Ovarian Adrenal Thyroid (OAT) Axis Imbalance. There are very strong interlinked relationships between the ovarian, adrenal, and thyroid systems in the women. These three organs are intimately co-dependent on each other for optimal function. This axis, also called the Ovarian Adrenal and Thyroid axis (OAT), must be balanced if a woman wants to feel good. When medication alters one of the organ's functions, it will invariably lead to an often unrecognized change in the other two organs. For example, if thyroid medication is administered, it is not uncommon to see concurrent menstrual irregularities, a function of ovarian hormones, and reduced ability to deal with stress, a function of the adrenals.

Let us look more closely at the reason. In Adrenal Fatigue, internal cortisol often creates a condition of multiple organ resistance, including the thyroid and ovaries. Thyroid tissues fail to respond as efficiently to the hormonal signal. Adrenal Fatigue is often accompanied by clinical or sub-clinical hypothyroidism. Laboratory values can be normal but classical signs of hypothyroidism may be present. Physicians and patients alike are often confused. Anti-depressants are often prescribed as a solution. However, this seldom works but will instead often make the condition worse.

A cortisol induced organ resistance applies to nearly all other hormone regulated organs including the ovaries and the pancreas. Few hormones are allowed to work at optimal levels in the presence of Adrenal Fatigue. A multitude of hormones including insulin, progesterone, estrogen, and testosterone become affected. The normal negative feedback loop in place can be disrupted. The ability of each hormone to regulate and fine tune its target organ to achieve homeostasis is often compromised. Blood pressure can becomes erratic, blood sugar levels may experience wide swings, bipolar and anxiety states come at will, and menstrual flow can become irregular. Even the brain may become less sensitive to estrogen.

Let us look more closely at how the ovarian system is affected in particular. Today, women often have exhausted adrenal glands by the time they reach their mid-thirties or early forties due to a stressful lifestyle. Stress is primarily regulated by our adrenal glands. In early stages of Adrenal Fatigue, cortisol output is high as the body attempts to neutralize the stress by producing more of it. However, when too much cortisol is produced, it will have multiple undesirable effects. For example, cortisol blocks progesterone receptors, making them less responsive to progesterone. Progesterone normally produced by the adrenals comes to a halt in favor of cortisol. Insufficient progesterone production leads to an imbalance of estrogen to progesterone. With reduced progesterone to offset estrogen, the body may experience a host of undesirable side effects associated with excessive estrogen. This leads to a condition known as estrogen dominance. It is no coincidence that we see a proliferation of conditions associated with excessive estrogen such as PMS, fibroids, and pre-menopausal syndrome when women reach their mid thirties and early forties.

It is interesting to note that most post- menopausal women who are experiencing hair loss have an adrenal function problem. Hair loss is a sign of excessive androgen. Some women tend to produce too much androstenedione, which then gets converted into estrone and testosterone. Testosterone in turn is converted into DHT, the more potent form of testostorone largely responsible for excessive hair loss. . Estriol can be given to offset the testosterone effects as estrogen balances testosterone in the body. Cortisol can be considered when closely supervised and used for a short period of time. It keeps the adrenal glands from getting stuck in the androgen part of the stress cycle if indeed it is in that state. Cortisol also complements the use of progesterone as well. The effective cocktail therefore consists of estriol, cortisol and progesterone. Each of these hormones, especially cortisol, has their own side-effects. Knowing what to use and when to use is critical, or hair loss could worsen.

Any serious attempt to normalize this axis should consider adrenal recovery as the first step. Adrenal normalization should precede hormone modulation. The adrenal glands deal with the daily stresses of life. A woman must normalize her adrenal glands in order to have a total body hormonal balance. In fact, replacement of deficient hormones alone without addressing the overall health of the adrenal gland is a band-aid approach and is often ineffective in the long run. The normalization process can begin with investigating and eliminating stressors. Stressors are often chronic in nature, and can be related to lifestyle, dietary, mental, and inflammatory causes. Women with heavy menstrual bleeding and adrenal exhaustion can normalize their adrenal functions with natural compounds to boost internal cortisol production, adequate sleep, proper diet, and nutritional supplementation before considering progesterone therapy. Exogenous cortisol replacement should only be considered as a last resort due to its long term negative effects.

Often times, the use of anti-depressants, thyroid replacements, and ovarian hormones often make women with OAT axis imbalance worse. Estrogen replacement often becomes ineffective, and symptoms of estrogen dominance like hot flashes, weight gain at the hips, water retention, and moodiness are commonly observed despite normal estrogen levels. Patients become frustrated as it seems that nothing can help when a downward spiral of multiple symptoms commonly surface: depression, insomnia, fatigue, metabolic and hormonal imbalances. Failing conventional therapy, many turn to natural compounds. It is not unusual to see many people take a full battery of these nutrients. For example, Vitamin C, DHEA, pregnenolone, natural progesterone, and natural thyroid replacement, just to name a few. In the beginning, this might be helpful. Unfortunately, a shot-gun approach by taking many nutrients seldom works and often backfires with time. The higher the dose the worse the patient can become. That is why chronic stress and Adrenal Fatigue can make one feel so rotten, like a slow-motion train wreck in progress. In severe cases, the patient often feels like the "walking dead" caught in a vicious downward cycle of deteriorating physical and emotional functions.

Adrenal Fatigue Protocol

Adrenal Fatigue can be reversed. You may need to allow 6 months to 2 years for the recovery process to take place. These are some of the important steps:

1. Removal of the stressors. This is the most important step. Emotional stressors such as marital, family, relationship or financial problems needs to be dealt with and normalized.


2. Sleep. The most important is to have enough rest. It is important to go to sleep by 10 p.m. every night. Why? This is because our adrenal glands kick in for a "second wind" to keep us going from 11 pm to 1 am. This puts tremendous stress on the adrenals. When we rest early, our adrenals are fully rested and the high gear is avoided. Between 10 p.m. and 1 a.m., our adrenals work the hardest to repair the body. We should also try to sleep in until 8:30 a.m. or 9: 00 a.m. if possible. This is because our cortisol level rises to its peak from 6:00 a.m. to 8:00 a.m. in order to wake us up and get us going for the day.
   
   In later stage Adrenal Fatigue, the level of cortisol falls and we feel tired. It will be more difficult to wake up. If we were to wake up too early, this will only increase stress on the adrenal glands, which will have to produce more cortisol when it is already exhausted.
   
   A good night sleep is therefore mandatory. Without a good sleep, our bodies cannot regenerate itself to deal with stressors the next day. We should also rest in a completely dark room to maximize melatonin production.
   
   If you are unable to fall asleep, take oral melatonin (0.5 mg to 3mg) 30 minutes before bedtime. You may begin with a low dose (0.5 mg) and gradually work upwards. If you start with 3 mg, the common over-the-counter dose and find it not helpful, go to a lower dose instead. The right dosage varies from person to person.
   
   If you have a tendency to wake up at 2 to 3 a.m. and find that you are unable to fall back to sleep, that is a sign of excessive stress. In this case, you may wish to consider a time-release melatonin. You may also wish to try other sleep aids such as 5-hydroxytryptophan (5-HTP) 50-100 mg, adrenal extracts, and trace mineral tablets. Another wonderful relaxant and sleep aid is magnesium.


3. Avoid Coffee or Caffeinated Beverages. Coffee and tea act as stimulants and interrupt sleep pattern. Herbal tea is acceptable because it does not contain caffeine.


4. Avoid TV and Computers. Some people may be photosensitive. Watching television or working at the computer may prevent the melatonin level from rising to induce sleep. If you are one of these people, you should turn off your television or computer by around 8 p.m. at night.M


5. Exercise. This is a wonderful stress reducer and a tremendous oxygenator. Exercise reduces depression, increases blood flow, normalizes level of cortisol, insulin, blood glucose, growth hormones, thyroid, and makes you feel generally much better.

   Exercise is a key component to adrenal recovery if done right. The key is to adjust the level of exercise in accordance to your capacity and do the proper amount at the right time. Over-exercise is a trigger for adrenal crash. More is not necessary better when it comes to exercise and Adrenal Fatigue.

   The more advanced your Adrenal Fatigue, the less you should exercise vigorously. Vigorous exercise can lead to a catabolic state and worsen Adrenal Fatigue. Those with severe adrenal weakness should start with customized gentle adrenal breathing exercises as the first step. Progress to adrenal restorative exercises, then to special adrenal yoga exercise series. Exercises specially designed for adrenal recovery are scaled based on exercise capacity, adrenal function, and autonomic nervous system function. You should feel fresh after each exercise session, with adequate recovery time for the body to recuperate. Strength should return gradually and consistently with the right program as catabolic state is reversed. Those with advance Adrenal Fatigue should not proceed with any exercise unless under professional supervision.

   One of the dangers of self-guided Adrenal Fatigue recovery programs is the tendency to over-exercise once there is more energy. The proper amount of prescribed exercise varies from person to person in different stages of adrenal recovery. Those in advance Adrenal Fatigue may only be able to tolerate 5 minute slow walk every other day, for example. This may be all the body can tolerate. Too much exercise exceeding the body's reserve capacity can worsen Adrenal Fatigue. As Adrenal Fatigue improves, regular exercise can be incorporated. Regular exercise should cover the following three categories:



• Aerobics - such as fast walking, stairs climbing, Nordic track, swimming, and treadmill.
• Anaerobics - such as weight lifting, push-ups, sit-ups, chin-ups
• Flexibility - such as stretching, yoga, and tai chi.
6. Nutritional Supplementation. In an adrenal recovery program, it is prudent to consider optimizing the adrenal gland functions gently when they are indicated along with lifestyle and dietary changes.

   An optimal balance of vitamins and minerals for optimum adrenal function can include:

1. 500 mg to 3,000 mg of vitamin C with bioflavonoid and synergistic co-factors. Vitamin C is perhaps the most gentle of all adrenal supporting nutrients. . It is best to get take Vitamin C in asorbic acid and sodium ascorbate form. Those who have a sensitive gastric system should consider mineral ascorbates. A properly personalized combination of different forms of oral vitamin C often works better than a single form. The proper delivery system also plays a critical and significant role. Nutrients are good only to the degree they can be delivered to the cell. The right combination of delivery systems (including liposomal, powdered, and capsulated) is therefore critical. One of the most common Adrenal Fatigue recovery program mistakes is the lack of properly administered vitamin C dosed for the body's specific need.
2. Glutathione by intravenous or by liposomal oral delivery to enhance the effectiveness and cellular bio-availablity of vitamin C, E, alpha lipoic acid, and carnitine. Glutathione acts as a liver detoxifier and helps recycle inactive oxidized vitamin C back to its reduced active form in the body after vitamin C has served its function.
3. 900 to 1,500 mg of Vitamin B5 (panthothenic acid) as most hormone production in the adrenal gland needs the co-enzyme A / pantethine, a by-product of Vitamin B5, to be produced.
4. 400-800 I.U. of Vitamin E is another important nutrient. It is involved in at least six different enzymatic reactions in the adrenal cascade. Take 400 to 800 I.U. of vitamin E daily.
5. 1000 to 5000 I.U of Vitamin D is a good nutrient to support hormonal synthesis.
6. Additional nutrients that may be considered include 10,000 to 25,000 I.U of beta-carotene, selenium (100-200 mcg), magnesium (200-800 mg), lysine (1-2 gm), proline (500mg - 1gm), glutamine (1-5 gm), DHEA 15-50 mg, and pregnenolone 25-50 mg, Ribose and co-factors 2,000-10,000 mg , CoQ 300-1,000 mg, Type 1 and Type 3 collagen.
7. Adrenal glandular, adrenal extract and herbals such as ashwagandha root, licorice root Korean Ginseng, Siberian Ginseng, ginger root, and ginkgo leaf can also be helpful for short term. They are widely promoted, their effectiveness and adaptogenic properties seem to be most suitable for those with very mild Adrenal Fatigue. Those with moderate to advanced adrenal weakness should exercise extreme caution prior to embarking on such compounds. The more advanced the Adrenal Fatigue, the more tendencies there are for these adaptogenic compounds to behave as stimulants for reasons that is not well understood. Stimulating the adrenals at a time when they need rest can therefore be devastating. They may give a short term sense of well-being but may lead to withdrawal and dependency issues long term. Some of these compounds can trigger and adrenal crisis. Stimulating the adrenals is thus not the best long term solution. Providing the adrenals the gentle nutrients they need to recover on their own is by far the most effective approach over time. Fortunately, there are many tools available without embarking on these compounds for total recovery for the vast majority of sufferers.
8. Steroids. Supplementing with steroids such as natural hydrocortisone or cortisone acetate in doses of 2.5 to 5 mg two to four times a day can be a safe and effective way to replenish depleted adrenals for a short time in very severe case when properly supervised. The problem with this approach is that most people will find it hard to get off once their body is used to it. An ever-increasing dose is often needed with time as the body develops tolerance. Its best to undertake this only when closely supervised by a knowledgeable physician along with a defined goal or weaning off this drug as soon as possible. The younger the person, the more this approach should be avoided unless it is absolutely necessary. Fortunately, there are many more gentler and non addictive natural compounds that are excellent and serve to help adrenal function without using steroids. Under the hands of an experienced clinician, this approach is seldom necessary.

It should be noted that while many practitioners use synthetic or bio-identical hormones (estrogen, progesterone, and testosterone) to modulate symptoms of fatigue and hormonal imbalance, this approach should be taken with care as it may mask the underlying root cause and worsen the overall condition over time.

The complete toolbox of natural compounds for adrenal recovery is therefore very big. Each tool serves a specific purpose. A systematic and comprehensive approach is necessary to avoid over stimulating or inadequate dosing. Proper timing is critical because each should be given only when the body is ready to assimilate, process and excrete. Knowing when and how much of each compound to use and to avoid requires extensive clinical experience if a fast-track recovery is the goal and minimization of mistakes a top priority.

Improper selection, dosage and timing of nutritional supplementation is the number one cause of recovery failures. Unless Adrenal Fatigue is in its mildest form, selecting the right compound, dosage, delivery system to match the stage of Adrenal Fatigue is best left to the experienced clinician.

Warning

It is very important to understand that a shot-gun approach by taking many nutrients at the same time seldom works and often backfires over time. The use of nutritional supplementation in overcoming Adrenal Fatigue needs to be individualized, base on each person's history, background, and body metabolic and clearance system. One person's nutrient may be another person's toxin. Each nutrient is like one bullet in the arsenal. Using the right bullet at the right time is critical. Misguided by marketing and often misinformed, many sufferers make the mistake of take a whole battery of nutrients without careful consideration and that approach seldom works long term in the case of Adrenal Fatigue. The more advance the condition, the more dangerous this approach. Even if some nutrients appear to work well at first, they may subsequently fail as the body developed tolerance and resistance. More is not necessarily better and may actually worsen the condition because improper administration may mask the underlying condition, creating a sense of temporary which eventually fails. Most only need a few natural compounds to get significantly better. The key is selecting the right ones.

In Adrenal Fatigue, the body's ability to process and assimilate nutrient is invariably compromised. Proper clearance of metabolites is a major concern. The more advanced the fatigue, the less the body is able to properly clear breakdown metabolites out of the body after nutrients have served their function. This is called the low clearance state. Without proper clearance, the best nutrient can accumulate in the body and become toxic. There is no laboratory test available to measure this. Experienced clinicians use various qualitative challenges to determine the amount of reserve capacity and clearance the adrenal has as a guide before initiating any comprehensive nutritional program. Failure to do so is a common mistake and a major reason why many self-guided program fails. Nutrients in the right dose should be administrated in a graded and step-wise approach, with follow up evaluation by a qualified health care professional.

Attention Because of tremendous individual variation, the use of nutritionals should therefore be personalized for your body. One person's nutrient can be another person's toxin. If you have a specific health concern and wish my personalized nutritional recommendation, write to me by clicking here.



7. Eating Pattern. When our cortisol levels are at its peak from 6 a.m. to 8 a.m. we may have no appetite. Many people skip breakfast because "they are not hungry". This is because our bodies need sugar to run on. Furthermore, our body's energy requirement does not change during this period. Even a small snack is better than nothing at all and will provide the needed energy even though there is no urge to eat.

Skipping breakfast is not a good idea. If you are low on sugar, the adrenals are instructed to secrete cortisol because cortisol activates gluconeogenesis to increase blood sugar level and allow the body to function. It is therefore important to have a healthy breakfast soon after waking and not later than 10 a.m. This will prevent the body being put in a position to play "catch-up" for the rest of the day.

The best time for lunch is from 11:00 a.m. to 11:30 a.m. Sometimes, a nutritious snack between 2:00 to 3:00 p.m. will be needed to sustain our bodies through the dip in cortisol levels that occurs between 3:00 to 4:00 p.m. Evening meals should be around 5:00 to 6:00 p.m. Supper, if needed, should be in small quantities and low in glycemic to avoid the steep rise in blood sugar commonly seen in high-glycemic index snacks such as cakes. These snacks will cause the blood sugar to rise and a corresponding increase in insulin output.

Over time, insulin secretion becomes dysfunctional, resulting in a hypoglycemic state in the middle of the night. These symptoms are characterized by nightmares, anxiety, and night sweats. When this occurs, the body will have to activate the adrenals to put out more cortisol in order to raise the blood sugar back to its normal level. This will eventually put an excessive burden onto the already fatigued adrenal gland if carried on year after year.


8. Diet. A poor or unfitting diet is one of the key and leading causes of Adrenal Fatigue. Without a diet that is bio-chemically and metabolically compatible with the needs of a damaged adrenal gland, complete recovery is simply not possible.