Fatigue

At least 50% of adults who seek medical treatment in New Zealand self-diagnose themselves as being afflicted with fatigue. This article will go into detail about one of the most common physiological reasons accounting for chronic tiredness that so many New Zealanders suffer from, a condition known as “hypo-adrenalism”, otherwise known as under-active (or ’burned-out’) adrenal glands.

I’m certain that many readers will be able to relate to this article, because so many people we see in our natural medicine clinical practices come in for similar problems. Most people get little joy from their fatigue-like state in a medical doctor’s office, apart from being told they need to ‘get a grip’ or to ‘stop being depressed and to get on with your life’. Surveys have shown that almost 60% of the population in America believe that they are under a great deal of stress at least once per week (presumably surveys completed in NZ would reveal similar statistics).

Conventional Western medicine recognises only really one form of adrenal insufficient hormone-related disease, a condition known as Addison’s disease. This condition was first recognised in 1855, it is life threatening and the person generally has to take corticosteroids for the rest of their life. Non-Addison’s hypoadrenia (adrenal fatigue) is not something that severe that it is considered a medical emergency; in fact, modern medicine does not even recognise it as a syndrome. Medical practitioners commonly view adrenal exhaustion as ‘depression’, and prescribe likewise. It is difficult to assess just how many people in this NZ suffer from poorly balanced adrenal hormone control, ‘because the blood tests all come back normal’. Is it really ‘all in the head’, in fact it is more likely in the back above the kidneys.

What are the adrenal glands?

The adrenal glands are a pair of small pyramid shaped hormone producing glands which live on top of your kidneys, they are very close to the major artery of your body, the aorta, where they can produce immediate responses by delivering hormones rapidly in to the circulatory system. Over 40 hormones are produced by these glands the size of a small walnut, and the most important ones in terms of exhaustion and stress are adrenalin, cortisol, aldosterone, and the steroid hormones such as the estrogens and testosterone.

Adrenal hormones are produced continually and extremely precisely, and these amazing glands are designed to be super responsive to changes in a person’s environment. This means that too much physical, emotional, and/or psychological stress can deplete your adrenal glands, and cause a decrease in the output of one hormone particularly, cortisol. With each tiny increment of reduction in adrenal function, every organ & system of your body becomes more profoundly affected. You not only become progressively more tired, your immune system slows right down, sex drive diminishes or goes out the window, changes occur to the way your body metabolises fats, carbohydrates and proteins. Fluid and electrolyte balance, heart and cardiovascular system, and many other alterations take place at biochemical and cellular levels.

Deepak Chopra mentions in his book called Quantum Healing, that every single thought a person has will initiate a cascade of change to the hormone system. We call this system the “hypothalamus-pituitary-adrenal axis”. These neuropeptides initiate the first of the three stages of stress, causing a response then a quick resolution, or a continual cascade of hormonal stimulation leading to widespread changes in body. Let’s take a brief look at these three stages.

The 3 Stages of Stress (the General Adaptation Syndrome)

1. The “fight or flight” (alarm) response(you are confronted with a stressful situation) causes the release of adrenalin, noradrenalin and cortisol from the adrenal glands. These powerful hormones direct blood toward the muscles and limbs in order to allow you to fight or flight. In addition, the pupils of your eyes dilate and you become much more alert. When the stressful situation reduces, the increased production of adrenalin, noradrenalin and cortisol and reverts back to normal. This occurs via a “negative feedback” mechanism that allows your body to normalise, a condition we call homeostasis.
2. The resistance phase (adaptive phase)is characterised by adaptation which involves you learning to cope with a perceived threat (a stressor). During this resistance phase, cortisol receptors in your brain become less sensitive to the feedback mechanism that produces homeostasis after “fight or flight”. This causes increased production of cortisol and results in various disorders controlled by your hormonal system. Ideally, the resistance phase continues until the stressful situation is resolved, leading to a return to the resting state. Stress-induced diseases like headaches, memory loss, insomnia, poor libido, high blood pressure and heart diseases occur during this phase.
3. Exhaustion occurs when the capacity for resistance (adaptation) is completely overwhelmed. The exhaustion of the adaptive capacity of the adrenal glands results in stress-induced diseases such as hypo-thyroidism (underactive thyroid). I generally find that patients initially develop adrenal exhaustion eventually leading to an underactive thyroid.. This stage is characterised by depletion of energy, and may lead to poor metabolism, insulin resistance, and eventually leading to poor immune states. The exhaustion phase of continual stress can eventually lead to adrenal insufficiency or even a total shutdown of the adrenal glands.

The Dilated Pupil Test

Here is a simple test you can do at home, to determine if you have adrenal fatigue, to do the test you can do it alone with a mirror. It may not be present if you only suffer mildly from hypoadrenia.

• Sit in a darkened room for a few minutes to dark-adapt your eyes, then shine the light from a not-to-strong penlight from about 6 inches away onto the center of one eye, keeping it there for at least 30 seconds.
• If you are healthy, you should see your pupil (the dark circle in the centre of the eye) contract immediately as the light hits your eye. The pupil normally remains contracted in the increased light. But, if you have some adrenal insufficiency, the pupil will not be able to hold its contraction and will dilate despite the light shining on it.
• Retest periodically, as you recover from hypoadrenia the iris will hold its contraction for longer, and your pupil will remain smaller for longer periods. This diminished ability of the iris to remain contracted is present in moderate to severe adrenally fatigued people.

Causes of Adrenal Dysfunction

Causes of adrenal dysfunction include:

1. The major cause is sudden, extreme or chronic prolonged stress. We tend to think of stress as emotional, (unhappy relationships, separation, divorce, death of loved one financial difficulties, traumas/shocks, etc) but it can be physical (e.g., accidents, surgery, prolonged illness, especially from a toxic liver and/or congested kidneys), nutritional (e.g., long-term deficiencies or excesses of nutrients, allergies), environmental (e.g., chemical sensitivities, metal toxicities, electromagnetic fields), thermal (e.g., prolonged excessive heat or cold), most pharmaceutical drugs (especially hormone pills), overwork, unhappy relationship, etc., all of which adversely affect the adrenals.
2. Frequent over-consumption of sugar(including in most processed foods, honey, marmalade, golden syrup, fruit juices, fizzy drinks), caffeine, alcohol, tobacco, marijuana, etc all of which stress the pancreas as well as the adrenals. Avoidance of high glycemic-index foods is very important in the adrenal stress syndrome;
3. Fasting, which further overtaxes weak adrenals as they attempt to maintain blood sugar levels.
4. Overuse of steroidal medicationsfor medical treatment of arthritis, asthma, inflammatory bowel disease such as ulcerative colitis, etc., or hydrocortisone creams for skin rash and itching–these deplete both the adrenals and the immune system.
5. Spinal vertebral misalignment and subluxations, particularly of the vertebrae C 7 through to T 10. See you Chiropractor or Osteopath. Poor posture and stress can be contributing factors.
6. Food Allergies.

Signs & Symptoms

Decreased ability to handle stress, the small things that never got to you finally are! You get more anxious more easily, the kids are really starting to get to you, you may have been yelling more at them (or your co-workers) lately.

Lethargy, everything seems like a chore. Even the easy jobs require an increased effort. Decreased productivity, you spend more time on the job but actually achieve less. Your can be more fuzzy mentally, you lose track of your thoughts, memory becomes more hazy, especially short-term.

Less enjoyment or happiness in life, you may even be diagnosed as having ‘depression’. Your partner is getting less attractive by the day, more irritating, and you wonder how you managed to keep the relationship going for so long. And,…… sex is the last thing on your mind if you can’t even lift your head off the pillow.

You may have difficulty getting up in the morning, you get up but feel that you could easily sleep several more hours. Fatigue not relieved by sleep, even after a good night’s sleep, you still don’t feel refreshed. You don’t really wake up until about 9.00 – 10.00am, you may have an energy drop in the afternoon (between 2.00 – 4.00pm) and could even feel a bit like you have been ‘drugged’ to some extent. You probably feel better after your evening meal, and may even get ‘second-wind’ later at night from 10.00 – 11.00pm, and may well stay up to 1.00 am or beyond! This pattern is not uncommon with hypoadrenia, and I find it particularly so with patients who work from home, or where both people in the relationship have got jobs and the kids to juggle.

More time required to recover from an illness. The cough you got two months ago is still hanging on. You seem to be getting recurrent colds, flu, sore throats, skin infections, etc. Have been on antibiotics several times in the past few years? You may well have recurrent sinusitis, asthma, hay fever, pneumonia or bronchitis.

Can’t really skip meals, you may need to ‘drive’ yourself every few hours with coffee, cola drinks, sweet snacks, just to keep on going. Headaches come from not enough fluid or food, and it can seem like you constantly need ‘something’ just to keep you going.

Increased PMT, bloated, tired, cranky, craving chocolate.

Recommendations – What to Do

Lifestyle – It was noted as early as the 1900s that unless a person changed their lifestyle to reduce the source/s of adrenal strain and developed new lifestyles to allow their adrenal glands to recover, complete healing was seldom seen. Relaxation is very important for recovery, slowing down your breathing, breathing deeply and abdominal breathing, not shallow breaths, progressive relaxation like meditation or Tai Chi are both excellent. Holidays are important, and so is working on improving the quality of your sleep. Do you live to work, or work to live?
Foods – It is very important that you eat breakfast, and that you definitely eat before 10.00am. Between 6.00 – 8.00am your cortisol levels tend to rise rapidly, in addition, poor liver function often accompanies low adrenal function. A liver herb or supplement can really help here, check with your practitioner first. Have an early (rather than later in the afternoon) lunch, and importantly, have a small snack early afternoon, a high quality protein snack will suffice. Make sure you ample protein, carbohydrate and fats in your diet. Totally avoid (for 3 months completely) sweet foods and stimulants such as coffee, tea, and chocolate.

Supplements – :

Vitamins – Vitamin B5 (Pantothenic acid is especially important for the adrenals, Vitamin C, and a good high- potency B complex, L-tyrosine, and Coenzyme Q10 ( 30 – 100 mg/day), Glandular – a good adrenal glandular extract will also help, particularly with burn-out.

Minerals – Trace minerals are required by our adrenal glands, these are particularly manganese, selenium, molybdenum, chromium, copper, iodine and zinc.

I recommend therefore a good multi vitamin & mineral complex, have at least two capsules or tablets every day with meals. You will need to contact your Naturopath regarding some of these supplements, along with the correct dosages to suit your situation.

Herbal medicines – there are several, some of my favourite adrenal herbs would have to be: Licorice, Siberian Ginseng, Withania, and Rehmannia. Check with your herbalist first.