Hampered detoxification processes can result in a condition labeled by many naturopathic and nutrition-oriented physicians as the “congested” or “sluggish” liver, or the more recently coined “impaired hepatic detoxification”. Standard liver enzyme blood tests may or may not be elevated in such cases.
The congested or sluggish liver is characterized by a diminished bile flow, a condition known in medical terms as cholestasis, while impaired hepatic detoxification refers to decreased phase I and/or phase II enzyme activity. Phase I detoxification rates that are in excess of phase II activity will also cause toxicity problems due to excessive accumulation of activated intermediates. Although there are more sensitive tests to determine the functional activity of the liver, such as a serum bile acid assay and various clearance tests, clinical judgment based on medical history remains the major diagnostic tool for the sluggish liver. The presence of chronic fatigue is a frequent symptom. Clearance tests using saliva, urine, and/or blood after chemical challenge by caffeine, aspirin, and acetaminophen can be useful in detecting Phase I and II imbalances.
Impaired liver function can result from intrahepatic problems caused by exposure to food additives, solvents (cleaning materials, formaldehyde, toluene, benzene, etc.), pesticides, herbicides, heavy metals (lead, mercury, cadmium, arsenic, nickel, and aluminum), and other toxins. Other causes include viral infections of the liver, some inherited disorders such as Gilbert’s syndrome, alcohol induced fatty deposits, the use of anabolic steroids/estrogens/oral contraceptives and hyperthyroidism. Bile flow can be restricted also by extrahepatic means such as gallstones, pregnancy, or other physical causes such as tumors.
Among the other symptoms, people with a sluggish liver may complain of depression, general malaise, headaches, digestive disturbances, allergies and chemical sensitivities, premenstrual syndrome, and constipation. Not surprisingly, these are the same types of symptoms people exposed to toxic chemicals often complain of. Many toxic chemicals (especially solvents) and heavy metals have an affinity for nervous tissue, giving rise to a variety of psychological and neurological symptoms such as depression, headaches, mental confusion, mental illness, tingling in extremities, abnormal nerve reflexes, and other signs of impaired nervous system function.
The capacity of the liver to detoxify any given compound is determined not only by the inherent toxicity of the compound but also by the available supply of nutrients and endogenous molecules required for Phase I and II reactions, by any pre-existing liver disease which may be present and by the total load of all toxins to which it is exposed.
Signs, symptoms & indicators of Liver Detoxification / Support Requirement
Positive results from coffee enemas
Counter Indicators
Coffee enemas do not help
Undigested fat in stools
Greasy/shiny stools
Pale stools
(High) cigarette smoke sensitivity
(High) chemical sensitivity
No desire/inability to recover from alcoholism or being a recovering alcoholic
Sickness caused by wine
Negative reaction to coffee
Greasy food intolerance
Unexplained nausea
Dark areas under eyes
Bags under eyes
Some health care providers believe that dark circles under the eyes indicate toxicity and a need for detoxification.
Metallic taste in mouth
Bitter taste in mouth
Allergic rhinitis
Liver/gallbladder cleanses help
(Severe) pain under right side of ribs
Counter Indicators
Liver/gallbladder cleanses no help
Foot odor/sweating
Counter Indicators
Absence of foot odor/sweating
A 'foggy' mind
Pain between shoulder blades
Breast soreness during cycle
Joint pain/swelling/stiffness
Itchy skin
Diminished perspiration
Bizarre/vivid/nightmarish/no bad dreams
Forgetting dreams
Strong-smelling urine
Counter Indicators
Absence of urine odor
Conditions that suggest Liver Detoxification / Support Requirement
Elevated SHBG
The liver is responsible for removing excess estrogen and SHBG, so any compromise in liver function (such as that caused by heavy alcohol consumption, for example) can exacerbate hormonal imbalances.
Chronic Fatigue / Fibromyalgia Syndrome
In one evaluation of 200 Chronic Fatigue and Fibromyalgia patients it was found that 80% had a significant impairment of liver detoxification function.
Patients suffering from toxic burdens may experience a wide range of symptoms, among them fatigue and poor tolerance for exercise. These processes have been postulated to be a central factor in the development of CFS. Oxidative damage to mitochondria and the detoxification process itself is being considered as a fundamental mechanism in the development of CFS. [1 Bland JS, HealthComm Inc., 1997; Int Clin Nutr Rev 1988;8(4): pp.173-5]
Headaches, Migraine/Tension
A ‘sluggish liver’ often contributes to headaches.
Hangovers
Acetaldehyde is a toxic substance produced in the body from alcohol and is one of the impurities found in cheap wine and ‘moonshine’ spirits. Some researchers believe that an acetaldehyde buildup is the cause of hangovers. If the liver’s detoxification pathways are impaired, aldehydes can, instead of being converted to the next intermediate product, build up to harmful levels and cause damage since they are often more toxic than the original substances from which they are derived.
It is probably the metabolism of methanol to formaldehyde and formic acid that caused the symptoms of the hangover. Quick methanol metabolizers suffer more. This is reinforced by the fact that the types of drinks associated with more severe hangovers contain higher levels of methanol. [Hangovers: Not The Ethanol, Perhaps The Methanol, British Medical Journal, January 4, 1997;14: pp.2-3]
All types of alcoholic drinks contain some methanol, a substance blamed for the worst hangovers. Whiskey, cheap red wine, fruit brandy and other dark spirits contain the most methanol, sometimes as much as 2% by volume. Vodka and other clear drinks contain the least. In the liver, methanol takes 10 times longer than ethanol to break down.
Magnesium Requirement
Magnesium deficiency has been found to be more common in patients with diabetes, liver disease or malabsorption problems.
Night Blindness
Reduced night vision can be linked to a variety of conditions caused by impaired liver function which in turn reduces vitamin A metabolism.
Psoriasis
Correcting abnormal liver function is of great benefit in the treatment of psoriasis. The connection between the liver and psoriasis relates to one of the liver’s basic tasks (filtering and detoxifying the blood). Psoriasis has been linked to the presence of several microbial byproducts in the blood. If the liver is overwhelmed by excessive levels of these toxins in the bowel, or if there is a decrease in the liver’s detoxification ability, the toxin level in the blood will increase and the psoriasis will get worse.
Fibrocystic Breasts
Impaired liver function can result in excess circulating estrogens and a worsening of breast tenderness.
Risk factors for Liver Detoxification / Support Requirement
Excess Protein Consumption
High protein intakes may cause extra metabolic stress to be placed on the liver and kidneys.
(History of) elevated liver enzymes
Counter Indicators
Normal liver enzyme levels
Pain medication use
Antibiotic use
Tetracycline use
Counter Indicators
Taking typical/taking low/taking high dose silymarin
(High) solvent exposure
Long term exposure to environmental pollutants and continued affronts to the detoxifying systems may lead to oxidative stress, high levels of phase 1 activity in the liver, and reduced phase 2 detoxification.
Significant/mild/severe diesel exhaust exposure
High/low/moderate alcohol consumption
History of hemorrhoids
History of unexplained nausea
History of gallbladder attacks
History of ovarian cysts
Liver Detoxification / Support Requirement suggests the following may be present
Liver Detoxification / Support Requirement can lead to
Chronic Fatigue / Fibromyalgia Syndrome
In one evaluation of 200 Chronic Fatigue and Fibromyalgia patients it was found that 80% had a significant impairment of liver detoxification function.
Patients suffering from toxic burdens may experience a wide range of symptoms, among them fatigue and poor tolerance for exercise. These processes have been postulated to be a central factor in the development of CFS. Oxidative damage to mitochondria and the detoxification process itself is being considered as a fundamental mechanism in the development of CFS. [1 Bland JS, HealthComm Inc., 1997; Int Clin Nutr Rev 1988;8(4): pp.173-5]
Psoriasis
Correcting abnormal liver function is of great benefit in the treatment of psoriasis. The connection between the liver and psoriasis relates to one of the liver’s basic tasks (filtering and detoxifying the blood). Psoriasis has been linked to the presence of several microbial byproducts in the blood. If the liver is overwhelmed by excessive levels of these toxins in the bowel, or if there is a decrease in the liver’s detoxification ability, the toxin level in the blood will increase and the psoriasis will get worse.
Recommendations for Liver Detoxification / Support Requirement
Coffee Enema
The coffee enema causes the liver to produce more bile (which contains processed toxins) and moves bile out towards the small intestine for elimination. This frees up the liver to process more incoming toxic materials that have accumulated in the organs, tissues and bloodstream. Coffee contains some alkaloids that also stimulate the production of glutathione-S-transferase, an enzyme used by the liver to make the detox pathways run. It is pivotal in the formation of more glutathione, one of the main conjugation chemicals, enabling toxins to be eliminated via bile into the small intestine. So in other words, a coffee enema speeds up the detoxification process and minimizes the backlog of yet-to-be-detoxified substances.
Herbal Combinations
Some of the scientific research and practical experience of people using Triphala down through the ages has demonstrated that it is an effective blood purifier that stimulates bile secretion as it detoxifies the liver, helps digestion and assimilation, and significantly reduces serum cholesterol and lipid levels throughout body. As a result, it is regarded as a kind of universal panacea and is the most commonly prescribed herbal formula.
Many Indian people believe that triphala is able to care for the internal organs of the body as a mother cares for her children. Each of the three herbal fruits of Triphala takes care of the body by gently promoting internal cleansing of all conditions of stagnation and excess while at the same time it improves digestion and assimilation.
Chinese Thoroughwax (Bupleurum falcatum)
Bupleurum has a unique reputation for deeply cleansing an overburdened liver.
Castor Oil
Castor oil packs are commonly placed over the liver.
Turmeric Extract, Curcumin
Turmeric helps increase bile flow making it a liver cleanser that can rejuvenate your liver cells and recharge their capability to break down toxins.
Therapeutic Fasting
Fasting has a powerful effect on improving liver function, an effect which continues after the fast. However, fasting should be avoided in cases of severe liver disease or failure.
Alcohol Avoidance
Acetaldehyde, a metabolic breakdown product of alcohol, is said to destroy vitamins B1, B6 and C. Even though supplements of these nutrients, together with the amino acid cysteine, may help the liver detoxify acetaldehyde, it would be wiser to avoid alcohol, it’s primary source.
Alpha Lipoic Acid
Alpha-lipoic acid has been used very successfully as a therapeutic agent in a number of conditions relating to liver disease, including alcohol-induced damage, mushroom poisoning, metal intoxification and carbon tetrachloride poisoning.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Weakly counter-indicative |
| Strongly counter-indicative |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Naturopathy
Medical practice using herbs and other various methods to produce a healthy body state by stimulating innate defenses without the use of drugs.
Enzymes
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Bile
A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.
Cholestasis
Cessation or suppression of bile flow.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Chronic Fatigue Syndrome
CFS (Chronic Fatigue Syndrome) is a disorder of unknown cause that lasts for prolonged periods and causes extreme and debilitating exhaustion as well as a wide range of other symptoms such as fever, headache, muscle ache and joint pain, often resembling flu and other viral infections. Also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Chronic Epstein-Barr Virus (CEBV), Myalgic Encephalomyelitis (ME), "Yuppy Flu" and other names, it is frequently misdiagnosed as hypochondria, psychosomatic illness, or depression, because routine medical tests do not detect any problems.
Anabolic
Anabolic compounds: Allow the conversion of nutritive material into complex living matter in the constructive metabolism.
Steroid
Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.
Hyperthyroidism
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Gallstone
(Biliary Calculus): Stone-like objects in either the gallbladder or bile ducts, composed mainly of cholesterol and occasionally mixed with calcium. Most gallstones do not cause problems until they become larger or they begin obstructing bile ducts, at which point gallbladder "attacks" begin to occur. Symptoms usually occur after a fatty meal and at night. The following are the most common ones: steady, severe pain in the middle-upper abdomen or below the ribs on the right; pain in the back between the shoulder blades; pain under the right shoulder; nausea; vomiting; fever; chills; jaundice; abdominal bloating; intolerance of fatty foods; belching or gas; indigestion.
Malaise
A vague feeling of bodily discomfort, as at the beginning of an illness. A general sense of depression or unease.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Premenstrual Syndrome
PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.
Constipation
Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Estrogen
One of the female sex hormones produced by the ovaries.
Fibromyalgia
(FMS): Originally named fibrositis, it is a mysteriously debilitating syndrome that attacks women more often than men. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain that often moves about the body. Fibromyalgia can be so severe that it is often incapacitating.
Mitochondrion
Structure inside a cell that is the location of the cell's energy production machinery. (Plural: Mitochondria)
Metabolism
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Vitamin A
A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.
Psoriasis
An inherited skin disorder in which there are red patches with thick, dry silvery scales. It is caused by the body making too-many skin cells. Sores may be anywhere on the body but are more common on the arms, scalp, ears, and the pubic area. A swelling of small joints may go along with the skin disease.
Protein
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.