Adrenal Fatigue

Do you ever feel like the hardest part of your day is getting out of bed in the morning, no matter how much sleep you have had? Ever catch yourself dozing off at work and gaze up at the clock to realize that you still have a few more hours of your workday to go? Do you ever feel irritable and unable to focus on tasks? You might be even remotely aware of what an annoying routine it has become for you to feel sluggish every day. Like many others, you are probably clueless as to why you continue to experience this unrelenting fatigue, and the only probable explanation you can think of that you are not having enough coffee to keep you going, right?

Although these symptoms may seem like a common occurrence for most people and only mildly concerning, they are actually signs that your adrenals may be in need to some support. The adrenal glands are two small glands that rest atop each kidney and serve many vital functions including regulating your body’s response to stress by releasing hormones such as cortisol, DHEA, and epinephrine ^[1]. When the adrenal glands are over-stimulated for a prolonged period of time, they begin to weaken and produce less hormones. Adrenal fatigue or adrenal dysfunction refers to a condition that results from impaired functioning of the adrenal glands. The symptoms include orthostatic hypotension or low blood pressure particularly when getting up, insufficient sleep (even after a long sleep), brain fog, inability to cope with stressful situations, and a characteristic bump in energy late in the evening ^[2]. Despite being increasingly common, adrenal fatigue has not quite received the recognition that it deserves and often goes unaddressed. In the conventional medical field, more attention is given to severe adrenal insufficiency conditions where the adrenals cease to function altogether, such as Addison’s disease and Cushing’s disease ^[1]. Adrenal fatigue may then represent a state that could progress to chronic adrenal insufficiency if left unaddressed or untreated ^[2]. This article will identify the causes of adrenal fatigue and its association with the HPA axis. Lastly, it will discuss the most effective naturopathic approaches to treating adrenal fatigue.

Stress and the HPA-Axis

The Hypothalamic-Pituitary-Adrenal axis or HPA axis, as its name suggests, refers to the complex interplay between the hypothalamus, pituitary gland, and adrenal glands, whose main function is to maintain stress-related homeostasis or balance ^[3]. The hypothalamus, also known as the “master gland” in the brain responds to stress by releasing a hormone called corticotropin-releasing factor (CRF). This hormone in turn signals the pituitary gland to release adrenocorticotropic hormone (ACTH), which then stimulates the adrenal glands to release cortisol ^[1]. The rise in stress hormone triggers feedback controls to signal the hypothalamus to stop producing CRF. In severe cases of adrenal fatigue, hormones are ceased to be produced and released by the adrenals as they become worn out. Some causes of adrenal fatigue include insufficient sleep, improper diet, increased caffeine intake, and prolonged periods of physical or emotional stress. Stress in particular is an important risk factor for many illnesses including headaches, heart disease, to immune deficiencies, to digestive issues ^[1]. It is estimated that 75-90 percent of visits to primary care related to stress- either acutely, or due to chronic problems associated with stress ^[1]. The implications of adrenal fatigue and excess cortisol extend further to include a weakened immune system. A weakened immune system in turn can lead to increased susceptibility to illnesses. When the adrenal glands have undergone prolonged intense periods of stress and eventually stop producing appropriate levels of cortisol, decreased cortisol can result in an overactive immune system. This in turn can lead to autoimmune diseases ^[4]. Prior to making a diagnosis of adrenal fatigue, it is important to distinguish adrenal fatigue from other similarly presenting conditions such as chronic fatigue syndrome. Diagnostic testing for adrenal fatigue begins with obtaining information regarding an individual’s health history, followed by lab testing to rule out the possibility of nutritional deficiencies, infectious diseases, or conditions such as anemia or hypothyroidism that may be causing the fatigue. Adrenal function can be measured using a salivary cortisol and dehydroepiandrosterone (DHEA) test; measuring blood pressure; and performing a physical exam test, specifically a Hippus test which examines pupillary dilation in response to light. Naturopathic approaches to treating adrenal fatigue include identifying the cause and addressing appropriate dietary needs and nutritional supplementation, considering botanical tinctures or capsules that act as adaptogens or anxiolytics which reduce anxiety, establishing proper sleep hygiene, and incorporating stress reduction techniques. The term “adaptogen” in particular refers to plants that improve the non-specific response to and recovery from stress ^[1]. According to researcher I.I. Brekhman who coined the term, an adaptogen has four main properties; 1. It is harmless, 2. It has a general, non-specific effect, 3. It increases resistance to physical, chemical, or biological stressors, and 4. It acts as a general stabilizer/normalizer ^[1].

Naturopathic Treatment

Licorice

Licorice, or Glycyrrhiza glabra is a popular herb used in traditional medicine to treat adrenal fatigue and ulcers. The main active ingredient Glycyrrhizin, is structurally similar to corticoids and is responsible for influencing cortisol balance ^[1]. Glycyrrhizin acts by binding to glucocorticoid and mineralocorticoid receptors, weakly mimicking the action of endogenous steroid hormones and sparing cortisol ^[1]. At higher amounts, licorice is found to have a strong effect on the kidneys, allowing cortisol to interact with aldosterone receptors, which in turn affects sodium/potassium balance and increases blood pressure. For this reason, licorice should be administered with caution to individuals with high blood pressure and they should be monitored closely.

Siberian Ginseng

Siberian ginseng or Eleuthrococcus senticosus is another herb known for its anti-stress effects which acts by modulating changes of the HPA-axis. Clinical studies have found Eleuthrococcus to increase the ability to accommodate to adverse physical conditions, improve mental performance, and enhance the quality of work under stressful conditions ^[5]. A double-blind study conducted on 45 healthy individuals ranging from 18-30 years of age randomized participants to receive Eleuthrococcus or a placebo for 30 days. The participants were then subjected to a test, known as the Stroop Colour-Word test (Stroop CW) to assess their stress response, as well as heart rate and systolic and diastolic blood pressure before and after treatment. The study found that unlike the placebo group, those taking the herb experienced a 40 percent reduction in heart rate and 60 percent reduction in systolic blood pressure in response to the stress test ^[6].

Withania Somnifera

Withania Somnifera, also known as Ashwagandha or Indian Ginseng, is a popular adaptogen from the Ayurvedic medical tradition. The withanolides found in Withania are biological substances with a sterol structure that are believed to be responsible for the plant’s adaptogenic and glucocorticoid-like effects. Studies have found that when Withania is administered, it treats many of the biological changes accompanying extreme stress including changes in blood sugar, adrenal weight, and cortisol levels ^[7,8].

Rhodiola Rosea

Rhodiola rosea, or “golden root” is a plant that grows abundantly at high altitudes in Arctic and mountainous regions throughout Europe and Asia ^[9]. This plant is not only known in traditional medicine for decreasing depression, but also for its adaptogenic properties in stimulating the nervous system, thereby eliminating fatigue and enhancing work performance ^[9]. A small study that was conducted to determine the effects of Rhodiola on individuals with Generalized Anxiety Disorder found significant differences between the baseline and post-Rhodiola score on the Hamilton Anxiety Rating Scale (HAM-A) ^[1].

Vitamin B5

Vitamin B5, also known as Pantothenic acid has been found to play an important role in proper adrenal functioning ^[2]. Common food sources of vitamin B5 include brewer’s yeast, corn, cauliflower, kale, broccoli, tomatoes, and avocado, to name a few. One study that observed the effects of vitamin B5 deficiency found that the group that was given a formula diet deficient in vitamin B5 developed recurrent upper respiratory tract infections and other similar symptoms. Urine analysis of the experimental group revealed decreased levels of adrenal hormones that progressively declined as the experiment continued ^[10]. Other common symptoms of vitamin B5 deficiency include fatigue, insomnia, depression, irritability, and vomiting ^[11]. This evidence suggests that vitamin B5 is important in supporting the adrenal glands and can be even more beneficial by supplementing with a B-complex vitamin.

Sleep Hygiene

Adequate sleep is not only necessary for healthy growth and development, but for restoration of mental and physical health. Lack of adequate sleep can greatly affect your mood, stress and cortisol levels. Proper sleep hygiene is therefore important and should include establishing a regular bed time, using the bed for sleeping only, and keeping the bedroom dark and quiet ^[2].

Stress Reduction

As stated previously, stress is risk factor not only for adrenal fatigue, but a number of illnesses including headaches, heart disease, immune deficiencies, and digestive issues. Stress reduction techniques can therefore help modulate the adrenal glands in releasing cortisol. Incorporating regular practices such as deep breathing, yoga, meditation or guided imagery, and exercise can be an outlet for managing stress and anxiety.

Conclusion

Adrenal fatigue is a common condition that can affect many aspects of one’s health, from causing fatigue, to disrupting hormonal balance, to affecting blood glucose levels. It is important to note that stress is the main factor that needs to be recognized and addressed in order to treat the cause, and not merely the symptoms. Naturopathic approaches to treating adrenal fatigue must include a thorough intake of health history to rule out other possible medical conditions that may be causing fatigue and similar symptoms, such as Chronic Fatigue Syndrome. Modalities such as botanical medicine, lifestyle and nutritional counselling, including sleep hygiene and stress reduction techniques can then be discussed to help restore the adrenal function. The list of natural interventions discussed in this article is not comprehensive. Always consult with a Naturopathic Doctor to determine what treatment is appropriate for you.