Have you've been struggling with a chronic health condition that hasn't been getting better? Perhaps you are feeling fatigued in the morning even when you get a good night's sleep? Maybe you are drowsy in the afternoon yet you can't fall asleep at night? If this sounds familiar then you may be suffering from a condition called adrenal fatigue syndrome. In our chaotic and stressful modern world the impact of this condition and its downstream sister condition of leaky gut syndrome are felt by many. Other symptoms that might signal you have weakened adrenals are:
- Waking up in the mid-portion of the night
- Aches and pains
- Increased susceptibility to infections
- Reduced tolerance for stress
- Craving for sweets and salty foods
- Allergies to things you were never allergic to before
- Intestinal discomfort
- A tendency to feel cold
Although there are no recent statistics available, Dr. John Tinterra, a medical doctor who specialized in low adrenal function, said in 1969 that he estimated that approximately 16% of the public could be classified as having severe adrenal fatigue, but that if all indications of low cortisol were included, the percentage would be more like 66%. This was before the extreme stress of 21st century living, 9/11, and the severe economic recession which began in 2008.
"The adrenals are known as ‘the glands of stress," writes James Wilson in his book Adrenal Fatigue: The 21st Century Stress Syndrome. “It is their job to enable your body to deal with stress from every possible source, ranging from injury and disease to work and relationship problems. Your resiliency, energy, endurance and your very life all depend on their proper functioning.”
Adrenal fatigue occurs when your adrenal glands (small, conical organs on top of the kidneys) cannot adequately meet the demands of stress. The adrenal glands mobilize your body's responses to every kind of stress (whether it's physical, emotional, or psychological) through hormones that regulate energy production and storage, immune function, heart rate, muscle tone, and other processes that enable you to cope with the stress. Whether you have an emotional crisis such as the death of a loved one, a physical crisis such as major surgery, or any type of severe repeated or constant stress in your life, your adrenals have to respond to the stress through a mechanism called the hypothalamic-pituitary-adrenal axis (HPA). If their response is inadequate, you may experience some degree of adrenal fatigue.
The hypothalamic-pituitary-adrenal axis (HPA) is a complex set of direct influences and feedback interactions among the hypothalamus, the pituitary gland and the adrenal glands. Under stress the hypothalmus secretes corticotrophin releasing hormone (CRH) which signals the pituitary to release adrenocorticotrophin hormone (ACTH) which then stimulates the adrenals to produce a number of hormones including cortisol.
The interactions among these organs is a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality and energy storage and expenditure. It is the common mechanism for interactions among glands, hormones, and parts of the midbrain that mediate the "fight or flight syndrome." Epinephrine, DHEA, and cortisol are some of the hormones produced by the adrenals when signaled by the HPA. Cortisol however, is the hormone with the most impact on our overall well being.
Called “the stress hormone,” cortisol influences, regulates or modulates many of the changes that occur in the body in response to stress including, but not limited to:
- Blood sugar (glucose) levels
- Fat, protein and carbohydrate metabolism
- Immune responses
- Anti-inflammatory actions
- Blood pressure
- Heart and blood vessel tone and contraction
- Central nervous system activation
Cortisol levels normally fluctuate throughout the day and night in a circadian rhythm that peaks at about 8 AM and reaches its lowest around 4 AM. While it is vital to health for the adrenals to secret more cortisol in response to stress. Once cortisol is produced it signals back to both the hypothalamus and pituitary gland to suppress the production of CRH and ACTH to curtail further cortisol production. It is very important that bodily functions and cortisol levels return to normal following a stressful event. Unfortunately, in our current high-stress culture, the stress response is activated so often that the body does not always have a chance to return to normal. This can lead to health problems resulting from too much circulating cortisol and/or from too little cortisol if the adrenal glands burn out from producing too much cortisol over an extended period of time (adrenal fatigue).
One of cortisol's functions is to reduce inflammation in the body, which is good, but over time, these efforts to reduce inflammation also suppress the immune system. Chronic inflammation, caused by lifestyle factors such as poor diet and stress, helps to keep cortisol levels soaring, wreaking havoc on the immune system. An unchecked immune system responding to unabated inflammation can lead to myriad problems: an increased susceptibility to colds and other illnesses, an increased risk of cancer, the tendency to develop food allergies.
Cortisol directly and indirectly can lead to these problems. Since it suppresses the immune system it allows pathogenic bacteria to invade gut and establish themselves in the digestive tract causing damage to the intestinal mucosal lining. This imbalance between beneficial and harmful bacteria in your gut called dysbiosis is what is believed to cause increased intestinal permeability. In addition, cortisol itself can lead to openings in the tight junctions that span the distance between the cells lining the gut wall. Just as gluten or pathogens open these gateways, so too will too much cortisol lead to “leaky gut”. Leaky gut syndrome refers to a malfunctioning intestinal barrier that is allowing toxins entry to the bloodstream. Imagine what goes on in a cortisol-flooded, stressed-out body when food is consumed: Digestion and absorption are compromised, indigestion develops, and the mucosal lining becomes irritated and inflamed. This may sound familiar. Ulcers are more common during stressful times, and many people with irritable bowel syndrome and colitis report improvement in their symptoms when they master stress management. And, of course, the resulting mucosal inflammation leads to the increased production of cortisol, and the cycle continues as the body becomes increasingly taxed. Inflammation also acts upon the liver and reduces tryptophan levels in the brain:
Tryptophan is an essential amino acid that is a precursor to the neurotransmitter serotonin. Serotonin produced outside of the gut is used to regulate mood and appetite. It is also important in sleep regulation as melatonin is made from it. Serotonin is also involved in cognitive functions, including memory and learning. Alter tryptophan and you alter serotonin and everything it regulates.
Normally, cortisol levels rise during the early morning hours and are highest about 7 a.m. They drop very low in the evening and during the early phase of sleep. But if you sleep during the day and are up at night, this pattern may be reversed. If you do not have this daily change (diurnal rhythm) in cortisol levels, you may have overactive adrenal glands.
Measuring your cortisol levels can be a huge indicator as to the root of your problem. It will let you know how stress is truly impacting your overall health.
The fact that cortisol levels fluctuate in a 24 hour period is why you need to test it four times in a day. This test is called a diurnal cortisol saliva test and it can be obtained from labs such as ZRT Labs. This is a take home tests that can be done in the convenience of your own home. If you only take one reading it won't give you an accurate picture of your cortisol levels in that 24-hour period. It may be at the right level at that one time you measured, but are your levels going up, when they should be going down? Is it too high in the morning and low at bedtime? Or the other way around? This could help shed light as to why you feel the way you do at certain times of the day.
Unfortunately there isn't a handy-dandy medication to pass out like there is when your thyroid or ovaries are out of balance. In the past few decades those medications have been on the list of top ten drugs sold annually. Also, you won't see many doctors recommending adrenal or cortisol testing is because it isn't being taught in the schools yet. Although if you go to many of the seminars and study the cutting edge information, – that is not sponsored by a drug company, you will hear a lot about adrenal fatigue and how to treat it.
The foundation of any program to improve renal function begins with stress reduction. Yoga, meditation and Tai Chi are good ways to lower stress. Getting plenty of sleep and moderating strenuous exercise will also help your adrenals recover.
A good naturopathic doctor or a Medical Doctor focused on integrative health is a good place to start. Also an ayurvedic practitioner such as Sharyn Galindo at North Shore Yoga's Integrated Healing Center can help you plan the treatments and life style changes necessary to support the adrenals and improve leaky gut syndrome. Some excellent support neutraceuticals such as Cortisol Manager manufactured my Integrative Therapeutics and Ultraflora Spectrum probiotics manufactured by Metagenics are also helpful.
Thankfully, there are genuinely effective steps you can take — right now — to help your body manage the effects of stress. You can feel calmer and more in control. You’ll be able to relax and finally get good quality sleep again. It all starts with understanding more about your adrenal function and how it’s affected by daily stress.