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.

THE BOTTOM LINE:
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.

Wisdom Wednesday: The Endocrine System

After evaluating general metabolism through the Krebs’s Citric Acid Cycle, it is time to look at hormone production in the body. I find evaluation and treatment of the endocrine system to be second only to dysbiosis in terms of challenges and rewards.

We start by testing the limbic system. That is the portion of the brain that gives you your sense of balance. It is also where the brain and endocrine system interact. An impairment of the limbic system generally indicates some endocrine dysfunction. The adrenals, pineal/pituitary gland, thyroid and reproductive system are all evaluated.

Frequently more than one endocrine organ is indicated as dysfunctional. Endocrine cross check is then performed. We find a weak muscle for each endocrine organ. (For example, a weak supraspinatous is commonly associated with the pineal/pituitary gland.) Then we cross check to see which organ appears to be the major involvement and treat it appropriately.

Chaste tree is often of great value in treating endocrine imbalances, especially if there is more than one organ involved. History usually includes poor sleeping habits, either onset insomnia or maintenance insomnia. Taken first thing in the morning, chaste tree stimulates production of melatonin by the pineal gland. Melatonin not only helps people have a better night’s sleep, it modulates all the other sex hormones. If your estrogen is a little high and your testosterone is a little low, or vice versa, chaste tree will often balance these levels as needed.

Adrenal imbalance, either as the major issue, or a minor involvement is almost universal. It is commonly said that all patients have adrenal imbalance, but only the women have an underactive thyroid. Although not always the case, there is some truth to that statement.

Adrenal adaptogens like Ashwaganda, Korean ginseng, Tribulus, Schisandra and Rehmannia are all great support for the adrenals. Licorice can also be used temporarily as a tonic. Although it provides great relief of symptoms, it does not help rebuild exhausted adrenal glands like the adaptogens do. Maca is also thought to be an adaptogen, but we don’t yet have enough research to confirm its’ ability to restore the adrenal glands.

Testing salivary cortisol (four samples over 24 hours) and DHEA can help confirm adrenal status.

The most common thyroid problem is a lack of iodine in the diet. This is especially true for people raised in the mid-west. Michigan is considered the goiter capital of the US as the soil iw so iodine deficient. A simple “iodine patch test” performed by applying a bit of mercurochrome to the skin on the under side of the forearm is an accurate test for iodine deficiency. The patch should last a minimum of eight hours. The sooner it disappears, the greater the iodine deficiency.

Thyroid blood tests can be very helpful, but can also miss some thyroid problems. The TSH (thyroid stimulating hormone) is actually a pituitary hormone telling the thyroid what to do. Although the medical norms are 0.4 to 4.4 uIL/ml, the healthy range is actually between 1 and 2. Anything above 2 is an indicator of subclinical hypothyroidism.

Even if the T3 and T4 (active and stable forms of thyroid hormone, respectively) are well within the medical norms, a large portion of the T3 may be “reverse T3” rendering it non-functional.

In Hashimoto’s Thyroiditis, the immune system is attacking the thyroid (and possibly other tissue sites as well). The tests for this disease are the TPO (thyroid peroxidase) and thyroid auto-antibodies. These tests are seldom run and can be transient as well, running high, then returning to normal, only to run high again. It is estimated that at least one third of the diagnosed cases of hypothyroidism in this country are actually Hashimoto’s Thyroiditis undiagnosed. I think the real number is closer to one half.

Modulating the immune system is the key to treating Hashimoto’s Thyroiditis. Currently, conventional medicine just supplements thyroid hormone to keep the TSH within medical norms.

My favorite herb for reproductive imbalances is the adaptogen Tribulus. It binds to any open hormonal sites in the brain. Those sites are open only when that particular hormone is low. Tribulus stimulates the brain to request more hormone production of the deficient hormone(s). So it is self regulating.

THE BOTTOM LINE:
Hormone imbalances are quite common. If you suffer from poor sleep and/or poor sex drive, have your hormone levels evaluated. Consider nutritional therapy in lieu of hormone replacement therapy (HRT).