The liver is probably the most talked about organ when it comes to lab work. How high are your liver enzymes this time? Will you be able to stay on steroid therapy if they go any higher? Just what do they mean?
First, a short course in the liver - what is it and what does it do. The liver is a large organ located just under the lower ribcage on the right side. It has the greatest number and most varied functions of any organ of the body. Your doctor can feel it if they dig their fingers up under your ribcage. It may be tender if it is inflamed. It has 3 basic functions. First, it stores and filters the blood. About 1400 ml. of blood flow through the liver each minute to be filtered. The majority of this blood comes directly from the intestinal tract where it has picked up many bacteria. These are cleansed by phagocytic immune cells. Poisons in the blood system from drugs, food or other parts of the body, are also cleaned out. Second, the liver makes bile which is collected in the gall bladder and released into the intestinal track in response to fat in the diet. This helps us to absorb the fat in our food, including the fat-soluble vitamins A, D, E & K. The bile is also one way the body gets rid of unwanted compounds, such as bilirubin, a breakdown product of old red blood cells. Your blood work will usually have a bilirubin measurement on it. It may even break it down into subcategories of conjugated and unconjugated. If elevated, these subcategories help your health care provider determine the location of the problem. The third function is in the metabolism of the foods we eat. This is an extremely complex function, the majority of the food you eat, which includes vitamins and minerals, travels straight to the liver to me metabolized.
Carbohydrates, sugar and starches, are reconfigured in the liver to be stored as glycogen. This is an "energy bank" of the body. The liver will release sugar into the blood as needed. Fats too are reconfigured in the liver. One product, triglycerides, are routinely measured. It makes cholesterol, of which 80% is converted into bile. An interesting note is that the majority of the cholesterol in the body is from your liver, not from your diet. If your liver function is good, then your cholesterol level will be good too. Fat is a concentrated energy source, delivering twice the amount of energy per gram as carbohydrate or protein. Speaking of protein, the liver also changes your proteins around from those that you have to those that you need. This interconversion of the amino acids is one of the most important liver functions. The plasma proteins albumin and globulin are also routinely measured. For vitamins and minerals, the liver acts as a storage depot for vitamin B-12, A, D, E and K. The greatest portion of your iron is stored in the liver as ferritin. Copper, vitamin C and the other members of the B-complex are also stored there. The liver also converts beta-carotene into vitamin A, and vitamins K and D into their active forms.
So far, your lab work can tell us about the function of your liver through levels of albumin, globulin, cholesterol, triglycerides, and ferritin. But, what about those "liver enzymes" you hear so much about. The two most famous are SGOT and SGPT, also known as AST and ALT. These enzymes, found in liver cells among others, help to convert one amino acid into another. When the liver cells rupture, these enzymes pore into the blood and the levels elevate. Another important enzyme is GGT which has a similar function. These 3 enzymes are the most commonly measured ones to help determine what shape your liver is in.
When your liver stops working right it can wreak havoc on your body. Your ability to make proteins, hence muscle, is diminished and you may experience loss of lean body mass. Likewise, your energy levels may sag. The ability to clean your blood decreases and your immune system suffers. What makes it stop working? Too many drugs causes the liver to be "overworked" in trying to clean them out and the cells can start to rupture. This is probably the most common cause of liver malfunction in the HIV+ patient. We all know that alcohol will destroy your liver and cirrhosis can result. Infections of the liver are called hepatitis and can result in permanent damage to the liver. Megadoses of vitamin A may cause liver failure. With all the drug insult to the liver, supplementing with vitamin A should be done only under the care of a health care provider skilled in nutrition and who is able to order and read your blood work. Note that beta carotene is not vitamin A. Large amounts of beta carotene will not be a stress on your liver. In fact, beta carotene is one of the main ways to treat a malfunctioning liver. There are some medical doctors in the HIV field who like to blame elevated liver enzymes on beta carotene and ignore the effects of the drugs they prescribe. They are wrong. As I have said before, a medical doctor is not knowledgeable about nutrition.
What to do if your liver is causing problems or you just want to prevent problems? First, adequate dietary protein is a must. Your body will use more protein than usual in making the millions of new T4 cells each day plus all the antibodies, interferons, globulins, etc. that are necessary for your body to fight the infection. Also the virus makes it easier for the body to "burn" protein for energy, rather than burning fat, so you will lose some there too. Second, avoid alcohol, especially if your enzymes are already elevated. In fact, avoid anything that has to be cleaned out by the liver, including caffeine and nicotine. Third, review all your medications to make sure you are taking only those that you have to. With so many, it is easy to continue to take one or two that were only meant to be taken for a short time.
Using supplements may help your liver. Vitamin C has been shown to be very helpful in cases of liver inflammation. Beta carotene, as mentioned before, helps to repair the damaged cells. Some substances, called "lipotrophics" or "fat-loving," help to mobilize fat from a liver that is fat congested. Use of liver glandular may be beneficial as well. Herbs that have shown to be beneficial include silymarin (milk thistle) and yakitron. Amounts vary depending on your particular health status and your weight.
As a chiropractor, when I analyze the spine, I usually find a problem in the area just below the tips of the shoulder blades, which is where the nerve to the liver comes from. Keeping this vertebra moving freely helps to eliminate any problems from the nervous system.
Our organs do not operate independently. Liver problems may be just a signpost leading us to other problems in the body. The American diet tends to be too high in carbohydrates. When you eat carbohydrate the pancreas secretes insulin. In the liver, this insulin causes the formation of fat from excess carbohydrate. Similarly, any stress (and infection is a stress) causes our adrenal glands to secrete cortisol. This cortisol will cause the liver to start changing amino acids into glucose which will ultimately end up as stored fat. There are innumerable ways in which our liver is affected by the foods we eat, the stressors in our life, the drugs we take and our "lifestyle" of cigarettes and alcohol.
As you can see it is imperative to your life that your liver function properly. You can also see that it is not a matter of what vitamin/mineral/herb/drug/etc. you take to make it all better. It takes the skill and expertise of someone who is knowledgeable and capable of diagnosing your particular situation as well as your decision to reduce or eliminate as many of those things that are damaging to your liver as possible.
Dr. Brian A. Smith is a chiropractic doctor and naturopathic physician who has specialized in the treatment of immune-suppressed individuals since 1987. He is a scientific advisory board member of AIDS ReSEARCH Alliance.
He maintains a private practice in Los Angeles and can be reached at (323) 306-4909. Questions from readers are welcome as are suggestions for future articles. You can also contact him via E-mail at: Send e-mail to Dr. Smith
All articles here Copyright © 1996 - 2008 - Brian A. Smith, DC
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Articles by Dr. Brian A. Smith:
HIV and CHIRO † VITAMIN C † BETA-CAROTENE † MINERALS † DMG † PROTEIN † DIET & HIV † MORE ON PROTEIN † NUTRITION † DHEA † LIVER † CHIRO † NAC † SILVER † ALT THERAPIES †