The liver is an important organ for homeostasis. The liver holds around 13% of the blood found in the body and performs over 500 actions. It's estimated that 30 million Americans have some form of liver disease. This article will discuss what the liver is, including its many functions. We’ll then discuss some common liver conditions, functional medicine testing for those liver conditions, and conventional and integrative medicine treatments for them.

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What is The Liver?

The liver is a reddish-brown organ weighing around three pounds. The liver sits in the upper right-hand corner of the abdomen, above the stomach and intestines- anteriorly. The gallbladder sits beneath and is connected to the liver. There are two main lobes that makeup eight segments of the liver, and together make up 1,000 smaller lobes called lobules. The lobules are connected to small tubes, called ducts, that connect to larger ducts, forming the hepatic duct. The hepatic duct then connects to the gallbladder and small intestine.

The liver is supplied with nutrients in two ways. First, the liver receives oxygenated blood from the hepatic artery. Second, nutrients are delivered from the hepatic portal vein.

What is The Liver's Role in The Body?

In the body, the liver performs over 500 functions, including:  

• Creation of proteins for the blood.
• Creation of cholesterol and other proteins that transport fat throughout the body.
• Creation of bile- aids in the breakdown of dietary fat and carries away waste.
• Creates glucose, or blood sugar, and stores it by converting glucose into its storage form, glycogen. The liver can then convert glycogen back into glucose, depending on what the body needs.
• Aids in fighting infections by making immune factors while also removing bacteria from the bloodstream.
• Breaking down hemoglobin, the oxygen taxi of the body. Hemoglobin also contains iron, which the liver will then store. Processing hemoglobin creates bilirubin, which can be toxic to the body; the liver will also break bilirubin down.
• Removes drugs and poisonous substances from the blood and breaks them down.

By-products are introduced into the blood or bile when the liver breaks down compounds in the body. Bile waste is transported and excreted into the stool. Alternatively, blood by-products are transported to the kidneys and, ultimately, excreted in the urine.

What are the Top Medical Conditions Associated with The Liver?

The top medical conditions associated with the liver are hepatitis and non-alcoholic fatty liver disease (NAFLD).

Hepatitis

Hepatitis are diseases that cause inflammation in the liver. Hepatitis can have many causes, including viruses, drugs, alcohol, and chemicals. Additionally, autoimmune processes and genetic disorders can also lead to hepatitis. There are five main viral types of hepatitis: A, B, C, D, and E. All viral types of hepatitis are considered to be the most concerning types of hepatitis, as these have the potential to spread. Hepatitis prognosis ranges from self-limiting, meaning it may resolve independently, to cirrhosis (permanent liver damage) and cancer. General symptoms include fatigue, yellowing of the eyes and skin (referred to as jaundice), light-colored stools, dark urine, and swelling and tenderness in the abdomen.

Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a condition of excessive fat in the liver not due to alcohol intake. Excessive fat, or fatty liver, is defined as having more than 5% of the liver’s weight composed of fat. There are two primary types of NAFLD: simple fatty liver and non-alcoholic steatohepatitis (NASH). Simple fatty liver occurs when excess fat is present, but there is little to no inflammation. This type of NAFLD generally does not cause or lead to liver damage. NASH, however, is the opposite. Inflammation is present in NASH, and it has the potential to cause fibrosis or scarring of the liver. Fibrosis may progress to cirrhosis, defined as hard, fibrotic tissue replacing the normally soft liver tissue. Cirrhosis is permanent and can lead to liver failure. Approximately 25% of the US population has NAFLD. NAFLD typically does not have any symptoms until the disease has progressed to cirrhosis. Obesity, type II diabetes, high cholesterol, and high triglycerides can increase the risk of developing NAFLD.

Functional Medicine Labs to Test for Root Cause of Liver Disease

Functional medicine labs to test for the root cause of liver disease may include comprehensive liver panels and hepatitis screens.

Comprehensive Hepatic Function Panel

The comprehensive Hepatic Function Panel includes different markers to assess liver health. This panel includes liver enzymes ALT and AST, which will be elevated when damage occurs to the liver. Bilirubin levels are also checked with this test. As discussed above, bilirubin is a substance created by the liver and can tell how the liver is functioning. Both total protein and a type of protein, albumin, are also measured. Because the liver makes proteins, including albumin, these markers can serve as markers of liver function.

Hepatitis Testing

The Access Medical's Hepatitis A, B, and C Antibody Panel with Reflex is a valuable test for identifying the presence of hepatitis and differentiating the various types.

Imaging Studies

Various imaging studies may be done to assess the liver, including MRIs, CTs, and ultrasounds that can visualize the liver and assess scarring, fat deposition, tumors, and other growths.

Biopsy

Biopsies are procedures that extract a small amount of tissue for further microscopic assessment. The sampled tissue is then evaluated for the presence of liver diseases.

Functional Medicine Labs That Can Help Individualize Treatment for Patients with Liver Disease

Functional medicine labs that can help with individualized liver disease treatment plans include comprehensive stool testing, micronutrient testing, and the hepatic detox profile.

Comprehensive Stool Test

The liver and gut are interconnected through the liver-gut axis. The liver and gut are primarily connected through the portal vein: a vein that carries products from the gut into the liver. The liver responds by creating immune cells and bile, which will then be released into the small intestines. Additionally, there is evidence suggesting that alternations in the microbiome, a collective group of organisms that inhabit the large intestine, can lead to liver inflammation and dysfunction. Because of these connections, a comprehensive stool test, such as GI-MAP by Diagnostic Solutions, may be helpful in liver conditions. This test assesses the microbiome, showing levels of various bacteria, viruses, fungi, and parasites that make up the microbiome.

Micronutrient Testing

Micronutrients are substances the body requires in small amounts but is crucial for optimal health. Many micronutrients are stored in the liver, including vitamin A, vitamin B12, and copper. Micronutrients require proper liver functioning in order for them to be utilized in the body, for example, fat-soluble vitamins A, D, E, and K, which require bile, produced by the liver, in order to be absorbed. Additionally, a wide array of micronutrients are required for liver detoxification, including vitamins B2, B3, B6, B12, folate, selenium, zinc, vitamin E, and NAC. Because of these reasons, a micronutrient test, such as the Spectracell Micronutrient Test, may be warranted in various liver conditions.

Hepatic Detox Profile

To assess detoxification, the Hepatic Detox Profile by Doctor's Data looks at two markers, mercapturic acid and d-glucaric acid. Mercapturic acids are produced at the end of phase II detoxification of the liver and thus may help to evaluate how detoxification pathways are running. D-glucaric acid is a marker for toxic substance exposure; it is linked to over 200 different chemicals.

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Conventional Treatment for Liver Disease

Conventional treatments include lifestyle changes, including the elimination of alcohol, medications, and liver transplants in severe, life-threatening cases.

Complementary and Integrative Medicine Treatment for Liver Disease

Complementary and integrative medicine treatment for liver diseases can include nutrition and supplements, including herbs.

Nutrition for Patients With Liver Disease

Since the liver utilizes a wide variety of micronutrients, eating a diet with a wide variety of fruits, vegetables, and healthy meats can ensure proper intake of all micronutrients needed for optimal detoxification and liver function. Additionally, keeping inflammation low is important for liver health, and thus an anti-inflammatory diet, such as the Mediterranean Diet, can be beneficial. The Mediterranean Diet consists of fatty fish, nuts, seeds, olive oil, fresh fruits, vegetables, herbs, spices, minimally processed whole grains, legumes, and beans. This way of eating emphasizes whole-plant-based foods that are rich in micronutrients and has been shown to reduce inflammation and support gut health.

Lastly, as alcohol is metabolized in the liver, avoidance of alcohol should also be recommended as many health risks are associated with it.

Top Supplements and Herbs for Patients with Liver Disease

Functional medicine supplements that can help patients with liver disease include milk thistle, probiotics, and vitamin D.

Milk Thistle for Liver Health

For centuries, milk thistle, also known as silybum marianum, has been used to aid liver function. Silymarin is a psychoactive component of milk thistle and has been studied for various liver conditions. A review published in the Advances in Therapy journal reviewed studies done involving Eurosil 85, a supplement with a proprietary blend that reportedly enhances the absorption of silymarin. Their review showed silymarin to have antioxidant effects in the liver, protecting both healthy cells and aiding in recovery in cells with preliminary damage. Thus, silymarin was shown to reduce liver damage, including fibrosis and cirrhosis.

Probiotics for Liver Health

Probiotics are supplements that contain microbes with the aim of supporting the microbiome. There is mounting evidence that suggests probiotics can be helpful for the liver, specifically in relation to NAFLD. Many studies have shown improvements in liver markers, including liver enzymes, with probiotic supplementation. Additionally, a meta-analysis done on probiotics and NAFLD revealed improvements in liver inflammation and liver tissue with probiotic administration.

Vitamin D for Liver Health

As a fat-soluble vitamin, vitamin D plays an essential role in bone health, inflammation, and immunity. In patients with liver disease, vitamin D deficiencies are common; 96% of those with alcohol-related liver diseases have reduced vitamin D levels. This is important, as vitamin D levels below 10 ng/mL in people with cirrhosis is associated with an increased risk of complications due to portal hypertension or high blood pressure in the veins of the liver. Vitamin D can protect liver cells, as it was shown to inhibit fibrotic tissue formation and block the formation of the inflammatory cytokine TNF-alpha, an inflammatory marker involved in liver disease.

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Summary

The liver is an important organ vital for human health. With over 500 different actions, the liver has a large amount of responsibility for many important actions in the body. Liver diseases, especially NAFLD, are, unfortunately, a common problem. Functional medicine testing can help to get to the root of various liver diseases and also help to create personalized treatment plans that may involve both conventional and integrative therapies.