Can Stress Cause Liver Damage?

Stress affects the mind, we all know. Awareness is also increasing of the impact of stress on heart health. But can stress affect liver function? Indeed, it can. Stress can damage the liver, one of the body's most vital organs, to the extent that it can lead to liver cirrhosis and even liver cancer.

Understanding the connection between stress and liver health

According to research, psychological stress has a clear connection with the physical hepatic inflammatory response. And hepatic inflammation is known to be one of the main triggers of liver diseases. This research, published in 2009 in the World Journal of Gastroenterology, reviewed "a number of studies on both human populations and animal models performed in recent years, all linking stress, mainly of psychosocial nature, and the evolution of three important liver-related pathological entities: viral hepatitis, cirrhosis, and hepatocellular carcinoma."

Briefly put, what happens is that when a person is under extreme stress - the experience of chronic stress is particularly bad - the neural pathways activate the hypothalamic-pituitary-adrenal (HPA) axis, and "all key hormones secreted by HPA components play different roles in the modulation of the immune response and the development of the inflammatory reaction", said the research abstract available online.

The abstract added: “In recent years, several studies have established an increasingly clear link between psychosocial or psychophysical stress, personality types, and the development of viral hepatitis.”

How can long-term stress affect liver health?

Other research has indicated that chronic, long-term stress leads to a decrease in nutrient-rich blood flow to the liver. Therefore, to the question "How does stress affect the liver?", the answer is, "In every way."

Statistics point to tens of thousands of deaths around the world every year because of liver ailments, and many of these, for all you know, could be caused by stress.

Here are some numbers:

• Africa sees around 53,000 to 103,000 deaths every year due to liver cirrhosis.
• More than 50 million people have chronic hepatitis infections in Africa. Their mortality risk stands at around 25%.
• According to a meta-analysis done on the effects of stress on liver damage, 40% of deaths caused by Non-Alcoholic Fatty Liver Disease (NAFLD) are attributable to psychological distress.
• In the United States, as per data published in 2020, NAFLD and its subtype Non-Alcoholic Steatohepatitis (NASH) affects approximately 30% and 5%, respectively, of the American population. About 100 million individuals in the US are estimated to have NAFLD.
• When it comes to liver cancer, Hispanic women and Asian/Pacific Islander men have the highest rates of developing the disease.
• According to Cancer. og, liver cancer causes 700,000 deaths globally each year. The populations of sub-Saharan Africa and Southeast Asia are the most vulnerable to this cancer.

What is stress and why do we get stressed?

Stress, i.e. chronic stress, has been categorized as a negative influence on several parts and facets of the human body, namely the heart, brain, and also immunity. But it's a relatively unknown fact that chronic stress can also lead to liver problems or liver damage.

Let's first understand what exactly stress is. Stress is a reactive emotion to any kind of demand, challenge, or problem that our brain feels we're ill-equipped to handle. This inability to manage the situation can manifest as emotional or physical tension.

Any event or challenge that makes a person feel frustrated, angry, sad, or overwhelmed can be stressful for him/her. These reasons are called stressors.

1. Short-term stress

It's not much of a problem when the stressors show effect for a short time. Short-term stress (known as acute stress) is good for the body.

Short-term, moderate stress (like the one you experience while preparing for an exam or meeting a deadline) can help improve the cognitive function of the brain and boost the body's immunity by increasing the production of interleukin. Short-term stress can also be caused by doing something untried and exciting (such as bungee jumping).

2. Chronic stress

When stress turns episodic, and then chronic, that's when the real problem begins. Episodic stress comes from high-frequency stressful episodes piling up one after the other, without giving time for the body and mind to recuperate. For instance, people in highly-stressful jobs such as in health care (during a pandemic), or in the military (during a war) are constantly exposed to episodic stress.

When the body and mind get no respite from the constant stress, it runs the risk of becoming chronic stress. This type of stress is extremely harmful to the human system because it triggers inflammation and several related problems, including liver problems.

Symptoms of stress

Symptoms of stress can differ according to the type of stress a person is going through.

1. Acute stress

When acute stress continues for more than a few days (but not to the extent of becoming episodic), it can lead to disturbed sleep or lack of concentration for that duration.

The symptoms are:

• Sweating
• Bouts of irritability
• Labored breathing
• Feeling of heaviness on the chest
• Increased heart rate

2. Episodic stress

Episodic stress is characterized by the muscles getting wound up due to being in a tense position for a long time. Its symptoms are:

• Muscle tension
• Migraines
• Hypertension
• Aggressive bouts of irritability
• Feeling of being overwhelmed, and trapped

3. Chronic stress

When stress enters the chronic stage, it causes serious hormonal imbalances. Its symptoms are:

• Frequent cough and colds
• Indigestion
• Weight gain
• Persistent headaches
• Emotional fatigue
• Panic attacks
• Depression

It's best to visit a doctor if any of these symptoms show up frequently. Delay in diagnosis and treatment will only hurt the heart, brain, liver, etc.

How does stress affect the liver?

With the number of psychosocial stressors increasing in today's times, their effect has also started getting more pronounced than ever.

Financial uncertainty, job loss or income loss, prolonged social isolation due to the pandemic, disturbed sleep patterns, and unreasonable expectations from oneself owing to the impact of social media - there are innumerable factors that induce stress these days.

Worse still, this stress is fast turning from acute to episodic to chronic, thus putting our health at risk, and causing more liver problems.

1. Stress leading to chronic viral hepatitis

As several studies have shown, high levels of psychosocial chronic stress lead to an increased chance and severity of chronic Hepatitis C.

This level of stress can even negate the effects of antibody response developed by Hepatitis B vaccination.

Stress stimulates the inflammation-related HPA-activated pathways and elevates the levels of glucocorticoids (GCs), which in turn trigger the liver's natural killer T (NKT) cells and increase levels of Fas antigens (a death receptor that can kill cells).

Excessive GCs restrict the recruitment of neutrophils (which can repair infected or injured tissues) as well as lymphocytes (which bring immunity) in the liver. They also restrict interleukin-6 (IL-6) and TNF-α, which play a vital role in stopping infections.

Due to these reasons, chronic stress can make the body susceptible to chronic liver hepatitis, which is caused by infectious viruses.

2. Stress leading to NAFLD

Stress may lead to disruption in protein folding in the brain, and in turn, trigger Non-Alcoholic Fatty Liver Disease (NAFLD).

It's already a known fact that chronic stress leads to visceral adiposity (increase in belly fat), which puts inflammation-inducing stress on the visceral organs, like the liver.

However, when endoplasmic reticulum (ER) stress disrupts cellular protein folding in the brain, that also leads to NAFLD.

The endoplasmic reticulum is responsible for maintaining a balance in protein folding; but when there's a nutritional excess, it leads to an overload of proteins on the ER folding capacity. To protect and preserve the ER functions, unfolded protein responses (UPR) are activated. When this activation keeps happening chronically, it leads to metabolic disturbances, including abdominal obesity.

When the UPR gets activated in the forebrain, it leads to NAFLD, irrespective of whether the person is obese or not, whether they're affected by other factors or not.

However, this correlation is more prominently seen in obese people suffering from stress. The culprit is adipokines, which are released by the adipose tissue (fat tissue). Adipokines have a direct effect on the balance and functioning of glucose and fat metabolism. So also, adipokines hurt IL-6 and TNF-α, which play a prominent role in NAFLD.

3. Stress leading to liver cirrhosis

It has been seen that chronic stress leads to inflammatory and fibrosing changes (wherein tissues are scarred) in a cirrhotic liver.

As we have already seen, stress-induced GCs alter the production of IL-6 and TNF-α, thus becoming causative of a liver infection.

These two factors, when combined, reduce hypothalamic mRNA (which helps build immunity) and protein expression of CRH (the central factor for stress response).

The resultant inflammatory and fibrosing damage caused to the liver, also negatively affects the NKT cell activity.

Sympathetic nervous system mediators, viz. epinephrine and norepinephrine, are affected by chronic stress in such a way that they lead to increased production of pro-inflammatory cytokines.

All these factors become causative for heightening the possibility and severity of liver cirrhosis.

4. Stress leading to liver cancer

Stress is known to increase the severity of cancers, in general. In the same vein, it also influences the progression of hepatocellular carcinoma (HCC), the most prominent type of liver cancer.

People having liver cirrhosis and excess NKT cell activity are more prone to developing HCC. In addition to that, chronic stress can negatively influence TNF-α, IL-1, and IL-6, in turn stimulating the NKT cells, which can boost the development/progression of the tumor at the cellular level.

Chronic stress can also lead to damage to DNA, problems in DNA repair, and imbalance in the process of apoptosis - all causative factors for increasing the risk of cancer.

Protecting the liver from stress-induced problems

As we've seen, stress can trigger liver problems even in the absence of other factors like alcohol consumption or obesity. Of course, these factors compound the problems when coupled with stress, but to cut the risk of liver damage due to stress, it is prudent to curb the level, duration, and severity of stress.

Try to avoid the stressors as far as possible, and try to cultivate a positive outlook even when facing setbacks. Some ways to manage stress positively are as follows:

• Be active: Indulge in some form of physical activity, be it walking, cycling, jogging, swimming, light aerobics, etc. This helps release feel-good hormones like endorphins and also burns flab (which otherwise leads to inflammation-inducing obesity and visceral damage).
• Eat right: Eat a healthy diet rich in vitamins, minerals, and fiber. Avoid having a diet laden with excessive saturated fats, processed foods, added sugars, and refined foods as they trigger inflammatory responses.
• Laugh a lot: Join a laughter therapy group or do it at home. A good, hearty laugh can release the tension in the muscles and it can trigger feel-good hormones that promote overall good health.
• Cut the caffeine: Coffee has benefits, but don't drink endless cups of it, and avoid caffeinated beverages such as fizzy drinks. To ensure stress-free sound sleep, don't drink coffee close to bedtime, as the caffeine stays in the body for several hours.
• Get social offline: Being social online can ironically lead to isolation from the world, which in turn can be a big stressor. Go out, talk to people, and vent your feelings; it helps in unburdening stress.
• Take up yoga/meditation: These are age-old techniques that can be practiced even at an older age. Meditation helps to relieve anxiety, depression, and high blood pressure; whereas yoga reduces excessive cortisol levels, and heart rate, among other things.
• Breathe deeply: Whenever you find yourself getting stressed, stop and close your eyes and breathe deeply. Practice deep-breathing exercises like belly breathing, diaphragmatic breathing, etc. to stimulate the parasympathetic nervous system, which plays an important role in the relaxation response.
• Release your feelings: Externalize your feelings instead of internalizing them and allowing them to fester inside and cause stress. Write a diary, take up a hobby, practice mindfulness, or talk out to a friend/family member/therapist for the same.

Conclusion

Stress is detrimental to the entire human body, and the liver is no exception to that. When a person is under constant stress, it becomes chronic and triggers chemical changes in the body that end up damaging the liver. This damage can even take the form of liver cancer, which kills more than half-a-million people annually around the world.

Stress management through basic steps like exercise, meditation, laughter therapy, etc is essential even before the signs of high stressshow up. And when symptoms of episodic stress, which is the precursor of chronic stress, do appear, then seeking medical help is necessary.

The liver is one of the most important large organs in the body, no less significant than the heart or the lungs. Keep stress at bay to keep the liver healthy.

Keep reading for credible information about similar health conditions, and how you can get good liver health with a good diet and healthy food.