adrenal fatigue

Dr. Chantell Groenewald 
M. Tech Hom (UJ)

What are the functions of our Adrenal Glands?

Our adrenal glands (or suprarenal glands) sits on top of our kidneys and acts as an endocrine gland which simply means it is responsible for the secretion of various hormones.  One of the hormones secreted by the adrenal glands is the steroid hormone cortisol.

Cortisol is often referred to as the ‘stress hormone’ due to the role it plays in the fight and flight reaction which is regulated by the hypothalamic-pituitary-adrenal axis (HPA axis). During a stress response, the adrenal glands are signalled via the HPA axis to secrete cortisol which in turn stimulates fat and carbohydrate metabolism i.e gluconeogenesis (process by which the level of glucose in the blood stream is increased). This response supplies the body with ‘fast’ energy to run away or fight during the fight or flight response. Cortisol is also responsible for inhibiting the functions of various other non-essential bodily functions during the fight or flight response. Once the fight or flight response is over, cortisol levels return to normal and systems functions are restored to normal.

The role cortisol plays in the fight and flight response is well known, however the effects of cortisol in our day to day functioning is far reaching. Cortisol levels start to increase in the early hours of the morning and is responsible for waking us up and directing the resources of the body to where it is most needed and then decreases again at night preparing us for sleep and maintenance functions in the body. Cortisol plays an important role in our body’s overall functioning and well-being. The systemic effects of cortisol include:

• Gluconeogenesis (mobilizing cortisol from stores in our body)
• Inhibits the effects of insulin
• Metabolism
• Anti-inflammatory
• Immune response
• Water balance
• Controls BP
• Fight and flight response

The stress response is essential for life, without it we would not be able to respond in a life threatening situation to preserve life, for example when we walk in the woods and come face to face with a bear.  In this situation the stress response is good, it will flood our cells with glucose and we can run away from the bear. Once the situation is resolved our stress hormones goes back to normal and our body has burned all the glucose while running away.

Chronic stress is not good. Unlike an acute stress response like running away from a bear, the situation does not resolve and we are chronically exposed to elevated levels of cortisol that is not eliminated from our system. Prolonged stress and exposure to higher than normal cortisol levels have adverse effects on our health for two reasons.

1. Our cells are chronically flooded by glucose
2. Bodily functions that are not essential to the fight and flight reaction are curbed, this includes immune function, digestion, hormone production and metabolism.

Some of the systemic symptoms associated with prolonged exposure to higher than normal cortisol levels include:

• Brain: Irritability, anger, anxiety, depression, poor concentration and memory loss
• Skin: Skin break outs such as psoriasis, eczema and acne
• Digestion: Slow metabolism, insulin resistance, small intestinal bacterial overgrowth, leaky gut, irritable bowel syndrome, decreased nutrient absorption, food allergies and intolerances
• Female health: Decreased levels and impaired production of estrogen, progesterone and testosterone which aggravates female health issues such as polycystic ovarian syndrome, endometriosis and uterine fibroids.
• Immune system: Recurrent colds and flu and poor recovery from illness
• Cardiac health: Increased blood pressure, triglycerides and increased risk of developing cardiovascular disease.

 
What is adrenal fatigue?
Adrenal fatigue refers to the period following prolonged periods of stress where your cortisol stores become depleted following prolonged periods of higher than normal cortisol production. There are two phases at play here:

• The ‘wired and tired’ phase usually precedes adrenal fatigue, this phase is characterized by waking up tired every morning and using various stimulants including caffeine to get you through the day until you are so wired at night, you have difficulty sleeping and the process repeats itself again the next day. These individuals are chronically tired yet struggle to sleep. I liken this phase to a tightly stretched elastic band, the slightest touch causes a huge response and it is during this phase that you will suffer from high levels of irritation and anger where you may have visions of getting out of your car and taking a cricket bat to someones car that just cut you off in traffic.
• The ‘tired and fatigued phase’  Your adrenal glands become less than able to respond adequately to stress and a period of extreme fatigue follows. During this phase you wake up tired and go to bed tired. You can sleep 10 restful hours every night and still wake up exhausted each morning. This phase I liken to stretched elastic band that has been cut and now lies on the floor with no potential energy. Instead of road rage you are oblivious to anyone else on the road and operate in a haze. Individuals with adrenal burnout are typically depressed and have no energy to fulfil their daily tasks, they experience low blood pressure, unexplained weight loss, poor immune function and brain fog to name a few. These symptoms mimics primary adrenal insufficiency (called Addidons disease) but with only milder symptoms.

 
How is adrenal fatigue diagnosed?
 Often a practitioner will make a clinical diagnosis based on your symptom picture and personal history. As previously mentioned adrenal fatigue cannot be diagnosed with a blood test. The ranges for serum cortisol levels are very wide and unless there is a primary pituitary insufficiency as with Addison disease, the blood serum levels will be within normal limits. A more accurate test to determine if there is a dysfunction of the adrenal glands production and secretion of cortisol is a salivary cortisol tests. This measures cortisol levels during three key intervals during the night and day to determine if your cortisol levels are reacting according to the normal circadian rhythm (ie high levels in the morning and low levels at night).
 
5 Changes to make to help manage chronic stress and adrenal fatigue.
1. Detox your gut
An unhealthy gut is a continuous source of inflammation. Inflammation triggers the release of cortisol for its anti-inflammatory properties, which can further exacerbate the chronic low grade stress response. Heal your leaky gut by destroying the bad bacteria, healing the gut lining and recolonizing with the good bacteria.
2. Meditation, yoga and breathing exercises
There is sufficient research that shows the calming effects of meditation, yoga and breathing exercises. This is crucial especially if we are continuously exposed to chronic low level stress. By practising relaxation techniques we over ride the bodies stress response and force our adrenal glands to regulate the secretion of cortisol.
3. Consider adaptogens to regulate the function of the adrenal glands
Under the supervision of a qualified physician, adaptogens such as Ashwaganda may be prescribed that function by regulating the secretion of cortisol by the adrenal glands.
4. Get enough sleep
Two hours of REM (rapid eye movement) sleep is what is needed to ‘shampoo our brain’ each night. This term coined by Dr. Sara Gottfried MD in the states so adequately describes why we need to get enough sleep at night. Research suggests we need at least 7-8 hours of sleep each night, of which 2 hours has to be deep or REM sleep. Research suggests that even partial sleep deprivation affects the hypothalamic-pituitary-adrenal axis causing higher than normal cortisol secretion by the adrenal glands.
5. Cut the stimulates and clean up your diet:
Stimulants such as caffeine, tobacco and sugar fuels adrenal overproduction of cortisol. Most people who suffer from chronic stress tend to rely heavily on stimulants to get them through the day. This unfortunately will only drain your already taxed adrenal glands. There are various detox, elimination and cleanse diets that will help you cut out all the stimulants and help you feel healthier and more energized than ever by helping you to get the necessary nutrition from your food. People often underestimate the power of healthy eating and I often see patients revived and energised from something as simple as changing their diet. Hippocrates said: “Let food be thy medicine and let thy medicine be food”.