Second Nature Care Blog


[fa icon="calendar'] Oct 19, 2021 7:14:05 PM / by Stephanie Finucane

If All Else Fails, Treat the Liver

By Steph Finucane

The liver is home to more than 500 bodily functions. If any of these is out of alignment, illness or disease could arise. In a recent article in the Townsend Letter, Douglas Lobay, BSc, ND, explains the vital role of the liver, which includes “detoxification, synthesis of proteins, and production of biochemicals necessary for digestion and gut health.” Additionally, the liver is “involved in glucose metabolism, glycogen storage, decomposition of red blood cells, production of cholesterol and hormones, storage of fat-soluble vitamins, and production of bile involved in fat metabolism.”

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Following a detailed explanation of the assessment of liver function related to biotransformation, drug metabolism, and phase 1 cytochrome P450 reactions and phase 2 conjugation reactions, Lobay notes that basic liver enzyme tests, such aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), “really do not reflect liver function as much as they show liver cell damage and inflammation.”

He also points out his observation of a steady rise in the upper limits of these same basic liver enzyme tests for several years. For example, more than 40 years ago the upper limits of ALT for males and females were 30 units/ml and 20 units/ml, respectively. However, over the years those limits have increased, with Lobay noting he has seen the upper limit as high as “65 units/ml” with one lab. He explains that the lab values chosen “are pre-determined by the bell-curve distribution of a large sample size of the general population. Could this mean that over time the overall general health of our liver is getting worse? I surmise that this may be so.”

While he agrees elevated liver enzymes due to multiple reasons, such as viral infection, alcohol consumption, toxic exposure, etc, Lobay believes the main perpetrator of “slightly” elevated liver enzymes is non-alcoholic fatty liver disease (NAFLD), potentially affecting up to 30% of the adult US population.

Lobay treats his patients with diet and supplements, “particularly the herb milk thistle.” Then he retests his patients’ basic liver markers, interpreting a drop in liver enzymes of at least 10 units/ml as “significant and meaningful.”

Additionally, Lobay finds it useful to assess patients’ detoxification pathways to “enhance a patient’s capacity to eliminate toxins and improve liver function with the use of dietary changes, foods, nutraceuticals, and natural supplements.” For example, the caffeine clearance assay will help indicate a patient’s “general functional capacity of specific phase 1 cytochrome P450 enzymes.” In other words, if the caffeine clearance is slow, such a patient would tend to be much more sensitive to caffeine, and vice versa.

To learn more about the body organ that can “store up to 10% of the body’s blood supply” and can be regenerated with “as little as 25% required for full recovery,” refer to Lobay’s full article in the June 2021 issue of the Townsend Letter.


Lobay D. Assessing liver function? Townsend Letter. 2021;455:33-36.

Topics: Detoxification

Stephanie Finucane

Written by Stephanie Finucane

Isadora Guggenheim, ND, FNP, RN, MS, CNS, LMT, owner of Second Nature Naturopathic Care, LLC
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