Posted by By Dr Ingrid Bauer, MD, MS on Oct 4th 2024
The liver is a key organ for maintaining homeostasis–balance–in the body. The liver not only clears toxins, but also produces important proteins and plays a central role in fat and glucose metabolism. In East Asian Medicine, the Liver is seen as a regulator of emotional well-being and the blood. A common condition faced by many people living a modern lifestyle is fatty liver disease. Excessive fat build-up in the liver can lead to inflammation and eventually fibrosis (hardening) of the tissues, resulting in liver dysfunction and even cirrhosis. Read on to learn more about traditional Chinese medicine perspectives as well as evidence-based Western medicine recommendations to optimize liver health naturally.
Key Takeaways:
1. The Liver's Crucial Role in Overall Health: The liver is a vital organ responsible for numerous functions, including detoxification, protein production, and metabolism. Its health is essential for maintaining overall well-being.
2. The Impact of Fatty Liver Disease: Excessive fat accumulation in the liver can lead to inflammation, fibrosis, and even cirrhosis. This condition is often associated with obesity, unhealthy diets, and sedentary lifestyles.
3. The Importance of Lifestyle Modifications: To prevent and manage fatty liver disease, it's crucial to adopt healthy lifestyle habits such as maintaining a healthy weight, eating a balanced diet, and engaging in regular physical activity.
4. The Benefits of Herbal Therapies: Both Western and Traditional Chinese Medicine offer herbal remedies that can support liver health and aid in the management of fatty liver disease. These herbs often possess antioxidant, anti-inflammatory, and detoxifying properties.
5. The Combined Approach of Western and TCM: A holistic approach to liver health often involves a combination of Western medical recommendations and traditional Chinese medicine practices, providing a comprehensive plan for optimizing liver function and well-being.
How does the Liver Work?
The liver is the largest internal organ in the human body, weighing about three pounds. It is a complex and multifaceted organ that is integral to many critical bodily functions. Consequently, maintaining liver health is essential for overall health.
5 BASIC FUNCTIONS OF THE LIVER
- Neutralizes and removes toxins that are ingested or produced by the body.
- Produces bile (which is stored in the gallbladder) that breaks down fats for healthy digestion.
- Regulates blood sugar levels and lipid metabolism for balanced energy.
- Produces, stores, and interacts with hormones involved in growth, immune response, and nutrient balance.
- Produces essential blood proteins like albumin, which helps regulate blood volume and carries hormones and nutrients throughout the body, as well as coagulation factors, which help with normal clotting.
TCM Perspectives on the Liver
In traditional Chinese medicine, the Liver stores Blood and ensures the flow of qi, life force or vital essence, through the body. Additional actions include regulating tendons and nails, opening to the eyes, and housing the “ethereal soul. ”
When the qi is constrained, and/or Blood is deficient, the qi stagnates, which can lead to emotional irritability and insomnia as well as abdominal sensations such as bloating and epigastric pain. Since the Lungs and Stomach need smoothly flowing qi to absorb oxygen and dietary nutrients, qi stagnation can impact breathing and digestion as well, including sensations of tightness in the throat, nausea and regurgitation. Classical herbs for moving the Liver qi and rectifying qi include Bupleurum (chai hu), Turmeric (yu jin), Mint (bo he), and Cyperus (xiang fu). Bupleurum, Dragon Bone & Oyster Shell Formula (chai ju jia long gu mu li tang) is a classical formula for soothing irritable emotions that incorporates herbs that move the liver qi with herbs that calm and settle the spirit.
The Liver’s storage of Blood relates to regulation of menses, Blood delivery to the tissues during activity and Blood return during rest. Blood deficiency can result in fatigue, menstrual pain or irregularities, and brittle nails and hair–not unlike the Western medical condition of anemia. One of the most widely used TCM formulas for menstrual irregularities is Free & Easy Wanderer (xiao yao san), which contains Bupleurum to move the Liver qi along with blood-building herbs Dong Quai (dang gui) and White Peony (bai shao), and digestion-supporting herbs Ginger (sheng jiang) and Chinese mint (bo he).
What is Fatty Liver Disease?
Nonalcoholic fatty liver disease (NAFLD) refers to any process NOT caused by alcohol or viral hepatitis that leads to excessive fat deposition in the liver. NAFLD is defined as just fat buildup, and can be seen on an ultrasound, but without any symptoms or lab abnormalities. Unchecked, this buildup of fat can oxidize, which creates inflammation and leads to liver damage, which is called nonalcoholic steatohepatitis (NASH). Over time, NASH can lead to cirrhosis of the liver, not unlike the long-term effects of alcohol or chronic viral hepatitis. In the United States, about 25% of adults have NAFLD and about 5% have NASH; up to 50% of individuals with NASH may develop cirrhosis.
The leading cause of fatty liver is obesity, especially when body fat accumulates in the trunk, sometimes referred to as an “apple-shaped” body habitus. A calorie-rich diet high in processed carbohydrates, especially high-fructose corn syrup, as well as excess poor-quality fats (grain-fed and hormone-supplemented meats and dairy, as well as hydrogenated oils and trans-fats), are top-contributors to fatty liver. Sedentary lifestyle, with low lean body mass and less caloric output, as well as pro-inflammatory habits like smoking or eating fried foods or charred meats, also contribute to fat buildup in the liver. Many people also inherit genes that increase their risk of fatty liver.
How do I know if I have Fatty Liver?
If you are concerned about fatty liver, please see a qualified clinician for a basic evaluation. In addition to measuring vital signs, especially blood pressure, they will also calculate your Body Mass Index (BMI) and your hip-to-waist circumference ratio. Lab tests may include a comprehensive metabolic panel, lipid panel, hemoglobin A1c, and high-sensitivity C-reactive protein (hs-CRP). If you have never been tested for viral hepatitis or HIV, these should be checked too. Abnormalities to look for include elevated ALT, high triglycerides, low HDL, high hs-CRP, high fasting glucose and/or elevated hemoglobin A1c. If you have an elevated ALT combined with any other abnormalities in the above labs, the next step is a liver ultrasound and/or “fibro-scan”. In some cases, if there are severe abnormalities on these scans, you may be referred for a liver biopsy, although thanks to advances in imaging technology, often the diagnosis can be made without such an invasive procedure.
What does Western Medicine recommend for Fatty Liver?
Western medical recommendations for reducing fat deposition in the liver and preventing the progression from NAFLD to NASH or cirrhosis are founded on common sense lifestyle recommendations.
- Lose belly fat (and build lean muscle)
- Control blood sugar and avoid high-fructose corn syrup
- Avoid “bad” fats (trans fats) & eat healthy fats (omega-3s, avocado)
- Avoid alcohol and other liver toxins
- Drink a moderate amount of coffee
- Consume natural sources of vitamin E and other food-based antioxidants
- Get tested for viral hepatitis and vaccinate against Hepatitis A and B
In addition to these treatments, it’s important to continue getting regular monitoring with labs and imaging to make sure your efforts are making a positive change!
Which Western Herbs support the liver?
In addition to adopting a healthy diet and exercising to lose fat and build muscle, Western herbalism offers a robust toolkit for supporting a healthy liver. We know that reducing inflammation and supporting the normal detoxification functions of the liver can help minimize the progression of liver disease, and also help us feel well enough to exercise and eat like we should!
- Antioxidant-rich herbs help neutralize toxins in the liver, making them easier to metabolize. Milk thistle, rosehips, dandelion, goji berries, and turmeric are a few excellent choices.
- Milk thistle has been extensively researched for its ability to support liver health, including playing a therapeutic role in NAFLD.
- Turmeric has been shown in a meta-analysis to improve biochemical markers in individuals with NAFLD.
- A product we love, which is an alcohol-free capsule, is Liver Cleanse by Thorne.
- Amino acid- and sulfur-containing herbs enhance the activity of glutathione, produced in the liver to make toxins water-soluble so they can be easily excreted. Spirulina, alfalfa, nettle, horsetail, burdock, and parsley are natural sources of these nutrients. Brassicas (broccoli, cabbage, etc) and alliums (onions, garlic & leeks) are great dietary sources of sulfur compounds as well.
- Digestive and fiber-filled herbs facilitate efficient nutrient absorption and help move waste out of the body. Try marshmallow, licorice, triphala, psyllium husk, rhubarb, and yellow dock to keep things moving along, in addition to robust portions of salads and cooked leafy greens in the diet.
- Bitters help aid the liver’s detoxification efforts by stimulating the production of digestive enzymes and promoting bile flow while improving the absorption of nutrients and elimination of wastes. Classic bitter herbs include artichoke leaf, gentian, Oregon grape root, and dandelion root, or our G.I. Feel Better tincture. For dietary sources of bitters, try dandelion greens, arugula, kale, swiss chard, collards, or mustard greens.
How does TCM view Fatty Liver?
From a TCM perspective, fatty liver can be seen as excessive stagnation of Liver qi plus damp heat in the body converting to Liver fire. Symptoms include headache, dry mouth, red eyes, and a bitter taste in the mouth, as well as easy nosebleeds or menorrhagia. Herbs to clear heat and dampness Gentian (long dan), Baikal skullcap (huang qin), Chrysanthemum (ju hua), which are often combined with blood-nourishing, cooling herbs like Raw Rehmannia (sheng di huang) and Moutan Peony (mu dan pi). A classical formula for addressing Liver fire is Gentian Liver-Draining Decoction (long dan xie gan tang).
Fatty liver can also result from deficiency and dampness of the Spleen (the TCM concept, not the anatomical organ), manifesting as sluggish digestion, bloating, low energy, low muscle mass and weight gain. To tonify and drain dampness from the Spleen, consume foods appropriate for the season (ie warm soups in winter not cold smoothies, and reserving raw fruits & veggies for the warmer months), avoid excessive cold beverages, and try to eat mindfully (ie not while driving, working, etc). Herbs to support the Spleen’s ability to regulate digestion and metabolism include Astragalus (huang qi), Codonopsis (dang shen), and Atractylodes (bai zhu). Traditional formulas that may support the Spleen and benefit fatty liver include Restore the Spleen Formula (gui pi tang) and Resolve the Middle Formula (jia wei ping wei fang).
Mentioned above, Free & Easy Wanderer (xiao yao san) supports both the coursing of the Liver qi and tonifying & draining dampness from the Spleen. While most commonly prescribed by acupuncturists for premenstrual symptoms and irregular periods, this formula may support a diverse array of individuals experiencing a combination of emotional upset, abdominal distention, and sluggish digestion. Multiple scientific studies have examined the role this formula may play in protecting the liver and in treating NAFLD.
Take Home Points
- The liver plays a key role in maintaining balance in the body
- Excessive fat buildup in the liver (NAFLD) can lead to inflammation (NASH) and ultimately fibrosis of the liver (cirrhosis)
- Maintaining a healthy weight through eating right and moving your body are the most fundamental ways to avoid fat buildup in the liver
- Western herbs and vegetables play a key role in maintaining liver health
- TCM formulas for promoting liver wellness are backed by traditional use and modern research.
Conclusion
Fatty liver disease is a growing concern worldwide, often stemming from unhealthy lifestyle choices and underlying health conditions. This comprehensive blog has explored both Western and Traditional Chinese Medicine perspectives on this condition, providing valuable insights into its causes, symptoms, and potential treatments.
By adopting a holistic approach that incorporates lifestyle modifications, herbal therapies, and a combination of Western and TCM practices, individuals can significantly improve their liver health and reduce the risk of complications associated with fatty liver disease. Remember, prevention is key, and with the right knowledge and strategies, it's possible to maintain a healthy liver and enjoy a vibrant life.