Adrenal Insufficiency Disorders

The adrenal glands are paired structures located at the upper poles of each kidney.

The adrenals have two main parts: the cortex and the medulla. The cortex is the outside part and produces many steroid hormones that regulate blood sugar and fluid balance. This is also where women make DHEA and some testosterone. The inside part, the medulla, is primarily involved in the secretion of epinephrine (adrenaline) and norepinephrine. This area prepares the body for a fight-or-flight response stress response. These hormones can set the tone for the nervous system to respond; blood pressure rises, pupils dilate, pulse rate increases as does blood sugar levels. Blood is shunted away from the digestive organs and toward the muscles and brain.

All stress weakens the adrenal glands, although the gland can adequately compensate for short-term stress situations (medulla pours adrenaline into our bloodstream), long-term stress can severely compromise the function of this organ. When long-term stress ensues, the adrenal must compensate by secreting cortisol (another steroid hormone). This will usually lower a women’s progesterone level and negatively affect her DHEA level. 

The question remains, what is stress? Most people think of ‘stress’ as something akin to an emotional feeling of nervousness, anxiety, worry, grief, depression, anger, etc.  This is true however any and all “stressors” have a negative effect on the adrenal glands. Some of these stressors are our own fault (our intent or how we thought about a stimulus) and some are not our fault (environmental, bacterial, disease states).

Adrenal insufficiency refers to the inability of the adrenal glands to produce a normal quantity of hormones. It may also be defined as a reduced ability to cope with stressors. Adrenal stress and fatigue are probably the most common imbalance in our population today, especially among women.

Adrenal insufficiency is commonly associated with the following symptoms, which can vary from mild to moderate to extreme. These symptoms include: fatigue, poor circulation (intolerance to cold), hypoglycemia (low blood sugar), low blood pressure, allergies, low stamina, depression, joint aches and pains, muscle weakness, low levels of hydrochloric acid, fear, low body temperature, and a lowered resistance to infection.

Adrenal burnout is a more severe mineral imbalance which affects the energy-producing mechanisms of the body. In adrenal burnout, the body is unable to cope with stressors, causing more extreme effects (most notably exhaustion), that requires longer to correct. Burnout has no respect for age. Today, we commonly find children in burnout. This could be because the child’s mother was in burnout when she was pregnant. The teenage years is one of the most common periods in which we see burnout occurring. Peer pressure and puberty add to and perpetuate stress. In many cases, the result of overwhelming fatigue and exhaustion, along with attraction to stimulants, can be a fatal combination that may result in suicide.

Causes Of Adrenal Insufficiency

1. Genetics. Genetic defects can affect the adrenal glands and can cause physical and emotional stress that can weaken the adrenal glands. 
2. Nutritional imbalances. Poor and inappropriate diet can start in childhood and continue through adult life. Poor food quality can induce poor digestion. Many foods today are low in nutritional value, laced with pesticides, steroids and antibiotics.  
3. Emotional and psychological stress. How our bodies relate to stressors will eventually deplete the adrenal glands. These would include emotional responses such as anger, depression, worry, tension and nervousness. A single overwhelming shock such as a death in the family, an illness, and abuse, or other psychological incidents, can nearly deplete the adrenals. Other emotional stressors include pressure from school or workplace, financial stress, family, and/or other relationships. 
4. Environmental toxins.  There are many toxins in our environment today. Some of the most common heavy metals that make their way into the human body are arsenic, lead, mercury, cadmium and aluminum. Other chemicals can be derived from household cleaners, pesticides, food additives, pesticides, and pollution. One of the newest adrenal stressors can come from over exposure to radiation (cell phones, microwaves, computers, WiFi, high-tension wires, TVs). 
5. Drugs, legal and illegal. All drugs that have a stimulant effect on the body have the potential to stress the adrenals. Note that stimulant use (cocaine, amphetamines, heroin, caffeine, sugar and/or alcohol) can weaken the adrenals and cause fatigue and exhaustion. These people become more attracted to stimulants, and have personality problems with anger, fear, and excessive compulsion. Prescription medical drugs, particularly cortisone or prednisone therapy, weaken the adrenal glands by creating hormone imbalance. The consequence is that patients on long-term steroid therapy have extreme difficulty getting off the drug which can cause reactions or inflammation, pain, and extreme fatigue. Steroids must be lowered very slowly to alleviate these adverse reactions. 
6. Infections. Both acute and extensive infections (viral, bacterial or fungal) are internal stressors that, if left uncorrected, can eventually weaken the adrenal glands by forcing the body into chronic stress response. 
7. Mental attitude. One’s attitude makes a huge difference in determining the stress response of the adrenal glands. Depression, worry, fear, and resentment tend to increase the stress response. Love, compassion and peace are the best ways to reverse this negative energy on the adrenals. What the new science of ‘energy medicine’ is clearly telling us is that intent plays the leading role in our overall state of health. Think positively!

Stages Of Adrenal Suppression

1. The Alarm State. The adrenal glands are kicked into action by fright, stress, or challenge. The body’s protective-response process called “fight or flight” is enacted. The body goes into a general adaptation mode. 
2. The Resistance Stage. The body begins to react to longer-term response and uses resistance to fight infection, meet emotional crisis, performing strenuous tasks, or dealing with other stressors. It’s a siege stage where different hormones react, especially the corticosteroids secreted by the adrenal cortex. These hormones assure the body a steady supply of energy long after glucose stores are depleted. A prolonged siege can cause great damage–organs weaken and adaptation-response kicks in. 
3. The Exhaustion Stage. This is the “burned out” stage, where heart, blood vessels, and adrenals are at most risk. Glucocorticosteroid stores (our ammonia dumps) get depleted. Hypoglycemia may result. Impaired adrenal function leads to fatigue and exhaustion and low immune function.  

The Major Hormones Produced By The Adrenal Cortex

Cortisol – A glucocorticoid hormone involved in multiple biological processes. Cortisol helps protect cells against the effects of excess insulin; positively effects the brain-central nervous system activity, normalize blood sugar (glucose) levels, positively effects the liver reserve of glycogen, has potent anti-inflammatory effects on tissues, helps to regulate white blood cells and lymphocytes, regulates the heart and blood vessels, regulating blood pressure; and strengthens heart contractions. The adrenals secrete cortisol in response to any type of stressor on the glands (all which induces inflammation).

Adrenaline – The hormones epinephrine (adrenalin) and norepinephrine (noradrenalin) respond to the body’s “fight or flight” situations. Adrenaline speeds up the rate of metabolism and produces other physiological changes that help the body respond to danger. 

DHEA (Dehydroepiandrosterone) – DHEA is a well-known sex hormone and acts as a precursor for the other sex hormones: pregnenolone, progesterone, estrogen, testosterone, and androstenedione. DHEA is also an immune system enhancer. It has antioxidant effects that benefit tissue repair, anti-aging factors, and is important in the body’s balance of cortisol.

Aldosterone – a mineral-corticoid hormone directly involved with the renin-aldosterone-angiotensin feedback loop that regulates renal potassium excretion while preserving the re-absorption of sodium. Aldosterone has a direct effect on fluid volume and blood pressure.

Primary Adenal Disorders

1. Addison’s Disease. This is an autoimmune condition that involves a failure of the adrenal cortex due to an underlying disease state such as an autoimmune phenomena, tuberculosis, metastatic carcinoma, lymphoma, hemorrhage, fungal infections, and sarcoidosis. The immune system mistakenly attacks the adrenal gland, destroying them and leading to cortisol depletion. It may be associated with diabetes and/or hypothyroidism. In most cases medication needs to be taken.
2. Hereditary or Congenitally Acquired. Disorders due to degeneration, trauma, nutritional deficiencies, electromagnetic energy fields, and vascular spasms can occur. Organic chlorine compounds and carbonates, dioxins and fire ant poison directly suppress glucose synthesis, resulting in hypoglycemia. Other chemicals implicating adrenal insufficiency include tobacco, street drugs, heavy metals, sugar, coffee, pollution, pesticides, herbicides, and fungicides. White flour can cause these problems and sugar robs the body’s nutritional reserves. They deplete nutrients, especially B-complex vitamins, magnesium and calcium. 
3. Cushing’s Syndrome. A rare disorder characterized by excessive production of cortisol or excessive overuse of cortisol due to some trauma. These patients have a characteristic appearance: heavy in buttocks and abdomen, ‘moon’ face, muscular weakness and bruising. 

Diet

When you are feeling unhealthy (especially with adrenal stress) it is obvious that healthy food choices is the best source of nutrients, and can increase your body’s ability to heal and speed your recovery. When you adrenals respond to stress the metabolism in your cells speeds up, burning many times the number of nutrients normally needed. By the time you are in a state of adrenal fatigue, your cells have used up much of the body’s stored nutrients and are in desperate need of a new supply.

The adrenal hormone cortisol helps keep blood sugar at adequate levels to meet the body’s demands for energy. However, when the adrenals are fatigued, cortisol levels drop lower than normal. This makes it more difficult for the body to maintain normal blood sugar levels. As a result, people with adrenal fatigue (hypoadrenia) tend also to have low blood sugar (hypoglycemia) and more allergies. The lack of adequate protein, essential fatty acids, and good complex carbohydrates, as well as a long time in between meals, will worsen the symptoms of adrenal fatigue.

Energy from food can be obtained by combining fats, proteins and starchy carbohydrates (such as whole grains) with every meal. Your body converts fats, proteins and starch into a blood sugar called glucose. Good protein sources are cold water fish, eggs, yogurt, soy, fowl and various plant sources. Avoid lunch meats, processed cheese, bacon, red meat, sausage and hamburgers.

Starchy carbohydrates are found mainly in grains and certain root vegetables, brown rice, barley, whole oats, millet, and buckwheat. Avoid white rice, pastries, white bread, baked goods and processed pasta. Vegetables are excellent food choices and can be steamed, stir-fried, sautéed, baked, boiled, or eaten raw. Essential fats are unsaturated oils from cold-water fish, flaxseed, walnuts, olive oil, sesame, sunflower and safflower.

 

Recommendation Of Lifestyle Approaches

1. Stop smoking or using any tobacco products, and limit consumption of alcohol and street drugs.
2. Get your thyroid gland function checked by a physician. 
3. Adrenal stress over time depletes nutrients, especially B-complex, magnesium and calcium. Contact a qualified health practitioner to set up a supplement protocol for you to follow.
4. Decrease intake of trans-fats, salt, processed foods, GMO foods and refined sugar. 
5. Decrease caffeine (coffee) and aspartame consumption (especially soft drinks). 
6. Food allergies have a negative effect on results. Try to identify potential food sensitivities (See the Elimination Diet).
7. Exercise adequately (but not excessively) at least 3 hours a week. 
8. Use stress-reduction techniques to decrease stress and improve sleep: prayer, meditation, yoga, tai chi, breathing, slow stretching, gardening, nature, biofeedback. Have fun! 
9. Get professional help with anger and rage. 
10. Limit exposure to extreme electromagnetic energy fields. 

If a patient exhibits an extremely low level of cortisol (called adrenal burn-out), physicians may prescribe a drug with hydrocortisone (Cortef), which works quickly to reverse adrenal fatigue. However, if steroid therapy continues many problems arise. The adrenal glands become unable to compensate for the loss of the drug over time, and rapid discontinuation causes rebound pain, inflammation, and fatigue. Patients must taper off the drug very slowly. Most patients need professional guidance when tapering. 

A good way to measure cortisol levels of adrenal function is via a Saliva Hormone Test. Saliva samples should be taken in the morning (or four different times a day) depending on your health care practitioner’s request. 

Supplement Protocol

1. B-COMPLEX VITAMINS
   The B vitamins are crucial for adrenal function. B vitamins help to rejuvenating cells that affect nerves growth (reduce stress), blood cell growth, and stimulated immune function. Many individual B vitamins plays important roles in improving the health of the adrenal. Pantothenic Acid (Vitamin B5) is essential to easing the proliferation of the adrenal cascade. Vitamin B5 increases energy production and takes much of the fatigue out of the adrenals. Niacin can also help with energy when recovering from adrenal fatigue, and also plays a role in the adrenal cascade. Pyridoxine (Vitamin B6) is a co-factor in several enzymatic pathways involved in adrenal function. Additional Folic Acid and Vitamin B12 may also be helpful.  Dosage: 100 mg of each major B vitamin twice daily (amount of individual vitamins in a complex will vary so see a qualified practitioner for each individual case).
2. VITAMIN C with BIOFLAVONOIDS
   Vitamin C is found in high concentrations in the adrenal glands. Vitamin C is critical for proper functioning of the adrenals and also enhances immune function, suppresses free-radical damage, and increases energy levels. The more cortisol made the more vitamin C is used, since adrenal function ‘feeds’ on this antioxidant vitamin. Vitamin C is stored in the adrenals and aids in the manufacture of Endorphins (natural painkillers), and functions as an anti-oxidant and immune stimulator.  Dosage: 1,000-8,000 mg daily as directed by a qualified health practitioner. Bioflavonoids are essential if vitamin C (ascorbic acid) is to be fully metabolized and utilized by the body. Dosage: About ½ the dosage of vitamin C daily.
3. RAW ADRENAL GLANDULARS
   Bovine raw adrenal and adrenal cortex have a positive role to play in improving human adrenal function. The protein derived from raw adrenal substances help to rebuild and repair the adrenal glands. Do not use raw adrenal glandular for extended periods of time (more than 6 months) without checking with your physician or qualified health practitioner. Dosage: As directed on label or as recommended by a qualified health practitioner.
4. DHEA (DEHYDROEPIANDROSTERONE)
   DHEA supplementation appears to be a suitable replacement for women with prolonged adrenal insufficiency and who test low in a hormone test. The rapid and lasting conversion of DHEA to androgens demonstrates a potential role of DHEA for androgen replacement in females in general. Women suffering from auto-immune disorders (rheumatoid arthritis, lupus, polyneuropathy or even fibromyalgia-like symptoms) will usually respond to DHEA supplementation. Use of the prescription drug prednisone has been reported to cause marked suppression of DHEA resulting in a loss of a key sex steroid precursor, leading to osteoporosis. Dose of 15-100 mg once or twice a day, decrease if acne occurs. Pregnenolone is another adrenal hormone that helps improve mood, energy, memory and hearing. See a qualified health care practitioner before supplementing with any hormone
5. PHOSPHATIDYL SERINE (PS)
   It is well known that phospholipids are molecular building blocks for cell membranes. PS is present in large amounts in brain tissue and is thought to be necessary for cognitive function. PS is safe, effective, and supports many cellular functions important to the brain, including mitochondrial integrity for energy production and activation of the protein kinase, which is an important enzyme needed for neuron signal transmission. PS may be more effective when given with ginkgo and acetyl-L-carnitine. In one study a woman taking 500 mg per day for 3 weeks had a significant increase in energy production to the brain. Doses of 100-500 mg daily consistently benefit memory, learning, concentration, word choice, and mood.
6. LICORICE (GLYCYRRHIZA GLABRA)
   Licorice is the herb best known for supporting the adrenals. Licorice may decrease the symptoms of hypoglycemia, a common side effect of decreased adrenal function. It may slightly increase blood pressure, but only in large quantities. Licorice has aldosterone-like properties that can be helpful in adrenal corticoid abnormalities while soothing nerves and decreasing the symptoms of hypoglycemia. Dosage: As directed on package or by a qualified practitioner. Note: Long-term use of licorice may cause an increase in blood pressure. Do not use with blood-thinning (Coumadin) like drugs.
7. SIBERIAN GINSENG (ELEUTHEROCOCCUS)
   An adaptogenic herb that is not strictly a pure ginseng (i.e. Panax or Korean ginseng), but has a wide range of activities to help support and rejuvenate adrenal function. It counteracts mental fatigue and is known to increase stamina, calm anxiousness, improves sleep, and improves endurance. Siberian ginseng is more appropriate for use in women than men. This herb has little effect on blood pressure or thyroid function. Dosage: See qualified practitioner for proper dosage.
8. MULTI-VITAMIN / MINERAL FORMULA with additional TRACE MINERALS
   All nutrients are important in supporting the adrenal and all of endocrine function.  Try to choose a potent formula that is well absorbed. The combination of antioxidants will help boost the immune system. Since drugs and other ‘stressors’ will deplete nutrients over time, especially minerals, the additional Trace Minerals can be very important for many body functions, including adrenal health. Trace minerals include zinc, copper, chromium, selenium, manganese, iodine and molybdenum. They also tend to have a calming effect on the body and are valuable to alkalize the body against the destructive effects of acidity. [See Acid/Base]. Dosage: As directed on package.
9. CALCIUM and MAGNESIUM
   These are two vital minerals needed in higher quantities to improve adrenal function. Magnesium can act like a spark plug for the adrenals and for the energy portion of every cell in the body. Magnesium is essential in formation of the enzymes needed for the adrenal cascade. Calcium (citrate form preferred) helps to settle the nervous system, and when adrenal stressors become excessive, calcium can have a buffering or calming effect on the body. Dosage: Magnesium 400-800 mg daily; Calcium 1,000-1,500 mg daily.
10. AMINO ACIDS and PROTEIN
    All of our body’s hormones are manufactured from amino acids. Supplementing with multiple amino acids formulas can be helpful in utilizing protein stores in the body. To ensure essential components are available, an adequate intake of quality protein is required. If protein intake is too low, then hormone production will decrease. Too low protein diets, prolonged fasting and severe weight loss can be detrimental to endocrine function. Dosage: 1-2 scoops daily of whey, rice or soy protein. Note: Patients on thyroid medications should avoid soy.
11. ASHWAGANDHA and other ADAPTOGENIC HERBS
    Sometimes known as Indian ginseng, this ancient herb has a direct benefit on the adrenal glands, acting as a tonic for all kinds of weaknesses, yet promoting vigor and strength. This herb is a potent adaptogen, which means that it helps the body resist ‘stressors’ in our environment, whether they environmental, psychological, bacterial, or physical. They also help to normalize cortisol levels. Other adaptogenic herbs include Milk Thistle (improves liver support which in turn helps adrenals), Astragalus, Ginkgo Biloba, Asparagus root, Gota Kola, and Ginger root. Dosage: As directed on label or as recommended by a qualified health professional.
12. COENZYME-Q10
    Coenzyme-Q is a potent antioxidant that carries oxygen to all organs in the body. CoQ is famous for helping to boost the immune system, decrease free radical destruction, improve cellular energy, and improve cardiac function (indirectly benefiting the adrenals). Dosage: 60-200 mg daily.
13. VITAMIN E
    A critical antioxidant, vitamin E is important for adequate adrenal function.  Vitamin E absorbs and neutralizes damaging free radicals inside the adrenals. Vitamin C enhances Vitamin E’s activity inside the cell. They work hand-in-hand in keeping the adrenal cascade functioning. It is better to choose a “tocopherol,” or mixed tocopherol forms. Dosage: 400-800 IU daily.
14. L-TYROSINE
    This essential amino acid is critical in thyroid function (especially when combined with iodine) and because the adrenals and the thyroid function together (in synergy), addition L-Tyrosine may enhance adrenal function.  Dosage: take 250-500 mg daily on an empty stomach.
15. OMEGA 3,6 ESSENTIAL FATTY ACIDS
    All steroid hormones (such as estrogen from sex glands and corticosteroid from adrenal glands) are made from lipid (fats) and cholesterol. Hence, an adequate daily intake of essential fatty acids is required for optimal adrenal function regarding the sex hormones. Eat (non-farm raised) salmon or ocean fish 3 times weekly. Also eat freely nuts, seeds, avocados and flaxseed. Dosage: 1,000-3,000 mg daily.
16. POTASSIUM
    Potassium is an important mineral for normal function of both the thyroid and the adrenal glands. Extra potassium may need to be supplemented if tissue levels are low. Dosage: 100-200 mg daily may be freely supplemented without a prescription, but when there is need for higher doses it is best to see a physician. Utilize the Hair Anaylsis to determine potassium levels.
17. ACUPUNCTURE and ACUPRESSURE
    These therapies are known to help relieve stress and balance the adrenal glands.

For High Cortisol States

High cortisol levels are definitely a reflection of long-term stress conditions. In addition to getting a complete thyroid and cortisol blood or saliva test, these are natural means of lowering cortisol.

1. PROGESTERONE CREAM – see a qualified health practitioner for appropriate dose. 
2. PHOSPHATIDYLSERINE – PS may modulate the cortisol releases that occurs in response to stress conditions. Dosage: 100mg up to 3 times a day, 20-30 minutes before meals and bedtime. 
3. VITAMIN C with BIOFLAVONOIDS (Hesperidin) – this combination helps the adrenals function. Dosage: 1,000-2,000 mg daily between meals. 
4. ACETYL-L-CARNITINE – an amino acid that may normalize elevated cortisol levels and improve scores on mood assessment. Dosage: 500mg 1-4 times a day. 
5. STRESS REDUCTION/BIOFEEDBACK 
6. PANTOTHENIC ACID (Vitamin B5) – found naturally in eggs and whole grains.  
7. PROTEIN and AMINO ACID supplementation

 

Center for Integrative Medicine’s Adrenal Support Protocol. Portland, OR. 2001.

Eck Institute of Applied Nutrition and Bioenergetics, Toxic Metal Elimination. Phoenix, AZ. 1991.

Friel, PN, Wright, JV. Suppression of Adrenal Function by Low-dose Prednisone. Alternative Medicine Review, March 2006. 11(1): 40-46.

Furlong, JH. Acetyl-L-Carnitine: Metabolism and Applications in Clinical Practice. Alternative Medicine Review. July 1996. 1(2): 85-93.

Gaby, A. DHEA: Biological Effects and Clinical Significance. Alternative Medicine Review, July 1996. 1(2): 60-69.

Ghen, MJ, Moore, CB. Implications of Adrenal Insufficiency. Integrative Medicine. Nov/Dec 2000.2(6): 30-34.

James, C. Low Sex Drive? Check Your Adrenal Glands. Alive #228,  October 2001. P. 41.

Kelly, S. Feeling Burnt Out? Alive #237, July 2002. Pp. 58-59.

Kidd, PM. Phosphatidylserine: Membrane Nutrient for Memory. Alternative Medicine Review, July 1996. 1(2): 70-83.

Marion, JB. Anti-Aging Manual. Information Pioneers, S. Woodstock, CN., 1996.

Wilson, James L. Adrenal Fatigue- the 21st Century Stress Syndrome. Smart Publications. Petaluma, CA 2001.

Whitaker, J. Dr. Whitaker’s Guide to Natural Healing. Prima Publishing, Rocklin, CA. 1996.