Adrenal disorders are probably the most common functional disorders found today. The adrenal glands are the primary stress organs of the body. Most of us are over-stressed; however, the adrenals must handle all kinds of stress that we may never consider. These include:
- Dietary Stress: diets high in refined carbohydrates, synthetic sweeteners and other food additives, added hormones and antibiotics, partially hydrogenated fats, caffeine and excess alcohol.
- Lifestyle: Social, family and work related pressures – deadlines, rushing, and lack of sleep.
- Over-training: intense weight-training and other anaerobic exercises.
- Toxins: a highly toxic environment filled with many sources of heavy metals and environmental toxins.
Adrenal Gland Physiology
The adrenal are two small organs attached above the kidneys. In Latin, ad means above and renal refers to kidneys. It is made up of:
- An outer cortex which produces steroid hormones: cortisol, aldosterone, progesterone, progesterone and DHEA.
- An inner medulla which produces catecholamines such as epinephrine and norepinephine.
The adrenal cortex normally produces only a small amount of sex hormones that have little effect on reproductive function. However, these act as important reserves in menopausal women. If the adrenals are exhausted, this can have a dramatic impact on the intensity of menopausal symptoms.
Mineralcorticoids (primarily aldosterone) secreted by the adrenal cortex have important effects on sodium and potassium balance. They act to increase sodium absorption and potassium secretion. Symptoms and signs of imbalance include: dehydration, excessive urination (may also be a thiamine need or prostate issue), excessive perspiration or perspiration with little or no activity, non-pitting edema and craving for salt.
Glucocorticoids (primarily cortisol) secreted by the adrenal cortex influence carbohydrate, fat and protein metabolism. As cortisol levels increase in response to stress, blood glucose concentrations rise as the liver releases stored glucose. This can cause hypoglycemia and lead to diabetes.
The catecholamines, epinephrine and norepinephine are released when a threatening situation is perceived. They increase heart and breathing rate, constrict bloods vessels and relax the bronchioles. Symptoms and signs include: dizziness on rising, asthma, hemorrhoids associated with the pooling of blood in the abdomen and varicose veins.
The Circadian Release of Cortisol
Cortisol is released in a rhythmic pattern. High levels in the morning gradually taper down until lowest levels are released at midnight. The reason that cortisol is highest in the morning is that sleeping is generally a fasting state. The body does not have available glucose from food intake to help with repairs and to supply the cells with the constant supply of glucose that they demand. Therefore, the adrenals will release cortisol during sleep to help meet glucose needs. The body will lose up to 2/3 of its stored glucose (in the form of glycogen) in a typical nights sleep. During the day, generally a non-fasting state, there is less demand for stored glucose and cortisol levels will drop if the pattern is normal.
When the circadian release of cortisol is abnormal, there are often sleep problems including the inability to stay or fall asleep, non-restful sleep and fatigue in the morning with difficulty getting out of bed. This can be charted in an adrenal lab test (the Adrenal Stress Index or ASI) that measures the levels of cortisol collected from saliva at various times of the day.
Usually people with overworking adrenals (hyperfunction) will have spikes in cortisol levels in the late evening making it difficult to fall asleep. People with exhausted adrenals (hypofunction) that can no longer produce sufficient amounts of cortisol will often wakeup in the middle of the night as glucose demands are not sufficiently met and they plunge into hypoglycemia. Cortisol levels in this state will be much lower than normal in a morning collection.
The Adrenal Response to Stress
The adrenal glands adapt to stress (be it chemical, emotional or physical) by going through three stages of response. The first stage is the alarm reaction. This represents the body’s initial response to stress. The adrenal glands go into a hyperfunctional state and increase cortisol levels. This stage is seen in the ASI with increased cortisol levels and normal levels of the hormone DHEA.
The second stage is called the resistance stage and occurs if stress is prolonged. The adrenals will adapt in this stage through a process known as “pregnenolone steal”. Pregnenolone is a hormone derived from cholesterol and is a precursor for cortisol and all of the sex hormones. The body has only a limited supply of pregnenolone. In times of prolonged stress, the body will convert this hormone into the increased levels of cortisol at the expense of our sex hormones. The body will prioritize the handling of stress over the need for sex hormones such as estrogen and testosterone. The ASI will show increased cortisol with low levels of DHEA. People may stay in this stage for many years and even over their entire lives.
The final stage of adaptation to stress is called the exhaustion stage. Here, the chronically stressed adrenals can no longer adapt to stress. There is marginal cortisol output and minimal adrenal reserves. The ASI will show diminished cortisol and DHEA levels. As this situation deteriorates, the adrenals move into a failure stage in which it lacks reserves and is unable to produce cortisol in response to stress.
Symptoms of Adrenal Hypofunction
As the ability of the adrenals to produce adequate cortisol diminishes, the following symptoms are common:
- Cannot stay asleep
- Crave salt
- Slow starter in morning
- Afternoon fatigue
- Dizziness when standing up quickly
- Afternoon headaches
- Weak nails
Symptoms of Adrenal Hyperfunction
When cortisol levels are high in response to stress, symptoms include:
- Cannot fall asleep
- Perspires easily
- Under high amounts of stress
- Weight gain when under stress
- Wake up tired even after 6 or more hours of sleep
- Excessive perspiration or perspiration with little or no activity
The Impact of Adrenal Stress Syndrome on Human Physiology and Metabolism
Many systems and functions of the body can be negatively impacted by adrenal dysfunction. These include:
- Blood sugar imbalances: Chronically elevated cortisol levels will down-regulate insulin receptors and create insulin receptor insensitivity. Here, the insulin receptors will not adequately respond to insulin and the pancreas will secrete more insulin in order to transport glucose into the cells. Over time, the ability of the pancreas to produce insulin will decline leading, potentially, to diabetes. Cortisol is responsible for returning low glucose levels back to normal. In cases of adrenal exhaustion, cortisol levels become decreased and the body is unable to stabilize glucose levels causing hypoglycemia. Hypoglycemia cannot be corrected unless the adrenals are normalized.
- Thyroid dysfunction: Elevated cortisol has a suppressive effect on the conversion of the inactive T4 hormone into the active T3 form. Blood studies are necessary to confirm this.
- Anterior Pituitary Hypofunction: Chronic stress can have a negative impact on the hypothalamus-pituitary-adrenal axis. This is identified when TSH levels in the blood are below 2.0 with subjective indications such as: reduced or absent sex drive, abnormal thirst, lack of menstruation and weight gain around the hips.
- Liver detoxification dysfunction: The body’s detoxification system becomes suppressed during adrenal stress syndrome due to chronic elevations of cortisol. The cortisol must be broken down in the liver for our body to eliminate it in our sweat, urine and feces. People with both adrenal hyper and hypo function may need specific support of the liver detoxification pathways. Signs include: constipation, bloating, acne or acne worse at menses, sensitivity to medications, and unresponsiveness to endocrine support (hormones or supplements).
- Intestinal Dysbiosis and Leaky Gut syndrome: Elevated cortisol levels have adverse effects on the GI tract by suppressing Secretory IgA (SIgA) and mucosal cell regeneration and by promoting a pro-inflammatory environment. SIgA is the main immunocyte in the gastrointestinal tract and forms an immune barrier to protect against GI infections including parasites and over-population of candida and other yeast organisms. Elevated cortisol can contribute to dysbiosis (an imbalance between beneficial and adverse bacteria) and leaky gut syndrome because of increased permeability due to thinning of the intestinal lining.
- Suppressed Immune System: Chronically elevated cortisol levels have a suppressing effect on the immune system (with suppressed Saga, decreased white blood cells, thymus gland atrophy and decreased interleukin-2 production) and thus can significantly decrease a person’s ability to fight infections.
- Gastric and Duodenal Ulcers: Increased cortisol levels allow the gastric and duodenal lining to thin and become more susceptible to the development of ulcers.
- Decreased Bone Density: Elevated cortisol has a negative effect on bone metabolism leading to calcium malabsorption, lower bone mineral density and increased risk of fractures.
- Insomnia: described earlier
- Cardiovascular Disease: Increased cortisol can raise blood pressure because of elevations of catecholamines and alterations in mineralcorticoid metabolism. These alterations increase vasoconstriction and alter sodium/potassium equilibrium leading to hypertension. High cortisol causes insulin resistance which can lead to a condition in which glucose can not readily be used for energy, but is instead converted into adipose tissue (fat). This can lead to obesity, increasing cardiovascular risk. Insulin resistance can also lead to elevated cholesterol, decreased HDL (“good cholesterol”) and increased risk of blood coagulation.
Treating Adrenal Stress Syndrome
Specific herbs and supplements can be extremely helpful to all types of adrenal dysfunction. Determination of the specific phase of dysfunction through an ASI test is helpful to properly choose the nutrients and herbs used in treatment. A person in adrenal exhaustion needs very different support than a person in adrenal hyperfunction. The ASI breaks down adrenal dysfunction into 7 distinct zones of imbalance, all needing somewhat different supplementation.
Certain lifestyle changes are beneficial to all categories of adrenal dysfunction. These include avoiding certain foods and chemicals that stress the adrenal glands. Limit or avoid:
- Concentrated sugars
- Caffeine (decaffeinated beverages are not acceptable as they still have significant levels of caffeine)
- Allergic foods (histamine is an adrenal stimulant)
- Partially hydrogenated fats (inhibit steroid hormone synthesis)
- Artificial Sweeteners
- Inadequate sleep
Further, it is important to stabilize blood sugar levels when treating the adrenals. It is important (in most cases) to:
- Eat a high protein breakfast.
- Not wait until overly hungry to eat.
- Snack on low glycemic foods such as raw nuts, seeds, hard-boiled eggs etc.
- Avoid fruit and carrot juices.
- Never consume high glycemic foods without a source of protein.
- Eat a well-balanced diet consisting of mostly organic vegetables, quality grains and high quality proteins.
It is crucial for people with any type of adrenal dysfunction to exercise 3-4 times per week in the aerobic heart range. Aerobic training includes long duration exercises such as walking, slow jogging and slow cycling and helps build normal adrenal function. Aerobic activity lowers elevated cortisol levels and primarily burns fats instead of sugars for energy. Aerobic exercise does not stress the adrenals as there is no need to normalize sugar levels during and after exercise.
Anaerobic exercises such as weight training and fast-paced jogging or running require explosive movements. Anaerobic training burns sugar for energy which the adrenals are required to normalize. Anaerobic exercise puts unnecessary stress on the adrenals and will slow or prevent their repair and return to normal function.