By: Dr. Fred Hui, M.D.

The adrenal glands are walnut-sized glands placed above both the kidneys. Despite their small size, they are responsible for the secretion of several vital hormones – like glucocorticoids (cortisol) which is responsible for glucose metabolism and energy production, mineralocorticoids (aldosterone) which deals with salt and water retention in the body and the sex corticoids. They also produce adrenaline and noradrenaline which play a vital role in dealing with stress and emergencies.
Due to the vital actions of these various hormones, the adrenals play a very important part in our lives by preparing us to face all the stresses in life, and by creating an overall mineral and hormonal balance in our bodies.

FUNCTIONS OF THE ADRENAL GLANDS:

Secretion of Glucocorticoids

• The adrenal glands are rightly called the ‘power source’ / ‘furnace’ of the body because of this function.
• Cortisol(a glucocorticoid secreted by the adrenal gland) works to keep up the body’s glucose and energy requirements between meals.
• This is achieved by :
o releasing stored glucose from the liver
o producing glucose from other sources within the body
o breaking down fat cells for energy etc.

• If you had normally functioning adrenal glands, your cortisol levels would be highest in the morning when you wake up (around 6-8am) and you’d be fresh and ready for the day. You’d most likely be a morning person!
• On the contrary, if you had weak adrenal glands, you would typically feel a lack in ‘horsepower’ throughout the day, especially in the mornings. This is because your ‘battery’ never really gets to ‘charge’ completely due to overuse and ultimately, exhaustion.

Secretion of Mineralocorticoids

• The mineralocorticoid called ALDOSTERONE helps to retain salt and water in the body.

• Patients with low aldosterone therefore can’t retain sufficient salt and water in their bodies, and so their blood volume will be low, at times thereby causing Low BP of around 100mmHg or lower(systolic). And low blood pressure in turn, causes light headedness on getting up quickly because of decreased blood volume and pressure to immediately pump blood into the head. Their external physical appearance would also give them away sometimes – like having a bony face, and dark, sunken eyes.

• Having low aldosterone would be like watering a plant that grows in a pot filled with sand. No matter how much you water it, it would just see right through and out. On the other hand, if it were mud instead of sand, it would absorb and retain the water for further use until the next watering.

• Keeping this example in mind, you can understand why someone with low adrenal function would need to use the washroom so often. If you went to a restaurant for dinner with friends, you might have to use the washroom before, during and after dinner. This is because; water is not absorbed and has to be eliminated right away.

Secretion of Sex Hormones

• Adrenal glands secrete another important hormone called DHEA (Dihydroepiandrostenedione)
• Your DHEA levels can easily be determined by a simple blood test (OHIP-covered).
• It is the precursor for other hormones like Testosterone and Oestrogen and hence the lack of it can cause low libido, vitality, menopausal symptoms, erectile dysfunction, low energy etc.

Secretion of catecholamines

• Catechol amines produced by the adrenals are Adrenaline and Noradrenaline. They are essential for ‘fight and flight’ response in the body. During an emergency, adrenaline draws out an ‘emergency procedure’ which the body follows.

• This includes increasing heart rate (to circulate more blood and oxygen per minute), dilating blood vessels in heart, legs and arms, while constricting those to other organs ( this is to prioritise blood flow during an emergency), increasing the energy available in skeletal muscles (by redirecting glucose to the muscles), dilating pupils etc.

• If the adrenal cortisol level is low or exhausted, the body may even have to rely on this “Emergency Task Force” i.e. Adrenaline to deal with stress.

CAUSES OF ADRENAL FATIGUE

Overworking the adrenals for a prolonged period can cause exhaustion of the glands.
This can be caused by excessive exercise, overworking, job stress, sleep deprivation, fear, anger, depression, guilt, anxiety, surgery, chronic pain/infection/ inflammation, chronic allergies/illnesses etc.

SYMPTOMS AND SIGNS OF CAF

If you have low adrenal function, you might be able to relate to some of these symptoms:

1) Morning tiredness
The production of cortisol by your adrenals glands is highest in the morning upon waking up – around 6
a.m. to 8 a.m. If you`re not feeling refreshed and energetic at this time, your adrenal glands might not be
functioning well enough because they`re exhausted.

2) Exhaustion after exercising
Normally, exercise would perk up one’s energy levels. However, if your adrenals are exhausted, your body wouldn’t be able to fuel this kind of exertion. And if you did push yourself, you might experience a “crash” phase, which might be as long as a nap or up to a few days even!

3) Cold hands and feet
Your adrenal glands are the “furnace” of your body. Feeling cold in your extremities may mean the heat
from the weak ”furnace” is not reaching those parts, which translates to inadequate production of your
adrenal hormones.

4) Very sensitive to environmental changes, like seasons, time zones, and sudden weather changes.
For example, when I travel back from Asia, I can get back to work in full efficiency the very next day with no jetlag or tiredness because my body adapts quickly. This is an example of good adrenal function.

5) Emotionally hypersensitive
Mood swings, cries for small reasons, can be startled easily, sudden angry
outbursts, irritable, impatient, panicky, over reacting to various situations.

6) Brain fog, concentration and memory problems
Adrenal hormones have stimulatory/excitatory effects on the brain and not having enough slows
down the mental processes.

7) Inability to cope with changes and stress–
The adrenal gland is your organ of adaptation- they help to keep the body stable and functional at all
times, by adapting to the ever changing situations in life. This includes all stresses in life, be it physical,
mental, psychological or hormonal.
For example-
• Any upsetting news/arguments can cause a disturbed reaction over the next few days instead of a few hours, thereby hampering daily life.
• Women with low adrenals will have a hard time adjusting to hormonal changes like menopause.
• Emotionally hypersensitive- mood swings, cries for small reasons, can be startled easily, sudden angry outbursts, irritable, impatient, panicky, over reacting to various situations

This can be illustrated by a boat on the waters. If the boat has a good stabilizer, then a wave would only rock it gently. On the other hand, if the stabilizer is weak, then every wave would be like a tempest to it.

8) Low blood pressure, the systolic reading being close to 100 mmHg or even lower.
This can also be associated with being lightheaded, especially on getting up quickly from a sitting/lying position, because the body is unable to react quickly to the change, which in this case would be to immediately increase blood flow to the head. Often, patients crave for salt which helps sustain the blood volume and therefore, the blood pressure.

9) Low blood sugar
In case of delayed meals or in between meals, the body ‘melts’ sugar stored in the liver to keep up with the energy demands. This adaptive controlled release fails in case of low adrenal function and hence would cause low blood sugar levels.

10) Multiple allergies/ sensitivities- could be seasonal, chemical, or even to perfumes and other strong
smells.
Many of these patients try to live in an allergen-free ‘bubble’ by spending a lot of time, effort and money AVOIDING several common situations/ substances – including people wearing perfumes, polluted towns and cities and cleaning chemicals. They are continuously challenged with the tedious task of changing their environment. They AVOID rather than ADAPT.

11) Low immunity and infections – may fall sick easily, chronic flu’s.
In other words, people with low adrenal function seem to be victim to catch infections, or they can’t get rid of lingering chronic infections

12) Inflammation
Patients with low adrenals do not have sufficient amounts of the basic anti inflammatory cortisone which
keeps tissues from being inflamed, and hence they may have skin inflammations, joint inflammation etc.

13) Decreased sex drive – The precursor of sex hormones (DHEA) is produced mainly in adrenal glands and is
found to be low in patients with adrenal fatigue

DIAGNOSING CHRONIC ADRENAL FATIGUE

Cortisol levels in the body can be determined by a simple saliva cortisol test which measures your body’s cortisol levels at 4 different times of the day.
For example, the production of cortisol by adrenals glands is highest in the morning upon waking up – around 6 am to 8 am. A drop in your levels around this time can explain your lack in morning energy.

• The saliva samples will be sent to the USA and the results received by us in approx. 3 weeks. This will then be interpreted by me- and on the basis of your levels and symptoms, the severity of your condition will be assessed. Accordingly, a treatment plan will be drawn out for you.

HOW TO TREAT ADRENAL FATIGUE

1) LICORICE DROPS

• This is a way to top up your cortisone levels without actually taking any medication.

• The brand I usually prescribe is St. Francis whole licorice drops- 30 drops in the morning, noon and late afternoon. This is available in most health food stores.

• How does licorice work?
It slows down the breakdown of the cortisone molecule. So, if each molecule of cortisone generally lasts around half an hour in the blood circulation before it’s broken down, the licorice causes it to remain for 45 mins. In this way, the number of molecules in circulation at any given time is increased, thereby increasing cortisone levels in blood without any external supplementation.

2) HORMONAL REPLACEMENT / TOP-UP METHODS

A) CORTEF(GENERIC NAME: HYDROCORTISONE)

• This is a higher level of Glucocorticoid (Cortisone) ‘top-up’ that I use in patients that have severe symptoms, and when quick intervention is needed.

• Cortisone replacement has been largely misunderstood by most doctors and patients too.
• In conventional medicine, the most commonly prescribed cortisone is PREDNISONE. It is prescribed only when symptoms are severe, for patients with eczema, asthma, arthritis, allergies and other inflammatory conditions.

• It’s a good quick-fix for getting rid of these symptoms and on completion of the course; the drug is slowly tapered off because of a risk of dependence. If the dose is not tapered off on time, you will begin to show symptoms of too much cortisone – like high bp, high blood sugar, puffed face, disturbed sleep, weight gain etc. Due to these reasons, your regular doctor would discourage you from starting any cortisone drug.

• Prednisone is a very potent drug that can cause dependence, and is prescribed in a suppressive dose (i.e. the dose is so high that the body’s own secretion of cortisone is suppressed). Each mg of prednisone is 4 times more potent than per mg of Cortef.

• Cortef, however, is a bio-identical, less potent, very low dose form of cortisone. This is a ‘supplemental dose’ as opposed to the ‘suppressive dose’ with prednisone. This allows you to get the benefit from cortisone, without actually suppressing or permanently affecting the secretive function of your glands.

More information on Cortef:

• To reassure yourself, I’d suggest you to google “adrenal fatigue+ hydrocortisone (or cortef)”. You will find several pages of information, reassurance and testimonials posted by naturally inclined doctors and patients who have used Cortef.
• Also, for patients who have been advised to take this drug for a longer duration, the book “Safe use of Hydrocortisone” by William Jefferies (available through Amazon) gives all the details you need on every aspect of cortisol.

The dosage:

The usual dosage I prescribe is
• 10mg in the morning on waking up,
• 5mg at noon, and
• 5 mg at 5pm

Hydrocortisone molecule has a short half life, and does not last >4hrs in our bodies, and this is why more frequent dosing is required.

Dr. William Jefferies recommends the bedtime dose of 5mg because he found that the patients woke up feeling more energetic because of residual hydrocortisone from the night dose. This, however, may cause sleep disturbances in some patients due to the energising effect it can have on our bodies. This is an individual variation and so, I would suggest that the bedtime dose must first be tried for a day or two. If it disturbs sleep – change dosage to 10mg (morning), 5mg (lunch) and 5 mg (supper).

The rare “CRASH” you should know about:

A small percentage of patients may experience a ‘crash’ when they start the hydrocortisone replacement regimen.

Contrary to what you’d assume, this is NOT because of a sensitivity you’re experiencing to the medication, and the action to be taken is NOT to taper to a lower, more comfortable dose.
In fact, if you feel a crash on initiation, this transition period calls for a doubling of dosage. Therefore, instead of 10,5 and 5 mg, you’d need to take 20,10 and 10 mg until your body adapts to the external supplementation, and this can then be tapered off to the original low dose over the next few days.

Explaining the crash:

Assume your body requires 50mg of cortisone to function ideally. Due to adrenal dysfunction, you produce only 30mg normally – but due to increased demands like excessive exercise, parenting and struggling hard to keep your job in spite of severe fatigue, your body cranks up the output to about 40mg, which is still below the required amount and yet completely exhausts your adrenals.

The 20 mg of cortisone given is to supplement the 30mg you produce yourself, so that you get the required 50mg. However, in a few patients, the adrenals have been so overworked and fatigued for so many years that when it receives the signal of an external supply of cortisol, it decides to take a breather. When this happens and the body suddenly stops producing the usual 30 mg, the only cortisol you receive is the 20mg you orally take, which is now 30mg below the normal requirement, and this causes the crash.

Experts suggest that during this period, the dose has to be doubled until the adrenals adapt, and in a few days the dose can be tapered to the standard low dose of 20mg.

B) FLORINEF (GENERIC NAME: FLUDROCORTISONE)

• Florinef is the low-dose ‘top-up’ medication that I prescribe for patients who are significantly low in aldosterone.
• As mentioned in detail earlier, aldosterone is the water and mineral retention hormone produced by the adrenal glands.
• Deficiency of this hormone may result in low blood volume, low blood pressure, light headedness, increased urination, bony face and sunken facial features.
• The dosage I usually prescribe is 0.1 mg a day. You may be advised to start with HALF a pill (0.05mg) a day, and increase it upto one pill (0.1mg) a day until your systolic blood pressure crosses 100 mmHg.

C) DHEA

• As explained earlier, DHEA is asex hormone produced by the adrenal glands. In patients with CAF, it’s very likely that they would be low on this hormone as well.
• Your DHEA levels can easily be determined by a simple blood test (OHIP-covered).
• DHEA is a precursor for other hormones like Testosterone and Oestrogen and hence the lack of which can cause low libido, vitality, menopausal symptoms, erectile dysfunction, low energy etc.
• The dosage I prescribe is usually 25mg a day, to be taken early in the morning before breakfast. The dosage may vary depending on how low your levels are.

3) I.V ADRENAL DRIP

• To understand how adrenal drips work on your body, you must first understand what your body is going through inside, if you have adrenal fatigue.

• Adrenal activity is regulated by the pituitary gland. When the adrenals are fatigued, the pituitary produces ACTH to perk up the adrenals to produce more hormones. Although this works for a while, they may become overworked and unable to respond later. The ACTH now simply stresses the glands further and causes them to fatigue more quickly. The lower the adrenal activity, the more ACTH is produced, which fatigues the adrenals further. This is a vicious cycle. As long as the ACTH ‘whip’ is around, the adrenals do not get a chance to regenerate.

• The adrenal drip you are prescribed contains Adrenal support injection. This fools the pituitary to believe that the adrenals are back on track, and therefore it stops the ACTH production. This finally gives the adrenals a much deserved chance to rest and regenerate.

• Your drip also contains a mix of several minerals and vitamins like Calcium, Magnesium, Zinc, Chromium, Selenium, Manganese, Potassium, Copper, Vit B5, B6, B complex, B12, Vit C etc. These minerals serve as the raw materials that help to rebuild the gland.

• The usual recommendation is two infusions per week for the first 10 weeks, each around 90 mins each. This varies from patient to patient, depending on the severity.
• This is followed by an assessment of your progress and accordingly, you will be advised to either continue or gradually stop and go on a maintenance dose.

DIET RECOMMENDED FOR ADRENAL FATIGUE

According to Chinese medical concepts, patients can be divided into Excess and Deficient.
‘Excess ‘patients are usually obese, have high bp, higher body temperature, more adrenaline, skin easily breaks out in pimples and are quick tempered. They would do well with a cooling diet, which I will explain below.
‘Deficient’ patients, on the other hand, are low in heat, energy, bp and are docile. They should be encouraged to have a warming diet.

‘Cooling’ & ‘Warming’ diets

The temperature, nature of food and method of cooking are very important factors that govern the suitability of the food for an individual.

The temperature of food

‘Deficient’ patients should avoid cold salads, water etc. Suppose you drink 3 glasses of cold water, and urinate it out at your body temperature in a few hours. You would lose a lot of body heat in the transaction, and this would cool you down further and shift you further away from a healthy state.
‘Excess’ patients are therefore encouraged to have cold salads, sandwiches and cold water, and ‘deficient’ patients should have more hot soups, hot tea, ginger tea etc.

The nature of food

Warming foods would include hot soups, ginger tea, steaks, hamburgers, all fried food etc. Very often, the only vegetable that seems to be included in ones’ diet are French fries! However, since high bp and obesity are major concerns here in Canada, they must actually refrain from having these foods.

Cooling foods would include raw vegetables, cold fluids, fruit salads etc. Deficient people would cool down further if they took these foods and hence must limit their intake. Unfortunately, low adrenal patients, like all people with illnesses, are advised by natural practitioners to eat ‘healthy’ by including raw vegetables and fruits in their diet. This is against the Chinese medicine diet concepts and it’s been noticed that a fair number of patients that come with adrenal fatigue, are weaker and sicker because of this low energy diet they’ve been advised.

The method of cooking

The more raw the food, the more cooling it will be to the body, and the more cooked the food, the more warming it is. This is because raw food requires more energy to be digested whereas cooked and fried food are already partially broken down and need significantly less energy to digest. Therefore, a raw tomato will be more cooling than a stewed/pan fried tomato.

Patients with low adrenal function would do best to refrain from raw salads and choose cooked foods instead, to not lose further energy.

MORE INFORMATION ON CAF:

A website that will greatly help you to understand your condition, the signs and symptoms, treatment and all other aspects of it is www.nthadrenalsweb.org .