Updated: Apr 26

In our last blog, we talked about the relationship between IBS, stress, and hormone balance. The liver plays an important role in synthesizing, metabolizing, and eliminating hormones. For that reason, any time a person has hormonal imbalance, we always consider liver health. In this article, we take a closer look at the relationship between gut health and liver health.

Common diseases of the liver include viral hepatitis, alcoholic liver disease, and nonalcoholic fatty liver disease. The direct causes of the first 2 conditions are clear: the hepatitis virus and alcohol are to blame. The cause of nonalcoholic fatty liver disease, however, is less obvious.

Fatty liver disease is simply defined as the accumulation of fat in the liver. If untreated, it can increase the risk for liver cirrhosis or liver cancer. Fatty liver occurs more commonly in people who also have obesity, diabetes, or metabolic syndrome. What’s interesting is that researchers have identified links between nonalcoholic fatty liver disease, small intestinal bacterial overgrowth (SIBO), and increased intestinal permeability (leaky gut).[1]

There is direct communication between the digestive tract and the liver, which researchers have termed the “gut-liver axis.” Most food, nutrients, and even toxins that are absorbed from the intestine pass directly to the liver before entering the general circulation. This mechanism makes evolutionary sense because the liver is a focal site for detoxification and metabolism. The liver is like a blood-filled sponge that soaks up any absorbed toxins before the blood goes on to the heart and the rest of the body. It is also like a processing plant, altering and activating nutrients so they can be used by body cells.

In conditions that damage the gastrointestinal tract, we often see a pattern that includes disruption of the normal intestinal bacteria (dysbiosis), damage to the intestinal lining (leaky gut), and upregulated immune responses (inflammation). This pattern can have dire consequences on the liver.

With dysbiosis, harmful bacteria flourish and produce toxins, called bacterial endotoxins. With leaky gut, the endotoxins pass from the intestines to the liver. Leaky gut and an increased load of bacterial endotoxins are clearly linked with an increased risk for developing liver disease—specifically nonalcoholic fatty liver disease.[2] It is thought that this pattern, which originates in the digestive tract, plays a direct role in deposition of fat in the liver as well as inflammation in the liver.[3][4]

Part of routine and preventive blood work in all patients is a screening for liver. It is not unusual to detect elevated liver enzymes in patients who have digestive disorders. When this occurs, it makes sense to investigate all potential reasons that the liver may be unhappy. As we said above, the hepatitis virus and alcohol are important considerations. Medications, such as acetaminophen (Tylenol), can also cause liver enzymes to become elevated. In addition, it makes sense to take steps to restore digestive health.

We take a calculated approach to restoring digestive health, which includes removing irritants, replacing nutrients, re-inoculating with healthy probiotics, and repairing the intestinal lining. In functional medicine, we call this approach the “4 R’s.” In our practice, we also call this approach the “leaky gut protocol.” As the gut begins to heal, we typically see resolution of digestive symptoms as well as normalization of liver health.

Related Products

  • If you are interested in supporting healthy liver function and detoxification, a great place to start would be adding Ultra Cleanse to your daily routine. Ultra Cleanse is a powdered dietary supplement that provides a complete source of protein, vitamins, and other nutrients to support gastrointestinal health, liver health, and a healthy inflammatory response.
  • If you prefer capsules over a powdered supplement, check out Ultra Liver.
  • If you are experiencing inflammation or take products like Tylenol on a regular basis, a product called BCQ can help protect your liver and reduce inflammation.


[1] Wigg AJ, Roberts-Thomson IC, Dymock RB, McCarthy PJ, Grose RH, Cummins AG. The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut. 2001;48(2):206-211.

[2] Volynets V, Küper MA, Strahl S, et al. Nutrition, intestinal permeability, and blood ethanol levels are altered in patients with nonalcoholic fatty liver disease (NAFLD). Dig Dis Sci. 2012;57(7):1932-1941.

[3] Miele L, Valenza V, La Torre G, et al. Increased intestinal permeability and tight junction alterations in nonalcoholic fatty liver disease. Hepatology. 2009;49(6):1877-1887.

[4] Nakamoto N, Schnabl B. Does the Intestinal Microbiota Explain Differences in the Epidemiology of Liver Disease between East and West. Inflamm Intest Dis. 2016;13-8.

About the Author: Dr. Gerard Guillory, MD is Board Certified in Internal Medicine and has published two books on Irritable Bowel Syndrome (IBS). In 1985, he opened The Care Group, PC. Today, his clinic is a Primary Care facility that is a hybrid of functional and traditional medicine treating patients with digestive disorders, autoimmune disease, and other conditions. You can learn more about Dr. Guillory here.