John T. Rowe, MD

Love Your Liver

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One Awesome Organ! 

          The liver is a much underappreciated organ, in my estimation.  The heart, the lungs and the brain get all the glory it would seem, but, as anyone with a liver problem will tell you, the liver is another vital organ that you cannot live without.  This amazing organ is located in the right upper abdomen just below the lungs and diaphragm and, perhaps signaling its importance, it is tucked under the right rib cage for protection.  It is the largest solid gland in the body and is divided into two lobes, the right being larger than the left.  The bulk of the work is performed by hepatocytes which are the cells comprising most of the liver.  Nearly two quarts of blood pass through the liver every minute.

The Power to Regenerate 

          The liver is one of the only organs that has retained some ability to regenerate itself after an injury.  The kidney is another hard-working organ that shares this ability, although to a lesser extent.  It is an interesting side note that the more highly evolved the organism, the less ability it has to regenerate.  Most high school students are familiar with the planaria worm, which when split lengthwise or crosswise will regenerate into two separate individual worms.  And further up the evolutionary scale, salamanders are able to regenerate limbs that have been amputated.  So, in the highly evolved human being, the liver holds a special place among the many other incredible organs of the human body in that it has retained some of this ability to regenerate itself. 

Functions of the Liver    

          So why do I love the liver?  Let me count the ways.  Let’s take a quick look at some of the functions this hard-working organ performs that make it so important?  Among some of the many things the liver does for us, it: 

-produces immune factors and removes bacteria from the bloodstream to combat infection.

-regulates bile production and excretion which helps digest food and absorb nutrients.

-converts glucose into glycogen for storage, which can be used later for energy.

-helps maintain the proper level of glucose in the blood.

-produces cholesterol and helps regulate its metabolism.

-acts as a filter to detoxify and purify the blood, clearing the blood of drugs and other toxins.

-converts poisonous ammonia into urea which is then excreted in the urine.

-synthesizes plasma proteins such as albumin and clotting factors, helping to regulate blood clotting mechanisms.

-stores vitamins and minerals, such as iron. 

Wow!  Talk about multitasking!  This is one busy organ.  Imagine performing all of these functions 24/7 for your entire life.  Now you are beginning to see why I have so much respect for the liver.  

Liver Tests 

          There are many tests that can assess liver function and disease, but a few of the most common blood tests that patients should be aware of can be summarized as follows: 

-LIVER ENZYME LEVELS:  Enzymes produced by the hepatocytes (liver cells) leak into the blood stream when the hepatocytes have been injured, causing elevated blood levels.  Examples are SGOT (AST), SGPT (ALT). 

-BILIRUBIN LEVEL:  Bilirubin is a breakdown product of hemoglobin from red blood cells which is cleared by the liver.  Numerous liver problems can interfere with this process, causing the bilirubin level to increase in the blood.  Elevated bilirubin is responsible for the jaundice (yellow discoloration) which can be associated with liver disease. 

-ALBUMIN AND COAGULATION FACTOR TESTS:  Assessing the level of these liver products measures how well the liver is performing its synthetic functions.  Example, INR as a measure of how long it takes the blood to clot. 

Liver Diseases

          Because the liver performs so many essential functions, it plays a significant role in many disease processes.  Its role as a filter for removing toxins and the rich blood supply necessary to fulfill this function put it at particularly high risk for injury.  As we continue our brief overview of the liver in the next articles of this series, we will look at some of the more common liver diseases, with a special emphasis on hepatitis, and we’ll get a better idea of why it’s so important to be nice to your liver. 

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ADHD Update

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Attention Deficit Hyperactivity Disorder 

          ADHD refers to a group of behaviors that make it difficult for children to pay attention and control impulses, affecting boys three times as often as girls.  A recent study released by the Centers for Disease Control and Prevention in Atlanta, Georgia reported that there has been a 22% increase in the number of children diagnosed with ADHD since 2003.  That means that there are now 5.4 million or one in ten children in the United States who have been given the diagnosis of ADHD.  The study attributed the increase to more awareness and better screening. 

          There is considerable public concern that children are being overmedicated and many medical professionals share that concern.  Two thirds of the children diagnosed with ADHD are on medications.  The most common medication is methylphenidate (Ritalin) or related drugs that are chemically similar to amphetamines.  These psychostimulants can increase heart rate and blood pressure and cause changes in the electrocardiogram (EKG).  Several recent studies have shown that the ADHD medication dose could be reduced by half simply by replacing it with a placebo (sugar pill) without causing any change in symptoms as perceived by teachers and parents evaluating the child.  Clearly this deserves further investigation and raises more questions than it resolves.

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Vicks VapoRub Works

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New Study Confirms Old Treatment 

          Reporting in the journal Pediatrics this month Ian M. Paul, MD and colleagues confirmed what mothers have known for years…Vicks Vaporub actually works.  Vicks Vaporub is a topical aromatic compound containing camphor, menthol and eucalyptus oils, which has been a popular remedy since it first became available almost one hundred years ago.  Although not quite that long ago, I can remember as a kid how my mother would apply Vicks to my neck and chest when I had a cold and how the soothing action relieved my stuffy nose.  Thanks, Mom.  You knew all along!  

          The study set out to determine whether a single application of vapor rub or petrolatum is superior to no treatment for nocturnal cough, congestion and sleep difficulty caused by upper respiratory tract infection in children.  There were 138 children between the ages of 2 to 11 years of age in the study.  Parents were surveyed the day before treatment and the day after either vapor rub, petrolatum ointment or no treatment had been applied to their child’s chest and neck before bedtime. 

          Vapor rub scored the best in the survey, although some irritant effects were reported.  The study concluded that parents rated vapor rub best for symptomatic relief of their child’s nocturnal cough, congestion and sleep difficulty caused by cold symptoms.  By relieving symptoms, both children and parents were able to get a better night’s sleep.  As with all treatment products, it is important to follow instructions for use of Vicks Vaporub, which is not approved for children under two years of age.

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Sensible Eating During the Holidays

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          The holidays are a time of celebration and get-togethers with family and friends.  Extra portions of food and sharing a meal with loved ones are a big part of the tradition for almost everyone and for many of us it starts with Thanksgiving and continues through New Year’s Day.  Most of us rationalize that if we’ve ‘been good’ in following our diets the rest of the time, we can let up a little bit around the holidays, since they only come around once a year. 

          That may or may not be true, depending on your individual situation, but for those who feel that they may have overindulged during the holidays, the American Diabetes Association has introduced a tool that you can implement on your own at home.  It’s called ‘Create Your Plate’ and it emphasizes portion sizes first, followed by food choices.  Here’s how it works:

1)     Put a line down the middle of your empty dinner plate.

2)     On one side, cut it again so you have three sections on your plate, one large and two smaller sections.

3)     Fill the largest section with non-starchy vegetables like green beans, spinach, lettuce, carrots, broccoli, tomatoes, onions, cucumbers or peppers.

4)     In one of the smaller sections, place starchy foods, such as whole grain breads, high fiber cereal, potatoes, pasta or rice.

5)     Fill the other smaller section with lean meat, such as chicken, turkey, fish, lean cuts of beef or pork, eggs or low fat cheese..

6)     Add an eight-ounce glass of low-fat milk or a six-ounce container of light yogurt.

7)     For dessert add a piece of fresh fruit. 

Hard to Resist!

          It is important to your overall health to avoid weight gain because it can lead to high blood sugar levels, high blood pressure and high cholesterol levels.  All of these factors can increase your risk for diabetes, heart and kidney disease.  You can still enjoy the holidays with sensible eating habits, but for those who find they have put on a few extra pounds by the end of the year, try using the ‘Create Your Plate’ tool as one of your New Year’s Resolutions.

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Diabetes Mellitus

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          Diabetes is a metabolic disorder resulting from insufficient insulin production by the pancreas, an organ located behind the stomach.  Insulin is a hormone that is normally secreted into the bloodstream by the pancreas in response to sugars in the food we eat.  Insulin helps transport sugar from the bloodstream into the cells.  When insulin is lacking, the cells which make up the muscles and other tissues are deprived of glucose, a specific type of sugar, which is the body’s main source of energy.  The sugar then builds up in the blood resulting in a situation called hyperglycemia.  This is why diabetes is sometimes described as ‘starvation in the midst of plenty’.  The cells are starved, but there is plenty of sugar in the blood. 

Types of Diabetes:  

          Type I diabetes, formerly referred to as juvenile diabetes, is most often diagnosed in childhood or adolescence and requires insulin injections.  Type II diabetes, the most common form of the disease, can occur at any age, but is more likely to occur later in life and can often be prevented.  Prediabetes is a state where blood sugar levels are elevated, but not high enough to make a diagnosis of diabetes.  Without treatment, prediabetes will likely lead to Type II diabetes and the long term damage to various organs in the body may already have begun.  For the purposes of this article we will not include a discussion of gestational diabetes and will focus mainly on Type II diabetes. 

Causes:  

          Type I diabetes results when the immune system attacks and destroys insulin producing cells in the pancreas.  It is unclear why this happens, but genetics and viruses may also play a role.  Prediabetes and Type II diabetes occur when the cells become resistant to the action of insulin and the pancreas is not able to compensate for this by increasing insulin production.  Inactivity and excess abdominal fat play a role in the development of Type II diabetes. 

Incidence: 

          A recent study by health insurer United Health Group reported that more than half of Americans will have diabetes or prediabetes by 2020.  Currently 26 million Americans have diabetes and 67 million have prediabetes.  More than 60 million Americans are not aware that they have diabetes.  By 2020 it is estimated that diabetes will account for 10% of the total health care costs in the United States or $500 billion annually.  The average cost of care for a person with known diabetes in 2009 was estimated to be $11,700 compared to $4,400 for a non-diabetic.  For a diabetic with complications the annual cost jumped to $20,700. 

Symptoms: 

          Some of the common symptoms with all types of diabetes include increased thirst, frequent urination, hunger, unexplained weight loss, blurred vision, wounds that heal slowly and frequent infections.  Some of these symptoms are a direct result of the sugar (fuel for the body) not getting into the cells (weight loss, hunger) and the resulting backup of sugar in the blood (osmotic diuresis).  A person with prediabetes may not have any symptoms. 

Risk Factors: 

          Family history and exposure to a viral illness may play a role in the development of Type I diabetes.  The risk factors for Type II diabetes include increased weight, inactivity, family history, and age.  The more fatty tissue you have the more resistant your cells become to insulin.  Lack of exercise means that less glucose is used as energy, while an increase in physical activity helps control weight and makes cells more sensitive to glucose.  Blacks, Hispanics, American Indians and American Asians have an increased incidence of diabetes.  As we get older the incidence of Type II diabetes increases due to a decrease in our activity level and an increase in weight.  In recent years, however, the incidence of Type II diabetes has been increasing dramatically in children, adolescents and young adults. 

Complications: 

          The short term complications of diabetes include hyperglycemia, ketoacidosis and hypoglycemia all of which can be life threatening.  We will focus on the long term complications, which occur gradually and are largely the consequence of the effects of diabetes on the blood vessels, both large and small.  The effects of diabetes on the cardiovascular system include an increased incidence of heart attack, stroke and narrowing of large arteries due to atherosclerosis.  Other complications include nerve damage, kidney disease, and blindness.  

Diagnosis: 

          A diagnosis of diabetes is made when the fasting blood sugar is greater than or equal to 126 ng/dl on two different occasions.  A level of 100 to 126 is considered prediabetes.  Another blood test called the Hemoglobin A1c can also be used to make the diagnosis.  A level of less than 5.7 is considered normal, a level of 5.7 to 6.4 is considered prediabetes and a level greater than 6.5 is considered diabetes. 

Prevention and Treatment: 

           There is no way to prevent Type I diabetes and it can only be treated by administering regular insulin injections.  Type II diabetes may be prevented by maintaining your ideal weight and getting sufficient exercise.  Treatment includes diet, exercise and oral medications, although sometimes insulin injections may be necessary.  Regular follow up with your healthcare provider is essential and should include routine eye exams and foot care and control of blood pressure and cholesterol levels.  Regular screening for asymptomatic patients should include children who are overweight and have other risk factors for diabetes, overweight young adults and all adults over the age of 45.  A diagnosis of prediabetes should be considered an early warning and an opportunity to take action before diabetes develops.

         

 

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Texting After Bedtime

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          Add yet another item to the list of electronic gadgets that should be prohibited in the teenager’s room…cell phones!  In a study by researchers at the JFK Sleep Center in Edison, New Jersey presented this month at the annual meeting of the American College of Chest Physicians, 40 teenagers were questioned on their use of electronic gadgets.  The results showed that 77% of the teens were having difficulty falling asleep…and for good reason.  The average number of texts or emails sent after lights out was 33.5 and the messages were being sent from 10 minutes to 4 hours after bedtime. 

          The study showed that the boys tended to spend more time surfing the web or playing video games, while the girls were more likely to call and send text messages.  Both boys and girls reported being awakened by an email or text message an average of one time per night.  The study suggested that using electronic devices after bedtime could be linked to anxiety, depression and ADHD (See our previous article on Sleep Requirements for Adolescents).  Because cell phones are being used more and more by younger children, this is an important consideration to keep in mind.  With web access now a common feature of cell phone accounts parents should maintain strict control over cell phone use in children and teens.

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