We’ve all heard of adrenal fatigue, but how do you know if you have it, how can you treat it, and what does it really mean?
When philosopher Albert Camus famously said, “Nobody realises that some people expend tremendous energy merely to be normal”, I believe he must have been talking about those of us suffering from adrenal fatigue.
I’m so stressed!
‘Stress’ is a term widely used today to describe a feeling of pressure and overwhelm in dealing with day-to-day life. Often the daily demands placed upon us build up and accumulate to a point where it’s almost impossible to cope.
Job pressures, family arguments, financial pressures, deadlines – these are common examples of ‘stressors’. But a stressor may be almost anything that creates a disturbance in the body, including exposure to hot or cold temperatures, environmental toxins, internal poisons produced by micro-organisms, physical trauma, and of course, strong emotional reactions.
Our body, being infinitely intelligent, has some basic control mechanisms geared toward counteracting the everyday stresses of life. However, if our stress is extreme, unusual, or long lasting, these control mechanisms can end up being quite harmful.
Stress triggers a number of biological changes known collectively as ‘general adaptation syndrome’ (G.A.S). The three phases of the G.A.S. are alarm, resistance, and exhaustion. These phases are controlled and regulated by our adrenal glands.
What are the adrenal glands?
The adrenal glands lie just on top of the kidneys and are composed of two distinct parts; the adrenal medulla and adrenal cortex. The inner portion of the adrenal gland, the medulla, is related to the sympathetic nervous system aka ‘fight or flight’ – and is responsible for producing adrenaline.
The outer layer of the adrenal gland, the cortex, secretes an entirely different group of hormones called corticosteroids. These hormones are all formed from cholesterol, which is why, in a balanced amount, cholesterol isn’t actually your enemy at all.
Out of the three main types of corticosteroid hormones, the first and most important for us in our discussion on adrenal fatigue is cortisol. Cortisol is required for proper carbohydrate metabolism, insulin release for blood sugar regulation, immune response, and the regulation of inflammation in the body.
The second type is aldosterone, which is responsible for the balance of sodium and potassium in the body and therefore fluid balance. The third type of hormones produced by the adrenals are sex hormones.
The alarm phase
The alarm reaction is the first stage of the general adaptation syndrome. This is the reaction we get when we are minding our own business wandering about the jungle, and a tiger jumps out in front of us and says, ‘You’re going to be my dinner’.
The reaction we have is called the ‘fight or flight response’; designed to counteract danger and mobilise the body’s resources for immediate physical activity. This is great if you have to run away from the tiger, but if you’re just under pressure from a deadline at work, the body’s response is no longer appropriate.
The physical changes in this phase are:
- Increased heart rate
- Blood shunted away from skin and inner organs and directed to the heart, lungs, and muscles
- Increased breath rate
- Increased sweat production
- Digestive secretions severely reduced
- Blood sugar levels increased dramatically as the liver dumps glucose into the bloodstream for energy
These changes are necessary when faced with a dangerous situation, but they can lead to chronic disease when engaged on a regular basis.
A lot of people these days eat on the run, have a sandwich at their desk, or eat via the drive-through after work. If they are still in the fight or flight response from a big day, they will not digest their food properly.
The body is quite clever in that it recognises that you don’t really need to digest your food while running away from the tiger, so it puts off that activity until later when you can relax into rest and digest mode.
But if you are continually running away from the tiger, when do you relax and digest?
Many stressed people end up with low hydrochloric acid levels in their stomach, leading to protein and mineral deficiencies. Minerals especially need to be ionised by stomach acid before they can be absorbed. It may also mean large particles of undigested food fermenting in the bowel creating a toxic environment and a leaky gut. You can end up bloated, constipated, and ill, just because you are too stressed to digest!
Blood sugar woes
The other factor that is of great significance in this alarm phase is the dumping of glucose into the bloodstream for energy. If this glucose is not used up by immediate physical activity, it circulates in the bloodstream where it can cause insulin resistance in the cells, making it harder for the glucose to be utilised in the future. Excess glucose can also be stored as fat if not used.
The resistance phase
While the fight or flight response is quite short-lived (although we can go into this state often), the next phase, ‘resistance reaction’, allows the body to continue fighting a stressor long after the effects of the fight or flight response have worn off.
In nature this was only designed to be active for a short period of time. Nowadays, however, we can live in the resistance phase for 40+ years!
Hormones secreted by the adrenal cortex (the corticosteroids) are largely responsible for the resistance reaction. The corticosteroids stimulate the conversion of protein into glucose, so that the body has a large supply of energy long after glucose stores are depleted, leaving us with higher than usual sugar levels circulating in the bloodstream.
Over a period of time this can change the natural composition of the body as muscle tissue is broken down for glucose production, which can then in turn be stored as fat if it is not utilised. At the same time, our mineralocorticoids ensure that sodium and fluid are retained to maintain an elevated blood pressure.
These changes may be necessary when faced with danger. They do allow us to cope with increasing amounts of stress, but prolonged resistance reaction, and continued stress, increases the risk of disease and results in the final stage of the general adaptation syndrome – exhaustion.
Exhaustion can manifest itself as a total collapse of body functions (a type of chronic fatigue) or as an ongoing inability to cope with daily life as the adrenals produce less and less cortisol in response to stress.
Some of the symptoms of low adrenal function are:
- Chronic fatigue and low energy
- Low blood pressure and dizziness on standing
- Salt cravings
- Anxiety, feelings of overwhelm, feelings of dread, or even panic attacks
- Dark rings under the eyes
- Memory loss and confusion
- The use of increasing amounts of caffeine to get going of a morning
Rather than treating for the actual cause of the health problems, many doctors will prescribe anti-anxiety or anti-depressant medication and possibly run a lot of inconclusive tests. The failure of the adrenal glands to produce optimal cortisol is something that is rarely investigated.
How do you test for adrenal fatigue?
Adrenal fatigue can show up very clearly in saliva hormone tests. In conjunction with evaluating the patient’s symptoms, we can arrive at a fairly accurate assessment of how the adrenal glands are working.
Saliva hormone testing checks the cortisol levels at four different times during the day and night to test the pattern of cortisol release. Cortisol should be released in a burst in the morning, giving us our highest amount for the day. It should then slowly decline until late in the evening when we should have very little left in our system as melatonin, our sleep hormone, kicks in.
In an adrenal fatigue pattern, that nice burst in the morning is often missing, and cortisol can remain quite flat during the whole day.
There are also blood tests and a 24-hour urinary excretion test that can give valuable insight as to the levels of cortisol production.
The three levels of treatment
Depending on the severity of the adrenal fatigue, there are normally three levels of therapies that we can choose from: food, herbs, and supplements; adrenal glandular extract; and low dose hydrocortisone medication.
Food, herbs and supplements
Fluctuating blood sugar levels can put a large stress on our adrenal glands. Taking sugar out of the diet is therefore an essential part of healing. Sugar comes in many forms; so it not just about stopping the chocolates, lollies, and sugar in your coffee; it is also about reducing carbohydrates in forms such as bread, pasta, cakes, biscuits, excess dried fruit, and alcohol.
Regular amounts of protein are required for healthy adrenal function (especially first thing in the morning), and eating small meals regularly can be of benefit.
There are several important herbs that are supportive of adrenal function and they belong to a family known as ‘adaptogens’, as they help the body adapt to stress. Liquorice root, Siberian ginseng, withania, rhodiola, and rehmannia are all beautiful tonics that can be formulated specifically for you by a qualified herbalist or naturopath.
Maca powder is a Peruvian root vegetable, which has also been used to improve energy and stamina in people with fatigue.
Although good quality food is the most important part of recovery, supplements can be of benefit in certain cases. Extra vitamin C, B5, and B6 alongside a good B complex and minerals such as sodium and magnesium are crucial, especially if there has been poor digestive function.
Food, herbs, and supplements along with lifestyle changes may be all that is needed for a full recovery.
Adrenal glandular extract
Adrenal glandular extracts are supplements made from the dried adrenal glands of animals. This method of treatment was used early in the 20th Century as a safe way of supplying hormones in hormone deficient states. They are theorised to strengthen the function of an exhausted adrenal gland, and this has proven to be the case in many naturopaths’ clinics.
If food, herbs, and supplements haven’t achieved the desired results, then adrenal glandular extract (if the person is not a vegan), would be the next step in the healing process.
Low dose hydrocortisone
If all else fails, or the person has severe adrenal insufficiency, then low dose hydrocortisone can be prescribed by a medical practitioner. This is used as ‘cortisol replacement therapy’ and may offer enough support over a period of time to allow the adrenal glands to fully recover.
In Dr. William Jefferies book, Safe Uses of Cortisol, he documents his research and clinical experience in successfully using low doses of hydrocortisone to treat a variety of ailments such as chronic allergies, autoimmune disorders, and chronic fatigue – all of which have adrenal exhaustion as a common base.
Medical practitioners today, however, are more familiar with the dangers of high dose cortisone therapy and are unaware of the ground-breaking research by Dr. Jefferies into the effectiveness of safe, physiologic dosages of hydrocortisone.
A competent medical practitioner would be required in this case to evaluate and monitor the use of such medication to obtain a complete healing.
Of course you can use any of the above methods of treatment, but if lifestyle factors are not addressed, then after recovery it will be very easy to slip into the same patterns and head for adrenal exhaustion again.
Work habits, relationships, perfectionist tendencies, attitudes, behaviours, and commitments all need to be examined and adjusted where appropriate to lower the stress burden. Counselling or an alternative therapy with a practitioner that can help to resolve emotional conflicts and set new boundaries can also help.
Regular exercise can support adrenal function when you have recovered enough to have the energy to start moving again, and it can also lower stress hormone levels when pushing the fight or flight buttons, or in the chronic stress of the resistance phase.
Meditation can also play a role in regulating the stress response, as can activities that utilise the breath such as yoga, tai chi, or qigong.
Having a passion in life that makes us jump out of bed in the morning is also a wonderful antidote to apathy and fatigue.
If we could all have six months to rest on the beach with good food, exercise, fresh air, and sunshine, and with no pressure or worries, our adrenals would happily recuperate for us. But in this frantic age we may not be able to take that time out. This is why, if you do suspect you are suffering from adrenal fatigue, it is so important to explore various healing modalities to find what works to guide you to a full recovery.
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