Don't overlook your liver as a contributor to your gut issues
07-03-2024
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I strongly believe that one of the biggest reasons people do not resolve their digestive issues is because they are looked at through the wrong lens. They're looked at in isolation as digestive issues. But a lot of times it's not just a digestive issue. The digestive issue(s) are a part of a bigger puzzle of factors. Our health is a complex web of different systems and organs. Nothing happens in isolation. Understanding this is key to resolving health issues and maintaining optimal health. There is no way around it. A great example of this is the way in which the liver plays a central role in our digestive health. Issues with the liver can and often do lead to a cascade of negative effects in the gut, like poor digestion, nutrient malabsorption, disrupted detoxification, intestinal permeability, inflammation and microbiome imbalances. There are many connections between gut issues & liver function. Elevated liver enzymes are seen in people with celiac, for example. Abnormalities in the liver are also seen with IBD. The liver is also the primary organ for metastasis of intestinal cancer. Issues in the gut can also lead to issues in the liver. Endotoxins from intestinal bacteria are often a key part of the pathogenesis of liver disease. Microbiome dysbiosis can also inhibit the beneficial effects that commensal bacteria in the gut have on liver regeneration. Many of the clients I’ve worked with who were dealing with digestive issues were also dealing with suboptimal liver function. Truly resolving their health issues required understanding & addressing the connections between them. Since the traditional health world often looks at things separately and doesn’t consider connections between them, the root cause of digestive health issues are usually overlooked. Leading to issues not being fully resolved and having problems continuously resurface. In order to understand the importance of the liver when it comes to digestive health and what things to consider, I’ll run through:
The liver & gut are connected through the portal vein & common bile duct. The liver is the primary recipient of gut derived products like nutrients & microbial components like LPS. Substances from the liver also end up in the gut such as bile, some IgA & bilirubin. Digestion Bile, which is essential for digestion of fats & absorption of fat soluble vitamins, is synthesized in the liver. It contains bile acids that make fats water-soluble by, allowing them to be broken down and absorbed along with fat soluble vitamins. Many nutrients in the small intestine then make their way to the liver. Some nutrients, like iron and fat soluble vitamins, are stored in the liver. Vitamin D is converted to 25OHD in the liver. The liver is also involved in enterohepatic circulation. Bile makes its way from the liver to the gallbladder and from there into the intestines. About 95% of bile salts are absorbed in the intestines and returned to the liver for recycling. This process helps ensure there are sufficient concentrations of bile acids for continuous fat digestion, detoxification & other processes. Disruptions to liver function can inhibit these important processes in the gut and liver. Common disruptions can come from nutrients deficiencies, circadian rhythm disruptions, cirrhosis, inflammation, toxin overload & a number of others. Issues in the liver can cause many downstream problems like nutrient deficiencies, motility disruptions, pathogen overgrowth, chronic inflammation or leaky gut. They’re also linked to conditions like IBD and celiac disease. Detoxification The liver plays an important role in detoxing many substances. Various enzymes, Kupffer cells & glutathione in the liver help to convert harmful substances into less harmful substances and prepare them for excretion via the digestive tract, kidneys or elsewhere. Bile is used by the liver to further dilute & remove waste. Including byproducts of normal processes like bilirubin as well as things like bacterial toxins. Conjugation binds waste to other substances like glucuronic acid making them more water-soluble to be excreted via bile. Bile acids support detoxification in other ways as well. For example, they affect pathogenic bacteria in the gut microbiome disrupting membranes and metabolic pathways. Changes in bile acid composition can significantly influence gut microbiome composition. Several things can disrupt these processes. Like fatty liver, bile duct obstructions (from gallstones, parasites, etc.), toxin overloads, nutrient deficiencies (like B vitamins, glycine, cysteine, sulfur), polymorphisms & oxidative stress. These disruptions to important processes with liver detoxification can lead to many problems like poor digestion, dysbiosis, more nutrient deficiencies, more oxidative stress, accumulation of toxins and chronic inflammation. Gut Lining The function of the gut lining is also affected by the liver. Substances from the liver like bile acids, antimicrobial peptides & secretory IgA support the it by protecting against pathogens, maintaining microbiome balance & regulating tight junction proteins. Bile acids directly & indirectly affect epithelial cells in the gut lining. They’re antimicrobial, protecting against pathogens, regulating gut microbiome composition and directly influencing expression & function of tight junctions (help keep the gut lining strong). Bile acids also activate receptors in immune cells, modulating responses. Like reducing pro-inflammatory cytokines, increasing anti-inflammatory cytokines & enhancing tight junction expression. They also enhance secretion of mucus providing a barrier against pathogens & toxins. Disruptions to the intestinal lining from changes in liver function can allow toxins and bacteria into the bloodstream, causing systemic inflammation and further disrupting liver function. Conditions like cirrhosis have been linked to this. Some metrics that can help understand how the liver is functioning include:
Some things that can help address these issues & support the liver:
There is certainly much more that goes into liver health and the ways in which it can affect the gut and overall health. But, these are some of the common issues that I see and the ways in which they contribute to or cause digestive issues. Focusing on these things was key in the many instances where clients I've worked with were dealing with digestive and liver issues. Without looking at things more holistically and considering these connections, it's unlikely their issues would have gone away for good. So, if you're struggling with digestive issues and can't quite crack the code. Or you continuously have issues resurfacing, looking into how your liver is functioning might be helpful. - Nick |