Optimizing Your Microbiome and Liver Health for Better Brain, Liver, and Hormonal Health: Part II


A Review of the Gut-Liver Connection

The connections between our organ systems, and their interplay, are vital for our overall health and vitality. Researchers are currently becoming more aware of these intricate links and the clinical implications of them.

Recently, the the two-way communication with the most attention has been between the gut and its specific organ connections. The gut-brain is one of the most popular links now; however, the bidirectional relationship between the gut and liver and the gut and thyroid are also gaining attention.

This broad appeal of our digestive tract’s interaction with all our other bodily systems has gained momentum since the discovery of our gut microbiome (its collection of microbes and their genes). These organisms have been found to impact all physical processes, including immune function, neurotransmitter production, detoxification and excretion, hormone metabolism, digestion, assimilation, and the synthesis of nutrients.

This has led both conventional and integrative medicine doctors to tout that a healthy digestive tract is paramount to thrive, regulate our mood, and enhance longevity.

Our liver has equally impressive roles, though it is being overshadowed by the gut. It is responsible for regulating over 500 different functions while also interacting with virtually every organ in the body, including our digestive, hormonal, cardiovascular, immune, and detoxification systems.

In fact, when the liver is not functioning optimally, neither is the gut, our brain, our hormones, and ultimately anything else.

Therefore, it’s not enough to just “treat the gut” when there are hormonal, mood, or digestive symptoms. You also need to examine the liver. Furthermore, it one’s gastrointestinal tract, its lining, and/or microbiota are dysfunctional, the liver has no hope of operating at its peak.

In this post and video, I provide insight on how a breakdown in the gut specifically impacts the liver, leads to liver diseases, and ultimately negatively affects the whole body. Thankfully, I’ll also address how to intervene for better gut-liver health using naturopathic and functional medicine approaches.

Topics include:

  • a quick summary of the liver-gut axis from part I
  • microbial imbalances and liver-gut dysfunction
  • liver diseases related to an unhealthy gut-liver axis
  • conventional and functional medicine tests to assess gut-liver health
  • the role of probiotics, nutraceuticals, and lifestyle for a healthy liver-gut relationship

Read on to learn more about how you can optimize your gut-liver link for better brain, hormone, and mind-body balance.

*Note: This post is based on one of my publications within the 10 article series that I wrote for Rupa Health. As usual, it contains some additional information and my clinical experience.

A Review of the Liver-Gut Link

The portal vein (a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas, and spleen to the liver) serves as the two-way connecting link between the gut and the liver. This feedback loop between the gut and liver is called enterohepatic circulation, and it determines the amount of bile acids produced, which are necessary for effective detoxification and digestion of fats.

The gastrointestinal tract (GT) cellular layers need to be intact to optimize this communication. The GT lining forms a permeable barrier that is responsible for filtering compounds that enter portal circulation and our bloodstream. The gut vascular barrier (GVB) is the final barrier of protection in the gut wall and modifies what can and can’t enter the portal vein. If there is any compromise to the GVB, various systemic and liver diseases, and a host of uncomfortable symptoms, can occur.


Microbial Imbalances and Liver Diseases

As noted, the gut microbiota is involved in many processes that affect the liver. Factors such as genetics, diet, alcohol, lifestyle, and medications all impact the microbiome and can positively or negatively alter its composition.

If there are too many negative triggers, an overgrowth of pathogens ensues and a type of dysbiosis, or imbalance in microbes, can result. Dysbiosis can fuel an unwanted series of events and result in a compromised liver-gut axis and immune dysfunction. These include:

  • a breakdown of the intestinal barrier (aka “leaky gut”),
  • leading to inflammation,
  • causing bacterial distribution throughout the body, and
  • modified metabolites being sent to the liver via the gut-liver axis

A further complication of dysbiosis is that it can cause alterations in insulin and blood sugar balance. This also negatively impacts the functioning of the liver-gut axis.

Recent evidence is emerging that certain bacteria populations are associated with liver diseases which may point to the type of dysbiosis. For example, an increase in Lactobacillus and Escherichia and a decrease in Coprococcus has been linked to a type of fatty liver disease.


Liver Diseases from Gut-Liver Dysfunction

Gut-liver dysregulation has been linked to various liver disorders including:

  • metabolic dysfunction-associated fatty liver disease (MAFLD), also known as non-alcoholic fatty liver disease (NAFLD)
  • nonalcoholic steatohepatitis (NASH)
  • primary sclerosing cholangitis (a gallbladder disorder)
  • liver cirrhosis (scarring of the liver)
  • metabolic syndrome
  • weight changes
  • autoimmune hepatitis (an autoimmune disease of the liver)

Conventional Lab Diagnostics for Liver Disease

Labs and imaging can help your doctor to differentiate and diagnose liver diseases and gut-liver dysfunction. A full explanation can be found in the accompanying Rupa Health article.

Below is an overview.


Conventional Blood Tests

  • A Complete Blood Count (CBC) (to assess inflammation and immune status)
  • Liver enzymes and function tests
  • Tests for chronic viral hepatitis
  • Celiac disease screening tests (a dysbiosis and autoimmune dysfunction in the intestine)
  • Fasting glucose, insulin, and hemoglobin A1c
  • Lipid profile


Imaging Procedures

  • Ultrasound
  • CT
  • MRI


Functional Medicine Labs to Assess the Gut-Liver Axis

  • Comprehensive Stool Tests (to assess dysbiosis and fully analyze digestive health and intestinal barrier integrity)
  • A small intestinal bacterial overgrowth (SIBO) test (related to how this type of dysbiosis can lead to “leaky gut”, gut-liver dysfunction, and NAFLD)

Naturopathic and Functional Medicine Support for the Liver-Gut Axis and Liver Health

Dietary patterns, lifestyle, probiotics, and other supplements can be used to promote better gut-liver health.

These can be used in conjunction with the holistic interventions discussed previously to balance the liver-hormone link. These include:

  • decreasing toxic exposures
  • movement
  • being mindful of liver-harming medications
  • drinking coffee
  • sleep
  • stress reduction
  • eating nutrient-dense, plant-powered, and gut-loving fermented foods (e.g., yogurt, kimchi, etc.)
  • specific nutrients and herbs (milk thistle being most evidence-based)
  • various essential oils, which act as antioxidants to protect the liver from cellular stress and inflammation

Below are specific, holistic interventions for when one has missed the preventive stage and has been diagnosed with a liver pathology.


Nutrition: A Mediterranean Diet

Of course, personalizing the diet is always best. That being said, the most researched dietary pattern for improving liver health in those with NALD and NASH is the Mediterranean diet (MD). MD consists of eating a diet rich in olive oil, vegetables, fruits, nuts, legumes, whole grains, fish, and seafood and consuming a lower amount of sugar and red and processed meat.


Lifestyle: Movement and Food Education

Clinical trials have shown that caloric restriction, weight reduction (of 5-10%), and exercise have improved liver markers and health in those with NAFLD.

I hesitate on even reporting this, because one does not know if this was the result of including healthy lifestyle interventions vs. cutting out calories and foods. It’s important for me to at least state this association, however, as it will be touted by experts in the field to promote weight loss.

If one does embark on losing weight for liver health, I feel it is crucial to be mindful of the potential eating-disordered behaviors that can emerge from one rigidly adhering to a dietary pattern. After all, eating disorders are the deadliest mental health disorder, so achieving one benefit in exchange for mental anguish and ultimate death is not a good trade off.

Furthermore, for the majority of people, any weight loss plan eventually ends with weight regain in the long-term. This has very negative implications on psychological and physical health including weight cycling and the harmful effects of weight stigma. Approaching dietary and exercise interventions from a health standpoint, vs. a weight-centric approach, is preferred.

Based on ethics (no one can “guarantee weight loss” with any diet plan), long-term statistics, and diet and healthcare culture fueling disordered eating, I no longer recommend a “diet “or promote weight loss. Rather, I provide education on foods to include for one’s situation, including liver health, promote body acceptance, and advocate for healthy, balanced lifestyle behaviors.



Probiotics have been found to support NAFLD management, likely through several mechanisms. These include how our microbiota population influences intestinal barrier integrity, dysbiosis, inflammation, immune tolerance, and the gut-liver axis.

Several human trials have reported an efficacy in various combinations of probiotics and microbial supplements:

  • One meta-analysis suggested that probiotics improved liver enzymes, hepatic (liver) inflammation, hepatic steatosis (fatty liver), and hepatic fibrosis (hardening of the liver) in those with NAFLD and NASH.
  • Various studies also reported that probiotics, synbiotics (a combination of prebiotics and probiotics), and lifestyle measures improved several liver parameter outcomes.
  • Incorporating a specific high-potency multi-strain probiotic, VSL #3, showed improved lipid parameters, liver function tests, and resolved hepatic steatosis in a trial with subjects with NAFLD.
  • Another study found significant improvement in liver health using a different multi-strain probiotic in NAFLD patients.


Other Nutraceuticals and Supplements

The following nutraceuticals have shown to promote improvements in patients with NAFLD and NASH:

  • Vitamins D and E
  • Carnitine
  • Polyunsaturated fatty acids (PUFAs)
  • Milk thistle
  • Resveratrol and anthocyanins (antioxidants)
  • Betaine

Of all these agents, vitamin E has the most evidence.

It is important to avoid excessive dosage and be aware of nutrient-nutrient interactions with these interventions. For these reasons, self-prescribing is discouraged.

Summary of Promoting Gut-Liver Health and a Healthy Liver

Due to various lifestyle factors, environmental exposures, genetics, and other triggers, detrimental alterations in gut flora, dysbiosis, and increased intestinal permeability can ensue. This leads to inflammatory changes in the liver through the gut-liver connection, resulting in systemic issues and various liver diseases.

Thankfully, liver-loving interventions, nourishing liver foods, probiotics, and specific nutraceuticals can be implemented to support the integrity of the gut-liver axis interface and improve liver health. Using naturopathic and functional medicine modalities, clients can improve their gut-liver axis and overall health.

Now that you understand power that our gut-liver axis has on our wellness, will you take at least one action today to optimize it?

Naturopathic Medicine and Holistic Resources for Hormonal, Mood, and Digestive Support

  • Free resources and more education on essential oils and mind-body wellness are available to you here.
  • An Integrative Mental Health and Stress Resource Guide.
  • Tools for coping with isolation and separation.

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Many blessings.
























See the full article and additional references in the Rupa article here.

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Disclaimer: This material is for information purposes only and is not intended to diagnose, treat, or prescribe for any illness. You should check with your doctor regarding implementing any new strategies into your wellness regime. These statements have not been evaluated by the FDA. (Affiliation link.)

This information is applicable ONLY for therapeutic quality essential oils. This information DOES NOT apply to essential oils that have not been tested for purity and standardized constituents. There is no quality control in the United States, and oils labeled as “100% pure” need only to contain 5% of the actual oil. The rest of the bottle can be filled with fillers and sometimes toxic ingredients that can irritate the skin. The studies are not based solely on a specific brand of an essential oil, unless stated. Please read the full study for more information.

Thanks Pixabay and Canva.