How to restore liver cells, protect from toxins and maintain liver health in fatty dystrophy and chronic hepatitis

Many people think of the liver as the main “cleansing station” of the body, and indeed - without it we would have a hard time.Many drugs and toxins are neutralized in the liver.But it also forms vital proteins, produces bile, deposits glycogen - in general, everything happens without which human life is impossible.More about the structure and functions of the liver, its most common diseases, their symptoms, treatment, as well as preventive measures we will tell you in this article.

The liver is the largest organ of the human body, its weight can reach 1.5 kg. In the norm, it is compactly “hidden” on the right side behind the ribs and only slightly protrudes beyond them by the edge of thin people, but in some diseases it increases so much that it drops to the level of the navel. The enlargement of this organ is called hepatomegaly and can occur in a wide variety of diseases.

The role of the liver in the human body is difficult to overestimate. It performs a number of vital functions - detoxification, digestive, regulatory and synthetic. Let's look at the main processes that occur in this organ:

• Transformation (metabolism) of incoming substances, including drugs. Very often it happens that they enter the body in an inactive form and, only after passing through the liver, are transformed into active forms. Sometimes for “complete conversion” requires passing not only through the liver, but also through the kidneys - as is the case with vitamin D;
• formation and secretion of bile, without which food will not be digested in the intestine;
• regulation of carbohydrate metabolism - when the blood glucose level rises, the liver quickly converts its excess into glycogen (“energy depot”). And vice versa: as soon as hunger comes, and there is nothing to eat - the liver breaks down glycogen (this process is called glycogenolysis) and the body receives the necessary “food”;
• control of cholesterol metabolism. Not always improper diet and obesity are to blame for hypercholesterolemia - liver disease can also lead to it. Cholesterol, triglycerides, useful and harmful lipoproteins are synthesized in this organ;
• synthesis of substances responsible for blood clotting - for example, prothrombin. Note: often a sign of liver damage is not jaundice (high levels of bilirubin), but bleeding;
• formation of enzymes, serum albumin, urea and many other substances.

The production and secretion of bile into the intestine is the main “digestive” function of the liver. Without it, there is no emulsification of fats (splitting them into small droplets), and hence their digestion with the help of enzymes. If a person did not produce bile - he would have to forget about fatty foods forever.

But there is another function of the liver, which many people do not even suspect - immune. This organ synthesizes a number of proteins that protect the body from infections and toxins:

• acute-phase proteins - for example, CRP (C-reactive protein), which triggers the immune response;
• complement factors - complement proteins trigger the inflammatory process and help destroy bacteria and viruses by activating phagocytosis.

Also in the liver there are special Kupffer cells, or macrophages - they are engaged in phagocytosis (absorption) of pathogens.

The health of the entire body depends on the condition of the liver. But, unfortunately, improper nutrition, alcohol, other diseases and infections disrupt the work of this organ - and sometimes irreversibly. That is why it is so important to know the main diseases of the liver, understand what they threaten the body, and try to prevent their occurrence.

Fatty liver dystrophy

Fatty liver disease, or liver obesity or steatohepatosis, is a disease in which too many triglycerides accumulate in the hepatocytes. It is considered the most common liver disease in the world. Most often such a diagnosis is established after ultrasound examination (ultrasound), because the structure of the organ with steatohepatosis has characteristic changes.

Causes of fatty liver dystrophy are diverse, but the fundamental in the diagnosis is the fact of alcohol consumption. If liver damage is associated with alcohol, doctors talk about alcoholic liver disease. If a person does not abuse harmful drinks - diagnose nonalcoholic fatty liver dystrophy (NAFLD), or nonalcoholic fatty liver disease (NAFLD).

Non-alcoholic fatty liver dystrophy often accompanies metabolic disorders and occurs in people with:

• obesity;
• metabolic syndrome;
• insulin resistance;
• high blood lipid levels, including triglycerides and low and very low density lipoproteins (“bad” cholesterol).

Other causes of NADHD:

• Taking certain medications (e.g., glucocorticosteroids, tamoxifen, chemotherapy drugs);
• Exposure of the liver to toxins;
• hereditary metabolic disorders;
• pregnancy (this complication develops late in pregnancy and is called “fatty hepatosis of pregnancy” or “microvesicular steatosis”).

As for the symptoms of fatty liver dystrophy, they are usually scanty and unspecific. There may be unpleasant sensations in the abdomen (abdominal discomfort), heaviness in the right subcostal region or increased fatigue, fatigue, lack of strength - but they are most often attributed to errors in diet and chronic stress.

Normal steatosis of the liver increases the risk of developing type 2 diabetes and coronary heart disease in the future, but it rarely turns into cirrhosis. But if inflammation joins the fatty dystrophy and steatohepatitis occurs, the situation worsens significantly. In 10% of patients with non-alcoholic steatohepatitis liver damage progresses, and within 10 years develops cirrhosis. They are also more likely to be diagnosed with liver cancer.

How to treat fatty liver dystrophy

Even with fatty dystrophy, regeneration of liver cells is quite possible, but it will take a lot of effort. First of all, it is necessary to stop the progression of steatosis - which means that you need to affect the factors that provoke its development.

As mentioned above, the most common cause of NASH is metabolic disorders. And they are dangerous not only for the liver - the endocrine and cardiovascular system suffer from them no less.

What first of all threatens a person with obesity and insulin resistance? That's right - diabetes, hypertension and atherosclerosis. These diseases do not improve the health of the liver, so the sooner the metabolism can be sorted out, the less the body as a whole will suffer.

The basis of treatment of steatohepatosis - the elimination of risk factors and correction of existing disorders, and help us in this correct diet, physical activity, avoidance of bad habits and drug therapy (drugs and dietary supplements “for the liver”).

Useful products for the liver

The diet for fatty dystrophy should be low-calorie (with concomitant obesity) or regular calories, but without “harmful”. Prohibited products include:

• fast food;
• fatty and fried foods (they contain harmful saturated fats);
• processed meat (sausages and sausages);
• sweets and confectionery (simple sugars increase fat deposition in the liver);
• carbonated and sugary drinks.

It is very important to minimize the use of saturated animal fats - they are found in butter, sour cream, hard cheese, cream, fatty milk. If possible, such products should be replaced with low-fat and introduce into the diet “unsaturated alternative” - various nuts, vegetable oils, fatty fish, etc.

Like saturated fats, simple carbohydrates should be removed from the diet - for example, sugar, baked goods, sweetened juices. Much more useful for the liver whole-grain bread, vegetables, legumes. In addition, they are also an excellent source of fiber.

What should be in the diet of a person with fatty hepatosis:

• fish - and first of all it is fatty sea fish (salmon, mackerel and sardines), which contains a lot of omega-3 fatty acids;
• vegetables - give preference to broccoli, cauliflower, spinach, cabbage, carrots, onions and garlic (but not potatoes!);
• fruits - low-sugar fruits (apples, green pears, various berries) are useful for fatty hepatosis;
• vegetable oils - olive oil can be added to salads or cooked dishes (instead of butter);
• whole grain foods - oatmeal, brown rice, whole grain bread and quinoa are a great source of complex carbohydrates and fiber. They help keep blood sugar levels stable and “revitalize” the liver;
• nuts and seeds - almonds, walnuts, flaxseeds and chia seeds contain healthy fats and antioxidants, as well as anti-inflammatory properties and prevent the transition of fatty dystrophy into the more dangerous steatohepatitis;
• legumes - they are rich in both protein and fiber and are virtually fat-free;
• green tea - rich in antioxidants and polyphenols, which improve liver health and help reduce fat deposits.

In fatty liver dystrophy, the popular Mediterranean diet has proven its effectiveness . It not only reduces fat stores in hepatocytes, but also reduces insulin resistance and improves cardiovascular health. The DASH diet has also been shown to work well for steatohepatosis and obesity .

Physical activity

Physical activity helps to “burn” calories and gets rid of extra pounds. In addition, it “accelerates” the metabolism, which also contributes to weight loss. Losing even 5-10% of weight reduces the amount of fatty deposits in the liver and reduces the risk of inflammation - the transition of fatty hepatosis to steatohepatitis.

In physically active people increases tissue sensitivity to insulin, normalizes blood pressure and blood sugar levels, better functioning of the heart and blood vessels.

Drug treatment of fatty liver dystrophy

Therapy of fatty hepatosis with drugs and dietary supplements is currently being actively studied, but doctors have not yet invented a “miracle pill”.

First of all, doctors recommend eliminating risk factors for the development and progression of fatty hepatosis - for this purpose, sugar-reducing drugs, drugs that increase tissue sensitivity to insulin, pills “from pressure”, statins (to normalize cholesterol levels) are used.

Gastroenterologists also use directly “liver” drugs - hepatoprotectors based on essential phospholipids derived from soy (e.g., Essenceale Forte H). In a number of studies they have demonstrated their effectiveness in fatty liver dystrophy.

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Ursodeoxycholic acid (UDCA, UDKA) also has a certain hepatoprotective effect. It normalizes the outflow of bile and helps to reduce blood cholesterol. But without a doctor's prescription and ultrasound examination of the liver / gallbladder to take ursodeoxycholic acid is prohibited - it may lead to exacerbation of gallstone disease.

According to preliminary research data, thiazolidinediones and vitamin E can have a positive effect on the liver in steatohepatosis. However, they do not reduce fibrosis, and vitamin E, in addition, is contraindicated in diabetes mellitus - a frequent companion of fatty dystrophy.

From dietary supplements, omega-3 fatty acids are used.

Other drugs - metformin, dapagliflozin, betaine, liraglutide and semaglutide - may also be used, but their efficacy still requires evidence.

How to protect the liver from alcohol?

Pills to protect the liver from alcohol, unfortunately, have not yet been invented, and the most effective method is still a single method - not to drink. It is also very difficult to restore the liver after prolonged and abundant “libations”. Ethyl alcohol has hepatotoxicity - it destroys hepatocytes and leads to the development of alcoholic liver disease (ALD).

It is based on the same fatty liver dystrophy (alcohol-associated steatosis), but in 10-35% of people it turns into alcohol-associated hepatitis, and in 10-20% - into cirrhosis.

But 3+ servings for women and 4+ servings for men daily is already “high risk” alcohol consumption.

Interestingly, the risk of developing alcohol-related disease differs from person to person, even if they drink in the same way. Provoking factors:

• Female gender - women only need half as much as men to forget about a healthy liver. They usually have smaller body size and lower activity of gastric alcohol dehydrogenase, because of which ethyl alcohol enters the liver in unchanged form;
• heredity - the tendency to develop ABP can be inherited (e.g., deficiency of cytoplasmic enzymes that remove alcohol);
• nutritional peculiarities - malnutrition, lack of protein in the diet or, conversely, excess fat, especially in combination with obesity, increase sensitivity to ethanol;
• the already mentioned above accumulation of iron in the liver in hemochromatosis, hepatitis and other diseases that worsen the work of this organ.

So what happens to the liver with alcohol abuse? First, fats begin to accumulate in hepatocytes, since their excretion is slowed down. Then the synthesis of triglycerides increases, which further “load” the liver cells and damage them.

It becomes more difficult for the liver to do its job, and it can no longer neutralize all the endotoxins that come through the intestinal walls (alcohol increases their permeability). To cope with the attack of “foreign agents”, macrophages (Kupffer cells) actively release free radicals - but they affect not only endotoxins, but also their own cells, thereby increasing oxidative stress.

This is how a vicious cycle occurs. Due to oxidative damage, hepatocytes die and are replaced by fibrous tissue, blood flow worsens, a large number of fibrous nodules are formed in the liver - and eventually cirrhosis develops.

Signs of alcoholic liver disease are more diverse than the symptoms of ordinary fatty hepatosis. This is due to the toxic effects of ethanol on the whole body and the rapid progression of fatty dystrophy into steatohepatitis and cirrhosis. In ABP may be noted:

• liver enlargement;
• pain in the right subcostal region and right side of the abdomen;
• a feeling of heaviness in the abdomen;
• jaundice (it may be manifested by only a slight yellowing of the sclerae - eye “whites”);
• weakness;
• increase in body temperature.

Recovery of the liver after alcohol

If the liver is not severely damaged by alcohol, it is enough to simply “give it rest”. This means - eat only healthy foods and forever forget about alcoholic beverages and hepatotoxic drugs. Given the high degree of regeneration of the organ, this is usually enough.

In medicine, a complete refusal from alcohol is called withdrawal - and it is it that is considered the main method of treatment of ABP. But in practice, few people can give up alcohol, and then drugs come to the rescue:

• opioid antagonists, baclofen - they somewhat suppress cravings for alcohol;
• disulfiram - this drug, on the contrary, causes very unpleasant sensations if combined with ethanol. Even if you drink alcohol within 12 hours after disulfiram - nausea, vomiting, fever and other unpleasant symptoms are ensured;
• benzodiazepines (gidazepam, diazepam) - they prevent the development of withdrawal syndrome (“white fever”).

The Internet is often interested in how to “detoxify” the liver - for example, when drinking large amounts of alcohol. This should not be done at home, as severe poisoning with ethyl alcohol can lead to death. “Detoxification of the liver from alcohol” is carried out only in hospital conditions with infusion of physiological solution, glucose, electrolytes, electrolytes, arginine, the use of diuretics (forced diuresis), symptomatic therapy.

In acute alcoholic hepatitis use:

• hormones (prednisolone);
• antioxidants (S-adenosyl-L-methionine, phosphatidylcholine, metadoxin). Important: antioxidants such as silymarin, vitamins A and E are ineffective in alcoholic hepatitis;
• pentoxifylline.

In alcoholic liver disease complicated by inflammation or fibrosis, doctors may prescribe hepatoprotectors based on essential phospholipids (we mentioned them when we talked about the treatment of simple fatty dystrophy).

Chronic hepatitis

Hepatitis is an inflammation of the liver. Gastroenterologists distinguish such types of this disease:

• viral (A, B, C, D, E);
• steatohepatitis;
• toxic, including medicinal;
• alcoholic;
• autoimmune and other rarely occurring types.

In hepatitis, unlike other liver diseases (such as fatty dystrophy), hepatocytes are destroyed, which causes the levels of liver enzymes - AST and ALT- to begin to rise in the blood. Usually the higher they are, the more pronounced the intensity of the inflammatory process. Bilirubin levels also rise, and the sclerae and skin may turn yellow.

In addition to jaundice, symptoms of chronic hepatitis may include:

• decreased or lack of appetite;
• weakness, lethargy;
• nausea;
• increased body temperature;
• a feeling of heaviness in the right subcostal area due to an enlarged liver;
• abdominal pain.

The second difference between chronic hepatitis and other diseases - with a long-term existing inflammatory process increases the risk of cirrhosis. This usually occurs if the liver is not treated in a timely manner.

Treatment of chronic hepatitis

Treatment of chronic hepatitis will depend on the cause that caused the disease. For example, with alcoholic defeat will help only a complete refusal of alcohol, with medicinal - exclusion of hepatotoxic drugs. With toxic hepatitis is very important to identify and eliminate the impact of toxins (for example, change jobs, if it is a harmful production), and with autoimmune will help only hormones.

The situation is different with viral hepatitis. Viral hepatitis A has the most favorable prognosis - even without specific antiviral therapy almost always comes recovery, and the pathogen is removed from the body, and the person safely forgets about it.

With viral hepatitis B more often comes self-healing with the removal of the virus (in 90-95% of adult patients), but if he remained in the body - to get rid of it will never be able to get rid of it. The disease progresses to a chronic form, but the risk of transforming hepatitis into cirrhosis and liver cancer is not very high.

The main medications for hepatitis B are antiviral drugs that curb the activity of the pathogen (but don't get rid of it!). They include:

• entecavir (nucleoside analog), adefovir, and tenofovir (nucleotide analogs);
• pegylated interferon-alpha;
• lamivudine and telbivudine - in case of ineffectiveness of first-line therapy.

The main goals of antiviral therapy for hepatitis B are suppression of ΗΒV DNA, loss of HBeΑg (in patients with initially positive ΗBeAg tests), and loss of HBsAg.

When significant improvement occurs, specific antiviral treatment is interrupted, but it is often continued long-term or lifelong.

Acute viral hepatitis C progresses to chronic hepatitis in 75% of cases and to cirrhosis in 30%. But, unlike hepatitis B, it can be cured.

In hepatitis C, direct-acting antiviral drugs (proteases and polymerases - ledipasvir, sofosbuvir, elbasvir, grazoprevir and others) are used. The effectiveness of such antiviral treatment with complete elimination of the virus from the body exceeds 95%.

Prevention of liver diseases

Prevention of fatty liver dystrophy and steatohepatitis includes proper nutrition, physical activity, control of cholesterol and sugar levels, abstinence from alcohol and smoking.

Protecting yourself from viral hepatitis is somewhat more difficult, but you still need to follow basic measures:

• not taking drugs, especially injecting drugs;
• use your own kits at nail salons;
• avoid casual sex and use condoms;
• be immunized against hepatitis B (if indicated).

The Liki24 team wishes you a healthy liver and excellent health!