Sunday, October 9, 2011

Adrenal Fatigue

This is a subject that I wish I knew nothing about. Unfortunately, I know a whole lot about it, having experienced varying degrees of adrenal fatigue over the years, from mild to I-can-barely-function severe. This is something that so many people are dealing with and, having recently suffered a bout of it, I thought I'd give it a proper post.

Adrenal fatigue creeps into our lives via so many different avenues. Stress, over-work, trauma, lack of sleep, major life changes, surgeries, infections, autoimmune disease, over-training, blood sugar fluctuations (these stress the adrenals), vegetarian/vegan diets (high in copper/low in zinc, as well as high in carbs that can cause blood sugar swings), Leaky Gut Syndrome, pregnancy... the list of contributing factors just goes on and on.

My own adventures in adrenal fatigue began with major knee surgery when I was 14, followed by years of poor sleep habits and hypoglycemia, coupled with a high-carb, low protein vegetarian diet, which made the hypoglycemia worse. I treated myself with vitamins and herbs with varying degrees of success (I never really corrected my poor sleep habits, which is critical. I can't stress this enough!).
By the time I was 31, I had a pretty severe case of adrenal fatigue going on. As a result, my reproductive hormones and cortisol had taken a major nosedive (as well as my fertility) I had to quit my stressful job, do a lot of lifestyle and diet changes, as well as alternative therapies (acupuncture and medical qigong) to get back on my feet.

To illustrate how easy it can be to end up with adrenal fatigue, let me tell you a little story: back in August, I went on vacation to my hometown. Though fun, while I was there, I got little sleep, ate more sugar than usual and had a stressful family situation occur. By the time I got back home, after the 11 hour drive, I was the most exhausted that I've been in years. I had scheduled an extra day to recover from my drive but then a coworker got sick and I had to immediately rush back to work and work several extra long days in a row while already feeling exhausted from my trip. By the weekend, I was fighting off a summer cold. About a month later, I got a nasty respiratory thing that was making the rounds and it really took the wind out of my sails and it felt like it took FOREVER to fully recover! Through all of this, I had really slacked off on my qigong practice, which didn't help matters!
All of that left me feeling fatigued and draggy and flabby (6+ weeks of not being able to work out due to fatigue/illness, coupled with whacked out adrenal hormones= a noticeable increase in belly fat!) I also had a very short and extremely painful menstrual cycle that month.

I went to my holistic doc and did an Adrenal Stress Index and it came back showing that my morning cortisol was very low, my progesterone was low and my DHEA was borderline low. My doc gave me an herbal formula to take in the morning and at noon to raise cortisol levels and he put me on a low dose of pregnenolone- the hormone precursor to progesterone and DHEA. I took coenzymated B vitamins with extra B5 as well as extra vitamin C.
I'm happy to report that my energy levels are really bouncing back. Also, my last menstrual cycle was longer and much more comfortable than the previous one.

We always hear about stress-induced high cortisol, which does all kinds of not-fun things like increasing belly fat and killing brain cells! But what happens when you've cranked out the stress hormones for so long that you've exhausted your adrenals? You start experiencing hormone cascade disruption in the form of "pregenolone steal":

What happens is that, instead of converting pregenolone into DHEA and then into sex hormones, it gets shifted toward cortisol production (cortisol is more vital to our existence than sex hormones are and so it gets prioritized. Cortisol is a major steroid hormone and too little of it really drives up inflammation).

Here's a little video discussing pregnenolone steal:

Effects of Stress - Pregnenolone Steal from Dr. Bryan Walsh on Vimeo.

There are 4 stages of adrenal fatigue:

Stage 1: Alarm Response/Fight-or-Flight (Increase in cortisol is still within the body's output capacity).

Stage 2: Resistance Response/chronic stress (The adrenals are not able to keep up with cortisol demand. Fatigue is present. Ability to handle stress is decreased. Sleep disruption occurs. Thyroid hormone conversion is affected.)

Stage 3: Adrenal Exhaustion (Low cortisol. Hormone production suffers and clinical symptoms appear. Muscle breakdown. Chronic fatigue. Increased pain).

Stage 4: Adrenal crash/failure

For a more detailed look at the stages of adrenal fatigue, please read Dr. Lam's informative article.

So, what are the symptoms of adrenal fatigue? Could I have it?

Morning fatigue/morning headache.
Not really feeling awake until around 10 a.m.
Afternoon “low” (feelings of sleepiness or clouded thinking) from 2 to 4 p.m.
A burst of energy at 6 p.m. when you finally feel better from your afternoon lull
Sleepiness around 9 p.m. to 10 p.m. However, you resist going to sleep
A “second wind” at 11 p.m. that lasts until about 1 a.m.
Never feeling rested, no matter how much sleep you get
Cravings for foods high in salt and fats
Increased thirst/frequent urination (water goes right through you)
Chronic low blood pressure
Sensitivity to cold and feeling chilled
Increased PMS or menopausal symptoms
Mild depression
Mood swings
Mental fog
Memory problems
A decreased ability to handle stress
A decreased ability to recover from illness/injury
Heat intolerance
Light-headedness when getting up from a sitting or lying down position
Decreased sex drive
Frequent sighing
Inability to handle foods high in potassium or carbohydrates unless they’re combined with fats and protein
Sugar cravings
Leaky Gut Syndrome
Increased food/seasonal allergies
Increased sensitivity to sunlight
Low progesterone/DHEA and possibly estrogen
Hot flashes
General inflammation
Achiness or joint pain
Poor exercise recovery
Difficulty losing weight/belly fat
Difficulty in changing body composition/hard gainer
Muscular weakness
Purple or blue under-eye circles
Vertical lines in the fingertips
Ringing in the ears
Heart palpitations or tachycardia
Thyroid hormone (T3) conversion impairment

You can fill out this questionnaire if you suspect adrenal fatigue.

A lot of these are symptoms of other health issues (and there's a lot of overlap between adrenal fatigue and other issues, as well) but if you score high on the questionnaire I recommend getting an Adrenal Stress Index. You don't need a doctor's prescription, although it's preferable to work with a doc or practitioner who is familiar with saliva tests and adrenal fatigue.
NOTE: Many conventional doctors do not recognize adrenal fatigue as a medical condition, nor utilize saliva hormone panels. They are trained to only recognize full-blown Addison's Disease. If your doctor falls into this category, you're going to have to find another practitioner to help you.

Once you know that you have adrenal fatigue, you have to be willing to commit to lifestyle changes in order to heal. If you have mild adrenal fatigue, you can recovery quickly with the right tools and changes. If it's more severe, realistically it will take a minimum of several months and it's highly recommended to seek the care of a good practitioner (someone who practices Functional Medicine/FunctionalEndocrinology or even a skilled acupuncturist/OMD). There may be underlying factors that need addressing that are beyond your ability to identify or address.

Be aware that for more advanced adrenal fatigue, the healing process is not a linear one. You might start to feel good and then feel not so great again for a little while. Be patient!

Some helpful things for healing adrenal fatigue:

-SLEEP! As much as possible, get 9+ hours. Yes, this is a lot, but you need that much to heal. Don't make the mistake I did by skimping on sleep!

-Get to bed early! Getting to bed before 10 is preferable. You want to go to sleep in that window of sleepiness before your second wind hits. That second wind is a surge of cortisol (not good!) and will work against your progress.

-Eat a diet (preferably Paleo/Primal!) that's easy on your blood sugar. Eat lots of protein and fat and to avoid blood sugar fluctuations and eat carbs like sweet potatoes or berries that are easier on your blood sugar. The cold, hard truth (that I learned the cold, hard way) is that it's a lot harder to heal adrenal fatigue on vegetarian/vegan diets (as per Dr. James Wilson, one of the most experienced in his field).

-Don't exercise too hard. You'll only set back your progress. Learn to gauge what you can actually handle. If you can't recover quickly or feel worse the next day, it's too much. I recommend sticking to short walks, gentle yoga and esp. tai chi or qigong (qigong really helped my healing!) Now is not the time to be trying to get buff (you won't be able get buff anyway until your cortisol/sex hormone levels are healthy!)

-Add 1/4-1/2 tsp. unrefined salt (any salt with color like Redmond Real Salt or Pink Himalayan) to your water. This sounds odd, but when you're in a state of pregnenolone steal, you're not making much aldosterone (see the chart), the hormone that regulates sodium/potassium levels and the balance of these minerals is upset, causing sodium loss, which is made worse by drinking large amounts of water, which further dilutes blood sodium levels (hence the low blood pressure/dizziness upon standing/muscle weakness/heat intolerance.) The salt will quickly correct those symptoms.

-Read "Adrenal Fatigue: The 21st Century Syndrome" by James Wilson. This is a fantastic book and it covers ALL aspects of healing adrenal fatigue.

-Be kind and patient with yourself. Give yourself permission to not get stuff done if it's not immediately pressing. Let go of perfectionism. Get help from others when possible.

-To help with mental stress, try L-Theanine. Theanine is an amino acid found in green tea and it helps the brain make alpha waves, which will put you into a calmer, more focused state. 100-400 mgs at a time is the dose. It can be a sanity saver!

-Deep breathing. Such a fundamental thing, but most of us don't even know HOW to breathe properly! Get yourself into the habit of doing a few minutes of deep breathing upon waking, before meals and before bed. I promise you will feel a difference!

Here's my favorite video illustrating proper breathing (qigong style!):

-Meditation. Meditation doesn't have to be complicated and you don't have to do it for an hour to reap the benefits. I like to do a meditation called the "5-8 Meditation", which is a simple breath awareness technique. All you have to do is sit in a comfortable position and breath into your relaxed belly through your nose for 5 counts, pause, and exhale slowly through your nose for 8 counts. Just be aware of how your breath feels and allow any thoughts to pass through you.
If you'd like to add a visualization, you can imagine cool, white light or water flowing down through the center of the top of your head and washing through you, taking any tension and stress with it. You can start with 5 minutes. Doing this in the morning before you start your day can have a profound effect on your whole day. It's also a great way to end the day.

For those who suspect mild adrenal fatigue or just need a little extra help with handling stress:

Besides taking advantage of the suggestions above, you can use supplements for a little extra help:

-Himalaya Stress Care is one of my favorite adaptogenic, adrenal supplements. It's been extensively researched over the decades (see Geriforte research papers) and is proven to reduce cortisol and boost adrenal function (it's also a great antioxidant!) You can take the recommended dose for maintenance or take a higher dose during periods of stress and/or fatigue.

I truly hope this info will help those that are feeling less than good due to the effects of adrenal fatigue!