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. 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 post-menopause 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).
There are numerous factors involved in the genesis of NAFLD 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, 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.
What we have to realise, is that if the liver, gut and lymphatic system are unhealthy as we move through menopause, then this impacts sleep … and we all know that lack of sleep impacts mental health.
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 Mel, who are regular exercisers, the state of the liver and not sleeping, can add to menopause and post-menopause mental health changes 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 many of the women on the MyMT™ programmes, I had no idea that the health of my liver was also affecting my sleep. And the lack of sleep was affecting my mental health. Why aren’t we told this, 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 both the liver and the circadian rhythm.
Studying women’s health and ageing led me towards better understanding that the circadian rhythm has a powerful influence on all of our body organs. From our heart, to our liver, muscles, blood vessels, gut, thyroid, adrenals and of course, our brain, the circadian rhythm imparts significant influence on our health, including mental health, as we age. Our circadian rhythm even influences fat cells, including those in the liver.
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, your liver health and your mental health, and of course, the lifestyle steps to take to improve the health of these organs.
As we move through menopause there are disruptions in these daily 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, liver and mental 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 your mental health. (Poggiogale, 2018).
Sleep quality influences inflammation.
This includes the accumulation of inflammation in our liver, which in many women who are putting on weight in menopause, can lead to NAFLD, which in turn may result in changing mental health and increased anxiety (Choi et al, 2021).
If we develop liver inflammation during menopause, LDL-cholesterol can also increase, joints and muscles may become sore and of course, 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. If you are awake between 2am and 4am are missing out on this essential coordinated 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.
Inadequate sleep has been associated with poor health outcomes in women as they age, such as obesity, Type 2 diabetes mellitus, cardiometabolic diseases, depression and 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.
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. So, 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.
That’s why I have 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, which in turn will help your mental health and vice versa, I hope you can join me on either of my 12 week programmes.
There is never a better time to start, but if you are hesitating, then I recommend you complete the MyMT™ Symptoms Quiz, watch the MyMT™ Masterclass on Menopause, go to the Testimonials and Success Stories on the MyMT™ website and find someone like you to read their story.
MyMT™ 12 week programs are normally available for NZ$299 each, but please do check out the MyMT website or subscribe to our newsletter to be alerted to any promotional offers.
Alternatively, as a starting point for you, you can purchase my online Masterclass on Menopause. This is only NZ$15 (approx. AUS$14 or UK£7.5). I hope you can join me in this powerful 2 hour webinar. The great news is that now you can watch it anytime, anywhere and even ‘pause’ it whenever you like. You also have access for 3 months.
Dr Wendy Sweet, Ph.D/ MyMT™ Founder/ Member: Australasian Society of Lifestyle Medicine.
References:
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.
Marjot T, Ray DW, Williams FR, Tomlinson JW, Armstrong MJ. Sleep and liver disease: a bidirectional relationship. Lancet Gastroenterol Hepatol. 2021 Oct;6(10):850-863.
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.
Related Tag: Sleeping Menopause
