To the Max

Are you maxed out?  Exhausted?  Just want to sleep the day away?  Fatigue is on the rise. As a culture we are more exhausted, more stressed out, busier, and sicker than ever!  Although a variety of things contribute to our overall exhaustion, one of the areas that is most taxed in our bodies is our adrenal glands. Adrenal Dysfunction is a relatively new concept and as a disorder is not commonly recognized by mainstream healthcare. For those dealing with this problem, it is very real. 
          Most people have heard of the adrenal glands and commonly associate them with adrenaline. The adrenal glands are much more complicated and provide a variety of functions for the body. Let me break this down a bit.  The adrenal glands are two cone shaped glands that sit one on top of each kidney. These glands consist of the cortex or outer layer and medulla or inner layer. The cortex secretes the cortical hormones including cortisol which controls how the body uses fat, protein, carbohydrates, and minerals, helps reduce inflammation, and affects metabolism; aldosterone which is in charge of sodium excretion and potassium loss, maintaining blood volume and pressure; and gonadocorticoids which act on the ovaries and testes affecting sperm production, body hair in female and work with adrenocorticotropic hormones (ACTH) which triggers the adrenals to produce cortisol.  The medulla is linked to our fight or flight system or the sympathetic nervous system and releases the adrenaline hormones epinephrine and norepinephrine.  These hormones help to raise heart rate and blood pressure, increase carbohydrate metabolism, and help the body get ready to respond to a stressor.  As you can see, these are some busy glands!  Taking care of them needs to be a priority in our stressed out world.  I want to dig into the role of cortisol in relation to adrenal dysfunction.  

          We’re going to get a little nerdy here so hang in there.  Cortisol is released in response to fight or flight situations as well as part of our sleep/wake cycle.  The hypothalamus receives a signal from the hippocampus and then releases the hormone CRH or corticotropin-releasing hormone. CRH signals the anterior pituitary gland to release ACTH.  This hormone is released into the blood stream and makes its way to the adrenal glands where it stimulates the cortex hormones to be released including cortisol.  This make up the HPA axis or hypothalamus, pituitary, adrenal axis.  Adrenal dysfunction is also known as HPA axis dysfuncntion.  In a fight or flight response, cortisol redirects energy to the parts of the body that require it for action. This is done by release of glucose from the liver.  The increase in glucose provides rapid energy for the body to respond to the stressor like running from a tiger or in our world, getting cut off in traffic.  After the stress response if over, the adrenals reduce the cortisol output and in a negative feedback response, send signals to the hypothalamus and pituitary, in the brain, to stop producing CRH & ACTH and the body comes back into a balanced state.  As you can see the communication between the adrenal glands and the brain is very important.  More on that in a later post!             Another critical function for the adrenal glands is to help balance our circadian rhythm.  As part of our natural sleep/wake cycle, cortisol is considered the waking hormone and works with its opposite hormone melatonin or the sleeping hormone which is released by the pineal gland.  In a healthy individual our cortisol levels fluctuate through the day in relation to our circadian rhythm.  Cortisol is lowest in the early hours of the morning, around 2-3am, increases a few hours before waking 5-6am, and is highest right after waking. Cortisol then slowly decreases throughout the day in preparation for our body to sleep again that evening.  The lowering of cortisol overnight helps with our memory and the increase for the day helps with autonomic body functions.  Adrenal dysfunction comes into play when we are under chronic stress and our body either becomes depleted of this necessary hormone or our cells receptors become overwhelmed and no longer able to receive cortisol thereby exhausting the function of the adrenal glands.  As I discussed earlier, when cortisol rises in response to a trigger by our sympathetic nervous system (fight or flight) glucose rises along with it to prepare the body to act.  When we are under chronic stress our body is in constant fight or flight and just as this may trigger cortisol resistance it can also trigger insulin resistance as our body works to deal with the excess glucose being released by the liver.  See how everything is connected! When cortisol remains elevated we also may begin to see, reduced muscle tone, type 2 diabetes, obesity, metabolic syndrome, depression, and memory issues.  Other contributing factors can be environmental or food sensitivities, lack of sleep, exposure to EMF’s, poor diet, overuse of stimulates including caffeine and energy drinks, chronic trauma, and over exercising.  Yes these all create stress in the body too!  In response to our heightened fight or flight response, the body shuts down any systems that are not immediately necessary for survival such as digestion, reproduction, growth, immune function, and detoxification.  As you can see, chronic stress can cause widespread health problems as these systems cannot function properly.

           The symptoms of adrenal dysfunction are vast, which is one of the reasons it can be difficult to identify, and why mainstream healthcare still does not recognize it as a syndrome.  Just a handful of the symptoms involved according to Dr. Lam of, Adrenal Fatigue Center, include:

 Unable to fall asleep despite being tired  Wake up in the middle of the night for no reason  Heart palpitations at night or when stressed  Low Blood pressure consistently  Low libido and lack of sex drive  Low thyroid function, often despite thyroid medications  Feeling of hypoglycemia though laboratory values are normal  Depression, often unresolved after antidepressant  Endometriosis  Irritable under stress  Anxiety  Feeling “wired” and unable to relax  Feeling of adrenaline rushes in the body  Fogging thinking  Waking up feeling tired in the morning after night’s sleep  Feeling tired in the afternoon between 3:00 and 5:00 pm  Coffee needed to get going in the morning and throughout the day  Coffee, tea or energy drinks triggering adrenaline rush and adrenal crashes  Feeling tired between 9:00 and 10:00 PM, but resists going to bed  Craving for fatty food and food high in protein  Craving for salty food such as potato chips  Exercise helps first, but then makes fatigue worse  Chemical sensitivities to paint, fingernail polish, plastics  Electromagnetic force sensitivity, including cell phone and computer monitors  Delay food sensitivity, especially to dairy and gluten  Abdominal fat accumulation for no apparent reason  Temperature intolerance, especially to heat or sunlight  Dysmenorrhea advancing to amenorrhea  Premature Menopause  Constipation for no apparent reason  Joint pain of unknown origin  Muscle mass loss  Muscle pain of unknown reason  Cold hands and feet  Inability to concentrate or focus  Gastritis despite normal gastroscopy  Dizziness for no known cause  Low back pain with no history of trauma and normal examination  Short of breath even though breathing is fine  Grave’s disease  Hashimoto’s thyroiditis  Legs that feel heavy at times  Dark Circle under eyes that does not go away with rest  Irritable Bowl Syndrome, with more constipation then diarrhea  Chronic Fatigue Syndrome unimproved with medicine  Fibromyalgia unresolved after conventional help  Systemic Candida that gets worse when under stress  Electrolyte imbalance despite normal laboratory values 

 It is not necessary for you to have all of these symptoms to receive a diagnosis of adrenal dysfunction, but when a number of these symptoms are present and happen with any consistency or increasing intensity, further investigation may be necessary.
          Adrenal Dysfunction has four stages the body goes through as it continues into dysregulation and eventually reaching exhaustion. The four stages include: 1. Alarm Reaction, 2. Resistance Response, 3. Adrenal Fatigue, and 4. Adrenal Failure. Alarm reaction or Early Fatigue stage occurs in response to more stress and increases its activity to counteract the A stressors.  This causes the pituitary gland to release more ACTH into the blood stream to stimulate the adrenal glands to produce more cortisol to assist the body in dealing with the stressor.  During this stage there may not be many noticeable symptoms with the exception of a little more tiredness than normal. In the Resistance Response stage, the body is now under chronic stress and the adrenals begin to be taxed, no longer able to keep up the output of cortisol needed to bring the body back into balance. Even though the release of ACTH remains high, the adrenals begin to slow down the output of cortisol as they begin the path to exhaustion. Due to the excess cortisol that has been in the body, cell receptors can also begin to reduce the amount of cortisol allowed into the cells leading to cortisol resistance. We also begin to see pregnenolone steal during this phase. Now this chronic stress begins to inhibit the production of the sex hormones including estrogen, testosterone, DHEA, and progesterone as the cortisol “steals” the pregnenolone needed to deal with its increased output. This down-regulates the production of the sex hormones leading to further imbalances in the body.  Cortisol levels become low in the morning when they’re needed to get us moving and remain normal in the evening when we need them to reduce to help us sleep. 

Common symptoms at this stage include,
Difficulty falling asleep
Frequent waking at nigh Increase in infections
Mild fatigue is involved at this stage

Stage 3 or Adrenal Fatigue, begins when our body can no longer produce enough cortisol to bring our bodies back into a state of balance.  We get the wired and tired feeling as our body ramps up and crashes over and over trying to balance the system. Fatigue will be more extreme and begin to affect daily activities.  Overall hormone imbalances will also become worse and DHEA levels will continue to fall.  As we are no longer able to release enough cortisol it will also be more difficult for our body to signal the release of glucose for energy which further exacerbates our fatigue and lack of get up and go.
Then we enter the final stage, adrenal failure, which is a critical stage that can
cause severe impairment.  The body down-regulates the production of cortisol even further to utilize it only in emergencies to keep the body alive.  Some of the symptoms at this point mirror Addison’s disease, which is adrenal insufficiency.

Extreme fatigue
Weight Loss
Muscle Weakness
No appetite
Loss of or irregular menses

Adrenal dysfunction is often either mis-diagnosed or ignored by the medical establishment as it is not easily identifiable by blood testing.  Generally a doctor is only looking for the extremes such as Addison’s so when the conventional blood test looks at ACTH production and the levels fall within the normal ranges it is not considered an issue.  A low functioning system can be just as loud an alarm bell as an extreme situation and should not be ignored.  Cortisol and DHEA levels are the best markers for identifying a dysfunctional system.  Cortisol can be tested using a saliva test that is taken at 4 points throughout the day.  Since cortisol levels fluctuate it is important to have more than just a snapshot at one point in the day to determine its level at all points in the day.  The DUTCH test has become the new gold standard for more accurate testing of adrenal dysfunction.  You can learn more about this test HERE.  DHEA can be tested at any point during the day.  With our without testing, steps can be taken to help improve adrenal function through diet, supplementation, and lifestyle changes.

Cleaning up the diet, removing junk foods,  reducing sugar, possibly reducing grains, reducing or eliminating caffeine and other stimulants, making sure to have adequate protein in the diet, removing food sensitivities, and adding vitamin C rich foods including bell peppers, citrus fruits, and greens to support the adrenal glands can help start to rebalance these glands.
Some adaptogens may prove helpful including ashwaganda, Echinacea, astragalus, and ginseng in improving adrenal function.  EFA’s such as fish oil, cod liver oil, krill oil, or evening primrose may assist in re-balancing the body. Magnesium, sodium, potassium, coQ10, and a B complex may help with energy levels.  In addition to nutrients rest and reducing stress is key. 
Without addressing these issues, the best diet in the world will not outweigh a stressful lifestyle.  Placing sleep at the top of the priority list and finding ways to deal with stress such as cultivating hobbies, meditation, light exercise, spending time with friends, gardening, or focusing on any activity that brings relaxation.  Exercise should remain light during the healing phase utilizing walking, light weights, yoga, or light aerobic exercise being cautious to monitor energy levels. 
          Adrenal Fatigue is not something to ignore.  When you have symptoms of fatigue or any other symptoms from the the list provided that continue consistently or become worse, steps need to be taken to insure this syndrome does not become worse affecting daily activities, life, family, work, and personal enjoyment.  Taking care to reduce our stress where we can, make healthy choices in regards to diet and how we spend our personal time, and resting when our bodies tell us to rest can go a long way not only to healing adrenal dysfunction, but also preventing it from become a problem in the first place.  In this world of busy lives, busy families, hectic schedules, fast food, and stress exposures we have choices to make every day to improve our health.  It may not always be easy, but making more good choices than poor choices can go a long way to improving our health and bring longevity and  vitality to our lives.

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