Dr. Kelsy Vick continues the spring cleaning series by focusing on the liver and how alcohol uniquely affects female physiology. She explains that women experience more severe alcohol-associated liver disease at lower levels than men due to differences in first-pass metabolism, estrogen-related sensitivity to liver damage, and immune activation in the liver. Regular drinking can raise estradiol while also making the liver prioritize alcohol over estrogen clearance, potentially contributing to estrogen dominance symptoms like heavy or painful periods, bloating, mood swings, breast tenderness, and sleep disruption; alcohol may also interfere with brain-to-ovary signaling and progesterone production, with evidence strongest for the estrogen effects. She discusses how timing in the luteal phase may increase sensitivity, clarifies that alcohol sedates rather than improves sleep, and recommends practical liver support without “detox” cleanses: cruciferous vegetables, fiber diversity, hydration, and quality sleep.

RESOURCES:

https://www.mayoclinicproceedings.org/article/S0025-6196(20)30926-5/fulltext

https://www.frontiersin.org/journals/gastroenterology/articles/10.3389/fgstr.2022.1005729/full

https://link.springer.com/article/10.1007/s00737-024-01483-9

https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.35391

https://pmc.ncbi.nlm.nih.gov/articles/PMC4729640/

https://pmc.ncbi.nlm.nih.gov/articles/PMC6676690/

https://pmc.ncbi.nlm.nih.gov/articles/PMC8594041/

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Your liver is doing about 500

jobs right now, and filtering

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00:00:04,200 --> 00:00:05,760

alcohol is just one of them.

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00:00:06,090 --> 00:00:10,320

The one most women don't know about

is the more you regularly drink,

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00:00:10,320 --> 00:00:14,010

the more estrogen that circulates,

and the more vulnerable your

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00:00:14,010 --> 00:00:15,660

liver becomes to that next drink.

6

00:00:16,140 --> 00:00:18,900

It's a compounding cycle,

not just a one-off event.

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00:00:19,110 --> 00:00:22,350

Alcohol doesn't just affect how you

feel the morning after like a hangover.

8

00:00:22,650 --> 00:00:26,400

It affects the hormonal environment

of your entire menstrual cycle.

9

00:00:29,546 --> 00:00:33,745

Your liver is doing about 500

jobs right now, and filtering

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00:00:33,745 --> 00:00:35,365

alcohol is just one of them.

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00:00:35,615 --> 00:00:39,126

The one most women don't know

about is clearing your estrogen.

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00:00:39,375 --> 00:00:43,785

And that connection changes how

you should think about everything

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00:00:44,085 --> 00:00:46,185

from your cycle to your skin,

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00:00:46,370 --> 00:00:48,770

to your mood the week before your period.

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00:00:49,070 --> 00:00:50,810

Welcome back to Wellness Books is the Pod.

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00:00:50,810 --> 00:00:51,560

I'm your host, Dr.

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Kelsey Vic, a board certified

orthopedic doctor, physical therapy,

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and a pelvic floor physical therapist.

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00:00:56,460 --> 00:00:59,940

And welcome back to week three

of our spring cleaning series.

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00:00:59,940 --> 00:01:04,845

This April, we are diving into

spring cleaning, but health and

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wellness, brain and body style.

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The first week we covered the lymphatic

system, the system in charge of cleansing,

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cleaning, and your immunity for your body.

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The second week we talked about the

glymphatic system, . That's similar to

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your lymphatic system, but for your brain.

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And this week, because our brains

and sleep are so connected to our

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liver and alcohol, I decided what

better time than to dive into.

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the liver.

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Specifically today is our spring

cleaning series and the liver as it

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relates to our female physiology.

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As a general rule of thumb and an interest

of mine, I like to keep a pulse on.

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All sorts of different aspects on

the wellness industry, including

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some of the more woowoo aspects

of the wellness industry.

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And that's not a knock on the

people who promote more woowoo

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theories and woowoo techniques.

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I really do believe that those people

are sometimes ahead of the game.

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Research can take, five to 10 years

in order to become public knowledge.

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So the people who are talking about.

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All of these seemingly out there, concepts

in health and wellness are probably the

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ones that are influencing the research

and ahead of the game when it comes

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to where science has not caught up yet

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when it comes to what we believe

are certain out there things.

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I think some of these more woowoo

ideologies and the men and women promoting

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them are really at the forefront of what

is going to become the next big thing.

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And with all of this input that

I'm hearing from some of these more

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woowoo out there experts, the liver

is going to be a huge trend that

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we see over the next few years.

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From supplements to education to products,

I think the liver is going to be the next

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sort of switch that we see right now.

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I'd say it's, you know, gut

health and the gut brainin axis.

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We have been hearing so much of

that for definitely the last five

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years, maybe even the last 10.

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Gut health has been huge

and I think the next.

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Iteration of that is going to

be talking about the liver and

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what we can do for our liver.

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As a side note, I have interviewed Dr.

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Felice Chan, who is a traditional Chinese

medicine practitioner, and she talks

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about how the spleen is a very vital organ

in traditional Chinese medicine and one

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that she looks at often in her practice.

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From a western medicine perspective,

the spleen was just sort of.

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Thrown into our education, we

didn't necessarily prioritize that.

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So I'm very interested to see how

wellness culture shifts from what

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we know about the gut-brain access

and gut health to more of these.

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Just thrown in their organs that we

don't talk about nearly as much in

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western medicine education that they

might talk about even more in eastern

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medicine education, specifically

with traditional Chinese medicine.

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So I love seeing that shift and

getting to compare and contrast.

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And I know that there are surgeons

and physicians and western medicine

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practitioners who focus on the spleen

and the liver, But from a general

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standpoint, from a, a general.

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Medical professional education.

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I think the liver and the spleen are

two very slept on organs, which is

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why I wanted to cover the liver today.

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And of course, we can't talk about the

liver without also talking about alcohol.

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But I never want this

episode to sound preachy.

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I said this, I believe last week.

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I drink cocktails, I drink alcohol.

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I'm not coming at this from

a, I'm better than you.

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You should not drink alcohol standpoint.

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It's more of like, here's.

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What your liver does here is how your

female physiology affects the liver.

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Here's how alcohol influences that,

giving you that knowledge, that education,

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00:04:43,900 --> 00:04:47,385

giving me that knowledge and education

to make informed decisions on the

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00:04:47,385 --> 00:04:50,530

actions and behaviors that I choose

to participate in with that knowledge.

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and I think it's just a cool way

for us to learn more about another

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system in our body and our female

hormones that influence that system.

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I.

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So let's dive right in to

the male female perspective,

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specifically looking at alcohol.

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I know many of us have had that

experience where we have one drink and

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00:05:09,232 --> 00:05:13,162

it seems to hit us harder than it does

our male friends or our male partners.

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And it's not necessarily a

tolerance issue or a body weight

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issue, although it could be.

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There's also a biological difference,

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and unfortunately, that

biological difference has real

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implications for how quickly damage

accumulates in our female bodies.

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And this is the part that

can get a little scary.

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Just like we covered last week,

women have a higher risk for

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developing Alzheimer's disease.

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Women also develop more severe cases

of alcohol associated liver disease.

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At lower levels than men.

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so let's look at some of the reasons why

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One of the reasons is

first pass metabolism.

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And you could think of this like

your body's pre-filter of alcohol.

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Before alcohol gets fully absorbed,

the stomach is supposed to take

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care of some of that filtering.

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It is supposed to pre-filter

some of that alcohol, helping us

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to break down a portion of it.

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Women's stomachs in particular

have significantly less of the

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00:06:06,109 --> 00:06:07,654

enzyme that helps to do that.

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So our pre-processing systems are just a

little less active than our male friend

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or our boyfriend or our husband's.

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This means that our livers get

a larger, more concentrated

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load of alcohol to deal with.

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In the process of breaking down that

alcohol produces a very toxic byproduct

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that's actually more damaging to

liver cells than the alcohol itself.

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more alcohol arriving at the liver

because we don't have as much of that

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enzyme that helps us pre-filter the

alcohol in our stomach means that we have

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more of that toxic byproduct produced.

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And over time, that just compounds.

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There's also obviously

hormonal differences in how

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our bodies handle alcohol.

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Research shows that regular alcohol

use of one or more drinks per day

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is associated with elevated

estradiol levels in women.

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estrogen itself, the same

hormone being elevated

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also makes your liver more

sensitive to alcohol related damage.

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So it's twofold.

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The more you regularly drink,

the more estrogen that circulates

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and the more vulnerable your

liver becomes to that next drink.

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It's a compounding cycle,

not just a one-off event.

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There's also differences in liver immune

cell activation between men and women.

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these are called cup for cells,

but they're basically the

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immune cells of your liver.

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Their job is to scan everything

coming from the gut and neutralize

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anything that shouldn't be there.

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Alcohol does two things that

put these cells into overdrive.

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First, alcohol makes

your gut more permeable,

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meaning more bacterial byproducts

leak through the intestinal

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wall and flood the liver.

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Second, and this part is more specific.

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Estrogen makes these immune cells

more sensitive to those byproducts

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so they overreact trigger a

full on inflammatory response,

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and the liver takes collateral

damage in the process.

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And because as we mentioned before,

alcohol raises estrogen, which sensitizes

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these cup for cells, these immune cells of

the liver, which amplifies inflammation.

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It's the same compounding loop.

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Now, none of this means our bodies are

fragile as women, it just means that

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they're different and that they handle

alcohol a little bit differently.

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So we deserve knowledge and action

that is based on some of those

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biological differences and how our

bodies actually handle something

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like wine, beer, or a cocktail.

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the alcohol research that helped

to set the guidelines for alcohol

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consumption was primarily based on men.

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So it's nice to have a little bit

of knowledge on how our bodies are

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different to know how to adjust those

guidelines for our female physiology.

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Now let's dive a little bit deeper

into that hormonal liver connection.

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That connection that not a lot

of people are talking about

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the week before your period.

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When everything feels amplified, your

PMS, your bloating, your emotional

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reactivity, your moodiness, your liver

is actually a part of that story.

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It's responsible for helping to

clear estrogen from your body.

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And alcohol makes that job way

harder in ways that can actually

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show up in your menstrual cycle.

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Alcohol doesn't just affect how you

feel the morning after like a hangover.

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It affects the hormonal environment

of your entire menstrual cycle.

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The severity of PMS, the

regularity of your ovulation

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and the downstream effects on things

like your skin, your mood, and that

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second half of your menstrual cycle.

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So how does this work?

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One of the functions of the

liver is to clear estrogen.

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However, when alcohol is present,

the liver prioritizes alcohol.

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It sees it as more of a foreign invader

or a toxic compound that needs to be

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taken care of over estrogen, so it

prioritizes the metabolism of alcohol

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over that clearance of estrogen.

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Alcohol also increases the

levels of estrogen in our body.

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By stimulating the enzyme that converts

androgens like testosterone to estrogen.

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So not only does alcohol increase

estrogen, but it also deprioritizes the

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clearance of estrogen in the liver because

the liver now favors alcohol clearance

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and alcohol metabolism Over one of its

normal functions of clearing estrogen.

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So how might this present

within our bodies?

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As we've talked about before, our

menstrual cycles are cyclical.

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It is this.

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Rhythmic fluctuation and dance

between the different hormones

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within our bodies, going from high

hormone phases to low hormone phases.

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It is this song and dance throughout

our 28 day plus or minus menstrual

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cycle When this dance becomes out

of whack, we can start to experience

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menstrual cycle related challenges.

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So when the estrogen progesterone balance

starts to shift more towards estrogen

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dominance, we can start to experience

things like heavy and painful periods,

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bloating, fluid retention, mood swings.

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irritability, breast tenderness,

and sleep disturbance.

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Okay.

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And the liver is only part of the story.

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Alcohol also affects us a little

more centrally in our hormonal

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control center of the brain.

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Our brain sends signals to our

ovaries to release certain hormones

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at certain times of the month.

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Based on that delicate balance,

that delicate dance and those

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hormone fluctuations that happen

throughout our menstrual cycle,

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alcohol interferes with that signal.

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which primarily affects the

amount of progesterone produced

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in the second half of our cycle.

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which brings us back to that estrogen

and progesterone balance, where alcohol

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is not only amplifying the amount of

estrogen we have in our bodies, but

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it's also decreasing the amount of

progesterone we have in our bodies,

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00:11:34,571 --> 00:11:38,681

which only further pushes us a little

bit more towards that estrogen dominance.

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We end up with too much estrogen

circulating because the liver is backed

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up because it's prioritizing alcohol

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and not enough progesterone being

produced because the hormonal signaling

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was disrupted from our hormonal control

center in our brain due to that alcohol.

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the estrogen piece of this puzzle

is well supported in human research.

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The progesterone and hormonal

control center in the brain

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00:12:02,025 --> 00:12:06,015

axis is more mechanistic and

confirmed with animal studies.

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00:12:06,265 --> 00:12:07,406

The biology makes sense.

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00:12:07,406 --> 00:12:11,875

The animal data is consistent, so

it's not a reason to disregard.

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00:12:12,125 --> 00:12:15,815

That mechanism in how alcohol

works in our female bodies.

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00:12:16,065 --> 00:12:20,415

But it is a reason to say maybe that the

research suggests rather than the research

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00:12:20,415 --> 00:12:21,855

actually proves this is happening.

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Here's something else I found

fascinating about alcohol.

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Our hormones as women, and when we

drink alcohol during the different

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phases of our menstrual cycle,

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the timing of when you drink

alcohol during your menstrual

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cycle actually matters.

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Research suggests the luteal phase

or that second half of your cycle

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is when our overall hormonal environment,

that song and Nance, between estrogen,

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progesterone is more sensitive

to alcohol's effects on estrogen.

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this is also when most women

might report drinking your blood

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sugar's a little outta whack.

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You might have more cravings.

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You might have PMS symptoms where

you turn to alcohol to help.

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So the timing of it all just compounds.

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You might be more likely to drink

during the phase of your cycle

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where the effects of alcohol

intensify on your hormonal system.

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This research is still developing.

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It's not perfectly consistent, But I

thought it was an interesting point

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to bring up as something we might be

finding in the future when it comes to

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when doctors, physicians, dieticians,

and fueling professionals actually

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educate us more on the effects

of alcohol on the female body.

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And I wanna reiterate,

this is not about fear.

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This is more just about information

and sharing research and science

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with you so that you have an idea of

why you might be feeling a certain

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way and being able to link it back.

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Oh yeah, that's right.

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I went to happy hour with my friends

a little while back, so this might

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be why I'm feeling a little bit more.

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Out of whack at this certain

time in my menstrual cycle.

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we've done a lot of episodes on

the importance of friendship and

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community and the overall importance

of friendship and community on

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our lifelong health and happiness.

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And it is actually the number

one predictor of your health

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and happiness long term Is the

quality of your relationship.

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So I know I mentioned Happy Hour and it

does relate to alcohol, but Happy Hour

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is also a way to enjoy time with friends.

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So I always try and approach some of

this education and information with a

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good amount of balance and real life,

but I wanted to throw that in there

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because I do feel like this can be.

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One of those things that people

take too far to the extreme.

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And it's something that I have

taken too far to the extreme where

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I saw the effects of alcohol on my

physiology and I would cancel any

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sort of alcohol related plans or plans

surrounding alcohol because of the

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results it would have on my physiology.

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And you can totally do that.

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But for me it was less of a balanced

mindset and more of a restrictive mindset.

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So I found that if I can.

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Approach alcohol and cocktails

in a community aspect.

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I feel better about it because

I know that this is a way that I

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can spend time with my friends.

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This is a way that I can use food and

drink to gather around a table, build

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community, build quality friendships,

versus it being something that I have

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to restrict because my female physiology

and my heart rate and all of that is

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going to freak out after one drink.

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So this education just helps me to be

more mindful of when I do drink versus

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when I don't, and actually be able to

make a choice that when I do have a

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cocktail, I know how it's affecting

my body and I'm still okay with that

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risk benefit ratio, knowing that I will

be able to build community and have,

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have fun at a happy hour with

friends, even though it is.

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Incorporating alcohol in some way.

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I can still feel good about that overall

activity without feeling so guilty

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and ashamed that I'm having alcohol.

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But it's definitely a constant

work in progress for me.

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Another component of alcohol that we've

heard is that alcohol can help you sleep.

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Wind down.

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To wind it down is a very common phrase,

and I feel like a lot of the time on

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planes, especially a lot of people will

drink alcohol or take a sleeping pill

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to help them crash out on the flight.

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Although it's technically true that

alcohol can help you get to sleep,

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it doesn't necessarily help the

quality of sleep that you have, and

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it actually can worsen the quality

of sleep that you're getting.

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It also might be why you're waking

up at 3:00 AM after having a

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few classes, Even if you don't

remember having trouble sleeping.

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So alcohol primarily affects rapid eye

movement sleep, or REM sleep And REM

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sleep is where our brain is working

on emotional memory consolidation, the

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regulation of cortisol for the next day.

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A lot of the integration of

some of the things that we've

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learned throughout the day.

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There's a lot that happens in REM sleep.

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Alcohol also disrupts slow wave sleep

in the second half of the night.

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Which, as we talked about last week,

is when the brain's glymphatic system,

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or its primary waste management and

cleansing system is primarily active.

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So if you listen to our glymphatic

episode last week, you know

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exactly why this matters.

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The people that get the best quality

of deep sleep have some of the best

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clearance of some of the markers

associated with Alzheimer's disease.

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So this deep sleep phase is

super important and alcohol

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affects that in a negative way.

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So alcohol as a sleep aid is one of the

more pervasive, I guess, wellness trends

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out there, but it is also one of the

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trends that has a lot of

misinformation around it.

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Okay, alcohol produces sedation,

not restorative sleep, and

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there's a meaningful biological

difference between those two things.

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So even one to two drinks a few

hours before bedtime meaningfully

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changes your sleep architecture.

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In ways that affect your next

day's mood, cognition, and energy.

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Even if you don't consciously register

that you had a bad night's sleep, I.

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So how can we actually support

our liver, whether it's related

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to alcohol or our hormones?

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What can we actually do with what I am

hypothesizing is the next big organ that

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a lot of people and supplement companies

and products will be targeted towards.

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Your liver should be doing its

job continuously and effectively

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and doesn't necessarily need any

of these liver detox protocols.

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If

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We can optimize the function of

our liver and what we're actually

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requiring the liver to clear out

our livers should be perfectly fine.

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There are evidence-based things we

can do to support our liver that

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don't include a $120 liver cleanse.

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Our job is to continuously support

the function of the liver of

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24 hour cleansing all the time.

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It does cleanse 24 hours a day.

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We don't necessarily need to

be giving it anything else

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that can help that cleansing.

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Our job is to support the process that

it's already doing and try to reduce what

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could possibly be burdening it, Not to

periodically shock it into a performance

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that it's already doing on its own.

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And hint a lot of these recommendations

and ways that we can support

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our liver cost almost nothing.

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Number one, cruciferous vegetables,

so things like broccoli, cauliflower,

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Brussels sprouts, kale, all

support, liver detoxification.

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In women specifically, it was found

that these cruciferous vegetables.

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Are associated with lower

pro-inflammatory markers, but overall

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fiber diversity is super important.

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Getting a lot of different.

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Food sources that have fiber as

a component is super important.

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the two other things you can do to

help support the liver are adequate

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hydration, and of course sleep quality.

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So the concept of liver cleansing

or liver detoxification through

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00:19:34,147 --> 00:19:38,297

a supplement stack or a juice

cleanse is not a clinical category.

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The liver detoxes

continuously 24 hours a day.

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We just need to be able to do the things

that support it and reduce the things

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that we're eating or the behaviors that

we're doing that might be burdening it.

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So I hope you enjoyed this

episode on the liver Alcohol, our

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hormones, our female physiology.

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I feel like it's a fun

take to look at this.

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Oregon that not a lot of people talk

about, but I really do hear about it a

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lot from some of the more woowoo wellness

and health educators and influencers

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00:20:06,427 --> 00:20:11,497

and business owners that I hear on

different podcasts or substack articles

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00:20:11,932 --> 00:20:18,042

but they all seem to think the liver

will be the next thing that we all start

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00:20:18,042 --> 00:20:20,352

to care about, just like we all are.

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Becoming more and more aware of our

gut health and the gut brain access,

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and all of the things that current

supplements and culture are promoting

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in the wellness industry.

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So thank you for listening.

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I hope you enjoyed this episode, and

I'll see you guys next week As we

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talk about spring cleaning, the system

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that is in charge of why you

pick up your phone, out of habit

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00:20:42,312 --> 00:20:45,077

and just start scrolling without

actually realizing you're doing it.

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So I'll see you next week on Wellness Fix.

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Is the pod okay?