Michael Lam, MD, MPH.
www.DrLam.com.
Content.
1. Metabolic System Imbalance.
2. Musculoskeletal System Breakdown.
3. Neurological System Dysfunction.
Fatigue and lethargy are common complaints amongst adult patients. Symptoms include tiredness, fearfulness, allergies, frequent influenza, arthritis, anxiety, depression, reduced memory and difficulties in concentrating, insomnia, feeling worn-out, inability to lose weight after extensive efforts points to adrenal fatigue. A weak adrenal system has profound systemic decompensatory actions, manifesting in a wide range of symptoms. No organ is spared. The organs affected and their resulting condition can be broadly classified into five major categories:
1. Metabolic System Imbalance. Hypoglycemia (low blood sugar) is common during adrenal fatigue. This is normally due to the combination of low cortisol and high insulin levels when the body is under stress. The normal stress response by the adrenals is to increase the blood glucose level. As the output of cortisol reduces in adrenal exhaustion, glucose released is slowed. This slowing, along with a high insulin level, leads to increased demand for glucose. Ultimately, this leads to hypoglycemia. Common symptoms of low blood sugar include dizziness and fainting. As cellular energy demand is not being met by blood glucose, the body will turn to protein and fat as sources of energy. This pathway is not as efficient but is, nevertheless, put on overdrive in order to provide required energy. Without adequate cortisol levels to elevate blood sugar levels by facilitating the conversion of glycogen, fats, and proteins to new glucose supplies, this increased demand is difficult or impossible to meet. Clinically, one of the hallmarks of adrenal fatigue is irregular blood sugar patterns with hypoglycemia. In the presence of increased insulin and decreased cortisol, blood sugar drops rapidly. Frequent small meals are needed to replenish energy needs.
Hypoglycemia itself is a significant stress on the entire body, and especially on the adrenals. While this can be overcome with a “sugar fix “consisting of an instant load of sugary drink or food such as coffee or soda, this is a short acting emergency remedy only. Usually symptoms go away immediately, but return after 1-2 hours. Reactivation and restoration of normal cell function required extra amounts of energy beyond what is normally required for maintenance of normal energy burn. With each hypoglycemic episode, more cells are damaged. Thus, the body reaches a new low with each insult of hypoglycemia. If this happens at the same time as demand for glucose increases, the stage becomes set for an adrenal crisis. With each plunge, their adrenal fatigue increases and their hypoglycemia worsens. By the end of the day, the person may feel nearly exhausted without having done anything. Low blood sugar times are most likely to occur at around 10:00 AM, 2:00 PM, and from 3-4:00 PM.
2. Musculoskeletal System Breakdown. Collagen and protein are broken down in a catabolic state of function during adrenal fatigue. This can lead to chronic pain syndromes, joint pains, chronic fatigue, and fibromyalgia.
Glucocorticoids, primarily cortisol, are steroidal hormones produced by the adrenal glands in response to stress. Cortisol output is usually high in stage 1 and 2 of adrenal fatigue. As adrenal fatigue progresses, cortisol output is often pushed to its limit. A chronically high cortisol output leads to a state of catabolism or the breakdown of protein in order to generate energy.
The cycle of breakdown or catabolism is normally followed by a process of rebuilding, or anabolism. In adrenal fatigue, the rebuilding process, normally carried out by androgens, is overwhelmed by the amount of catabolic hormones. The rebuilding process is slowed and retarded. Muscles broken down are not adequately replaced. Collagen is broken down without significant replenishment. Outwardly, wrinkles starts to develop as premature aging sets in. Internally, organ and muscle breakdown lead to chronic muscle and joint pains of unknown origin, especially after streneous exercise or heavy lifting.
As the collagen structure of internal organs breakdown, their function is compromised. Gastrointestinal track motility and contraction forces are reduced. Adrenal fatigue is often associated with the poor ability to digest protein. Common symptoms include indigestion and irritable bowel syndrome. The amount of acid production may not be sufficient to help break down food, resulting in further improper digestion.
It is no surprise that secondary fibromyalgia and chronic fatigue syndrome is commonly associated with adrenal exhaustion. Many have postulated that adrenal fatigue often precedes fibromyalgia and chronic fatigue. These may indeed be part of many symptoms of adrenal dysfunction.
3. Neurological System Dysfunction. This can lead to insomnia, sleep disorders, brain fog, anxiety and depression.
During adrenal exhaustion, the brain requires increased energy and is especially affected by a lack of glucose as well as toxic metabolite built-up. As far as the body is concerned, ensuring a well functioning brain is top priority. Most mechanisms involved in regulating blood sugar are designed to ensure that the brain always has adequate glucose with which to function with. Insufficient glucose available to brain tissues contributes to many neurological symptoms of Adrenal Fatigue, including sleep disorder, brain fog, anxiety, and depression
Sleep Disorders. Both too high and too low night time cortisol levels can cause sleep disturbances. The liver is often lacking the necessary glycogen reserve required by the adrenals to keep blood glucose stable during the night. When this happens, blood glucose levels may sometimes fall below the threshold that hypoglycemic (low blood sugar) symptoms ensues. This can lead to sleep disruption during the night. Waking up between 1:00 and 3:00 AM is a hallmark of low blood sugar during this time. Sometimes it is accompanied by nightmares, sudden onset of heart palpitations, anxiety attacks, and cold sweats. Lack of sleep can be a significant body burden in itself. The body’s ability to self repair is compromised when sleep is deprived. This further contributes to Adrenal Fatigue and sets off a vicious downward spiral of cascading dysfunction.
Every time the wake/sleep cycle is altered, it takes some time for the body and cortisol levels to normalize. Chronic lack of sleep is strongly associated with decreased immunity, impaired glucose tolerance,decreased alertness and concentration.
Cortisol, DHEA, testosterone and estrogen are key hormones produced in the adrenals. Decreased levels of each of these hormones and reduced adrenal function have been linked to depression. It comes as no surprise that adrenal exhaustion is strongly associated with increased fears, anxiety, depression, and difficulties in concentrating.
Brain fog is a mental state where your memory is clouded and unclear. It is not a state of loss of memory, immediate or past. It is a state where your memory appears to be “so close and yet so far” in terms of the ability to recollect. Sometimes you cannot remember where you put your keys, or what you did yesterday. You are confused. It is often associated with adrenal fatigue, hormonal imbalance, PMS, estrogen dominance, heavy metal poisoning, and hypothyroidism. Brain fog usually is transient in its duration, lasting anywhere from hours to days, and in advanced cases, can become chronic. The exact pathophsyiology is unclear. It has been postulated that excessive metabolite build up in the brain over time due to poor clearance is a major factor. Brain fog usually goes away as the body’s detoxification system kicks in. But if the system is not performing optimally, brain fog may stay for a long time. Some people try to do various types of detoxification, thinking that it would help. Sometimes it does, but most of the time, inexperienced detoxification can lead to worsen brain fog. It may trigger a re-toxicification reaction, with symptoms such as fever, muscle and joint pain, and general malaise.
4. Hormonal System Imbalance. Key hormones associated with adrenal exhaustion include epinephrine (adrenalin), estrogen, testosterone, melatonin, progesterone and thyroid. Their imbalances can lead to estrogen dominance, hypothyroidism, adrenaline rushes, fragile blood pressure, hirsutism, hair loss, and acne.
A. Epinephrine imbalance leads to reactive adrenaline rushes and fragile blood pressure states. Blood pressures in adrenal exhausted states are normally low, but they can abruptly shoot up for no apparent reason when the adrenalin state is activated. Advanced adrenal exhaustion is often associated with frequent reactive adrenalin rushes, lasting up to a few hours, a few times a day.
B. Estrogen and progesterone imbalance lead to a continuum of estrogen dominance conditions including PMS, endometriosis, PCOS, cystic breast disease, and irregular menstrual periods, just to name a few.
Estrogen increases thyroid-binding proteins in the bloodstream. Thyroid blood test results may therefore be normal although there may be insufficient thyroid hormone in the tissues, resulting in a state of sub-clinical or clinical hypothyroidism.
When estrogen levels are high, the adrenal cortex also fails to respond to signals from the brain. A woman with estrogen dominance may have adequate levels of total cortisol in her bloodstream. Blood tests of total cortisol may be well within normal range. However, free, available cortisol level may be low. Since only free cortisol can pass through cell membranes and activate receptors inside the cell, the effectiveness of cortisol is blunted at the cellular level.
Just as estrogen dominance can contribute to adrenal insufficiency, adrenal insufficiency can contribute to estrogen dominance. Cortisol is made in the adrenal cortex from progesterone. When the adrenals are weak, there is a tendency towards a lowered progesterone output in favor of cortisol. A low progesterone level is often the result, leading to a state of relative estrogen dominance with its many undesirable consequences mentioned above. This forms a vicious cycle. Excessive estrogen affects both thyroid and adrenal function. In turn, dysfunctional thyroid and adrenal fatigue makes estrogen dominance worse.
C. Thyroid hormone imbalances lead to clinical or sub-clinical hypothyroidism that is refractory to thyroid replacement therapy.
When the adrenals are weak, the ability of the adrenals to handle the stress associated with normal body function and energy requirement is often compromised. To enhance survival, the adrenals force a down-regulation of energy production. In other words, the body is being forced to slow down in order to conserve energy. The body needs to rest in time of stress. Lower energy output reduces workload of the body. This slowdown can result in hypothyroid symptoms despite sufficient circulating levels of T4 and T3.
Laboratory tests of T4 and T3 might look normal and TSH might increase. Classic symptoms of hypothyroid are evident with persistent low body temperature. The physician reading the tests might be misled into thryoid replacement. In such cases, thyroid replacement without first considering adrenal fortification often fails. Thyroid replacements tend to increase metabolic function. Raising the basal metabolic rate is akin to putting all systems of the body into overdrive at a time when the body is trying to rest by down-regulation.What the body wants (to slow down) and what the medications are designed to do (to speed up) are dimetrically opposed to each other.
Thryoid medication administered under such cirumstances may, in some cases, lead to a temporary relief of symptoms and a boost of energy at first. This is often short lived, and comes at a price. Those less fortunate with constitutionally weak adrenals might be intolerant to thyroid medicatons right from the start. Those that are able to accept thyroid replacement and remain stable might find themselves requiring it for life, often at an increasing dose as time passes. The overall fatigue level continues to increase well beyond what the medication is trying to combat. Only by increasing medication dosage or switching to more powerful thyroid medication can worsening fatigue be avoided. The tendency is to switch from one medication to another. Starting with synethetic T4, to T4/T3 blends, and ultimately, to potent T3. The patient is subjected to on-going trial and error as one drug after another fails. As this is going on, the body continues to decompensate as the medication usually dispensed becomes stronger and stronger. The patient often continues to get worse despite the physician’s best attempt to help. It comes as no surprise that as much as 70% of patients on thryoid replacement continues to complain of hypothyroid symptoms. Ultimately, fatigue returns with a vegeance with time or stress, as thyroid medication further weakens pre-existing adrenal weakness and often precipitates an adrenal crisis.
D. Cortical Hormone Imbalance. The adrenal cortex comprises 80 percent of the adrenal gland and is responsible for producing over 50 different types of hormones in three major classes – mineralcorticoids , glucocorticoids, and androgens.
Aldosterone, a mineralcorticoid, modulates the delicate balance of minerals in the cell, especially sodium and potassium. It, therefore regulates our blood pressure. Stress increases the release of aldosterone, causing sodium retention (leading to water retention and high blood pressure) and loss of potassium and magnesium. Higher than normal blood pressure is a sign of early adrenal fatigue. Magnesium is involved in over 300 enzymatic reactions in the body. When the body lacks magnesium, it will suffer from a variety of pathological conditions such as cardiac arrhythmias, uterine fibroid, and blood pressure imbalance.
The most important glucocorticoid is cortisol. In early adrenal fatigue, cortisol level rises to help the body overcome stress. As adrenal fatigue advances, cortisol output generally drops, and the body’s ability to handle stress reduces. Cortisol contracts mid-size arteries. People with low cortisol (as in advance stages of adrenal fatigue) tend to have low blood pressure and reduced reactivity to other body agents that constrict blood vessels. Lower than normal blood pressure is a sign of advance adrenal fatigue.
As adrenal fatigue worsens, the body’s overall ability to maintain stable blood pressure is reduced, resulting ultimately in a condition known as labile blood pressure, where the blood pressure varies and flutuates widely.
E. Androgen imbalance. Both male and female hormones are secreted by the adrenal cortex, but their quantity is small and their effects are usually masked by the hormones from the testes and ovaries.
In adrenal exhaustion, the masculinization effect of androgen secretion may become evident after menopause or under stress – when estrogen levels from the ovaries decrease in absolute terms but increase in relative terms in a state of estrogen dominance. In women, the androgens ( testosterone and related hormones ) affect secondary sex characteristics, leading to an increased conversion from testosterone to dihydrotestosterone or DHT. This leads to:
- Seborrhea (a form of skin inflammation which has no known cause).
- Acne.
- Hirsutism / hair loss (alopecia). It comes as no surprise that most post-menopausal women who are experiencing hair loss have an adrenal function problem.
- Velvety, light-brown-to-black, markings usually on the neck, under the arms or in the groin, associated with high insulin levels (acanthosis nigricans).
In male, low libido is invariably an important sign of adrenal exhaustion. The body is in the process of preparing itself for survival. Production of hormones deemed less important by the body, such as reproductive hormones, are shunted to produce cortisol to ensure survival. Sex drive is reduced in both men and women, while period irregularity becomes common. Miscarriage prevalence is also increased. Long term androgen excess also increases the risk of infertility, cardiovascular disease, hypertension, osteoporosis, uterine cancer, and pituitary adenoma.
5. Immune System Dysfunction. This can result in exaggerated auto-immune responses such as rheumatoid arthritis and Hashimoto’s Thryoiditis, allergic rhinitis, skin sensitivities, psoriasis, hypo-active immune state of function, and frequent infections. Internal dysbiosis, candidiasis, recurrent herpes infection, HIV, and Hepatitis C are some manifestations.
A. Allergies. Allergic reactions usually have strong adrenal components. Most allergies involve the release of histamine and other pro-inflammatory substances. The body’s response is cortisol, a strong anti-inflammatory hormone. The level of circulating cortisol is directly responsible for the degree of inflammation in the body and the resulting symptoms of allergies. The weaker the adrenals, the higher the tendency of allergies because the more histamine is released, the more cortisol it takes to control the inflammatory response and the harder the adrenals have to work to produce more cortisol. When the adrenals are exhausted, cortisol output is compromised, allowing unopposed histamine to inflame the tissues more. This vicious circle can lead to progressively deepening adrenal exhaustion and producing more severe allergic reactions. People with food and environmental allergies commonly have weak adrenal function. Common food allergens include wheat, corn, soy, milk, and eggs. One could be gluten free and still have wheat allergies.
B. Autoimmune Disease. Autoimmune disease such as Hashimoto’s Disease or rheumatoid arthritis represents a spectrum of diseases in which the white blood cells of the immune system become overly active. The degree of hyperactivity is normally modulated by cortisol. In Adrenal weakness, cortisol output drops below normal, making the body more susceptible to autoimmune and inflammatory reactions. Toxin release from virusus becomes un-opposed. The inflammatory reaction only cascade upwards and the overall condition worsens. In other words, the cortisol levels are inadequate for the degree of reaction taking place in particular tissues or locations in the body.
Steroid medications such as prednisone or hydrocortisone are commonly prescribed to suppress auto-immune responses. These drugs mimic the anti-inflammatory effects of cortisol. While there may be a temporary sense of well-being, this usually is short lived due to the many side effects associated with these medications. Long term use is to be avoided.
A body under stress needs the anti-inflammatory effect of cortisol to restrain various physiological mechanisms to prevent them from causing havoc in the body; such as toxins secreted by over-reactive white blood cells in an auto-immune disease setting. Cortisol thus protects the body from autoimmune processes and uncontrolled inflammation. The lack of cortisol commonly seen in advance adrenal fatigue compromises this protective function and can lead to unrestrained damage by overactive white blood cells.
C. Infections. One of the most frequent overlooked causes of adrenal fatigue is chronic infection. Respiratory illnesses and herpes are more prone in people with adrenal fatigue, and adrenal fatigue leaves a predilection towards developing respiratory problems. Respiratory infections, such as colds, bronchitis, sinus infections, mycoplasma infections, pneumonia, and flu are especially hard on the adrenal glands and fatigue them rapidly. Recurrent respiratory infections are one of the most significant body burdens hampering recovery from Adrenal Fatigue.
Adrenal fatigue can occur after just one single episode of a serious infection. The more severe the infection, the more frequently it occurs or the longer it lasts, and the more likely it is that the adrenals are involved. It is not unusual for infection to trigger an adrenal crisis. At the same time, chronic infection (such as prolong flu, periodontitis, or candidiasis) of known or unknown origin may also act as a trigger. Adrenal fatigue can also take place over time as the adrenals are gradually fatigued by prolonged or recurrent infections. Stealth virusus and other infectious agents such as parasites and fungus are commonly overlooked as culprits. The direct effects of a smoldering pathogen in the body as well as the systematic stress the infection creates put the adrenals on overload chronically and weaken the immune system. This further weakens the immune response and makes it harder to fight off the infection. It is no surprise that adrenal exhaustion is commonly associated with frequent and repeated infections from the common cold to sinus infections to gastro-intestinal dysbiosis, with slower than normal healing time. The immune weakness that results from altered adrenal function also sets the stage for pathogens responsible for fibromyalgia to be activated, resulting in greater debilitation. One must think of adrenal exhaustion if there is a longer than normal recovery period after an illness with decreased stamina and pronounced morning tiredness.
