All about the liver


Every year, April 19 is observed as World Liver Day. To know more about the vital organ, NT BUZZ got in touch with dietician and nutritionist, Shwetha Bhatia

Liver disease doesn’t get as much attention as heart problems. However, the liver too is a vital organ and looks after immunity, metabolism of nutrients, digestion, and detoxification. “So when your liver doesn’t work well, that can affect your whole body. Chronic liver disease can be fatal,” says celebrity nutritionist Shwetha Bhatia who is also a psychologist, entrepreneur, wellness guru, sports consultant, and fitness athlete.
Bhatia usually takes up cases involving fat loss, hormonal disorders (diabetes, thyroid, PCOS), cardiac disorders (includes post cardiac rehab training), GI tract disorders (includes liver / pancreatic disorders), renal disorders, neurological disorders, pediatric nutrition,  pregnancy (prenatal and postnatal care, includes training), sports nutrition for professional as well as recreational sports, strength and conditioning programmes (includes rehab), and  more recently COVID-19.
Talking about some common liver problems, their causes and solutions, Bhatia says that liver damage can be acute ie temporary or chronic which means it is progressive and serious. Common causes of liver problems can be infections for eg hepatitis, alcohol consumption, obesity (non-alcoholic fatty liver disease-NAFLD), diabetes, medications/drugs, autoimmune conditions, diseases of the gallbladder and bile ducts, cancer, inherited/genetic disorders. “Liver damage builds up in phases. Beyond a certain point, it will lead to cirrhosis or end stage liver disease. The solution is identifying and treating the cause as early as possible. Lifestyle changes need to begin and continue through the treatment. Medical management is also necessary,” says Bhatia, who is also the owner/founder of Gym and Tonic fitness center, Panaji.
The advanced form of liver disease, alcoholic cirrhosis (alcoholic liver disease or ALD), Bhatia says, is the result of excessive alcohol consumption over a period of time. “It is fatal. Alcohol abuse over the years leads to the replacement of healthy liver tissue with scar tissue. It occurs in three stages viz fatty liver, alcoholic hepatitis, and cirrhosis,” she says. Fatty liver, also known as steatosis, is characterised by an excessive accumulation of fat inside the liver cells. It makes it hard for the liver to function properly. Heavy drinkers usually get to the fatty liver stage in their early years of alcohol abuse. Other lifestyle related causes are being overweight or diabetes.
A fatty liver can be detected on a sonography or may show up as elevated liver enzymes in a blood test. “Fatty liver is seen even in normal weight individuals. It is a buildup of fat in the liver due to the consumption of extra carbohydrates. Carbs get converted to glucose after digestion. If in excess they store as fat in the liver and fat cells. Carbs include cereals, pulses, fruits, starchy vegetables like potatoes, sugar (including honey, jaggery). If you are overweight/diabetic you need to control these,” says Bhatia.
The second stage of ALD, alcoholic hepatitis is characterised by the inflammation of the liver leading to the degeneration of liver cells quickly. This stage might last for some years but will eventually progress to absolute liver damage if the patient continues to drink. Jaundice is the most common symptom in this stage along with nausea, vomiting, loss of appetite, abdominal tenderness, fatigue and weakness, and weight loss. In cirrhosis, the last and final stage of ALD permanent scarring of healthy liver tissue occurs. A patient with liver cirrhosis will witness liver failure symptoms, along with the symptoms of alcoholic hepatitis ie fluid accumulation in the abdomen (ascites), internal bleeding, confusion and kidney/heart dysfunction.
The only treatment for alcoholic cirrhosis, says Bhatia, is complete abstinence from alcohol. “It reduces the risk of further damage to the liver. Nutrition and medical management are also necessary at every stage allowing the liver to recover,” she adds.
Another liver-related issue is congenital liver disease, which usually presents at birth. “These disorders are rare. These liver disorders usually block the bile ducts, affecting the flow of bile, a fluid made in the liver which helps with digestion,” she says. When the bile ducts are blocked, bile builds up in the liver, causing damage. Some congenital liver defects include biliary atresia, a life-threatening condition in infants where the bile ducts are blocked or have developed abnormally, and biliary cyst, a condition where the bile ducts, either inside or outside the liver, have abnormal dilations.
And while there is a common notion that regularly consuming chocolate, cheese, ghee and oil destroys the liver, Bhatia busts this myth. “Neither of these can damage the liver,” she says, adding that the dos for a healthy liver are to keep your sugar in check, maintain a healthy body fat percent whereas don’ts include binge drinking and taking medications like painkillers, etc, randomly.
And although ‘liver detox’ seems to have gained popularity in recent times, Bhatia is quick to state that there is no such thing as a liver detox. In the context of human biochemistry, detoxification refers to a metabolic pathway that processes unwanted chemicals for elimination, she says. “It involves a series of reactions that neutralise and solubilise toxins, and transport them to organs like the liver and kidneys, so that they can be excreted from the body. Simplifying it: Your liver helps to detox the body. This is happening 24/7 and not when we decide to go on a ‘detox diet’.”
Common sources of toxins are diet-preservatives, colours, pesticides, medications (not vitamins), pollutants in water, high temperature cooking, food processing, bacteria, air pollution, cigarette smoke, alcohol, etc.
The nutrients that take part in this detoxification process include protein/amino acids (eg, methionine, cysteine, glutamine, Phase 1); Vit B complex (Phase 1 and 2); Vit A/C/E, copper, zinc, calcium, magnesium, iron, selenium (Phase 1); flavonoids (green tea, soya); quercetin (apples, onions); sulforaphane (cruciferous veg, Phase 2 and 3); others: garlic, turmeric, lemon, ginger, cumin, fennel, artichokes, carom seeds, olives, bell peppers, cinnamon, chlorophyllin, probiotics, milk thistle, curry leaves, mustard leaves, water.
“Excess carbohydrates can affect the phase 1 processes. Detoxification needs to be managed on a daily basis by adding the necessary nutrients through the diet, exercising, and reducing exposure to toxins,” says Bhatia.