Nutrition and lifestyle management in populations with adrenal fatigue

Adrenal fatigue is a condition that occurs when the adrenal gland become stressed and burned out, due to physical, psychological, or lifestyle based issues, decreasing the output of the adrenal hormones, with repercussions that affect the whole body, and which results in the presentation of a variety of symptoms, the most notable of which is fatigue. Adrenal fatigue is a relatively new syndrome, at least in terms of its labeling and diagnostics. In fact, it has not as yet been widely accepted as a condition in mainstream medicine, but by a small group of doctors, who are mostly naturopaths or functional medicine practitioners.

Adrenal fatigue has been labeled by Dr Wilson (2003), the author of one of the first published books on the subject, as “the 21th century stress syndrome”, as long standing non abating stress of various origins is at the root cause behind this condition. Many kinds of stress may lead to this condition, as any form of chronic long standing pressure that triggers an adrenal response, may in the long run result in the adrenal glands becoming fatigued, with the symptomatology that ensues.


Causes and symptoms of adrenal fatigue

Causes

Stressors that may precipitate an adrenal response are the following:

•  Physical Stressors- such as a diet poor in nutrients or high in sugars and toxins; ongoing unresolved physical illness; unresolved dental problems, such as abscesses or gum infections; smoking; lack of exercise or excessive exercise; lack of sleep (which can also be a symptom of adrenal fatigue); too much caffeine, alcohol or prescription drugs; repeated or major surgeries; menopause or perimenopause.
• Emotional and Psychological Stressors – ongoing relationship problems; aftereffects of unresolved childhood trauma; death of a loved one; divorce; unemployment; financial issues; stresses at work; over-working; fast paced lifestyle.
• Environmental Stressors – repeated  exposure to environmental toxicity such as molds or harsh chemicals;
• Infectious Stressors – recurring or chronic infections such as bronchitis, sinusitis and other respiratory infections; ongoing dental infections; ongoing yeast infections; systemic yeast overgrowth.
• Or a combination of these.

(Lam, 2005; Wilson, 2003)

Usually adrenal fatigue happens as a result of a combination of several of the above stressors which are present over a period of time. For example if a person suffers a death of a family member, coupled with financial issues and a poor diet, they may develop adrenal fatigue.  This is because every time the body is under stress, the adrenals respond to that stress with the fight or flight response, secreting adrenal hormones. Over a period of time, if the stressors are ongoing, the adrenal glands will become depleted. Hormone production in the first stages of the condition will spike, but eventually the adrenal hormone response will decrease. In extreme cases the adrenal gland can become completely exhausted, causing severe health issues including death (Wilson, 2003; Lam, 2005).



Signs and symptoms of adrenal fatigue

There are various signs that show the presence of adrenal fatigue, the degree of which depends on the level of progression of the exhaustion of the adrenal glands. Common signs of adrenal fatigue are as follows:

•    Difficulty getting up in the morning
•    Continued fatigue not relieved by sleep
•    Craving salt or salty foods
•    Lack of energy
•    Decreased sex drive
•    Decreased ability to handle stress
•    Increased effort in carrying out daily tasks
•    Increased time in recovery from illness, injury or trauma
•    Light headed when standing up quickly
•    Mild depression
•    Less enjoyment and happiness in life
•    Increased PMS
•    Symptoms increase if meals are skipped, light or inadequate
•    Fuzzy unfocused thinking
•    Decreased tolerance to people and irritation
•    Low energy between 3pm-4pm, followed by a surge in energy after 6pm or late at night after 11pm
•    Decreased productivity

(Wilson, 2003)

Symptoms of more advance adrenal fatigue are insomnia, usually with waking occurring at 3am, with inability to go back to sleep until about 6am (due to a disruption of the cortisol cycle), anxiety, low blood pressure, muscle pain, multiple chemical sensitivities, food allergies, low body temperature, menstrual irregularities,  heart palpitations, respiratory infections and hypoglycemia (Lam, 2005).

Symptoms of Adrenal Fatigue may appear multiple and varied because many systems of the body become concurrently dysfunctional. For example, salt craving and low blood pressure can be attributable to hormone aldosterone deregulation. Heart palpitations can be due to sympathetic nervous system over activity. Muscle and joint pain are often due to the catabolic state of the body. Insomnia may be due to metabolic imbalances, and PMS due to excessive estrogen (Lam, 2005).

In addition to the above symptoms, many recognized conditions are related to adrenal fatigue, including irritable bowel syndrome, metabolic syndrome, polycystic ovarian syndrome, diabetes, hypotension, estrogen dominance, obesity, hypothyroidism, and auto-immune diseases (Lam, 2005).


The physiology of adrenal fatigue

The adrenal glands are two small glands, each about the size of a large grape. They are situated on top of the kidneys. Their purpose is to help the body cope with stress and help it to survive. Each adrenal gland has two compartments. The inner compartment modulates the sympathetic nervous system through secretion and regulation of two hormones, called epinephrine and norepinephrine, which are responsible for the fight or flight response. The outer adrenal cortex comprises eighty percent of the adrenal gland and is responsible for producing over fifty different types of hormones in three major classes - glucocorticoids, mineral corticoids and androgens (Lam, 2005).

The most important glucocorticoid is cortisol. When cortisol is lowered, the body is unable to deal with stress (Lam, 2005).
Mineralcorticoids, such as aldosterone, modulate the delicate balance of minerals in the cell, especially sodium and potassium. It therefore regulates our blood pressure and the fluid in the body. Stress increases the release of aldosterone, causing sodium retention (leading to water retention and high blood pressure) and the loss of potassium and magnesium , which is what occurs in the early stages of adrenal fatigue. Magnesium is involved in over three hundred enzymatic reactions in the body. When the body lacks magnesium, it will suffer from a variety of pathological conditions (Lam, 2005).

The adrenal cortex is also responsible for producing all of the sex hormones, although in small amounts. One exception is DHEA, a weak androgenic hormone that is made in large amounts in both sexes. DHEA, together with testosterone and estrogen, are made from pregnenolone (Lam, 2005).

Pregnenolone also leads to the production of progesterone and is one of the intermediary steps in the making of cortisol. Pregnenolone is therefore one of the most important intermediate hormones being produced in the hormonal cascade. Prolonged deficiencies in pregnenolone, which are found in adrenal fatigue, will lead to the reduction of both glucocorticosteroids and mineral corticoids such as cortisol and aldosterone (Lam, 2005).

As we can see most of the hormonal cascades occurring in the body are linked in one way or another to the adrenal hormones, hence why multiple systems in the body become deregulated when the adrenal glands become fatigued or begin to fail.

Cortisol

The most important anti-stress hormone in the body is cortisol. Cortisol protects the body from excessive adrenal fatigue by:

• Normalizing blood sugar level. Cortisol increases the blood sugar level in the body, thus providing the energy needed for the body to physically escape threat of injury in order to survive during situations that trigger the flight or fight response. More energy is required when the body is under stress and cortisol is the hormone that makes this happen. When the adrenals are fatigued excessive cortisol is secreted during the early stages of the condition. In the later stages, when the adrenal glands become exhausted, cortisol output is significantly reduced.
• Anti-inflammation Response.  When we have a minor injury or a muscle strain, the body's inflammatory cascade is initiated, leading to swelling and redness commonly seen when an ankle is sprained or you have an insect bite. Cortisol is secreted as part of the anti-inflammatory response. It's objective is to remove and prevent swelling and redness of nearly all tissues. These anti-inflammatory responses prevent mosquito bites from enlarging, bronchial stress from forming, and eyes from swelling shut from allergies, etc. People with adrenal fatigue are therefore prone to inflammation and small bites and cuts do not easily heal.
• Immune System Suppression. Cortisol influences most cells that participate in the immune reaction, especially white blood cells. Cortisol suppresses white blood cells, natural killer cells, monocytes, macrophages, and mast cells. People with high cortisol levels are therefore often immunologically weak.
• Vaso-constriction. Cortisol contracts mid-size arteries and tends to increase blood pressure. People with low cortisol have low blood pressure and reduced reactivity to other body agents that constrict blood vessels.
  In summary, cortisol sustains life via two opposite, but related, regulatory actions: releasing and activating the existing defense mechanisms of the body, while shutting down and modifying the same mechanisms to prevent them.  People with adrenal fatigue therefore cannot tolerate stress and will as a result experience even more severe stress. As their stress increases, progressively higher levels of cortisol are required. When the cortisol level cannot rise in response to stress, it is impossible to maintain the body in optimum stress response and the body becomes debilitated (Lam, 2005).

The female body and adrenal fatigue

Fatigued  adrenals and estrogen dominance

Fatigued adrenals result in a reduction of the adrenal produced sex hormones, including a reduction in progesterone output. In a woman this tilts the estrogen to progesterone ratios in favor of an excess of estrogen. Excessive estrogen in turn causes insomnia and anxiety, which further taxes the adrenal glands. This leads to a further reduction in progesterone output and even more estrogen dominance. After a few years in this type of vicious cycle, the adrenal glands become exhausted. This dysfunction leads to blood sugar imbalance, hormonal imbalances, and chronic fatigue (Lam, 2006).
Estrogen dominance is the root cause of a host of female health issues. Conditions associated with this include fibrocystic breast disease, PMS, uterine fibroids, breast cancer, endometriosis, infertility problems, endometrial polyps, polycystic ovarian syndrome, auto-immune disorders, low blood sugar problems, and menstrual pain, etc. (Lam, 2006)

Adrenals during menopause and perimenopause

Adrenal hormones are important to healthy menstruation. The adrenal glands are the only source of testosterone in women, and after menopause are the only source of the female hormones, estrogen and progesterone. These and other adrenal hormones play a major role in menstruation, sexual function, physical and psychological well-being, and the aging process, among other things. When these hormones are low, a number of unpleasant physical and psychological symptoms can occur. It has been observed clinically that many women experiencing adrenal fatigue, also experience PMS and tend to have difficulty during perimenopause and menopause (Wilson, 2002).

When women enter perimenopause and menopause, the ovaries slow their production of estrogen and progesterone, and the adrenal glands have to intervene to compensate hormone production for menopause to proceed smoothly. If the adrenals are already fatigued, it may be more difficult to meet this extra demand for hormone production. In fact, the adrenals may become even more depleted by the additional requirement made on them by the hormonal changes present in perimenopause and menopause, creating a vicious cycle (Wilson, 2002).


Recovering from adrenal fatigue

Recovering from adrenal fatigue can be a challenging process, with many setbacks, a healing journey that can last from a few months to many years, depending on the severity of the exhaustion of the adrenal glands, how many other systems in the body are affected, and the measures taken to recover. Regardless of which approach is chosen, recovery from adrenal fatigue is usually gradual. People often experience temporary setbacks and plateaus which can be experienced as discouraging. Whatever approach is chosen, it is important to persevere long enough to see results and to continue despite apparent lack of progress (Wilson, 2003). Aside from supplementation, to support the body’s systems that have become unbalanced due to the disruption of the hormonal cascade, a large part of the road to recovery consists in removing all possible stressors from the body, both those responsible for creating the adrenal fatigue at the onset, and any other possible sources of adrenal stress that the body may have created due to the exhaustion of the adrenal glands themselves (Fatayerji, 2004)


Physical body approaches

There are many things that can be done at the physical body level to support the recovery of the adrenal glands from fatigue.

Rest

Rest is very important in adrenal fatigue recovery. Aside from the obvious cutting down on overwork or any situation that will fatigue the mind or the body, it is also important to get enough sleep and for that sleep to be restful. The cortisol cycle is unbalanced in people with adrenal burn out and difficulty sleeping or staying asleep is a symptom of such disruption. It is important to sleep at correct points of the adrenal/cortisol cycle, so as to deepen sleep and for rest that is restorative. To get the most restorative sleep, it is wise to go to bed before 10:30pm, before the second wind of the cortisol cycle kicks in, which jolts the body awake. To stay asleep it is advisable to take magnesium citrate supplements before going to bed, with a light protein snack. This helps avoid the bottoming out of the cortisol cycle that causes people to wake up at around 3am. Also for those that do not have early work commitments, it is wise, if possible to sleep between 6am and 9am, as sleeping at this time helps raise cortisol levels. Sleeping between 6am and 9am is not only restorative for the adrenals, but also helps avoid the cortisol and energy lows that many sufferers experience in mid afternoon.

Supplements

A variety of supplements can help people with adrenal fatigue. Particularly useful are all the B vitamins, including B12, as these are essential in the adrenal hormonal cascade; vitamin C, as it stimulates adrenal function and the immune system; Vitamin E, as it is useful at several stages of the adrenal hormone cascade; minerals, especially magnesium and calcium, are also useful, as are the trace minerals. Adrenal extracts can also be useful (Wilson, 2003).

In women it is also useful to supplement with Omega 3 fatty acids and GLAs, which can be found in healthy fats such as Oil of Primrose. In perimenopausal and menopausal women progesterone creams can also help counteract estrogen dominance and its ensuing symptoms.

With all supplements it is important that they be of high quality, as organic as possible and that they do not trigger any allergy or sensitivity, as this can further stress the adrenals. In severe cases of adrenal burnout supplementation needs to be very carefully monitored and ideally needs to occur under the supervision of a physician or naturopath, as in compromised individuals, erroneous supplementation can trigger an adrenal crash or crisis, worsening the condition (Lam, 2009).


Nutrition

Balanced regular nutrition and removal of food allergens and food sensitivities is essential for adrenal recovery. Meals need to be frequent, small, balanced and regular. Regular meals, preferably six meals a day, as to avoid hypoglycemic attacks. Hypoglycemic attacks are very stressful for the adrenal glands and can precipitate adrenal crisis. Hypoglycemia is almost always present in the medium to advanced stages of adrenal fatigue, as the disrupted adrenal cascade, disrupts insulin response as well as the ability of the liver to store glycogen (stored sugar reserves). Sugar and energy drops are a real issue for adrenal sufferers. Small frequent balanced meals, with complex carbohydrates, high quality proteins and fats, no sugars, and the least amount of chemical additives possible, will usually provide the nutrition required and avoid blood sugar imbalances (Wilson, 2003).

It is also beneficial to get tested for chemical sensitivities, as during adrenal fatigue, the body develops inflammatory and autoimmune responses to many foods. The autoimmune response is stressful to the adrenals, so eliminating food allergens/sensitivities is also a ways to rest the adrenals. Food sensitivities will usually lessen as the adrenals heal and often these foods can be added back into the diet at a later time (Fatayerji, 2004).

Detoxification

Accumulation of toxins in the body can trigger and worsen adrenal fatigue. However a body in which the adrenals are fatigued is especially weak. Fasting and detoxifying are therefore not always advised, and can even be counterproductive. Improper or excessive detoxification are a common setback in adrenal recovery. Aggressive detoxification and fasting, while excellent for supporting the recovery of toxic illnesses such as cancer, not only drains the already fatigued body of energy, but releases stored toxins into the blood stream that an adrenal compromised body is not able to process. Most with advanced adrenal weakness are unable to excrete and clear toxins from the body in a timely manner, leading to a state of retoxification, which increases the stress load on the adrenals significantly. Gentle detoxification may be considered when the adrenal function is healthy, or fatigue is mild. Generally, a gentle and complete healthy organic nutritional program aimed at rebuilding adrenal function and all compromised body systems is best. As adrenal function returns, toxin elimination will occur spontaneously in a more manageable way (Lam, 2005).

Exercise
Exercise is very beneficial for adrenal recovery, but it must be gentle and enjoyable. Exercise that is competitive or that pushes the body is not beneficial for adrenal sufferers, as it will act as a stressor and exacerbate the condition. However gentle exercise, such as stretching, walking, yoga, or slow strength building exercise with weights, is beneficial, as it helps regulate hormones, assists in the elimination of toxins, supports liver function and the optimum functioning of the lymphatic system. It also can help reduce stress and support relaxation. Mild but regular exercise is a good addition to any adrenal recovery program (Wilson, 2003).

Resolve illness or infection

If there is any chronic illness responsible for depleting the adrenals, especially dental infections, these need to be taken care of. There have been many cases in which full recovery was not achieved until dental problems were resolved, including extraction of root canals (Wilson, 2003).



Psychological and emotional approaches

Since there can be emotional and psychological origins to the stresses that precipitate adrenal fatigue, it is important to identify these stressors and work towards reducing them or eliminating them from one’s life.
If there are any unresolved issues from childhood or post traumatic issues of any kind it is wise to seek to resolve these with therapy or other healing approaches. If there are any psychological patterns that are at the root of fear and anxiety these need to be resolved. Many people who suffer from adrenal fatigue, for a variety of reasons, are fearful of life and can be negative thinkers. For example adults who experienced abuse in childhood, may have learned to see the world as frightening and overwhelming and still be suffering from post traumatic stress disorder in particular situations that act as triggers. The same may be the case for individuals raised by anxious parents and who were not taught how to adequately deal with stress, problems or conflict. In many cases some form of psychological healing is essential for full recovery.

Learning how to relax and put one’s mind at rest is also essential, as is the introduction of free form time, play and enjoyable activities. This is particularly useful for those whose adrenals became fatigued due to overwork and excessive focus on achievement.

Many adrenal sufferers also benefit from taking an honest look at their relationships. If there are toxic relationships with significant others, emotionally draining friendships or otherwise energy depleting situations in one’s life, these need to be eliminated or curtailed (Wilson, 2003).


Spiritual approaches

The spiritual approach is not suited for everybody, as not all people are comfortable with the idea of a higher power, a divine principle or the subtle energy aspects of life. However for those that do, spiritual approaches can help considerably in the healing of adrenal fatigue. As mentioned in the psychological approach section, people with burned out adrenals often have an underlying belief that the world is a dangerous place or that they are inadequate to meet their tasks and are running some degree of negative, worry based, stressful self talk at the mind level of their being. A strengthening with the relationship with a higher power, to which concerns and worries are surrendered to, can be very beneficial. Affirmations such as “All is well”, “ The universe is a safe place”, “ I am one with my higher power who easily takes care of all my concerns”, “I surrender to the higher flow”, “ I am relaxed in the hands of Spirit and all my worries are handled as is for the highest good”, “ I trust in the divine plan” can be very helpful stress soothing mantras.

Also useful are spiritual healing approaches or energy psychology approaches, eliminating stress from the body and energy field energetically or engaging in processes that clear the lower chakras. Stress is often a base chakra issues, as the base chakra is associated with feeling secure and rooted in the world. Stress can also be linked to third chakra issues. When a tendency to fear and stress is present, alongside with dealing with the underlying psychological root causes, it can be useful to also work energetically on the base chakra itself, either in meditation or supported by an alternative practitioner.

Meditation and guided imagery processes, with a focus on peace and relaxation, and the healing of body and mind, with an aim to make the adrenal sufferer more connected to a still benign personal and universal flow, are also beneficial.



Conclusion

Adrenal fatigue is a modern condition that is related to our contemporary busy and stressful lifestyle. Personal challenges, poor nutrition, and a psychological makeup prone to anxiety of various origins, are common contributors to the developing of this syndrome. Hormonal changes can also contribute, precipitating the condition in perimenopausal and menopausal women. The road to recovery requires multiple approaches, physical, psychological and spiritual. Elimination of stressors, rest, good nutrition, and resolution of imbalances are essential to rebuilding the adrenals and the body systems impacted by the disrupted adrenal hormonal cascade. Set backs are to be expected, but perseverance and consistency will usually reverse the condition within a few years at most. As this is a condition created by ongoing lifestyle issues, the path to recovery requires a deep lifestyle change. If recovery is embraced as an opportunity for personal growth, it can become a vehicle for a very positive experience. When what does not work is discarded, what is broken is healed, and new healthier habits are learned, a new way of being can emerge. As with all challenging illnesses, adrenal fatigue can be an opportunity for change, betterment of life and personal evolution. 


Copyright 2011 Katie Gallanti. This article is a summary on adrenal fatigue, consult references for sources of the information. Consult authors Dr Lam and Dr Wilson for expert advice and treatment, to whom goes much of the credit regarding the information in this article, in particular the parts on physiology and physical approaches.


References

Fatayerji, D. (2004). How to heal from adrenal fatigue. North County Press.
Lam, M. (2005). Ovarian-Adrenal Imbalance. Retrieved on January 7th 2011 from http://www.drlam.com/articles/ovarian_adrenal_thyroid.asp
Lam, M. (2006). Estrogen Dominance (The Silent Epidemic). Retrieved on Jan 6 2011 from http://www.drlam.com/articles/Estrogen_Dominance.asp
Lam, M. (2009). Seven adrenal recovery mistakes. Retrieved on January 9th 2011 form http://www.drlam.com/adrenalfatiguecenter/7mistakesofadrenalfatigue.asp
Personal Wellness Network (2005). Adrenal exhaustion. Retrieved on January 7 2011 from http://www.safemenopausesolutions.com/adrenalexhaustion.html
Wilson, J. (2003) Adrenal fatigue: The 21st century stress syndrome. Smart Publications.
Wilson, J (2002) PMS and menopause. Retrieved Jan 6 2011 from http://www.adrenalfatigue.org/adrenal-fatigue-related-health-conditions/syndrome-x-and-burnout.html
Wilson, J. (2002) Syndrome X and burnout. Retrieved on Jan 6 2011 from http://www.adrenalfatigue.org/adrenal-fatigue-related-health-conditions/syndrome-x-and-burnout.html