Liver disease affects billions of people worldwide. With its vital role in detoxification, metabolism, digestion, protein synthesis, and micronutrient storage, liver disease can have profound health consequences. A growing body of evidence supports the efficacy of a functional and integrative approach in addressing liver disease. This holistic approach aims to understand the underlying causes of dysfunction, optimize liver function, and promote overall wellness by combining traditional medicine techniques with complementary and integrative (CIM) therapies. This article will explore the general principles of liver disease and a patient-centered approach to optimizing liver health with functional testing and CIM interventions.
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What Is Liver Disease?
The liver is a vital organ in the upper-right quadrant of the abdomen responsible for over 500 essential bodily functions, including detoxification of harmful substances, metabolism of nutrients, and synthesis of bile, proteins, and cholesterol. Liver disease is a term that encompasses any condition that affects the structure or function of the liver (1). An estimated 80-100 million American adults have some form of liver disease, although only 4.5 million have been diagnosed. Common types of liver disease include hepatitis, cirrhosis, non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease, and liver cancer (2).
Symptoms of Liver Disease
Symptoms of liver disease can be vague, non-specific, and vary depending on the specific condition (2). When signs and symptoms of liver disease appear, they may include (1, 2):
- Fatigue and weakness
- Jaundice (yellowing of the skin and eyes)
- Abdominal pain and swelling
- Nausea or vomiting
- Loss of appetite
- Dark urine
- Pale stools
- Easy bruising
- Itchy skin
- Swelling in the lower extremities
- Weight loss
What Causes Liver Disease?
Liver disease has many causes, commonly including infection, immune dysregulation, genetics, metabolic dysfunction, and cancer (1, 6). Some individuals may have a combination of factors contributing to their liver disease.
Viral Hepatitis
Viral hepatitis is a group of infectious diseases caused by viral hepatitis viruses A, B, C, D, and E. These viruses target and infect the liver, leading to inflammation and liver damage. (7)
Non-Alcoholic Fatty Liver Disease
NAFLD occurs when excess fat accumulates in the liver in people who drink little or no alcohol. When little-to-no inflammation occurs from fatty liver, it is called non-alcoholic fatty liver (NAFL). When inflammation occurs and causes liver injury, the disease is called non-alcoholic steatohepatitis (NASH). NAFLD is often associated with obesity, diabetes, high cholesterol, and metabolic syndrome.
There exists bidirectional crosstalk between the gut and the liver, which has been termed the gut-liver axis. Diet, the microbiome, bile acids, and the degree of intestinal permeability ("leaky gut") can influence the development of NAFLD.
Alcoholic Fatty Liver Disease
Excessive and prolonged alcohol consumption can lead to alcoholic liver disease, which ranges in severity from fatty liver to hepatitis (liver inflammation) and cirrhosis (liver scarring).
Autoimmune Liver Disease
When the body's immune system attacks the liver, autoimmune liver disease can develop. These diseases can lead to cirrhosis and, eventually, liver failure. Autoimmune liver diseases include primary biliary cholangitis, primary sclerosing cholangitis, and autoimmune hepatitis. (8)
Autoimmune diseases are multifactorial, involving the interplay of environmental factors, including diet, toxin exposure, and stress, in genetically susceptible individuals.
Other Causes of Liver Disease
Additional causes of liver disease include inherited genetic disorders, cancer, and the use of certain prescription or over-the-counter medications and supplements (1).
Functional Medicine Labs to Test for Root Cause of Liver Disease
Early diagnosis and understanding of the underlying cause of liver disease influence the treatment approach and patient prognosis. Functional medicine tests help to do both so that appropriate management strategies can be implemented to address liver disease effectively. These tests are often ordered with liver imaging and biopsy, which can visualize the liver and analyze its tissues to assess for and determine the degree of liver disease.
Liver Panel
A liver panel assesses liver function by measuring liver enzymes, proteins, and bilirubin, which will elevate due to liver dysfunction or damage. Abnormal findings within this panel are often the first indicators of liver disease and indicate the need for additional testing and imaging.
Viral Hepatitis
A hepatitis panel measures immune proteins called antibodies made by the immune system in response to hepatitis A, B, and C infections to diagnose and differentiate between the types of viral hepatitis.
Autoimmune Panel
An ANA is a screening blood test that looks for antinuclear antibodies in the blood, which may be a sign of an autoimmune disorder if present in large amounts. An autoimmune liver disease panel can be ordered with serum ANA to screen for autoimmune proteins more specific to autoimmune liver disease.
Metabolic Function
Diabetes and lipid panels can be ordered to comprehensively evaluate metabolic health, which helps determine the underlying causes of NAFLD. The diabetes panel measures six biomarkers, including glucose, hemoglobin A1c, and insulin, to assess insulin sensitivity and glucose metabolism. Impaired lipid metabolism is often observed in patients with chronic liver diseases. While dyslipidemia and elevated cholesterol can expedite the progression of NAFLD, reduced cholesterol levels can indicate cirrhosis and liver failure.
Gut Assessment
A comprehensive stool analysis and SIBO breath test help evaluate the gut-liver axis and identify dysbiosis, intestinal inflammation, and increased permeability as causes of NAFLD and liver inflammation.
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Conventional Treatment for Liver Disease
Conventional treatment for liver disease depends on the specific condition, but common approaches include vaccinations to prevent viral hepatitis; lifestyle modifications; and medications and surgery to manage symptoms, slow disease progression, and manage disease complications (2). The only current treatment for end-stage liver disease is liver transplant.
Functional Medicine Approach to Treating Liver Disease
A functional medicine approach to treating liver disease aims to optimize liver function and prevent disease progression by addressing the underlying causes and supporting the body's innate healing abilities. It emphasizes an integrative and collaborative approach that considers the whole person and utilizes various healing modalities.
Best Diet for Patients With Liver Disease
The best diet for patients with liver disease can vary depending on the specific condition. However, in general, key principles should be considered to support liver health and prevent malnutrition, which is prevalent in patients with chronic liver disease and adversely affects patient outcomes (5).
The nutritional focus should be on a nutrient-rich, well-balanced, anti-inflammatory diet that provides essential vitamins, minerals, antioxidants, and fiber for gastrointestinal and liver function, reduces inflammation, improves metabolism, and nourishes the patient (3). Evidence strongly supports using the anti-inflammatory Mediterranean diet in treating NAFLD and its associated risk factors, including insulin resistance, type 2 diabetes, obesity, and dyslipidemia. This dietary plan is a collection of eating habits characterized by a high intake of fruit, vegetables, legumes, and complex carbohydrates and moderate consumption of fish and olive oil as the primary sources of healthy fats. The Mediterranean diet is therapeutic in preventing and treating fatty liver disease by effectively aiding weight loss, improving glucose and lipid metabolism, and reducing systemic and cardiovascular inflammation. (4)
Alcohol consumption should be avoided since alcohol puts excess stress on the liver, induces inflammation, worsens liver damage, and impedes healing.
Supplements and Herbs for Patients With Liver Disease
Research suggests that nutraceutical supplementation can benefit patients with liver disease by reducing inflammation and protecting the liver from further damage. Supplements should be tailored to the patient's needs, specific to the underlying cause of liver disease. Popular dietary and herbal supplements recommended by functional medicine doctors for treating liver diseases are summarized below.
Fish Oil for Liver Disease
Omega-3 fatty acids in fish oil supplements are anti-inflammatory polyunsaturated fatty acids (PUFAs). Omega-3s are essential for cell membrane structure and function and modulate the risk of cardiovascular disease. A 2016 meta-analysis including ten studies concluded that omega-3 PUFAs improved liver fat accumulation, reduced liver inflammation as measured by gamma-glutamyl transferase (GGT), and improved triglyceride and HDL cholesterol compositions in patients with NAFLD/NASH.
Milk Thistle for Liver Disease
Milk thistle (Silybum marianum) has been used as a liver-protective herb for centuries. Silymarin, the bioactive component of milk thistle, has been studied for various liver conditions and is known to have antioxidative effects in the liver that reduce liver damage. Silymarin has also been shown to reduce the liver enzyme alanine transaminase (ALT), liver fibrosis, and insulin resistance. (7, 9)
Vitamin E for Liver Disease
Commonly used with silymarin, vitamin E can reduce liver fibrosis, liver enzymes, fatty deposition, and inflammation in patients with NAFLD because of its anti-inflammatory and antioxidant properties.
Probiotics for Liver Disease
Probiotics can be beneficial in managing liver diseases by optimizing the gut-liver axis through their positive influence on the microbiome, intestinal barrier integrity, immune tolerance, and inflammation. Research has demonstrated that probiotics improve liver enzymes, fatty deposition, inflammation, scarring, and cardiometabolic markers. (10, 11)
Complementary and Integrative Medicine for Patients With Liver Disease
Using the results of the 2012 National Health Interview Survey, a 2017 review found that 41% of adults with liver disease used CIM therapies as part of their treatment regimen. The most commonly reported CIM therapies included herbs and supplements, massage, chiropractic/osteopathic manipulation, mind-body therapies and exercise, diet therapy, homeopathy, and acupuncture.
Research on using acupuncture for treating liver disease is limited but favors its positive effects on treatment outcomes. Studies have suggested that acupuncture may benefit patients with viral hepatitis, NAFLD, and cirrhosis. Results noted in these studies include reduced liver inflammation and liver enzyme levels, improved liver function and insulin resistance, decreased liver fat content, and alleviation of liver disease-associated symptoms.
Mind-body therapies activate the body's innate relaxation response to address chronic physical and emotional stress. Mindfulness-based stress reduction (MBSR) can help manage stress, anxiety, depression, and sleep disturbances associated with chronic liver disease to promote overall quality of life.
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Summary
Liver disease has many potential causes that ultimately affect the structure and function of the liver. Integrating functional medicine principles into a treatment strategy can improve liver function, manage symptoms, and enhance the overall quality of life for patients with liver conditions. These principles include identifying underlying causes of disease and promoting whole-body health through diet, nutraceutical supplements, and other CIM modalities.
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