General Health - Adrenals - A student's guide - Part II
After last issue’s whistle-stop tour of adrenal anatomy and physiology, this quarter’s article explores the key nutritional strategies that can be used to help clients recover from adrenal dysfunction.
Protocol ideas for Adrenal Health
Blood sugar balancing
When blood sugar levels drop, cortisol (as well as other hormones) is activated to bring about the biochemical reactions needed to raise blood sugar levels. Constant dips in blood sugar levels tax the adrenals, forcing them to produce more and more cortisol. What’s more, when adrenal fatigue becomes pronounced, the adrenals are physically unable to produce enough cortisol to combat hypoglycaemia. This means that dietary management of blood sugar levels is key for both the prevention and treatment of adrenal fatigue. Encourage clients to eat three meals and two to three snacks a day, with a regular intake of concentrated protein, moderate amounts of low GI carbohydrates and healthy fats with plenty of fresh vegetables. They should aim to eat breakfast within an hour of waking, lunch around 12pm and dinner about 6pm, with snacks spread evenly through the day.
The majority of people with adrenal fatigue have a frequent need to urinate and have cravings for salt, which they often satisfy by using excessive amounts of table salt or eating foods such as salted peanuts, crisps and chips. These imbalances are a result of the reduced secretion of aldosterone. This mineralocorticoid hormone normally helps the body to retain an appropriate amount of sodium, but when adrenal function becomes compromised, aldosterone levels drop and sodium excretion increases. The natural physiological reaction to this is for the body to increase its taste for salt.
Therapeutic use of salt can actually help the adrenals to recover and combat some of the effects of adrenal fatigue, such as low blood pressure, but it is important to use the right kind of salt. Table salt and the salt used in commercial food processing are pure sodium chloride, excessive intake of which can greatly imbalance the levels of electrolytes in the body. A much healthier option is to use an unrefined salt, such as Himalayan rock salt or unpurified Celtic Sea salt. These types of salt contain a balance of mineral and trace elements that is much more in harmony with the body’s biochemistry.
The best strategy to use with clients is to ask them to salt their food and drinking water to taste. The body naturally regulates the craving for salt in response to its needs. Drinking water can be salted throughout the day but should definitely be drunk first thing in the morning. One of the biggest mistakes clients with adrenal fatigue make is starting the day with a potassium-rich breakfast such as fruit or vegetable juice. This can make them feel much worse, because it forces their already tired adrenals to secrete more aldosterone! Although the body needs a good supply of potassium, it also needs adequate sodium in order to use the potassium properly.
In an attempt to bolster energy levels, many clients will turn to stimulants to force their body to function. Caffeinated drinks, alcohol, chocolate and artificially enhanced soft drinks can over-stimulate hyper-functioning adrenals or further deplete cortisol levels in states of adrenal fatigue. Try to get clients to swap their daily poison for a decaffeinated alternative, the occasional cup of green tea, herbal teas, dandelion or roasted cereal coffee or filtered water. A good substitute for chocolate is the naturally sweet and caffeine-free alternative carob, which can be purchased as bars, chips or powder.
One of the roles of cortisol is to manage over-zealous immune reactions. Therefore, if one of your clients is regularly consuming a food or additive, to which they are allergic or sensitive, they are greatly adding to their adrenal burden. Laboratory tests for sensitivities or a controlled elimination and rechallenge protocol can help to identify culprit substances so they can be removed from the diet in order to speed recovery.
Exercise can help to normalise cortisol and insulin levels, lift mood, support thyroid function and aid detoxification. The problem is that excessive, high intensity or competitive exercise can drain the adrenals by heavily pulling on cortisol reserves. Regular gentle exercise, such as yoga, tai chi, qi gong, swimming, walking and dancing can aid proper adrenal function and recovery. Just be sure to caution your clients against the kind of exercise that leaves them in pain or exhausted!
Sleep is the ultimate parasympathetic activity, allowing the body time to recover and regenerate. In non-stressful conditions, glucocorticoid secretion has a marked circadian rhythm, with the highest levels of hormone being released between 4am and 8am, and the lowest levels being secreted between midnight and 3am. However, it’s quite common for people with adrenal dysfunction to experience a sharp peak in energy levels at about 11pm. This can be caused by a random pulse of adrenaline or cortisol, which then keeps the sufferer up until the early hours of the morning. To avoid this, it is best to ask clients to try to get to bed by 10.30pm and sleep in until 9am as often as their schedule will allow. This gives the adrenals more time to recover, rather than having to pump out high levels of cortisol from the early hours onwards!
Working shifts can also be detrimental to adrenal health, because every time the sleep-wake pattern changes, it takes several days for the HPA axis to adjust. If your client is working a shift pattern, it may be worth them discussing alternative arrangements with their boss in order to aid their recovery.
Adrenal dysfunction can result from any number of different stressors, both physical and emotional, but common features amongst adrenal clients are skewed stress perception, a reduced ability to effectively manage challenging situations and an inability to relax. Simple lifestyle interventions to help people better manage stress, such as breathing exercises, meditation and guided imagery, can be helpful for the majority of clients, but for those who have become almost addicted to their stress, a cross-referral to a practitioner specialising in a technique such as NLP may be useful to help the client learn to function in a more relaxed state.
Nutraceutical support for adrenal function
Necessary for the production of cortisol and other adrenal hormones, vitamin C also helps to protect the adrenals from the high levels of free radicals produced during times of stress(1). In doses of 1500-3000mg, vitamin C has been shown to reduce cortisol levels and protect against some of the detrimental effects of a chronic resistance phase(2,3).
This is essential to neutralise the free radicals produced during the manufacture of adrenal hormones. Vitamin E is best taken in a natural form at a dose of 400-800IU.
The B vitamins are vital cofactors for the enzymes involved in the production of adrenal hormones and energy metabolism. Deficiency of B vitamins is common in adrenal fatigue, so a high strength B complex taken two to three times a day can restore nutrient levels and improve energy.
A component of coenzyme A, this particular B vitamin is highly concentrated in the adrenals and vital for both steroid hormone production and energy metabolism. This has been confirmed by studies carried out using rats showing that pantothenic acid supplementation can support the production of adrenal hormones during times of stress(4). A good therapeutic dose for humans is 500-1000mg, three times a day.
Many of the enzymes involved in energy metabolism and adrenal steroidogenesis rely on magnesium as a cofactor. Unfortunately, chronic stress depletes magnesium levels(5), predisposing sufferers to fatigue and insomnia. Dosing 400-800mg of magnesium in the evening can help to offset stress-induced depletion and aid restful sleep.
This works with magnesium to calm an overactive nervous system. Doses of 500-1000mg taken about an hour before bed can aid sleep by encouraging the release of melatonin(6). A regular intake of calcium can also help to offset bone density loss associated with a chronic resistance phase.
Essential fatty acids
Omega 3 fatty acids can lower cortisol release influenced by mental stress. In a study of human volunteers, three weeks of supplementation with 7.2g of fish oil per day significantly blunted the effects of mental stress on plasma adrenaline and cortisol(7).
This phospholipid supports the production of calming neurotransmitters and has been shown to dampen ACTH and cortisol response to acute stressors(8). Studies using doses of 400-800mg per day have demonstrated positive effects on response to both mental and physical challenges(9,10).
This amino acid is a precursor for the production of the catecholamine neurotransmitters, adrenaline and noradrenaline, released from the adrenal medulla. Tyrosine can be particularly helpful in cases of low mood or motivation and when concomitant low thyroid is suspected, since tyrosine is also a precursor for
the production of T3 and T4. Tyrosine is best absorbed away from food, so encourage clients to get into a routine of taking 500mg mid-morning and mid-afternoon.
Research into Rhodiola, a well-known herbal adaptogen, spans over 30 years. Trials in humans have shown that Rhodiola rosea extract exerts an anti-fatigue effect, increases mental performance, particularly the ability to concentrate, and decreases cortisol response to stress(11).
Recent research has shown that Ashwagandha influences hormone activity by supporting HPA axis function. It can aid adaptation to both physical and chemical stress, increase catecholamine production and reduce cortisol depletion at times of challenge(12,13).
Extracts of Siberian ginseng have been found to have a specific affinity for binding to both glucocorticoids and mineralocorticoid adrenal receptor sites. Overall, this type of ginseng prolongs the resistance phase of stress, while reducing the alarm and exhaustion stages(14).
The root of the liquorice plant contains the triterpenes glycyrrhizin and glycyrrhetinic acid, which are metabolised to chemicals similar in structure to the adrenal cortical hormones. Subsequently, liquorice has a natural mineralocorticoid-like activity, making it particularly useful for combating low blood pressure in the exhaustion stage of stress(15). In addition, liquorice can also help potentiate the action of cortisol by inhibiting the enzyme that inactivates steroid hormones(16). Provided high blood pressure is not a problem, liquorice can be included in an adrenal protocol as a food, tea or herbal extract.
These are extracts, prepared from animal adrenal tissue, which can support and enhance adrenal activity. They provide all the essential constituents for adrenal repair in the optimum form and proportions, along with very small amounts of adrenal hormones(17). Extracts are available as liquids or tablets and dosages vary depending on the brand.
Working with non-responders
Recovery from adrenal dysfunction takes time, but, if your client still hasn’t shown any sign of improvement after one to two months of treatment, there may be other factors depleting their adrenal reserves. The diagram above highlights some additional health aspects you might want to consider investigating.
1. Patak P, Willenberg HS, Bornstein SR. (2004) Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocr Res. 30(4):871-5.
2. Peters EM, Anderson R, Nieman DC, Fickl H, Jogessar V. (2001) Vitamin C supplementation attenuates the increases in circulating cortisol, adrenaline and anti-inflammatory polypeptides following ultramarathon running. Int J Sports Med. 22(7):537-43.
3. Brody S, Preut R, Schommer K, Schürmeyer TH. (2002) A randomized controlled trial of high dose ascorbic acid for reduction of blood pressure, cortisol, and subjective responses to psychological stress. Psychopharmacology (Berl). 159(3):319-24.
4. Jaroenporn S, Yamamoto T, Itabashi A, Nakamura K, Azumano I, Watanabe G et al. (2008) Effects of pantothenic acid supplementation on adrenal steroid secretion from male rats. Biol Pharm Bull. 31(6):1205-8.
5. Takase B, Akima T, Uehata A, Ohsuzu F, Kurita A. (2004) Effect of chronic stress and sleep deprivation on both flow-mediated dilation in the brachial artery and the intracellular magnesium level in humans. Clin Cardiol. 27(4):223-7.
6. Pierpaoli W, Regelson W, Fabris N (1994) The aging clock: the pineal gland and other pacemakers in the progression of aging and carcinogenesis: Third Stromboli Conference on Aging and Cancer. New York. New York Academy of Sciences.
7. Delarue J, Matzinger O, Binnert C, Schneiter P, Chioléro R, Tappy L. (2003) Fish oil prevents the adrenal activation elicited by mental stress in healthy men. Diabetes Metab. 29(3):289-95.
8. Monteleone P, Maj M, Beinat L, Natale M, Kemali D. Blunting by chronic phosphatidylserine administration of the stress-induced activation of the hypothalamo-pituitary-adrenal axis in healthy men. Eur J Clin Pharmacol. 1992;42(4):385-8.
9. Starks MA, Starks SL, Kingsley M, Purpura M, Jäger R. (2008) The effects of phosphatidylserine on endocrine response to moderate intensity exercise. J Int Soc Sports Nutr. 5:11.
10. Hellhammer J, Fries E, Buss C, Engert V, Tuch A, Rutenberg D (2004) Effects of soy lecithin phosphatidic acid and phosphatidylserine complex (PAS) on the endocrine and psychological responses to mental stress. Stress. 7(2):119-26.
11. Olsson EM, von Schéele B, Panossian AG (2009) A randomised, double-blind, placebo-controlled, parallel-group study of the standardised extract shr-5 of the roots of Rhodiola rosea in the treatment of subjects with stress-related fatigue. Planta Med. 75(2):105-12.
12. Mishra LC, Singh BB, Dagenais S. (2000) Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): A review. Altern Med Rev. 5(4):334-46.
13. Archana R, Namasivayam A. (1999) Antistressor effect of Withania somnifera. J Ethnopharmacol. 64(1):91-3.
14. Friedman, M (2005) Fundamentals of Naturopathic Endocrinology. Toronto. CCNM Press. p129.
15. Friedman, M (2005) Fundamentals of Naturopathic Endocrinology. Toronto. CCNM Press. p224.
16. Kageyama Y, Suzuki H, Saruta T. (1992) Glycyrrhizin induces mineralocorticoid activity through alterations in cortisol metabolism in the human kidney. J Endocrinol. 135(1):147-52.
17. Friedman, M (2005) Fundamentals of Naturopathic Endocrinology. Toronto. CCNM Press. p226.