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Stress, Cortisol and the Immune System: What Makes Us Get Sick?

The Case of the Poor Student: Sick after Exams
It’s happened to all of us, in some form. Here’s how it happened to Tom: he was staying up late for the last two weeks cramming for his barrage of final exams, and finally his last exam was over. After one more late night—this time partying—he woke up with that all-too-familiar soreness in his throat, along with that annoying stuffy nose. “Great,” he thought. “I’m sick in time just for Christmas shopping. Must be that pesky cold bug going around again.”

What is Psychoneuroimmunology?
Just how exactly stress affects our immune system has long been debated, but the field of psychoneuroimmunology is still relatively new. Coming from the Latin roots psych- (meaning mind), neur- (meaning nerve or nervous system), and immuno- (meaning immune), psychoneuroimmunology is the study of how the mind can affect immune system functioning. Drawing upon many disciplines of science including immunology, psychology, and physiology, psychoneuroimmunology is a very integrative field with scientists studying a wide variety of things. Although many discoveries have been made, not many people are aware of just how significant they are. In order to understand just how stress can affect our immune system, you must first understand how the immune system responds under normal circumstances to invading pathogens.

Pathogens? You Shall Not Pass!
You Shall Not Pass sign by Flickr user Tar Sands BlockadePathogens, defined as disease producing agents (such as viruses and bacteria), are pesky organisms that cause our immune system to mobilize into action. In response to pathogens present in the body, the immune system induces the inflammatory response. Even though the bodily mechanics behind the inflammatory response are complicated, for many people it causes symptoms like stuffy nose, sore throat, and even fever. What many people don’t seem to understand is that the inflammatory response is a result of the body’s immune system trying to “get rid” of invading pathogens; it’s not the pathogens themselves that cause things like sore throat and runny nose. More importantly, pathogens themselves aren’t the only causes of the inflammatory response; hormones have also been identified as a regulator of the inflammatory response as well.

Hormones—Not Just for Sex
Hormones, better known as the “chemical messengers of the body”, are released by specialized organs (called glands) during certain events. Although their “reputation” in the general public is that they deal with sex-specific behaviours, hormones have several roles in the body. One of the best known hormones is insulin, which is released by the pancreas into the blood; it acts as a messenger, telling the cells in your body to start taking in glucose (a type of simple sugar). One of the chief hormones released under stressful conditions is cortisol. Released by the kidneys, it helps mobilize the body into a “fight-or-flight” mode by causing increased blood pressure, heart rate, and sugar breakdown. Think of the last time you were in a stressful or nervous situation; can you remember your heart racing? Another interesting property of cortisol is that it acts as an anti-inflammatory signal, meaning that it acts as an “off switch” for your immune system, helping prevent the inflammatory response described earlier.

Cortisol, a Stress Hormone
Dr Hans SelyeSince its initial discovery by Hans Selye in 1907, cortisol has been the subject of many studies, yielding several different conclusions. Initially, it was found that elevated levels of cortisol were associated with elevated levels of stress, and it was thought that cortisol was released as a cause of stress, as described earlier. However, later studies showed a negative relationship between stress and cortisol levels; they found lower cortisol levels in people living under highly stressful circumstances. How could this be?

When the results of these experiments were further analyzed, scientists found startling relationship. With experiments where participants were subjected to conditions of acute stress (shorter duration), like speaking in public, or being suddenly startled, cortisol was found to be in elevated levels. However, when participants were under conditions of chronic stress (longer duration), like divorce or unemployment, scientists found lower levels of cortisol. This caused them to believe that maybe the relationship between stress and cortisol levels wasn’t so simple. More evidence continued to support the claim that acute stress caused sudden elevation in cortisol levels; if this stress continued, cortisol levels would decline. What implications does this have for Tom’s situation described earlier?

How Cortisol Affects our Immune System: The Traditional Theory
As mentioned earlier, stress is thought to have an immunosuppressive impact on the immune system, mediated through cortisol. Thus, if someone is subjected to a certain stressor, their immune system would be temporarily “shocked”, and pathogens would have a relatively easier time entering and proliferating (growing) within the body. This would result in that person having a greater chance of getting “sick”. Although this theory explains how stress may affect our immune system, perhaps it’s not so simple. It doesn’t explain how for most people, it’s not until the stressor is removed that symptoms of the inflammatory response begin to manifest. Growing evidence is showing support for an alternative theory—one that suggests that inflammation is a result of cortisol dysregulation.

How Cortisol Affects our Immune System: An Alternative Theory
People on subway wearing germ masks by Flickr user Eneas de TroyaPerhaps the symptoms experienced by Tom described earlier weren’t a result of pathogen presence, but rather a result of faulty cortisol regulation? Note that in his case, Tom didn’t get sick while studying for exams, but rather after his last exam was finished–not until his stressor was removed. Since he was placed in a stressful situation, his kidneys were constantly releasing cortisol, suppressing his immune cells (so he’d see no signs of the inflammatory response). Over the course of his exams, his immune cells would constantly be receiving this anti-inflammatory signal, but what happened the stress was suddenly removed, cortisol levels suddenly dropped, and the anti-inflammatory signal went away? Maybe the sudden drop in cortisol’s anti-inflammatory signaling is enough to manifest the inflammatory response?

What happened to Tom may have been a combination of things. The stress onset may have caused his cortisol levels to rise, suppressing his immune system. In its weakened state, he may have been exposed to a variety of pathogens, which were then able to enter and proliferate within his body. Although this pathogen may have been present, his immune system was also constantly being signaled by cortisol to suppress inflammation, explaining why he didn’t see any symptoms during his exams. However, after his exams were over, the combination of pathogens living in his body along with absence of the anti-inflammatory signal may together have caused him to experience symptoms of the inflammatory response—sore throat, stuffy nose, and fever. It may very well be that a combination of both Tom’s mental state of stress along with exposure to pathogenic agents that caused Tom to “get sick.”

A Problem in Science: Lack of Integration
Pathogenic mediation of the inflammatory response is a widely understood principle, but hormonal—specifically hormones pertaining to mental state—control of bodily processes is still not completely understood. Perhaps this is because of the nature of the field. The traditional science disciplines generally tend to be reductionistic, focusing on certain reactions or mechanisms. However, there are many phenomena that cannot be explained within the context of one scientific field in isolation; like how your mental state influence your immune system functioning. In the field of psychoneuroimmunology, questions cannot be answered by looking specifically at immunology or specifically at psychology, but require people to integrate over a variety of scientific disciplines, which may explain why the field is still relatively new.

Implications—What Does this Mean for Me?
From an evolutionary standpoint, the delayed inflammatory response caused by cortisol’s immunosuppressive properties would be advantageous over those without this delayed response, even in the context of Tom’s case. Which would you rather happen? Would you rather combat sickness amidst tackling a barrage of exams? Or would you rather be able to study for exams without showing any signs of being sick, and deal with it after exams are over? If your life depended on getting good grades, the choice would be obvious.

The impacts of stress on our health have been widely studied, and these data give us more concrete evidence, into the adverse affects of stress on health. Perhaps now the question isn’t whether or not stress affects us negatively, but rather how we can effectively remove stress, or at least learn techniques to reduce the impacts of stress.

Image Credits: You Shall Not Pass sign by Flickr user Tar Sands Blockade; Dr. Hans Selye image courtesy of Library and Archives Canada/PA-11671; People on subway wearing germ masks by Flickr user Eneas de Troya

*This piece was originally published by Alvin Lim in The Science Creative Quarterly. Accessed 9/23/14 http://www.scq.ubc.ca/stress-cortisol-and-the-immune-system-what-makes-us-get-sick/

References
Anisman, H., Griffiths, J., Matheson, K., Ravindran, A., & Merali, Z. Posttraumatic stress symptoms and salivary cortisol levels. American Journal of Psychiatry. 2001. 158, 1509–1511.

Bauer, ME. Stress, glucocorticoids and ageing of the immune system. Stress. 2005 Mar;8(1):69-83.

Kaufmann I, et al. Stress doses of hydrocortisone in septic shock: beneficial effects on opsonization-dependent neutrophil functions. Intensive Care Med. 2007 Sep 29

Leonord, B. Stress, depression and the activation of the immune system. World J Biol Psychiatry. 2000 Jan;1(1):17-25.

Miller, G.E., Chen, E., & Zhou, E.S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychological Bulletin, 133, 25-45

Prignet et al. 2004. Clinical review: Corticotherapy in sepsis. Critical Care, 2, 122-129.

 

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Who Suffers From Adrenal Fatigue?

Who Suffers From Adrenal Fatigue?

Anyone who does not get enough rest and relaxation to enjoy life, who drives him/herself constantly, who is never satisfied or is a perfectionist, who is under constant pressure (especially with few outlets for emotional release), who feels trapped or helpless, who feels overwhelmed by repeated or continuous difficulties, or who has experienced severe or chronic emotional or physical trauma or illness is probably already suffering from some degree of adrenal fatigue.

Adrenal Fatigue Doesn’t Discriminate

People from every walk of life, every culture, and every age can suffer from adrenal fatigue. The political leader, the university student, the homeless person, the farmer, the villager in a war torn country, the Hollywood director, the factory worker on a swing shift, the medical doctor with an HMO, and the single parent with little support probably all have the factors in their lives that can lead to adrenal dysfunction, even though they lead very different lifestyles. The cost is untold in the loss of productive hours, creative ideas, sound business decisions, and other intangibles such as happiness, not to mention good health and longevity.

Your Job May Be a Factor

stressed doctor by Flickr user Celestine ChuaSome professions are harder on the adrenal glands than others. If you look at insurance company actuarial tables of the mortality rates, drug abuse, and number of sick days in different professions, what you are seeing–barring physically dangerous jobs–is largely the amount of adrenal fatigue experienced in those jobs. The medical profession is a good example of a profession prone to adrenal fatigue. Physicians, on average, die approximately 10 years younger, have higher rates of alcoholism and several times the drug addiction rates of the rest of the population.

Typically medical students go directly to medical school from an undergraduate program. During the first two years of medical school they learn approximately 25,000 new words, staying up many late nights to do so. At the end of the four years of study, they graduate and become residents in a specialized area of study, working between 80 and 110 hours per week, sometimes under a great deal of pressure from superiors and other students. By the time they graduate and finish their residency, they are often burdened with heavy debt and feel emotionally isolated.

Over two-thirds of those who are married end up divorced by the end of their residency. Because of their experiences during their training they may feel they can trust no one. This makes work and home unsafe places to be. After residency, most new doctors move immediately into a practice. Once in practice, they frequently work long hours with little rest, sometimes resorting to amphetamines or other stimulants in order to keep going. They often have little home life because they are working most of the time, which leads to marital dissatisfaction. Although this is a generalization and is certainly not true for every doctor, it is a description that fits many of the medical students, residents and young doctors I have worked with recently in practice. In fact, I know one doctor who, after collapsing at the end of her residency, decided to make a career of teaching professionals how to deal with stress.

police officer directing traffic by Flickr user James RussoThe police force is another profession that is very hard on the adrenals. I have counseled many policemen who are on the verge of collapse because of the stress involved in their job. You might think that it is the danger these people live with day in and day out that produces the stress, but much of their stress comes from the demands placed upon them by their commanding officers. If these people are also involved in a weekly rotating shift, the stress is magnified because their bodies never have a chance to adjust to the new circadian rhythm produced by each sleep change. People on alternating shifts with less than three weeks between shift changes are continually hammering their adrenal glands. Every time the wake/sleep cycle is altered, it takes several days to weeks to establish a normal hormonal pattern for the new wake/sleep cycle.

Middle executives, secretaries, and teachers are examples of professionals who suffer from “sandwich stress.” This is stress that comes from having to meet the demands and expectations from above and below without the power or authority to make the necessary changes or to do their job effectively. It is frequently the person in the middle who takes the blame when things go wrong, but not the credit when things go right.

People in this position commonly have more than their share of health problems. They often suffer from metabolic syndrome (a complex of signs and symptoms that includes glucose intolerance, increased triglycerides, low HDL cholesterol, insulin resistance, hypertension, central obesity, and accelerated atherosclerosis). These disorders reflect the effects of stresses that produce elevated cortisol levels. However, sometimes this phase is followed in time by a drop in cortisol levels to below normal, as the adrenals are less able to respond to the stress.

An important factor to remember is the ability to withstand stress varies by person. One person may withstand a stress quite easily and be ready for more, but another person, or that same person at another time, may find the same stress overwhelming and impossible to bear. It is important to understand that the onset and continuation of adrenal fatigue has great individual variation.

Image Credits: Stressed doctor by Flickr user Celestine Chua; Police officer directing traffic by Flickr user James Russo

Dr. James L. WilsonAbout the Author: With a researcher’s grasp of science and a clinician’s understanding of its human impact, Dr. Wilson has helped many physicians understand the physiology behind and treatment of various health conditions. He is acknowledged as an expert on alternative medicine, especially in the area of stress and adrenal function. Dr. Wilson is a respected and sought after lecturer and consultant in the medical and alternative healthcare communities in the United States and abroad. His popular book Adrenal Fatigue: The 21st Century Stress Syndrome has been received enthusiastically by physicians and the public alike, and has sold over 400,000 copies. Dr. Wilson resides with his family in sunny Tucson, Arizona.

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The Anti-Inflammatory Effects of Cortisol

 

The Anti-Inflammatory Effects of Cortisol

mosquito on skin

Among many other jobs, cortisol helps keep insect bite swelling under control

Cortisol is a powerful anti-inflammatory, even when secreted at normal levels. It acts quickly to remove and prevent redness and swelling of nearly all tissues. These anti-inflammatory actions keep mosquito bites from flaring into giant lumps, bronchial tubes and eyes from swelling shut from allergens, and mild scratches from looking like you have just had a close call with a mountain lion.

Cortisol maintains the balance through the unwritten law that “for any physical body to remain in homeostatic equilibrium every inflammatory reaction must have an opposite and equal anti-inflammatory reaction.” Although there are other anti-inflammatory responses occurring at local sites, cortisol is the main anti-inflammatory agent circulating naturally in your body. You can assume that almost any time you have an inappropriate amount of redness and/or swelling, there is too little cortisol in circulation.

Cortisol has similar anti-inflammatory control over auto-immune reactions. In auto-immune reactions, white blood cells attack parts of your body as if they were the enemy. These reactions can range from mild to life threatening. In most auto-immune reactions, cortisol levels are inadequate for the degree of reaction taking place in particular tissues or locations in the body.

This is one of the reasons why strong corticosteroids (prednisone, prednisolone, etc.) are used with all diseases involving inflammatory processes, including auto-immune diseases. These hormones imitate the anti-inflammatory effects of cortisol, although often with serious undesirable side effects. Cortisol not only affects the redness and swelling but also the actions of the white blood cells, as described in the next section.

The Effects of Cortisol on White Blood Cells

Cortisol influences most cells that participate in immune reactions and/or inflammatory reactions, especially white blood cells. It specifically regulates lymphocytes, the commanders of the white blood cells. Cortisol and corticoids (cortisol like substances) also affect the actions of other white blood cells with names such as natural killer (NK) cells, monocytes, macrophages, eosinophils, neutrophils, mast cells and basophils. These white blood cells gather in defense of the body at places of injury or perceived invasion and some flood the area with very powerful chemicals to attack the invaders.

firefighters spraying a fire

Cortisol rushes to put out the “fire” started by white blood cells’ reaction to invaders

Although they are a great defense, these chemicals irritate the surrounding tissues, causing redness and swelling. Cortisol reacts like a crew of firefighters, rushing to the site to put out the fire made by the lymphocytes and other white blood cells. It keeps the local white blood cells from sticking to the site and releasing their chemicals and also controls the number of circulating lymphocytes and other white blood cells, so there are fewer white blood cells available. This prevents an overreaction by the immune system and controls the irritation and tissue destruction that takes place at the site of congregating white blood cells.

Cortisol also reduces the rate at which lymphocytes multiply and accelerates their programmed cell death to further protect the body from this overreaction. In fact, when cortisol is elevated during the alarm reaction, there is almost a complete disappearance of lymphocytes from the blood. That is why your immune system is suppressed when you are under stress or taking corticosteroids. On the other hand, when circulating cortisol is low its moderating effect on immune reactions is lost and lymphocytes circulate in excess. In this situation inflammation is greater with more redness and swelling, and it takes a longer time for the inflamed tissue to return to normal. So, directly and indirectly cortisol dramatically influences most aspects of immune function.

Dr. James L. WilsonAbout the Author: With a researcher’s grasp of science and a clinician’s understanding of its human impact, Dr. Wilson has helped many physicians understand the physiology behind and treatment of various health conditions. He is acknowledged as an expert on alternative medicine, especially in the area of stress and adrenal function. Dr. Wilson is a respected and sought after lecturer and consultant in the medical and alternative healthcare communities in the United States and abroad. His popular book Adrenal Fatigue: The 21st Century Stress Syndrome has been received enthusiastically by physicians and the public alike, and has sold over 400,000 copies. Dr. Wilson resides with his family in sunny Tucson, Arizona.

References:

Collip J, Anderson, Evelyn M. Thyrotrophic Hormone of Anterior Pituitary.
J.A.M.A. 104 (12): 965-969, 1935.

Duncan WC, Jr. Circadian Rhythms and the Pharmacology of Affective Illness.
Pharmacol. Ther. 71 (1): 253-312, 1996.

Hartman F, Brownell, KA., & Hartman, WE. The Hormone of the Adrenal Cortex.
Am. J. Physiol. 72: 76, 1930.

Mortensen RMW, Gordon H. Aldosterone Action. Physiology 3rd edition:
1668-1710, 1995.

 

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Chronic Diseases and Adrenal Function

 

Chronic Diseases and Adrenal Function

vial of hydrocortisone

Hydrocortisone, a corticosteroid, is used to imitate the actions of cortisol

Because the adrenals are the glands of stress, they are a big factor in the process of and recovery from most chronic diseases. The reason for this is simple: most chronic disease is stressful. The processes that take place in chronic diseases, from arthritis to cancer, pull on the adrenals as more and more demand is made upon the body by the disease. Therefore, if someone is suffering from a chronic disease and morning fatigue is one of their symptoms, the adrenals are likely involved.

In any disease or disease process in which treatment includes the use of corticosteroids, diminished adrenal function is most likely a component of that disease process. All corticosteroids are designed to imitate the actions of cortisol, a hormone secreted by the adrenals, and so the need for them arises primarily when the adrenals are not providing the required amounts of cortisol. If the cortisol response is appropriate, there is little need for the external synthetic drugs that imitate its action, except in extreme instances.

With that said, there are a few diseases that particularly stand out as having an adrenal component: chronic fatigue syndrome, fibromyalgia, alcoholism, ischemic heart disease, hypoglycemia, rheumatoid arthritis and chronic and recurrent respiratory infections. In the cases of chronic fatigue syndrome and fibromyalgia, substantial evidence is now emerging that these syndromes may result from unusual infectious microorganisms that are not detected by the typical laboratory tests. A growing number of peer reviewed papers are now confirming the presence of these microorganisms in these particular illnesses. These pathogenic microorganisms act as a tremendous body burden, draining adrenal resources.

glass of whiskeyAdrenal fatigue often precedes a syndrome such as chronic fatigue, fibromyalgia and some cases of alcoholism. The immune weakness that results from altered adrenal function sets the stage for easier infection or greater debilitation. In many alcoholics, adrenal fatigue and the resulting hypoglycemia predispose the person to a compulsive desire for alcohol. In other cases of alcoholism, the adrenals become fatigued by the continual use of alcohol. In either case, adrenal fatigue is an intimate component of most alcoholism. Adrenal support greatly enhances the treatment protocol for alcoholism.

Chronic and recurrent bronchitis, pneumonia and other chronic lung and bronchial diseases typically have an adrenal fatigue component. This includes many cases of asthma, influenza and allergies. This relationship appears to be both causal and resultant, meaning frequent respiratory ailments can lead to adrenal fatigue and adrenal fatigue can leave a predilection toward developing respiratory problems. The association between adrenal function and respiratory infection was first written about in 1898, but by the mid 1930’s physicians apprised of the importance of the adrenals in resistance to infection and to overall health were also aware of the relationship of the adrenals to chronic and recurrent respiratory problems.

Later it became known that even the proper development of the lungs in the fetus is dependent upon an adequate amount of adrenal hormones, especially cortisol. If there is a lack of cortisol from the adrenals in the fetus during development, the lungs don’t develop properly and early problems in the lungs are more frequent and more serious. The tip-off that there is a low adrenal component to any of these illnesses is a longer than normal recovery period with decreased stamina and excess fatigue. When these symptoms are present, adrenal fatigue is likely a component of the symptom picture, no matter the cause.

Image Credits: Vial of hydrocortisone by LHcheM via Wikimedia Commons

Dr. James L. WilsonAbout the Author: With a researcher’s grasp of science and a clinician’s understanding of its human impact, Dr. Wilson has helped many physicians understand the physiology behind and treatment of various health conditions. He is acknowledged as an expert on alternative medicine, especially in the area of stress and adrenal function. Dr. Wilson is a respected and sought after lecturer and consultant in the medical and alternative healthcare communities in the United States and abroad. His popular book Adrenal Fatigue: The 21st Century Stress Syndrome has been received enthusiastically by physicians and the public alike, and has sold over 400,000 copies. Dr. Wilson resides with his family in sunny Tucson, Arizona.

References:

Back JC, Casey, John, Solomon, S., Hoffman, MM. The Response of the Adrenal
Cortex to Chronic Disease. In: GEW Wolstenholme aRP, ed. The Human
Adrenal Cortex: Its function throughout life. Boston: Little, Brown and
Company. pp. 94-119, 1967.

Bellometti SG, L. Function of the hypothalamic adrenal axis in patients with
fibromyalgia syndrome undergoing mud-pack treatment. Int J Clin Pharmacol
Res 19 (1): 27-33, 1999.

Bourne I. Local corticosteroid injection therapy. Acupuncture in Medicine 16 (2):
95-102, 1998.

De Becker P, De Meirleir, K., Joos, E., Campine, I., Van Steenberge, E., Smitz,
J., Velkeniers B. Dehydroepiandrosterone (DHEA) response to i.v. ACTH in
patients with chronic fatigue syndrome. Hormone & Metabolic Research. 31 (1):
18-21, 1999.

Dessein P, Shipton, EA., Joffe, BI., Hadebe, DP., Stanwix, AE., Van der Merwe, BA.
Hyposecretion of adrenal androgens and the relation of serum adrenal steroids,
serotonin and insulin-like growth factor-1 to clinical features in women with
fibromyalgia. Pain 83 (2): 313-319, 1999.

Feher I. Secretory function of adrenal cortex in chronic alcoholis. Med Pregl 52
(6-8): 221-225, 1999.

Harrower HR. Arthritis, p. 288, 1932.

Kuratsune H, Yamaguti, K., Sawada, M., Kodate, S., Machii, T., Kanakura, Y.,
Kitani, T. Dehydroepiandrosterone sulfate deficiency in chronic fatigue
syndrome. Bioorganic & Medicinal Chemistry Letters. 1 (1): 143-146, 1998.

Lee S, Schmidt, ED., Tilders, FJ., Rivier, C. Effect of repeated exposure to alcohol
on the response of the hypothalamic-pituitary-adrenal axis of the rat: I. Role of
changes in hypothalamic neuronal activity. Alcohol Clin Exp Res 25 (1): 98-105,
2001.

Neeck G, Riedel, W. Hormonal pertubations in fibromyalgia syndrome. Ann N Y
Acad Sci 876: 325-338; discussion 339, 1999.

Rivier CL, S. Effect of repeated exposure to alcohol on the response of the
hypothalamic-pituitary-adrenal axis of the rat: II. Role of the length and regimen
of alcohol treatment. Alcohol Clin Exp Res 25 (1): 106-111, 2001.

Scott L, Teh, J., Reznek, R., Martin, A., Sohaib, A., Dinan, TG. Small adrenal
glands in chronic fatigue syndrome: a preliminary computer tomography study.
Psychoneuroendocrinology 24(7): 759-68, 1999.

Straub RC, M. Involvement of the hypothalamic—pituitary—adrenal/gonadal axis
and the peripheral nervous system in rheumatoid arthritis: viewpoint based on a
systemic pathogenetic role. Arthritis Rheum 44 (3): 493-507, 2001.

Watterberg K, Scott, SM., Backstrom, C., Gifford, KL., Cook, KL. Links between
early adrenal function and respiratory outcome in preterm infants: airway
inflammation and patent ductus arteriosus. Pediatrics 105 (2): 320-324, 2000.

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How Adrenal Function Affects Your Everyday Life

How Adrenal Function Affects Your Everyday Life

The purpose of your adrenal glands is to help your body cope with stresses and survive. In fact, the adrenals are known as “the glands of stress.” It is their job to enable your body to deal with stress from every possible source, ranging from injury and disease to work and relationship problems. Your resiliency, energy, endurance and your very life all depend on their proper functioning.

Napoleon Bonaparte on horseback

Like Napoleon, the adrenal glands are small but mighty.

Just as Napoleon, a small man with great power, mobilized huge forces to make his presence felt in every part of his world, so your adrenal glands command powerful hormones to extend their influence throughout your body and your life. No bigger than a walnut and weighing less than a grape, each of your two adrenal glands sit like a tiny pyramid on top of each kidney. From this central location they not only significantly affect the functioning of every tissue, organ and gland in your body, but they also have important effects on the way you think and feel. The forces that these two little Napoleons mobilize largely determine the energy of your responses to every change in your internal and external environment. Whether they signal attack, retreat or surrender, every cell responds accordingly, and you feel the results.

One way to get an overview of the far-reaching extent, variety and depth of the effects of your adrenal hormones is to take a look at the wide range of medical conditions treated with drugs that imitate the actions of the adrenal hormone cortisol (synthetic corticosteroids). The uses of hydrocortisone (a corticosteroid) listed in The Physicians’ Desk Reference will give you the story. They include treatment of diseases and disorders of the joint mucus membranes, the heart, the blood, the respiratory tract and lungs, the gastrointestinal tract, the skin, the eyes, and the nervous system.

Hydrocortisone is also used to control swelling and inflammation as well as symptoms of allergies, cancer, viral infection, and immune and auto-immune disorders. However, the effects of your body’s own adrenal hormones on your health and bodily functions are even more varied, profound and extensive.

diagram of kidneys and adrenal glandsThe hormones secreted by your adrenals influence all of the major physiological processes in your body. They closely affect the utilization of carbohydrates and fats, the conversion of fats and proteins into energy, the distribution of stored fat (especially around your waist and at the sides of your face), normal blood sugar regulation, and proper cardiovascular and gastrointestinal function. The protective activity of anti-inflammatory and anti-oxidant hormones secreted by the adrenals helps to minimize negative and allergic reactions to alcohol, drugs, foods and environmental allergens. After mid-life (menopause in women), the adrenal glands gradually become the major source of the sex hormones circulating throughout the body in both men and women.

These hormones themselves have a whole host of physical, emotional and psychological effects, from the level of your sex drive to the tendency to gain weight. Every athlete knows that muscular strength and stamina are acutely affected by the adrenal hormones, more commonly known as steroids. Even your propensity to develop certain kinds of diseases and your ability to respond to chronic illness is influenced significantly by the adrenal glands. The more chronic the illness, the more critical the adrenal response becomes. You cannot live without your adrenal hormones and, as you can see from this brief overview, how well you live depends a great deal on how well your adrenal glands function.

Dr. James L. WilsonAbout the Author: With a researcher’s grasp of science and a clinician’s understanding of its human impact, Dr. Wilson has helped many physicians understand the physiology behind and treatment of various health conditions. He is acknowledged as an expert on alternative medicine, especially in the area of stress and adrenal function. Dr. Wilson is a respected and sought after lecturer and consultant in the medical and alternative healthcare communities in the United States and abroad. His popular book Adrenal Fatigue: The 21st Century Stress Syndrome has been received enthusiastically by physicians and the public alike, and has sold over 400,000 copies. Dr. Wilson resides with his family in sunny Tucson, Arizona.

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The Regulation of Cortisol, the Stress Hormone

The Regulation of Cortisol, the Stress Hormone

Cortisol is responsible for many of the life sustaining functions attributed to the adrenal glands. Although cortisol is secreted by the zona fasciculata in the adrenal glands, it is regulated primarily from the brain. The amount of cortisol circulating at any particular moment is regulated by a complex interaction between the hypothalamus, the pituitary gland, and the adrenal glands. This regulatory trio, often referred to as the HPA axis, operates through a negative feedback system.

the regulation of cortisol illustration

Click image for larger version

A negative feedback system works like the thermostat in a house or apartment. The thermostat senses the heat in the room and compares it with the desired temperature at which it has been set. When the heat gets too low, the thermostat signals the relay switch to tell the furnace to ignite, sending out hot air into the room and raising the heat. When the heat has risen to the desired level, the thermostat signals the furnace to quit until more heat is needed. This cycle is called a negative feedback system because when enough heat is released, a negative signal is sent to slow or stop the input.

In your body, your hypothalamus is analogous to the thermostat, your pituitary to the relay switch, your adrenals to the furnace, and your body to the room (see the illustration “The Regulation of Cortisol”). The amount of cortisol released is comparable to the heat released from the furnace. To a large extent you control the thermostat through the demands you place on your body. These demands arise from the physical situations your body has to deal with (diet, exercise, work, climate, etc.) and your reactions (emotional and physiological) to them. This negative feedback system is described below in the language of physiology.

The Physiology of Cortisol Regulation  

The HPA Axis is one of the most important elements of the whole body process known as homeostasis, the process that maintains a steady internal biochemical and physiological balance in your body. The HPA Axis adjusts cortisol levels according to the needs of the body, under normal and stressed conditions, via a hormone called the Adrenal Corticotrophic Hormone (ACTH). ACTH is secreted from the pituitary gland in response to orders from the hypothalamus and travels in the bloodstream to the adrenal cortex. There it activates cells in all three (or four) zones to produce their various hormones.

illustration of the HPA axis

Click image for larger version

Each zone generates different hormones as end products, but the process of making all hormones in all zones begins with ACTH binding to the walls of the adrenal cells. This initiates a chain reaction of intracellular enzymes that release cholesterol within the cell. The cholesterol is then used inside the adrenal cells to manufacture pregnenolone, the first hormone in the adrenal cascade. No matter which adrenal hormone is being produced, pregnenolone is the first hormone formed in the series.

In the zona fasciculata, pregnenolone is processed to form cortisone and then cortisol. Cortisol, once manufactured, is released into circulation. It takes less than a minute after the initial stimulation by ACTH for newly synthesized cortisol to be circulating through your blood to every part of your body, including to your hypothalamus where the concentration of cortisol is being constantly measured. Your hypothalamus, in its regulatory function, analyzes and integrates input from many different external and internal sources.

This input includes information from brain centers about overall excitability, energy requirements of your body, and sensory data from your brain centers for hearing, seeing, smelling, touch and taste. Based on this information, your hypothalamus determines how much cortisol your body requires and subsequently releases its own hormones as messengers.

The primary hormone messenger from the hypothalamus is corticotrophin releasing factor (CRF) which signals the pituitary gland to secrete a specific amount of ACTH. Thus ACTH is sent from the pituitary to your adrenal glands to begin the process described above all over again. Alterations in ACTH levels, and hence cortisol levels, are made minute by minute using this negative feedback loop, modulated by other information received by the hypothalamus as shown in the illustration.

Dr. James L. WilsonAbout the Author: With a researcher’s grasp of science and a clinician’s understanding of its human impact, Dr. Wilson has helped many physicians understand the physiology behind and treatment of various health conditions. He is acknowledged as an expert on alternative medicine, especially in the area of stress and adrenal function. Dr. Wilson is a respected and sought after lecturer and consultant in the medical and alternative healthcare communities in the United States and abroad. His popular book Adrenal Fatigue: The 21st Century Stress Syndrome has been received enthusiastically by physicians and the public alike, and has sold over 400,000 copies. Dr. Wilson resides with his family in sunny Tucson, Arizona.

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Gluten-Free Side Dishes: Three Quick and Tasty Recipes

 

Green Beans with Garlic Butter Sauce

sauteed green beans by Flickr user pongGreen beans contain a wide range of vitamins and minerals, and this dish is a tasty change-up from steamed or boiled green beans. If you want, you can substitute spinach or watercress for the green beans.

Ingredients:

  • 1 tablespoon butter
  • 1 tablespoon olive oil
  • 4-5 cloves of fresh garlic, peeled and sliced
  • 1 pound green beans, washed and with ends removed
  • 1/4 cup grated Parmesan cheese (optional)
  • salt and pepper to taste, if desired

Preparation:

  1. Bring a pot with water (enough to cover green beans) to a boil. Add green beans, and let them boil for 4-5 minutes.
  2. Drain green beans and place aside in an ice bath.
  3. Put a large skillet over medium heat. Melt butter with the olive oil, and add the garlic. Cook garlic until lightly brown, stirring often.
  4. Add the green beans, with any salt and pepper. Cook for 3-5 minutes, or until tender. Stir the beans every so often.
  5. Remove from heat, plate and sprinkle with Parmesan cheese, if desired.

Roasted Brussels Sprouts

Brussels sprouts by Flickr user johnsu01Brussels sprouts are a nutrient-dense vegetable, but many people, not just children, can’t get over the taste. Roasting these miniature cabbages is a great way to make them more palatable.

Ingredients:

  • 1 and 1/2 pounds of Brussels sprouts, ends trimmed and yellow outer leaves removed
  • 3 tablespoons olive oil
  • 1 teaspoon sea, Celtic or Himalayan salt
  • 1/2 teaspoon freshly ground pepper

Preparation:

  1. Preheat oven to 400* F (205* C).
  2. Add Brussels sprouts, olive oil, salt and pepper to a large plastic bag or mixing bowl, and gently mix together.
  3. Spread Brussels sprouts onto a baking sheet, large enough to prevent crowding. Roast for 30-46 minutes, shaking the pan every 7 minutes or so for even browning. Lower the heat if necessary.
  4. When done, Brussels sprouts will be dark brown and crispy on the outside and tender on the inside.

Baked Parmesan Tomatoes

Parmesan baked tomatoes by Flickr user MigleThis is a simple, blissful dish that can be eaten on its own or as an accompaniment, like between slices of your favorite gluten-free bread. Enjoy these for breakfast, lunch or dinner, hot or cold. You can add just about any fresh herb as a topping, like oregano, basil or rosemary.

Ingredients:

  • 4 (or as many as you like) medium-sized tomatoes, sliced horizontally in halves.
  • 1/4 cup grated Parmesan cheese
  • 1 teaspoon chopped fresh oregano
  • salt and pepper to season
  • 4 teaspoons extra virgin olive oil

Preparation:

  1. Preheat oven to 350* F (180* C).
  2. Place tomatoes cut side up on a baking sheet. Top with Parmesan, oregano (and/or any other herb you wish to use), salt and pepper.
  3. Drizzle with oil and bake for about 15 minutes, or until tomatoes are tender.

More gluten-free recipes are available on Dr. Eric Bakker’s website here: http://www.naturopath.co.nz/Recipes/Gluten+Free+Recipes.html

Image Credits: Green beans by Flickr user pong; Brussels sprouts by Flickr user johnsu01; Tomatoes by Flickr user Migle

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Yeast Infections: Frequently Asked Questions with Answers

Warner's Safe Yeast ad by Flickr user boston_public_libraryYeast Infections: Frequently Asked Questions with Answers

What Are Yeast Infections?

Candida albicans, a yeast-like fungus, naturally lives inside most people. Since it’s not a foreign object or invader this fungus is not inherently bad; problems arise when too much of this fungus is created. Molds and yeasts spread and reproduce by releasing millions of microscopic spores into the air, where they eventually settle on a favorable surface. Yeasts and molds prefer warm, dark and moist environments, which means there are many places in your body conducive for mold and yeast growth.

Who Gets Yeast Infections?

Anyone from birth to old age and from any race or culture can develop and suffer from a yeast infection. People vary greatly in their ability to develop and maintain a yeast infection in their bodies. A high stress lifestyle, a life crisis or a continuing difficult situation can cause a yeast infection in even the healthiest person because these factors will lower a person’s resistance and increase their susceptibility.

However, there are certain factors that increase susceptibility to yeast infections. These include a diet high in take-out foods; alcohol consumption; too little sleep and rest; taking an antibiotic or the oral contraceptive pill; a diet high in refined sugars and simple carbohydrates like pasta and bread; and a mother with a yeast infection during gestation and birth. Unfortunately many of these factors are common in modern life.

What Causes Yeast Infections?

The adrenal glands mobilize the body’s response to every kind of physical, emotional and psychological stress through hormones that regulate energy production and storage, heart rate, muscle tone, immune function and other processes that deal with stress. Adrenal fatigue is produced when the output of regulatory adrenal hormones is diminished through over-stimulation of the adrenals by severe, chronic or repeated stress, or because of adrenals weakened by poor nutrition, congenital factors or other causes. In adrenal fatigue the adrenal glands function, but not well enough to adequately meet the demands of stress. The causes of adrenal fatigue usually stem from one of four common sources that overwhelm the glands:

1) Disease states such as severe or recurrent pneumonia, bronchitis or flu, cancer, AIDS, auto-immune and other illnesses.

2) Physical stress such as surgery, poor nutrition, addiction, injury, and exhaustion.

3) Emotional/psychological stress from relationships, work or other unavoidable life situations.

4) Continual and/or severe environmental stress from toxic chemicals and pollutants in the air, water, clothing or food.

What are the Common Symptoms of a Yeast Infection?

A candida yeast infection overgrowth can potentially cause many symptoms. The most common in my experience are:

  • Fatigue, tiredness and general weakness or malaise
  • Bloating and flatulence (gas)
  • Food allergies and sensitivities
  • Itching skin near areas such as the scalp, ear, groin, armpit or vagina
  • Strong cravings for carbs and/or sweet foods like candy, ice cream, chocolate
  • Vaginitis (vaginal thrush) accompanied often by a vaginal discharge
  • Anxiety and depression
  • Impaired memory, poor concentration
  • A foggy brain, feeling spaced out

What are the Less Common Symptoms of a Yeast Infection?

Additionally, numerous other less common symptoms may be exhibited. Of these, those I see most frequently in the clinic include:

  • Cystitis/urethritis (urinary tract infection–painful, burning or “stinging” sensations when trying to urinate)
  • Menstrual irregularities
  • Loss of libido
  • Stiff, creaking and painful joints, muscle pain
  • Indigestion or heartburn
  • Diarrhea or constipation
  • Inhalant allergies and multiple chemical sensitivities
  • Mucus or catarrh, hay fever, sinusitis or a persistent cough
  • Heart arrhythmia, fast heartbeat
  • Discolored nails, acne and other skin eruptions, especially when itching
  • Earaches, headaches, and dizziness

Can People Recover From a Yeast Infection?

Although a yeast infection may only last a short while, especially if it was caused by one transient stressful event such as one round of antibiotic, it can debilitating and last for many years–even a lifetime–without proper treatment. However, with proper treatment, most people can fully recover from a yeast infection.

Can a Yeast Infection Become Chronic?

Yes, in some people the digestive and immune systems do not return to normal levels of function without help, either because their diet and lifestyle remained poor, their stress levels were too great or too prolonged, or because their general health is poor. However, when a yeast infection becomes chronic, it is almost always because of the ignorance of factors that can be changed through the correct modification in lifestyle and diet.

I want to prevent a Yeast Infection from returning. How do I stay healthy?

The guidelines for keeping healthy and preventing the recurrence of a yeast infection are very similar to the overall principles of good health. A moderate lifestyle with good quality food, regular exercise and adequate rest, combined with a healthy mental attitude to the stresses of life goes a long way towards keeping your body strong and resilient. However, because modern life can be so stressful and diets can be so compromised, certain nutritional supplements specially designed to counter a yeast infection and help restore the digestive microbial balance and maintain a healthy digestive system.

For more on yeast infection prevention and support, visit my website www.yeastinfection.org

Image Credit: Warner Yeast ad by Flickr user Boston Public Library

Dr Eric Bakker, NZ naturopathic physicianAbout the Author: Eric Bakker B.H.Sc. (Comp.Med), N.D, R.Hom. is a highly experienced naturopathic physician who has been in clinical practice for 25 years. Eric is passionate about improving people’s lives through proven wellness and lifestyle principles, natural medicine practice as well as public and professional practitioner education. Eric specialises in candida yeast infections, as well as adrenal fatigue, and thyroid disorders. Dr. Bakker has written one of the most comprehensive books on yeast infections called Candida Crusher. Website:  candidacrusher.com  You can complete his online survey to determine if you have a yeast infection here, or link through to his many YouTube videos: www.yeastinfection.org  Dr. Bakker’s Blog:  www.ericbakker.com

 

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Not All Food Allergies are the Same: Type 1 and Type 3 Responses

 

A true food allergy is not as common as you may actually think. Food sensitivities/reactions, which are much more common in my experience, are often mistaken for allergies. A true allergy to food is mediated by the immune system, and involves an antibody reaction to a specific food or drink. Food allergies are categorized into groups, and for this purpose I’m focusing on two of those: Type 1 immediate response (IgE) and Type 3 delayed response (IgG).

Type 1 or IgE Response (Immediate Food Allergy)

allergic reaction-hives on man's back

Hives are a common symptom of a food allergy

The best known and most studied form of food allergies is called a Type 1 immune reaction, or IgE mediated response. An IgE reaction occurs immediately after exposure to the allergen. With this allergy, the immune system creates an antibody called IgE (Immunoglobulin E) that attacks certain foods, causing a reaction. Type 1 food allergies occur in less than 5 percent of the population, and mostly in children. These type of allergies usually occur in the genetically predisposed individual (one or both parents have an allergy).

Since this pathway occurs immediately, it is often easy to recognize a Type 1 allergy. This is the immunological pathway behind seasonal allergies such as hay fever. The most common test for this type of reaction is the RAST (radioallergosorbent) or “scratch” test which is performed by doctors or specialists. This involves scratching the skin and applying a test substance and then waiting for a “wheal and flare response,” often a skin reaction.

The problem I find with this test is that it’s not always a reliable indication of an allergy, with many patients showing a “false negative” test and at times even an exaggerated positive response. The test substance may be too old to invoke a reaction or the test substance may not specific enough to the particular person and therefore does not invoke the reaction. There are simply too many reasons why this test can fail.

Type 1 Food Allergy Symptoms

The allergen and resulting symptoms are unique to the individual, so symptoms can vary by person. However, some people don’t have any idea that they have a food allergy. Not long after the response, allergy symptoms become apparent, including swollen hands, itchy and swollen eyes, sensations of the lungs, and in severe cases closing of the larynx or throat. Anaphylaxis is the most alarming response (difficulty breathing, fast heart rate, panic) and other symptoms may include stomach cramping, diarrhea, hives, swelling, itching and skin rashes.

Type 1 Food Allergy (IgE) Summary

grilled shellfish platter

Shellfish: Tasty, but one of the most common food allergens

-Generally no more than one or two foods are involved in causing these allergic symptoms.

-Even the tiniest trace amounts of food can trigger this intense allergic reaction.

-Allergic symptoms commonly appear within 2 hours after consumption, but may occur within minutes.

-Primarily affects the skin, airway and digestive tract manifesting in conditions such as asthma, rhinitis, urticaria, angioedema, eczema, vomiting, diarrhea and anaphylaxis.

-This type of allergy is usually a permanent, fixed food allergy.

-Frequently IgE responses show as positive on “RAST” and skin tests, but this is not always the case. Variables include the experience of the person doing the testing, the conditions the test was performed under, and if the patient was taking drugs (like antihistamines) beforehand.

-Although mixed immediate/delayed onset allergic reactions have been reported (e.g., eczema), the IgG antibody is not characteristically involved in IgE responses.

-Mast cells, basophils, histamine and tryptase release are all commonly involved in this type of reaction.

Type 3 or IgG Response (Delayed Food Allergy)

Non-IgE-mediated allergies involve antibodies like IgG (Immunoglobulin G). Symptoms of an IgG-dependent reaction may occur hours–even days–following exposure to the allergen. When foods are involved, these are often referred to as “delayed food reactions”. The IgG antibody may bind to the food antigen and form an immune complex, and these complexes may deposit in various tissues and trigger inflammatory reactions. It is most unfortunate, but conventional medicine often does not recognize these types of immune responses.

Delayed Food Allergy (IgG) Summary

-Anywhere from 3 to 10 food allergens may be involved, and in some cases up to 20 foods have been reported.

-It is more rare for a person in this category to be only allergic to one or two foods.

-Unlike IgE allergies, larger amounts of food often in multiple feedings are commonly needed to provoke these types of allergic reactions. Reactions may not occur after a single food challenge.

-Virtually any tissue, organ, or system of the human body can be affected, making it difficult to distinguish between an IgE and IgG response.

-It has been estimated that addictive cravings and withdrawal symptoms can be clinically significant in 20-30% of patients suffering from this type of allergy.

-The offending foods are rarely self-diagnosed. Multiple doctor visits involving different physicians are often the rule, not the exception, before proper diagnosis and treatment is provided.

-Allergic foods are commonly favorite foods, eaten often and in larger amounts.

-Unlike IgE responses, IgG responses are often alleviated or reversed.

-IgG responses typically show as negative on RAST and skin tests.

-Sensitized lymphocytes, eosinophils, platelets, release of PAF and leukotrienes may be more prevalent.

For more on food allergies, check out our blog on Food Allergies, Sensitivities and Adrenal Fatigue and Making Sense of Food Allergies, Sensitivities and Intolerances

Image Credits: Hives on back by DLdoubleE (Own work) [Public domain], via Wikimedia Commons

Dr Eric Bakker, NZ naturopathic physicianAbout the Author: Eric Bakker B.H.Sc. (Comp.Med), N.D, R.Hom. is a highly experienced naturopathic physician who has been in clinical practice for 25 years. Eric is passionate about improving people’s lives through proven wellness and lifestyle principles, natural medicine practice as well as public and professional practitioner education. Eric specialises in candida yeast infections, as well as adrenal fatigue, and thyroid disorders. Dr. Bakker has written one of the most comprehensive books on yeast infections called Candida Crusher. Website:  candidacrusher.com  You can complete his online survey to determine if you have a yeast infection here, or link through to his many YouTube videos: www.yeastinfection.org  Dr. Bakker’s Blog:  www.ericbakker.com

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Progesterone and Pregnenolone: Two Ps in a Pod

Progesterone and Pregnenolone: Two Ps in a Pod

peas and podProgesterone and pregnenolone are steroid hormones manufactured in several areas of the body: the adrenal cascade, ovaries and testicles. Progesterone is made from pregnenolone and both are metabolized into DHEA. In the adrenal cascade, pregnenolone is the first hormone to be made from cholesterol and progesterone is the second. Besides DHEA both can be converted into several other adrenal hormones, including the sex hormones, aldosterone and cortisol. Hormones like pregnenolone and progesterone are incredibly versatile, letting your body’s wisdom choose which other hormones it will make from them based on your individual needs.

With adrenal fatigue, sex hormone levels often fall because your adrenal glands are not able to manufacture adequate amounts. One key function sex hormones serve is to act as antioxidants that help prevent the damage caused by cortisol. The lower the levels of sex hormones, the more damage there is to tissues, especially when stress levels are high. This oxidative damage is one of the key factors contributing to rapid aging.

Both progesterone and pregnenolone have been used with success to ease premenstrual syndrome (PMS). This is not surprising considering that the most common cause of PMS seems to be too little progesterone and/or too little magnesium. The addition of oral pregnenolone or natural progesterone cream is often used as relief for the side effects and symptoms of PMS. Both pregnenolone tablets and progesterone cream are available from many health food stores and some pharmacies.

It is important to note that we are speaking of natural progesterone and not the synthetic tablet-form progestins typically prescribed by a doctor. Synthetic progestins can have many side effects and should be avoided. The reason most progestins have side effects is that none of them are exactly like the natural progesterone your body makes. The progesterone contained in progesterone cream, however, is usually a naturally-derived plant progesterone (phytoprogesterone) that has been converted into the same molecule as the progesterone in your body. In my experience, this form can be used safely by most women.

Use of progesterone cream for PMS typically involves rubbing 1/4 to 1/2 teaspoon cream into the tender areas of your skin (swimsuit areas plus the inside of thighs and arms) each morning and evening. Premenopausal women should apply it from the 12th day of the menstrual cycle to the 26th day (the first day of bleeding is counted as the 1st day). Post-menopausal women can use it for 21 days each month. A great resource for more information on this topic is What Your Doctor May Not Tell You About Menopause by Dr. John Lee.

smiling HCP with patientBoth pregnenolone and progesterone can be used to raise the hormonal levels in both men and women, and decrease some aspects of adrenal fatigue. Bypassing the very complex and energy consuming steps required to make pregnenolone or progesterone from cholesterol means fatigued adrenals do not have to work nearly so hard to keep hormone levels adequate. Using hormone replacement therapy for adrenal fatigue is an area that requires skill. Although some of the hormones mentioned here can be purchased without a prescription, I highly recommend using a physician familiar with hormone replacement in cases of adrenal fatigue. If you cannot find one in your area, try our Find a Practitioner section to see if we have someone near you.

Hormones work together in symphony to perform in the concert of life. To throw in a hormone here and another there in a haphazard way is like having a heavy metal band thrown in with an orchestra. Hormones are powerful engineers of body processes and balancing them calls for delicate precision. The timing, the quantity and the form of hormone used are all critical. It is best to work with an expert who will monitor your progress using laboratory tests. If you do embark upon this yourself, use caution: start low and go slow.

Dr. James L. WilsonAbout the Author: With a researcher’s grasp of science and a clinician’s understanding of its human impact, Dr. Wilson has helped many physicians understand the physiology behind and treatment of various health conditions. He is acknowledged as an expert on alternative medicine, especially in the area of stress and adrenal function. Dr. Wilson is a respected and sought after lecturer and consultant in the medical and alternative healthcare communities in the United States and abroad. His popular book Adrenal Fatigue: The 21st Century Stress Syndrome has been received enthusiastically by physicians and the public alike, and has sold over 400,000 copies. Dr. Wilson resides with his family in sunny Tucson, Arizona.

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