ADRENAL STRESS AND WHAT TO DO ABOUT IT
ZOLTAN P. RONA, M.D., M.Sc.
Stressed out? Chronically tired? Burned out? Allergies getting worse instead of better? Catching one infection after the next despite a good diet? Premature menopause? If you are coping with some or all of these health problems, chances are high that you are suffering from varying degrees of adrenal insufficiency.
How do the adrenals weaken?
Most commonly, different types of stress are involved. While some of these stresses are beyond our immediate control (nasty bosses, postal worker strikes, stock market crashes, unfriendly in-laws, hurricanes, etc.), many stresses weakening the adrenals are dependent on our diet and lifestyle choices. For example, a high caffeine and refined carbohydrate intake, cigarette smoking, heavy alcohol consumption and drugs too numerous to list all stress the adrenals by causing a greater than normal secretion of adrenal hormones leading to eventual depletion of stress hormone reserves. Working long hours under fluorescent lights at a sedentary job and getting little to no exercise also weakens adrenal function. So does long hours of watching television, reading newspapers filled with bad news and staring at computer screens.
Menopause is one major life event strongly connected to adrenal glandular function. In the healthy female, once the ovaries stop producing estrogen and progesterone, the adrenal glands take over production to maintain a comfortable balance. If this transition period does not occur smoothly, women entering the menopause will experience severe and often debilitating hot flashes, vaginal dryness, depression, loss of libido, accelerating osteoporosis, memory disturbances and blood sugar control problems (hypoglycemia). Adrenal insufficiency can cause exaggerated or early menopausal symptoms that create theillusion that prescription hormone replacement therapy is needed.
The ability to deal effectively with physical, chemical, emotional and other environmental stressors such as viruses, ionizing radiation and prolonged physical exertion depends largely on the health of your adrenal response.
The adrenals are a pair of glands shaped like Napoleon's hat that lie just above the kidneys. They secrete more than three dozen hormones derived from cholesterol directly into the bloodstream. Each gland, about one to two inches in length and weighing only a fraction of an ounce each, is composed of two distinct parts, the inner adrenal medulla and the outer adrenal cortex. The outer region secretes hormones known as corticosteroids of which there are three types: mineralocorticoids, glucocorticoids and the 17-ketosteroids (sex hormones).
Adrenal cortical hormones are controlled by ACTH, a pituitary hormone. The inner adrenal medulla secretes epinephrine (adrenalin) and norepinephrine (noradrenaline), the hormones that mediate the “flight-or-flight” alarm response to stress. Adrenal medullary hormones are controlled by the sympathetic nervous system.
The glucocorticoids (cortisol, corticosterone, cortisone) cause blood sugar levels to go higher, reduce inflammation and dampen the allergic response. Abnormal levels of glucocorticoids could be partially responsible for hypoglycemia or diabetes, an exaggerated pain response and poorly controlled allergies. The mineralocorticoids, the most important of which is aldosterone, cause the body to retain sodium while increasing potassium excretion. Abnormal aldosterone levels can therefore create imbalances between sodium and potassium and, consequently, fluid levels in the body. The major sex hormone produced by the adrenal cortex is the androgen, DHEA (dehydroepiandrosterone) which is then converted into other sex hormones (testosterone, estrogens, progesterone).
Shades of Imperfection
Conventional medicine categorizes adrenal function as either normal, low (adrenal insufficiency a.k.a. Addison’s disease) or high (Cushing’s Syndrome, a rare disorder caused by an overactive adrenal cortex). Most individuals affected by suboptimal adrenal function fall between these two extremes and are left without any medical solution to their health problems.
Adrenal weakness is at the bottom of poorly controlled stress conditions ranging from anxiety, allergies and recurrent infections to hypoglycemia, depression, autoimmune disease and chronic fatigue of unknown cause. If the initial screening tests fail to show either low or high levels of various steroids, reductionistic medical thinking, regardless of patient signs and symptoms, is that adrenal function is normal. Studies, however, show that adrenal function can be compromised long before abnormalities start appearing in such laboratory tests and that the use of adrenal glandular support reverses signs and symptoms and replenishes depleted organ reserves.
Signs and Symptoms of Weak Adrenal Function
The many signs and symptoms of adrenal insufficiency are often brushed off by conventional doctors as “nerves” requiring a prescription for anti-depressants, tranquilizers or estrogen. Many of these signs and symptoms, however, should alert both doctor and patient to look deeper into organic sources with the use of special tests (e.g. glucose tolerance test, cortisol, DHEA, hormone challenge tests, etc.). The results of these tests could provide a more definitive diagnosis.
An inability to concentrate, excessive fatigue, nervousness, irritability, depression and anxiety are the commonest symptoms associated with poor blood sugar control (hypoglycemia or diabetes) and ultimately to adrenal glandular weakness. Lightheadedness or dizziness, faintness or fainting as well as insomnia are also common problematic blood sugar control symptoms. So are cold, clammy palms and red palms or fingertips.
Progesterone is one of the most important hormones secreted by the adrenal gland. Progesterone has a major role to play in healthy menstruation, bone building and fertility. Many women who suffer from hot flashes, vaginal dryness, mood swings and premenstrual syndrome symptoms (fluid retention, depression, food cravings, breast pain and tenderness) are often suffering from relatively low progesterone levels which can often be corrected by normalizing adrenal function.
The adrenal glands are responsible for blood pressure control. If you have access to a blood pressure measuring device there is a simple self test you can use if you suspect low adrenal function. Take or have someone take your blood pressure several times both reclining and standing. If your blood pressure is usually somewhat on the low side (postural hypotension) on standing (105/60) but elevated to (120 or 130/70 or 80) on reclining, chances are high that your adrenals are malfunctioning. There should be very little difference between standing and reclining blood pressures if adrenal function is optimal.
Other, lesser known signs of adrenal weakness or insufficiency are:
Skin thin, dry or scaly Skin pigmentation of temples Exaggerated reflexes Angular appearance with long arms and legs (span is greater than the height) Inflammation of lymph glands of the neck (swelling, pain, or tenderness) Thin-muscle type (asthenic habitus) Sparse hair on body, but usually a full head of fine and abundant hair. Typically blond and blue eyed, or red headed with skin allergies Crowded lower teeth - with a high palatal arch (roof of mouth) Pain and tenderness over adrenal area when pressure is applied.
(Positive Rogoff's sign). Scanty perspiration (except under arms or hands and feet).
The Adrenal Insufficiency Connection
A long list of suboptimal health conditions and diseases are stress-related and stem from a weak or an exaggerated adrenal response. The following is just a partial list of conditions requiring adrenal glandular support:
Anxiety/Panic attacks Asthma Autoimmune diseases (e.g. fibromyalgia & chronic fatigue syndrome, Graves’ disease, multiple sclerosis, rheumatoid arthritis, etc.) Cancer Diabetes Mellitus (Type II) Depression Headaches (tension, migraine) Hypoglycemia Infertility Premature menopause Menstrual problems (premenstrual syndrome, dysmenorrhea, menorrhagia, amenorrhea) Multiple chemical hypersensitivity / allergies Recurrent flus, colds and other infections
Adrenal Glandular Support
The vast majority of cases requiring adrenal glandular support programs can help themselves without prescription hormones. A combination of diet and lifestyle changes with or without nutritional supplements is usually all that’s required.
Diet: avoid foods and beverages that unnecessarily stress the adrenals, especially alcohol, caffeine, tobacco, fried foods, processed foods, pork, sugar and refined carbohydrates. A high percentage of symptomatic individuals are allergic to gluten (wheat, spelt, rye, barley, oats) and casein (dairy products) and should avoid these foods altogether. Unless allergic to them, eat more deep water ocean fish, salmon, tuna, trout, fresh fruits and green leafy vegetables, garlic, onions, shiitake or maitake mushrooms, olives and legumes.
Lifestyle: regular moderate exercise, meditation, biofeedback or other relaxation techniques to reduce stress; in more severe cases, consultation with a health care provider is required.
Nutritional and Herbal Supplements (dosages are dependent on severity of symptoms and individual tolerances):
Multiple vitamin and mineral supplement Green drink (spirulina, chlorella, barley, kamut, etc.) Bee pollen B complex vitamins with extra vitamin B5 (pantothenic acid) or royal jelly Vitamin C and bioflavonoids Raw adrenal extract Raw liver extract Coenzyme Q10 Astragalus Echinacea Licorice root (can raise blood pressure if used excessively) Milk thistle Siberian ginseng.
Hormone replacement: In more severe cases that fail to respond adequately to the natural approach, low dose adrenal hormones could be prescribed for short periods of time. These include:
DHEA Pregnenolone Cortisol Testosterone Progesterone Estrogens
The use of steroid drugs (e.g. prednisone) for extended periods of time can cause the shrinking (atrophy) of the adrenal glands and should be monitored regularly to prevent long term side effects. This is far less likely to occur when one takes low dose DHEA, pregnenolone or other natural steroids but should not be ignored as a remote possibility. For more information on reversing adrenal woes, see the references below and consult a natural health care practitioner for an individualized adrenal enhancement regime.
Cleare, Anthony, J. and Wessely, Simon, C., Chronic Fatigue Syndrome: A Stress Disorder?British Journal of Hospital Medicine, 1996;55(9):571-574.
Freeman, Roy, M.D. and Komaroff, Anthony L., M.D., Does the Chronic Fatigue Syndrome Involve the Autonomic Nervous System?" American Journal of Medicine, 1997;102:357-364.
Goldberg, Samuel, M.D., et al. Adrenal Suppression Among Asthmatic Children Receiving Chronic Therapy With Inhaled Corticosteroid With and Without Spacer Device, Annals of Allergy, Asthma and Immunology, March, 1996;76:234-238.
Rubin, Robert T., et al. Adrenal Gland Volume in Major Depression: Relationship to Basal and Stimulated Pituitary- Adrenal Cortical Axis Function," Biological Psychiatry, 1996;40:89-97.
Selye, H. Stress in Health and Disease. Buttersworth, London, UK, 1976.
Tintera, John W. HYPOADRENOCORTICISM, 1969; the Adrenal Metabolic Research Society of the Hypoglycemia Foundation, Inc., 153 Pawling Avenue, Troy, New York, USA 12180.
Tintera, John W. The Hypoadrenocortical State and Its
Management,: N.Y. State J. of Med., Vol. 55, No. 13, 7/1/55.
Wilder, Ronald, L. Adrenal and Gonadal Steroid Hormone Deficiency in the Etiopathogenesis of Rheumatoid Arthritis, Journal of Rheumatology, 1996;23(suppl 44):10-12.