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Understanding Your Liver Health
Analysis by
Dr. Joseph Mercola
Fact Checked
June 13, 2022
STORY AT-A-GLANCE
Your liver weighs a little over 3 pounds, lters all of your blood each day, and when
healthy is the only organ capable of regenerating; the liver performs nearly 500 functions,
including regulating your cholesterol levels
Three primary liver enzymes, AST, ALT and GGT, offer insight in the health of your liver;
GGT is correlated with iron toxicity, increased disease risk and overall mortality, and has
become a central factor in the life insurance underwriting process
While iron is necessary for biological functioning, overload signi cantly damages your
liver and may lead to heart disease, diabetes, cancer and neurodegenerative diseases
Strategies to normalize your liver function include reducing your carbohydrate intake,
balancing your omega-6 to omega-3 ratio, exercising, avoiding medications metabolized
in the liver and optimizing your gut microbiome
This article was previously published April 8, 2019, and has been updated with new
information.
Your liver weighs a little over 3 pounds and is located on the right side of your abdomen.
Reddish brown in color, it's rubbery to the touch and protected by your rib cage.
1
Your
liver is the largest solid organ and one of the largest glands in your body, carrying out
over 500 essential tasks to maintain optimal health.
2
One of the main jobs of the organ is to process and purify blood coming from the
hepatic artery and the hepatic portal vein. The liver has two main lobes, each of which
have eight segments.
3
Each segment is made up of approximately 1,000 lobules
connected by small ducts that eventually come together to form the common hepatic
duct.
4
In addition to ltering your blood, the liver regulates many chemical levels and excretes
bile your intestines use to help break down fat.
5
Your liver also produces cholesterol,
stores and releases glucose as needed, and regulates blood clotting. As your liver
metabolizes chemicals or breaks down harmful substances, they are released into the
bile or blood.
Bile enters your intestines and ultimately leaves your body in stool, while blood by-
products are ltered out by your kidneys and leave through your urine. Your body stores
vitamins A, D, E, K and B12 in the liver,
6
and the liver functions as part of the phagocyte
system, a portion of the immunological function of your body.
7
In other words, your liver is highly important to your health. It is also the only organ in
your body able to regenerate.
8
In mice, if two-thirds of the liver is removed, the tissue
regrows to its normal size within seven days. In humans, as long as 25 percent of
healthy tissue remains, it regrows without any loss of function in approximately 15 days.
What Do Your Liver Enzymes Tell You?
Although most health practitioners rely on reference ranges provided by a laboratory or
de ned by their hospital facility, there is an evidence-based set of optimal ranges that
more readily predict underlying pathology. Dr. Brian Walsh is a naturopathic physician
who has extensive training in molecular biological pathways.
In a previous article, one topic we discussed were two of the tests commonly used to
evaluate liver function — the liver enzymes aspartate aminotransferase (AST) and
alanine aminotransferase (ALT). The laboratory value ranges for the high end for AST is
40 units per liter (U/L) and 56 U/L for ALT.
9
However, Walsh believes the medical literature "very clearly show that, a) men and
women should have different AST and ALT reference ranges, and b) [the ideal range] is
not much above 20 U/L."
These two speci c enzymes are found mainly in your liver. They are elevated when there
is a form of liver damage or injury. A sudden acute jump may indicate injury to the liver,
while chronically elevated levels may suggest ongoing damage.
Some of the more common diseases triggering elevated ALT and AST are viral hepatitis
A, B or C, cirrhosis of the liver, alcoholic fatty liver disease, hemochromatosis (iron
overload) or diminished blood ow from shock or heart failure.
10
Another measurement important in the prediction of mortality is gamma-glutamyl
transferase (GGT). This liver enzyme is correlated with iron toxicity, increased disease
risk and all-cause mortality.
11
In an interview with Gerry Koenig, chairman of the board at
the Iron Disorders Institute, we discuss the importance of GGT and its involvement in
glutathione metabolism and transport of amino acids.
GGT is an important measurement of liver damage,
12
potentially greater than AST or ALT,
and may also be used as a biomarker for excess iron and early death. Determining
mortality risk is a chief responsibility of insurance underwriters who use laboratory
values and biomarkers to assign risk scores.
13
Liver function tests, particularly GGT, have become a central factor in the life insurance
underwriting process.
14
GGT is necessary in the production of your body's primary
antioxidant, glutathione. When elevated, it breaks glutathione down.
15
Researchers have also found variations in enzyme levels are inheritable and may change
by age and sex. To examine the genetic architecture, researchers sampled twins, their
siblings, parents and spouses, and found the same genes in uence liver enzymes, but
the relative contribution to the variation differs in males and females.
16
The Importance of Monitoring Iron Levels for Liver Health
Another factor associated with liver damage is iron overload. Iron is one of the most
common nutritional supplements used today, as you may nd it isolated, added to
multivitamins and in forti ed processed foods. While it's necessary for biological
function, too much may do tremendous damage.
In fact, iron overload may be a more common problem, and far more dangerous, than
iron de ciency anemia.
17
Nearly all adult men and postmenopausal women are at risk
for iron overload as there is no clear e cient iron excretion method. In other words,
these populations do not lose blood on a regular basis.
Blood loss is the primary way to lower excess iron. If excess iron is left untreated it may
contribute to cancer, heart disease, diabetes and neurodegenerative diseases.
18
Iron
triggers damage by catalyzing a reaction with hydrogen peroxide within the
mitochondrial membrane, forming hydroxyl free radicals.
These are among the most damaging free radicals and cause severe mitochondrial
dysfunction.
19
This in turn is at the heart of many chronic degenerative diseases.
GGT may also be used as a screening marker for excess free iron,
20
as it is highly
interactive with iron and will tend to raise GGT levels. When your serum ferritin and GGT
are high, you have a signi cantly increased risk of chronic health problems.
Balance Omega-3 and Omega-6 Fats for Optimal Liver Function
The American Liver Foundation estimates nearly 25 percent of adults in the U.S. are
affected by nonalcoholic fatty liver disease (NAFLD). The condition is associated with
serious risks as it may cause the liver to swell (steatohepatitis) and may lead to liver
cancer or liver failure.
21
It often has no symptoms but may be suspected if you suffer from other associated
conditions and your blood tests have high levels of liver enzymes. Progression from
NAFLD to nonalcoholic steatohepatitis (NASH) is one of the leading causes of cirrhosis
in adults in the U.S.
22
Excess amounts of omega-6 fatty acids are challenging to the liver.
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Although both
omega-3 and omega-6 are necessary for good health, dietary changes over the past
several decades have increased the ratio of omega-6 to omega-3 up to 25-to-1, well
above a healthier 5-to-1 ratio, or the 1-to-1 ratio recommended by some experts.
24
Experimental studies have suggested this divergence increases your body's ability to
gain fat and, more importantly, increase systemic in ammation. Additionally, the
lopsided ratio plays a role in the development of obesity through an increased activity of
the cannabinoid system and AA eicosanoid metabolites.
25
Researchers have found this process may be reversed by increasing eicosapentaenoic
acid (EPA) and docosahexaenoic acid (DHA), both components of marine-based omega-
3 fat. Research has also found excessive amounts of damaged omega-6 are associated
with in ammatory diseases such as NAFLD, cardiovascular disease, in ammatory bowel
disease and Alzheimer's disease.
26
The primary therapeutic action of marine-based omega-3 is reducing in ammation,
while omega-6 is needed to initiate the in ammatory response.
27
When the ratio is
unbalanced in favor of omega-6, it increases the rate of in ammation. Other health
bene ts associated with a healthy omega-3 to omega-6 ratio include balancing low-
density lipoprotein cholesterol and triglyceride levels,
28
reducing blood pressure
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and
preventing atherosclerosis.
30
In addition to reducing the risk of obesity and in ammation, balancing your omega-3
fatty acids against your omega-6 intake can also help reduce your GGT level,
31
improve
liver fat, reduce triglycerides and improve HDL levels in those with NAFLD or NASH, both
in ammatory processes not triggered by alcohol intake.
Cholesterol Pro le Reveals Challenges
Your liver is responsible for cholesterol regulation, as it not only synthesizes cholesterol
but also removes it from your body, converting it to bile salts to be eliminated in your
feces.
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When damaged, your liver is unable to regulate cholesterol levels normally.
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This may
result in atherogenic dyslipidemia, or elevated levels of triglycerides and LDL, with low

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