Fatigue and the Liver

The Liver and Its Functions

Blood passes through the liver at about 3 pints (6 cups) per minute, making the liver an extremely busy organ. In charge of a long list of life-sustaining functions, a few of the liver’s crucial duties, include:

  • Producing bile, which helps carry away waste and breaks down fats in the small intestine during digestion.
  • Producing certain proteins for blood plasma.
  • Manufacturing sex hormone binding protein – liver health is essential for a good sex drive. If the liver is compromised in such a way that it is producing too much of this protein, it can depress your sex drive.
  • Making cholesterol and special proteins to help carry fats through the body.
  • Regulating carbohydrate metabolism – converting excess glucose into glycogen for storage.
  • Storing vitamin A, vitamin D, many of the B vitamins, iron and copper.
  • Converting poisonous ammonia to urea (urea is an end product of protein metabolism and is excreted in the urine).
  • Clearing the blood of drugs and other poisonous substances.
  • Resisting infections by producing immune factors and removing bacteria from the bloodstream.

If your liver is unhealthy, compromised or diseased, it could be working too hard for long periods of time, thus becoming overrun with toxins. The liver’s task of keeping your blood stream clean becomes difficult. In such cases, many different symptoms of poor health may occur, especially allergies, headaches and chronic fatigue.

Symptoms of liver disease are nonspecific, meaning there is no distinct symptom that indicates that something is wrong with the liver or how serious it is. Fatigue is one such symptom.

What is Fatigue?

Different than drowsiness (a need to sleep), fatigue is characterized by a decreasing ability to exert oneself – a physical and mental lack of energy and motivation. It is usually associated with the feeling of being tired, bored, weak, and/or irritable.

Fatigue can occur at any time of day but occurs most often in the morning, many cases in as little as one hour after waking up. Some people will experience it all day long.


Several factors have been shown to contribute to fatigue:

  • Poor sleep and lack of rest
  • Drug and alcohol use
  • Stress and depression
  • Other diseases
  • Chronic pain
  • Lack of exercise
  • Poor nutrition
  • Not drinking enough water and fluids
  • Impaired immune system
  • Certain medical treatments

Keep in mind that because it can have many causes, one must consult with his or her doctor to help pinpoint what is contributing to the fatigue. For those who have liver disease, it is likely the most common symptom. It is a symptom that is universal to all types and stages of liver disease.

Understanding the liver’s role in energy production clarifies how a compromised liver can result in fatigue. The liver is intimately involved in supplying the body with energy. As indicated above, the liver converts glucose into glycogen, storing it for later use. When the body needs energy, liver glycogen can release glucose to provide fuel for creating a burst of energy. Additionally, if the body is low in carbohydrates, the liver can manufacture more from fat or proteins.

By producing, storing and supplying the body with glucose, the liver is a key player in preventing fatigue. A liver unaffected by disease releases glucose between meals, or whenever the cells need nourishment and energy. While a healthy liver maintains a steady level of energy throughout the day, one hampered by disease has a reduced ability to produce glucose, and less space to store it.

For those will liver disease, the continued, long-term response of the immune system contributes to fatigue. The release of neurotransmitters (chemicals in the brain) is part of a healthy immune system response. When the body is physically or emotionally stressed, the immune system activates, causing the brain to release the appropriate substance for self-protection. Liver disease causes a chronic, uncontrollable stress to the patient, weakening the immune system and decreasing the release of certain neurotransmitters.

Managing Fatigue

Since fatigue is a symptom, not a disease, the treatment depends on what is causing the it. For those that have liver impairment, being informed about the detrimental effects of alcohol, drug use, poor sleep, dietary habits and a highly stressful life can empower an individual to make positive lifestyle changes. In addition to making healthful lifestyle decisions to reduce fatigue, these changes will also support the liver and strengthen the immune system.

The following are some helpful tips:

  • Try to avoid overloading your day with a busy schedule by prioritizing necessities.
  • Work at the time of the day when you feel your best and arrange to do things then.
  • When possible, conserve your energy by sitting down to perform activities you typically do while standing.
  • Rather than trying to sleep when you are fatigued, rest or do a lighter, easier activity since you will regain more energy from this sort of break.
  • Pace yourself by including regular breaks in your day.
  • Pass on large, heavy meals in favor of smaller, more frequent ones.
  • Since hot temperatures can be draining, take warm showers.
  • Establish a pre-sleep routine at night to wind down and prepare your body for sleep.
  • Improve sleep patterns: this can include cutting out caffeine after 4pm, sticking to a routine of retiring and rising at the same time every day, modifying your sleep environment to minimize sound, light and distractions, and taking time to unwind by purposefully relaxing before bedtime.

This information is intended for educational purposes only and should not be used in any other manner. This information is not intended to substitute for informed medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider.

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About the Author

Stephen Holt, MD, PhD, FACP

Stephen Holt, M.D. is a Distinguished Professor of Medicine NYCPM (Emerite) and a medical practitioner in New York State. He has published many peer-review papers in medicine and he is a best-selling author with more than twenty books in national and international distribution. He has received many awards for teaching and research. Dr. Holt is a frequent lecturer at scientific meetings and healthcare facilities throughout the world. He is a best selling author and the founder of the Holt Institute of Medicine.

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