Episode 82: Living for Your Liver

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Welcome to Supplementing Health, a podcast presented by Advanced Orthomolecular Research. We are all about applying evidence based and effective dietary lifestyle and natural health product strategies for your optimal health. In each episode, we will feature very engaging clinicians and experts from the world of functional and naturopathic medicine to help achieve our mission to empower people to lead their best lives naturally.

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[01:06] Cassy Price: Welcome to Supplementing Health. The liver is a detoxification powerhouse within our bodies, processing our blood and breaking down, balancing and metabolising the nutrients, hormones and drugs that we ingest into forms that are readily used by the body. Today, Amanda Montalvo, Registered Dietician, is here to discuss this process and the role that the liver has in hormone production and metabolization. Hi Amanda, thanks for joining me today.

[01:31] Amanda Montalvo: Thanks for having me. I am excited to talk about the liver and detox.

[01:36] Cassy Price: Why don’t we get started with what the difference is between phase one and phase two detoxification within the liver? It is something that gets thrown around and we hear a lot about when we are talking about the liver processing, I am not sure that everyone understands both sides of that process.

[01:52] Amanda Montalvo: We need both. I would say they are both important. Phase one is kind of like, we think about it like our first line of defence against toxins. Phase one is really going to be triggered by external toxins in our environment. That can be from foods that we are eating, chemicals, toxins, mould and that sort of thing. That is going to trigger that phase one. Phase one is really all about oxidation. It actually creates free radicals which doesn’t sound great because I think a  lot of people probably know that free radicals can create more inflammation in the body. That is why phase two is so, so important, because it helps us convert those, neutralise them and clean them up.

But phase one, that is really what it is all about. It is activated by those external toxins. It is starting that process of turning those toxins into water soluble compounds and that just means that they are easy for us to eliminate. Then phase two comes in and it is really all about conjugation. There are six different pathways. It is very intense. It is very nerdy. What is happening there is that we are neutralising those free radicals. That is allowing our body to eliminate them. We make them water soluble and that allows us to get rid of them through things like our sweat, our urine, our stool and our bile. We need both of them to work together. If phase two is not working as well, we can definitely have some issues and more inflammation in the body from those free radicals from phase one. That is really how they work together.

[03:27] Cassy Price: Very cool. Can we get a little nerdy for a second and can you share what those six pathways are? Do they each have their own role, or do they work together to complete the phase two detoxification?

[03:40] Amanda Montalvo:  Half of them work mostly on hormones but not completely. I will kind of go through each one and what they process and metabolise, and then the other half are really based around processing out chemicals from different medications, pesticides in our environment and stuff like that. I would say that probably one of the most important ones is glucuronidation, this is really well known in phase two detoxification for how it is processing our hormones. It processes estrogens, certain androgens like testosterone and DHEA, but also thyroid hormones so T3 and T4. Hormones are one piece of glucuronidation, that pathway. It is important for bilirubin. Even some micro toxins from mould, if we have mould exposure, we can build up those micro toxins. Medications like Enzed’s that are really common. Benzodiazepines. Certain types of anxiety medications, Tylenol, codeine, morphine. It is important for other things outside of hormones, but I would say hormones are probably the primary thing that it is doing. Another really popular one that I feel like I probably get the most questions about is methylation. That is primarily working on metabolising estrogens.

[05:04] Amanda Montalvo: This is the one where people are like, “Am I methylating okay? Do I have certain genetic issues that are impairing my methylation? Do I need more B vitamins to support that?” It really is important for estrogen levels and metabolising it, getting it out of the body. We also need methylation for things like norepinephrine and epinephrin which are adrenalin and dopamine. Interestingly, it is important for estrogen but it is also important for histamine. Histamines can have a very close connection. They can make us estrogen dominant if we are not processing them out of the body properly. It is big for that as well. Even arsenic. That is probably the biggest things that methylation is known for.

The last hormone related one is sulfation. This is where it is processing out probably the most of our steroid hormones so estrogen, progesterone, DHEA, melatonin, T3 and T4 and those are thyroid hormones. Sulfation is also really big for norepinephrine and epinephrin, and that adrenalin that I talked about that methylation takes care of, and dopamine. Even things like plastics that we are exposed to like BPA, certain additives in different products that we are using like triclosan. It is important for some of those, I would say, more like chemical type toxins as well, but it is big one for our hormones. Glutathione conjugation, this is a very fancy one that is mostly just processing out our environmental toxins. What a lot of people think of when they think of liver detox is processing out pesticides and herbicides and what we are exposed to in our environment like heavy metals, mercury, lead, arsenic, cadmium are probably some of the biggest ones. This is probably the biggest one for micro toxins that we get exposed to from mould. Then again, certain medications like Tylenol, tetracycline, so different antibiotics and then alcohol.

Another big one is that acetylation.

[07:11] Amanda Montalvo: This is responsible for certain anxiety medications; it is probably the biggest medication one. Benzodiazepines, antibiotics, blood pressure meds, really high strength anti-fungal and anti-bacterial’s. Then histamines. Our last one if you guys are still with me is glycination.  This is really important for more of the lower end meds like aspirin or certain types of Enzed’s and stuff like that, non-steroidal autoinflammatory drugs and things from food. It is a really big one if we are getting exposed to salicylates from certain foods or food dyes. Personal care products that contain ingredients that can throw off our hormones as well. Sodium benzoate is probably one of the really common ingredients in different personal care products that can build up in the body and is also used in foods. Those are really the six pathways. Half are more hormone based and half are more environmental toxin based.

[08:15] Cassy Price: That is super interesting. You had mentioned when you were talking about methylation, the role that B Vitamins play in that. Are there other vitamins, minerals or nutrients that should really be considered when you are trying to strengthen one pathway over the other?

[08:33] Amanda Montalvo: I think it kind of depends on the person and where they are coming from. B vitamins are really important. Folate is going to be really important. B12. Choline is another B vitamin that doesn’t get a lot of attention that is also very important for methylation. Then certain amino acids like glycine, cysteine, methionine, those are also going to be really helpful, and you can get those from different animal proteins but also bone broth, gelatine, collagen and stuff like that. Vitamin C. I feel like vitamin C is probably the most underutilised for methylation, but it is a powerful antioxidant that can help.

[09:15] Cassy Price: How does liver disease influence those processes as well? Can imbalances in your hormones and potential toxic overload be signs of liver disease in the early stages?

[09:32] Amanda Montalvo: Signs of liver disease, I would say maybe, but there are so many other things that you want to look at too. Liver disease, if you think about it our liver has over 500 different functions. Detoxification and processing hormones are really important ones but there are many other things that can kind of show up as well. If we think about if we are experiencing liver disease and say that those functions are slowed down, you can definitely have a difficult time processing things like estrogen. We have to metabolise estrogen down different pathways inside the liver and then that helps us eliminate it from the body. If we are not doing that properly you can reabsorb that estrogen or other toxins, if your other pathways are disrupted. What that is going to do is increase the burden on your liver. That could definitely lead to higher estrogen levels. I also think about if you have the beginning signs of liver disease and your liver isn’t functioning well, that is going to take a huge hit for digestion because the liver is so important for having that bile production which helps us break down and absorb certain nutrients like fat soluble vitamins properly and to keep digestion moving. Even if we are dealing with constipation and we are not having a bowel movement everyday then we are also going to be reabsorbing that estrogen. I think directly and indirectly that disfunction in the liver could definitely lead to hormone imbalances down the road. I think of how our liver impacts our thyroid. We need thyroid so that we can ovulate and make progesterone and that progesterone balances out that estrogen. I think there are a number of different ways that it could impact hormone heath.

[11:20] Cassy Price: You mentioned that obviously a regular bowel movement is important and that could be a sign of a sluggish liver function. Are there other signs that could be pointing to sluggish functioning that aren’t necessarily within that disease realm?

[11:38] Amanda Montalvo: I think even poor energy. I would say blood sugar swings. I know people don’t always know how to identify that, but if you are having really big shifts in your energy and experiencing that all of a sudden you hit a wall in your day and you are like, “I can’t do anything else, my brain is not functioning.” That is a sign that your body is either not getting enough energy or it is not utilising that energy well. I would say that brain fog, big blood sugar swings where it is impacting your mood, maybe you are feeling hangry. One really important thing that our liver does is that it stores glucose, and that glucose helps us keep our blood sugar stable between meals and at night when we are sleeping. Waking up at night would be another one. Even things like loose stools or constipation if you go either way, that is going to impact. Sometimes we have slow digestion and sometimes our body reacts in the opposite way, and you try to eliminate as quickly as we can if we are not digesting food properly. Then I would say things like headaches, not necessarily hormonal related headaches where you are having them at specific times in your cycle, but more of those less predictable headaches where you are having them a lot more frequently.  

[12:54] Cassy Price: Can you support the liver function with digestive aids earlier on like enzymes, probiotics, and really focusing on those sorts of things to really help support the liver?

[13:08] Amanda Montalvo:  Yes. I really like supporting digestion with digestive ‘gooders’. That is going to allow you to stimulate your own digestive process. It is not that I don’t like enzymes. I just think that if we are trying to have an end result of your digestion getting better, and you not needing to take supplements forever, then things like bitters can stimulate your own production of stomach acid which is really important. If we are not making enough stomach acid, we are not going to break down our food properly and we can actually miss out on a lot of important nutrients. Of course, that is going to slow down our digestion and lead to more constipation. Then it helps with bile production and bile movement and making enough of our own digestive enzymes. The goal is over time you don’t need digestive bitters forever, they are just kind of a more short term thing. Supporting that digestion in the short term is going to allow you to support phase three of detox, which a lot of people forget about. That is elimination. We do eliminate a lot through our stool. That daily bowel movement is essential. Using things like bitters, relaxing at your meals, chewing your food, trying to have good posture like sitting up straight, not eating while you are doing a million other things, because that is going to put you in that fight or flight mode, and it is really hard for your body to relax and concentrate on your body breaking down that food and absorbing it. Those are all things that you can do to start supporting digestion.

[14:33] Cassy Price: Speaking of the fight or flight response, that is obviously linked to stress, when you are stressed obviously your hormone picture changes significantly, especially if it is chronic stress. How does that over time with chronic stress and excess cortisol and adrenaline and whatnot impact the liver function?

[14:57] Amanda Montalvo:  A lot of it is related back to your body hyper focusing in and really prioritising that fight or flight response, rather than a lot of those rest and digest functions that your liver is involved in. If we think about, if we are constantly prioritising making cortisol, making adrenaline, those norepinephrine and epinephrin, getting glucose from the liver and all of those things that are allowing us to respond to that stress, we have a lot less energy and focus on those more, I don’t want to say, unnecessary but they are not deemed essential to our bodies. Ovulating, making hormones, digesting your food properly, digestion is really going to get shut off when we are in that fight or flight mode which can lead to a lot more of all of those processes being put on the back burner. That can be digestive issues, hormone imbalances, period problems and all of that kind of stuff. Definitely that can show up as some of those symptoms of that sluggish liver with brain fog, lower energy and that sort of thing.

[16:07] Cassy Price: Can having excess estrogen result in additional stress on the liver? Even if your liver was originally functioning properly, could having too much estrogen actually result in a sluggish liver down the road?

[16:22] Amanda Montalvo: I think it depends on how well you are supporting it and what is the other burden on the liver. When we look at the cumulative effect of hormones and toxins, our toxic load of our liver is really cumulative. If you have excess estrogen but you are working on other areas of your health, I think that that can be balanced out. It does increase the burden. It does give your liver more work to do. If we think of in our day to day, how many of those toxins and chemicals are we exposing ourselves to. As you start to swap out products you are slowly reducing that toxic load and that burden on your liver. It would be the same thing with your hormones.

[17:07] Cassy Price: Okay. What are the botanicals or herbal supplements that you most often recommend when you are trying to support and boost the liver function? I know we talked about a few already like the bitters and the B vitamins. Are there others that you tend to regularly include in your protocols?

[17:26] Amanda Montalvo: I look at liver support a little bit differently than a lot of practitioners. I always go back. I try not to treat the symptom. If someone has high estrogen or maybe they do a DUTCH hormone test and we can see that they’re not metabolising their estrogen down the favourable pathway, maybe it is more of an inflammatory pathway and it can create issues. My question is always why. Why is that pathway not working correctly? I never want to force detoxification. I want to make sure that that person has all of the things that their liver needs in order to do all of its different roles plus detoxification. That typically looks like a few things.

Number one, getting enough protein in your diet. It is really important. We need important amino acids, like I mentioned before for methylation, we also need those for any phase two detoxification. Getting that glycine, cysteine, taurine, methionine from those animal proteins and bone broth and stuff like that is really important. I usually say 100 grams of protein a day minimum is the goal. That is going to ensure that your liver has those amino acids that it needs to thrive. I also think that getting enough calories, in general, is really important. A lot of popular liver detoxes and cleanses cut your calories and it always baffles me because your liver has over 500 functions. It is not just detoxing. If we take away energy, you don’t know that detox is going to be prioritised. If we take away protein, it likely definitely won’t be, because your liver is not going to have the resources that it needs. Eating enough in general, is really important. That is really where I start with everyone. Then I do recommend prioritising whole food carbs because think about how your liver stores glucose so that we can have that balanced blood sugar throughout the day and allow us to sleep through the night.

[19:18] Amanda Montalvo: If we aren’t giving our liver adequate carbs to perform that task, how is it going to perform all of those other ones? I think starting with the foundations is really important. Then focusing in on, “Okay, am I getting enough of these B vitamin rich foods?” You can also add things like vitamin A, zinc and copper. Beef liver is a huge one that I like to use with clients because it has a ton of B12 and B vitamins in general, but it is also going to give you that free form vitamin A that is so important for liver health, thyroid health, hormone health and so much more. Then things like antioxidants. I talked about that phase one. We can actually stimulate phase one with things like vitamin C, vitamin E and ideally, you are getting that vitamin C from whole food sources. Vitamin E is a little bit harder. Even some of the basics like magnesium, selenium, zinc. Our liver needs those in order to function properly so, let’s eat our nutrient dense foods first. And then if someone is doing that, and then they are ready for the next step, maybe they have high estrogen or digestive issues and they want to really work on that, then that is when things like milk thistle can be really helpful that stimulates phase one. You want to make sure that you have all of those nutrients, so that phase two can happen properly. Phase one is really creating these inflammatory free radicals. Phase two is what is neutralising those and getting them out of the body.

[20:52] Cassy Price: Do you usually see that one phase is diminished over the other or is it usually that both phases will be sluggish at the same time period?

[21:04] Amanda Montalvo: It depends. I feel that I usually see more issues with that phase two, because it is way more nutrient dependant. Think about the six different pathways, especially the hormonal ones, glucuronidation, sulfation, methylation; I feel like phase two probably needs the most support for people. Phase one is not really that hard to stimulate. We all have toxins in our environment. Even caffeine can stimulate phase one. It is usually phase two that needs the most support.

[21:36] Cassy Price: Okay. We know that alcohol consumption obviously does impact the liver and the liver function because it is an additional toxin in the body that is has to process. To what degree does that alcohol consumption play a role in the optimal function overall? And how can it impact these different processes?

[22:00] Amanda Montalvo: I think the biggest thing with alcohol, there is a lot of confusion, people know that “Okay, alcohol is going to impact my liver.” But it is so different in the way that anything else would. The main reason why is because unlike other nutrients, that we can usually store in the body until we need them, we can’t store alcohol. As soon as we introduce that into our bodies, we have to process it. You’re going to halt all of those other processes that we have been talking about this whole time like liver detoxification, blood sugar management, all of that kind of stuff that your liver does. And it is going to be solely focusing on processing out that alcohol and how quickly it does that is going to depend on the person. If you have eaten, alcohol metabolism is going to be a lot faster if we are in a fed state versus an unfed state because the enzyme that we use to break it down is a lot higher when we have eaten something. It is also going to depend on your metabolism and how healthy you are in general. The slower your metabolism, the slower you are going to process out that alcohol. We don’t know exactly how long it is going to impact a person. It could be up to days, and I think a lot of times we don’t quite realise that. You can be impairing detox and fat burning for days because of consuming alcohol and your body has got to get rid of it, it has got to process it out, it does not have a choice.

[23:28] Cassy Price: When you consume alcohol, we know consuming alcohol later in the evening can impact sleep and melatonin production, how does that play into the whole overall hormone picture? Is there an optimal time to consume alcohol if you are going to indulge?

[23:52] Amanda Montalvo:  I would say earlier in the evening would be ideal, but also making sure that you are not consuming it on an empty stomach. That is going to change how you are processing it as well. Having a meal that has protein, fat and carb in it prior to consuming alcohol is going to change how you process it. I think a lot of people can feel that. You feel a lot different if you have fed yourself appropriately the next day after drinking than if you did not. I think that is really important. One thing that I do recommend keeping in mind for everyone but especially women is how alcohol impacts estrogen. It does impact your estrogen levels, so if you are already struggling with estrogen dominance or access levels, or you have a history of things like endometriosis that are greatly impacted by estrogen, or if you are menopausal and you are taking hormone replacement therapy, you will be increasing your estrogen with alcohol. So it is a really important thing to keep in mind. It can help you make it very worth it, be more careful about choosing when you are going to indulge and just bring a little bit more to the forefront. I have so many clients that might only have one or two glasses of wine a night, but I am like “that is still – it is taxing your liver, it is increasing your estrogen and it is slowing down how well you are processing that estrogen.” It does add up over time.

[25:17] Cassy Price: Does the type of alcohol that you are drinking make a difference? If it is a clear alcohol like a vodka or something compared to a red wine or a rum that is a darker type of alcohol?

[25:30] Amanda Montalvo: Not to my knowledge with how the ethanol is processed in the body. It could impact what you are drinking it with. I feel that people with wine and stuff like that, they are more having it with a meal, so you are more likely to process it better if you are in the fed state. What other nutrients are in that alcohol or are your mixing it with sugary things and that sort of thing? Overall, it is more the amount of alcohol that is going to have the biggest impact.  

[26:00] Cassy Price: Interesting. Fantastic. If listeners wanted to work with you and get your input on their own liver health and digestive process, how could they go about getting a hold of you?

[26:16] Amanda Montalvo: I would say my Instagram @hormonehealingrd would be a great place to start. I really focus a ton on minerals and that is what you are going to see there. I also have a podcast the Are You Menstrual? podcast. That goes through all of the foundations of everything that I was talking about. We have an episode on the liver as well. Connect with me in those places. I have a course where you can do hair testing, look at your mineral status and see if you have any of the signs of liver stress, like high cobalt and things like that, and I have protocol templates in there that teach you how to build a protocol based on your results.

[26:56] Cassy Price: Fantastic. Well thank you so much for taking the time to chat with me. I really appreciate it. I think this was jampacked with a lot of really awesome information. I think it is a great place for people to start and go from there.

[27:08] Amanda Montalvo:  Thanks for having me.

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