01 Feb The importance of loving your liver in perimenopause

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When you think of your liver, you’d be forgiven for immediately thinking about how much alcohol you’ve consumed in the past few days. Our liver certainly plays a major role in metabolising and detoxifying alcohol. In fact, this process takes precedence over all other detox processes the liver conducts. (I’ll come back to that a bit later!). First let’s look at what else the liver does…

The “other” functions of the liver

The liver is one powerhouse of an organ. It helps to metabolise, transform or detoxify almost everything we put into our bodies, readying it for (re)use or elimination, including:

  • macronutrients (protein, fats, carbohydrates)
  • alcohol, drugs and toxins
  • bilirubin (the waste byproduct of aged red blood cells) and
  • hormones (1, 2)

 

It also where we:

  • make bile (which helps break down the fat from our diet)
  • create cholesterol (important for hormone production)
  • convert most of our thyroid hormone T4 into its active form, T3
  • start to activate Vitamin D into a useable form
  • make proteins involved in our immunity, reproduction and growth
  • store vitamins and minerals including iron, copper, and vitamins A,E,D,K. (1)

 

Yep – it is one impressive body part!

Why the liver is (particularly) important during perimenopause:

As the major detoxification site for hormones, your liver is one organ you really want to look after during perimenopause. If it’s not functioning well, it can have some nasty knock-on effects, ranging from increased peri and PMS symptoms to much more serious consequences, such as increased risk of cancer.

Let’s take a closer look (and bear with me, this gets a little bit nerdy…I promise I’ll try to keep it short!)

Liver detox 101

The detoxification process in the liver involves 2 stages (or phases as they are scientifically known).

Phase 1 involves the liver breaking down substances (e.g. hormones, toxins, nutrients) into byproducts called metabolites. This makes that substance less chemically reactive or harmful to the body.

Phase 2 involves the liver then adding groups of compounds to the metabolite to allow it to become water-soluble and easier for us to excrete.  This process occurs via 6 different pathways, depending on the compound added.

Many factors can disrupt the detoxification process including medications, toxins, oxidative stress, genetic mutations, poor gut health, and kidney dysfunction and disease (to name a few).

The liver also needs to have several support actors, namely nutrients, available for the two phases to work effectively and in a balanced manner.  Magnesium, B-vitamins, protein, fibre and other nutrients all play an integral role in the process.

In addition to the liver, our gut health, bile production and kidney function all play a significant role in the metabolism and elimination of toxins and are often referred to as Phase 3. (I will discuss this phase in more detail in my upcoming blog on gut health in perimenopause).

To achieve optimal liver functioning, each of the 3 phases needs to be in balance to ensure that toxins and unwanted substances are actually eliminated and not stuck in the liver and/or recycled by our bodies; while other substances are reused and recycled by the body efficiently.

 

So, how does this relate to perimenopause?

Optimal detoxification of estrogen is important during perimenopause, as it’s a time when we often see fluctuations in estrogen (remember the rollercoaster ride that estrogen goes on during this stage).

Perimenopause is also a time when we can see a reduction in SHBG (sex hormone binding globulin) which binds to estrogen and helps it to be less active in the body.

The resulting higher levels of active estrogen can exert effects throughout the body. In some ways this is a positive and essential process, as estrogen is required for numerous functions including maintaining bone strength, heart and brain health and insulin sensitivity (to name a few). (4)

However, an excess and imbalance in circulating estrogens can have negative effects, and may result in symptoms such as weight gain, bloating, breast soreness or tenderness and increased PMS.(4)

The imbalances and excesses can arise if estrogen is not metabolised and excreted effectively. Estrogen is detoxified in the liver via 3 different pathways, resulting in 3 different metabolites:

  • 2- hydroxyestrone (2_OH)
  • 4 hydroxyestrone (4-OH)
  • 16 hyroxyestrone (16-OH)

 

2-OH is generally termed “good’ estrogen, as it can have a weak positive effect on estrogen receptors in the body (helping it to do all those important functions listed earlier). Conversely, growing research is showing excess 4-OH and 16-OH estrogen metabolites can cause damage to the body, and are the types of estrogen usually associated with an increased risk of DNA damage and estrogen-related cancers (5).

If the liver’s 2-OH detoxification pathway is not functioning well, estrogen will be pushed down the 4-0H and 16-OH estrogen pathways, which may see an increase in circulating “bad” estrogen in the body. (5) (This is where functional testing such as the DUTCH test can really help to work out which detox pathways might not be working optimally).

So what can I do to help my liver detox efficiently?

Eat a varied wholefoods diet (organic where possible)

This helps provide your body with the support-actors required in the liver’s detoxification processes:

Fibre – fibre contains phytonutrients (plant nutrients) such as lignans which can help produce SHBG, promote 2-OH estrogen working in the body, support the detoxification and excretion of all 3 estrogen metabolites.

  • include a wide variety of vegetables, fruit, and wholegrains to your diet for their fibre content (not to mention all the other nutrients they provide!)
  • flaxseed has the highest amount of lignans than any other source and is great to mix into smoothies, sprinkle over porridge or yoghurt or use in baking. (3)

 

Cruciferous vegetables – broccoli, cabbages, brussell sprouts all contain plant compounds such as DIM which can help to push estrogen down the preferred detoxification pathway. (3)

Legumes and beans – such as edamame and soybeans (tofu, tempeh, soy products) contain isoflavones which can have a weak estrogen-like effect in the body, and therefore may help reduce the amount of ‘bad’ estrogens from binding to estrogen receptors in the body. The also contain great amounts of fibre and B vitamins, essential in the detoxification process. (3)

Leafy Greens – such as dark-green lettuce, spinach and kale contain magnesium and B-vitamins, essential for optimal liver detoxification (3)

Other liver supporters include garlic, eggs, onions, berries, turmeric and green tea – which work to support detox pathways and reduce oxidative stress and inflammation in the body. (3)

Good quality protein is also important as various amino acids (which make up proteins) are required in the 6x Phase 2 detoxification pathways (3)

Drink more water

Water is essential to help the body eliminate toxins and metabolites via the kidneys and bowel. Aim for 2-3L of water per day (see my blog on water here) 

Reduce or eliminate your alcohol intake

As mentioned earlier, the detoxification of alcohol takes precedence over everything else in the liver. Consequently, the detoxification of estrogen will take a back seat if you’ve had a drink (or few). This may not be an issue if you drink irregularly, however if you are drinking more than occasionally and experiencing some of the symptoms listed earlier, reducing your alcohol may help. It’s also important to note that there is no safe amount of alcohol for those with estrogen-related cancers, or those with a family history of estrogen-related cancers (6).

Reduce your toxic load

Other toxins will also add to the liver’s processing load. Where possible look to reduce your intake of processed foods, refined sugars, caffeine, additives and preservatives. Instead opt for a wholefoods diet, including organic and pesticide free meat and produce where possible.

Look around your house to see where other toxins might be lurking – skin care and beauty products are often laden with chemicals. Look for products that are free of sulphate, parabens, and phthalates. Scented candles, air fresheners and cleaning products are all other common products to consider.

Check your elimination

Are you pooing at least 1x day and not constipated? If you are feeling like you’re a bit sluggish, look to increase your fibre and water intake to get things moving so those toxins can get out.

Sweating is also another way in which we can help eliminate toxins from our body and reduce the burden of detoxification on our liver. Yet another good reason to exercise regularly, and/or hit the sauna!

 

In summary

Love your liver! As the key player in the metabolism of hormones, it really is one organ in your body that you want to be functioning optimally during perimenopause.

If you suspect that your liver might be a bit sluggish and contributing to your peri symptoms, why not reach out to me and book a free discovery call or 1:1 and we can see what is happening for you.

 References:

1.Ozougwu, J.C., 2017. Physiology of the liver. International Journal of Research in Pharmacy and Biosciences, 4(8), pp.13-24.

2.Kalra A, Yetiskul E, Wehrle CJ, Tuma F. Physiology, Liver. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023. PMID: 30571059.

3.Hodges RE, Minich DM. Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application. J Nutr Metab. 2015;2015:760689. doi: 10.1155/2015/760689. Epub 2015 Jun 16.

4. Briden L, 2021, Hormonal Repair Manual, Every Women’s Guide to healthy hormones after 40, Macmillan, Sydney Australia

5.Samavat H, Kurzer MS. Estrogen metabolism and breast cancer. Cancer Lett. 2015 Jan 28;356(2 Pt A):231-43. doi: 10.1016/j.canlet.2014.04.018. Epub 2014 Apr 28. PMID: 24784887; PMCID: PMC4505810.

6. Liu Y, Nguyen N, Colditz GA. Links between alcohol consumption and breast cancer: a look at the evidence. Womens Health (Lond). 2015 Jan;11(1):65-77. doi: 10.2217/whe.14.62. PMID: 25581056; PMCID: PMC4299758.