Adrenal Exhaustion Page 3

Four Phases of Adrenal Exhaustion.

Phase A: Chronic Single System Dysfunction.

A weak adrenal system has profound systemic decompensatory actions, manifesting in a wide range of symptoms. The organs affected can be broadly classified into five major categories:

1. Metabolic System Imbalance, resulting in conditions such as metabolic syndrome, hypoglycemia, and diabetes.

Metabolic syndrome, also known as syndrome X, consists of a complex set of signs and symptoms that includes glucose intolerance, insulin resistance, high blood pressure, central obesity, low HDL “good” cholesterol, high triglyceride. While present in earlier stages of adrenal fatigue, manifestation of this syndrome becomes more prominent during adrenal exhaustion as the adrenal cortisol level drops. If unattended to, metabolic syndrome ultimately leads to diabetes and accelerated arthrosclerosis .

Hypoglycemia (low blood sugar) is common during adrenal exhaustion. 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 blood glucose level. As the output of cortisol reduces in adrenal exhaustion, glucose released is slowed. This slowing, along with 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 source of energy. This pathway is not as efficient but is nevertheless put on overdrive in order to provide the much needed 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 exhaustion is irregular blood sugar patterns with hypoglycemia. People with Adrenal exhaustion often find themselves in a no win situation. When they are under stress (even a mild stress such as a mild argument or excessive homework), demand for blood glucose increases, but their exhausted adrenals cannot produce enough cortisol to generate higher glucose levels from reserves. In the presence of increased insulin and decreased cortisol, blood sugar drops rapidly.

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 requires 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 an increasing demand for glucose, the stage is set for 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. In short, hypoglycemia is a hallmark of adrenal exhaustion as it places great demand on the adrenal glands. Adrenal Exhaustion often precedes adult onset diabetes as well.

2. Musculoskeletal System Breakdown. Collagen and protein are broken down in a catabolic state of function, leading to chronic pain syndromes, 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, corstiol output is often pushed to its limit. A chronically high cortisol output leads to a state of catabolism or the breakdown of protein. Due to the lack of glucose in the blood from metabolic dysfunction, the body breaks down protein to generate simple amino acids. The amino acid is then used as an alternative energy source from glucose to feed the brain.

The cycle of breakdown or catabolism is normally followed by a process of rebuilding, or anabolism. In adrenal exhaustion, the rebuilding process, normally carried out by androgens, is overwhelmed by the amount of catabolic hormones. Rebuilding process is slowed and retarded. Muscles broken down are not replaced with new ones. Collagen is broken down without replenishment. Outwardly, wrinkles develop as premature aging sets in. Internally, organ and muscle breakdown lead to chronic muscle and joint pains of unknown origin.

As the collagen structure of internal organs breakdown, their function is compromised. Gastrointestinal track motility and contraction forces are reduced. Adrenal exhaustion 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. Protein is made up of amino acids. Just as sugars and carbohydrates seem to weaken the adrenals, amino acids seem to strengthen them. Nutritional supplements such as digestive enzymes, betaine HCL, and hydrolyzed collagen are often good supporting nutrients for the GI tract at this stage to help food metabolism, but its effectiveness is often blunted unless the underlying adrenal weakness is repaired.

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 one of many symptoms of adrenal exhaustion. There is no doubt clinically that adrenal exhaustion contributes to the overall fibromyalgia chronic fatigue picture, no matter the cause.

3. Neurological System Dysfunction, leading to severe insomnia, 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 lacking the glycogen reserves needed by the adrenals to keep blood glucose high during the night. When this happens, blood glucose levels may sometimes fall so low that hypoglycemic (low blood sugar) symptoms disrupt sleep during the night. Waking up between 1:00 and 3:00 AM often indicates 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 morning cortisol levels, increased circulating estrogen levels, and decreased alertness and concentration.

Cortisol, DHEA, testosterone and estrogen are all 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, brain fog, and difficulties in concentrating. They often have less tolerance than they normally would and are more easily frustrated.

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. Most people complaining of brain fog usually have concurrent adrenal fatigue or some form of hormonal imbalance. When the body is decompensated, the ability to metabolize nutrient, food, and medication is reduced. Some of these metabolites are fat soluble. The brain is lipophilic, and has a tendency to attract these metabolites, usually from the liver. The metabolites circulate to the brain and have tendencies to stay there instead of circulating out quickly. This is one postulated thesis. Excessive metabolite build up in the brain over time impedes brain function, resulting in a state called brain fog.

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 worse brain fog. During the detoxification process, more metabolites can be released into the circulation, with symptoms such as fever, muscle and joint pain, and general malaise.

There is no medicine to relief brain fog. Most nutritional supplements that enhance liver function and encourage cleanses tend to make the condition worse because the body is too exhausted to process the toxic release during a detoxification process.

4. Hormonal System Imbalance. Key hormones associated with adrenal exhaustion include epinephrine (adrenalin), estrogen, testosterone, melatonin, progesterone and thyroid.

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 fails to respond to signals from the brain. In other words, even though the brain is requesting more cortisol to be made, there is a blunted response from the adrenals for this request. As a result, the cortisol output is sub-optimal relative to the demand signal. In addition, estrogen impairs adrenal function by interfering with the release of cortisol from the adrenal cortex. High levels of estrogen can lead to a corresponding increase in levels of cortisol-binding globulin. In turn, cortisol-binding globulin interferes with hormone function. It circulates in the bloodstream, binds to cortisol, and renders it inactive. Thus, 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-clinically hypothyroidism that is refractory to thyroid replacement therapy. In adrenal exhaustion, one of the body’s primary down-regulation mechanisms is reduce thyroid function. This is the body’s way to conserve energy to maximize its chances of survival. Low adrenal function worsen thyroid function by reducing T4 to T3 conversion. In addition, a body under stress may produce more reverse T3. RT3 acts as a braking system against T3 to slow down the metabolic rate. It exerts its negative feedback on T3 by tying up thyroid receptors.

In addition, thyroid is intricately related to the ovarian system. By its regulation of metabolism, it affects the reproductive gland activities, the menstrual cycle, and the ability to become pregnant. Thyroid hormones also stimulate progesterone production in the ovaries. It is not unusual for women to overcome infertility problems when their subclinical hypothyroidism is resolved.

D. 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 reduce 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 symptoms can range from hyper to hypo function. This can result in exaggerated auto-immune responses such as rheumatoid arthritis, a hypo-active immune state of function, and frequent infections. Internal dysbiosis becomes common.