Can Stress Cause Liver Problems?

Overview

Have you ever felt frustrated, hurt, or exhausted by physical or psychological challenges? If you have, then you’ve experienced stress. Stress is normal and everyone experiences it once in a while. You might have heard that stress affects the brain, heart, and lungs, but stress also affects the liver. Stress reduces blood flow to the liver and may cause liver cell death. The liver makes room for such changes by being able to regenerate. Damage to the liver can cause liver and health problems because the liver is a vital organ.

What is Stress?

Stress is your body's response to physical or psychological strain or tension. Your body responds to stress by activating its stress response. Any challenge that threatens your well-being and evokes your stress response is a stressor. Stressors come in different forms: physical (injuries, illnesses, infections, pain) or psychological (public speaking, an exam, financial problems, dating).

The stress response is the body's fight-or-flight response. It releases hormones that make your body react – your heart beats faster, your muscles tense up, and you sweat. The stress response prepares you to save or protect yourself from your stressor. Short periods of stress are tolerable because the stress response stops once you get rid of your stressor. Long-lasting (chronic) stress takes a toll on your body because the stress response is consistently activated.

Stress is a difficult concept. There are many sources of stress and everyone responds to stressors differently. You might be stressed by something that does not bother someone else. It is difficult to diagnose or quantify stress because of how subjective it is. However, you can identify when you are stressed by looking out for the signs.

Signs you are stressed

To know whether you are stressed, you have to pay attention to your body’s response to a potential stressor. Your signs of stress may be physical or mental. You might also notice behavioural changes when you are stressed. 

Physical signs of stress

  • Tensed muscles
  • Shaky hands
  • Headaches
  • Dizziness
  • Chest pain
  • Dry mouth
  • Fast heartbeat 
  • Upset stomach or indigestion
  • Teeth grinding

Mental signs of stress

  • Nervousness
  • Worry
  • Difficulty concentrating 
  • Feeling overwhelmed
  • Difficulty making decisions
  • Forgetting 
  • Feeling unsettled

Behavioural changes

  • Lack of sleep
  • Sleeping too little
  • Oversleeping
  • Unsatisfying sleep
  • Loss of appetite 
  • Overeating 
  • Being irritable 
  • An urge to drink or smoke more

Impacts of stress on the liver

Stress, whether short-term or chronic, affects different processes within the body through the stress response system. Hormones released by this system affect different organs in the body, including the liver. 

The liver is an important organ. It carries out many activities that are necessary for maintaining health and a well-functioning body. When stress affects the liver, it reduces the liver’s efficiency.

Role of a healthy liver

The liver is the largest internal organ and the second largest body organ. The liver’s weight ranges from 1.36 - 1.59 kilograms, and it holds about 25% of blood at a time. The liver carries out many functions:

  • Regulation of glucose in the blood. The liver stores excess glucose from food as glycogen. When blood glucose levels reduce, the liver breaks down glycogen to glucose and forms more glucose from fats and proteins.
  • Synthesis of proteins from amino acids. Proteins are also metabolised and degraded in the liver.
  • Blood clotting. The liver synthesizes proteins responsible for blood clotting.
  • Synthesis of lipids like cholesterol, phospholipids, triglycerides, and lipoproteins.
  • Formation of bile. Bile aids the absorption of fat and fat-soluble vitamins (vitamins A, D, E, and K) from your intestines. Bile also helps you remove excess cholesterol from your body.
  • Metabolism and transport of bilirubin. The liver breaks down haemoglobin from old red blood cells to form bilirubin. Bilirubin is passed with bile into the intestine and excreted in faeces. 
  • Inactivation of hormones like growth hormone, insulin, testosterone, and oestrogen. 
  • Metabolism of alcohol and drugs. The liver processes alcohol and drugs absorbed by the intestine.
  • Production of immune factors and resistance to infections. The liver destroys toxic substances that come from the intestine. 

Stress contributes to liver cell death

The body responds to stress by releasing stress hormones like cortisol into the blood. Cortisol causes inflammation of liver cells and consequent liver cell death. The body also releases epinephrine and norepinephrine, which have been shown to be toxic to the liver and cause cell death. Stress hormones also increase the permeability of the liver. This means there could be increased absorption of toxic substances that harm liver cells.1

Stress impairs blood flow 

The stress response reduces blood flow to the liver. The body diverts blood to other organs like the muscles to facilitate the flight or fight response. If blood flow to the liver reduces significantly, liver cells won't get enough oxygen, so they die. Dead liver cells cause inflammation and liver injury.1

Signs of liver stress

The effects of stress on the liver don't show up immediately because the liver, is a vital organ that accommodates minor changes in the body. Also, the liver regenerates when there is minor liver cell damage. When the stress on the liver is prolonged or significant, it manifests in the following symptoms to indicate that it is not functioning properly.

Jaundice

Jaundice is the yellowing of the skin and the whites of the eyes due to the buildup of bilirubin (a yellowish-brown pigment) in the blood. It is the function of the liver to remove bilirubin from the blood and excrete it through bile. If the liver can't function properly, it doesn’t get rid of bilirubin easily. A buildup of bilirubin is toxic. Seek medical help if you notice yellowing of your skin or the whites of your eyes. In dark-skinned people, skin yellowing may not be clear but yellowing of the eye is.

Digestion problems

Bile, produced by the liver, aids the digestion and absorption of fats. When bile is insufficient, the digestion of fat slows down and fats accumulate in the gut. This slows the whole digestive process and leads to constipation. Also, bile contains 97-98% water which helps move faeces through the gut. When there isn't enough bile, faeces won't move as easily and this contributes to constipation.

Body aches and pains

An important function of the liver is to clear out toxins from the blood. Muscles and joints don’t have access to clean blood if the liver doesn't work properly. Also, stress prepares the body for fight or flight by tensing up the muscles. The body aches and pains that come from muscle tension are worsened when there are toxins in the blood.

Fatigue

Fatigue is reported by many people with liver problems. However, the exact relationship between liver problems and fatigue is uncertain. The liver is involved in many of the body's normal functions and fatigue can be a symptom of other health problems—depression, lack of exercise, or a poor diet. It’s difficult to point out how stress causes fatigue through the liver.

Darker urine

Urine removes one of the byproducts of the breakdown of bilirubin—urobilin. Urobilin is responsible for the yellowish colour of urine. Before bilirubin is ready for excretion, it is transformed as it goes through the liver, gallbladder, and intestine. Dark-coloured urine could be a sign that bilirubin itself is present in urine.2 This may be because bilirubin escapes to the blood before it is fully transformed. It may also be because the passage of bile is blocked. Seek medical help if you notice dark coloured urine. Dark urine could also be a side effect of a drug you're taking.

Common Liver Problems

Liver disease

Liver disease is any illness that results from damage to the liver, or from the liver not functioning properly.

Fatty liver disease

The liver is the primary organ that metabolizes fat. So, the cells of the liver are prone to accumulating fat when the liver is damaged. Accumulation of fat in the liver may be due to obesity or being overweight. This causes a form of fatty liver known as non-alcoholic fatty liver. Accumulation of fat may also be due to excess alcohol intake. This causes alcoholic fatty liver disease. Accumulation of fat in the liver leads to inflammation of the liver which damages liver cells. In turn, damaged liver cells cause scarring (fibrosis) which progresses to cirrhosis of the liver

Hepatitis

Hepatitis is the inflammation of the liver. Prolonged inflammation of the liver could cause damage to liver cells, scarring of the liver, and cirrhosis. Inflammation of the liver could be a result of toxins or the accumulation of fat in the liver. Hepatitis can also be caused by viral infections. There are different types of hepatitis caused by viruses:

  • Hepatitis A is transmitted from the faeces of an infected person to a healthy person. It is commonly transmitted in unsanitary environments.
  • Hepatitis B is transmitted through blood, semen, and vaginal fluids. It is commonly transmitted from an infected person through unprotected sex or contact with blood (from infected syringes and sharp objects, and from transfusion of infected blood).
  • Hepatitis C is spread by contact with the blood of an infected person. 
  • Hepatitis D only affects people with hepatitis B, as the hepatitis D virus needs the hepatitis B virus to survive. Like hepatitis B, hepatitis D is transmitted from an infected person through blood and unprotected sex. 
  • Hepatitis E is transmitted through faeces and water infected with the hepatitis E virus. The virus also infects pigs, boars, deer, and rabbits and can be transmitted when the meat of these animals is eaten raw or undercooked. 

Autoimmune hepatitis is a rare disease where the immune system attacks liver cells. In this lifelong condition, the immune system treats liver cells as foreign and damages them.

Cirrhosis

Cirrhosis is an advanced form of liver scarring. Cirrhosis occurs as a result of inflammation of the liver or liver-cell damage. Cirrhosis of the liver blocks free blood flow in the liver and prevents the liver from functioning normally. Cirrhosis causes permanent liver damage and may lead to liver cancer

Common causes of liver problems

The common causes of liver problems are as follows:

Obesity

If you are obese or overweight, you are at risk of non-alcoholic fatty liver disease. This disease develops in four stages:

  • Stage 1 - Fat accumulates in the liver. This stage is mild and may go away without being noticed. 
  • Stage 2 - The liver gets inflamed. This stage is also known as non-alcoholic steatohepatitis.
  • Stage 3 - Fibrosis of the liver. If inflammation is untreated, it leads to fibrosis (scarring) of the liver which can be reversed.
  • Stage 4 - Cirrhosis of the liver. After years of fibrosis, the liver becomes severely cirrhosed. 

Obesity is also a risk factor for diabetes, heart disease, and kidney disease.

Hepatitis

Liver inflammation from viruses, toxins, and or fat accumulation causes liver problems. Inflammation could lead to fibrosis and cirrhosis of the liver. Inflammation also attracts immune cells which attack and damage liver cells. 

Alcohol abuse

Alcohol abuse damages liver cells, causes fat accumulation in the liver, and leads to alcoholic fatty liver disease. Alcohol abuse takes two forms

  • Binge drinking, which could cause fat build-up in the liver and inflammation. The liver can recover from this assault.
  • Drinking more than the recommended amount for many years. This can cause inflammation, fibrosis, and cirrhosis of the liver.

To avoid alcohol abuse, it is recommended that you drink no more than 14 units of alcohol each week. If you drink up to 14 units each week, you are advised to spread your drinking over three days.

Summary

Stress is the response of the body to physical and psychological strain. Stress affects different parts of the body, including the liver. The liver accommodates changes in the body, but if stress is significant or long term, it affects the liver.

References

  1. Joung J, Cho J, Kim Y, Choi S, Son C. A literature review for the mechanisms of stress-induced liver injury. Brain Behav [Internet]. 2019 Feb 13 [cited 2022 Aug 18];9(3):e01235. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422711/
  2. Hoilat GJ, John S. Bilirubinuria. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Aug 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK557439/

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Roseline Akpa

Bachelor of Science degree in Human Physiology, Ahmadu Bello University, Nigeria

She is a freelance health writer interested in mental health, holistic health, and health tech.

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