By Dr. Baljit Pawa, MD
The father of medicine, Hippocrates, once said, “ Health begins in the gut”. Integrative medicine has highlighted the importance of optimal gut health for many years. However, the focus has primarily been on absorption of nutrients, creating a healthy microbiome, maintaining a good gut lining, and promoting ideal motility. It is well known, that a normal functioning gastrointestinal tract is important for our health and longevity. However, one of the most vital organs in the gut system is rarely given the priority it deserves, our liver.
It is essential to focus on the importance of a healthy liver since it is the epicenter of detoxification in our body which is exposed to unprecedent levels of toxins these days. Some of the 500 functions of the liver include:
- Filter all the blood from the gut to breakdown down poisonous substances, such as alcohol and drugs.
- Produce bile to digest fats and carry away waste
- Synthesize proteins (albumin, clotting factors)
- Produce nutrients (Vitamin K, B12, Minerals)
- Store fat soluble vitamins
- Regulate amino acids
- Resist infections
- Regulate blood sugar
- Break down our hormones
Liver health is important for everyone and especially so for women. Recent data suggests that females have a higher incidence of liver related problems. Women may be more susceptible than men when it comes to liver disease. Several factors that have been postulated include smaller liver size, specific distribution of various enzymes in females, protein production differences, and also the greater use of oral contraceptives by women. Females are more commonly affected by toxin-mediated disease of the liver such as alcohol and drugs even though the incidence of alcohol dependence is higher in men.
In some ways, society has normalized drinking alcohol to the detriment of women’s health. TV ads, social media, the entertainment industry and recreation activities glorify drinking culture without showing harm or risk for future disease to women. It took decades for policy makers to print the harmful effect of cigarettes on fetal health or to make policies to deter people from smoking in public places due to a direct link to lung cancer. Liver diseases and liver cancers have risen dramatically over the past few decades and alcohol may become one of the main culprits. Alcohol has recently been added to the list of general carcinogens by the Cancer society. We have to get ahead of the trend and promote optimal liver health.
Liver health and disease:
Finding the cause for breast cancer is a formidable task, the etiology is complex and usually multifactorial. It is somewhat surprising to some women, that alcohol is an independent risk factor for breast cancer, coming in at a higher percentage than the risk of taking hormone therapy. Since we cannot control some of the other risk factors such as breast density, genes, or environmental exposure, we should put our focus on factors we can control (diet, exercise, and alcohol intake). When having conversations with women, it is best to aim for 2-3 drinks per week with a few days in between drinks.
The Alcohol Research Group of California (ARG) spearheaded the #DrinkLessForYourBreasts initiative, to create awareness and education around the risk of alcohol and breast cancer. At Westcoast Women’s clinic, a comprehensive, individual risk profile is undertaken for each patient. Among other risk factors for breast cancer it asks specifically about the amount of alcohol consumed. It is important for women to realize that the enzymes which break down their estrogen also compete with alcohol. Higher levels of circulating estrogens and its metabolites may be implicated in breast cancer.
Maintaining bone density is vitally important to prevent fractures. Among other risk factors such as genetics, use of steroids, small body frame and a deficiency of vitamin D, we also see excessive alcohol as a cause. The latter being a modifiable risk factor. The speed of bone tissue turnover is impaired with the excessive consumption of alcohol. Alcohol can also impair how nutrients (Calcium, Vitamin D, Protein) are absorbed in the gut. Drinking alcohol excessively over longer periods of time impairs hormones and changes proteins produced by the liver thus it weakens the bones causing them to become brittle. The amount of alcohol you drink can be an important consideration when it comes to prevention and management of osteoporosis.
Many studies are under way and further investigations are pending on hormone data and alcohol use. Preliminary data suggests that alcohol affects hormone levels in women as young as 15. It is thought that binge drinking in younger women predisposes them to fertility problems later. There was also a higher incidence of endometriosis and menstrual irregularities in seasoned drinkers. Onset of menopause was also affected in older women who consumed excessive alcohol. It is thought that alcohol impairs the levels of estradiol in the serum because it competes with the enzymes that break down estrogen and impacts the amount of sex hormone binding globulin which is needed to transport estrogen to the tissues.
This condition means you have extra fat stored in your liver, it is also known as hepatic steatosis. Excessive alcohol consumption can lead to a fatty liver. Fat cells invade the normal cells of the liver disrupting normal function such as producing bile. The fat accumulation can eventually lead to inflammation and cirrhosis in severe cases. Alcoholic fatty liver is preventable and in its early stages can be completely reversed by stopping alcohol. It should be noted that some types of fatty liver are associated with obesity or genetics and not due to alcohol consumption.
Autoimmune diseases of the liver
Many autoimmune diseases can involve the liver, the three most common ones directly affecting the liver are: Autoimmune hepatitis, primary cholangitis and primary sclerosing cholangitis. It is interesting to note that again there is gender difference in the incidence and prevalence of autoimmune diseases. There is a remarkable increase in symptoms when hormones fluctuate in women such as at puberty, pregnancy and menopause. There may be a role in the way the liver metabolizes estrogen levels. Lower circulating levels of female hormones seem to predispose women to a higher incidence of autoimmune diseases in general.
Signs and symptoms of liver disease (depends on severity)
- Abdominal pain and changes in stool color
- Nausea, vomiting
- Itchy skin
- Swollen ankles/legs
- Tea colored urine
- Jaundiced eyes
- Ascites (fluid on the abdomen)
Diagnostic tests for liver health (depending on severity)
- liver function tests
- a complete blood count test, clotting factor tests
- CT scans, MRIs, or ultrasounds to check for liver damage or tumors
- a liver biopsy, which involves removing a small sample of your liver and examining it for signs of damage or disease
How to take care of your liver
- Limit your intake of alcohol. Drink in moderation. Men should limit to 2 drinks per day and women should only have 1 or ideally 2-3 per week.
- Eat a healthy, high fibre, low saturated fat diet and avoid highly processed food. Many saturated fats and high carb foods promote fatty liver. Reduce visceral fat (belly fat).Eat cruciferous vegetables (contain Indole-3-carbanol) which reduces your risk.
- Protect yourself from HIV, Hep A and C, practice safe sex, consider vaccination for Hep A and B
- Regular exercise increases energy and prevents fatty liver. Aim for 150 min per week of cardio activity
- Be careful with medications and supplements that can damage liver function. Ex: Daily intake of Tylenol of great than 3000mg (6X500mg) can potentially cause liver damage, and certain natural herbs may have detrimental effects on your liver function. Always check with your health care provider for safety.
- If you also have high cholesterol, diabetes and /or hypertension pay close attention to your liver as these disease are directly related to liver function
- Cut down /avoid smoking
- Stay well hydrated
- When considering hormone therapy avoid oral estrogens (oral contraceptives or hormone replacement therapy) , speak to a qualified health care provider about alternate routes of delivery such as transdermal route which avoids the liver.
For more information:
- Speak to one of our Health coaches about a personalized risk assessment.
- At Westcoast Womens Clinic our diagnostic hormone testing examines how estrogen is broken down by the liver giving us indication of your qualitative and quantitative hormone analysis.