Adrenal Dysfunction: Wired and Tired?

Dr. Jon Repole 

What is Adrenal Fatigue?

Adrenal fatigue, though a widely recognized term, is somewhat of a misnomer. It suggests that the adrenal glands themselves become "fatigued," which isn't entirely accurate. A more appropriate term would be "stress adaptability." This concept better captures the idea that the body's ability to adapt to stress diminishes over time due to prolonged exposure to the number one killer - low-grade chronic stressors (poor diet, sedentary lifestyle). Charles Darwin never said, "It's the strongest that survive." He said, "It's the most adaptable that survive." This adaptability is crucial for maintaining health and well-being.

To better understand adrenal fatigue, consider it like a bank account. In this metaphor, stressors are withdrawals, and recovery activities (like rest, relaxation, and self-care) are deposits. When we're young, our adrenal "bank account" tends to have a healthy balance. We can handle stress and recover quickly. However, as we age and face continuous stress without adequate recovery, our adrenal reserves begin to deplete.

Imagine going through life making more withdrawals than deposits. Initially, you might not notice the deficit (low-grade chronic stress), but over time, this imbalance catches up with you. By the time many people reach their 40s and 50s, the signs of an overdrawn adrenal bank account start to appear. It's unfortunate but in our office we typical here the same host of symptoms which include:

• Chronic fatigue
• Hormonal dysfunction
• Loss of libido
• Irritability
• Feeling "hangry" (hungry and angry)
• Sleep issues
• Concentration problems
• Brain fog 
• GI distress 
• Decreased immunity 
• Loss of vitality 
• Weight fluctuations 
• Inflammation 
• Sugar and salt cravings 
• Exercise intolerance 
• Food sensitivities 
• Anxiety and depression 
• And more

Adrenal Physiology 101

The adrenal glands are small, triangular-shaped glands located on top of the kidneys. They are part of the endocrine system and play a crucial role in managing stress. The relationship between the hypothalamic-pituitary-adrenal (HPA) axis is central to understanding adrenal function.

The HPA axis involves a complex set of interactions between the hypothalamus, the pituitary gland, and the adrenal glands. When a stressor is perceived, the hypothalamus releases corticotropin-releasing hormone (CRH), which signals the pituitary gland to release adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal glands to produce cortisol, the primary stress hormone. This process helps the body respond to stress, but chronic activation can lead to adrenal dysfunction.

The General Adaptation Syndrome and Adrenal Dysfunction

Adrenal fatigue can be understood through the lens of the General Adaptation Syndrome (GAS), a concept developed by Hans Selye in 1936. GAS describes the body's short-term and long-term reactions to stress, divided into three phases: Alarm, Resistance, and Exhaustion. Adrenal dysfunction corresponds to these phases as follows:

1. Wired (Alarm Phase): In this initial phase, the body reacts to stress by releasing high amounts of adrenaline and cortisol. This leads to a "wired" feeling, where individuals may feel hyperactive, anxious, and have trouble sleeping. Archetype: The Go-Getter. This person is always on the move, taking on multiple projects, thriving on the adrenaline rush, and pushing their energy to the limit without sufficient rest.

2. Wired and Tired (Resistance Phase): As stress continues, the body tries to adapt by sustaining high cortisol levels. Over time, this leads to feelings of being both wired (due to ongoing stress hormone production) and tired (due to the body's resources being depleted). Individuals in this phase may experience fluctuations in energy, difficulty focusing, and frequent illness due to a weakened immune system. Archetype: The Soccer Mom. This person is juggling numerous responsibilities, constantly busy, and unable to fully relax, leading to a persistent state of high alert and exhaustion.

3. Tired (Exhaustion Phase): Eventually, the adrenal glands become exhausted and can no longer produce adequate amounts of cortisol and other hormones. This results in chronic fatigue, depression, weakened immunity, and a host of other health issues. Archetype: The Burnout. This individual has reached their limit, feeling perpetually fatigued, disengaged, and unable to perform daily tasks without significant effort.

The Difference Between Stressors, Stress Response, Distress, and Eustress

Understanding the nuances of stress is essential for managing adrenal health. Here are key concepts to consider:

• Stressors: These are events or conditions that cause stress. They can be located in any of the dimensions: physical, emotional, epigenetic, environmental, relational, mental, spiritual, or shadow. Examples include work infections, poor dietary choices, existential angst, sedentary lifestyle, and overworking. 

• Stress Response: This is the body's reaction to a stressor. It involves physiological changes like increased heart rate, elevated blood pressure, and the release of stress hormones such as cortisol and adrenaline.

• Distress: This refers to negative stress that overwhelms the body's ability to cope. It can lead to health problems like anxiety, depression, and adrenal fatigue.

• Eustress: This is positive stress that can be beneficial and motivating. Examples include exercise and fasting, which are considered hermetic stressors. These stressors, in moderation, can stimulate the body's adaptive mechanisms and improve resilience and increase longevity.

4 Types of Stress

1. Acute Stress: This is short-term stress that arises from specific events or situations. It can be thrilling and exciting in small doses, but too much acute stress can lead to anxiety and other health issues.

2. Episodic Stress: This occurs when someone frequently experiences acute stress. People who are always in a rush, take on too much, or have a pessimistic outlook may suffer from episodic stress.

3. Chronic Stress: This is long-term stress resulting from ongoing situations such as a difficult job, an unhappy marriage, or persistent financial problems. 

4. Post-Traumatic Stress: This type of stress follows a traumatic event such as an accident, natural disaster, or violent assault. It can lead to post-traumatic stress disorder (PTSD), a serious condition that requires professional treatment.

Frontal Lobotomy: The Triune Brain and Stress

The concept of the triune brain, developed by neuroscientist Paul MacLean, divides the human brain into three parts: the reptilian brain (brainstem), the limbic brain (midbrain), and the neocortex (cerebral cortex). In our discussion we will include one more proposed brain center - angel lobes - a topic that deserves its own separate blog post. Each part plays a distinct role in our responses to stress:

1. Reptilian Brain: This is the most primitive part of the brain, responsible for basic survival functions such as heart rate, breathing, and the fight-or-flight response. Under chronic stress, this part of the brain becomes overactive, leading to heightened reactivity.

2. Limbic Brain: This area governs emotions, memories, and social interactions. Chronic stress can disrupt the limbic system, leading to emotional instability, loss of connection with others, and increased irritability.

3. Neocortex: The most evolved part of the brain, responsible for higher-order thinking, problem-solving, and self-control. Chronic stress inhibits the neocortex, leading to what is metaphorically referred to as a "frontal lobotomy." This results in decreased emotional intelligence (EQ), poor decision-making, and a diminished ability to respond thoughtfully rather than react impulsively.

4. Angel Lobes: This term refers to the proposed connection between certain parts of the brain, particularly the prefrontal cortex, and our highest Self or spiritual consciousness. It's believed that when we are in a state of peace, connection, and mindfulness, these areas are highly active. Chronic stress, however, can inhibit the function of the angel lobes, reducing our ability to connect with our higher self, experience spiritual well-being, and maintain a sense of purpose and meaning.

When stress is unrelenting, the balance between these brain areas becomes skewed. The reptilian brain takes over, the limbic system becomes dysregulated, the neocortex's functions are suppressed, and the angel lobes' connection to higher consciousness is diminished. This triune brain imbalance makes us more reactive, less connected, and less capable of managing stress effectively. In general, we experience a kind of frontal lobotomy (affecting the rational part of our brain), causing us to lose our ability to respond thoughtfully and connect with what truly nourishes us. Instead, we lash out, engage in harmful activities, seek immediate pleasure over long-term benefits, and more.

A Functional Medicine Approach

Functional and holistic medicine offers a comprehensive approach to diagnosing and treating adrenal fatigue by addressing the root causes rather than just the symptoms. This involves thorough lab testing and personalized treatment plans.

Lab Interpretation

1. Blood Work (Cortisol and DHEA Ratios): Blood tests can measure cortisol and DHEA levels, providing insights into adrenal function. The ratio of cortisol to DHEA is a crucial marker. Imbalances can indicate adrenal dysfunction and affect all other hormone pathways including sex and thyroid hormone production. 

2. Saliva Testing (The Adrenal Stress Index Test): Saliva tests measure cortisol levels at four points throughout the day, offering a detailed view of adrenal function. This test helps identify the specific phase of adrenal fatigue so you can tailor treatment accordingly. Salivary testing is the preferred diagnostic method for diagnosing adrenal dysfunction. To interpret the Adrenal Stress Index (ASI) test:

   • Morning Levels: Cortisol levels should be highest in the morning to help with waking and energy. Low levels indicate adrenal insufficiency, while high levels can suggest an overactive stress response.
   • Noon and Afternoon Levels: Cortisol should gradually decrease throughout the day. Significant deviations can indicate dysregulation.
   • Evening Levels: Low evening cortisol is necessary for proper sleep. Elevated levels may indicate that the body is not transitioning to a restful state.
   • DHEA Levels: DHEA helps counterbalance the effects of cortisol. A low DHEA-to-cortisol ratio can suggest chronic stress and adrenal fatigue.

Impact of Gut Health, Neurotransmitters, and Heart Coherence on Adrenal Dysfunction

Gut health plays a crucial role in adrenal function. The gut-brain axis connects the gastrointestinal system with the central nervous system, influencing stress responses. Poor gut health can lead to inflammation and dysbiosis, exacerbating stress and adrenal dysfunction. Neurotransmitters like serotonin and dopamine, primarily produced in the gut, affect mood and stress resilience.

Heart coherence, the harmonious interaction between the heart, mind, and emotions, can significantly impact stress management. Techniques that promote heart coherence, such as biofeedback and focused breathing, can enhance parasympathetic activity, reducing the strain on the adrenal glands.

How Stress Hormones Impact Female and Male Hormone Production

Stress hormones like cortisol can profoundly impact the production of sex hormones. Evolutionarily, the body prioritizes survival over reproduction. During times of stress (e.g., running from a saber-toothed tiger), the body diverts resources from reproductive functions to manage the immediate threat.

• Females: Chronic stress can lead to irregular menstrual cycles, reduced fertility, and symptoms of estrogen dominance such as PMS and weight gain.
• Males: Prolonged stress can reduce testosterone levels, leading to decreased libido, erectile dysfunction, and muscle weakness.

Treatment to Reverse Adrenal Dysfunction

1. Stress Management: Incorporate stress-reducing practices such as meditation, deep breathing exercises, and yoga to help shift the body from the sympathetic "fight-or-flight" state to the parasympathetic "rest-and-digest" state. Techniques like progressive muscle relaxation, guided imagery, and biofeedback can also be beneficial in promoting parasympathetic dominance. Check out all the tools you can use in a previous post - The Stress Toolbox: 15 Techniques to Create Inner Peace

2. Whole Food Plant-Based Diet: Focus on nutrient-dense foods, including more raw foods and green leafy vegetables. Eating a diet rich in whole, unprocessed plant foods provides essential vitamins, minerals, and antioxidants that support adrenal health and overall well-being.

3. Adequate Sleep: Prioritize 7-9 hours of quality sleep each night by establishing a consistent sleep routine. Going to bed early, ideally by 10 PM, is crucial for adrenal recovery, as the peak hours for adrenal repair are between 10 PM and 2 AM. Protecting and reprogramming circadian rhythms is essential for optimal adrenal function. Supplements such as magnesium, lavender, valerian, chamomile, passionflower, and 5-HTP can support better sleep.

4. Hydration: Drink plenty of water to stay hydrated and support overall bodily functions.

5. General Supplemental Adaptogenic Herbs: Utilize adaptogenic herbs such as ashwagandha, rhodiola, and holy basil. These herbs help balance cortisol levels, enhance resilience to stress, and support overall adrenal health.

Individualized Supplemental Regimen Based on Phase of Care

A more nuanced and individualized supplemental regimen can be developed based on the specific phase of adrenal dysfunction. Research from the "Evaluation of a functional medicine approach to treating fatigue, stress, and digestive issues in women" highlights the importance of tailored interventions:

Low Cortisol Levels

• Licorice Root: Helps prolong the action of cortisol in the body.
• Adrenal Extracts: Can support adrenal gland function.
• Vitamin C: Essential for adrenal health and cortisol production.
• Vitamin B5 (Pantothenic Acid): Supports adrenal function and energy production.

High Cortisol Levels

• Phosphatidylserine: Helps lower cortisol levels and improve cognitive function.
• Magnolia Bark: Reduces cortisol and supports relaxation.
• Holy Basil: An adaptogen that helps modulate cortisol levels.
• Omega-3 Fatty Acids: Anti-inflammatory properties can help reduce stress-induced inflammation.

Hormonal Support for Females and Males

Female Hormonal Support:

• Vitex (Chaste Tree Berry): Helps balance estrogen and progesterone levels.
• Maca Root: Supports hormonal balance and improves energy.
• Evening Primrose Oil: Provides gamma-linolenic acid (GLA), which supports hormonal health.

Male Hormonal Support:

• Tribulus Terrestris: May help increase testosterone levels and improve libido.
• Fenugreek: Supports testosterone production and sexual function.
• Zinc: Essential for testosterone production and overall reproductive health.

Conclusion

Adrenal fatigue can significantly impact your quality of life, but understanding its phases and implementing targeted strategies can help you regain your vitality. By adopting a functional medicine approach and making lifestyle changes tailored to your specific needs, you can take back your life from adrenal fatigue and enjoy improved health and well-being.