The Role of The Adrenals in Health and Disease

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A diagram showing the effects of functional health on the brain.

The function of the adrenal glands is to keep you safe in the face of danger and to mobilize resources that are required to help you to fight or escape or survive.

As part of the sympathetic nervous system, the adrenals get involved whenever the demands on the body exceed the body's normal capacity to handle them.

The fight-flight response gets evoked in the case of a hungry tiger chasing you, a near miss on the road, or fighting off a robber in a dark alley. These are rare incidents, yet most people living in our modern world experience this sort of stress response pretty much 24/7.

The kinds of stressors that cause adrenal response are more likely in the realm of mental-emotional stressors, like job related challenges or relationship discord, toxic exposure and imbalances in nutrients and the microbiome.

These stressors result in nutrient depletions, hormonal dysregulation, blood sugar and blood pressure elevation and a whole lot more, just as if there were a physical stressor.

What is “Adrenal Fatigue”?

Adrenal fatigue is considered a “made up thing” by many western medicine practitioners, yet we see people everyday suffering from the results of stress on the body.

They were taught that the only dysfunctions of the adrenal glands are autoimmune in nature, like Addison's, which is an immune depression of adrenal function, and Cushings, which is an overactivation.

So when people report to their doctors feeling exhausted and depressed, unable to lose weight, have no libido, and have a “tired and wired” presentation, and they ask if this could be adrenal fatigue, they are often laughed at told that, “It's all in their head,” or “They're hypochondriacs.”

So let’s go back to the science to define adrenal dysfunction, so we can support people to handle their day-to-day stressors and mitigate them in ways that don't cause damage.

Dr. Hans Selye and The General Adaptation Syndrome

Back in the 1950’s, Dr. Hans Selye, an Austrian-Canadian endocrinologist and researcher who is widely known for his work on stress and its impact on the body, coined the term “stress” and was the first to describe what he called the General Adaptation Syndrome, which outlines the body's response to stress.

He also discovered the hypothalamic-pituitary-adrenal (HPA) axis and its role in the stress response.

Throughout his career, Selye authored more than 1,700 scientific publications and received numerous honors and awards for his contributions to the field of stress research.

His work has had a significant impact on modern-day medicine and our understanding of the mind-body connection. His research and works defined the general adaptation syndrome as having three stages.

Stage 1: Alarm Reaction

According to Selye, the alarm reaction is the first stage of adrenal dysfunction, and it occurs when the body is exposed to stress. During this stage, the body responds with the “fight or flight” response, which includes an increase in heart rate, blood pressure, and respiration. Physical symptoms of this stage can include sweating, anxiety, and tension headaches.

Stage 2: Resistance Stage

The resistance stage occurs when the body is exposed to prolonged stress. During this stage, the body continues to produce stress hormones such as cortisol, but at a lower rate than during the alarm reaction stage. Physical symptoms of this stage can include fatigue, difficulty sleeping, loss of libido and digestive problems.

Stage 3: Exhaustion Stage

The exhaustion stage occurs when the body has been exposed to prolonged stress and is no longer able to produce adequate amounts of stress hormones. During this stage, the body experiences a decrease in cortisol and other hormones, which can lead to a range of health problems. Physical symptoms of this stage can include chronic fatigue, weight gain, and a weakened immune system.

Adrenal Dysfunction and Health

Adrenal dysfunction can have serious consequences for overall health. Prolonged exposure to stress can lead to a range of health problems, including high blood pressure, diabetes, and depression. It's important to recognize the signs of adrenal dysfunction and take steps to manage stress in order to prevent long-term health problems.

Management and Prevention of Adrenal Dysfunction

Preventing adrenal dysfunction requires a dedicated approach to managing stress. This can include exercise, meditation, and other relaxation techniques.

Adrenal Fatigue in the “New World”

The above maps out well “Adrenal Fatigue” from a functional perspective. Lately, however, the concept of adrenal fatigue, is getting questioned.

Do the adrenals really fatigue and stop being able to make cortisol, or are there other factors involved?

I prefer to look at it as adrenal dysfunction or better yet, HPA axis dysfunction.

The Stress Response: Understanding Adrenal Dysfunction and HPA Axis Dysregulation

The hypothalamic-pituitary-adrenal (HPA) axis is responsible for regulating the body’s response to stressors by stimulating the release of stress hormones, like adrenaline and cortisol, by the adrenal glands.
When this system is dysregulated, as a result of chronic stress, infection, trauma, or other factors that can disrupt the delicate balance of the system, it can lead to overproduction or underproduction of cortisol.

Symptoms of HPA Axis Dysfunction

The symptoms of HPA axis dysfunction can vary depending on the underlying cause and the severity of the condition. Some common symptoms include:

  • Chronic fatigue
  • Insomnia
  • Depression and anxiety
  • Brain fog and memory problems
  • Digestive problems
  • Blood sugar imbalances
  • Low libido
  • Autoimmune conditions
  • Weight gain or loss

Assessment and Management of HPA Axis Dysfunction

There are a variety of tests that can help determine the state of the HPA Axis. The conventional medical approach is to test morning cortisol.

Since cortisol has a circadian pattern of secretion, morning cortisol doesn't give us enough information.

I prefer salivary cortisol, measured at 4 times throughout the day, 24-hour urine collection, or urine samples taken 4 times throughout the day.

The types of tests will be compared in a future article.

The Role of The Adrenals in our health and how it affects our body

Impact of HPA Axis Disruption on Overall Health

HPA axis dysfunction can have a significant impact on overall health. Chronic stress and dysregulation of the HPA axis has been linked to a range of conditions, including cardiovascular disease, diabetes, autoimmune diseases, and mental health disorders. Therefore, it's important to recognize the symptoms of HPA axis dysfunction and take steps to manage stress and support the system to prevent long-term health problems.

Stress is a part of life, and the human body has evolved to respond to it in a way that helps us cope with the challenges we face. The hypothalamic-pituitary-adrenal (HPA) axis is a critical system designed to support our response to stress and keep us alive in the face of physical danger.

When this system gets dysregulated, it can lead to a range of health issues.

Identifying adrenal dysfunction and HPA axis dysregulation can be challenging, as the symptoms are often vague and can overlap with other conditions.

Management needs to address the underlying stressors and includes a combination of lifestyle changes, such as mindfulness practices like meditation and HeartMath, getting enough sleep, and eating a Whole Foods, clean diet, along with supplements and adaptogenic herbs to support the system.

Among the most commonly used adaptogenic herbs are ashwaganda, tulsa, and rhodiola rosea.

Download my Adrenal Resource guide at http://www.Reinventhealthcare.com/adrenal for a detailed list.

We now know that there's a lot more going on than the simple explanation of 3 stages. There are metabolites to consider, the impact on thyroid and sex hormone function, and much more.

Subscribe to the Reinvent Healthcare podcast to stay up to date. We're planning to go into a lot more detail in future episodes.

As part of a functional evaluation, listen to the words people use. Worry is a clue.

Inflammation and Adrenal / HPA Axis Dysfunction

Often overlooked as a player in adrenal dysfunction is inflammation. Inflammation can be the result of a recent injury, car accident, a fall, or an old injury that doesn't seem to be healing.

It can be caused by an autoimmune process.

It can result from nutrient imbalances in the fatty acid cascade.

There could be food stressors, multiple food sensitivities, nutrient deficiencies, there can be toxic elements in the food.

There might even be a chronic viral or bacterial infection, like EBV, H-Pylori or other. All of these things affect the HPA Axis and the response of the adrenals.

The Impact of Elevated Cortisol and Adrenaline

In summary, cortisol can either save you or kill you.

Excess cortisol release in the absence of lions and tigers and bears can be deadly.

When the triggering events don’t require physical responses like fighting or escaping, but are related instead to stress on the job, caring for a loved ones, food stress, or toxic exposure, excess cortisol can be deadly

Stressful events trigger the hypothalamus to release a hormone called ACTH, an adrenocorticotropic hormone.

ACTH stimulates the adrenals to jump into action and secrete adrenaline, also known as epinephrine. And, following the adrenaline comes the release of cortisol. Think about adrenaline as the fast-acting, first line of defense, that results in increased strength. It’s adrenaline that comes into play when you hear stories about a 90 pound woman lifting a car off her son. There’s no way under normal circumstances that she could lift that much weight without adrenaline.

Adrenaline works at the expense of resources within the body and only lasts for a short time.

Then cortisol takes over.

They both cause increased heart rate, blood pressure, and respiration rate. They cause the pupils to dilate, so we can see better.

They also cause a decrease in digestion and increased blood clotting so that if there's an injury as we're running away from the tiger, we're not going to bleed to death.

Long-term, increased blood clotting can lead to stroke, heart attack, or an aneurysm bursting.

There’s also a shift in mental alertness from wizard brain – high-level problem solving – to lizard brain – survival mode.

Chronically elevated cortisol can cause weight gain as a result of the elevation of blood sugar and the release of insulin.

Over time, cortisol damages the hippocampus, the part of the brain responsible for short-term memory. This presents as not remembering things like where you put your keys, why you entered a room, or even people’s names.

Chronic cortisol suppresses the immune system and the phenomenon of getting sick on weekends or vacations.

In conclusion, the term adrenal fatigue may no longer be in favor, but dysfunction of the HPA axis is real.

Subscribe to the blog to get notifications of future articles in this series

Download our adrenal health guide at www.ReinventHealthcare.com/adrenal and get more in-depth information from our recorded Adrenal Thyroid Workshop.

And comment below on your experiences

References:

  1. McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: central role of the brain. Physiological reviews, 87(3), 873-904.
  2. Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature Reviews Endocrinology, 5(7), 374-381.
  3. Selye, H. (1956). The stress of life. McGraw-Hill.
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