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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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Do You Need Caffeine to Keep Going? Keep Reading

Do You Need Caffeine to Keep Going? Keep Reading

Do you feel like a zombie until you’ve had your coffee? Do you count down the hours until your next caffeine break? Your body (or mind) may be reliant on ‘go-go juice’ to keep going. But, you’re not alone; in fact, caffeine addiction is quite commonplace. Whether the addiction is psychological or brought on by a body burden (like adrenal fatigue), dependence on caffeine can be bad news.

How do you know if you’re addicted to caffeine?

cup of coffeeHave you tried going a full day without coffee or any caffeinated drinks? Did you find yourself feeling worse (headache, fatigue, irritability)? You could have experienced symptoms of caffeine withdraw. The good news about caffeine withdraw is that the symptoms are short-lived, typically lasting a few days at most.

You can also gauge dependency by your mentality on caffeine. Do you feel like the day is doomed if you don’t have that first cup? Or think of clever ways to time travel back home to retrieve the thermos you left on the counter? Maybe consider sneaking a sip from your coworker’s mug? As ridiculous as it may sound, caffeine dependency can make us do silly things to get our fix.

What’s so bad about caffeine?

Caffeine, a natural alkaloid, is not inherently evil. What makes it dangerous is the amount and type consumed. Generally, authorities agree that 300-400 mg of caffeine per day is safe for most adults. (There are about 95 mg of caffeine in an 8-ounce cup of coffee.) Not all caffeinated drinks are created equal; there are big differences between a cup of green tea, a can of diet soda and a Starbucks peppermint mocha.

Caffeine can be especially detrimental to those with certain conditions, like adrenal fatigue and chronic high stress. Additives like creamer and sugar can make matters even worse. The short pick-me-up feels good at first, but leads to a crash that makes you feel worse than before. In addition to the harm it can do to already exhausted adrenal glands, here are some negative side effects of frequent caffeine use:

  • insomnia by Flickr user petitefoxSleep disturbances – Coffee consumption can make you groggier in the morning.
  • Digestive issues – Caffeine irritates the stomach lining, causing excessive production of stomach acid, which can lead to a variety of digestive disorders. Moreover, research has shown a definite link between coffee drinking and ulcers and heartburn.
  • Neurological disturbances – Headaches are one of the most common symptoms of excess caffeine and also of fluctuating caffeine levels throughout the day.
  • Nutritional deficiencies – Frequent coffee intake can cause a significant loss of several vitamins and minerals, including vitamins B and C, calcium, iron, and zinc.

 How can I be less reliant on caffeine?

Cutting back on or eliminating coffee and other detrimental caffeinated products isn’t easy, but it can be done. Many people think they need caffeine to keep going, and without it they’ll be a pile of useless mush on the floor. In fact, the opposite is true: eliminating your dependence on caffeine can lead to positive changes in energy levels, mood, sleep quality, and overall health. Here’s some tips on cutting out the caffeine:

  • Cut back slowly – Quitting a caffeine addiction cold turkey can lead to undesirable side effects. Try reducing the amount first. Cut back to one cup per day, or have smaller servings.
  • Stick to decaf – For many, the need for coffee is psychological. Try switching to decaf. Your body may not even realize the difference!
  • Drink more water – Dehydration and lack of water can lead to fatigue and lethargy. If you’re thirsty, have some water first. Staying hydrated can do wonders for energy levels.
  • Get off the crutch – If you feel like you need coffee to survive, there are other problems to be addressed. Your body doesn’t need caffeine like it does vitamins and minerals. A reliance on caffeine is a sign of an underlying issue, be it psychological or physical. Adrenal fatigue is one such example of an underlying issue.

What are safer alternatives to coffee and soda?

In addition to the tips above, there are safer alternatives to harmful caffeinated drinks. Here are some healthier options:

  • Green tea – Green tea has about one-fourth the caffeine of coffee, and is the best food source of catechins, a powerful antioxidant that can reduce the risk of heart disease.
  • Water – We don’t need to tell you that you need water to survive, but you may not know how much water, or lack thereof, can affect energy levels. Plus, the energy benefits of water are not short-lived and there’s no crash afterward.
  • Nut milks – Not all nut milks are created equal, but good ol’ natural nut milks are easy to make yourself with some nuts, water and a blender. Nut milks have the health benefits of raw nuts, namely essential fatty acids.
  • Vegetable juices/smoothies – The juicing craze is in full-swing, but it’s not all hype. Natural vegetable juices and smoothies can be very beneficial for their vitamin and mineral content. Plus, it’s easy to make your own if you own a juicer.

Image Credits: Insomnia by Flickr user petitefox


Harvard Health Publications. Benefit of Drinking Green Tea. Harvard Health Services, Sept. 2004. Web. 15 Oct. 2014.

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Reframing: How to Manage Unavoidable Stress

Reframing: How to Manage Unavoidable Stress

stereogram by Flickr user fdecomite

Can you see the hidden image? Click picture for larger version.

Have you ever looked at one of those pictures containing a hidden image? At first you look and look from every angle, but all you can see is the regular picture. Then suddenly your focus shifts, the hidden image appears and you see it so differently that it becomes impossible not to see it that way. Reframing is a similar process of changing focus in which new information and/or a new point of view alters the way you see something. When you change how you see something, you also change how your body responds. That is why one of the most effective ways to lessen the stressful effects of an unavoidable, difficult situation is to reframe or refocus your perception of the situation. This often allows you to adapt yourself to the situation in a more positive way or gives you a key to changing the situation for the better.

lifesaver by Flickr user emdot

Reframing can literally be a lifesaver

It takes some imagination and effort but reframing can literally be a lifesaver. Sometimes, the way circumstances unfold allows us to reframe miserable experiences into beneficial ones (like finding out that a negative lab test result was an error). However, it is usually up to us to “turn lemons into lemonade” by consciously altering how we see our difficulties in order to experience them as something better. If we wait around hoping life will present us with a series of happy endings we will probably be disappointed. However when we choose to use reframing techniques to shift our perceptions about situations that have been wearing us out with stress, we empower ourselves to stay healthy. We change how our bodies actually experience and respond to these situations. The psychological changes produce physiological changes that directly affect our health.

Many times, changing the impact of a situation is not as difficult as you might imagine. If you look at a situation from a different angle or allow your attitudes or beliefs about it to change, quite often the stress and tension that the situation provokes will begin to diminish. For example, if you go to work every day and think your boss hates you, or you dread going because of the unpleasant people you work with, you are really seeing yourself as the victim in this situation. Instead, you could decide that this is really a master’s training course on how to handle difficult people that you are taking while looking for another job. This way you can benefit from studying these people and your reactions to them. Changing your responses puts you back in control of the situation.

You can then pick one reaction each week that you want to change, or somehow diffuse, and continually work at mastering yourself so you are no longer a victim. In other words, turn it into an opportunity for getting something you want or need instead of allowing it to be an obstacle to what you want or need. Each time you lose your temper or get uptight, instead of blaming or criticizing yourself, realize that you need more practice in deflecting other people’s negativity and maintaining a positive emphasis on your own perceptions and goals.

The positive changes you make will give you more confidence that you can actually find a work situation that you would enjoy–something you might have thought was impossible a few months before. Remember: we are not required to sell our souls in order to work. That is a belief that some of us hold and, as a result, we find ourselves working for companies that demand it.

It surprises many people to discover that not only is it possible to change a belief about something, but that changing the belief often changes the situation. If, for example, you believe you must exhaust yourself at work in order to get ahead, then you are in a real bind. The only way you can win is to lose. If you win at your job, you lose with your health and if you are not exhausted, you must not be doing your job.

equations on chalkboardA belief is like an internal equation you live by. In this example if you can replace your equation that job success=exhaustion with an equation like job success=focus with relaxation, then new possibilities can arise for you. In the first equation you have a sense of powerlessness and your job controls you; in the second equation you are empowered to have much more control over yourself and your job experience.

What you believe (your equation) about success in this case governs your freedom to choose work attitudes and behavior that either lead to health or to debilitation, and possibly to actual success or failure. For example: if you have to work late some evenings, you can set a limit on how much is reasonable for you to finish and how many extra hours you are willing to put in to meet your job goals. Then while doing the work you can use techniques like deep breathing to stay focused and relaxed. In a relaxed state, you will usually work more effectively than you do when you put yourself under the gun, so you might even get the job done faster. The important result for your health is that you can do whatever you have to do with less stress.

Image Credits: Stereogram image by Flickr user fedecomite; Lifesaver by Flickr user emdot

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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Who Suffers From Adrenal Fatigue?

Who Suffers From Adrenal Fatigue?

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

Adrenal Fatigue Doesn’t Discriminate

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

Your Job May Be a Factor

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

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

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

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

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

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

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

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

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

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The Anti-Inflammatory Effects of Cortisol


The Anti-Inflammatory Effects of Cortisol

mosquito on skin

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

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

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

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

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

The Effects of Cortisol on White Blood Cells

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

firefighters spraying a fire

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

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

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

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


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