
The Liver: A ‘Blob’ That Runs the Body - tysone
https://www.nytimes.com/2017/06/12/health/liver-bodily-function.html
======
mhalle
The flip side to the liver's amazing duties in the body is the catastrophic
impact on health when it fails. A failed liver takes out basically every body
system.

When the liver can't break down bilirubin, you get jaundice and itch all over.

When the liver becomes cirrhotic, blood can't move through it, increasing
pressure in the portal vein and precipitating life-threatening bleeds in the
stomach and esophagus. For an extra bonus, clotting factors are manufactured
in the liver, so these bleeds can be uncontrolled.

The spleen enlarges and gobbles up white blood cells, compromising immunity.

Ammonia and other yet not fully understood toxins that the liver can't filter
cross the blood-brain barrier and cause hepatic encephalopathy, ranging from
brain fog to coma.

Liver disease is also tied to hepatorenal syndrome (kidney failure) and
hepatopulmonary syndrome (lung damage), both of which can be sudden and fatal.

Ascites (retention of fluid) also accompanies cirrhosis, often requiring
paracentesis, which in turn is correlated with sepsis that the compromised
immune system can't fight (also often fatal).

Low Vitamin D in cirrhotic patients leads to osteoporosis, including vertebral
fractures.

Inability to process protein leads to muscle wasting and weight loss, reducing
strength and immunity.

And finally, cirrhosis is correlated with an increased risk of liver cancer.

The cure for any of these conditions? Transplant, if you're lucky and the
other systems aren't too badly damaged. Everything else is just holding on.

And to get a transplant? You have to be sick enough and sufficiently close to
death that you're eligible, but strong enough to survive major surgery. No
insurance in the US? They won't even assess you.

A liver transplant saved my life three years ago. I've lived this list of
symptoms. My debt to the universe is to educate when possible, to console when
necessary.

~~~
JumpCrisscross
> _No insurance in the US? They won 't even assess you._

Do you have a source that goes into the reasoning behind this? I could guess,
but I'd prefer to give the subject the respect it deserves.

~~~
mhalle
Liver transplants can cost $700K to $1M+. In the US, insurance (or Medicare)
typically engages in a special negotiated contract with the hospital. This
amount is too expensive for a hospital, or even many affluent individuals, to
pay without insurance. (I'm sure there are exceptions for the exceedingly
rich.)

For me, a magical additional insurance policy appeared in my hospital account
to which all transplant-related expenses were charged.

In addition, to get an organ in the US you must pass a series of exams
regarding your physical and mental health, diet, your ability to get post-
transplant support, and your willingness and ability to take care of your new
organ. Alcohol and drug tests as appropriate. And for these evaluations, money
can only indirectly help you.

I would also guess that there is a correlation between those people who have
insurance and those that can pass the transplant evaluation, though that's a
hidden variable that the powers that be probably want to stay hidden.

Organs are just too scarce to waste on a person who will squander one. It's a
life and death competition between patients. It's horrible to see the people
who get left behind, who wait too long, get sidetracked by some "miracle"
cure, or even happen to live in the wrong region of the country where organs
are scarce.

But the true miracle of a successful transplant is almost unfathomable (and
that's said by a rationalist). From death's bed to walking a couple kilometers
in a month and a half.

~~~
paulcole
>Do you have a source that goes into the reasoning behind this?

A simple "no" would have sufficed.

That 1M "cost" you mentioned isn't actually the cost is it? It's the amount
the hospital wants to recover from an insurer. The true dollar cost is much
lower.

I'm not saying it's easy to get an organ transplant without insurance, but to
say it's impossible without anything but speculation isn't very useful.

~~~
mhalle
I was evaluated by two US transplant centers that function under a government-
regulated evaluation regimen, and spent more than a year researching the
process.

Neither would proceed with any paperwork or testing without proof of insurance
coverage specifically for transplant.

Honestly, I'm not especially concerned with edge cases like "is it possible to
get a transplant without insurance if I offer to pay cash?" or questions about
what a transplant really costs.

Those are irrelevant academic questions for the vast majority of transplant
patients.

------
cbanek
Liver failure is a big thing, but thankfully we have a drug for curing HepC
now, which uncured causes liver damage.

Liver regeneration is also fantastically interesting. If only we could figure
out how to trigger that regeneration when the liver is too damaged.

I'm reminded of Star Trek 4, where McCoy gives an old woman what looks like a
candy, then you see her later on talking about how she grew a new kidney.

~~~
mhalle
The HepC drugs are remarkable. They also open new opportunities for
transplanting HepC positive livers into HepC positive patients (expanding the
donor pool), then zapping it post transplant.

But while HepC may be one of the first viral infections we can cure, non-
alcoholic fatty liver disease is on the rise, even in young people. And this
population is on average less motivated to make lifestyle changes that can
stop or slow the disease.

~~~
pm90
> And this population is on average less motivated to make lifestyle changes
> that can stop or slow the disease.

Hmmm, how do you mean? We've seen a lot of people try to change their diets
and lifestyle to be more healthy. Anecdotally, all my coworkers are very
diligent, or at least mindful, about eating healthy (of course they splurge
when going out, but on a daily basis they try and stick to healthy food).
Granted most of my coworkers are younger millennials, but I think a
fitness/healthy eating lifestyle has permeated US society.

~~~
mhalle
Let me try and be more precise. Non-alcoholic fatty liver disease is strongly
correlated with obesity. Obesity is a public health problem that is getting
worse, not better. It is tied to diet and lifestyle that cannot quickly be
corrected, even among highly motivated individuals.

Compound that with the fact that fatty liver disease (or any liver disease)
will probably not be detected before symptoms emerge that indicate actual
damage to the liver has occurred. It's impossible to quickly become un-obese,
even for the motivated patient. This puts these patients at risk for advancing
liver disease.

Contrast that with HepC. It can be detected before overt symptoms of liver
disease sets in. It can be cured in as little as eight weeks. The cure itself
doesn't require any lifestyle change (though IV drug users need to prevent re-
infection, and insurance companies in the US won't give you a second chance).
And the cure has been shown to allow the liver to heal.

Your co-workers aren't the at-risk population.

~~~
pm90
Good point. Just wondering: is there any way I can proactively check for liver
health to make sure its healthy? It seems like a ridiculously important organ
to not have checked at some regularity.

~~~
mhalle
Ask your doctor about a liver enzyme test, and get an HepC test if you have
any possible risk you contracted it.

The liver enzyme tests will tell you if the liver is fighting off anything.

That said, you're probably OK if you don't have any major risk factors or
symptoms.

------
mrfusion
What a fascinating organ!

I never realized the liver only holds 400 calories. I always figured it was a
few thousand. (I just looked it up)

So is your body always burning fat or does the liver glycogen have to be
depleted first? Does the liver deplete every night when you're sleeping?

I really don't have a great mental model of this stuff.

Is it true that you need to reach high insulin levels before the body starts
storing fat?

~~~
ghostbrainalpha
For most people the liver does deplete throughout the night, which is why
early morning "fasted cardio" is popular for burning fat.

But as the food in your stomach processes the liver is continually getting
more calories. So if you eat a huge meal right before going to bed its
possible to never switch to fat burning.

~~~
Mtntk
>But as the food in your stomach processes the liver is continually getting
more calories. So if you eat a huge meal right before going to bed its
possible to never switch to fat burning.

Probably that's because some people advice eat pasta a night before your
sports event. To have some calories in your body to burn in the morning until
first food stop.

------
justzisguyuknow
> _Others have found that signals from the liver may help dictate our dietary
> choices, particularly our cravings for sweets, like a ripe peach or a tall
> glass of Newman’s Own Virgin Limeade — which our local supermarket chain
> has, to our personal devastation, suddenly stopped selling, so please,
> liver, get a grip._

What the heck is that doing in an otherwise (seemingly) scientific article?

~~~
fencepost
>> Newman's Own Virgin Limeade

> What the heck is that doing in an otherwise (seemingly) scientific article?

Particularly since both Limeade and sugar/simple syrup are easy to make.

Syrup: 2c sugar/1c water, heat until clear, cover, cool, store in a squeeze
bottle.

Limeade: 10% fresh squeezed lime juice, sugar syrup to taste but probably no
more than 10%, 80% water. Depending on size & squeezer, figure maybe 1/2 oz of
juice per lime. It's even easy to make single glasses.

------
alfon
Some case studies that I find interesting:

Cirrhosis presenting as Parkinsonism -
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771969/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771969/)

Reversal of parkinsonism following liver transplantation. -
[https://www.ncbi.nlm.nih.gov/pubmed/12578945](https://www.ncbi.nlm.nih.gov/pubmed/12578945)

------
agentgt
The liver storing ability to store glycogen is one of the reasons many fitness
enthusiasts would avoid (or not) fructose.

From what I have heard fructose often gets broken down in the liver and thus
often gets stored there (I'm probably missing a whole bunch here so assume I
am wrong).

Because of this various athletes and bodybuilders would use fructose to either
gain weight or rapidly fill carb stores but only would do so sparingly (ie
during carb refilling during a ketogenic diet).

~~~
js2
With respect to endurance sports where you will exercise long enough to
exhaust glycogen stores, you actually want a mix of fructose and another sugar
such as maltodextrin.

[http://fellrnr.com/wiki/Fructose](http://fellrnr.com/wiki/Fructose)

[http://fellrnr.com/wiki/Nutrient_Timing](http://fellrnr.com/wiki/Nutrient_Timing)

When you hear a marathon runner refer to hitting the wall, what's happenened
is that they've exhausted their glycogen stores.

~~~
noir_lord
Cyclists call it 'the bonk' and it's fucking horrible.

It's like been incredibly drunk and tired at the same time.

Happened to me the first time I did a 60 mile ride in winter, wind back was
brutal, I got about 10 miles from home on the outskirts of town, found a
petrol station ate a cornish pasty and two mars bars and it took about 30
minutes before I could summon the energy to get on the bike and coast home.

I learnt the lesson the hard way that day.

I've found it relatively easy to avoid since mostly by drinking at least a
litre of isotonic an hour on the bike (adjusting for climate) and eating
reasonable amounts of carbs the day before.

~~~
logfromblammo
Some people eat restricted carbohydrates and then exercise to bonk _on
purpose_. It's based on research by a Dr. B.K. Pedersen of Copenhagen.

And some medieval monks wore shirts made from hair. "Bonk training" seems like
a perfectly horrible way to lose body fat.

------
snakeanus
"In order to access our website, your browser must accept cookies from
NYTimes.com"

Why would they need that?

~~~
codyb
To prevent you from bypassing their paywalls by using private tabs.

~~~
nkozyra
What browser doesn't use cookies in private tabs? In chrome it's basically
treated like an isolated sandbox, but it will still gladly accept cookies.

~~~
nilved
Safari uses different cookie jars for each private tab. Chrome uses different
jars for each private window. (I believe.)

~~~
nkozyra
Right, I'm just saying being in a private tab wouldn't prompt a cookie error

------
bluetwo
Anyone take Milk Thistle? It is supposed to help the liver, especially if it
has been damaged, say by years of moderate drinking. Asking for a friend.

~~~
scottLobster
I'm no expert, but I looked into this issue for my mom some years ago (had
cancer on her liver) and what you're looking for specifically is Silymarin,
the ingredient in Milk Thistle that actually has the protective benefits.

[https://www.ncbi.nlm.nih.gov/pubmed/21466434](https://www.ncbi.nlm.nih.gov/pubmed/21466434)

The issue with raw Milk Thistle supplements is that it's a lower dose of
Silymarin as you're just getting the plant, you'd want "Milk Thistle Extract",
which is concentrated Silymarin. As with all supplements though, read the
label and research the brands you buy. Counterfeit products are rampant in the
industry, as is inconsistent dosing.

Mayoclinic has some dosing reccomendations: [http://www.mayoclinic.org/drugs-
supplements/milk-thistle/dos...](http://www.mayoclinic.org/drugs-
supplements/milk-thistle/dosing/hrb-20059806)

~~~
dredmorbius
Interesting recent stories out of Santa Cruz and mushroom poisoning
(generally: hepotoxic), treated with Silymarin.

Well, 2014 recent:

[http://www.slate.com/articles/health_and_science/medical_exa...](http://www.slate.com/articles/health_and_science/medical_examiner/2014/02/most_dangerous_mushroom_death_cap_is_spreading_but_poisoning_can_be_treated.html)

------
hjm3
Love the sponsored content food items

~~~
imsd
I thought it was odd as well, but I'm not sure that it's sponsored? From my
understanding, FTC guidelines necessitate that publications disclose sponsored
placements and I imagine The New York Times would be at the forefront of these
requirements ... Or am I mistaking?

~~~
jeffdavis
The NYT content falls well within "free speech" and any attempt to constrain
it would backfire horribly regardless of what the laws or regulations say.

Smallet outlets would be a better target, but still likely to backfire.

------
known
Check
[https://en.wikipedia.org/wiki/Glycemic_index](https://en.wikipedia.org/wiki/Glycemic_index)

------
medymed
Great article, but 'runs the body' is a bit overkill. If you want to endanger
your personal safety, try convincing a nephrologist that the liver runs the
body.

~~~
gozur88
Or a cardiologist.

Turns out you need pretty much everything in there.

~~~
pavel_lishin
And yet, according to my wife's surgeon, gall bladder removal surgery is the
most common surgery in America. (Though he might be biased.) You don't appear
to need your appendix. You can live fine with one kidney, or half a liver. I
_think_ you can get by with one lung. I've had friends who've had huge
portions of their digestive tract removed.

I realize that that just speaks to the body's generally robust build, and its
redundancy, but you can probably remove more organs from a human body and have
it keep running than random parts from under a car's hood.

~~~
d33
[https://en.wikipedia.org/wiki/Hemispherectomy](https://en.wikipedia.org/wiki/Hemispherectomy)

------
grw_
UberLivers anyone? I fear organ donation is scheduled for disruption. I found
this programme discussing issues around social media donor-matching campaigns
quite interesting-
[http://www.bbc.co.uk/programmes/b08nq6fh](http://www.bbc.co.uk/programmes/b08nq6fh)

------
benevol
> Scientists hope that the new insights into liver development and performance
> will yield novel therapies for the more than 100 disorders that afflict the
> organ, many of which are on the rise worldwide, in concert with soaring
> rates of obesity and diabetes.

No need to wait, an excellent book explains how to easily clean your liver:
[http://www.ener-chi.com/books/the-amazing-liver-
gallbladder-...](http://www.ener-chi.com/books/the-amazing-liver-gallbladder-
flush)

The thing is you can literally see all the things that have been jamming your
liver for years, as they're being "washed" out when you go to the toiled -
very impressive. Keep in mind that a liver that is jammed does not fully clean
your blood. If your blood is not clean, it will eventually cause trouble all
over your body.

~~~
crpatino
Downvotes are for signaling failure to honour conversation protocol, no
disagreement of opinion. You guys shoud know better.

If you want to argue that liver cleansing is a quack, do so in a comment.
Better yet, ignore the parent and let it fall to the bottom of the
conversation.

~~~
chc
That is not accurate. Downvotes are for comments that negatively contribute to
the conversation. One way a comment can negatively contribute is by failing to
honor protocol, but it is not the only way. Even simply extraneous comments
like lazy jokes probably should be and conventially are downvoted on Hacker
News. Promoting pseudoscience definitely doesn't seem like a very good
contribution to me.

~~~
crpatino
Then you should argue against it, and let the best argument win.

Last time I checked, Chc was not the infallible God of Truth and Goodness.
Maybe it is not a good contribution, but it is not for you alone to tell.

~~~
dpark
> _Maybe it is not a good contribution, but it is not for you alone to tell._

"Maybe it is an abusive, racist comment, but it is not for you alone to tell."

Your argument is hollow, because it applies to literally every reason to
downvote. But technically you're right. Which is why we have _voting_.
Collectively the readers decide which comments contribute to the conversation.

There is no moral obligation to give equal airtime to quackery and fraud.

