Liver Awareness - Globulins

“Morgan here checking in with you again as we are finally done celebrating the New Year”.

“To refresh your memory Plucky, we were talking about the proteins your liver produces. The last time we were discussing Albumin. Now we are going to dive into Globulins.”

I am telling you about these things because I looked at a blood panel report one day and could not understand much of it. All the symbols and numbers were so intimidating and confusing! It is scary being sick and not knowing what is going on inside you! If you learn a little more about yourself, you will be better equipped to understand some of the things your doctor discusses and maybe even know what is in those confusing reports. “

C’mon Plucky, time to 

get back to work!

“Today I’m going to explain Globulins and how they affect your health. Next time we’ll try to unravel those blood panel test results.”

GLOBULINS

As we have talked about before, proteins are the most abundant compounds in your serum (the rest of your blood after the red blood cells, white blood cells and platelets have been removed). Amino acids are the building blocks of all proteins. In turn, proteins are the building blocks of all cells and tissue. They are the basic components of enzymes, many hormones, antibodies and blood clotting agents. Proteins act as a transport substance for hormones, vitamins, minerals, lipids and other material. Lipids are fat-like substances in your blood and tissues. Your body needs a small amount of lipids to work normally.

Proteins also help balance the osmotic pressure of your blood and tissue. Osmotic pressure is part of what keeps water inside a particular compartment of your body. Other proteins play a major role in maintaining the delicate acid-alkaline balance of your blood (pH). pH stands for potential hydrogen. In addition, serum proteins serve as a reserve source of energy for your tissues and muscle when you are not ingesting enough.

“Good grief Morgan, what does all that mean?”

“First Plucky, your blood tells a lot about you and even though it sounds complicated you need to know a few terms. Second, Plucky, your osmotic pressure has to do with the pressure on the outside of your capillaries while your blood pressure is pressure from inside your capillaries. This is important because this is how your blood keeps at correct density and smoothly flows through your veins and arteries. When your Albumin level is low (osmotic pressure is low), it allows too much water into your cells causing edema. You know, like when your ankles or feet swell.  Now back to the Globulins:

Chemical structure of human serum
albumin (HSA). HSA is the most
abundant protein in blood plasma
and is an important transport protein.

The major serum proteins are divided into two groups: 

Albumin and Globulins. Globulins are a group of proteins in your bloodstream that help to regulate the function of the circulatory system. (Your circulatory system is responsible for transporting materials throughout your entire body.  It transports nutrients, water and oxygen to your billions of body cells and carries away wastes such as carbon dioxide that body cells produce.) Globulins are produced in the liver and immune system. They have multiple different functions; the group includes immunoglobins, enzymes, carrier proteins and complement. Your globulin levels will affect the amount of ample proteins in your bloodstream. If these proteins are not kept at the proper level, it can be difficult for your body to fight infections, clot, or transport nutrients to the muscles.

Human Circulatory System

Globulin is made up of different proteins called alpha, beta and gamma. The alpha and beta globulins are made by the liver, while the gamma globulins are made by the immune system. Certain globulins bind with hemoglobin, hemoglobin is another protein in your blood that carries oxygen from your lungs to your tissue and returns carbon dioxide back to your lungs. Other globulins transport metals, such as iron in the blood that help fight infection.

At certain times when your Doctor needs to get more information from your blood, serum globulin can be separated into several subgroups by Serum Protein Electrophoresis Test (we will go into the details of why and how later).

SUBGROUPS OF GLOBULINS

Lipoproteins of the blood, LDL and
HDL (cholesterol)

• Alpha 1 globulin (α1) – This fraction consists of:

High-density lipoprotein (HDL) the good type of cholesterol. Transcortin, aka corticosteroid binding globulin (CBG) or (serpin A6). Serpin is a serine protease inhibitor. Transcortin is a major transport protein for glucocorticoids and progestins. These are the hormone transporters I was telling you about, more specifically, estrogen. A female hormone.

α1 antitrypsin (α1AT) a protease inhibitor. This is the major protein associated with alpha 1 globulins. It inhibits a wide variety of proteases. Protease, also called proteinase or peptidase, is a type of enzyme that occurs naturally in living things and forms part of many metabolic processes. They form part of the larger systems in the body, including the digestive, immune, and blood circulation systems. When you have a virus (HCV or HIV) in your body, the virus uses a healthy cell for replication. It does this by making the healthy cell produce certain proteins the virus can use to make more copies of itself. Two of the proteins used by the virus are reverse transcriptase and protease.

“Time-Out Morgan! I’m lost again. 

What’s does that mean to me?

“OK Plucky, that was a mouthful, I agree. However, it has to do with your cholesterol and I know you know about that. The protease inhibitors are important when your body is helping me fight viral infections like HCV and HIV. The HCV virus survives by replicating itself at a high rate. It does this by making healthy cells produce proteins that the virus needs to survive. Your healthy cells will produce proteases. You’ve heard about the new protease inhibitor drugs. These assist the protease inhibitors you already have!

• Alpha 2 globulin (α2) - Consists of:

Haptoglobin (HP). Binds the globin portion of free hemoglobin that’s made when red blood cells die (red blood cells have a life of 110-120 days). Haptoglobin transports this back to the liver for recycling. Haptoglobin is known as an acute phase reactant. Its level increases during acute conditions such as infection, injury, tissue destruction, some cancers, burns, surgery or trauma. Its purpose is to remove damaged cells and debris and rescue important minerals such as iron.

Macroglobulin (α2M). A protease inhibitor and one of the largest plasma proteins. It transports hormones and enzymes, exhibits effector and inhibitor functions in the development of the lymphatic system and inhibits components of the complement system and hemostasis system. Meaning, they act as back up inhibitors when inhibitors that are more specific are consumed during traumas which lead to major activation of the proteolytic cascade in coagulation and fibrinolysis. A proteolytic cascade occurs when several proteases activate each other; and, Fibrinolysis is a process that prevents blood clots from growing and becoming problematic.

Prothrombin (Pro). A coagulation factor that is needed for normal blood clotting. Prothrombin is a precursor to thrombin. Tests will measure prothrombin time (PT).

Ceruloplasmin (CER). Transports copper. An acute phase reactant. It is frequently elevated when you have inflammation, severe infection, tissue damage, and may be increased in some cancers. It is reduced in Wilson’s Disease.

• Beta globulins (β) – Consists of:

Low-density lipoproteins (LDL). The bad type of cholesterol.

Transferrin (TF). The main protein in the blood that binds to iron and transports it throughout the body. Beta globulins consist mainly of transferrin. The amount of transferrin that is available to bind to and transport iron is reflected in measurements of the total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC), or transferrin saturation.

Microglobulin (β2m). A class 1 antigen is a marker that is increased in serum during immune activation. Β2m values have emerged as markers for the activation of the cellular immune system, as well as a tumor marker in certain hematologic malignancies. Urine β2m values in both serum and urine can help distinguish a problem of cellular activation from a renal disorder.

“So Morgan! I think I am starting to get it! My blood is the lifeline of all those things my organs need to keep functioning properly, keep my immune system strong to fight invaders in my body. And help distribute all those proteins I need. WOW. Plus a sample of my blood will let the Doc know where something is going wrong in my body. Is that right Morgan?"

You’re getting the hang of it Plucky. The body is very complex and your blood provides you with nutrients and hormones that must get to the right destination. Healthy blood is very important for your life. Now we can finish up with the Gamma Globulins as they are important to your immune system:

• Gamma globulins (γ)

These proteins are also called antibodies. These globulins are the only globulins not produced in the liver; they are produced by the immune system. They help prevent and fight foreign substances (antigens), such as bacteria or viruses, causing them to be destroyed by the immune system.  

The most significant gamma globulins are immunoglobulins (Ig). Your body makes different immunoglobulins to combat different antigens. Sometimes your body may even mistakenly make antibodies against itself, treating healthy organs and tissues like foreign invaders – this is called an autoimmune disease.

THERE ARE 5 SUBCLASSES OF ANTIBODIES:

Immunoglobulin A (IgA). Found in high concentrations in the mucous membranes, particularly those lining the respiratory passages and gastrointestinal tract, as well as saliva and tears.

Immunoglobulin G (IgG). The most abundant type of antibody. It’s found in all body fluids and protects against bacterial and viral infections.

Immunoglobulin M (IgM). Found mainly in the blood and lymph fluid. It is the first antibody to be made by your body to fight a new infection.

Immunoglobulin E (IgE). Associated mainly with allergic reactions.

Immunoglobulin D (IgD). This exists in small amounts in the blood and is the least understood antibody.

IgA, IgG and IgM are often measured together to give your doctor important information about your immune system function, especially relating to infection or autoimmune disease.

“As you can see, your blood protein levels can tell your doctor a lot about what is going on with your body. Blood tests are routinely performed and I want you to be familiar with some of the symbols so as to better understand them. I’m going to talk about blood tests and how to interpret them next time. I’ll also go into what the normal ranges should be. Although normal values do vary from lab to lab. So, until next time, enjoy life and love your liver!”

Morgan d’Organ

 

NEW YEAR'S RESOLUTIONS 

Tis the season to be making resolutions.  Getting healthier is always number 1.   So, I thought, why not write about how to be healthier in 2015.   So, I’ll be talking about keeping me efficient and feeding me properly.  Nutrition and the liver are interrelated in so many ways.  We’ve talked about how everything we eat, breath, and absorb through our skin must be refined and detoxified by me.  So, all these things are either helping or hurting me.



HEALTHY RESOLUTIONS
 

 

Poor nutrition is not generally a cause of liver disease, except in alcoholic liver disease and liver disease found among starving populations.  On the other hand, good nutrition (a balanced diet and the proper amount of supplements) can actually help a damaged liver to regenerate new liver cells.  In fact, in some liver diseases, nutrition becomes an essential form of treatment.

A Healthy Liver is Like a Processing Plant

 Carbohydrates, proteins, fats, vitamins, and minerals go to the liver where they are broken down and stored.  Later, they are remade into whatever the body needs and carried through the bloodstream to wherever they will be used.  Even when the liver is damaged, these nutrients still come to the liver after they have been digested. But, once they arrive, the liver can’t process them, and they build up.  This build-up causes more liver damage.  As a result, what you eat, or don’t eat, is very important.  Your diet needs to provide nutrients without causing further damage.  I strongly believe that you should talk to your doctor about what your diet should include, or exclude. 

In general, your diet should include:

·         Plenty of fluids – 1 ounce of fluid for every 2 pounds of body weight.

·         Plenty of fruits and vegetables

·         Lean protein like fish, skinless chicken, egg whites and beans

·         Whole grains – oats, brown rice, barley and quinoa

·         Low-fat or non-fat dairy products

·         Healthy fats such as nuts, avocados, coconut oil, and olive oil.

Antioxidants

Most of the above are rich in antioxidants.  Antioxidants protect against free radical injury.  Free radicals are produced in all of us due to the body’s metabolic process. We’ll go into free radicals in just a bit.  Apart from protecting the liver, antioxidants have been shown to inhibit cancer cells, fight the aging process and protect the sight.

Oxidative damage is a frequent cause of liver cell injury, which is, most definitely, a path to worsening of chronic liver disease.  Cellular oxidation is a natural process where free radicals break down organic tissue.  Free radicals have to do with cells and molecules.  Cells are made up of many different types of molecules. Molecules consist of one or more atoms and, atoms consist of a nucleus, neutrons, protons and electrons.  Without going into a complete chemistry course, free radicals are formed when an atom is out of balance (an unpaired number of electrons).  The free radical will try to balance itself by attacking the nearest stable molecule, stealing its electron, which creates another free radical, beginning a chain reaction.  Antioxidants neutralize free radicals by donating one of their own electrons, ending the electron stealing process.

Some antioxidants and their best food sources.

·         Beta-carotene – found in many foods that are orange in color like sweet potatoes carrots, apricots, pumpkins and mangos.  Some leafy green vegetables such as spinach and kale are also rich in beta-carotene.

·         Lycopene – a potent antioxidant found in tomatoes, watermelons, guava, papaya, apricots, and oranges.

·         Selenium – This is a mineral, not an antioxidant.  However, it is a component of antioxidant enzymes.  Selenium is found in soil so, the amount found in foods grown in the soil depends on where they are grown.  Plant foods like rice and wheat are the major dietary sources.

·         Vitamin A – Foods rich in Vitamin A include liver L, sweet potatoes, carrots, milk, egg yolks, and mozzarella cheese.

·         Vitamin C – This can be found in abundance in citrus fruits, poultry, and fish.

·         Vitamin E – Found in almonds, walnuts, hazelnuts, pecans, legumes, spinach, broccoli, mangos and many oils such as safflower, corn and soybean.

Supplements and Vitamins

 

 

There are a host of over-the-counter antioxidant supplements and multi-vitamins.  In general, taking a multi-vitamin is a good idea for managing liver disease.  Be aware that not all multi-vitamins are created equal and you should, most definitely, talk to your doctor before beginning a vitamin regimen.   There are a few things to be aware of when choosing a multi-vitamin.

·         Vitamin A – although Vitamin A has several benefits to offer, it can be toxic to your liver in high doses.  No more than 5000 units per day.

·         Vitamin E – also has several benefits but, can be hazardous if taken in excess.  Anything more than 1200 IU per day can thin the blood and cause bleeding.

·         Iron – may promote the formation of scar tissue on your liver.  Those with chronic liver disease, especially those with cirrhosis, should take a multi-vitamin with no iron – unless your doctor has determined that you are iron deficient.

·         Vitamin D – Vitamin D deficiency is extremely common in people with liver disease, a supplement is probably a good idea.  But, be aware, it can affect blood sugar and blood pressure.

Plucky just tapped me on my left lobe.  He wants you to know that the above amounts are what “experts” suggest but, you really need to talk to your doctor about what your specific needs are!!  

Fat Soluble or Water Soluble?

Vitamins are classified as either fat soluble or water soluble.

·         Vitamins A, D, E, and K are fat soluble, meaning they dissolve in the body’s fat tissue before your body uses them.  Once they dissolve in fat stores, your bloodstream will absorb them as needed.  Any extra will be stored in the liver and fat tissue.  Once they have been stored, they tend to remain there.  So, if you take too much of a fat soluble vitamin, overtime you can have too much of that vitamin present in your body, a potentially dangerous condition.

·         Vitamins C and B and pro- vitamin A are water soluble, meaning they dissolve in water.  Leftover amounts leave your body through urine.  That means you need a continuous supply in your diet.

Benefits

·         Vitamin A – Fat soluble.  Helps maintain healthy soft tissue and is an antioxidant.  It also helps preserve mucous membranes and skin, this is important in immune function because it helps keep viruses and bacteria out.  Again, be aware, too much vitamin A can be toxic to your liver.  Predominately found in animal liverL, whole milk and some fortified foods.

·         Vitamin D – Fat soluble.  Imperative for bone health.  Without Vitamin D you would not be able to properly absorb calcium or phosphorus.  There has also been research in the areas of immunity and cardiovascular health promoting increased intake of Vitamin D.  The primary source is sunlight.  Other sources are fatty fish, eggs, beef and many dairy products are fortified with it.  There isn’t enough Vitamin D in natural sources, so a supplement is often necessary.  Vitamin D deficiency is extremely common in people with liver disease and may predict non-response to anti-viral therapy in Hepatitis C patients.  But, be aware that Vitamin D can affect blood sugar levels.

·         Vitamin E – Fat soluble.  Primarily an antioxidant and it protects other vitamins and fatty acids from oxidation.  It also protects red blood cells from oxidation and helps form new red blood cells.  It is found in foods such as tomatoes, spinach, almonds, and cereals.

·         Vitamin K – Fat soluble.  It is used by your liver in creating protein vital to blood clotting.  And, helping other proteins with cell growth and bone health.  There are many foods that contain Vitamin K.  Some of these are leafy greens, broccoli, onions, beans, turkey and soymilk.    

·         Vitamin C- Water soluble.  Needed for the growth and repair of tissues in all parts of your body.  It is used to form an important protein used to make skin, tendons, ligaments, and blood vessels.  Heals wounds and forms scar tissue.  Vitamin C can be found in citrus fruits, poultry, and fish.

·         Vitamin B – Water soluble.  B vitamins are a class of vitamins that play important roles in cell metabolism.  Although these vitamins share similar names, research shows that they are chemically distinct vitamins that often co-exist in the same foods.  B vitamins are found in whole, unprocessed foods.  They are particularly concentrated in meat such as turkey, tuna, and liver L. Some other good sources are legumes (like black beans), whole grains, potatoes, tomatoes, chili peppers, tempeh, nutritional yeast, and brewers yeast.

Importance of Diet

People with liver disease should pay special attention to their diet.  One that helps the liver function and protects it from working too hard.  Generally, a low-fat, heart smart diet is good for your liver as well as your heart.  Again, consult with your doctor about your dietary requirements.  This can seem overwhelming but, you can start with a few easy changes, like substituting:

·         Egg whites for whole eggs.  2 egg whites=1egg

·         Season foods with fresh lemon juice, herbs and spices instead of salt.

·         Ground turkey for ground beef.  You can use ½ of each.  Make sure both are “lean”.

·         Dark chocolate for milk chocolate or white chocolate.

·         Frozen low-fat yogurt for ice cream.

·         Unsweetened applesauce for butter or oil in recipes.

·         Extra virgin olive oil.  This should be your go to oil

·         Spinach, arugula, watercress and kale instead of iceberg or romaine lettuce.

·         Whole wheat flour for all purpose flour.

·         Air popped popcorn for chips

·         Turkey bacon for bacon

These things are by no means everything you can do, they are just a good place to start.  You should really steer clear of fast foods.  They are full of sodium and empty calories.  In conclusion, the best advice I can give you is to cook more often, eat fresh foods and talk to your doctor before making any changes to your diet.  So, as I always say, love your liver!  Look for us to get back to the importance of proteins in my next blog.

Happy 2015, Morgan