Adefovir

There's such a thing as being too forgiving, especially when it comes to major body parts. The liver is the largest solid organ in the body; it's also, due to its lack of inner nerve endings, called the "silent organ." People can have chronic liver conditions for years without realizing it, says Caroline Riely, M.D., associate medical director of the American Liver Foundation. "Even patients with cirrhosis often have no symptoms at all."

But silence shouldn't breed complacence. "Without the liver, you can't live," says Leonard Seeff, M.D., senior scientist for hepatitis research at the National Institute of Diabetes & Digestive & Kidney Diseases. The liver makes proteins that regulate blood clotting, neutralizes toxins in the blood, produces immune agents to fight infection, generates bile to help digest fats, and stores glucose for when you need energy. "It's the metabolic factory of the entire body," says Seeff.

Can you strengthen your liver? Well, it's not a muscle; you can't go to a gym and do liver presses and liver curls. But a number of integrative practitioners believe that a polluted environment is a main cause of liver disease, and that it's important to assist the liver's functions by decreasing the toxins you put into your body.

You should eat organic foods "as much as possible," says Frank Lipman, M.D., founder and director of the Eleven Eleven Wellness Center in New York City and author of Total Renewal. "That way, you avoid pesticides and herbicides on vegetables and fruit, along with the hormones, steroids, and antibiotics that come with various animal products." He also recommends water filtration.

Certain foods apparently contain nutrients that support liver detoxification properties. Lipman encourages adding blueberries, cabbage, broccoli, Brussels sprouts, watercress, walnuts, and almonds to your diet, along with ginger, rosemary and garlic. Carolyn Dean, M.D., N.D., author of Natural Prescriptions for Common Ailments, says that the best foods for the liver tend to be bitter, such as dandelion greens, chard and spinach. She encourages patients to eat fruits, vegetables and whole grains to get the proper vitamins and minerals, while reducing saturated fats and proteins from animal sources. Also, omega-3 fatty acids, found in oily fish, legumes and wheat germ, may help the liver process fats and reduce the production of triglycerides.

none for the road

Consuming alcohol only in moderation is useful to protect a healthy liver, but reducing intake to bare to a bare mimimum--or, preferably, eliminating it altogether--is vital when the liver has been damaged by disease or abuse. Most medications are metabolized or eliminated by the liver, and some of them may cause liver injury in susceptible individuals. Avoid taking aspirin, ibuprofen, naproxen, and especially acetaminophen (the common pain reliever in Tylenol and numerous cold remedies) with alcohol. Muscle relaxants, antidepressants, cholesterol drugs and oral antibiotics may lead to abnormal liver-function tests, as can the herbs chaparral, coltsfoot, comfrey and kava. Even vitamin A can stress your liver's capabilities if you dramatically exceed the recommended daily value.

An injured liver stops manufacturing important proteins, such as those that prevent excessive bleeding, and it no longer metabolizes bilirubin, which builds up and leads to jaundice, a yellowing of the skin and eyes. With long-term damage, liver cells stop regenerating and are replaced by scarring and fat deposits. "That's cirrhosis," says Riely. "It's an end stage of liver disease, but it's not necessarily a death sentence." Yet as the condition worsens, the liver is deprived of blood, leading to liver failure and, potentially, liver cancer.

Alcoholism gets the most press as a cause of cirrhosis, but hepatitis B is the most common cause worldwide, with hepatitis C doing the most harm among Americans, says Seeff. Both these viral diseases can become chronic, quietly wearing down the liver for 20 or 30 years after they're contracted. "And the vast majority of people affected with hep B and particularly hep C have no symptoms at all," says Seeff. "So many of them don't know they have the disease."

There are less-common conditions as well, such as autoimmune hepatitis and inherited problems. "Women have a greater variety of liver diseases," notes Riely, "but men have more liver problems because a greater number of them have hepatitis or alcoholic liver disease."

The United States is also seeing an increase in nonalcoholic steatohepatitis, or NASH, which is related to the rise in obesity. As fat builds up in the liver, it creates scar tissue and the cycle continues. "Liver disease, particularly the development of cirrhosis, is a dramatically increasing problem in markedly overweight persons," says Seeff.

An annual blood test may tell you if your liver is healthy. Elevated serum levels of the enzymes alanine and aspartate transaminase (ALT and AST) are an indication that something is wrong. Your doctor may then look for specific diseases; a panel of tests simultaneously screens for the hepatitis viruses.

Meanwhile, make sure your diet is as liver-supportive and chemical-free as possible, and avoid common transmission routes for hepatitis (see sidebars, pages 50 and 52). Saunas are useful for eliminating toxins, says Dean, as is milk thistle (see "the herbal approach to liver health").

Another natural option, she adds, is alpha-lipoic acid, a powerful antioxidant that helps recycle vitamins C and E, supports liver function and protects the organ from drug toxicity.

Dean tells her patients to try two or three liver-friendly things each day rather than a dozen. "If you get obsessive, you'll just stop, and that defeats the purpose."

According to Dean, the body is constantly regenerating itself. "Every seven years or so you have a new body," she observes. "If you give it the right building blocks you can overcome incredible odds."

what (not) to do for your liver

(1) About 50 percent of those who drink too much get cirrhosis. Carolyn Dean, M.D., N.D., advises a maximum of two alcoholic beverages per day for men, one for women. Even better: Stick to one or two drinks per week.

(2) Like alcohol, drugs must be metabolized by the liver. Don't exceed maximum daily dosages, and avoid taking unnecessary medication of any kind. Don't mix acetaminophen with alcohol.

(3) Hepatitis B and C can be acquired through unprotected sex, sharing needles or possibly snorting cocaine. Use condoms if you have multiple sex partners.

(4) A study at the University of Texas Southwestern Medical Center found that men with tattoos had a ninefold greater risk of hepatitis C. Patronize regulated tattoo parlors, and insist that all needles be sterilized.

(5) Don't share toothbrushes or razors with others.

RELATED ARTICLE: The herbal approach to liver health.

milk thistle

The gold standard of liver-friendly herbs is milk thistle. German scientists were the first to isolate silymarin from the milk thistle fruit. Silymarin is a free-radical fighter that helps the liver counteract toxins and pollutants and stimulates regeneration of liver cells at up to four times the normal rate; it is now sold in Germany as a supportive treatment for chronic liver disease.

Carolyn Dean, M.D., N.D., advises patients to take 200 to 300 milligrams of milk thistle, two to three times a day. "It is very safe and very effective," she says. (Allergic reactions are rare, though it can interfere with certain HIV medications.)

Milk thistle won't prevent abuse-related liver damage. But once a patient stops drinking, it may help the organ recover more quickly. Milk thistle may also help reduce liver enzyme scores for hepatitis patients, lowering the risk of cirrhosis, says Leonard Seeff, M.D.

licorice root

Glycyrrhizin, found in licorice root, is widely used for chronic liver problems in Japan. It appears to reduce levels of serum transaminase, enhance the production of antibodies, and lower the risk of post-transfusion hepatitis, according to clinical phytotherapist David Hoffman, author of Medical Herbalism. Other hepatic tonics include dandelion, fringetree, black root and balmony.

bitter herbs

Also recommended are the bitter herbs, such as artichokes, dandelion greens, chard, spinach and arugula, whose astringent quality keep bodily fluids moving through the liver. Green tea, ginger tea, chicory, warm lemonade and dandelion-root tea all have liver-supporting properties, too.

ayurveda

To treat liver disorders, ayurveda utilizes Phyllanthus niruri, also called stonebreaker or gale of the wind, which may block the enzyme that the hepatitis B virus needs to replicate; other herbs of choice include bhringraj, turmeric and licorice root, along with long pepper to enhance the immune system. A qualified practitioner will customize cleansing, purification and rejuvenation therapies; in general, a wholesome, non-spicy vegetarian diet is prescribed. Consult your physician before undertaking any treatment options.

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