The Detox Mistake That Keeps Your Body Feeling Off with Dr. Josh Levitt

What's the first sign that the liver is struggling before any lab will catch it?

Hmm, that's a good question. It comes up a lot. Like, we look at liver function tests, LFTs, AST, ALT, these kinds of numbers, and very often people's liver is overwhelmed, sluggish, congested, if you will, and it doesn't always show up in labs because that requires the cells to be fully damaged. But some common symptoms are digestive problems. That's a big one because the bile that the liver makes is responsible for emulsifying, digesting, and absorbing fat. So fat difficulty, digesting and absorbing fat, is one problem, digestive issues, skin issues, surprisingly, because the skin kind of is like a secondary detoxification pathway. So we see a lot of skin breakouts and various problems in the skin when the liver is congested, and also brain fog and fatigue, hormonal imbalances, because the liver is very much involved in processing and metabolizing of hormones, including cortisol.

Dr. Josh, welcome to Rooted in Wellness.

Thank you for having me. This is a treat and it's so lovely here.

I know. Excuse me, we're gonna have some flies come into the studio. Just let them be.

It's nature. We're cool with nature.

We're cool with nature. We were talking about the inspiration. I couldn't think of a more suited person to come onto this podcast. Just the story you just told and how we can just bridge the gap between the beauty of Eastern medicine and Western medicine. And when we came up with the word rooted, you know about my personal healing journey. I had to go get rooted again at the ashram in myself and like the belief that I knew that my body could heal itself. I had to remember that. And Western medicine, while it did heal me, it kind of took away that faith that you had caught on to so quickly. I talk about that a lot. So to kick things off, you know, so many of our listeners know that our intention is to help as many people as possible, but also to help them feel more rooted again in themselves, in their health and their happiness, and what I believe is our inner capacity to be able to heal ourselves. So what are 2 or 3 things that help you feel more rooted every day?

Well, it's a great question. Yeah, it's so personal. You know, and I, first of all, I totally agree. You know, people lose that faith, either healthy people who have an acute illness, it's like, oh my gosh, like, this is bad, this is scary, I'm not used to this. And that's one way to get that faith kind of rocked a little bit. And then people, sadly, who are chronically ill, who just lost that faith a long time ago and are now just sort of bobbing like a cork in this sea of treatments and whatnot. And that's a really scary place to be. I feel very grateful to be in the former group, right? Like, generally healthy person, really take good care of myself. And that goes to the answer to your question. Things that I used to— so I'm connected to the natural world. I grew up in Southern California here, beautiful, and nature is the biggest teacher that I have. For me, that's like very much about the ocean. I grew up as a surfer and that's still something that connects. So I don't get to surf too much these days living in Connecticut where I live, but water, natural sources of water is super grounding. Food and the food coming from the earth and just thinking a little bit about that food from the earth. And then also beyond food, to just plants in the natural world, right? So like, I, I walk around no matter where I am, and it's— this is an interesting thing, you know. We're in this beautiful setting. I wish all of your viewers could see. Like, it's just so, so gorgeous here. And to me, there's this interesting phenomenon. A lot of people have this thing called green blindness. Like, they look out there and they just see green— trees, shrubs, plants, small plants, weeds, whatever. But for a person who's like trained and studied herbal medicine and plants and botany, like, they're all— they're all different entities, right? Sentient beings almost. And like, and a lot of them are friends. I, I think about it that way. I know sounds almost like cliché or woo or out there or something, but like, you know, you look around and they're like, oh, that's an old friend. That's a new friend. That's a, that's a plant medicine. That's a food plant. You know, these kinds of things. And I think like, this is my answer to your question. Knowing and understanding and having a relationship with the natural world around me, especially the plants, is one of the things that keeps me the most rooted.

So powerful. I love that you brought that up. This is your crowd, to be able to have those conversations. When we first moved here, I really noticed the difference. We'd lived in a condo previously. I had to show my daughter how to really integrate and like, oh, you can talk to leaves and trees. And I know it sounds so weird and woo, but she actually could feel the energy off of it. And then she started to notice how the different trees, it wasn't just green anymore. They're all vastly different. And even the way living here for a year now, how they change in season, it's just all so different and so special. And yeah, I asked that question as being so important because I think people think that we have figured it out. And a lot of people think that experts will say, say some sort of biohacking modality, or when they are so strict on their protocol. But I would say 90% of the time, most people say the connection to nature.

So thank you for that. Yeah, yeah, yeah.

Having been on this journey and worked with so many patients, do you notice when you feel uprooted? Are there rituals in your life that cause you to feel uprooted?

Oh, for sure. I mean, you know, I think, like, like I said before, I'm a surfer, right? Like, I'm really connected to that. And I would bring it back to this question of, of balance. Like, a lot of people talk about balance as this, like, static thing, you know, that this, like, thing to strive for. Maybe it's like work-life balance or balancing your health or balancing your fitness or whatever you're, you know, and, um, I think like I've thought maybe more about balance than most people have and, and maybe being a surfer and a person who has like objectively really good balance, like I can stand on one foot for a long time, you know, but what I would argue is that like balance is, is a dynamic thing, right? And anybody who's got good balance is not good at balance. They're good at managing imbalance, right? And so like feeling uprooted. Yeah, of course. Like all the time, you know, every day, you know, there's something that like, so So because it's just that balance is about course correction, right? Like you're not, it's not a fixed object of humans, not inanimate, right? Like we have a dynamic life inside of our own health and all the physiology that's going on in our family and our friends and the environment in which we live. And so, yeah, I think absolutely I get uprooted multiple times a day, I think. Um, and then, and I don't see that as a problem. That's just like the wave pitching this way and then me going, oh, I have to go that way, you know, to maintain some— something that looks like balance from the outside.

Yeah, amen. What a brilliant answer. So many people search for, for balance, uh, so managing the imbalances, which is really powerful.

That's what I would say. Yeah, balance isn't, isn't the thing. It's not, it's not something to strive for. It's, it's trying to manage imbalance is what you want to strive for, I would say.

Yeah. This is a little off topic, but have you ever done yoga?

Of course.

Yeah, yeah, yeah. Tree pose.

Tree pose. It's about balance. That's the one with the foot on the inside of your thigh, right?

Yeah, you went to surfing, I went to tree pose. And what's so funny, whenever I teach my kids yoga, when they do tree pose, they turn it into a tree. They balance for a second and then they start to wave around trying to catch their balance, and we just have so much fun laughing at that. Yeah, that's what life is, just being able to move around, catching yourself off guard and not punishing yourself for— there's no wagon, there's no calling up the wagon.

Someone who's like really effectively doing tree pose and like looks super static and like, you know, it's, it's fixed position, they're also doing exactly what your kids are doing, but just on a microscopic level. Like the foot's going like doo doo doo doo doo. And it's called proprioception, right? Like your nervous system is telling your brain like where your body exists in space and then you're making little course corrections. And that's a system you can train that like any surfer, yogi, or person who does slackline or whatever is good at that. And yeah, I think, you know, you can balance like a, you know, something on its edge on a table or a rock in the woods or something like that. But that's a different process than what we're talking about here. You know, it's— we're not fixed, we're not inanimate that way.

You got it.

Yeah.

All right, you ready for some rapid fire? Yeah, we're gonna go deeper. Some people get nervous. No need to get nervous. We're gonna dive deeper into everything. All right, number 1: the worst daily habit for your liver that most people don't even realize they're doing.

The worst daily habit for the liver I think that most people don't realize they're doing— I was gonna say alcohol, um, because it's just such a common and well-known liver toxin, but I think most people know that they're doing that.

They know now.

Yeah, yeah, they know now. I think with respect to liver health, like, there's things that are inside of our control— food, drink, alcohol, these kinds of, you know, chemicals that you might spray on your lawn or garden. And then, and I think my answer is, the things that are outside of our control. And this is— and I don't want to ever fearmonger here because your liver is amazing and it's resilient and it can do almost magical things in terms of detoxification, but it is heavily burdened by our modern world regardless of how clean we try try to live, right? Like, we buy organic food and we drink out of glass containers and we try to not touch the receipt that came out of the printer because it has BPA on it. You know, we know that, that kind of stuff. But still, sadly, all of us, all of us, including polar bears and penguins that are thousands of miles from the nearest source of these toxins, have environmental toxins in their blood and stored in their adipose, in their fat tissue, which is another interesting story. Um, and so that's the answer. It's, it's people are just being— we're being exposed, you know. And, um, it's a, it's a sad reality and, and one of the reasons that's so important to support your liver.

We have to go deeper into that.

Yeah.

Um, yeah, it's such a good point. It's just, it's so, uh, it's seeped into all aspects of our, our living, right? We can't avoid it.

So it's ubiquitous.

Yeah, sadly. One food or drink that people think is healthy that the liver absolutely hates?

I think people have this desire to want to believe that red wine or tequila or something like that is like the good alcohol. And that's, that's my answer. It's fine. We could talk more about that. And I have a lot to say about that. I'm not recommending that people are abstinent and not drinking at all. I'm definitely not recommending that. But I think a lot of people want to believe that their choice of alcoholic beverage is healthier for their liver than it is, because it's not.

Sorry. That's so great. As a nutritionist, I'm always laughing. So if I am going to have some alcohol, what's it going to be? Tequila, same, same.

Yeah, totally. I mean, there are— there probably are better choices, like ones with sugar, you know, drinks with sugar are probably worse. But I mean, can we talk about this a little bit?

Yeah, let's have a—

I mean, like, it's come up a lot lately, like, in, in podcast world, it's come up a lot. Like, I think there's been a lot of, you know, attention to like, the right amount of alcohol is zero.

Exactly right.

And, and I, and I get that. And I think— so the way I— the frame that I put around that for people is this. It's like, it depends on what you're optimizing for. And so if— have you ever heard of the, um, they call it like the fat and happy hypothesis? It's like a really interesting thing.

Fat and happy? No, but I have a feeling I know what you're talking about.

Yeah, it's like a little tangent. Can I go on a little tangent? Please do. Um, so the fat and happy hypothesis comes from research that shows it was mostly done on men who are like a little overweight, like 20, 30 pounds overweight, were happier than people who were, who were thin. And it goes to this question. We'll get back to the alcohol in a second. Like, what are you optimizing for? So if you're optimizing— there's a hummingbird right there. Oh my gosh, so cute. I love it. So if you're optimizing for six-pack abs, right, then like you're going to make sacrifices, right? Like you're going to not have ice cream after dinner, this kind of thing. And so people who've decided they're not optimizing for six-pack abs and are maybe more like optimizing for a good social life or, you know, a pleasant experience, they're going to be a little puffier. But they also might be a little happier. Right. And this is exactly how I feel about alcohol. Right. If you're optimizing for awesome liver function and optimal health, physical health, the right amount of alcohol is none. Yeah. If you're optimizing for like, you know, being a normal person in life and enjoying the wedding or the party or the cocktail hour, happy hour with your family or your friends or whatever, then a little bit of alcohol is probably okay. And again, Pick your poison and support your liver.

You got it. Yeah, I had this clip. I went on Jay Shetty's podcast and one of the closing questions was my thoughts on alcohol. But of course, the part that went viral is me just saying no amount of alcohol is, is a good amount. But in context, it's if me genetically, I'm just a poor detoxifier going through perimenopause where my brain fog is already intense, it's probably not the best idea for me, right? So I agree with you. It's a time and a place thing. I'm also half Danish where like 2 o'clock is have a drink. Yeah, every single day, right? And I see these old ladies on patios having a beer every Sunday, and they have so much joy. So I'm with you— happiness first, lowering your load if it's something that you need, but yeah, live your life.

Yeah, and I agree with you. Like, for, for optimal health, like purely physical health, especially with respect to the liver, which we're talking a lot about today, like, yeah, the right amount is zero. Like, that clip should have gone viral, and most people ought to drink a lot less than, than they do. But I think that, like, You know, like our balance conversation earlier, it's a spectrum, right? And, you know, people got to chill a little bit.

I know. All right, let's keep going. The most underrated liver-supporting food that's probably already in your kitchen.

Oh, gosh, that's a good one. There's so many good liver foods. I think maybe— I guess I have to wonder who we're talking to here and what's already in their kitchen. There's some really good ones. Here's a surprising one that's probably not in people's kitchen, but it's right outside. How about that? And that is dandelion. Dandelion. Yeah, dandelion, which be careful with dandelion. There's, it's, it's, it's sprayed a lot. Like it's an interesting thing. People like think of dandelions in the yard as a scourge, right? It's like a weed. Um, and there's so many good quotes about like weeds are just plants that you don't, that you don't know very well, you know, that sort of thing. And dandelion root, the root of dandelion is a very, is a liver herb. Yeah. Um, the leaf is also a bitter herb, really great. It's also, uh, has a diuretic effect as well. So I think dandelion is a very underappreciated herb that is maybe not in people's kitchens, but like, it's certainly in their yard.

You know, it's actually one of the first foods that go on most of my client protocols just for support. Yeah, but you have to finely chop up dandelion leaves in order for it to be a little bit more palatable. Yeah, dandelion.

I like young ones. The young ones are a little bit less bitter. And again, don't— if your yard is treated, you know, for those of you out there, if your yard is treated with pesticides or herbicides or whatever, don't, don't eat those dandelion leaves.

Yeah, don't do it. Uh, overrated or underrated? Juice cleanses for your liver.

Overrated. Overrated. Juice cleanses are overrated.

They're overrated. Yeah. Where's the juice coming from? Have they even sprayed? How much sugar are you taking in every day? Right. So many things to consider.

And also that your liver is not like a tube that needs to be flushed. It's a solid organ, you know. And so like juice is fine, you know, it's a concentrated, you know, extract from that plant. Now depending on the juicer, missing a lot of fiber. So yeah, I'm pretty comfortable with overrated on juice cleanses.

Love it. What's the first sign that the liver is struggling before any lab will catch it?

Hmm, that's a good question. And it comes up a lot. Like, we look at liver function tests, LFTs, AST, ALT, these kinds of numbers, and very often people's liver is overwhelmed, sluggish, congested, if you will. And it doesn't always show up in labs because that requires the cells to be fully damaged. But some common symptoms are digestive problems. That's a big one because the bile that the liver makes is responsible for emulsifying, digesting, and absorbing fat. So fat fat difficulty digesting and absorbing fat is one problem. Digestive issues, skin issues, surprisingly, because the skin kind of is like a secondary detoxification pathway. So we see a lot of skin breakouts and various problems in the skin when the liver is congested. And also brain fog and fatigue, hormonal imbalances, because the liver's very much involved in processing and metabolizing of hormones, including cortisol.

Immune health. Yeah, yeah, right. So much, right?

So much. Yeah, so it's so It's so complex what's going on in there.

Yeah, a lot of people today, you know, are feeling like they're doing a lot of the right things and they're still feeling, you know, off, or maybe they're suffering from some of those symptoms that you just mentioned. I think growing up we always just were told or taught that the liver is just this filter doing its thing every single day, but now we're understanding that there's so much more that's connected to it. Totally. I have to do a lot of education with my clients on helping them that, you know, shift. We're so focused on gut health, but no one's talking about like the gut-liver axis or the liver-brain axis as well. Yeah. So what would you want listeners to know about their liver that might surprise them of being so much more than just a filter?

Yeah, you mentioned the brain thing, which triggered me to remember this, this really interesting kind of fun fact, if you will, which is that, um, the word— you know the word melancholy? Yeah. Melancholy means depression, right? Like, it's like a sadness, right? Depression. But the word in Latin, right, medical Latin, melan— M-E-L-A— mela means black or dark, right? We know that from like melatonin, the hormone that comes in dark, uh, um, hopefully not, but, um, melanoma, right? Like melanin, the pigment in our skin. Mela means black, it means dark. And chole, C-H-O-L-E, is, is about bile. Cholesterol, which is made of cholesterol. There's a lot of cholesterol in bile. Uh, the gallbladder gallstones are called choleliths. A gallbladder removal surgery is a cholecystectomy. So melancholy means black bile. And so in Ayurveda, yeah, and in lots of other healing traditions, with the exception of Western conventional medicine, it's what long been known that the liver— black bile— before we even knew what was going on with human, you know, normal conventional physiology, we knew that liver disease caused black bile, and we called it melancholy. So that's just like an ancient example And there are so many others. Like I said, hormonal health, blood sugar control, digestion, psychiatric health, skin dermatologic health. All of these things are connected to, to, to liver health, liver function.

So many symptoms. And a lot of doctors aren't really necessarily trained, as we were saying before, to just investigate.

Right. Like, if the labs are normal, then you're good, right? And like, there's so many people out there. I'm sure many of your listeners have had that frustrating experience. Like, I don't feel good, and then you get the labs back and they're like, you're good. And it's like, hey doc, remember I'm not good actually? Like, remember when I told you before you ran the labs I don't feel good? Well, you're good on paper. And it's like, well, can we dig a little deeper maybe?

Yeah. What are the standard labs? Let's go through them. So ALT, AST, what else are you looking for when you're looking at liver health?

Yeah, like on a conventional panel, like the so-called LFTs, which stands for liver function test, will be AST, ALT, GGT on some of, some of the panels, which is more specific to alcohol. Uh, we'll see bilirubin will be another one, and then there's a few others. Alk phos, serum albumin these, these sorts of things. And many of those again can be normal. What people need to understand about these liver labs, and I think this is an important like education piece, is that like, and no one ever thinks about this, right? Like when we draw blood, we draw it out of your, your vein in your arm usually, right? So that's your blood. And then we're checking your liver. So it's like, how do you do that? Like, like how is that even happening? No one like biopsied your liver. They got the blood. And let's say, let's say the AST or ALT was, was elevated in the blood. How'd that happen? Well, Well, those enzymes are supposed to be in liver cells, which are called hepatocytes. They're like enveloped cells, right? There's billions of them inside your liver. And if those cells break open from damage, trauma, inflammation, infection, whatever, the cells break open and the stuff that was inside the cells leaks out into the blood and we find it in, in the, in the, in the blood when we check it. So if your ALT or AST or GGT or any of these things are elevated, it's because your liver cells quite literally have broken open more than they normally should for some reason. Which needs to be investigated, and we found those enzymes in your blood. So that's really what we're looking for. But like we, like we've been talking about, there's a whole bunch of liver function problems that can happen before you've got liver cells breaking open and vomiting out their contents into your bloodstream, you know.

So with your training in natural medicine, naturopathic medicine, what are some other symptoms that you would look for? I know when I go to an Ayurvedic practitioner, they'll immediately look at the whites of my eyes or at my nails or at my tongue. What are some things that you would look for or what are some like common symptoms that people might be suffering from for you to say, let's tune in?

I would look at all of those things. And before I would look at anything, I would just talk to the person, right? And hear their story and listen to what they're telling me, right? And very often, and again, sadly, in this world that we live in, it's not a stretch to suggest that most people need to pay a little more attention to their liver because of all the things that are outside their control. We talked about that earlier. Environmental chemicals and pesticides and herbicides. And then what personal care products are they using? And what, what stuff is off-gassing from the furniture in their homes? And the care— the lawn care chemicals that they're— they or their gardener is spraying on their lawn, right? So those are all clues without looking at anything, right? Um, and then the things that are in their control. What are they eating? What are they drinking? What do they look like? Like, how, you know, how— what's their body habit? You know, do they have a big belly? Um, and that is clear indicator that there's going to be not just fat in that belly, but fat enveloping and almost marbling through the liver itself. So these are all— don't need to be very sophisticated or very, uh, astute observer or diagnostician to know that, like, the liver needs some attention. And then all of those other things, right? Like the whites of their eyes, in a severe case they'll turn yellow from bilirubin backing up. That's called jaundice. We'll look at the quality and character of their skin, all of those soft, softer signs. And then, you know, just do a thorough history. Also palpate their abdomen and see if, you know, what it feels like in there. Ask them questions about their digestion and then, uh, try to fix it. Try to fix it.

Yeah, those are all really great tips. So for listeners, imagine if Dr. Josh and I were with you right now. Just do an audit. This isn't about getting fearful or going crazy at home, but like do an audit of your house and the chemicals that you're exposed to, including the furniture and the pans and the plastics and the perfumes. Hopefully you don't have any glade plug-ins and all of that, right? But yeah, you just, you never know. And a lot of people live in environments where they could be spraying Right. We just have to be mindful. Just do an audit. Just know what you're exposed to. I think that that's a good component. Yeah. What about bilirubin elevation? Yeah. Is it the same in terms of accumulation?

Yeah, it's a little different, right? Bilirubin is a component of the bile, and the bile is the fluid that the liver makes, which is, if you have one, stored in your gallbladder and then squirted out into your small intestine to help you emulsify fat. And bilirubin is a component of that. So if that system gets backed up, up, which can happen for a variety of reasons, that bilirubin will show itself in the blood. It'll back up and manifest itself in the bloodstream. And in severe cases, that will turn a person jaundiced, right, where you'll see the yellow in the eyes, the yellowing of the skin. It can be extremely itchy. And that's an obstruction of liver bile outflow, which, which causes bilirubin to back up. Um, it can also happen— and this is actually really an important thing, I've never talked about this publicly too much, but like, people see this all the time— bilirubin in many, many people is just elevated. —yeah, um, and they're otherwise healthy and nothing's wrong. And that is a condition that's called Gilbert's— yeah, Gilbert's, G-I-L-B-E-R-T-S— Gilbert's syndrome, uh, an asymptomatic benign elevation of bilirubin that just happens to some people. I— the way I describe it to people is like, we're, we're all kind of like, you know, if you take averages, right, like, and look at the human average, we're all kind of like somewhere between 5 feet and like 6 foot 2. But like, some people are 4'11" and some people are 6 foot 7, and and they're not— they don't have a disease. Maybe, maybe they do, but maybe they don't. Um, they're just looking a little bit of an outlier. And like, it's the same thing with bilirubin. Like, if everything else is cool and you're asymptomatic and you're not jaundiced, it's just Gilbert's, chill. Don't worry. Yeah, yeah, that's so cute.

Yeah. Did you know that you always wanted to go into the natural side of medicine? You're sharing a little bit about your story.

What was the inspiration? No, I didn't. I didn't at all. Um, I went to UCLA right down the road. It was like, this is a nostalgia for me being, being here. Um, and I studied human physiology there, physiologic science. And I always wanted to be a doctor. Yes. At the time when I was at UCLA, my, um, my dad was training, uh, medical residents at UCLA in the med center there. And so I had kind of like maybe VIP access, if you will, to the— a lot of the doctors at UCLA. And they were all telling me— this is like more than 30 years ago— um, that it ain't what it used to be, right? Like, being a doctor is just not as good as it used to be. They were talking about the influence of pharma and the influence of insurance companies and big hospital systems and stuff. And so gave me pause. So I took, um, I took a year off after I graduated from college, kind of did that gap year thing to go explore. And on that exploration, at one point I was, I was traveling, like hitchhiking through Europe, and I was all over the place, all over the world actually, and with a backpack and sleeping on beaches and all that kind of stuff. Um, and so I wound up getting, um, a blister on my foot. I— my hygiene wasn't the best at the time, you know, just kind of those were the days. And that blister got infected and I got cellulitis, which is a severe ascending infection up my leg. It was very, very problematic. Antibiotic. Um, I was in Switzerland at the time and I got a prescription for antibiotic called into a pharmacy in, in Zurich, Switzerland. And so I went in there feverish with this very bad problem on my leg, and I got, I think it was Keflex, which cured the infection, which was good. Thank goodness for that. But in Swiss pharmacies, um, they have all this natural stuff. They had like herbs and vitamins and homeopathic stuff, and I was just like, wow, what is all this? And, you know, I didn't need that stuff at the time, or maybe I did, right? But like, I needed the antibiotics. So that just lit this spark in me, and I started reading and studying about herbs and plants and herbal medicines, which was not like a mainstream thing at— in those days. Um, and you know, it was that day in that Swiss pharmacy, at a time when I needed antibiotics, that like the spark got lit, and it's still just burning hot, you know? And it's ironic, I think, because like I'm a naturopathic doctor, and I got started in this field on the day that I needed conventional medicine. Like, I needed an antibiotic. I could have lost my leg or my life in that situation. And ever since then, I feel like that's my job, is like to try to bring those two worlds closer together, right? That like there's good stuff in Western medicine, like, like what I got that day and what lots of people get every day. And there's really good stuff in the natural medicine world. And those two worlds need to meet, come together, at least come a little bit closer together. Yeah. Yeah.

Have some mutual respect. You got it. Yeah, I love that story. Thanks for sharing. When I went to India after I became a nutritionist, I went to just this herbal apothecary and there was these women that were working. There's just hundreds and hundreds of different types of plants. And all of them wore a t-shirt that said, "In nature we trust." That was my moment. Like, this is so cool. How do they know how to pull from the trees and the plants and then give that for healing, right? Yeah.

And there, you know, I mean, it's so much even more powerful there because there wasn't really a big gap. Like, you know, these traditions and that knowledge has been handed down and down and down and down and codified in texts and whatnot. In this country, sadly, like, we have this, like, obsession with the new. I often think about, like, music, right? Like, we had vinyl records, and then we went to 8-track tapes, and then we went to cassette tapes, and then we went to CDs, and now we're in, like, you know,, you know, solid-state, like, you know, media. And like, every time there was a transition, we like got rid of the old one. No more CDs, no more vinyl records, whatever. And now then, now the vinyl records are back, right? So we did the same thing in medicine. It was like natural medicine was medicine. That's all we ever had for so long. Antibiotics only became useful, um, in the 1950s, right? It's not that long ago. But once they did, and then we started in with better living through chemistry, '60s and '70s in this country, All the natural medicine wisdom, all the institutions, all the texts gone. Forget about it. Whereas in India and in Europe, that didn't happen. They were like, oh, new stuff, cool. Let's, let's like, let's put the CDs on the shelf with the vinyl records and then let's put the, you know, you know what I mean? Like, and so here, and so I think we should all be grateful that like naturopathic medicine has come back, you know? Yeah, same. Yeah. Good choice.

Along with the vinyl records. Along with the vinyl records. Yeah. Have you seen over the years then, you know, As a result of the modern world and with your background, I'm sure a big part of your training is really about the body's filtration system in every aspect and always that the body needs to filter. Are you noticing differences in labs or inflammatory markers shift? We talked about the assaults from the modern world, but what about from things like stress? We know that the liver has so many different types of functions, but what else is happening?

It does. Yes. I mean, I mean, when in my training, like, senior mentor-style naturopathic doctors would often, even if a person had, you know, a non-liver disease, right, like maybe it was an autoimmune disease or whatever the case may be, they would often say things like this elusive thing that I didn't understand at the time, like treat the liver. I was like, treat the liver? Like, it's a skin problem, you know, or treat the liver, it's an immune problem. That's just weird, you know. Like, I didn't understand that. Now I understand that, that what they meant was that the liver is one of the, the old word— I love the old words— we talked about melancholy here, but there's a word called emunctories, which are like the waste management channels, right? And like the liver is one of them. The bowel is another. The skin is another. The lungs are another. And then the kidney, right? That's how we get the stuff out. Right. And the, those emunctories need to be clear, right? Like you, you, you, you, you can't like let the garbage pile up, right? Like the, the, the truck has to come. And if it stops coming because the garbage truck goes on strike, you're going to have problems. You know, it's going to seep in. And that's, I think to your question, what we're seeing. Yes, absolutely. Like this is ever more true now than it was when they were telling me treat the liver back then.

Absolutely. I had a feeling. What's interesting, what I notice if I'm coaching someone, when you've lived with any type of symptom for so long, you identify with it. You don't know what not normal is. And a lot of people don't actually know that those pathways could be compromised. Yeah, right. If it's sluggish liver, digestion, maybe they're not good sweaters. Yeah, right. Maybe, maybe there is accumulation in some aspect of that. They just don't know. So what should somebody do in terms of supporting with daily liver detoxification? What are you a fan of?

Yeah, no, you're so— you're so right. And I feel like I neglected to answer the question about stress too, because it is— it is absolutely important. It's like, you know, it's not a physical exposure in the way that like maybe alcohol or environmental chemicals or heavy metals are or something, but it's very much an exposure. Um, and it does actually really lead to a physical exposure because when you're stressed— I'm sure a lot of your listeners know about this already— is like your cortisol levels rise, and other hormones too, but cortisol is the prototypical stress hormone. And guess who clears the cortisol out? You know, guess who metabolizes the cortisol? Your liver, right? That, that's, that's, it's a major metabolic organ. And so the liver is very much responsible for the clearing out of not just cortisol, but all of our hormones. And so yeah, burdening it with all the kind of toxins that we're talking about in the food and the medications and all these environmental exposures, but cortisol fits into that pattern as well. Um, and so So yeah, it's critical. So that was the answer to the stress question. And then the second follow-up question was about—

Yeah, well, let's have her on the stress first. Yeah, yeah, yeah, sure. 'Cause I'm sure every single person listening, like, you know, we're laughing at, yeah, we all have stress. It's like, it's laughable these days, but the body takes toll. In Ayurveda, we say that all digestion completely halts when we try to eat under stress. It makes no sense. We should never do it. But when we think about the liver also, you probably studied just that, like, emotional connection also to the liver. And you mentioned clearing cortisol, but it's about so much more. So if you're not thinking about your liver every single day, but you're somebody who's waking up and you know you're in a season of elevated stress, or maybe you've been there consistently for some time, I guess the message I really want to hone in on is there's a potential to support your body with day-to-day practices throughout these seasons of life so that you don't have to get to the high acute inflammatory state. Yeah. So maybe we can add on in, like, how did Eastern medicine— or when you went to naturopathic school, how did they understand that the liver was part of this emotional component as well?

Yeah, I don't, I don't know how the old— you know, I've read a lot of the sort of naturopathic history books and whatnot, and I think it's interesting to see the evolution, right? Like, back in the day of Hippocrates, we didn't even know that the heart was a pump that pumped blood through the system, right? We didn't know, understand how, like, anatomy and physiology totally worked at that point. And at that point, they were working with what they called humors, right? You know, which was like this kind of like this, you know, they were really good observers at that time. There was black bile and they had phlegm and they had blood. And then in Eastern medicine, Chinese, you have Chinese medicine, you have like the five elements theory and then you have yin and yang and you have like kidney heat and, you know, and liver wind and all these kinds of things that are basically rooted in observation, right? Like Ayurveda has doshas, right? Where you see like the the body character and the personality characteristics and all the uniquenesses about different individuals and kind of classify them. So I think medicine— people who have been medical people, healers, have always observed, you know, and, uh, and then as science and like anatomy and dissection and physiology and biochemistry kind of evolved, I think we started to like maybe over-index in a way on all the scientific stuff and then use high-tech tools like laboratory work and X-rays and then CT scans CT scans and ultrasounds and MRIs to kind of do the observing for us. And I think that's one of the unfortunate realities of kind of modern-day Western medicine, is that the observing and the discussion and the classifications in those old systems— I'm not saying we should go back to humors, you know, um, but I think there is a place for that kind of, of, of observation. And I think it's what makes a really good diagnostician, actually. I agree.

Well, kind of goes back to that point too. I think we're living in a time— sure, a lot of your patients, they come in, they've got this checklist of all the things that they're doing for their health, and are still not feeling their best, right? All the time. And if we're not optimizing the body at just like that cellular level and supporting our organs, then we're missing so much of the picture. And today, you know, what are some of the biggest concerns that we're, that we're seeing, especially just trending? Hormone imbalance, you know, people being diagnosed with thyroid issues. Well, we have to remember that everything in the body is connected and we tend to silo everything, right?

You just reminded me, I just had this flash. Like, when I was in school, there was a, there was a class that I, that I loved, actually, and it was called, uh, psychoneuroimmunology. Yeah. Which was, which was, and there was even a textbook at the time. Psycho, right? Neuro, like the, the, the mind, brain. Neuro, the nervous system. And, uh, immunology and the connection between the immune system. And then I understood that, like, maybe a year later after I took that class, it was called called like psychoneuroimmunoendocrinology. So like adding on the like hormonal system. And then like you could add on psychoneuroimmunoendocrinogastroenterology, right? Like, and like, and then you could have this like the longest word ever.

Cardiology.

Yeah, exactly. Cardiology, dermatology, you know, added up like it goes orthopedics, even go on and on and on. And it's like, this is so funny. It's like, it's like conventional science, like evidence-based medicine's attempt to say what, what people like us have been saying all the time. Like, duh, like, it's all, like, it's all connected. Like, that's what we've been trying to say. Like, you know, yeah, so funny. So that was a good class though, by the way. I was—

it's good stuff. Yeah, that's hilarious. But again, it's just affirming what Eastern traditions have always known, right? That it's all connected.

Should this be so— should this be such a, such an aha moment or an epiphany that it's all connected? And of course also, and you can, I think, dig this too, it's not just all connected like in us. Like, it's all connected to like our families and our neighborhoods and all— and our pets and our everything, right? Like, we're— it's all connected, you know?

Um, yeah, I'm sure a lot of our listeners are wondering like, okay, Dr. Josh, on social I'm seeing liver teas, detox cleanses, this type of purge, this type of fast. Yeah, what works? What's too much? Where do we start? Should Do you always partner with a practitioner? What's the way to do it?

It's a great question. And like, I don't— I'm not like— I'm not good at marketing, right? Like, I don't want to be a pitchman, right? I make products that help people with these sorts of things. People can check those out. Do you need to see a practitioner all the time? No. But I don't think, you know, we're at a weird time, right? That like credentials don't equal credibility anymore. And that's okay in a sense. Like, you know, people— it used to be like, oh, you know, you're Ivy League trained, whatever. Like you have a certain amount of experience or you have these plaques on the wall and that's what— conferred credibility. Now it's like how many followers you have or whatever that like confers credibility. And that, that can be fine. Like, I'm not anti-influencers at all or social media. I think it's a great thing, but it's like buyer beware, right? So if I may, like the liver cleanse thing, this liver flush thing, can I talk about that for a second? So this has been going on forever, right? And I'm going to give you a real example from my own practice. So I had a person come in who had upper right quadrant pain, right upper quadrant pain. It turned out to be gallstones. We did an ultrasound, there's gallstones in there. And so this person wanted to do a cleanse, like one of these flushes. And many of your listeners have either maybe done these things or certainly heard about these things. And these flushes usually involve consuming large amounts of, oftentimes, some kind of juice like apple juice or lemon juice or something, a lot of olive oil, um, you know, some other ingredients in these kinds of cleanses. And then often followed by an Epsom salt magnesium sulfate flush. And you wind up pooping out these, these impressive stones, right? And so this person wanted to, wanted to do this, and we had, we had classified the gallstones on ultrasound. We knew how big they were, we knew how many they were. And so I was like, I don't like this plan because I'm worried that the gallstones could get stuck. And that, you know, if they, if they get stuck on the way out, you got a big medical problem. So anyway, I said, I will, I will give you not my blessing, but my— I'll, I'll let you do it. It if you let me ultrasound the gallbladder again afterwards. And so they did. And so they did the whole thing. And I saw these graphic pictures of these disgusting looking stones, of which there were many. They were very stone looking things coming out into the toilet. I don't need to see pictures, by the way. It's like, thanks.

Like, you're gonna tell me about it, like TMI, right?

But they were impressive. And then I was like, all right, well, another ultrasound. So we got another ultrasound and all the stones were still there in the gallbladder, just same size, same number. There was nothing had changed. So in that case, and in most of the cases, a lot of these kind of flushes and cleanses that people are doing are creating these impressive things that you purge out from what you, what you took, right? So like it was a combination of the oil and the acid hitting the acid environment in the stomach and then switching to an alkaline environment and getting mixed with bile. And it creates what's known as a saponification reaction. Saponification is the reaction they use to make soap. And so that, you know, you mix lye and other, other things, oil together, and it makes soap. And so those stones were soap. You turned your intestine into a soap-making factory, and then you pooped out all those soap stones, and you thought, I feel great, you know, I feel so cleansed, I got all that junk out of me. And it's like, well, not, not exactly, you know. So to your question, like, don't do that. Like, it's certainly— don't do that unless you're doing it under medical supervision. And what you should do, like, the liver is a solid organ, you don't need like a flush, it's not a pipe. You need to support it daily. And that means drinking an electrolyte drink with liver-supportive botanicals. I happen to have made one of those, by the way. Yeah, that's amazing. It's delicious. Yeah, it's delicious. It's called LTV. And that's a— you know, again, no pitch here, but that's, that's an example of what daily liver support looks like, right? Like a daily drink that has well-balanced marine-derived electrolytes and dandelion, milk thistle, which is really important, the amino acid taurine, which we didn't talk about, and schizandra berry, an Ayurvedic herbal medicine, um, that's really good for the liver. So that's one example. Example of a great way to just do the daily gentle support of one's liver. And then you can ramp it up from there. You know, I have other, other products as well that like are more, are more potent or designed for people who have more serious issues with their liver if they need, if they need that kind of support. So yeah, that's my answer.

So good. Your stories help so much. Yeah, just because you hear about these cleanses, I know they seem so appealing, and a lot of people have the tendency to want to go hard. They want to hardcore something where they're going to feel the impact and do a hard thing to themselves when it's just not necessary. You gave me a flashback to one of my teachers in nutrition school, the Canadian School of Natural Nutrition. She was very passionate about liver health, but she like made us put up our hand and swear that we would never just randomly prescribe that to anybody to do on their own because it can be too intense. And it's just like gut cleansing, right? You take out the good, the bad, and the ugly, but the good you take out also. And if you're stripping your system of the good, you've got to repopulate it with the good stuff.

Of course. And there may be like a time and a place place for a more aggressive protocol, right, on the natural medicine side. But when— but that's not— but with— when it comes to liver support, right, that may be true, like, if you have acute toxicity, right? Like, if you overdosed on Tylenol, which is the most common liver toxin, or if you ate an amanita mushroom by accident and your liver is toxic, or whatever, you know, had some kind of problem of that sort. And yeah, yes, you then need an aggressive intervention, right, to, to try to minimize the adverse effects of that. But we're talking about, like, chronic daily, you know, excessive exposures that accumulate over time. And those kinds of problems don't respond well to aggressive short-term solutions. You know, I think this is true in fitness, it's true in nutrition, it's true in sleep, it's true in so many of those fundamentals. It's just like, it's the daily grind, right? Like, it's just get, get it right most of the time, you know. Do it every day. I know you don't feel good today, still exercise. I know you, you know, you know, whatever. It applies to nutrition as well, you know. Just, just, just keep after it, right? And that, that's how I approach liver health as well.

So what's like a daily, you know, top 3 or top 5 to support the liver?

I think the first thing is to attempt to minimize the exposures, right? Like always, that's for sure the first thing. It's like, oh, my liver is toxic. Well, like, you know, it's sort of like, you know, that old joke, like, Doc, it hurts when I do this, and the answer is don't do that. Stop doing that. That's the first thing, right? Like, and there's so many exposures, and I think people You know, all, all these eco people, people used to tease me, why do you use that toothpaste? Why do you use that, you know, these kind of, that kind of soap, that kind of— well, this is why, because it is, is my attempt for me and for my family and my household to minimize my exposures. That's, that's actually more important than anything else.

Yeah, it's not always about adding more, it's about taking away.

Absolutely right. If you're doing something like you're poking yourself, you know, that's the, that's the first thing to do. So that's like a far and away number one and maybe even like bleeds into number two as well. And then the, the next part would be like consider liver support. And that is, I mentioned a bunch of those things already, like the amino acid taurine, making sure that you're getting enough hydration, especially with electrolytes, really important for liver health. And taurine, interesting amino acid, helps your liver hold on to the hydration, right? A lot of people drink and then their blood volume goes up. And then they pee it out and they don't get cellular hydration. And taurine is one of the things that helps with that. And then I think that like there is room now and it's— this is actually a weird thing, right? Like I'm a person who owns a nutritional supplement company, right? Like I— and we produce products that I, that I formulate and I feel really good about them and I wish people didn't need them. Like I, like it's actually true. Like it's like, it's a bummer that people should take this product that I made every day. Like, you know, like, I wish that it was clean. I wish the world was clean and like we didn't need to like hydrate with electrolytes that were infused with liver-supportive botanicals. Like, that would be the best, but I get it, we don't. Like, it's, you know, the food that we eat, the water that we drink, the air that we breathe, the products in our homes and on our bodies and in our environment are putting an extra burden on our liver. So we are— we have arrived at a point where daily liver support is basically not optional. And And so, you know, and so now if you're going to support your liver, sure, like, look at my— look at my products. I would love that. But I would love it even more if we didn't— if we didn't need them, honestly. Yeah, you know, I'm with you.

Yeah. Milk thistle tea, do you think it's enough as a tea, or does it have to be an extract? That's a good question.

It's— I don't— I don't think it's enough as a tea. The active component of milk thistle, right, it's a plant, it's a beautiful plant, by the way, prickly white veins on those leaves and beautiful purple flowers. It's the seed that's the active part, and the seed is tough, you know, it's a seed, um, very woody. And so it needs to extracted with something that's beyond just water. I mean, milk thistle tea is fine, but the water extraction in the form of a tea— and this is of note, you probably know this, but maybe your listeners don't— tea, the first thing is tea is, is a plant, Camellia sinensis. What you're actually talking about is called an infusion, which is like taking a medicinal plant and pouring hot water over it, and that can pull some of the active compounds out of it. Then you can do this other thing called a decoction, which I'm sure you've heard of, which is like taking more woody plant material like bark and roots and stuff and boiling it in there. And that's very common in Ayurvedic medicine, Chinese medicine. So at the very least, if you're going to use milk thistle seed whole, you would want to decoct it. That is to say, boil it so that you have a more potent extraction. But the milk thistle that we use in supplements is extracted usually with alcohol, and that pulls even more of the silymarin, which is the active compound in milk thistle, out so that we can then concentrate it and put it in a product that, that can really help people. That's the way That's what the research points to.

So good. Yeah. And I love your honesty too. Yeah. With supplements, you know, I just want to hover again on the fact that when you support the function of your body itself, your need for all the extra supplements that you might be taking may go away. And I do want to hover on your specific supplement because I look at supplements every single day. Brands approach me all the time. You know that I emailed your brand and I'm like, tell me about the background, the heavy metal testing, where the ingredients come from. And you guys sent me full reports of everything for me to go through. I was so impressed. Yeah, I was smiling ear to ear. But then when I got your liver support formula— can you tell us about the inspiration for this? And maybe for listeners, um, so it's called Ultra Liver. The ingredients that they have aren't in a singular form, and what I so appreciate is the synergy that happens between these ingredients to support the liver with detoxification. Yeah. So not only do you have taurine, the milk thistle, berberine, um, N-acetyl-L-glutathione, like I was like, come on, that's great! I don't think I've ever seen that— dandelion, reishi, and schisandra berry, which I absolutely love together. It's a great formula.

Yeah, what was it inspired by? It was inspired by basically exactly the conversation that we just had, you know. Created this formula several years ago knowing that the liver was this sort of core organ, right, that really needed support. And a lot of the formulas out there were, like you said, kind of just like either low-quality ingredients, potent, not the right synergy. And like, in terms of synergy, it's interesting, you know, the— I get this question a lot. Like, we want to follow the evidence, right? So the ingredients in there all have on their own a lot of evidence for very supporting various aspects of liver health, right? TMG and acetylcysteine, acetyl glutathione, like you mentioned, milk thistle seed, all these other ingredients. And so that's great. And like, I'm well acquainted with all of that research. And then there's always this big question about like, what about all of it together? And I think about it like this, like The formula is derived from my own experience in clinical practice, seeing what works. Often using tinctures in combinations is the way that it's used in traditional herbal medicine, and then putting it in a delivery system that just works for people. That's like a manageable cost at good quality and can hit all of the targets that we're looking for. You know, we could get way deep in the weeds on like all the nuances of liver health and why each one of those ingredients was— I selected each one, but I think about about it like more art— in an artistic way, which is to say that like, it's like an orchestra or a band or something, right? Like where there's like a harmony, like a symphony, right? That is much greater than the sum of its parts. Like an individual instrument, like a violin or an oboe or whatever it is in a symphony orchestra, it just does that one thing. But when you put it together with all the rest, it's like this magic that happens. And that's what synergy is. And that's what ultra liver is. And that's why I think it works so well for people. Right. And it's such a pleasure. I got to tell you, like, it's so gratifying to create a product and then hear from people that the product helped them. It's just like an— it's like, it's like a— it's amazing to me, you know, to put it out there, to know that out there online, someone's going to see, you know, a promotion or an offer, me often in a video because I do a lot of those kind of videos. And then not ever have heard of UltraLiver or any of the other products that I've created, and, and, and, and then be convinced that it's something they should try, and then to hear back from them a month later that it helped them in a meaningful way. Like, you know, it's like good stuff.

Yeah. Well, even as a practitioner, and this is why, like, I was so grateful to tell you my love for this, um, because I'm often trying to put ingredients together, and then all of a sudden it's, you know, 5 or 10 capsules, which I never want for my client either. So I'm grateful for that.

And supplements are, you know, they're They're, they're a tool in the toolbox, right? And like, and certainly not the only one. I'm very big on food. I'm very big on movement. I'm very big on sort of mind-body medicine and all the other things that we need to do. But I also do find that supplements are, they fit into the model for a lot of people's lives. They're easy, right? Like it's simple to do, whether it's Ultra Liver like that or the other one we were talking about earlier with the electrolytes, it's called LTV, a simple, really delicious like daily drink. And I think for a lot of people it's like a a great entry point into getting some results fairly quickly because a lot of this other stuff we're talking about, like, we have to remember a lot of these people don't feel good, right? Like, they don't feel good, and that includes their motivation. And so it's really nice— like, we were talking earlier about, like, giving— restoring faith in their body to heal. And, like, you have to give people, like, a little bit of a win, just a little win, you know? And I find that supplements are really good at that, you know, well-crafted supplement can give someone a win and they wake up and they're like, whoa, I'm like better, you know? And then they're inspired to like do the next thing and eat better and, you know, and maybe they even get to a point where like they can handle it without the extra support from an encapsulated product, you know, or something like that. So that's, that's, that's how I think about it.

So good. With hormone imbalance and hormones being, you know, all the hype right now. Yeah. I think that there's a time and a place for HRT. I think it's saving a lot of women, but I think a lot of doctors are also rushing to HRT without looking at how the body's functioning. Talk to us about the liver hormone access.

Yeah, you're right. I think there's a place for it too, for sure. It's been interesting being in medicine this long, like the pendulum swung, right? So when I was in the early 2000s, it was like the pendulum swung away from HRT. It was like, this stuff is dangerous, it's causing cancer and heart disease and da da da da. Like, no one should be on this anymore. Everyone stopped cold turkey all the HRT, and then now we came back and like, maybe we like over-indexed on the dangers, maybe not so bad. But so I— yes, there's a time and a place with respect to hormones, right? Like the liver is a metabolic factory, right? It's a processing organ and it processes hormones, detoxifies them. People don't think of hormones as a toxin, and they're not necessarily, but they do need to be metabolized, right? So they don't necessarily need to be detoxified, but they do need to get handled, right? Like processed. Repackaged, certain portions of them excreted, certain portions of them recycled. And that all that processing happens in the liver. And so yet another reason where if— and I don't have a lot of data, I don't think there is very much to support this contention, but that like when the liver is well supported and optimally functioning in that hormonal processing realm, the expectation would be that menopausal or perimenopausal symptoms would be better because it would ease, help ease that transition, you know. So that's the time in there.

Yeah, that's great. Yeah, I think it's just a conversation that needs to be had, especially for people. I just, I see the frustration. People, they start HRT and they were expecting the sun, moon, and the stars, and then they didn't necessarily get the payoff. Well, we've got to do some deeper investigation. Yeah. And I just hope that that was more part of the conversation around gut health and liver health as well, so that you understand if your body's actually doing what it needs to do to be able to take advantage of Yeah. When we— oh, I'm sure something I wrote down is lemon. I'm sure all of our listeners, what about lemon water? Lemon water every day.

Yeah, it's good. I mean, I'm a fan.

Like, everyone thinks it's an Ayurvedic practice, but there's no lemons in India.

Yeah. So yeah, the lemons seem like they come from— yeah, I, uh, I see a lot of them in Italy. I don't know where the— I don't know where the lemon comes from, you know, um, where its original origin is. But, um, I mean, look, lemon water, it's great. Like, it's a good thing to do. I'm happy for people to do it. I wouldn't expect that it's gonna do— you know, there's a little bit of citric acid there. There's some vitamin C there, so there's some minerals in there. I don't think lemon water is some kind of panacea. You know, one thing that's kind of interesting that might, might be worth noting and maybe relevant for some people— the best thing that lemon water is probably good at is preventing kidney stones because of the citric acid. Citric acid helps to keep calcium and oxalate, which are what come together and form the most common type of kidney stone. So like, of all the things that lemon water is touted to do— detoxification, clear your skin, improve your gut, or whatever— I think it's fine to do. It's not something that that I routinely, like, recommend unless a person is kidney stone prone, in which case I will recommend it. Yeah, it can be supportive.

Yeah. Um, but like so many things, you know, variety and diversity.

I wouldn't bet the ranch on lemon water for most, for most people.

Yeah, yeah, I'm with you. Yeah. Um, can we talk about bowel movements for a second?

Poop is one of my favorite subjects. Yeah, let's do it.

I was gonna say, you and I probably talk about poop every day.

Yeah, yeah, dinner table conversation, much to my kids' and probably your kids' dismay. Are you serious right now? I'm trying to eat dinner.

So let's make the connection between what we're seeing in our elimination. Yeah. With, uh, with liver or liver function. Yeah. And bile.

I mean, they're directly related, right? Like the liver, we talked about it as like a detoxification organ and a processing plant, and, and it is all of those things. But, um, I think primarily like it's a digestive organ, right? The, the way it works in health is that the liver makes bile. That bile gets trickled down into the gallbladder. It sits there and gets concentrated, and it waits until the stomach sends a message called CCK, which stands for cholecystokinin. You eat fat or oil, or even a little bit, the stomach produces CCK. That CCK goes to the gallbladder and tells the gallbladder there's fat coming down the line. The gallbladder then goes, and it squirts the bile out through the bile duct, in through this little hole that's called the sphincter of Oddi. Which is pretty fun. And, uh, and that bile then coats the food that just left from the stomach in the small intestine, and it emulsifies the fat so that the fat can be broken down into component parts and, and digested and absorbed, right? Hopefully those are good fats that you can, you know, nourish yourself with. Um, and then that— but so interestingly, and many people don't know this, the bile has kind of like a yellowy-orange color, and it matures as it goes on down the line inside your intestine. And by the time that it comes out, usually around a day later, it's brown. And it is responsible for the color of the stool, right? So that, that's why normal poop is a normal brown color. If, if the waste went through you too quickly, you might see a different color, you know, lighter color. If the bile is obstructed because there was a stone blocking or the liver wasn't producing it for whatever reason, the bio— the, the poop color would be light. And in fact, if you have a pale gray stool, that's very problematic, you know, and that's something that needs to be evaluated. So that's just one example of like— and the main one— of how the liver and the digestive tract are— well, it's part of it. Yeah.

Oh God. Yeah, thanks for going there. Yeah, it's so funny, a lot of people— what's trending right now is becoming the CEO of your own health. And, um, a lot of people are just talking came out through external ways or testing or whatever it is. Yeah. Look at your poop. Yeah. Look at your poop. Look at your eyes. Look at your urine. Look at how you're excreting so that you understand what you need to do. What are you seeing?

I'm just— this is like I'm flipping the tables a little bit because I'm just curious from you. You're supposed to be asking me questions, I suppose, but about GLP-1s, because it's like that's the conversation that's happening now. And I just like, I'm curious, like what you're seeing in your world, because this is this natural medicine world that we live in. And like those drugs have come on the scene and they've really been a game changer in a lot of ways. So I'm just— yeah, I'd love to talk about that a little bit.

Yeah, let's talk about that. So I've had a handful of people, or I have a handful of people who are taking GLP-1. There was one woman specifically, I'm going to think about her. She's had weight issues her entire life, rheumatoid arthritis. She's done every diet with consistency and just has never been able to lose a pound. Yeah, common story. Common story. Started GLP-1, magic for her. She got her quality of life back. The food noise completely went away.

They're amazing that way.

However, she'd gotten so used to not eating that she was becoming malnutrition. So we were becoming so strategic with how she was intaking calories. And she had a really great doctor though, who was like really monitoring her dosing when she was feeling better. She was going in for consistent checkups and stuff like that. Another person who's gone on it has complete body dysmorphia. There's no number on the scale that's going to matter. No pants size is going to matter. She still sees herself as this overweight girl.

And so then it's frustrating. Frustrating.

Yeah. But then I have somebody else who has a family history of Alzheimer's and diabetes and Parkinson's, right? And her HbA1c is constantly like up towards 5.7, 5.6. And for her, it's been a game changer. And so when I look at the lens of prevention and longevity and disease prevention, right? Yeah. Then I think it's magic. Yeah. Yeah. So I guess along— and this is where you would come in— finding a doctor that I can partner with to really keep a close eye on these on these, uh, clients. Yeah, to see how it's working for them.

It is an interesting time for us, right? Like, it's, it's kind of like maybe cognitive dissonance, right? Like trying to hold two truths at the same time, because there's like some, some, some changes that are happening that are so positive that these— for these people that have never been able to achieve these kinds of results before, and will very much correlate with improvements or decreases in risk of all kinds of badness coming down, coming down the line. That's great. Um, but then there's also, yes, the lean muscle problems. There's liver— there's interesting liver stuff too, actually, which is that I don't know if you know this, maybe you do, but like when, when you lose weight rapidly, whether it's on a, on a medication or not, however you do it, those, that fat gets mobilized off of your body, right into your bloodstream. And guess where it goes? It goes to your liver. Your liver has to process that fat. And here, here's a fun fact. Most people have no idea about this. Like when you lose weight, however much it is, like 5 pounds, 50 pounds, whatever, I always like ponder this question or ask people the question, like, where'd it go? Like, where, where are those pounds now? And most people think that it's, that it was heat, that it went off as heat, or they pooped it out, or they peed it out, or sweated it out or something. None of those are true. You can't turn mass weight into energy heat. That's not how it works. That, that would like violate a fundamental like rule of thermodynamics. What actually happened is the fat went to your liver for processing. It got broken down, ultimately converted into carbon dioxide, and your lungs were the exhaust pipe. So when person loses 50 pounds on a GLP-1, they literally breathe breathed it out, which is amazing, right? And at the same time, that fat was a storehouse for toxins, right? Like, which is— we've been talking about toxins this whole time. Like, people lose weight on a GLP-1 or otherwise, and the fat mobilizes, and the toxins that were stored in that fat also go to the liver. So it's an interesting phenomenon we're seeing now, is that a lot of people who are losing weight quickly— and there's many who are doing this on these drugs— their liver function tests go up when they lose weight for a while. Yeah, right. 6 months, 9 months, a year, only to come down. And so I think that's actually especially important for people on that journey. And congratulations if it's working for you, but those people should really pay attention to their liver also.

That is such a great call out. Yeah. What are your thoughts on glutathione?

I mean, I love this stuff, right? We all need more of it. Yeah.

So again, studies. Yeah. So I'm thinking, so that's a good takeaway. If you're on a GLP-1 or considering a GLP-1, monitor your liver, work with a practitioner, make sure it's the right option for you for longevity. Yeah.

And don't freak out either, because it's quite possible. I think it's 30-ish percent of people who will lose weight on a GLP-1 or lose weight quickly in any way, we'll see their liver function test transiently elevate. Don't freak out, it'll probably come back down. But support your liver, and, um, you know, I can talk to you about how you might want to do that. But yeah, that's a really important thing. I'm glad we covered that. Yeah, I'm sorry if you brought that up.

Thank you. So glutathione, yeah, trending, super. Yeah, liposomal capsule, spray. Do you prescribe one or the other?

Yeah, yeah. I mean, glutathione is super important in the liver and in the it's like a powerful master antioxidant that it's called. It's really responsible for a lot of the detoxification pathways that we've been— that we've been talking about. It gets depleted when the liver is overwhelmed, right? So the classic case of this is acetaminophen, which is Tylenol, toxicity. Tragically, yeah, so many people overdose on Tylenol, some on purpose and many by accident. And what that does, just as an example, example, is it causes the liver to use that glutathione to, to burn through the Tylenol. It helps detoxify it. And then if, if the dose is overwhelming, you'll run out of glutathione. And so, and I'm getting to my answer here, what people— what emergency room doctors do in the case of acute acetaminophen poisoning is they don't give glutathione at all. Not liposomal, not spray, not pills. They give N-acetylcysteine, NAC, and they give it IV in that, in that, in emergency rooms. NAC is an interesting substance that way. Used as a dietary supplement, but it's also a drug used in emergency rooms every day. And when you give NAC intravenously, it will dramatically and significantly increase the glutathione levels in the liver and save people's lives from acute Tylenol poisoning and other types of toxicity. So my first choice to your question about how to boost glutathione levels is with NAC, N-acetylcysteine. Yeah, rather than glutathione itself, actually. I'm so happy you said that.

Yes. Yeah, NAC is one of my favorite supplements. So let's just call out, just as a benefit for people who might be seeing that ALT/AST elevation, or somebody who is on a GLP, what would be your, you know, few recommendations for them? What's the approach?

Yeah, so the first thing is like you got to figure out why that's happening, right? Like don't, don't be irresponsible about it and make sure that you're seeing some qualified healthcare practitioner to like at least have a handle on what is the reason for this, this elevation. Because it could be an infection, it could be a toxic thing, it could be an autoimmune thing, it could be— and it probably is for most people fatty liver, right? The accumulation of fat, the marbling of fat in the liver, which is causing the damage and making those cells break open. But you got to figure out what it is. Why are the liver function tests elevated? Once we've established that, then it comes to the question of like, all right, well, do, do whatever it is you need to do to treat that. And if we're talking about that marbling, that fatty liver— nonalcoholic fatty liver disease is what it used to be called. It just changed the name to metabolic associated liver dysfunction, MAFLD. ASLD, is— well, I mean, I'm going to sound like a, like a, like a tired old horse here, right? Like, support your liver again, right? You got to support your liver. And this again involves minimizing the potential exposures. And if you're overweight, losing weight is a big, big part of that equation. Minimizing any exposures like alcohol or environmental toxins in your food or in your, you know, life and work environment, personal care products. And then consider the use of these things like we're talking about— N-acetylcysteine, trimethylglycine, glycine, taurine, milk thistle. The list goes on and on. Reishi, dandelion root, schizandra. Everything we talked today.

Yeah, this is great. We have covered a fraction of everything that you educate on. You're a phenomenal educator. Thank you. I'd love to have you back.

I'll come back to Japan anytime. Anytime. Yeah.

How do you like to connect with your audience?

Um, well, you have so many great YouTube videos. Yeah, totally. I have all those things. It's so funny. I'm like a reluctant spokesperson in that way. I never— when I was in medical school, I I never would've thought that here I am on Instagram, right? So, um, I'm on Instagram and I love connecting with people there. Um, respond to all the questions and comments there. That's @drjosch, D-R-Josh Levitt, J-O-S-H L-E-V-I-T-T on Instagram, also on TikTok. And then my company is called Up Wellness where I, and I'm the co-founder and medical director there and I'm the responsible for the creation of these formulas. I'm the main spokesperson there and that is upwellness.com. Yeah. All good places to check out. I got my stuff.

You have phenomenal products. I took all your products to a retreat this past weekend and everyone loved the electrolyte sticks. So yeah, yeah, you talked about it. I'm really proud of that one. Yeah, it's great. It's a great product. All right, to wrap things up, um, tell us about something that you're most excited about in the future of health and wellness.

Oh gosh, um, you know, that fire that got lit back in Switzerland when I needed antibiotics that day is still burning sort of hotter than ever, and I I think, you know, in health and wellness just generally, I'm excited because I think the trajectory of natural medicine is just continuing to rise. Like, when I got into it, it was like this kind of like, you know, kind of niche, obscure, alternative thing. My parents were like, oh, like, is this— are you sure? You know? Um, and now it's like, look, like, look at this. This is like amazing. There's podcasts about it. There's like institutions built around it. And so I'm just excited to watch where that goes. I'm also really grateful to see the conventional traditional medicine and alternative medicine, whatever you want to call it, are getting closer together. I feel like that's part of my work. And then on my own level, like, I, I, I love the conversational part of things, right? So I'm, um, very excited to just continue the conversations with people like yourself and everybody out there in the healing world, because I think there's so many different things that are medicine, right? And, um, and I want to just keep shining lights on those. I consider myself a lamplighter in that, in that way.

You absolutely are. Let's bridge the gap. Yeah, totally. Love on your liver, support your energy, your clarity, your hormones, your detoxification, your mood, and your vitality.

It'll support you back. You got it.

Yeah, thanks for being here today. Yeah.