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
5 - "Dr. Lam,"
Dr. Lam,

You have helped me enormously. I am no longer exhausted from morning until night. I can even walk part way up the mountain by our little house in the Blue Ridge Mountains. That's great!

It has been a great pleasure to work with you. I admire and respect you tremendously. You have indeed pulled me away from the edge of a very steep cliff.

All the best to you along with my heartfelt thanks.


  • Nicki says:

    ‘ If the cortisol level is off balance or dysregulated, our gallbladder function will automatically be affected negatively. ‘ MAKES SO MUCH SENSE!

  • Nigel says:

    Can glutathione help repair minor damage caused by alcohol?

  • Francisco says:

    Wow, I new cortisol was related to adrenals but I didn’t actually know what it was. Thanks for explaining this so well.

  • Cindy says:

    Is it pertinent that one detox their liver if they also suffer from adrenal fatigue?

    • Dr.Lam says:

      It is to be considered, provided you do it right and time properly with the right intensity.


  • serenity says:

    Wow very interesting read it seems all the systems are intertwined and related to one another

  • Aurora says:

    I recently donated a portion of my liver to my aunt who suffered from hepatitis c. I’ve now noticed, almost 6 months later, that I am beyond fatigued. I can barely function anymore. Am I feeling this way because of the loss of a part of my liver? Will this fatigue pass?

  • john says:

    Dr. Lam, I have had adrenal fatigue for 5 years. I was very sick from 2012 to 2015. I have recovered significantly during the last months to the point that I feel almost normal many days. However, I still have food sensitivities in my body and intolerance to all supplements. Certain foods and all supplements trigger either pain in my right eve, sleep deprivation or both of them. Can this be due to liver congestion?

    • Dr.Lam says:

      That is a possibility, but there are also other factors to consider. collectively, they point to a body that has still some ways to go to complete healing.

      Dr Lam

  • Max says:

    Can a congested liver be painful?

  • Kevin says:

    I’ve heard that occasional red wine is good for the body, but should it be avoided if you have a congested liver?

    • Dr.Lam says:

      A normal body can process alcohol while a congested liver will have a harder time. Often times you do not see the damage until later on.

      Dr Lam

  • Jack says:

    What makes this very deterring is that you say to check with doctors. But yet at the same time you repeatedly state that most doctors are not versed on adrenal issues, and also respeatedly state that adrenal issues get worse, and even with those who try basic everyday supplements like B, C it gets worse and worse. I didn’t realize adrenal fatigue was this complicated for the vast majority without an actual rare adrenal gland disease, or one is older, with a myriad of already presented health issues and history.

    You even say to the extent that if one would go to the hospital that they miss issues or even liver issues in late stages of adrenal fatigue which could be dangerous according to your article of adrenal exhaustion as well. How is one supposed to feel secure dealing with general practioners, and even hospitals, of all things if you were in bad/late conditions?

    When you say go “slow” and be careful can you give me an example, time frame, etc.

    • Dr.Lam says:

      General recovery from AFS can take from 6 months to 2 years. The more educated you are, the easier it is for you to find a provider that can communicate and attend to your need. We try to educate as many providers as possible but the process is slow and can take a generation.

      Dr Lam

  • Garret says:

    When I take my prescription pain medication, my skin smells salty. Is this a liver tox issue?

  • Flynn says:

    At night I sweat and the smell is very strong. Is this due to liver congestion?

  • Kassandra says:

    I had my gallbladder removed 3 years ago- how does this affect my cortisol production?

  • Anthony says:

    do you recommend doing a gallbladder detox or a liver detox or both?

  • Charles says:

    Can eating disorders such as anorexia and bulimia affect the liver?

  • Mary Lomax says:

    I am reading this article and I now wonder if this is the reason my blood tests keep coming back with slightly elevated liver enzymes?
    They have since my early 20’s. But the levels were just very slightly over the limit – nothing to indicate cirrhosis or Hepatitis. About 6 years ago I even had an ultrasound of my liver to rule out fatty liver disease (I was not overweight at the time and exercised 5 days a week). But my doctor was still puzzled about the labs. I asked if I needed to stop drinking alcohol and he said no. I am now 35 and have two small children. The stress of pregnancy on my body and big life changes have equaled chronic stress for about five years now. I am currently about 15 pounds overweight. I also drink more now than I used to = parenthood! I am not trying to lose weight at this point. I just want to be healthy again and the weight will come off. After some research, I am now sure that Adrenal Fatigue applies to me. I need to consume more protein and healthier foods. I need to eliminate alcohol and probably those two cups of coffee in the morning. I can’t be a stressed mom just eating whatever, whenever I can. I need to be intentional about my health!! And I need to keep researching to see the best approach to take. Thank you for your information!

  • Esther says:

    Like Adrenal fatigue wears down the liver, can it also wear down the kidneys?

  • Jone says:

    if you have high cortisol, does that mean you are giving your liver more work to do ?

    • Dr.Lam says:

      Cortisol is a steriodal hormone that has to be broken down by the liver. The more cortisol you have in the body, the harder the liver has to work.

      Dr Lam

  • kathy everett says:

    Yes. I have liver/gallbladder discomfort if i eat bad fats, fried foods, nuts..etc. I have liw cortisol levels in the morning and although i have some general fatugue i still can di house work; swim, go for walks.
    I am a vegetarian and do nit eat wheat product’s. Lemon juice really helps with my liver/gallbladder issues but i am very under weight and gave difficulty gaining. Could use your help Dr Lam. Its ok if you use bug medulical terns because i can look them up.
    Thank you

  • Anita says:

    My Doctor has tested my hormone levels and said that my cortisol levels are extreamly high and I also suffer from Gallstones. so my question is could high cortisol levels contribute to gallstones?

    • Dr.Lam says:

      Cortisol is responsible for the recycling of bile acids from the blood. If this recycling is disrupted, the animals develop gallstones in research studies.

      Dr Lam

  • Benji Thompson says:

    How efficient is the system with out the gall bladder ? I’ve had my gall bladder removed a few years ago and Im wondering if some of the symptoms I have been having are related ? Could it be a build up of the last few years ?

    • Dr.Lam says:

      Its hard to say. Generally speaking, if the rest of the body is strong, the compensatory mechanism is automatic and you should not have a problem. Everyone is different, however. There may be subclinical issues that is not very evident by laboratory test but still problematic.

      Dr Lam

  • Caleb says:

    I have received a liver transplant surgery. Can it be possible to inherit congestion issues from the donor liver, or is how I’m feeling more likely to be due to the anti-rejection drugs?

    • Dr.Lam says:

      It could be both. Because congestion is not measurable by lab but is a subclinical condition that can be very severe in symptoms, you should first make sure you check with your conventional doctor first. Many people have liver congestion in various degrees, but not everyone is symptomatic.

      Dr Lam

  • Juliet says:

    Are there long term risks associated with liver congestion?

    • Dr.Lam says:

      Some symptoms include brain fog, chemical sensitivies, low immune system, metabolic disturbances, increase risk of liver pathology – no good news.

      Dr Lam.

  • Shanon Todd says:

    I Love reading your articles. I deal with Adrenal Fatigue,
    Thank You
    My Doctor is trying to get my body back where it needs to be. She has me DHEA and progesterone, and other vitamins, she is hoping that she does not need to put my on steroid all the time she is hoping on success on her way of treating me.My cortisol levels are very low 1.2. My anxiety is so off the charts and I hate feeling this way. i want to feel whole again and not hurt and feel anxious , it is awful.

  • Julie Beitscher says:

    Is Gilberts related to adrenal/thyroid?
    Do you think Gilberts is really hypothyroid and/or low adrenal?

  • Kate says:

    Thanks! So if I have brain fog, fatigue, and lethargy after a meal, I should drink lemon water (before and/or after the meal)?
    What else can I do to prevent and/or deal with this?
    Thank you for the lemon water reminder!

    • Dr.Lam says:

      you should first look into if the lethary can be food related , such as gluten, wheat, corn, or diary. Avoid carbs is another thing you can do , and that will stabilize your metabolism. Talk to your doctor if that fails.

      Dr Lam.

  • KATH says:

    my tsh levels were 0.09
    my doctor says im hyperthyroid, but my pulse is 75, my skin is dry, my bowel is sometimes loose,,my temp upon waking is 36.6 sometimes 37

    my problem is i hope i can sleep better
    i am taking lorazepam 0.5
    i quit hydroxycine

    now i am working on testing my d3 levels
    i also bought phosphatidylserine to help me lower cortisol at night
    but i am not sure if iam high or low cortisol

    and how will my adrenals recover with insomnia? this cycle has to stop
    i hope i can fins a good doctor,,she told me to stop my thyroid meds for one month and see if my sleep will improve.

    i dont know what to do
    i just hope i can sleep normally again
    i hope i cansleep normally again
    i dont understand

    they dont have a 24 hour saliva test for my cortisol
    i also dont want to take hydrocortisone as much as possible as i am young and i read how my adrenals may stop producing its own
    only blood testfor cortisol

    please help me
    i dont want to die

    last december there are four days were i only sleep for one day
    this was the pattern of my sleep last month two days straight no slep
    then sleep on one day then another two days of no sleep





    • Dr.Lam says:

      You have many medical issues that can only be dealt with by your doctor. Sometimes sleep can be so dirupted that the only way is to take sleeping medication and your doctor can help you on that. As far as AFS is concern, call my office and we will talk to get more history as to what is going on.

      Dr Lam

  • Alex says:

    How is cortisol synthesized in the body?

    • Dr. Lam says:

      It is made in the adrenal glands. The raw material starts with cholesterol and there are many steps to go thru ending up in cortisol.

      Dr Lam

  • Conrad Retolla says:

    At what point can you say that coritsol is the main factor in food digestion ? What other resources should be exhausted before pointing the finger at cortisol ?

    • Dr. Lam says:

      Cortisol is a late factor in terms of affected the digestion. The key in overall disgestion is metabolic speed that is regulated by the thyroid and that is why low thyroid is often associated with weight gain.

      Dr Lam

  • Jody says:

    Thank you Dr. Lam for this very important work. Now I have an explanation & understanding of what has happened to me & why I have been feeling this way for many years. As a police dispatcher, my daily life is extremely stressful & I am now certain that my cortisol levels are imbalanced. How can I know how severe my situation is & how do I fix it.
    Jody Moruzzi
    13312 Ranchero Rd #1
    Oak Hills CA 92344

    • Dr. Lam says:

      You can write to me through the Ask The Doctor on the web, or call my office and I will be able to explain to you your options over the phone.

      Dr Lam.

  • Josefine says:

    I have swelling on the side of my mouth that was diagnosed as cellulitis. Even though my bloodwork has shown my liver to be clear, could my condition be attributed partially to liver congestion?

    • Newsletter says:

      Usually no. cellulitis is an infectious process usually caused by bacteria and wound related

      Dr Lam

  • laetitia cloete says:

    I have a gallbladder operation i know my stones form in my liver struggle with overweight as i read in your article that if your liver is toxic you metabolism will be slow what mist i do any help

    • Newsletter says:

      My article called detoxification may be helpful, but you do have to be careful and make sure you start very slowly and with your history , see your doctor first. Vegetable juicing is very good for many , but again, go slow to start. Drink more water with a bit of lemon is simple and works wonders too!

      Dr Lam.

  • Zaia says:

    Thank you for this article and your great website! Can you please comment on what the effects are of gallbladder removal on liver function and adrenal fatigue? Conventional medicine seems to think life goes on as normal after gallbladder removal, but I have found this to be incorrect. I would be very interested to read your thoughts on this. Thank you!

    • Newsletter says:

      Life does go on for the majority of the people. Those with liver and adrenal issues can fare very differently. GI disturbance can be worse in many cases. There is no formal studies in this area but clinically we see it.

      Dr Lam.

  • jane says:

    Thank you for this excellent article.

    • Newsletter says:

      You are welcome. Conventional medicine does not understand how important liver can play in your overall health, especially in the toxic environment we are in. Simply drinking a lot of water with some lemon will do wonders !

      Dr Lam