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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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Signs and Symptoms of Adrenal Fatigue

Signs and Symptoms of Adrenal Fatigue

tired man on bus by Flickr user rrrtem

Everyone’s experience with adrenal fatigue is different, including how they got to that state in the first place. There are shared signs and symptoms of adrenal fatigue, which many sufferers experience. Below are some of the more common symptoms; do these sound like you or people you know?

Continued fatigue not relieved by sleep or rest
Despite getting adequate sleep, do you still wake up feeling tired and groggy? Refreshed is often a foreign word for people experiencing adrenal fatigue.

Strong cravings for salt or salty foods
Do you feel like you just can’t get enough salt? Do you often crave salty foods and snacks, or add salt to already salty foods? (You can learn more about the association between salt and adrenal function in this blog.)

Overall lack of energy
For people with adrenal fatigue, most things feel like a chore–even simple tasks and things they used to enjoy. Everyday tasks seem to take ten times the effort than usual. For some, simply getting out of bed or off a chair is a major challenge.

Decreased sex drive
Sex is one of the last things on your mind when you barely have the energy to keep your head up. Stress itself can interfere with sex drive. Cognitive distraction (thinking or worrying about problems) interferes with sexual functioning. So if you are ruminating about multiple stressors, it will be difficult to put your full attention on either your partner or your own sensations and responses.

Decreased ability to handle stress
Do little things that never bothered you before now pose a problem? Road rage, constant anxiety and compulsive behaviors (like binge eating, smoking and heavy drinking) can be signs of a weakened stress response, and possibly adrenal fatigue.

Increase in time to recover from illness, injury or trauma
The cold you got in September seems to be hanging around for months; a simple cut on your finger takes weeks to heal; two years after the loss of a loved one you are still incapacitated by grief. High stress and/or adrenal fatigue can lead to a weakened immune system.

Decreased joy and happiness
You find it hard to see the joy, even in activities you love. Things that typically excite you now elicit a “meh” response. You almost never do something just for fun. It’s become harder to laugh and enjoy yourself, as well as the company of others.

Increase in PMS difficulties
An increase in bloating, fatigue, cramping, irritability and other not-so-savory effects of PMS can be experienced with adrenal fatigue.

Reliance on caffeine and sweets to keep going
Do you feel like you need caffeine just to get through the day? Do you find yourself going for sugary snacks to get that short-lived spike in energy? The downside to this, other than the empty calories and lack of proper nutrition, is the effect caffeine and sugar have on already weakened adrenals. Moreover, this reliance creates a vicious cycle; the crash after the short-lived spike leaves you even more tired and ‘needing’ more.

Weakened mental capacity
You frequently lose your train of thought and find it harder to maintain focus. Decisions, even the small ones, have become more difficult to make. Moreover, you find your memory failing you, and may experience a ‘mid fog’ that puts you in a mental haze. You may also find that tasks take longer than usual, and it’s harder to stay on track.

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What Not to Eat When You Have Adrenal Fatigue

What Not to Eat When You Have Adrenal Fatigue

It is hard to say which is more important when you have adrenal fatigue – what to eat or what not to eat! Eating the wrong foods or combination of foods can throw you off for hours and even days, so do not even try to sneak something by; it is just not worth the price you have to pay. In this blog I outline the types of foods that are best left alone, and why.

The Addictive Cycle of Sugar and White Flour Products

donut with sprinklesIronically, foods made with these ingredients such as doughnuts, rolls, pies, cakes, cookies, crackers, candy bars, and soft drinks are the ones that many people suffering from adrenal fatigue crave. This is because when you have adrenal fatigue you also usually have hypoglycemia (low blood sugar) and foods made from refined flour and/or sugar quickly raise your blood sugar. Unfortunately, they raise your blood sugar so high and so fast that too much insulin is released in response. This excess insulin then causes your blood sugar levels to crash, leading to hypoglycemic symptoms and more cravings. Furthermore, sugar and white flour are entirely naked calories, the metabolism of which drains an already depleted body of the vitamins and minerals it needs to heal or to maintain.

If you replace the items made with white flour like pies, cakes, cookies, crackers, most desserts, commercial breads and pastas, and all caffeine containing or sweet drinks like sodas with foods that contain nutrients and not just energy, you will quit robbing your body of what it needs. More than that, you will be able to get off the perpetual hypoglycemic roller coaster ride that leaves you fatigued, inefficient, and aging more quickly inside.

The Evils of Hydrogenated and Partially Hydrogenated Oils

french friesHydrogenated and partially hydrogenated fats are oils that have been altered chemically to have certain properties (like remaining solid at room temperature) that have nothing to do with your health. Three common examples are vegetable shortening, margarine and the oil in commercial peanut butters. These adulterated fats are used in almost all commercially prepared food items found in grocery stores and in many restaurant foods.

The good fats are those that the body can use to build tissue, such as nerve and cell wall membranes, and the bad fats are the ones that block this from happening. 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. What you are really craving are the essential fatty acids.

Avoid Deep Fried Foods

Most deep fried foods are fried in hydrogenated or partially hydrogenated fats. These fats are kept at high temperatures and are often reused. As the oil is heated above a certain temperature or reheated, it breaks down, forming toxic free radicals and becoming rancid. This means that eating deep fried food causes not only the same problems as hydrogenated fats, but also the additional problems created by toxic free radicals. Because free radicals are produced when oils break down with heat, you should also avoid food fried in oils high in essential fatty acids (cold pressed sunflower, flax, peanut, safflower, etc.) or any foods fried at a high temperature or for long periods of time.

Avoid “Fast” Foods and Junk Foods

There are numerous problems with typical fast food and junk food. They all contain white flour, sugar, hydrogenated fats, or all three. Often their ingredients are poor quality with little nutrient value, and artificial colors, flavors and preservatives are used to make up for this. What nutrients they do have are frequently lost while they are kept hot or stored for long periods of time. It is questionable whether some junk foods are even food at all. You do not need these “foods,” as they only create havoc with your biochemistry, make you fat, and leave you feeling wrecked.

Avoid Foods That Trigger Allergies or Sensitivities

It is important to completely eliminate all foods and food substances that trigger allergies or sensitivities. Unless there is an anaphylactic reaction (cannot breathe) or hives, most people are not aware that their symptoms may be a reaction to a food they are sensitive too. For more on the role these foods play in your health, read our blog series on identifying and eliminating food allergies and sensitivities.

The Hidden Message in Chocolate Cravings

chocolate barIf you have a piece of chocolate once or twice a year, you can probably skip this section. However, if you crave chocolate, would almost be willing to kill for chocolate, or if chocolate is a coveted part of your diet, then you need to read this. A craving for chocolate can sometimes actually be your body’s craving for magnesium, since chocolate contains large amounts of magnesium. This is especially true in women who crave chocolate before they menstruate or who have PMS. Magnesium helps mediate the symptoms of PMS because it is intimately involved in the manufacture of progesterone. A lack of magnesium can lead to inadequate progesterone levels, producing the PMS symptoms. In the body’s wisdom, it craves chocolate because chocolate is rich in magnesium. The unfortunate aspect, however, is that chocolate is also high in caffeine and a caffeine-like substance, theobromine, that over stimulate the adrenals leading to further adrenal fatigue.

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 Thyroid – Adrenal Connection

 The Thyroid – Adrenal Connection

the thyroid systemIt has been known for over half a century that about 80% of those suffering from adrenal fatigue also have a number of symptoms of low thyroid. If your adrenal fatigue has a thyroid component, it is usually necessary to strengthen both the adrenals and the thyroid simultaneously for full recovery to take place.

The thyroid is another endocrine gland sensitive to the effects of stress. Unlike the adrenal glands that have many functions, the thyroid has one major function: to control the rate at which energy is produced in the individual cells of the body. However, getting your thyroid function tested has the same disadvantages as testing for adrenal function using blood tests; marginally low thyroid function does not show up on these standard tests. Compounding the problem, insurance companies have limited thyroid testing to only one test (typically the TSH) instead of allowing a wider range of thyroid blood tests that could give more information.

There are some observations, though, that you can make yourself to determine if your thyroid may be low. Although these are not precise or conclusive, I have found them valuable clinical indicators that make me suspect thyroid function to be lower than optimal. A list of these follows:

  • Your basal body temperature, taken before rising in the morning, is below 98.2°F (oral) or 97.2°F (underarm).
  • Your stamina or capacity does not improve with increased exercise. (Typically, as you exercise, your stamina and capacity increase with repeated exercise, even if you have adrenal fatigue).
  • At 9:30 PM you hit a wall and are ready for bed but there is no 11:00 PM second wind (as is often seen in pure adrenal fatigue).
  • Reaction time is slightly slower than you know it should be when you are driving a car, engaging in sports or operating equipment.
  • You gain weight easily, especially around your hips and thighs, even when eating the right foods in normal portions.
  • The outside of your eyebrows are much thinner than normal.
  • You feel sluggish and not fully awake much of the day. (Those with pure adrenal fatigue usually feel awake by 10:00AM, or if not by 10:00AM, after the noon meal.)
  • Your energy does not noticeably improve after your evening meal or after 6:00PM.
sleepy man by Flickr user smanography

Feeling sluggish and sleepy throughout the day can be a sign of low thyroid function

If approximately half of the above indicators are present, then you may have a low thyroid component to your adrenal fatigue. If so, there are several possible solutions. Both your adrenals and thyroid are ultimately regulated in similar ways by a gland called the hypothalamus. Taking a hypothalamus extract may help normalize your thyroid as well as your adrenal function when they need a little fine-tuning.

Supporting the adrenal glands can also go a long way in supporting the thyroid gland. Underperforming adrenals can tax the thyroid, and vice versa. In addition to diet and lifestyle changes, there are herbs, vitamins and glandular extracts available that can help with adrenal support.

Note that both of these glands are very sensitive to and easily undermined by body burdens. If low thyroid seems to be a factor in your adrenal fatigue, check for body burdens again before doing anything else. The above are only some of the body burdens that can continually compromise your health without your knowledge.

The key to determining underlying body burdens is to look at your “Health History Timeline” (PDF link-right click to save). Note any things that occurred within a few months of the onset of your adrenal fatigue. Once the body burden is discovered, find a way to limit or remove it. Just because they are sometimes difficult to isolate or treat, does not mean they are not important. The real detective never gives up until the crime is resolved.

Image Credits: Thyroid system via Wikimedia Commons; Sleepy man by Flickr user smanography

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Key Steps to Beating Adrenal Fatigue Naturally

Key Steps to Beating Adrenal Fatigue Naturally

stressed man on bench by Flickr user ranoushSimple fact: adrenal fatigue stinks. It robs you of your well-being, makes you feel terrible, and for a lot of people can cause alienation and loss of work. On top of that, many practitioners do not recognize adrenal fatigue, and end up turning people away or offering solutions that can be harmful if unneeded (antidepressants are a popular patch).

Hope should not be lost with adrenal fatigue. There are many things you can do on your own that will help. Changes in your diet, lifestyle and added supplementation can do wonders. It will take time and effort, but every bit will be worth the progress. Dr. James L. Wilson has spent much of his professional career helping people with adrenal fatigue, from those with mild cases to those who are practically bedridden. In the video below, Dr. Wilson outlines what you can do to beat adrenal fatigue naturally.

More on adrenal fatigue and food

More on adrenal fatigue and lifestyle

More on adrenal fatigue and supplements

Questions? Please feel free to post them as comments.

Image credit: Stressed man on bench by Flickr user ranoush

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The Role of DHEA in Adrenal Fatigue and Loss of Libido

The Role of DHEA in Adrenal Fatigue and Loss of Libido

saliva test vialsDHEA is one of the androgen hormones secreted by the adrenal glands and is the precursor to several other sex hormones. DHEA levels often become depressed during adrenal fatigue. A saliva test can determine whether your DHEA levels are below normal. I usually recommend measuring DHEA-S levels with the saliva test as well because the adrenals are the primary source of DHEA-S (but not necessarily DHEA). Adrenal fatigue syndrome often involves decreased DHEA-S. The DHEA-S level is a direct indicator of the functioning of the area within the adrenal glands that produces sex hormones (the zona reticularis).

Saliva tests for testosterone, the estrogens, progesterone and other hormones can also be done, if needed, and may be of value in working with adrenal fatigue. Testosterone and DHEA-S levels are two of the most reliable indicators of biological age. Testosterone and DHEA-S levels below the reference range for the person’s age may be indicators of increased aging. If the cortisol levels are also decreased, the three tests together further indicate chronically decreased adrenal function.

Although the sex hormones are made primarily by the gonads (ovaries and testes), the adrenal zona reticularis manufactures an ancillary portion of sex hormones for each sex and also produces male hormones in women and female hormones in men to keep the effects of the dominant sex hormones in balance. DHEA and its relatively inactive precursor, DHEA-S, are two other major hormones that are manufactured and secreted by the zona reticularis. Nearly all of the DHEA-S in circulation is manufactured by the adrenals, which is why DHEA-S blood or saliva levels are excellent indicators of adrenal function.

The adrenal sex hormones and their immediate precursors such as DHEA, pregnenolone and androstenedione do more than add to or balance other sex hormones. They also help balance the effects of cortisol and act as cellular anti-oxidants. Thus, the sex hormones and DHEA both limit cortisol’s possible detrimental effects on cells and at the same time facilitate its actions by functioning as hormonal anti-oxidants. These precursors have their own actions as well as serving as raw material from which the sex hormones are made. For example, DHEA is exported to most cells and once inside the cells, it often becomes the resource material from which small amounts of local hormones can be created to carry out various specific tasks.

The Physiological Effects of Stress and Aging on Adrenal Sex Hormones

two ladybugs mating on a branchThe more the adrenals are stimulated by stress and internal demands, the less responsive the zona reticularis becomes. Consequently, the adrenal output of sex hormones and their precursors decreases with chronic stress and adrenal fatigue. When less DHEA-S is manufactured in the zona reticularis, less DHEA-S and DHEA is available for export and use by other cells. This diminishes your ability to respond adequately to the demands placed on your body for increased DHEA-S and DHEA, thus, in turn, increasing the negative effects of chronic stress.

Loss of libido is commonly associated with adrenal fatigue, probably due in large part (in both men and women) to a drop in testosterone production by the adrenals. From your body’s point of view, when you are in the midst of having to fight tigers and run for your life (i.e. when you are under a lot of stress), it is not a good time to feel amorous because your energy must be used for survival.

Output of adrenal sex hormones and their precursors also decreases with age. A decline in DHEA and testosterone levels accounts for many of the degenerative processes of aging. In fact, the levels of these two hormones in males track the progression of biological aging more closely than do any other markers. As we lose the available DHEA and testosterone, we become less able to counter the intense effects of cortisol in the cells. With age, cortisol levels remain relatively steady, while DHEA and testosterone decline and the other hormones range somewhere in between. In general as the levels of sex hormones and their precursors such as DHEA and testosterone decrease because of age, stress and adrenal fatigue, their many and varied beneficial effects decrease as well.

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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