Every day in my clinical practice I speak with patients who are
not feeling well and do not know why. They experience fatigue and lack of
motivation and endurance. They often feel wired and tired. They get
conventional blood tests and are told everything looks okay. However, their
sleep is disturbed, they think they may have hypothyroidism, they crave salt
and caffeine, experience hypoglycemia, trouble concentrating, and feel fragile
and shaky. In their recent health history they have experienced long term
stress. For instance: may have been a caretaker for a loved, finished a
graduate degree program, have endured the rigors of a divorce, or have strained
family relations. They have experienced the metaphorical perception of
consistently seeing “lions, tigers and bears.” The above listed symptoms are
typical for a patient experiencing adrenal fatigue.
Carefully assessing the adrenal function is important. The
ad-renals sit on top of the kidneys and help the body deal with stressful
situations. The stress can be physical, mental-emotional or spiritual. When the
stress has become long term the adrenal function eventually becomes
compromised. It is “fatigued” and its function becomes deficient. Fatigued
adrenals have far reaching effects. They can influence thyroid, testicular and
ovarian function, result in unchecked inflammation (joint pain, allergies) and
impact immune function. I always marvel how the systems in the body are so
connected.
The adrenals are multifaceted in their function. Here is a
summary. There are two main components of the adrenals: the cortex and the
medulla. The adrenal cortex secretes cortisol and dhea
(dehydroepiandrosterone). The adrenal medulla secretes catecholamines (epinephrine
and norepinephrine). The focus of treatment is primarily on the cortex and
restoring cortisol and dhea to a normal level.
The secretion of epinephrine and norepinephrine are mediated by the
sympathetic nervous system. The adrenals are linked to the hypothalamic and
pituitary system. This is known as the HPA axis which, when in balance, is a
regulatory feedback system. Often the whole HPA axis needs to be rebalanced.
The brain is connected to the glandular secretion of the body.
Appropriate signaling takes place and the individual can adapt to his or her
environment. However, often the stress, and-or the perception thereof, is
prolonged and the system can no longer maintain an appropriate reaction. The
HPA axis can no longer keep up and the symptoms of adrenal fatigue emerge.
Cortisol is secreted to help the individual metaphorically jump
over the multiple hurdles in life. Cortisol secretion is the “gas” after the
accelerator is pushed on. It is the second wind that some people experience in
the evening hours. It helps students get through finals week. It supports a person’s
energy level and sense of alertness. It has a diurnal rhythm, meaning it
fluctuates with the night and day cycle. Normally it is elevated in the morning
and then tapers down towards the evening.
Assessing cortisol function with four evenly spaced salivary
samples on a typical day is an easy way to measure levels. In eighty percent of
lab results I see sub optimal levels. The other twenty percent have excess
cortisol levels. Hyper cortisol function needs a different treatment strategy –
namely to down regular the hyper excitation. The goal with treatment of low
cortisol levels is elevate them into a normal range. Treatment strategies vary.
Usually there is a component of glandular support along with herbal and
nutritional medicines. Occasionally cortisol is prescribed.
Dhea is an important adrenal hormone that balances cortisol’s
function. Levels of dhea are often deficient along with cortisol.
Supplementation is also required. The majority of dhea is secreted by the
adrenal glands though the ovaries also secrete it. Dhea supports energy
production, immune function, and has general restorative function. It is a
weaker androgen and needs to be used with caution in women.
I wish I could offer a simple remedy for adrenal support. However,
each patient has unique needs. In clinical practice I consider glandular
adrenal extracts foundational to treatment. Herbal extracts and specific
nutrients are close seconds. Herbs such as: Siberian ginseng, holy basil,
licorice, and rhodiola and at the top of my list. Nutrients such as B vitamins,
especially pantothenic acid, and Vitamin C are paramount.
Usually I recommend three to six months of adrenal treatment.
Ideally supportive lifestyle changes can be implemented too. These would include
eight hours of sound sleep, routine exercise as tolerated and creating
harmonious relationships with family and friends. In addition, I recommend
eating real whole foods and have a regular meditative practice to restore the
mind-body-nervous system function.
