Setting Adrenal "Fatigue" Straight

Adrenal dysfunction refers to adrenal mal-functioning. Commonly however, adrenal dysfunction is blanketly referred to as ‘adrenal fatigue’ instead. The term adrenal fatigue is inaccurately used to refer to any of the stages of adrenal dysfunction. Correctly, it should strictly refer only to the third stage of adrenal dysfunction. Adrenal dysfunction is composed of 3 stages which were best described by Hans Selye some 70 years ago. He called the series of stages ‘the general adaptation syndrome,’ described here.


Stages of Adrenal Dysfunction

Stage 1: Arousal

      Both cortisol and DHEA increase with episodic stress, but recovery returns to baseline

      This may be asymptomatic     

Stage 2: Adaptation

      Cortisol is chronically elevated and DHEA declines

      Symptoms of stress arise such as anxiety attacks, mood swings, depression

State 3: Exhaustion

    Adrenal insufficiency yields low cortisol and DHEA levels

      Patients present with depression and fatigue


Patients can present with a variety of symptoms of adrenal gland dysfunction including: fatigue, low energy, weakness, moodiness, anxiety or depression, muscle and bone loss, hormonal imbalance and skin problems, to name a few. Also common is an over-reaction to stress in which a minor event causes a disproportionate reaction of anger, irritation or sadness.

What cause adrenal dysfunction

Perhaps the most obvious of all the causes of adrenal fatigue is chronic stress. I have alluded to this before however I’d like to point out here that the term ‘stress’ can refer to physical or psychological stress. For example, physical stress could include: toxins, infections, nutrient deficiencies, hormone imbalances, allergies and certain prescription medications. Psychological stress could be events such as: a divorce, an unhappy marriage, a stressful job, a difficult family life, or a lack of social or familial support. It could also come in the form of imagined stress. For instance, re-living past trauma or worrying about what people may be thinking of you, still takes the same toll on your body as any other stressful current event would. The fact is, the body doesn’t know the difference between a psychological stress – real or imagined – and a physical emergency. To the body, stress is stress; whether  physical or psychological or both.  They  are all equally detrimental to the adrenals. Another of the many causes of adrenal fatigue is poor diet. A diet high in sugar, simple carbohydrates, food preservatives, alcohol or stimulants like caffeine, leads to adrenal dysfunction. These foods cause the blood sugar to spike and in order to regulate glucose levels the adrenal cortex must produce excess cortisol. Over time, this leads to adrenal dysfunction.

Assessment and treatment of adrenal dysfunction:

The most common laboratory evaluation I use for adrenal fatigue is a 4-point salivary cortisol test. Salivary cortisol concentrations reflect the free, biologically active fraction of cortisol in the plasma and provide results that are of greater diagnostic significance than plasma total concentrations alone (Peters and Walker).

I have developed what I refer to as ‘the 3 legged’ and ‘the4 legged’ approach to treating adrenal dysfunction. At the most basic level, the first leg of my approach covers modifications in nutrition and lifestyle. Eating organically grown, phytochemically dense food that is devoid of fillers and preservatives is a must. Meals need to have a low glycemic load and good sources of clean protein. The majority of your plate (about 2/3) must be composed of vegetables, and a few servings of low glycemic load fruits can be included as well. Chewing food appropriately and hydrating well are also important. Next in leg 1 is the lifestyle component. This includes exercise that is appropriate for the stage of adrenal dysfunction. A person in stage 1 adrenal dysfunction with high cortisol levels would need more of an aerobic program, whereas someone in stage 3 needs more gentle movement that will not cause further stress to the body. I also address the level of stress in one’s life and how to best modify it. It is crucial to have hobbies that are enjoyable and a relaxation protocol that really works for each particular patient. The second leg involves tailored nutraceuticals that help heal and reverse the adrenal dysfunction. This can include nutraceuticals like a B-Complex with B6 in the activated or P-5-P form, 5-MTHF, biotin, omega 3 fatty acids, vitamin C and zinc. These are all the well researched vitamins and minerals that help heal the adrenals. The 3rd leg is adaptogens. Adaptogens are herbs and botanicals that help the body adapt to the stressors and also may facilitate communication between the adrenals and the higher centers of the brain. The 4th  and optional leg is hormonal supplementation. Hormonal supplementation can help the adrenals recover more quickly and may assist both the brain and adrenals to re-establish their balance and connection together. The most commons hormones I use are DHEA and pregnenolone in very low doses. I only use hormones along with the other 3 legs. Luckily, in many cases we may only need the first 3 legs to bring the patient back to balance.

A Final Word

In conclusion, the most important aspects of addressing adrenal dysfunction are to stage the patient and understand the root cause of the dysfunction. Then, and only then, can a personalized approach utilizing functional medicine tools be tailored to the individual needs of each patient.With focus and attention to the nutritional content of the diet, lifestyle modification, supplementation with vitamins, minerals, adptogens and possibly hormones, the good news is that it is fully possible to achieve a complete recovery from adrenal dysfunction.  

Are You Toxic?

We live in a toxic world.  Toxins are everywhere and affect every aspect of our health. Therefore the question we should all be asking is not ARE we toxic, but rather HOW toxic are we?  The increasing rates of insulin resistance, diabetes, cancer, hormonal problems and obesity in the United States in large part is due to toxins.  This link has been studied by several researches and several studies explain the mechanisms (1, 2, 3, 4,10,12, 13).  Many of these toxins are environmental xenobiotics or “endocrine disruptors” that modify intercellular communication and function.  Chemicals commonly detected in people including DDT, Polychlorinated biphenyls (PCB's), Bisphenol A, Polybrominated Diphenyl Ethers (PBDE's) produce a higher ratio of the 4 and 16 hydroxylated estrogen derivatives.  

These are potentially more genotoxic by modifying members of the CYP450 enzyme family and thus contributing to hormonal dysfunction and cancer.  Changes in DNA methylation (epigenetic modification) which can ultimately change estrogen receptor activity are thought to also play a role in cancer, obesity, and insulin resistance.  Low level arsenic exposure has also been reported to be associated with insulin resistance and diabetes (5). Exposure to heavy metal toxicants is almost unavoidable in today’s world. We are routinely exposed to heavy metal toxins through food, ground water, industrial waste and exposure to industrial environments.  Heavy metals affect all our organ systems but particularly the cardiovascular and nervous systems (6,7)The increasing rates of allergies, asthma, fibromyalgia, multiple chemical sensitivities, and neurological conditions—particularly movement disorders and tremors have also been linked to toxins (8,11, 13). This is in large part due to the effect of toxins on our mitochondria.

The problem becomes even more daunting when you consider the exposure to toxins is happening before we are born. In a study spearheaded by the Environmental Working Group (EWG) in collaboration with Commonweal, researchers at two major laboratories found an average of 200 industrial chemicals and pollutants in umbilical cord blood from 10 babies born in August and September of 2004 in U.S. hospitals (9). Tests revealed a total of 287 chemicals in the group. The umbilical cord blood of these 10 children, collected by Red Cross after the cord was cut, harbored pesticides, consumer product ingredients, and wastes from burning coal, gasoline, and garbage.  

This study represents the first reported cord blood tests for 261 of the targeted chemicals and the first reported detections in cord blood for 209 compounds. Among them are eight perfluorochemicals used as stain and oil repellants in fast food packaging, clothes and textiles (including the Teflon chemical PFOA, characterized as a likely human carcinogen by the EPA's Science Advisory Board) dozens of widely used brominated flame retardants and their toxic by-products; and numerous pesticides.

Of the 287 chemicals detected in umbilical cord blood, we know that 180 cause cancer in humans or animals, 217 are toxic to the brain and nervous system, and 208 cause birth defects or abnormal development in animal tests. The dangers of pre- or post-natal exposure to this complex mixture of carcinogens, developmental toxins and neurotoxins have never been studied. So, how do we know if toxins are responsible for the problems we are seeing? What signs do we look for?  What can we do about it? First, Let’s review the signs of potential toxicity.  Then we will go over a practical approach.

Common symptoms indicating excessive toxins:

— Fatigue

— Depression

— Headaches

— Cognitive problems 

— Brain fog 

— Memory problems

— Neurological issues 

— Balance problems 

— Tremors

— Muscle aches/achiness

— Breathing difficulties

— Skin conditions

— Autoimmune disorders

— Chemical sensitivities 

We must assume we are all toxic to some degree and tailor a detoxification program that can be incorporated into our daily routine. This means looking at our genetic predispositions if possible, our family history and our exposures throughout our personal history.  If we are not able to do genetic testing then we must implement a detoxification program that encompasses the most common genetic single nucleotide polymorphisms (SNPs). We need to be aware of our exposures and how to minimize them. Starting with our exposure to household cleaners, detergents, fabric softeners, personal care items including make-up, shampoos, creams and lotions. We must assume we are all toxic to some degree and tailor a detoxification program that can be incorporated into our daily routine. This means looking at our genetic predispositions if possible, our family history and our exposures throughout our personal history.  If we are not able to do genetic testing then we must implement a detoxification program that encompasses the most common genetic single nucleotide polymorphisms (SNPs).

We need to be aware of our exposures and how to minimize them. Starting with our exposure to household cleaners, detergents, fabric softeners, personal care items including make-up, shampoos, creams and lotions. For every synthetic, toxic cleaning supply there are more green alternatives including essential oils, vinegar and baking soda. Green alternatives can be found at several websites (14, 16, 17).  Look for natural alternatives to chemical weed and bug killers and take preventative measures such as mulching for weeds and using traps, barriers, fabric row covers, or plant-based repellants to get rid of pests. Limiting our exposure to processed and genetically engineered foods, high fructose corn syrup, pesticide laden fruits, vegetables and meats where the animal was treated un-humanely and with antibiotics and/or hormones. Limiting our exposure to plastics, especially the contact with our food and water is essential. We need to increase our consumption of cold water fish, free range meats, organic fruits and vegetables, nuts and seeds. 

Next include a targeted personalized detoxification based on each individual’s unique gene-environment interaction that begins with the food we eat and the water we drink. Particularly we want to eat organic whenever possible and nutrient dense food with a high antioxidant load (15). Then we add known ingredients/supplements/nutrients into our diet that help us eliminate toxins. Lastly, we implement lifestyle changes that help us not only detoxify - like exercise, massage, far infrared sauna, but also decrease our exposure to the stress chemicals our bodies produce.  We include supplements known to affect both phase 1 (oxidation) and phase 2 (conjugation) detoxification in the liver (18,19,20).

In summary, being aware of the effects of toxins on our physiology, identifying our sources and removing them as much as possible is a great way to start reducing our toxin load.  Next we add clean, wholesome detoxifying foods to our diet that will improve detoxification and biotransformation.  This is further augmented with personalized specific nutrients knows to aid in liver detoxification. Lastly we implement lifestyle modifications that will not only help us detoxify but also help us process our stress hormones in order to further decrease our total body load.

References:

1.  1. Latini et al., Mini-Reviews in Medicinal Chemistry, 2010, 10, 846-855.

2.  Soto, A. M. & Sonnenschein, C. Nat. Rev. Endocrinol. 6, 363–370 (2010).

3.  Alonso-Magdalena et al. Endocrine disruptors in the etiology of type 2      diabetes mellitusNat Rev Endocrinol. 2011 Jun;7(6):346-53.

4.   Environmental Health Perspectives VOLUME 114 | NUMBER 11 | November 2006

5.  Navas-Acien A, Silbergeld EK, Pastor-Barriuso R, Guallar E.  Arsenic exposure and prevalence of type 2 diabetes in US adults. JAMA 2008; 300: 814-22.

6.   http://www.emedicine.com/EMERG/topic237.htm .

7.  Houston MC. Altern Ther Health Med 2007;13(2):s128-33

8.  Exner N, Lutz AK, Haass C, Winklhofer KF. Mitochondrial dysfunction in 8.  Parkinson's disease: molecular mechanisms and pathophysiological consequences.  EMBO J. 2012 Jun 26;31(14):3038-62.

9.  http://www.ewg.org/reports/bodyburden2/execsumm.php.

10.  Acquavella J, et al.  A case-control study of non-Hodgkin lymphoma and exposure to pesticides. Cancer. 1999;85:1353-1360.

11.  Wang A, Costello S, Cockburn M, Zhang X, Bronstein J, Ritz B. Parkinson's disease risk from ambient exposure to pesticides.  Eur J Epidemiol. 2011 Apr 20.

12.  Havas, M. Electromagn Biol Med. 2008;27(2):135-46 .

13.  Havas, M.  Electromagnetic hypersensitivity: biological effects of dirty electricity with emphasis on diabetes and multiple sclerosis. Electromagn Biol Med. 2006;25(4):259-68.

14.  www.ewg.org.

15.  www.foodnews.org.

16.  http://www.thedailygreen.com/green-homes/latest/green-cleaning-spring-cleaning-460303

17.  http://www.thedailygreen.com/green-homes/latest/green-cleaning-spring-cleaning-460303#ixzz0S9ny6nP7

18.  Brown MD.  Green tea (Camellia sinensis) extract and its possible role in the prevention of cancer. Altern Med Rev. 1999 Oct;4(5):360-70. 

19.  Andrews GK. Regulation of metallothionein gene expression by oxidative stress and metal ions. BiochemPharmacol 2000;59(1):95-104.
20.  Lichtlen et al.. Bioessays. 2001;23(11):1010-7.  http://www.thedailygreen.com/green-homes/latest/green-cleaning-spring-cleaning-460303#ixzz0S9ny6nP7

18.  Brown MD.  Green tea (Camellia sinensis) extract and its possible role in the prevention of cancer. Altern Med Rev. 1999 Oct;4(5):360-70. 

19.  Andrews GK. Regulation of metallothionein gene expression by oxidative stress and metal ions. BiochemPharmacol 2000;59(1):95-104.


20.  Lichtlen et al.. Bioessays. 2001;23(11):1010-7..