I’ve been thinking about the liver a lot lately, and it’s funny because for years I barely paid attention to it unless something showed up on labs or it came up in a very textbook kind of way.
Now I can’t stop seeing it in everything.
It shows up adjacent to the categories people usually come to me with...
Someone comes to me tired all the time and we end up looking at what the liver is doing with blood sugar overnight, especially that 2–4 AM window when it’s quietly releasing glucose so your brain and body don’t dip too low while you’re asleep.
Someone else is dealing with PMS or PMDD and suddenly we’re not just talking about hormones in isolation, we’re talking about estrogen metabolites, liver processing pathways, bile flow, and whether the body is actually clearing estrogen through the liver and gut at the same pace it’s producing and recycling it.
Someone is stuck on fat loss and we’re in insulin signaling, liver glycogen storage, and the constant decision the liver is making between using fuel now, storing it, or holding onto it for later.
It’s rarely the same starting point they thought they were walking in with. And that keeps happening often enough that it starts pointing to something bigger.
We’re taught to think of the body in separate boxes. Hormones in one box. Gut in another. Metabolism somewhere else. Cholesterol off on its own. Most experts are still trained this way.
But when you look at enough real people over time, that separation doesn’t make sense. The liver sits in the middle of everything. It’s constantly reading insulin signals, blood sugar levels, amino acids, fats, cortisol rhythms, estrogen shifts, inflammation, and even time of day, all at once.
Then it makes decisions about whether to store glucose as glycogen or release it, whether to make more glucose overnight or slow it down, whether to produce cholesterol or export it, whether to make bile, whether to break down hormones, and how to move things through detox pathways.
It’s doing prioritization work allllll day and allllll night.
Symptoms don’t usually show up as one clean signal from one clean system. They show up as clusters.
Skin changes that don’t make sense. PMS that feels different than it used to. Fatigue that doesn’t match sleep. Bloating after foods that used to feel fine. Cholesterol shifts that feel random. That vague “something is off but I can’t even explain it” feeling.
Bile is one of the clearest ways to see this. Most people think of bile as something that helps digest fat, which is somewhat true. But bile is also one of the main ways the body moves hormone waste out after the liver has processed it (especially estrogen that’s gone through phase I and phase II detox pathways).
Once those estrogen metabolites reach the gut, the system is still working on them. Certain gut bacteria (called the estrobolome), can change estrogen metabolites before they leave the body. Some get pushed out. Some get reactivated. Some get pulled back into circulation through enterohepatic recycling.
So what looks like blanket 'hormone levels' is actually a this collection of liver processing, bile flow, gut bacteria, fiber, transit time, and clearance speed.
That loop explains a lot of patterns people call hormonal imbalance, because often the issue isn’t hormone production, it’s how well production, processing, transport, and elimination are working together.
This is also one reason I pay attention when women report worsening PMS, PMDD, breast tenderness, heavier periods, or symptoms that seem to intensify despite hormone levels that don't look very different on paper. Hormones don't exist in a vacuum. The body has to process, package, transport, and eliminate them efficiently.
The thyroid is part of this conversation too! Thyroid hormones influence metabolism throughout the body, including processes that affect cholesterol handling, bile production, energy expenditure, and liver function itself.
This becomes even more obvious during perimenopause and menopause.
Estrogen doesn’t just drop in a straight line. It becomes more variable, and that variability changes how hard the liver has to work across multiple systems at the same time.
The liver is involved in cholesterol production, bile production, blood sugar regulation, and fat metabolism. Estrogen interacts with all of those systems directly. When estrogen patterns become less predictable, liver workload shifts with it.
Blood sugar regulation is a big piece of this that often gets missed.
The liver is one of the primary organs responsible for maintaining blood glucose between meals and overnight. When insulin resistance develops, the liver often becomes less responsive to insulin's signal to slow glucose output. As a result, it may continue releasing glucose even when blood sugar is already elevated. This is one reason fasting glucose, fasting insulin, triglycerides, fatty liver patterns, and cholesterol changes so often travel together.
So then ... during perimenopause and menopause, when fluctuating estrogen can make blood sugar regulation less predictable, some women notice that the same foods, workouts, or routines that worked for years suddenly stop producing the same results. And it can be SO frustrating. Often the answer is improving insulin sensitivity and reducing the amount of metabolic pressure the liver is being asked to manage.
What I see in my work is often women getting told their labs look “normal,” or maybe being told one or 2 things is flagged as if those are standalone markers, while their actual experience of their entire body is clearly changing.
Energy that used to feel endless becomes less predictable and finite. Digestion feels a lot more reactive. Body composition shifts despite effort. Skin gets weird. Sleep feels less restorative.
Liver enzymes like ALT and AST are part of the story. I pay attention to them, and I tend to like seeing them quite a bit lower than the upper ranges of "normal" on the lab ranges because I often see that alongside systems that seem to be handling metabolic load with less background irritation.
But enzymes only tell a small part of the story. They don’t show blood sugar timing, bile flow, gut recycling patterns, or how the liver is communicating with muscle, gut, hormones, and circadian rhythm. So they’re clues, but not the whole story.
One common example of this is non-alcoholic fatty liver disease (NAFLD). I don’t think of it as just a liver issue. I think of it as a metabolic pattern that shows up in the liver.
The liver is one of the body’s main energy decision centers. It decides what gets used for fuel, what gets stored, what gets converted, and what gets exported. When insulin signaling becomes less efficient over time, and energy intake and energy use stop matching cleanly, the liver is often one of the first places where that mismatch shows up. Fat in the liver is often the result of a longer pattern involving blood sugar swings, lower muscle uptake of glucose, poor sleep, chronic stress load, lower movement, and hormonal changes over time.
The liver is reflecting that environment and participating in it at the same time. Instead of asking, “What’s wrong with the liver?,” the question becomes, “What is the liver being asked to manage right now?”
Because -- thankfully -- the system is adaptable! It responds.
Strength training improves how muscles handle glucose, which lowers pressure on the liver. More muscle mass gives glucose somewhere else to go. Sleep improves how the liver regulates glucose overnight. Circadian rhythm affects how it handles fat, sugar, and detox processes across the day. Fiber helps carry hormone waste out through the gut so less gets recycled. Even a short walk after meals changes blood sugar in a way that reduces liver workload almost immediately. And of course, greatly reducing or eliminating alcohol is a biggie. These days I probably have about 4 drinks a year or less. I'm just not interested and really respect my body more and more, the older I get.
The system is always responding to input.
Some of those inputs can be really simple. Bitters before meals, dandelion root tea, adequate protein, sufficient fiber, blood sugar management, regular bowel movements, and strategic use of certain supplements can all support the pathways involved in digestion, bile flow, and elimination. Castor oil packs are another tool many people find helpful, although the research is still evolving and I tend to view them as supportive rather than foundational. The fundamentals usually move the needle the most.
It's also worth mentioning that more is not always better when it comes to supplements. Over the last several years, liver injury linked to supplements has increased significantly. Sometimes it's contamination, undisclosed ingredients, megadosing, concentrated extracts, or interactions between supplements and medications. The liver is responsible for processing much of what we take in, which is why quality, dosing, and context matter.
When ferritin is elevated, cholesterol markers are shifting, liver enzymes begin trending upward, or imaging shows signs of fatty liver disease, I view those as signals worth investigating rather than ignoring. In more severe cases, ongoing liver injury can progress to fibrosis, cirrhosis, or liver failure. Fortunately, most people are nowhere near that point. More often, what we're looking at are early warning signs and opportunities to reduce the load before bigger problems develop.
Which brings me back to capacity!
The liver has a baseline load every day -- hormones, medications, supplements, alcohol, environmental chemicals, supplements, food additives, and normal metabolic waste.
On top of that baseline, life adds variability. Sleep changes. Stress changes. Food. Movement. Hormones. They change!
What I notice most often when we start to improve liver function is less unpredictability. Less reactivity. More recognizable energy. Predictable digestion. Better skin. And PROGRESS.
“I feel like myself again.”
That's always a great sign.
If this is connecting a few dots, this is the kind of work I go deeper into inside The Metabolic Edge, my group coaching membership where symptoms, metabolism, hormones, digestion, and physiology are all looked at as one connected system alongside workouts, meals, and lifestyle. Enrollment will open briefly on June 30th. Join the waitlist here.
I also take a limited number of 1:1 clients for deeper pattern-based work and custom plans and coaching. Learn more.
I've had a bunch of DMs this week about whether or not I offer 1-time consults. I don't typically advertise that I do, because most people do best in either group or 1:1 coaching. However, I do offer a small number of one-time consults for clarity and direction when someone just needs a map or a lab review with a plan and next steps. If you want more info on that, you can hit "reply" to this email.
Stay wild + well,
Tara
P.S. In case you missed it:
I shared a case study recently on insulin resistance that connects directly into a lot of this physiology.
Not Standard American Way. Not Fearful Crunchy. Somewhere in the middle.
Some birthday thoughts and personal goals here.
P.P.S. What I'm loving lately:
Milk thistle for my liver
Sunrise walks, raw dogged lately -- no music or podcasts. Just me, my many many thoughts, the cute bunnies, and the pretty sky. Magnolia asked if she could wake up extra early to join me on a walk last week, which was so fun! <3
Forest sounds -- add that to the dinner jazz, classical, and spa music playlists for moments when you need some peace. Try it when walking, cooking, as background music, while you eat. Trust me, it's kind of awesome.
Our portable, low EMF sauna -- for SO many benefits, but very appropriate here for liver health as well. Infrared sauna can support liver health by improving insulin sensitivity, circulation, sleep quality, and stress resilience — all of which can reduce the metabolic workload placed on the liver. Think of it less as "detoxing" the liver and more as creating an environment where the liver can do its job more efficiently.
