Weighing about 2-3 pounds, the liver is a vital organ located in the upper right-hand side of the abdomen. It performs numerous functions for the body: converting nutrients derived from food into essential blood components, storing vitamins and minerals, regulating blood clotting, producing proteins and enzymes, maintaining hormone balances, and metabolizing and detoxifying substances that would otherwise be harmful to the body. The liver also makes factors that help the human immune system fight infection, removes bacteria from the blood, and makes bile, which is essential for digestion.

Natural supplements for liver health, herbal remedies
There are many substances, herbs and supplements that could be helpful in protecting liver tissue from damage. One well known substance is silymarin, a derivative from the milk thistle plant that has been used for centuries to treat liver ailments. Research results of some small studies suggest silymarin protects cells and has anti-inflammatory and regenerative properties. Acetylcysteine is another nutrient that could help liver tissue particularly in those who take acetaminophen. There are other supplements that can be of benefit, such as SAM-e and alpha lipoic acid, but long term research is not yet available to know which to take and in what dosages and combinations.

Int J Mol Science. 2015. Oxidative Stress and Inflammation in Hepatic Diseases: Therapeutic Possibilities of N-Acetylcysteine.d Liver disease is highly prevalent in the world. Oxidative stress (OS) and inflammation are the most important pathogenetic events in liver diseases, regardless the different etiology and natural course. N-acetyl-l-cysteine (the active form) (NAC) is being studied in diseases characterized by increased OS or decreased glutathione (GSH) level. NAC acts mainly on the supply of cysteine for GSH synthesis.

The protective effects of Phyllanthus emblica Amla extract on ethanol induced rat hepatic injury.
J Ethnopharmacology. 2006.
This study was undertaken to investigate the protective effects of amla extract on ethanol induced rat liver injury. Amla (0.5 and 1 mg/ml) increased cell viability of rat primary cultured liver cells being treated with ethanol. Liver toxicity markers studied in rats included serum transaminases (AST and ALT), serum triglyceride (STG), hepatic triglyceride (HTG), TNF-alpha and IL-1beta together with histopathological examination. Pretreatment of rats with amla at oral dose of 25, 50 and 75 mg/kg or SL (silymarin, a reference liver protecitve agent), 4 h before ethanol, lowered the ethanol induced levels of AST, ALT and IL-1beta. Histopathological studies confirmed the beneficial roles of amla and silymarin against ethanol induced liver injury in rats.

I am interested in a supplement to support the liver. I am in good health and I'm concerned about adding a bit of support for when I am drinking wine, taking OTC pain killers, sleeping pills or having too much red meat (protein) since those types of foods overwork the liver.
   A. Milk thistle and acetycysteine are good options that you can discuss with your health care provider.

Dietary pills that can cause liver injury include:
Many of the products implicated in liver injuries are bodybuilding supplements spiked with unlisted steroids (which often are not listed on the labels), and herbal pills and powders promising to increase energy and help consumers lose weight. Kava herb is another one that has been implicated in such harm. Popular products like vitamins, minerals, probiotics and fish oil have not been linked to hepatic harm.

Herbs associated with possible liver damage
Celandine herb
Kava may harm the liver if used daily.

Diet and food intake
Consuming a high sugar diet could harm the livers of otherwise healthy men. A sugar-rich food intake is associated with unhealthily high levels of fat in both the blood and the liver.

Liver disease and malfunction
This can manifest itself in many different ways. Manifestations of liver disease that are particularly important include jaundice (a yellowish discoloration of the skin and the whites of the eyes), cholestasis (reduction or stoppage of bile flow), liver enlargement, portal hypertension (abnormally high blood pressure in the veins that bring blood from the intestines to the liver), ascites (accumulation of fluid in the abdominal cavity), liver (hepatic) encephalopathy (a liver disorder in which toxins build up in the blood, leading to brain dysfunction), and liver failure.

Liver disease diagnosis
Liver function tests for elevated liver enzymes is the most important first step to be done. Additional tests to determine liver disease include: Antinuclear antibodies, smooth muscle antibodies, antibodies to liver/kidney microsome type 1, antimitochondrial antibodies, and perinuclear antineutrophil cytoplasmic antibodies constitute the standard serological repertoire that should be assessed in all liver diseases of undetermined cause.

Elevated Liver enzymes, reasons why elevated
Common causes of elevated liver enzymes include: Medications, such as certain nonsteroidal anti-inflammatory drugs, acetaminophen, cholesterol-lowering medications, antibiotics and anti-seizure medications; drinking too much alcohol; obesity; diabetes; infection, such as viral hepatitis and mononucleosis; autoimmune disorders of the liver and bile ducts, such as autoimmune hepatitis and primary sclerosing cholangitis and primary biliary cirrhosis; metabolic liver disease, such as hemochromatosis and Wilson's disease; excessive use of vitamin supplements and certain herbal supplements; tumors of the liver or bile ducts.

Q. Interested to find and read your Q & A on people’s concerns re abnormal Liver Function Tests. There is however an omission in your discussion of possible causes of abnormal results excluding alcohol and that is high levels of stored iron due to Genetic Haemochromatosis (GH), Best Regards, Trustee – The Haemochromatosis Society (UK) Howard Don.

Elevated liver enzymes in children
Isolated elevation of liver enzymes in most children is generally benign and need not be a cause for immediate action or concern. Findings of prolonged abnormal liver enzymes are not rare in infants and young children. As long as these abnormal enzymes are isolated and do not involve jaundice, for example, these infants and children can be followed conservatively and there is no need for liver biopsy in most cases.

Liver function tests
A typical Liver Function Test measures several levels of enzymes and other factors. Several laboratory assays are commonly called liver function tests (LFTs), although these tests are neither specific to the liver nor true measures of liver function. As a result, alanine aminotransferase (ALT or SGPT), aspartate aminotransferase (AST or SGOT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and bilirubin have proven problematic for clinicians. These include:

AP (Alkaline Phosphatase) U/L (30 to 120)
GGT (Gamma-glutamyl transpeptidase) U/L (5 to 35)
LD Lactate Dehydrogenase U/L (100-225) is an enzyme found in many body tissues, especially the heart, liver, kidney, skeletal muscle, brain, blood cells, and lungs. LDH catalyzes the interconversion of pyruvate and lactate. Exercising muscles convert (and red blood cells metabolize) glucose to lactate. Lactate is released into the blood and is eventually taken up by the liver. The liver converts lactate back to glucose and releases glucose into the blood. This glucose is then taken up by resting muscles, red blood cells, and other tissues.
AST (Aspartate aminotransferase) U/L (5 to 45)
ALT (Alanine aminotransferase) U/L (5 to 45)
Albumin g/L (38-55)
Clotting Studies (Prothrombin Time) Seconds (11 to 13.5)
Total Bilirubin - Normal range is 3 - 18 umol/L (0.17 - 1 mg/dL).

Enlarged liver
Hepatomegaly is the medical term for enlargement of the liver. It's not a disease but a sign of an underlying problem. Many conditions can cause hepatomegaly and impair the function of the liver, including: congestive heart failure, fatty liver due to alcohol abuse, liver cancer, hepatitis, blood disorders such as leukemia, excessive iron in the body (hemochromatosis)

Fatty liver condition, NASH
Fatty liver disease can range from fatty liver alone (steatosis) to fatty liver associated with inflammation (steatohepatitis). This condition can occur with the use of alcohol (alcohol-related fatty liver) or in the absence of alcohol (nonalcoholic fatty liver disease).

A carbohydrate-restricted diet improves metabolism and could lead to improved outcomes in those with non-alcoholic fatty liver disease (NAFLD).

Regular physical exercise significantly improves measures of nonalcoholic fatty liver disease independently of dietary changes.

Weight loss can improve liver health of obese or overweight people, whether excess pounds are shed through lifestyle changes or weight-loss surgery. People with nonalcoholic steatohepatitis (NASH), an aggressive disease characterized by fat in the liver, which affects 2 percent to 5 percent of Americans, can lead to permanent liver damage.

J Agric Food Chem. 2014. Garlic essential oil protects against obesity-triggered nonalcoholic fatty liver disease through modulation of lipid metabolism and oxidative stress.

Sci Rep. 20175. Evaluation of the effects of L-carnitine on medaka (Oryzias latipes) fatty liver. L-carnitine is a compound known to transport fatty acids into the mitochondria to enhance β-oxidation-mediated metabolism of fats. In this study, the effects of L-carnitine administration on fatty liver of medaka (Oryzias latipes) were analysed, to check for disease improvement and metabolic changes. Additionally, the effects of the concomitant administration of L-carnitine and eicosapentaenoic acid (20:5n-3) (EPA) were investigated. Findings indicated reduced lipid deposition, increase in metabolites associated with β-oxidation, and significant reduction in fatty acid levels in the liver, implying improvement in fatty liver condition. Concomitant administration of L-carnitine and EPA resulted in further benefits, via changes in fatty acid composition in the medaka fatty liver model.

Amino Acids. 2017. Oral arginine supplementation protects female mice from the onset of non-alcoholic steatohepatitis. Dietary arginine supplementation has been proposed to have positive effects on the development of liver diseases. In the present study, we investigate if an oral Arginine supplementation in diet protects mice fed a fructose, fat and cholesterol enriched Western-style diet from the development of non-alcoholic steatohepatitis (NASH).

Nonalcoholic fatty liver disease NASH is an increasingly recognized health problem that many doctors do not immediately recognize. Nonalcoholic fatty liver disease is estimated to affect more than 64 million people each year in the United States.
   Increased fat accumulation in the liver is observed in 20-30% of the population in the Western world, and in approximately 10% of this cohort it is associated with nonalcoholic steatohepatitis, which is characterized by inflammation and fibrosis. Disease presentation of nonalcoholic fatty liver disease ranges from a disease with no symptoms to cirrhosis with the complication of liver failure and hepatocellular carcinoma. Nonalcoholic fatty liver disease is suspected on the basis of various clinical aspects (an elevated alanine aminotransferase concentration, presence of obesity and diabetes) that alone are not sufficient to establish diagnosis or prognosis. The major diagnostic procedure is liver biopsy, which allows assessment of liver injury. In most cases, Nonalcoholic fatty liver disease is associated with insulin resistance, which is therefore the target of most current Nonalcoholic fatty liver disease treatment modalities. Various treatment strategies such as weight loss and/or exercise, thiazolidinediones, metformin, lipid-lowering agents and antioxidants have been studied. So far, no single intervention has convincingly improved liver histology. It is recommended that patients at high risk of developing advanced liver disease, and who are not part of controlled studies, should receive nutritional counseling and take physical exercise to achieve moderate weight loss and improve insulin sensitivity. Aerobic activity reduces the risk and improves symptoms. The milk thistle extract silymarin can be of help.

Alcoholic hepatitis is a serious complication of alcohol abuse due to its high mortality rates particularly at short term. It may complicate pre-existing alcoholic fatty liver or cirrhosis and is mainly diagnosed on clinical and laboratory grounds although liver biopsy is occasionally needed to exclude other pathology and confirm the diagnosis. Accumulating evidence suggests that cytokines and immunity are actively involved in its pathogenesis. Management includes abstinence and supportive care. Treatment with corticosteroids has been studied in several clinical trials with conflicting results. However, recent evidence supporting the beneficial effect of TNF-alpha inhibition provides an encouraging alternative. Here we summarise the current state in diagnosis and management of alcoholic hepatitis and briefly review the latest advances in pathophysiology that may lead to new therapeutic strategies for this difficult clinical condition.

Cirrhosis and its disease-related complications are the 12th leading cause of mortality among U.S. adults and are the 5th leading cause of death for individuals aged 45 to 54 years.

Liver disease symptom and sign
Symptoms of liver disease are variable and subtle in the early stages of the problem. Liver disease symptoms include: Poor appetite (anorexia)- Weight loss- Lethargy- Anemia- Light colored stool- Bleeding disorders- Distended abdomen due to ascites or hepatomegaly. Vomiting (emesis), nausea, or diarrhea - Orange colored urine or mucous membranes due to jaundice.

Liver damage from Drugs
There are many medications that can cause harm including stating drugs used for cholesterol. The US FDA noted that three patients using Telithromycin (Ketek) developed serious liver damage.

Viagra, or sildenafil may cause hepatotoxicity.

Curr Drug Saf. 2013. Liver injury associated with antidepressants. Antidepressants are commonly prescribed and used in the management of depression, anxiety disorders, and other psychiatric illnesses. Antidepressants used in therapeutic dosing ranges are associated with causing several adverse drug reactions including hepatotoxicity. Paroxetine, fluoxetine, fluvoxamine, citalopram, mirtazapine and venlafaxine are associated with reversible liver injury upon discontinuation of the agent. Patient cases of hepatotoxicity involving the use of nefazodone, trazodone, duloxetine, bupropion, and sertraline Zoloft are linked to causing death in its users. Due to the idiosyncratic nature of hepatotoxicity, monitoring of liver function tests and immediate discontinuation upon abnormal lab findings or signs and symptoms of liver dysfunction are crucial since most cases of hepatic damage are reversible when detected early. Onset of antidepressant-associated hepatotoxicity varies from 5 days to 3 years. Antidepressant-induced liver injury can occur in the absence of identifiable, underlying risk factors such as cirrhosis and hepatitis infection; only a few cases of hepatic injury involve patients with chronic hepatitis infection.

Phytomedicine. 2015. Drug-induced liver injury: A 2-year retrospective study of 1169 hospitalized patients in a single medical center. Although herbal medicines (HMs) are widely used in Asian and Western countries, medicinal information concerning their hepatic toxicity or interaction with conventional medicines (CMs) is sparse. The aim of our study was to estimate the prevalence of drug-induced liver injury among total inpatients prescribed HMs or CMs. The common causative HMs for hepatotoxicity were Ephedrae Herba and Scutellariae Radix, while CMs included antidepressants, antihistamines, and antibacterials.

Liver cleanse
Most people who talk about doing a liver cleanse probably don't know what they mean or attempting to do, and possibly may not realize that they already have a healthy, functioning liver. They may attribute some of their symptoms to a weak liver whereas the problem may lie elsewhere.

Terms used in conjunction with a liver problem or disease:
Cholestasis - reduction or stoppage of bile flow
Hepatic - having to do with the liver
Hepatocyte- individual liver cell
Hepatomegaly - enlarged liver
Hypertrophy- increased size of an organ
Hypoalbuminemia - low albumin
Hypoproteinemia- low protein
Icterus (jaundice) - yellow discoloration of skin or mucous membranes
Jaundice - a yellowish discoloration of the skin and the whites of the eyes

Herbs that could protect liver tissue
Pergularia herb

Questions
Q. I am interested in Polycystic Liver Disease and TMG. I am familiar with TMG for fatty liver but I read that TMG can cause the stomach to produce more bile which is a cause of the cysts in the liver to grow. Is it possible DMG, TMG or betaine could cause the liver cysts to grow more rapidly?
   A. We have not seen any research regarding the relationship between polycystic liver disease and trimethylglycine.

About Mucuna Pruriens. It sounds very interesting, especially since I take an anti-depressant which works very well but which I'd prefer not to take. Can you tell me if this supplement is liver friendly? I have an autoimmune liver disease.
   A. We have not seen research that mucuna pruriens causes any harm to the liver but it is not easy to predict what would happen in someone with liver disease took the supplement.

Q. Isn't there a concern for the liver when you take lots of supplements?
   A. it is possible that excess of some supplements could place stress on the liver.

Q. Could 5-HTP cause liver damage?
   A. Thus far this has not been reported in the medical literature, but I prefer using small amounts of supplements. In the case of 5-HTP, using it a few times a week at a dosage of 50 mg with a week off each month should not present a liver problem issue.

Q. Would lipoic acid be helpful in liver disease?
   A. I have not seen any research regarding the use of lipoic acid supplement for liver disease.

Q.  I'm new to your web site and learning a lot. I've been using Liv.52 for my liver for some time. I see other things that you recommend for the liver, but not Liv.52. The ingredients in Liv.52 are not in the products that you recommend. What do you think about Liv.52 and why don't you mention it?
   A. We are not familiar with Liv 52. An internet search reveals Liv 52 has these ingredients and the claims made by the company selling it. Capers (Capparis spinosa) - Well-documented hepatic stimulant and protector. Improves the functional efficiency of the liver. Wild Chicory (Cichorium intybus) - Powerful hepatic stimulant, increases bile secretion, acts on liver glycogen and promotes digestion. Black Nightshade (Solanum nigrum) – Promotes liver and kidney health and has shown hepatoprotective activity in cases of toxicity induced by drugs and chemicals. Arjuna (Terminalia arjuna) – Tonic for heart and liver. Regulates hepatic cholesterol biosynthesis. Negro Coffee (Cassia occidentalis) – Digestive and hepatic tonic.  Yarrow (Achillea millefolium) – Stimulative tonic for the liver. Tamarisk (Tamarix gallica) - Hepatic stimulant; also provides digestive support.
   We have created a new article on Liv 52 and provided some of the published research which looks promising. There are countless products on the market that are promoted for liver health and we just can't learn about all of them. There has been a lot study with milk thistle and acetycysteine for liver disease.

Do you know whether mixed carotenes in moderate amounts can be handled by a liver that is diseased? That is, would they accumulate in the liver and do harm; would they still be beneficial to the body?
   The influence or side effect of an herb or natural substance has much to do with the dosage. In most cases small amounts are handled by the body quite well. Liver disease is a broad term and too vague to make any specific or further suggestions regarding the use of carotenoid supplements.

I receive your newsletter and have a question. I'm a 59 year old male in excellent health. I take chrysin and maca to naturally try and enhance testosterone. I just had my blood work done. Everything was fine except for two of my liver tests. My AST (SGOT) and ALT (SGPT) were slightly elevated. The numbers: AST 59, ALT 66. Is it possible that these two supplements could be contributing to the slight elevation? When I last had my blood work done and wasn't taking these, the liver tests were normal. And if these two is causing the slight elevation, is it bad for the liver?
    There are many causes for elevated liver enzymes and it is not possible for me to know the cause in your situation. A good way to find out is to stop the herbs for a month or so and then check the levels of the liver enzymes again. If back to normal, it would be likely that the herbs were involved. If you wish you could retest again after restarting the herbal supplements to see if they are truly the cause of the liver enzyme elevation.