In the last issue of the newsletter, we explored the anatomy and
physiology of the liver from a natural health perspective. In this
issue, we get to reap the reward for our diligence. We cover what
can go wrong with the liver, how doctors test for it, and what you
can do about it again from a natural health perspective. In
addition, we will spend some time on the gallbladder and biliary
tree, the bile ductwork that ties everything together. Considering
that gallbladder removal (cholecystectomy) is now one of the most
common surgeries in the world, with over a half million performed
each year in the U.S. alone, that should be of interest to a number
of people. In fact, roughly 20 million Americans suffer from
gallstones, and 750,000 of them undergo cholecystectomies each year.
There are 800,000 hospitalizations and $2 billion spent annually on
gallbladder disease in the U.S. The bottom line is that gallbladder
surgery pays for many boats for many doctors every year and there
are far better, less expensive ways to deal with the problem.
What can go wrong with the liver
As we learned in the last issue of the newsletter, the liver is
amazingly resilient and, at the macroscopic level, not much goes
wrong with it. Because it is so well protected, it is rarely
affected by trauma, but when it is (automobile accidents, war,
etc.), it is often fatal because of the large blood supply that
serves it. Likewise, although primary liver cell cancer is common in
Africa and Asia (related to a very specific combination of "insults"
to the liver's cells), it is very rare in the United States and the
rest of the developed world where those insults tend not to exist.
Although hepatitis (particularly hepatitis B) and cirrhosis can be
contributing factors, the primary cause of hepatocellular carcinoma
is aflatoxin B1.
Liver cancer
Aflatoxin B1 is the most potent liver cancer-forming chemical known.
It is a product of a mold called Aspergillus flavus, which is found
in food that has been stored in a hot and humid environment (common
storage conditions in much of the third world, especially Southern
China and Sub-Saharan Africa). This mold is found in such foods as
peanuts, rice, soybeans, corn, and wheat (all staples in the third
world). It is thought to cause cancer by producing changes
(mutations) in the p53 gene. These mutations work by interfering
with the gene's important tumor suppressing (inhibiting) functions.
Generally, both hepatitis B and aflatoxin B1 are required for
hepatocellular cancer.
That said, metastatic cancer, which is carried to the liver from
other organs (think back on how the portal system feeds blood from
the intestinal tract, pancreas, and spleen through the liver) is
very common.
Hepatitis A
Hepatitis A is a viral disease that affects the liver. Transmission
can occur through:
Direct person-to-person contact
Exposure to contaminated water or ice
Contaminated shellfish (think oysters on the half shell)
Fruits, vegetables, or other foods that are eaten uncooked and that
were contaminated during harvesting or subsequent handling.
The symptoms of hepatitis A are fever, lack of appetite, nausea, and
fatigue, and then jaundice. Jaundice is a yellow or orange tint to
the skin or whites of the eyes. Some persons with hepatitis A will
have no symptoms at all -- especially children. The symptoms of
hepatitis A, if you have them, usually last about one or two weeks,
and, in most cases, no specific treatment is required in order to
get better. Infected persons shed the virus in their stools from a
week or two before symptoms begin until a few days after jaundice
begins. Because of this, persons who are ill with hepatitis A should
not work in restaurants, child care centers, or nursing homes until
their symptoms have resolved.
The hepatitis A IgM test is used to screen for early detection of
infection and is used to diagnose the disease in patients with
evidence of acute hepatitis. Hepatitis A IgM is the first antibody
produced by the body when it is exposed to hepatitis A. On the other
hand, hepatitis A IgG antibodies develop later and remain present
for many years, usually for life, and protect you against further
infection by the same virus. There is no test specifically for
hepatitis A IgG antibodies, although a total antibody test (which
detects both IgM and IgG antibodies) detects both current and former
infection with hepatitis A and will remain positive even after
receiving the hepatitis A vaccine.
Hepatitis B
The hepatitis B virus results from exposure to infectious blood or
body fluids containing infected blood. Possible forms of
transmission include (but are not limited to) unprotected sexual
contact, blood transfusions, re-use of contaminated needles &
syringes (which explains why the incidence of hepatitis B among drug
users is so high), and transmission from mother to child during
childbirth. It should also be noted that if you are into the latest
fashion trends centered around body piercing and tattooing, you have
to be extremely careful with the equipment that is used on you. Make
sure the equipment is totally sterile. Using non-sterile equipment
can transfer the hepatitis B virus or other blood born diseases to
your body.
Also, be careful when eating out. Eating uncooked, raw food or
eating from outside vendors can infect you with hepatitis B. This is
of particular note when visiting third world countries, but can
still be a problem in any developed country.
Symptoms of hepatitis B include:
Loss of appetite
Fatigue
Nausea and vomiting
Itching all over the body
Pain over the liver (on the right side of the abdomen, under the
lower rib cage)
Jaundice
Urine becomes dark in color -- not yellow, but dark like tea
Stools are pale in color (grayish or clay colored)
The danger of hepatitis B is that it can become acute, and then
chronic -- ultimately leading to severe liver damage. Unfortunately,
there is no treatment that can prevent acute HBV infection from
becoming chronic once you get it. The degree of liver damage is
related to the amount of active, replicating (multiplying) virus in
the blood and liver. Antiviral agents, the medical treatment of
choice for chronic hepatitis B, do not work in all individuals with
the disease, and may not even be required as in many cases the
infection may resolve itself over time.
Although, it's difficult to prevent hepatitis B from progressing if
you get it, it is possible to protect yourself from getting it in
the first place through immunization. The primary test for hepatitis
B is for HBsAg (the hepatitis B surface antigen). Its presence
indicates either acute or chronic hepatitis B infection.
Hepatitis C
Hepatitis C (HCV) is the most dangerous of the hepatitis viral
infections, and it is the most common cause of chronic liver disease
in North America. It is difficult for the human immune system to
eliminate the virus from the body once infected, and infection with
HCV usually becomes chronic. Over time (often decades), hepatitis C
damages the liver and can lead to liver failure. As mentioned, it is
difficult for the immune system to clear the virus with up to 85% of
newly infected people failing to clear it and thus most people
become chronically infected. It is estimated that in the U.S. alone
more than three million people are chronically infected with
hepatitis C, with between 8,000 to 10,000 people dying each year. In
the U.S., hepatitis C is the leading cause of liver transplant
surgery.
Treatment usually involves a combination of an antiviral (most often
ribavirin) and alpha interferon. Alpha interferon is an antiviral
protein normally made in the body in response to viral infections.
The alpha interferon used in treating hepatitis C, however, is not
natural. It is a recombinant form that usually involves the addition
of a large molecule of polyethylene glycol to "improve" uptake,
distribution, and excretion of the interferon, not to mention
prolonging shelf life and of course, increasing profits for the
companies holding patents.
Peginterferon (owned by Roche), the current alpha interferon of
choice, can be given once weekly and provides a constant level of
interferon in the blood, whereas standard interferon must be given
several times weekly and provides intermittent and fluctuating
levels. In addition, peginterferon is more active than standard
interferon in inhibiting HCV and yields higher sustained response
rates with similar side effects. Because of its ease of
administration and better efficacy, peginterferon has replaced
standard interferon both when used alone and as part of a
combination therapy for hepatitis C.
Combination therapy can indeed lead to rapid improvements in up to
70 percent of patients, but it often doesn't last. Long-term
improvement only occurs in 35-55 percent of patients. And
unfortunately, there are side effects, which frequently include
profound fatigue, headache, fever, muscle pain and chills. In fact,
that's just the tip of the iceberg.
Fortunately, there are natural alternatives. Ten years ago, I was
introduced to someone who had hepatitis C and who reacted badly
(extremely so) to his interferon treatments. By the time I met him,
he had reached the point that he had stopped his interferon
treatments, as death was preferable to the side effects associated
with his treatment. As I said, those side effects can be profound.
Fortunately, using a different approach, which we'll talk more about
at the end of this report, he was able to drop his numbers to
undetectable levels and maintain those for years. When I last spoke
to him about two years ago, he was still symptom free after eight
years and that's despite never giving up many bad habits including
heavy, daily cigarette smoking. Since then, I have personally seen
that experience duplicated several more times with other HCV
patients.
Testing for hepatitis C, usually involves a series of five tests
each filling in a piece of the puzzle.
Anti-HCV tests detect the presence of antibodies to the virus,
indicating exposure to HCV. These tests cannot tell if you still
have an active viral infection, only that you were exposed to the
virus at some point in the past.
HCV RIBA testing confirms the presence of antibodies to the virus.
It is used to verify the results of the Anti-HCV test.
HCV-RNA testing identifies whether your infection is active.
Viral Load or Quantitative HCV tests determine the level of
infection and are used to determine if treatment is working.
Viral genotyping is used to determine exactly which type of
hepatitis C is present. As it turns out, there are 6 major types of
HCV, and they all respond differently to treatment. This test is
often ordered before treatment to give your doctor an idea of the
likelihood of success and how long treatment may be needed.
Cirrhosis of the liver
Cirrhosis is a degenerative disease of the liver that is often
caused by alcoholism, but also may result from hepatitis and even
parasites. It is characterized by formation of fibrous tissue,
nodules, and scarring, which interfere with liver cell function and
blood circulation and can often lead to blood backflow. Symptoms
include weakness, weight loss, fatigue, abdominal swelling due to
fluid accumulation, clotting defects, jaundice, and tenderness and
enlargement of the liver. Tests for cirrhosis include prolonged
prothrombin time and decreased albumin. Cirrhosis is untreatable and
when advanced ends in portal hypertension, liver failure, hepatic
coma, and death. As already mentioned, the primary tests for
cirrhosis include prothrombin time (a test that measures how long it
takes blood to clot) and decreased albumin. As discussed last issue,
the liver makes all prothrombin and fibrinogen (clotting factors)
for the blood, as well as albumin, the major blood protein. Thus,
tests indicating low levels of these proteins would be indicative of
liver problems.
Liver enzyme tests
A simple liver blood enzyme test is often your doctor's first step
in determining liver problems. The test is simple. Under normal
circumstances, liver enzymes reside exclusively within the cells of
the liver, but if the liver is injured for any reason, these enzymes
spill out into the blood stream. Thus, if tests reveal them in the
bloodstream, it's an "indication" of problems. Specifically, your
doctor is looking for the two aminotransferase enzymes: aspartate
aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or
SGPT). Again, if these enzymes are found in the bloodstream, they
are indicative of liver problems. They are not, however, conclusive.
Higher-than-normal levels of these liver enzymes do not
automatically mean that you have liver problems. For example, high
levels of these enzymes can be caused by muscle damage -- such as
that produced by intense exercise. Moderate alcohol intake can also
raise levels as can aspirin. Also, even if the levels are raised as
a result of real liver problems, the actual levels are not
indicative of the extent of liver damage. For example, patients with
hepatitis A may demonstrate very high levels for one to weeks before
the condition, as mentioned earlier, totally resolves itself and
goes away. On the other hand, patients with chronic hepatitis C
infection typically show very little elevation. Again, liver enzyme
tests merely indicate a potential problem.
Bilirubin test
In addition to the liver enzyme test, the prothrombin time test, and
the albumin test mentioned above, a complete liver panel will
usually include one more test, the bilirubin test. Again as we
discussed last issue, the liver excretes bilirubin, the broken-down
pigments from dead red blood cells, by metabolizing it with bile
salts and excreting it through the feces. Bilirubin is what makes
our feces brown. If for some reason, bilirubin is not excreted (as
in obstructive jaundice) the feces will turn clay-colored. Likewise,
if bilirubin is found in the bloodstream, it's indicative that
something is amiss in the liver and that bilirubin is flowing in the
wrong direction out into the bloodstream.
Gallstones and the biliary system
As we discussed last issue, gallstones don't start in the
gallbladder; they are related to cholesterol metabolic defects
originating in the liver itself. They also happen to be associated
with obesity and pregnancy. Essentially, if the cholesterol produced
in your liver is too thick and becomes too concentrated in the bile
and sits too long in the gallbladder, it can crystallize and form
gallstones. It is estimated gallstones result in some 600,000
hospitalizations and more than 500,000 operations each year in the
United States alone. Bottom line: it's one of the most prevalent
digestive disorders known.
The usual treatment is laparoscopic surgery to remove the
gallbladder. The surgery itself has now become so routine that it
can be completed in about an hour and the patient leaves the same
day -- back to work the next day.
However, because it does not address the underlying cause of the
problem (metabolic issues in the liver), gallbladder surgery often
does not resolve the patient's discomfort. And because it eliminates
the body's regulating mechanism for the release of bile when needed,
it often creates new digestive problems of its own. In fact, after
gallbladder removal, some 13% of patients report persistent pain.
Another 17% report chronic diarrhea, and another 20% report
intermittent digestive problems and pain. The bottom line is that
although surgeons will report an almost 100% success rate for the
surgery, patients will report a 50 % failure rate. It's all a matter
of perspective. The surgeon considers the surgery successful if the
patient survives, there are no immediate problems, and she collects
her fee without a lawsuit. The patient, unfortunately, has to live
with the long term results.
The biliary tree
The biliary tree is the anatomical term for the treelike path by
which bile is secreted from the liver on its way to the duodenum.
It is referred to as a tree because it begins with a multitude of
small branches coming from the thousands of liver lobules which
empty into the common bile duct, which is sometimes referred to as
the trunk of the biliary tree. Hanging off the trunk, tucked up into
the liver is the gallbladder. It is a secondary outpouching, if you
will -- an outpouching of the bile duct coming from the liver, which
is itself an outpouching of the digestive tract. The gallbladder
lies in a groove under the liver, between the two lobes, and is a
soft, thin-walled sac, shaped like a fat carrot, with its narrow end
pointing toward the bile ducts.
Liver duct system
Bile drains from the ultra small bile ducts (ductiles) that service
each of the liver's tens of thousands of lobules into progressively
larger ducts, culminating in the common bile duct. The right and
left hepatic ducts join just outside the liver to form the common
hepatic duct.
Bile passing through the common bile duct exits and enters the
gallbladder through the cystic duct. Most physicians refer to the
gallbladder as a vestigial organ (as they do the appendix) meaning
that it's lost most of its original function and now pretty much
"gets in the way." To them, this explains why the gallbladder does
not usually empty completely, which allows gallstones to form
leading to pain, infection, inflammation, and even cancer. This also
explains why they remove upwards of half a million gallbladders a
year in the United States alone.
They are wrong!
The gallbladder serves a definite function. It is not vestigial. It
regulates the flow of bile so that it can "push out" into the
digestive tract in bursts as needed to assist in the digestion of
fats. In fact, the gallbladder will contract to squeeze out stored
bile when stimulated by a fatty meal. Without the gallbladder, bile
merely dribbles out in a constant flow, thus being present when not
required and insufficiently present when needed. This can lead to a
whole series of digestive problems including poor digestion,
intestinal distress, diarrhea, and an inability to fully break down
fats. In fact, many people, as they age, need to take an ox bile
supplement (available at all health food stores) with their meals to
compensate for insufficient bile in their digestive tracts. If you
have digestive problems after eating fatty meals, it's one of the
first things you (and your doctor) should look at.
It is important to understand that problems with the gallbladder
rarely stem from the gallbladder itself. They stem from the liver,
which if not functioning properly will manufacture bile that is
prone to "stoning." Thus removing the gallbladder does not eliminate
the problem; it merely eliminates ONE place problems can manifest.
Where else can problems manifest? If you follow the biliary tree
down past the gallbladder, you will find that the common bile duct
joins the pancreatic duct before entering the duodenum through the
ampulla of Vater. And there's the problem. Although stones and
sludge formed in the liver can no longer get trapped in the
gallbladder (if it's been removed), they can still quite easily get
lodged in the pancreatic duct and ampulla of Vater. This causes the
digestive juices secreted by the pancreas to back up into the
pancreas itself and start inflaming and digesting pancreatic tissue.
This is called pancreatitis.
In other words, by merely removing the gallbladder and not
addressing the underlying problem of "bad bile" being formed in the
liver, you may potentially merely be moving symptoms from the
gallbladder to the pancreas. Fortunately, there are alternatives.
Dietary changes will often help. But the best way to optimize the
health of your liver, gallbladder, and pancreas is to regularly
cleanse and flush the liver and gallbladder.
The liver gallbladder flush
Of all the things I talk about in my books and newsletters, the one
that medical doctors have the hardest time with is detoxes and
flushes. In fact, the "scientific" community will regularly speak
out against the concept. But most of that hostility comes from
confusion, misunderstanding, and prejudice. Yes, it's true that
there is a great deal of "noise" that contributes to that confusion.
A search on the internet shows that the word detox has been
associated with everything from shampoos to footpads. On the other
hand, it's not that hard to separate the wheat from the chaff if one
wants to. Certainly there's a whole lot of chaff in the medical
community that must be ignored: hormone replacement therapy,
angioplasties, and Tamiflu to name just a few.
That said, the principle of the liver/gallbladder flush is simple.
You deprive the body of all fats and oils for a period of time to
allow bile and cholesterol to build up in the liver and gallbladder.
You then consume a drink containing a large amount of olive oil,
which requires the liver and gallbladder to purge all of their bile
in an attempt to digest this sudden intake of fat. This produces a
figurative "wringing" action on both the liver and gallbladder
causing them to empty. In addition to the purging of bile and
cholesterol, a good flush will also help the liver purge accumulated
fats and toxins. There are several cautions when doing a
liver/gallbladder flush.
You will want to have done an intestinal cleanse before doing the
liver flush. Why? Because when the liver and gallbladder purge, they
dump into the duodenum. If the intestinal tract is not flowing
smoothly the purged bile and toxins can either backup into the
bloodstream through the liver or be reabsorbed into the bloodstream
through the intestinal tract. This can lead to a cleansing reaction.
You will want to soften any gallstones before doing the flush.
Otherwise, if the stones are large and hard, it will be quite
painful (possibly even harmful) when the hard rough stones are
squeezed through the bile ducts. At one time I used to recommend
products such as Phosfood Liquid, Super Phos 30, and liquid extracts
of chanca piedra. And they work. In the end, I designed my own
softening formula that works far better and faster than these other
alternatives often in a matter of one to two hours. But more
importantly this formula helps with all kinds of stones including
kidney, gallbladder, and pancreatic. In any case, you will want to
do one of these programs before doing a liver detox to soften the
stones.
One day versus five day liver cleanses
If you search under liver flushes on the net, you will find two
programs recommended a five day program and a one day program. The
principles of both programs are the same. The one day program is
essentially the same as the last day of the five day program. I
prefer the five day program for a number of reasons.
You get to build the strength of the morning purge drink from one to
five tablespoons of olive oil over five days. This not only provides
a cumulative effect; it also allows the body to adapt, thus making
the five tablespoon drink easier to handle.
Whereas both programs will purge the gallbladder, the five day
program does a much better job of purging the liver too.
The five day program is accompanied by herbal teas and tinctures
that also contain:
Lipotropics so they help purge fats from the liver
Antiparasitic herbs so they help flush parasites from the liver
Liver rebuilding herbs such as milk thistle and Picrorhiza kurroa
that help regenerate liver function
And are accompanied by juice fasts that help the entire body rebuild
and repair itself
What you can expect on the liver detox
If you are so inclined (and you should be), you should examine what
you deposit in the toilet during the liver/gallbladder flush. Check
for "stones" which may or may not be visible. The bile from the
liver gives some stones their typical green color, but also look for
black, red, and brown stones, as well as stones with blood inside
them. During the course of the cleanse, some people will pass many.
Be glad, because the more you pass, the healthier you become. You
may also find untold numbers of tiny white cholesterol "crystals"
mixed in with the waste. But do not be fooled. Oftentimes, the olive
oil is converted into little "soap beads" in the intestinal tract,
and many people confuse these little beads with actual stones. Also,
keep in mind that if you are softening your stones before doing the
flush, they will develop the consistency of toothpaste thus they
will be significantly elongated when "squeezed" out and not look
very beadlike at all. And if you are taking psyllium during the
program (which I recommend), most of the waste will be encased by
the psyllium and not be visible at all.
If you don't notice anything, though, it doesn't mean the flush is
not working. Also, many people don't have gallstones. But they do
have toxins and accumulated fat in the liver, and those are being
purged. In the end, though, it's not what you see, it's how you
feel. Wait for a few days after the cleanse and then evaluate. Did
you lose weight? Do you feel lighter and cleaner? Did your senses
come alive? Does food taste better? Are colors brighter? Is your
breathing a little easier, less congested? These are the true
evaluations of the liver detox.
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