Adrenal fatigue presents a complex clinical picture, but it ultimately provides answers to many questions about the effect of chronic stress on the body, as well as many symptoms that medical experts could not explain, which caused intense discomfort in patients.
In this last chapter of the series of articles on adrenal fatigue, we will present some of the therapeutic strategies available, which have been shown to combat the causes associated with it, and consequently the enormous burden that this places on those who suffer from it.
Dr. Alfonso Galán González – Neolife Medical Team
When faced with unavoidable stressors, the patient’s response is key.
In this last chapter of the series of articles on adrenal fatigue (AF), we will present some of the therapeutic strategies available, which have been shown to combat the causes associated with AF, and consequently the enormous burden that this places on those who suffer from it.
Our knowledge and understanding of AF is continuously expanding and consequently so are the treatment options available, although studies published on the matter are still scarce.
The management of adrenal fatigue includes reducing the stressors of the hypothalamic–pituitary–adrenal axis (HPA), enhancing the hormonal action of this axis, and supporting all those systems that have been damaged by the catabolic effect of elevated cortisol levels and low levels of dehydroepiandrosterone (DHEA).
Many of these measures fall into the category of what we would call “lifestyle changes”, so patient collaboration and involvement is key.
Taking control of known stressors
The analysis of the current levels of stress and its management are the obvious starting points for those individuals in whom “avoidable” stress is part of their usual lifestyle.
Work-related stress, which typically includes working late or night shifts, is closely linked to unfavorable cortisol/DHEA ratios.
Having regular patterns of rest, work, meals, etc., as well as daily, weekly, or annual relaxation patterns is critical to maintaining optimal health.
Moderate, non-competitive exercise also helps to reduce stress.
When faced with unavoidable stressors, the patient’s response is key. Learning to perceive and respond to stressful situations in a way that does not affect the HPA axis is very important in the prevention of axis dysfunction (1,2,3).
Control of blood sugar levels
The relationship between stress and blood sugar imbalance is often overlooked. When we think of stress, we usually think of extreme situations, like the death or illness of a loved one, divorce, etc., while other small stressors like blood sugar levels may not occur to us.
The relationship between cortisol and blood sugar is evident given the effect cortisol has on regulating its levels in situations of stress. When we also consider that abdominal fat (the consequence of overproducing insulin and cortisol) produces inflammatory mediators that lead to a higher secretion of cortisol, we see that in many cases, it is difficult to determine what is the cause and what is the effect, and that they are intimately linked phenomena.
Therefore, it is very important to break this vicious cycle of cortisol-insulin-fat-inflammation-stress. How can we do this?
1. Lower the blood sugar impact of the diet.
Both hyper and hypoglycemia are stressors that lead to the production of cortisol. In this regard, we recommend:
- Following a Mediterranean diet.
- Avoiding refined carbohydrates, soft drinks, and increasing the consumption of whole-grain products.
- Not skipping breakfast as it determines blood sugar levels for the rest of the day and allows a good transition from the elevated levels of morning cortisol.
- Supplementing your diet with fermentable soluble fiber if necessary.
- Increasing phytonutrients, the intake of brightly colored vegetables, herbs and spices that improve insulin resistance (4.5).
2. Measure insulin sensitivity early.
It is highly recommended that you measure insulin resistance before blood sugar levels are altered. You need to measure insulin, HDL, LDL and VLDL cholesterol, triglycerides, PCR as an inflammation marker, and assess how they are related to detect early insulin resistance patterns.
3. Measure the cortisol/DHEA ratio.
Without good stress control, an individual will begin to show signs of HPA axis deregulation with low DHEA levels and inadequate cortisol secretion. With this information, plus the symptoms you present, we may diagnose adrenal fatigue, and you may start implementing changes.
4. Maintain an adequate sleep pattern.
Poor sleep quantity and quality is directly linked to visceral fat and HPA axis dysfunction. In fact, sleep deprivation is a method used to recreate stress in studies of the HPA axis. Moreover, obese patients present a higher risk of developing sleep apnea, which worsens their already altered physiological clinical picture. The recommendation is to maintain a regular sleep pattern of about 7 hours every night.
5. Set realistic goals.
Your adherence to the program is absolutely essential if you wish to achieve your goals. Rather than a weight loss goal, your focus should be on improving insulin resistance and reducing inflammation.
Vitamins and minerals
The synthesis and secretion of cortisol depends on an adequate intake of several vitamins, such as vitamin C, Niacin (B3), pantothenic acid (B5), Biotin (B8), and folic acid (B9). The relationship between the adrenal cortex and minerals is complex. The aldosterone produced in the adrenal cortex has a profound effect on mineral regulation. When cortisol and aldosterone are stimulated with stress, both lead to a loss of potassium. Moreover, in stressful situations the level of calcium in the lower gland, and the levels of potassium, zinc, iron, and copper in the blood are also compromised. A well-balanced vitamin and mineral supplement is critical for adrenal recovery (6).
Phosphatidylserine is a membrane phospholipid that is essential for all cells, especially brain cells. Several studies have shown that supplementing it lowers the cortisol stress response (7,8).
Pregnenolone and DHEA
Pregnenolone, which has already been widely reviewed in another blog post (click here), is a precursor to the other adrenal hormones and has also been shown to have a role in regulating cortisol fluctuations.
The use of DHEA, also reviewed in this blog (click here), has been proposed as beneficial. Several studies suggest that increasing DHEA levels via supplementation in patients with low levels of DHEA or altered cortisol/DHEA ratio helps combat the catabolic effects of cortisol without affecting its production (9).
An adaptogen is defined as any substance that improves the body’s ability to resist stress and which exerts a balancing effect on various systems of the body (immune, nervous, cardiovascular system, etc.). Several botanicals have been proposed as adaptogens: Siberian ginseng, Ashwagandha, Astragalus membranaceus, etc.
The effect of adaptogens in combination with vitamins and minerals has been shown to be additive and beneficial for HPA axis dysfunction (10).
This is where this series of articles on adrenal fatigue comes to an end. As you can see, adrenal fatigue presents a complex clinical picture, but it ultimately provides answers to many questions about the effect of chronic stress on the body, as well as many symptoms that medical experts could not explain, which caused intense discomfort in patients. There is a lot of work to be done, obviously, to clarify the mechanisms that lead to each symptom and to find better and more effective forms of treatment. But it is evident that the adrenal gland should be at the center of this research.
(1) Gadinger, M. C., Loerbroks, A. et al. Associations Between Job Strain and the Cortisol/DHEA-S Ratio Among Management and Nonmanagement Personnel. Psychosom Med. 2010.
(2) Kyrou, I., Chrousos, G. P. et al. Stress, visceral obesity, and metabolic complications. Ann N Y Acad Sci. 2006; 1083:77-110.
(3) Elenkov, I. J., Iezzoni, D. G. et al. Cytokine dysregulation, inflammation and well-being. Neuroimmunomodulation. 2005; 12(5):255-269.
(4) Nilsson, A. C., Ostman, E. M. et al. Effect of cereal test breakfasts differing in glycemic index and content of indigestible carbohydrates on daylong glucose tolerance in healthy subjects. Am J Clin Nutr. 2008; 87(3):645-654.
(5) Nilsson, A. C., Ostman, E. M. et al. Including indigestible carbohydrates in the evening meal of healthy subjects improves glucose tolerance, lowers inflammatory markers, and increases satiety after a subsequent standardized breakfast. J Nutr. 2008; 138(4):732-739.
(6) Jaroenporn, S., Yamamoto, T. et al. Effects of pantothenic acid supplementation on adrenal steroid secretion from male rats. Biol Pharm Bull. 2008; 31(6):1205-1208.
(7) Monteleone, P., Beinat, L. et al. Effects of phosphatidylserine on the neuroendocrine response to physical stress in humans. Neuroendocrinology. 1990; 52(3):243-248.
(8) Monteleone, P., Maj, M. et al. 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):385-388.
(9) Genazzani, A. R., Pluchino, N. et al. Long-term low-dose oral administration of dehydroepiandrosterone modulates adrenal response to adrenocorticotropic hormone in early and late postmenopausal women. Gynecol Endocrinol. 2006; 22(11):627-635
(10) Panossian, A. and Wikman, G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol. 2009; 4(3):198-219.