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The doctor: Tired and can’t concentrate? It may be adrenal dysfunction

1A significant proportion of my clients experience symptoms such as fatigue, sleep difficulties, mood disorders and poor concentration, which are often brushed off by the doctors they consult as “just one of those things.” They are invariably left with a mountain of normal tests and the belief they are imagining their problems.

The reality is that most of these people are stressed. Unfortunately, complaining about stress carries negative connotations. It is also perceived to be a part of normal life, traditionally difficult to quantify and poorly understood.

So what is this “stress”?

Stress is the body’s way of responding to a demand or threat.  The human body evolved a beautifully complex biological system called the HPA (hypothalamus-pituitary-adrenal) axis. In simple terms, this is our fight or flight response.    

• Hypothalamus – This is the region of the brain that connects the autonomic nervous system and the endocrine system with the pituitary gland. It is important in maintaining bodily homeostasis – through regulating sleep, emotions, body temperature, hunger, thirst and more.
• Pituitary gland – This is another another tiny gland located in the brain. It is considered the master gland because it regulates other endocrine glands.
• Adrenal glands – These are located on top of the kidneys. They produce a number of important hormones such as adrenaline and cortisol.

Cortisol is the adrenal hormone in the HPA axis that we often refer to as the stress hormone and which tends to get most of the attention, although it’s actually only part of the picture. Cortisol — in synchrony with many other hormones — sounds the alarm in times of stress, preparing the body for a physical response.

The adrenal glands are responsible for many of the functions we need to stay alive and healthy, including:

Converting carbohydrates, proteins and fats to blood glucose for energy
Balancing fluids and electrolytes
Storing fat

Cortisol is extremely important for keeping our body systems in balance, as well as protecting our cells. For example:

It controls the strength of the immune system: too much cortisol weakens the immune system, setting the stage for increased susceptibility to infections and cancer. Too little leads to an overactive immune system and autoimmune disease.
It normalizes blood sugar.
It regulates blood pressure and electrolyte balance

As you can see, the HPA axis has been vital to our survival, particularly during periods of danger. Unfortunately, our modern lifestyles have tipped the safety-danger balance into chronic survival mode and over-activation of the HPA axis. Adrenal dysfunction occurs when the amount of stress overextends the capacity of the body to compensate and recover. Ironically, it is this constant perception of danger that is now making us sick.  

This is often given the misnomer of adrenal fatigue in popular health articles and media. However rather than a burning-out of the adrenals, there becomes a dysregulation and blunting of the HPA axis response, culminating in a variety of signs and symptoms.

Difficulty awakening from sleep
Need of stimulants to get going in the morning
Afternoon or evening fatigue
Central weight gain
Frequent illness and infection
Difficulty dealing with deadlines
Lack of libido
Low blood pressure
Poor memory or ‘brain fog’
Loss of executive functioning
Hunger cravings
Thinning of skin and loss of hair
Low body temperature

So why are we in survival mode, anyway?

It is important to point out, that when most people refer to ‘stress’, they tend to think of it in the context of emotions. It is true to say that chronic emotional stress is very common in Western society. The most common causes of stress are work pressure, changing jobs, death of a loved one, moving homes, illness and marital disruption. However, cortisol can be triggered by external and internal factors, meaning it can be kicked on by a fear-inducing boss as well as an unhealthy diet. Excessive stress can be from many different sources:

Emotional stress
Environmental toxins
Disrupted day-night rhythm and poor sleep
Poor diet and nutritional deficiencies
Chronic infections or illness
Under-eating or over-exercising
Poor gut health

How do we treat adrenal dysfunction?

The first step is to identify the problem and find a clinician who can help diagnose and guide treatment. The solutions are remarkably simple on paper but often difficult to sustain unless a firm commitment is made to making lifestyle changes. Identifying and removing stressors is the most important step, although frustratingly for some, these can be subtle in nature. Here’s a few lifestyle tips: 

Restore a consistent day-night rhythm; waking and sleeping more in-tune with sunrise and sunset.
Base your nutrition around a balanced, non-genetically modified, whole food diet
Correct any nutritional deficiencies
Avoid negative people
Incorporate gentle-to-moderate exercise into your daily routine. Be careful not to over-train, which can put more stress on the adrenals.
Find ways of incorporating mindfulness and relaxation exercises into your daily routine
Improve the quality of your water and air consumption. This often involves restricting drinking to mineral or spring water, implementing water filters and installing air purifiers.
Consider adrenal-supportive supplements: Vitamin C, B-complex, chromium, Magnesium, Zinc and Vitamin E
Consider Adaptogenic herbs or hormonal therapy, under the guidance of your functional medicine physician  

The final point worth remembering is that adrenal dysfunction is often an accumulation of stress over a prolonged period of time, sometimes a number of years. Therefore, restoring normal adrenal function can require perseverance for a number of months before optimal health is achieved.

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