Liver Health 101: What you need to know | Biowell Health

By Cérine Cherkaoui: Head Dietitian & Clinic Director at The Liver Clinic

Ask someone how they’d know if their heart was struggling, and most people can name a few signs straight away. Ask the same about the liver, and most people go quiet. That’s not because liver disease is any less serious, it’s because it’s largely silent. It doesn’t behave like diabetes or heart disease, where routine bloods can flag a problem early. With the liver, blood tests often don’t move outside the “normal” range until real damage has already been done. What actually picks up steatosis (fatty liver) or fibrosis (scarring) while it’s still early and reversible is a liver scan, a FibroScan, not a blood test.

That’s the whole reason we’re focusing on liver health right now: you shouldn’t have to wait for something to go wrong before you start looking after it.Here’s the good news hiding in all of this though. Your liver is one of the only organs in the body that can properly regenerate itself. Look after it, and damage like fatty build-up or early scarring can genuinely reverse itself. That window closes once scarring becomes extensive and permanent, a stage known as cirrhosis, so the earlier you catch a problem, the more of it you can undo.

The catch is that it has no pain receptors, so most people never get the obvious warning sign that would push them to act sooner. What you get instead tends to be vague and easy to mistake for something else entirely: brain fog, persistent tiredness, waking in the middle of the night, digestive issues, or generally higher inflammation in the body. None of these point straight to the liver on their own, which is exactly why they get missed.

In the longevity world especially, so many people are leaning on supplementation to cope with day-to-day life, work stress, poor sleep, all of it, and ashwagandha sits on that list for a huge number of my clients. It’s become one of the most popular “natural” additions to people’s routines, and it’s not a bad supplement. But it puts a demand on the liver that most people taking it have no idea about, and I think that’s worth explaining properly.

What Your Liver Actually Does All Day

In short, your liver filters, converts, stores and cleans up after almost everything else your body does:

Filters your blood, clearing out toxins, alcohol, medication and waste products.
Turns food into usable energy, storing glucose, iron and vitamins for later.
Makes bile, which you need to digest fat.
Produces the proteins responsible for blood clotting.
Clears excess hormones once they’ve done their job, and produces the proteins that keep your stress and sex hormones in balance, including the one that binds and regulates your circulating testosterone and oestrogen.

Because so much runs through it, it’s easy to overload without realising. Alcohol is the obvious one, but so is a diet heavy in sugar and ultra-processed food, which over time can lead to a fatty liver, carrying extra weight, taking several medications together, or assuming “natural” automatically means “liver-friendly. ” And this isn’t rare: as many as 1 in 3 adults in the UK are thought to have some degree of what’s now called MAFLD (metabolic-associated fatty liver disease, previously known as non-alcoholic fatty liver disease), and most have no idea. It’s rarely one big thing. It’s usually a stack of small habits nobody’s questioned.

The “More Must Be Better” Trap

This is something I see constantly in clinic, particularly with clients in the UK and the US who are into longevity or preventative health. There’s a real belief that piling on more supplements means staying more on top of your health. I’ve had people walk in taking close to forty different supplements a day, and from the outside, most look genuinely well. It’s usually not until we go through their lifestyle, sleep and mental health properly that a pattern shows up: an awful lot of them are carrying a huge amount of stress.

Stress on the liver is a real double-edged sword. It raises cortisol, which pushes your liver to release more glucose and blunts your insulin response, which disrupts sleep, which raises cortisol again. The liver sits right in the middle of that loop, quietly absorbing the impact even before anything shows up on paper. A study tracking over 170,000 adults found that people with higher perceived stress had a meaningfully greater likelihood of fatty liver disease, independent of other factors, and researchers have since mapped out a biological pathway for why: chronic stress and elevated cortisol drive fat to accumulate in the liver directly, not just through the worse habits stress tends to bring with it.

In Traditional Chinese Medicine, each organ is traditionally linked to an emotion, and the liver’s is anger. The pattern is familiar: people are so busy holding everything together that they never get the space to process frustration, so it just gets held.

The Ashwagandha Question

This is exactly where ashwagandha tends to come in. People reach for it because it can alleviate stress, and there’s decent research behind it for lowering cortisol and easing stress and poor sleep.

What doesn’t get said enough is how many products it’s quietly in. Ashwagandha turns up in stress gummies, sleep blends, multivitamins and pre-workouts alike, so plenty of people are taking it from two or three sources at once without realising they’re stacking doses at all. Once inside the body, its active compounds (withanolides) are broken down by the liver, and in asubset of people this seems to trigger an immune-mediated reaction rather than a simple dose response, which is why injury has turned up even at completely standard, label-recommended amounts. A growing number of clinical case reports now link ashwagandha to liver injury, serious enough to need hospital treatment.. The risk does appear to climb the longer someone takes it continuously without a break, and I regularly see clients turn up for a FibroScan on the higher end of the fibrosis scale with no idea ashwagandha, taken continuously across several products, may have played a part.

That’s really why cycling matters. What I usually recommend is taking it for about three months, then stopping for a proper break before starting again, rather than using it continuously and indefinitely.

What Else Puts Your Liver Under Pressure

A few other supplements and medications worth knowing about:

Garcinia cambogia, common in fat-burning supplements, has been tied to liver inflammation and fibrosis
Antidepressants and Antibiotics
Statins
HRT
High-dose vitamin A or niacin can build up to harmful levels well above what you’d get from food or a standard multivitamin

Supplements aren’t regulated the way medicines are, so quality and potency vary considerably between brands, which is exactly why I only recommend sourcing them from somewhere you trust. It’s also why I would recommend de-liver-ance if you’re looking for liver support.

It Doesn’t Work Alone

Your liver isn’t operating in isolation, it’s in constant conversation with the rest of your body, especially your gut. The gut-liver axis is a genuinely close relationship: what happens in your gut microbiome directly influences liver inflammation and fat storage, and vice versa. Left untreated, fatty liver doesn’t stay a liver problem either, it’s one of the strongest predictors we have for going on to develop type 2 diabetes, heart disease and stroke, together known as metabolic syndrome. Looking after your liver is, in a very real sense, looking after nearly everything else too.

The Whole-Lifestyle Combo

If there’s one thing I’d want you to take from this, it’s that liver health was never meant to be tackled one habit at a time. You can’t fix your diet and ignore everything else, or exercise hard and eat terribly, and expect your liver to thank you for it.In my own recommendations, that combination usually looks like: regular movement (a 30-minute walk most days puts very little strain on the body and counts for more than people think, though moderate exercise is ideal, virtually any kind adds up), decent sleep hygiene, and actively managing stress and anger rather than sitting on it, through meditation, grounding practices, or simply protecting time for whatever genuinely connects you to yourself. Add proper hydration, cutting back on additives and artificial sweeteners your body doesn’t really recognise, and alongside all of that, a liver-support supplement such as de-liver-ance, and you’ve got the full picture: not a single fix, but a lifestyle that adds up.

Further Insights: It’s Not Just What You Swallow

What you breathe in and put on your skin matters too, household cleaning products, air fresheners, fragranced personal care items and certain cosmetics all carry chemicals absorbed through the lungs and skin, and your liver still has to process them.

Microplastics deserve a mention as well. A 2024 study in Nature Medicine found microplastics accumulating in human brain tissue at higher concentrations than in the liver or kidneys, rising sharply between 2016 and 2024, with separate research showing they trigger oxidative stressdirectly in liver cells. We can’t avoid them entirely, but cutting back on plastic food storage,bottled water and heavily packaged food all reduce your daily load.

Get Checked, Don’t Just Guess

If you’ve been on ashwagandha or anything else long-term, drink regularly, carry extra weight, or can’t remember the last time anyone checked your liver, it’s worth getting a baseline.

Remember, blood tests alone won’t reliably catch this early, but a FibroScan will.

The Bottom Line

Your liver does an enormous amount of quiet work, and it’s one of the few organs built to bounce back if you give it the chance. Ashwagandha can absolutely be useful for stress and sleep, but like anything active, it deserves informed, moderate use rather than indefinite use on autopilot. Stay a bit curious about what you’re asking your liver to process, whether that’s a supplement, a habit, or a glass of wine, and treat it as one part of a whole lifestyle rather than a box to tick on its own. If it’s been a while since you checked in on yours, book a FibroScan at our Liver Scan Day at Biowell Health and find out where you actually stand.