Ask anyone to tell you what their liver is for and chances are you’ll get a shrug for an answer. Ask them where it’s even located in their body and they might wave their hand broadly over their torso. Somewhere in there. (It’s actually in the upper right-hand part of your abdomen, beneath your diaphragm.)
Your liver is one of the hardest working organs, performing more than 500 vital functions, according to the Canadian Liver Foundation. Chief among them: it cleanses your blood; regulates your hormones and cholesterol; fights off infections and toxins; and processes everything you eat, drink, breathe and rub on your skin, all without complaint. It takes care of you — if you take care of it.
Ignore your liver, and it will break down. Abuse it with toxins, including overconsumption of alcohol or acetaminophen (Tylenol), and it will fail you. And it will do so without you even knowing, until it’s too late. Taking that vital little organ, weighing about a kilogram, for granted can have serious consequences.
A liver runs through it
Wayne Aelick, who lives on the shores of Lake Huron, would never have suspected his liver was in trouble. His diagnosis made a circuitous route through his colon when he developed ulcerative colitis, inflammation of the bowel caused by a faulty immune system which can lead to liver damage. When his condition worsened — even after treatment — he underwent an ileostomy, a procedure in which the small intestine is diverted through an opening in the abdomen to allow stool to bypass the colon.
But a year later, he was getting worse. Aelick underwent a proctocolectomy to remove his colon and rectum. Then, he was diagnosed with primary sclerosing cholangitis — a disease of the bile ducts. To fix that, he had a procedure called transjugular intrahepatic portosystemic shunt (TIPS), in which a stent is inserted to connect the portal veins to blood vessels to relieve blood pressure on the liver. But it was too late — his liver was failing rapidly.
Aelick was so sick that he was put on the transplant list and, luckily within just five months (many people wait years), got his new liver. That should have been the end of his troubles but, while still in the hospital recovering, he developed Type 2 diabetes — a complication for about 15 per cent of liver transplant recipients. A year later, his kidney function weakened.
He’s doing well now, but why all this happened to him, Aelick doesn’t know.
“I lived a fairly normal life,” he says. “I never did drink alcohol very much, just once or twice a year at a party.”
And though he had been overweight at the start of his health issues — he weighed about 270 pounds a year before his diagnosis — he bought a treadmill and changed his diet. In twelve months he lost about 90 pounds, and then came the ulcerative colitis diagnosis.
“The doctor [told me], ‘If you hadn’t lost the weight you’d just be a fat guy with ulcerative colitis,’” he says. “It had nothing to do with the weight loss.”
Fatty liver is most common
The most common type of liver disease, affecting one in four Canadians, is non-alcoholic fatty liver disease (NAFLD), a buildup of fat in the liver of people who drink very little, or no, alcohol. Non-alcoholic steatohepatitis (NASH) is an advanced form of NAFLD, which can lead to scarring, called cirrhosis.
“We also see fatty liver as a complication of some other medical conditions, including when people lose a lot of weight,” says Dr. Jordan Feld, professor of medicine at the University of Toronto, and research director at the Toronto Centre for Liver Disease.
“Fatty liver can occur with significant weight change, going up or down,” he says. “We see it in people with anorexia, for example. But the reason it’s a population health problem is that it’s following the obesity epidemic.”
Many people mistakenly associate liver disease with alcoholism, or think that alcohol played a role. However, alcohol only causes one out of more than 100 different types of liver disease, according to Nem Maksimovic, senior manager, support & education for the Canadian Liver Foundation. Age is also a factor, as is the high incidences of hepatitis B and C (despite available vaccines), particularly with the opioid epidemic and shared needles.
Obesity and diabetes raise liver disease risk
People with obesity, or who have metabolic conditions like diabetes or high blood pressure are also at higher risk of developing liver disease, says Maksimovic, adding that autoimmune liver diseases have also been on the rise — a growing number he attributes to better screening and diagnostic methods.
“The three most common are autoimmune hepatitis, [which is] inflammation of the liver. Many autoimmune conditions are a combination of environment [chemicals in cleaning products, insecticides and fungicides, for example], genetics, dietary patterns, stress, and sleep cycles,” Maksimovic says. “Two other [rising] diseases, called primary biliary cholangitis and primary sclerosing cholangitis [which affected Aelick], are biliary tract conditions, where the bile ducts narrow, preventing healthy blood flow, causing inflammation, and may also result in cirrhosis.”
Change your life, save your liver
Both Maksimovic and Feld emphasize lifestyle changes — healthier diet, more exercise, no smoking — to ward off liver disease. “Even modest weight loss can have a significant improvement in fatty liver and its consequences,” says Feld.
As for diet, Maksimovic says that though there have been foods that have been labelled ‘liver healthy,’ there’s no specific diet that’s considered a liver healthy diet.
“It’s important to eat a whole, balanced diet, while minimizing ultra-processed foods,” he says.
Fatty liver doesn’t have a lot to do with fat
Feld says the “fatty” in fatty liver disease is not so much related to fat as it is to sugars and carbohydrates. “When we’re advising people about diet, we’re focusing less on fat and more on refined sugars and carbohydrates and trying to get people to reduce their intake of those.”
Citing remarkable improvements in how hepatitis C is treated — with a cure rate above 95 per cent — Feld’s research is using that model to treat other liver disease.
“There’s a lot of development in hepatitis B and fatty liver right now as being the two most active areas where I hope we will have very effective new treatments within the next couple of years,” he says, adding that hep C treatment has improved so much that transplant specialists are now taking organs from people who die with the disease and transplanting them, and then treating the hep C in the recipient.
“Unfortunately, many people who die, particularly in the opioid crisis, are young and otherwise healthy, who may also have hep C from injection drug use,” he says. “It’s a shame we can’t have at least some good come out of those deaths with [the donation of] an organ.”
Even without those successful treatments and transplants, the liver is a remarkably resilient organ.
“If you cut out half of someone’s liver and give it to someone else, in between six and 12 weeks, both halves are back to a full size, fully functioning liver,” Feld says.
The goal, he adds, is to harness that regenerative capacity so that someone with severe liver disease could have their own liver regenerate quickly enough that they won’t need a transplant.
Feld’s research is also looking at the methods used in other organ transplants, which keep the organs alive outside the body, improve their function, then place them into the recipient. This would open the door to donors who were previously deemed unqualified because of age or imperfect health.
In the meantime, organ donations continue to be scarce, with Canada among the lowest organ donor countries in the world. “There’s more people dying on the transplant list than new organs coming in,” says Maksimovic. “That’s always been the case.”
Feld says donors’ wishes are often overruled by well-meaning family, and emphasizes the need for would-be donors to make their intentions clear. Also, he says, people can be hesitant because they don’t know what their organs will be used for, or how life-saving they can be.
Wayne Aelick knows. “I thank my donor every day,” he says. In fact, every Christmas he writes a letter to his donor’s family through his transplant coordinator (donors are anonymous) letting them know how he’s doing, and thanking them for their sacrifice.
As for what he tells the donor-hesitant, “Please don’t take your organs to heaven, heaven knows we need them here.”
Amen to that.