Adrenal Fatigue that has been around forever. It was first described in the medical literature by a French Doctor named Emile Sargent in 1898. This was after an epidemic of influenza. Most MD’s however have forgotten this disease state. They know of the extreme Adrenal exhaustive state referred to as Addison’s Disease only. This extreme state is when there is very little output from the Adrenals and that person will die unless aggressive efforts such as fluids, minerals and cortisone are given immediately. Today most MD’s are oblivious to the common human condition of Adrenal Fatigue. It was not until 1974 that non academic doctors even started paying attention to the fact that this might be a real disease, after the naturopathic physician, James Wilson PhD, wrote about it in nonscientific literature.
In all the other Endocrine Glands, there can be too much (hyper) or too little (hypo) function, but with the Adrenal Gland only too much activity, (Hyperadrenalisim or Cushing Disease) is well established. No function (Addison’s) is recognized, but not low function, which is much more common and easily documented is ignored. When an additional sudden burden of stress is added to our already over taxed system, the Adrenals cannot shove that extra bit of Hormone to get us over the bump and we slump. Actually this is only part of the problem, the other element is the down regulation of the hormonal receptors from being inundated with excess hormone for extended periods of time. Additional aches and pains also often start to show up because of the inability for our soft tissue to degrade these hormonal excesses. That is why these patients may present with fibromyalgia symptoms and if too much of them exist then the overlap disease Fibromyalgia is often diagnosed.
ANATOMY/PHYSIOLOGY: Simply put the Adrenals are a paired grape size gland sitting on top of the Kidneys. Although most know them as a single secreting cell mass, they are actually four glands in one. The most interior tissue or the MEDULLA secrets “Adrenalin” which is a combination of Norepinehrine (mostly) and Epinephrine (some) on demand from the brain which has been stimulated unconsciously by stress via mostly specific pathway of nerves referred to as the Sympathetic Nervous System and slightly from other chemicals in the blood. The outer three layers, are the CORTEX which functions as a true endocrine gland and is stimulated by chemical messengers secreted into the blood stream from the “Master Gland”, which is called the Pituitary. There are more than 50 specific hormones and many more cell types in the Cortex. These give us the needed advantage of either fight or flight. These mechanisms have been finely tuned for survival in a hostile environment over mankind’s existence.
The Pituitary gland drives the Adrenal who itself takes direction from the Hypothalamus, (which is a small portion of our brain) and is located between the cortex and the Pituitary. The Hypothalamus gets its signals from our sensory neurons as well as the thinking part of the brain. It then secretes its chemicals to the pituitary through a special route that tells the “master gland” to release whichever hormone it thinks is best for the person at that moment. However, there are other influences that come into the equation. One is that the Pituitary does not gradually release its hormone, but pulses it according to according to the circadian rhythm as well as the strength of the stimulus it’s responding to. there are actually 350 pulses a day with the peak at 8 A.M. and their done at 4 P.M. In addition, it also gives a boost with meals. A special carrying protein, Serum Hormone Binding Globulin (SHBG) is superimposed on these activities and it has a life of its own, but generally increases during times of stress or “special events” such as Sex. This stress chemical transports the Adrenal Hormones to various body parts of diverse need for them to operate at a higher level. To make matters even more complicated, there is a “free” Adrenal Hormone that acts on the receptor of that targeted tissue and the “bound” that is just the transporter of the hormone.
INCIDENCE: Our lifetime response to stress is accumulative as well as additive. Therefore, the more stressful events, the longer the episode, and the more intense the stress is the more the Adrenals burn out. At times, they have no reserve for even menial tasks such as staying awake after meals. Adrenal Fatigue can run in families because certain genetic types are more prone to it. Our ancient ancestors were also exposed to stress, but compared to our modern life it was only a small fraction. Life was not as complicated centuries ago. Sure there were natural disease, but life was basically food, clothing and shelter. Whereas the average person living in today’s society is exposed to artificial light, violent entertainment as well as complex current events, the internet, highly refined diets, and the insecurity of tomorrow add up to Adrenal Fatigue.
SYMPTOMS: The most all-encompassing is Fatigue, Brain Fog, and Poor Concentration. However, a decrease in Sex Drive and Performance, Sweet and Salt Cravings, poor sleep patterns, Low Blood Sugar Spells, Light Headed on standing, an increase in PMS or Menopausal symptoms, Irritability, rapid Heart Rate or Heart Palpitations, Swollen Ankles in the evening, frequent Sighing and easily Confused. Also more Allergies, both airborne (Cedar Fever), but also food such as Food Sensitivities, Gluten Intolerance, and Multiple Chemical Sensitivity are more common with Adrenal Fatigue. Also noted is more Infection from minor colds to very serious like pneumonia. Heart Disorders from the benign Mitral Valve Prolapse Syndrome to the malignant (Heart Attacks) occur more with the Adrenal Fatigue Syndrome.
There is often a specific pattern of Fatigue in which the individual wakes up tired-even more than when they went to bed, gradually gains energy around noon only to crash around 2P.M. The person then limps through the rest of their day and early evening and when everyone else is getting tired, they start getting their “second wind”. They find themselves up at midnight still “energized” and living off tomorrows energy. There is a subtle difference between FATIGUE and simply TIRED. Whereas both have a lack of energy in common, in the latter, a person would state, if “I could only get some sleep, I would feel better. With the fatigued person that is not the case. Also, both the tired and the fatigued person would not want to run around the block, but the tired one would be able to do it with some encouragement. The fatigued person would simply be unable no matter what was offered them. A common symptom is the need for more caffeinated beverages as well as the need to lie down after a psychological or physical incident. Even something pleasant like socializing with friends or family cause fatigue. Less productivity at work and at home is also a common complaint and burnout is not uncommon.
PHYSICAL FINDINGS: The Vital Signs are revealing in that the Systolic Blood Pressure is low, frequently under 110. The Temperature is also low, often less than 98 degrees. Upon standing, there is normally a 5 to 10 mmHg increase in Systolic Blood Pressure compared to sitting, however, with Adrenal Fatigue it will stay the same or even go down a few points. Moreover, the Pulse will go up more than 10 on standing from the sitting down pulse rate. There is also a difference in Pupillary Size compared to normal people. The pupil is the black circle inside the blue or brown surrounding iris. In the normal person, when a light is shined into the eye from the side, the pupil will get smaller for as long as 20 seconds. However, with Adrenal Fatigue, the pupil will start to dilate sooner and the faster it dilates, the worse the Adrenal Fatigue is. Additionally, the Deep Tendon Reflexes (Knee Jerks to a rubber hammer) are very brisk compared to normal persons. If a light scratch is made with a pin on the skin, it turns reddish-pink within 30 seconds in a normal person, however, not so with this problem. It will remain white for over a minute which is called the Sargent’s White Line. Another physical finding is the Rogoff Sign, this is tenderness when the back is tapped just beneath the ribs, adjacent to the spine. Rogoff is the doctor who first discovered this tell tale sign.
LABORATORY STUDIES: The most common tests done are the salivary (sputum) assays for CORTISOL and DHEA. However, they are not routinely performed by the physician’s usual labs and not paid for by insurances. Some specialty labs such as Doctors Data (doctorsdata.com) or Great Smokies (greatsmokies.com) do these for less than $200 a study. We do them as part of our hormone panel which measures adrenal function on a full 24 hour cycle. Also for around $200 but we are able to gain the actual free levels of the hormones also.
In a normal person, when the graph of the above labs is reviewed, there is a peak of the CORTISOL at 8AM and lower values for the rest of the day. Not so for the Adrenal Fatigued who has relatively low values in the AM and higher later in the day. Also the DHEA-S, which is a precursor of CORTISOL is lower than normal indicating there is not enough of this pre-hormone to make adequate amounts of DHEA. Unusual physical or psychological stress that day which includes vigorous exercise, excessive caffeine, acute allergy and the consumption of certain supplements (licorice) or medications (steroids) will invalidate the test results. Surgery, trauma, and acute depression could also give false readings.
TREATMENT: Most illnesses are related to the mismatch of lifestyle on what the human body needs and can adapt for. Adrenal Fatigue is one such condition. Absolutely no stress is bad for the human mind and body. Whereas, light stress is healthy, but like most things too much of even a good thing is ultimately BAD. To really be cured, one has to stop the process which for most of us means changing our lifestyle. Some people thrive on excitement, but sooner or later it will wear them out. Interestingly, most Adrenal Fatigue cases want help when they are burning the candle at both ends, they simply want more wax! The proper treatment is not to give more wax, but to simply light and burn one end of the candle. Do less, think smarter and most importantly make better life choices. Lifestyle change is not only the cornerstone, but is actually the keystone for successful recovery. Decreasing stress, improving sleep, making good food choices, staying in a positive way of thinking and prayer or meditation are all part of a strong foundation for recovery. Additionally, moderation is the key phrase when it comes to the intake of caffeine, alcohol and even spices. Extreme negative emotions like getting angry is bad for the Adrenals. Be optimistic, laugh often, give everyone in your life (especially yourself) the benefit of a doubt. Be kind to everyone and be willing to give and receive lots of Love. There is no easy fix, unfortunately, the longer and more severe the Adrenal Fatigue has existed, the longer it will take to heal. Although, with good therapy, patients start feeling better in just a few days, it often takes weeks to months before they are greatly improved with a lasting cure taking years to accomplish.
Luckily, we here at the Center for Health and Healing have been dealing with Adrenal Fatigue for years and have found the best and quickest path to success is in addition to the necessary lifestyle changes is the use of Bio-identical Hormone Replacement therapies. We start with an adrenal support base and bio-identical hormones compounded specifically for the patients based on their test results. Since the Adrenals via the Pituitary is impacted upon as well as modulates other endocrine glands, often the Thyroid and the Gonads (ovaries/testes) need to be evaluated also.
In some cases of poor adrenal response, we find heavy metal toxicity such as the “silver” teeth fillings (which is 35% mercury). Also drugs, vitamin and mineral deficiencies should be considered in non responders. The supplements that heal the Adrenals are Vitamins, Minerals, Herbs, Homeopathics and Glandulars. The most important Vitamin is “C” with dose as high as the bowel will allow, usually between 6 and 15 grams daily. B vitamins including B12, (methlycobalamine), B5, B6, Folic Acid, and Vitamin D3 at 5000 to 15, 000 mg daily are also recommended. Other relaxing herbs such as Valarian Root, Kava Kava, Ginseng, Rodiola, and Hops are directed. Relaxing supplements such as daily 5HTP or GABA are sometime used.
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