Barbell Shrugged - Physiology Friday: [Liver Health] Verified Assessment, Optimization + Protocol Design

Episode Date: February 14, 2025

In today's episode of Barbell Shrugged the team digs into liver health, biomarkers, and optimization. The liver is a remarkable organ that performs numerous essential functions necessary for our overall well-being. Maintaining a healthy liver is vital, and understanding the role of biomarkers and optimization can help us achieve that goal. Our lifestyle choices significantly impact liver health. Unhealthy habits such as a processed food-heavy diet, excessive alcohol consumption, sedentary behavior, and chronic stress can damage the liver. On the other hand, adopting a healthy lifestyle with a balanced diet, regular exercise, stress management, and moderate alcohol consumption promotes optimal liver function. Biomarkers play a crucial role in assessing liver health. These measurable indicators, including liver enzymes like ALT and AST, bilirubin levels, and imaging techniques like ultrasound and MRI, provide valuable insights into liver function and overall health. By monitoring these biomarkers, healthcare professionals can identify inflammation, damage, and diseases such as fatty liver disease or viral hepatitis at an early stage, enabling timely intervention and prevention of further damage. Diet is a key factor in optimizing liver health. A nutrient-rich diet low in processed foods, added sugars, and unhealthy fats supports liver function. Foods such as leafy greens, cruciferous vegetables, fruits, whole grains, lean proteins, and healthy fats like avocados and olive oil provide necessary nutrients and antioxidants for the liver's detoxification processes. Supplements and herbs can also aid liver health. Milk thistle, containing silymarin with antioxidant and anti-inflammatory properties, has been used for centuries for its hepatoprotective effects. Other supplements like N-acetylcysteine (NAC) and turmeric have shown potential benefits in supporting liver health. It's important to consult with a healthcare professional before starting any new regimen to ensure personalized guidance. Alcohol consumption significantly impacts liver health. Excessive and chronic alcohol consumption leads to inflammation, fatty liver disease, and cirrhosis. Practicing responsible drinking by limiting alcohol intake and incorporating alcohol-free days is crucial for liver protection. Mental well-being is intertwined with liver health. Chronic stress and poor mental health can affect liver function. Implementing stress management techniques such as meditation, exercise, and seeking support from loved ones or professionals can reduce stress levels and support liver health. In conclusion, optimizing liver health through lifestyle modifications, biomarker monitoring, dietary adjustments, responsible alcohol consumption, and stress management is essential for overall well-being. Prioritizing a healthy lifestyle and seeking professional guidance can make a significant difference in supporting the liver's vital functions. Remember, a healthy liver leads to a healthier life. Anders Varner on Instagram Doug Larson on Instagram Travis Mash on Instagram Dan Garner on Instagram

Shrug family this week on Barbell Shrug Physiology Fridays back. Dan Garner is on the microphone today and we're going to be talking about liver health, what you can be looking for in your blood work and protocols to make your liver enzymes healthier. As always friends, make sure you get over to rtalab.com. That is the signature program inside Rapid Health Optimization where you can learn about all things lab testing, analysis, program design, and how we can go execute and make you healthier and performing better than you ever have in your entire life. And you can access all of that over at aretelab.com. That's A-R-E-T-E-L-A-B.com, aretelab.com. Friends, let's get into the show. Welcome to Marvel Shrugged. I andrew varner doug larson dan garner back on the podcast today bro

how are you feeling after getting skeletal and then getting super jacked and then taking 437 pictures of yourself and putting them on the internet i feel great man that's like that's a good that's a good cruise to go through dude you were you did have kind of a wild year like you went from from you did marathon bench 405, and did a bodybuilding show, you know, internal bodybuilding competition, a challenge we'll call it. You didn't actually go on stage, but you did it for yourself and, and for the team here, that's a, that's a lot of gangster goals in one year. You hit all into the spectrum, endurance, full strength and physique. Yeah. Yeah. I, I appreciate that, man. It was, uh, I knocked all those out in one year. Yeah, yeah, I appreciate that, man. It was I knocked all those out in one year.

And for a lot of reasons, I think that it's important to walk the walk as a coach, I absolutely see it as a part of my job description to do wild shit. I think that if I'm going to take on pro athletes, and I'm going to take on executives with big goals, then I should put myself in similar uncomfortable situations and knock out different ends of the spectrum. Because a lot of people come to us here at rapid with bucket list stuff hey man i want to run a marathon hey i want to get my bench like these are actually pretty common things people want to knock out so i want to be a leading from the front in that perspective and i also kind of in a big way you know father time is undefeated and there's actually going to be a certain point in our life where I can't set these

goals. And that kind of scares me. It won't even be up to me. Like at a certain, when you're hit a certain age, you're not going to press 405. You know, that's just something that's not going to happen. So I actually kind of see it as almost like a type of desperation. There's a type of urgency to knock out all these crazy things while i still can and um and really just kind of continue to keep getting better and better and better so yeah man it's been a hell of a year but it's been a lot of fun yeah dude the uh the 405 bench press and the the big squat numbers that i think you're going to be chasing here to be able to mentally and physically stay in it because you i'm not saying 40 is like the end of anything,

but mentally I don't have those. Uh, I have lost the desire to try to back squat 400 plus pounds anymore. Yeah. I've been 40 for three days and I think, uh, my back squat has gone down 50 pounds in three days. I don't feel like I used to,

I don't feel like I used to last week. I been 40 for three days my back squat's down my posture is hunched over my libido is down i just i kind of just shuffle through the house grumpily you know how you know you know like dad noises when you get off the couch and just that's right i was not gonna get off the couch that's when i sit down onto the couch that's how you know you're getting old is when you make noises by going down. You sit down, you go, can you sit down? That's a real dad noise. Yeah, man.

So I think it's important to set big goals. Get that set and the things that I've got a couple of big goals that I'm after right now that I want to hit before December. I just think it's important to stay fired up. And the only way for me personally, I'm just speaking from experience, for me to stay personally fired up is to do shit I haven't done before. I get leaner than ever or bench the 405, run a marathon. These things are all firsts for me.

So I'm always just kind of chasing that thing that I've never done before. And I'm going to do it again. Love it, dude. Today, we're going to be talking about the liver and I'd love to just start at the highest level of what is the liver's role when it comes to overall health, well-being, and then really the optimization side, which we'll be digging into with biomarkers and just understanding how this plays into really peak health. Yeah, what is what is what is what is the liver's responsibility? Man, the liver's responsibility is so many things like the liver is one of those things that if you're as dorky as me,

like this stuff can get you so fired up. I'm serious, man, the liver, like, there's a I deem certain organs is underrated. That's how much of a nerd i am not enough people are talking about the golgi tendon organ you know stuff like that i hope when you're like at a party someone like brings up the liver and says something that's like 65 true and you're just like don't say it dan don't say it don't and then you can't help yourself well i won't be able to help myself because like people could be over there talking about like the super bowl and i'll be like y'all let's talk about something else i hear an incorrect fact about the liver over there and i'm all over that guy let's go let's go let's go talk about an organ but um i think this is actually so like the liver

oh man it's it's three to four pounds in weight it's about the size of half of a football and we would die if we didn't have it. It's absolutely critical. It's not like, you know, you can lose a kidney or you can lose an appendix. Like there are some things that we can kind of go without. You cannot go without your liver. It does so many cool things. It's a manufacturing facility.

It is a processing facility. It is a storing facility. Like it does so many cool things. Like from a storage perspective, a lot of people know that it stores glycogen, right? Liver holds onto some glycogen and it releases it in times of lower blood sugar, but it also stores fat soluble vitamins and keeps them on an as needed basis. So you're storing vitamins A, D, E, and K in the liver, and then you can release them on an as needed basis when the body needs them. The liver can also store up to 10% of your body's blood at any given time. So it's a warehouse

storing a lot of things. From a manufacturing perspective, it produces so much like it's producing structural components, it's also producing chemical components, like your liver is producing transporter proteins, like albumin. We've discussed on this podcast a bunch because of its importance in blood chemistry. But your liver is also making cortisol binding globulin. It's making sex hormone binding globulin. Your liver is making hormones. It's making IGF-1 in order to get us jacked after the gross hormone pulse at night. It's making angiotensinogen in order to regulate our blood pressure for the people out there looking after their health. The liver is converting inactive vitamin D into active

vitamin D. The liver is what's actually synthesizing our cholesterol. The liver makes cholesterol every single day and we use cholesterol to make hormones. The liver makes bile. Bile is very important for detoxification and for acting as an antimicrobial component to ensure we don't get pathogens coming in from our food. It breaks down our fats. So, I mean, that covers the warehouse and the manufacturing component. But from a processing perspective, the liver is also a processing plant. Like it filters our blood. The kidneys typically get a lot of the fame for filtering and cleaning the blood. The liver absolutely also cleans the blood. There's a reason why it can store 10% of our blood at any given time. It is a cleaning facility all by

itself. And then from a processing perspective, I'm sure a lot of the audience would predict me saying that the liver is a massive detoxification organ. So it's processing a lot of things in terms of metals, environmental pollutants, our own hormones, a lot of that stuff. So between it being a warehouse, a processing plant, a manufacturing facility, we need it or else we would die. And there's actually a really cool study done in 1931 where the scientists and scientists can do some fucked up shit sometimes but the scientists actually they cut two-thirds of a rats or a group of rats and cut two-thirds of their liver off by the end of the next week they had their full liver weight back again the liver is like a zombie it actually regenerates it's super super cool Like you wouldn't think of any organ or limb

or anything actually regenerating. The liver regenerates. It is very, very, very difficult in order to truly damage your liver. And that's why people can be on medications for decades and the liver can just keep on processing. You can be an alcoholic for 10 years before you actually get liver cirrhosis. Like the liver is unbelievably tough and unbelievably regenerative. So I think that's probably a good overview on how important this thing is and all the different roles it's involved in. Is that mostly because it's just so incredibly vascular? It's very vascular and its ability to hypertrophy its own cells is massive. So it's actually, it's not producing brand new cells.

It's actually hypertrophying current cells in order to get back to its current weight. So super, super, super cool stuff. How would people know if their liver is working optimally? Dr. Andy Galpin here. As a listener of the show, you've probably heard us talking about the RTA program, which we're all incredibly proud of. It's a culmination of everything Dan Garner and

I have learned over more than two decades of working with some of the world's most elite performers, award-winning athletes, billionaires, musicians, executives, and frankly, anyone who just wanted to be at their absolute best. RTA is not a normal coaching program. It's not just macros and a workout plan. It's not physique transformation and pre and post pictures. Arte is something completely different. Arte is incredibly comprehensive and designed, each with their own special expertise to maximize precision, accuracy, and effectiveness of your analysis and optimization plan. Arate isn't about treating symptoms or quick fixes. It's about unlocking your full potential and looking, feeling, and performing at your absolute best, physically and mentally, when the stakes are the highest. To learn more, visit aretelab.com. That's A-R-E-T-E lab.com. Now, back to the show. There's a lot of symptoms, man. So the reason why I laugh, it's a good question.

Yeah. So one of the symptoms of your liver not working properly is unexplainable anger. And I was like was like oh my liver is gone hold on a second everybody everybody just peeked their head up like oh um yeah but maybe it's this anger thing i have every every night my liver acts up right around bedtime every time i put my kids to bed my liver acts up weird dude every single time i'm on the road and i got to make a left turn, my liver is just absolutely irritated. But yeah, the symptoms of somebody's liver not working properly, oh, you can absolutely have hormone imbalances. So then those symptoms can go a long way. So that's typically, you know,

a lot of people are looking directly at hormone levels for symptoms. But you know, something I've said a lot on this podcast before is the symptom is never the problem. The symptom is only ever the result of the problem. Yeah. So if we've got symptoms in the hormonal world, be it erectile dysfunction, maybe low libido, maybe difficulties with fat loss and muscle gain. If you have mood disturbances, these things can all actually be trailed back to liver. So that's a big one. The unexplainable anger.

That's not a big one. That's just a funny one that I remember actually from fatty liver research specifically. And another big one, if your liver is not functioning normally, you're typically going to have a tough time with digestion. You're going to have a tough time with bloating specifically in response to fatty foods. So the liver, it manufactures this thing called bile. And then it puts this bile in this little bile warehouse that's right connected to the liver called the gallbladder. And then that bile is supposed to be secreted into the small intestine when we consume fatty foods in order to, it's called emulsification, in order to emulsify that fat into fatty acids so that we can take it

up into the lymphatic system and properly absorb these things. But if we don't actually make bile or there's a problem with bile flow, then that fat will sit in our gut and will remain undigested. And that undergoes a process called rancidification. So your fats go rancid if they don't actually get eaten or rather broken down properly by bile. And this happens to all the macronutrients. If protein gets eaten by bacteria, it putrefies. Protein was supposed to be broken down by enzymes and hydrochloric acid.

But if we have hypochlorhydria or an inability to activate certain important protein enzymes, then that protein will be eaten by bacteria and it putrefies. Carbohydrates, they ferment. In the context of this conversation, fats, they go rancid. So then you'll see, and it makes me think about the liver, if somebody has, say, whole eggs, something that's super healthy, really good for us, but it constantly bloats them and distends them. If a steak bloats them and distends them, like some people say, red beet just kind of slows me down. It digests slow. That's probably a liver thing. That's not steak.

There are millions and billions of people who digest steak just fine on a regular basis. Chicken thigh is the same thing. And something I picked up across my career is you'll come across people who talk about the fish oil burps. That's a liver issue. That's a liver issue. You don't just have fish oil burps. That's a malfunction in the digestive tract like it's weird to me when you take a step back and if you'd like imagine you were an alien so you have no bias whatsoever and you're like these people have

just associated a severe digestive symptom with just like this thing they just they called it fish oil burps so now it's just accepted that doesn't really make any sense and i've actually identified that across my career as um a bile issue and that's we should probably be looking into the liver and supporting it yeah when you said uh how connected the liver and the gallbladder are what happens when people have their gallbladder removed? How does that affect the liver's ability to do its job? It does. Yeah. So the liver is still able to make bile and it's still able to secrete the bile, but not nearly at the same level. So I actually do recommend supplementing with ox bile for those populations. So if you don't have a gallbladder, in the same way, like if somebody wants to supplement with enzymes, they're replacing a pancreatic secretion issue. If they want to supplement with hydrochloric acid,

they're replacing an inability of the T cells within the stomach to secrete hydrochloric acid. But for like a lot of times people just get their gallbladder removed and they forget that that housed bile and bile is super critical for many, many things. And in the same way that you would supplement with enzymes or hydrochloric acid, you should be supplementing with bile in fat containing meals. So if somebody had their gallbladder removed, I would put in bile with fat containing meals for a couple of reasons. I mean, first off, bile is what's going to emulsify those fats into fatty acids so we can uptake them, right?

That one's kind of like pretty straightforward. But a lot of people forget that bile is what actually allows the catalyzation to take place of pancreatic enzymes. So when you eat a food with, say, just a normal square meal, right, that meal is going to go from mouth, esophagus to stomach, and then ultimately is going to enter the first section of the intestines, which is the duodenum. You're going to get that food. It's going to enter the duodenum. The duodenum, it's going to get a secretion of enzymes from the pancreas over here. And then it's supposed to get droplets of bile from the gallbladder on the other side.

And then when the bile comes into contact with the enzymes, it allows those enzymes to catalyze, become active, and properly break that meal down. But if we have a poor secretion of bile or no bile, then the pancreas can't just activate its own enzymes. Hydrochloric acid and a low pH value of the food has been demonstrated to increase the catalyzation of enzymes. So acid does play its own role here, but bile activates enzymes, bile emulsifies fats, and bile is also what's supposed to regulate the pH of that food. So it's actually what restores some more alkalinity to the food once it's entered the duodenum so that it's not at the same pH level as the stomach. So yeah, dude, if you haven't been given any instructions post gallbladder removal surgery, I'm a big fan

of incorporating about 500 milligrams of ox bile with fatty containing meals and probably going on a slightly lower fat diet. Yeah. I actually talked to a decent number of people that have had their gallbladder removed coming into the program, which is really cool. I don't know how many actual people are in there, but I hear a decent amount. I didn't know that it was like such a common thing. Dr. Justin Marchegiani It's super common. It's actually kind of common because of the recommendations that were provided to us, say across the, say from the Ancel Keys days in the later 50s, early 60s, where I said fat is what's going to kill you. So

a lot of people said carb dominant diets and And basically, 90% of our diets were cereal. And we were told that that was the healthy and good way to go. If you have a very, very low fat diet, then your gallbladder has very little reason to stimulate bile flow. And if it has no reason to stimulate bile flow and secrete bile into the small intestine, well, then bile becomes stagnant and creates gallstones. Those gallstones build up in your gallbladder. All of a sudden you need it removed. So I'm actually not a fan of going super low fat in diets, unless you've had your gallbladder already

removed, then it makes a little bit more sense, but it's pretty common actually in bodybuilding right now to go hyper, hyper low fat. Um, and it's basically done for the purpose of maximizing insulin. Like it's like, if you have, in terms of say training specificity, if you want to get better at the squat, you just need to squat, right? In terms of dietary specificity, a lot of bodybuilders approach the off season,

anabolism, anti-catabolism. That's the only thing that matters in my life is over the fractional synthetic rate beating the fractional breakdown rate beating the fractional breakdown rate of my skeletal muscle tissue. But if you zoom out and take a little bit of a bigger picture view, the avoidance of needing gastrointestinal surgery in the long run is going to be beneficial for your anabolism and anti-catabolism, not to mention the bile does activate enzymes. The bile is antimicrobial. The bile does regulate pH.

The bile actually plays a role in how effective the thyroid is as well. So like there are many things in this department as to why you would want to incorporate some fats in the diet. They'll generally go really low fat because they figure the more insulin I can produce, the more anabolic and anti-catabolic I am. And I don't need fats because fats typically increase testosterone in natural individuals. But if I inject my hormones, then I don't really need those fats and I can get away with it because I'm getting synthetic versions of those hormones. So it's generally the rationalization made there. But I absolutely think that in the big picture, it loses its efficacy in the long run. And even in bodybuilders, I recommend at least 25% of your daily caloric intake coming in the form of fats.

You mentioned earlier, fatty liver disease, how does that what what is fatty liver disease? And then how does that kind of play into probably like the downrange effects of obesity, probably getting into some sort of like diabetes type things. What is the relationship between fatty liver disease and some of these more common, really nasty problems? Well, I'm glad that you said more common because fatty liver is so common. It's crazy, you guys. Like there's calculators that you can use online. Like you can do fibrosis score. You can do the fatty liver index. You can do the NAFLD calculator.

These are predictive values that don't just look at one marker because there's no one marker for fatty liver. It's a relationship of several markers that predicts fatty liver. And you can actually have normal AST and ALT, which are typically representative of liver health. You can have normal AST and ALT and have fatty liver, and you can actually have normal AST and ALT, which are typically representative of liver health, you can have normal AST and ALT and have fatty liver. So this is this has already been demonstrated in the research. So it is the relationship with the pattern between markers that is predictive of fatty liver. And holy crap, when you start doing that calculation on all the blood work, like say that comes my way, you have no idea how common it is.

No idea. It's so, so, so common. But then you start to dig into it and then you start to realize why it's so common. One of the biggest things that causes fatty liver is insulin resistance. One of the largest problems in America is insulin resistance. So you start to see those, the similar patterns actually present themselves. So when you're looking at a lab and you start to see, okay, there's elevated cholesterol here, there's elevated AST and ALT, and there's elevated GGT and there's elevated glucose,

fatty liver. That's like the boom, boom. That's like the, that is absolutely 100. You have the elevated glucose because you're insulin resistant. You have the elevated AST, ALT and GGT because your liver is under distress and you have the elevated glucose because you're insulin resistant you have the elevated ase alt and ggt because your liver is under distress and you have high levels of cholesterol because that cholesterol is not being processed through the liver properly and secreted through the bioflow so you have this relationship that is absolutely representative of fatty liver and then that

actually sends you down a pathway of things that you really don't want to be connected to because then fatty liver creates more insulin resistance and insulin resistance creates a worse high fatty liver so you end up in this cycle that puts you down a pathway of things that fatty liver has been connected to early cognitive impairment fatty liver actually inhibits phase two detoxification so your ability to deal with things like environmental pollutants or clear hormones out of your body. Both those things are inhibited. Typically, when you say phase two detox, people think environmental pollutants, and it is true.

But we do need to metabolize our own hormones as well. And those go through the same phasic processes that occur in the liver. It's been connected to so many things. So you're going to see insulin resistance cause it. And then you're going to see the symptoms of this manifestation create things mentally, physically in a huge net across the entire body. And a lot of the things that you would kind of see as basic are the things that help here, exercise and resistance training. One of the top things that reduces fatty liver, why increases insulin sensitivity, fatty liver is not created because you're eating fat. Fatty liver is typically created through de novo lipogenesis of carbs to fat. So that's why insulin resistance is what's creating a lot of fatty liver. And the process of resistance training,

which increases insulin sensitivity is one of the most effective things that you can do in order to get out of that fatty liver situation. But there's a lot of supplements and strategies and protocols and things that you can do in that department if you want to walk down that road too. Yeah. Yo, let's dig through, you just mentioned phase two, detoxification and clearing hormones. I think a lot of people just think you have a certain amount of hormones in your body. They don't think about you always producing new hormones and clearing out old hormones and then having some net balance there, income expenses, revenue, profit type calculation.

How does all that work? And if you can't clear hormones, what does that mean for most people who hear hormones and they instantly think like testosterone, like that's kind of like the hormone that most people are wanting, or at least for myself, anyone else who just turned 40. Like I just said earlier in the show, I just turned 40. Like I want my testosterone to stay as high as possible for as long as possible so I can stay young and youthful and have energy, et cetera, et cetera. How does all that play together with the liver? Yeah. So phenomenal question, man. So when we have hormones, we're supposed to make hormones, we're supposed to use hormones, then we're supposed to clear hormones. That is a

process that's supposed to happen every single day. There's a reason why there's pulsatile releases. Like I mentioned earlier, pulsatile release of growth hormone happens within the first few hours of falling asleep. You have a pulsatile release of testosterone in the first few hours of waking up. There are things that happen in pulsatile releases, and that's because hormones aren't stagnant. Hormones are allostatic. They are going to adapt and pulsitily release in response to the current stress load of the body. So we are supposed to create hormones, we're supposed to use them, and then we are supposed to metabolize them. What metabolizes them? The liver. Liver has a giant role in metabolizing and clearing these hormones.

And it happens through four phase processes. It's important for people to understand this, to really lay this out in a way that they can grab onto. There is four things that the liver is going to do in order to clear if it's going to be an environmental pollutant or a hormone. Same process. All right. Phase zero, one, two, and three. Phase zero detoxification is discovered in 2006. And this is the process to where a transporter protein grabs onto something fat soluble and brings it into a cell. Okay. So just to kind of back up, if we're going to detoxify something, whether it's a hormone or a, a, a, uh, it's environmental pollutant. The entire goal is to convert this fat soluble thing into something that's water soluble so that we can

sweat it out, or it can go out in the urine, or it can go out in the feces. Um, you can actually detoxify through your tears or your spit, anything that's actually water soluble. That's excretion, um, is viable way for something to get out of our body. So this detoxification process is the goal is to convert something that's fat soluble into something that's water soluble. And it is phase zero, one, two, and three. Phase zero is what actually is the transporter protein that grabs onto this fat soluble thing and brings it into a cell that's capable of detoxification. So since this episode is about the liver, we'll talk about a hepatocyte, hepatoliver site cell. So it's important to point out though, too, that liver is famous for detoxification, but the lungs can detoxify,

the skin can detoxify. Like, and this makes sense too, right? The skin has all phasic detoxification ability, because if we have exposure to something on our skin, it's purportant that we're able to detoxify it. There's type two avioli proteins within our lungs that are capable of detoxification too. So we breathe in something, we should have ready to go detoxification capacity there. Our Sertoli cells on our testes have full capability of detoxification. And it's thought that that was an evolutionary protective mechanism to allow us to reproduce despite our bad decisions about what we put in our body. There's detoxification to protect our sperm in these scenarios. So we've got phase zero bringing something into a cell that's capable of detoxification, our trusty old hepatocyte in the

zombie-like liver. Phase one, now that it's in the cell, by the way, phase zero, fun fact, can be inhibited by piperine. So that common black pepper that you see added to curcumin all the time, phase zero can actually be inhibited by piperine. That's already been demonstrated. So it's interesting to where if somebody has a type of detoxification issue, and they're slamming tons of curcumin in order to do whatever they're trying to do, those populations tend to kind of do those things. Piperine can actually inhibit phase zero. So that's already been demonstrated. But besides that, phase one of this process is when you add a molecule of oxygen to this thing. And what you're

doing is you're exposing, the details of this aren't as important as the big picture, but you're exposing something known as a hydroxyl group. And this essentially is what creates this intermediary metabolite. So people in the world of detoxification have probably heard about if something goes through phase one, but doesn't go through phase two, then it's possibly more dangerous and more damaging than what the compound originally was. And that's often case, it's not always true, but it is often true to where in phase one, you're actually changing the molecular

structure of this damaging compound. Okay. And if that compound doesn't successfully go through phase two and then reenter circulation, it can create more free radical damage than it was originally ever going to. Okay. So it's very important for phase two to actually take place. Now we've changed. Okay. So phase zero, we got it in the cell. Phase one, we've changed the molecular structure. Phase two, this is now biotransformation to where this is a successful transformation of making this thing water soluble. There's many different ways to do this. You can go through glutathione conjugation. You can go through glucuronidation. You can go through sulfation. There's many different ways in which to accomplish phase two, but this is broadly considered

the phase where this is now where it becomes water soluble. This is now when it's ready to enter into phase three. Phase three is excretion. Okay. So phase three is getting it now out of the cell. So phase zero, enter. Phase one, change the molecular structure. Phase two, make it water soluble. Bam. Phase one, change the molecular structure. Phase two,

make it water soluble. Bam. Now we're ready for phase three. It's water soluble. So now that it's water soluble, it can enter the bloodstream and be sweated out, peed out, moved in the feces, whatever it's going to go. That is the excretion process. That is the metabolism process. And phase three is actually dramatically accelerated by something called St. John's wort. There's a supplement called St. John's wort that it's one of the most researched- I would never take that without you saying it's a supplement that you should take. Take wort? St. John's wort? I know, that worst marketer ever, right? Right. It's one of the most researched supplements of all time though. And it's not because it's so magical. It's researched actually by the pharmaceutical industry because it's so

effective at excretion that it makes medications less effective because medications are in your system for a shorter period of time. Because if you take St. John's wort with it, it excretes it out much faster. So you'll actually see St. John's wort with it, it excretes it out much faster. So you'll actually see St. John's wort on a ton of medications that say do not take with St. John's wort. And that's because it accelerates the excretion process of getting the medication out there sooner than it otherwise would have so that its half-life is shorter and it's not as effective as it otherwise would have been. That is, it sounded like a super long-winded answer, but believe it or not, that is a very abbreviated version of what detoxification truly is. Each of those phases involves a ton of biochemistry. To get all the way back to Doug's point, this is what's actually going to be happening in areas like TRT and testosterone. And this basic process and the efficiency of this basic process is important to understand because let's just go with TRT, okay?

The average person who's after TRT, probably insulin resistant. If you are after TRT, then your lifestyle has created low testosterone, okay. I've been quite vocal about that to where the symptom is never the problem. The symptom is always the result of the problem. So it's not the question of, Hey, I've got low testosterone. Let me take testosterone. That's not the question. The question is why was testosterone low to begin with? I probably had something to do with sleep, probably had something to do with stress, probably had something to do with diet, probably had something to do with insulin resistance, possibly inflammation, lack of activity, or some combination of all the above. Regardless, in this type of physiological profile,

a lack of liver efficiency is extremely likely, especially if you've already tried certain other things and they're not working for you. You still have the symptoms of lower libido. You still have the symptoms of difficulty dropping body fat and building muscle mass and strength, but you just don't have the competitive drive that you used to have when you were younger. This is inefficient liver. And what can happen is you have insulin resistance, which creates a type of inefficient liver, which we've already discussed can inhibit, slow down or even completely inhibit phase two detoxification. This can create estrogen dominance in a male because you're going to create estrogen. Estrogen is supposed to be excreted from the body. If it's not excreted, you don't have an estrogen production problem. You have an estrogen metabolism problem.

So you might be 40, 45 and getting kind of man boobs. And it's not because of your age, it's because of your lack of estrogen excretion ability currently taking place. And when you have estrogen building up, well, that's going to run antagonistic with testosterone. Testosterone's going to be lower. So this is where we start to create that liver testosterone connection to where if you have an estrogen clearance problem well then you are going to create estrogen dominance not because of your estrogen production but because of your lack of clearance but now that we have a lack of clearance of estrogen the teeter-totter relationship between estrogen and testosterone is going to keep testosterone lower so then when you inject testosterone and bring testosterone back up well you never actually solved your liver problem that is still going to be there. But a second thing too, is you're just going to now become even more estrogen dominant because a lot of that testosterone is just simply going to be converted to estrogen from a bunch of aromatase in the body. That's another big conversation we can get into. But there is a

huge, huge door to be opened for people to balance their hormone through a healthy liver when it comes to estrogen dominance, or when it comes to low testosterone due to a byproduct of estrogen dominance. We also did an entire episode on the thyroid hormone connection, sorry, the thyroid liver connection last year and how many roles the liver plays in T4, T3, RT3, many, many different things. So if you're somebody who has hormone imbalances and you're not somebody who has done a comprehensive look at your liver function

or had somebody look at a comprehensive understanding of phase zero to phase three and all the things that you could possibly doing to be inhibiting these things, which is many um then that's your next step in order to become a better version of yourself yeah also if you can't if you can't clear testosterone do you also does your body down regulate the production of testosterone if you can't clear testosterone will your body down regulateulate the production of testosterone? Not only will it downregulate the production of testosterone because it's seeing free floating

in the surface, you'll actually downregulate your sensitivity on the receptors as well. Because if clearance is never taking place, then you're going to have an elevation or a stabilization of a hormone that should be having a pulsatile situation allowing for sensitivity of the receptors to take place. To go back to kind of a body building example, again, this is a big reason why guys actually go periods of time on a very, very low dose or even completely off to resensitize certain receptors of the body so that when they go back on testosterone, they have this sensitization and new hypertrophic potential from that process because they've given their

body, you could say, a quote unquote break from a receptor perspective. But they've allowed their levels to come back down so they can bring them back up again to resensitize receptors on a much lower and non-super physiologic scale. That's also what's happening here if you simply don't clear your hormones. Nice. Let's talk about how do people kind of avoid this nutritionally, training, supplementation? What are some like uh steps people can take uh that are worried about their liver um i will i mean action steps you want to look at ast alt ggt fatty liver index fibrosis score cholesterol glucose hemoglobin a1c these are all things that are really connected

yeah well the liver is involved in so many different things right so um there's a there's a lot that you can look at in that regard and trail it back to the liver because when it's a warehouse a manufacturer and a processor you're going to see it in many areas in the blood but as far as like immediately actionable items um intermittent fasting it's actually been demonstrated to really help with fatty liver. It creates a type of autophagy effect within the liver to where it activates certain AMPK genes within the liver to help really reduce fat content of the liver. So uniquely for the liver, I'm not always a fan of intermittent fasting, especially for things like body composition or performance. But if somebody has fatty liver issues, I am certainly a fan of

utilizing intermittent fasting for fatty liver. I think reducing fructose intake is definitely ideal. Fructose is only two metabolic steps away from being stored as fat and liver. It's very, very easy for the body to convert fructose into liver fat. So that's coming in the form of soda. That's coming in the form of way too much fruit. True story, by the way. I had a client about 10 years ago, so hopefully she doesn't listen to this podcast. But I had a client about 10 years ago who had about a 60 to 90 minute commute, something like that, to work.

She would eat a bag of apples on the way to work. A bag. Little too much fructose. That seems like a lot to begin with. Yeah. Yeah. Are apples unhealthy? No. Are a bag of them unhealthy on the way to work? Yes. Okay. So, when I say reduce fructose, I'm not saying fruit is bad. I'm saying let's reduce soda because that's got tons of high fructose corn syrup. But don't go crazy with fruit either just because it is very direct in its way in which to impact to novel epigenesis within the liver. Increasing choline intake is actually very important.

Something we didn't bring up in this podcast is choline. So non-alcoholic fatty liver disease or NAFLD, you'll see it as people say it sometimes, that's actually been touted as a choline deficiency. So in the same way that you get rickets if you don't have enough vitamin D, if you don't have enough choline, you get non-alcoholic fatty liver disease. So it's like it's a deficiency in choline that will directly cause that. This has absolutely been demonstrated already. So sources of choline like egg yolks are excellent for your liver health.

So getting some choline in there, getting some fasting in there, reducing your fructose intake, and then increasing sulfur. Sulfur foods tend to bump this phasic efficiency that we talked about previously. Eggs contain sulfur. So you're getting kind of a one-two hit there with choline. Choline's in egg yolks though. So we can't just go with egg whites. But eggs contain sulfur, garlic contains sulfur, broccoli contains sulfur. These are all like the dietary things that you can do between fasting, choline, eggs, and sulfur. From a supplementation perspective, it's a little bit unique because you can take specific approaches depending on your own unique

issues and possibly what your lab work looks like. You could take a choline supplement if you don't like whole eggs, or if you say if you have an allergy to eggs, then you could just take a choline supplement. That'd be very effective. NAC, N-A-C, N-acetylcysteine, that's a precursor to glutathione, which helps promote, you know, phase two glutathione conjugation. It's very effective at improving liver health. And it really helps recover the liver as well. If the liver has been damaged, that's one that you can utilize to actually acutely recover the liver. A lot of people don't know milk thistle is not one that you would want to use to acutely recover the liver. A lot of people don't know milk thistle is not one that you would want to use to acutely recover the liver. Milk thistle actually has a type of hormetic effect on the

liver to where it's kind of an acute stressor to the liver. But in the long run, this is what helps protect your liver. So if you want to use milk thistle for liver health, you actually want to do it during periods of purity. So like during a time where you're very healthy, and you don't take a bunch of milk thistle after a brutal night of drinking, because that's actually you're using it at the wrong time. That's where something like NAC would make a lot more sense. So choline, NAC, Tudka is definitely another big one. Tudka helps stimulate bioflow. Tudka also improves insulin sensitivity. So beyond getting bioflowing, you are getting insulin sensitive, which helps reverse that fatty liver process.

We're going to use milk thistle for resiliency. And that's it. Those are, those are really the big ones between diet and supplements. Those would be the big rocks that, that, that you would want to knock down, um, anything more sophisticated than that. And even including that would, would really depend upon your labs. Yeah, we kind of intentionally avoided just talking about alcohol for an hour here, which is obviously like the most, it's like the thing that everybody's going to associate with having an unhealthy liver. How long does it take to kind of clear the alcohol out of your system i i would assume this is like a

consistency of alcohol starts to create a lot of problems in there where if it's like once a week once every other week once a month something like that it's not going to have that dramatic an effect on liver health if there was a obviously if you're an extreme alcoholic that's going to be a problem um but like how how long does it take to clear alcohol really if you just if you're an extreme alcoholic, that's going to be a problem. But like how long does it take to clear alcohol? Really, if you were to like touch on that just for a little bit on the effects of alcohol on the liver and how long does it take for it to get healthy? Sure, sure. Yeah. So we bring cutting edge information here at Barbell Shrugged.

Alcohol is bad for your liver. Okay. Why we stayed away from it. The common information that everybody wants we waited until minute 55 talk about it yeah no dude so alcohol alcohol absolutely is bad for your liver alcohol damages the liver there's a reason why you know one is called non-alcoholic fatty liver disease because it's already so prevalent

that you can have alcoholic induced fatty liver issues. Um, it damages the liver. Um, it actually scars the liver. That's what you're assessing a lot on fibrosis scores is actual organ scarring. Um, it's connected to brain shrinkage, which we've talked about in the past. Um, alcohol typically as a, as a clearance, um, from, from a half-life perspective, you typically want to have, um, the rule of one drink takes about two hours to clear and that stacks. So if you have five drinks in one hour, it's still going to take about 10 hours to clear. Okay.

And that creates a problem because when you have alcohol in your system, then you're not metabolizing anything else. And it creates a lot of de novo lipogenesis, which creates a lot of fatty liver. Okay, so it's it's like basically the fastest way to have liver problems is to have a lot of alcohol. But I will provide something unique that a lot of people probably don't know. serotonin, actually excess serotonin increases cancerous growth in liver tumors. So excess serotonin has been connected and linked to excessive and accelerated growth in the tumors, in cancerous tumors in livers. So it's not alcohol-specific serotonin.

That's one of the reasons why alcohol makes us feel so good. It dramatically increases serotonin, which is a big problem all by itself. But excess serotonin increases cancerous growth in livers. And on top of alcohol's damage directly to the liver, one of the reasons alcohol makes us feel great is because it increases serotonin, but then that's a problem for cancer in the liver. Wait, hold on. The very last question here. The downstream effect of processing alcohol, is it that it also can't be doing all the other jobs it's supposed to be doing because it's so it's so involved with processing alcohol so it's not just alcohol is bad

for it but it's also not doing uh like clearing hormones like we mentioned earlier or any other job that it's supposed to be doing because it's so tied up with the alcohol you got it man a very layman's term way to say that totally right but then in the layman's answer too like he had five drinks 10 hours of being tied up and not dealing with anything else and then getting a backlog of everything else that has to do after it's already been damaged where can people find you sir i can be found at dan garner nutrition on instagram you're on fire these days on the instas by the way yeah man i uh i just got a lot of energy i want to help a lot of people let's rock and roll there you go doug larson on instagram doug c larson i am anders varner at anders varner and

we are barbell shrugged at barbell underscore shrugged and make sure you get over to arete lab.com that is the signature program inside rapid health optimization where you can go and experience all the lab lifestyle performance testing analysis and coaching to help you optimize your health and performance and you can access all of that over at arete lab.com friends we'll see you guys next week