Adrenal Fatigue Syndrome and Teen Health – Part 1

By: Michael Lam, MD, MPH; Dorine Lam, RDN, MS, MPH

Teen Health and Maturing BrainThe prevalence of Adrenal Fatigue Syndrome (AFS) among teenagers and young adults is on the rise. We are seeing an onslaught of this problem as young as the early teens, and some even experience significant AFS symptoms in their pre-teen years. It’s become clear that AFS is a growing concern for teen health.

Teen Health: The Maturing Brain

According to neuroscience, the brain is largely an unfinished product by the time a child reaches the age of twelve. This is a drastic departure from previous medical wisdom. For centuries, children entered initiation rites and started learning trades at about the onset of puberty. It is thought that the brain is mature enough to learn, make decisions, and take on proper responsibilities. Brain scan studies show that the brain is far from fully developed at this age. Both white and gray matter continues to undergo significant changes structurally well past puberty, into the late teens. The brain may not mature until as late as age twenty-five.

Lets examine the anatomy. At birth, we are equipped with most of the neurons our brains will have in our lifetime. In fact, we have the most in utero, with maximum brain-cell density between the third and sixth month of gestation, where prenatal neural growth is at full throttle. During the final months before birth, our brains spontaneously undergo a dramatic auto-pruning process where extra and unnecessary brain cells are eliminated as part of the house cleaning exercise. Proper pruning is part of the normal brain routine before allowing the fetus to enter the world. Autism may be the consequence of a pruning process gone astray. The brain actually grows very little over the course of childhood relative to other organs. By the time a child is six, the brain is already closer to ninety percent or up to ninety-five percent of its adult size.

Anatomically, the neurons grow bushier between ages six to twelve. Each neuron makes dozens of connections to other surrounding neurons. New pathways or highways, for nerve signals are created. This proliferation process peaks at age eleven for girls and about twelve-and-a-half for boys, when a second round of pruning begins. This wave of neuron proliferation followed by pruning starts during puberty, extending into the late teens and possibly to young adulthood. Gray matter then thins out at the velocity of about 0.7 percent a year, tapering off only in the early twenties. The final pruning process affects some of our highest mental functions. Unlike what happens prenatally, the neuronal synapses are affected primarily and are made more efficient. The neuronal highway network as a result has less traffic, allowing transmission speed of signals to increase as the brain matures.

Playing piano and teen healthHow the adolescent spends their time can affect this primary process and is guided both by genetic factors as well as by the use-it-or-lose-it principle. The more the brain is used, the stronger it is. For instance, practicing piano quickly thickens neurons in the brain regions that control the fingers. The last portion of the brain to be pruned is the prefrontal cortex. This is where logic and executive functions are located. Prioritizing, planning, organizing tasks, discipline, suppressing feelings, and the all important decision making functions are among the final steps of the brain maturation process. It comes as no surprise that most young teenagers succumb to peer pressure and are unable to stand their ground on decisions they make.

As this pruning process goes on during adolescence, the brain’s white matter with its fatty myelin sheaths thickens. The thicker the myelin, the better the electrical conduction. Electrical voltage resistance is reduced, and nerve-signal transmission speed increases. This thickening can continue, much like tree rings, until well into adulthood, up to age forty.

During maturation from adolescence into young adulthood, neuron connections are therefore fewer but faster. Signal transport efficiency is increased, but due to the loss of the absolute number of neurons from pruning, its raw potential and trauma recovery potential may be limited if physically injured. This efficiency means a tendency to make fast emotional and feeling-based decisions that depend on impulse rather than logic and can have an effect on teen health. The ability to logically and systematically weigh the pros and cons typical of an adult in important decision-making processes is often overshadowed and overpowered by emotions at hand. Teenagers and young adults therefore tend to make many wrong choices as a result. In other words, the maturing brain has yet to be fully developed to allow a comprehensive thought process to take place.

Teen Health: Dependent on Sex Hormones

While the brain is undergoing structural changes and maturing during the teenage years into young adulthood, the body also comes under a rampant hormonal assault starting in puberty that can effect teen health. Between the ages of six and eight, the adrenal glands on top of each kidney start to increase production of pro-hormones and upstream hormones such as pregnenolone and DHEA (dehydroepiandrosterone). These then in turn are used to make normal downstream sexual hormones such as estrogen, progesterone, and testosterone necessary for physical maturation.

At puberty, the ovaries and testes output of estrogen and testosterone respectively increases. The reproductive system matures as a result. The body shape changes in the female as menses begins, with hair growth in the armpits and groin girth increase. In the male, the voice deepens as muscle mass increases driven by testosterone and other anabolic hormones, many of which originate in the adrenal glands.

Puberty and Teen HealthSex hormonal change can trigger intense emotions and unpredictable behavior. These adrenal sex hormones are highly active once they circulate in the brain. When attached to brain receptors, a direct influence on serotonin and other neurochemicals that regulate mood and excitability can result. Select neuroendocrine hormonal pathways contribute to the appetite for sexual desire. Strong but fragile emotions are activated from the brain and may be put on over-drive during this time. The thrill seeking mentality and increased sexual appetite of adolescents and young adults may well be rooted in the presence of such over-activation.

Males lag behind females in brain development. Girls therefore are more mature overall if all other parameters are the same. Unfortunately, the onslaught of excessive estrogen load from a variety of sources such as obesity, hormone laced food and xenoestrogens (synthetic chemicals that behave like estrogen once in the body) from the environment including common items like nail polish and shampoo etc. may un-stabilize the female hormone balance during this fragile period, leading to a state known as estrogen dominance. Excessive estrogen in the body presents as a continuum of symptoms including irritability, anxiety, insomnia, water retention, and PMS. Conditions such as endometriosis, fibrocystic breast disease, PCOS, are present in more advanced states of estrogen dominance.

Cognitive Disconnect

For about a decade from early teens up to mid-twenties, the brain has to deal with both raging hormones and normal maturation concurrently. A cognitive disconnect commonly arises as the maturing brain finds itself caught in limbo between making few major decisions in childhood and transitioning into the need to make multiple adult responsible decisions on a daily basis that are frequently distracted by hormonal imbalance.
The pre-frontal regions of the brain are responsible for logical disciplined behavior and decision-making. Mature pre-frontal cortex will lead to a calm decision making process that puts the brakes on risky, impulsive addictive behavior. In late adolescence and early young adulthood, the body is physically nearing maturation and awarded the adult status by society but the brain maturation is lagging behind. A dissonance occurs where the struggle between doing what appears to feel good (dictated by recent and past experiences) versus doing what is right (control by the pre-frontal cortex). This is the time most vulnerable to reckless drinking, driving, and sex.

Stress and Teen Health

Teenage years are therefore particularly stressful because of increasing social and academic demands at a time when the body is transitioning to adulthood, with much of the brain growth incomplete while the body’s growth related hormones are on full steam ahead. Growth hormone, testosterone, estrogen, progesterone and thyroid hormones are just some of the hormones that undergo rapid acceleration output as the body matures. These hormones need the mature brain as a braking mechanism in order to achieve a balanced socially acceptable outcome. A stressed out maturing brain under construction may not possess enough processing power to facilitate proper daily decision making exercises in a balanced and socially acceptable fashion.

Doing More and More and Teen HealthThe combination of raging hormones and mal-adaptation of a maturing brain may prove to be too stressful for some adolescents or young adults to handle. The adrenal glands are the major hormonal control center. It secretes over fifty hormones to help the body maintain homeostasis. It is also the major stress control center of the body. It is connected to the brain by numerous hormonal axes and pathways. They include Hypothalamic-Pituitary-Adrenal axis, the Hypothalamic-Pituitary-Gonadal axis, and the Ovarian-Adrenal Thyroid axis. The more stress present, the harder the adrenals have to work and the greater the chances of breakdown for the glands that are involved in these axes.

Dysfunction of any axis from excessive stress will invariably lead to dysregulation of other axes. Imbalances between axes can cause havoc in the body. Negative and positive hormonal feedback loops may be damaged or overstressed, leading to a body that enters a state of decompensation. The nutritional and energy reserves may not be sufficient to provide what is needed for the body to overcome stress. Constant strain and drain on this reserve results in a low energy state. As the body’s energy is depleted, vitality is lost. Let us look at a typical example of what can go wrong with this neuroendocrine decompensatory cascade and its impact on teen health.

Case History of Teen Health Affected by Adrenal Fatigue

Jenny is a sixteen-year-old teenager who is in high school. She had a normal childhood and was a vibrant child until age 9, when her low energy state started to be evident. Her fatigue only got worse since her early teens. She presents with a four-year history of worsening fatigue and reduced energy for no apparent reason. She has been seen by many conventional doctors and had numerous blood tests. Her thyroid, cortisol, ACTH, DHEA, as well as hormonal and metabolic tests are normal or borderline normal for teen health. Cancer and anemia panels are negative. Her menarche started at age twelve. Because of her menstrual pain and excessive bleeding, she was put on pain medication. For social withdrawal symptoms she was given an antidepressant. She was also prescribed sleeping pills for insomnia, which she started but received no significant benefits.

She has seen numerous functional medicine doctors as well. Various tests including toxic metal, mineral, intracellular magnesium, food allergy, gastric fluid, saliva cortisol, and stool analysis are normal. Her thyroid studies are normal with the exception of a high rT3. She tested negative for Lyme disease and Epstein Barr Virus. She tested for MTHFR genetic variant defect and the results were unequivocal. A trial of methylated B12 and folate was marginally helpful at best. Her Vitamin D level is below normal for optimal teen health, but despite supplementation, her symptoms do not improve. Natural Supplements and Teen HealthAt one point, she was started on natural supplements consisting of herbs, glandular, amino acids, minerals, vitamin C, enzymes, and probiotics. All of which are slightly beneficial in boosting energy in the beginning but soon lose effectiveness and fatigue returns. In addition to the functional doctors, she sees a chiropractor for back adjustments and an acupuncturist. However these modalities do not seem to help more than one to two days each time. Liver cleanses and colonics do not help but make her condition worse.

Her diet is rather good, thanks to her concerned parents. In addition to avoidance of junk food, she is off wheat, corn, dairy and eggs. There is definite improvement with a strict healthy diet but not enough to overcome worsening fatigue.

While she was physically active in her early teens, now she is unable to exercise and is struggling just to do some lights yoga three to four times a week. She used to be a highly competitive school athlete, participating in track and field teams but it became too difficult for her. She felt drained after training and it took her days to recover.

Jenny was a high academic achiever, but found over the past few years that her mental concentration is suffering. She becomes impulsive, easily irritable, and confrontational with her loved ones and friends. She still experiences pain from time to time, especially during her menses, and this causes worsening insomnia as well. Now she has to eat every two to three hours in order to avoid symptoms of hypoglycemia such as nausea, irritability, and fatigue. At one point, a doctor diagnosed her as having postural orthostatic tachycardia syndrome (POTS). She was started on a heart medication called beta blocker to slow down the heart rate. That worked for a short time, but eventually her body did not tolerate medicine well so she had to stop. Her resting heart rate is well above normal and can go up to over 120 beats per minute when under stress. She also recently experienced frequent lightheadedness on standing from a sitting position, low body temperature, and irregular heartbeats. On the weekends she spends most of her time on the couch and essentially housebound. Social interactions have been severely restricted. Her academic performance has suffered greatly as she is unable to stay focused and have the discipline to complete assignments and homework on a timely basis. She is depressed thinking about how she will miss college unless her fatigue improves. Her family is equally distraught, not knowing what to do after years of being in the dark. They have depleted their savings, having spent thousands of dollars on the numerous physicians and battery after battery of tests without any results.

There is no specific traumatic event that triggered her initial episode of fatigue. Her parents did mention that she has undergone a lot of physical stress from participation in athletic activities during school and that Jenny kept pushing through physically for a few years even though she was not feeling well.

Teen Health and Body Constitution

Stress and Teen HealthThis case brings up a very typical example of a high achieving teenager who is obviously in trouble as the body decompensates and weakens. The typical profile has a Type A personality, is a high academic achiever, athletic, focused, intelligent, and has much to accomplish in life but somehow is not able to live up to the higher standards due to physical exhaustion even though all medical workup is normal.

Low constitution is commonly traced back to childhood and family history can also play a role in teen health. The mother’s pregnancy may be rocky. Post-partum fatigue is common. Low thyroid during pregnancy may have gone undetected. The mother may have a long history of Adrenal Fatigue Syndrome but it is not discovered or attended to. Many have history of infertility issues and miscarriages, especially in the first trimester.

Stressed out mothers can give birth to stressed out offspring who appear healthy and asymptomatic for years. Stressed out babies and children can be but not always are more irritable, are emotionally unstable, have increased food sensitivities, experience more frequent infections, short attention span, ADD, ADHD, frequent infections, skin rashes of unknown origin, and a lower immune system, as compared to other children their age. Weight and height is normal. It’s not until puberty that the body’s energy and nutritional reserves fall below the critical threshold required for healthy living, at which point the body starts falling apart physically.

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© Copyright 2015 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Questions

Unfortunately, we are seeing that much more nowadays than a few decades ago. Hormone-laced food and stress can contribute to this.

It is usually is more prominent from age 30 onwards. Sadly, we see AFS cases in teenagers more often.

One can develop thyroid hormone dysfunction at any age. A lot may be related to your constitution, heredity, or stress level. Most commonly, we see the problem surfacing from teenage years to middle age.

A conventional medical workup is necessary. Clinically the picture of presnetation needs to be factored in for puberty as well. A detailed history will often be the best clue.

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