STRESS, CORTISOL AND FATIGUE

How the adrenal hormones can make or break your health.

by Virginia Hopkins and John R. Lee, M.D.

     Underlying many of the symptoms of premenopause syndrome in most women are two tired adrenal glands that have been flogged for years into over-producing the “up” hormones epinephrine, adrenaline, androgens, and cortisols. In Western industrialized societies in general, and in America in particular, we love to be in a high energy mode, zipping and zooming around being busy and efficient. What this means in terms of our hormone balance (men and women) is that we exist in a culture that lives off of its adrenal function.

What are the Adrenal Glands?

     The adrenals are two small glands, about the size and shape of a flattened prune, that sit on top of the kidneys. Different parts of the adrenal glands play different roles in regulating the body. One part plays a role in speeding up the heart rate, narrowing blood vessels and raising blood pressure and blood sugar, by secreting two hormones called epinephrine (also called adrenalin) and norepinephrine (noradrenalin). You probably recognize the name epinephrine because synthetic variations of this hormone are found in over-the-counter cold and allergy remedies that work by narrowing blood vessels. Epinephrine (adrenalin) is the hormone secreted when you're under stress. To help you respond to the stress and in response to the release of these hormones, your body simultaneously and quickly speeds up the heart and sends blood flooding into the heart, lungs, muscles and brain, and away from the digestive system; sugar is dumped into the blood in large quantities to provide quick energy; and breathing is faster.

     When we're stimulated by epinephrine we tend to be very alert, focused and energetic. This type of energy is particularly valued in the business world. Some people will work themselves into an anger or fear response just to get a “hit” of epinephrine. The bad news is that epinephrine is not a hormone meant to be used all the time — it's designed to be used in emergencies for short bursts of intense energy. If we're always calling on our epinephrine to get us up and going, eventually we fall prey to an imbalance and our adrenal medulla becomes exhausted.

     Other parts of the adrenal glands play literally dozens of ongoing roles in regulating blood sugar, the movement of carbohydrates, proteins and fats in and out of cells, inflammation, muscle function, mineral balance and kidney function.

     Chronic stress causes chronically elevated levels of cortisol. The adrenal glands respond to any stressors that increase energy requirements. Fasting, infection, intense exercise, pain, or emotional or mental stress stimulate the secretion of a releasing hormone from the hypothalamus in the brain, which tells the adrenals to secrete extra cortisol and other stress hormones. There’s also a regular daily cycle of cortisol release into the bloodstream, with peaks in the morning and late afternoon and lows in mid-afternoon and during deep sleep.

Symptoms of Too Much Cortisol

• Weight gain (especially around the mid-section)
• Blood sugar imbalances (a good clue to these symptoms is whether you're a sugar junkie and/or get shaky when you don't eat regularly)
• Thinning or papery skin
• Muscle wasting
• Memory loss

     Recent research has shown that people who have high cortisol levels year after year from leading overly stressful lives age faster and have more deterioration in the part of the brain called the hippocampus which is responsible for memory and spatial navigation.

     It's possible for a woman to have both the symptoms of excess cortisol, from years of chronic stress, and the symptoms of adrenal exhaustion, which is the inability to maintain adequate production of adrenal steroids. The symptoms of cortisol deficiency are included in the symptoms of tired adrenals, listed below.

Symptoms of Tired Adrenals

     If you have some or all of the following symptoms, you may be suffering from what is known in the medical world as mild adrenal insufficiency, and what we like to call tired adrenals:

• Constant fatigue, especially in the mornings when trying to get out of bed and after exercise
• Muscle weakness
• Low blood pressure
• Low metabolism coupled with decreased thyroid function
• Excess pigmentation, which may look like tanning or dark freckles on the skin
• Allergies and/or asthma
• Low reserves for coping with stress — if anything doesn’t happen on schedule, you're unable to meet demands and have to take time to recuperate
• Irregular menstrual cycles, fibrocystic breasts, anovulatory periods, infertility
• Difficulty resisting infectious illnesses like flu and upper respiratory infection
• Depression caused by the constant fatigue, weakness and inability to cope with stress

     Women with tired adrenals often suffer from low pressure, which can cause weakness and dizziness. One of the best cures for low blood pressure caused by tired adrenals is salt. It's a misconception that salt is bad for everyone — excessive salt can create high blood pressure in some people. Using a moderate amount of salt is perfectly healthy, and it's unhealthy to eliminate it from the diet.

     Women with tired adrenals usually get a lot of benefit from using natural progesterone cream. They may also need to use some natural cortisol in small doses to regain hormone balance.

How High Cortisol Affects Your Other Hormones

     Chronic stress leads to chronic high levels of cortisol in the bloodstream, which creates a need for more hormones (e.g. thyroid, insulin, progesterone, testosterone) in order to do the same job. According to Dr. David Zava, who has studied the interaction of cortisol and hormones, “When cortisol is high the brain is less sensitive to estrogens. That’s why you can have a postmenopausal woman with reasonable amounts of estrogen, but when you put her under a stressor and her cortisol rises, she’ll get hot flashes, which are a symptom of estrogen deficiency. She really doesn’t have an estrogen deficiency, the brain sensors have just been altered. If you then drive the estrogen levels up with supplementation to treat the hot flashes, she’ll start getting symptoms of estrogen dominance like weight gain in the hips, water retention, and moodiness. And the hot flashes usually don’t go away. This is why you often can’t effectively treat someone with hormonal imbalance symptoms such as hot flashes by simply adding what seems to be the missing hormone, be it thyroid, progesterone, estrogen or testosterone. If your cortisol is chronically high you’ll have overall resistance to your hormones. It’s essential to address the stress factor if you want to achieve hormone balance.”

How to Support and Heal Your Adrenals

     The single best remedy for restoring tired adrenals is rest. If you have tired adrenals and you try to prop them up with supplemental hormones and herbs without resting, you may get away with it for awhile but eventually that will stop working too and you'll create disease in your body. You need to do both if you want to heal. Here’s a list of things you can do to support and heal your adrenals.

• Use natural progesterone cream to support adrenal hormone production
• Manage chronic stress more effectively through creative outlets, exercise, counseling, journaling, etc.
• Get enough sleep and play time
• Take an adrenal-supporting herbal formula that includes some or all of the following herbs: licorice root, bupleurum, peony root, dioscorea, Siberian ginseng, smilax (sarsasparilla).
• Increase salt if you have low blood pressure (use sea salt)
• Check your thyroid symptoms and levels
• Take a good multivitamin/mineral supplement daily that includes:
• The B complex vitamins (all of the B vitamins)
• Magnesium 300 to 400 mg daily
• Vitamin C, 500 to 1000 mg daily
• Vitamin E, 400 IU daily
• Check your hormone levels and supplement DHEA if needed, 5 to 10 mg daily or every other day.
• Have your doctor check your cortisol levels and supplement natural hydrocortisone in small, physiological doses if needed (5 to 10 mg, 1 to 3 times daily, with meals).
• Avoid:
• Chronic stress
• Stimulating herbs such as ephedra, and caffeine
• Sugar and refined carbohydrates
• Dairy products
• Feedlot meats (eat only range-fed meats that are drug free and free of pesticide residues)

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Note: Parts of this article were excerpted from Hormone Balance Made Simple and What Your Doctor May Not Tell You About Premenopause, by John R. Lee, M.D. and Virginia Hopkins