The liver is a powerhouse of an organ. Your liver is working hard, doing it best to process what you eat and drink into energy and nutrients, breaks down toxins like alcohol, medications, and natural byproducts of metabolism and acts as a filter to remove harmful substances from your blood.

If you eat a healthy diet, your liver “tells” you that you are doing a good job. You get the message because your liver is able to function properly and provided your overall health is good, you feel in great physical shape. In contrast, if you do not care about your diet by consuming fatty or fried food and alcohol, your liver is defenseless and literally is under attack.

How can I improve my liver function?

You might start to wonder, what foods are good for liver health? Are there nutrients you can take daily to help your liver cleanse and repair?

The good news is there are several different nutrients to help your liver function efficiently.

• Vitamin E

This powerful antioxidant is a fat-soluble vitamin that the liver seems to do very well with. Vitamin E helped to down-regulate genes involved with oxidative stress and cholesterol production. Lowering both factors will aid you in liver repair and liver detox.

Research showed that vitamin E may significantly improve liver function by concluded that the liver enzymes (AST, ALT, ALP) and inflammation that is produced when the liver is under stress can be reduced when vitamin E is taken.⁽¹⁾

In addition, a 2014 study revealed that patients who received vitamin E (400IU/800IU per day) over a period of 96 weeks experienced reduced inflammation and fat content in the liver, as well as decreased liver cell death.⁽²⁾

Vitamin E food sources include sunflower seeds, almonds, avocados, spinach, leafy greens, papaya, kiwi, and broccoli.

• Vitamin C

Vitamin C is also an antioxidant that helps to neutralize other molecules called free radicals. Not enough antioxidants create an imbalance called oxidative stress, which can harm cells and cause liver diseases. In addition, the study stated that vitamin C helps to prevent fat accumulation in the liver, which can lead to fatty liver disease.⁽³⁾

Vitamin C food sources include guavas, strawberries, oranges, tomato, broccoli, kale, pineapple, lemon, and cauliflower.

• B-Complex Vitamins

Eating enough foods with B vitamins can help prevent infection and reverse many symptoms of liver disease in its early stages. It can also improve the nutritional deficiencies that often develop when you have liver disease.

In fact, liver disease can cause vitamin B1, B6 and B12 deficiencies. For example, severe vitamin B1 deficiency can cause a decline in mental abilities, a vitamin B6 deficiency can cause numbness and tingling from nerve damage while a vitamin B12 deficiency can cause anemia.  About 90% of vitamin B12 is stored in the liver. When the liver becomes damaged, the levels of vitamin B12 decrease.

B-Complex Vitaminsfood sources include oats, spinach, beans, nuts, fish, chicken, eggs and dairy, sweet potatoes and soy milk.

• Vitamin D

The “sunshine” vitamin actually does a lot more for you than you think. Sufficient vitamin D levels are vital to have a healthy liver.  A lack of vitamin D seems to exaggerate liver inflammation and inhibit bile production while increasing vitamin D can help decrease the inflammation. New evidence suggests that low serum Vitamin D may cause nonalcoholic fatty liver disease.⁽⁴⁾ Meanwhile, another study stated that higher vitamin D levels seem to help inhibit the virus in Hepatitis from replicating so quickly, reducing the viral load the liver has to contend with.⁽⁵⁾  

Vitamin D food sources include fatty fish, eggs, mushrooms, cheese, and cod liver oil.

• Zinc

The liver is the organ in charge of zinc metabolism and zinc is necessary for proper liver function. A deficiency in zinc can lead to problems in the liver like poor liver regeneration and liver lesion. Moreover, the study concluded that zinc may be vital in preventing liver cirrhosis. ⁽⁶⁾

Zinc food sources include chickpeas, pumpkin seeds, hemp seeds, sesame seeds, almonds, cashews, dairy, eggs, dark chocolate meat and shellfish.

• Coenzyme Q10 (CoQ10)

CoQ10 may be crucial to aiding your liver to adapt to stress and stay healthy.CoQ10 may help the liver to adapt under the stress of metabolic processes. We are continually exposed to substances that our liver has to neutralize. CoQ10 may help aid in the liver detox process. It may also considerably lower inflammatory liver enzymes and c-reactive protein.

CoQ10 food sources include: spinach, cauliflower, broccoli, strawberries, oranges, peanuts, sesame seeds, and pistachios, fatty fish, meat

Keep in mind that if you do not help your liver, it cannot help you and eventually lead to poor liver health and liver diseases. In conclusion, it is important to eat a healthy diet, exercise regularly and maintain a healthy weight.

References:

• Ken Sato et al. Vitamin E has a beneficial effect on nonalcoholic fatty liver disease: A meta-analysis of randomized controlled trials. Nutrition. Volume 31, Issues 7–8, July–August 2015.
• Sanyal AJ, Mofrad PS, Contos MJ, et al. A pilot study of vitamin E versus vitamin E and pioglitazone for the treatment of nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol. 2004 Dec;2(12):1107-15.
• Dana et al. Dietary vitamin E and C intake is inversely associated with the severity of nonalcoholic fatty liver disease. Liver, Pancreas and Biliary Tract. 2019. Volume 51, Issue 12, P1698-1705.
• Mitra Hariri et al. Effect of Vitamin D on Non-Alcoholic Fatty Liver Disease: A Systematic Review of Randomized Controlled Clinical Trials. Int J Prev Med.2019; 10: 14.
• Jeremy et al. Vitamin D and the Liver—Correlation or Cause?2018 Apr; 10(4): 496.
• Kurt et al. The role of zinc in liver cirrhosis. Ann Hepatol. Jan-Feb 2016;15(1):7-16.

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What is Fatty Liver Disease?

Fatty liver disease is a common condition caused by having too much fat build up in your liver. It is normal to have a tiny amount of fat in liver cells, but liver is considered fatty if more than 5-10% of it is fat. Untreated fatty liver will cause cirrhosis of the liver while untreated cirrhosis will leads to liver failure or liver cancer.

There are two main types of fatty liver disease:

• Alcoholic fatty liver disease (ALFD): Due to heavy alcohol use.
• Nonalcoholic fatty liver disease (NAFLD): Occurs when fat builds up in the liver due to eating a high-fat, high sugar diet or obesity.

Unfortunately, fatty liver can be a silent disease and often goes undetected leaving many people unaware they are high risk. According to the Malaysian Liver Foundation, approximately 60% of adults in Malaysia suffer from fatty liver and they may not even realize their liver is struggling because they don’t experience any symptoms.

Risks Factors in Fatty Liver

The known and common risk factors of fatty liver disease are:

• Overweight or obesity
• High alcohol intake
• High-fat diet, especially in saturated fats
• Diabetes
• Having metabolic syndrome (large waist size, insulin resistance, high blood pressure, high cholesterol and high triglyceride levels).
• Lack of exercise

Relation of Fatty Liver disease and Covid-19

Latest research found out that people with fatty liver disease are more than twice as likely to become seriously ill with COVID-19.⁽¹⁾  It means those who are having liver disease such as alcohol-related liver disease, nonalcoholic fatty liver disease, and especially cirrhosis, or scarring of the liver, can make them more likely to get severely ill from COVID-19.

In another study, carried out by teams from UK BioBank and a diagnostic imaging company called Perspectum, involved looking at more than 42,000 liver scans. Data collected has indicated that one in nine people have more than 10% of fat in their liver, have an increased risk of being admitted to hospital with severe COVID-19 complications.⁽²⁾

Apart from that, the Centers for Disease Control and Prevention (CDC)  already lists liver disease as one of the conditions that may increase a person’s risk for severe COVID-19.

How to Prevent/ Getting Rid of  Fatty Liver Disease?

Currently, there is no medication specifically for fatty liver disease. Lifestyle changes are the first-line treatment and prevention for fatty liver disease. Fortunately, the liver has an amazing ability to repair itself. If you making lifestyle changes like avoid alcohol or lose weight, it is possible to reduce liver fat and inflammation and reverse early liver damage. Let’s see some of the diet and lifestyle tips below that can  prevent or reverse fatty liver disease.

• Weight Loss

Research suggests that losing weight is one of the best ways to control or reverse fatty liver if you are overweight or obese. According to The National Health and Morbidity Survey 2019, one in two adults in Malaysia are either overweight or obese. Fatty liver rate has been estimated to be about 30%. Aim for a healthy weight falls within BMI of 18.5 to 24.9 kg/m².

A good goal is to lose 10% of your total body weight, but even a loss of 3% to 5% can improve your liver health by lowering inflammation and the odds of injury to your liver cells. In a three-month study of overweight adults, reducing calorie intake by 500 calories per day led to an 8% loss of body weight, on average, and a significant decrease in fatty liver score.⁽³⁾

Meanwhile, a study in the JAMA Internal Medicine found that people who lost just 3% to 6% of their body weight reduced their liver fat levels by 35% to 40%.⁽⁴⁾

• Maintain a Well-Balanced and Healthy Diet

Having to choose healthy food does not mean you need to give up on your favorites.  A diet for fatty liver disease should include a wide variety of foods. Eating high fiber and natural foods is a good starting point. Choose foods contain complex carbohydrate (e.g. brown rice, wholegrain bread,oats) , fiber, and protein can provide sustained energy and promote satiety.

Try to cut down on refined carbohydrates like white rice, white bread, sweet desserts and soft drink. In one study, obese adults who consumed a diet high in calories and refined carbs for 3 weeks had a 27% increase in liver fat, on average, even though their weight only increased by 2%.⁽⁵⁾

You can always think of a way to turn your favorites into a healthy option. For example:

• Bake or air fry your foods instead of deep fry to take off the extra oil.
• Use low-fat yogurt instead of mayonnaise.
• Steam your vegetables rather than boiling them to avoid loss of nutrients.
• Remove all visible fat from food before you cook it, take the skin off chicken and trim the white fat off any meat.
• Keep a supply of healthy snacks to hand like fresh-cut fruits, unsalted baked nuts and seeds, greek yogurt or baked vegetables chips.
• Limit the number of times you eat out to once a week. Prepare and take your own packed lunch to work.

• Exercise Regularly

Regular and moderate physical activity leads to a healthy body weight and can be an effective way to decrease liver fat. Aim for 150 minutes of activity weekly, or 30 minutes five times a week.

Scientific data showed that performing a combination of aerobic exercise (brisk walking, jogging, hiking, cycling) and resistance training (pushup, chin-up, sit-up, body squat) appear to diminish the amount of fat stored in liver cells.⁽⁶⁾ In a 4-week study, obese individuals who trained for 30-60 minutes, five days per week, saw an impressive 10% loss in liver fat, even though their weight remained unchanged.⁽⁷⁾

Since working out regularly is important for reducing liver fat, choosing something you enjoy and can stick with is your best strategy.

• Avoid or Limit Alcohol

When you drink alcohol, your liver has to process and remove it from your body; which is not easy. The process of breaking alcohol down can generate harmful substances that can damage liver cells, promote inflammation, and weaken your body’s natural defenses. The more alcohol that you drink, the more you damage your liver.

If you have fatty liver disease , you should not drink at all as it can lead to more serious liver damage. On the other hand, for those who want to prevent from fatty liver disease should try to limit your alcohol use to the recommendations where the intake of alcohol should be limited to no more than 1 standard drink per day for women and no more than 2 standard drinks per day for men. A “drink” being equivalent to 150ml wine (12% alcohol), 285ml beer (5% alcohol), or 30ml of spirits (40% alcohol).

• Supplements/ Herbs That May Improve Fatty Liver

Results from several studies suggest that certain herbs, vitamins and supplements may help reduce liver fat and decrease the risk of liver disease progression.

Silymarin from milk thistle seed is one of the best-researched herbal supplements that focused on promotes normal liver cells regeneration and supports the detoxification process. In a 90-day study of people with fatty liver, the group who took a silymarin (milk thistle extract 250-376mg per day) supplement and followed a low-calorie diet experienced twice the reduction in liver size as the group who followed the diet without taking the supplement.⁽⁸⁾

Turmeric is another natural herb supported by research that could prevent or treat non-alcoholic fatty liver disease. Curcumin in turmeric possesses powerful antioxidant and anti-inflammation effects, It also lowers levels of liver enzyme (marker of liver damage) alaine aminotransferase (ALT) and aspartate aminotransferase (AST).

In a study that included 60 adults with elevated ALT levels, the participants were randomly assigned to take 3 grams of turmeric powder, 3 times daily or placebo for 12 weeks. Compared to the control group, the turmeric group had significantly lower levels of ALT (−26.5% vs. -3.4%) and AST (−23.1% vs. -2.2%).⁽⁹⁾

References:

• Targher G, Mantovani A, Byrne CD, et al. Risk of severe illness from COVID-19 in patients with metabolic dysfunction-associated fatty liver disease and increased fibrosis scores. Gut 2020;69:1545-1547.
• A Roca-Fernández et al. High liver fat associates with higher risk of developing symptomatic COVID-19 infection. medRxiv 2020.06.04.20122457
• Scaglioni Fet al. Short-term multidisciplinary non-pharmacological intervention is effective in reducing liver fat content assessed non-invasively in patients with nonalcoholic fatty liver disease (NAFLD). Clin Res Hepatol Gastroenterol. 2013 Sep;37(4):353-8.
• Dimitrios A. Koutoukidis et al. Association of Weight Loss Interventions With Changes in Biomarkers of Nonalcoholic Fatty Liver Disease. JAMA Intern Med. 2019 Sep; 179(9): 1262–1271.
• Sevastianova Ket al. Effect of short-term carbohydrate overfeeding and long-term weight loss on liver fat in overweight humans. Am J Clin Nutr. 2012 Oct;96(4):727-34.
• Van der Windt. D.J.al. The Effects of Physical Exercise on Fatty Liver Disease. Gene expression. ;18(2), 89–101.
• et al. Endurance Exercise Reduces Hepatic Fat Content and Serum Fibroblast Growth Factor 21 Levels in Elderly Men. The Journal of Clinical Endocrinology & Metabolism. 2016 ;101(1), 91-198.
• Sorrentino Get al. Efficacy of lifestyle changes in subjects with non-alcoholic liver steatosis and metabolic syndrome may be improved with an antioxidant nutraceutical: a controlled clinical study. Drugs R D. 2015 Mar;15(1):21-5.
• Sang-Wook Kim et al. The effectiveness of fermented turmeric powder in subjects with elevated alanine transaminase levels: a randomised controlled study. BMC Complement Altern Med. 2013; 13: 58.

Torula yeast is also known as Candida utilis. It can be found everywhere including wood, paper pulp and any substrates that are rich in cellulose. It has a high nutritional value. Torula yeast has high protein content can be as high as 60%. The protein content in torula yeast is similar to soybeans but it also presents with a full range of B-complex vitamins. Torula yeast is an important source of glutathione which has a strong antioxidant activity that protects our body against oxidative stress.

What Are The Proposed Benefits of Torula Yeast?

• Prevent cellular damage by free radical and peroxides
• Facilitate the excretion of toxin during liver detoxification

Clinical Evidence

Study reveals that torula yeast extract has high glutathione concentration with high antioxidant properties. (1)

(1) Kieliszek et al. Metabolic Response of the Yeast Candida utilis During Enrichment in Selenium. Int. J. Mol. Sci. 2020, 21(15), 528

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Moreover, the liver is also a key player in your body’s digestive system. Everything you eat or drink, including medicine, passes through it. In short, your liver is a strong organ and it works hard to protect your health. If your liver stops working, so do you !

Unfortunately,  the liver is very slow to complain. Therefore, people who have problems with their liver are frequently unaware due to no symptoms.  The liver is such a determined organ that it will continue working even when two-thirds of it has been damaged. Some possible symptoms of poor liver health include chronic fatigue, jaundice of eye and skin, loss of appetite, fluid retention at lower extremities, itchy skin and mood swings.

Stop taking the liver for granted !

In Malaysia, diseases of the liver are on the increased. They are among the top 10 causes of mortality in Malaysia. Common causes of liver diseases are viral infections, fatty liver, alcohol, autoimmune conditions and inherited conditions. In particular, fatty liver has reached an epidemic proportion in Malaysia given that one quarter of the adult population suffers from the disease.

The liver is an organ you could easily trash if you do not take good care of it. What we eat and how we live our lives do affect liver health, even without us noticing. By learning more about your liver and how you can keep it healthy, you may actually help improve liver health and reduce the risk of developing liver diseases.

It is time to rejuvenate your liver 

The good news about the liver is that it has the ability to regenerate and to heal itself if we really take care of it. Using a combination of diet and lifestyle changes , you can help protect and improve your liver health, allow it to do what it does best.

• Maintain a Well-Balanced Diet

A well-balanced diet includes a variety of fresh whole foods including fruits and vegetables, whole grains (brown rice, wholemeal bread, quinoa), protein sources (legumes, lean meats, tofu, eggs), dairy (low-fat yogurt, milk and cheese) and sources of healthy fat (nuts, avocado, fatty fish).

It is crucial to limit the amount of processed , high fat and high sugar foods. A 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.

• Maintain a Healthy Body Weight

Being overweight or obese has been linked to deposits of fat in the liver. This leads to chronic inflammation and scarring of the liver (known as cirrhosis).  Body mass Index (BMI) greater than 23kg/m² is classified as overweight while BMI equal or above 25kg/m² is obese.

According to The National Health and Morbidity Survey 2019, one in two adults in Malaysia are either overweight or obese. Fatty liver rate has been estimated to be about 30%.

A study in the JAMA Internal Medicine found that people who lost just 3% to 6% of their body weight reduced their liver fat levels by 35% to 40%.⁽¹⁾

• Exercise Regularly

Regular, moderate physical activity lead to a healthy body weight and also promotes normal liver health. Aim for 150 minutes of activity weekly, or 30 minutes five times a week. You can make simple changes like taking parking as far away from office  doors as possible, taking the stairs instead of escalators or elevators or going for a walk after dinner instead of sitting watching TV.

Scientific data showed that performing a combination of aerobic exercise (brisk walking, jogging, hiking, cycling) and resistance training (pushup, chin-up, sit-up, body squat) appear to diminish the amount of fat stored in liver cells.⁽²⁾ In a 4-week study, obese individuals who trained for 30-60 minutes, five days per day, saw an impressive 10% loss in liver fat, even though their weight remained unchanged. ⁽³⁾

• Limit or Eliminate Alcohol

Your liver treats alcohol like any other toxic chemical. Too much alcohol can damage liver cells and lead to fatty liver, fibrosis, and the deadly disease, cirrhosis. Malaysia, though a small country, is the tenth largest consumer of alcohol in the world.

“The National Health and Morbidity Survey (NHMS) 2019 claims that 1 in 2 Malaysian drinkers binge drink , which means 6 or more standard drinks per sitting at least once a week.”

The intake of alcohol should be limited to no more than 1 standard drink per day for women and no more than 2 standard drinks per day for men. A “drink” being equivalent to 150ml wine (12% alcohol), 285ml beer (5% alcohol), or 30ml of spirits (40% alcohol).

• Stop Smoking

Smoking can increase the risk of both liver cancer and cirrhosis of the liver. The toxic chemicals in tobacco smoke can cause inflammation and eventual cirrhosis. Smoking

also promotes the production of cytokines, chemicals that cause even more inflammation and damage to liver cells.

A study conducted on the relation of smoking and risk of liver cirrhosis showed that 12% of  liver cirrhosis cases among women and 6 % of liver cirrhosis cases among men have been attributed to smoking.⁽⁴⁾

• Support Healthy Liver Function with Herbs

Many herbs such as milk thistle seed and turmeric have traditionally been used to promote normal processes of the liver and offer natural support for detoxification.

Silymarin from milk thistle seed is one of the best-researched herbal supplements that  focused on promotes normal liver cells regeneration and supports the detoxification process.

A double blind, prospective, randomized study was performed to determine the effect of silymarin on the outcome of patients with cirrhosis. Of the 170 patients with cirrhosis, 87 were treated with silymarin 420 mg/day and 83 received placebo for at least 24 months,  with a median observation period of 41 months.The 4 year survival rate was 58% in silymarin treated patients and 39% in the placebo group. ⁽⁵⁾

Curcumin in turmeric possesses powerful antioxidant effects and lowers levels of liver enzyme (marker of liver damage) alaine aminotransferase (ALT) and aspartate aminotransferase (AST).

A study included 60 adults with elevated alanine aminotransferase (ALT) levels. The participants were randomly assigned to take three grams of turmeric powder, three times daily or placebo for 12 weeks. Compared to the control group, the turmeric group had significantly lower levels of ALT (−26.5% vs. -3.4%) and AST (−23.1% vs. -2.2%).⁽⁶⁾

In summary, when something goes wrong with the liver, it can have a serious effect on almost every other organ in the body. The liver can be a very forgiving organ, but it has its limits. Fortunately, you can easily take care of your silent partner by practicing healthy lifestyle and avoiding risky behaviors that can lead to liver cell damage and diseases.

References:

1. Dimitrios A. Koutoukidis et al. Association of Weight Loss Interventions With Changes in

Biomarkers of Nonalcoholic Fatty Liver Disease. JAMA Intern Med. 2019 Sep; 179(9): 1262–1271.

2. Van der Windt. D.J.al. The Effects of Physical Exercise on Fatty Liver Disease. Gene

expression. ;18(2), 89–101.

3. H. et al. Endurance Exercise Reduces Hepatic Fat Content and Serum Fibroblast Growth

Factor 21 Levels in Elderly Men. The Journal of Clinical Endocrinology & Metabolism. 2016 ;101(1), 91-198.

4. Dam MKet al. Smoking and risk of liver cirrhosis: a population-based cohort study. Scand J

Gastroenterol. 2013 May;48(5):585-91.

5. Anton Gillessen et al. Silymarin as Supportive Treatment in Liver Diseases: A Narrative Review.

Advances in Therapy volume 37, pages1279–1301(2020)

6. Sang-Wook Kim et al. The effectiveness of fermented turmeric powder in subjects with elevated

alanine transaminase levels: a randomised controlled study. BMC Complement Altern Med. 2013; 13: 58.

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 The liver is a large, meaty organ that sits on the right side of the belly. It is the heaviest organ in the body. Our liver is working hard for 24/7 as it performs over 500 vital functions including digestion, metabolism, detoxification, immunity, protein synthesis and the storage of nutrients within the body to keep us healthy and alive. However, its function is often not noticed and taken for granted.

Functions of the Liver

• Blood detoxification and purification
• Excretion of bilirubin, cholesterol, hormones, and drugs
• Enzyme activation
• Bile production and excretion
• Metabolism of fats, proteins, and carbohydrates

Example of Liver Diseases

• Diseases caused by viruses, like hepatitis A, hepatitis B, and hepatitis C
• Diseases caused by drugs or too much alcohol such as fatty liver disease and cirrhosis.
• Liver cancer
• Inherited diseases, such as hemochromatosis and Wilson disease

Symptoms of Poor Liver Function 

• Fatigue and Tiredness
• Jaundice of Eye and Skin
• Loss of Appetite
• High Levels of Cholesterol
• Itchy and Sensitive Skin
• Unexpected outbursts of emotion

Ways to Keep Your Liver Healthy

1. Maintain a healthy weight
   Weight loss is key to preventing complications of fatty liver. A study showed that losing 10% of one’s body weight can reduce liver fat, resolve inflammation, and potentially improve scarring.
2. Have a balanced and healthy diet
   Include more high fibre foods such as fruits and vegetables and whole grains. For proteins, choose more fish, white meat, beans and nuts. Saturated fats and trans fats found in deep fried foods, red meats and processed food might lead to excess fat buildup and store in the liver that cause fatty liver disease.
3. Avoid alcohol intake
   Alcohol must be broken down by the liver.  However, Alcoholic beverages can create many health problems. They can damage or destroy the liver cells and lead to inflammation and scarring (cirrhosis).
4. Regular exercise and have an active lifestyle
   Regular exercise is key to a healthy liver. Exercise decreases stress on the liver, increases energy levels and helps to maintain healthy weight. Aim for at least 30 minutes of exercise a day, such as brisk walking or swimming.

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