Adrenal Fatigue

Adrenal Fatigue, A Nutritional Therapy Approach.

1. About adrenal glands

The human body has two adrenal glands, with size about 2.5 by 5 centimetres, that sit on top of the kidneys. Alongside the thyroid gland, parathyroid, pituitary, pancreas, ovaries or testicles, adrenal glands are part of the endocrine system. All these glands produce hormones responsible for controlling just about every operation in the body. 

The adrenal glands produce over 50 different hormones and each gland has two distinct parts with unique functions. The outer adrenal cortex produces steroid hormones such as aldosterone, cortisol and androgens. Rather the inner medulla is responsible for a production of adrenaline and noradrenaline.

Function

The adrenals control our metabolism, response to stress, blood pressure, immune system, sex hormones and so many other bodily functions. These glands are part of the hypothalamus-pituitary-adrenal (HPA) Axis. The hypothalamus located in the brain acts as a body’s thermostat by controlling homeostasis and signaling in case of imbalance. It communicates directly with the pituitary gland, which sends signals to modulate various organs and glands, including the adrenals.

Adrenaline and noradrenaline

The medulla part of the gland approximately produces 80% of adrenaline and 20% of noradrenaline circulating in the blood. The release process happens relatively quickly, within 2 to 3 minutes from the stressful event. Both hormones regulate our “fight or flight” response. During a “fight or flight” these hormones will increase blood flow to the muscles, blood pressure, breathing and heart rate. They also reduce blood flow to the gastrointestinal system, inhibiting gastrointestinal motility and emptying of the bladder. In the brain these hormones raise alertness, vigilance, formation, retrieval of memory, and focused attention. However, they also increase restlessness and anxiety. When the stressful situation ends the adrenal glands stop producing adrenaline and noradrenaline.

Pregnenolone 

This endogenous hormone is a precursor to most of the steroid hormones. They include progesterone, dehydroepiandrosterone (DHEA), different forms of oestrogen and other sex hormones, as well as cortisol and aldosterone. Parts of the brain and spinal cord also produce pregnenolone, where it acts as a neurosteroid. Interestingly, all steroid hormones use cholesterol as a common precursor, only proving that it is absolutely essential for our bodies.

Androgens and DHEA

Adrenal glands produce male sex hormones, also known as androgens, which are being synthesised in the gonads and adrenals. One of most abundant and important one is DHEA, which is another sex hormone precursor, neurosteroid and a strong antioxidant. In general, these hormones do not have a strong effect on the body until they convert into more potent androgens. These are testosterone (male sex hormone), or oestrogens (female sex hormones) in men and women respectively. For example, females also produce testosterone, needed for libido and sexual arousal, but at lower levels.

Through a mid-life period (menopause in women and andropause in men), the adrenal glands gradually become the major source of the sex hormones production.

Aldosterone

The adrenal cortex produces the primary mineralocorticoid aldosterone, which influences salt/electrolyte and water balance.

Aldosterone acts on the kidneys to provide active reabsorption of sodium and an associated passive reabsorption of water, as well as the active secretion of potassium. This in turn results in an increase of blood pressure and blood volume.

Cortisol

The adrenal glands secrete in their cortex a basal level of cortisol all the time, but can also produce bursts of the hormone in response to HPA activity like during stress. Cortisol release fluctuates throughout the day and night in a circadian rhythm, that peaks between 6 and 8 in the morning to wake us up, and reaches its lowest at around 4 am.

One of the primary activities of cortisol is to increase available glucose to the nervous system and simultaneously block glucose uptake into other tissues, by breaking down protein and fat in the liver into glucose. Cortisol is more important in altering the body’s metabolism under conditions of longer-term, chronic stress, rather than acute stress where adrenaline comes into action.

Cortisol also has a powerful anti-inflammatory and anti-allergy action. The activation of the stress system seen during an infection it is a protective mechanism. This may prevent an over-activation of the inflammatory response (1).

This is why, hydrocortisone (synthetic medical correspondent) helps to treat dermatitis, allergic reactions and inflammatory conditions. These range from from arthritis to ulcerative colitis.

2. Effects of prolonged exposure to cortisol

One of the most important functions of the adrenal glands is the fight or flight response, please read my article about “stress”. During acute stress, the hypothalamus stimulates the adrenal medulla to release adrenaline and noradrenaline. However, if the stressor is still present after this phase, the stress response will continue. This involves adrenocorticotropic hormone (ACTH) output from the pituitary gland, which causes a stady release of cortisol and DHEA from the adrenal cortex. Whilst attempting to maintain high cortisol production to manage stress, the adrenal glands are unable to maintain the production of other necessary hormones.

Based on cortisol’s primary action, prolonged elevated levels may cause a lowered immune function and prolong wound healing time (2). The effectiveness of cortisol to regulate the inflammatory responses is altered, because of decreased tissue sensitivity to the hormone. Immune cells specifically become insensitive to cortisol’s regulatory effect. In turn, chronic inflammation and a dysfunctional immune system may promote the development and progression of many degenerative diseases.

more on cortisol

Over production of cortisol has a negative effect on skeletal and muscular system. Not only it reduces calcium absorption in the intestines, but also impairs function of osteoblast cells. These cells are responsible for production of a new bone tissue. Elevated and prolonged levels of cortisol can prompt to a breakdown of proteins and muscle wasting (3). It can furthermore down regulate the synthesis of collagen (4). Collagen is a building block of all connective tissue. It keeps our joints and bones healthy, contributes to eye health, strengthens gut wall and blood vessels. It also makes our skin firm, supple and overall youthful.

Cortisol works with adrenaline to create short-term memories of emotional events, which may originate as a way to remember what to avoid in the future (5). However long-term exposure to cortisol damages cells in hippocampus in the brain (6). This damage may result in impaired learning and memory (7, 8).

3. Adrenal fatigue

The concept of adrenal fatigue was created in 1998 by a chiropractor and naturopath Dr. James L. Wilson. His belief was that even though the adrenal glands are capable of working very hard for a long period of time, at some point their function gradually declines. This can lead to the glands becoming chronically exhausted and unable to produce adequate levels of hormones. If the stressors are not removed or get worse, this is when adrenal fatigue syndrome enters into more advanced stages.

Although, medical organisations, including the Endocrine Society, do not consider adrenal fatigue as a medical condition, the symptoms are very real.

Symptoms

It is very important to mention, that in each stage of adrenal fatigue, there is a different combination of symptoms based on fluctuating levels of hormones, ranging from an overdrive into a complete burnout phase. For these reasons, all the symptoms mentioned below (and other less common ones) don’t need to appear together.

Fatigue and stress both have a significant impact on blood sugar balance, and for this reason the condition often paves the way to hyper- or hypoglycemia and metabolic syndrome with a risk of type 2 diabetes. One of the symptoms of blood glucose and electrolyte imbalance, due to cortisol and aldosterone dysfunction, is craving for sweet and salty foods.

In case of prolonged stress exposure, or in early stages of adrenal dysfunction, just as with cortisol, aldosterone levels also first rise. This helps the body to conserve water, which can result in its retention. However, when adrenal exhaustion progresses, aldosterone production tends to fall, resulting in inability to hold sodium, an increased urine flow and subsequently loss of bodily fluids.

In a late stage of adrenal fatigue or so-called burnout stage, with chronically lower levels of circulating hormones especially cortisol and aldosterone, symptoms appear in forms like reactive hypoglycemia, low blood pressure, postural/ orthostatic hypotension, dizziness, high resting heart rate and heart palpitations.

More hormonal dysfunction

Adrenal fatigue have been also associated with low thyroid function with all its associated symptoms. They include brain fog, anxiety and depression, feeling cold, insomnia, poor digestion, weight gain around the abdomen area. Severe lack of energy, especially in the morning and mid-afternoon, may be symptomatic of adrenal fatigue. This lack of energy induces people to rely on stimulants, like caffeine and sugar, to perform basic daily activities.

Because of decreased production of sex hormones, low libido, erectile dysfunction in men and an increased PMS or menopausal symptoms in women may occur. This, in both sexes, is often accompanied by aching joints, back pain and loss of muscle.

When discussing problems with adrenal function, it’s important to understand that adrenal fatigue is not the same thing as adrenal insufficiency. Adrenal fatigue is also different to Addison’s or Cushing’s disease. Also, unlike chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME), which is often triggered by an infection and can come on quite suddenly, adrenal fatigue usually takes years to develop.

Diagnosis

Because orthodox medicine doesn’t recognize adrenal fatigue as a condition, it leaves many people to suffer with their very real symptoms. Regardless, there are few tests you can do to paint a better picture.

The common test that Drs mostly use to analyse cortisol levels is a blood tests. However, many nutritional therapists, naturopaths and integrative doctors agree that cortisol blood test is not sensitive enough to detect the abnormalities adrenal fatigue. For this reason, a saliva test is more reliable, which many private labs offer.

A 24-hour salivary panel could help recognise abnormal cortisol patterns throughout the day and night as well as cortisol/ DHEA ratio, showing a lack or overload of stress response.

Many practitioners also recommend testing thyroid function (which can be also prescribed by a medical doctor) because of the way these hormonal systems are interconnected.

Other conditions that may give symptoms of adrenal fatigue include: hypothyroidism, various autoimmune conditions, vitamin D deficiency, sleep disturbances, POTS (postural orthostatic tachycardia syndrome), anemia, fibromyalgia, post bacterial or viral infections such as Lyme Disease or mononucleosis and others. Please, include those possibilities as part of diagnostics

Two safe home tests

The eye pupil contraction test- the theory behind this test is that, in people with weakened adrenal function, the pupil will not be able to contract correctly while exposed to light.

Postural low blood pressure test- using a blood pressure monitor, we can test our blood pressure when laying down and then after standing. In healthy people, when rising from a laying position, blood pressure rises as well. However, if there is no rise or a drop in blood pressure levels, it is possible that the adrenals have been overworked.

4. Holistic approach to adrenal fatigue

There are no guidelines in western medical community for the treatment of adrenal fatigue. Seeking help from a nutritional therapist or naturopath may be the best way for getting the right help and a protocol tailored to your personal needs.

Diet

There are plenty of foods that may offer adrenal support, helping to replenish your body and restore energy. However, you must start by removing any inflammatory foods and toxins or chemicals in your environment.

Try to buy organic whole foods and prepare your own meals whenever possible.

As mentioned earlier, aldosterone levels are lowered as adrenal fatigue progresses. Without ability to retain sodium, the body tends to lose water faster, resulting in dehydration. The obvious solution to this is drinking more water with added electrolytes and an emphasis on sodium. Water without added minerals can only dilute electrolytes left in your body, only adding to the problem.

say no to stimulants

Sugar and sweeteners are the biggest enemy to the adrenals, therefore they need to be removed from the diet. Look out for hidden added sugars in various products and please read labels carefully. For instance, processed foods may contain added sugars.

Even when your body craves for sugar and carbs, opt for whole grains, preferably without gluten and with low glycaemic index. Carbohydrates are very important for sustained energy, but only when combined with fibre, good fats and moderate amount of protein. I would not recommend consumption of red, processed meats and farmed fish, as they may be packed with hormones, antibiotics and other toxins.

Coffee and energy drinks are to be avoided as well. They may seem like a good idea to boost your energy levels, but only for a short term. They will interfere with your sleep cycle and increase cortisol levels, only prolonging recovery time (9). Herbal, green or white tea, with naturally low caffeine content, is a good option. Chicory or dandelion coffee are great substitutes, with lots of nutrients and caffeine free.

Exercise

Moderate exercise, even simple walking can help. Yoga, tai-chi, cycling or any other gentle exercise can improve quality of life and reduce stress responses. If you feel tired after, it’s sometimes best to only walk until adrenals are sufficiently restored.

Sleep

Along diet and gentle exercise, getting a healthy night sleep (link to article) is an essential component of supporting adrenals. Lack of sleep can raise your cortisol levels after a sleepless night causing a chain reaction (10). So, try to have 8-10 hours of sleep, going to bed no later than 10 pm. If, on top of regular sleep, you want to take a nap during the day, do that. The best body’s restoration happens during sleep. There are many supplements you can take to help you sleep better. Some of the best ones can be found here.

Vitamins & minerals

When your body needs extra nutrients supplements can be used to ensure that you are getting back to balance as soon as possible.

Magnesium deficiency is very common nowadays, as high stress, sugar and caffeine intake may deplete our body from this essential mineral. Its deficiency plays a role in adrenal insufficiency (11) and may induce anxiety and HPA axis dysregulation (12). Magnesium in the body promotes relaxation and improves sleep (13). Magnesium supplementation also decreases serum cortisol levels after aerobic exercise (14).

One of my favourite magnesium supplement is Nutri Advanced, magnesium glycinate.

Researchers have being studying B-Complex in relation to stress. They found that vitamin B12 deficiency may be associated with stress on the adrenal cortex in some animals (17). Vitamin B5/ pantothenic acid is another frequently deficient B vitamin in people with adrenal stress. I highly recommend Jarrow B-complex, as it presents some B vits in their methylated form.

High-dosage treatment with vitamin C has been shown to decrease circulating cortisol levels (18). On top of that, vitamin C is excellent to boost your immune function and support collagen production. If you are worried about acidic and laxative effects of ascorbic acid, I recommend looking into the highly absorbable liposomal vitamin C. Otherwise a food status and raw vitamin C, which has a 97% increase in its bioavailability compared to its synthetic version, so you do not need high dose.

omega 3 and Adaptogens

Omega 3 fatty acids from fish or algae may reduce cortisol release during mental stress (15). A 2010 study showed that 6 weeks of fish oil supplementation significantly increased lean mass and reduced salivary cortisol (16).

One of my favourite fish oil supplement is Wiley’s peak 1000mgs due to its potency and purity. If you are vegan, I recommend you Cytoplan algae oil.

Adaptogenic herbs offer a more balanced response to continuous stress, regulating various hormones including cortisol production. Adaptogens also help adjusting cellular sensitivity to stress hormones, effecting in a healthier overall response to stress.

Two popular adaptogenic herbs are ashwagandha and rhodiola rosea. Ashwagandha is widely recognised as a calming agent (19), reducing inflammation and enhancing immune system function (20). Ashwagandha may also help with thyroid function, increasing production of both T3 and T4 hormones (21). 

Rhodiola rosea is an adaptogen that has been proven to reduce the secretion of cortisol during stressful situations (22). Research shows that rhodiola may offer anti-depressive and cardio-protective effects as well (23).

Lifestyle changes

There are few lifestyle practices that may be beneficial in reducing stress.

Regular dancing has been shown to lead to a significant decrease in salivary cortisol levels (24). Music therapy can also reduce stress hormones in certain situations (25) as well as simple, genuine laughter and the experience of humour (26).

Massage therapy has been studied in terms of stress reduction and shown to decrease levels of cortisol and increase levels of serotonin and dopamine (27).

5. Final words

Adrenal glands are part of the endocrine system that produce hormones responsible for controlling major metabolic mechanisms.

One of the most important functions of the adrenal glands is the fight or flight response.

Unfortunately, in our fast and stressful world, the adrenal glands are frequently overworking. This can lead to the glands becoming chronically exhausted and unable to produce adequate levels of hormones.

Fatigue and stress have a significant negative impact on blood sugar balance, immune function, inflammatory responses, water balance, mood, sleep to name just a few. Despite the lack of understanding from the Western medicine point of view, there are several foods, herbs, supplements and lifestyle changes, that may help adrenal glands to recover from prolonged exposure to stress. Seeking help from a nutritional therapist or naturopath it’s a great way for getting the right treatment, which will be designed to our personal needs.

Author, Sylwia Wyrębek, Naturopathic Nutritionist

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References:

  1. https://zenodo.org/record/1235876#.Xl_QkC2cat8
  2. https://www.semanticscholar.org/paper/Mucosal-wound-healing-is-impaired-by-examination-Marucha-Kiecolt-Glaser/e2a7a1a977b306a301b41dee709ebf61d839714a
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC425032/
  4. https://pubmed.ncbi.nlm.nih.gov/3062759-hormonal-control-of-collagen-metabolism-part-ii/
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  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586582/
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  17. https://www.ncbi.nlm.nih.gov/pubmed/6543022
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  22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155223/
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  24. https://www.semanticscholar.org/paper/Emotional-and-Neurohumoral-Responses-to-Dancing-The-Quiroga-Bongard/0b800b85d81dad4bc03d32192a937679a74c27f0
  25. https://pubmed.ncbi.nlm.nih.gov/15086180-reduction-in-salivary-cortisol-level-by-music-therapy-during-colonoscopic-examination/
  26. Berk LS, Tan SA, Berk D (2008). “Cortisol and Catecholamine stress hormone decrease is associated with the behavior of perceptual anticipation of mirthful laughter”. The FASEB Journal. 22 (1): 946.11.
  27. https://www.tandfonline.com/doi/full/10.1080/00207450590956459

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