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ADRENAL FATIGUE
LABORATORY TEST
Adrenal fatigue has been demonstrated in laboratory studies of surrogate
markers of adrenal function. Two such markers used are cortisol
and DHEA by serum. These two markers by blood give a general picture of the body as to whether it is in anabolic (build up) or catabolic state ( breakdown). It is not diagnostic.
Another way to test your adrenal health is to measure your level of free
key adrenal hormones such as cortisol and DHEA. Saliva
testing is preferred as it measures the amount of free and circulating hormones and thus more accurate , but again, this is not diagnositic.
DHEA can be measured anytime during the day. Cortisol, on the other hand,
is the highest in the morning and lowest in the evening before bedtime. Taking 4 samples of cortisol (at 8 am, noon, 5 pm, and before
bedtime) is desirable if saliva test is undertaken. With multiple samples taken throughout
the day, we are able to map the daily diurnal curve of free cortisol in
the body relative to DHEA level. This will give us a much clearer
picture of adrenal function.
If you are taking oral or applying topical supplemental hormone creams
such as DHEA or pregnenolone, the saliva test results may be elevated immediately.
Blood test results will also increase, but it will take about 3 months to
show.
Stress can also affect the levels of adrenal hormones. Your cortisol level
tested after a quiet and relaxing morning will be very different from that
taken when you are under tremendous stress.
To rule out sub-clinical
infection as a cause of adrenal fatigue, specialized test measuring the
immunoglobulin response may be necessary as normal culture for bacteria and
parasites will often be negative.
WARNING: Due to tremendous individual variance and the body's constant changing state, laboratory tests should be undertaken judiciously under the right setting and only when needed in order to be cost-effective and relevant. It is not uncommon to have adrenal fatigue symptoms with "normal" laboratory results, and vice versa. Furthermore, in advance adrenal fatigue, the 24 hour cortisol curve invariably becomes flattened most of the time and can stay that way for an extended period of time, even during recovery. Therefore, one can be easily confused as test results can be misleading. Over-reliance on test is a common adrenal recovery mistake.
A good history by an astute and and experieiinced clinician is by far the best and most accurate way to ascertain adrenal fatigue status and is far better than any laboratory testing.
Laboratory tests are best used as supporting tools under the guidance of the right health professional and should not be relied on as a sole gauge of adrenal function and therapeutic options. Consumers often make the mistake of embarking on a self-guided nutritional recovery program that relies on laboratory test without understanding their limitations. Over time, this approach often leads to improper use of nutrients which makes the condition worse.
Paradoxical Reactions
In adrenal fatigue, the body can often exhibit multiple paradoxical reactions that one does not normally expect. These include:
a. A sense of fatigue or malaise instead of a sense of calm when taking steroids
b. A sudden onset of anxiety attacks and impending doom at rest
c. Sudden onset of heart palpitations despite normal cardiac function
d. Sudden onset of dizziness and lightheadedness at rest ,or after stressful situiation, or after taking certain types of food, especially carbohydrates.
e. Sudden onset of fluctuating blood pressure
f. Staying in bed for an extended period of time with no energy to get up even after a full night's rest
g. A sense of being "beaten up" that lasts for days after vigorous exercise
h. Inability to think clearly and difficulty recalling even a recent problem
i. Waking up in the middle of the night for no reason and the inability to go back to sleep
j. Being constipated instead of having loose bowel when taking high doses of vitamin C or magnesium
k. A sense of getting wired up and anxious after taking Vitamin C, adrenal glandular, or herbs
l. Getting more toxic instead of feeling better when going through a detoxification program like juice fasting.
m. Sudden onset of fragile emotional states such as crying for no apparent reason
n. Taking multiple trips to the Emergency Room because one feels impending doom even though one is told that nothing is wrong after a complete work-up.
o. A sense of well-being after taking selected nutrients, only to be followed by a "crash"
p. Fluid retention/depletion in a settting that is highly sensitive to sodium load that is hard to maintain.
One can have any combination of the above. The exact pathophysiology of each of these symptoms is not fully known. Collectively, they point to an adrenal that has lost its ability to maintain the fine control necessary of a stable internal homeostasis environment. Self-directed recovery programs normally fail in such cases because normal healing tools do not apply. It is best to consult a professional for help if you have a significant number of these paradoxical reactions.
WOMEN AND ADRENALS
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, have 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 short-gun approach by taking many nutrients seldom works and often backfire 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
| 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. |
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. Some common herbs that enhance sleep are valerian (root),
hops (whole plant), and licorice (root).
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.
 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. The key is to adjust the level of exercise in accordance to your capacity. The more advance your adrenal fatigue, the less you should exercise vigorously. Vigorous exercise can lead to a catabolic state and worse adrenal fatigue
Simple exercises such as brisk walking, or climbing stairs are easy to do and can be done almost anywhere. You should vary your routine so that exercise becomes fun. When exercising. You should exercise to no more than 50% of your capacity and feel fresh after each exercise session, with plenty of rest for the body to recouperate.
It is important not to over-exercise as that can further drain adrenal function and trigger adrenal crisis.
You should cover the following three categories of exericise as indicated:
- Aerobics - such as fast walking, stairs climbing, Nordic
track, swimming, and treadmill.
- Anerobics - 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:
A. 500 mg to 3,000 mg of vitamin C with bioflavonoid and syndergistic 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. Avoid calicum ascorbate. Those who have a sensitive gastric system should consider mineral ascorbates. A properly personalized combination of different forms of oral vitmain 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 capsuated) 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. Intravenous or oral liposomal delivery system is preferred.
B. Reduced 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.
C. 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.
D. 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.
E. 1000 to 5000 I.U of Vitmin D is a good nutrient to support hormonal synthesis.
F. 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,
G. Adrenal glandular, adrenal extract and herbals such as ashwagandha root, licorice root , Korean Ginsemg, 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 advance adrenal weakness should exercise extreme caution prior to embarking on such compounds. The more advance the adrenal fatigue, the more tendency it is for these adaptogenic compounds to behave as stimulants for reasons that is not well understood. Stimulating the adrenals at a time when it needs rest can therefore be davastating. 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 it needs to recover on its 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.
H. 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 appraoch is seldom necessary.
It should be noted that while many practitioners use synethetic 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 approch is necessary to avoid overstimuating or inadquate dosing. Proper timing is critical because each should be given only when the body is ready to assimulate, 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 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.
It
is very important to understand that a short-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 adminstration 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 advance the fatigue, the less the body is able to propery clear breakdown metabolites out of the body after nutrients has serve its function. Without proper clearance, the best nutrient can accumulate 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 comprehenisve nutritional program.
Failure to do so is a common mistake and why many self-guided program fails. Nutrients in the right dose should be administrated in a graded and step-wise
approach , with follow up evaulation 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. |
8. 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.
9. 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.
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