Maybe It's Adrenal Fatigue?

I know... you’re really not that familiar with your adrenal glands. Well, believe me, your doctor is just as unfamiliar as you are. I can’t tell you how many patients step through my door with one diagnosis after another, still feeling as bad as the first day they went to the doctor, and the real issue is the elusive adrenals. Perhaps part of the reason is that this isn’t something you can treat with just a pill and a prayer. This is a lifestyle approach and a therapy each and every day. Balance is the key, and although you may need to be conservative and regimented for a few weeks, you can certainly relax and find a natural balance that keeps your energy up and your weight down for the rest of your life. Insomnia, weight gain around the middle of the body, anxiety for no reason, depression, low blood pressure, sugar dysregulation, epic dreaming, chronic inflammation... do these sound familiar? Well, allow me to introduce you to the idea that you might have adrenal fatigue. Been diagnosed with fibromyalgia? Adrenal fatigue. Chronic Fatigue Syndrome? Yes indeed... adrenal fatigue. Panic Disorders... step right up to adrenal fatigue.

So just what do I mean? Well, that’s going to take some explaining because adrenal depletion is not viewed by the medical community as a condition that merits significant attention, yet virtually 75% of my patients suffer from some level of adrenal fatigue. The adrenals gained more notariety when Matt Damon experienced severe adrenal fatigue during grueling dieting and training while preparing for a recent film.

Adrenal fatigue is usually the result of some type of stress or combination of stressors. These can be weather-related, noise, pollution, internal toxic load, lack of proper nutrition, chemical agents, trauma, emotional agents, biological pathogens and even radiation which can actually fragment the DNA of our cells. Some of the most common symptoms are:

• constant tiredness
• need for extra sleep
• inability to cope with stress
• reduced sex drive
• low back pain
• sighing
• yawning
• recurrent infections
• irritability
• craving sweet food
• irrational anxiety
• epic dreaming
• weight gain around the middle of the body
• low blood pressure

The adrenal glands are dependent on stimulation by the anterior pituitary. Without it, the adrenal cortex atrophies and cortisol secretion ceases. So checking on the health of the pituitary is important. Balance in the body is determined by the balance between two of the adrenal’s hormones... cortisol and DHEA. This is a delicate balance because increased cortisol levels can exhaust DHEA production. Also many drugs can deplete the adrenals such as the statin drugs. The use of statin drugs cause low libido and muscle fatigue, problems that are even worse if you don’t have enough essential fatty acids in your diet.

A huge factor in the balance between cortisol and DHEA is sugar balance. That’s right, sugar! This is where stress comes in, because stress will cause an elevation in adrenalin which causes the body to release stored sugar. Cortisol makes this worse by instinctively drawing glucose from muscle tissue. Both of these factors will then cause a spike in insulin in order to restore normal blood glucose levels and guess what! Weight gain!

Phases Of Adrenal Fatigue

There are three phases that have been documented and accepted in treating adrenal fatigue. Knowing which phase you’re in can help to pinpoint which treatments might be the most effective and which things to focus on in adjusting your lifestyle. Generally we associate each phase with a different type of stressed feeling. Phase I is stressed and wired, while Phase II is tired, then wired, while Phase III is stressed and tired. Each phase can take up to three months to regain some measure of health and balance, which means that if someone is in Phase III adrenal fatigue, they should plan that it will take 9 months to reach full recovery. So I hope you have lots of patience!!!!

In Phase 1, you will experience normal adaptation and resistance to stress. This is the alarm phase which means it is intended to be of short duration, such as 30-40 minutes and should be without symptoms, except perhaps a surge in energy and alertness from the release of adrenalin and insulin. Both cortisol and DHEA increase during this phase. High levels of cortisol will initially cause the insulin surge, which can also be exacerbated by foods such as caffeine, sugar, nicotine, high-glycemic carbohydrates and hydrogenated oils. So in this phase, you should reduce these foods first and foremost. Food and diet at this point is a HUGE factor, so it is an easier one to change.

In this phase, I focus on adaptogenic herbs to fine-tune the stress response mechanism so that Phase 1 is more efficient. The response will be stronger and faster and the feedback control is more effective so the response is shut off faster. Adaptogen is a term first defined in 1947 by Lazarev as "a substance which elicits a state of raised resistance to stressors." It allows for adaptation to excessive strain or stress. Adaptogens help the adrenals to produce normal levels of hormones despite chronic stress being present. They promote regeneration, increase concentration and increase glucocorticoid action. Adaptogens increase anabolic biosynthesis of RNA and proteins, increase carbohydrate metabolism by also regulating blood glucose absorption. They also save serotonin which balances and maintains mood. In order to work effectively, adaptagens need to be taken consistently twice each day for 3-4 months. Some adaptogens include Rhodiola, Eleuthero, Ashwaganda, and Codonopsis.

Phase I Adrenal formulas:

Ashwaganda — this is an adrenal adaptogen for people living with daily uncontrollable stress. It helps to reduce onset insomnia and promotes a feeling of calmness. This is particularly helpful when the cortisol level is very high. It is excellent as an antiinflammative and for people with anemia. It also promotes growth and appetite. 5-10 ml per day.

Standard Process Drenamin — this formula is designed for the adrenal structure, as opposed to function, helping to restore and rebuild the adrenal glands. It is also a vasodilator to bring blood to the glands, essential for chronic fatigue, food or environmental sensitivity, hypoglycemia, low blood pressure and a general dragging feeling. 3-6 per day.

Organically Bound Minerals — this formula is for sympathetic dominance, when you feel anxious all the time. Some of the typical symptoms that we see in the clinic which would lead us to suggest this would be frequent sighing, breathlessness, dry mouth, gagging easily or tachycardia. It also helps to prevent polyglandular weakness.

MediHerb Valerian Complex — this formula is a temporary aid for sleepless nights and nervousness. 4 per day, particularly before bed.

Hawthorn — this helps to balance blood pressure irregularities that typical with adrenal fatigue.

Ginger — this wonderful herb helps to modulate cortisol levels and increase the adrenals’ ability to adapt.

MediHerb Withania Complex — this is an excellent formula for people with the afternoon energy slump. A dose late in the day should only be used if you are sleeping soundly at night. 2-4 tablets per day.

Let’s move on to Phase 2 known as the resistance phase, in which cortisol remains high but DHEA decreases and we become sympathetic dominant. We are, during this phase, hyperadrenal. Symptoms during this phase may include anxiety attacks, mood swings, onset insomnia, restless leg syndrome and a generally "stressed" feeling. Due to the higher cortisol levels, many patients experience "epic" dreaming, which is very exhausting. Increased cortisol levels extend the length of REM cycle sleep, allowing less time for Delta Wave sleep, which is the period of healing, repair and growth. Because of this, healing capacity diminishes and immunity weakens.

Increased levels of cortisol require additional calcium to sustain higher cortisol production. If there is insufficient calcium that is bioavailable, the body will cannibalize bones and other structures. Higher levels of cortisol will increase prolactin which can cause a lack of ovulation and increases the removal of calcium from bones into the blood, which supports sympathetic dominance. High cortisol increases obesity by increasing fat deposition and the loss of lean muscle mass. It also has an antagonistic effect upon insulin production. High cortisol also causes headaches from vasoconstriction and inhibits the conversion of T4 to T3 for thyroid function. It shrinks and kills off hippocampus cells depleting emotional memory.

During this phase, higher protein intake can cause an elevation in cortisol potentially making symptoms more severe, so less protein is the rule. As the DHEA decreases, depression will begin. It is common for potassium levels to be low compared to sodium levels during this phase so I recommend Hippocrates’ Broth which is high in potassium and great for the adrenals. Adaptogenic herbs in this phase will have a sparing effect in order to delay the onset of Phase 3. They also counter chronic immune depletion in stressed individuals.

Phase 2 Adrenal Formulas:

Rehmannia - this extract for the adrenals can provide energy in 30-45 minutes. It is recommended when there is a high systolic blood pressure level. 5 -8 ml per day as an adrenal tonic.

Ashwaganda — this is an adrenal adaptogen for people living with daily uncontrollable stress. It helps to reduce onset insomnia and promotes a feeling of calmness. This is particularly helpful when the cortisol level is very high. It is excellent as an antiinflammative and for people with anemia. It also promotes growth and appetite. 5-10 ml per day.

California Poppy — this opiod-like analgesic helps to reduce REM sleep, so that more time is spent in Delta Wave sleep, the phase in which DHEA and adrenal hormones are replenished.

Ginger — this wonderful herb helps to modulate cortisol levels and increase the adrenals’ ability to adapt.

Organically Bound Minerals — this formula is for sympathetic dominance, when you feel anxious all the time. Some of the typical symptoms that we see in the clinic which would lead us to suggest this would be frequent sighing, breathlessness, dry mouth, gagging easily or tachycardia. It also helps to prevent polyglandular weakness.

Fat-Soluble B vitamins (G) — these are the fat-soluble B vitamins that are essential to restore normalized neurological balance and to help with mental performance.

Standard Process Drenamin — this formula is designed for the adrenal structure, as opposed to function, helping to restore and rebuild the adrenal glands. It is also a vasodilator to bring blood to the glands, essential for chronic fatigue, food or environmental sensitivity, hypoglycemia, low blood pressure and a general dragging feeling. 6 per day.

Standard Process Min-Tran — this formula provides the minerals necessary to reduce sympathetic dominance and to act as a tranquilizer for sleep.

Rhodiola — this amazing herb has been shown in clinical studies to increase endurance, memory and productivity. It has been used to treat fatigue, depression and impotence. This is the perfect formula for someone who has a demanding job and a very stressful work environment, particularly if it is a physical occupation. It is essential for those experiencing erectile dysfunction as a result of stress. We have also used it to treat people traveling to high altitudes. It is the essential ingredient in recuperating from a stressful event.

MediHerb Valerian Complex — this formula is a temporary aid for sleepless nights and nervousness. 4 per day, particularly before bed.

MediHerb Fe-Max Iron Tonic — excellent as a general daily restorative tonic. 5 ml per day.

Nettle Leaf — this extract provides a multi-mineral support for the deficiencies common with phase 2 fatigue.

MediHerb Livco — this liver detoxifier helps to reduce headaches that are due to elevated cortisol levels.

Bulgarian sourced Tribulus — helps to regulate and increase DHEA levels, helping with atrophied muscles and low libido. 2-4 tablets per day.

Skullcap — this is perfect for relaxing the nervous system and reducing symptoms of anxiety, panic, fear and lack of control.

And now, the bottom of the barrel, Phase 3 known as the exhaustion phase in which cortisol and DHEA are both low. This poor person is now Parasympathetic Dominant and hypoadrenal, causing the body to enter a conservation mode. Symptoms of this phase are depression, maintenance insomnia and exhaustion, all of which can contribute to a chronic fatigue state. Low levels of cortisol can bring on fibromyalgia symptoms, impotence in men, panic disorders, infertility, anorexia nervosa, low white blood cell levels and low blood pressure. To prevent the blood pressure from dropping any further, I use a combination of Standard Process Drenatrophin PMG and Cataplex B to support the adrenals.

Sleep will be disturbed by waking up and not returning to sleep, a result of cortisol surges from the adrenals having lost their proper timed response. These surges can be worsened by hypoglycemia issues. Low levels of DHEA can cause recurring infections, arthritis, obesity and early menopause. Adrenal tonics can conserve cortisol during this phase.

Adrenal tonics increase available energy from our reserves. They nourish and restore the adrenal glands, reduce side effects of corticosteroid drugs and improve regulation of cortisol and DHEA output. They give the adrenal glands a rest by temporarily giving us energy. In this way they protect the adrenals against damage. Tonics include Licorice, Rehmannia and Korean Ginseng (in limited amounts). Tonics should be given first thing in the morning and for no longer than 4 weeks.

Phase 3 Adrenal Formulas:

Rehmannia — this extract for the adrenals can provide energy in 30-45 minutes. It is recommended when there is a high systolic blood pressure level. 5 -8 ml per day as an adrenal tonic.

Licorice — this extract has so many uses, but here, it helps with all the symptoms of phase 3 adrenal depletion, particularly excessive fatigue. It also is the perfect choice for low systolic blood pressure levels. 4 ml per day, preferably in the morning.

MediHerb Nevaton — for emotional stress and a depleted nervous system. 3-4 tablets per day.

Eleuthero — This is the formula for low DHEA and low cortisol, making it perfect for Phase III. It helps with exhaustion, maintenance insomnia and depression. It provides great support for environmental and occupational stress and can protect during and after radiation exposure, such as in cancer treatment. It helps to improve mental and physical performance. 2-8 ml or 3-4 tablets per day.

Korean Ginseng — this tonic is excellent for the first 4 weeks of treatment as a rescue remedy. It can be continued in elderly individuals. 2 ml per day in the morning.

MediHerb Astragalus Complex — for recurring infections common with phase 3 adrenal depletion. 3-4 tablets per day.

Rhodiola — this amazing herb has been shown in clinical studies to increase endurance, memory and productivity. It has been used to treat fatigue, depression and impotence. This is the perfect formula for someone who has a demanding job and a very stressful work environment, particularly if it is a physical occupation. It is essential for those experiencing erectile dysfunction as a result of stress. We have also used it to treat people traveling to high altitudes. It is the essential ingredient in recuperating from a stressful event.

Water-Soluble B vitamins — this complex of water-soluble B vitamins is essential to Phase III adrenal fatigue sufferers. There is increased excretion of water-soluble components during this phase which must be replenished. It helps to improve the transmission of nerve impulses, blood sugar metabolism and puts strength in the vessels.

Standard Process Super EFF — this essential fatty acid complex is to increase hormone production of the cholesterol-based hormones of the adrenal glands. 3 tablets per day.

Trace Minerals B12 — this formula is perfect for providing the complex minerals necessary for Phase III adrenal fatigue.

Dessicated Adrenal extract - this is for severe exhaustion or sudden shock as well as prolonged severe stress and should only be used short-term. Note: Do not use with Korean Ginseng. 6 tablets per day.

Standard Process Vasculin — this helps to keep blood pressure stable at a higher level.

And now on to your lifestyle...

Foods and Nutritional Concentrates: Since the adrenals are natural body tissue they require nutrition for optimal function and a healthy life. There are many foods in our diet which contain all the right things for the adrenals to function. But it’s not just about the food, it’s about how you eat. With adrenal fatigue, eating behavior is a crucial factor in balancing nutritional reserves and adrenal function.

The main goal of adrenal nutrition is to break the cycle of cascading hormonal stress that provides the stimulus to our eating choices and patterns. First, you cannot reduce your calorie intake or skip meals for weight loss. That simply convinces the body that it is a "fasting" mode and it will promote storage of all nutrients and reduction of metabolism to make those reserves last. The second thing is that is you eat any high-sugar item, it will not only cause an insulin surge, but also an adrenalin surge as well increasing fat storage. In fact, this is the reason that we crave sugar when we are depressed, or mistake the drop in blood sugar for needing actual sugar to offset fatigue. When under stress, we will tend to eat more calories per meal, and increase our intake of refined sugars and carbohydrates. This simply continues the cycle of stress eating, sugar fluctuations and adrenalin and cortisol imbalances.

So here are the eating rules:

• Eat little amounts often throughout the day, 5-8 small meals.
• Don’t skip breakfast and be sure to have your first meal within 1 hour of rising.
• Eliminate all sugar and refined carbohydrates.
• Add protein to each meal.
• Eat essential fats. This gives your body something else to use as energy instead of sugar.
• Don’t eat quickly or on a time schedule.
• Chew your food very well. This improves digestion and limits bacteria content in food.
• Be sure to drink as much water as possible throughout the day — no carbonated water and do not count the water in juice, tea or coffee.
• Increase your natural fiber intake. Fiber controls blood sugar swings and slows digestion, so digestion is more complete and you feel full longer with less food.
• Eliminate caffeine in all forms, including tea, coffee, chocolate, colas and even some headache medications. Caffeine is a stimulant to the release of cortisol and insulin. Over time it can make your body insulin-resistant.
• Reduce alcohol consumption. Alcohol acts as a diuretic causing dehydration, it interferes with the metabolism of essential fatty acids, blocks nutrient absorption and raises insulin levels, not to mention how it affects liver detoxification ability.

Sweating: Releasing stored toxic material and rebalancing water through sweating can help to reduce high cortisol levels and bring about a more relaxed state of the nervous system. Massage Therapy can speed this process by increasing circulation and reducing the muscle tension that can interfere with proper hormonal secretion and transport.

Exercise: We all know that exercise is important for health, but it is something that you need to evaluate with adrenal fatigue. In Phase I, exercise can be essential. Depending on the amount of energy you have, you need to do both cardiovascular exercise and resistance-training with weights to build muscle. Only anaerobic activity such as weight training can increase your basal metabolic rate that is the essential determinant of body shape all through the day. Do as much cardiovascular as you are able, but don’t forget to get resistance-training in as well.

But once you are into Phase 2 and Phase 3 adrenal fatigue, you may not have enough energy to spend exercising. In fact, excessive exercising can really deplete the body dramatically making symptoms worse. Many Chronic Fatigue sufferers are simply expending too much energy to allow enough for adrenal restoration to occur.

Lifestyle: Adrenal fatigue is a sign that your body does not process stress well, and you need to arrange your life to accommodate that weakness. If you continue to expose yourself to chronic daily stress in your job, your relationship and your life, you will not have the support of your adrenals and all the functions they control will be reduced. Nothing has to be done overnight, but you need to find ways to reduce stress a little more each day. Therapies such as yoga, meditation, tai chi, massage, acupuncture and breathing can all help to release tension and daily accumulated stress hormones.

So What’s The Outcome...

Once you have experienced adrenal fatigue symptoms for a lengthy period of time, you may not be able to simply change your diet and achieve the results you need. Paying attention to what your body needs is crucial... rest when you need to, exercise when you can, eat healthy and avoid foods that can artificially stimulate your energy reserves, or deplete your body. Don’t make the mistake of underestimating adrenal fatigue, because the damage that can occur can truly ruin your life...