Stress…The Saga Continues

Updated: Sep 19, 2018

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We began discussing stress in the last article. Let’s continue that discussion now by looking at the work of Hans Selye and discussing a popular term today, Adrenal Fatigue.

The concept of stress and the body adapting to it began with Hans Selye. He termed this process as the General Adaptation Syndrome. It consists of three stages.

Stage 1 Alarm: This is when the Sympathetic Nervous System is activated and the body prepares for “fight or flight” in response to a stressor.

Stage 2 Resistance: The body attempts to activate the Parasympathetic Nervous System in an attempt to return to baseline (i.e. homeostasis) while still dealing with the stressor. Often, the stressor is eradicated or reduced due to the Stage 1 reaction. However, this is not always the case and the the stressor persists.

Stage 3 Exhaustion: In this stage, the body’s resources become exhausted if the stressor persists long enough. This can lead to disease and death. (1)

Depiction of General Adaptation Syndrome. Image copied from https://en.wikipedia.org/wiki/Stress_(biology)

This model has been used to explain the body’s response to exercise. Avid exercisers will be familiar with terms overreaching and overtraining syndrome. This model also provides some explanation of how stress leads to increased aging and disease. Selye believed that this model helped to explain the cause behind many, if not all, chronic disease processes. (2)


Is Adrenal Fatigue Real?

Yes and no. The term Adrenal Fatigue suggests that your Adrenal glands become “fatigued” over time due to chronic stress. This idea proposes that your Adrenal glands will initially increase Cortisol output in response to stress. However, over time the Adrenal glands become worn out and hormone levels drop, especially Cortisol.

So, the question is, does this actually occur? Hormone levels, including Cortisol, may decrease. This is seen in Addison’s Disease. In this disease, the Adrenal glands are unable to produce enough Cortisol and Aldosterone and it can be a life-threatening situation. It is a rare condition and a quick Google search shows that there are less than 200,000 cases in the United States per year. This disease appears to primarily be an Autoimmune Disease. Therefore, the reason that the Adrenal glands are unable to produce sufficient hormones is due to the fact that the body has attacked and damaged the Adrenal gland.

Presentation of Addison’s Disease. Image copied from http://allfornursing.blogspot.com/2012/07/ms-addisons-disease-vs-cushings-disease.html

Does this also occur with chronic stress? People who are experiencing chronic stress may have alterations in their hormone levels. There are tests that can be performed to look at Cortisol and other hormone levels and yes, the levels may be decreased. Well, that proves Adrenal Fatigue exists! Right? Not exactly. Think back to previous articles (link, link). We learned that the Adrenal glands produce Cortisol and other hormones. We also learned that the brain is the primary control center for these hormones and not the glands themselves. So, in chronic stress, the problem does not appear to be that the Adrenal glands are unable to produce hormones, but that there is dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) Axis. HPA Axis Dysregulation is a more accurate term and does not lend itself to being confused with Addison’s Disease as easily. However, it is a mouthful and requires fairly significant explanation to make sense.


Does This Distinction Matter?

Presentation of Cushing’s. Image copied from http://columbiasurgery.org/conditions-and-treatments/cushings-syndrome

Before we discuss that, let’s talk briefly about Cushing’s Syndrome and Cushing’s Disease. Cushing’s is the other side of the coin of Addison’s Disease. Cushing’s Syndrome is caused by excess Cortisol. The excess Cortisol could be due to a tumor on the Adrenal gland that results in overproduction of Cortisol or it could be due to medications. Cushing’s Disease is caused by a tumor on the Pituitary gland that leads to increased Adrenocorticotropic Hormone (ACTH) being released. (Recall that ACTH tells the Adrenal gland to release Cortisol.) There can also be an ectopic tumor that produces ACTH leading to excess Cortisol. (4)

Let’s assume that you decide to have your Cortisol levels assessed with a Salivary Cortisol Test. For this test, you collect four saliva samples throughout the day; morning, noon, evening and night. The level of Cortisol in the morning should be higher since it helps to wake you up. Then throughout the course of the day, the level should drop and be the lowest at night so that you can go to sleep.

Depiction of Cortisol levels throughout the day. Image copied from http://www.endocrinesurgeon.co.uk/index.php/adrenals-the-cortex-cortisol

Often, these tests are only looking at the Free Cortisol level and not Total Cortisol which consists of the Free and Bound forms. Let’s suppose that your test shows that the free levels are low so you decide to take supplements or medications, like Hydrocortisone, to raise your Cortisol level since you believe that your Adrenal glands are fatigued and cannot produce sufficient levels for you. This makes sense, right? It does on the surface, but you don’t have enough information. It is possible to have low Free Cortisol but high Total Cortisol. In this case, these supplements or medications are not going to be helpful and will lead to worsening health due to excess Cortisol. This could even lead to a Pseudo-Cushing State, which mimics Cushing’s Syndrome. (5) By thinking about things in regards to HPA Axis dysregulation, you don’t assume that the issue is with the gland. Instead, you take a holistic view and search to determine where in the HPA Axis the problem lies.

Also, the term Adrenal Fatigue is not recognized by Conventional Medicine or the scientific literature. (6) HPA Axis Dysregulation is recognized in the scientific literature. It has been studied in conjunction with obesity (7) and Alzheimer’s Disease. (7,8) This diversity in research findings relating the HPA Axis dysfunction to disease helps support Selye’s belief that “stress” is the causative factor in disease. (2)


What Do I Do About This?

Photo by Nandhu Kumar from Pexels

We discussed meditation in the last article (link). This is a great place to start. Deep diaphragmatic breathing can help tremendously. It can help improve attention, decrease negative affect and decrease cortisol levels. (9) It can also decrease anxiety and depression. (10,11) Meditation helps with how you perceive stress and how you perceive stress determines how you respond to it.

Photo by Kaboompics // Karolina from Pexels

Another big contributor to stress is the food you eat. Most people eat at least three times per day and every bite you eat could be increasing the stress load on your body. How? That food you are eating may not be well tolerated by your body. Now your body has to mount a defense against that food which means there is increased load on your body. We’ll tackle that topic in depth in the next installment.

Maybe you are still confused about what to do. This is when you need to reach out for help. I recommend that you find a Functional Medicine Practitioner. I would love to help you with whatever health issue you are facing. We could establish a partnership where we use your story along with different tests to determine what is contributing to your specific issues. Then we can develop a specific plan, focusing on diet, lifestyle and supplements, that will address your needs. Please contact me via my website (link) or Facebook page (link).


Disclaimer:

This article is for educational use only. Nothing contained in this article should be considered, or used as a substitute for, medical advice, diagnosis or treatment. This article does not constitute the practice of any medical, nursing or other professional health care advice, diagnosis or treatment. Always seek the advice of a physician or other qualified health care provider with any questions regarding personal health or medical conditions. Never disregard, avoid or delay in obtaining medical advice from your doctor or other qualified health care provider because of something you have read in this article. If you have or suspect that you have a medical problem or condition, you should contact a qualified health care professional immediately. If you are in the United States and are experiencing a medical emergency, you should dial 911 or call for emergency medical help on the nearest telephone.

References/Citations:

  1. www.explorabe.com/general-adaptation-syndrome

  2. www.ncbi.nlm.nih.gov/books/NBK349158/

  3. www.pituitarysociety.org/patient-education/pituitary-disorders/cushings/what-causes-cushings-disease-and-cushings-syndrome

  4. www.pituitarysociety.org/patient-education/pituitary-disorders/cushings/diagnosis-of-cushings-disease-and-cushings-syndrome

  5. www.ncbi.nlm.nih.gov/pubmed/27557747

  6. www.ncbi.nlm.nih.gov/pubmed/26356039

  7. www.ncbi.nlm.nih.gov/pubmed/23273603

  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455070/

  9. https://doi.org/10.1089/acm.2005.11.189

  10. https://doi.org/10.1089/acm.2005.11.711

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