Stress and Adrenal Fatigue

Stress and Adrenal Fatigue

We come equipped with a marvelous emergency response system that allows us to fight for our life or run for our life. Known as the “fight or flight” response this innate hormone response gave primitive-man the energy to “fight the saber-toothed tiger”.

In today’s complex world it seems we are always “fighting imaginary tigers” or “running from imaginary bears” and our adrenal gland is paying the price. A poor diet with too much sugar, starch, and caffeine will make matters worse. Add poor sleep to the mix and our recipe for adrenal fatigue is nearly complete!

The adrenal glands make our stress hormones. They are located on top of our kidneys and when we are stressed they pump out our “fight-or-flight” hormones. If we had to march for days without food and water it is the adrenal gland that would keep us going. Normally the adrenal gland comes into play during a time of stress, such as a mentally challenging time where we need extreme attention, in a fight, during infection or surgery, with sleep deprivation, or similar situations that stress our body.

With “adrenal fatigue” we are mostly referring to cortisol, which is a steroid hormone that helps raise our blood sugar, regulate our immune system, control inflammation, affect the tone of the heart and blood vessels, and stimulate the brain. It plays a very important role in energy production and many people with chronic fatigue are low in their production of cortisol.

The response to chronic stress - first defined as occurring in three stages by Hans Selye as alarm, resistance and exhaustion - typically results in abnormal adrenal function and adrenal fatigue, as well as abnormal cognitive, metabolic, energy, endurance, immune and glycemic function.

People with low cortisol often complain of fatigue. They frequently have a really hard time getting going in the morning and feel tired even though they slept plenty of hours. They might complain of being overwhelmed with everyday chores and even enjoyable activities feel like a burden. Sometimes depression and low sex drive are symptoms of adrenal fatigue. Inability to handle stress is a common feature. They sometimes are prone to low blood sugar, getting weak, shaky, sweaty and light-headed if they go without eating for long. Or they might be prone to light-headed spells reflecting low blood pressure. Some people are prone to frequent infections or prolonged time to recovery.

Cortisol is a diurnal (daytime) hormone, meaning it has wide swings in the levels from day to night. It is normally at its peak within 30-90 minutes after awakening in the morning and then drops to a lower level throughout the day.

We often see patients complaining of daytime fatigue combined with insomnia. These patients usually have low cortisol in the day with a spike toward evening – which is the reverse of the normal pattern. As such patients may get a “second wind” after dinner and be full of energy at bedtime. We call this “wired but tired”. In many of these cases the nocturnal (night) hormone melatonin is also reversed, being low during the middle of the night when it is supposed to be at its peak. These patients will not be helped with their sleep disturbance until the abnormal cortisol response is tamed.

Addison’s disease is the conventional medical syndrome of low cortisol in which people produce no cortisol at all. Without cortisol replacement they will die. Adrenal fatigue refers to people that can make enough cortisol to sustain life, but not nearly the optimal amount to promote health and wellness.

Standard testing might include giving an IV infusion of the pituitary hormone that normally stimulates more cortisol production (ACTH) then measuring to see if cortisol doubles or triples in the bloodstream. This is called an ACTH stimulation test. Another method is to measure cortisol in a 24 hour urine collection as a means to quantify the amount made over time.

We often recommend a salivary cortisol test in which the patient simply collects saliva at different times during the day, such as 8 am, noon, 4 and 8 pm. In this manner we can see what the cortisol level is doing throughout the day and it is very convenient for patients. It also minimizes the possibility of stress causing a sort of false elevation in cortisol beyond what we think is a baseline – driving to the lab and getting poked with a needle will normally raise cortisol!

Adrenal fatigue is a controversial area in medicine. Not all physicians will recognize the diagnosis and the standard tests for cortisol might miss adrenal fatigue. Since cortisol normally varies so much through the day it is important to check the level at different times.

Treating adrenal fatigue involves lifestyle modifications that include improving diet, exercise, and stress management. We usually suggest acupuncture and relaxing activities such as meditation, yoga or tai chi. I recommend all my patients undergoing treatment read “Adrenal Fatigue” by Dr James Wilson. It is well written and covers the topic thoroughly, especially the lifestyle issues.

The supplements used for adrenal fatigue are designed to support, fortify and restore adrenal function, and fall into 3 basic categories:

glandular extracts which are taken from adrenal gland tissue with the actual hormones taken out, providing the nucleic acids, proteins and building blocks for cortisol production
herbal extracts with adaptogenic properties designed to support and nourish healthy, balanced adrenal gland function
vitamins designed to enhance energy production and adrenal function

In severe cases we will add cortisol hormone in physiologic doses. We are always addressing the underlying issues that may have contributed to the adrenal fatigue, such as other hormone imbalances including menopause or low thyroid disorders, inflammatory processes such as impaired gut function or delayed food allergies, chronic infections or heavy metal toxicities. In time the natural supplements or the cortisol can usually be weaned off of as the adrenal gland recovers. Sometimes patients need cortisol forever as the adrenal gland is not capable of recovery.

Adrenal fatigue is one of the most under-recognized conditions in our society. If you suffer from vague symptoms of fatigue, poor sleep, or just not feeling up to par then consider the supporting role your adrenal gland plays in overall health. A simple saliva test, a few lifestyle changes and a little nutritional support may be all your adrenal system needs to help get you back on track.

Inset

The next free seminars are “Adrenal Fatigue” Monday, March 26th, and “Supplements: Why you need them and how to choose them”, Monday, April 9th, both at 6pm, at the IMC. Seating is limited so RSVP at 245-6911 or online at HYPERLINK "mailto:rsvp@imcwc.com" rsvp@imcwc.com.

Bio

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado ( HYPERLINK "http://www.imcwc.com" www.imcwc.com). Call (970) 245-6911 for an appointment or more information. 

He is also medical director of Integrative Weight Solutions, a holistic, physician supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss. For more information see HYPERLINK "http://www.integrativeweightsolutions.com" www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.