LIVER STRESS AND HOW TO CORRECT IT - PART 1

Liver Stagnation

The signs of liver stress may not be obvious to the Western medical practitioner who frequently looks to the blood pathology for evidence of abnormal liver function. However, these indicators will only appear if the person has an inflammatory condition of the liver (hepatitis, alcohol or drug abuse), or when the liver has reached less than 30% of its functional capacity. As the liver plays such a vital role in overall health, we need indicators to help us assess how well our liver is coping and whether we need to take steps to assist it, or reduce its burden.

This is where we turn to traditional Chinese Medicine, which provides us with an easy framework for our personal interpretive analysis. Eastern meets Western perspective in that both agree on the main functions of the liver: receiving nutrients from the digestion, packaging and shipping them out to the rest of the body; detoxification of the blood; the breakdown and elimination of hormones; and the elimination of cholesterol through its conversion to bile salts. But using the Chinese approach we are able to plot many of our symptoms and refer them directly back to our liver.

Take this case as an example:
A 38 year old lady came to see me as she wished to have a baby but felt that her body needed an overhaul before she became pregnant.  She was currently suffering from fibroids (since 33 years) that were increasing in size and placing pressure on the bladder. She was generally constipated but suffered diarrhoea with spicy food, fluid retention with alcohol, haemorrhoids, frequent headaches, and painful periods. When we looked back over her past history she had taken the contraceptive pill for a total of 11 years, suffered cystitis quite frequently and had glandular fever at 18 years. She also suffered hayfever since 31 years.

Would you suspect that liver congestion was the cause of these complaints? In Chinese medicine the liver is regarded as one of the principal engines of the body. It works hard, but if it has more work than it can comfortably fulfill it will heat up, slowly becoming more inefficient before it grinds to a halt. The Chinese will associate liver disharmony with patterns of heat and stagnation/congestion in the body. In the above case the first sign of liver congestion was glandular fever at 18 years. A taxed liver will have an increased susceptibility to the Epstein Barr virus. Adding insult to injury, there followed 11 years on the contraceptive Pill. All synthetic sex hormones burden the liver by affecting bile salt secretion1 and physicians are warned of the dangers of prescribing to patients who may be genetically predisposed to gall stones. What does this mean? Your bile system is the mechanism whereby you detoxify the whole body (it is also your natural laxative – hence constipation can indicate liver congestion). If this is impaired, then not only will toxins accumulate within the system but your conversion of cholesterol to bile acids may be impaired leading to gall stones and high cholesterol. This is stagnation, and in the case above the stagnation has finally manifested as fibroids and painful periods.

If you’re feeling that this is a bit far-fetched, then let me explain. In Chinese medicine the liver “irrigates” through its meridian pathway (energy channel) the lower abdomen, or drainage ditch as it is often referred to. The lower abdomen is the most toxic area of the body – it is the area where we eliminate our waste via the kidneys, the colon, and in females, the uterus. If elimination is adequate then this area retains its health. As a fail-safe mechanism, the venous circulation, which drains this potentially toxic environment, passes directly to the liver for cleansing – toxins from this area are therefore prevented from passing into the system. Once the blood is cleansed it is sent to the lungs, via the heart, to be oxygenated. If the liver cannot fulfill this function adequately, either due to toxic overload from the colon, or to an impairment in the liver’s detoxification capacity, toxins will accumulate in this lower area and symptoms of toxicity/stagnation will arise. The growth of tumours, fibroids, cysts in the reproductive areas are all attributable to liver stagnation. Any painful cramps, spasms or sharp stabbing pains in this area, such as painful periods or spastic colon, also indicate liver stagnation. Specific symptoms in the liver will be hepatitis, glandular fever, gall stones and, in the circulation, high cholesterol. As you can see liver stagnation can ultimately lead to heart disease. In the case above negative signs associated with spicy food and alcohol confirm the liver disharmony, as both these will “heat the liver” – as will stimulants such as caffeine- containing beverages.  

Let’s take another example and see if you can piece the information together.
A lady of 55 years visited me. She was complaining of fullness in the liver area and found it difficult to sleep on her right side (the liver lies on the right just under the ribs). She had sharp, deep stabbing pains in this area that would wake her at night. Her liver function tests were normal. Over the past 4 months she had done six liver/gall flushes (Epsom salts, olive oil and lemon juice) and said that on each occasion she had passed hundreds of “stones,” but the situation continued to worsen. When we went back over her history she had always suffered with “menstrual migraines”, at 25 years had glandular fever, and suffered considerable stress during her life. The situation didn’t really come to a head until she was around 50 with worsening indigestion, insomnia, pains in the left armpit and breast and the “gall bladder attacks”, as she referred to them. She really felt quite ill and nauseous most of the time. 

This is a different set of circumstances with the initial symptoms of liver congestion being migraines, in this context associated with the menstrual cycle. We shall return both to this theme and the role of stress on the liver in the following sections, but keeping on track you can see that she had glandular fever at 25 and over the following decades her digestion became progressively worse. The liver supports the digestion and symptoms of heat, indigestion or ulceration in the digestive tract indicate heat being transmitted from the liver. So we have a hot stagnant liver that is starting to make cholesterol gall stones. The insomnia can also be a liver heat symptom – hence the insomnia and hot flushes that often go together during menopause. Within four months of treatment, most of the symptoms had subsided (with diet alone) and she decided to do another liver flush. Not only did the flush make her feel extremely ill (too much fat) but she phoned me to say that she had only passed a few stones. We had corrected the underlying pathology.

Liver Stress and Hormones

In the preceding paragraphs we discovered how the liver “irrigates” and detoxifies the organs in the lower abdominal area, and that when the liver stagnates, this area can resemble a toxic dump leading to tissue changes and disease of the colon and reproductive organs.

However, when things go wrong in the reproductive area, you are informed by your doctor that the “cause” of the problem has nothing to do with the liver (because your liver function tests are normal), but is due purely to hormonal influences. The reason you have painful, irregular, heavy periods, ovarian cysts, fibroids, endometriosis, pre-menstrual tension and severe mood swings is because your hormones are out of balance. The treatment offered is usually some form of hormone replacement, which may either be the contraceptive pill, or HRT.

Traditional Chinese medical wisdom tells us that the liver is the “planner” of the hormonal cycles, and that any disruption to the smooth flow the cycles, both the menstrual and the gestation cycle, is due to liver stagnation. How can this be? The liver neither produces nor activates the sex hormones. However, when we look at Western medical science we find that the liver is the principle organ involved in the control of the activity of sex hormones – in other words it is responsible for the biological activity of the hormones. The liver produces proteins, sex hormone binding globulins (SHBG), which have the specific task of grabbing and binding 97-98% of your sex hormones. It is only the remaining 2-3% of unbound or “free” hormones that have biological activity.

Let’s take the young adolescent who has just reached puberty. Suddenly massive changes are occurring – the smiling youngster becomes moody and emotional and develop spots and acne, and girls may experience menstrual difficulties. The surge in sex hormones around puberty is eight times the adult levels! The liver has much more work to do in adolescence than in adulthood in controlling the hormones, and if already struggling, then puberty is far from smooth and can become a very rocky ride indeed for some.

The liver not only checks the activity of hormones by producing the binding globulins, but also it deactivates any excess hormones by breaking them down and eliminating them to the outside. So you can see that ultimately, albeit indirectly, the liver does control and plan our hormonal cycles.

The practitioner of Chinese medicine will treat liver stagnation as the primary cause of hormonal imbalance. To the practitioner of Western medicine the main thrust will be hormonal manipulation with either synthetic or herbal/plant steroids. But as we learned previously, the effect of steroids on the liver (particularly synthetic) impairs the bile system – increasing liver stagnation. This has a two-fold outcome. Firstly, the bile is the medium for the disposal of our toxic waste. The liver detoxifies the blood and the waste products are carried away in the bile. Any inhibition to the bile flow will obviously mean that we are not getting rid of our toxic waste. The sex steroids interfere with bile salt secretion leading to a reduction and stagnation of bile flow, and a subsequent increase in the toxic load. Secondly, they interfere with the main route of cholesterol elimination – its conversion to bile salts. So inhibition of bile salt metabolism may lead to an increase in blood cholesterol and the formation of cholesterol gall stones in the predisposed. Far from addressing liver stagnation we are compounding the problem.

Case history
A 55 year old lady came to see me with colitis, depression, anxiety and balding at the temples (temporal recession). When we traced her case we could see a history of hormonal imbalance. She had always suffered heavy and painful periods and acne, and was prescribed the pill for 10 years to help ease these symptoms. She came off the pill to start a family, but had to undergo fertility treatment (more hormones) which was unsuccessful. In her late 30s, due to severe migraines and insomnia she was recommended to try HRT (yet more hormones!). Subsequent to this treatment she developed fibroids and cysts which were surgically removed. She stopped the HRT but at 53 years she resumed the treatment for depression and anxiety.

You can see from this case that had the original disharmony been corrected in puberty, then she may never have progressed to the stage she is today. In this case, all the symptoms may be due to an insufficient production of SHBGs by the liver. When this occurs we see symptoms of oestrogen and androgen over-activity. 

Oestrogen over-activity
Heavy, painful periods indicate oestrogen “over-activity”. The liver is not producing enough SHBGs to grab and bind the hormones. In females, the greater the oestrogen activity, the heavier the menstrual cycle. The role of oestrogen during the first half of the menstrual cycle is to stimulate the glandular growth of the endometrium (uterine lining) in preparation for pregnancy. If pregnancy does not occur, the uterine lining is shed. The greater the oestrogen activity, the greater the glandular growth, and the heavier the shedding of the lining (heavy period).  Introducing synthetic sex hormones (oestrogen and progesterone derivatives) inhibits the rise and fall of natural hormones during the monthly cycle and ovulation will not occur. The inhibition of the cyclical secretion of natural sex hormones results in an overall reduction of natural sex hormones – hence the symptoms abate. Treatment is similar for endometriosis (a condition which may lead to painful periods, breakthrough bleeding and eventual scarring of the reproductive organs) as this is also exacerbated by natural oestrogens which stimulate cell proliferation in hormone-sensitive tissues outside the womb.  

Oestrogen promotes growth; during the menstrual cycle it promotes the growth of the uterine lining, which is shed at menstruation, and during pregnancy it supports maternal and foetal growth. So it is hardly surprising that we find “over-growth” in oestrogen-primed tissue such as the uterus (fibroids, tumours), ovaries (cysts, tumours), and breast (lumps and tumours).  Many malignant tumours of the female reproductive organs and breast are “oestrogen positive.” This means that oestrogen acts as a growth factor for the cancer. Oestrogen-blocking drugs (such as Tamoxifen) are the treatment of choice to inhibit oestrogen’s stimulant activity on breast cancer cells. (Incidentally, insulin growth factor 1 [IGF-1] also stimulates cell division and increases the risk for breast, prostate and colon cancer.2 High levels are found in the milk of cows injected with Monsanto’s genetically engineered synthetic bovine growth hormone [rBGH], given to increase milk yield. It is best to always choose organic dairy products wherever possible).
 

Androgen over-activity
The situation may also be complicated by excess androgen activity. Females also secrete androgens (male hormones), but their activity is suppressed by the production of SHBG. If the liver production of SHBG, sex-hormone binding globulin (the protein responsible for grabbing and binding excess sex hormones) is reduced, the biological activity of both free androgens (masculine hormone) and free oestrogens is increased. We then see virilization (masculinization) of females which leads to infertility, facial hair growth and temporal recession (balding at temples).

A condition closely related to this (and also on the increase) is polycystic ovarian syndrome (PCOS), where multiple cysts form in the ovaries. Here, the ovarian follicles fail to mature, the egg is not released, there is no ovulation, and the follicle turns into a cyst. This syndrome leads to virilization, weight gain and infertility. In these patients, liver production of SHBG is markedly reduced, and consequently free androgen and oestrogen activity is elevated.
 
In the case history above, (infertility, then later incidence of fibroids and cysts, and current balding at the temple) all the symptoms point to an impaired capacity by the liver to produce SHBG. This leads to an increase in free oestrogen activity (fibroids) and free androgen activity (cysts, balding). Loading the system with synthetic sex hormones would not only tax the bile delivery system, but also the binding globulin capacity. Clearly, the treatment would have exacerbated the existing disharmony, but more importantly, as nothing was done to alleviate the burden on the liver and correct the disharmony, by default, we see a continuing decline in health.

Alternative treatments must look primarily at resolving liver stagnation while enhancing the sex hormone detoxification pathways. The liver must not only control the activity of hormones circulating in the system, but also degrade them for their ultimate removal. This is dependent upon fully functioning detoxification pathways. The secret of treatment, as we shall see later, is not to prescribe products but to reduce the burden on the liver: it’s more a case of not what you put in, but what you leave out!

Liver Stress - Emotional and Physical Energy

In this next section on liver stress we look at how the liver governs the smooth flow of both physical and emotional energy. Emotional upset is as capable of creating liver heat and stagnation as a poor diet. Many will relate to the powerful effect emotions can have both on the digestion and the lungs. The area can “seize” up and the diaphragm tighten, making both digestion and breathing difficult. This is stagnation of liver energy due to emotional disharmony.

A key factor in healing often lies in the ability to reduce the emotional burden of the liver, which in turn improves its capacity to carry out its many functions including detoxification and replenishment of the blood. The emotions and the physical work hand in hand: when the liver is healthy, the emotions flow smoothly; but when the liver is stagnant, the emotions become irrational. The emotional will affect the physical and vice-versa.

Unflattering associations of anger and resentment are often attributed to the liver, but, in reality, its emotional counterpart relates primarily to our disposition or how we respond to situations. An even temperament tends to support the constitution of the liver, while an over-reacting disposition tends to promote liver heat and stagnation. Prolonged frustration or constrained emotion undermines the liver, and this may subsequently manifest as anger or deep-seated resentment. Modifying our disposition or emotional tendencies may be as critical in the healing process as changing the diet. Counting to ten or chilling out are both useful strategies - and believe me, practice does pay off!

On a physical level the liver is responsible for the smooth flow of energy. This brings harmony of movement to the limbs and harmony of function to the organs. The liver is the distribution hub; it receives and processes nutrients from the digestion and transfers these to the blood, which delivers them to the tissues for energy and maintenance.

Case study
A 53 year old lady saw me having been diagnosed with chronic fatigue syndrome when she was 39 years old. She had a stressful childhood and developed psoriasis and acne in her teens. She was prescribed antibiotics for the acne, and  took these daily over a 15 year period. After a virus at 39 years, she slowly deteriorated and felt “physically stuck”. She suffered increasing muscle pains and spasms in the legs and arms, a stiffening of the limbs, arthritic symptoms, irritable bowel syndrome with a tight, cramping bowel and, more recently, pains and paralysis in her arms at night.  Insomnia and night sweats also complicated the picture and she said her liver “felt hot” with sharp stabbing pains under the ribs.

You can see from this picture that liver stagnation can be traced back to the emotional difficulties of an unhappy childhood. Acne and psoriasis followed (clear indications of liver stagnation), while long-term antibiotic abuse reduces natural resistance and compounded the liver stagnation picture.

However, muscle pain, spasms, cramping and sharp stabbing pains anywhere in the body are also associated with liver stagnation. If the smooth flow liver energy is inhibited, deficient or interrupted, then spasms, cramps and cholicky pain will be felt. What is being described is blood deficiency. 

As we have seen, the liver is responsible for nourishing the blood. The principal energy substrates that all tissues require are glucose and oxygen. In their presence, tissues burn fuel efficiently for energy. A deficiency of oxygen and glucose incurs a build-up of acidity (lactic acid), which may precipitate in the tissues and result over time in the stiffening and hardening of soft tissues and joints (arthritis).  The liver is the principal organ for maintaining blood sugar levels. If the glucose levels fall, the liver will convert stored glycogen to glucose, or, under hormonal stimulation, will break down protein to release glucose into the circulation. The brain and the nervous system are dependent upon glucose for energy, while other tissues may also use fats (also supplied by the liver). Symptoms of low blood sugar (low energy, panic attacks, sweats, shakes, palpitations, food cravings) relate directly to liver function.

The liver also governs the uptake and storage of iron. It produces proteins which ferry dietary iron to the liver. The liver stores iron and B12 –nutrients required for the development of healthy red blood cells. It is the red blood cells, replete with iron, which carry the oxygen to the tissues from the lungs. Once again the liver plays a major role. Blood deficient in iron and B12 may lead to anaemia with symptoms of fatigue, pallor, heart palpitations, generalized acidity of the tissues and, as in the case above, paralysis (also numbness and pins and needles) in the limbs. This is a complex pattern of insufficient oxygen, increasing acidity and displacement of minerals which together cause adverse reactions in the muscles. Fibromyalgia is frequently associated with chronic fatigue syndrome and has its roots in liver stagnation and blood deficiency.

Obviously the quality of the diet and the efficiency of the digestion is an over-riding consideration, as a deficient diet will lead to blood deficiency. For example, many people who are vegetarians over a prolonged period (10 years) may run into iron, zinc and calcium deficiencies. Their diet technically may be rich in these nutrients, but digestibly inaccessible. A poor iron status will lead to inadequate oxygenation (as will smoking where carbon monoxide displaces oxygen), rising acidity, and consequently deterioration of all body tissues. You can be a healthy vegetarian, but this requires greater diligence in your dietary choices and methods of food preparation.

In this article on Liver Stress, you will have gained insight into the diverse roles of the liver and how it impacts many organs and their functions once liver disharmonies arise. In the second part we shall discover how to reduce the burden and release liver stagnation through the application of diet and detoxification methods.

1. The Liver and Biliary System,  P.W.Brunt, M.S. Losowsky, A.E. Read;  ISBN 0 43304560 4; Heinemann Medical Books; pp 118,225.
2. http://vvv.com/healthnews/milk.html