Sluggish Liver and Adrenal Fatigue Syndrome -Part 2

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

Read Part 1 | Part 3

Liver Congestion and Adrenal Fatigue Syndrome

An adult male at work suffering from a sluggish liver and becoming fatigued.While small fluctuations of cortisol levels within the body are well tolerated during normal daily living, chronic imbalance and dysregulation can be problematic.

Chronic stress is particularly worrisome, because it leads to over activation of the HPA axis, resulting in Adrenal Fatigue Syndrome mentioned earlier. In the early stages of AFS, cortisol, the main anti-stress hormone, rises. This is part of the automatic compensatory effort of the adrenal glands to help the body deal with stress. The unintended consequence is increased risk of fatty liver that can eventually lead to liver congestion or a sluggish liver in layman’s terms. Unfortunately, this is seldom attended to as a possible risk because symptoms of liver dysfunction have yet to surface in early stages of AFS, where most sufferers remain asymptomatic. While they may be tired and unable to work at peak performance, this is compensated by taking in caffeine drinks and sugary foods as sources of energy.

The underlying insult to the liver because of stress induced AFS and resulting high cortisol continues unabated unless the stressors are removed. If left unabated, the liver workload increases, and liver function is marginalized. Breakdown of metabolic products slows, resulting in sluggish liver or stagnation. Like a clogged water pipe, excess input will only create a backlog and spillover at the source. Weak liver function and resulting congestion leads to a rise in the level of internal toxins, as toxic metabolites remain unprocessed and thus unable to be broken down into less harmful metabolic byproducts for excretion out of the body.

Signs and Symptoms of Sluggish Liver

A woman suffering from Adrenal Fatigue and sluggish liver.Accumulation of such toxins within the liver can be responsible for a myriad of symptoms. They include fatigue, anger, psoriasis, neck and back tension, acne, acidosis, eczema, joint and muscular pain of unknown origin, cramps, menstrual irregularities, PMS, dizziness, pulsating headaches, insomnia, depression, anxiety, hormonal imbalance, brain fog, food sensitivity, insomnia, intolerance or sensitivity to drugs and nutritional supplements. A weak liver may also weaken the kidneys and contribute to digestive problems, including lowered vitamin B12 absorption.

When the liver is chronically congested, sediment often settles out of the bile and accumulates in clumps that resemble stones or sand in the gallbladder. As a result, the gallbladder can become clogged as well. Pre-existing stones can further aggravate the situation as they become lodged in the bile duct leading to the small intestine. It is common for AFS sufferers to complain of discomfort in the gallbladder area, especially after a meal.

You can tell how well a person’s liver and gallbladder is functioning simply by looking carefully at a person’s skin color, tone, pigmentation level, and texture. Dry, pale, and mottled skin with dark spots and pigmentation are signs of underlying sluggish liver. Unfortunately, by the time these are observed, congestion within can be well entrenched.

Advanced Adrenal Fatigue Syndrome and Liver Congestion

The exhausted adrenals have failed for adrenal fatigue sufferers, affecting all other systems in the body and leading to sluggish liverAs AFS proceeds to more advanced stages, the adrenal glands become exhausted in a continuous effort to put out ever increasing demands of the anti-stress hormone cortisol. Over time, cortisol output begins to drop below normal after reaching peak output. Low cortisol level affects gallbladder function by negatively impacting the bile recycling process. Fat metabolism becomes suboptimal. With the resulting deregulated fat metabolism, the liver is further burdened with increased workload. The detoxification pathways responsible for breaking down substrates into smaller toxic metabolites within the liver are marginalized. Internal toxin buildup increases, further overloading the liver and the body, which has been working hard since AFS appeared.

Throughout the AFS progression from mild to severe, relentless insult on the liver continues. This results in the vicious cycle of a decompensating liver faced with a concurrently increasing metabolic workload as AFS advances. The liver is a silent soldier bearing much more of the brunt of a losing battle at the frontlines. It comes as no surprise that most sufferers of advanced AFS usually have some degree of sluggish liver and dysfunction at the same time. However, physical and laboratory examination continues to be normal as the injury is occurring at the cellular level and therefore remains sub-clinical and evades detection.

Read Part 1 | Part 3

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

Dr. Lam’s Key Question

High liver enzymes are not normal. You should continue to follow your doctor’s advice, find out what is the underlying cause of the elevated liver enzymes.

Sluggish liver is one of the main symptoms of Adrenal Fatigue
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I own and use your Adrenal Fatigue Yoga DVDs and love them. I use your site for all kinds of adrenal fatigue information. I have also tagged your site in Amazon reviews of adrenal products. I am very familiar with the way you write (I am a writer, and notice these things).


  • Skip says:

    Dr. Lam
    For me the chronic stress raised my BP. For years I was put on bp meds, diuretics, anti-depressants and anti-anxiety meds.
    I could take one or two and became very sick. The bp meds didn’t work. They’d try another. And another . And at one point hospitalized me and drugged me for 3 days to get my bp down. Nothing worked. My bp would only spike w meds. It debilitated me.
    I got finger waves in the ER for not taking my meds even though they’d drive up my BP above 200.
    I’d tell the doctors it felt like the meds were “building up” in my system. They’d say it was just my anxiety.
    Now I can see I wasn’t crazy.
    Thank you. So much.

  • Jason says:

    I’m confused. Is a congested liver diseased or unhealthy? Thanks Dr. Lam!

    • Dr.Lam says:

      It is unhealthy , and laboratory test are usually normal , so in conventional medicine, it is considered normal. Functionally , we know its wrong. Its like Pre-diabetes, but there is nothing called Pre-liver problem in regular medical world, so it is ignored largely.

      Dr Lam

  • Stephanie Rodriguez says:

    I have AF with very low cortisol & low aldosterone (although my cortisol is finally bouncing back after many years of treatment, but not my aldosterone). I also have Hashimoto’s. I am on Naturethroid & Florinef & have been slowly getting better, but my liver enzymes are low (out of range). How do I get my liver to bounce back? Also, would love to know how to get my body to produce aldosterone again.

  • Quinton says:

    I have had afs for a year and three months at this point i feel as if it’s definitely my liver preventing me from healing i have no spleen.. I started doing coffee enemas but those have caused me to go into a healing crisis and cause more constipation extreme anxiety needle feelings in knees he’d ach and I can tell its raising my cortisol I’m trying to figure out a more gradual way to detox with out creating too much of immune response not sure how to find a naturopathic doctor in Dallas Texas I trust enough to spend money on.. Is this something you could help with??? Thank you so much

    • Dr.Lam says:

      When you have a healing crsis, it may mean that what you are doing is too much for the body to handle. Detox is good concept but has to be done right,and that involves a very detailed plan of first preparing the body so it can support the insult from detox. A personalized program and careful monitoring each step along the way is important. We do provide a telephone coaching service to get to the root problem but you have to qualify by calling our office.

      Dr Lam

  • Cesar says:

    What is the expected result one would feel when the body starts to get rid of metabolite build-up?

    • Dr.Lam says:

      A sense of steadiness will return. the body feels good and “lighter” and not so draggy. Food intolerance will reduce and energy will increase. Brain fog in particular will reduce and clear thinking returns. Libido will also increase as a side benefit, and overall, the body has energy but do not feel tired.

      Dr Lam

  • Polly says:

    Other than the liver, are there other part of the body that can get congested? Would doing a juice cleanse help as in detoxing?

    • Dr.Lam says:

      Almost every organ can and do get congested. The liver and the extracellular matrix are the most easily affected. juice cleanse can work for those in strong and healthy shape but can also crash you if you are in advance stages. you have to be very careful, or you end up worse. that is why you need to be under the care of someone who knows, not blindly doing it if you are in advance stages.

      Dr Lam

  • mollie says:

    I have severe AFS and have been using the herbs you mentioned and steroids but I continue to get worse. I am also diagnosed with Adult Growth Hormone Deficiency and take Nordatropin injections. Nothing helps me. I have pain, anger, extreme sweating, rapid heartbeat, anxiety, no appetite and complete change of bowel movements. Can you help me?

    • Dr. Lam says:

      Almost all adults have Adult GH deficiency. that is not unusual. What is unusual is that you are not improving with your doctor, and have symptoms suggestive of sympathetic overtone. This is when the body is overloaded with adrenaline, a condition commonly associated with advance AF. Something is block the GH from working, and something is triggering the adrenaline. we have to get to the root cause. that requires a detailed history. Call my office and we will talk. So far what you tell me is not unusual. its part of the AF picture in advance stages.

      Dr Lam.

  • Hadewych says:

    Dear dr Lam,
    I had a adrenal crash 2 years ago. Since then climbing out slowly. Am now in adrenal fatigue – hashimoto situation. This illness was due to 13 mercury fillings and a dental implant. During the gradual removal of mercury I got worse until I couldn’t stand up anymore. I go into a sauna – infrared cabine as often as I can these days . I also follow a strict diet since more then 2 years and have a good doctor. The recovery of my thyroid is slow and my liver area hurts from time to time.
    Hadewych (Belgium)

    • Dr. Lam says:

      What you experienced is very common. Heat therapy that is good for normal people may crash you if you are too aggressive so do be very careful and take in a lot of fluid. You can try some epson salt bath soaks. With your history of crashes with mercury removal, detox needs to be very gentle and slow. you need a personalized approach to match each stage of detox to your body’s ability to handle toxic metabolites, along with gentle adrenal support along the way. The two working in unison can bring wonderful results. Read Heat Therapy & Adrenal Fatigue Syndrome for more information.

      Dr Lam

  • raj says:

    15 yrs back i was told i have gilbert syndrome i.e congenital hyper bikirubin. these total when tested total upto 2 . now diagnosed with adrenal mass i.e adenoma. adrenal suppression test dexamethosone of 0.9.
    constant insomnia and psoriasis etc etc etc
    do i need liver detox etc

  • Shelley says:

    I tried the link below under Newsletter October 7th, “good simple tips” and got a “file not found” message. Could someone check it?


  • Leah says:

    I have been dealing with stage 3 AFS for almost 3 years now, with glandulars(didn’t know better and was desperate) which I am now weaning myself off of, superfoods, herbal tinctures for my hormones, and lifestyle changes. I often had nausea at night but thankfully that is almost non-existent. I’m sure I have a sluggish liver, according to your article, and would love to try your program but am not sure I can afford it. We are a one-income family with five children. What should I do?

    • Dr. Lam says:

      We do understand that some people do have financial challenges and we do try to help everyone if possible. You can call our office and find out more details.

      Dr Lam

  • JoJo says:

    So what does one do about this? Obviously detoxing while the adrenals are in advanced Stage 3 is out of the question. What to do? Thanks.

    • Dr. Lam says:

      Its a tricky balancing act. You want to detox but you cannot generate adrenal crashes. Start with understanding the body. Lab is not helpful. Close monitoring is needed along with clinical experience to avoid retoxification reaction Read Retoxification & Adrenal Fatigue Syndrome for more information. Everyone’s program is different, and the body will change along the recovery as well. That is why a personalized program is needed, and why most self-navigation effort fail as well as most professionals. We do offer a telephone based nutritional coaching program for this. You have to call our office and see if you qualify.

      Dr Lam

  • Brenton Konwol says:

    Thank you Dr Lam, articles like these make it easier to understand what my doctor is trying to tell me, but cannot find the words to explain.

  • Luana Hiebert says:

    This describes me to a t! I have been working on stage 3 AF for some time, and have improved a lot, but lately the fatigue and Fibro pain have been increasing. So now I see I need to work on my liver. But you don’t say how to do that! Where can I find that information?

    • Newsletter says:

      when you are in advance stages of AF, the way to de-congest is very very tricky because the body is generally weak and can crash easily.
      I have an article called Detoxification that is good for normal people. Read Detoxification & Adrenal Fatigue Syndrome for more information and that is a good introduction for those who are strong. For those who are weak, the best and safest way is to start very very slow if at all. Many times,the body will not accept even ‘baby-dose’ of detoxification, and the body will crash.

      To be successful, a personalized program specific for the body and the state of weakness is a must if long term healing is the goal. Close monitoring is absolutely required as the body changes along the way and is often like a moving target. That is why most people lacking the clinical experience will often fail and body gets weaker and more sensitive as a result. We telephone coaching service offer a comprehensive program if you are at a lost of what to do.

      Dr Lam

  • Tina says:

    This is a great article. I’m being treated for hypothyroidism and adrenal fatigue, but I believe my liver is definitely sluggish. My doctor does not pay any attention to this however as my test are within range. Any suggestions on how to deal with this issue in the later stages of adrenal fatigue would be hugely appreciated! I’ve been thinking of trying some liver/gallbladder cleanses, but now I’m hesitant. Many thanks!

    • Newsletter says:

      If you have advance adrenal fatigue, the approach needs to be very different and can change drastically due to liver congestion and concurrent extra cellular matrix pollution that has to be cleared first before you can work with the adrenals successfully.

      Understanding where you are at therefore makes a big difference because the wrong approach can make you worse.

      Dr Lam

  • Stacy Schwartz says:

    Excellent article…fits me to a t! So I’ve tried some liver tonics from my nutritionist and they made my insomnia worse. I believe I have adrenal fatigue and I guess a clogged liver. I’ve had insomnia since peri menopause 5 years ago. I am taking rhodiola and ashwagahnda, but now will stop. Will your next part discuss how to unclog the liver? Thanks!!

    • Newsletter says:

      Having worse off insomnia in cases like yours often is a sign that what you are doing is not what the body wants. it may be due to tonic too strong or ingredients not acceptable. Try to stay away from herbs and glandular products if possible as they can have unpredictable effects in many,not all . there are many other possibilities too, and the picture will become clear with a detailed history, not lab. if your problem remain unresolved, you can write to me through the ask the doctor section and we can go from there.

      Dr Lam.