Saul Marcus, ND - Naturopathic Doctor

247 West 35th street, 10th floor - New York, NY 10001

Phone:(646)330-0388 | Email: saul@drsaulmarcus.com

Contact Office For Appointment

Adrenal Exhaustion and the General Adaptation Syndrome

The adrenals are small glands about the size of an almond that sit on top of each kidney. They are responsible for producing the stress hormones epinephrine (adrenaline) and cortisol.

It's important that we have just the right amount of these hormones. Too much or too little can produce unwanted symptoms.

Much of what we know today about the adrenals and their reaction to stress comes from the work of Hans Selye. His General Adaptation Syndrome (GAS) describes how the adrenal glands adapt to stress over time, along with changes in hormones.

Phase 1 Alarm

Imagine that it is several thousand years ago and you're being chased after by a saber-toothed tiger. In a “fight or flight” response your adrenals release huge amounts of epinephrine and cortisol. This boost in stress hormone does many things such as:

  • Raises blood pressure
  • Strengthens heart contractions
  • increases blood sugar
  • Excites mood and focuses mental clarity.

Basically it gives the body the energy it needs to respond to the immediate danger. [1]

However, there is also a downside to this:

  • Decreased digestion
  • Decreased detoxification
  • Lowers immune system function
  • Gluconeogenesis and protein catabolism is stimulated. [2]

"Protein catabolism and gluconeogenesis" means that the body will break down its own proteins and eat itself alive in order to get enough energy to escape the emergency. The body does this as a mechanism to survive short term threats like a saber-toothed tiger. This is mean to be a short term adaptation to stress, not a way for the body to function on a daily basis.

Phase 2 Resistance

In an adaptation to chronic stress the body keeps cortisol elevated all the time. This is a doorway to chronic illness such as high blood pressure, diabetes, and cancer. Remember, during this stage the body will catabolize or eat itself to get the extra energy demanded by high levels of stress. This phase can last for months, years or even someone's entire life. [3]

Phase 3 Exhaustion

In some people the adrenals glands can't keep up and cortisol production drops. Too much cortisol is bad, but so is too little.

Why we need to have some cortisol (not too much or too little):

  • Maintain blood sugar
  • Maintain blood pressure
  • Regulate inflammation
  • Proper fluid and electrolyte regulation

Sub-optimal cortisol levels can leave us in a state of fatigue. [4] [5]

The key concept is that Cortisol itself is not "bad" or "good." It is cortisol out of balance which is bad.

What kind of stress causes adrenal fatigue?

It is true that road rage, aggravation at work, and personal relationships contribute to stress. However this is not the only cause of stress. Excessive physical activity, lack of sleep, working long hours poor diets, allergies, injuries and chronic inflammatory states (which can include GI disorders), infections and pain can also contribute to stress. [6] [7] [8] [9]

The adrenals don't know if you are fighting off a saber-toothed tiger, sitting in traffic or have an infection. There is only one response to stress: produce more cortisol.

Prolonged stress no matter the source can push people towards Adrenal Exhaustion. [10]

Signs of adrenal exhaustion can include :

Conventional treatment for Adrenal Fatigue

As far as conventional medicine is concerned there are 2 major types of adrenal disorders involving cortisol.

These are uncommon diseases of the endocrine system and caused by factors such as autoimmunity or tumors. [12]

Adrenal Exhaustion is not a disease per se. There is no diseased organ or localized pathology. It's an adaptation to prolonged stress.

When medical doctors run tests for adrenal function they are not looking for Adrenal Exhaustion. They are looking for Addison's or Cushing's disease. If they are testing blood levels of cortisol, it probably will look "normal" in cases of Adrenal Exhaustion. According to the National Institute of Health normal 8AM blood cortisol ranges from 6 – 23 micrograms per deciliter. So you can have greater than 3 times more cortisol levels than someone else and the both of you are "normal." [13]

Rather than having Adrenal Exhaustion identified as a cause of fatigue, patients are more likely to here the following from medical doctors:

There are some diagnoses for severe fatigue. However, these are intended to indicated conditions which are more severe/complex:

Testing cortisol levels:

If testing cortisol many non-conventional practitioners prefer saliva tests over blood. Saliva has several advantages:

Is it necessary to test cortisol?

Based upon everything in this article, it may seem that testing cortisol is essential. However, Adrenal Exhaustion does not happen in isolation. If someone is tired due to a chronic viral infection - their cortisol may be low, but it's much more important to treat the immune system and help them overcome the infection, rather than testing cortisol and then trying to force it up with medications/supplement based off of lab tests.

Each case is different. Sometimes cortisol tests are very important, sometimes they are not and sufficient information can be gathered from case history alone. This is best determined on a case by case basis, under guidance of an competent practitioner.

Recommended books on adrenal fatigue:

Adrenal Fatigue: the 21st Century Stress Syndrome James L. Wilson, N.D., D.C., Ph.D.

References:

[1] Wilson, James. "Adrenal Fatigue: The 21st Century Stress Syndrome." Smart Publications, p. 287-290, 2002.

[2] Guyton & Hall. "Pocket Companion to Textbook of Medical Physiology, Tenth Edition." Saunders, p 596.

[3] Wilson, James. "Adrenal Fatigue: The 21st Century Stress Syndrome." Smart Publications, p. 290-291, 2002.

[4] Wilson, James. "Adrenal Fatigue: The 21st Century Stress Syndrome." Smart Publications, p. 287-290, 2002.

[5] Yeager MP et al, Glucocorticoid regulation of the inflammatory response to injury, Acta Anaesthesiol Scand, Vol 48, No. 7, p 799-813, 2004.

[6] Guyton & Hall. "Pocket Companion to Textbook of Medical Physiology, Tenth Edition." Saunders, p 596.

[7] Bengmark S. Nutritonal modulation of acute-and "chronic"-phase responses, Nutrition, Vol. 17, No. 6, p. 489-495, 2001.

[8] Webster JL & Sternberg EM, role of the hypothalamic-pituitary-adrenal axis, glucocorticoids and glucocorticoid receptors in the toxic seequelaw of exposure to bacterial and viral products, J Endocrinol, Vol. 181, p 207-221.

[9] Hulsewe KW et al. Inflammation rather than nutritional depletion determiens glutamine concentrations and intestinal permeability, Clin Nutr, Vol. 23, No. 5, p 1209-16, October 2004.

[10] Smit, Altta, Arturo O'Byrne, Bruno V. Brandt, Ivo Bianchi, and Klaus Kuestermann. Introduction to Bioregulatory Medicine. New York: Thieme, p. 30, 2009.

[11] Wilson, James. "Adrenal Fatigue: The 21st Century Stress Syndrome." Smart Publications, p. 27-44, 2002.

[12] Guyton & Hall. "Pocket Companion to Textbook of Medical Physiology, Tenth Edition." Saunders, p 598 - 599.

[13] http://www.nlm.nih.gov/medlineplus/ency/article/003693.htm (Accessed february 1, 2010)

[14] Guyton & Hall. "Pocket Companion to Textbook of Medical Physiology, Tenth Edition." Saunders, p 597.

[15] http://www.diagnostechs.com/salivatesting.html (Accessed february 1, 2010)

[16] Vgontzas, A.N. , Bixler, E.O., Lin, h, Prolo, p, & G, Mastorakos. (2001). Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications . The Journal of Clinical Endocrinology & Metabolism , 86(8), 3787-3794.[17] Wilson, James. "Adrenal Fatigue: The 21st Century Stress Syndrome." Smart Publications, p. 125, 2002.

 

Note - this article originaly posted 2010 - edited 2015