Adrenal Dysfunction – Revisited

The long-time readers of WHN may remember an article I did about a year back that discussed the adrenal glands and what happens to people when they become fatigued.  When your adrenals become fatigued, you become fatigued.  In the article ( and in some articles since ), I described a simple saliva test for assessing adrenal function and checking cortisol output through out the day.  Cortisol is the main hormone released by the adrenal glands in response to stress, but it is also released in a daily rhythm that helps to run our bodies and maintain a normal sleep/wake cycle.  By looking at the cortisol output over the course of the day (along with other factors that the test looks at), we can tell a lot about how your adrenal glands are functioning and how your body responds to stress.  In that article, I concentrated on what happens when we find low cortisol output, otherwise known as adrenal fatigue.   After that article, many people came to see me feeling like they had symptoms of adrenal fatigue – they were tired, they had a hard time waking up in the morning, they didn’t feel like their digestion worked as well as it used to, they had sleep issues, they just felt worn out and over stressed.

We ran the adrenal test and – low and behold – they were not low in cortisol, but instead were overproducing it.  This is something that I have been finding more and more in people.  The answer to why this is so lies in how we live our lives.

Our adrenal axis (the brain, hormone system, and the adrenal glands) operates on a negative-feedback loop.  The brain tells the glands to produce cortisol.  They do, and the cortisol eventually finds its way back up to the brain, where it is recognized.  The brain then essentially says, “Okay, now there is enough cortisol, the adrenal glands should turn off now.”  This is called a negative feedback loop and they are very common where hormones are concerned.  In this way, the levels of the hormone can be kept in check by the brain.  However, this is a delicate system.  The system was made to handle times of short, intense stress.  Way back when, our stressors came hard and fast (in the form of predators) and then were gone, allowing us to return to whatever we were doing.  The system turned on, kicked our bodies into “fight or flight” mode and then turned off again when the threat was gone.  In this modern era, however, the system is under a terrific amount of, well, stress.  Most of us live our lives with a stress around every corner, whether its stress at work, stress at home, stress about a relationship, fighting traffic, worrying about finances, etc, etc, etc.  Not to mention the “hidden stressors”.

You can put your body through a lot of stress without ever really knowing it.  When you eat foods that you are sensitive to (again- discussed in a past article), you evoke a mini stress/allergic reaction at the level of your gut.  It is important to say that here I am not talking about an outright allergy, but instead a more subtle sensitivity to a food.  This sensitivity can result in some symptoms sometimes, but other times it remains hidden.  It can evoke this stress reaction from your adrenal without you ever being conscious of it.  Other hidden sources of stress on the body include:  pain, lack of sleep, chronic inflammation, emotional strain, anxiety, depression and high amounts simple carbohydrates (creating blood sugar imbalances).

This constant stress response eventually wears away at the ability of the negative feedback loop (discussed above) to function and at some point, it will become overwhelmed and fail.  When this happens, the adrenal axis looses its day/night cycle and we typically see high cortisol levels persisting into the night (when it is supposed to be very low).  This “broken shut off switch” is the first stage of adrenal dysfunction, and the stage that a lot of people around here seem to be in!  Eventually, the adrenals will tire and cortisol levels will drop, but that’s down the road (assuming you do nothing).  This loss of the day/night cycle of the adrenals and the associated high overall cortisol levels has many repercussions.  High cortisol levels:

-       Suppress the immune system

-       Promote Osteoporosis

-       Are associated with Alzheimer’s Disease

-       Suppress Thyroid function

-       Increase Blood Sugar levels

-       Allow for Yeast Infections/Overgrowths

-       Disrupt Progesterone levels

-       Contribute to Andropause feelings

-       Cause low Libido

-       Contribute to PMS

-       Contribute to Irritable Bowel

-       Contribute to High Blood Pressure

Furthermore, high cortisol at night makes it almost impossible to get a good night’s rest.  Higher than normal cortisol levels keep you body in a constant low-level “fight or flight” response.  In this state, your body cannot enter the deepest, and most restorative, levels of sleep.  People wake up feeling groggy, even when they slept through the night.  Or, the higher cortisol levels can wake you up, and some people experience waking for no apparent reason.  Or, you can have difficulty falling asleep in the first place.  Or, sometimes people have no trouble sleeping, but just feel stressed out all the time. Or, they feel like they are running on overdrive for no reason.

Because you can still have the symptoms of groggy in the morning and fatigue during the day (due to poor sleep), many people confuse this picture with one of adrenal fatigue.  Then they, or their health care provider, put them on adrenal stimulants to amp up their cortisol levels so they won’t feel so tired.  I can not tell you how wrong this is, and how often I see it in my practice. 

So what do we do?  The plan starts with some form of stress reduction.  It doesn’t matter if it’s yoga, tai chi, relaxation tapes, and deep breathing exercises – whatever!  Also, it is important to modify the diet to reduce the amount of simple carbs and what are known as “high glycemic foods”, as well as identifying and removing any food sensitivities.  However, the real heart of the regimen lies in the use of specially prepared phosphatidyl serine derivatives, which help to re-establish the broken feedback loop and restore a proper day/night cycle.  I also like to use low dose adaptogens (ginseng, licorice, rhodiola, etc) to nourish the adrenals while we are helping them remember how to turn off.  The whole aim of this program is to re-teach your body how to relax and that it’s okay to shut down and go to bed.