posted February 25, 2014 02:32 PM            

Ignored by mainstream medicine, adrenal fatigue is a common problem seen routinely every day at any busy medical office. The paramount symptom is fatigue unrelieved by sleep. Other symptoms include craving for salty foods, hypoglycemic episodes, decreased libido, stress intolerance, light headed upon standing, depression, loss of memory and cognitive decline, allergies, sinus problems, and prolonged recovery from flu-like illnesses. The basic underlying cause is low cortisol output by the adrenal glands.

A Self-Help Book for Chronic Burn-Out called Adrenal Fatigue

The definitive book on this topic is entitled, “Adrenal Fatigue”, by James L Wilson, PhD, a self-help guide for all of us chronically stressed out members of the "rat race" suffering from this new 21st century epidemic. (1) In his book, Wilson outlines how to diagnose and treat adrenal fatigue, a syndrome not yet recognized by mainstream medicine and it should be. I found Chapter 10 on physical signs of adrenal fatigue the most useful. This chapter describes the findings on physical examination such as the unstable pupil, blood pressure reduction upon standing, and Sergent's white line test.

Cortisol Testing

Chapter eleven of Wilson's book covers the different cortisol testing methods available for cortisol in saliva, blood, and urine, as well as the ACTH stimulation test. Wilson favors the four sample salivary cortisol test as the easiest and most convenient method; with the added advantage that salivary testing can be done at home without a doctor's prescription.

Another chapter in the book covers treatment and recovery from adrenal fatigue with modification of diet and lifestyle, and diet, avoiding food allergies, and the use of hormone supplements and dietary supplements. He also weighs the use of Cortef (cortisol) vs. adrenal cortical extracts.

Results from Years of Chronic Stress

Adrenal fatigue is the net result of years of continuous high cortisol output by the adrenals caused by chronic stress from job, family, illness, injury, and poor diet and lifestyle associated with high-tech modern living. After years of chronic stress, the two small triangular supra-renal glands poop out, and we become another casualty of adrenal fatigue, the 21st century epidemic. Since mainstream doctors can't seem to help, either ignoring the syndrome, or prescribing SSRI anti-depressants for it, this self-help book may be a life-saver.

Definition of Adrenal Fatigue:
"Adrenal Fatigue is a collection of signs and symptoms that results from low function of the adrenal glands. The paramount symptom is fatigue that is not relieved by sleep. The syndrome may be caused by intense or prolonged stress, or after acute or chronic infections, especially respiratory infections such as influenza, bronchitis or pneumonia....People suffering from Adrenal Fatigue often have to use coffee, colas and other stimulants to get going in the morning and to prop themselves up during the day.“ Quoted from James L. Wilson, Adrenal Fatigue.(1)

Symptoms and Conditions Associated with Adrenal Fatigue
Anxiety
Asthenia - lack of, or loss of strength, generalized weakness
Asthma
Autoimmune problems
Bronchitis - recurrent, chronic or slow recovery from
Burnout
Chemical Sensitivity
Chronic fatigue syndrome (CFS)
Chronic infections,
Chronically run down - with early morning fatigue and low blood pressure
Chronic mental and/or physical exhaustion
Cravings for carbohydrates, sweets or salt
Depression
Fatigue - severe, disabling early morning fatigue
Feeling tired despite sufficient hours of sleep
Fibromyalgia
Hair loss
Hypoglycemia
Immune System dysfunction - frequent illnesses
Insomnia - or non-restful sleep
Low Blood Pressure
Nervous breakdown (nervous exhaustion)
Pneumonia
Respiratory infections - recurrent, chronic or slow recovery from
Rheumatoid arthritis
Reliance on stimulants like caffeine
Slow recovery following acute infectious diseases, especially influenza, pneumonia, or other respiratory Infections
Weight gain

Why is Cortisol Important?

Cortisol is the stress hormone, and is produced in response to stress. Cortisol is important for blood sugar regulation. Cortisol mobilizes glycogen in the liver to maintain blood glucose levels. Symptoms of hypoglycemia are common in low cortisol adrenal fatigue. Also low blood pressure or inability to maintain blood pressure upon standing is also a common symptom. Another physical exam finding is an unstable pupil response to light. The pupil at first contracts and then after a few seconds opens and closes.

The Adrenal Glands Make the Cortisol

The two small triangular adrenal glands are located just above the kidneys and secrete the hormone cortisol in response to stress, physical, emotional, or traumatic stress. The adrenal glands make the hormone cortisol.

What is Cortisol? It's the Stress Hormone

Cortisol is a steroid hormone, and like all the others it is made from cholesterol. Cholesterol, in turn, is made from Vitamin B5 and Acetyl CoA. The manufacture of steroidal hormones can be best understood by referring to a steroidal pathway chart.

Salivary Cortisol Test:

Although cortisol can be measured in a blood sample, the best way to measure cortisol levels is with 4 saliva samples taken throughout the day. There are literally hundreds of medical research studies validating the usefulness of salivary cortisol measurements. A recent study showed that low early morning salivary cortisol is associated with chronic fatigue syndrome in women.(8) We use a 4 sample salivary kit that has a cotton cylinder that is placed under the tongue to collect the sample. Collecting a sample with this kit is much easier than the older method of spitting into the tube.

Nutritional Supplement Program for Adrenal Fatigue and Recovery

The keystone of the treatment program is a nutritional supplement program to restore adrenal function that includes vitamin C, B5, magnesium, biotin and adaptogenic herbs. Recovery takes about 6 weeks.

Cortef for Severe Cases of Adrenal Fatigue

In very severe cases of adrenal failure, Cortef tablets are available and produce a dramatic improvement in clinical condition. For more information, see the classic book, Safe Use of Cortisol by William Mck Jefferies. (41) Cortef is the name for bio-identical cortisol which is widely available at the local drug store. Synthetic forms of cortisol such as prednisone and dexamethasone are not recommended as they can be associated with adverse side effects.

Other Useful Interventions For Adrenal Fatigue:

Avoid excess caffeine, refined carbohydrates, alcohol and sugar.
Get plenty of sleep.
Take steps to reduce stress with gentle exercise, meditation, and yoga.
Bioidentical hormones as determined by lab profile.

Warning:
Paradoxically, thyroid medication may worsen symptoms when given to a patient with adrenal fatigue. Salivary cortisol testing and treatment of adrenal fatigue is mandatory prior to beginning thyroid medication to avoid this pitfall.

Cortisol's Relation to Thyroid Function - Avoiding A Common Pitfall

Low cortisol level adrenal fatigue will induce a protective state in which the body’s metabolic rate is reduced in order to cope with low cortisol levels. The body compensates by reducing thyroid function by shunting thyroid hormone production into the reverse T3 pathway, the inactive form of thyroid hormone. This creates a functional low thyroid state which will show up on thyroid labs. Treating the patient with thyroid hormone under this scenario is a common error and a pitfall to be avoided. Giving thyroid hormone to a patient with low cortisol adrenal fatigue will only make the patient feel worse. The low adrenal function must be addressed first before attempting to raise thyroid levels. This is done with a salivary cortisol test and a nutritional supplement program over 6 weeks as described above. In the event the patient is already taking thyroid hormone medication which doesn't seem to be working or is not tolerated, this is a red flag that most likely cause is low cortisol adrenal fatigue. Once this is addressed, the patient will do well with thyroid medication.

For More Reading:

Another excellent book on adrenal fatigue is, “From Fatigued to Fantastic”, by Jacob Teitelbaum MD.(43) Also recommended is the article, “Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia” by Kent Holtorf M.D. (44)

posted February 26, 2014 10:21 AM            

But then I just stopped eating so much sugar, and it does make a huge difference.

Now if I could just cut back on my coffee...

I take vitamin B and Calcium/Magnesium supplements, since the coffee is so hard to give up. :/

posted February 26, 2014 03:17 PM            

Violets
This thread might be helpful for you
The Benefits of Licorice Root to the Adrenal Patient