Adrenal Fatigue, The Harsh Truth.

In recent years, some symptoms like fatigue, brain fog, and weight gain have become so widespread that it has attracted intense scientific studies. Research results show that although these symptoms are shared among many health conditions, hormonal abnormalities, namely adrenal hormones, play a key role in the appearance of these symptoms.

In this article, we look at Adrenal Fatigue from the perspective of naturopathic medicine and the solutions it offers.

What is adrenal fatigue?

The main theory about adrenal fatigue was first popularized by Dr. Hans Selye who was studying the effect of stress on physiology and called it “general adaptation syndrome” but the term “adrenal fatigue” was first used in 1998 by James Wilson, a naturopathic doctor.

Dr. Wilson described it as a group of related signs and symptoms that appear when the adrenal glands function below the necessary level. He believed adrenal fatigue is usually associated with constant stress and often starts after chronic infections like flu, bronchitis or pneumonia. People with adrenal fatigue may not have any physical signs of disease, but still may feel tired and fatigued that does not dissolve with more sleep and rest. They also have cravings for salty foods!
To truly understand adrenal fatigue, we must know adrenal glands and their function.

Adrenal glands are two glands located on top of each kidney that are mainly responsible for producing your fight or flight response in stressful situations. They release hormones such as cortisol, adrenalin, DHEA, pregnenolone along with sex hormones like estrogen, progesterone, testosterone and also neurotransmitters such as dopamine to regulate blood pressure, metabolism, electrolyte balance, blood sugar, digestion, and immune response. The stressful situation can be internal or external, mental or physical resulted from chronic illness or environmental pollution, poor diet, too much exercise, lack of proper sleep and emotional abuse.

When faced with these stress triggers, your body provides a surge of energy and suppresses any energy expenditure to survive. It releases cortisol to increase blood sugar, breakdown protein and carbohydrate stores, and suppresses the immune system.

If the stressful situations become too frequent as it is in modern daily life with all the air and noise pollution, traffic, digital radiations, intense work schedules, relationship complications, and inadequate dietary nutrients, these intense chemical reactions are repeated constantly leading to insulin resistance, immune system damage and muscle loss. When adrenal glands constantly work hard to release required hormones, they being overworked over time and through three stages they become unable to produce enough hormones to the point where hormone production is below the normal range, which leads to adrenal failure.
Among functional medicine community, Dr. Chris Kresser believes that the term adrenal fatigue does not appropriately describe these symptoms and has suggested the term “HPA axis dysfunction” which is more holistic and takes into account the hypothalamic–pituitary–adrenal system that regulates your long term stress response in contrast to sympathoadrenal medullary system (SAS) that is responsible for short term stress response. These systems protect you from danger, but overstimulation will eventually lead to harm from the system itself.
Dr. Kresser believes that adrenal fatigue is not just about low levels of cortisol, which is often diagnosed by cortisol saliva test. 3 to 5 percent of total cortisol produced by adrenal glands are unbound from a protein carrier and the rest are cleared out of the bloodstream by different mechanisms until they release through urination; therefore, low levels of cortisol test result is not necessarily an indication of total cortisol production!

In addition, the normal cortisol range considered by laboratories can affect the interpretation of the result as well in which if the range is too broad the actual low level cortisol is not diagnosed, but if the range is considered too narrow, every test will fall in low range cortisol.

The saliva sample collection is another important factor as 50% of total cortisol production happens in just half an hour after waking up in the morning so if the test is collected any other time, it misses the peak production window; therefore, test results are falsely low!

He believes some diseases like Addison or chronic adrenal insufficiency which causes very low levels of cortisol might be diagnosed as adrenal fatigue as well.
HPA axis function is to protect you from its released hormones when the production is dangerously high or consistent which will cause in less sensitivity in receptors leading to cortisol resistance that naturally causes reduction in cortisol production which does not result from adrenal fatigue but by protective mechanisms in the brain, central nervous system or tissue-specific regulatory mechanism. Decreased bioavailability of cortisol hormone might be perceived as adrenal fatigue as well while high-level conversion of cortisol to cortisone is the actual cause.

Dr. Amy Myers another functional medicine expert believes that decrease of stress hormone will cause a reduction in thyroid hormones production along with the enzymes that affect thyroid hormones conversion and eventually lead to hypothyroid symptoms. Inflammatory immune cells called cytokines are also released in stress response, which causes thyroid insensitivity in receptors. Your immune system is suppressed to focus on stressors and to prevent inflammation resulted from stress; therefore, possibility of infection is high, which might result in autoimmune thyroid disease.

Naturopathic medicine is all about revealing the root cause of health conditions and allowing the body to heal itself so the symptoms are dissolved; therefore, considering the HPA axis with vast number of research that has been done helps to do just that. Focusing solely on adrenal fatigue will limit the diagnosis, preventing true healing.

There are some factors that cause abnormality in HPA axis which can be summarized in 4 groups:

• perceived stress
• inflammation
• high or low blood sugar
• circadian disruption

Perceived stress can be positive or negative and is very individualized while inflammation is resulted from chronic disease, gut microbiome disorders, obesity and diet. High or low blood sugar can trigger HPA axis which in turn results in insulin or leptin release disruption. Exposure to sunlight can also affect circadian rhythm with too much exposure at night or too little exposure during the day disrupting your natural cycle.

The over activation of stress mechanism and HPA axis affects your metabolic reserve and resilience as well. Metabolic reserve is the subtotal of your vitality and each stressful experience can deplete this reserve leaving you drained and fatigued which might take time to be replenished. Overtime the replenishing system becomes less efficient too; therefore, you lack enough vitality to be resilient against stress and it just becomes worse by every attack.

In addition, many modern health conditions such as diabetes, PTSD, depression, obsessive compulsive disorder, hyper or hypothyroidism, asthma, eczema, premenstrual tension syndrome, rheumatoid arthritis, fibromyalgia, obesity, alcoholism and chronic fatigue syndrome stimulate your HPA axis which leads to excessive metabolic reserve depletion and resilience loss.

How adrenal fatigue is treated by naturopathic medicine?

As far as metabolic reserve is concerned you should try to replenish your vitality with adequate dietary nutrients, proper sleep, just enough exercise and practice stress management techniques in order to build resilience against stress of any kind, either mental or physical. These changes are very individualized; therefore, no one size will fit all that is why integrative medicine designs an individualized lifestyle plan for each patient.

The perceived stress must be reduced or managed trough efficient techniques.
Any inflammation caused by bad food choices or chronic diseases must be addressed in order to improve HPA axis function. Specifically gut microbiome must be enhanced to increase digestion of foods and production of vitamins, minerals and digestive compounds.

Regulating blood sugar level is a very important step which can be achieved by diet and exercise or in diabetes cases by medication as well.

Aligning with natural cycles of light and dark and avoiding artificial light during the night will regulate circadian rhythm resulting in HPA axis improvement.

Do you need to visit a naturopathic doctor for adrenal fatigue diagnosis?

If you have been experiencing fatigue, mental fog, rapid change in weight and unusual salt or sugar cravings without any know condition specifically if you live in busy cities like Los Angeles, you should visit a trusted naturopathic doctor to find out the true cause of your symptoms which might be adrenal fatigue.

In your visit, you will be asked in details about your symptoms and medical history along with your lifestyle. Some specialty lab tests will be ordered from reputed laboratories that specialize in adrenal fatigue diagnosis.

If adrenal fatigue is diagnosed, you will be provided with a comprehensive lifestyle and treatment plan uniquely designed for you in order to heal fast, restore your vitality and achieve optimum health.

The plan includes every detail of your lifestyle from sleeping pattern to eating habits, supplementation, excising level and techniques to eliminate stress sources and manage your own stress responses specifically in dealing with relationships and work environment. Fun and play is considered as well. Specialty naturopathic therapies will be incorporated according to your unique circumstances.