc.), pesticides, herbicides, heavy metals (lead, mercury, cadmium, arsenic, nickel, and aluminum), and other toxins.  Other causes include viral infections of the liver, some inherited disorders such as Gilbert's syndrome, alcohol-induced fatty deposits, the use of anabolic steroids/estrogens/oral contraceptives and hyperthyroidismBile flow can be restricted also by extrahepatic means such as gallstones, pregnancy, or other physical causes such as tumors.

The congested or sluggish liver is characterized by a diminished bile flow, a condition known in medical terms as cholestasis, while impaired hepatic detoxification refers to decreased phase I and/or phase II enzyme activity.  Phase I detoxification rates that are in excess of Phase II activity will also cause toxicity problems due to excessive accumulation of activated intermediates.

The activity of Phase I detoxification enzymes decreases in old age.  Aging also decreases blood flow through the liver, further aggravating the problem.  Lack of the physical activity necessary for good circulation, combined with the poor nutrition commonly seen in the elderly, add up to a significant impairment of detoxification capacity, which is typically found in aging individuals.  This helps to explain why toxic reactions to drugs are seen so commonly in the elderly.

Signs and Symptoms

The presence of chronic fatigue is a frequent symptom.  Among the other symptoms, people with a sluggish liver may complain of depression, general malaise, headaches, digestive disturbances, allergies and chemical sensitivities, premenstrual syndrome, and constipation.  Not surprisingly, these are the same types of symptoms people exposed to toxic chemicals often complain of.  Many toxic chemicals (especially solvents) and heavy metals have an affinity for nervous tissue, giving rise to a variety of psychological and neurological symptoms such as depression, headaches, mental confusion, mental illness, tingling in extremities, abnormal nerve reflexes, and other signs of impaired nervous system function.

Diagnosis and Tests

Although there are more sensitive tests to determine the functional activity of the liver, such as a serum bile acid assay and various clearance tests, clinical judgment based on medical history remains the major diagnostic tool for the sluggish liver.

Clearance tests using saliva, urine, and/or blood after chemical challenge by caffeine, aspirin, and acetaminophen can be useful in detecting Phase I and II imbalances.

Treatment and Prevention

General treatments include:

  • Protection against toxic substances

    • Artichoke leaf extract
    • Milk thistle (Silymarin)
  • Bile creation enhancement (cholerectics) often lowers cholesterol

    • Dandelion
    • Artichoke leaf extract (cynara which becomes caffeic acid in stomach)
    • Curcumin
  • Bile movement enhancement (cholagogues)

  • Fatty Infiltration reduction

    • Alcohol avoidance
    • Low fat diet
    • High water-insoluble fiber consumption
    • Carnitine supplementation (other lipotropics less effective)
  • Protection from free radical damage

Signs, symptoms & indicators of Liver Detoxification / Support Requirement:

Lab Values - Chemistries

Supplements and Medications

Counter-indicators

Symptoms - Abdomen

Symptoms - Allergy

(High) cigarette smoke sensitivity

No one really is allergic to smoke.  Many people insist that they are allergic to smoke created by cigarettes or cigars, but the truth is that they have having an allergy-like reaction due to other health complications.

Symptoms - Bowel Movements

Symptoms - Food - Beverages

Symptoms - Gas-Int - General

Garlic/onion intolerance or intolerance of both garlic and onion

An inability to digest onion or garlic may indicate compromised liver function.

Symptoms - General

Symptoms - Head - Eyes/Ocular

Bags under eyes

Some health care providers believe that dark circles under the eyes indicate toxicity and a need for detoxification.

Symptoms - Head - Mouth/Oral

Symptoms - Head - Nose

Symptoms - Liver / Gall Bladder

Symptoms - Mind - General

Symptoms - Reproductive - Female Cycle

Symptoms - Skeletal

Symptoms - Skin - General

Symptoms - Sleep

Symptoms - Urinary

Conditions that suggest Liver Detoxification / Support Requirement:

Circulation

Digestion

Hemorrhoids

If the liver is too congested, blood may not flow easily back to the liver through the hemorrhoidal veins and this might cause swelling of a weakened vein.

Hormones

Immunity

Chronic Fatigue / Fibromyalgia Syndrome

In one evaluation of 200 Chronic Fatigue and Fibromyalgia patients it was found that 80% had a significant impairment of liver detoxification function.

Patients suffering from toxic burdens may experience a wide range of symptoms, among them fatigue and poor tolerance for exercise.  These processes have been postulated to be a central factor in the development of CFS.  Oxidative damage to mitochondria and the detoxification process itself is being considered as a fundamental mechanism in the development of CFS.  [1 Bland JS, HealthComm Inc., 1997; Int Clin Nutr Rev 1988;8(4): pp.173-5]

Infections

Metabolic

Migraine/Tension Headaches

A 'sluggish liver' often contributes to headaches.

Susceptibility To Hangovers

Acetaldehyde is a toxic substance produced in the body from alcohol and is one of the impurities found in cheap wine and 'moonshine' spirits.  Some researchers believe that an acetaldehyde buildup is the cause of hangovers.  If the liver's detoxification pathways are impaired, aldehydes can, instead of being converted to the next intermediate product, build up to harmful levels and cause damage since they are often more toxic than the original substances from which they are derived.

It is probably the metabolism of methanol to formaldehyde and formic acid that caused the symptoms of the hangover.  Quick methanol metabolizers suffer more.  This is reinforced by the fact that the types of drinks associated with more severe hangovers contain higher levels of methanol.  [Hangovers: Not The Ethanol, Perhaps The Methanol, British Medical Journal, January 4, 1997;14: pp.2-3]

All types of alcoholic drinks contain some methanol, a substance blamed for the worst hangovers.  Whiskey, cheap red wine, fruit brandy and other dark spirits contain the most methanol, sometimes as much as 2% by volume.  Vodka and other clear drinks contain the least.  In the liver, methanol takes 10 times longer than ethanol to break down.

Nutrients

Magnesium Requirement

Magnesium deficiency has been found to be more common in patients with diabetes, liver disease or malabsorption problems.

Organ Health

Night Blindness

Reduced night vision can be linked to a variety of conditions caused by impaired liver function which in turn reduces vitamin A metabolism.

Reproductive

Fibrocystic Breast Disease

Impaired liver function can result in excess circulating estrogens and a worsening of breast tenderness.

Skin-Hair-Nails

Psoriasis

Correcting abnormal liver function is of great benefit in the treatment of psoriasis.  The connection between the liver and psoriasis relates to one of the liver's basic tasks (filtering and detoxifying the blood).  Psoriasis has been linked to the presence of several microbial byproducts in the blood.  If the liver is overwhelmed by excessive levels of these toxins in the bowel, or if there is a decrease in the liver's detoxification ability, the toxin level in the blood will increase and the psoriasis will get worse.

Symptoms - Female

Cysts in breasts

The liver is responsible for breaking down hormones.  If it is not fully functioning, estrogen can build up in the body and increase the risk of breast cysts.

Symptoms - Liver / Gall Bladder

Tumors, Benign

Risk factors for Liver Detoxification / Support Requirement:

Addictions

Diet

Excess Protein Consumption

High protein intakes may cause extra metabolic stress to be placed on the liver and kidneys.

Supplements and Medications

Symptoms - Environment

(High) current exposure to solvents

Long-term exposure to environmental pollutants and continued assaults on the detoxifying systems may lead to oxidative stress, high levels of phase 1 activity in the liver, and reduced phase 2 detoxification.

Symptoms - Female

History of cysts in breasts

The liver is responsible for breaking down hormones.  If it is not fully functioning, estrogen can build up in the body and increase the risk of breast cysts.

Symptoms - Food - Beverages

Symptoms - Food - Intake

Symptoms - Gas-Int - General

History of hemorrhoids

If the liver is too congested, blood may not flow easily back to the liver through the hemorrhoidal veins and this might cause swelling of a weakened vein.

Symptoms - Liver / Gall Bladder

Symptoms - Reproductive - General

Uro-Genital

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Liver Detoxification / Support Requirement suggests the following may be present:

Laboratory Test Needed

Liver Detoxification / Support Requirement can lead to:

Immunity

Chronic Fatigue / Fibromyalgia Syndrome

In one evaluation of 200 Chronic Fatigue and Fibromyalgia patients it was found that 80% had a significant impairment of liver detoxification function.

Patients suffering from toxic burdens may experience a wide range of symptoms, among them fatigue and poor tolerance for exercise.  These processes have been postulated to be a central factor in the development of CFS.  Oxidative damage to mitochondria and the detoxification process itself is being considered as a fundamental mechanism in the development of CFS.  [1 Bland JS, HealthComm Inc., 1997; Int Clin Nutr Rev 1988;8(4): pp.173-5]

Skin-Hair-Nails

Psoriasis

Correcting abnormal liver function is of great benefit in the treatment of psoriasis.  The connection between the liver and psoriasis relates to one of the liver's basic tasks (filtering and detoxifying the blood).  Psoriasis has been linked to the presence of several microbial byproducts in the blood.  If the liver is overwhelmed by excessive levels of these toxins in the bowel, or if there is a decrease in the liver's detoxification ability, the toxin level in the blood will increase and the psoriasis will get worse.

Recommendations for Liver Detoxification / Support Requirement:

Botanical

Silymarin / Milk Thistle

Four herbs that can promote liver health include milk thistle, dandelion root, globe artichoke and turmeric.

Castor Oil

Castor oil packs are commonly placed over the liver.

Detoxification

Coffee Enema

The coffee enema causes the liver to produce more bile (which contains processed toxins) and moves bile out towards the small intestine for elimination.  This frees up the liver to process more incoming toxic materials that have accumulated in the organs, tissues and bloodstream.  Coffee contains some alkaloids that also stimulate the production of glutathione-S-transferase, an enzyme used by the liver to make the detox pathways run.  It is pivotal in the formation of more glutathione, one of the main conjugation chemicals, enabling toxins to be eliminated via bile into the small intestine.  So in other words, a coffee enema speeds up the detoxification process and minimizes the backlog of yet-to-be-detoxified substances.

Diet

Therapeutic Fasting

Fasting has a powerful effect on improving liver function, an effect which continues after the fast.  However, fasting should be avoided in cases of severe liver disease or failure.

Alcohol Avoidance

Acetaldehyde, a metabolic breakdown product of alcohol, is said to destroy vitamins B1, B6 and C.  Even though supplements of these nutrients, together with the amino acid cysteine, may help the liver detoxify acetaldehyde, it would be wiser to avoid alcohol, it's primary source.

Environmental

Lab Tests/Rule-Outs

Nutrient

Alpha Lipoic Acid

Alpha-lipoic acid has been used very successfully as a therapeutic agent in a number of conditions relating to liver disease, including alcohol-induced damage, mushroom poisoning, metal intoxification and carbon tetrachloride poisoning.

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