Stress and Adrenal Fatigue
Subjects in this article:
• What is stress?
• What is the role of the adrenal glands?
• What is cortisol?
• What is DHEA?
• Adrenal fatigue
• Some Causes
• Some Symptoms
• ‘My doctor says my blood-tests are fine, but I don’t feel fine.’
• Functional Testing
• Do you need an adrenal test?
• Solutions for Adrenal Fatigue
• Nutraceuticals
“There cannot be a stressful crisis next week. My schedule is already full.”
– Henry Kissinger
What is stress?
We hear countless suggestions of how to manage or avoid stress. Some say that at least 75% of the prevalent diseases in the western world are related to stress-responses in the body. If this is true, we might call stress an epidemic. How can we address this deep problem and bring healing? First, we must understand what stress is, and in particular, how the body experiences stress. We must also listen to what our own bodies are telling us, and respond intelligently to our symptoms, and the causes behind them.
Scientists have generally disagreed on the definition of stress for the past seventy-five years. Is it the result of failure to adapt to a stressor, or is it a side-effect of successful adaptation to a stressor? We usually think of stress as negative, as ‘distress.’ However, even positive life-changes, wonderful surprises, and overwhelming feelings of happiness, can trigger physiological responses identical to the ‘stress response’.
In the 1950’s, the Hungarian-Canadian endocrinologist Hans Selye first coined the term “stress”, and with his book The Stress of Life, he helped bring the concept of stress to the world’s attention. In the book, he revealed a recurring set of physiological effects when rats were exposed to a variety of stressors, such as ulcers, atrophy of the lymphatic organs, and hypertrophy of the adrenal gland. His simplified view of stress involves a three stage process: 1) an alarm reaction, including increased adrenocortical secretions, and activation of the sympathoadrenal system, 2) resistance, an attempt at adaptation, involving actions to balance the effects of adrenocortical hormones on the body’s water, electrolytes, and carbohydrate metabolism, and finally 3) exhaustion, a depletion of the adrenal glands’ power to manufacture corticosteroids. This model demonstrates the central role that the adrenal glands play in the stress response.
One of the limitations of Selye’s view is the assumption that the stressed subject is unable to remove itself from the clutches of the stressor. A lab animal or person that successfully escapes its circumstances may have a very different physiological outcome. We generally have the power to respond proactively to stressors, and when we do so, our adrenal glands and other organs respond differently. When we can keep the bigger picture of life in view, and choose our response to stress, we can become even more resilient than if we had avoided the stressor from the start. If you are under stress, take at least a moment to remember what life is all about.
What is the role of the adrenal glands?
How well you live, and how well you feel, depend heavily on your adrenal glands. Your youthfulness depends on them. Your propensities to develop illness, to overcome illness, and to prevent illness, all depend on your adrenals. They are a major source of sex hormones, especially in persons over forty years of age. The adrenals are known as the stress glands, as they enable us to deal with any kind of stress, including internal imbalances. They also influence just about every organ or tissue and process in the body, determining the breakdown of carbohydrates and the conversion of fats, the regulation of blood sugar, and the health of the gastro-intestinal system, among many other essential areas of health. Briefly, the adrenal glands work to provide balance in the following areas:
• The immune system
• The sleep/wake cycle
• Brain function
• Glucose metabolism in muscles
• Protein metabolism
• Energy function
• Allergic reactivity
We all know the feeling of being “pumped up with adrenaline” in reaction to a perceived emergency. What is actually going on inside our bodies?
The adrenals are small organs capping the kidneys, and they serve as an extension of the sympathetic (“fight or flight”) nervous system. When a message of alarm reaches these glands, the regions within them begin secreting the hormones epinephrine (or “adrenaline”) into the bloodstream. Epinephrine quickly prepares the body for intense action. It boosts the oxygen and glucose supplies in the brain and muscles, and suppresses other non-emergency bodily processes, especially digestion and immune-system functions. The suppression of immunity functions is one reason many people get sick after a stressful event.
The outer regions of the adrenal glands secrete various steroids, including cortisol, aldosterone, and some sex hormones and their precursors (such as DHEA). Some of these hormones regulate potassium and sodium levels and water balance. DHEA contributes to the regulation of metabolism. We will come back to DHEA after we focus on cortisol and its relation to the stress-response.
What is Cortisol?
Cortisol is popularly known as the “stress hormone”. When it hits the bloodstream, it increases blood pressure and blood sugar and reduces immune responses, in preparation for a fight or flight response. Cortisol secretion in the adrenals is triggered by a cascade of feedback mechanisms in the hypothalamus and pituitary glands. This feedback system is called the hypothalamus-pituitary axis (HPA).
Higher levels of cortisol actually mediate or suppress alarm-reactions to stress, sometimes even inducing euphoria and the inhibition of pain. As a temporary emergency measure, suppressing reactivity can give the body a chance to attempt to escape or remove the stressor. Under normal conditions, this suppression-effect can also help restore homeostasis after the stressful event. However, sustained or chronic stress involves prolonged cortisol secretion. Long-term exposure to cortisol can result in insulin resistance and other blood sugar problems. It can also damage or even kill brain cells, leading to problems such as impaired learning, and brain dysfunction.
What is DHEA?
DHEA (dehydroepiandrosterone) could be called ‘the youth hormone’. Ideally, we would maintain DHEA levels late into life, but for most people, levels normally peak at age twenty and then gradually decline. When they are seventy, they may have a mere twenty percent of their peak amount. Measuring DHEA levels has thus become a popular tool for health and longevity.
DHEA is the most abundant product of the adrenal glands, and it is also the most abundant circulating steroid hormone in humans. When the adrenals are chronically overworked and straining to maintain high cortisol levels, they lose the capacity to produce DHEA in sufficient amounts.
Because of potential side-effects, it is very important to test DHEA levels before attempting supplementation.
Adrenal Fatigue
When adrenal “alarm” and “resistance” last more than a few minutes, the adrenal glands stay longer in the “exhaustion” mode. The body is built to bounce back from stress, but when stress becomes a way of life, sustained “exhaustion” turns to chronic adrenal fatigue. Some research suggests that people with post-traumatic stress disorder (PTSD) demonstrate low levels of cortisol, in contrast to the normal fight-or-flight response, in which cortisol levels are elevated. This is a clear case of “burn-out”, what we have termed adrenal fatigue.
Some Causes
Common phenomena that can lead to adrenal fatigue include:
• Being stuck, psychologically, in the ‘small picture’; unable to respond to stress proactively
• Not having proper sleep or rest
• Poor diet
• Anxiety or reactive behavior. This can become a vicious cycle of stress for the adrenals.
• Over-working, or an intense drive for success, especially when there is no deeper purpose or meaning behind it
• A lack of emotional or physical outlets
• Environmental toxicity
• An attitude of powerlessness
• Having hypoglycemia and other blood sugar issues
• Severe respiratory infections. These can have a very detrimental effect on adrenals.
• Other physical or emotional traumas of various levels, such as car accidents, the death of a friend or family member, and surviving or even witnessing a catastrophic or tragic event.
Remember, the longer the stress is prolonged and unresolved, the more potential for adrenal fatigue. The good news is that when you address these causes, and support healing intelligently, you can recuperate relatively quickly.
Some Symptoms
• Chronically tired, difficulty in getting going in the morning. Even a full night’s sleep may not be refreshing.
• Feeling that everything in your life is a chore; inertia with daily tasks; hard to face any kind of stress
• Difficulty concentrating or making decisions. Lightheaded, fuzzy or surreal feelings.
• It takes a long time to heal from infections or illnesses
• Exhaustion long after a bout of sinusitis, bronchitis, or pneumonia
• The healing of skin infections and bruises is unusually slow.
• Enjoyment of life is decreased.
• Intolerance or irritability with spouses, children, or others is increased.
• Craving for salty foods.
• Experience of a decline in energy at 3:00 or 4:00pm, a feeling of tiredness at 9:00 or 10:00pm, and an increased energy later at night, after about 11:00pm.
Symptoms of adrenal fatigue might manifest long after a stressful or traumatic event. This delay could last even six months. Dysfunction usually presents gradually, and so symptoms may start long before people report them. Also, unless a doctor is trained and experienced in finding and treating adrenal dysfunction, it will probably go overlooked.
Adrenal fatigue often accompanies other illnesses, and this is another reason it can be overlooked. It is very likely that adrenal function is involved in conditions such as chronic fatigue, fibromyalgia, hypoglycemia, auto-immune diseases, and allergies, even though they have different labels. The adrenals are needed for the recovery from any disease. Therefore, any road back to health should include improving adrenal function.
‘My doctor says my blood-tests are fine, but I don’t feel fine.’
You may be wondering why your doctor doesn’t know much about adrenal fatigue. Western Medical Science first mentioned the concept of adrenal health in 1898. However, the important role of adrenal health is still widely overlooked today, partly because routine blood tests are not accurate enough. Conventional tests and drug prescriptions are focused on the gross breakdown of adrenal function, such as in Addison’s Disease or Cushing’s Disease (Cushinoid). However, most of the adrenal problems that may affect you can only be found with subtler, more accurate, personalized tests. We need to know the ‘gray areas’, the precise levels of hormonal deficiency, the time of day that a deficiency appears, the component of the gland that is not functioning well. Then, to treat these problems effectively, we have to address the causes and stimulate healthy glandular function with carefully selected natural compounds.
If you feel depressed, some doctors might just tell you to go to a psychotherapist. Of course there’s nothing wrong with psychotherapy, but if you continue to overlook a case of adrenal fatigue, the results of your therapy may be compromised.
Functional Testing
Doctors tend to view us in black or white; either we’re sick or well. Degrees of dysfunction are not understood. Adrenal fatigue is a matter of the gray areas of compromised function; therefore, ‘functional testing’ is essential. The ACTH Stimulation Test is an example. ACTH is a hormone produced by the pituitary gland, and it influences the adrenals. In this test, we stimulate or challenge the glandular system to see the degree of response. If the adrenal glands are functioning normally, they will respond to the stimulation by doubling the cortisol levels found in the saliva. We test again after an hour, to see if there is a cortisol reserve. If levels are lower either time, some level of adrenal dysfunction can be suspected. Conventional doctors use this test, but only to see if adrenals are not functioning at all. They miss the ‘gray areas’.
Another important factor in determining levels of functioning is ‘biochemical individuality’. Each person is unique, so when you look at test values for any gland, there’s a wide range for ‘normal’. Many doctors overlook the fact that you have your own unique set-point. If the doctor considers a reading of ‘40’ to be normal, but your normal level is ‘70’, your depleted state will go unnoticed. This concept is written in Harrison’s Principles of Internal Medicine, 14th Edition, Volume I, p. 1970: “Most hormones have such a broad range of plasma levels within a normal population. As a consequence, the level of a hormone in an individual may be halved or doubled and thus be abnormal for that person, but still may be within the ‘normal’ range.”(Fauci, Anthony S. et al.) This comes from the ‘bible’ of internal medicine, and yet very few doctors follow it, besides holistic MDs.
Once the level of functioning is determined, it is still important to look under the tip of the iceberg of this data. It takes much experience and skill to pinpoint the causes of dysfunction, and to devise successful treatment strategies.
Do you need to test your adrenals?
If some of the causes and symptoms listed above seem to fit you, it may be appropriate to check your adrenals. Your current adrenal function can be better understood with ACTH testing, a twenty-four hour urine test, a saliva test for cortisol, and/or blood tests that measure DHEA and pregnenolone. We may use vitamin profiling tests or organic acid tests, to help us determine if you have functional nutritional deficiencies or need for certain natural compounds in your body.
Solutions for Adrenal Fatigue
The good news is that adrenal dysfunction can be reversed to such a degree that you can feel better than you can ever remember feeling. Boosting our adrenal function can even help us make a spiritual shift in life.
To change how your adrenal glands respond to your life-experiences, it is important to learn to be proactive in your behavior. Sometimes you can convert a normally stressful situation into a positive challenge, by focusing on the good. Other times you have to know to let go. It can be proactive to choose to stay away from stressful situations that you can’t currently handle well. On the other hand, studies show that the greatest physiological benefits come from meeting stress, viewing it as a challenge, and overcoming. Paths that can help one overcome stress include ‘reframing’ such as in cognitive therapy, seeing the bigger picture, and seeing the light in the darkness. Other forms of psychotherapy, prayer and meditation, acts of generosity, living in a healthy environment and a loving community, are powerful resources as well. Your guiding beliefs, how you see yourself and the world, affect your body in profound ways.
Nevertheless, even when you have made significant positive lifestyle changes, you may still need to lend physical support to the processes of detoxification, re-balancing and revitalization. You may need to supplement our body with the natural compounds or that have become deficient, until your organs have fully emerged from fatigue. These biochemical compounds are called nutraceuticals. When they used to ignite healing, they can significantly improve the functioning of your cells and organs, and give you profound results.
This, by the way, is my dietary advice in a nutshell: If it’s made by G-d eat it, if it’s made by man, leave it. Organically grown produce is rich with nutrients, and low on traces of pesticides. In order to build an ‘adrenal resiliency’ diet, one must limit consumption of processed foods such as refined carbohydrates, refined sugars, trans-fatty acids, alcohol, and caffeine. Most Americans also need to dramatically reduce their consumption of meat and dairy products.
Nutraceuticals
Nutraceuticals are a vital part of treatment, because we often need high dosages of a nutrient to push the biochemistry in a positive direction. The cells of your body have a virtually unlimited power to detoxify and return to function. When we use these natural compounds to trigger this power, we can bypass some of the energy consuming steps toward rejuvenation. The adrenals are then relieved, allowing them to repair and revitalize themselves, and to perform their own magic. Our input can thus allow our bodies to reach higher and higher levels of functioning, even beyond what is considered ‘normal’.
At our offices we may treat your adrenals with hormonal therapy, herbs and vitamins, including intravenous vitamin therapy (see treatments below). We may also utilize infrared low-level laser therapy, which is a non-invasive way of increasing blood flow and energy production in the adrenals.
When using nutraceuticals, the biochemical individuality of each person needs to be addressed. In most cases, the effectiveness of these substances is unleashed through the knowledge gained from functional testing and personal consultation with a professional. There are also safety issues involved in the use of some of these compounds, and so we are obliged to caution against self-administration. When you are in consultation with a good naturopathic MD who understands your unique biochemistry and needs, you can rest assured that your treatments will be safe, accurate, and effective.
Hormonal treatments for adrenal fatigue might include:
• Pregnenolone: this precursor hormone is produced early in the process of adrenal function. As a neurosteroid, it can boost mental performance. It was discovered in the same period as cortisol, but remained in relative obscurity, since scientists felt they could make more money with synthetic substances derived from cortisol, such as prednisone. Like other hormonal treatments, the safety and effectiveness of pregnenolone is ensured through testing and consultation.
• Cortisol: in some situations, we need to replace cortisol in a natural form (as opposed to the synthetic prednisone). A physician must be consulted, and doses should never exceed 20 mg.
• DHEA: supplementation of this compound is very effective for some people. Having your DHEA levels tested is important, since it is a sex steroid molecule. Also, if you have had cancer, you will have to evaluate the effects of DHEA treatment with a medical doctor.
• Phosphatidylserine: this nutraceutical can support hormonal rebalancing, including exercise-induced elevation of cortisol levels.
Vitamins and Herbs for adrenal fatigue might include:
• Licorice root extract (in a highly concentrated form) is a powerful treatment for some people. However, if you have a history of high blood pressure or heart palpitations, a medical doctor should evaluate the effects this extract may have on you.
• Vitamin C is an important part of treatment, because this compound is necessary for the production of adrenal hormones. In the past, measuring the levels of vitamin C in a patient’s blood was the main way of determining adrenal function. Vitamin C is one nutraceutical treatment that may be self-administered.
• Vitamin B5 (pantothenic acid) in high dosages
• Co-enzyme A is an important nutrient for adrenal function, since it is needed for the production of hormones and cellular energy.
• Magnesium is required for hundreds of vital functions in the body. Magnesium deficiency can be a link in many chronic disorders, including adrenal dysfunction.
• Ginseng (Panax, Siberian, and Korean). It helps to consult a doctor who can help you determine the most effective types and uses of ginseng for your body.
• Ashwagandha has been used for 2,500 years to help treat fatigue, stress, and memory loss.
• Rhodiola rosea can help alleviate depression and stress.
• Cordyceps fungus has been used for thousands of years in Chinese Medicine to help increase cellular energy metabolism, boost adrenal functions, and modulate immune function.
In some sever cases of adrenal fatigue we carefully employ safe uses of cortisol. The prescription therapy Cortef is bio-identical to the cortisol produced in your adrenals (as opposed to Prednisone), and it can therefore interact with the body’s own inner wisdom to produce better functioning.
Glycemic control (blood sugar management) may also be important in recovering adrenal and overall health. Sliding Scale Insulin (SSI) does not mimic human physiology, and it appears to be ineffective and potentially dangerous. For more information on glycemic control, read our article on Hypoglycemia.
