Adrenal Fatigue

Michael Lam, MD, MPH
www.DrLam.com

INTRODUCTION TO ADRENAL FATIGUE SYNDROME

Fatigue and lethargy is one of the most common complaints amongst adult patients. If you have symptoms such as tiredness, fearfulness, allergies, frequent influenza, arthritis, anxiety, depression, reduced memory and difficulties in concentrating, insomnia, worn-out, inability to loose weight after extensive efforts, you may be suffering from adrenal fatigue (technically known as hypoadrenia).

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 is 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. When our adrenal glands become fatigue and unable to handle stress.

Adrenal fatigue was first described in the medical texts in the 1800s as a clinical condition. It was 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 diagnosed as a sickness for the past 50 years. Instead, adrenal fatigue was considered as a condition whereby no treatment was available other than to tell the "relax" and take anti-depressants. This often makes the condition worse as the root cause is left unresolved. Over time, the condition worsen as the natural progression of this pathology takes it course.

Adrenal fatigue should not be confused with another medical condition called Addison's disease where the adrenal glands are not functioning. While Addison's disease is often caused by auto-immune dysfunction, adrenal fatigue is largely caused by stress. Adrenal fatigue is the non-Addison's form of adrenal dysfunction. Unfortunately, conventional medicine only recognizes Addison's disease as hypoadrenia, despite the fact that adrenal fatigue is a fully recognizable condition. As such, do not be surprised if your doctor is unfamiliar with this condition.

Signs and Symptoms of Adrenal Fatigue

• Tendency to gain weight and unable to loose 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 laying down position.
• Unable to remember things.
• Lack of energy in the mornings and also in the afternoon between 3 to 5 pm.
• Feel better suddenly for a brief period after a meal.
• Often feel tired betweeen 9 - 10 pm, but resist going to bed.
• Need coffee or stimulants to get going in the morning.
• Crave for salty, fatty, and high protein food such as meat and cheese.
• Increase symptoms of PMS for women; period are heavy and then stop, or 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 reasons.
• Feels better when stress is relieved, such as on a vacation.
• Difficulties in getting up in the morning
• Lightheaded

• 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, it is time you consider adrenal fatigue as a possible cause once you have ruled out other organic pathologies. None of the signs or symptoms by itself can definitively pinpoint adrenal fatigue. When taken as a group, these signs and symptoms do form a specific adrenal fatigue syndrome or picture - that is of a person under stress. These signs and symptoms are often the end result of acute severe or chronic 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 test, is of no 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 system in place, and the control center is the adrenal glands. When this gland becomes dysfunctional, our body's ability to handle stress reduces

ADRENAL GLANDS 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 to cope with stress and help it to survival. Each adrenal gland has two compartments. The inner or medulla modulate the sympathetic nervous system through secretion and regulation of two hormones called epinephrine and nor epinephrine that 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 fluid in the body. Stress increases the release of aldosterone, causing sodium retention (leading to water retention and high blood pressure) and loss of potassium and magnesium in 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 and uterine.

The adrenal cortex is also responsible for producing all 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 also leads to the production of progesterone and as 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 as that in adrenal fatigue will lead to reduction of both glucocorticosteroids and mineralcorticoids such as cortisol and aldosterone respectively.

Cortisol (The Hormone of Death)

The most important anti-stress hormone in the body is cortisol. Cortisol protects the body from excessive and adrenal fatigue by:

Normalizes blood sugar - Cortisol increase blood sugar level in the body, thus providing the energy 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 happens. In adrenal fatigue, more cortisol is secreted during the early stages. In 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 a ankle is sprained or 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 tress 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 of existing defense mechanisms of the body and 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, where it is

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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