Stress and Adrenal Glands

“Adrenal fatigue” is a condition that, although addressed by many naturopathic doctors, is not frequently treated by conventional practitioners. “True” adrenal disease is not often diagnosed until the adrenal glands are either in failure or there are noticeable tissue changes. Adrenal failure is also known as Addison’s disease, and typically is the result of autoimmune destruction of the adrenal cortex causing a halting in the production of the hormones generated by the adrenal gland. It’s not clear whether or not long-term adrenal fatigue contributes to the destruction of the adrenal glands, but it is apparent that this middle ground adrenal dysfunction can have some potentially severe effects on your health. Research has begun to demonstrate the existence of what’s called “subclinical” adrenal disease without complete adrenal failure and it appears that chronic stress is a major contributor to clinical adrenal fatigue.

Stress is everywhere, in chronic and acute, physical and psychogenic forms. The body is equipped with a complex system of hormones and neurotransmitters designed for dealing with stress and this adaptation response is a great example of the link between mind and body because stress is actually a physical result of perceived threats. Although these threats and stressors have changed over time (i.e. most of us don’t have to outrun large animals to survive), the body’s physical response to them has not. The adrenal glands are central to the stress response and, in addition to the mineralcorticoids, and sex hormones, they produce the primary stress hormones; epinephrine, norepinephrine, and cortisol. In response to a stressor, the body’s immediate reaction is typically like an alarm, cascading into the well-known “fight or flight” response, and resulting in an increase in the release of stress hormones, increased heart rate and blood pressure, decreased blood flow to the gastrointestinal tract, and increased blood flow to the heart, brain, and skeletal muscles.

When exposed to prolonged periods of stress, it becomes difficult to continually adapt and levels of the stress hormones may not return to baseline levels. The glucocorticoids released during early adaptation to long-term stressors, such as cortisol, prepare the body for short and long-term survival by freeing up stored proteins (i.e. muscle tissue) and fatty acids in addition to promoting the production of glucose by the liver, resulting in increased blood glucose levels. Continued exposure to stress not only results in continued release of glucocorticoids and their subsequent effects, but also affects the feedback loop that dictates when and how much cortisol should be released, decreasing its sensitivity to the high levels of circulating cortisol. Long-term elevations in cortisol leads to two main changes in the body; decreased muscle mass, and an increase in fat around the abdomen, as the body attempts to store its fuel. Over time, insulin resistance, mild obesity, hypertension, and elevated triglycerides and lipids may occur.

In later stages of the body’s stress response, the adrenal glands begin to fatigue and cortisol output declines, as the body’s ability to manufacture cortisol is compensated. Adrenal fatigue appears in the form of headaches, low blood pressure, sensitivity to carbohydrates, alcohol intolerance, inability to concentrate, depression, and fatigue. There are many ways to diagnose adrenal hyperfunction and adrenal fatigue, and they all have their strength and weaknesses. One of the more popular methods involves testing cortisol levels throughout the day. Another tests ACTH levels throughout the day (ACTH is a pituitary hormone that stimulates the adrenal glands to produce cortisal; it’s part of a feedback loop with cortisol). Any method used should involve a comprehensive history and evaluation of exposure to stress, perception of stress, and symptoms.

Naturopathic treatments for adrenal fatigue typically include therapeutic nutrition, herbs, and lifestyle adjustments to not only optimize adrenal function but also to help change the way that people experience and perceive stressors. Of course it would be impossible to eliminate stress, but ensuring adequate sleep, exercise, and good dietary choices, helps. One of the supportive therapies that may be utilized is Vitamin B-5 (pantothenic acid), which acts as part of a coenzyme complex that is vital to adrenal cortex function. B-5 can be found in brewer’s yeast, eggs, cheese, peanuts, fish, and chicken but despite widespread availability, supplementation would likely be recommended for adrenal support. There is also a category of herbs called “adaptogens” noted for their ability to stabilize the adrenal glands and promote balanced responses to stress. Some of the better known and more researched herbs that fall into this category include Rhodiola, Glycyrrhiza (licorice root), Korean Ginseng, Siberian Ginseng, Ashwaganda, and Schisandra.

Clearly, adrenal fatigue is a complex problem that will continue to manifest itself as we propel ourselves as a society towards faster paced lifestyles. The seemingly basic adjustments of increased and improved sleep, more exercise, and a healthy diet, can provide most with a good arsenal to help combat stress but others may benefit from more comprehensive interventions. One of my teachers once joked that we should put Ginseng in the water; maybe she wasn’t entirely wrong.