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Dr. Bakker’s Guide to Gluten-Free Baking

Dr. Bakker’s Guide to Gluten-Free Baking

Many people have told they believe gluten-free baking to be a bit of a myth: something that sounds good, but is too good to be true. I’ve heard horror stories of inedible, unrecognizable rocks coming out of the oven. I can assure you: it doesn’t have to be this way. In this blog, I’ll cover the basics of gluten-free baking.

Baking and Cooking Gluten-Free

assortment of fresh baked breadsOnce you’ve mastered gluten-free baking and cooking (and it really is easy), you won’t want to go back. The important thing to remember is to keep it simple. Once you’ve learned how to use white flour alternatives, and there are plenty, you’ll be able to incorporate them into all your recipes requiring flour.

As with any new venture, don’t fear failure. Your first batch or two may turn out to be more useful as hockey pucks, but keep your sense of humor and don’t get discouraged. Baking in general requires trial and error, but once you get it you’ve got it.

But What About the Leavening?

The only problem with gluten-free flours is that they often require an additional leavening agent. I recommend using xanthum gum as a leavening agent in your gluten-free flour recipes and mixes. Alternatively, you can purchase pre-made, gluten-free flour and pancake mixes. You might be surprised at how well these pre-made mixes can turn out! As always, check the label for any funny business.

What About Oats?

organic steel cut oats by Flickr user ArtizoneNot all rolled oats are free of gluten. In fact, oats in general can be a real problem for those with celiac disease or a high sensitivity to gluten. Often times the oat crop is cross-contaminated with another crop, like wheat. If available, organic, stone milled oats are a good alternative. These may still contain trace amounts of gluten, which I’ve generally found to not be a problem for my gluten-sensitive clients.

If your digestive system is sensitive, you may have to get used to the high fiber content in rolled oats. My advice is to start low and go slow, perhaps preparing a half cup of oatmeal once or twice a week, and see how that goes for you. You can add more as your tolerance builds. Be sure to drink plenty of water, and taking a probiotic can be helpful as well.

White Flour Alternatives: The Breakdown

White rice flour: Plain white rice flour can have a gritty texture. It’s perfectly fine for baking, as long as you’re using it in something you don’t mind having a sandy texture. It can be good for biscuits and some cookies.

Sorghum flour: This flour tends to be soft and sweet with a smooth texture, and can be great for baking.

Brown rice flour: I find this flour to be superior to white rice flour. It contains more nutrition, and tends to give more body to your baking, especially when blended with lighter flours. I’ve also found that both brown and white rice flour work well as a thickening agent in gravy.

Almond flour: This flour can add a subtle but great flavor to your baked goods. It also adds protein, fiber, and essential minerals like calcium and magnesium to the mix.

buckwheat pancakes by Flickr user Brenda WileyBuckwheat flour: This is my go-to flour for making pancakes. It tastes great, and has great protein content. Note: even though it’s part of the name, there’s no relation to wheat. Buckwheat is actually part of the rhubarb and sorrel family.

Millet flour: Millet flour is an alkaline grain that is high in fiber and protein.

Quinoa flour: This flour is quite high in protein, but should be used sparsely as it does have a strong flavor. Quinoa flour is best used blended with other flours.

Coconut flour: Coconut flour is amazing! It’s high in fiber, has a great taste and is quite versatile. This flour does soak up moisture, so be mindful of the amounts you use. I recommend using about a half cup in a gluten-free flour blend for best results.

Note: Almond, buckwheat, coconut and quinoa flours are generally denser and work best blended in small amounts. Start out with 1/3 cup and do some experimenting. It really comes down to application and personal preference.

Dr. Bakker’s Basic Gluten-Free Flour Mix

Combine:

  • 1 cup sorghum flour
  • 1 cup tapioca or potato starch (Important: do not use potato flour.)
  • 1/3 to 1/2 cup almond meal, buckwheat flour, millet flour or quinoa flour
  • 1 teaspoon xanthan gum (this is essential to avoid making ‘bricks’)

Gluten-Free Self-Rising Flour Mix

Combine:

  • 1 cup basic gluten-free flour mix (you can use the previous recipe)
  • 1 1/2 teaspoons baking powder (check to be sure it’s gluten-free!)
  • 1/2 treaspoon salt (I recommend Celtic or sea salt)

I have more gluten-free recipes available on my website, including bread and pizza base mixes, which you can find here. There are also excellent gluten-free muffin recipes available on this blog here.

Image Credits: Rolled oats by Flickr user Artizone; Buckwheat pancakes by Flickr user Brenda Wiley

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 27 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, psoriasis, as well as adrenal fatigue, thyroid and digestive disorders. Dr. Bakker has written one of the most comprehensive books on yeast infections called Candida Crusher. He has also written what may well be the most comprehensive Natural Psoriasis Treatment Program available. You can find more articles by Dr. Bakker on his blog at www.ericbakker.com

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Adrenal Fatigue and Exercise: Start Low and Go Slow

Adrenal Fatigue and Exercise: Start Low and Go Slow

exercise equipment - weights, scale, shoes and ball

If you have adrenal fatigue, exercise is probably the last thing you feel like doing. But before you skip this blog, listen to all the good things it will do for you. And remember: dancing and making love are exercise too!

Benefits of Exercise

Rapid breathing expels volatile gases out of your body that become harmful if they build up. The increased blood flow helps keep plaque from building up in your arteries while stimulating your liver to perform its 3,000+ functions more efficiently. Cell function improves with the accompanying acceleration of carbon dioxide, oxygen and nutrient exchange. Exercise normalizes levels of cortisol, insulin, blood glucose, growth hormone, thyroid, and several other hormones and puts more oxygen into your brain.

Exercise also decreases depression, which is a common side effect of adrenal fatigue. There are studies that show that exercise can be as effective in treating depression as are some pharmaceutical agents. Physical activity is empowering as well as rejuvenating.

What Exercise is Best for Adrenal Fatigue?

Exercises – combine aerobics, anaerobics and flexibility

Exercises – combine aerobics, anaerobics and flexibility

Exercise should be enjoyable. It should not be highly competitive, grueling or debilitating. What you need is something that increases lung capacity, muscle tone and flexibility while having fun. (See illustration “Exercises – combine aerobics, anaerobics and flexibility”).

Yoga with breathing exercises, ta’i chi, kick boxing, swimming, fast walking, dancing, and any number of team sports and exercise programs are all good ways to get your body moving. Pick something that is enjoyable to you. Remember you are not working out to run a marathon or set new records, but to bring your body back to life and take pleasure in it again. There will be days, especially when you first begin exercising, that you do not feel like doing anything physical. When this happens, instead of forcing yourself to exercise, start slow and gently work into it.

In other words, do not let the exercise become another stressor in your life. When part of you resists, simply treat that part with kind understanding, acknowledge its resistance, but do not let it undermine your commitment to your health. People with adrenal fatigue often feel too tired to exercise. However, if you set a routine time to exercise, no matter how you feel, you will soon experience the rewards of your self-discipline.

How Do I Know if I Am Exercising Correctly?

woman stretching dramatically

“…And the hip bone is connected to the pain bone.”

Exercise at your own pace and not the pace of the person next to you or your friends. If you get tired, rest or quit for a while or for the day. If you are tired the next morning, take it easier the next time. As your stamina increases, gradually increase your exercise.

The purpose of exercising in this program is not necessarily to become stronger, but to increase your body’s tone, flexibility and aerobic capacity. Two weeks after you start exercising daily you should notice that you are beginning to feel better. You should feel good after a workout and should only be slightly or mildly sore the day after. If you feel worse after a workout or the next morning, you probably exercised too hard and need to step it down a notch.

Type A personalities who are out of shape are particularly prone to doing this. In their minds, they are in much better condition than they actually are and so make more demands on their bodies than they should. Exercise done properly makes you feel better physically and mentally. If you are not experiencing this within a few weeks of starting a regular program, either cut back a little or try a different kind of exercise. The most important requirement is that exercise becomes enjoyable for you.

Further reading on exercising for adrenal fatigue: Fundamentals of fitness: Cardiovascular Exercise; Getting Fit to Get Happy; Exercising for Stress Relief

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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Brain Fog: Could Food Sensitivities be to Blame?

Brain Fog: Could Food Sensitivities be to Blame?

edited brain illustration by Flickr user Allan AjifoBrain fog is common among those suffering from adrenal fatigue, but did you know brain fog can also be caused by food intolerances? It doesn’t have to be a food you’re allergic to; in fact, I’ve seen several patients whose allergy testing came back relatively clean but still experienced side effects after eating certain foods. How is this possible?

But first: what is brain fog? Just like it says, it feels like your brain is surrounded by a haze. This can mean difficulty focusing, recalling things, remembering where things are, and loss of focus or concentration.A sensitivity to salicylate, amine, gluten or glutamate—chemicals found naturally in foods—could be to blame. Sensitivities to these natural chemicals are fairly common, and don’t really show themselves on typical allergy tests. It’s estimated that 18 million Americans have non-celiac gluten sensitivity—six times more than those with celiac disease. A majority of these cases go unnoticed or are misdiagnosed as other conditions.

Salicylates and Brain Fog

Salicylates are amazing chemicals. They act as a natural preservative to protect against rot and harmful bacteria, and also protect against insects by poisoning them. Chemically, salicylate closely resembles aspirin, so those with sensitivity to aspirin may be sensitive to foods high in salicylate as well.

Foods with Moderate Salicylate Content
Lemon, mango, pear, red apples, kiwi fruit, asparagus, broccoli, cauliflower, mushroom, onion, parsnip, turnip, spinach, kohlrabi, peanut butter/peanuts, pistachio, coconut, walnuts, pecans, pine nuts and sesame seeds

Foods with High Salicylate Content
Apricot, blueberry, avocado, grapefruit, watermelon, peach, cherries, pineapple, plum, strawberry, alfalfa sprouts, eggplant, cucumber, chicory, endive, zucchini and bell peppers. Note: all dried fruits are generally too high in salicylates for sensitive people.

The most common symptoms of salicylate intolerance, in addition to brain fog, include persistent cough, congestion, hyperactivity (especially in children), rash or hives, post nasal drip, headache and fatigue.

Amines and Brain Fog

Amines are the chemicals that give food their flavor. Foods with higher amine content tend to have more intense flavors. These natural “flavor bits” are created during the breakdown of specific proteins, or when they ferment as part of the normal aging and ripening process. The longer the food ripens, the higher the amine content.

Foods with High Amine Content
Because they occur in fewer foods, amine intolerances are generally easier to identify and eliminate than salicylate intolerances. Amines can be found in wine, numerous alcoholic beverages, aged cheeses, chocolate, canned or smoked fish, aged and/or smoked meats, and some produce (tomato, banana, avocado).

The most common symptoms of amine intolerance, in addition to brain fog, include difficulty concentrating, dull headaches, fatigue, nasal congestion and irritable bowel syndrome.

Glutamates and Brain Fog

Glutamates, AKA glutamic acid, are naturally recurring amino acids found in many foods, particularly gluten grains like rye, barley and wheat. They can also be found in legumes, dairy products, meats and even in gluten-substitute grains like millet, flaxseed and quinoa.

Of the three chemicals, glutamic acid generally affects the less people. However, some people do experience side effects, like headaches and fatigue, after consuming foods containing glutamic acid. If you suspect you’re sensitive to glutamates, it’s best to avoid corn and corn by-products (especially high fructose corn syrup), gluten products, soy and dairy. For more on gluten intolerance and celiac disease, read this blog article.

How Do You Know if Your Brain Fog is Caused by Sensitivities?

You could be affected by more than one food, so some time and detective work may be required to fully understand what is bothering you. One of the best things you can do for yourself is to keep a food diary. Every day, make a log of every meal and snack you consume. After eating, make a note of how you feel. If you experience side effects like brain fog after eating, make detailed notes next to that meal.

For more on identifying and eliminating food sensitivities, read this blog article. I also encourage you to speak with your healthcare practitioner about your concerns, especially before considering an elimination diet. It may take some trial and error, but finding and eliminating the source of your brain fog, and other undesirable side effects, will be well worth your time.

Image Credits: Brain illustration by Flickr user Allan Ajifo

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 27 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, psoriasis, as well as adrenal fatigue, thyroid and digestive disorders. Dr. Bakker has written one of the most comprehensive books on yeast infections called Candida Crusher. He has also written what may well be the most comprehensive Natural Psoriasis Treatment Program available. You can find more articles by Dr. Bakker on his blog at www.ericbakker.com

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Hypothyroidism: An Introduction

Hypothyroidism: An Introduction

What is Hypothyroidism?

diagram of anterior thyroid glandSimply put, hypothyroidism means an underactive thyroid gland. Despite its small size, everything slows down when the thyroid doesn’t produce enough hormone to keep the body running properly. It is estimated that 4.6% of the US population aged 12 and above has some form of hypothyroidism. Those most affected are people aged 50 or older, particularly female.

Before we go further into hypothyroidism, let’s talk about the gland itself. The thyroid is an endocrine (hormone-secreting) gland located at the front of the neck, just above the sternum. Your thyroid has some big responsibilities. In addition to controlling metabolism (the rate at which cells perform functions essential to life), the thyroid also helps keep the body warm. These important tasks are performed by releasing T4 and T3, hormones produced by the thyroid gland.

What Does Hypothyroidism Feel Like?

The thyroid plays a big part in many functions of the body, so symptoms of hypothyroidism can vary from person to person. Symptoms tend to develop over time, and can increase in severity if left untreated. Here are some of the more common symptoms of low thyroid function:

  • Fatigue
  • Weight gain not explained by diet or lifestyle
  • Constipation
  • Thin and brittle hair, skin and nails
  • Decreased tolerance for cold weather
  • Heavy and irregular menstrual periods

If left untreated, hypothyroidism can also lead to decreased sense of taste and smell, slow or slurred speech, mental health issues and infertility.

What Causes Hypothyroidism?

soldier with grenade

In autoimmune conditions, the immune system attacks a non-intruder. Probably not with a grenade, though.

One of the leading causes of lowered thyroid production is autoimmune disease. These occur when the immune system mistakenly attacks a ‘good’ part of the body, like the thyroid gland. Autoimmune thyroiditis can begin suddenly, or develop over time. Hashimoto’s disease is a common example of hypothyroidism caused by autoimmune disease.

Hypothyroidism can also be caused by surgery and/or radiation on the thyroid gland. With surgery, part of all of the thyroid gland may need to be removed due to nodules, goiters, Grave’s disease, or even cancer. When part of the gland is removed, the remaining bit may be able to produce enough hormones to keep things relatively normal. If the whole gland is removed, hypothyroidism is certain.

Some other potential causes of lowered thyroid function are congenital hypothyroidism, thyroiditis (inflammation of the thyroid gland), certain medicines, damage to the pituitary glands (which gives the thyroid instructions to produce) and irregular levels of iodine.

The Thyroid-Adrenal Connection

About 80% of those suffering from adrenal fatigue also have a number of symptoms of low thyroid. Supporting the adrenal glands can also go a long way in supporting the thyroid gland. Underperforming adrenals can tax the thyroid, and vice versa.

Because thyroid controls metabolism and how efficiently the body uses energy, it affects every other system and organ in the body. The adrenal glands impact the thyroid too. Rising levels of cortisol (a stress hormone produced by the adrenals) can decrease the production of thyroid stimulating hormone, thus decreasing thyroid hormone production. High levels of cortisol can also cause thyroid hormone to be converted to a weaker form, creating low thyroid symptoms.

Because of their relationship, both low adrenal function and low thyroid function can create fatigue, sluggishness, lowered sex drive and depression.

How Do You Know if You Have Hypothyroidism?

doctor consulting with patientHypothyroidism shares symptoms with other conditions and diseases, so a physical exam and testing are usually required to find out for sure if you have a thyroid problem. There are different tests available to measure the presence and levels of thyroid hormone in the body, and vary by need. For example, there are different tests to determine the presence of Hashimoto’s disease.

Some types of hypothyroidism, using Hashimoto’s again as an example, require lifelong treatment. This typically involves the daily use of synthetic thyroid hormone, like Synthroid. Dietary changes are also recommended, as there are foods that can help (and foods that can inhibit) thyroid function. There are also vitamins and herbs that can help support thyroid function, such as selenium, zinc, Omega-3 fats, antioxidant vitamins (like A, C and E) and B vitamins.

Image Credits: Thyroid gland diagram via CC by CFCF; Physicians and patient by Flickr user Mercy Health

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Omega What Now? Making Sense of Fatty Acids and Oils

 

Omega What Now? Making Sense of Fatty Acids and Oils

cheeseburger by Flickr user Phil Dragash

Sorry fast food cheeseburger, you’re just not the good type of fat.

Most North Americans consume too much fat in their daily diet (40-55% of daily calories). Despite this huge over-consumption of fat, most North Americans are sadly lacking in the essential fatty acids that promote good skin quality, reduce inflammation and slow down the aging of body tissues.

Ideally, fats should not make up more than 20-25% of your total daily calories. It is very important that they are the right kind of fats. The type and quality of fats in your diet is critical because they become a major part of your cell walls, nerves and the membranes of your body.

People with adrenal fatigue often crave fats and oils, partly because foods high in fats make them feel better for longer than low fat or sweet foods. Some fats also contain cholesterol needed by the adrenal glands to make the steroid hormones essential for adrenal activity throughout your body.

Essential Fatty Acids

Polyunsaturated fatty acids come in 2 categories: non-essential and essential. Non- essential fatty acids are those the body can make by itself from other fats and oils. Essential fatty acids are the fatty acids we need to get from food because we cannot make them ourselves. Essential fatty acids are very important for us to consume in adequate amounts in order to maintain good health. Lack of intake or imbalances in the essential fatty acids has been shown to lead to a myriad of health problems.

salmon filet by Flickr user Ernesto Andrade

Salmon is known for its Omega 3 content. And deliciousness.

There are 2 types of essential fatty acids: alpha-linolenic and linoleic. Alpha-linolenic acid belongs to the Omega 3 group of fatty acids and linoleic acid belongs to the Omega 6 group. Omega 3 fatty acids have more double bonds (3 to 6) and come from colder, more northern climates. Examples of foods high in omega 3 fatty acids are salmon, sardines, soybeans, walnuts, flax seeds, and in smaller amounts, dark green plants.

Omega 6 fatty acids have fewer double bonds (2-4) and come from more southern plants such as sesame, sunflower, safflower, and corn. Both groups of essential fatty acids are extremely important to your health.

An improper balance of essential fatty acids fosters the development of many conditions such as heart and circulatory disorders, arthritis and cancer. Because these oils contain a high number of double bonds, they are relatively unstable, so it’s best to buy them in small quantities and keep them in the freezer.

The right balance of essential fatty acid intake contributes significantly to adrenal recovery, as well as to your general health. For optimum health the best balance of essential fatty acids is a 4:1 ratio of omega 6 oils to omega 3 oils.

One easy way to get the right amount of essential fatty acids in this ratio is to mix 1 tablespoon of flax seed oil with 1 tablespoon of sunflower or safflower oil daily. Add this mixture, uncooked, to food just before you eat it (as salad dressing, mixed in with vegetables, sauces or grain, added to smoothies, etc.).

Here are some simple rules to make certain your essential fatty acid intake is adequate:

  • Mix flax seed oil with safflower or sunflower seed oils in a 1:1 ratio
  • Consume 1-2 tablespoon (uncooked) per day, sprinkled on meats, vegetables, grains, etc.
  • Use only fresh, raw, cold pressed, unrefined oils
  • Buy organically grown oils stored in lightproof containers, when possible
  • Keep all oils in the refrigerator or freezer
  • Squeeze one capsule of 400 IU vitamin E (mixed tocopherols) into every ¼ cup oil
  • Eat cold water ocean fish as a source of omega 3 oils (avoid tuna, mackerel and swordfish as they tend to be high in mercury)
  • Eat fresh seeds and nuts (except peanuts) as a source of omega 6 oils
  • Avoid all hydrogenated or partially hydrogenated oils (read labels on food)
  • Use lower temperature cooking methods
  • Avoid all deep fried foods
  • Avoid restaurant foods cooked with oils
hydrogenated oil ingredient

Not one, not two, but three hydrogenated oils!

Even if you eat the right quantity of essential fatty acids in the right ratio, their value can be negated if you also consume poor quality or hydrogenated oils. When you eat foods containing hydrogenated and partially hydrogenated fats they disrupt normal fatty acid metabolism in your body. They use up the enzymes that normally would be utilized by the good oils, and prevent your body from creating quality cell membranes and nerve sheaths. As a result, your body cannot transform essential fatty acids into the materials it needs to make various cell wall components and other structures.

Any time you see hydrogenated or partially hydrogenated oils or fats, put that food back on the shelf and do not buy it. Alternatives are available in health food stores and in the grocery store, if you look carefully. Even though you may crave these familiar foods, eating them seriously interferes with your ability to heal.

Read more on foods to avoid when you have adrenal fatigue

Image Credits: Cheeseburger by Flickr user Phil Dragash; Salmon fillet by Flickr user Ernesto Andrade

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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Cortisol and HPA Axis Function in Major Depression

Cortisol and HPA Axis Function in Major Depression

depressed manThe World Health Organization lists depression as one of the leading causes of disability worldwide.[i] It is well known that stress can precipitate major depression and influences its incidence, severity and course[ii]. It is also known that many of the features of major depression potentially reflect dysregulation of the stress response of the hypothalamic-pituitary-adrenal (HPA) axis[iii].

There are a number of clinical conditions in which depression and cortisol, a prime adrenal hormone, are associated but the HPA axis pattern differs from that of major depression. These conditions include but are not limited to posttraumatic stress disorder[iv], bipolar disorder[v], fibromyalgia, chronic fatigue syndrome[vi], functional gastrointestinal disorders[vii], early sexual abuse[viii], Cushing’s syndrome[ix] [x] [xi], Addison’s disease[xii] [xiii], and adrenal fatigue[xiv].  Due to space constraints, this article will focus on HPA axis function in major depression.

Major depression is a heritable disorder that affects approximately 8% of men and 15% of women[xv]. For over 75% of patients, major depression is a recurrent, lifetime illness characterized by repeated remissions and exacerbations[xvi]. Its effects extend beyond psycho-emotional to negatively influence neuroendocrine regulation, autonomic function, and the regulation of sleep, appetite and metabolic activity[xvii] [xviii].

The long-term physiological impact of major depression has serious implications for health, including increased incidence of coronary artery disease[xix] [xx] [xxi], premature osteoporosis[xxii] and the doubling of all-cause mortality at any age[xxiii] [xxiv] [xxv].

The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV)[xxvi], the principal diagnostic instrument used for psychiatric diagnosis in the United States, lists two distinct clinical major depressive syndromes that seem to be the antithesis of one another: melancholic and atypical depression. This distinction is based on their patterns of psychological and behavioral symptoms[xxvii].

Melancholic depression is actually a state of pathological hyperarousal. Its psychological manifestations are intense anxiety; feelings of worthlessness; recollections of past transgressions, failures and helplessness; dread of the future; and feelings of personal deficiency which color thought and affect[xxviii] [xxix].

Severe melancholic depression has long been associated with consistently elevated levels of cortisol[xxx]. Its physiological manifestations include hypercortisol, suppression of growth hormone and the reproductive axes, insomnia (most often early-morning waking) and loss of appetite. The melancholia is greatest early in the morning[xxxi]. Only 25 to 30% of patients with major depression present with pure melancholic features[xxxii].

Atypical depression in many ways is the opposite of melancholic depression. It is associated with a disturbing sense of disconnectedness and emptiness, punctuated by brief emotional reactions to external circumstances. People with atypical depression seem walled off from themselves, and complain of cognitive and mental weariness. They tend to avoid others, often with a sense that contact would be too demanding, tiring and poorly received. They present with lethargy, fatigue, excessive sleepiness, increased food intake, weight gain and depressive symptoms that worsen as the day progresses[xxxiii].

15 to 30% of patients with major depression show pure atypical depression features[xxxiv], about half as frequent as melancholic depression. More recently it has emerged that atypical depression is marked by paradoxically low cortisol levels[xxxv].

The HPA axis functions differently in these two types of major depression. Melancholic depression occurs with an overall hyperactive HPA axis with elevated corticotrophin releasing hormone (CRH), adrenocorticotropic hormone (ACTH) and cortisol. Atypical depression occurs with an overall hypoactive HPA axis with decreased CRH, ACTH and cortisol.

Thus, although both produce major clinical depression, their presenting symptoms and neuroendocrine responses are nearly opposite. It is interesting to note that neither type of major depression shows the same HPA axis patterns as Cushing’s syndrome[xxxvi], Addison’s disease[xxxvii] or adrenal fatigue, which has an HPA axis pattern more closely resembling Addison’s than either of the major depression types[xxxviii].

Although most patients with major depression can be classified as either melancholic or atypical, not all cases within a classification resemble one another[xxxix]. The majority of patients with major depression present with a mixture of cognitive, affective and physiological features (referred to as a mixed neurovegetative type) and do not show clearly hyper or hypo HPA axis function[xl] [xli].

However, those who do show a clear melancholic or atypical presentation and HPA axis pattern have a much poorer outcome[xlii]. In other words: those suffering from major clinical depression where the HPA axis is clearly disturbed, in either an overactive or suppressed pattern, have a poorer prognosis.

In summary, depression is one of the most common health problems occurring worldwide. Cortisol, both high and low, has been closely associated with major depression in which two distinct clinical sub-types can be separated out; melancholic and atypical. Melancholic depression is more frequent and shows an overall elevated HPA axis pattern with high cortisol as an end-point, whereas atypical depression shows an overall hyporeactivity of the HPA axis manifesting as low cortisol.

Neither pattern is identical to the HPA axis responses seen in Cushing’s syndrome, Addison’s disease or adrenal fatigue. Thus, there appear to be several response patterns associated with depression and cortisol. Therefore, once depression is diagnosed, the astute clinician should investigate HPA function further to gain important information that will lead to a more accurate diagnosis and a more effective therapeutic outcome.

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:


[i] Murray AL. Evidence-based health policy – Lessons from the global burden of disease study. Science. 1996; 274: 740-3.

[ii] Kessler RC, McGonagle KA, Zhao S et al. Lifetime and 12 month prevalence of DSM – III –R  psychiatric disorders in the United States. Results from the national co-morbidity survey. Arch. Gen. Psychiatry. 1994; 51: 8- 19.

[iii] Yehuda R & Seckl J. Mini review: Stress – Related psychiatric disorders with low cortisol levels: A metabolic hypothesis. Endocrinology. Oct. 4, 2011; 152 (12).

[iv] Kanter ED, Wilkinson CW et al. Glucocorticoid feedback sensitivity and adrenocortical responsiveness in posttraumatic stress disorder. Soc. Biol. Psychiat. 2001; 50:238-245.

[v] Maripuu M, Wikgren M et al. Relative hypo- and hypercortisolism are both associated with depression and lower quality of life in bipolar disorder: A cross-sectional study. PLOSone.org. June 16 2014; 10.1371/journal.pone.0098682.

[vi] Gur A, Cevik R et al. Cortisol and hypothalamic-pituitary-gonadal axis hormones in follicular-phase women with fibromyalgia and chronic fatigue syndrome and affective depressive symptoms on these hormones. Arthritis Res. & Ther. 2004; 6 (3); 232-238.

[vii] Ehlert U, Nater UM, Boehmelt A. High and low unstimulated salivary cortisol levels correspond to different symptoms of functional gastrointestinal disorders. J Psychosomatic Res. 2005; 59; 7-10.

[viii] King JA, Mandansky D et al. Early sexual abuse and low cortisol. Psychiat. & Clin. Neurosci. 2001; 55; 1: 71-74.

[ix] Sonino N, Fallo F, Fava GA. Psychosomatic aspects of Cushing’s syndrome. Rev. Endocr. Metab. Disord. 2010; 11: 95-104.

[x] Sonino N & Fava GA. Psychosomatic aspects of Cushing’s disease. Psychother. Psychosom. 1998; 67: 140-146.

[xi] Sonino N & Fava GA. Psychiatric disorders associated with Cushing’s syndrome. Epidemiology, pathophysiology and treatment. CNS Drugs. 2001; 15: 361-373.

[xii] Kaushik ML & Sharma RC. Addison’s disease presenting as depression. Indian J. Med. Sci. 2003; 57: 249-251.

[xiii] Tintera J. Hypocortisolism. 8th Printing. Adrenal Metabolic Research Society. Mt. Vernon, NY. 1974; p. 3 & 5.

[xiv] Wilson JL. Clinical perspective on stress, cortisol and adrenal fatigue. Advances in Integrative Medicine. 2014; 1: 93-96.

[xv] Kessler RC, McGonagle KA, Zhao S et al. Lifetime and 12-month prevalence of DSM – III –R  psychiatric disorders in the United States. Results from the national co-morbidity survey. Arch. Gen. Psychiatry. 1994; 51:8 – 19.

[xvi] Frank E & Thase ME. Natural history and preventive treatment of recurrent mood disorders. Amer. Rev. Med. 1999. 50: 453-68.

[xvii] DSM-IV APA TFo. Diagnostic and Statistical Manual of Mental Disorders: DMS-IV. American Psychiatric Association: Washington DC, 1994, p. 886.

[xviii] Gold PW & Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: High versus low CRH/NE states. Molecular psychiatry. 2002: 7; 254-275.

Frank E & Thase ME. Natural history and preventive treatment of recurrent mood disorders. Amer. Rev. Med. 1999. 50: 453-68.

Gold PW & Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: High versus low CRH/NE states. Molecular Psychiatry. 2002: 7; 254-275.

[xix] Barefoot JC & Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation. 1996; 93: 1976-1980.

[xx] Penninx BW, Geerlings SW, Deeg DJ, van Eijk JT, van Tilburg W, Beekman AT. Minor and major depression and the risk of death in older persons. Arch. Gen. Psychiatry. 1999; 56: 889-895.

[xxi] Pratt LA, Ford DE, Crum RM, Armenian HK, Gallo JJ, Eaton WW. Depression, psychotropic medication, and risk of myocardial infarction. Prospective data from the Baltimore ECA follow-up. Circulation. 1996; 94: 3123–3129.

[xxii] Michelson D, Stratakis C, Hill L et al. Bone mineral density in women with depression. New England J. Med. 1996; 335: 1176–1181.

[xxiii] Barefoot JC & Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation. 1996; 93: 1976-1980.

[xxiv] Penninx BW, Geerlings SW, Deeg DJ, van Eijk JT, van Tilburg W, Beekman AT. Minor and major depression and the risk of death in older persons. Arch. Gen. Psychiatry. 1999; 56: 889-895.

[xxiv] Barefoot JC & Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation. 1996; 93: 1976-1980.

Eijk JT, van Tilburg W, Beekman AT. Minor and major depression and the risk of death in older persons. Arch. Gen. Psychiatry. 1999; 56: 889-895.

[xxv] Pratt LA, Ford DE, Crum RM, Armenian HK, Gallo JJ, Eaton WW. Depression, psychotropic medication, and risk of myocardial infarction. Prospective data from the Baltimore ECA follow-up. Circulation. 1996; 94: 3123-3129.

[xxvi] DMS-IV APA TFo. Diagnostic and Statistical Manual of Mental Disorders: DMS-IV. American Psychiatric Association: Washington DC 1994, p. 886.

Gold PW & Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: High versus low CRH/NE states. Molecular Psychiatry. 2002: 7; 254-275.

[xxvii] Levitan R, Lesage A et al. Reversed neurovegetative symptoms of depression, a community study. Am. J. Psychiatry. 1997; 154:934 – 940-943.

[xxviii] Gold PW & Chrousos G. The endocrinology of melancholic and atypical depression: Relation to neurocircuitry and somatic consequences. Proc. Assoc. Am. Phys. 1999; 111: 22- 34.

[xxix] Gold PW & Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: High versus low CRH/NE states. Molecular Psychiatry. 2002:7; 254-275.

[xxx] Carroll BJ. The dexamethasone suppression test for melancholia. Br. J. Psychiatry. 1982; 140: 292-304.

[xxxi] Gold PW & Chrousos G. The endocrinology of melancholic and atypical depression: Relation to neurocircuitry and somatic consequences. Proc. Assoc. Am. Phys. 1999; 111:.22-34.

[xxxii] Gold PW & Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: High versus low CRH/NE states. Molecular Psychiatry. 2002:7; 254-275

[xxxiii] Gold PW & Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: High versus low CRH/NE states. Molecular Psychiatry. 2002:7; 254-275.

[xxxiv] Gold PW & Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: High versus low CRH/NE states. Molecular Psychiatry. 2002:7; 254-275

[xxxv] Yehuda R & Seckl J. Mini Review: Stress-related psychiatric disorders with low cortisol levels: A metabolic hypothesis. Endocrinology; published online Oct. 4, 2011: 152 (12).

[xxxvi] Starkman MN, Schteingart DE, Schork MA. Depressed mood and other psychiatric manifestations of Cushing’s syndrome: Relationship to hormone levels. Psychosomatic Med. 1981. 43 (1); 3-17.

[xxxvii] Maripuu M, Wikgren M et al. Relative hypo- and hypercortisolism are both associated with depression and lower quality of life in bipolar disorder: A cross-sectional study. PLOSone.org. June 16 2014; 10.1371/journal.pone.0098682.

[xxxviii] Wilson JL. A case for adrenal fatigue or non-Addison’s hypoadrenia. AV presentation: Queensland’s College of Medicine, Brisbane AU. July 16, 2012.

[xxxix] Gold PW & Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: High versus low CRH/NE states. Molecular Psychiatry. 2002: 7; 254-275.

[xl] Gold PW & Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: High versus low CRH/NE states. Molecular Psychiatry. 2002: 7; 254-275.

[xli] Levitan R, Lesage A, Parikh S, Goering P, Kennedy S. Reversed neurovegetative symptoms of depression: A community study. Am. J. Psychiatry 1997; 154: 934-940.

[xlii] Gold PW & Chrousos GP. Organization of the stress system and its dysregulation in melancholic and atypical depression: High versus low CRH/NE states. Molecular Psychiatry. 2002: 7; 254- 275.

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Mindfulness Matters: Living in the Moment to Improve Your Health

woman staring at nature, mindfulnessMindfulness Matters: Living in the Moment to Improve Your Health

At some point in your life, someone probably told you: “Enjoy every moment. Life is short.” Maybe you’ve smiled and rolled your eyes at this well-intentioned relative or co-worker. But the fact is, there’s something to it. Trying to enjoy each moment may actually be good for your health.

The idea is called mindfulness. This ancient practice is about being completely aware of what’s happening in the present—of all that’s going on inside and all that’s happening around you. It means not living your life on “autopilot.” Instead, you experience life as it unfolds moment to moment, good and bad, and without judgment or preconceived notions.

“Many of us go through our lives without really being present in the moment,” says Dr. Margaret Chesney of the University of California, San Francisco. She’s studying how mindfulness affects health. “What is valuable about mindfulness is that it is accessible and can be helpful to so many people.”

Studies suggest that mindfulness practices may help people manage stress, cope better with serious illness and reduce anxiety and depression. Many people who practice mindfulness report an increased ability to relax, a greater enthusiasm for life and improved self-esteem.

One NIH-supported study found a link between mindfulness meditation and measurable changes in the brain regions involved in memory, learning and emotion. Another NIH-funded researcher reported that mindfulness practices may reduce anxiety and hostility among urban youth and lead to reduced stress, fewer fights and better relationships.

A major benefit of mindfulness is that it encourages you to pay attention to your thoughts, your actions and your body. For example, studies have shown that mindfulness can help people achieve and maintain a healthy weight. “It is so common for people to watch TV and eat snack food out of the box without really attending to how much they are eating,” says Chesney. “With mindful eating, you eat when you’re hungry, focus on each bite, enjoy your food more and stop when you’re full.”

Chesney notes that as people start to learn how to be more mindful, it’s common and normal to realize how much your mind races and focuses on the past and future. You can just notice those thoughts and then return to the present moment. It is these little, regular steps that add up and start to create a more mindful, healthy life.

Finding time for mindfulness in our culture, however, can be a challenge. We tend to place great value on how much we can do at once and how fast. Still, being more mindful is within anyone’s reach.

You can practice mindfulness throughout the day, even while answering e-mails, sitting in traffic or waiting in line. All you have to do is become more aware—of your breath, of your feet on the ground, of your fingers typing, of the people and voices around you. Here are some tips to help get you started:

  • Take some deep breaths. Breathe in through your nose to a count of 4, hold for 1 second and then exhale through the mouth to a count of 5. Repeat often.
  • Enjoy a stroll. As you walk, notice your breath and the sights and sounds around you. As thoughts and worries enter your mind, note them but then return to the present.
  • Practice mindful eating. Be aware of taste, textures and flavors in each bite, and listen to your body when you are hungry and full.
  • Find mindfulness resources in your local community, including yoga and meditation classes, mindfulness-based stress reduction programs and books.

Sourced from NIH News in Health

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To Salt or Not To Salt? That Is The Question

To Salt or Not To Salt? That Is The Question

Confused about how much salt you need? Worried because the media and medicine appear to unanimously suggest that each shake of a salt shaker drives a nail into your coffin? Wondering what to do if you crave salt or feel better when you add it to your food? You are not alone. Lots of people are wondering the same things, especially the many experiencing adrenal fatigue. I hope this blog will help ease your concerns and provide more useful guidance on salt use.

salt shakerMuch of recent research and media coverage has focused on lowering salt intake and the harmful effects of sodium over-consumption. There has even been talk of requiring warning labels on foods containing over a certain amount of sodium. However, there is an alternate point of view based on scientific research that has been generally ignored by the media and traditional medicine. From this perspective, there can be health benefits to salting foods (within moderation) if you crave salt or notice you feel better when you add salt to your food[i] [ii]. So which position is correct? The answer is both.

An article in the August 14, 2014 issue of the New England Journal of Medicine spoke on the relationship of salt consumption and cardiovascular deaths. It reported that Americans consume about 3.5 grams of sodium daily (approximately 1½ teaspoons), slightly lower than the average global intake of 3.95 grams per day (approximately 2 teaspoons)[iii]. The article concluded that the global incidence of both hypertension and cardiovascular deaths increased once sodium consumption surpassed 2.0 grams per day.

They then theorized that a worldwide 2.3 grams/day reduction in individual sodium consumption to less than 2.0 grams/day would result in approximately 1.65 million fewer deaths annually from cardiovascular events. The authors’ rationale is that for every 2.3 grams/day reduction in sodium consumption, systolic blood pressure drops an average of 3.82 mm Hg[iv], and for every 3.82 mm Hg drop in systolic blood pressure, approximately 1.65 million lives would be saved due to the established relationship between lowering blood pressure and decreasing deaths from cardiovascular causes.

This is an impressive statistical meta-analysis-type study and worth consideration. However, keep in mind it is a theoretical rather than clinical model and the number of lives saved were only predicted, not actualized.

illustrated heart by Flickr user Garrett AmmonThe study also did not take into account a number of other variables associated with hypertension, sodium consumption and cardiovascular disease, and it assumed a causal relationship of salt to cardiovascular-related deaths based primarily on only correlational evidence. It is important to keep in mind that there has never been a long-term study showing the direct relationship between sodium consumption and cardiovascular deaths[v]. The evidence has only been associative, not causal.

Studies evaluating the association between sodium intake and cardiovascular problems have been inconsistent. A number of recent studies have reported an association between low sodium intake and an increased risk of cardiovascular death[vi] [vii] [viii]. Even the recommendations for maximum daily sodium intake vary among different health organizations and groups: 2.0 grams by the World Health Organization (WHO)[ix], 2.3 grams by the United States Center for Disease Control and Prevention (CDC)[x], 1.5-2.4 grams by other studies and experts[xi] [xii] [xiii] [xiv] [xv], and 1.2- 2.4 grams by some major institutions[xvi]. In fact, the global effects of sodium consumption and the heterogeneity of these effects according to age, sex, and country have not been clearly established[xviii].

In contrast, results from the Prospective Urban Rule Epidemiology (PURE) study–involving over 156,000 people aged 35 to 70 from different socioeconomic backgrounds in 17 countries–showed the importance of considering potassium along with sodium intake, and that low potassium intake as well as high sodium intake may be dangerous to health.

They found a strong interaction between sodium excretion, potassium excretion and hypertension; increased blood pressure was more strongly associated with high sodium excretion in people with lower potassium excretion. To achieve greater health benefits, including blood-pressure reduction, the authors suggested higher quality diets rich in potassium (more fruits and vegetables) rather than aggressive sodium reduction alone[xx] [xxi].

mounds of salt by Flickr user Dubravko SoricSome of the authors of the PURE study also used somewhat different modeling techniques. They separated subjects by sodium consumption into groups of high (>7 grams/day), medium (3-6 grams/day) and low (<3 grams/day) sodium intake. Their statistical results revealed that those who consumed more than 7 grams of sodium per day had a higher number of cardiovascular and other-cause deaths than those who consumed 3-7 grams of sodium daily. But those who consumed less than 3.0 grams of sodium/day had a higher death rate than those in the medium consumption group (3-6 grams/day).

When the death rate of the group consuming more than 7 grams per day was compared with the group consuming less than 3 grams per day, the group consuming less than 3 gm per day had a higher death rate in all categories, including increased risk of death from cardiovascular causes, stroke, myocardial infarct and heart failure, as well as the composite of all those previously mentioned. In addition, all-causes mortality (dying from any cause) was also more common among those in the low salt intake group[xxii].

In commenting on the results of the PURE study, Suzanne Oparil, editor of the New England Journal of Medicine, said, “… This large study does provide evidence that both high and low levels of sodium excretion may be associated with an increased risk of death and cardiovascular-disease outcomes, and that increasing the urinary potassium excretion counterbalances the adverse effect of high sodium excretion.

These provocative findings beg for randomized controlled outcome to compare reduced sodium intake with the usual diet. In the absence of such a trial, the results argue against reduction of dietary sodium as an isolated public health recommendation.”[xxiii] In other words, the jury is still out on whether sodium restriction should become an accepted universal recommendation as a preventive measure for cardiovascular disease.

As can be seen from the research above, there are conflicting conclusions about the health benefits of significantly lowering sodium consumption. If Americans consuming approximately 3.4 grams/day of sodium take the advice of the first study and cut their sodium intake by 2.3 grams/day, they would reduce their daily intake to 1.1 grams/day.

As some of the studies referenced above show, such a low daily sodium intake places people in the highest risk group for developing cardiovascular disease and dying of any of several cardiovascular-related causes in addition to all-cause mortality, rather than preventing it. It also ignores the tremendous influence stress and other factors play in hypertension[xxiv] [xxv], including tissue levels of nutrients such as potassium[xxvi], magnesium[xxvii] [xxviii] and niacin[xxix].

fatigued adrenal glandsWhat about the people who crave salt or have adrenal fatigue? In the 1940s and earlier, physicians advised patients with low adrenal function to increase their salt intake to help with their fatigue, which was in part due to their lack of ability to retain sodium. Aldosterone, a mineralocorticoid steroid hormone produced by the adrenal glands, plays a primary role in sodium retention. I have found that patients with adrenal fatigue often find it very beneficial to add salt to their food and sometimes to their drinking water.

Water follows sodium in the body, so when mineralocorticoid levels (such as aldosterone) are low, sodium is excreted along with water resulting in salt cravings and thirst to replenish sodium and water depletion. In severe cases, I have recommended adrenal fatigue patients keep a glass of salted water (salted to taste) by their bedsides to drink first thing in the morning before rising. Doing this appears to greatly improve their ability to function in the morning.

Cortisol, another major adrenal steroid hormone, is a glucocorticoid but also acts as a mineralocorticoid. Therefore, when cortisol is low, even if aldosterone is normal, there may be insufficient sodium retention and excess potassium accumulation in the body. This creates a need for more sodium to replenish the sodium loss, rebalance the sodium/potassium ratio, and carry on sodium’s many functions. Sodium is one of the most prominent circulating cations aiding pH balance and substituting in for divalent cations, such as magnesium or calcium, when either is in short supply. When sodium is low, the natural physiological response is a salt craving to replace the lost sodium.

In adrenal fatigue, high blood pressure is not a usual concern. In fact, it is common for adrenal fatigue patients to have low blood pressure or blood pressure that stays flat or drops by 10 mmHg or more when they rise from a prone position. This is due to the mild hypovolemia and hyponatremia created by the low cortisol, and possibly low aldosterone seen in adrenal fatigue. As mentioned above, patients often find it very beneficial to salt their food and sometimes their drinking water to taste.

As long as popular opinion and research funding focus primarily on a single causal agent for such a wide-spread and complex problem as cardiovascular disease, there will continue to be lots of research dollars spent chasing a myth while the American public continues living their stressful lives–a greater cause of hypertension than sodium consumption[xxxi].

blood pressure monitorIf you are eating a well-balanced, healthy diet without processed food, your desire for or lack of desire for salt will probably guide you sufficiently well in your sodium consumption. Listen to your intuition and follow it when it comes to adding or not adding salt. What is your body telling you? However, If you are sensitive to salt, as are about 6% of the population, or have existing hypertension and notice that your blood pressure rises when you take in extra sodium from food, you need to be very conscious about your salt intake and monitor it judiciously.

If you are consuming the North American average of about 3.4 grams/day of sodium, then you are generally in safe waters. You should question the recommendation of any health care professional that you lower your salt intake for health reasons, including cardiovascular disease, unless you have a genetic predisposition for sodium-dependent hypertension, your blood pressure increases with sodium intake, or you have other health reasons to limit salt intake. It would be good to discuss this issue thoroughly with your physician before blindly adopting a low sodium diet.

If you have adrenal fatigue and you have the typically low blood pressure that goes along with this syndrome, your sodium intake is likely insufficient, especially if you have salt cravings. Salt your foods to taste and see if it makes you feel better. If it does, continue doing it until it does not help anymore.

Adrenal fatigue responds well to lifestyle modifications that reduce stress and improve stress management when they are combined with dietary changes and supplements designed to help strengthen the adrenal glands, nutritionally support adrenal hormone production and balance the hypothalamus-pituitary-adrenal (HPA) axis stress response system. Once adrenal hormone production has been optimized by these measures, you will probably notice a decreased desire for salt. As this changes, continue to be guided by your taste.

Using this common sense approach, most of your worries about too much or too little salt consumption can be relegated to salting to taste, leaving the finer points to academic discussions and spirited talk among colleagues – allowing you to enjoy your food and life more completely.

Image Credits: Heart illustration by Flickr user Garrett Ammon; Mounds of salt by Flickr user Dubravo Soric

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:

[i] David Brownstein, Salt Your Way to Health, 2nd ed. (West Bloomfield, MI: Medical Alternatives Press, 2010), 145 pp.

[ii] James L. Wilson, Adrenal Fatigue: The 21st Century Stress Syndrome, 26th ed. (Petaluma, CA Smart Publications, 2014), 361 pp.

[iii] Dariush Mozaffarian et al., “Global Sodium Consumption and Death from Cardiovascular Causes,” The New England Journal of Medicine 371, no. 7 (2014): 624-633.

[iv] World Health Organization (WHO), Prevention of Cardiovascular Disease: Guidelines for Assessment and Management of Cardiovascular Risk (Geneva: World Health Organization (WHO), 2007).

[v] Suzanne Oparil, “Low Sodium Intake — Cardiovascular Health Benefit or Risk?,” The New England Journal of Medicine 371, no. 7 (2014).

[vi] M.J. O’Donnell et al., “Salt Intake and Cardiovascular Disease: Why Are the Data Inconsistent?,” 34, no. 14 (2013): 1034-1040.

[vii] Oparil, “Low Sodium Intake — Cardiovascular Health Benefit or Risk?.”

[viii] Niels A. Graudal, Thorbjørn Hubeck-Graudal, and Gesche Jürgens, “Effects of Low-Sodium Diet Vs. High-Sodium Diet on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterol, and Triglyceride (Cochrane Review),” American Journal of Hypertension 25, no. 1 (2012): 1-15.

[ix] World Health Organization (WHO), Guideline: Sodium Intake for Adults and Children (Geneva: World Health Organization (WHO), 2012).

[x] Centers for Disease Control and Prevention (CDC), “Americans Consume Too Much Sodium (Salt),” (2011). http://www.cdc.gov/features/dssodium/ (accessed 12/01/2014).

[xi] Paul K. Whelton et al., “Sodium, Blood Pressure, and Cardiovascular Disease: Further Evidence Supporting the American Heart Association Sodium Reduction Recommendations,” Circulation 126, no. 24 (2012): 2880-2889.

[xii] National Institute for Health and Clinical Excellence, “Prevention of Cardiovascular Disease at Population Level (Nice Public Health Guidance 25),” (2010). https://www.nice.org.uk/guidance/ph25.

[xiii] Dietary Guidelines Advisory Committee, Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services2011.

[xiv] U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010 Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans2010.

[xv] Scientific Advisory Committee on Nutrition, Salt and Health2003.

[xvi] Mozaffarian et al., “Global Sodium Consumption and Death from Cardiovascular Causes.”

[xvii] Martin O’Donnell et al., “Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events,” The New England Journal of Medicine 371, no. 7 (2014): 612-623.

[xviii] Mozaffarian et al., “Global Sodium Consumption and Death from Cardiovascular Causes.”

[xix] Andrew Mente et al., “Association of Urinary Sodium and Potassium Excretion with Blood Pressure,” The New England Journal of Medicine 371, no. 7 (2014).

[xx] Ibid.

[xxi] O’Donnell et al., “Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events.”

[xxii] O’Donnell et al., “Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events.”

[xxiii] Oparil, “Low Sodium Intake — Cardiovascular Health Benefit or Risk?.”

[xxiv] S. Kulkarni et al., “Stress and Hypertension,” Wmj 97, no. 11 (1998): 34-38.

[xxv] Suzanne Oparil, Amin Zaman, and David A. Calhoun, “Pathogenesis of Hypertension,” Annals of Internal Medicine 139, no. 9 (2003): 761-776.

[xxvi] Maria Carolina M. D. Delgado, “Potassium in Hypertension,” Current Hypertension Reports 6, no. 1 (2004): 31-35.

[xxvii] Bruno Sontia and Rhian M. Touyz, “Role of Magnesium in Hypertension,” Archives of Biochemistry and Biophysics 458, no. 1 (2007): 33-39.

[xxviii] Fangzi Liao, Aaron R. Folsom, and Frederick L. Brancati, “Is Low Magnesium Concentration a Risk Factor for Coronary Heart Disease? The Atherosclerosis Risk in Communities (Aric) Study,” American Heart Journal 136, no. 3 (1998): 480-490.

[xxix] Harold E. Bays et al., “Blood Pressure-Lowering Effects of Extended-Release Niacin Alone and Extended-Release Niacin/Laropiprant Combination: A Post Hoc Analysis of a 24-Week, Placebo-Controlled Trial in Dyslipidemic Patients,” Clinical Therapeutics 31, no. 1 (2009): 115-122.

[xxx] The Merck Manual of Therapeutics and Materia Medica : A Source of Ready Reference for the Physician, ed. Merck and Co (Rahway, N.J.: Merck, 1940), 32-33.

[xxxi] K. G. Walton et al., “Stress Reduction and Preventing Hypertension: Preliminary Support for a Psychoneuroendocrine Mechanism,” J Altern Complement Med 1, no. 3 (1995): 263-283: 263.

[xxxii] Mozaffarian et al., “Global Sodium Consumption and Death from Cardiovascular Causes.”


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Stress Stories: Case Histories of Adrenal Fatigue

Stress Stories: Case Histories of Adrenal Fatigue

Everyone’s journey through adrenal fatigue is worth telling. Below are four case studies of adrenal fatigue from my past experience. Do any of these sound like you?

vintage style office worker making a call by Flickr user starmanseriesFrank was always at the office. He was the guy everyone wanted to be like. Within 6 years he had been promoted 4 times and had become vice president of sales. His dreams were coming true. Unfortunately the company had expanded too fast and began downsizing, asking more of those remaining. Frank was one of the fortunate ones whose job was secure, but he had to dramatically expand his workload.

This meant late hours at the office several times per week and taking work home almost every weekend. By cutting out his exercise time and getting fast food meals on the run, Frank was able to squeeze more hours out of the day. More cups of coffee were required to get him going in the morning, but once noon rolled around, he was as good as new.

Frank then discovered that he could get even more work done if he could just get past 11:00 at night. Once he got past 11:00, he got a second burst of energy that kept him going until about 2:00. Although he began to look a little ragged around the edges, Frank was able to keep this up for 6 years.

One early morning, Frank came home to find his wife’s car gone. Going inside he found her clothes gone and a note. Frank was dumbfounded. How could she leave him? Ignoring any phone calls, Frank just sat there, wondering what had gone wrong. Friends finally got Frank to come to the door and check himself into a hospital. He was diagnosed as suffering from post-traumatic depression, but the medications were only partially effective. Frank improved, but dragged himself through life. With time and treatment, Frank made a full recovery.

Frank is a good example of someone who has driven himself to adrenal exhaustion through blind ambition, overwork, poor food and no relaxation. Frank’s case is a common story of adrenal fatigue brought on by overwork, poor food, poor lifestyle, over-ambition and lack of perspective. The emotional trauma of his wife leaving him flattened an already depleted man.

stressed mom with kids by Flickr user Jeffrey SmithBrianna is a mother of four. She had always wanted children, but also wanted a career. Being self-employed she had little time to spare, especially when the children became older and had different social activities and sports to attend. Although she had never really had time to recover between the birth of her third child and her fourth, she continued to push herself.

Most of her family’s activities still revolved around Brianna, leaving her with almost no free time. What little free time she had was not very relaxing, as most of it was spent with the family and there was almost palpable tension between her husband and her. Brianna felt chronically tired and stressed. On the way to work one morning, she was hit from behind while sitting in her car waiting for the light to change. The constant pain she had in her neck tired her even more.

At the end of her rope and unable to really function at work or at home due to her constant neck pain, she finally heeded the advice of a friend and sought the help of a chiropractor. Luckily, in addition to being able to get her out of pain, the doctor recognized that she was suffering from adrenal fatigue. Eventually she recovered her long lost energy and was once again a happy woman.

Brianna’s case illustrates how an already over-burdened person with unrealistic expectations combined with lack of rest and marital discord produced adrenal fatigue. When a physical trauma was the straw that broke the camel’s back, she could no longer compensate and felt the full extent of her adrenal fatigue.

engineer in lab by Flickr user Argonne National LaboratoryKevin was a bright engineer who loved his job. He was given the opportunity to manage a small chemical plant. Within the first year of his new job assignment, Kevin’s wife noticed that he was changing. He developed allergies for the first time. It became harder and harder for him to get up at 4 AM to get ready for work. He became more short-tempered and intolerant of her and the children.

Thinking it was probably the pressure of his new job, Kevin asked for and was given an assistant, as he had already increased production considerably. But even with working fewer hours and taking less active responsibility, Kevin continued to deteriorate. His energy dropped lower and lower and he became almost despondent as he just tried to make it through each day.

His wife demanded a vacation, thinking what he needed was a rest. Within a few days of their vacation Kevin felt like a new man. His old energy returned and he once again became loving and affectionate. He looked forward to returning to his job.

Once back, however, it was only a matter of a day before Kevin felt the same old tiredness and brain fog descend on him again. They had only been back for 2 weeks when their family got notice that Kevin’s father had died. Although Kevin dreaded the stress of the funeral, to his surprise, as they approached his old home, he felt better and better.

Even having to drive most of the night to return to work by the following Monday morning didn’t bother him. However, by the first evening of work, Kevin was back to his same old symptoms. He struggled on for a few more weeks until one day the previous manager made a brief stop to the plant. As they talked, Kevin learned that the former manager had taken an early retirement for health reasons. The man told him that as soon as he left the plant he felt 20 years younger.

Telling the previous manager of his growing problems with handling the job, Kevin described some of his symptoms. The retired manager revealed that he had left because of chemical sensitivities and that while in the plant he had experienced many of the same symptoms as Kevin. He was good enough to meet Kevin at a place outside the plant to discuss what might be done about the situation. Together they approached the company to make the needed safety improvements, including a drastic reduction in chemical fumes collecting in several of the plant buildings.

Kevin’s case is an example of adrenal fatigue caused by chemical sensitivity. Any number of ‘body burdens’ can continually zap your adrenals, often without you being aware of what is happening.

librarians by Flickr user Thompson Rivers UniversitySandra was never a high-energy person. Frequently sick as a child, she chose to work as a librarian because it made little physical demand on her. However, her first job was not what she expected it to be. Taking a position in a university medical library, she was given a rotating shift that changed weekly. As the library was open 24 hours a day, she hardly had a chance to get used to one schedule before it was time to change.

This schedule interrupted her sleeping pattern, which interfered with her concentration at work. Her boss became more and more demanding until one day Sandra simply broke down and started crying for no reason while re-shelving books. Afterwards, she poured out her tortured soul about how she couldn’t sleep anymore, how she was constantly fatigued, that her boss expected too much, and how she hated being a librarian, something she thought she would love.

She also complained that she felt mildly ill most of the time, her memory and patience were shot, and that she had become even more socially withdrawn. All she wanted to do was get away from everyone, pull the covers up over her head and sleep until she was darn good and ready to get up.

Being already somewhat fragile, it didn’t take much to push Sandra beyond her limits. After her outbreak she was referred to a staff psychiatrist who diagnosed her as being depressed. Several antidepressants later, when she showed only slight improvement, she was given a series of shock treatments that only made her fragile constitution more vulnerable.

After several years on disability, she finally discovered a doctor who understood adrenal fatigue. Slowly she was able to find her way back to health and found a job in a library much more suited to her personality and needs. For Sandra, it was a long, hard journey back to recovery, because no one understood her limited capacity for stress.

Sandra’s case is an example of people who have marginal adrenal reserve to begin with. Not much is needed for her to be overwhelmed. Looking at it from the outside, people are often quick to judge these people as weaklings or quitters, when they just do not have the reserve capacity to take on the stresses inherent in many work and social events.

Image Credits: Vintage salesman by Flickr user starmanseries; Stressed mom by Flickr user Jeffrey Smith; Engineer by Flickr user Argonne National Laboratory; Librarians by Flickr user Thompson Rivers University

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 Sweet Stuff: How Sugars and Sweeteners Affect Your Health

The Sweet Stuff: How Sugars and Sweeteners Affect Your Health

spoon in sugarMost of us love sweet foods and drinks. But after that short burst of sweetness, you may worry about how sweets affect your waistline and your overall health. Is sugar really bad for us? How about artificial or low-calorie sweeteners? What have scientists learned about the sweet things that most of us eat and drink every day?

Our bodies need one type of sugar, called glucose, to survive. “Glucose is the number one food for the brain, and it’s an extremely important source of fuel throughout the body,” says Dr. Kristina Rother, an NIH pediatrician and expert on sweeteners. But there’s no need to add glucose to your diet, because your body can make the glucose it needs by breaking down food molecules like carbohydrates, proteins, and fats.

Some sugars are found naturally in foods, such as fruits, vegetables, and milk. “These are healthful additions to your diet,” says Dr. Andrew Bremer, a pediatrician and NIH expert on sweeteners. “When you eat an orange, for instance, you’re getting a lot of nutrients and dietary fiber along with the natural sugars.”

Although sugar itself isn’t bad, says Rother, “sugar has a bad reputation that’s mostly deserved because we consume too much of it. It’s now in just about every food we eat.”

Experts agree that Americans eat and drink way too much sugar, and it’s contributing to the obesity epidemic. Much of the sugar we eat isn’t found naturally in food but is added during processing or preparation.

About 15% of the calories in the American adult diet come from added sugars. That’s about 22 teaspoons of added sugar a day. Sugars are usually added to make foods and drinks taste better. But such foods can be high in calories and offer none of the healthful benefits of fruits and other naturally sweet foods.

glass bottles of Coca ColaSugar-sweetened beverages like soda, energy drinks, and sports drinks are the leading source of added sugars in the American diet. Juices naturally contain a lot of sugar. But sometimes, even more is added to make them taste sweeter.

“Juices offer some vitamins and other nutrients, but I think those benefits are greatly offset by the harmful effects of too much sugar,” says Bremer.

Over time, excess sweeteners can take a toll on your health. “Several studies have found a direct link between excess sugar consumption and obesity and cardiovascular problems worldwide,” Bremer says.

Because of these harmful effects, many health organizations recommend that Americans cut back on added sugars. But added sugars can be hard to identify. On a list of ingredients, they may be listed as sucrose (table sugar), corn sweetener, high-fructose corn syrup, fruit-juice concentrates, nectars, raw sugar, malt syrup, maple syrup, fructose sweeteners, liquid fructose, honey, molasses, anhydrous dextrose, or other words ending in “-ose,” the chemical suffix for sugars. If any of these words are among the first few ingredients on a food label, the food is likely high in sugar. The total amount of sugar in a food is listed under “Total Carbohydrate” on the Nutrition Facts label.

Many people try cutting back on calories by switching from sugar-sweetened to diet foods and drinks that contain low- or no-calorie sweeteners. These artificial sweeteners—also known as sugar substitutes—are many times sweeter than table sugar, so smaller amounts are needed to create the same level of sweetness.

People have debated the safety of artificial sweeteners for decades. To date, researchers have found no clear evidence that any artificial sweeteners approved for use in the U.S. cause cancer or other serious health problems in humans.

But can they help with weight loss? Scientific evidence is mixed. Some studies suggest that diet drinks can help you drop pounds in the short term, but weight tends to creep back up over time. Rother and other NIH-funded researchers are now working to better understand the complex effects that artificial sweeteners can have on the human body.

Studies of rodents and small numbers of people suggest that artificial sweeteners can affect the healthful gut microbes that help us digest food. This in turn can alter the body’s ability to use glucose, which might then lead to weight gain. But until larger studies are done in people, the long-term impact of these sweeteners on gut microbes and weight remains uncertain.

“There’s much controversy about the health effects of artificial sweeteners and the differences between sugars and sweeteners,” says Dr. Ivan de Araujo of Yale University. “Some animal studies indicate that sweeteners can produce physiological effects. But depending on what kind of measurement is taken, including in humans, the outcomes may be conflicting.”

De Araujo and others have been studying the effects that sugars and low-calorie sweeteners might have on the brain. His animal studies found that sugar and sweeteners tap differently into the brain’s reward circuitry, with sugars having a more powerful and pleasurable effect.

artificial sweetners by Flickr user amyvdh“The part of the brain that mediates the ‘I can’t stop’ kinds of behaviors seems to be especially sensitive to sugars and largely insensitive to artificial sweeteners,” de Araujo says. “Our long-term goal is really to understand if sugars or caloric sweeteners drive persistent intake of food. If exposed to too much sugar, does the brain eventually change in ways that lead to excess consumption? That’s what we’d like to know.”

Some research suggests that the intensely sweet taste of artificial, low-calorie sweeteners can lead to a “sweet tooth,” or a preference for sweet things. This in turn might lead to overeating. But more studies are needed to confirm the relative effects of caloric vs. non-caloric sweeteners.

“In the long run, if you want to lose weight, you need to establish a healthy lifestyle that contains unprocessed foods, moderate calories, and more exercise,” Rother says.

When kids grow up eating a lot of sweet foods, they tend to develop a preference for sweets. But if you give them a variety of healthy foods like fruits and vegetables early in life, they’ll develop a liking for them too.

“It’s important for parents to expose children to a variety of tastes early on, but realize that it often takes several attempts to get a child to eat such foods,” says Bremer. “Don’t give up too soon.”

The key to good health is eating a well-balanced diet with a variety of foods and getting plenty of physical activity. Focus on nutrition-rich whole foods without added sugars. Get tips on healthy eating and weight control at http://win.niddk.nih.gov.

Sourced from NIH News in Health

Image credit: Artificial sweetners by Flickr user amyvdh

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