Simple Ways to Support

LIVER AND
GALLBLADDER
FUNCTION
by HEALTHMEANS
 2 HealthMeans

CONTENTS
3 Introduction
4 Biotransformation, aka Detoxification
6 Bile Creation
7 Bilirubin Balance
8 Storing Vitamins and Minerals
10 Blood Clotting
11 Carbohydrate Metabolism
12 Protein Metabolism
14 Cholesterol Production and Management
16 Contribution to the Immune System
17 Thyroid Hormone Regulation
19 References
INTRODUCTION
The liver is arguably our most complex and well-known organ. It has been linked to over 500 physiological
functions, it makes up approximately 2% of an adult’s body weight, and it contributes to almost every
system in the body, including the digestive, endocrine, immune and nervous systems [1]. Its jobs are so
recognized that there are even cartoons depicting a suffering liver after a night of too many cocktails!

But, for such busy organs, what do the liver and gallbladder actually do? And how do we best support
them? In this eBook, we’ll cover the top 10 jobs of the liver and gallbladder and the best ways to keep them
happy and healthy. So, grab a cup of coffee (yes, your liver loves coffee!) and let’s dive into the amazing
world of our second largest organ and its bile-filled sidekick [2].
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BIOTRANSFORMATION,
AKA DETOXIFICATION
The most well-known job of the liver and gallbladder is detoxification. Our awareness of this crucial function
of our physiology has increased over the past decade, as more people prioritize health in an increasingly
toxic world.

Detoxification is technically called “biotransformation.” Thankfully, this process isn’t unique to the liver! Many
organs participate in the biotransformation and release of many thousands of substances. However, the
liver and gallbladder are the primary organs of biotransformation. They contain multiple cells and enzymes,
operating together in “phases” that help us get rid of unneeded compounds. Some of these compounds
are external and are found in our air, water, food or prescription drugs. However, others originate from
inside us, such as hormones, bilirubin or metabolic waste [3].

Notice that we didn’t say that the liver biotransforms only toxic substances. The common idea of
“detoxification” leads to confusion about the true nature of biotransformation and the liver’s role in this
complex part of our physiology. Yes, toxicants found in smog or municipal water absolutely undergo
transformation. But the thought of “detox” conjures up colloquial ideas of cleaning, purging or even
deprivation—actions that can hinder the very detoxification that we want to occur!

As stated above, thousands of substances undergo this process, including biologically necessary ones, such
as hormones. And the steps of biotransformation are highly dependent on rest and a balanced intake of
adequate food and nutrients. One surprising nutrient stands out among all others: protein.

The need for protein shows up in every step of biotransformation. Specifically, protein is needed to create
enzymes, such as the famous CYP450 enzymes, that participate in the multiple phases mentioned above.
Our daily dietary intake of protein from well-sourced protein-rich foods such as meats, fish, eggs, dairy and
soy give our liver the amino acids (the building blocks of protein) it needs to safely transform and release
everything from pesticides to progesterone.

Interestingly, protein is often omitted from “detox” protocols. While it’s terrific to increase our intake of fruits
and vegetables (hopefully with the fiber included), we also need adequate proteins to achieve the goal of
optimal biotransformative liver and gallbladder function.
 5 HealthMeans

A second fantastic way to support biotransformation is a simple but often overlooked step: stay hydrated.
Our daily intake of clean water directly relates to our liver’s ability to create bile and our gallbladder’s ability
to store bile.

Why is bile important in biotransformation? Bile is the water-based sanitation worker of the liver! It helps
to deposit heavy metals, exogenous drugs and environmental toxins into the GI tract for release. And, at
approximately 95% water, it relies on our ability to drink enough water to keep flowing [4].

A common question is, how much water is enough? A practical way to track adequate water intake is
through the color of the urine. Our urine should be light yellow, not clear, cloudy or dark. However, keep
in mind that riboflavin supplementation can turn the pee neon yellow! So, this rule doesn’t apply to those
taking B2.
BILE CREATION
As stated above, bile is essential for releasing unneeded substances
from the liver into the GI tract. But its formation and function are a
bit more complex than just this one job.

Historically, not much was known about bile due to its “hidden”
nature. As opposed to more external secretions, such as sweat
and urine, bile is created inside bile ducts deep within the liver—its
secretion can only be viewed with an electron microscope. In fact,
our understanding of bile’s physiological role wasn’t clarified until
the 1990s!

Bile consists of conjugated bilirubin, bile salts, phospholipids,

cholesterol, electrolytes and water. It flows from the liver’s bile
ducts, a series of tree branch-shaped tubes, into the common hepatic duct, one of the main branches of
the biliary tree, and, finally, into the gallbladder and small intestine [5].

Let’s pause here to focus on the concentrating action of the gallbladder. As its name suggests, the
gallbladder is a hollow bladder about the size of a pear. Bile, also known as gall, is transported here via the
liver’s bile ducts. Once in the gallbladder, bile is stored and concentrated into a form that will best aid in the
digestion of fats in the upper part of the small intestine, also called the duodenum. As fats enter the small
intestine from the stomach, hormones signal the gallbladder to contract, releasing bile and breaking the fats
down into an absorbable form [6].

Amazingly, we secrete approximately 2.5 cups of bile per day! Along with fat digestion, bile also helps us
excrete and balance cholesterol. Bile is also antimicrobial, as well. The bilirubin present in bile gives urine its
characteristic yellow color and feces its characteristic brown color. If bile cannot flow from the gallbladder
to the small intestine, levels of yellow-colored bilirubin can build up in the body, leading to the yellowing of
eyes and skin seen in jaundice.

So, how do we boost our bile? Again, hydration is incredibly important. But another recommendation comes
from Eastern medicine—consume bitter foods.

Traditionally, bitter herbs and foods, such as arugula, radicchio and dandelion leaf have been used to
stimulate gastric secretions, including bile. And a little goes a long way. The amount of bitter food is not as
significant as the taste. Today, we can purchase Swedish bitters in tincture form or simply eat a few bites of
bitter foods with our meals to help with fat digestion and the release of toxicant-laden bile.
BILIRUBIN
BALANCE
One compound found in bile is bilirubin. Bilirubin
results from the breakdown of old red blood
cells, specifically a protein they contain called
hemoglobin. The liver and gallbladder are in charge
of getting rid of this fascinating compound. Bilirubin
is unique in that it can act as both an antioxidant
and neurotoxin.

Let’s start with how bilirubin is produced. Hemoglobin is how red blood cells can provide oxygen to
every cell and tissue in our bodies, as well as how we transport carbon dioxide out of our tissues and
dispel it through our lungs. After approximately 120 days, red blood cells are no longer functional.
These overworked RBCs are taken to the spleen or liver for recycling. Once in the liver, hemoglobin gets
segmented into its two parts, heme and globin.

Bilirubin enters the scene when we follow the path of heme, an iron-rich compound now waiting in the liver
to be metabolized and excreted from the body. Through a series of enzymatic reactions, heme is turned
into bilirubin [7].

The liver is the central hub of bilirubin in the body. Any heme that has been turned into bilirubin in other
tissues, such as the spleen, hitches a ride on the protein albumin for transport to the liver. And unless the
liver and gallbladder can adequately release bilirubin through the bile, it will build up in the body, leading to
the common yellowing of the skin and eyes seen in jaundice.

As mentioned earlier, however, bilirubin is an antioxidant. In fact, it is one of the most powerful antioxidants
found in nature! So, what would be the problem with too much bilirubin? Paradoxically, it’s not just an
antioxidant; high levels can be toxic [8]. Elevated levels of bilirubin can lead to major disruptions in brain
and lung function [9], most commonly seen in newborns. Thankfully, the liver and gallbladder act to create
the perfect balance of bilirubin in our bodies.
STORING VITAMINS
AND MINERALS

You may be familiar with animal liver as a superfood due to its high levels of B vitamins and fat-soluble
vitamins A, D, E and K. Well, our livers are also filled with nutrients! The liver is a storage hub for fat-soluble
vitamins as well as B12, copper and iron.

Dietary vitamin A is taken into the liver by specialized cells, called parenchymal cells. From there, it
is released into the bloodstream as needed, or stored. Vitamin A may assist in the metabolism of
carbohydrates, lipids and proteins that occurs in the liver—stay tuned for more on the liver’s role in
metabolism later in the eBook.

We either consume vitamin D in the foods we eat or synthesize it from contact with the sun on our skin.
Vitamin D binds with vitamin D binding protein and is then shuttled to the liver for storage. Interestingly,
the same enzymes that assist in biotransformation, the cytochrome P450 enzymes covered previously, also
assist in changing vitamin D to a form our bodies can store.

Vitamin E is known for its antioxidant properties, and the liver regulates this vital nutrient. The liver changes
vitamin E into its useable form, alpha-tocopherol, and then sends it out into the blood for circulation or
stores it. Vitamin E travels through our blood on two well-known lipoproteins—very low-density lipoprotein
(VLDL) and low-density lipoprotein (LDL). You may have seen measurements of these lipoproteins on your
blood tests [10].
 9 HealthMeans

The liver also stores and repackages vitamin K into VLDL for transportation around the body. However,
lower amounts of vitamin K appear in the body compared to the other fat-soluble vitamins. We’ll cover
more on the role of vitamin K in blood clotting later in the eBook.

Although it’s not well known, the body also stores vitamin B12—thanks to the liver! B vitamins are water-
soluble, so it is often assumed that all B vitamins must be replenished daily. However, B12 is slightly
different. The body stores approximately 1 to 5 milligrams, the equivalent of 1,000 to 2,000 times the
amount the average person eats in a day. This is why symptoms of B12 deficiency can take many years to
appear [11].

Finally, copper and iron are also found in the liver. The relationship between these two metals contributes
to critical parts of our biochemistry, and the liver serves as the backdrop for their complex balance.

Dietary iron and copper are absorbed in the first part of the small intestine and are then transported
to the liver. Once in the liver, both minerals undergo transformation into optimal forms that are then
distributed to every organ, tissue and cell of the body! Copper and iron rely on each other to create new
red blood cells, produce ATP, balance the nervous system and modulate immune function, specifically the
reticuloendothelial system (RES) that gets rid of foreign matter in our blood. The main site of the RES? You
guessed it—the liver [12]. Amazingly, the liver even acts as an iron “sink” during times of iron overload. It
holds excess iron in order to protect the heart and pancreas from iron-induced damage.

We can keep our liver’s nutrient reserves stable by paying attention to nutrient-dense foods. Animal foods,
such as egg yolks, pastured pork, fish roe, trout, red meat and aged cheeses, are our best sources of
vitamins A, E, D, K, B12 and iron. Natto, a fermented soy condiment, is a fantastic source of vitamin K, while
sunflower seeds, oysters, spirulina and shiitake mushrooms are high in copper.

Be aware, however, that excessive supplementation with iron and/or copper can lead to mineral imbalances
and possible physiological damage. While some people need daily supplementation with these essential
nutrients, many of us don’t. Be sure to work closely with your doctor or licensed healthcare professional to
get individualized supplementation recommendations for your unique needs.
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BLOOD CLOTTING
Imagine you cut your finger while chopping onions for dinner. Instantly, incredible biochemical processes
go to work to stop the bleeding and heal the wound. The organ at the center of these commands? The liver!

Proper coagulation of the blood is carried out through specialized proteins, many of which are formed
in the liver. These clotting factors immediately begin the coagulation cascade anytime damage occurs
in the body. Importantly, they stop bleeding by creating an appropriate amount of blood clotting—over-
coagulation of the blood can be just as detrimental as no coagulation at all!

Amazingly, one of the nutrients stored by the liver plays a key role in blood clotting. Vitamin K and its
role in coagulation are most well-known due to the vitamin K given to newborns shortly after birth. This
supplementation is due to newborns’ very low levels of vitamin K paired with the concern of internal
bleeding, especially in the brain. Why? Sufficient levels of vitamin K are needed for proper blood
coagulation, and deficiencies can lead to hemorrhages. In fact, vitamin K was named for the German word
for coagulation, “Koagulation,” after its anti-hemorrhagic traits were identified. Specifically, vitamin K must
be present to properly form the proteins in the coagulation cascade [13].

Balanced blood clotting is an often overlooked but critical physiological process! The best way to support
this occurrence is through being good to our liver by lowering our alcohol intake and staying hydrated.
However, specific actions can also aid the coagulation cascade. Make sure to consume enough dietary
protein along with foods rich in vitamins K1 and K2 such as dark green leafy vegetables, natto and
aged cheeses.

Finally, pay attention to your gut

bugs! Our intestinal microbiota
synthesizes its own vitamin K, and
that can impact the whole body.
The best way to feed our beneficial
bacteria is with prebiotic foods such
as leeks, garlic, onions, Jerusalem
artichokes and oats.
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CARBOHYDRATE
METABOLISM
We often hear the word “metabolism,” but what does it actually mean? This term is often used to refer
specifically to nutrient metabolism, the series of biochemical reactions that occur to turn our food
into energy. The liver and gallbladder play huge roles in the metabolism of all three macronutrients—
carbohydrates, lipids and proteins.

Dietary carbs are digested into their component parts—fiber, micronutrients and simple sugars, such as
glucose. Glucose is then brought to the liver from the intestine through the portal vein, a blood vessel that
carries nutrient-rich blood from the intestines, pancreas and spleen to the liver.

Some glucose is used to make glycogen, the storage form of glucose, analogous to starch in plants. Some
is used to make fatty acids—yes, an excess of glucose in the diet can lead to excess fat gain, and this
transformation happens in the liver! Some is used to make the building blocks of our genetic structure,
nucleotides, while other glucose molecules are, along with proteins, used to produce structural compounds
such as hyaluronic acid present in skin, connective tissues and the eyes. Finally, some carbohydrates are
used to create our primary form of biochemical energy, ATP.
 12 HealthMeans

The liver is the organ responsible for all of these processes of carbohydrate metabolism. Essentially, our
liver is the hub of glucose control, i.e., blood sugar control. Along with the laundry list of duties above, it also
works closely with our brain and pancreas to sense and maintain the level of glucose in our bloodstream
[14]. Ideally, the liver will hold a blood glucose level that closely vacillates around 89 mg/dL no matter if
we’ve just eaten or have been fasting overnight.

So, how do we best support these multiple, varied carbohydrate activities orchestrated by the liver?
First, eat a balanced diet. The foundation of many popular diets is to drastically reduce macronutrients
or food groups. However, for our liver and gall bladder to optimally metabolize, transform and store
carbohydrates, we need a balance of macro- and micronutrients in our daily diet. So, do your best to eat
approximately 30% of your diet as well-sourced protein, 30% as whole-food fat and 40% as colorful, fiber-
rich carbohydrates, and see how you feel. You can adjust your macronutrient ratios based on your unique
biological and lifestyle needs

Next, consume B-vitamin-rich foods. Every step of carbohydrate metabolism is heavily reliant on the help
of B vitamins, from B1 (thiamine) to B12 (cobalamin). Chicken and beef liver are fantastic sources of B
vitamins, but not everyone’s favorite foods. So supplementation with freeze-dried liver capsules is an easy
option. Other dietary options include salmon, leafy greens, eggs, beef, oysters, clams and mussels, as well
as whole grains and legumes.

Some people use supplemental forms of B vitamins—if you suspect that your liver needs help with its
carbohydrate duties, ask your doctor or nutritionist about supplementation and if it’s appropriate for you.
Notably, some pharmaceutical drugs such as proton pump inhibitors and steroids can deplete B vitamins.

PROTEIN METABOLISM
Similar to its role in the intricate metabolism of carbohydrates, the liver is also the central organ in protein
metabolism. When we eat protein-rich foods, they first undergo chemical digestion in the stomach. At a
startlingly low pH of 0.8 to 1.5, the stomach’s highly acidic environment and abundance of protein-digesting
enzymes called proteases break down our dietary proteins into their amino acid building blocks.

From here, the digestive process continues in the small intestine. More proteases are released from the
pancreas and interact with the amino acids in the first part of the small intestine, the duodenum. Eventually,
the amino acids are absorbed into the bloodstream and shuttled to the liver on the same highway used by
carbohydrates—the hepatic portal vein.
 13 HealthMeans

Once in the liver, amino acid metabolism begins! The amazingly diverse functions of the liver include further
breaking down amino acids in order to produce energy or to transform them into the carbohydrates and
fats that the body needs. Additionally, the liver is in charge of restructuring essential amino acids into non-
essential amino acids, i.e., amino acids we must get from our foods versus ones our liver can make. Finally,
our liver uses dietary proteins to create critical proteins needed in the blood. These blood proteins are the
body’s “taxis”—they transport compounds in our blood, such as hormones, vitamins, enzymes and drugs,
from place to place. You may have noticed these blood proteins, called albumin and globulin, on your blood
tests [15].

Our liver must also take care of the cleanup from this protein party! The process of protein metabolism
leads to a toxic byproduct—ammonia. Thankfully, healthy hepatic function will take care of ammonia by way
of the urea cycle. Excess ammonia is chemically converted to another waste product, urea, which is then
released by the kidneys in our urine.

Interestingly, while carbohydrates and fats are stored by our body, protein is not. So, the careful intake,
digestion and metabolism of protein is critical for our many protein-dependent physiological needs.
This unique aspect of protein marks one way we can support its metabolism—we need to eat adequate
amounts! Yes, too much protein can be problematic, but a wide range of protein sources supports not only
liver function via enzyme creation, for instance, but long-term structural and neurochemical health as well.

Another way to support protein metabolism is through the intake of vitamin B6. This B vitamin is commonly
found in poultry, pork, soybeans, peanuts, oats and bananas and is a necessary cofactor for the breakdown
and transformation of amino acids in the liver [16].
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CHOLESTEROL PRODUCTION
AND MANAGEMENT
Did you know that your liver is responsible for approximately 10% of your body’s cholesterol production?
We generally assume that most of our cholesterol comes from our diet. However, it’s more accurate to
think of cholesterol as a creation of the liver. For instance, if you eat around 200 milligrams of cholesterol
each day, the amount found in one egg yolk, your liver will then create another 800 milligrams from your
dietary macronutrients—carbohydrates, fats and proteins.

But why would the liver produce so much cholesterol if it’s such a dangerous substance?

Before we get to the specifics of how the liver synthesizes and manages our cholesterol, let’s bust a few
myths about this misunderstood lipid. Yes, cholesterol can be problematic. Under the right circumstances,
it contributes to heart disease, stroke risk and type 2 diabetes.

However, cholesterol is essential for life, meaning we will not have functioning cells without it! It is a major
component of cell membranes and influences how these membranes function. It is the backbone molecule
of vitamin D, all our steroid hormones, such as cortisol, and our sex hormones too! And it makes up our bile
and plays a critical role in the digestion and absorption of the fat-soluble vitamins discussed earlier in the
eBook [17].

This all sounds fantastic, but it begs the question: Why does cholesterol have such a bad reputation?
The answer to this is one of the most contentious conversations in nutrition, so there is a lot to unpack!
However, the most concise explanation is that cholesterol is found at the scene of the crime. The “crime” in
question? Inflammation [18].

When we experience any damage in the body, such as in the lining of our arteries, veins and capillaries,
the immune system responds precisely how it should—with inflammation. This is a normal and healthy
process that leads to the killing of any invaders and the repair of tissues. However, tissue repair
requires…you guessed it…cholesterol! And, if inflammation is ongoing, i.e., chronic inflammation, then
prolonged damage and thus prolonged repair must occur. This means more and more cholesterol will
access the harmed area and do its best to fix the issue. Unfortunately, unless the inflammatory response
is addressed, disease can result.
 15 HealthMeans

It’s important to note that genetics play a role in this process as well. Some people simply make more
cholesterol than others. This can lead to detrimental effects connected to the abundance of cholesterol.
However, by and large, the best remedy for the illnesses linked to high cholesterol is lowering inflammation.

So, how does the liver form cholesterol and transport it to those damaged tissues to begin with? The
first step is digestion, as described in the previous sections. Nutrients are shuttled from the small
intestine to the liver for transformation and storage. In the case of cholesterol creation, fats, proteins and
carbohydrates are chemically transformed into precursor compounds. Through a series of enzyme-fueled
reactions, these compounds are synthesized into the end product of cholesterol [19].

Interestingly, one of these enzymes may be familiar to you—HMG-CoA reductase. This enzyme plays a
significant role in the transformation of macronutrient-derived precursor compounds into cholesterol. And
it’s the target of the cholesterol-lowering drug class, statin drugs. These drugs inhibit the actions of HMG-
CoA and so are called HMG-CoA inhibitors.

Once cholesterol has been formed, it must be transported throughout the body. The liver takes care of
this as well! It packages cholesterol into lipoproteins (structures made of fat and protein) that can take
cholesterol through the blood. The most famous of these cholesterol “cars” are LDL and HDL—low-density
lipoprotein and high-density lipoprotein. LDL is the car that takes cholesterol from the liver to other places
in the body. HDL transports cholesterol from the body back to the liver for excretion.

The liver gets rid of excess cholesterol by packaging it up into transport compounds called micelles. These
little fat packets are a significant component of bile and are stored in the gallbladder. The formation of bile
and the resulting digestion of dietary fats comes full circle, as bile is released from the gallbladder and the
micelles containing excess cholesterol are moved into the colon. From here, cholesterol is either recycled
and reabsorbed into the bloodstream or released in the feces [20].

From this process, we can see why those with high cholesterol are urged to eat a high-fiber diet! Soluble
fiber found in kidney beans, oatmeal, pears, apples, citrus fruit, barley and carrots binds the cholesterol
present in the small intestine so it’s not as likely to be reabsorbed into the bloodstream. Additionally, these
fiber-rich foods are a fantastic support for our good gut microbiota, another key to balanced cholesterol
and inhibition of inflammation [21].
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CONTRIBUTION
TO THE IMMUNE
SYSTEM
The liver is not generally thought of as an immune organ,
but some of its hundreds of functions are immune based.

THE LIVER’S IMMUNE CONTRIBUTIONS INCLUDE:

• Production of proteins that protect us during the beginning phases of a pathogenic attack
(acute-phase proteins). These proteins tell our body’s temperature to rise, and they prepare
white blood cells for action. An example of these proteins is C-reactive protein, often tested
in the blood to measure levels of system-wide inflammation.
• Production of complement proteins that tag pathogens for destruction, slice apart
infectious organisms and clear invaders from our system.
• Production of cytokines, the “hormones” of the immune system. These compounds allow
the many different parts of the immune system to stay in close contact to mount an
organized attack.

In fact, the liver has its own unique immune cells! White blood cells, called lymphocytes, that are found in
the liver are distinctly different from other lymphocytes in our bodies.

The liver’s need for immune vigilance makes perfect sense when considering the amount of blood it filters
from the intestines. Dietary bacteria and even beneficial bacteria that should colonize our intestines, liver-
targeting viruses and parasites, and toxic metabolic products must be monitored by the liver’s intra-organ
immune system [22].

Though we’ve covered it before, adequate intake of dietary protein is paramount. This one small action can
greatly support the liver’s immune activities. Cytokines, antibodies and lymphocytes are all created from the
protein that we eat.
THYROID HORMONE
REGULATION
The liver and the thyroid have an intimate, interdependent relationship—they form the thyroid-liver axis.
The liver relies on thyroid hormones for proper metabolic rate, and thyroid hormones depend on the liver
to turn thyroid hormones “on” or “off” and to transport these hormones—T4 and T3—throughout the body.

Thyroid hormones also influence cholesterol balance. They interact with the liver-based enzymatic
processes that lead to cholesterol creation and transportation. Thyroid diseases, such as hypothyroidism
and hyperthyroidism, can lead to issues with blood lipids. Those with hypothyroidism may experience
increased total and LDL cholesterol levels and reduced HDL levels. People with both hypo- and
hyperthyroidism may be more susceptible to slowed bile excretion and the formation of gallstones [23].

The best way to support the liver-thyroid axis is to monitor the health of both organs! It’s necessary to
find a practitioner who can expertly check and treat any thyroid abnormalities—these problems are often
overlooked, especially in women. Tyrosine-rich foods, such as organic soy, chicken, turkey, fish, peanuts,
lima beans, pumpkin seeds and sesame seeds, are particularly good for the thyroid,. Iodine-rich foods,
such as seaweeds and shellfish, can also be supportive for thyroid health. However, if you are aware of an
autoimmune thyroid condition, please check with your practitioner before consuming these foods regularly.
Liver enzymes, such as AST and ALT, along with blood lipids, are commonly run on most blood panels.
These tests will help you and your doctor create a complete picture of your thyroid and liver health.
HERE’S
TO HEALTH.
 19 HealthMeans

REFERENCES
1. Kalra A, Yetiskul E, Wehrle CJ, et al. Physiology, Liver. [Updated 2021 May 9]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/
books/NBK535438/
2. Heath RD, Brahmbhatt M, Tahan AC, Ibdah JA, Tahan V. Coffee: the magical bean for liver diseases.
World J Hepatol. 2017 May 28;9(15):689-696. doi: 10.4254/wjh.v9.i15.689. PMID: 28596816; PMCID:
PMC5440772.
3. Phang-Lyn S, Llerena VA. Biochemistry, Biotransformation. [Updated 2021 Aug 30]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.
nih.gov/books/NBK544353/
4. Boyer JL. Bile formation and secretion. Compr Physiol. 2013 Jul;3(3):1035-78. doi: 10.1002/cphy.
c120027. PMID: 23897680; PMCID: PMC4091928.
5. Hundt M, Basit H, John S. Physiology, Bile Secretion. [Updated 2021 Oct 1]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/
books/NBK470209/
6. Jones MW, Small K, Kashyap S, et al. Physiology, Gallbladder. [Updated 2021 May 9]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.
nih.gov/books/NBK482488/
7. Dean L. Blood groups and red cell antigens [Internet]. Bethesda (MD): National Center for
Biotechnology Information (US); 2005. Chapter 1, Blood and the cells it contains. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK2263/
8. Jayanti S, Vítek L, Tiribelli C, Gazzin S. The role of bilirubin and the other “yellow players” in
neurodegenerative diseases. Antioxidants (Basel). 2020 Sep 22;9(9):900. doi: 10.3390/antiox9090900.
PMID: 32971784; PMCID: PMC7555389.
9. Hansen TW. Bilirubin brain toxicity. J Perinatol. 2001 Dec;21 Suppl 1:S48-51; discussion S59-62. doi:
10.1038/sj.jp.7210634. PMID: 11803417.
10. Albahrani AA, Greaves RF. Fat-soluble vitamins: clinical indications and current challenges for
chromatographic measurement. Clin Biochem Rev. 2016 Feb;37(1):27-47. PMID: 27057076; PMCID:
PMC4810759.
11. O’Leary F, Samman S. Vitamin B12 in health and disease. Nutrients. 2010 Mar;2(3):299-316. doi:
10.3390/nu2030299. Epub 2010 Mar 5. PMID: 22254022; PMCID: PMC3257642.
12. Collins JF, Prohaska JR, Knutson MD. Metabolic crossroads of iron and copper. Nutr Rev. 2010
Mar;68(3):133-47. doi: 10.1111/j.1753-4887.2010.00271.x. PMID: 20384844; PMCID: PMC3690345.
13. Halder M, Petsophonsakul P, Akbulut AC, Pavlic A, Bohan F, Anderson E, Maresz K, Kramann R,
Schurgers L. Vitamin K: double bonds beyond coagulation insights into differences between vitamin
K1 and K2 in health and disease. Int J Mol Sci. 2019 Feb 19;20(4):896. doi: 10.3390/ijms20040896.
PMID: 30791399; PMCID: PMC6413124.
14. Adeva-Andany MM, Pérez-Felpete N, Fernández-Fernández C, Donapetry-García C, Pazos-García
C. Liver glucose metabolism in humans. Biosci Rep. 2016 Nov 29;36(6):e00416. doi: 10.1042/
BSR20160385. PMID: 27707936; PMCID: PMC5293555.
15. Trefts E, Gannon M, Wasserman DH. The liver. Curr Biol. 2017 Nov 6;27(21):R1147-R1151. doi:
10.1016/j.cub.2017.09.019. PMID: 29112863; PMCID: PMC5897118.
16. Parra M, Stahl S, Hellmann H. Vitamin B₆ and its role in cell metabolism and physiology. Cells. 2018 Jul
22;7(7):84. doi: 10.3390/cells7070084. PMID: 30037155; PMCID: PMC6071262.
17. Huff T, Boyd B, Jialal I. Physiology, Cholesterol. [Updated 2021 Mar 2]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/
books/NBK470561/
18. Rajendran P, Rengarajan T, Thangavel J, Nishigaki Y, Sakthisekaran D, Sethi G, Nishigaki I. The vascular
endothelium and human diseases. Int J Biol Sci. 2013 Nov 9;9(10):1057-69. doi: 10.7150/ijbs.7502.
PMID: 24250251; PMCID: PMC3831119.
19. Craig M, Yarrarapu SNS, Dimri M. Biochemistry, Cholesterol. [Updated 2021 Aug 18]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.
nih.gov/books/NBK513326/
20. Cohen DE. Balancing cholesterol synthesis and absorption in the gastrointestinal tract. J Clin Lipidol.
2008 Apr;2(2):S1-3. doi: 10.1016/j.jacl.2008.01.004. PMID: 19343078; PMCID: PMC2390860.
21. Villette R, Kc P, Beliard S, Salas Tapia MF, Rainteau D, Guerin M, Lesnik P. Unraveling host-gut
microbiota dialogue and its impact on cholesterol levels. Front Pharmacol. 2020 Apr 3;11:278. doi:
10.3389/fphar.2020.00278. PMID: 32308619; PMCID: PMC7145900.
22. Robinson M, Harmon C, O’Farrelly C. Liver immunology and its role in inflammation and homeostasis.
Cell Mol Immunol 13, 267–276 (2016). Available from: https://www.nature.com/articles/cmi20163
23. Malik R, Hodgson H. The relationship between the thyroid gland and the liver. QJM. 2002
Sep;95(9):559-69. doi: 10.1093/qjmed/95.9.559. PMID: 12205333.
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