(Part 4 of a 5 part series on hormones)
Adrenal fatigue plays a role in chronic fatigue, hypothyroidism, fibromyalgia, depression, menopausal symptoms, PMS, Osteoporosis, Andropause (male menopause), insulin resistance, seasonal depression and any other endocrine imbalance you can name. Cortisol, one of the adrenal hormones that is released during states of stress is implicated in cardiovascular disease too. Flattened cortisol levels have been shown to preceed heart attacks in 50% of cases and it doubles the risk of future myocardial infarctions (MIs). The lower the cortisol, the lower the chance of survival post cardiac arrest. It is now thought that what has been called chronic fatigue syndrome is actually adrenal fatigue:
Is CFS adrenal fatigue?
- There are reduced salivary cortisol and cortisone levels at all times of the day in CFS.
- There is a flattened and depressed salivary cortisol curve in CFS.
- Fatigue scores and ACTH response improves with low-dose cortisol therapy.
Adrenal Fatigue Symptoms actually are the same as CFS symptoms:
- Can’t get out of bed
- Tired most of the day
- Second wind after supper
- Fall asleep quickly but may wake up 2-3 times
- Carb, caffeine, and salt cravings
- Too tired to exercise
- Irritability
Why isn’t there more attention paid to this very real issue in medicine? Stress sells pharmaceuticals. That’s why we don’t have a pharmaceutical that addresses stress. Below are the diseases which interestingly correspond with the top selling drugs AND are caused by stress:
- Hypertension
- Ulcers
- Insomnia
- Allergies
- Asthma
- Infections
- Chronic pain
- Depression
- Erectile dysfunction
- Menopause
- Hypothyroid
There are several different types of stress:
- Physical: injury, surgery, allergies, sedentary or extreme activity
- Emotional: job, family, money, death, illness, marriage
- Lifestyle: lack of sleep, lack of exercise, obesity, smoking, alcohol
- Aging: menopause (why do some women glide through and others have 10 years of symptoms?)
- Prescription medications
Here’s what stress is supposed to do for most mammals:
- Wakes them up with the sunrise with no alarm clock
- When they see their next meal, they run and catch it
- If they see someone who wants to eat them, they run away or fight them off
- They go to sleep with the sunset
Mammals are designed so that the perception of stress prepares the body for physical activity. Most of our stressors come from sources that do not require any physical activity like finances, relationships, jobs, traffic, our own thoughts, and:
Modern stressors:
- Alarm clocks
- Cell phones
- Kids
- Money
- Jobs
- Relatives
- Lack of exercise
- Lack of sleep
- Poor diet and food allergies
- Medications
- Substance abuse
- Pollution
- Illness
- Menopause
When a zebra is being chased by a lion, they react with an increase in blood pressure, heart rate, perfusion of oxygen to the muscles, lowered reproductive hormones and a reduction in urine (so they can run away). Once the lion has chosen its prey from the herd and taken it down, the rest of the zebras stop running and calm down to graze once again. We are supposed to calm right down after a stress reaction, but rarely do since so many of our stressors occur back to back rather than every 3 days (the lion’s feeding schedule) like our zebra cousins.
What happens if you have stress and your body won’t normalize?
- Sleep disturbances
- Rheumatoid arthritis and other autoimmune issues
- Renal disease
- Ulcers
- Poor healing
- Shortened life expectancy
- A change in your cardiovascular flexibility
ALARM leads to RESISTANCE which leads to EXHAUSTION which leads to a decreased immune system.
These are the expected actions of a healthy adrenal cortex in response to stress:
- Mental clarity, focus, response to stress
- Normalization of blood sugar
- Normalizes tissue inflammation
- Regulates sodium and potassium
- Blood pressure regulation
- Cardiac function
- Enhances insulin sensitivity
- Wakes us up and winds us down
However, too much cortisol will make us gain weight, decrease our mental clarity and will leave fat deposits on the belly.
Not enough cortisol and we are fatigued all of the time.
It needs to be JUST RIGHT
Symptoms of elevated cortisol: Extreme=cushings disease
- Excessive energy
- Anxiety and panic
- Abdominal weight gain
- Inhibits release of inflammatory cytokines
- Difficulty falling asleep from a racing mind
Symptoms of dampened cortisol: Extreme=addisons disease
- Fatigue
- Irritability
- Foggy mind
- Immune exhaustion
- Low energy
- Lack of initiative
- Salt cravings
This doesn’t happen overnight…
Stages of adrenal depletion:
- Stage 1: elevated cortisol, low DHEA
- Poor sleep, loss of muscle mass, truncal weight gain, facial weight gain, glucose intolerance, depression, fluid retention
- Stage 2: low normal levels-flat
- Stage 3: low cortisol and DHEA all day
- Fatigue, carb cravings, mental fogginess, dark circles under yes, headaches, salt cravings, exercise intolerance, poor healing, heartburn.
A flat adrenal curve and elevated nighttime cortisol and metastatic breast cancer are tied. What else happens when there is too much or too little cortisol on board?
Acute stress=cortisol excess
- Decreased immunity
- GI problems
- Ulcers
- Infections
- Cancer
- Elevated BP and HR
- Increased blood sugar
- Depletion of other key hormones
- Sexual function
- Periods
- Bone loss
- Metabolic changes
- Change in appetite: Cravings for carbs and fats and resulting weight gain
- Bone loss
- Decreased mental function and anxiety
- Joint and muscle pain
- Sleep disturbances
Chronic Stress=cortisol depletion
- Decreased immunity
- GI problems
- Ulcers
- Infections
- Cancer
- Low BP
- Low blood sugar
- Thyroid dysfunction
- Sex hormone imbalance
- Salt and water dysregulation
- All day fatigue
- Change in appetite: cravings for carbs, fats, caffeine, snacks
- Decreased mental function, depression
- Weight gain
- Irritability
So how do you normalize cortisol levels?
- Bio-identical hormone replacement therapy with hydro-cortisol based on your salivary levels of cortisol which have been tested 4 times in a day. This is a prescription medication and should be supervised by a medical provider who is trained to understand the adrenal glands.
- Eat a balanced diet with low glycemic carbs
- Whole foods
- Lots of fiber
- Protein, fat and low glycemic index carbs at each meal
- Low salt (please eat Celtic Sea Salt or its equivalent)
- Eliminate alcohol, caffeine and other stimulants
- Exercise MODERATELY. Too much or too little exercise can both be damaging to the adrenal glands.
- Vitamins and Supplements:
- Vitamin C 1 gm a day in divided doses
- Calcium and Magnesium
- Opposite times of day
- 400-600 mg/day
- B-Complex: Good for adrenal adaptation to surgical stress and buffers the rise of cortisol after stress.
- L-Theanine (Green Tea without caffeine)
- Phosphatidylserine: Lowers night-time cortisol which causes people to awaken exhausted after a night’s sleep.
- Botanicals: Adaptogens and tonics which will both strengthen the adrenal glands and adapt to their ever changing needs. Panax ginseng, Ashwagandha, Licorice, and Rhodiola are all good choices, depending on what lab tests reveal.
- Sleep is one of the MOST important things you can do for your adrenals.
- Stress management. I like the E-M wave from Heart Math coupled with the exercises in the book, “The Heart Math Solution”, meditation, yoga, and energy work like Reiki.
What is the goal of treatment? What does a normal cortisol level look like in a body that is adapting to stress properly? This can take a year or more to achieve, depending on your starting level, but you will have:
- Clear mind
- Stable moods
- Balance between tissue growth and breakdown
- Good energy at wakeup and during the day
- Healthy sleep at night
- Balanced appetite
- Bone preservation
- Balance between anxiety and fatigue
- High immunity
Books for further reading:
- Why Zebras Don’t Get Ulcers: Saplosky
- Adrenal Fatigue: Wilson
Next week I will talk about the 5th part of our hormone series: The Thyroid
Here’s to your health…
