Everything you put in your mouth passes through your liver before moving onto the rest of your body. One could hypothesize that any herb taken orally in a tea, tincture, capsule, oil, powder or glycerite is a liver herb as it passes through your liver and therefore in some way effects the largest organ in your body.
For example, in my clinical experience, when folks have a “weak”, “burdened” or “stagnant”liver it is wise to go easy on the amount and number of herbs offered until the liver has been nourished and strengthened. Folks with liver challenges, whether diagnosed or not, tend to react to herbs in ways not necessarily helpful to their healing.
One extreme example of this is the herxheimer’s reaction (commonly referred to as herx or herxing) experienced by those struggling with Lyme Disease. Plants herbalists consider gentle such as cleavers (Galium aparine) may cause pain, fatigue and general malaise when taken by those struggling with the chronic infections associated with Lyme disease. One of the reasons for this is cleavers is a plant that moves toxins from the interstitial fluid and into the lymphatic system. Once in the lymph system the toxins flow into the liver where they are metabolized for removal. If the liver is already burdened by the toxins associated with Lyme Disease, plants like cleavers may too pushy the liver asking it to do more than it capable of. This contributes to the herxheimer’s reaction.
Herxheimer’s is an extreme reaction. Not all folks who have a challenged liver respond to herbal medicine with pain and malaise. However, I found that it is essential to always consider the health of a person’s liver when offering medicine. Supporting a patient’s liver when it shows signs of being overwhelmed will improve their health and sense of well being no matter what they have come to see the herbalist for. Most conditions will improve when the liver vital.
How does one know a liver is “weak” or “burdened”? A herbalist learns to watch for many different types of signs that a patient’s liver needs to be supported. Considering the liver has about 500 actions it performs to keep you well, there are many different types of signs the liver offers when needing support. Some signs I watch for are:
- Waking up tired, achy and feeling mildly hung over without drinking any alcohol the night before.
- Disturbed sleep (either falling asleep or waking up frequently at night.)
- Female hormonal imbalances.
- Hyperglycaemia and any other blood sugar imbalance such as fatigue after eating.
- Cystic acne (possible hormone imbalance with origin in the liver.)
- Pain in the right shoulder, neck and head.
- Pain below the ribs on the right side, and sometimes on the left side.
- Sense of not being able to take a deep breath
- Disturbed digestion and bowels
- Migraine headaches
- Bruising easily
- Red eyes, dry eyes, burning eyes, rashes around the eyes
- Repetitive emotions of frustration and depression as well as burst of creativity followed by low period.
More serious clinical manifestation of “weak” liver are jaundice, fluid build up in the abdomen, legs and ankles and itchy skin.
Let’s explore one of the most common signs that a patient’s liver is weak or burdened and one of the most common reason for folks to see a herbalist – insomnia. Many of the herbs commonly used to support sleep also support the liver’s health in some way: Hops (Hummulus lupus), St John’s Wort (Hypericum perforating), Chamomile (Matricaria recutita), Motherwort (Leonarus cardiaca), just to name a few.
What is the relationship between disturbed sleep and the liver you maybe wondering. Isn’t insomnia a neurotransmitter imbalance and all in the brain? This is certainly a biomedical approach to insomnia. But traditional herbalist approach insomnia often through considering the health of the liver.
To begin, let’s review the four stages of sleep.
Stage 1 begins as you fall asleep or immediately follows REM sleep (when you dream). It lasts up to 5 minutes and your body begins to relax while your heart rate and breathing slowing down.
Stage 2 comes next. During this stage your body’s temperature reduces, your heart rate and breathing continues to slow down and your eyes stop moving. This stage lasts between 10 minutes to an hour.
Stage 3 is your deepest sleep. This is when the wear and tear on your body from the day before is repaired, cancer cells are killed and imbalances in your biome are taken tended to. You brain is quite quiet during stage. This stage lasts between 20 and 40 minutes.
Stage 4 is REM sleep and this is when you dream. During REM your eyes begin to move again while your brain activity, heart rate and breathing increases. While I personally feel dreams are profoundly complex part of life, let’s for the sake of this article stay with the standard biomedical model approach to the importance of dreams which is dreams are good for your brain and mental health.
So what does this have to do with the liver? Research has shown that a moderate or large amount of alcohol before bed limits the REM cycle. Researchers also have have linked most chronic conditions associated with liver such as Non-alcoholic fatty liver disease, Hepatitis C, Cirrhosis with disturbed sleep, both difficulty falling asleep and waking at night, as well as increased fatigue during the day. [1] The health of your liver directly influences the quality of your sleep, while the quality of your sleep directly influences the health of your liver. This understanding about the relationship between sleep and the liver is not new to traditional herbalists. The body clock used in Traditional Chinese Medicine teaches that the liver is most active between 1 and 3 am is commonly referred to herbalists when assesssing a patient’s sleep. But the question needs to be asked – what is the liver actively doing between 1 and 3 am?
During the day the liver is busy sorting through everything you are putting into your mouth.
The liver sorts out the good from bad whether you have eaten it, drank it, breathed it or absorbed it through your skin. Your liver cells process all nutrients, sending some and sends off into your blood stream to be delivered to your body’s cells for energy while others are stored as sugar to be used later. During the day, your liver cells increase the production and release of bile. Bile has many purpose: balancing the gut’s biome, emulsifying eaten fats and encouraging peristalsis leading to bowel movements. Your liver is also busy processing all the toxins you encounter during the day, whether from your food and water intake, pharmaceutical drugs or exhausted from the diesel truck you were stuck behind in traffic, just to name a few. This list of daytime activity does not even touch on the role your liver is playing in making and recycling hormones, creating enzymes used by your immune system or dealing with the cellular debris caused by the wear and tear on your body during your hot yoga class.
To do all this daytime sorting and nourishing and disposing your liver cells need energy. They get that energy from the work done by mitochondria. Mitochondria are the creators of energy for each cell in your body. Because liver cells do so much work and it needs a lot of energy. About 25% of each liver cell is made up of mitochondria. To increase the energy the liver cells need for each days work, the mitochondria inside each liver cells begin dividing as your body wake ups each morning. This sound great, the liver can accomplish all its tasks because every morning its mitochondria double making more energy. Everyone, including our livers, want more energy.
But as always, everything comes with a price. The price of all that daytime liver energy is mitochondrial damage. As the mitochondria creates energy for your liver to do all its wonderful metabolizing during the day, free radicles are created. The more energy the mitochondria create, the more free radicles floating around inside and outside of liver cells. Free radicles are loose oxygen molecule. These fiery molecules burn minute holes in the membranes surrounding the mitochondria causing leaks which disturb their internal environment. Some free radicles damage the mitochondrial DNA, causing them to malfunction. Current research is suggesting that cancer begins in a cell’s mitochondria DNA. Some free radical escape the mitochondria and begin to disrupt other parts of the cell, including the nucleus where your DNA is stored and this is definitely cancer causing. All this means that your liver does not have the energy it needs to all its sorting of the good, bad and ugly of life.
This is where sleep comes. It is during sleep that that the liver’s mitochondria repair themselves. As the sun goes downs and your body begins to prepare for sleep, the mitochondria in your liver begin to merge. Instead of dividing as you wake you, your mitochondria come together to form bigger mitochondria while you sleep. During this time, the mitochondria repair themselves from the free radicle damage. When you sleep is when you heal. Your liver in particular needs rest to restore damaged bits and pieces of mitochondrial DNA and membranes.
So what happens when you eat, have a few drinks, do an intense workout before bed or late at night. Your liver does not have the energy resources it needs to process the nutrients, toxins and cellular debris caused by late night activities. Nor does it have energy it needs to repair the mitochondria. Its resources are spread to thin. Its sort of the like multi-tasking. Chronic multi-tasking is difficult to maintain and creates mental exhaustion, loss of focus, frustration and nothing is gets done, particularly tasks that require a sustained focus like mitochondrial repair.
When the liver is overworked at night, sleep becomes restless. This is why alcohol disrupts your sleep and you wake up hungover. The liver cells process alcohol. At night the liver simply does not have the resources to process the extra glass of wine. Somethings in the relationship between the repair stage of sleep and REM sleep goes askew and both the physical and emotional processes that happens during sleep do not take place. Toxins continue to circulate in your blood stream until you and your liver are awake enough to deal with them. Unfortunately, the next day has begun with a little less energy both physically and emotionally.
Once the liver gets behind on the mitochondria repair necessary to sort out the good from the bad symptoms of a burden liver begin to appear. One of the ways the liver begins to cope with the loss energy and the continued toxic load is to increase its storage of fat. (Toxins are stored in fat cells all over the body) and Non-alcoholic fatty liver disease (NAFL) develops.[2]
If someone tells they wake up feeling with foggy head, heavy body and with no energy, you know the liver is challenged to process toxins and self repair. [3]
Luckily, for those shift workers , those struggling with disturbed sleep from PTSD or Mom’s with a kid who won’t sleep, just to name a few reasons why we might not get the sleep we need, there are herbs to support the health of the liver’s mitochondria and therefore indirectly supporting a good night’s sleep. These are the plants that are high in flavonoids and are often referred to as hepatoprotectants. They include milk thistle (Silybum marianus), Schinsandra (Shinsandra chinoisis), Licorice (Glyccyhriza spp.), Burdock Root (Articum lappa) and Rhodiola (Rhodiola rosacea).
These plants with their array of flavonoids, also found in most fruits and vegetables, ease the number of free radicles circulating within your cells and in particular your liver cells. They are an essential part of any herbal protocol formulated to support the health of the liver. Some of these herbs like Licorice, Schinsandra, and Rhodiola are labeled as adaptogens and it is believed that they support sleep through their effects on moderating cortisol levels. It is important to remember that these herbs also protect the liver and support it its ability to function which means sleep between 1 and 3 am.
Let’s return to folks who respond to herbal protocols in unexpected ways: pain and malaise.
One of the reasons these patient’s have difficulty taking herbs, particularly herbs that push toxins into the liver, like lymphatic herbs or anti-microbial herbs, is because the liver is already burdened and unable to cope with all its jobs before introducing herbs. The toxins therefore end up circulating through the blood longer creating herxheimer’s like reactions. In cases like these, it is wise to offer hepatoprotectants that support the liver’s mitochondria before increasing its workload.
Hepatoprotectants, although not known as hypnotics (herbs that bring on sleep), will improve the quality of sleep while supporting the repair of the liver’s mitochondria. This will effect every part of life: mood, energy, appetite, digestion, libido, immune function, etc. After all the meaning of the word liver is to live.
[1] Shah NM, Malhotra AM, Kaltsakas G. Sleep disorder in patients with chronic liver disease: a narrative review. J Thorac Dis 2020;12(Suppl 2):S248-S260. doi: 10.21037/jtd-cus-2020-012
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664866/