Stress Affects Energy Production in the Liver Mitochondria
The liver is a fascinating organ – especially as women transition menopause.
According to traditional Chinese medicine, the expression “the liver stores the soul and controls the deliberations” indicates that the liver plays an important role in the process of regulating emotion.
This is because the liver stores blood and blood stores the soul. Qi and blood are the material bases of emotional activities. Which is why, in Chinese medicine, you cannot understand stress, without understanding its effects on the liver. [Yu Wei et al., 2018].
It is hard to dispute that for millions of women today, stress is part and parcel of everyday life. I know myself and from the women who join me in my coaching community and with the Practitioners who join me for the certified courses, that family, social and work obligations can easily overpower precious time and resources, causing both physical and emotional stress to take a greater toll on menopause symptoms and general health.
Stress has been defined as any action or situation (stressor) that places increased physical or psychological demand on one’s state of internal balance, or homeostasis.
To meet these increased demands, the body must have the ability to cope, which means that there are also increased neural and endocrine (hormonal) demands on the Hypothalamus-Pituitary-Adrenal-Thyroid Axis (HPA-Thyroid Axis), in response to repeated or chronic stress.
For women who have had decades of stress, including the physical stress of training and competing in sports or participating in demanding exercise, this is where attention needs to be given to the health of the liver.
Researchers now understand that just one episode of stress messes up liver biochemistry.
Hepatic (liver) mitochondria are specialized energy-producing powerhouses packed inside liver cells (hepatocytes) that drive metabolism, detoxification, and whole-body balance. Each liver cell contains up to 2,000 mitochondria, which make up about 18% of the cell’s total volume to meet the organ’s massive energy demands.
But here’s the thing – there is one thing in midlife and older women, which causes disruptions to the regulation of mitochondrial energy production in the liver, and this is chronic stress.
Chronic psychological stress (termed Allostatic Load) not only has a profound impact on psychological well-being but also causes damage to physical health, including in the liver.
Human physiology is well developed to handle stress to promote survival – we all know this. But during menopause, as the liver (and other organs and the nervous system) age, women can become more susceptible to stressors – both emotional and physical.
When there is too much stress, the body goes into overload, resulting in allostatic load. This is a dysregulated state that predicts functional decline, accelerates ageing, and increases mortality in humans. [Bobba-Alves et al., 2023]
But here’s the thing – the accumulation of allostatic load is now known to be defined by gender – coping differences occur between males and females, and female health tends to suffer more.
A chronically-stressed liver produces more glucose
Chronic stress contributes to inflammation, which in the liver, can sit around for years. [Joung et al., 2019]. When chronic stress is present, so too are higher circulating levels of cortisol. This is because the reaction to any given stressor, involves the stimulation of the pathways within the brain leading to the (over)activation of the HPA-Thyroid Axis.
Reactions to stressors, impact sympathetic nervous system drive, releasing larger amounts of cortisol into the circulation.
Higher levels of cortisol stimulates the liver to produce more glucose in response to the increased energy demands on the body, i.e. the ‘fight or flight’ response. In response to the need for more glucose, the liver produces it from stored glucose. This process is known as gluconeogenesis, which leads to increased blood glucose levels.
In response to these higher blood glucose levels, the pancreas releases insulin to carry the glucose to the brain and muscles. Which is why, over time, if stress continues and cortisol remains elevated, this can lead to insulin resistance.
‘Psychological stress is associated with a variety of pathological conditions resulting in liver injury through multiple systems, including the sympathetic nervous and adreno-cortical system.’ [Joung, Cho et al, 2019, p. 1].
Stress (both physical and psychological) leads to the reduction in hepatic (liver) blood flow and the reduction of mitochondrial activity – the organelles responsible for energy production in the liver.
For Practitioners, this connection is an important one.
The resulting reduction in oxygen uptake in the liver, due to reduced liver blood flow, causes inflammation in the liver – mainly in the mitochondria, which are the cells that help to burn fats to turn into energy. This inflammation places a lot of strain on ageing liver cells, (Chandel et al, 2000).
Furthermore, when hepatic blood flow is reduced, then this also impacts the health of the gut, through the gut-liver axis.
The gut-liver axis refers to the bidirectional communication and interaction between the gut, its microbiome, and the liver, influencing gastrointestinal and liver health and disease. [Albillos et al., 2020].
Some of your clients may well be arriving in peri-menopause and menopause, with a tired, inflamed liver, not only from physical or emotional stress, but also from menopause-related insomnia. This places an additional burden on the health of the liver, contributing to Non-Alcoholic Fatty Liver Disease, (NAFLD) and/or Metabolic Associated Fatty Liver Disease (MAFLD). [Bagnato et al., 2024]
If your client’s blood work has shown that their liver enzymes are high (whether they drink alcohol or not), you might want to discuss the connection between their liver health and stress levels with them.
Peta was the same – as a competitive triathlete and coach, she was frustrated with not being able to lose weight and have the energy she needed to train and compete. As she mentioned,
“I’d lost all my mojo and drive to train. Getting out of bed was hard enough. All the reading I had done had told me that my oestrogen levels were dropping in peri-menopause, so I was stuffing myself with oestrogen products but Wendy’s programme told me I was feeding myself stuff that was making my liver health worse – and the stress of training and lack of sleep and everything plus feeding myself high protein (eggs etc) sports nutrition foods, had turned my body into a cocktail of hormones.”
High Intensity Exercise (including heavy weights) Increase Liver Energy Production Demands
Female exercisers who are training more intensely, (including heavy weight training) and women who work in physically demanding jobs, must remember that before, during and after exercise or when workloads are high, the liver has a lot of work to do.
When muscles are demanding more glucose (sugar) to function, e.g. as in exercise or sports participation, the liver is busy turning over glucose and lactic acid from its storage cells.
The muscles only store enough glycogen (stored glucose), to produce small amounts (up to 20 seconds) of ATP (the energy molecule) at the commencement of exercise – ATP is needed for muscle contraction.
The harder women train or exercise or the more stress that they experience daily, the more work the liver has to do to keep supplying both the muscles and brain with energy.
To achieve this, the adrenal glands are producing more cortisol, but it’s the liver that is playing a crucial role in the metabolism of cortisol and can produce it locally, converting cortisone to cortisol via the enzyme 11-beta-HSD1. [Thau, 2023).
The higher the production of cortisol, the more that it is also demanding cholesterol from the liver. For more and more cortisol to be produced, the liver is producing cholesterol to help the adrenal glands make cortisol.
The increased production of cortisol then becomes problematic for women in their menopause transition, because it uses up progesterone in the production pathway.
When progesterone levels are low in comparison to oestrogen, menopause symptoms may become worse.
The role of progesterone cannot be underestimated and if progesterone is low, then symptoms can become worse. The diagram below shows the numerous roles of progesterone in females.
This is why, you cannot help your clients manage their stress levels, without giving consideration to the role of the liver and the inflammatory changes that have occurred over many years. All this, at a time of life, when ageing changes are also impacting the liver’s function and size, including the role of enzymes. (Brady, 2015).
Alcohol Reduces Hepatic Energy Production
The role of the liver and the evidenced detoxification pathways are covered in both the Menopause and Lifestyle Practitioner Course and the Menopause Weight Loss Coach Course.
In these courses, I also talk about the impact of alcohol on an ageing and inflamed liver. It’s a topic in menopause symptom management that increasingly, I can’t ignore. Alcohol damages hepatic (liver) mitochondria by disrupting energy production, increasing harmful oxidative stress, and impairing quality control mechanisms that clear out damaged cells. [Hoek et al., 2002].
Hepatic inflammation during menopause, reduces ALDH enzymes, which affects alcohol metabolism. As such, some women find that certain types of alcohol impact the severity of their hot flushes.
Alcohol aromatises into oestradiol, a form of oestrogen. In humans, oestradiol (E2) is the predominant circulating oestrogen. If women have breast cancer, then they may know all about this type of oestrogen already.
EVOO Helps Hepatic Energy Production
I talk a lot about the powerful compounds in Extra Virgin Olive Oil in all of my programmes, the Practitioner courses included.
Extra virgin olive oil (EVOO) improves hepatic (liver) mitochondrial function by reducing oxidative stress, boosting energy production, and protecting cells from high-fat diet damage.
In an extensive review of the nutritional benefits of Extra virgin olive oil (EVOO), specific to mitochondrial energy production, Silva-Soto et al., (2025) have demonstrated EVOO as having considerable potential in improving mitochondrial health and protecting against chronic diseases.
As the authors state:
‘EVOO improves mitochondrial membrane fluidity and integrity, ensuring its functionality and efficiency. On the other hand, nutrition literacy, an important component of health, is a critical determinant of people’s eating behaviors.’ [
20 mls a day is all your clients need to help improve their mitochondrial function.
I hope you can join me on any of the certified MyMT™ Education courses. Please also reach out to the Course Convenor, Georgia, if you have any questions.
Georgia Sweet, Course Convenor
Dr Wendy Sweet, PhD/ Member: Australasian & British Societies of Lifestyle Medicine
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