Wednesday, May 21, 2014

Wisdom Wednesday: Hidden Adrenal Issues

For years, nutritionists, including me, have struggled to resolve adrenal issues. When they are found in the initial evaluation of the endocrine system (see last weeks’ Wednesday Wisdom), you must determine whether the adrenals are underactive (adrenal fatigue), overactive (adrenal stress), or both. Yes, the adrenals can be up and down, like a rollercoaster, on a daily or even hourly basis.

In general, direct glandular support, including the use of an adaptogen, is required to rebuild the adrenal glands. This often takes three or four months of nutritional therapy. I believe the constant overstimulation and stress of modern life makes it difficult for the adrenals to recover.

Once the general endocrine function of the adrenals is restored, an underlying or ‘hidden adrenal’ issue is often present. Undetected and untreated, endocrine function will quickly fail again.

Sometimes all that is required is continued support with an adaptogen. However, more often, hormone activity must be evaluated and treated, above and beyond glandular function. The adrenals may now be functioning normally, but cortisol levels can still be high and DHEA may also remain low.

We evaluate the ‘hidden adrenal’ by challenging the adrenal response to joint stress and histamine response. If either of these tests is positive, then ongoing adrenal support is vital.

West Point Military Academy runs a very stressful program. It is very difficult to get in and even harder to stay. The stressors are physical, emotional, and mental. Over the course of four years, 25% of cadets will have knee surgery. This is a direct result of multiple stress factors as the major support for the knee comes from muscles associated with the adrenal glands. When stressed for a long period of time, the ‘hidden adrenal’ can not support weight bearing stressors induced by running or other forms of exercise. The ‘hidden adrenal’ patient is often the one that is easily injured every time they try to return to vigorous exercise.

Vitamin C is the most basic support for adrenal function. I have a Barbados cherry tree in my front yard. It produces the Acerola cherry, the highest natural source of vitamin C on the planet. If you look at the ingredient list on any vitamin C supplement, you will often see it listed. My tree produces fruit from May through October each year. Everyday, during those months, my family and I compete with the local bird population for our daily dose of vitamin C.

Ascorbic acid is not really vitamin C, although medically the labels are used synonymously. Ascorbic acid is the anti-oxidant portion of the vitamin C complex. It acts like a wrapper surrounding and protecting the bioflavonoids, taurine, quercitin, and copper that make up the remainder of the vitamin C complex.

The mainstay of adrenal support are the adrenal adaptogens that I frequently mention – Ashwaganda (my personal favorite), Schisandra, Tribulus, Rehmannia, Korean ginseng, and Chaste Tree. You might add Maca to that list as it is thought to be an adaptogen.

Licorice is the tonic of choice. Tonics give an immediate lift but provide no long term support. Licorice should not be used with an overactive adrenal gland. It must also be used with caution in anyone having high blood pressure.

High cortisol levels from long term adrenal stress result in a loss of up to 50% of cortisol receptors in the cells of the body. Licorice works by temporarily making the remaining receptors more receptive to cortisol. This is what creates the ‘tonic effect’ of licorice. However, it also stimulates increased production of rennin in the kidneys which ultimately raises blood pressure to increase venous return to the heart from the lower extremities.

I seldom recommend DHEA supplementation. This is HRT (hormone replacement therapy) and can depress DHEA production by the adrenals, creating a need for more and more supplementation. Healthy adrenals produce about 25mg of DHEA per day, yet you can buy 50mg tablets of DHEA in any health food store. On the rare occasion I do use DHEA, I recommend 5 or 10mg per day for 1 week only. That creates a tonic effect without suppressing adrenal hormone production.

Try to reduce your stressors. Put that cell phone away when you can. Limit TV and video game time. Please don’t go to sleep with the TV on. Make time in your busy schedule to unwind. Take a vacation, read a book. If you suffer from adrenal stress or fatigue, consider nutritional evaluation. Give the adrenals time to respond, they are working too hard to begin with.