The Liver: A ‘Blob’ That Runs the Body

https://www.nytimes.com/2017/06/12/health/liver-bodily-function.html

by tysone • 9 years ago

240 102 9 years ago

nytimes.com

hjm3• 9 years ago

Love the sponsored content food items

austinpray• 9 years ago

That definitely stood out to me.

imsd• 9 years ago

I thought it was odd as well, but I'm not sure that it's sponsored? From my understanding, FTC guidelines necessitate that publications disclose sponsored placements and I imagine The New York Times would be at the forefront of these requirements ... Or am I mistaking?

jeffdavis2• 9 years ago

The NYT content falls well within "free speech" and any attempt to constrain it would backfire horribly regardless of what the laws or regulations say.

Smallet outlets would be a better target, but still likely to backfire.

medymed• 9 years ago

Great article, but 'runs the body' is a bit overkill. If you want to endanger your personal safety, try convincing a nephrologist that the liver runs the body.

gozur88• 9 years ago

Or a cardiologist.

Turns out you need pretty much everything in there.

pavel_lishin3• 9 years ago

And yet, according to my wife's surgeon, gall bladder removal surgery is the most common surgery in America. (Though he might be biased.) You don't appear to need your appendix. You can live fine with one kidney, or half a liver. I think you can get by with one lung. I've had friends who've had huge portions of their digestive tract removed.

I realize that that just speaks to the body's generally robust build, and its redundancy, but you can probably remove more organs from a human body and have it keep running than random parts from under a car's hood.

agentgt• 9 years ago

The liver storing ability to store glycogen is one of the reasons many fitness enthusiasts would avoid (or not) fructose.

From what I have heard fructose often gets broken down in the liver and thus often gets stored there (I'm probably missing a whole bunch here so assume I am wrong).

Because of this various athletes and bodybuilders would use fructose to either gain weight or rapidly fill carb stores but only would do so sparingly (ie during carb refilling during a ketogenic diet).

ibejoeb2• 9 years ago

Robert Lustig does a good talk about sugar metabolism in "Sugar: The Bitter Truth": https://www.youtube.com/watch?v=dBnniua6-oM

Also, "The Trouble with Fructose": https://www.youtube.com/watch?v=Yh4JBXaKnmA

Despite the baity titles, it's a good talk with real biochemistry.

Edit: better video added up top

agumonkey2• 9 years ago

Lustig is not a joke, but I'd love to have other wise point of view on the matter.

rscho• 9 years ago

Fructose has the particularity among sugars that its uptake in the gut is not regulated, and can be easily metabolized. This means you can load your body with fructose, with both the benefits and nefarious consequences that implies.

js2• 9 years ago

With respect to endurance sports where you will exercise long enough to exhaust glycogen stores, you actually want a mix of fructose and another sugar such as maltodextrin.

http://fellrnr.com/wiki/Fructose

http://fellrnr.com/wiki/Nutrient_Timing

When you hear a marathon runner refer to hitting the wall, what's happenened is that they've exhausted their glycogen stores.

noir_lord• 9 years ago

Cyclists call it 'the bonk' and it's fucking horrible.

It's like been incredibly drunk and tired at the same time.

Happened to me the first time I did a 60 mile ride in winter, wind back was brutal, I got about 10 miles from home on the outskirts of town, found a petrol station ate a cornish pasty and two mars bars and it took about 30 minutes before I could summon the energy to get on the bike and coast home.

I learnt the lesson the hard way that day.

I've found it relatively easy to avoid since mostly by drinking at least a litre of isotonic an hour on the bike (adjusting for climate) and eating reasonable amounts of carbs the day before.

scottLobster2• 9 years ago

I've found this guy's videos to be a good distillation of the issue. It's basically Lustig's work but there's some other sources as well.

Why Sugar is as Bad as Alcohol: https://www.youtube.com/watch?v=f_4Q9Iv7_Ao

Food Industry's Secret Weapon (WHY Sugar is addictive & in 80% of Food): https://www.youtube.com/watch?v=LPxIssabhTc

benevol• 9 years ago

Scientists hope that the new insights into liver development and performance will yield novel therapies for the more than 100 disorders that afflict the organ, many of which are on the rise worldwide, in concert with soaring rates of obesity and diabetes.

No need to wait, an excellent book explains how to easily clean your liver: http://www.ener-chi.com/books/the-amazing-liver-gallbladder-...

The thing is you can literally see all the things that have been jamming your liver for years, as they're being "washed" out when you go to the toiled - very impressive. Keep in mind that a liver that is jammed does not fully clean your blood. If your blood is not clean, it will eventually cause trouble all over your body.

treehau5• 9 years ago

https://www.quackwatch.org/01QuackeryRelatedTopics/flushes.h...

crpatino5• 9 years ago

Downvotes are for signaling failure to honour conversation protocol, no disagreement of opinion. You guys shoud know better.

If you want to argue that liver cleansing is a quack, do so in a comment. Better yet, ignore the parent and let it fall to the bottom of the conversation.

chc• 9 years ago

That is not accurate. Downvotes are for comments that negatively contribute to the conversation. One way a comment can negatively contribute is by failing to honor protocol, but it is not the only way. Even simply extraneous comments like lazy jokes probably should be and conventially are downvoted on Hacker News. Promoting pseudoscience definitely doesn't seem like a very good contribution to me.

pavel_lishin3• 9 years ago

Peddling what is obviously bullshit fails to honor conversation protocol as well.

grw_• 9 years ago

UberLivers anyone? I fear organ donation is scheduled for disruption. I found this programme discussing issues around social media donor-matching campaigns quite interesting- http://www.bbc.co.uk/programmes/b08nq6fh

mrfusion• 9 years ago

What a fascinating organ!

I never realized the liver only holds 400 calories. I always figured it was a few thousand. (I just looked it up)

So is your body always burning fat or does the liver glycogen have to be depleted first? Does the liver deplete every night when you're sleeping?

I really don't have a great mental model of this stuff.

Is it true that you need to reach high insulin levels before the body starts storing fat?

ghostbrainalpha• 9 years ago

For most people the liver does deplete throughout the night, which is why early morning "fasted cardio" is popular for burning fat.

But as the food in your stomach processes the liver is continually getting more calories. So if you eat a huge meal right before going to bed its possible to never switch to fat burning.

Mtntk• 9 years ago

But as the food in your stomach processes the liver is continually getting more calories. So if you eat a huge meal right before going to bed its possible to never switch to fat burning.

Probably that's because some people advice eat pasta a night before your sports event. To have some calories in your body to burn in the morning until first food stop.

bluetwo• 9 years ago

Anyone take Milk Thistle? It is supposed to help the liver, especially if it has been damaged, say by years of moderate drinking. Asking for a friend.

sov• 9 years ago

I'm not sure if there's been much of a more recent update to this in the past 8 or so years, but my recollection of Milk Thistle studies is that they're largely ineffective for liver disease and marginally effective for acute hepatitis.

scottLobster2• 9 years ago

I'm no expert, but I looked into this issue for my mom some years ago (had cancer on her liver) and what you're looking for specifically is Silymarin, the ingredient in Milk Thistle that actually has the protective benefits.

https://www.ncbi.nlm.nih.gov/pubmed/21466434

The issue with raw Milk Thistle supplements is that it's a lower dose of Silymarin as you're just getting the plant, you'd want "Milk Thistle Extract", which is concentrated Silymarin. As with all supplements though, read the label and research the brands you buy. Counterfeit products are rampant in the industry, as is inconsistent dosing.

Mayoclinic has some dosing reccomendations: http://www.mayoclinic.org/drugs-supplements/milk-thistle/dos...

dredmorbius• 9 years ago

Interesting recent stories out of Santa Cruz and mushroom poisoning (generally: hepotoxic), treated with Silymarin.

Well, 2014 recent:

http://www.slate.com/articles/health_and_science/medical_exa...

Mc_Big_G• 9 years ago

I like examine.com's analysis of supplements: https://examine.com/supplements/milk-thistle/

Mz2• 9 years ago

Liver disease (chronic) Several studies of milk thistle in liver disease caused by viruses or alcohol report improvements in liver tests. However, most studies have been small and poorly designed. More research is needed before a conclusion can be made.

B -- Good scientific evidence for this use

http://www.mayoclinic.org/drugs-supplements/milk-thistle/evi...

I have taken milk thistle. Some people don't tolerate it well. There are alternate things that can be taken in that case.

Looking back on my notes, the reason it helps is that it boosts glutathione. IIRC, you cannot take glutathione directly as a supplement. So, instead, you need to take things that help the body create glutathione, and milk thistle is one of the things that can do this.

If you don't tolerate milk thistle well, you should research glutathione precursors. But be aware that a lot of the websites you will most readily find are kind of sketchy.

You also need to remove the stress from the liver. Said friend needs to stop drinking. It may also help to do other things to reduce stress on the liver.

zaptheimpaler2• 9 years ago

I've been taking it for a while - hasn't had any noticeable benefits for me, but based on my research online and asking a few doctors there is no harm in taking it. No downside, possible upside so go for it.

lazerpants• 9 years ago

Also research NAC [0] supplements. They work as a precursor to glutathione in the liver which is typically depleted during the course of alcohol consumption. Might only be effective for acute effects of alcohol though.

Edit: Also, make sure your friend is consuming coffee [1].

[0] https://en.wikipedia.org/wiki/Acetylcysteine

[1] http://www.journal-of-hepatology.eu/article/S0168-8278(17)30...

mhalle9• 9 years ago

The flip side to the liver's amazing duties in the body is the catastrophic impact on health when it fails. A failed liver takes out basically every body system.

When the liver can't break down bilirubin, you get jaundice and itch all over.

When the liver becomes cirrhotic, blood can't move through it, increasing pressure in the portal vein and precipitating life-threatening bleeds in the stomach and esophagus. For an extra bonus, clotting factors are manufactured in the liver, so these bleeds can be uncontrolled.

The spleen enlarges and gobbles up white blood cells, compromising immunity.

Ammonia and other yet not fully understood toxins that the liver can't filter cross the blood-brain barrier and cause hepatic encephalopathy, ranging from brain fog to coma.

Liver disease is also tied to hepatorenal syndrome (kidney failure) and hepatopulmonary syndrome (lung damage), both of which can be sudden and fatal.

Ascites (retention of fluid) also accompanies cirrhosis, often requiring paracentesis, which in turn is correlated with sepsis that the compromised immune system can't fight (also often fatal).

Low Vitamin D in cirrhotic patients leads to osteoporosis, including vertebral fractures.

Inability to process protein leads to muscle wasting and weight loss, reducing strength and immunity.

And finally, cirrhosis is correlated with an increased risk of liver cancer.

The cure for any of these conditions? Transplant, if you're lucky and the other systems aren't too badly damaged. Everything else is just holding on.

And to get a transplant? You have to be sick enough and sufficiently close to death that you're eligible, but strong enough to survive major surgery. No insurance in the US? They won't even assess you.

A liver transplant saved my life three years ago. I've lived this list of symptoms. My debt to the universe is to educate when possible, to console when necessary.

JumpCrisscross2• 9 years ago

No insurance in the US? They won't even assess you.

Do you have a source that goes into the reasoning behind this? I could guess, but I'd prefer to give the subject the respect it deserves.

jlrbuellv• 9 years ago

Not OP, but I received a bone marrow transplant 6 months ago, and the amount billed to my insurance so far has exceed 2 million USD. So I assume no transplant team could survive without someone agreeing (in advance) to pay the bill for the transplant and post transplant related care. If I had walked in with a big enough wad of cash, it's possible I could have got on the list too, but my case has pretty much gone as smoothly as possible, with complication I could see the bill approaching a much bigger number,

mhalle9• 9 years ago

Liver transplants can cost $700K to $1M+. In the US, insurance (or Medicare) typically engages in a special negotiated contract with the hospital. This amount is too expensive for a hospital, or even many affluent individuals, to pay without insurance. (I'm sure there are exceptions for the exceedingly rich.)

For me, a magical additional insurance policy appeared in my hospital account to which all transplant-related expenses were charged.

In addition, to get an organ in the US you must pass a series of exams regarding your physical and mental health, diet, your ability to get post-transplant support, and your willingness and ability to take care of your new organ. Alcohol and drug tests as appropriate. And for these evaluations, money can only indirectly help you.

I would also guess that there is a correlation between those people who have insurance and those that can pass the transplant evaluation, though that's a hidden variable that the powers that be probably want to stay hidden.

Organs are just too scarce to waste on a person who will squander one. It's a life and death competition between patients. It's horrible to see the people who get left behind, who wait too long, get sidetracked by some "miracle" cure, or even happen to live in the wrong region of the country where organs are scarce.

But the true miracle of a successful transplant is almost unfathomable (and that's said by a rationalist). From death's bed to walking a couple kilometers in a month and a half.

DougWebb• 9 years ago

My ex-wife is still recovering from her second liver transplant. The first one was when she was 20, due to a genetic disease that causes sudden liver failure around that age. That time, she went from ER to transplant to recovery in just a few days, because of how quickly she became sick enough to move to the top of the list.

They never told her that liver transplants are pretty much always temporary, at least with the immuno-suppressant drugs that were available most of the past 20ish years. Even with drugs, most people's bodies are constantly attacking the foreign liver and damaging it beyond its ability to repair itself. 20 years is a pretty good run; hers lasted 22.

This time around, she was in the hospital for two months (seemed much longer) while they tried to keep her alive. She went through all the symptoms you mentioned. Towards the end she suffered full-on dementia from the toxins in her brain. After two months of suffering, she lost her will to live, and told me and her family that she was giving up. I was sure she'd be gone by the end of the week, but that night the miracle happened; a compatible liver was available and she was at the top of the list. The next day, after a very long surgery (working around 22 years of scar tissue from the first transplant) she got a healthy new liver.

She remained in the hospital two more months, mostly in rehab, while her brain returned to normal (mostly) and she learned to walk again. It took months after going home for her to be strong enough to fully care for herself.

Unfortunately, the decades of drugs and months of liver failure pushed her kidneys past their limit. She's not on dialysis yet, but most likely she will need a transplant before the year is up. It's just a matter of time, and she's trying to find a living donor. If she can find one, she can get the transplant before she gets too sick again, which will make recovery much easier.

Organ transplants are absolute miracles of modern medicine, but we need artificial organs. Whether they're completely mechanical, natural organs grown artificially, or custom gene-spliced organs to prevent rejection, we need them. There aren't enough organs available now to meet the need, and the patients who get them have to go through hell first. And the ones who don't, don't survive at all.

klipt• 9 years ago

we need artificial organs

Or a way to farm organs in the lab.

If self driving cars succeed in massively reducing accident deaths (yay!) an unintended consequence will be huge shortfalls in donatable organs.

Razengan• 9 years ago

My debt to the universe is to educate when possible, to console when necessary.

I don't have any liver related problems, or know/knew anyone with them, but I must thank you for having that sentiment.

CamelCaseName• 9 years ago

Can you give some advice on how to keep my liver healthy?

oh_sigh2• 9 years ago

Don't drink too much, exercise, eat a healthy diet, dont use unclean needles, insist a condom be worn during sex

blonky3• 9 years ago

My docs told me, while I was waiting for a transplant, that fatty liver is a problem. Even though a donor looks healthy, their liver can be too fatty for transplant. Eat right and exercise.

zaptheimpaler2• 9 years ago

I have a liver disease of unknown cause - doctors have investigated every cause under the sun for many years without success, and it looks like ill need a transplant at some point. Would you mind if i contact you with a few questions?

snakeanus2• 9 years ago

"In order to access our website, your browser must accept cookies from NYTimes.com"

Why would they need that?

codyb• 9 years ago

To prevent you from bypassing their paywalls by using private tabs.

nkozyra2• 9 years ago

What browser doesn't use cookies in private tabs? In chrome it's basically treated like an isolated sandbox, but it will still gladly accept cookies.

alfon• 9 years ago

Some case studies that I find interesting:

Cirrhosis presenting as Parkinsonism - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771969/

Reversal of parkinsonism following liver transplantation. - https://www.ncbi.nlm.nih.gov/pubmed/12578945

cbanek• 9 years ago

Liver failure is a big thing, but thankfully we have a drug for curing HepC now, which uncured causes liver damage.

Liver regeneration is also fantastically interesting. If only we could figure out how to trigger that regeneration when the liver is too damaged.

I'm reminded of Star Trek 4, where McCoy gives an old woman what looks like a candy, then you see her later on talking about how she grew a new kidney.

mhalle9• 9 years ago

The HepC drugs are remarkable. They also open new opportunities for transplanting HepC positive livers into HepC positive patients (expanding the donor pool), then zapping it post transplant.

But while HepC may be one of the first viral infections we can cure, non-alcoholic fatty liver disease is on the rise, even in young people. And this population is on average less motivated to make lifestyle changes that can stop or slow the disease.

pm902• 9 years ago

And this population is on average less motivated to make lifestyle changes that can stop or slow the disease.

Hmmm, how do you mean? We've seen a lot of people try to change their diets and lifestyle to be more healthy. Anecdotally, all my coworkers are very diligent, or at least mindful, about eating healthy (of course they splurge when going out, but on a daily basis they try and stick to healthy food). Granted most of my coworkers are younger millennials, but I think a fitness/healthy eating lifestyle has permeated US society.

justzisguyuknow• 9 years ago

Others have found that signals from the liver may help dictate our dietary choices, particularly our cravings for sweets, like a ripe peach or a tall glass of Newman’s Own Virgin Limeade — which our local supermarket chain has, to our personal devastation, suddenly stopped selling, so please, liver, get a grip.

What the heck is that doing in an otherwise (seemingly) scientific article?

fencepost• 9 years ago

> Newman's Own Virgin Limeade
What the heck is that doing in an otherwise (seemingly) scientific article?

Particularly since both Limeade and sugar/simple syrup are easy to make.

Syrup: 2c sugar/1c water, heat until clear, cover, cool, store in a squeeze bottle.

Limeade: 10% fresh squeezed lime juice, sugar syrup to taste but probably no more than 10%, 80% water. Depending on size & squeezer, figure maybe 1/2 oz of juice per lime. It's even easy to make single glasses.

known• 9 years ago

Check https://en.wikipedia.org/wiki/Glycemic_index

The Liver: A ‘Blob’ That Runs the Body

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