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Signs of the (Changing) Times: 12 Symptoms of Menopause

Signs of the (Changing) Times: 12 Symptoms of Menopause

hot flashes cartoonMenopause literally means ‘the last period.’ While many women would gladly leave behind the woes that come with menstruation, not many would gladly go through menopause in return. It is possible to experience little or no discomfort during menopause, but for some women it can be one of the most challenging times of their lives.

Generally speaking, menopause is determined after menstruation has stopped for twelve months. For most women, this will start between 45 and 55 years of age. The time when most women start to experience the undesired effects is perimenopause, a term used to describe the transitional period leading up to and through menopause.

This is a time of great change. Over time, the ovaries cease production of vital hormones, such as estrogen and testosterone. With such a drastic change in hormone levels, it’s no wonder that menopause can make one feel like their body is short-circuiting. Here are the twelve most common signs your body has begun the transition:

1) Lack of Periods

This one may seem overly obvious, but a lack of menstruation is a good sign that menopause is happening. Typically, periods become shorter and lighter over time, eventually stopping altogether. An irregularity in your cycle could also be due to stress.

2) Mood Swings

Menopause can make some women feel like mild-mannered Bruce Banner turning into the raging Incredible Hulk. Those quick switches to anger, sadness, and depression for no obvious reason can be chalked up to hormones. This side effect alone can be very challenging to one’s sanity, as well as the sanity of those around them.

3) Hot Flashes

Hot flashes are probably the most referenced part of menopause, though not all women experience them. If you have, you don’t need me to tell you it’s possible to go from burning up to ice cold in a matter of minutes. The cause of hot flashes isn’t totally known, though it likely has to do with hormones affecting the hypothalamus, your body’s thermostat.

4) Insomnia

There are two kinds of insomnia: sleep onset (trouble falling asleep) and sleep maintenance (trouble staying asleep). Unfortunately, both can be experienced during menopause. Insomnia during menopause can be blamed largely on the fluctuation of estrogen. Regular exercise and magnesium supplementation can often help.

5) Weight Gain

There are several factors that can attribute to menopausal weight gain. The two biggest, ironically, are some of the smallest glands in the body: the adrenal and thyroid glands. In these cases, I often check the patient’s adrenal and thyroid hormone levels.

6) Decrease in Sex Drive

Testosterone is largely associated with males, but it’s a critical hormone for women as well–especially when it comes to sex drive. A woman’s desire for intimacy, as well as sexual energy and self-confidence, are powered by testosterone, estrogen and progesterone–all which drop dramatically during menopause.

7) Vaginal Dryness

One of estrogen’s many responsibilities is to keep the skin around the vagina healthy and lubricated. Dry skin, not just in the vaginal area, is common during menopause. Unfortunately, this can cause painful intercourse. Fortunately, there are natural supplements, as well as gentle lubricants, which can help.

8) Anxiety

Progesterone is a calming hormone, working to buffer you from stress and anxiety. When progesterone levels are low, like during menopause, you’re more vulnerable to the effects of stress and anxiety. For most women, perimenopause is the time when they’re most susceptible.

9) Fatigue

Considering everything that goes on, it’s understandable to be a little (or a lot) tired during menopause. But what if the fatigue continues beyond menopause? Once the ovaries slow down hormone production, the adrenal glands must pick up the slack. This increase in production can sometimes bog down the glands of stress, leading to adrenal fatigue.

10) Incontinence

Did you know estrogen helps keep the bladder and urethra in good order? As estrogen levels decrease during menopause, the bladder control mechanisms weaken, leading to leakage and/or more frequent trips to the bathroom. Kegel exercises are one way to help reinforce and strengthen bladder control during menopause.

11) Difficulty With Concentration and Memory

Many of my otherwise sharp patients have complained to me about loss of memory, brain fog and forgetfulness during menopause. Unfortunately this is a common and frustrating side effect of menopause, and one that can also be chalked up to lowered estrogen levels.

12) Night Sweats

Not to be confused with hot flashes (though they can occur together), night sweats occur, naturally, at night. Also known as sleep hyperhidrosis, night sweats can vary by degree, sometimes making you feel like you just got out of the shower. Generally, menopausal night sweats go away after a few months, but can recur under chronic stress.

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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Is Chronic Inflammation Affecting Your Health?

Is Chronic Inflammation Affecting Your Health?

Many of the illnesses and conditions we commonly attribute to growing old can actually be attributed to inflammation. While increased inflammation can be part of the aging process, not everyone is affected the same. One of the best things I’ve been able to do for my own patients is identify and control any inflammation they’re experiencing. This is often easier said than done, but has lead to significant improvements in the health of many of my patients.

What Does Chronic Inflammation Feel Like?

hand pain by Flickr user jilly999

Ouch! For some, chronic inflammation manifests as stiffness, swelling and pain in joints.

First, let’s discuss what it feels like to experience chronic inflammation. Keep in mind that this is a condition that can build slowly and fester over time, and the side effects aren’t always heavily pronounced.  Here are some of the more common signs and symptoms of chronic inflammation:

  • Difficulty thinking / poor concentration
  • Stiffness and/or swelling in joints
  • Weight gain not necessarily attributed to diet and lifestyle
  • Chronic aches and pains
  • Congestion
  • Lowered immune function (difficulty fighting off infection or recurring instances)
  • Recurring digestive issues (heartburn, constipation, diarrhea, etc.)

Is All Inflammation Bad?

The inflammatory response is a vital process in helping the body heal. Everything from cuts, bruises, bug bites, the cold and the flu are handled by your body’s inflammatory response. To be specific, these are examples of an acute inflammatory response, which is different from the response associated with conditions like heart disease, cancer and diabetes.

When your body is healthy and functioning at an optimal level,  it will repair itself rather quickly without help needed on your behalf. The complex and incredible human immune system detects a threat or invader right away, and quickly reacts with a defense appropriate to the attack. Once the threat is neutralized, your body ‘calls off the dogs’ and returns to homeostasis.

When Good Inflammation Goes Bad

Chronic inflammation occurs when there’s a pesky, persistent injury, like an infected tooth or an ulcer. It can also be caused by an autoimmune disease, such as rheumatoid arthritis and Hashimoto’s thyroiditis. In these cases, low-grade inflammation occurs over an extended period, sometimes years.

Over time this can cause damage to vital parts of the body, including blood vessels, joints and brain tissue. This is due to the excess of immune  cells and pro-inflammatory compounds, which constantly circulate in the body and cause damage to blood vessels, joints and brain tissue. This is why chronic inflammation can lead to serious conditions like diabetes, heart disease, arthritis and Alzheimer’s.

What You Can do to Ease Inflammation

gluten free aisle by Flickr user Memphis CVB

Is gluten-free better than free gluten? Inflammation would say so.

There are many different diet and lifestyle changes that can help calm the fires of inflammation. There are also vitamins and minerals that can help, especially omega-3 fatty acids.

Adapting a gluten-free diet is a necessity for those with Celiac’s, but can be good for anyone with chronic inflammation. This makes sense, considering Celiac’s is an autoimmune condition. Going gluten-free does not lead to being symptom-free, but when combined with other changes can lead to significant improvements.

Generally speaking, going gluten-free means eliminating grains and refined carbohydrates from your diet. With grains, some experts will say avoid them all, but there are some that may be acceptable, such as quinoa, amaranth, and millet. There’s also debate over whether meat is an inflammatory food. Some experts say avoid meat altogether to avoid increasing inflammation. I generally tell my patients to include lean animal proteins if they wish, and can have them with no issue.

Last, but certainly not least, one must make sure to support their adrenal glands when dealing with chronic inflammation. Cortisol, a hormone secreted by the adrenal glands, is widely considered to be the body’s top anti-inflammatory agent. For this reason, chronic inflammation can also lead to adrenal issues, such as adrenal fatigue. For more on this topic, please read my blog on improving adrenal function to reduce inflammation.

Image Credits: Joint pain image by Flickr user jilly999; Gluten-free aisle image by Flickr user Memphis CVB

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-Friendly Recipes: Quinoa Tabouleh, Roasted Beet Salad, and Mixed Bean Salad

1. Quinoa Tabouleh

Quinoa is an amazing grain. It contains significant amounts of dietary fiber, thiamine (B1), riboflavin (B2), vitamin B6, folate, iron, magnesium, phosphorous, zinc, copper and manganese. This super grain is an excellent non-animal source of protein, and it’s also a safe choice for those sensitive to gluten.

Tabouleh is quick and simple to assemble. It can be eaten as a snack or served as a side for lunch or dinner. Feel free to experiment and add your own ingredients, like chickpeas, cucumber, lemon juice, scallions, or jalapeños for spice.

Ingredients:

  • tabouleh by Flickr user Joshua Bousel1 cup of dry quinoa (makes 3 cups when cooked)
  • 1/2 cup finely chopped parsley
  • 1/4 cup chopped coriander
  • 1/4 cup chopped mint leaves
  • 2 medium tomatoes, diced
  • 4 tablespoons olive oil
  • salt and pepper to taste

Instructions:

  1. Bring 2 cups of water to a boil. Stir in the quinoa, reduce heat to low and simmer for 15-20 minutes, or until all the water is absorbed. While the quinoa is cooking, you can prepare the other ingredients. Once done, fluff the quinoa with a fork and let sit to cool. Once cool, gently mix in all other ingredients. Now you’re done, so enjoy!

2. Roasted Beet Salad

Beets get their vibrant color from a natural pigment called betalain. When consumed, betalain acts as a powerful antioxidant. There are also significant amounts of folate, manganese, potassium, copper, fiber and magnesium in beets. There’s also a recipe for Dr. Bakker’s Universal Dressing below, if you don’t want to use your own.

Ingredients:

  • roasted beet salad by Flickr user Jules Morgan2-3 medium-sized beets, cut into 1 inch cubes (scrub in water first to clean, but do not peel)
  • 1 red pepper, seeded and cut into 1/2 inch strips (you can also roast the red pepper in the oven or a dry skillet, just until it blisters)
  • 1 large tomato, cut into 1 inch cubes (you can use any variety of tomato you wish, or a blend of different kinds)
  • 1 small red onion, finely sliced
  • 3 cloves of garlic, peeled and finely sliced
  • A small block of feta cheese, cut into small cubes (you can use any type of goat cheese, or other cheese of your liking–but not Velveeta!)
  • 1 tablespoon sesame seeds, as a topping (can also be toasted in a dry skillet or in the oven)
  • Green or black olives, pitted and chopped

Instructions:

  1. Pre-heat the oven to 350* F/180* C.
  2. Rub the cubed beets in olive oil, and space them out on a baking sheet
  3. Place in the oven for about 20 minutes, or until they’re tender and sweet-tasting
  4. While the beets are roasting, you can roast the red pepper and sesame seeds on the stove-top, if desired.
  5. Put the beets, red pepper, garlic, tomato, red onion and cheese in a bowl and gently mix.
  6. Add the sesame seeds and gently mix again.

Instructions for Dr. Bakker’s Universal Dressing: Mix together the juice of 1 lemon, 1 tablespoon extra virgin olive oil, 1 small clove of finely chopped garlic, a small sprig of parsley (torn apart or chopped to spread), and salt and pepper to taste.

3. Mixed Bean Salad

It’s jokingly said that beans are the magical fruit, though they do have some super powers. Like quinoa, beans are a great non-animal source of protein. Beans also contain hearty levels of key vitamins and minerals, like vitamin C, thiamin, riboflavin, niacin, folate, magnesium and manganese.

Ingredients:

  • mixed bean saladBeans ( A mix is good, and if you have time to rinse and cook your own even better. A canned mix is acceptable as well. A good mix would be kidney beans, black-eyed peas, garbanzo beans and black beans.)
  • 1 clove of garlic, finely chopped
  • 2 teaspoons olive oil
  • 2 teaspoons fresh lemon juice
  • 1 celery stalk, trimmed and finely chopped
  • 1/2 a red pepper (can be roasted, if desired)
  • 1/4 cup black olives, pitted and chopped
  • 1/4 cup parsley leaves, roughly chopped
  • 1/2 a small red onion, thinly sliced
  • A handful of arugula leaves (or more if you like–you can also use different greens, or a mix)
  • Salt and pepper to taste
  • You can also add your choice of rice, grain or pasta, if desired

Instructions:

  1. Place lemon juice, garlic and olive oil in a jar and shake well to mix.
  2. Place the rest of the ingredients, and any extras, in a bowl.
  3. Add the mixed dressing and gently toss to mix. Enjoy!

You can find more easy, healthy and tasty recipes by Dr. Bakker and his team at http://www.naturopath.co.nz/Recipes.html

Image Credits: Roasted beet salad by Flickr user Jules Morgan; Tabouleh by Flickr user Joshua Bousel; Mixed bean salad courtesy of naturopath.co.nz

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Digestive Issues: The Three Most Common Causes

Digestive Issues: The Three Most Common Causes

Good health starts in the gut. It may seem cliche by now, but this statement is certainly true. If the gut isn’t working properly, it’s likely that nothing else will either. There are many potential causes of gut distress, and in this article I am addressing the three most common culprits, along with their common side effects. Do any of these sound familiar to you?

1. Stress

stressed woman on bench

I’m so stressed I could sit! But in all seriousness, stress can really do a number on your gut health.

Stress has short- and long-term effects on gut health. It can lead to poor digestion, decreased nutrient intake and disruptions in microbial balance, and can immediately cause stomach discomfort.

There’s a close relation between your emotions and your gut, which is often referred to as the second brain. Your second brain actually produces more neurotransmitters than the brain in your head. In fact, more than 80% of your body’s serotonin is produced in the gut!

On top of that, stress can cause even the strong-willed to abandon healthy eating habits in favor of quick and nutrient-devoid comfort foods. These are the type of foods that further compound gut distress and leave you feeling worse. High stress can also cause people to be less active, eliminating one of the best stress reducers from their lives (exercise).

Side effects of stress on the digestive system include constipation, diarrhea, indigestion/heartburn and loss of appetite. Malabsorption and improper digestion can also be brought on by chronic stress.

How to Relieve a Gut Damaged by Stress

It’s important to address both the effects of the stress and the stress itself. I like to recommend lighter exercises for stress management, such as walking, swimming, yoga, tai chi and meditation. I also make nutritional recommendations, which are best done on a case-by-case basis. There are many vitamin, mineral and herbal supplements that can support the stress response system, as well as the digestive system. In most cases, prescription drugs are not required.

Many folks with digestive issues have unaddressed emotional issues. In order to truly recover, it’s important to deal with the root cause lying beneath the surface. Don’t be afraid or ashamed to talk with someone. It takes a strong person, not a weak one, to ask for help.

2. Fermentation of the Digestive System

pint of beer

During fermentation your gut makes its own “beer,” though not one you’d want to drink.

Fermentation tends to take place in the small intestine, and is a ‘backfire’ of the digestive system. Just like it sounds, your body starts making its own beer and wine (in a bad way), instead of properly breaking down starches and sugars. This disorder, though common, can be quite serious, as it disrupts both the digestion and absorption processes.

The most common cause of gut fermentation is stress. Stress can lead to hypochlorhydria (a lack of stomach acid), which paves the way for fermentation. Fermentation can also occur after traveling overseas, after a long holiday (especially if stress and bad food are in the mix), while recovering from an illness, or after antibiotic treatments.

Symptoms of fermentation include bloating, increased gas, nausea, changes in bowel and/or appetite, body odor, cold hands or feet, increased sweating, fatigue and irritability.

How to Relieve a Gut Damaged by Fermentation

Fermentation can be detected by way of a simple urine test. If the urinary indican chemical is present, chances are the gut is not digesting food properly. Treatment typically involves a “kill program” made of specific herbs and nutrients, as well as strict diet changes excluding all starches, sugars and yeast. Digestive enzymes taken at mealtime may also prove helpful.

Generally, fermentation itself is not a serious problem and can be easily remedied. If left untreated, it can progress into a more serious issue. such as dysbiosis.

3. Candidiasis (Yeast Infection)

human tongue affected by oral candidiasis

Candida overgrowth can manifest in several ways, including oral thrush

There are more than 400 different species of organisms living in the gut, and it takes a balance of their population to maintain good gut health. Candida Albicans is one of these organisms, and is generally not harmful until an overgrowth occurs. This imbalance, known as intestinal dysbiosis, is extremely common and can manifest in several ways.

Like many of the problems discussed here, the most common cause of intestinal dysbiosis is chronic stress. Dysbiosis can also be brought on by fermentation, poor eating habits, high alcohol consumption, antibiotic treatments and some forms of birth control.

Symptoms of candida overgrowth include skin rashes/irritation, chronic fatigue, brain fog, vaginal thrush, increased urinary frequency, diarrhea, bloating and constipation.

How to Relieve a Gut Damaged by Candida Dysbiosis

Generally, a candida overgrowth can be easily detected by a healthcare practitioner. There are several questionnaires that can be helpful, as well as serum and stool tests to measure candida antibodies. I recommend being tested for candida overgrowth before taking any strong measure to fix it.

For mild cases, treatment often includes a special diet, anti-fungal supplements, as well as vitamin and mineral-based supplements. For more severe cases, heavier testing and treatment may be required, such as the use of anti-fungal drugs, a comprehensive digestive stool analysis and food allergy panel.

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

Image Credits: Tongue affected by candidiasis By James Heilman, MD (Own work) CC BY-SA 3.0 via Wikimedia Commons

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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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