Adrenal Fatigue

Perhaps no other health topic deserves more attention than that of adrenal function due to the fact that adrenal burnout is one of the primary causes of the low energy and fatigue that many people suffer from today. Furthermore, these two walnut-sized glands secrete hormones that affect every major physiological process in the body.

The primary function of the adrenal glands is to manage perceived stress. However, ironically, the adrenal mechanisms designed to protect us from danger can be dangerous to our health and well-being. This is because chronic stress has multiple, deleterious consequences.

This article will focus on “adrenal fatigue” and strategies for helping the ever-growing population who is experiencing it.1

Modern Stress and the Human Body

Adrenal fatigue, whether mild to severe, is usually secondary to some form of stress. Modern chronic stress can take the form of mental/emotional (relationships, job, money), environmental pollution, chronic infection or illness, noise, traffic, crowds, terrorism, data overload, decisions, deadlines, delays, electromagnetic fields (EMFs), social pressures, over/under exercise, alcohol, cigarettes, medications, caffeine, excess sugar/refined carbohydrates, insomnia, skipping meals, harmful food quality, allergens, etc. And it’s not just the type of stressors, but the pile-up effect of multiple stressors.

Stress is defined as any disturbance that can trigger the “stress response,” generally recognized to occur through a series of three stages called the General Adaptation Syndrome.

I. The first stage, alarm, is the body’s initial response to stress, which activates the sympathetic nervous system. This causes the release of the adrenal catecholamines, adrenaline and nor-adrenaline, which are released into the bloodstream increasing heart rate, blood pressure, and alertness, physically preparing the body for a fight or flight. In addition, the brain sends hormone messengers (CRH, ACTH) to the adrenals through the HPA (hypothalamic-pituitary-adrenal) axis. An activated HPA axis results in the release of stress hormones, in particular cortisol, along with other mediators such as growth factors and cytokines. This is an immediate short-term response to stress and when abated, the HPA axis is turned off in a negative feedback loop while the parasympathetic system balances and relaxes the nervous system.

Figure 1. Pathways of Steroid Hormone Synthesis from the Brain to the Adrenal Glands (Simplified)

II. The second stage, resistance, occurs if the stress is prolonged. Many steroid hormones are made in the adrenal glands through the conversion of cholesterol to pregnenolone (fig 1). In this stage, the adrenals begin preferentially shunting pregnenolone into increased production of the main stress hormone cortisol and to a lesser extent, aldosterone. These hormones ensure that blood pressure does not drop (sodium retention) and that protein is converted to glucose to supply energy long after glucose stores are depleted. Cortisol reigns in this stage and is responsible for many of the life-sustaining properties of the adrenal glands. Some people remain in this stage with elevated cortisol much of their lives. Although proper cortisol levels are beneficial, high levels, over time, result in physiological changes and diseases attributed to chronic stress. Equally affected by high cortisol, the negative feedback loop of the HPA axis becomes disrupted as the hypothalamus gland becomes less sensitive to the signal that tells it to stop producing the messenger hormone.2 HPA axis overdrive results in what is called maladaptation. Unfortunately, with enough high-intensity stressors for a long enough period, most people will maladapt.

III. Unremitting stress, maladaptation and loss of adrenal gland reserve lead to a decreased production of stress hormones such as cortisol, aldosterone, epinephrine and DHEA. Many individuals visit or reside in this third and final stage of adaptation to stress called the exhaustion stage. Here the glands are failing to optimally meet the demands placed upon them and fatigue intensifies. Adrenal hormone deficiency, especially cortisol, causes a loss of glucose to the cells for energy. This alone is a major reason for fatigue. The exhaustion stage may develop gradually or be precipitated by a single serious event such as an illness, infection, injury or crisis. Regardless of the onset, it is associated with many disorders.3 Adrenal deficiency, called adrenal hypofunction or hypoadrenalism by many doctors, can range in severity. Adrenal fatigue should not be confused with Addison’s disease, which is the adrenal failure state. Adrenal fatigue is largely caused by stress while Addison’s disease is an autoimmune condition in about 80 percent of cases.4

Symptoms of Adrenal Fatigue

The adrenals respond the same to every kind of stress no matter the source, yet people are genetically different in their response to stress making them more or less vulnerable to stress-related disorders.5 With prolonged stress, chronic fatigue presents as the major complaint, but stress also can contribute to depression, anxiety, weight gain and have diverse effects on the gastrointestinal tract and other organs.

An individual with adrenal fatigue is typically described as someone who wakes up tired, depends on caffeine to “get through the day,” craves sweets, feels light-headed or irritable before a meal, may get a “second wind” in the evening, and has trouble with sleep. They often have a history of skipping meals and/or a diet high in refined carbohydrates, synthetic additives and trans-fats, all of which helped contribute to the adrenal fatigue. They commonly resonate with “all work and no play.” Some have suffered a major crisis, have a chronic infection, or are repeatedly exposed to toxins as environmental, drugs, alcohol or food sensitivities. The signs and symptoms for adrenal fatigue commonly include those listed in Table 1.

Many factors must be considered when evaluating an individual with adrenal fatigue. Mainstream medicine and many research studies focus on identifying an infectious agent as the cause. The Epstein-Barr Virus (EBV) emerged as the leading, yet controversial, candidate6-9 thought to be linked to chronic fatigue syndrome (CFS). The connection to adrenal fatigue is that chronic infections caused by infectious organisms such as viruses, bacteria or fungi, nearly always lead to adrenal fatigue.

Stress and the Adrenals

The adrenal hormones, cortisol in particular, have many regulatory functions influencing all major systems and the utilization of carbohydrates, proteins, fats and minerals. For example, one of cortisol’s main functions is to make glucose (blood sugar) available from body stores between meals or when a stressful event demands it. Insufficient cortisol results in suboptimal glucose levels or hypoglycemia10 causing symptoms of fatigue, light-headedness, shakiness or irritability if meals are delayed or missed.11 Less available glucose leads to cravings for fast-acting carbohydrates (sweets, breads, alcohol) creating insulin fluctuations and diabetes risk. The demand for nutrient cofactor support from vitamin C, minerals and B vitamins is increased. Insufficiencies of these and other nutrients contribute to the symptoms of a person with adrenal fatigue. Blood glucose levels are also maintained during sleep through the breakdown of glycogen under the influence of cortisol. In most cases, the inability to stay asleep during the night is a blood sugar issue. A drop in fasting glucose during sleep, due to a lack of cortisol, sparks a stress response activating the catecholamines to raise glucose levels to compensate. Since catecholamines are stimulatory they cause awakening, thereby adding to the fatigue problem.

The HPA axis and cortisol help prevent an over-zealous immune system activation of inflammation. When cortisol is decreased, individuals become more susceptible to inflammatory responses.12 This may be seen as slow tissue healing, autoimmune disorders, joint and muscle pain and hypersensitivity reactions (allergies, hay fever, asthma, eczema, or hives).

In adrenal fatigue, there may be decreased catecholamines secretion, affecting vascular tone, associated with lowered blood pressure. A common feature of serious adrenal fatigue, “orthostatic hypotension” is often marked by a dizzy feeling when arising from a lying or sitting position to standing (orthostatic).

Additionally, the low levels of aldosterone that occur during adrenal fatigue result in the tendency to retain potassium and lose sodium, chloride and water. Any loss of sodium-rich extracellular fluid creates a state of dehydration, resulting in the craving for salt and water that are necessary for adrenal recovery.

Finally, healthy thyroid function depends upon proper adrenal function. Hypothyroidism (low thyroid function) is often secondary to adrenal stress.13 Furthermore, some low thyroid symptoms, such as depression and hair loss, are similar to those of adrenal fatigue. For example, one of the reasons why adrenal stress affects thyroid function is because the thyroid depends on the same hypothalamus/pituitary communication system as the adrenals; therefore, with maladaptation, the communication with the thyroid gland is also disrupted.14-15

Diagnosing Adrenal Fatigue

The first step in determining if someone is suffering from adrenal fatigue is to measure cortisol levels. This is done through a salivary adrenal function test, which measures the daily variations in cortisol concentration. The normal circadian rhythm of cortisol is characterized by a steep increase in the morning (8 a.m. peak), followed by a gradual tapering off until about midnight where the levels are lowest (fig 2). The loss of morning cortisol was seen in studies of chronic fatigue syndrome (CFS).16 If the results of one’s salivary adrenal function panel show low morning cortisol, it points directly to HPA axis dysfunction and adrenal fatigue (or exhaustion).17 The test will also indicate levels of DHEA, a hormone important in adrenal health. The test is helpful in choosing the best course of action for optimizing adrenal function.

Or, individuals can choose to take a salivary Comprehensive Hormone Panel, which can also help determine progesterone and DHEA levels in addition to cortisol levels throughout the day. Maintenance of sufficient levels of progesterone, a direct precursor to cortisol, is important for all but particularly for stressed postmenopausal women who have lost the ovarian production of hormones and depend on the adrenal gland to supply them.

Lifestyle Changes

In people whose test results show low cortisol levels, the adrenal situation must be normalized. This can be accomplished in part through at least 8 hours of sleep (bed by 10 p.m.) and identifying and removing stressors.

One of the most significant stressors to remove is the exposure to high-glycemic-load diets of refined sugars and carbohydrates that create insulin fluctuations and shift the HPA axis toward sympathetic over-activity.18-19 A low-glycemic diet balanced in protein, healthy fats, and complex carbohydrates like vegetables, eaten as smaller meals more frequently (5-6 small meals/day), has a positive influence on hormone signaling20-21 (see fig 2). Protein is important for the adrenals and requires adequate stomach acid (HCL) for digestion. Individuals with adrenal fatigue are notoriously low in HCL, and HCL supplementation (GastricAid®) is therefore recommended for adrenal fatigue.

Other adrenal stressors to avoid are caffeine, stimulating drugs, alcohol, allergenic foods, artificial sweeteners (aspartame), nicotine and partially hydrogenated oils. Exercise is encouraged, such as walking, gradually increasing distance and pace.

It is important to note that the adrenals need cholesterol to make adrenal hormones. Avoiding fats (both saturated and unsaturated) and excessively lowering cholesterol levels, as with statin drugs, deprives the adrenals of adrenal hormone precursors, increasing the risk for such conditions as depression and impulsive behavior.22 Also, if an individual persists with anemia, infections, leaky gut or food allergies, over-exercise, low cholesterol (below 150), unstable blood sugar or severe emotional stress, it may be more difficult to achieve a positive change in the salivary adrenal test.

Natural Adrenal Support

Addressing adrenal gland depletion while concomitantly supporting HPA axis receptor sensitivity is the goal of an adrenal-supporting supplement regimen. This regimen can result in improved adrenal function and increased energy. Vitamin C with bioflavonoids and vitamins B5 and B6 are important adrenal nutrients along with B1 and zinc, which are particularly important for needed blood sugar balance. Zinc is also necessary for the ACTH response. L-carnitine supports the burning of fats (fatty acids) for energy, which contributes to better glycemic control between meals and proper weight management. Another amino acid, L-tyrosine enhances dopamine and catecholamine synthesis and improves stress-associated declines in noradrenaline and performance.23

Adaptogens include botanicals containing compounds that support the stress response through producing a normalizing effect on the HPA axis. They are capable of a bi-directional effect, supporting the gland in times of over-secretion or under-secretion of stress hormones. One such adaptogen is Eleutherococcus senticosus, found to have even greater anti-fatigue properties than Panax ginseng, and to improve work output, presumably through better oxygen uptake and metabolism. It has decreased fatigue severity and duration and optimized HPA axis function under stress.24-28 Another adaptogen is Rhodiola rosea, which has roughly 200 scientific studies since 1960 to support its effective long-term use in combating fatigue, restoring energy, improving memory and mental performance with less mental fatigue, and enhancing proper thyroid activity.28-33 Bacopa monnieri also plays an adaptogenic role. It has many impressive cognitive and anti-fatigue benefits and positively influences the retention of new information learned. Studies also show significant antidepressant effects.34-40

Licorice root extract works with the above adaptogens. Its components glycyrrhizin and glycyrrhetinic acid impact enzymes that result in a net increase of cortisol availability, which is restorative for the adrenal glands.41-42

Another successful way to support recovery from stress is through the use of adrenal glandulars, the cornerstone of potent, effective adrenal therapy. The glandulars provide essential constituents of nucleic acids and other cellular factors without the damaging side effects of synthetic cortisol.43-44

Each of the natural adrenal-supporting substances mentioned above are found in CP’s newly reformulated CortiTrophin®, intended to support the stress response on multiple fronts.

Additional support can be given to the adrenals by supplementing with Extension B-Plex (B complex), HCL as GastricAid®, as well as DHEA and HerBalance™ progesterone cream if the Comprehensive Hormone Panel indicated these two hormones are warranted. Testing zinc levels through the Zinc Oral Solution test is also recommended. Because people with adrenal fatigue are often salt depleted, it’s also important to nourish the adrenals by using a Celtic Sea Salt that contains a blend of natural minerals.

Conclusion

The aforementioned botanicals, vitamins, amino acids and adrenal glandular found in the new and improved CortiTrophin offer an effective and comprehensive approach toward improved adrenal health, especially when combined with diet, lifestyle, rest and stress management. After undertaking this regimen, individuals whose salivary hormone test indicates low cortisol levels will likely experience enhanced energy and an improved quality of life.

For best results, use CortiTrophin for 6 to 8 weeks, then discontinue for one week before resuming use again, following this schedule as needed.

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