The Liver: A ‘Blob’ That Runs the Body | Hacker News Reader

The Liver: A ‘Blob’ That Runs the Body

nytimes.com

240 pointstysone102 comments

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.

> 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.

Not OP, but I received a bone marrow transplant 6 months ago, and the amount billed to my insurance so far has exceed 2 million USD. So I assume no transplant team could survive without someone agreeing (in advance) to pay the bill for the transplant and post transplant related care. If I had walked in with a big enough wad of cash, it's possible I could have got on the list too, but my case has pretty much gone as smoothly as possible, with complication I could see the bill approaching a much bigger number,

If this makes thankful you have insurance, maybe the number is inflated. It's not unheard of for the net amount paid to be far less.

Any patient in the situation should be thankful for insurance. When your liver is failing, you have your hands full.

The only major variable you should try to optimize is wait list time. Outcomes are roughly comparable across centers and are monitored by the government.

From what I have read about transplants, I would not automatically assume the figure above is inflated. They seem to generally be quite expensive.

> Not OP, but I received a bone marrow transplant 6 months ago, and the amount billed to my insurance so far has exceed 2 million USD.

Transplants are expensive, but the amount billed to your insurance is not a meaningful number in any way. Hospitals don't actually expect insurers to pay that; they set the number absurdly high as a starting point for the back-and-forth negotiations. This is particularly true for very expensive procedures which are almost always paid for by private insurance - both because of the expense, but in some cases by law.

(On that note, even looking at the amount paid by your insurance is misleading as well, because if you're on private insurance, you're paying not just for your own care, but to cover the care of people who are on Medicare and Medicaid, since private insurers are required to cover the costs of those patients' care as well. This is especially true for high-end, expensive, and/or chronic or terminal treatments like dialysis.)

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.

> happen to live in the wrong region of the country where organs are scarce

Where should you move if you want an organ?

Do the research if your life depends on it, but New Orleans, Indianapolis, and Tennessee are good bets. Georgia and Florida too.

The reasons are morbidly fascinating and too detailed to go into here.

Sounds interesting. Could you give us a quick summary?

A combination of lots of people killing themselves(usually in auto accidents) plus many people who need a liver being ineligible to get one due to alcoholism/drug addiction/other health problems.

Varies by state because of details of organ donation laws, religious makeup, quality of healthcare. Blue states tend to have fewer donors (seat belt laws, gun laws, more social safety net). High concentration of hospitals is generally bad (car accident victim on the Mass Turnpike gets rushed to one of a number of world class hospitals, lives, not a donor). So Boston bad. New York worst state in US: need an organ in NYC? Relocate while you can.

Midwest and southern generosity typically drives higher donation rates. Neighboring states may draw organs from your state.

Transplant hospitals that do many cases get really good at it, and have enough experience that they will use organs other centers will reject. My liver was rejected by at least one other transplant center before it arrived in Indianapolis. (They let me see it before surgery. How cool is that?) So think twice before ruling out an organ just because someone else said no.

Blood type, physical size, and exact timing of things can cause lucky breaks.

Yeah, some places are better than others. When I was waiting for a transplant, I lived in the western United States. I shared an organ distribution region with California. My docs told me: "That sucking sound you hear is all the needed organs going to California." Ha! I waited 2.5 years for a transplant.

>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.

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.

My ex-wife is still recovering from her second liver transplant. The first one was when she was 20, due to a genetic disease that causes sudden liver failure around that age. That time, she went from ER to transplant to recovery in just a few days, because of how quickly she became sick enough to move to the top of the list.

They never told her that liver transplants are pretty much always temporary, at least with the immuno-suppressant drugs that were available most of the past 20ish years. Even with drugs, most people's bodies are constantly attacking the foreign liver and damaging it beyond its ability to repair itself. 20 years is a pretty good run; hers lasted 22.

This time around, she was in the hospital for two months (seemed much longer) while they tried to keep her alive. She went through all the symptoms you mentioned. Towards the end she suffered full-on dementia from the toxins in her brain. After two months of suffering, she lost her will to live, and told me and her family that she was giving up. I was sure she'd be gone by the end of the week, but that night the miracle happened; a compatible liver was available and she was at the top of the list. The next day, after a very long surgery (working around 22 years of scar tissue from the first transplant) she got a healthy new liver.

She remained in the hospital two more months, mostly in rehab, while her brain returned to normal (mostly) and she learned to walk again. It took months after going home for her to be strong enough to fully care for herself.

Unfortunately, the decades of drugs and months of liver failure pushed her kidneys past their limit. She's not on dialysis yet, but most likely she will need a transplant before the year is up. It's just a matter of time, and she's trying to find a living donor. If she can find one, she can get the transplant before she gets too sick again, which will make recovery much easier.

Organ transplants are absolute miracles of modern medicine, but we need artificial organs. Whether they're completely mechanical, natural organs grown artificially, or custom gene-spliced organs to prevent rejection, we need them. There aren't enough organs available now to meet the need, and the patients who get them have to go through hell first. And the ones who don't, don't survive at all.

> we need artificial organs

Or a way to farm organs in the lab.

If self driving cars succeed in massively reducing accident deaths (yay!) an unintended consequence will be huge shortfalls in donatable organs.

All the more reason to make organ donation opt out or mandatory.

You know, at some point negative tradeoffs kick in when you try to go do far with this idea of "making everyone do the right and honorable thing, all the time." Such as, for example, the very, very negative implications of the idea that "society" (really, the government) outright owns your internal organs.

Let's stick to education and (why hasn't been tried?) financial incentives, please.

Explain why making organ donation after death an opt-out process would have any negative tradeoffs, let alone a net negative effect.

Someone who appear brain dead at first glance, their family might be pressured to turn off life support to take out the organs, to give to another person in the same hospital.

If that first glance was mistaken and the person was in a coma that could recover months from now, then basically a man was killed for his organs.

It is highly unlikely that the recipient is in the same hospital. The ER team who oversees the brain-dead person is not the same team who handles the organ transplantation. The docs who treat the patient with a failed liver aren't the people who decide where the organ(from the deceased donor) goes. This is a myth that needs to die. Doctors don't 'let someone die' because they are an organ donor. There's a complex system in place to regulate the distribution of organs.

edit: I am a liver transplant recipient.

Opt-out. Problem solved. If you are that worried about it, you can opt out. Most folks won't care.

This is a utilitarian-ish argument. I would consider the following questions:

- Who owns your organs before death?

- Who owns your organs after death?

- I assume you are opting-out from a government mechanism for organ donation. What is the origin of the government's power to claim your dead organs unless you opt-out?

1. You do

2. No one does

3. The origin for the claim is that you accept to give your organs, and it is that way by default in a lot of countries because most people either don't care or actively want to save lives. If you don't want to give them for whatever reason, you can always opt out

I would also like to point out that this whole point seems like debating for the pleasure of rhetoric : there is no specific downside to having organ donation opt out by default, as a lot of countries do, for example France since 76. And if you don't agree with organ donation, just opt out. There is, however, a huge upside : saving a lot of lives.

Actually the person above specifically suggested it could also be mandatory, as this were an equally palatable option.

So it was mostly that suggestion that I was responding to. As to the negative tradeoffs in that option -- I think they're pretty obvious.

(Hint: we'd have to in effect force members of certain religious to at least formally disavow that aspect of their religion, for one).

As to opt-out, while of course different, it's still in the same (troublesome) territory as the 'mandatory' option -- definitely a major insult to people with strong personal or religious convictions about the issue. At the end of the day, it's inseparable from the idea that your body is, on a certain level, state property.

Which, aside from being repugnant to many people, is also in conflict with the emerging social consensus that, by and large, one's dominion over one's physical body is absolute and inviolable† -- which just so happens to form the legal and philosophical bedrock behind the idea that one should be free to choose to terminate a pregnancy; as well as (in the case of terminal illness, at least), the manner and timing one's own death; and of course, the manner in which one's body is disposed;

The same should naturally hold for the disposition of one's organs after death. We would never think of passing a law making, say, chemical dissolution the default disposal method for your body after death, unless you "opt-out" and choose some other method -- even though this is touted to have many environmental benefits. Nor would we think to propose that, by default, your body be served up for whatever experimental purposes the local university might have in mind (unless you "opt-out", that is). It'd just be way to repugnant to many people, and open up too many cans of worms ethically and legally.

So the organ donation issue is basically right in the same territory.

† Aside from proscriptions against controlled substances, of course. But that's just one of the many schizophrenic negative tradeoffs of that particular policy.

But don't financial incentives lead to thieves stealing your organs?

Not if you structure them properly.

Where I live (Austria), it's opt-out already. I didn't find concrete numbers, but I read that Austria is therefore among the top transplant nations.

We may have a way to farm organs literally and soon.

https://www.technologyreview.com/s/603857/crispr-may-speed-p...

It was already ten years ago that some scientists figured out how to grow a 'mini liver' in a bioreactor. They've developed the technology a lot further since then, but it still looks to be 15-20 years out for full commercialization. The CRISPR solution may do wonders for people waiting desperately on organ lists in the meantime.

> My debt to the universe is to educate when possible, to console when necessary.

I don't have any liver related problems, or know/knew anyone with them, but I must thank you for having that sentiment.

Can you give some advice on how to keep my liver healthy?

Don't drink too much, exercise, eat a healthy diet, dont use unclean needles, insist a condom be worn during sex

My docs told me, while I was waiting for a transplant, that fatty liver is a problem. Even though a donor looks healthy, their liver can be too fatty for transplant. Eat right and exercise.

I have a liver disease of unknown cause - doctors have investigated every cause under the sun for many years without success, and it looks like ill need a transplant at some point. Would you mind if i contact you with a few questions?

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.

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.

> 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.

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.

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.

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.

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?

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.

>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.

> 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?

>> 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.

Some case studies that I find interesting:

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

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

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).

Robert Lustig does a good talk about sugar metabolism in "Sugar: The Bitter Truth": https://www.youtube.com/watch?v=dBnniua6-oM

Also, "The Trouble with Fructose": https://www.youtube.com/watch?v=Yh4JBXaKnmA

Despite the baity titles, it's a good talk with real biochemistry.

Edit: better video added up top

Lustig is not a joke, but I'd love to have other wise point of view on the matter.

What would this other point of view show? I don't see how there can be alternative opinions on this, metabolism isn't that different between humans.

I guess you could argue that he didn't reach the correct conclusion, but that's different point.

Googling 'Lustig criticism' gives you a good place to start. Though with nutritional science, everything is so far from consensus (and when there is a consensus, it's 20 years behind the science) that you should treat this as a jumping-off point to read the literature instead of an authoritative rebuttal.

http://www.alanaragonblog.com/2010/01/29/the-bitter-truth-ab...

There's a section about halfway down where he discusses Lustig's claims that things like HFCS are metabolized differently and negatively.

Because I'm not a doctor or a biologist, so I need a few counterpoints as checks in order not to be blinded. It's just a quick check valve while I read more about the subject.

Me too. I know this is essentially his gig now, but I haven't seen anyone attack the science. If there's a reasonable refutation out there, I'm all ears.

In his video he talks about the amount of salt in Coca Cola like it's part of some grand conspiracy.

Coke has very little salt, so it makes me question a lot of his other claims.

I'm gonna echo GP

>I haven't seen anyone attack the science. If there's a reasonable refutation out there, I'm all ears.

Ray Peat addresses the science better than anyone I've read. He's a biology phd from University of Oregon with a specialization in biochemistry, physiology, and endocrinology. Many of his ideas are not the mainstream but everything he writes about is extensively researched and cited.

He has a number of articles on sugar but a good one to start with is Sugar Issues[0]. It can get a bit technical so I would recommend keeping wikipedia and google handy. It looks to have around 50-100 references for further investigation. Here's also one of his many radio interviews where he discuses sugar (starts in earnest with respect to sugar at around 14:35, but whole talk is great)[1].

Basically, sugars (glucose, fructose, sucrose, lactose) are healthy and protective for a wide variety of reasons - as long as they are able to be fully oxidized by the mitochondria, to produce carbon dioxide and a greater number of ATP. Many of the alleged "evils" of sugar are actually due to the polyunsaturated fats, which inhibit proper metabolism of sugar and damage cells in a variety of ways. One well established mechanism is by competing with glucose for oxidation, resulting in higher blood sugar levels. This is known as the Randall cycle (or glucose fatty acid cycle) and actually serves as the foundation for an as-of-yet unchallenged theory of type 2 diabetes.

I highly recommend reading ray peat, and listening to his interviews. His intelligence, recall, and ability to synthesize information to form coherent biological models across a variety of topics are all-together astounding. I honestly recommend all of his articles and interviews. It takes some time and re-readings to fully grasp the concepts he advances, but it is well worth it.

[0] http://raypeat.com/articles/articles/sugar-issues.shtml [1] https://www.youtube.com/watch?v=Lx96YYKvA9w

Fructose has the particularity among sugars that its uptake in the gut is not regulated, and can be easily metabolized. This means you can load your body with fructose, with both the benefits and nefarious consequences that implies.

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/Nutrient_Timing

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

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.

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.

I've found this guy's videos to be a good distillation of the issue. It's basically Lustig's work but there's some other sources as well.

Why Sugar is as Bad as Alcohol: https://www.youtube.com/watch?v=f_4Q9Iv7_Ao

Food Industry's Secret Weapon (WHY Sugar is addictive & in 80% of Food): https://www.youtube.com/watch?v=LPxIssabhTc

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

Why would they need that?

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

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.

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

> Chrome uses different jars for each private window. (I believe.)

Pretty sure that Firefox does the same.

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

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.

I'm not sure if there's been much of a more recent update to this in the past 8 or so years, but my recollection of Milk Thistle studies is that they're largely ineffective for liver disease and marginally effective for acute hepatitis.

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

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...

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...

I like examine.com's analysis of supplements: https://examine.com/supplements/milk-thistle/

Liver disease (chronic) Several studies of milk thistle in liver disease caused by viruses or alcohol report improvements in liver tests. However, most studies have been small and poorly designed. More research is needed before a conclusion can be made.

B -- Good scientific evidence for this use

http://www.mayoclinic.org/drugs-supplements/milk-thistle/evi...

I have taken milk thistle. Some people don't tolerate it well. There are alternate things that can be taken in that case.

Looking back on my notes, the reason it helps is that it boosts glutathione. IIRC, you cannot take glutathione directly as a supplement. So, instead, you need to take things that help the body create glutathione, and milk thistle is one of the things that can do this.

If you don't tolerate milk thistle well, you should research glutathione precursors. But be aware that a lot of the websites you will most readily find are kind of sketchy.

You also need to remove the stress from the liver. Said friend needs to stop drinking. It may also help to do other things to reduce stress on the liver.

I've been taking it for a while - hasn't had any noticeable benefits for me, but based on my research online and asking a few doctors there is no harm in taking it. No downside, possible upside so go for it.

Also research NAC [0] supplements. They work as a precursor to glutathione in the liver which is typically depleted during the course of alcohol consumption. Might only be effective for acute effects of alcohol though.

Edit: Also, make sure your friend is consuming coffee [1].

[0] https://en.wikipedia.org/wiki/Acetylcysteine

[1] http://www.journal-of-hepatology.eu/article/S0168-8278(17)30...

Love the sponsored content food items

That definitely stood out to me.

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?

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.

Check https://en.wikipedia.org/wiki/Glycemic_index

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.

Or a cardiologist.

Turns out you need pretty much everything in there.

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.

https://en.wikipedia.org/wiki/Hemispherectomy

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

> 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-...

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.

https://www.quackwatch.org/01QuackeryRelatedTopics/flushes.h...

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.

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.

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.

> 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.

Peddling what is obviously bullshit fails to honor conversation protocol as well.

No, but downvoting people who does not share you opinion is. Double-plus for downvoting people that calls you on your hypocricy.

The terapeutic modalities you have label under the collective label of "bullshit" is a valid options for millions of people in America alone. And the reason this is so is because doctors distill hubris in their interactions with everyone else (like you), and then when they are found in a mistake or in some sort of self serving scheme, they pretend nothing happened (like you) and try to blame someone else (like you).

What to help science win? You need to win back the hearts of all those millions of people that got disillusioned with modern medicine. And the way to do so is to treat people with respect and let the strenght of your arguments set the direction of the debate. Once you have to resort to censorship and name calling, you have already lost.

The rules aren't an API to work around. They have a spirit and an ethos.

You can't say 'yah boo you guys have to listen to me by your own rules' and not expect to get called out on it.

Not all opinions are equal.

This place has its faults but tolerating pseudoscience especially quack medicine is not one of them.

> Once you have to resort to censorship and name calling, you have already lost.

I'd like to live in a world where this is true, where voiced opinions were all fairly evaluated and the right decision made. But I don't.

People hear bullshit and believe it when they should know better, and silencing dissenting opinions actually works quite well.

Thank you for engaging, dpark. You mentioned elsewhere that the (HN) audience collectively decides. You are right, I have taken a small punishment in my karma numbers, but I am willing to pursue this regardless.

You claim that people hear and believe bullshit. That itself is a symptom; mainstream medicine has been unable to provide adecuate healthcare services, so the quacks come in and fill in the gap. Your chosen side is very eager to throw accusations of malfeasance and stupidity, but in many cases it would be more accurate to say that people is doing a (perhaps misguided) attempt to deal with hard realities with limited options. It does not help that said side is prone to downplay its own pursuit of profit motive.

This state of affairs is not new at all. According to Lester King's "The Medical World of the Eighteen Century", this goes back at least to the days of Henry VIII in the English speaking world (and has its roots in the medieval customs and institutions of the guilds and the Church). The problem is fundamentally economic and political (who has the right to ministrate health of their fellow man), but doctors like to hide behind appeals to authority (ancient tradition first, later science).

True Science should have no business taking sides on what ultimately ends up being comercial disputes; theirs is to look at Nature and figure out how it works. I am obviously engaged in the Alt-med scene, and I can tell you by personal experience that it does work well enough. The problem is that, being a low status subject, the ranks of its practicioners are filled with anti-intellectual types; and yes, this means there're lots of bullshit being peddled out there, and even the stuff that seems to work does probably work according to principles that are unknow to the people that use them. And it is an herculean taks just trying to figure out what's complete bonkers and what's real phenomena waiting to have an actual explanation.

> You claim that people hear and believe bullshit. That itself is a symptom; mainstream medicine has been unable to provide adecuate healthcare services, so the quacks come in and fill in the gap. Your chosen side is very eager to throw accusations of malfeasance and stupidity, but in many cases it would be more accurate to say that people is doing a (perhaps misguided) attempt to deal with hard realities with limited options.

I fully believe that many of the people promoting and peddling treatments that don't work honestly believe that they do work. Nonetheless, if the treatment is worthless, it's still bullshit.

The problem isn't that modern medicine provides insufficient services. It's that modern medicine is fundamentally unable to cure or even treat many conditions, because we simply lack the knowledge. "Alternative medicine" rushes to fill the gaps because people desperately want something. So they buy into vitamins to cure cancer and homeopathy to treat virtually everything but in the absence of evidence of efficacy, these are just snake oil.

There's also carryover effect where some people assume that if medicine can't cure everything, then they have to doubt it's effectiveness for even the things it can cure. People also like to believe that they have secret knowledge. People enjoy imagining that they know things that even the doctors don't know. Plus conspiracies of knowledge suppression etc.

> True Science should have no business taking sides on what ultimately ends up being comercial disputes; theirs is to look at Nature and figure out how it works.

I'm not sure what you mean. Science is on the side of proof. Any "alternative" medicines that have proven effectiveness aren't alternative any more.

> I am obviously engaged in the Alt-med scene, and I can tell you by personal experience that it does work well enough.

Personal experience just isn't very meaningful. There are two many confounding factors and biases involved. You can find people who swear by the effectiveness of pretty much anything.

What matters is verifiability. The ability and willingness to put medicines through double blind studies is what separates medicine from alternative medicine.

> The problem is that, being a low status subject, the ranks of its practicioners are filled with anti-intellectual types; and yes, this means there're lots of bullshit being peddled out there, and even the stuff that seems to work does probably work according to principles that are unknow to the people that use them. And it is an herculean taks just trying to figure out what's complete bonkers and what's real phenomena waiting to have an actual explanation.

The problem is that its ranks are filled with people who don't practice actual medicine.

Ok, I will make one last comment and let this discussion to rest.

It is curious you mention Snake Oil. There was a post a few days ago on HN, reporting that Science has found actual biochemicals in oil of some snakes that may be useful in modern health care.

Snake oil was a well known remedy in Chinese pharmacopea, but unfortunatelly is was introduced to America by an unscroupulus peddler and bigot, who thought that as long as it was a con anyways, it did not matter what kind of oil he would peddle.

Then, the name of a genuine prescientific remedy ended up being the class exemplar of all fake cures out there. And the discovery of this chemicals took 200 years longer because real doctors would not dare take the status hit to even consider the possibility that it might be something real behind the quack's claims.

> And the discovery of this chemicals took 200 years longer because real doctors would not dare take the status hit to even consider the possibility that it might be something real behind the quack's claims.

And the alternative is what precisely? For doctors to not tell people when the "medicine" they're using is a worthless scam?

> Double-plus for downvoting people that calls you on your hypocricy.

If you're referring to yourself, 1) I didn't downvote you, 2) your accusation of hypocrisy is baseless and false.

> What to help science win? You need to win back the hearts of all those millions of people that got disillusioned with modern medicine.

I don't want to help science win. If I do want anything in this ludicrous debate you're trying to single-handedly have with me, it's to stop snake-oil salesmen from harming people with either bad products, or completely useless products that prevent them from actually getting help they need. Every $100 you spend on glyconutrients is a $100 you don't spend on actually making yourself healthier.

This is me signaling that I'm done with this conversation.

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