At the very end of class on Tuesday 10/24 Rich mentioned that when a client has trouble taking normal doses of herbs or supplements without having a reaction, he often suspects that poor liver function may be playing a role and he assesses for that. I would like to know what specifically he would recommend using to asses for liver function? Tongue diagnosis and other liver patterns we learned in TCM from Andrew? Anything else specifically? My understanding is that liver enzymes are often not useful as they can appear "normal" despite signs of stress to the liver. Thank you!

Rich said: Thanks for the question. That is correct, that this is not related to liver enzyme levels. This isn't a question of liver damage or liver disease in any way. A bit oversimplifying, liver enzymatic activity mainly is part of Phase I liver metabolism. What we're mostly referring to here is poor Phase II liver metabolism. Phase I activity actually creates a toxic load - free radicals and with that oxidative stress, and some of the metabolites created have toxicity. You can think of Phase II as the "clean up crew" stage - strong antioxidant activity and conjugation of metabolites to then excrete through the bile. So - labs are not the main thing imo to indicate this. One additional clinical question / clue is if someone is very sensitive to perfumes, cleaners, detergents, etc. This to me is usually enough evidence that the person needs support in the form of NAC, liposomal glutathione or another bioavailable form, milk thistle...turmeric can also be helpful. Also bumping up antioxidants. Most digestive bitters act more on Phase I than Phase II. In Chinese medicine terms, you sometimes might see a Liver Qi stagnation or blockage, and can look for signs of that. I hope that helps!

Yes, that is helpful. Thanks!