Sick and Tired

This article first appeared in The Gloss magazine, October 2016

Living in a constant state of stress could be the cause of your sleep disturbances, digestive problems and fatigue. The problem lies in overworked adrenal glands.

Are you amongst the growing band that can’t quite figure why they can’t sleep, why they can’t lose weight or why they are always, always tired? If so, you’re not alone and many healthcare experts use the term ‘adrenal fatigue’ to describe this constellation of symptoms associated with hormonal imbalances in the body. However, since the term was first coined in the late 1990s it has become somewhat controversial with much of allopathic medicine refuting its existence, while the burgeoning world of functional medicine is starting to understand the intricacies of these imbalances more thoroughly.

Living with stress

Shabir Daya is a pharmacist and founder of the UK-based on-line health resource Victoria Health. He believes that adrenal stress as the modern misunderstood syndrome that affects most of us to varying degrees. “Stress, whether physical, emotional or environmental, can stimulate a cascade of hormone production by the adrenals that includes adrenaline, noradrenaline and cortisol,” he explains. “These hormones should theoretically work very well to keep our body within its normal mode of operation. Unfortunately, in modern society, we are constantly being subjected to all types of different stressors, and whether the stressor is work related, emotionally linked or even hormonally associated, this constant stress causes our bodies to release continuous amounts of cortisol as well as the contradictory adrenaline to keep up with these demands. This is termed ‘adrenal stress’, which is only the starting point. After a while, the adrenals cannot manufacture cortisol and with very little cortisol going around the bloodstream, one feels completely fatigued and this phase is termed ‘adrenal exhaustion’.

We all know that some amount of cortisol is essential. It’s the hormone that wakes us up in the morning. The problem is that high levels can impact nearly every system and hormone in the body. “Excess cortisol switches off our digestive system causing any number of issues such as reflux, indigestion, bloating and constipation,” adds Daya. “It affects our immune system making us more susceptible to infection and it affects nearly every hormonal gland including the thyroid, pancreas and the reproductive organs. Additionally cortisol has a major impact on the nervous system and the neurotransmitters resulting in anxiety, sleep disturbances and mood swings.” What’s more, while the adrenals are busy trying to keep up with the demand for cortisol, they don’t produce sufficient energising hormones resulting in tiredness and fatigue and although the body may be tired sleep is prone to disruption.

Traditional Chinese medicine

Traditional Chinese medicine has its own spin on this, as Paul Mc Carthy, Founder of the Summerhill Clinic and Academy of Classical Chinese Medicine in Dublin explains: “The signs and symptoms attributed to the label ‘adrenal burnout’ are similar to energetic disharmonies such as Kidney Yin or Yang Deficiency, or imbalances between Kidney and Heart, Kidney and Spleen etc. These terms Kidney, Spleen etc. are energetic concepts and don’t reflect the organs as they are described in western anatomy and physiology, but in essence twenty people with the ‘diagnosis’ of adrenal burnout may all be treated quite differently (with a combination of acupuncture, herbal medicine, nutritional advise and lifestyle changes) depending on their unique circumstances.”

Western medicine

Dr Silvano Mascadri from Espace Henri Chenot wellness clinic at Palace Merano in Italy defines adrenal burnout as ‘a condition in which the adrenal glands fail to produce an appropriate and necessary amount of hormones needed for energy production, maintenance of blood sugar levels, immunity and the healthy digestion of nutrients.’ In many cases the problem is linked to an excessive amount of hormones, most especially cortisol, generated by intense periods of stress. “Cortisol attacks our body in different ways from mental confusion and irritability to digestive disorders like irritable bowel syndrome (IBS), depression, anxiety, immune system deficiency, excessive fatigue, sudden weight loss/gain and more. The hippocampus (the part of the brain with the largest deposits of cortisol receptors) wasn’t ‘designed’ to respond continuously to stress, but as many of us live constantly in this mode, with the hippocampus constantly on, this is where the real danger is,” she warns.

Functional medicine

Cork-based nutritional therapist Karen Ward no longer buys into the concept of ‘adrenal burnout’ as she believes that “science has a totally different spin on HPA-Axis dysfunction (or Hypothalamic-Adrenal Axis dysfunction) now which is fascinating, and as opposed to throwing lots of nutrients at the adrenals such as B vitamins, high dose vitamin C etc, what has emerged is that its the brain, its stress response and the gut that needs support to help a person coming back from 'burnout'.”

Ward sees lots of exhausted people (mostly women) at her clinic outside Kinsale, but she says it’s not adrenal fatigue that they suffer from, as the adrenals continue to function, unless of course, its Addison’s disease or Cushing’s, both full blown autoimmune conditions. In essence, it’s a breakdown in communication between the brain, the pituitary gland and the adrenals, primarily the result of chronic stress and all that accompanies it. Every body organ is affected too. “Even 2 glasses of red wine a night can affect how the body uses cortisol if the liver is already a little toxic,” she warns.

She is adamant that practitioners need to fully understand where the dysfunction is. “Testing is key and whether it’s the adrenal glands or the brain, it’s cortisol we are dealing with and the DUTCH test (Dried Urinary Total Cortisol) provides the most comprehensive look possible. And once we dig deeper to the root cause, multiple therapeutic interventions are possible including adaptogenic herbs, specific phospholipids, along with other dietary and lifestyle measures to support patients return to a state of internal balance.

Dr Carrie Jones relies on DUTCH too. A naturopathic doctor specialising in hormones and women’s’ health based in Portland, Oregon, she feels that the current focus on adrenal fatigue is misleading to say the least. “The symptoms are very real,” she says “but we’re all blaming the adrenal glands when we need to think bigger. We need to look to outside triggers like the brain, viruses, our fat tissue and obesity, amongst many other possible causes. We need to find the cause and not just blame the glands.”

She understands why medical doctors may be skeptical about this adrenal story. “The adrenal glands don’t go through menopause like the ovaries do, so I can see why they [the medical community] say that they don’t give out and shut down. But there is something seriously wrong now that is greatly affecting the quality of the adrenal hormonal output and sadly our society is getting sicker.”

While every discipline has their own specific therapeutic nuances, they are in unison on some basic lifestyle measures that will help reset our natural body rhythms. Most notable amongst these are: Learning to relax (many of us still need to ‘learn’ this basic prerequisite), unplugging from all technology (especially in the evening), exercising moderately, getting adequate sleep, eating a diet rich in healthy fats, with moderate protein and low in stimulants and refined carbohydrates and taking care of our gut. To quote Jones: “Everything is a balance and we are just not very balanced now.”

Dr Carrie Jones’s herbal recommendations:

Always consult your healthcare provider before taking any supplements. Avoid if pregnant or breastfeeding. Quality counts - only buy from reputable suppliers.

Ashwagandh: Ayurvedic herb restorative to the adrenal glands, the immune system and the thyroid. Typical dose: 250-500mg once or twice daily.

Panax quinquefolius (American ginseng): Adaptogen for the adrenals and all over health tonic. Typical dose: 250-500mg once or twice daily.

Eleutherococcus senticosus: Adaptogen for the adrenals and helps reduce anxiety and improve focus. Typical dose: 500-1000mg once or twice daily.

Cordyceps sinensis: From the fungi family is an immune and kidney tonic and helps support HPA axis communication. Typical dose: 500-1000mg taken once or twice daily.