Inflammation, Stress | May 21, 2018 | Author: Naturopath
Synonymous with stress, the adrenal glands produce a wide range of hormones that help us deal with the ups and down of life. They secrete over fifty different hormones, including adrenaline and cortisol. The concept of “adrenal fatigue” was first coined in 1990s, and tired adrenals are often blamed for ongoing fatigue and malaise.
But is it real?
Stage 1: Alarm Reaction. The adrenals respond to sudden stressors, and cortisol levels sky-rocket.
Stage 2: Resistance. If the stress becomes chronic or remains for a long period of time, the adrenals become “fatigued” trying to provide enough hormone to deal with the onslaught of stress. Cortisol levels are high or normal in this phase.
Stage 3: Exhaustion aka “adrenal fatigue”. Resistance has failed, stress continues, and the adrenals have little left to give. They continue to function but are unable to raise stress hormones high enough to meet physiological demands.
This model has some issues. Studies have shown that many people diagnosed with “stage 3” can suddenly have their cortisol levels miraculously shoot back up to stage 1 levels. Clinical work has shown that improvement to other body systems can alleviate the adrenal glands. Due to these inconsistencies, the Endocrine Society rejects adrenal fatigue, and a 2016 systematic review of evidence found that there is no medical substantiation behind the term “adrenal fatigue” .
Does that mean that adrenal fatigue doesn't exist?
Not necessarily – we might just have the wrong idea about it.
The updated model of adrenal fatigue is a little more holistic. Neuroendocrine immunology is a new branch of medicine that looks at the connection between the endocrine, immune and nervous systems.
Under this model, the adrenal glands are seen as “end of the line” glands – they are at the end of a chain of reactions that begin in the brain.
The hypothalamus in the brain acts as a connection point between the three systems, and it responds to their input by sending control signals to the rest of the body, including the adrenal glands.
If we look at some of the hormones that the adrenal glands produce, it's obvious that they are intimately connected with these systems:
Adrenaline and Noradrenaline: Initiate and prolong the rapid response to stress known as “fight or flight” response.
Mineralcorticoids (e.g. Aldosterone): Regulate electrolytes and blood pressure.
Glucocorticoids (e.g. Cortisol): Influence immune response, metabolism and more.
Androgen hormones (e.g. DHEA): Precursors for sex hormones such as testosterone and oestrogens.
With this more holistic perspective, it's easy to see “adrenal fatigue” as more than a gland-specific state – the underlying cause involves the interconnected systems. Neurotransmitters from the nervous system, cytokines from the immune system, and hormones from the endocrine system converge at the hypothalamus which may then responds to this input by signalling the adrenal glands to release (or reduce) stress hormones . It could also signal other body systems to promote feelings of fatigue.
In this model, there is nothing actually wrong with the adrenal glands themselves. They are producing what they're told, when they're told. The dysfunction arrives from earlier in the chain – other parts of the neuroendocrine system and the immune system, which also connect to the rest of the body.
Under the neuroendocrine model, the underlying causes of adrenal fatigue all have something in common: oxidative stress and inflammation. When the hypothalamus detects oxidative stress it signals the body to promote symptoms of fatigue – possibly in an effort to prevent creating more inflammation through more activity.
Glands are sensitive to the functioning of all of the other body systems, and because of this it can be easier and more effective to fix your adrenals by focussing on the underlying problems than trying to revive “fatigued” adrenals.
While addressing the underlying issue at hand, there are natural therapies that can help to support and nourish the adrenal glands:
Physically active people have been shown to have a higher resilience to all types of stress, but the type of A 2015 found that people with the stress hormone levels of clinically diagnosed adrenal fatigue significantly improved following physical activity .
But remember that over-training leads to major oxidative stress and inflammation – forget HIIT classes and opt for yoga instead.
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Improving your resilience against stress is easier said than done. Some level of daily stress is generally unavoidable, but if you’re experiencing symptoms of severe fatigue, now’s the time to pull back and prioritise what actually matters most to you. Keep you “to do” list short in an effort to soothe the nervous system and connect to an inner sense of calm as much as possible. Mindfulness meditation works for many people, while guided visualisation meditations are more effective relaxation tools for others. In terms of diet, cut out the caffeine and stay away from sugar-y refined carbs which throw hormones of balance, increase inflammation and oxidative stress .
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The adrenal glands are the body's richest store of vitamin C. Concentrations here are 100x higher than what is found in the blood. Vitamin C is required for the synthesis of adrenaline and cortisol, so it gets used up quickly under stress  . As an antioxidant, it can also help to fight the inflammation underlying states of adrenal fatigue. Although scurvy is thought of as an outdated diagnosis, many people today suffer from vitamin C insufficiencies – coincidentally, vitamin C is quickly depleted when the body is under stress .
Vitamin C is found in most fresh fruits and vegetables. Kiwi fruits, broccoli, red capsicums, lemons and green leafy vegetables are particularly rich sources. For an extra boost, vitamin C is one of the safest nutrients to supplement at up to 2,000mg per day.
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Like vitamin C, the B group vitamins are quickly eliminated when the body is under stress. They are required as co-factors in hundreds of enzymatic reactions, including those used in creating cellular energy and neurotransmitters.
B vitamins can help to fight fatigue and supply the neuroendocrine system with cofactors for optimal functioning .
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Speak to your doctor and/or an endocrinologist if you experience any of these following symptoms as part of your fatigue picture:
 Cadegiani, F. A. & Kater, C. E. (2016) Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord., 16:1, 48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997656/
 Tomas, C., et al. (2013) A Review of Hypothalamic-Pituitary-Adrenal Axis Function in Chronic Fatigue Syndrome. ISRN Neurosci.. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045534/
 Alghadir, A. H. & Gabr, S. A. (2015) Physical activity and environmental influences on adrenal fatigue of Saudi adults: biochemical analysis and questionnaire survey. J Phys Ther Sci., 27:7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540814/
 The Endocrine Society (2017) Adrenal Fatigue. https://www.hormone.org/diseases-and-conditions/adrenal/adrenal-fatigue
 Redmann, A., et al. (1995) Ascorbate depletion prevents aldosterone stimulation by sodium deficiency in the guinea pig. Eur J Endocrinol., 133:4, 499 – 506. https://www.ncbi.nlm.nih.gov/pubmed/7581976
 Patak, P., et al. (2004) Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocr Res., 30:4, 871 – 875. https://www.ncbi.nlm.nih.gov/pubmed/15666839
 Velandia, B., et al. (2008) Scurvy Is Still Present in Developed Countries. J Gem Intern Med., 23:8, 1281 – 1284. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517958/
 Wilson, J. L. (2014) Clinical perspective on stress, cortisol and adrenal fatigue. Advances in Integrative Med., 1:2, 93 – 96. https://www.aimedjournal.com/article/S2212-9626(14)00005-4/fulltext
 Head, K. A. & Kelly, G. S. (2009) Nutrients and Botanicals for Treatment of Stress: Adrenal Fatigue, Neurotransmitter Imbalance, Anxiety, and Restless Sleep. Altern Med Rev., 14:2, 114 – 140. http://archive.foundationalmedicinereview.com/publications/14/2/114.pdf