Yellow Liver, Yellow Liver (sing along)


What is your most important organ? Ask any man and he will undoubtedly point to his bladder’s siphon hose. But it isn’t. The liver is one of the more important organs you possess. Without it you will die, whereas you can get by without a kidney, or a lung or a thyroid, or even Willy the Wonder Wand (a delicacy enjoyed by Isaan ducks, I believe)! Yes, I’d rate my liver fairly highly.

Think of your liver as a filtering and de-toxifying device. Chemicals are taken up by the liver, to be broken down into non-toxic chemicals, all to protect your system. Clever organ your liver, to know what’s good for you and what isn’t.


The most well known liver toxin is our old friend Ethanol, more usually referred to as booze. There is “common wisdom” that says certain types of booze are more damaging than others, but that just isn’t so. Irrespective of the color or shape of the bottle it came in, ethanol is ethanol, is ethanol. It is the percentage of alcohol that is the important factor. That alcohol affects the liver is generally accepted, with the end result being called Cirrhosis, a fibrous hardening of the liver which then becomes unable to carry out its job correctly. Toxins build up. You feel unwell and it’s all downhill from there.

Some proprietary or prescription drugs can produce an inflammation of the liver tissues too. Or worse, produce a breakdown of the liver tissue itself. Amongst these is the headache medication paracetamol (the ubiquitous medication you can even buy in the corner stores), but before you throw them out of your bathroom cabinet, it requires some heavy and very frequent dosage of paracetamol to do this.

Other prescription items that may produce liver problems include Methyldopa, several penicillins, Simvastatin (the cholesterol lowering drug), Diclofenac (a non-steroidal anti-inflammatory) and Ketoconazole (anti-fungal). But it is rare – so don’t stop taking your prescriptions yet!

Prescription drugs can be dangerous (even though you can get most of them over the counter in Thailand), but that’s why they have a PI (patient information) leaflet inside the box (the bit you throw away and don’t read). Probably if you read about it, you wouldn’t take it!

However, what about “Health food” preparations? The purveyors of these all cite the fact that the ingredients are “natural” so everyone assumes that this means “safe”. Not so, I’m afraid. Lead, for example, is a naturally occurring compound, and not much good for young kidneys. However, since we are talking about liver problems, hands up all those of you who have heard of Echinacea? Supposedly fixes everything from falling hair to fallen arches – but is it “safe”? Well, Echinacea, along with Kombucha Tea are two of the commonest compounds showing a well documented history of being toxic to the liver. So if you’re sipping Kombucha tea because you’ve drunk too much alcohol last night, I would suggest that you change to water, or go back to booze (stop hangovers – stay drunk)!

Others for sale in the Health Food shops with known toxic effects on the liver include Evening primrose oil, Valerian, Chaparral, Japanese Daisaiko-to (for dyspepsia), Chinese Jin-bu-huan and several forms of herbal teas such as those from Heliotroprium, Senecio crotalaria and Symphytum. Makes you think that the shops that sell them may be incorrectly named, doesn’t it!

So how can we see what stage your liver is at after the onslaught of liver toxins? There is a new test called Fibroscan which can show if your liver is in trouble. My hospital’s Gastrointestinal and Liver Center can arrange it for you.

But while the column this week seems to be spreading doom, gloom and disaster, it’s not quite that bad. The liver is a very powerful organ and is capable of regenerating itself quite quickly, so in most cases of toxicity following ingestion of chemical compounds (including alcohol), by stopping taking it the liver recovers and the patient feels well again.

So remember that if you are taking anything regularly and you feel unwell, it may be the liver – but tell your doctor everything you have been taking! And no thanks, I’ll give the herbal tea a miss today.