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Comprehensive Adrenal Fatigue Article
By: Michael Lam, MD, MPH
www.DrLam.com

Introduction to Adrenal Fatigue

Fatigue and lethargy are some of the most common complaints amongst adult patients. If you have symptoms such as tiredness, fearfulness, allergies, frequent influenza, arthritis, anxiety, depression, reduced memory, difficulties in concentrating, insomnia, worn-out, and the inability to lose weight after extensive effort you may be suffering from Adrenal Fatigue Syndrome.

Adrenal Fatigue has a broad spectrum of non-specific, yet often debilitating symptoms. The onset of this condition is often slow and insidious. Patients are told that they are stressed and need to learn to relax more. Yes, we all know that "stress kills" to a large extent. But, the question is how?

The real truth is that stress and Adrenal Fatigue are not a mysterious entity at all. Our body has a built-in mechanism to deal with it. Being able to handle stress is a key to survival, and the control center in our bodies is the adrenal glands.

Adrenal Fatigue Syndrome is one of the most prevalent conditions, afflicting almost every adult in one way or another. Despite effective diagnostic tools and treatment programs, most conventional physicians were simply not informed of Adrenal Fatigue and not prepared to take Adrenal Fatigue as a serious threat to health.

This condition was seldom considered as a dysfunction sickness Instead, Adrenal Fatigue Syndrome was considered a condition whereby the cause is thought to be associated with stress, and no remedy was available other than to tell the person to "relax" and take anti-depressants. Over time, the condition worsens as the natural progression of this pathology takes its course if not reversed. Adrenal Fatigue Syndrome is not a medical condition recognized by mainstream institutions, and for good reasons. Invariably, the adrenal glands are structurally normal. Low cortisol, the most common associated finding, may be caused by factors outside the adrenal glands.

Adrenal Fatigue Syndrome should not be confused with another medical condition called Addison's disease where the adrenal glands are not functioning according to conventional endocrinologists' standards. While Addison's disease is often caused by an auto-immune dysfunction, Adrenal Fatigue Syndrome is largely caused by stress or by a host of other factors, including dysregulation of the HPA Axis, nervous system problems, immune system problems, and metabolic-nutritional problems. It is a complex condition with complex clinical presentation, depending on the stage of dysfunction. Those in neuroscience may prefer to label this condition Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation because of its strong association with dysfunction of the HPA axis. Forward looking endocrinologist may be more comfortable with calling this condition Non-Adrenal Illness Affecting Adrenal Function because of the associated low cortisol output which does not meet the diagnostic criteria for Adrenal Insufficiency.

Conventional medicine only recognizes Addison's disease as hypoadrenia. As such, do not be surprised if your doctor is unfamiliar with this condition. To put it simply, Adrenal Fatigue Syndrome is the non-Addison's form of adrenal dysfunction sub-clinically. Because many causes may be involved, Adrenal Fatigue Syndrome is technically a more accurate nomenclature than Adrenal Fatigue. The addition of "syndrome" implies no definitive cause. It would be up to the physician to determine the list of symptoms and signs appropriate to the syndrome.

We will be using the terms Adrenal Fatigue Syndrome and Adrenal Fatigue interchangeably because Adrenal Fatigue is the most commonly used terminology recognized and used by the public.

Signs and Symptoms of Adrenal Fatigue:

  • Tendency to gain weight and unable to lose it, especially around the waist.
  • High frequency of getting the flu and other respiratory diseases and these symptoms tend to last longer than usual.
  • Tendency to tremble when under pressure.
  • Reduced sex drive.
  • Lightheaded when rising from a horizontal position.
  • Unable to remember things.
  • Lack of energy in the mornings and in the afternoon between 3 to 5 pm.
  • Feel better suddenly for a brief period after a meal.
  • Often feel tired from 9 - 10 pm, but resist going to bed.
  • Need coffee or stimulants to get going in the morning.
  • Cravings for salty, fatty, and high protein food such as meat and cheese.
  • Increased symptoms of PMS for women; periods are heavy and then stop, or are almost stopped on the 4th day, only to start flow again on the 5th or 6th day.
  • Pain in the upper back or neck with no apparent reason.
  • Feels better when stress is relieved, such as on a vacation.
  • Difficulties in getting up in the morning.
  • Lightheaded.

Other signs and symptoms include:

  • Mild depression
  • Food and or inhalant allergies
  • Lethargy and lack of energy
  • Increased effort to perform daily tasks
  • Decreased ability to handle stress
  • Dry and thin skin
  • Hypoglycemia
  • Low body temperature
  • Nervousness
  • Palpitation
  • Unexplained hair loss
  • Alternating constipation and diarrhea
  • Dyspepsia

If you have many of these signs and symptoms, and you have ruled out other organic pathologies, it is time to consider Adrenal Fatigue as a possible cause. None of the signs or symptoms by themselves can definitively pinpoint Adrenal Fatigue. When taken as a group, these signs and symptoms do form a specific Adrenal Fatigue syndrome or picture of a person under stress. These signs and symptoms are often the end result of acute, severe, chronic, or excessive stress and the inability of the body to reduce such stress. Stress, once a "basket" term used by physicians to explain non-specific symptoms, undetectable by conventional blood tests, is not a mystery to the body at all.

The ability to handle stress, physical or emotional, is a cornerstone to human survival. Our body has a complete set of stress modulation systems in place, and the control center is the adrenal glands. When these glands become dysfunctional, our body's ability to handle stress is reduced.

Adrenal Gland Basics

The adrenal glands are two small glands, each about the size of a large grape. They are situated on top of the kidneys. Their purpose is to help the body cope with stress and help it to survive. Each adrenal gland has two compartments. The inner or medulla compartment, modulates the sympathetic nervous system through secretion and regulation of two hormones, called epinephrine and norepinephrine, which are responsible for the fight or flight response. The outer adrenal cortex comprises 80 percent of the adrenal gland and is responsible for producing over 50 different types of hormones in three major classes - glucocorticoids, mineralcorticoids and androgens.

The most important glucocorticoid is cortisol. When this is lowered, the body will be unable to deal with stress. This happens in Adrenal Fatigue.

Mineralcorticoids, such as aldosterone, modulate the delicate balance of minerals in the cell, especially sodium and potassium. It therefore regulates our blood pressure and the fluid in the body. Stress increases the release of aldosterone, causing sodium retention (leading to water retention and high blood pressure) and the loss of potassium and magnesium in the early stages of Adrenal Fatigue. Magnesium is involved in over 300 enzymatic reactions in the body. When the body lacks magnesium, it will suffer from a variety of pathological conditions such as cardiac arrhythmias.

The adrenal cortex is also responsible for producing all of the sex hormones, although in small amounts. One exception is DHEA, a weak androgenic hormone that is made in large amounts in both sexes. DHEA, together with testosterone and estrogen, are made from pregnenolone.

Pregnenolone also leads to the production of progesterone and is one of the intermediary steps in the making of cortisol. Pregnenolone is therefore one of the most important intermediate hormones being produced in the hormonal cascade. Prolonged deficiencies in pregnenolone, which are found in Adrenal Fatigue, will lead to the reduction of both glucocorticosteroids and mineralcorticoids such as cortisol and aldosterone respectively.

Steroid Hormone Syntesis Pathway flow-chart

Cortisol (The Hormone of Death)

The most important anti-stress hormone in the body is cortisol. Cortisol protects the body from excessive Adrenal Fatigue by:

  • Normalizing blood sugar level. Cortisol increases the blood sugar level in the body, thus providing the energy needed for the body to physically escape threat of injury in order to survive. Cortisol works in tandem with insulin from the pancreas to provide adequate glucose to the cells for energy. More energy is required when the body is under stress, from any source, and cortisol is the hormone that makes this happen. In Adrenal Fatigue, more cortisol is secreted during the early stages. In the later stages of Adrenal Fatigue (when the adrenal glands become exhausted), cortisol output is reduced.

  • Anti-inflammation Response. Cortisol is a powerful anti-inflammatory agent. When we have a minor injury or a muscle strain, our body's inflammatory cascade is initiated, leading to swelling and redness commonly seen when an ankle is sprained or you have an insect bite. Cortisol is secreted as part of the anti-inflammatory response. It's objective is to remove and prevent swelling and redness of nearly all tissues. These anti-inflammatory responses prevent mosquito bites from enlarging, bronchial stress, and eyes from swelling shut from allergies, and Adrenal Fatigue.

  • Immune System Suppression. People with high cortisol levels are very much weaker from the immunological point of view. Cortisol influences most cells that participate in the immune reaction, especially white blood cells. Cortisol suppresses white blood cells, natural killer cells, monocytes, macrophages, and mast cells. It also suppresses Adrenal Fatigue.

  • Vaso-constriction. Cortisol contracts mid-size arteries. People with low cortisol (as in advance stages of Adrenal Fatigue) have low blood pressure and reduced reactivity to other body agents that constrict blood vessels. Cortisol tends to increase blood pressure that is moderated.

  • Physiology of Stress. People with Adrenal Fatigue cannot tolerate stress and will then succumb to severe stress. As their stress increases, progressively higher levels of cortisol are required. When the cortisol level cannot rise in response to stress, it is impossible to maintain the body in optimum stress response. In this respect, we can conclude that stress does kill.

In summary, cortisol sustains life via two opposite, but related, kinds of regulatory actions: releasing and activating the existing defense mechanisms of the body, while shutting down and modifying the same mechanisms to prevent them.

Cortisol Regulation

The adrenal glands are controlled via the hypothalamus-pituitary-adrenal (HPA) axis. There is an existing negative feedback loop that governs the amount of adrenal hormones secreted under normal circumstances in people with Adrenal Fatigue. For example, the HPA axis adjusts cortisol levels according to the body's need via a hormone called Adrenal Corticotrophic Hormone (ACTH) that is secreted from the pituitary gland in response to signals from the hypothalamus. When the ACTH binds to the walls of the adrenal cells, a chain reaction occurs within the cell. This leads to the release of cholesterol where it is manufactured into pregnenolone, the first hormone in the adrenal cascade. After this, cortisol is released into the blood stream where it travels in the circulatory system to all parts of the body and back to the hypothalamus.

Cortisol and ACTH are not secreted uniformly throughout the day. They follow a diurnal pattern, with the highest level secreted at around 8:00 a.m. in the morning after which there is a gradual decline throughout the day. Episodic spikes during the day can also occur when the body is stressed or when certain foods are taken. The cortisol level is at its lowest between midnight and 4:00 a.m.

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