S1 E13: Liver: Hormone Superhero


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Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it.

Amanda: In this episode, we are doing a special tribute to one of our hardest working organs, which is the liver. The liver is best known for detoxification, but most people forget that your liver has to be healthy and functioning optimally to actually detox. We’re going to talk about exactly what that means and how popular detox programs and supplements are often missing the mark when it comes to actually supporting your liver.

Emily: So even though the liver gets its reputation for being a detox organ, it’s not just a detox organ. There are actually 500 vital bodily functions that the liver helps operate. And all of these or most of them affect so many different systems in the body. And we’re going to be talking about a few of those. So right now, just talking about the liver and how it affects our hormones, which I know a lot of you are going to be most interested in, because this is a podcast about hormone health. But let’s dive in really quickly with how it affects these certain areas starting with hormones.

So the liver does process hormones, like estrogen is a really big one, and it makes them inactive so that we can get rid of those hormones through digestion. So this is really important for hormone balance, because if you have a ton of excess estrogen circulating through your body, that’s going to cause unwanted symptoms that are related to estrogen dominance. But it’s also really important to remember that the liver is so intimately connected with the thyroid. So the liver actually converts thyroid hormone T4 into the active form of T3, so it goes from inactive to active. We’ve talked about this before in previous episodes, but that is huge. And sometimes when you’re not feeling your best when you think you may have thyroid symptoms or a sluggish thyroid, and your doctor tells you you’re fine because your TSH is good…a lot of times what we’re missing is that conversion, right. So how well is your body, or more specifically, your liver converting that T4 to T3, because if that’s not happening, you’re going to experience a lot of sluggish thyroid symptoms. So super important. 

Not only that, but when it also comes to the thyroid, the liver allows us to metabolize carbs for energy use in the body. And this is very important for thyroid health. We talked about how important carbohydrates are for a optimally functioning thyroid. And so this is all based on how well your liver is functioning. Another one is the liver and the gut. As I said, we’re going through these kind of fast, but we will dive deeper in this episode, we’re just giving you a little intro. So with the liver and the gut, the liver makes and converts cholesterol. So this can be used for different areas of the body. And if you know anything about hormones, you know that they are produced from cholesterol. So we need cholesterol in order to produce sex hormones. It also produces bile, which helps us to break down our fats and absorb fat-soluble vitamins.

So as you can see, those are already three really big areas that all kind of come back to our hormones, right? If we don’t have adequate thyroid hormone, that’s going to affect the rest of our hormones. If we’re not digesting our foods well and making cholesterol that’s gonna affect our hormones. So it’s really important to put all this into perspective about how the liver affects so many different systems, which then in turn, go back and affect the liver.

Amanda: I know and bile is such a big one too, because like, obviously, if that bile helps us, you know, break down fat into little tiny particles so we can easily absorb them. But we, like, get rid of things in our bile like toxins, different specific hormones, actually, we can get rid of byproducts through the bile. So it’s one of those things that I feel like we don’t always think about, and especially people who struggle with things like constipation. I’m like, how is, how is your liver? Because if you don’t have adequate bile that can lead to that sluggishness of our digestion. And then if you aren’t breaking down fat well, because of inadequate bile, then… and you, say you’re eating like a decent amount of fat in your diet, then that can definitely lead to more constipation. And this is one we often see in clients that don’t have a gallbladder anymore, and so there’s really nowhere for that bile to go, then we often will see that they’re…most of those people struggle with constipation or very loose stools. Usually they alternate and they’re kind of going back and forth. So bile is a huge one, and that is produced in your liver and then it goes to your gallbladder. And then that is put out into our duodenum when we are eating and breaking down our food. 

Another really big area is blood sugar. Right? I think that this is probably the one that Emily and I talk about the most on this podcast. I mean, I can’t, if we…the first like three episodes, I feel like we’re just kind of honing in on like, what our metabolism is, why keeping blood sugar stable is such an important aspect of a healthy metabolism. And the liver is really responsible for that. So it acts as the body’s kind of fuel reservoir for glucose, which is just that sugar, blood sugar broken down carbohydrates that our bodies run off of. And the liver helps to keep your circulating blood sugar levels stable and make sure that our body constantly has that fuel. When we are given plenty of carbs, like for that fuel, say you’re eating carbs in the majority of your meals, you try to balance things out with protein, fat, and carb consistently throughout the day…this is what allows your liver to store enough sugar is, it’s called glycogen is the stored form of that glucose, and that’s what helps when your body is stressed. When maybe you don’t, you have to like, you’re super busy so you skip a meal, you didn’t have time to eat, or at night when we’re sleeping. This is what allows us to keep that blood sugar consistent during that time. So it’s really, really important. And this is another way that the liver is going to impact hormones. 

Again, like so often people will comment on our Instagram posts or reach out to us and talk about all that they’re struggling with estrogen dominance, their periods are painful, they want to know like what supplements you should take for their liver. They, they’re…or they’ll say like, I know, I should support my liver but, like, I don’t know what to do, what should I take? And this is where you really have to zoom out and look at, okay, well, if your liver performs over 500 different really important functions in the body, how are we going to ensure that it’s supporting your hormones properly if it can’t even do its job? And I think that’s the biggest takeaway that we want you to have, like Emily said, talking about, like, how it’s really important for certain, processing hormones, for converting thyroid hormone for digestion in order to keep everything in a good place, and it makes sure your liver has the fuel it needs. It does need glucose and amino acids. And that’s why we are always harping on the protein and carbs. So when our liver runs out of that glucose, what happens is, like say, like, at nighttime if you’re sleeping. So you sleep for eight hours and you use up the majority of that glucose stored in your liver, then it will start to convert things like proteins and amino acids from those proteins and then waste products and fat byproducts and turn that into glucose. And this is called gluconeogenesis. This is when our body is making its own glucose because it ran out of getting it from you and the diet basically.   

Our liver can store about 100 to 130 grams of glucose. This is a healthy liver, I want to emphasize, because sometimes we have issues storing glucose in the liver and a lot of that…maybe you get hangry often, maybe you have lots of blood sugar imbalances, you have a hard time keeping that in a good place. And a lot of that is coming back to…can your liver actually do this properly? Does it have enough thyroid hormone? Does it have enough potassium? Is it getting amino acids from your diet, from protein? So we should be able to store up to 130 grams of glucose. And this lasts us seven to nine hours when we’re fasting, right. So we’ll use this up quicker if we are working out in a fasted state, if we’re super stressed all day for skipping meals, if we’re eating lower carb…all those things are going to eat up that glucose that’s stored in the liver. And then that is going to give your liver another function to do, right, when we ask our liver to perform that gluconeogenesis on top of all its other functions, we’re giving it more work. And this will impact all the other systems in the body that run off of glucose. So this is gonna put a burden not only on your liver, but your brain and your nervous system, your reproductive system and your hormones, your thyroid, and ultimately our adrenal glands. And so if you are someone that really resonates with feeling like you have low energy, you’re in that burnt out state, or maybe you get those like bouts of adrenaline…I have a lot of clients that deal with this where, like, they might get like overly stressed and too stimulated from time to time. That all…I would really consider like is your liver getting the things that it needs? Are you able to store that glucose? All those things are going to have such a big impact.

Emily: For sure. And I think it’s worth mentioning that our bodies are really intelligent, and while they’re is a lot—we’re going to talk about this—but while there is a lot out there advertising, oh, you know, you need to detox your liver, you need to cleanse your liver…that’s actually not the right approach. Because our livers are already detoxing, like, we don’t need to do anything to produce that detoxification or those functions that we discussed. Because when you give your liver what it needs, basically with just good nutrition, as Amanda was saying, the right macro, micronutrients, all of that good stuff, it’s going to be able to do what it was meant to do and created to do just fine. And with that said, I am going to talk about dysfunction with the liver. But I think it’s, it’s important to remember that your liver doesn’t just stop functioning, right. So it’s not like it’s just oh, I’m, I’m done, I’m not getting, you know, a juice cleanse every, every other month. So I’m just gonna stop doing what I was created to do. No, the liver is really, really smart. It keeps up with this really, really well. And we don’t have to do anything special to make sure that this happens. It’s really just about going back to the basics and giving it what it needs so that it can continue to function just like every other system in the body, right.

So now that I’ve just kind of gotten that rant out of the way, I do want to talk about what does happen when we don’t give the liver what it needs through proper nutrition. And there are a couple things here. So when the liver becomes impaired, the end results are going to look like higher levels of aldosterone, growth hormone, and glucagon. And this is basically just from stress. So this is a stress response that’s going to promote the excretion of magnesium in the urine. So what does that mean? Well, that means that we’re, we’re looking at mineral deficiencies and imbalances here. So this stress response on the liver is going to create these imbalances. And it’s, it’s all kind of a cycle because we need minerals in order to support the liver. So it’s kind of a vicious cycle. But then, without a functioning liver, we might see those hypothyroidism symptoms that I talked about earlier, and that’s going to be from the low conversion rate of T4 to T3 so you might see lower levels of T3. A sluggish liver can also contribute to the excess estrogen circulating through the body. So that’s going to be estrogen dominant symptoms like painful or heavy periods, breast tenderness, weight gain, fibroids, low or super high libido, fatigue, and mood disorders. So those are just a few things that can happen when we do stop kind of giving the liver what it needs just through basic nutrition. But Amanda is going to talk about a few more. 

Amanda: And another thing just to kind of go off of the estrogen dominance symptom piece, again, is that your liver is going to also have a big impact not only on estrogen, but that estrogen is going to impact thyroid function. So if we have an excessive amount of estrogen hanging around in the body, then we make more of a certain binding protein. And that binding protein also binds to thyroid hormone. So it’ll make that active thyroid hormone then inactive and can lead to those hypothyroid type of symptoms. So again, it’s just, everything is connected, and it’s all going back into each other. But estrogen dominance can lead to thyroid issues, thyroid issues can lead to estrogen dominance, and then the liver has a big connection to all of that.

And the other kind of big thing that we see happen when people have liver dysfunction are digestive issues. So it could be just not breaking down your food well, because you don’t have enough bile production or that bile is not properly flowing through into the digestive tract. And that’s going to lead to poor digestion, absorption of fat, light colored stools, you can have stools that float, but it’s also eventually that can lead to vitamin deficiencies, like the fat-soluble vitamins like vitamins A, D, E, and K. And if you listened to our copper and iron episode, you know that vitamin A is so, so important. It’s probably I think one of the most important vitamins for thyroid health as well. And we have a whole blog post on this. So I definitely recommend looking at that. If you’re concerned about vitamin A and you have thyroid issues, a lot of it can come back to your liver health as well though, as you’re probably kind of realizing. So digestion is a big one, fat-soluble vitamins are big ones, but then even things like constipation, poor appetite. Those are huge and they do tend to come up. And yes, like a sluggish metabolism, sluggish thyroid can cause constipation, but so can not having adequate bile production. So it’s just about looking at all of the different areas that could be impacting this for you and not just the one. And of course, you know, if you do have, if you don’t have a great appetite that can be caused by running off of stress and having high stress hormones. Even just having a slow metabolism in your body conserving more energy that’s going to impact your hunger and fullness cues. But we do tend to see those with liver dysfunction deal with reduced appetite as well.

Emily: Yeah, and I think it’s funny how when we think of digestion and like, oh, you know, my digestion is not working. Well, a lot of us tend to go straight to either, well, okay, how’s my stomach acid? How’s my gallbladder? How’s just like my GI in general, like all the small intestine, all of that. We consider that but I feel like it’s very rare that people actually look at liver health and think about, well, the fact that my liver produces bile, that’s huge, you know, and it helps us break down those fats. So I think it’s just a good reminder to think about how is my liver doing if I’m not experiencing proper digestion?

Amanda: Yeah, it’s easy to want to look at like, do I have a parasite? Do I have overgrowth? SIBO? Pathogens? And not that those things can’t impact you and they definitely can. But it’s kind of like, why did they happen in the first place? Why are you having overgrowth in your small intestine, it’s usually related to a sluggish thyroid, sluggish metabolism, you know, like, and poor digestion. So you always want to, I would definitely consider liver function as a basic foundation versus just going straight to like an intense gut protocol, because you can have the same issue come back like a year or less later, because you didn’t really get to that root. So digestion is a huge red flag for liver function. And then things like cholesterol and triglycerides are another big one. We tend to see high cholesterol or low cholesterol with people that have liver dysfunction. And a lot of that is mainly we tend to see higher cholesterol for the most part, because you know, 80% of cholesterol is going to be produced by your liver. And so you’ve got some liver dysfunction going on, maybe it’s super stressed, maybe you have some excess iron, and your liver is not converting and clearing that cholesterol well, you’re gonna, it’s going to add up. But same with like thyroid, right. If you have a sluggish thyroid, then that can also lead to high cholesterol levels, inflammation, stress, all those things can lead to high cholesterol—it’s not always just going to be your liver. But for the most part, it’s always gonna play a role. And then high triglycerides, because our liver helps keep our fat levels and our blood at a healthy level and not excessive. But if that liver is not functioning properly, then we are much more likely to have high triglyceride levels. So that’s another, two great things that you can look at by just doing like a lipid panel on bloodwork.

And then the last kind of big sign that we see the most frequently with those who have dysfunction of liver is skin health and skin-related issues, right? Like, people will have, if you have lots of rashes, psoriasis, eczema, acne, especially if you’ve been dealing with things for a long time. Typically, these are not going to be like the first symptom that you ever deal with, they’re going to be something that comes much later when your body has already been stressed for a long time. So that is one where if you do have a lot of skin issues, you’d want to look at what is my bloodwork, like, you know, how is my digestion? Do I have a gallbladder? You know, that’s, of course, that’s going to play a huge role if you can actually get that bile. And then do I have some of these other symptoms of estrogen dominance, is, how is my thyroid working…all of those things are going to be huge. We do tend to see more skin issues in those that have maybe either dieted or have been undereating for a long time or have been like on more like restrictive type of like elimination protocol type of diets for a long time, and their bodies are just running off of stress hormones, their immune system is completely overstimulated and probably depleted at this point, low vitamin A…like all those things are such big influences on that immune system and on the liver. And so once your body gets past this, like certain level of stress and inflammation, then typically you’re going to start to see that show up in your skin. 

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Emily: I love talking about the liver and learning about it, because looking back at my…we just went through so many different things the liver can affect, especially a dysfunctioning liver, right? So looking back at my health history, and I’m, I’m sure that a lot of our listeners can relate pretty much every single one you listed or we listed, I have had in the past, right? So the acne, the poor digestion and constipation, the high cholesterol, the estrogen dominance symptoms, the low T3, like, literally every single thing has been something I’ve dealt with. And I know it can be overwhelming for those of you listening, because you might think, well, you’re telling me it could be the liver. But it could also be, you know, the thyroid, and it could also be, you know, blood sugar imbalance and a gallbladder that’s not moving bile properly. Like there’s so many things that it could be, but you have to understand that it’s one piece of the puzzle that’s just affecting every other piece, right. So if you’re missing one piece, it affects the whole puzzle. And that’s kind of a dumb analogy, but basically, it all goes hand in hand, as Amanda was saying, and it’s nothing in isolation. So if the liver, dysfunctioning liver affects one part of your body, that’s going to have a trickle down effect to so many other parts. And that’s what’s important to understand. But what we are going to talk about is how to support the liver in a holistic way. All of those things are going to affect the rest of the systems too. So it’s not just like, the things we talked about in this episode are only going to help the liver, it’s going to help your body as a whole. And that’s the good news. Even if you’re overwhelmed by all this information, know that the things that we talk about and recommend for good, optimal liver health are going to be great for optimal health in general. But I just wanted to point that out. And I will say what was the big red light for me was when I got my HTMA back, and I noticed that my cobalt was really high. And Amanda explained to me that that can indicate liver distress. And I think Amanda, remind me, I think my cobalt was like one of the highest you’d ever seen, right?

Amanda: Yeah, it was, it was like off the, so high that it was off the charts on that first hair test that you did. 

Emily: So she explained to me that that was a big indicator of liver stress. It could also indicate that there’s a bio unavailability of B12 or poor absorption of B12. So sometimes that can be related to low stomach acid, which I also know that I struggle with. But I just thought this is really eye opening. Because again, like I said, I’ve struggled with all of the, you know, the classic symptoms of hypothyroidism. And just like I said, the acne and all of that. And so being able to see that on the page that whoa, my liver really is stressed out, like, how do I support my liver? That was huge for me.

Amanda: And we can’t forget your blood sugar issues. And that was kind of like when, when I initially saw that, obviously, Emily has a history with PCOS and hypothyroidism, which can definitely impact your blood sugar. But for her, it really, she needed a huge liver focus because that really high cobalt was just showing so much stress. And then she already was dealing with somewhat of a sluggish thyroid. So she already had so many things that were making it difficult for her liver to do its job and have energy and store glucose. And so that was showing up in her day to day of having these like big highs and lows and just huge swings with blood sugar. And so once she started more consistently consuming carbohydrates and balanced the protein and fat and not kind of fearing those things…and just you know, beef liver and vitamin A and like support, all those things that support your basic needs and the liver and everything and adrenal cocktails. It’s like over time, that really helped make your blood sugar that much more stable, but I’m sure it’s because it had a big impact on that liver function

Emily: Oh 100%. And you could tell by my next HTMA my, my cobalt came way down. I think it was in the completely normal range on my second test. So everything I’ve been doing, I think, you know, vitamin A was a huge one, Amanda, because you, I got on beef liver, I got on the cod liver oil. And knowing my history and the different pharmaceuticals I had taken in the past…I know my vitamin A was struggling. So we’re going to talk about everything that supports the liver, including those micronutrients. That’s super important. But I just wanted to point out if you have done an HTMA and you do see high cobalt, that is one of those big, kind of, red flags when it comes to liver health. Another big one is having high iron because this can indicate liver stress, because when the iron gets stored in the liver, it impairs liver function. Okay, so if you do have high iron on your HTMA, chances are you’re also storing iron in your tissues in your liver. And then lastly, low sulfur can just be an indication that you’re not detoxing as well. So we need sulfur in order to detox properly.

Amanda: Yeah, I think it’s mostly for phase two, but it might be for phase one as well. But sulfur is a huge one, it’s really easy to get from food. It’s definitely, it’s found in both plant and animal foods typically in abundance, especially if you eat meat, it’s like you typically can meet your needs. But a lot of people struggle with that because they’re not breaking it down well, or maybe they’re not getting enough animal products in, maybe their body’s super stressed, poor detoxification in general—all those things are going to impact it. But those are just a few markers if you have a hair test that you can look at, I think it’s helpful just to kind of see. 

And I was reading this review for something. I was looking at some herbal product that a client had sent me. And she was like, I can’t remember the name and I’m not gonna share the brand anyway. But I was reading these reviews, it was an herbal-based product. It ended up being totally fine. And I was like, you can definitely take this if you want. It was, it was more just like a blend to like support your liver of certain herbs, which we’re going to talk about some of them in a bit. But it was interesting, I was reading…I always like to read the reviews to see like people’s experience. And so I was reading some of the lower star reviews. And this person basically commented saying that the, she was blaming all this like liver, like, excess iron accumulated. She, like, had an MRI, saw that she had all these liver issues that she didn’t know about, and she had one before she started taking. And then she had to have another one after and do some bloodwork. And she was like, I had all these changes in my liver in the meantime. And I mean, I don’t believe that, because then the next thing she said was that she’s been iron deficiency anemic for the majority of her life. And it’s like, yeah, so you’ve been accumulating iron in your liver and it’s not in your blood, which makes you look anemic. And so of course, and she had hair loss issues and so on, which of course, like she thinks she has hair loss because she doesn’t have enough iron. Her liver thinks that she has hair loss because she has too much stored in the liver. So iron is an interesting one. It’s not that it’s like, like, we need iron, you know, we don’t want to not have any, we just again, we want to keep it in circulation. So when it’s not, it does tend to accumulate in the liver and impair a lot of its function. So if you do a hair test and you see high, you don’t see high cobalt, but your iron is really high, it could because you are getting rid of some excess iron and moving it, but a lot of times it’s that it’s stored up in the liver and creating a lot more inflammation and distress in the body.

Emily: Okay, before we dive into supporting the liver, which I know you’re all waiting patiently, we’re going to talk about first what does not support the liver. And Amanda, do you want to take the reins on this?

Amanda: Yeah, so because we were going to go through I mean, a lot of this stuff you guys know if you’ve been listening to our podcast, you know, and we hope that it just encourages you that you’re on the right path. So often people want like a special supplement or pill or something. But those don’t work typically. Like, if we think about, you know, Emily and I were before we started this, like what do we see people do for liver detoxes or like what have we done in the past? Like, what are we, what have we been advised to do? And I think one of the most popular ones that I see are like detox protocols that are very, like juice-based, smoothie-based, not that we’re against smoothies here, eliminating carbs, and like they eliminate animal protein. I think that’s probably the most common types of like liver detox or cleanse that I will see. And we’re just like, but this does everything you don’t want to do to support your liver, right? It’s, it’s eliminating animal protein, which takes away all those important amino acids and B vitamins and copper and vitamin A and all those things that we need to have that liver function optimally. So that’s a huge on. It like, typically, if we have low carb or it’s just like a calorie restriction, that’s like a huge part of a lot of liver detoxes, is like, yeah, of course you feel different because you’re cutting your calories in half, and your body is now running off of stress hormones. So I hear this so, so much like, I will have people be like, oh, I had this person do a liver detox, like other practitioners…typically they’re not like dieticians or nutritional therapists they’re more like health coaches, nothing against health coaches, but I think you kind of need to have this baseline understanding of things to really understand like what’s happening in your client’s body. So like, of course, if someone cuts their calories, starts drinking juices, is running off of cortisol, and their liver’s, you know, their liver’s basically just prioritizing gluconeogenesis and making glucose to keep your blood sugar balanced…they’re gonna feel different and they might even get a boost in energy and lose a little bit of weight. But then as soon as they go back to that norm, it’s going to go back to whatever they were experiencing before and sometimes make them feel even worse.

So a lot of those detox protocols are not actually getting in there and working on what building blocks does your liver need, especially things like fasting. Like a lot of people will be like, I’m going to support my liver and detoxification of my body by fasting, and like, yes, you can increase autopha

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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