Adrenal Fatigue

I'm interested in the action of cortisol, which this article spells out; adrenal fatigue is pretty interesting in itself though...

Signs and Symptoms of Adrenal Fatigue

1. Tendency to gain weight and unable to loose it, especially around the waist.
2. High frequency of getting the flu and other respiratory diseases and these symptoms tend to last longer than usual.
3. Tendency to tremble when under pressure.
4. Reduced sex drive.
5. Lightheaded when rising from a laying down position.
6. Unable to remember things.
7. Lack of energy in the mornings and also in the afternoon between 3 to 5 pm.
8. Feel better suddenly for a brief period after a meal.
9. Often feel tired betweeen 9 - 10 pm, but resist going to bed.
10. Need coffee or stimulants to get going in the morning.
11. Crave for salty, fatty, and high protein food such as meat and cheese.
12. Increase symptoms of PMS for women; period are heavy and then stop, or almost stopped on the 4th day, only to start flow again on the 5th or 6th day.
13. Pain in the upper back or neck with no apparent reasons .
14. Feels better when stress is relieved, such as on a vacation.
15. Difficulties in getting up in the morning
16. Lightheaded


Other signs and symptoms include:

Mild depression
Food and or inhalant allergies
Lethargy and lack of energy
Increased effort to perform daily tasks
Decreased ability to handle stress
Dry and thin skin
Hypoglycemia
Low Body Temperature
Nervousness
Palpitation
Unexplained hair loss
Alternating constipation and diarrhea
Dyspepsia

If you have many of these signs and symptoms, it is time you consider adrenal fatigue as a possible cause once you have ruled out other organic pathologies. None of the signs or symptoms by itself can definitively diagnose adrenal fatigue. When taken as a group, these signs and symptoms do form a specific syndrome or picture - that is of a person under stress. These signs and symptoms are the end result of acute severe or chronic excessive stress and the inability of the body to reduce such stress. Stress, once a "basket" term used by physicians to explain non-specific symptoms undetectable by conventional blood test, is of no mystery to the body at all.

The ability to handle stress, physical or emotional, is a cornerstone to human survival. Our body has a complete set of stress modulation system in place, and the control center is the adrenal glands. When this gland becomes dysfunctional, our body's ability to handle stress reduces, and symptoms will arise..

Let us now look at how the adrenal glands work.

ADRENAL GLANDS BASICS

The adrenal glands are two small glands, each about the size of a large grape. They are situated on top of the kidneys. Their purpose is to help the body to cope with stress and help it to survival. Each adrenal gland has two compartments. The inner or medulla modulate the sympathetic nervous system through secretion and regulation of two hormones called epinephrine and nor epinephrine that are responsible for the fight or flight response. The outer adrenal cortex comprises 80 percent of the adrenal gland and is responsible for producing over 50 different types of hormones in three major classes - glucocorticoids, mineralcorticoids and androgens.

The most important glucocorticoid is cortisol. When this is lowered, the body will be unable to deal with stress.

Mineralcorticoids such as aldosterone modulate the delicate balance of minerals in the cell, especially sodium and potassium. It therefore regulates our blood pressure. Stress increases the release of aldosterone, causing sodium retention (leading to water retention and high blood pressure) and loss of potassium and magnesium. Magnesium is involved in over 300 enzymatic reactions in the body. When the body lacks magnesium, it will suffer from a variety of pathological conditions such as cardiac arrhythmias, uterine fibroids and osteoporosis.

The adrenal cortex is also responsible for producing all sex hormones, although in small amounts. One exception is DHEA, a weak androgenic hormone that is made in large amounts in both sexes. DHEA, together with testosterone and estrogen, are made from pregnenolone, which in turn comes from cholesterol.

Pregnenolone also leads to the production of progesterone and as one of the intermediary steps in the making of cortisol. Pregnenolone is therefore one of the most important intermediate hormones being produced in the hormonal cascade. Prolonged deficiencies in pregnenolone will lead to reduction of both glucocorticosteroids and mineralcorticoids such as cortisol and aldosterone respectively.

Cortisol (The Hormone of Death)

The most important anti-stress hormone in the body is cortisol. Cortisol protects the body from excessive stress by:

Normalizes blood sugar - Cortisol increase blood sugar level in the body, thus providing the energy for the body to physically escape threat of injury in order to survive. Cortisol works in tandem with insulin from the pancreas to provide adequate glucose to the cells for energy. More energy is required when the body is under stress from any source, and cortisol is the hormone that makes this happens. In adrenal fatigue, more cortisol is secreted during the early stages. In later stages ( when the adrenal glands become exhausted), cortisol output is reduced, and blood sugar balance becomes a problem.

Anti-inflammation Response - Cortisol is a powerful anti-inflammatory agent. When we have a minor injury or a muscle strain, our body's inflammatory cascade is initiated, leading to swelling and redness commonly seen when a ankle is sprained or an insect bite. Cortisol is secreted as part of the anti-inflammatory response. It's objective is to remove and prevent swelling and redness of nearly all tissues. These anti-inflammatory responses prevent mosquito bites from enlarging, bronchial tress and eyes from swelling shut from allergies, and swelling from being too intense.

Immune System Suppression - People with high cortisol levels are very much weaker from the immunological point of view. Cortisol influences most cells that participate in the immune reaction, especially white blood cells. Cortisol suppresses white blood cells, natural killer cells, monocytes, macrophages, and mast cells. It also suppresses the auto-immune system response to foreign insult.

Vaso-constriction - Cortisol contracts mid-size arteries. People with low cortisol (as in advance stages of adrenal fatigue) have low blood pressure and reduced reactivity to other body agents that constrict blood vessels. Cortisol tends to increase blood pressure that is moderated by calcium and magnesium.

Physiology of Stress - People with adrenal fatigue cannot tolerate stress and will then succumb to severe stress. As their stress increases, progressively higher levels of cortisol are required. When the cortisol level cannot rise in response to stress, it is impossible to maintain the body in optimum stress response. In this respect, we can conclude that stress does kill.

In summary, cortisol sustains life via two opposite but related kinds of regulatory actions: releasing and activating of existing defense mechanisms of the body and shutting down and modifying the same mechanisms to prevent them from overshooting and causing damage or cell death.

Cortisol Regulation

The adrenal glands are controlled via the hypothalamus-pituitary-adrenal (HPA) axis. There is an existing negative feedback loop that governs the amount of adrenal hormones secreted under normal circumstances. For example, the HPA axis adjusts cortisol levels according to the body's need via a hormone called Adrenal Corticotrophic Hormone (ACTH) that is secreted from the pituitary gland in response to signals from the hypothalamus. When the ACTH binds to the walls of the adrenal cells, a chain reaction occurs within the cell. This leads to the release of cholesterol where it is manufactured into pregnenolone, the first hormone in the adrenal cascade. After this, cortisol is released into the blood stream where it travels in the circulatory system to all parts of the body and back to the hypothalamus, where it is measured. This completes the negative feedback loop.

Cortisol and ACTH are not secreted uniformly throughout the day. They follow a diurnal pattern, with the highest level secreted at around 8:00 a.m. in the morning after which there is a gradual decline throughout the day. Episodic spikes during the day can also occur when the body is stressed or when certain foods are taken. The cortisol level is at its lowest between midnight and 4:00 a.m.

COMMON CAUSES OF ADRENAL FATIGUE

Chronic stress is very common in the western society. The most common causes of stress are work pressure, death of a love one, moving house, changing jobs, illness and marital disruptions. Adrenal fatigue occurs when the amount of stress overextends the capacity of the body to compensate and recover from stress.

Stressors that can lead to adrenal fatigue include:

Anger
Chronic fatigue
Chronic illness
Chronic infection
Chronic pain
Depression
Excessive exercise
Fear and guilt
Gluten intolerance
Low blood sugar
Mal-absorption
Mal-digestion
Toxic exposure
Severe or chronic stress
Surgery
Late hours
Sleep deprivation
Excessive Exercise
Excessive sugar in diet
Excessive caffeine intake from coffee and tea
One of the most commonly overlooked causes of adrenal fatigue is chronic or severe infection that gives rise to an inflammatory response. Such infection can occur sub-clinically with no obvious signs at all. Parasitic and bacterial infections including Giardia and H. pylori are often the main culprits.

STRESS RESPONSE From a Hormonal Perspective

At work, what happens if your boss screams at you? Let us now examine some of the effects within our body from a hormonal perspective.



Your hypothalamus signals your pituitary gland to release ACTH.

The ACTH will stimulate the adrenal medulla to secreted epinephrine, and the adrenal cortex to secrete cortisol, among other hormones.

Your cortisol level will increase and convert more stored glycogen into blood sugar for energy. Energy is also increased from the release of epinephrine from the adrenals.

Your heart rate will increase (from the epinephrine)

You will tend to sweat more (from cortisol)

Your muscle tension will increase (from cortisol and epinephrine)

Your digestion will slow down as blood is diverted away to more important tissues.
Your bladder and rectum muscle may relax.

When the above physiological response occurs over a long duration, or in certain cases when there is acute stress, then adrenal fatigue can result as the adrenal glands become worn out.

ADRENAL FATIGUE PROTOCOL



Attention
Because of tremendous individual variation, the use of nutritionals should therefore be personalized for your body. One person’s nutrient can be another person’s toxin. If you have a specific health concern and wish my personalized nutritional recommendation, write to me by clicking here.

Adrenal Fatigue can be reversed. You may need to allow 6 months to 2 years for the recovery process to take place. These are some of the important steps:



1. Removal of the stressors. This is the most important step. Emotional stressors such as marital, family, relationship, or financial problems needs to be dealt with and normalized.

2. Sleep. The most important is to have enough rest. It is important to go to sleep by 10 p.m. every night. Why? This is because our adrenal glands kick in for a "second wind" to keep us going from 11 pm to 1 am. This puts tremendous stress on the adrenals. When we rest early, our adrenals are fully rested and the high gear is avoided. Between 10 p.m. and 1 a.m., our adrenals work the hardest to repair the body. We should also try to sleep in until 8:30 a.m. or 9: 00 a.m. if possible. This is because our cortisol level rises to its peak from 6:00 a.m. to 8:00 a.m. in order to wake us up and get us going for the day.

In later stage adrenal fatigue, the level of cortisol falls and we feel tired. It will be more difficult to wake up. If we were to wake up too early, this will only increase stress on the adrenal glands, which will have to produce more cortisol when it is already exhausted.

A good night sleep is therefore mandatory. Without a good sleep, our bodies cannot regenerate itself to deal with stressors the next day. We should also rest in a completely dark room to maximize melatonin production.

If you are unable to fall asleep, take oral melatonin (0.5 mg to 3mg) 30 minutes before bedtime. You may begin with a low dose (0.5 mg) and gradually work upwards. If you start with 3 mg, the common over-the-counter dose and find it not helpful, go to a lower dose instead. The right dosage varies from person to person.

If you have a tendency to wake up at 2 to 3 a.m. and find that you are unable to fall back to sleep, that is a sign of excessive stress. In this case, you may wish to consider a time-release melatonin. You may also wish to try other sleep aids such as 5-hydroxytryptophan (5-HTP) 50-100 mg, adrenal extracts, and trace mineral tablets. Another wonderful relaxant and sleep aid is magnesium. Some common herbs that enhance sleep are valerian (root), hops (whole plant), and licorice (root).

3. Avoid Coffee or Caffeinated Beverages. Coffee and tea act as stimulants and interrupt sleep pattern. Herbal tea is acceptable because it does not contain caffeine.

4. Avoid TV and Computers. Some people may be photosensitive. Watching television or working at the computer may prevent the melatonin level from rising to induce sleep. If you are one of these people, you should turn off your television or computer by around 8 p.m. at night.

5. Exercise. This is a wonderful stress reducer and a tremendous oxygenator. Exercise reduces depression, increases blood flow, normalizes level of cortisol, insulin, blood glucose, growth hormones, thyroid, and makes you feel generally much better. You can exercise 20 to 30 minutes a day, dividing each session into 10-minute blocks.

Simple exercises such as brisk walking, or climbing stairs are easy to do and can be done almost anywhere. You should vary your routine so that exercise becomes fun. Plan to burn about 2,000 to 3,000 calories each week. When exercising, you should cover the following three categories:


Aerobics - such as fast walking, stairs climbing, Nordic track, swimming, and treadmill.
Anerobics - such as weight lifting, push-ups, sit-ups, chin-ups
Flexibility - such as stretching, yoga, and tai chi.

6. Nutritional Supplementation. It is prudent to optimize the adrenal gland functions. Supplement such as DHEA at 15 to 30 mg, pregnenolone at 25 to 50 mg, low dose natural cortisol at 25 to 50 mg, natural progesterone at 20 mg, or cortisol enhancing agent such as licorice root extract can be taken.

We should take an optimal balanced of vitamins and minerals for optimum adrenal function. These include:

A. 500 mg to 3,000 mg of vitamin C with bioflavonoids, lysine, proline, pine bark extract

B. 100 to 200 mg of fat-soluble vitamin C called ascobyl palmitate

C. 900 to 1,500 mg of vitamin B5 (panthothenic acid) as most hormone production in the adrenal gland needs the co-enzyme A, a by-product of Vitamin B5, to be produced.

D. Vitamin E is another important nutrient, which is involved in at least 6 different enzymatic reactions in the adrenal cascade. Take 400 to 800 I.U. of vitamin E daily.

E. Take 10,000 to 25,000 I.U of beta-carotene and other important minerals such as selenium (200 mcg), magnesium (500 mg) as well as important amino acids such as lysine (1-2 gm), proline (500mg - 1gm) and glutamine (1-5 gm) or more in advance cases.

F. DHEA 15-50 mg , pregnenolone 25-50 mg , adrenal glandular, adrenal extracts, licorice root can be helpful.

It is very important to understand that a short-gun approach by taking many nutrients at the same time seldom works and may even backfire. The use of nutritional supplementation in overcoming adrenal fatigue needs to be individualized, base on each person's history, background, and body metabolic system. One person's nutrient may be another person's toxin. Each nutrient is like one bullet in the arsenal. Using the right bullet at the right time is critical because there are not many bullets available. Many simply take the whole battery of nutrients without this consideration and that approach seldom works long term in the case of adrenal fatigue. Even if some nutrient appear to work well at first, it may subsequently fail as the body developed tolerance. More is not necessarily better and may make things worse in many cases because during the recovery process, the metabolism changes, and it is important to match the dosage to the metabolic throughout the entire journey for maximum effectiveness.

In adrenal fatigue, the body's ability to process and assimilate nutrient is often compromised. Testing doses are often used initially to see the amount of reserve the adrenal has before application of any high dose nutrient. Nutrients in the right dose should be administrated in a graded and step-wise approach , with follow up by the health care professional .

7. Supplementing With Natural Hydrocortisone or cortisone acetate in doses of 2.5 to 5 mg two to four times a day can be a safe and effective way to replenish depleted adrenals. However, this should be done under the guidance of a physician and it is a prescription drug.