Welcome back for all the people that have managed their way through the somewhat nerdy part one and part two of The Liver – Our Great Alchemist. So far, we have seen that the liver is our internal alchemist, working in the shadows, undertaking many tasks at the same time. The liver also converts many nutrients, food stuff, botanicals and pharmaceuticals into golden opportunities for healing. We reviewed the two-major phases of liver detox phase I and phase II. We also threw in a third phase (phase III) that is not covered by most textbooks on liver detoxification.
In this blog, we are going to concentrate on the assessment of these detoxification processes. We are also going to introduce the energetics of the liver and some of the emotions related to its processes. To do these assessments totally right, you will need access to a lab, but we will show you rough work arounds to do this at home. For best results though, you should see a Naturopathic Doctor, or other health care practitioner in your area that does these tests.
Phase I assessment
Phase I assessment methods can be assessed by the clearance of caffeine, which is given to the patient in pre-measured amounts, and then samples of saliva are taken over an eight-hour period. A simple self-test (but much less accurate) can be done by the scent of caffeine in your urine after a morning coffee. If it can be smelled 3 -5 hours after consumption it is alright. Less time, it is too fast, with additional time, too slow. A low caffeine clearance indicates an impaired Phase I reaction, and an increased susceptibility to toxins. Possible causes include drugs (e.g. antihistamines, benzodiazepines, antidepressants, H2 blockers, amphetamines, oral contraceptives, isoniazid), nutrient deficiencies (e.g. Cu, Mg, Zn, vitamin C), grapefruit juice, and aging. A high caffeine clearance may indicate an excessive production of intermediate metabolites and depleted glutathione. Causes include certain drugs (e.g. alcohol, nicotine, phenobarbitol, sulfonamides, steroids), a heavy toxin exposure, and charcoal broiled meats
Phase II assessment methods is best done by a lab, as it measures the clearance of acetaminophen and either acetyl salicylic acid or sodium benzoate in the urine. Low clearance of acetaminophen indicates impaired Phase II glutathione conjugation and a tendency to an impaired detoxification of acetaminophen, nicotine, organophosphates and epoxides, caused by a potential deficiency of glutathione, vitamins B2 and B6, selenium and zinc, or an excessive exposure to toxins, or from fasting.
Impaired Phase II suggests an increased susceptibility to neurotoxins, estrogens, coumarin, methyl-dopa, Parkinson’s and Alzheimer’s diseases, rheumatoid arthritis, and an impaired ability to deactivate neurotransmitters.
You should get this tested if you are sensitive to fumes; especially petrochemicals, paints, perfumes and colognes; or often react adversely to various pharmaceutical drugs. Having these sensitivities though is a good indication of a problem if you don’t have access to the lab test. Remember last blog, where we suggested food rich in glutathione like the cabbage family, raw garlic, onion. Turmeric (Curcuma longa) is also specifically beneficial for reactivating phase II. I particularly like the use of Black Radish (Raphanus sativus nigra) for it ability to tone up phase II. Often people just do a detoxification cleanse and eat more of these foods for 3 – 6 months instead of getting the somewhat cumbersome and expensive test.
Liver function balance is necessary to eliminate toxins and the fundamental maintenance of homeostasis and the vitality of the body. Its lack of balance can directly lead to an increase probability of cancer, chronic fatigue, neurological diseases, autoimmune diseases and endocrinal disorders.
Liver issues are particularly well suited for treatment with botanical medicine. In what might at first seem like confusing language to strengthen the Liver (Tonic action) we often work what is often called “detoxification of the Liver.” Eliminative function has long been seen to be an important component to the maintenance of vitality in the body in the Western herbal tradition, for it is the accumulation of waste materials and toxins that actively impair the ability of the vital force to maintain homeostasis. Although the liver is but one of five major eliminative organ systems of the body, including the bowels, kidneys, lungs and skin, most wastes and toxins at some point enter hepatic circulation via the blood. Whatever their origin, they need to be filtered, processed, and eliminated, either in the bile, or passed along to the kidneys to be secreted as urine. The stimulation of bile flow has long been one of the key therapeutic strategies in Western Herbal folk traditions, often accompanied by purgative remedies to radically remove bile from the body. Although it is an approach poorly understood and easily discredited by modern medicine, it addresses the “…retentive tendency of the enterohepatic cycle,” which in modern times has been lengthened by a decrease in fiber content in the diet, and as a result, increased intestinal transit time.
It is almost impossible to conceive of the great number of tasks and activities performed by our alchemist (the liver) on a daily basis, and to this extent, it is difficult to generalize the activities of the liver. Given this complexity of function, herbalist Michael Moore encourages a perspective that views the liver as a kind of physiological metaphor. In this context, the “liver” is not so much a specific organ, but rather a kind of “liver energy,” a series of activities that are performed in many cells throughout the body, such as the functions of the smooth and rough endoplasmic reticulum of the generic cell. Thus, the liver can be seen as the command center that guides many of the metabolic activities in all cells of the body via harmonics or morphic resonance. This concept is heavily echoed in Traditional Chinese Medicine (TCM). Therefore, botanicals that are considered “liver herbs” in fact stimulate the “liver energy” of all cells, including those in other organs such as the small intestine, spleen, pancreas, bone marrow, kidneys and skin. Moore suggests that using such “liver herbs,” including Oregon Grape (Mahonia), Barberry (Berberis) and Huan Lang Su (Coptis), we actually “fool” the liver “…into an intentional over-response by introducing a low-toxicity agent that resembles a high-toxicity stress,”.
The number and diversity of remedies that act upon the hepatobiliary system is great, and to this extent it is important to distinguish between them. Generally speaking all “hepatic” remedies act to increase bile excretion, although their concomitant effects upon liver metabolism is different. Some of these remedies are mild, such as Dandelion Root (Taraxacum) and Barberry (Berberis), whereas others are more powerful, such as Fringe Tree (Chionanthus) and Celandine (Chelidonium). Another way to distinguish the large diversity of hepatic remedies is to distinguish between remedies such as Mahonia, Berberis, and Yellow Dock (Rumex), which appear to stimulate the liver towards anabolic processes, versus those that have a more catabolic property, such as Taraxacum, Burdock (Arctium), and Wormwood (Artemisia).
In energetic terms, we differentiate them by appending the term “warming” to liver remedies that promote anabolism, and “cooling” to those that have a catabolic property. The understanding of this difference between warming and cooling hepatic remedies assists in considering genetic differences between individuals when it comes to liver metabolism, which for example, could be explained by variability in the different enzymes which comprise the cyt P450 system.
Further, there are a variety of liver remedies that are not the prototypical bitter tasting remedies that are considered “hepatics”. These work more directly on the blood or lymphatics to assist in liver metabolism. To this extent, Michael Moore identifies the syndromes of liver deficiency and liver excess in his Herbal Energetics in Clinical Practice.
In Chinese medicine, it is well known that the emotion associated with the liver is anger, but many feel (including myself) that it is the tip of the iceberg. Other emotions that are also associated with the liver are: jealousy, envy, competition, resentment, irritability and frustration. One of the big questions here is; do the emotions cause problems in the liver (or liver energy), or does the liver cause these emotions? From my experience, it is an vicious cycle that feeds onto itself. The only way out, is to break the cycle. This can be done by doing a liver detoxification, or emotional work (like flower essences, counselling, systemic constellation, meditation, or some other form of therapy). Of course, the best approach is to do both.
In our next blog, we will look at liver deficiency and excess symptoms and what botanicals and other treatments can balance them out.
 Pizzorno, Joseph and Michael Murray, eds. 1999. Textbook of Natural Medicine. 2nd ed. Vol. 1-2. London: Churchill Livingstone, p 155.
 Mills, Simon and Kerry Bone. 2000. Principles and practice of Phytotherapy. London: Churchill-Livingstone, p 187