May is Hepatitis Awareness Month and as good as any time to have a liver talk. Many people seem barely aware of the enormous importance of the liver. This may be because the liver is a non-complaining organ. Three quarters of the liver can be damaged and you might not notice any signs of it. Nobel Laureate Pablo Neruda underscores this in his eloquent poem Ode to the Liver. Neruda describes the liver as “modest, together friend, profound worker” and an “invisible machine”[i].
The liver is praised in poetry, art and myth. Prometheus had his liver destroyed daily by an eagle. At night, his liver would mend, only to be pecked at again the next day. Although this exaggerates the capability of the liver, it illustrates that the Greeks recognized the awesome ability of the liver to recover.
Some ancient cultures believed that the liver was the most important organ, more so than the heart. The Greeks believed that the soul resided in the liver. It was the source of love and passion. Journalist Mary Roach noted that if the liver maintained this prestige, we would be seeing bumper stickers declaring “I (liver symbol) New York” rather than “I ♥ New York”.
There are literary connections to the liver. In Shakespeare’s Macbeth, a coward is called lily-livered. The liver is normally a dark reddish-brown or maroon color. A bloodless liver, white as a lily, refers to a lack of courage. Portraying the mighty liver, Neruda writes “Seafaring anger soul whose innards measure blood, you live hands on oars and eyes ahead navigating the hidden mysteries, the alchemist’s chamber of life’s microscopic, echoic, inner oceans.[ii]”
In keeping with liver awareness month, here is some liver trivia. These facts may not win you a Jeopardy championship, but you may win at Hepardy.
- The word liver traces its origins to a number of languages, Old English and German being two of them. It may mean to “fatten up.” This seems particularly apt, given the rise of fatty liver disease in the United States.
- The liver is the largest internal organ. Roughly, the size of a football, a man’s liver typically weighs around three pounds.
- Everything passes through your liver. This includes everything you eat, breathe, and apply to your skin.
- The liver is made up of specialized cells called hepatocytes. Hepatic comes from the Greek word for liver, hepar. Hepatitis means inflammation of the liver. A hepatologist is a liver disease specialist.
- The liver can re-grow damaged cells. This is known as regeneration. The liver can regenerate an entire liver from only one-fourth of a functioning liver.
- A veritable highway system of arteries, veins and capillaries run through the liver. A quart and a half of blood flows through the liver every minute.
- The liver produces bile, which is necessary for the digestion of fats. Bile passes through a duct system that rivals the Alaskan pipeline. Most of the bile pours into the small intestine, where it breaks down fat. Some bile is stored in the gall bladder.
- You can live without your gall bladder. You cannot live without your liver.
- A double-layered membrane encases the liver. This protects the liver against friction from nearby organs.
- Liver cells do not have nerves. This means that technically a liver biopsy would not hurt if doctors could perform a liver biopsy without puncturing the skin, membrane and surrounding tissue. However, the majority of liver biopsy procedures are percutaneous, meaning a needle needs to pass through the skin and surrounding tissue in order to get to the liver. This is why a local anesthetic is used to numb the area.
- The liver has over 500 functions. The human body relies on the liver for regulation of energy, hormonal balance and clotting. It also filters nutrients, poisons and bacteria.
- The immune system depends on the liver. The liver produces approximately one quart of lymph fluid daily.
- Drugs and alcohol are metabolized by the liver.
- The liver is an important player in the metabolism of carbohydrates, protein, and fats.
The liver is always doing something such as storing, converting, producing, maintaining, breaking down, processing, filtering, regulating, or removing something. Neruda’s ode puts it like this: “you suck and score, you distinguish and divide, you increase and lubricate, you give home to life’s enzymes and grams of experience”.
In short, the liver is more of a factory than a house for the soul. However, what a grand factory it is! Neruda dubs it a visceral warehouse. So as you eat, drink, breathe, work, and play, remember to care for your liver. Be aware, not just in October but all year. “Do not betray me! Work on! Do not arrest my song.[iii]”
[i] Neruda, Pablo, “Oda al Higado”, translated by Morales, H. and Hochman, W.
[iii] Neruda, Pablo, “Oda al Higado”, translated by Kalant, O.