Wellness

Understanding Stress

THE EFFECTS OF STRESS ON YOUR ADRENALS AND YOUR BODY

Does the world seem to move at a faster pace than ever before? Perhaps you feel a little tired from the holidays, or it seems that you can’t regain your normal energy no matter what you do or how many doctors you visit? If any of this seems to describe your current state, ask yourself—when was the last time I really felt relaxed and well? Unfortunately, Americans have been suffering with a human energy crisis for decades. We have set up a society than runs 24/7 with big business, that holds important breakfast meetings starting at 7 am, gyms that are open round-the-clock and fast food restaurants for even faster people.

We live in a time where even our youth are going at a non-stop pace. It is not uncommon for some kids to attend as many as three after school activities on a given day. In fact, sobering statistics from pediatric obesity experts state that this will be the first time in history that our children will not outlive us. They are doomed to chronic diseases such as diabetes, heart attacks and strokes at an early age, unless we do something now to drastically change the disease trend of the country. But where do all these problems that we and our kids have stem from? Naturally it starts with us, the parents. Many patients are wandering around suffering from adrenal fatigue, burn out, and are stressed to the max. Elevated cortisol levels will literally kill us unless we learn to take initiative now. Excess cortisol production from chronic stress leads to an easy extra 10 to 15 lbs of stubborn belly fat that you can’t get rid of. Let’s look into how anti-aging physicians evaluate adrenal function and learn what we can do to restore that lost “mojo.” The adrenal glands that control our reactions to stress and help us with the toils of daily living are located in a very special place on top of the kidneys. The adrenals are a key player in hormone control throughout the body and their state of health directly influences our well being. These very small crescent-shaped glands can secrete their hormones directly into our circulation.

They produce many hormones including cortisone (in response to stress), hydrocortisone, testosterone, estrogen, DHEA (dehydro epiandersterone), progesterone and aldosterone—to name a few. Over many years, the adrenal glands can cope up to a certain point and then they will start to fatigue. Soon after, they will be unable to keep up with the ongoing stresses presented and will slowly but surely fail. This is also known as the “stressed and wired” phase which progresses to “stressed and tired.” When this occurs the person is at extremely high risk of facing both a personal and professional collapse. Many patients report drastic changes in their ability to handle the busy daily stresses. A simple add-on task seems to be insurmountable, they lose their interest in things that normally would give them pleasure (anhedonia) and they are unable to find the energy to get up in the morning, despite obvious needs to get the kids to school or go to work to pay the rent. Often partners initially try to put up with these problems and then eventually give up as patients are unable to rouse themselves out of their extreme state of fatigue and distress.

HOW DID WE GET THIS WAY?
Unfortunately, we often don’t learn to say no until it is too late and end up paying heavily with unforeseen consequences. The hormonal balance in the body is responsible for so many important factors that determine energy production, so it’s amazing that we function as well as we do for such long periods until we notice that something is off. People learn to ignore the warning signs that their adrenals are suffering, and continue to push themselves with little pep talks, chiding themselves for not having the energy that they used to. They may keep themselves going by eating chocolate, drinking teas and coffees. Patients of this type often have almost little to no free time and feel chronically tired and stressed. In the end, they may start having psychosomatic complaints that are vague and difficult for doctors to pinpoint such as chronic fatigue and fibromyalgia. Often patients will note uncharacteristic, sudden temper outbursts for which they later feel remorseful while energy levels deteriorate as they feel more and more despondent that they cannot get through the day. Tranquilizers and other anti-depressants are often prescribed with initial benefit, but no further relief. Pain killers and alcohol are temporary boosters and downers that eventually are of little benefit.

Left unrecognized, adrenal burn out can be brought on by long hours spent at work, especially on the grave yard shift, which will affect a patient’s melatonin production. Melatonin is another natural hormone made in the body at night during sound sleep once the pineal gland in the brain senses that it is dark outside (almost pitch black is best). Melatonin functions to regulate the circadian rhythm or sleep/wake cycle and you start producing it about 20 minutes into deep sleep. Unhindered rest at night is critical for proper production of Melatonin, which acts as a powerful antioxidant in the body. Many health experts have shown melatonin to be a potent protector against cancer and possibly the onset of Alzheimer’s disease. Worldwide travelers have often taken advantage of melatonin, using up to 20mg (be sure to consult with your physician) to overcome the effects of jet lag after a long flight. It helps them find good energy and relieve the toils of fatigue and loss of good sleep during the travel process. Melatonin administration can also help the production of cortisol by increasing the DHEA sulfate/cortisol ratio after six months of treatment. This can be a wonderful way to support low adrenal reserve.

THE IMPORTANCE OF GOOD ADRENAL FUNCTION
Simply put, good adrenal function is vital to health. The adrenals are the body’s sensors of stress. When they believe that the person is actively undergoing some sort of important stress, they directly influence adrenaline production (epinephrine release) for that famous “fight vs. flight” response. There are many incredible stories that people have told about super human strength and hero-like feats during a fire, a hurricane, etc. where loved ones were saved due to the powerful hormone surge that occurs. The elevated cortisol that is secreted also creates an immediate supply of glucose (sugar) for consumption by muscle and brain tissues to cope with the stress. Under longstanding conditions, however, this can become a set up for the development of diabetes. One other important side to all of this, is to realize that without proper adrenal function in place, virtually all the other sex hormones such as testosterone, estrogen and progesterone are greatly affected. This can influence the patient’s ability to get pregnant naturally, and also affect the success of fertility treatments and can later bring on a more intense and abrupt menopause, with greater tendencies for dreaded hot flashes and night sweats. Males can experience potency issues, have low libido and show signs of erectile dysfunction. All hormones work together in a “symphony in the body” according to Dr. Pam Smith, executive director of the American Academy of Anti-Aging Medicine’s Fellowship Program (A4M). Low adrenal reserve will require higher dosing of hormone replacement to achieve appropriate effects in the body. It is always more prudent to give the lowest doses needed to achieve clinical improvement to decrease risks of the side effects and problems seen with high hormone dosing.

ARE YOUR ADRENALS ON THE WANE? Traditionally blood serum testing at precisely 8 am was used as a screening for patients at risk. Newer testing modalities include four-point salivary testing for both cortisol and melatonin, which can be done conveniently at home rather than at the medical lab. Results usually take a few weeks to come back. It is very important to make sure that full blown Addison’s disease or insufficiency is also ruled out. If a person succumbs easily to allergies and infections, feels constantly drained and exhausted and experiences low blood pressures and sugars, then they may warrant a more intensive evaluation. Both the thyroid gland and the adrenals need proper evaluation. Addison’s may need vigorous treatment. Levels of hydrocortisone, aldosterone, epinephrine and ACTH can be measured in blood, plasma and urine. An ACTH challenge test can also be done to distinguish between other diseases such as Cushing’s Syndrome, which is caused by an adrenal tumor. Also a high potency steroid suppression test can be administered which temporarily shuts down overactive adrenal activity. Specialized diagnostic scanning with abdominal X-rays, MRI, CT scan, arteriography and radionuclide testing and IVP tests can be performed to help determine if a patient has an adrenal calcification, tumor, atrophy or other growths of the glands.

SUPPORT &TREATMENT
Treatments of adrenal fatigue can start with high-potency natural supplements. The first goal, of course, is to remove any harmful stressors from a patient’s immediate environment. Serious consideration to lifestyle changes are tantamount
to restoring good health, including trying to limit consumption of processed foods and chemical additives. Excess alcohol and tobacco are to be avoided because these substances can harm the already overtaxed adrenal glands.

Below is a simple list to support adrenal function from Life Extension’s Disease Treatment and Prevention with a few added favorites of my own:

• Ashwaganda 75mg
• Vitamin C 3 grams daily
• DHEA 50mg daily
• L-theanine 100 to 400mg daily
• Pantothenic Acid (vitamin B5) 1500mg daily
• Melatonin 300ug to 6 mg at bedtime, daily
• Phosphatidylserine 300mg daily
• Licorice (Glycerrhiza glabra) 1000mg or less daily
• Relora (Magnolia Officinalis) 125 mg

Adrenal Extracts in high potency supplements, OraAdren, AdrenAll (take ½ hour prior to bedtime to assist with sleep) Intravenous Infusion with Vitamin C, B’s and Magnesium These are but a few of many items that can be used for adrenal support. Occasionally patients will need true cortisol replacement, in which case I use a dosing schedule that follows the pattern of the body, usually somewhere between 2.5 to 7 mg four times a day, as described by the great pioneer in the field, Dr. William Jeffries. (Dosing needs to be individualized as with any other medication.) Investigation for gluten sensitivity in the diet can also be another useful adjunctive along with thyroid support. I also like to use a specially designed herbal tea to be taken at noon, for patients that aren’t fond of swallowing a lot of pills. It works well, is pleasant tasting, and makes patients perform the most important task of all, learning to take a small break away from a grueling day’s work. Taking away trigger foods with empty simple refined carbs can also be very helpful along with the addition of healthy fat to the diet, which promotes good energy. Often timing of meals can help patients avoid sugar spiking, which can worsen energy highs and lows.

Adjunctive care with massage therapy, bio-energetic medicine techniques with acupuncture and stretch therapy, cranio-sacral therapy, yoga and meditation can all be excellent non-medical remedies that are often soul-relieving and effective when combined with the other suggestions already mentioned. One of my favorite natural remedies is to have an activity that helps you get away mentally from the stresses of the day (think soul soothing—playing music, painting, spiritual or inspirational reading, poetry or quiet activities such as walking on the beach, relaxing on a boat hearing the waves or taking a stroll in a verdant green garden). Ensuring that these simple activities, even as little as 10 to 15 minutes a day, make it into the daily schedule can be all you need in order to get through the grind of life. So, be sure to take the time to stop and smell the roses, not only is it the green thing to do but it is also the adrenal thing, too.

Dr. Gloria Hakkarainen, MD, FACOG, FASBP, FABAAM is an OB/GYN and also board certified in multiple disciplines. She specializes in wellness, weight loss, and anti-aging, all with a focus on prevention. She practices at Palm Beach Weight & Wellness Centers in West Palm Beach.