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

In this article:
Fatty liver disease
How to treat fatty liver dystrophy
How to protect the liver from alcohol?
Liver recovery after alcohol
Chronic hepatitis
Treatment of chronic hepatitis
Prevention of liver disease
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 "cleaning station" of the body and indeed - without it we would be very hard.Many drugs and toxins are neutralized in the liver.But it also forms vital proteins, produces bile, stores 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. Normally, it is compactly "hidden" on the right side behind the ribs and only slightly protrudes beyond them through the margin in thin people, but in some diseases it grows so much that it descends to the level of the navel. Enlargement of this organ is called hepatomegaly and can occur in a wide variety of diseases.

The liver is not only the largest organ, it is also the most "regenerative". Even if 75% of the liver parenchyma is removed, it will still be able to regenerate completely. This is why partial liver transplantation is possible and used successfully in transplantology - thanks to regeneration, both donor and recipient remain alive, healthy and with a complete organ

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

  • Transformation (metabolization) of incoming substances, including drugs. It very often 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" it is necessary for them to pass not only through the liver but also the kidneys - as with vitamin D;
  • the formation and secretion of bile, without which food will not be digested in the gut;
  • regulation of carbohydrate metabolism - when blood glucose levels rise, the liver quickly converts the excess into glycogen ('energy store'). And vice versa: as soon as hunger arises and there is nothing to eat - the liver breaks down the glycogen (this process is called glycogenolysis) and the body gets the "food" it needs;
  • controlling cholesterol metabolism. Poor diet and obesity are not always 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 bilirubin levels) but bleeding;
  • formation of enzymes, serum albumin, urea and many other substances.

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

Without emulsification of fats it is impossible to absorb fat-soluble vitamins (A, D, E and K), and without bile itself it is impossible to eliminate excess cholesterol, bilirubin, toxins and other metabolic products. It is also an excellent stimulator of intestinal peristalsis.

But there is another function of the liver that many people don't realize - 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.

There are also special Kupffer cells or macrophages in the liver - these are involved in phagocytosis (absorption) of pathogens.

The health of the whole body depends on the state of the liver. But unfortunately, poor diet, 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 liver diseases, understand what threatens the body and try to prevent their occurrence.

Fatty liver disease

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

The causes of fatty liver dystrophy are diverse, but fundamental in the diagnosis is the fact of alcohol consumption. If liver failure is associated with alcohol, doctors speak of alcoholic liver disease. If a person does not abuse harmful beverages - diagnose non-alcoholic fatty liver dystrophy (NAFLD), or non-alcoholic fatty liver disease (NAFLD).

Important! Both alcoholic and non-alcoholic fatty liver dystrophy can have very serious consequences for the body, although of course the prognosis is much more favorable for NAFLD. But protecting and "cleansing" the liver of alcohol is not easy and the success rate is usually low.

Nonalcoholic fatty liver dystrophy often accompanies metabolic disorders and occurs in people with

  • obesity;
  • metabolic syndrome;
  • insulin resistance;
  • elevated levels of lipids in the blood, including triglycerides and low- and very low-density lipoproteins ('bad' cholesterol).

Other causes of NADHD:

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

Eating fatty foods alone does not lead to HPAH - in a healthy body, 'extra' lipids are broken down and converted into energy. But if metabolism is disturbed, fat processing and excretion are slowed down. They accumulate, deposit in liver cells - and thus cause steatohepatosis

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

Remember! Even in advanced stages of the disease, the liver usually doesn't hurt because it has no pain receptors. This is why many "liver" pathologies for a long time can be hidden. Pain usually occurs when the organ is significantly enlarged and its capsule is stretched.

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

The main danger of steatohepatitis is that it causes "functional" hepatocytes to be replaced by "non-functional" connective tissue. This leads to fibrosis of the liver (the appearance of "scarring") and then to cirrhosis - a condition in which the organ almost completely ceases to perform its function. Cirrhosis is incurable and without a transplant leads to death

How to treat fatty liver dystrophy

Even with fatty dystrophy, regeneration of liver cells is quite possible, but it will require a lot of effort. First of all, it's necessary to stop the progression of steatosis - which means you need to influence the factors that cause it to develop.

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

What primarily threatens a person with obesity and insulin resistance? That's right - diabetes, high blood pressure and atherosclerosis. These diseases do not improve the health of the liver, so the sooner the metabolism can be resolved, the less the body as a whole will suffer.

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

Useful liver products

The diet for fatty dystrophy should be hypocaloric (with concomitant obesity) or regular calorie, but without "harmful". Prohibited products include:

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

Keep in mind: body weight should be reduced gradually, as too drastic a weight loss can also damage the liver. The ideal rate is minus 0.5-1 kg per week

It's very important to minimize the use of saturated animal fats - these are found in butter, cream, hard cheese, sour cream, full-fat milk. If possible, these products should be replaced with skimmed ones and "unsaturated alternatives" - various nuts, vegetable oils, oily fish, etc. - should be introduced into the diet.

In addition to saturated fats, simple carbohydrates should be eliminated from the diet - e.g. sugar, pastries, sweetened juices. Wholegrain bread, vegetables, legumes are much healthier for the liver. They are also an excellent source of fiber.

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

  • Fish - and first and foremost it's fatty sea fish (salmon, mackerel and sardines), which contains lots of omega-3 fatty acids;
  • vegetables - prioritize broccoli, cauliflower, spinach, cabbage, cabbage, carrots, onions and garlic (but not potatoes!);
  • fruits - low-sugar fruits (apples, green pears, various berries) are useful for fatty liver disease;
  • Vegetable oils - olive oil can be added to salads or ready-made meals (instead of butter)
  • Whole grain foods - oatmeal, brown rice, brown rice, wholemeal bread and quinoa are an excellent source of complex carbohydrates and fiber. They help keep blood sugar levels stable and 'sanitize' the liver;
  • Nuts and seeds - almonds, walnuts, walnuts, flaxseeds and chia seeds contain healthy fats and antioxidants as well as anti-inflammatory properties and prevent fatty dystrophy from turning into the more dangerous steatohepatitis;
  • legumes - rich in both protein and fiber and 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 deposits 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 'burn' calories and shed extra pounds. In addition, it "speeds up" your metabolism, which also contributes to weight loss. Losing even 5-10% of your weight reduces the amount of fatty deposits in the liver and reduces the risk of inflammation - the transition from fatty liver disease to steatohepatitis.

Physically active people increase the sensitivity of tissues to insulin, normalize blood pressure and blood glucose, and improve heart and blood vessel function.

Drug treatment of fatty liver dystrophy

Therapy of fatty liver disease 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 liver disease - to this end, sugar-lowering drugs, drugs that increase the sensitivity of tissues to insulin, "pressure" pills, statins (for normalizing cholesterol levels) are used.

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

Ursodeoxycholic acid (UDCA, UDKA) also has some hepatoprotective effect. It normalizes bile flow and helps reduce blood cholesterol. But without a doctor's prescription and ultrasound examination of the liver / gallbladder taking ursodeoxycholic acid is forbidden - it can lead to an exacerbation of gallbladder disease.

Important! In fatty dystrophy hepatoprotectants are not used as monotherapy, they must necessarily complement a proper diet and a physically active lifestyle.

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

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

Other drugs - metformin, dapagliflozin, betain, liraglutide and semaglutide - can also be used, but their effectiveness still needs to be proven.

Drug therapy in fatty liver dystrophy is prescribed only if non-drug methods are insufficient. However, proper nutrition, physical activity and correction of metabolic disorders are still the most effective ways to treat steatohepatitis.

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 the only one - not to drink. It is also very difficult to restore the liver after prolonged and heavy "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 develops into alcohol-associated hepatitis and in 10-20% into cirrhosis.

The "threshold" for alcohol consumption (the amount beyond which the risk of ABP increases dramatically) is currently unknown - it is different for each person. The conditional daily "norm" or moderate consumption is considered to be 1 serving of alcoholic beverage (10-14 g ethyl alcohol) for women and 2 servings for men

But 3+ servings for women and 4+ servings for men daily is "high risk" drinking.

Important! In the case of concurrent liver damage (common fatty dystrophy, steatohepatitis, viral hepatitis) or hemochromatosis there is no "alcohol threshold" - in these cases even a can of beer is dangerous for a person

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

  • Female gender - women only need half the dose as men to forget a healthy liver. They usually have smaller body sizes and lower gastric alcohol dehydrogenase activity, due to which ethyl alcohol enters the liver in unchanged form;
  • heredity - the tendency to develop BPA may 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 aforementioned accumulation of iron in the liver in hemochromatosis, hepatitis and other diseases that worsen the activity of this organ.

So what happens to the liver with alcohol abuse? First, fats begin to accumulate in the hepatocytes because their excretion is slowed down. Then triglyceride synthesis increases, which further "loads" liver cells and damages them.

The liver has a harder time doing its job and can no longer neutralize all the endotoxins that pass through the intestinal walls (alcohol increases their permeability). To cope with the onslaught of 'foreign agents', macrophages (Kupffer cells) actively release free radicals - but these not only affect endotoxins but also the body's own cells, increasing oxidative stress.

This creates a vicious circle. Because of oxidative damage, hepatocytes die and are replaced by fibrous tissue, blood flow worsens, a large number of fibrotic nodules form in the liver - and eventually cirrhosis develops.

The signs of alcoholic liver disease are more diverse than the symptoms of ordinary fatty liver disease. 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 can be seen

  • enlargement of the liver;
  • pain in the right subcostal region and right side of the abdomen;
  • a feeling of heaviness in the abdomen;
  • jaundice (may manifest as only a slight yellowing of the sclera - the 'whites' of the eyes)
  • weakness;
  • increased body temperature.

Liver recovery after alcohol

If the liver is not seriously affected by alcohol, it is sufficient to simply "give it a rest". This means - eat only healthy food and forget alcoholic drinks and hepatotoxic drugs forever. Given the high degree of organ regeneration, this is usually enough.

In medicine, a complete refusal of alcohol is called withdrawal - and it is this that is considered the main method of treatment for BPA. But in practice, few people are able to give up alcohol, and that's when drugs come to the rescue:

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

On the Internet, people are 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 ethyl alcohol intoxication can lead to death. "Detoxification of the liver from alcohol" is carried out only under hospital conditions with infusion of physiologic solution, glucose, electrolytes, electrolytes, arginine, use of diuretics (forced diuresis), symptomatic therapy.

In acute alcoholic hepatitis is used:

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

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

In the instructions for Essenciale Forte H in the list of indications, not only non-alcoholic and alcoholic steatohepatitis, but also liver cirrhosis are described. However, it is important to realize that the more serious the liver condition, the less we should hope for hepatoprotectants. And, of course, they will be completely ineffective if you continue to consume alcohol.

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 drug-induced;
  • alcoholic;
  • autoimmune and other rare types.

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

Please note: jaundice is not necessarily a sign of liver inflammation. Doctors even distinguish separate forms of hepatitis - without jaundice. But if it occurs - first of all, you need to check the condition of the liver.

In addition to jaundice, symptoms of chronic hepatitis may include

  • decreased or no 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 happens if the liver is not treated in time.

Treatment of chronic hepatitis

Treatment of chronic hepatitis will depend on the cause of the disease. For example, with alcohol withdrawal only a complete withdrawal from alcohol will help, with medication - exclusion of hepatotoxic drugs. In toxic hepatitis it is very important to identify and eliminate the impact of toxins (for example, change your job, if it is a harmful production), and in autoimmune will help only hormones.

Remember! Without removing the main challenging factor to restore the liver in chronic hepatitis is impossible. You can take hepatoprotectors and useful supplements for years, but the hepatocytes will still be destroyed.

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

With viral hepatitis B more often comes self-healing with the elimination of the virus (in 90-95% of adult patients), but if it remains 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 hepatitis turning into cirrhosis and liver cancer is not very high.

It's important! In children, acute viral hepatitis B becomes chronic in 90% of cases

The main drugs for hepatitis B are antiviral drugs that slow down 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 - if first-line therapy fails.

The main targets 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 therapy is discontinued, 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 disease

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

Protecting against viral hepatitis is a little more difficult, but you still need to follow the basics:

  • Don't take drugs, especially injectable drugs;
  • use your own kits at nail salons
  • avoid casual sex and use condoms;
  • get vaccinated against hepatitis B (if indicated).

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

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