By Karen Raterman
The constant barrage of processed foods, alcohol and environmental toxins in everyday life have given the concept of “liver detox” a prominent buzz among the health conscious, seeking a quick fix to support stressed or damaged liver cells. But periodic support for the liver may represent just the tip of the iceberg when considering the necessity of hepatic support for maintenance of overall health. By Karen Raterman.
A built-in purification system, the liver is detoxing all day, every day, to help the body stay in prime working order. As such, it has an expansive relationship with many health systems. Clinicians are now beginning to understanding its implications for cardiovascular health, connections to the endocrine and metabolic systems, as well as the importance of the detoxification function.
But a key question is how much liver support is necessary in this era of unprecedented toxic burden? Ongoing studies are investigating the importance of liver support for general health and to address the potential impact of liver health in chronic issues, such as obesity, diabetes, heart disease and cancer. Research is showing great promise for the hepatoprotective properties of nutritional interventions as well as phytochemicals in providing both short- and long-term liver support. This article will address ways to assess the individual nature of liver support, key nutrient connections to detoxification pathways and a review of research on botanical medicines for liver support.
The liver and chronic disease
Chronic degenerative diseases are at an all-time high, with an estimated one-third of U.S. adults having some form of cardiovascular disease1, approximately 30 million diagnosed with diabetes2, 1.7 million new cases of cancer3 annually, and 70% of American’s classified as overweight1.
The science is now conclusive that these conditions are due, in part, to the Western inflammatory diet characterized by high intake of fatty acids and processed foods, with low consumption of mono- and poly-unsaturated fatty acids, dietary fiber and micronutrients4. Coupled with an unprecedented level of environmental toxins, such as pesticides and plasticizers, and growing pharmaceutical usage, the average American’s liver detoxification system is on constant overload.
Symptoms of toxic overload vary, ranging from fatigue, joint pain, headaches and depression to allergic reactions and gastrointestinal upsets. While the liver is capable of regeneration and healing, it can leak damaging fluids into the bloodstream when overloaded, which can damage organs and lead to disease.
While a healthy liver can do an effective job of keeping the body detoxified, there is evidence that our internal purification system may be falling behind. According to the Centers for Disease Control’s Second National Report on Human Exposure to Environmental Chemicals, blood and urine samples from 2,500 healthy subjects all contained toxins. The report, which tested for 116 chemicals, did not even include an analysis of toxins present in fatty tissues, where these residues are often stored.5
It is a safe bet that a majority of patients would benefit from some form of liver support. For those with serious health issues or excess weight, liver support may be even more critical.6 But how much detoxification is appropriate and how the liver is linked to these various symptoms are two questions that remain.
Strong evidence suggests that liver support is necessary and at least occasional detoxification can be beneficial even for healthy patients. An emerging body of science now suggests that detoxification can address both specific health symptoms and aid in weight loss. In 2012 researchers at the Morrison Center in New York and the University of California, Irvine, looked at the impact of a meal replacement-enhanced, low-calorie detox diet on health symptoms and weight loss over four weeks. The study concluded that the diet not only addressed symptoms among the 31 subjects, but also helped them lose on average 8.9 pounds over the course of four-week study.6
Although these successes are encouraging, it is increasingly important to better define the process that occurs in the liver and place more clarification on the practice of detoxification, according to Adam Killpartrick, DC, CNS, of Suncock Valley Chiropractic in Pittsfield, N.H. “When you think about liver support, it is often about milk thistle and dandelion.” But there is much more to understand, he said. “Acetylation, methylation and glycosylation are all ways the body binds to and eliminates toxins. All these processes are nutrient driven. So vitamins B5, B12 and C drive acetylation, which is the primary phase-2 process.” Methylation is linked to folic acid and vitamin B12, so perhaps those are nutrients, often found in a good multivitamin, that may be beneficial on an ongoing basis, he noted.
Protocols that involve liver support should always be individually based and follow an assessment of a patient’s biomarkers that indicate how he/she is doing with detoxification, along with gut bacteria, neurotransmitters, metabolism and nutrient levels. Urine profile tests provide important insights for both practitioners and patients on these functions.
Killpartrick believes more attention is needed on how the liver affects various other systems and contributes to problems like hormonal issues and hypo-thyroidism. For example, he noted one patient with thyroid problems was having T4 to T3 conversion issues and showing symptoms of hypo-thyroidism. “The body was not making this conversion properly. But what is the primary site of conversion? The liver. This is not often addressed, but it is a huge missing piece.”
Medications are another significant toxic burden that are not consistently considered in evaluating liver function. Drug interactions are always of concern, noted Killpartrick, but he explained that if a patient is taking a medication that will speed or slow the detoxification pathways, either effect can lead to liver toxicity.
It is important to help patients understand that taking medications can be a catch-22. If a medicine is causing a toxic burden, it might be more beneficial to take it down a bit, Killpartrick added. “A medication assessment is just good medicine and great education for patients.”
Regulating the liver
Research is ongoing to clarify how nutrients impact liver function, but studies are also showing that a number of botanicals have promising hepatoprotective properties.
One of the most well-known is Silymarin (Silybum marianum) commonly called Milk thistle, a traditionally used standard to support natural liver detoxification.* Early studies concluded that compounds in Silymarin, such as flavoligands and flavonoid taxifolin, enhance hepatic glutathione and antioxidant activity to contribute to liver protection.7,8*
More recently, studies are looking further at Silymarin’s effect on influencing inflammatory and apoptic mechanisms9 and its ability to support liver function in the presence of environmental toxins.* One 2014 study, conducted by the Chinese Department of Food Science, showed that Silymarin increased liver cell viability in mouse liver cells injured by Di(2-ehtyhexyl)phthalate (DEHP), thus supporting the theory that it may be of value in toxicity from exposure to commonly used DEHP plasticizers.10
N-acetyl-L-cysteine (NAC) is a precursor to glutathione, the body’s master antioxidant, which binds to toxins and helps defend cells against damage from waste materials.* NAC is commonly used to help provide support for detoxification pathways because there is clear evidence linking glutathione’s usefulness in preventing oxidative stress.* While more research is still needed, several trials have investigated NAC’s role in preventing oxidative stress in patients by helping to modulate their glutathione metabolism.11*
Another plant with a long history of stress protective effects, Schizandra (Schisandra chinensis) has several well-studied biological abilities, including liver protection, anti-toxic and antioxidant properties that support cardiovascular health and digestive processes.12* It is particularly interesting for its abilities to support hepatocytes themselves13, Killpartrick noted. “When you think of what goes on in a detox, there is some collateral damage in the liver itself and schizandra can help with that,” he said.
With well-documented abilities to address inflammation and digestive issues, turmeric (Curcuma longa) may also play a significant role in liver health and detoxification.* Curcumin is the fraction of the root that is the well-known spice, and its active components have been shown as beneficial to help maintain healthy inflammation levels.14* Turmeric and curcumin supplements are well tolerated, although low bioavailability after oral administration has hampered its clinical use14.**
Like turmeric, dandelion (Taraxacum officinale) is a well-known antioxidant with acknowledged effects on organs, such as the liver and gallbladder.* Dandelion extract has been tested for its oxidative stress reducing abilities in rat liver cells damaged by carbon tetrachloride, a well-known liver toxin used in fire extinguishers and refrigerants.15
The current Western diet, medication usage and exposure to a variety of unavoidable environmental toxins may be overloading the body’s internal detox system powered by the liver. Even those who are healthy and experience few of the common symptoms from these toxins could benefit from ongoing liver support provided by a good multivitamin. More targeted liver support and protection is proving beneficial for patients with a variety of recurring symptoms and is proving to be an essential part of restoring healthy liver function.* But any approach to liver support should be based on the needs of each individual and undertaken only after a complete patient history and nutrient/biomarker assessment.
*This information is intended for professional use by medical professionals. These statements have not been evaluated by the FDA. This information is not intended to diagnose, treat, cure, or prevent any disease.
** Turmeric is counter-indicated during pregnancy and not suggested for use in large doses for women who are pregnant.
Karen Raterman is Principal of New Leaf Communications, which specializes in content marketing strategies and development, corporate communications, public relations and social media strategies for natural brands, dietary supplements and botanical ingredients. Karen brings 20 years of experience in the natural products industry with market insights across the industry supply chain, in all sales channels and in consumer health and wellness trends. She is a contributing writer to New Nutrition Business and Nutrition Business Journal.
- Heart Diseases and Stroke Statistics—2014 Update, A Report from the American heart Association [pdf]. Available at http://circ.ahajournals.org/content/early/2013/12/18/01.cir.0000441139.02102.80. Accessed Dec. 1, 2014.
- National Diabetes Statistics Report, 2014. Available at http://www.diabetes.org/diabetes-basics/statistics/. Accessed Dec. 1, 2014.
- Cancer Facts and Figures—2013 American Cancer Society [pdf] Available at http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf Accessed on Dec. 1, 2014.
- John Neustadt, ND, “Western Diet and Inflammation,” Integrative Medicine Vol. 10, No. 2 (2011); 50-54.
- Fourth National Report on Human Exposure to Environmental Chemicals, Updated Tables, August 2014 [pdf]. Available at http://www.cdc.gov/exposurereport/pdf/FourthReport_UpdatedTables_Aug2014.pdf. Accessed on Dec. 2, 2014.
- Jeffrey A. Morrison, MD, CNS; Anita l. Iannuci, Ph.D, “Symptom Relief and Weight Loss from Adherence to a meal Replacement-enhanced, Low-calorie Detoxification Diet,” Integrative Medicine Vol.11, No.2, (2012); 42-47.
- Nancy Vargas-Mendoza, Eduardo Madrigal-Santillán, Ángel Morales-González, Jaime Esquivel-Soto, Cesar Esquivel-Chirino, Manuel García-Luna y González-Rubio, Juan A Gayosso-de-Lucio, José A Morales-González, “Hepatoprotective effect of silymarin,” World Journal of Hepatology 2014; 144-149. Accessed Dec. 3, 2014, doi: 10.4254/wjh.v6.i3.144.
- Fulvio Cacciapuoti, Anna Scognamiglio, Rossella Palumbo, Raffaele Forte and Federico Cacciapuoti, “Silymarin in non alcoholic fatty liver disease,” World Journal of Hepatology 2013; 109-113. Accessed Dec. 3, 2014, doi: 10.4254/wjh.v5.i3.109.
- Anupom Borah, Rajib Paul, Sabanum Choudhury, Amarendranath Choudhury, Bornalee Bhuyan, Anupam Das Talukdar, Manabendra Dutta Choudhury and Kochupurackal P Mohanakumar, “Neuroprotective Potential of Silymarin against CNS Disorders: Insight into the Pathways and Molecular Mechanisms of Action,” CNS Neuroscience and Therapeutics, 2013; 847-853. Accessed Dec. 3, 2014, doi: 1-.1111.cns.12175.
- Diana Lo, yuh-Tai Wang, Ming-Chang Wu, “Hepataoprotective effect of silymarin on di(2-ethylhexy)phthalate (DEHP) induced injury on liver FL83B cells,” Environmental Toxicology and Pharmacology 2014; 112-118. Accessed Dec. 3, 2014, doi: 10.1016/j.etap.2014.05.005.
- San Miguel, B, Alvarez, M, Culebra, JM, Gonzalez-Gallego, J, Tunon, MJ, “N-acetyl-cysteine protects liver from apoptotic death in an animal model of fulminant hepatic failure,” Journal Apoptosis 2006; 1945-1957. Accessed on Dec. 3, 2014,avaialbe at http://www.ncbi.nlm.nih.gov/pubmed/17021698
- Alexander Panossian and Georg Wikman, “Pharmacology of Schisandra ciniensis Bail.; An overview of Russian research and uses in medicine,” Journal of Ethnopharmacology 2008; 1830-212. Accessed on Dec. 4, 2014, doi:10.1016/jep.2008.04.020.
- Han I Jang, Gyeong-Min Do, Hye Min Lee, Hyang Mok Ok, Jae-Ho Shin, Oran Kwon, ”Schisandra Chinensis Baillon regulates the gene expression of phase II antioxidant/detoxifying enzymes in hepatic damage induced rats,” Nutrition Research and Practice, 2014; 272-277. Accessed Dec. 4, 2014, doi: http://dx.doi.org/10.4162/nrp.2014.8.3.272 .
- Gary N. Asher, MD, MPH and Kevin Spelman, PhD, “Clinical Utility of Curcumin Extract, Alternative Therapies, Col. 19, No.2, 2013; 20-22.
- Abdulrahman L. Al-Malki, Mohamed Kamel Abo-Golayel, Gamal Abo-Elnaga and Hassan Al-Beshri, “Hepatoprotective effect of dandelion (Taraxacum officinale) against induced chronic liver cirrhosis,” Journal of Medicinal Plants Research 2013; 1494-1505. Accessed on Dec. 4, 2014, doi: 10.5897/JMPR12.116.
- P. Ovadje, S. Chatterjee, C. Griffin, C. Tran, C. Hamm, S. Pandey, “Selective induction of apoptosis through activation of caspase-8 in human leukemia cells (Jurkat) by dandelion root extract,” Journal of Ethnopharmacology, 2011; 86-91. Accessed Dec. 4, 2014, doi:10.1016/jep.2010.09.005