How to protect the liver in a coronavirus pandemic?

Than dangerous liver damage

To understand how hard the body is having with a sick liver, you need to know what this amazing organ is doing. The liver is by nature stakhanovets. Its functions should be divided into 10 organs, but not — all itself. It is really irreplaceable: without a liver, a person absolutely will not be able to live. It endlessly “chemicates” to neutralize dangerous compounds and remove from the body. The liver was dealing with detox long before the word came into vogue — it’s an organ that cleans blood from slags, toxins, allergens. Liver will turn off — you will “choke” poisons. It’s not a thickening of paints, because it’s enough to look at people who require urgent transplants.

In addition, the liver produces bile, stores glucose stocks, participates in the production of hormones and vitamins, cholesterol and bilirubin, lipids, phospholipids and lipoproteins, is a repository for impressive volume of blood, neutralizes and removes from the body excess hormones, mediators, vitamins… Three days and three nights you can talk about the tasks of the liver to understand how hard it will become if on this” factory” will fail.

How COVID-19 enters the liver

To penetrate human cells, COVID-19 uses angiotensin-converting enzyme-2 receptors (APF-2 or ACE-2) that are located on surface of airway and gastrointestinal tract cells. This suggests that the virus can multiply in the digestive system. Especially much APF-2 is found in cells of the stomach, duodenum, rectum, as well as in cholangiocytes (biliary tract cells) and hepatocytes (liver cells). This is the first risk factor that has to coronavirus liver damage.

The second risk factor (perhaps even more dangerous) is exposure to drugs that are used in the treatment of COVID-19. Any medicines are metabolized in the liver. That means any pill you take goes through there recycling. Part of the drugs have hepatotoxic effects on the organ. Simply put, leads to damage or death of liver cells. These drugs are used in the therapy of viral infections.

Summary: when infected with COVID-19, the liver can get two strokes — through direct exposure to infection and drug therapy. Refusing treatment is not naturally necessary, but protecting the liver is necessary. This applies to both healthy and people with available liver pathologies.

We build up liver protection

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Here are recommendations issued by the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD). Special concerns of hepatologists are caused by patients with the following pathologies:

  • Autoimmune diseases of the liver and biliary tract

These patients are constantly taking immune-reducing drugs (glucocorticoids, cytostatics, etc.), and experts recommend continuing the standard therapy during the pandemic. It is not possible to change the dosage of drugs independently: this can cause worsening of liver disease, and any chronic diseases in the stage of aggravation increase the negative prognosis for coronavirus infection.

  • Chronic diseases in the stage of aggravation and decompensation

This is the logical continuation of the first point. First of all, people with cirrhosis of the liver are at risk — especially those with decompensated, with ascitis or/and high risk of bleeding.

  • Patients with non-alcoholic fatty liver disease (NADBP) or steatohepatitis (NASH)

Here you need to explain that the vast majority of fatty liver disease has people with extra weight, because fat is deposited in the liver too. So, according to recent studies, such people have a high risk of severe current COVID-19, in addition they tend to have associated problems (diabetes mellitus, hypertension and obesity) that further exacerbates the risk of fatal complications of coronavirus infection.

Quite an unexpected twist. Many people still believe that NACBP is, in fact, not even a disease and it is not especially necessary to treat it. However, to date, it has been established that NACBP itself and associated metabolic disorders can determine the prognosis of the course of coronavirus infection. Attention: Fatty liver disease is available in about a third of the world’s population due to the high prevalence of obesity.

With regard to liver protection drugs, hepatologists recommend using ursodeoxycholic acid (UDHC) drugs to prevent possible complications of COVID-19. This substance has a stabilizing effect on the lining of cells of both the liver itself and the biliary tract and protects them from damaging effects of external factors. In addition, studies have shown that this acid helps prevent pulmonary edema and fibrosis — typical complications of coronavirus infection.

EASL and AASLD experts also advise to reduce the burden on the liver as much as possible during the COVID-19 pandemic so that the organ can meet the infection (if it happens) in better condition. It’s important to remember that the liver has a supercapacity to self-repair. To do this, alcohol use should be restricted or excluded, smoking (or at least smoking less than usual), and nutrition normalized. Livers will be much easier if you reduce the amount of fatty and sweet food in your diet and increase your intake of vegetables, fruits, easily digestible protein and the right fats (avocado, unrefined vegetable oil, seeds, etc.).

And bring physical activity back into your life as soon as possible. Studies show that light load — not important cardio or strength — positively affects liver performance.

Author: Evgeny Ivanovich Sas, gastroenterologist, hepatologist, doctor of medical sciences

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