Liver Health and Adrenal Fatigue Syndrome – Part 1

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


Introduction to Liver Health

Adrenal fatigue can cause liver health congestion symptomsThe liver, along with the kidneys, skin, and intestine, is the waste management plant of the body, and having proper liver health is important. The liver filters blood to remove bacteria, modulate bile secretion to eliminate cholesterol, regulate hemoglobin, breakdown products, and remove negative results left by prescription drugs.

Because of its importance, the body has provided us with more liver than we normally need for daily living. A healthy person can donate half of their liver. Due to the excess reserves, liver injuries and damages are often not symptomatically recognized but are frequently given no attention to thinking it is a normal occurrence by many Adrenal Fatigue Syndrome (AFS) sufferers.

There is little room to disregard the role the liver plays for those in advanced stages (stages 3 and 4) of Adrenal Fatigue Syndrome. Without a strong and optimized liver, complete AFS recovery is retarded at best and often not possible. Fortunately, those in earlier stages of AFS (stages 1 and 2) normally do not present with significant liver congestion, unless there is prior history of liver damage, such as with alcohol and infection.

Let us begin with understanding the role cortisol plays as the key determinant of liver and gallbladder health.

Cortisol and Liver Health

Cortisol is the body’s main anti-stress hormone secreted by the adrenal glands as a response to stress. Stress can be metabolic such as a sugar imbalance, physical such as over exercise, or emotional such as going through a divorce or accident.

Compromised adrenal function leads to the underproduction of cortisol which causes many of the symptoms of adrenal fatigue including liver health issuesIn addition to its many anti-inflammatory and metabolic control properties that are critical in stress reduction, cortisol has been found to have great effect on liver function. Elevated plasma cortisol has been shown to inhibit non-hepatic glucose utilization, raise plasma insulin levels, and increase hepatic gluconeogenesis in vivo. In addition, there is a direct connection between cortisol levels and fatty liver disease. This is seen in early stages of Adrenal Fatigue Syndrome, where the adrenal gland production of this hormone is put in overdrive due to hypothalamic-pituitary-adrenal (HPA) axis overstimulation. High cortisol, a hallmark of early stages of AFS, is known to promote fat deposits in the liver and is associated with a higher incidence of non-alcoholic fatty liver. Fortunately, this is reversible. Studies have shown that in the absence of cortisol, liver fat accumulation slows.

For decades, the medical community has known that those with liver cirrhosis present with a higher incidence of concurrent adrenal dysfunction. When the adrenal glands are not producing adequate amounts of steroid hormones, primarily cortisol, a medical condition called Adrenal Insufficiency (AI) or Addison’s Disease arises. Lifelong steroid therapy is required. This is very different from Adrenal Fatigue Syndrome, where the adrenal glands are still pathologically intact and making hormones, though at a lower level, but not low enough to be called AI. Symptoms of AFS are much more intense than AI in the early stages, but as AFS progresses to the advanced stage, sufferers can be incapacitated and bedridden.

The term hepatoadrenal syndrome is used to define adrenal insufficiency in patients with advanced liver disease who have sepsis and/or other complications. Liver cirrhosis is considered to be among the major groups of high-risk diseases with a predisposition to AI. Decreased levels of HDL and LDL cholesterol, along with increased levels of pro-inflammatory mediators, exhaustion or fatigue of the adrenal cortex, and glucocorticoid resistance have all been implicated as pathophysiologic mechanisms involved in AI development in critically ill patients with sepsis. Clearly, adrenal and liver health and functions are closely connected. The key connecting bridge is cortisol. The exact mechanism is not yet known, but it is clear that liver and adrenal dysfunction is closely tied. It is important, therefore, to look at liver health comprehensively anytime adrenal dysfunction is implicated.

Cortisol and the Gallbladder

Adrenal Fatigue affects your gallbladder and liver healthIn addition to the liver, cortisol also has a strong and direct effect on gallbladder and bile production. When we are hungry, cortisol, a glucocorticoid hormone, is released from the adrenal glands. Upon reaching the liver, glucocorticoid receptors are activated, and the gallbladder prepares for the imminent food intake. After a meal, bile is released from the gallbladder into the intestine. Bile acids contained in bile are critical for fat digestion. They emulsify fats into small constituents so fat can be broken down and absorbed. After that job is completed, bile is recycled through the blood back to storage in the gallbladder. Our body recovers ninety-five percent of bile acids from the bowel content. This important recycling process is controlled in part by cortisol. If the cortisol level is off balance or dysregulated, our gallbladder function will automatically be affected negatively. Symptoms can include liver/gallbladder discomfort after a meal, improper digestion with food particles in the stool, and signs of toxic overload such as brain fog, fatigue, and lethargy after a meal.

Read Part 2 | Part 3

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


Dr. Lam’s Key Questions

They all contain the active ingredient for detox: activated charcoal.

The molecules in Zeolites can be used to attract and hold several types of toxins and heavy metals like lead, aluminum cadmium, arsenic and mercury. These metals are then passed out of the body through urination and defecation.

Yes, the Bemer machine helps to increase the circulation. Therefore more metabolites can be carried away. If you have AFS, you have to be careful not to overdo it.

Studies have shown that 1 cup of coffee could have health benefits. You should know that if you do drink coffee, it is for pleasure only and not to stimulate you.

If you need to take energy drinks to get through the day, you may be suffering from AFS. When you have AFS, it does affect your liver. Supplementation is hard to recommend, sometimes singles are better, sometimes a combination is more effective because of the synergistic effect.

Add cucumber, mints, apples or berries.


Adrenal fatigue can cause liver health congestion symptoms

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