When you’re plodding the hallway at 2am feeling exhausted and despairing and you know you’ve got a busy day ahead of you, I bet you haven’t given your liver a thought have you? However, you need to. Your liver has its own circadian clock and if your liver is a bit unhealthy (and whose isn’t after 40-50 years of living in a modern society?) then this may be affecting the quality and duration of your sleep.
Whilst you won’t actually know if your liver is ‘unhealthy’ or not until you have liver function tests done, you may have heard of a liver condition called Non-alcoholic fatty liver disease (NAFLD).
This important liver problem is due to the accumulation of excessive fat (known as hepatic steatosis), rather than due to alcohol abuse and scientists studying the data from the National Health and Nutrition Examination Survey in the United States (NHANES), predict that this highly prevalent condition is only going to worsen in coming decades. For women transitioning menopause and about to go into the next phase of their life (their older years), the state of our liver health is an important consideration – especially for those women already post-menopausal and overweight or obese. (Arshad et al, 2019).
I’m not sure if you’ve heard of NAFLD, but there are numerous factors involved in the genesis of it and this is where our past lifestyle as well as our genetics come into play.
As many of you will already know from my previous articles, the liver is the site of toxin clearance, as well as nutrient absorption. It works alongside our lymphatic system and digestive system to keep our immune system functioning well.
I often say to women in my private coaching community (and I discuss this in my Masterclass on Menopause), that because we are the first generation of women to have engaged with decades of changing food production and availability, as well as many of us having been exposed to the increasing prevalence of household chemicals, pesticides and alcohol over our lifetime, and of course, various medications, our poor liver, gut microbiome and lymphatic system has had a lot of work to do over the years.
Hence, it’s no surprise that many of us have arrived in mid-life and our liver, gut and lymphatic system has simply become tired and unhealthy. I was the same. And for women like Linda, who have been trying to exercise off their weight for years, the state of our liver and not sleeping, adds to the menopause and post-menopause weight loss confusion as well as our response to exercise too.
One of the most important medical discoveries of the past two decades has been that the immune system and inflammatory processes are involved in not just a few select disorders, but a wide variety of mental and physical health problems that dominate present-day health problems worldwide. Chronic inflammatory diseases have been recognized as the most significant cause of death in the world today, with more than 50% of all deaths being attributable to inflammation-related diseases such as ischemic heart disease, stroke, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease (NAFLD) and auto-immune and neuro-degenerative conditions (Furman, Campisi et al, 2019).
Like Linda and other women on my programmes, I had no idea that the health of my liver was also affecting my sleep. Why aren’t we told this, when we rock up for our HRT or when we spend endless money on expensive sleep supplements?
The powerful connection between your liver and your sleep:
Your circadian rhythm orchestrates your metabolism in daily 24-hour cycles. Circadian derives from the Latin roots ‘circa’- meaning ‘around’ and ‘diēm’ meaning ‘day’, and like all daily or diurnal rhythms, circadian rhythms are periodic patterns that repeat themselves approximately every 24 hours. Hence, these rhythms organize your metabolism and metabolic processes based on the timing of both feeding and fasting over a 24 hour period. This is how the body controls and increases its metabolic efficiency. (Poggiogale, 2018).
The circadian system comprises a central pacemaker in the brain and a series of clocks in peripheral tissues throughout the body, including liver, muscle, and adipose tissue. When I was pulling together the research for the content of the MyMT™ Transform Me weight loss programme, I became fascinated by our circadian rhythm. Not only is this what the desperation of sleep deprivation did to me, but the more I was studying women’s post-menopause health and ageing, the more I became exposed to studies that frequently mentioned the role of the circadian rhythm and it’s powerful influence on all of our body organs. From our heart, to our liver, muscles, blood vessels, gut, thyroid, adrenals and of course, our pituitary gland, our circadian rhythm imparts significant influence on our health as we age. Our circadian rhythm even influences our fat cells.
Studies in humans report circadian rhythms in glucose, insulin, glucose tolerance, lipid (fat) levels, energy expenditure, and appetite. Several of these rhythms peak in the biological morning or around noon, and this means that eating earlier in the daytime is optimal for food intake. I talk about this in my ‘Sleep All Night’ module in both of the different MyMT™ programmes which you can explore HERE. You will learn all about how menopause hormonal changes affect your circadian rhythm and what to do about it.
Most importantly, if we are going to get on top of our health and our weight, then we must also understand that as we move through menopause there are disruptions in these rhythms. This may lead to impairment of our metabolism and influence the early stages of metabolic diseases that follow us into older age – we just need to look at our mother’s generation to see the result of changing inflammation as women get older.
The emergence of evidence that circadian rhythm misalignment, induced by mis-timed light exposure, sleep, or food and fluid intake (and, I might add, menopause hormonal changes), adversely affects metabolic and liver health in humans is crucial to understanding why you are putting on belly fat and why your liver is implicated in your sleep quality and quantity. (Poggiogale, 2018). And when we don’t sleep properly for nights on end, this means that inflammation levels are increasing in our changing body. This includes the accumulation of inflammation in our liver, which in many women who are putting on weight in menopause, can lead to NAFLD. When we develop liver inflammation, our LDL cholesterol can increase, our joints and muscles can become sore and of course, our hot flushes can worsen as well as our weight.
Whilst inflammation is a well designed evolutionary process which helps to keep our immune system protected from bacteria, viruses, toxins and infections by eliminating pathogens and promoting tissue repair and recovery, it’s the extent of internal and chronic inflammation, which health researchers caution about (Furman, Campisi et al, 2019). It’s this chronic inflammation that I’m talking about here. Chronic inflammation can sit around in our liver for decades and depending on the degree of inflammation and the accumulation of fat in liver ducts, this affects our sleep quality and duration of sleep.
Overnight, our liver is working hard to help organs and tissues repair. But not sleeping due to our mis-aligned circadian clock, means that our liver timing overnight also becomes ‘misaligned’. Hence, nutrients that would generally go towards healing and recovery of our immune system, may not be allocated. Any of you who are awake between 2am and 4am are missing out on this essential co-ordinated task between your liver, lymphatic system and immune system. It’s no wonder that your muscles and joints are aching in menopause if you are an exerciser as well. You aren’t recovering overnight like you used to. That’s why in the MyMT™ programmes, I bring your attention to sleep and not exercise in the first instance. First things first – get the foundations of your health sorted first. Inadequate sleep has been associated with poor health outcomes in women as they age, such as obesity, Type 2 diabetes mellitus, cardiometabolic diseases, as well as to the increased risk and progression of NAFLD (Marin-Alejandre, Abete et al, 2019).
I think we all know that when we don’t sleep well, this also disrupts our eating behaviours. And yes, I’ve gone for the chocolate in the fridge or the cookies in the container, at all hours of the day and evening, simply to re-charge my brain with glucose and to help my energy levels! But herein, lies the weight and NAFLD conundrum too – this turn towards too much glucose (as well as unhealthy fats and processed carbohydrates) may also alter insulin levels. Insulin is the hormone that is secreted by your pancreas in response to blood sugar (glucose) levels.
If blood levels of glucose are erratic, then this can also contribute to worsening liver health – the liver is the site of excess glucose storage along with your muscles. But if you aren’t a regular exerciser and lead a more sedentary life because you are too tired, then herein lies another problem for women in menopause and post-menopause who aren’t sleeping. Your physical activity levels decline too. I also know that feeling which is why I want to share with you, three factors you can put into place right now.
My 3 Lifestyle Factors to Improve your Liver, which in turn will improve your Sleep:
- Apples and Tomatoes – eat them daily. Food-based nutrients have been and continue to be investigated for their role in the modulation of metabolic pathways involved in liver detoxification processes. I talk about these foods in my Liver Lover module as part of both MyMT™ programmes. Several publications to date have leveraged cell, animal, and clinical studies to demonstrate that food-derived components and nutrients can modulate processes of conversion and eventual excretion of toxins from the body and if you missed my article about Lycopene in tomatoes and the role of these compounds on liver health, then you can add it to your reading list HERE.
- Learn to breathe more efficiently. If you think about the location of your liver, it sits underneath the right side of your diaphragm. If you are mainly sedentary, then sitting most of the day may be reducing your liver function. Your liver is replete with lymphatic vessels which help to remove toxins, so improving your breathing, posture and including regular stretching, will also improve your liver health.
- Reduce saturated fats in your diet UNTIL you sort out your liver health – this includes coconut oils, coconut cream and of course, cream and butter products too.
When you are ready to help your liver, which in turn will help your sleep and vice versa, I hope you can join me on either of my 12 week programmes. You can learn more about how they work below.
Arshad, T., Golabi, P., Paik, J., Mishra, A., & Younossi, Z. M. (2018). Prevalence of Nonalcoholic Fatty Liver Disease in the Female Population. Hepatology communications, 3(1), 74–83. https://doi.org/10.1002/hep4.1285
Furman, D., Campisi, J., Verdin, E. et al. (2019). Chronic inflammation in the etiology of disease across the life span. Nat Med 25, 1822–1832. https://doi.org/10.1038/s41591-019-0675-0
Hodges R., & Minich D. (2015). Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application. J Nutr Metab. 760689. doi: 10.1155/2015/760689. Epub 2015 Jun 16. PMID: 26167297; PMCID: PMC4488002.
Koenig G., & Seneff S. (2015). Gamma-Glutamyltransferase: A Predictive Biomarker of Cellular Antioxidant Inadequacy and Disease Risk. Dis Markers. 818570. doi: 10.1155/2015/818570. Epub 2015 Oct 12. PMID: 26543300; PMCID: PMC4620378.
Marin-Alejandre, B. A., Abete, I., Cantero, I., Riezu-Boj, J. I., Milagro, F. I., Monreal, J. I., Elorz, M., Herrero, J. I., Benito-Boillos, A., Quiroga, J., Martinez-Echeverria, A., Uriz-Otano, J. I., Huarte-Muniesa, M. P., Tur, J. A., Martínez, J. A., & Zulet, M. A. (2019). Association between Sleep Disturbances and Liver Status in Obese Subjects with Nonalcoholic Fatty Liver Disease: A Comparison with Healthy Controls. Nutrients, 11(2), 322. https://doi.org/10.3390/nu11020322
Poggiogalle E., Jamshed H., & Peterson C. (2018). Circadian regulation of glucose, lipid, and energy metabolism in humans. Metabolism. Jul;84:11-27. doi: 10.1016/j.metabol.2017.11.017. Epub 2018 Jan 9. PMID: 29195759; PMCID: PMC5995632.