The liver is incredible. Most people think of it as a filter, but filters are physical barriers that accumulate junk and have to be cleaned. The liver isn’t a filter. It’s a chemical processing plant. Rather than sit there, passively receiving, filtering out, and storing undesirable compounds, the liver encounters toxic chemicals and attempts to metabolize them into less-toxic metabolites that we can handle.
It oxidizes the toxins, preparing them for further modification
It converts the toxins to a less-toxic, water-soluble version that’s easier to excrete
It excretes the toxins through feces or urine
Bam. It’s an elegant process, provided everything is working well back there. And it’s not the only process it controls.
The liver is the primary site of cholesterol synthesis and disposal. It creates cholesterol as needed and converts excess into bile salts for removal via the bile duct. The liver also plays a huge role in the burning of fat for energy, the storage of vitamin A, the metabolism of hormones, and the regulation of blood sugar. If you enjoy burning ketones, you can thank the liver because that’s where they’re produced.
The liver supports full-body health, in other words. If it isn’t working correctly, nothing is. Everything starts to fall apart.
How do we support the liver?
It’s not one thing we do. It’s many things. It’s nutrition, supplementation, lifestyle, sleep — everything. It’s also the things we don’t do. The stakes are high, you see. Whenever there’s a grand overarching orchestrator regulating dozens of different processes in the body, you must protect it from multiple angles. A lot can go wrong. Or right, depending on how you look at it.
Since the liver is “hidden away” and you can’t really “feel” it, you may not give it too much thought. When you’re overweight, you know it. When your fitness is suffering, you consciously experience it. When your liver is overburdened or suffering, you don’t necessarily know it. That’s where doing the right things for the sake of doing them comes in handy.
So, what should you do to maintain pristine liver health?
Liver health depends on steps you take toward a healthy lifestyle, and equally as important, the things you refrain from doing. Here are some things you can to to contribute to lifelong liver health:
Reduce linoleic acid intake
Reduce refined carb intake
Reduce alcohol intake
Stop overeating, and lose weight
Practice time-restricted eating
Eat fatty fish and get omega-3s
Eat egg yolks and other choline sources
Take whey protein
Regularly deplete your liver glycogen
Get good, regular sleep
Reduce Linoleic Acid Intake
When a patient can’t eat, they get something called parenteral nutrition — a direct infusion of nutrients into the gut. The classic parenteral nutrition consists of an emulsion of olive oil and soybean oil. It’s very rich in linoleic acid and typically leads to elevated liver enzymes and fatty liver. That’s right: the medical establishment for whatever reason just accepts that people receiving parenteral nutrition have a high chance of developing fatty liver disease.
Okay, but what’s happening here? Is it really causal? Yes. The more linoleic acid you eat, the more oxidized metabolites of linoleic acid show up in your body. The more oxidized metabolites of linoleic acid you have, the higher your risk of fatty liver. These toxic metabolites of LA are actually full-fledged biomarkers of liver injury.1
The bottom line: your liver prefers smart fats like avocado oil, butter, lard, fatty fish, and olive oil over industrial seed oils.
Reduce Refined Carb Intake
The real danger of refined carbs is that they tend to be nutrient-poor. They’re basically just pure starch (or sugar). All the energy, none of the micronutrients required to metabolize that energy.
Your liver works hard to convert carbs into glucose that your body can use. When you don’t use the glucose in your blood, it gets stored in the liver and skeletal muscle as glycogen, and if you have excess after that, it gets stored as body fat. With refined carbs, it’s easy to get there.
Studies show that carb overfeeding, especially with fructose, can lead to non-alcoholic fatty liver disease,2 which affects how efficiently your liver works.
Of course, the combo of high linoleic acid and high refined carbohydrate is just about the worst thing possible.
Reduce Alcohol Intake
To detox alcohol, the liver converts it into the metabolite acetaldehyde. Acetaldehyde is far more toxic than ethanol itself, so the body then releases acetaldehyde dehydrogenase and glutathione to break down the acetaldehyde. If you stick to just a few drinks and space them out accordingly, your body’s natural antioxidant enzyme production can keep up. If you start binging, though, glutathione stores become overwhelmed and the liver must produce more. Meanwhile, acetaldehyde, which is between 10-30 times more toxic than ethanol, accrues in your body.3
Here’s where dosage matters. The more you drink in a given allotment of time, the higher the liver burden. Your liver doesn’t metabolize ethanol all at once. It’s an ongoing physical process. It takes time, and glutathione. Glutathione is also a physical material. You need more substrate, like glycine and cysteine, to produce it. Without enough glutathione (and there’s never enough if you drink too much), your liver will incur damage and develop fat.
The number one risk factor for getting a fatty liver with impaired function is gaining excess body fat. Don’t get fat. If you are fat, lose it. Losing weight is the number one risk factor for losing a fatty liver.
Figure out what type of diet helps you eat normal amounts, and then go follow that diet. For most of my readers, it’s a low-carb Primal or keto approach. For others, it’s full-on carnivore. And yes, there are some for whom a moderate or even high carb diet works best. Whatever satiates you is the one that will improve your liver function.
Overeating fat especially can be bad, because the extra fat doesn’t need to waste any extra steps becoming available to your liver.
Practice Time-restricted Eating
In mice fed a typical soybean oil-fructose-based lab diet, the “high-fat” kind that reliably plumps up their livers, switching to a shortened eating window eliminates the metabolic fallout. They don’t get fat, they don’t get insulin resistant, and, most importantly, they don’t get fatty or dysfunctional liver.4
Eat Fatty Fish and Get Omega-3s
If you offset some of that olive oil and soybean oil with a blend of medium triglycerides and fish oil, liver enzymes may drop and overall integrity of the liver may improve.5 Amazing how that works.
Fish oil isn’t the only option. In fact, eating actual seafood is ideal because in addition to the omega-3s it also provides micronutrients and macronutrients that enhance liver function. If you’re not a fish eater, supplements can fill in the gaps.
Eat Yolks and Other Choline Sources
Choline protects against fatty liver by providing the backbone for VLDL—the particle the liver uses to transport fat out into the body. Without adequate choline, you can’t make enough VLDL for transport and the fat tends to accumulate in the liver.
De novo lipogenesis, or the creation of fat from carbohydrate, is a hallmark of fatty liver disease.8 When liver glycogen is full, it becomes far more likely that your liver will turn any subsequent carbohydrate it encounters into fat for storage. If you keep liver glycogen low, or regularly deplete it, you can avoid de novo lipogenesis because there’s usually a place to store the glucose.
Furthermore, keeping liver glycogen low increases fat utilization from all over the body, including the liver.9 A few of my favorite ways to deplete glycogen:
Fast. Fasting is a reliable way to burn through available liver glycogen.
Reduce carbs. Going low-carb or keto is a reliable, if slightly slower way to burn through your liver glycogen.
Get Good, Regular Sleep
Certain molecules responsible for clearing liver fat operate according to a circadian schedule.10 If you don’t get to sleep at a normal, consistent time, your rhythm is disrupted and the molecules can’t do their jobs.
If you hadn’t already noticed, these are good health practices in general. We keep running into this phenomenon, don’t we?
What’s good for the liver is good for the brain is good for the cardiovascular system is good for your performance in the gym is good for the mirror.
It makes things easier and harder.
You know what to do.
Thanks for reading, everyone. Do you have any other recommendations for liver health? Which of these do you follow?
Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.