Your Liver
You may never stop to think about it, but your liver is essential to your life.
If your liver stops working, so do you.
The liver is a resilient organ that’s easy to ignore – until something goes wrong. Because of its wide-ranging responsibilities, your healthy liver can come under attack by viruses, toxic substances, contaminants and diseases. However, even when under siege, the liver is very slow to complain. People who have problems with their liver are frequently unaware because they may have few, if any, symptoms. Your liver is such a determined organ that it will continue working even when two-thirds of it has been damaged.
The Canadian Liver Foundation is bringing liver research to life by sharing what we learn from important research to help Canadians protect their liver health and prevent liver disease in themselves and their loved ones.
About the Liver
Facts & Myths
Risk & Prevention
Tests
Find a Doctor
About the Liver
Weighing in at a little over one kilogram, your liver is a complex chemical factory that works 24 hours a day. It processes virtually everything you eat, drink, breathe in or rub on your skin; in fact, the liver performs over 500 functions that are vital to life.
Every day, your liver helps your body by providing it with energy, fighting off infections and toxins, helping clot the blood, regulating hormones and much, much more.
To give you an idea of your liver’s critical roles, here is a partial list of its functions:
Your liver:
- Cleanses your blood: Metabolizing alcohol and other drugs and chemicals, neutralizing and destroying poisonous substances.
- Regulates your supply of body fuel: Producing, storing and supplying quick energy (glucose) to keep your mind alert and your body active. It produces, stores and exports fat.
- Manufactures many of your essential body proteins involved in: Transporting substances in your blood, clotting of your blood, and providing resistance to infections.
- Regulates the balance of hormones: Including sex hormones, thyroid hormones, cortisone and other adrenal hormones.
- Regulates your body’s cholesterol: Producing cholesterol, excreting it and converting it to other essential substances.
- Regulates your supply of essential vitamins and minerals: Including iron and copper.
- Produces bile: Eliminating toxic substances from your body and aiding with your digestion.
Your liver is…
Your power source.
It helps digest your food and turns it into energy. By converting proteins, carbohydrates, fat and vitamins into energy, the liver ensures that your body has what it needs to keep going.
Your liver is…
Your engine.
It drives many of your body’s critical systems and when it breaks down, your body will too.
Your liver is…
Your pharmacist.
It must process all medications, vitamins or herbal remedies you take before they can take effect. Mixing or overdosing medications can damage this vital organ.
This is a myth.
You can be born with liver disease, contract it from a virus, develop it from what you eat and drink, be exposed to various toxins or suffer from it for unknown reasons. Alcohol only causes one out of more than 100 different types of liver disease. In Canada, non-alcoholic fatty liver disease is the most common liver disease, affecting over seven million Canadians.
This is a fact.
Pediatric liver specialists in Canada see thousands of children – from newborns to teens – who suffer from various forms of liver disease. The major causes of liver disease in children are genetics (e.g Wilson’s Disease, alpha 1 antitrypsin deficiency, tyrosinemia), viruses (e.g. hepatitis A, B, C) and blockages in the flow of bile from the liver (e.g. biliary atresia, alagille syndrome).
This is a myth.
You can have liver disease and not know it because the symptoms can be vague and easily confused with other health problems. In some cases, a person may have no symptoms at all but the liver may already have suffered significant damage.
If you do experience symptoms, they could take the form of fatigue, nausea, dark urine or yellowing of the skin and whites of the eyes (jaundice).
This is a myth.
Jaundice can be an early warning sign of liver disease. Many babies have “newborn jaundice” lasting three to five days after birth because their liver is not yet fully developed, however, jaundice that does not clear up after 14 days of life, dark urine and/or pale stools, an enlarged abdomen and vomiting are signs that your baby should be seen by his or her doctor.
This is a fact.
Cirrhosis is a scarring of the liver that can happen when any form of liver disease reaches an advanced stage. It is not only related to alcoholic liver disease. Cirrhosis develops because of pre-existing liver conditions or disease. They include:
- Viral infections caused by chronic viral hepatitis (types B and C)
- Metabolic disease such as alpha-1 antitrypsin deficiency, galactosemia and glycogen storage disorders
- Inherited diseases such as Wilson’s Disease and hemochromatosis
- Biliary cirrhosis resulting from diseases such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC)
- Toxic hepatitis caused by severe reactions to prescribed drugs or prolonged exposure to environmental toxins
- A heart condition such as congestive heart failure
- Chronic alcoholism
This is a fact.
Liver cancer is currently one of the fastest rising cancers in Canada. Many factors play a role in the development of liver cancer, such as chronic hepatitis B and C, consumption of alcohol, and obesity.
This is a myth.
When your liver starts to fail, toxins can build up into your brain causing a condition that resembles Dementia called hepatic encephalopathy (HE). HE is the deterioration in brain function observed in people with acute liver failure or chronic liver disease.
HE symptoms include trouble sleeping at night, difficulty thinking clearly, poor concentration, anxiety, mental fogginess, etc.
This is a myth.
Despite the promise of a newer, healthier you from well-marketed products and programs that are meant to cleanse your digestive system, the liver does not need to be cleansed – it does that job itself. To draw an analogy, soap does not need to be cleansed either!
This is a fact.
A liver transplant is a life-preserving operation that replaces a diseased and poorly-functioning liver with either a whole or portion of a healthy donated liver. While the diseased organ is replaced with a healthy liver, often the original disease can return and cause similar liver damage. For example, a liver transplant for hepatitis C does not eliminate the illness. In many cases, the virus will re-affect the liver within one year. Autoimmune disease (PBC, PSC and autoimmune hepatitis) are also known to re-occur after a liver transplant.
This is a myth.
Basic liver tests are not part of annual check-ups requested by your family doctor, so many family doctors do not typically run these tests unless they suspect a possible liver issue. Obvious signs or symptoms may only develop when liver disease has already progressed to a severe stage, so it is important for everyone to learn more about the risk factors and symptoms of liver disease and then use this information to engage in liver-healthy discussions with your doctor during your check-up.
Risk & Prevention
Every day you make decisions that affect your liver health. The choices you make on household product purchases, food consumption and daily activity can have positive or negative effects on your liver.
To safeguard your healthy liver, it is important that you understand the critical roles the liver plays in maintaining your overall health and how activities that you may take for granted can help or hurt this vital organ. By learning more about your liver and how you can keep it healthy, you may actually help reduce your risk of developing not only liver disease but also other health conditions including diabetes and heart disease.
Click the icons below to learn about different risks and what you can do to keep your liver safe.
Medication & Alternative Therapies
Over-the-Counter Pain Killers
Alcohol Consumption
Body Beautification
Travel
Sex
Chemicals in the Home
Food and Drink
Herbal or Pharmaceutical Medication & Alternative Therapies
Many chemicals that are intentionally or accidentally inhaled or consumed can have toxic effects on the liver. Among these chemicals are drugs (both prescription and over-the-counter), industrial solvents and pollutants. As the body’s clearinghouse for most drugs, herbal remedies, vitamins, and diet supplements, the liver is vulnerable to the toxic consequences of self-medication.
The following are some tips to help safeguard your liver health and ensure the medications and remedies you need to take to achieve their desired effect:
- To avoid potentially life-threatening complications, you should talk to your doctor about all medications or supplements – pharmaceutical and herbal – that you are taking or thinking of taking
- If your doctor prescribes a long-term medication, ask for a liver test before you start the medication and after the first few weeks of taking the drug to determine how your liver is tolerating it. Follow up with regular liver tests throughout the duration of your treatment
- Always read and follow the dosing instructions as dictated by your doctor or the medication label. Never take more than the recommended dose and be sure to take into consideration other medications that you may be taking at the same time that may have similar ingredients.
- Never mix medication with alcohol. Alcohol increases the risk of possible liver damage. Acetaminophen can be especially toxic when combined with alcohol.
- Be careful about mixing Tylenol® with other products that contain acetaminophen. By taking more than one pain reliever or cold remedy at a time, you may accidentally take more acetaminophen than is safe. Consult your doctor about acetaminophen if you have liver disease.
- Avoid certain herbal supplements (see list below) as well as certain vitamins in high doses as they have the potential to cause damage to the liver. For example, high doses of vitamins E, K – and especially vitamins A and D – may be harmful.
Herbal Supplements that can be harmful to the liver:
| Artemisia | Gardenia | Ma huang |
| Atractylis gummifera | Germander | Mistletoe |
| Callilepsis laureola | Greater celandine | Plantago seed |
| Chaparral leaf | Hare’s ear | Red peony root |
| Chrysanthemum | Heliotropium | Senecio |
| Comfrey | Jin bu huang | Skullcap |
| Crotalaria | Kava / Kava Kava | Valerian root |
| LIV.52 |
- Avoid grapefruit, grapefruit juice or supplements with grapefruit bioflavonoids if you are taking medication. The chemicals in grapefruit (both rind and pulp) can interfere with the liver enzymes that break down drugs. A variety of different medications – including some anti-depressants, blood pressure medications, cholesterol-lowering drugs and tranquilizers – have been shown to have potentially serious interactions with grapefruit products. For more information, consult your doctor or pharmacist or visit the Health Canada website.
- If you have a chronic liver disease or other liver condition, consult your doctor before taking any form of prescription or non-prescription medication or herbal remedy. Liver disease compromises the liver’s ability to perform its normal processing functions so you may be unable to take medications to treat other health conditions.
- Avoid the use of any form of recreational or ‘street’ drugs because they can put you at risk of contracting hepatitis B or C and can cause serious harm to your liver. Even a single ‘experiment’ could lead to a potentially life-threatening liver disease. If you do use drugs, make sure you use sterile drug-use equipment (e.g., syringes, cookers, filters, water, tourniquets, pipes, straws) and never share any of it.
Acetaminophen is the active ingredient in Tylenol®, one of the most popular over-the-counter pain relievers. It is used in a variety of conditions to relieve headaches, muscle and joint pain, pain during menstruation, and to reduce fever. Many people may not realize that aside from Tylenol® there are more than 200 other products that contain acetaminophen including many over-the-counter cough and cold products, and some muscle relaxants.
All drugs, even over-the-counter ones, have potentially harmful side effects. Since many drugs medications, including acetaminophen, have to be processed by the liver, people with liver disease have to be especially careful about what and how much medication they take.
Accidental acetaminophen overdoses are responsible for many hospital admissions, and overdose can lead to death both in children and adults. It is therefore vital that you take whatever steps possible to reduce this risk. Here is some valuable advice:
- Always read and follow the dosing instructions as dictated by your doctor or the medication label.
- Never mix medication with alcohol. The combination of acetaminophen and alcohol, for example, can lead to liver failure.
- Be careful about mixing Tylenol® with other products that contain acetaminophen. By taking more than one pain reliever or cold remedy at a time, you may accidentally take more acetaminophen than is safe.
- If you take other medications, consult your doctor or pharmacist about possible drug interactions.
- Consult with your doctor about taking acetaminophen if you have liver disease.
- Take Tylenol® and all other pain relievers only when really necessary
It is very important to speak to your doctor about the risks and benefits of all medications before making the decision to take them.
When you have a glass of wine, beer, or other liquor, your liver is responsible for processing this alcohol and detoxifying your blood. Breaking down alcohol is only one of more than 500 vital functions performed by your liver. This means it can only handle so much alcohol at once. If you drink excessively, either through binge drinking or by having multiple drinks on a daily basis, you’re making your liver work overtime. The consequences of this abuse may be the destruction of liver cells, a build-up of fat deposits in your liver (fatty liver), or more seriously, liver inflammation (alcoholic hepatitis), permanent scarring (cirrhosis) and even liver cancer.
The following are some tips to consider when deciding whether you should have that first drink or order the next round:
- Never mix alcohol and medication. The combination of acetaminophen and alcohol, for example, can lead to liver failure.
- If you are a woman, don’t give in to peer pressure to drink more than you might otherwise. Women absorb more alcohol than men and therefore are more susceptible to alcohol-related liver disease even if they consume less alcohol.
- Don’t choose your drinks based on the belief that one form of alcohol is not as harmful as another. The amount of alcohol – not the type – is what matters. One ‘drink’ is equivalent to 12 oz. (341 ml) of beer, 5 oz. (142 ml) of wine, 3 oz. (86 ml) of sherry or port, 1.5 oz. (43 ml) of spirits. Each has the same effect on the liver whether taken alone or diluted.
- If you have hepatitis or any other form of liver disease, avoid alcohol completely. Alcohol can compound ongoing damage to the liver.
- Don’t play ‘drinking games’ which encourage excessive consumption of alcohol within a short period of time.
- Limit your alcohol consumption to one or two drinks, but never on a daily basis. As far as your liver is concerned, the safest amount of alcohol is no alcohol at all.
Body art, piercings, painted nails and toes are all forms of self-expression. They may serve as a memento to mark a special occasion, a way of symbolizing what you value or just a spontaneous self-indulgent splurge. Whatever the motivation behind them, these body beautification rituals all carry a degree of risk if not done correctly. Inadequately sterilized tools, reused needles or contaminated inks could expose you to hepatitis B or C – two blood-borne viruses that can cause severe and potentially fatal liver disease.
To help ensure that a decorated body is the only thing you walk away with, here are a few simple steps you can take:
Inquire about:
- Whether the business uses an autoclave machine for sterilization between each client (only an autoclave will kill the virus that causes hepatitis)
- Whether this machine is regularly tested and serviced
Ensure the staff:
- Wear surgical gloves whenever there is a possibility of contact with blood or bodily fluids/tissues
- Use the autoclave machine for sterilization of tools and equipment between each client
- Dispose of all contaminated sharp objects in an appropriate puncture-proof container
Here are some additional points to inquire about before and during your visit to a spa, tattoo shop, or other location that provides body beautification services.
Before:
- Inquire about the staff’s knowledge of hepatitis and HIV transmission risks
- PLUS all points listed previously
During:
- Ensure the location is clean and clearly set up for the stated purpose.
- Ensure the staff:
- Wear clean outer clothing
- Wash hands with soap and warm water before and after each procedure (or use waterless hand cleaner)
- Wear aprons or other protective clothing whenever there is a possibility of blood contact with clothing
- Work on surfaces that are made of smooth and non-porous materials.
- Clean all surfaces with a solution of bleach and water
- PLUS all points listed previously
Protecting your liver while travelling can be as easy as taking some preventative steps before you leave home and following a few simple precautions while you are away.
The following ideas will help ensure that you don’t bring home any “unwanted souvenirs” from your trip:
Before your trip
(3 months prior to departure)
- Learn potential health risks and if you need to be immunized for hepatitis A and B, and other diseases such as malaria and yellow fever. Many vaccinations require time to become effective.
(2 months prior to departure)
- Check if your prescription medications are up to date and if they are legal in the country you are visiting.
- Get a medical check-up and tell your doctor about the countries to be visited, length of stay in each country, time of the year in each country (season), type of accommodation (major hotel, rustic tent, etc), and type of travel (bus tour, backpacking, etc).
During your trip
- Take precautions to ensure water is safe (use bottled, purified or boiled water for drinking, making ice cubes, brushing teeth, washing food, etc).
- Practise good hand-washing techniques and keep hand sanitizers nearby.
Vaccination Checklist:
• Illness: Hepatitis A
Transmission: Transmitted via food/water in areas of poor sanitation
Vaccine & Illness Notes: Injections given at Day 0 and Month 6 or Month 12 for lifetime immunity.
• Illness: Hepatitis B
Transmission: Transmitted via blood and sexual contact with infected persons.
Vaccine & Illness Notes: Injections given at Day 0, Day 30, and Month 6 for lifetime immunity.
• Illness: Hepatitis C
Transmission: Transmitted via direct contact with blood of infected persons.
Vaccine & Illness Notes: No vaccine available therefore critical to take lifestyle precautions (e.g. practise safe sex, avoid unsafe tattooing/piercing & other direct contact with blood etc.).
• Illness: Malaria
Transmission: Transmitted via mosquito.
Vaccine & Illness Notes: Oral medication taken 1-2 days or weeks (depending on medication) before entering a high risk area for malaria, each day or week while there, and 7 days to 4 weeks after leaving the area.
• Illness: Yellow Fever
Transmission: Transmitted via mosquito.
Vaccine & Illness Notes: Single injection, but must be given 10+ days before travelling (immunity for 10 years). Can lead to liver failure which is associated with jaundice, hence the name “yellow fever.”
Ask Your Doctor:
- how to reduce your risk of illness
- to confirm whether or not immunizations are necessary for protection against diseases you may encounter, for routine health measures or as legal requirements for entry into some countries
- to renew any prescriptions you may be on and need while you are away and to provide a letter about these medications if you will need to carry them during your trip
- Get recommended immunizations (from your family doctor or travel clinic)
More Tips Before Travel:
- At least one month before, confirm that your health insurance coverage is adequate and current. Understand how it is accessed while abroad.
- Keep track of current travel health notices.
- Pack medical/first aid kit. Keep medication in your hand luggage, including doctor’s letter for prescription medication.
- Pack list of travel medical clinics in the region you are visiting.
- Pack some safe sex supplies before you go (if you might be sexually active while away) as they are not always as readily available abroad and quality can differ between countries.
- Pack a water purifier (ex: SteriPen etc) to sterilize water.
- Pack insect repellent (the most effective ones contain DEET).
- Pack waterless alcohol-based hand wipes or sanitizer for when soap and clean water aren’t available.
More Tips During Travel:
- Find out the local emergency number and address of the nearest hospital when you arrive.
- Practise safe sex.
- Make sure dairy products are pasteurized, fruit/veggies are adequately cooked, well-washed or peeled, and meats/fish well cooked and eaten just after preparation. Avoid food from street vendors.
After You Return Home:
- Monitor your health for at least 10 days
- If you become ill, consult a health care provider and tell them: a) your symptoms b) where you traveled c) if you’ve had close contact with any severely ill persons
Before you get involved in any kind of sexual activity, it is important to know the risks and how to protect both you and your partner. Hepatitis is a liver disease that can be transmitted sexually. The most common forms are hepatitis A, B and C.
In order to lower the risk of contracting hepatitis during sexual activity, it’s important to take the following precautions:
- Get vaccinated for hepatitis A and B (there is currently no vaccination for hepatitis C).
- Practice safer sex by using a condom during vaginal, oral, or anal sex.
- Wash your hands carefully after sex and before making food, eating, drinking or smoking.
- If you suspect that you or your partner may have been exposed to hepatitis A, B or C, contact your health provider right away.
How can it be transmitted sexually?
Hepatitis A is not usually transmitted through sexual activity. However, any oral/fecal contact, including that which may occur during sexual activity, is a high risk for contracting hepatitis A. This can include:
• Anal sex
• Anal or fecal contact to the mouth (e.g. from fingering partner’s anus or handling a used condom after anal sex then putting fingers on/in mouth)
How can I protect myself and my partner?
• Get vaccinated. A hepatitis A vaccine is available and is given in two injections 6 to 12 months apart
• Wash your hands carefully after bowel movements, after sex, before making food, and before eating, drinking or smoking
• Keep your genital and anal areas clean before having sex
• Use a condom during vaginal, anal or oral sex
• If you suspect that you or your partner may have been exposed to hepatitis A, contact your health care provider right away.
How can it be transmitted sexually?
Hepatitis B is significantly more infectious than AIDS and carries a high risk of sexual transmission. Exposure to blood, semen, vaginal discharge or other bodily fluids during sex can put you at risk of contracting hepatitis B. This can include:
• Unprotected vaginal, oral or anal sex
• Shared use of sex toys
Other non-sexual activities that may carry a risk of exposure include:
• tattooing, body piercing, manicures or pedicures with non-sterile equipment or inks
• sharing of needles or other drug equipment
How can I protect myself and my partner?
• Get vaccinated. Hepatitis B vaccines are available and are given in three doses over a period of six months.
• Practise safe sex
• Sterilize sex toys before and after use
• Do not share personal hygiene items that may retain traces of blood, including toothbrushes, nail clippers, razors or nail files
• If you suspect that you or your partner may have been exposed to hepatitis B, contact your health care provider right away.
How can it be transmitted sexually?
The risk of contracting hepatitis C through sex is very low. Any activity that may lead to exposure of blood however does carry some risk such as:
• rough sex where blood is present
• vaginal sex with a woman during menstruation
Other non-sexual activities that may carry a risk of exposure include:
• tattooing, body piercing, manicures or pedicures with non-sterile equipment or inks
• sharing of needles or other drug equipment
How can I protect myself and my partner?
There is no vaccine for hepatitis C so the best approach is to adopt safer sex practices and take precautions to avoid any accidental contact with blood.
• Use condoms during vaginal, oral or anal sex
• Do not share personal hygiene items that may retain traces of blood, including toothbrushes, nail clippers, razors or nail files.
• If you suspect that you or your partner may have been exposed to hepatitis C, contact your health care provider right away.
Not only does your liver metabolize what goes in your body, but it also metabolizes what goes on your body. This includes inhaling, ingesting, or simply coming into physical contact with chemical cleaning agents.
To keep your home as liver-friendly as possible, follow these tips:
- When cleaning or painting, ensure the room is well-ventilated and/or wear a mask. Since the liver has to detoxify everything you breathe in, exposure to airborne chemicals can damage your liver.
- Take precautions to avoid exposure when using weed-control chemicals or spraying for bugs.
- Investigate more organic methods for maintaining your lawn and gardens, as well as for the cleaning of indoor surfaces.
- Take every opportunity to get outside and enjoy some exercise. Exercise helps keep your body – and especially your liver – strong and better able to defend itself against pollutants.
Healthier cleaning options for you and your home:
When you are looking for effective ways to get out stains, fight odours or disinfect surfaces, sometimes it pays to do things ‘old school’. The following are some tried and true cleaning products that home owners relied on long before anyone had ever heard of an ‘anti-bacterial wipe.’
• Pure Soap
For generations, people washed their clothes, their homes and themselves with pure soap. Today, it is the key ingredient of many alternative cleaning recipes. Soap biodegrades safely and completely, and is non-toxic. Make sure that you use soap without synthetic scents, colours or other additives.
• Vinegar (5% acetic acid)
Vinegar is a mild disinfectant which cuts grease, cleans glass, deodorizes, and removes calcium deposits, stains and wax build-up.
• Cornstarch
Cornstarch is an odourless powder that is great for carpet cleaning and greasy stains.
• Washing Soda (Sodium Carbonate)
A key ingredient for washing clothes, washing soda cuts grease, removes stains, disinfects, and softens water. Washing soda should not be used on aluminum.
• Baking Soda (Bicarbonate of Soda)
Baking soda works well as an abrasive and it also deodorizes, removes stains, polishes, and softens fabrics.
• Salt
Salt dissolves easily in water and makes a great abrasive for cleaning pots and pans or mixed with vinegar or lemon juice to clean sinks, tiles and glass and to remove coffee and tea stains.
Want your home to smell clean and fresh?
Try the all-natural air purifiers – house plants. Or try these natural solutions to diminish odour and add a fragrant smell to your house:
• white vinegar removes odours naturally on surfaces and in the air
• baking soda absorbs odours, so place a few open boxes throughout the home
• boiling spices like cinnamon in a little bit of water releases its fragrance
• essential oils diluted in water can be used as a spray freshener – try a combination of your favourite essential oils like lemon (an especially effective air deodorizer) and cedar
References:
Basic Ingredients for Green Cleaning. Greenpeace Canada.
Greening up your spring cleaning. CBC News, April 2007
Breathe Easy with Natural Air Fresheners. Simple Earth Media
The liver is the world’s most efficient factory. It helps power your body by storing and releasing energy when you need it. Your liver plays a key role in converting food into the chemicals essential for life and it is therefore important to make food choices that optimize liver health.
Although there is no specific ‘liver health diet’, these general guidelines will help ensure that your liver is functioning at its best:
- Eat small regular meals. Do not skip meals or over-eat.
- Drink 6 to 8 glasses of fluids (preferably water) a day.
- Regularly choose a variety of whole foods including fruits and vegetables, protein sources (legumes, lean meats), whole grains (quinoa, wild rice), dairy (low-fat yogurt, milk and cheese) and sources of healthy fat (nuts, avocado, fatty fish).
- Increase your intake of fresh of fruits and vegetables, especially brightly coloured ones with deep bright pigments such as oranges, yellows, reds and greens. Fruits and vegetables are high in antioxidants, which are vital for overall liver health.
- Maximize consumption of raw vegetables with high sulphur content (i.e. broccoli, Brussels sprouts, cabbage, cauliflower, garlic and onions).
- Wash fruit and vegetables right before use to remove pesticides. Avoid washing too far ahead to reduce sweating or spoilage.
- When cooking vegetables and fruits, steam or bake them. This retains more nutrients than boiling.
- Moderate your consumption of saturated fat and simple sugar, as high intakes of sugar (fructose) sweetened beverages and fatty foods high in saturated fat have been associated with an increased risk for developing a fatty liver.
- Consume vitamin D fortified dairy products, and vitamin D fortified plant-based foods to ensure your vitamin D needs are met. This is important to promote liver health and a healthy body weight.
- Choose whole-grain products over white/bleached/refined products
Your liver cares about everything you eat and drink, every single day. Too much sugar and saturated fat in your diet can have a similar effect as too much alcohol – fat build-up in the liver. When it is full of fat, the liver cannot perform all of its 500 functions, and it can become progressively more damaged to the point of developing cirrhosis and even cancer. If you want a healthy liver, the best strategy is to make healthier choices on a daily basis.
On January 22, 2019, Health Canada released an update to Canada’s Food Guide . This is exciting news for Canadians. Several changes to the Guide’s layout and content have been done to ensure that Canadians are provided with up-to-date and evidence-based nutritional information. Emerging as important concepts within the new food Guidelines are a renewed focus on plant-based foods, lower intakes of processed foods that contain higher levels of sugar, a background on saturated fat intake, and a less direct emphasis on dairy products. What does this mean for Canadians living with liver disease? Click here to read more.
What is sodium?
Sodium is a mineral that is required for maintaining blood pressure and a normal fluid balance in the body and transmitting nerve impulses.
Is sodium the same as salt?
No. Table salt (sodium chloride) is the most common form of sodium. Others include sodium bicarbonate (baking soda), sodium benzoate (preservative), sodium cyclamate (sweetener) and sodium nitrate (preservative).
How much sodium is in table salt?
Table salt is about 40 per cent sodium. One teaspoon of salt contains approximately 2300 milligrams (mg) of sodium.
How much sodium do I need?
Most Canadians consume far more sodium than is needed. The recommended amount per day is between 1500 mg (considered adequate intake) and 2300 mg (upper amount) for people 9 -50 years of age. For people over 50 years of age, an adequate intake drops to 1300 mg per day until 70 and then 1200 mg over 70 years of age. However, the average daily intake in the Canadian diet is about 3500 mg of sodium, although many Canadians eat well in excess of 5000 mg per day.
Can I get too much sodium?
Yes. The higher your sodium intake, the greater risk you are at for high blood pressure and stroke. If high blood pressure is already present, a high sodium intake may make it worse. High blood pressure is a health risk associated with heart and kidney disease. It is a good idea to have your blood pressure checked regularly by a health care provider. Often an individual can be unaware of having high blood pressure.
How does sodium relate to my liver disease?
As the function of the liver deteriorates, fewer proteins such as albumin are produced, resulting in an accumulation of fluid in the abdominal cavity known as ascites and in the legs and feet, known as edema. Both conditions result from an abnormal accumulation of sodium associated with portal hypertension and liver disease. Patients with ascites should restrict their sodium intake to no more than 2000 mg per day.
Do I have to avoid all salty foods?
Not necessarily all the time. However, if you want to lower your sodium intake to meet current recommendations, you should avoid eating salty foods on a daily basis. Your physician will advise you as to whether or not you need to restrict your sodium intake. Learning to read food labels to check the sodium level per serving will help you to compare foods for sodium content and to make food choices with lower sodium content.
| HIGHER SODIUM CHOICES | LOWER SODIUM CHOICES |
| Canned vegetables | Fresh or frozen vegetables |
| Vegetable juices | |
| Creamed vegetables | Uncreamed vegetables |
| Bouillon cubes | Homemade stock/broth* |
| Processed cheeses | Block cheeses |
| Dill Pickles | Fresh cucumbers |
| Sauerkraut | Fresh cabbage |
| Ready-to-eat cereals | Home-prepared cereals |
| Instant cooked cereals | Quick-cooked cereals |
| Canned and dehydrated soup | |
| Ready to eat and frozen store bought meals | |
| Jelly powders | Homemade gelatin desserts |
Rice & pasta mixes Casserole mixes Cake & cookie mixes Instant potato mixes Gravy, sauce & dip mixes | Homemade versions of these foods |
Smoked, pickled canned or seasoned meats, fish and poultry Luncheon meats | Fresh meat, fish and poultry |
| Garlic salt, onion salt, celery salt | Garlic powder, onion powder, fresh celery, garlic, onion |
| Ketchup, soya, steak, & Worcestershire sauce | Lemon, vinegar, herbs |
| Salt shaker | Herb shaker** |
| Restaurant meals | Home cooked meals |
* When you make your homemade stock or broth, be careful when you use commercial products, they may contain unexpected additional sodium.
** Read labels carefully to ensure low sodium content.
Always taste before salting!
This usually means you will use less salt. Try this test. Place wax paper or foil over a plate and pretend you are salting a meal. Measure the salt. One teaspoon contains about 2300 mg of sodium.
Add less salt when you prepare and cook food!
Try adding less salt to your food for example, when cooking vegetables, pasta, soups and stews.
Reduce the salt in recipes!
Your taste for salt is a learned taste that can be unlearned. Gradually reduce the salt in recipes so your taste for salt can adjust more easily. The salt in most recipes can be halved with no effect on the product.
Experiment with other flavourings!
Lemon and vinegar are natural flavour enhancers that are low in sodium. Replace the salt shaker with an herb shaker (combine one tablespoon each: dried basil, parsley, marjoram, thyme, sage, onion and/or garlic powder).
Plan ahead to reduce your reliance on high sodium convenience foods!
The more ‘instant’ or processed a food, the more likely it is to be high in sodium. The same food made from scratch has less sodium added and tends to be less expensive.
Be aware of the sodium content of the food you eat!
Read the list of ingredients on labels for other sodium-containing compounds in addition to salt such as: monosodium glutamate (MSG), sodium benzoate, sodium nitrate and sodium bicarbonate.
Should pregnant women cut down on salt?
Sodium used to be restricted in pregnancy because it was thought this would help reduce fluid retention. However, it is now known that a certain amount of fluid retention is part of having a normal pregnancy and a healthy baby. Sodium is necessary to ‘balance’ the extra fluid in the pregnant woman’s body. Therefore sodium restriction is NOT recommended in pregnancy. If you think you use a lot of salt, it would be a good idea to discuss this with your physician.
Choose your food wisely
The following table shows some interesting differences in the sodium content of some foods. Try to get in the habit of considering the sodium content of the meal as a whole. Ask yourself if there is a lower-sodium alternative. For example, if you use canned instead of fresh tomatoes in a recipe, you could add less salt than called for by the recipe. Fresh or frozen corn would be a lower-sodium alternative to canned or creamed corn and would thus be a better accompaniment to high-sodium meat such as ham. Remember that 3/4of your daily sodium intake could be from pre-made or packaged foods.
How Sodium Increases With Processing
Apple 2 mg | Applesauce 1 cup – 6 mg | Apple Pie 1/8 frozen- 208 mg |
Bread One slice, white – 114 mg | Pound Cake 1 slice – 171 mg | English Muffin 393 mg |
Butter 1 tbsp, unsalted – 2 mg | Butter 1 tbsp, salted – 116 mg | Margarine 1 tbsp – 140 mg |
Chicken ½ breast – 69 mg | Chicken Pie frozen – 907 mg | Chicken Dinner Fast food – 2243 mg |
Corn 1 mg | Canned Corn 1 cup – 194 mg | Corn Flakes 1 cup – 256 mg |
Cucumber 7 slices – 2 mg | Cucumber with salad dressing – 234 mg | Dill Pickle 928 mg |
Lemon 1 mg | Soy Sauce 1 tbsp – 1029 mg | Salt 1 tbsp – 1938 mg |
Milk 1 cup – 122 mg | Dry Milk ½ cup – 322 mg | Cottage Cheese 4 oz. – 475 mg |
Pork 3 oz. – 59 mg | Bacon 4 slices – 548 mg | Ham 3 oz. – 1114 mg |
Potato 5 mg | Potato Chips 10 pcs – 200 mg | Instant Mashed 1 cup – 485 mg |
Steak 3 oz. – 55 mg | Jumbo Burger Fast food – 990 mg | Meat Loaf frozen dinner – 1304 mg |
Tomato 14 mg | Tomato Soup 1 cup – 932 mg | Tomato Sauce 1 cup – 1498 mg |
Water – Tap 8 oz. – 12 mg | Club Soda 8 oz. – 39 mg | Antacid in water 564 mg |
Does the sodium content of the water supply vary?
YES! The sodium content of the water supply varies from one area to another. Some bottled water has sodium compounds added as well. Check the ingredients on the bottle. However, the level of sodium may not be listed.
LOW SODIUM 100 mg or less per litre | MEDIUM SODIUM 101-300 mg per litre | HIGH SODIUM 301 mg or more per litre |
What about softened water?
Hard water contains a lot of calcium and magnesium. A water softener replaces these minerals with sodium. Softened water, therefore, contains more sodium. If you have a softened water supply in your home, the taps from which you take your drinking water should not be hooked up to the softener.
Some quick tips to help reduce the sodium in your diet:
- remove the salt shaker from the dinner table
- watch the extras such as condiments like ketchup, soy sauce, pickles and relish
- have home cooked meals most often
- season with herbs, lemon, garlic and spices
- choose unsalted snacks
- choose unprocessed foods such as fresh vegetables
- compare food labels and learn what they mean
- cut the salt in recipes in half
- choose your food wisely and plan ahead
Resources: www.dieteticsatwork.com, www.ontario.ca/eatright or 1 (877) 510-5102.
Recipes
Diet is an important part of managing fatty liver and other liver diseases. To help you get started, the following are several recipes taken from the book Healing Fatty Liver Disease: a Complete Health & Diet Guide by Dr. Maitreyi Raman, Angela Sirounis and Jennifer Shroubsole.
Country Lentil Soup
Thai Turkey Stir-Fry
Teriyaki Halibut
Vegetarian Chili
Portobello Mushroom Burgers with Cheese Filling
Check out this helpful resource for additional information about liver-healthy food and drink: Choose This, Not That (also available in French and Chinese).
Recipes excerpted with permission from Healing Fatty Liver Disease: A Complete Health & Diet Guide Including 100 Recipes by Dr. Maitreyi Raman, Jennifer Shrubsole, Angela Sirounis © 2013 Robert Rose Inc. May not be reprinted without publisher permission.
Tests
Liver disease can often be difficult to diagnose because its symptoms can be vague and easily confused with other health problems. In some cases, a person may have no symptoms at all yet his or her liver may already have suffered significant damage. Risk factors can vary significantly across the 100+ different forms of liver disease. The good news is that many liver diseases can be prevented, managed or in some cases even cured, but early identification is critical so it is important that you ask your doctor for a liver test.
What are liver tests (LTs)?
Liver tests are blood tests used to help determine the health of your liver and your bile ducts. Liver tests are used to guide your healthcare provider, along with your history and physical examination, in the diagnosis and management of your liver disease. These tests measure the levels of certain enzymes and proteins in your blood, how well the liver is performing its functions, or measure enzymes that liver cells release in response to damage or disease. Abnormal liver test results don’t always indicate liver disease. Your healthcare provider will be able explain your results and what they mean.
What are the most common LTs?
Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST)
These are liver enzymes normally found in liver cells that leak out of these cells and make their way to the blood when liver cells are injured. The ALT is considered to be a more specific indicator of liver inflammation as AST is also found in other organs such as the heart and muscles. In acute injury to the liver, as in viral hepatitis, the level of the ALT and AST may be used as a general measure of the degree of liver inflammation or damage. In chronic liver disease, this is not the case, for these enzymes may be entirely within the normal range even in the presence of cirrhosis (liver scarring).
Alkaline Phosphatase
This is the most frequently used test to detect blockage (obstruction) in the biliary system. Elevation of this enzyme may be found in a large number of disorders such as gallstone disease, alcohol-related liver disease, drug-induced inflammation of the liver, primary biliary cholangitis (PBC), and biliary tumors. Although this enzyme is found both in the liver and bile, and leaks into the bloodstream in a manner similar to that described for the ALT and AST, alkaline phosphatase is also found in other organs such as bone, placenta, and intestine. For this reason, it is often useful to measure another enzyme not found in these organs, either the gamma-glutamyl transpeptidase (GGT) or 5′-nucleotidase (5′-NT), along with the alkaline phosphatase when the origin of the elevated alkaline phosphatase is not clear. Abnormalities of the 5′-NT or GGT would then suggest liver or biliary tract disease.
Bilirubin Test
Bilirubin is a pigment formed primarily from the breakdown of a substance called heme found in red blood cells. It is taken up from the blood, processed, and then secreted into the bile by the liver. There is normally a small amount of bilirubin in the blood in healthy individuals (<17µmol/L). A damaged liver cannot process bilirubin properly which leads to high level of this pigment in the blood. Levels greater than 50 µmol/L are usually noticeable as jaundice (yellowing of the skin and eyes).
Albumin Test
Albumin is the main protein which is made by the liver. Although there are many factors which can affect the level of albumin circulating in the blood, chronic liver disease causes a decrease in the amount of albumin produced, and therefore the level of albumin in the blood is reduced.
Prothrombin Time and INR
The prothrombin time (also called the “protime” or PT) and the INR are tests used to assess blood clotting. Blood clotting factors are proteins made by the liver. When the liver is injured, these proteins are not produced normally. The values for the PT are usually expressed in seconds and compared to a control patient’s blood (normal +/- 2 seconds of control).
Other Liver Tests
Highly specialized tests may be used to indicate more specifically the presence of certain liver diseases. For example:
- Specific antibodies, proteins, and nucleic acids may be used to indicate the presence of viral hepatitis B (HBsAg, HBV DNA) or hepatitis C (anti-HCV antibodies, HCV RNA).
- Elevations in the serum iron, transferrin saturation and ferritin may indicate the presence of hemochromatosis.
- A deficiency of ceruloplasmin is usually seen in patients with a copper metabolism disorder called Wilson disease.
- A low level of alpha-1-antitrypsin may indicate the presence of lung and/or liver disease in children and adults due to alpha-1-antitrypsin deficiency.
- Immunologic tests such as the antimitochondrial antibody may suggest the presence of primary biliary cholangitis (PBC).
- Antinuclear and/or anti-smooth muscle antibodies may indicate the presence of autoimmune hepatitis.
To learn more about disease-specific tests, please visit our Liver Diseases section.
Liver Biopsy
Liver biopsy is a diagnostic procedure used to obtain a small amount of liver tissue, which can be examined under a microscope to determine what is causing the liver disease and the degree of fibrosis (scarring) of the liver. Read more:
The most common way a liver sample is obtained is by inserting a needle into the liver for a fraction of a second. This can be done in the hospital, and the patient may be sent home within two to three hours if there are no complications. The physician determines the best site, depth, and angle of the needle puncture by physical examination or by having an ultrasound mark the appropriate spot. The skin and area under the skin are anesthetized, and a needle is passed quickly into and out of the liver. Approximately half of individuals have no pain afterwards, while another half will experience brief localized pain that may spread to the right shoulder.
Another common technique used for liver biopsy is guiding the needle into the liver through the abdomen under direct guidance by imaging techniques. Ultrasound, or less commonly CT scan is used to pinpoint the site of the tumor and target the needle’s entry into the liver under direct observation. An instrument called the “needle gun” is used to take the biopsy. After this procedure, the patient is usually allowed to go home the same day. Liver biopsies performed under direct radiologic guidance depend on availability and pattern of practice at the local hospital.
Less commonly used biopsy techniques include those that are performed during laparoscopy (usually when laparoscopy is performed for other reasons), transvenous or transjugular liver biopsies, and during open surgical procedures performed for other reasons.
With laparoscopy, a lighted, narrow tubular instrument is inserted through a small incision in the abdominal wall. The internal organs are moved away from the abdominal wall by gas that is introduced into the abdomen. Instruments may be passed through this lighted instrument or through separate puncture sites to obtain tissue samples from several different areas of the liver. Patients who undergo this procedure may be discharged several hours later.
Transvenous or transjugular liver biopsy may be performed by an interventional radiologist in special circumstances, usually when the patient has a significant problem with blood clotting (coagulopathy).With this procedure, a small tube is inserted into the internal jugular vein in the neck and radiologically guided into the hepatic vein, which drains the liver. A small biopsy needle is then inserted through the tube and directly into the liver to obtain a sample of tissue.
Finally, liver biopsy may be done at the time a patient undergoes an open abdominal operation, enabling the surgeon to inspect the liver and take one or more biopsy samples
as needed.
Liver biopsy is often used to diagnose the cause of chronic liver disease that results in elevated liver tests or an enlarged liver. If the diagnosis is known, such as hepatitis C, then the main reason for a liver biopsy is to determine whether the patient has a progressive disease. In many cases, the specific cause of the chronic liver disease can be established on the basis of blood tests, but a liver biopsy is used to confirm the diagnosis and to determine the amount of damage to the liver. Liver biopsy is also used after liver transplantation to determine the cause of elevated liver tests and determine if rejection is present.
The primary risk of liver biopsy is bleeding from the site of needle entry into the liver, although this occurs in less than one per cent of patients. Other possible complications include the puncture of other organs, such as the kidney, lung or colon. A liver biopsy procedure that damages the gallbladder by mistake may lead to leakage of bile into the abdominal cavity, causing peritonitis. Fortunately, the risk of death from liver biopsy is extremely low, with a mortality of 1 in 5,000.
In order to reduce the risk of bleeding, the coagulation status is assessed in all patients prior to a biopsy. If the prothrombin (coagulating) time is too slow or the platelet count is low, a standard biopsy is not recommended. Vitamin K or fresh frozen plasma may be used to correct clotting abnormalities in such patients. Another alternative in this situation would be a transjugular biopsy.
The primary alternative to liver biopsy is to make the diagnosis of a liver disease based on the physical examination of the patient, medical history, and blood testing. In some cases, blood testing is quite accurate in giving the doctor the information to diagnose chronic liver disease, while in other circumstances a liver biopsy is needed to assure an accurate diagnosis.
FibroScan (FS) is a completely non-invasive diagnostic instrument to measure fibrosis (scarring of the liver) of the liver. FS uses an “elastic wave” (transient elastography) to measure hepatic stiffness which correlates with fibrosis. FS is based on the premise that as the liver becomes more fibrotic, the tissue density increases and the liver becomes less elastic. FS is easier to perform, safer and less expensive in comparison to a liver biopsy. Measurements with the FS can be taken at multiple locations of the liver whereas a liver biopsy tissue sample is taken from one location in the liver.
Liver biopsies are usually not recommended to diagnose liver cancer except on rare occasions when a diagnosis is not clear. Typically, liver cancer is diagnosed by using a CT scan or an MRI. A biopsy of a liver cancer has a small but real risk of having some cancer cells follow the pathway of the needle and spread outside of the liver.
In most circumstances, a liver biopsy is only performed once to confirm a suspected diagnosis of chronic liver disease. Occasionally, liver biopsy is repeated if the clinical condition changes or to assess the results of medical therapy, such as drug treatment of chronic viral hepatitis or autoimmune hepatitis. Patients who have undergone liver transplantation often require numerous liver biopsies in the early weeks to months following the surgery to allow accurate diagnosis of whether the new liver is being rejected or whether other problems have developed.
How to Find a Primary Care Physician
(Family Doctor or GP)
If you do not have a family physician, try going to a walk-in clinic to see if they are able to take you on as a patient. Walk-in clinics may be able to provide you with names of family physicians/GPs in the area whom they know are taking on new patients.
You can also talk to friends, family and neighbours in your community to see if they can recommend any doctors in the area so you can contact them to see if they are taking new patients. Ask your local pharmacist, optician, dentist, audiologist, sports therapist or trainer if they’re aware of any family physicians planning to open a clinic or new practice in your area. They may also be able to direct you to an established physician who is taking on new patients.
Another source of information and guidance on finding a physician is your provincial medical association. In most provinces and territories, the Ministry of Health or a provincial College of Physicians and Surgeons offers an online directory of physicians, often sorted by location and specialty.
Click the here to find a directory in your area.
