Liver Fatigue in Individuals Living with Adrenal Fatigue

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

Read Part 1 | Part 2

The Real Question

Questions to ask about liver fatigueThe 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.

Read Part 1 | Part 2

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


  • Peter P says:

    Could you please add to your article the importance of testing for and clearing high levels of b-glucuronidase, as this was a main factor for my downward spiral with pain, fatigue and tolerance of supplements. I also suspect leaky gut in conjunction with the high enzyme level was to blame. b-glucuronidase causes a myriad of unusual symptoms and issues when trying to detox and I imagine only further stress the adrenals.

    Peter P

    • Dr.Lam says:

      That is a good suggestion. It is tied into calcium d glucarate, and you can search for the article on that. Thank you.

      Dr. Lam

  • Charlie says:

    Hi Dr Lam,

    How would you suggest we begin addressing liver congestion and issues?

  • Chelsea says:

    Thank you so much for this information.

    I believe you answered the question that has been foremost on my mind as I have been studying this issue. I’ve actually been studying about health issues for a very long time and I have improved my health, but, have never gotten rid of the extreme fatigue, high cortisol, or my giant belly.

    I keep reading that one should detox this way and that, but, until now, I only read one thing that supported my experience with seriously trying to detox my lymph system. Because, what happened was that I got very ill, got brown spots on my arm, gained more weight all around rather quickly (but, especially in my belly), aged about 5-10 years in a couple of months time and became chronically dehydrated.

    So, I read this other article, a day or two ago, that said detoxing is fine when you are ready for it, but, you need to clean up your diet and clear up the issues you can clear up that way, first, because, otherwise the toxins that get released are just going to stay in your system, maybe going back to where they came from , but, definitely in your fat cells and blood and that will make you gain weight, get ill, etc

    Everyone else seems to be saying to do the detox of the liver and if you don’t detox the liver first, you will never clear up your digestion.

    I have ordered some supplements that I’ve seen recommended for liver detoxification. But, before I start taking them, I want to make sure I am taking them at the right time. Thanks to your article and the other one, I can see that I really need to wait a while and continue working on cutting out some things and adding more of others.

    So, again, thank you.

  • Anonymous says:

    I have been on Dr Lam’s adrenal recovery program since july…i was in adrenal exhaustion for many years, due to poor dental decisions. My liver was very compromised…I have had very gentle help for my liver from my adrenal consultant at…i went off all supplements and am doing very gentle juices and deep breathing exercises….among other things…the key is gentle, careful, and consistent…I highly recommend their program…it is very personalized to your needs!

  • Jen says:

    What are the suggestions to detoxify and aaaiat the liver.. Esp for those of us with MTHFR issues.

    • Dr. Lam says:

      There are no easy answer when you have both issues as both needs to be concurrently taken care of at the same to be optimum. The key is the degree of intervention and that depends on the person’s history, constitution, and state of function which changes like a moving target during the recovery process. We take time to formulate a comprehensive plan, follow by close follow up until stable as the first step among many steps that has to take place. The process is slow but it works and many feel better over time.

  • Ann Magoon says:

    If the methods of detoxing the liver can lead to adrenal crashes, what do you suggest for liver detox in an AF patient? I have had adrenal problems all my life, have always been a high cortisol producer and in the past 20 years have been in adrenal fatigue. I can’t get much done in my day, due to fatigue and lack of much interest in doing so. I’ve recently had a total tooth extraction due to dry mouth damage. Post op, I had high cortisol for about a week, it has settle down now, but now I am suffering from the ebb of the cortisol rush, sore joints etc. My endocrinologist is holding of on any treatment till furthur testing, which already show low cortisol in the morning and high in the evening. What would you suggest for cleaning my liver?

    • Dr. Lam says:

      Low cortisol in am and high in night is what is called a reverse curve. this is common in people with advance adrenal weakness. Cleaning the liver needs to be very careful as any rush of toxin can aggravate the system and crash you. There are many ways to get to Rome, so to say. I cannot tell you all the ways because everyone is different. Also along the recovery, many changes will happen. Often you have to allow to concurrently support adrenal and liver function, while keeping the liver burden low. its a balancing act.

      Dr Lam