Around the peri-menopausal transition, many women are surprised to find out they are dealing with increased weight gain, high cholesterol levels, metabolic syndrome and gall bladder stones. The majority of gall bladder removal surgeries occur in women during the perimenopausal transition. Many times women are told that its their poor diet and lifestyle choices, however, its difficult to accept this when often the woman hasn’t changed anything about their diet and lifestyle and all of a sudden what worked before no longer works at all.
Perimenopause is a significant period of transition for women, marked by changes in hormone levels, particularly the decline of estrogen. However peri-menopause also greatly affects the adrenals, insulin levels, testosterone levels and thyroid. All of these hormonal changes combined lead to common peri-menopausal symptoms such as weight gain, hot flashes, fatigue and mood disturbances. A lot of these changes can be in part due to the liver and the gall bladder.
There are four stages to perimenopause:
- Stage 1: Progesterone production drops due to lack of quality ovulation.
- Stage 2: The brain senses lower than normal hormones and tries to compensate by sending strong signals to the ovaries. This leads to fluctuating levels of estrogen. Estrogen levels increase drastically and also fall drastically. leading to irregular and unpredictable cycles.
- Stage 3: Estrogen levels steadily decrease and cycles become long.
- Stage 4: Menopause, where there is a loss of ovulation/cycle for more than 12 months.
These changes to hormone levels have significant impact on the liver and gall bladder. Why? These two organs are responsible for processing, activating, metabolising and excreting hormones. In turn, reproductive hormones, particularly estrogen, also help enhance the function of both the liver and the gall bladder. Huge rises in estrogen that occur in stage 2 of peri-menopause can burden the liver and gall bladder leading to a very noticeable increase in symptoms of estrogen dominance such as heavy periods, short cycles, and breast tenderness. On the other hand a loss of estrogen in the later stages of perimenopause leads to loss of adequate liver and gall bladder function. Around the peri-menopausal transition there is a loss of blood flow to the liver and gall bladder. This can lead to reduced overall function of the liver and a reduced ability to regenerate liver cells. Another significant change during perimenopause is the reduction of bile, which can affect the gall bladder. Bile is produced by the liver and stored in the gall bladder, and its release into the small intestine aids in digestion. A loss of bile, or stagnation of bile flow, is hugely associated with the increased prevalence of gall bladder stone formation and other gall bladder issues around the time of peri-menopause. These changes also affect cholesterol production and contribute to a large increased risk of cardiovascular disease in women in peri-menopause.
The relationship between estrogen and the liver and gall bladder.
The right amount of estrogen has a protective effect on liver function.
-It inhibits the formation and development of fibrosis, which can lead to fatty liver.
-Protects against fatigue by preventing mitochondria damage and prevents pre-mature aging.
-Promotes a favourable balance between an anti-oxidant and a pro-oxidant state, which is important in reducing wide spread inflammation.
-Helps in the breakdown and metabolism of fats in the liver
-Maintains the balance of bile salts and cholesterol in the bile, which prevents the formation of gall bladder stones and keeps cholesterol levels in check.
With these known benefits of estrogen on the liver its easy to see why a loss of estrogen contributes to loss of optimal function in the liver.
Insulin, thyroid and liver/gall bladder relationship.
Peri-menopause is one of the most common times for a woman to develop insulin resistance and thyroid problems. This occurs due to taxed adrenal glands as well as the loss of estrogen. Thyroid hormones have a significant effect on glucose metabolism and the development of insulin resistance. Low thyroid levels can affect the gall bladder’s ability to contract and release bile, leading to bile stasis and an increased risk of gall bladder stones. The liver is also responsible for converting around 70% of T4 hormone into its active T3 state, so as liver functioning slows, thyroid function can also slow down leading to a vicious cycle between the thyroid, liver and gall bladder. These factors are largely associated with increased weight gain in peri-menopause.
How to help the liver adjust to peri-menopausal changes.
The first step in assisting the liver through the peri-menopausal transition is simply to be aware that these changes will take place. Many women are completely taken by surprise at the sudden weight gain, digestive changes and sudden increase in cholesterol levels. Having knowledge around the changes that occur at peri-menopause can help take a lot of stress out of navigating a sometimes difficult transition.
What to include:
- More liver supportive foods like cruciferous vegetables, beetroots, citrus, dark chocolate, broccoli sprouts and leafy greens.
- Adequate hydration (around 8 cups water a day).
- Enough quality protein, preferably plant-based sources as these are lower in saturated fat.
- Bitter foods and herbs like dandelion root that help increase bile flow.
- Ginger and turmeric can help increase digestive enzymes and speed up the flow of bile.
- Lots of heathy mono and poly unsaturated fats like olive oil, avocado, nuts and seeds and other heathy oils. These help lower cholesterol levels.
- Complex carbohydrates from whole-grains which contain b vitamins that assist in liver function.
- Magnesium. Magnesium is a crucial macro-mineral needed to support phase 2 liver detoxification and many other important functions in the body. Magnesium is generally low in women in peri-menopause and adequate levels are needed for insulin, blood sugar, adrenal function, thyroid function. Foods high in magnesium include nuts and seeds, leafy greens and dark chocolate.
- Antioxidant rich foods like berries, citrus and pomegranates help to counteract some of the damage caused by inadequate functioning of the liver.
- Phytoestrogen rich foods like soy, flax seeds and pomegranates. These help balance estrogen levels and can also block harmful estrogen metabolites produced by a poor functioning liver. Read my articles on soy here and flax seeds here.
- Choline rich foods and potential supplements. The liver creates its own choline with the help of estrogen. Once estrogen is lost, choline production also decreases. Low choline leads to accumulation of fat in the liver and can contribute to non alcoholic fatty liver disease. Choline is richest in animal based foods like eggs and beef, however these foods are also high in saturated fat which contributes to fatty liver disease and gall bladder stones. Plant-based foods rich in choline include soy, sunflower seeds and broccoli. Soy or sunflower lecithin contains choline and is helpful in accelerating the removal of fat from the body. Dosages of 1-2 TBSP a day. Choline supplementation can also be used under the direction of a health professional.
- Attempt gentle intermittent fasting overnight. During the peri-menopausal transition, the body begins to be more efficient in converting “ketones” into energy as opposed to “glucose”. The best way to create ketones is through fasting. Studies on intermittent fasting are much more promising for women in menopause than women of reproductive age. Fasting allows enough time for the liver to perform its function. The best way to support the liver and gall bladder with gentle intermittent fasting is to avoid snacking and stick to fasting overnight (earlier dinner) while still consuming breakfast. Be mindful that fasting for too long causes the release of cortisol which disrupts blood sugar and interferes with the liver. Stick to a fasting window of no more that 14-16 hours overnight and experiment on the time frame that works best for you.
What to limit/exclude:
- Alcohol
- Foods high in trans fats and saturated fat. Some saturated fat in the diet is ok, but it is best consumed without sugar. The combination of saturated fat and sugar (especially in the same meal eg. rich cheesecake, pastries etc) is the most aggravating for liver health and is responsible for elevating cholesterol as well as increasing risk of diabetes.
- Refined sugars and refined carbohydrates (sweets, lollies, white bread, cakes, white pasta etc). These burden the liver by causing large spikes and drops in blood glucose, causing the liver to work over time to store glucose and send it into the blood stream when necessary.
- Overeating. Overeating is the biggest trigger to gall bladder attacks, even more so than high fat meals
- Snacking an grazing. Snacking without allowing adequate time in between meals keeps the liver and gall bladder constantly working without adequate time to rest.
The liver and gall bladder are just one area of change in peri-menopause. To ease the transition into menopause, more aspects need to be considered such as gut health and supporting the adrenals. However understanding the changes that a loss of hormones can have on the liver and gall-bladder provides some answers into why the prevalence of gall sones, weight gain and cardiovascular disease increases around peri-menopause. Supporting the liver with targeted nutrition and lifestyle practices can help improve liver function, improve quality of life and reduce the risk of developing many associated conditions like metabolic syndrome, fatty liver, gall stones, cardiovascular disease and diabetes to name a few.
References:
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Vyakaranam, S., Vanaparthy, S., Nori, S., Palarapu, S., & Bhongir, A. V. (2014). Study of Insulin Resistance in Subclinical Hypothyroidism. International journal of health sciences and research, 4(9), 147–153.
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Gierach, M., Gierach, J., & Junik, R. (2014). Insulin resistance and thyroid disorders. Endokrynologia Polska, 65(1), 70–76. https://doi.org/10.5603/EP.2014.0010
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