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The adrenal glands are the main stress control system of the body. Adrenal Fatigue is a decrease in the adrenal glands' ability to carry out this normal function. It is commonly caused by chronic stress from any source (including emotional, physical, mental, or environmental) that exceeds the body's capacity to adjust appropriately to the demands placed on it. Adrenal Fatigue has a broad spectrum of non-specific yet often debilitating symptoms. The onset of this disease is often slow and insidious.
Stressors that can lead to Adrenal Fatigue include anger, chronic illness, depression, surgery, high sugar intake, over exercise, sleep deprivation, just to mention a few. One of the most commonly overlooked causes of Adrenal Fatigue is chronic or severe infection. Such infection can occur sub-clinically with no obvious signs at all. Parasitic and bacterial infections including Giardia and H. pylori are often the main culprits. Not to be missed is a tooth that has had root canal work done but still contains germs that secrete toxins chronically.
Signs and symptoms of Adrenal Fatigue include tendency to gain weight, especially around the waist, and inability to lose it; high frequency of the flu and other respiratory diseases where symptoms tend to last longer than usual; a tendency to tremble when under pressure; reduced sex drive; lightheadedness when rising from a supine position; brain fog; lack of energy in the afternoon; reliance on coffee to get the day started; craving for salty and fatty food; chronic pain of unknown origin; and feeling better during a vacation. None of the signs or symptoms by themselves can definitively diagnose Adrenal Fatigue. When taken as a group, these signs and symptoms do form a specific Adrenal Fatigue syndrome or picture that of a person under stress.
Adrenal Fatigue Progression:
Stage 1: Alarm Reaction (Flight or Fight Response). At this stage, the body is alarmed by the stressors and mounts an aggressive anti-stress response to reduce stress levels. There are generally no outward symptoms of decompensation, as the anti-stress response mediated by an increased cortisol output from the adrenals is well within the body's output capacity. The person conducts a normal life but does notice that coffee helps to get the day going, even though an ever increasing amount may be needed.
Stage 2: Resistance Response. With chronic or severe stress, the adrenals eventually are unable to keep up with the body's demand for cortisol. Normal daily functions can be carried out, but the sense of fatigue is pronounced at the end of each day as the body needs more rest than usual to recover. Despite a full night's rest, the body does not feel refreshed in the morning. Anxiety starts to set in, and the person becomes easily irritable. Insomnia becomes more common, as it takes longer to fall asleep. There is also frequent awakening as well. Infections can become more recurrent. PMS and menstrual irregularities surface, and symptoms suggestive of hypothyroidism (such as sensations of feeling cold and a sluggish metabolism) become prevalent.
Stage 3: Exhaustion. As adrenal function weakens further, the body's need for adrenal hormones remains unabated if stress is not reduced. The adrenals are having tremendous difficulty and may no longer be able to keep up with the ever increasing demand for cortisol production. Cortisol output may plateau and start to decline. This progression usually happens gradually over a long period of time, perhaps years.
Because the variety of symptoms presented at this stage can be convoluted and overwhelming, it is helpful, from a clinical recognition perspective only, to further delineate this stage into four broad overlapping phases. The boundaries of each phase are decidedly indistinct. They do not represent an absolute sequential gradation process and should not be viewed as such. Most if not all suffering from adrenal exhaustion usually present signs and symptoms in various degrees of each phase concurrently. That is the norm. The more advanced the exhaustion, however, the more late phase manifestation is presented.
As this happens to one organ system, the rest of the body also down-regulates and reacts unfavorably. Digestion slows to conserve energy, clearance of metabolites slows to conserve energy, and basal metabolic rate drops to conserve energy. Weight loss is extremely difficult. At this phase, the adrenals have lost most of their ability to serve as the body's stress control center. It becomes hypersensitive and reacts negatively to any attempts to jump start it for reasons not well understood. The adrenals continue to exhibit frequent crashes through physiological mechanisms that defy conventional scientific logic. Current concepts point to the likelihood of pump failure, low-clearance state, positive feedback loops, receptor site dysfunction, and electron driven retoxifications as possible etiology for the wide variety of extreme paradoxical reactions commonly seen in this phase. Basic nutrients critical to proper adrenal function, such as Vitamin C, become severely depleted. Administration of Vitamin C, cortisol, DHEA, and pregnenolone, all of which are normally required and welcomed by the adrenals, cease to bring about any improvement in symptoms but may instead become ineffective and possibly toxic. The more the adrenals are exhausted, the less the adrenals can tolerate medication or nutrients, even in small doses. Nothing appears to work in this phase. Any attempted administration of nutrients by mouth or by intravenous injection in fact may make the condition worse. The brutal downward decompensatory cycle is well entrenched. Sufferers become desperate and try to overcome their physical and mental exhaustion on their own to no avail. Depression sets in and suicidal tendencies surface.
This is not a state to be in for self-navigating. Expert professional guidance is absolutely needed. Unfortunately, qualified physicians in this area are extremely rare.
Stage 4: Failure. Eventually, the adrenals are totally exhausted. Patients at this stage have a high chance of cardiovascular collapse and death. When Adrenal Fatigue has advanced to this stage, the line between it and Addison's disease, also called adrenal insufficiency, can get blurry. Symptoms at this stage include sudden penetrating pain in the lower back, abdomen or legs, severe vomiting and diarrhea, dehydration, low blood pressure and loss of consciousness. Addisonian crisis is rare, as in most cases; the symptoms are severe enough that patients are quick to seek medical treatment before a crisis occurs. However, in about 25 percent of patients, the symptoms first appear during an Addisonian crisis. Left untreated, an Addisonian crisis can be fatal. While the etiology of the conditions may be different, the ultimate clinical presentations can be quite similar in both Addisonian crisis and Stage 4 Adrenal Fatigue as they represent a continuum of decompensation in adrenal functions.
As the body progresses through to the more advanced stages of Adrenal Fatigue, the overall array of symptoms generally become more pronounced and convoluted. Fatigue can become unbearable as the body's ability to deal with normal stresses of life weakens with each stage. In severe cases of Adrenal Fatigue, the body can often exhibit multiple unusual and paradoxical reactions that one does not normally expect. This is especially prevalent in Stage 3. This is reflective of deepening adrenal exhaustion, with disequilibrium, loss of homeostasis, multiple endocrine axis imbalance, pump failure, receptor site sensitivity or retoxification reaction of the body. Symptoms can include:
Although sub-clinical adrenal dysfunction and its various stages were recognized as distinct clinical syndromes since the turn of the 20th-century, most conventional physicians are unfamiliar with this condition because it is difficult to diagnose correctly by traditional blood tests. Adrenal hormones may be low in the case of Adrenal Fatigue, but are still within the "normal" range and not low enough to warrant the diagnosis of Addison's disease by regular blood tests. Conventional physicians are not taught the significance of sub-clinical Adrenal Fatigue. They are misguided by the results of blood tests, which unfortunately, are not sensitive enough to detect sub-clinical Adrenal Fatigue. As a result, patients tested for adrenal functions are told they are "normal" but in reality, their adrenal glands are performing sub-optimally, with clear signs and symptoms coming from the body that are crying out for help and attention.
The adrenal glands are usually the first in the order of endocrine functions to breakdown when stress has overwhelmed the body's normal compensatory response. Unfortunately, this is seldom recognized as a pathological state. Acceptable social compensatory actions such as coffee intake often mask the underlying problem as the adrenals are put in over-drive to cover up the early signs and symptoms of Adrenal Fatigue. The next endocrine gland to be affected is the insulin-producing portion of the pancreas. The body's blood sugar becomes imbalanced and this dysfunction is temporarily fixed by the intake of soda drinks, energy potions and donuts. After the pancreas comes the thyroid. Sluggishness, feeling cold and weight gain are the predominant symptoms that bring patients to their physicians, usually for the first time. This is often when hypothyroidism is first diagnosed. Thyroid replacement medication is routinely prescribed. However, over 70 percent of those patients taking thyroid medications still are symptomatic over time. Along with hypothyroid are symptoms of estrogen dominance, a state reflective of ovarian system dysfunction. Presenting symptoms include PMS, endometriosis, lumpy breasts, and irregular menstrual cycle. Hormone replacement medication may work short term, but unless the adrenals are first attended to, the patient's response is often blunted and ultimately fails. Finally, the parathyroid glands, the pineal gland, the autonomic nervous system, and the hypothalamus become affected. By this time, the OAT axis is severely imbalanced.
Adrenal Fatigue is often the last to be detected and only considered seriously, when the patient is already severely decompensated, with concurrent severe ovarian and thyroid involvement. Even when detected, there is inadequate attention paid to the frequent concurrent ovarian and thyroid imbalance in what is now a full-blown state of Ovarian-Adrenal-Thyroid (OAT) axis imbalance.
The key to this imbalance lies in the adrenal glands, for it is there that cortisol is modulated. In Adrenal Fatigue, internal cortisol imbalance often creates a condition of multiple organ resistance, including the thyroid and ovaries. Adrenal Fatigue is an important common and often overlooked cause of secondary clinical or sub-clinical hypothyroidism. Classically, the patient presents himself to the doctor's office complaining of fatigue, dry skin, weight gain, low body temperature, and insomnia. Thyroid laboratory test results show either normal or high TSH, normal or low T3 and free T3, normal or low T4 and free T4. The patient is normally prescribed a variety of thyroid replacement medications. Temporary improvement may be experienced by the patient but the improvement ultimately fails as recovery response is blunted and the symptoms continue to persist. Excessive thyroid medicine may be prescribed to normalize what may appear to be sub-optimal blood levels. The body is put on overdrive as the basal metabolic rate is raised. This can unmask pre-existing adrenal weakness; exacerbate existing Adrenal Fatigue and trigger adrenal exhaustion and adrenal crisis. Anti-depressants are often prescribed as a solution to control symptoms as the physicians run out of options to help the sufferer. This seldom works but will instead often make the OAT imbalance worse off.
It is important to recognize that optimum adrenal function plays a key role in this imbalance. When the adrenals are weak, cortisol induced, organ resistance applies to nearly all other hormone regulated organs including the ovaries, the thyroid, and the pancreas. Few hormones are allowed to work at their 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 can be blunted and binding carrier hormones in the blood can be disrupted. The ability of each hormone to regulate and fine-tune its target organ to achieve homeostasis is therefore often compromised. Blood pressure can become erratic, blood sugar levels may experience wide swings, bipolar and anxiety states come at will, reactive adrenaline rush becomes uncontrollable, brain fog becomes prevalent, metabolic function slows down and menstrual flow becomes irregular.
Due to their lack of clinical training on Adrenal Fatigue, clinicians often find themselves treating symptoms of weak thyroid and ovarian systems while ignoring adrenal dysfunction. Let us take a look at how this can lead to devastating effect. In early stages of Adrenal Fatigue, cortisol output is high as the body attempts to neutralize stress by producing more of it. However, when too much cortisol is produced, it will have multiple undesirable effects. For example, cortisol blocks the progesterone receptors, making them less responsive to progesterone. Progesterone normally produced by the adrenals comes to a halt in favor of cortisol production.
Insufficient progesterone production leads to an imbalance between estrogen and progesterone. With reduced progesterone to offset estrogen, the body may experience 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.
Many chronically ill patients have both low adrenal and thyroid functions. In such cases, it is important to begin the recovery process by supporting the adrenal glands before raising the thyroid hormone. Otherwise, increased circulation of the thyroid hormone may further strain the already weak adrenal glands, leading to adrenal crashes and further decompensation. Recovery plans focusing on single organ dysfunction without considering the axis imbalance often fail and may in fact make the condition worse off.
Attempts to rebalance ovarian and thyroid hormones without careful attention to adrenal hormones often fail. Conversely, an approach focusing on adrenals first often leads to spectacular results as the ovarian hormones and the thyroid hormones will often rebalance themselves as the adrenal glands recover.
The thyroid gland acts like the body's barometer. Its main function is to help cells convert oxygen and calories into energy. It regulates heart rate, blood pressure, body temperature, metabolism, and growth.
More than 10 million Americans have been diagnosed with thyroid disease and another 13 million people are estimated to have undiagnosed thyroid problems. About 10 percent of the adult population is afflicted with this frequently overlooked disease of epidemic proportion. A dysfunctional thyroid can affect almost every aspect of health. It is one of the most under-diagnosed hormonal imbalances of aging, together with estrogen dominance, and Adrenal Fatigue. It is estimated by age 50, one out of every twelve women will have some degree of hypothyroidism. By age 60, it is one out of six. In fact, among the elderly, hypothyroidism is sometimes misdiagnosed as dementia.
The thyroid gland, under TSH signal, secretes two essential thyroid hormones: triiodothyronine (T3) and thyroxine (T4), which is responsible for regulating cell metabolism in every cell in your body. A healthy person secretes all of the circulating T4 (about 90 to 100 mcg daily) and about 20 percent of the circulating T3. The T4 made by the thyroid gland circulates throughout the body and is converted into approximately equal amounts of T3 and reverse T3 ( rT3). Most of the biological activity of thyroid hormones is due to T3. It has a higher affinity for thyroid receptors and is approximately four times more potent than T4. rT3 acts as a braking system to T3. Not only is it inactive (having only 1 percent of T3 activity), it binds to T3 receptors and block the action of T3. T4 should therefore be considered a pro-hormone and precursor to T3 and rT3. Normal physiological production ratio of T4 to T3 is 3.3:1. A properly functioning thyroid gland requires a perfect balance of T4, T3, and rT3. The T3/rT3 ratio is therefore one of the most useful markers for true tissue hypothyroidism and a crucial marker of diminished cellular function.
There are a variety of factors that can contribute to the development of thyroid problems: such as exposure to external radiation, over-consumption of soy products, taking drugs such as lithium that have anti-thyroid effects, over-consumption of uncooked "goitrogenic" foods, such as broccoli, turnips, radish, cauliflower and brussels sprouts, adrenal insufficiency or fatigue (commonly caused by chronic stress), mercury intoxication (amalgams are 50 percent mercury), auto-immune diseases and infection.
As one of the master regulators of body metabolism, symptoms of low thyroid function generate a global response. Symptoms include:
Fatigue and low energy, with need for daytime naps due to defect at cellular energy conversion and difficulty in converting from T4 to T3.
Skin that becomes dry, scaly, rough, and cold due to increase demand on metabolism ( e.g. cold weather) with little thyroid reserve.
Excessive unexplained hair loss due to slowing down of cell turnover and tissue/hair production.
Sensitivity to cold in a room when others are warm due to sluggish conversion of nutrients and oxygen to heat.
Brain fog, depression due to inadequate levels of thyroid in brain.
Constipation that is resistant to magnesium supplementation.
Unexplained weight gain due to reduced metabolism that enlarges fat cells which sequester T4, causing depletion and further sluggishness.
High cholesterol resistant to cholesterol lowering drugs.
Low libido, PMS, miscarriage, and infertility due to disruption of testosterone, estrogen, and progesterone.
Abdominal cramping and IBS due to reduced muscular activity of bowl wall due to thyroid depletion.
Hypothyroidism can be primary or secondary. Primary hypothyroidism can easily be cured with administration of thyroid replacement therapy. If hypothyroid symptoms such as low body temperature, fatigue, dry skin and weight gain persist despite thyroid replacement therapy regardless of laboratory values, one must look elsewhere for the cause of low thyroid function.
Secondary hypothyroidism is low thyroid function caused by malfunction of another organ system. One of the most frequently overlooked causes is Adrenal Fatigue. Adrenal Fatigue is perhaps the most common cause of secondary low thyroid function, both clinically and sub-clinically. Low adrenal function often leads to low thyroid function, classically evidenced by high thyroid binding globulin (TBG), low free T4, low free T3, high TSH, and low body temperature. Few physicians are trained to detect this connection. Fortunately, secondary hypothyroidism can be reversed when the underlying root problem (such as Adrenal Fatigue) is resolved.
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Michael Lam, M.D., M.P.H., A.B.A.A.M., is a western trained physician specializing in nutritional and anti-aging medicine. Dr. Lam received his Bachelor of Science degree from Oregon State University, and his Doctor of Medicine degree from the Loma Linda University School of Medicine in California. He also holds a Master’s degree in Public Health. He is board certified by the American Board of Anti-Aging Medicine where he has also served as a board examiner. Dr. Lam is a pioneer in using nontoxic, natural compounds to promote the healing of many age-related degenerative conditions. He utilizes optimum blends of nutritional supplementation that manipulate food, vitamins, natural hormones, herbs, enzymes, and minerals into specific protocols to rejuvenate cellular function.
Dr. Lam was first to coin the term, ovarian-adrenal-thyroid (OAT) hormone axis, and to describe its imbalances. He was first to scientifically tie in Adrenal Fatigue Syndrome (AFS) as part of the overall neuroendocrine stress response continuum of the body. He systematized the clinical significance and coined the various phases of Adrenal Exhaustion. He has written five books: Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs, The Five Proven Secrets to Longevity, Beating Cancer with Natural Medicine (Free PDF version), How to Stay Young and Live Longer, and Estrogen Dominance. In 2001, Dr. Lam established www.DrLam.com as a free, educational website on evidence-based alternative medicine for the public and for health professionals. It featured the world’s most comprehensive library on AFS. Provided free as a public service, he has answered countless questions through the website on alternative health and AFS. His personal, telephone-based nutritional coaching services have enabled many around the world to regain control of their health using natural therapies.
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