Liver Fatigue in Individuals Living with Adrenal Fatigue

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Dorine Lam, RDN, MS, MPH

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The Real Question

The clinically important question when dealing with AFS sufferers in advanced stages is not about whether the liver is involved but more about the degree of congestion and the level of reserve remaining in the liver for normal function. Bear in mind that even at this point, no gross pathological signs of hepatic cell injury are apparent therefore the concept of liver fatigue evades the conventional medical world and is merely passed over as insignificant with no action required. This may work well for those who are constitutionally strong.

Those who have prior liver injury such as hepatitis, poor lifestyle habits such as a history of excessive alcohol use, or a weak constitution tend to do worse.

Unfortunately, routine liver function tests will be unremarkable, and liver congestion is usually ignored as a contributing factor to fatigue, while AFS progresses.

Even among alternative health care practitioners, the usual focus with the patient is on generating energy when faced with fatigue as the chief complaint. This usually leads to the use of energy stimulating herbs and adaptogens such as ashwagandha, rhodiola, maca root, green tea, as well as glandular. Without a healthy liver to break down these compounds, work load of an already over burdened liver only increases, resulting in further congestion. It comes as no surprise that with chronic use of herbs, hormones, medications and glandular in the AFS setting, the risk of liver congestion increases.

General Liver Decongestion Approaches For Liver Fatigue

Recovery from liver fatigue involves sticking to a pathA comprehensive adrenal fatigue recovery plan for those in advanced stages of AFS should therefore consider liver optimization as an important component. A detailed history is required as a starting point. However, depending on the level of liver fatigue and congestion already suffered, recovery is easier said than done.

Liver Decongestion Principals for Advanced Adrenal Fatigue Syndrome

Chronic AFS sufferers in advanced stages tend to be fragile and weak. This is especially true if there is a long history of adrenal crashes and prior use of glandular, herbs, and steroid medications. This historic backdrop presents special challenges. Like a rubber band that has been repeatedly used and over stretched over time, the risk of breaking increases exponentially with each stretch after the breaking threshold is reached. The threshold breaking point that indicate where rapid decompensation takes place is not readily known and varies from person to person, due to the lack of clear laboratory indicators or signs.


Those who experience adrenal crashes repeatedly will generally be able to tell when they are close to this breaking point. Unfortunately, by the time they are on the alert, the body has already suffered much damage internally. Most are unaware of the damage within until too late, when the crash happens. That is why many advanced AFS sufferers experience repeated setbacks and congested liver and failed in their recovery efforts despite their best attempts, even with professional help. Not being alert and attentive to early signs of detoxification failure and congestion within is a common mistake during AFS recovery.

Recovering from liver fatigue involves gentle nutritional approaches with healthy diet choices like wheatgrassThe more advanced the AFS, the higher the risk. Liver congestion may be so severe internally that any gentle attempt to detoxify or cleanse the liver by the ways previously mentioned may trigger adrenal crashes and paradoxical reactions. Cleanses, flushes, sauna, wheatgrass ingestion, steroid use, and IV therapy are common culprits. They are widely touted as excellent healing and detoxification tools, but the body disagrees. The problem is not so much on the approach but the already marginalized body with minimal reserves.


The liver and the adrenal glands are intimately connected though cortisol, the main anti-stress hormone. Cortisol dysregulation can lead to liver fatigue and gallbladder dysfunction. Similarly, severe liver disease is associated with adrenal insufficiency. When the adrenals are overstressed, the liver can become congested over time. The weaker the adrenals become the higher the risk. Liver congestion represents an important roadblock to complete Adrenal Fatigue Syndrome recovery. This is seldom recognized. Without careful consideration to liver function, intracellular function, and extracellular matrix, indiscriminate use of herbs, drugs, detoxification and glandular compounds can worsen liver function and AFS concurrently. They should be placed on hold while a more fundamental approach to optimize the internal milieu takes priority.

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© Copyright 2015 Michael Lam, M.D. All Rights Reserved.