Have you recently experienced a major stress in your life, be it illness, job, death, children, etc? After this stress, have you felt as though you just cannot seem to get yourself together, or at least back to where you used to be? Are you usually tired when you wake up, but still “too wired” to fall asleep at night? Is it hard for you to relax or to get exercise? Do you find that you get sick more often and take a long time to get well? If so, then you, like many other Americans may be experiencing symptoms of Adrenal Fatigue.
Adrenal fatigue is not a new condition. People have been experiencing this condition for years. Although there is increasing physician awareness, many are not familiar with adrenal fatigue as a distinct syndrome. Because of this lack of knowledge, patients suffer because they are not properly diagnosed or treated.
Adrenal fatigue is a condition in which the adrenal glands function at a sub-optimal level when patients are at rest, under stress, or in response to consistent, intermittent, or sporadic demands. The adrenal glands are two small glands that sit over the kidneys and are responsible for secreting over 50 different hormones—including epinephrine, cortisol, progesterone, DHEA, estrogen, and testosterone. Over the past century, adrenal fatigue has been recognized as Non-Addison’s hypoadrenia, subclinical hypoadrenia, neurasthenia, adrenal neurasthenia, and adrenal apathy.
Generally patients who present with adrenal fatigue can often be heard saying, “After______, I was never the same.” The onset of adrenal fatigue often occurs because of financial pressures, infections, emotional stress, smoking, drugs, poor eating habits, sugar and white flour products, unemployment and several other stressors. After experiencing many of these events over a long period of time, the adrenal glands tend to produce less cortisol, the body’s master stress hormone. Cortisol’s main role in the body is to enable us to handle stress and maintain our immune systems. The adrenal gland’s struggle to meet the high demands of cortisol production eventually leads to adrenal fatigue.
Patients with adrenal fatigue have a distinct energy pattern. They are usually very fatigued in the morning, not really waking up until 10 AM, and will not usually feel fully awake until after a noon meal. They experience a diurnal lull in their cortisol (the stress hormone produced by the adrenal gland) and as a result, they feel low during the afternoon, generally around 2-4 PM. Patients generally begin to feel better after 6 PM; however, they are usually tired after 9 and in bed by 11 PM These patients find that they work best late at night or early in the morning.
Some key signs and symptoms of adrenal fatigue include salt cravings, increased blood sugar under stress, increased PMS, perimenopausal, or menopausal symptoms under stress, mild depression, lack of energy, decreased ability to handle stress, muscle weakness, absent mindedness, decreased sex drive, mild constipation alternating with diarrhea, as well as many others.
Although there no specific tests that will provide a true diagnosis of adrenal fatigue there are tests that may contribute to an assessment, such as a postural hypotension test, an AM cortisol test, or an ACTH stimulation test. It is customary for a physician to assess the adrenals together with thyroid tests to rule out insufficiency, which sometimes occurs in long-standing hypothyroidism.
A single determination of plasma cortisol or 24-hour urinary free cortisol excretion is not useful and may be misleading in diagnosing adrenal insufficiency. However, if the patient is severely stressed or in shock, a single depressed plasma cortisol determination is highly suggestive. An elevated plasma ACTH level in association with a low plasma cortisol level is diagnostic.
Treatment for adrenal fatigue is relatively simple. Lifestyle modifications can be initiated to treat this condition. Simple changes such as more laughter (increases the parasympathetic supply to the adrenals), small breaks to lie down, increased relaxation, regular meals, exercise (avoiding any highly competitive events), early bedtimes and sleeping until at least 9 AM whenever possible can all benefit those experiencing adrenal fatigue.
A diet that would be conducive to treating adrenal fatigue includes one that combines unrefined carbohydrates (whole grains) with protein and oils (nuts and seeds) at most meals—olive, walnut, fiber, flax and high-quality fish oil. It is also important for patients to eat regular meals, chew food well, and eat by 10 AM and again for lunch. Patients should look to avoid any hydrogenated fats, caffeine, chocolate, white carbohydrates, and junk foods. Diets should have a heavy emphasis on vegetables. It may be of additional benefit that patients add salt to their diet, especially upon rising and at least a half-hour before their lowest energy point of the day. (Preferably, 1/8 to 1/2 teaspoonful of sea salt, Celtic salt, or sea salt w/kelp powder added to an 8 oz glass of water). In adrenal fatigue, one should not follow the USDA’s Food Guide Pyramid, as these patients tolerate fewer carbohydrates and need more protein.
The addition of nutritional supplements may also offer additional benefits to patients experiencing adrenal fatigue. They should consider the addition of:
- Vitamin C 2,000-4,000 mg/day Sustained Release
- Vitamin E w/mixed tocopherols 800 IU/day
- Vitamin B complex
- Niacin (125-150 mg/day) – as inositol hexaniacinate
- B-6 (150 mg/day)
- Pantothenic acid (1200-1500 mg/day)
- Magnesium citrate (400-1200 mg)
- Liquid trace minerals (zinc, manganese, selenium, chromium, molybdenum, copper, iodine)– calming effect
- If depression is present – Add SAM.e 200 mg bid; DL-Phenylalanine (DLPA) 500 mg bid
Some herbal remedies that have been noted as possible therapies include Licorice, Ashwagandha, Maca, Siberian Ginseng, Korean Ginseng. Note: Licorice can and, if taken over time, does have a propensity to elevate blood pressure. It should not be used in persons with a history of hypertension, renal failure, or who currently use digitalis preparations such as digoxin.
Under the supervision of a physician hormone supplementation with DHEA, Pregnenolone, and Progesterone may also offer some benefits. There are several glandular extracts on the market that contain adrenal, hypothalamus, pituitary, thyroid, and gonadal that are also often recommended.
Sometimes the initiation of hydrocortisone (Cortef®) may be necessary as a replacement hormone when cortisol is not being produced by the adrenals. While the initiation of corticosteroids, such as hydrocortisone may have quick and dramatic results, they can sometimes make the adrenals weaker rather than stronger. As a result, the initiation of hydrocortisone is usually a last resort. It is important to note that patients may have to undergo treatment for 6 months to 2 years.
While a cortisol measurement may be helpful to confirm any thoughts or ideas that a patient may have decreased adrenal function, typically blood cortisol levels would be tested along with blood levels of potassium, and sodium. If the pituitary gland is the cause of adrenal failure electrolyte levels are usually normal. Practitioners usually pay attention to extremely low cortisol levels, which generally diagnoses Addison’s disease—a condition in which the adrenal glands are completely depleted, also considered a medical emergency.
Natural Hormone Replacement Therapy (NHRT): If you are currently on or considering the use of Hormone Replacement Therapy (HRT) and you think individualized, natural HRT makes more sense than a “one-size-fits-all” approach, then you may want to look into naturally compounded, bio identical, plant-derived Hormone Replacement Therapy. Compounding is preparing medicines tailored to patients’ individual needs. Compounding is the preparation, mixing, assembling, packaging, or labeling of a drug as the result of a practitioner’s Prescription Drug Order based on the pharmacist-patient-prescriber relationship. Compounding offers patients their choice of drug, strength, dosage form, excipients, or lack of and can be decided on a case-by-case basis. This process allows for medical treatments that otherwise might not be possible.
With an individualized approach to hormone therapy, you can know exactly what your hormone levels are, compare the benefits vs. risks of all possible therapies, and choose the ideal replacement protocol to bring your hormones back to their proper balance. If your doctor is willing to prescribe conventional HRT, s/he should be more than willing to prescribe naturally compounded HRT.
Estradiol, the principal estrogen found in a woman’s body during the reproductive years, is produced by the ovaries. Estradiol is very effective for the symptomatic relief of hot flashes, genitourinary symptoms, osteoporosis prophylaxis, psychological well-being and reduction of coronary artery disease.
Because it is much more potent than estriol, it can be more effective for symptomatic relief than estriol. When Estradiol is replaced using a parenteral (sublingual, percutaneous, or transdermal) route, it is not subject to first pass metabolism by the liver, and therefore does no produce high levels of estrone. Using these routes of administration a woman can mimic the physiologic release of estradiol from the ovaries, thus receiving natural hormone replacement.
Estriol is the weakest of the three major estrogens. In fact it is 1000 times weaker in its effect on breast tissue. Estriol is the estrogen that is made in large quantities during pregnancy and has potential protective properties against the production of cancerous cells.
An important article in the 1966 Journal of the American Medical Association by H.M. Lemmon, M.D., reported a study showing that higher levels of estriol in the body correlate with remission of breast cancer. Dr. Lemmon demonstrated that women with breast cancer had reduced urinary excretion of estriol. He also observed that women without breast cancer have naturally higher estriol levels, compared with estrone and estradiol levels, than women with breast cancer. Vegetarian and Asian women have high levels of estriol, and these women are at much lower risk of breast cancer than are other women. Estriol’s anticancer effect is probably related to its anti-estrone properties-it blocks the stimulatory effect of estrone by occupying the estrogen receptor sites on the breast cells.
Estriol is the estrogen most beneficial to the vagina, cervix and vulva. In cases of vaginal dryness and atrophy, which predisposes a woman to vaginitis and cystitis, topical estriol is the most effective and safest estrogen to use. Because of this estriol is better than estradiol for the treatment of urinary tract infections.
None of the American drug products contain Estriol, so it is not available in most drug stores, although it has been used widely in Europe for over fifty years. Because estriol cannot be patented it does not hold much interest for the pharmaceutical industry. Its availability through compounding has caused its use to grow rapidly throughout the country.
Estrone is the estrogen most commonly found in increased amounts in post menopausal women. The body derives it from the hormones that are stored in body fat. Estrone does the same work that estradiol does, but it is considered weaker in its effects.
Biest is a combination of two estrogens: estriol and estradiol. It is most commonly found in a ratio of 80:20, estriol to estradiol. This combination allows for all of the protection of estriol while providing the cardiovascular and osteoporosis benefits along with the vasomotor symptom relief of estradiol.
Triest is a combination of three estrogens: estriol, estradiol and estrone. It is most commonly found in a ratio of 80:10:10, estriol, estradiol, and estrone. This combination is very popular and contains all of the three major circulating estrogens. It is slightly weaker in its effect when compared to biest. However, this can be compensated for by increasing the strength or by slightly changing the ratios.
Progesterone is produced by the ovaries and the adrenal glands in women and, in smaller amounts, in the testes and the adrenal glands in men. One of its most important functions is in the female reproductive cycle. Progesterone prepares the lining of the uterus for implantation of a fertilized egg, then helps to maintain it during pregnancy. If pregnancy does not occur it signals the uterus to shed this lining.
Progesterone also plays an important role in brain function and is often called the “feel good hormone” because of its mood enhancing and antidepressant effects. Optimum levels of progesterone can mean feelings of calm and well being, while low levels of progesterone can mean feelings of anxiety, irritability and even anger. Current research shows that progesterone may pay a role in the maintenance of the nervous system, the sense of touch, and motor function.
Pregnenolone is a superhormone that is key to keeping our brains functioning at peak capacity. Some scientists believe it is the most potent memory enhancer of all time. Perhaps what is even more amazing are the studies that demonstrate pregnenolone enhances our ability to perform on the job while heightening feelings of well-being. In other words, this superhormone appears to make us not only smarter but also happier.
Like the other steroid hormones pregnenolone is synthesized from cholesterol. In a complex series o steps, cholesterol is broken down into different steroid hormones as the body needs them. It is first synthesized into pregnenolone and used by the body in that form. What is not utilized undergoes a chemical change that “repackages” it into DHEA. DHEA in turns used by the body as DHEA and is also broken down into estrogen and testosterone. This chain of hormones is known as the “steroid pathway.” Because pregnenolone gives birth to the other hormones, it is sometimes referred to as the “parent hormone.”
Pregnenolone was studied extensively in the 1940s. It was shown to be beneficial in elevating mood, improving concentration, fighting mental fatigue, improving memory and relieving severe joint pain and fatigue in arthritis. Pregnenolone has vast therapeutic potential and is currently undergoing further studies in these areas.
Short for Dehydroepiandrosterone, DHEA is a steroid hormone distinguished from others by its unique chemical structure. DHEA is produced by the adrenal glands (located just above the kidneys) as well as by the brain and the skin, and is the most abundant steroid in the human body.
As newborns, we have an extremely high level of DHEA, but within a few days after birth, our DHEA level drops to nearly zero. Then between the ages of six and eight, we experience the even called “adrenarche” in which our adrenal glands begin to stir and gear up for puberty. At the same time our DHEA level begins to rise steadily and continues to rise until it peaks at around age twenty-five to thirty. From that point on in declines at a rate of about 2 percent a year, and we begin to feel the result of this decline in our mid-forties. By eighty our DHEA level is only fifteen percent of what it was when we were twenty-five. This drop in DHEA levels correlates dramatically with the signs and “symptoms” associated with aging.
DHEA is currently the focus of some of the most exciting medical research of this century. Researchers at distinguished medical centers all over the country are studying the properties and promise of DHEA. It is proving to be a potent protector against cancer. It protects against heart disease by lowering blood cholesterol and preventing blood clots. Studies also demonstrate that DHEA improves memory, strengthens the immune system, prevents bone loss, and may even protect us from diabetes and autoimmune disease. It has been shown to fight fatigue and depression; it enhances feelings of well-being and increases strength. DHEA alleviates symptoms of menopause, reduces body fat, and is even known to enhance libido.
Because DHEA is showing such tremendous promise in so many areas, and because of the limited amount of space provided here, we recommend further reading on the superstar of superhormones. An excellent resource for more information is the book “The Superhormone Promise” by W. Regelson, M.D., and Carol Colman.
Usually considered a male hormone or androgen, women also produce testosterone although in much smaller amounts than men do. Testosterone works differently in the bodies of men and women, but it plays a very important role in the overall health and well-being of both sexes. Often called the “hormone of desire” because of its powerful effect on libido, testosterone is also important in building strong muscles, bones, and ligaments as well as increasing energy and easing depression. Low levels of testosterone have been known to cause fatigue, irritability, depression, aches and pain in the joints, thin and dry skin, osteoporosis, weight loss, and the loss of muscle development.
As with all of the hormones, testosterone must be dosed properly to be effective without causing unwanted side effects. The dose in women is generally one-tenth that used in men. Because testosterone is not effective when it is taken orally it is usually prescribed as a topical gel, cream or as a sublingual tablet. Although testosterone was discovered more than sixty years ago, only very recently have we begun to fully understand and appreciate the power of testosterone.
HUMAN GROWTH HORMONE – HGH
HGH is one of many endocrine hormones, like estrogen, progesterone, testosterone, melatonin and DHEA, that all decline in production with age. While many of these hormones can be replaced to deter some of the effects of aging, HGH reaches far beyond the scope of any of these hormones. Not only does it prevent biological aging, but it acts to significantly reverse a broad range of the signs and symptoms associated with the aging process.
The decline of growth hormone with age is directly associated with many of the symptoms of aging, including wrinkling, gray hair, hair loss, decreased energy and sexual function, loss of muscle and increased body fat, cardiovascular disease, osteoporosis, and overall lower life expectancy.
The good news is that there is now clinical evidence which demonstrates that by replacing growth hormone we can dramatically reverse all of these symptoms. Although this may appear to be too good to be true, the more closely the scientific evidence is examined the more clear it becomes that everything that we associate with aging may be due totally or in part to the decline of HGH levels in our bodies.
Until recently, the only way to increase HGH levels in the body, was to use injectable HGH. These injections are very effective, although they are costly and difficult to use. Now, there are natural substances that have been well documented to increase growth hormone by stimulating the bodyís own production of HGH. According to researchers, these cutting edge natural secretagogues may have the ability to more closely mimic the bodyís youthful GH secretion patterns.
These natural substances which stimulate the body’s own production of HGH are known as secretagogues. They can be introduced into the body in two ways: orally or transdermally (topically applied to the skin).
The oral secretagogues are very popular and have shown to be very effective. They include such products as Pro-HGH®, Rejuvamin®, Rejuvamax® and Medi-Tropin®. Though effective, all of these except Medi-Tropin® are available without a prescription. Achieving consistent results with the oral products can be difficult due to changes in absorption from the stomach and the necessity for the stomach to be empty for four hours prior to use.
Trans-D Tropin ®
Trans-D Tropin ®, a transdermal product that is now available by prescription only, provides a very efficient delivery system and an ease of administration that leads to better patient compliance and consistent results. Trans-D Tropin ® is a natural complex which mimics growth hormone releasing hormone(GHRH). The transdermal delivery system allows frequent dosing, up to four times daily, which more closely resembles the body’s own natural response. Imitating this natural response results in an effective and superior release of the body’s own growth hormone.
Saliva Test for Hormones
Adequate levels and an appropriate balance of the steroid hormones (estradiol, progesterone, testosterone, DHEA, cortisol) are necessary for maintaining optimal health and well being in both females and males. This family of steroid hormones supports a wide range of essential physiological functions, including blood lipid balance, bone mineral density, fertility, sexuality, a general sense of well being, as well as certain aspects of brain functioning. The saliva test measures levels of specific hormones that are produced in the body, consumed as foods, dietary supplements or medication. Saliva yields a direct measure of “free hormone ” level and is comparable to that measured by blood. Also, timing of the test can be precisely controlled and levels can be determined at optimum times. Saliva testing provides a means to establish whether or not your hormone levels are within the expected normal range and it is simple and non-invasive. It is appropriate to monitor and titrate doses to minimize side effects and risks without compromising the benefits of replacement therapy.
PyriLinks-D (urine sample)
* must be ordered by a physician
Medical insurance may pay for testing
As a society, we are acutely exposed to daily stresses, be they emotional, physical, or mental. Work situations, family changes and obligations, changes in our bodies and in our health–all of these can contribute to the stress demands on our bodies. Our bodies respond to these stresses in a similar fashion despite the source. Physiologically, each time we are exposed to stresses, our adrenal glands respond by producing certain hormones. One part of the adrenal gland, the adrenal cortex, responds to long and short-term stresses, while the adrenal medulla responds to sudden or alarm situations, producing our “fight or flight” response. With the amount of stress we are exposed to each day, you’d think our adrenal glands were of considerable size, but that isn’t the case. Our adrenals weigh about 5 grams each and reside in our bodies just above our kidneys in the low back area. For small glands, they play an enormous role in our health. Their function also tends to decline over a person’s lifetime, leading some researchers to coin a new term “adrenapause” to define this loss. As such, we need to have ways in which we can keep our adrenal glands healthy.
From a preventive standpoint, we can reduce our exposure to certain stresses, as well as change the degree to which we allow stresses to affect us. This involves making choices about what we subject ourselves to, as well as how we respond to situations we can’t avoid or change. The amounts of hormones, specifically glucocorticoids and catecholamines, that are released by the adrenal glands are directly related to the amount of stress the body endures, and these hormones can affect nearly all the tissues in our bodies. Individuals exposed to long-term stress have higher circulating glucocorticoids than a person who is unstressed does. Certain lifestyle changes, such as exercise, meditation, breathing exercises, and yoga, have all been demonstrated to ease our response to stress. Those who incorporate one or more of these into their days are noticeably more resilient to daily stresses.
We can also address adrenal health through nutritional support and herbs. Vitamin C and the B-complex vitamins are crucial to adrenal health. Being water-soluble vitamins, they are easily depleted and may need regular supplementation, especially in times of stress. Vitamin C is stored in high concentrations in the adrenal glands, which is evidence of its need for this important vitamin. It has been shown that a person’s need for vitamin C varies, depending on what their body is going through at the time. Infection, for an example, can increase the body’s need for vitamin C considerably. Herbs which address adrenal health are referred to as adaptogens, because they help the body adapt to changes, or stresses. Some of the most notable herbs utilized for adrenal support are licorice, ginseng, and astragalus. Astragalus has long been used in Chinese medicine as a tonic. Research has demonstrated its value in enhancing immunity through multiple mechanisms. Ginsengs are commonly prescribed to increase energy and support adrenal function. Research has demonstrated improved functioning under stress as well as increased working capacity following ginseng use. For women, Siberian ginseng appears to be the most appropriate of the ginsengs, as from a Chinese medicine perspective, it is more cooling (less likely to induce hot flashes) and can be used on a regular basis. Borage leaf also provides specific support to the adrenal cortex and can be used daily to support adrenal health.
Diet is another factor that plays a strong role, as it can supply the body with nutrients as well as deplete the adrenals, depending on what choices are made. For example, sugar and caffeine tend to draw energy from the adrenal glands, so stay away from them during times of stress or if you are working at improving adrenal health. In contrast, nutrients that are found in fresh fruits and vegetables supply healthy support for the body. Nutrient-rich foods, like kelp and other seaweed, are good sources of key vitamins and minerals important to glandular health.
A balanced program for supporting adrenal health includes scheduling time to exercise and taking some time for you to be mindful of your stress level and facilitate adjustments when necessary. Remember that treating health holistically means addressing mental, physical, and spiritual aspects of one’s life, for they all affect one another and can contribute to health as well as disease.
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