Cortisol is one of the strongest messengers in our bodies. It prepares you for fight or flight, mobilizes sugars and gears up fat storage. In normal subjects, 8 am cortisol levels range between 10-22 mg/dL, with optimal range being 13-18. You need cortisol to maintain blood pressure and to simply get you out of bed. Cortisol is also known as the “stress hormone.” It suppresses inflammation so that you can safely handle life’s challenges. When you have very high cortisol with sustained or acute stress, you can develop hyperglycemia, obesity, heart attack, and unexplained pain, because the shut off valve doesn’t stop, and this results in even more inflammation. We call this adrenal fatigue.
I’ve diagnosed and treated many patients with adrenal burnout in my career as a nephrologist. The endocrine society on the other hand, denies its existence altogether. I believe they have it all wrong. True, the science to support this phenomenon is weak, which is precisely why the medical community urgently needs to better identify this complex disease process. Reminds me of the days when physician societies dissed “fibromyalgia” as a real disease. Adrenal fatigue, like fibromyalgia is a reality, and one we cannot afford to ignore any longer. The concept is fairly simple.
Imagine the grind of an average city dweller’s day: work, eat, run. A cycle perpetuated with inadequate diet, poor sleep, injury and infection. At times, the persistent stressors all hit you at once, or in succession, and suddenly things don’t function normally.
Common symptoms and signs of adrenal fatigue are:
- Sense of wired, but tired feeling
- Joint aches
- Sugar fluctuations
- Nighttime awakenings
- Anxiety or depression
- Either very low or high AM cortisol level
A 72 year old woman with major depression came to me last year with sudden bout of worsening depression. Her psychiatrist had tried her on a course of thyroid medication. Her cortisol spiraled out of control, and for a year we struggled to figure out what went wrong. After numerous psychotropic medications, we finally decided to treat her for adrenal fatigue with a low dose corticosteroid, called Medrol. Along with a strict sleep schedule and supplemental herbs and vitamins, we effectively relieved the pressure off the adrenal gland, and sensitized her receptors to the action of her natural cortisol. After two weeks, she returned to my office a new person. Her depression resolved and once again, she was able to think clearly. Her cortisol and thyroid levels now are within normal range.
There is a fear of steroids out there, when in truth corticosteroids have been a mainstay in medicine for centuries- with as many uses as imaginable.
My approach to adrenal fatigue:
- Stress reduction
- Frequent naps and proper sleep hygiene
- Avoidance of heavily processed foods and toxins (e.g. alcohol)
- Rhodiola and relora to create cortisol receptor sensitization
- B complex for cortisol production
- Vitamin D3 to support mood
- Low dose corticosteroids (up to 12 weeks) in severe cases
In our modern day lifestyles, with all the rush, congestion, traffic, pollution, financial struggles, sugary and highly processed diets, excessive exercise or sedentary ways, undoubtedly, we burn out the adrenal gland. There is no doubt in my mind adrenal fatigue exists and that it is poorly understood by the medical community. Clearly, we need more research into this phenomenon, without which we will never be able to give it the cure it demands.
Stress Reduction Technique
If you feel adrenal burnout, try this breathing exercise that Jolene Hart CHC, AADP passed along at our Quarterly Seminar last Spring. This is an excerpt from her website:
The 4-7-8 (or Relaxing Breath) Exercise
This exercise is utterly simple, takes almost no time, requires no equipment and can be done anywhere. Although you can do the exercise in any position, sit with your back straight while learning the exercise. Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise. You will be exhaling through your mouth around your tongue; try pursing your lips slightly if this seems awkward.
- Exhale completely through your mouth, making a whoosh sound.
- Close your mouth and inhale quietly through your nose to a mental count of four.
- Hold your breath for a count of seven.
- Exhale completely through your mouth, making a whoosh sound to a count of eight.
- This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.
Click here to view all the internal medicine services available at Seaside Medical!