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Abby's Magazine - Volume 5 Issue 2| Page 69 Health problems can also occur if the nutrients that the liver needs to process toxins or excesses are in limited supply. Like a sewage treatment plant that is short staffed, if these nutrients are in short supply, the liver cannot process as quickly or as thoroughly as needed. If the liver becomes overburdened because of insufficient nutrients, the toxins or waste build up and the excess can escape back into the body, leading to serious health concerns. Hormone Metabolism The liver plays a vital role in the body's use of hormones, both those that are produced naturally in our bodies as well as those hormones that are "introduced" via hormone therapies. It acts as a hormone processor, manufacturing and/or regulating some hormone levels, and directing various hormones to perform their proper function in other parts of the body. But when the body experiences a hormone excess (whether produced by the body or introduced by hormone therapy), the liver may not be able to process the hormone(s) as quickly or efficiently, causing a hormone imbalance. Estrogen Hormones Of primary concern for women's health is the liver's role in regulating the sex hormones, primarily the estrogen hormones. This is a consideration for women undergoing hormone therapy, whether it is conventional hormone replacement therapy (HRT), typically consisting of synthetic hormones that are not biologically identical to human hormones, or a biologically-identical hormone therapy (BHT). Researchers are gaining new insight into how estrogens are metabolized and the effects of that metabolism. They found that estrogens break down into estrogen metabolites that have varying levels of estrogenic activity, and that the stronger the estrogenic effect, the greater the risk of developing estrogen related cancer. Phase I and Phase II Pathways The liver metabolizes hormones and other substances using two primary phases known as the Phase I and Phase II pathways. During Phase I, some hormones or substances are metabolized directly, but often they are converted into intermediate forms, which are then further metabolized in Phase II. Cumulatively, these two phases of biological transformation are how the liver provides the body with nutrients and supports the excretion of excess or toxic substances in the urine, liver bile, perspiration and exhaled air. The pathways depend on a large number of nutrients, including enzymes and amino acids, and their availability (or lack thereof) seems to have a significant influence on the metabolic outcome. For example, the Phase I pathway is the main metabolic pathway for the estrogen hormones. In premenopausal women, the ovaries produce estrogen, primarily estradiol, most of which the body converts to estrone, and eventually estriol. The liver then metabolizes the remaining estradiol and the converted estrone, breaking it down further, and excreting the excess from the body. Some researchers and practitioners now believe that the liver's ability to metabolize estrone is the key to understanding estrogen-related cancer risk. During Phase I metabolism, estrone is converted into various metabolites including 2-hydroxyestrone, a very weak estrogen, and 16-alphahydroxyestrone, a very potent estrogen. If the conversion process favors the stronger form(s) rather than