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Thursday, July 09, 2020

Adrenal Fatigue

Adrenal Fatigue

These days it seems that many people are overwhelmed by stress and fatigue. It is growing complaint doctors are hearing from patients. Adrenal gland dysfunction can be the root cause of such symptoms as fatigue, weakness, feelings of being run down, metabolic disturbances, immune system problems, and thyroid gland disturbances. 

Adrenal Fatigue
Adrenal Fatigue

Constant stress (both physical and emotional), disorders such as Cushing's syndrome and Addison's disease, as well as poor nutrition are ways a person can succumb to disruption of proper adrenal gland function. The adrenal glands lay just anterior to both kidneys and are responsible for the production and secretion of special steroidal and peptide hormones. 

Despite their relatively small size, they are non-the-less very important glands.

 The hormones responsible for maintaining blood pressure and acting as excitatory neurotransmitters are produced from the innermost part of the gland called the medulla. The outer aspect, the cortex, secretes other classes of compounds called steroid hormones.

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The adrenal gland hormones play a critical role in human immune function and maintaining a balance of serum electrolytes, such as sodium and potassium. Disturbance of this gland's function can have a profound impact on a person's health, while total shut down or suppression of the gland can cause death.

There are several tests that can be conducted to determine if there is adrenal gland insufficiency or dysfunction. One can measure levels of such hormones as hydrocortisone (cortisol), aldosterone, epinephrine, and ACTH in blood or even urine studies. Serial saliva measurements of cortisol throughout the day are another helpful tool. 

Imaging studies such as MRI and CT-scan are also helpful in revealing the presence of adrenal gland tumors or atrophy. The average amount of cortisol produced by the adrenals is approximately 10-15mg per day. There is a tight balance for too little or too much of these hormones often cause problems.

Once adrenal gland dysfunction is established there are some treatment options that include nutritional support for the milder cases. 

For severe cases, such as Addison's Disease very potent glucocorticoid and mineralocorticoid drugs are usually prescribed and the patient is monitored very closely for high potassium levels, low sodium levels, and conditions that can be life-threatening in times of stress (as in pneumonia or another serious infection). Those on high doses of steroids like prednisone need to be cautious and watch for adrenal suppression.

For milder cases caused by stress Dehydroepiandrosterone (DHEA) has been helpful. I, however, do not recommend taking this as a supplement without proper testing. While it is available over the counter, it is too strong a compound to be taken without physician supervision. Serum levels of DHEA-S guide the dosing of this hormone.

 Extract of licorice (Glycyrrhiza) offers support of the adrenals due to its effects on reducing the breakdown of hydrocortisone in the body. Once again physician supervision is suggested when using glycyrrhizin products as they can be harmful at high doses.

Pantothenic Acid (vitamin B-5) is also helpful since it is a precursor of acetyl CoA and acetylcholine. Vitamin B-5 is necessary for the biosynthesis of adrenal hormones. The amino acid L-theanine, which is found in tea, has been shown to increase levels of the neurotransmitter GABA and is often helpful as a calming agent. L-theanine plays a role in reducing stress, thus indirectly affecting adrenal function.

Vitamin C (Ascorbic Acid) is a modulator of chronically elevated cortisol levels resulting in heavy exercise and stress on the body system. Vitamin C attenuates and influences cortisol levels as well as imparting anti-inflammatory properties. 

Finally, Melatonin, an antioxidant hormone, released by the pineal gland that regulates the circadian rhythm and sleep, has an affects on the pituitary-adrenal axis. Even low doses of Melatonin increase serum DHEA-Sulfate to cortisol ratios in test subjects according to a couple of scientific trials.

Occasionally a naturopathic physician will recommend glandular extract replacement therapy.

 This should be entered into carefully. Strict supervision of doses and treatment should follow. A theoretical risk (albeit minuscule) is that of "mad-cow" disease from taking such animal products. However, there has never been a reported case.

The combination of prescription and/or non-prescription adrenal support compounds is something that is customized for each patient. There are varying degrees of Adrenal fatigue that require a variety of supportive therapeutics. Always consult a knowledgeable physician.

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