Stressed and Tired: Adrenal Support part 4

In this final installment of my adrenal stress series, let’s take a look at low cortisol and the end stages of adrenal fatigue.

Recall that in the first stages of adrenal stress the cortisol is upregulated and the patient presents with anxiety, irritability, nervousness, and an inability to cope with stress. When that condition goes on long enough, the adrenals eventually become very fatigued and cortisol drops off to below normal, and sometimes flat lines altogether. When that happens, severe and prolonged fatigue sets in, and along with it a whole host of other related maladies, such as low libido and reproductive problems, muscle aches and inflammation, low immunity, and allergic reactions, to name just a few.

Nutritionally, these patients need aggressive support in nourishing the adrenal glands directly with adrenal extract, B-vitamins, magnesium, etc, as discussed in previous posts. But the plant kingdom also offers some very powerful options for supporting the entire HPA axis in these patients.

Of note are four herbs in particular: Rhodiola, Cordyceps, ginseng, and Licorice.

Rhodiola
Also known as “Arctic Root,” Rhodiola is a flowering plant that grows at high altitudes in regions of Eastern Europe and Asia. In Russia, rhodiola has been used for centuries to cope with the cold Siberian climate and stressful life, where it was valued for its purported ability to promote energy and stamina, enhance mental and physical performance, and prevent fatigue. Russian scientists conducted a great deal of anti-stress research on rhodiola, who categorized is as an adaptogen due to its ability to increase resistance to a variety of chemical, biological, and physical stressors. Based upon the impressive results of this research, rhodiola became widely used by Russian athletes and cosmonauts to help maintain energy levels, promote a healthy mood, and increase attention span and physical performance.

Cordyceps
Cordyceps is one of the most valued medicinal plants in Chinese medicine, where it is traditionally used as an adaptogen to support vitality, as a lung and kidney tonic, and to stimulate libido. It has similar properties to those of ginseng, such that it is traditionally used to strengthen the body after exhaustion. The wide spectrum of activities of cordyceps in quite impressive, with observations of beneficial effects on the respiratory, renal, hepatic, cardiovascular, immunological, and nervous systems, as well as glucose and lipid metabolism.

Asian Ginseng
Ginseng root is a highly valued tonic in traditional Chinese medicine, noted for its ability to stimulate mental and physical activity, enhance stamina and prevent fatigue, and increase resistance to stress. According to tradition, the individual who will benefit from ginseng is run down and has exhausted his/her reserves. Although the exact mechanisms have not been determined, animal and human studies suggest that ginseng may influence the activity of the HPA axis in multiple ways. These mechanisms may include 1) promoting the synthesis of corticosterones by increasing levels of cyclic adenosine monophosphate in the adrenal cortex, 2) influencing feedback mechanisms of stress hormone receptors, 3) stimulating adrenocorticotropic hormone (ACTH) in the pituitary gland, 4) increasing HPA sensitivity to glucose corticoids, and 5) inhibiting cortisone-induced adrenal and thymic atrophy. Through these actions, ginseng appears to promote a healthy stress response by helping to balance HPA axis function.

Licorice

Licorice is an herb with an unparalleled reputation for promoting health and longevity, and it has gained a reputation for strengthening the body during periods of stress. This perennial herb is native to southern Europe, Asia, and the Mediterranean, and was used by ancient Chinese, Egyptian, Greek, and Roman cultures. Currently, licorice is not only one of the most frequently used herbs in traditional Chinese medicine, but it is one of the most popular and widely used herbs in the world. Licorice is well known for its ability to influence adrenal hormone levels. The adrenocorticoid activity of licorice is associated with glycyrrhizic acid and glycyrretinic acid. These activities have ben reported to bind to both glucocorticoid and mineralcorticoid receptors, possibly displacing endogenous steroids and thus contributing to an increase in cortisol availability. Additionally, research suggests that glycyrrhizic acid and glycyrretinic acid increase the half life of cortisol by inhibiting its enzymatic breakdown in the kidneys and liver, thus it is an excellent choice for those with low cortisol production.

Licorice also demonstrates immunosupportive, immunomodulatory, hepatoprotective, and detoxifying qualities. In addition, licorice is traditionally and widely used to promote the health of and soothe mucous membranes of the respiratory and digestive systems.

While the best method of dealing with stress is to get out from under it, that is not always possible in the fast-paced Westernized culture. However, nutritional support of stress defense mechanisms is an excellent way to prevent and treat stress-related conditions.

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Related formulas:

Adreset

Licorice Plus

Managing Stress-Related Disorders, Part 3: Adrenal Extract

The endocrine system is like a house of cards. It is an interwoven system where all the individual components are interdependent. It is therefore difficult to affect one area of it without tripping off the whole thing. That is important in understanding adrenal fatigue, because the stress on the adrenals could actually be caused by another malfunctioning system, such as that of blood sugar metabolism. But that is a discussion for another day.

In the last post I talked about hypercortisolemia, where the cortisol is in a chronic state of elevation and the patient manifests with anxiety, restless sleep, irritability, etc. When that state goes on long enough, soon the adrenal glands begin to fatigue and the cortisol drops off. Since we need a certain amount of cortisol for normal function, a lack of it can cause terrible fatigue, low libido, a loss of drive and motivation, and eventually inflammation.

For this post, let’s focus on treating low cortisol with the use of adrenal glandulars.

Glandular Therapy for Adrenal Support
The concept of using animal tissues in treatment of disease and support of health is a controversial one in medicine, with opinions ranging from useless to miraculous. On the one hand, we have thyroid hormones, insulin, and estrogens, for example, which are used routinely. On the other hand, we have extracts of tissues from glands such as adrenal, pancreas, pituitary, thyroid, etc, which can be taken orally to help support those same tissues in humans.

The argument against using glandulars as supplements is that it is simplistic to think that eating an animal’s glands would help strengthen one’s own like glands. From a medical perspective, one should be able to measure the hormone activity of any substances used and monitor their effects in the body. Glandulars, however, are usually measured by the amount of the actual glands present, but we do not really know what they do. Further, since these glands are broken down into their basic nutrients in the digestive tract, many believe that they would not necessarily go directly to improve one’s own glands.

The pro argument is that it is likely that the basic components of those gland tissues may offer the precursor substances that our own bodies and glands can use to enhance their functions. And there may be hidden factors that may offer some benefit. The glands, like foods, supply basic nutrients, such as amino acids, fatty acids, vitamins, other active substances, and a potential "life force," for lack of a better term, where a drug will not. Some evidence from radioisotope studies suggests that glands, when eaten, do in fact influence the function of the human glands.

In modern medicine, glandular therapy began in the late nineteenth century when physicians suggested that their patients eat the animal parts, usually from cows, that corresponded to the weak areas of their own bodies. So people began eating brains, hearts, kidneys, and so on as part of their medical treatment.

Actually, glandular therapy began much earlier than this, as the ancient Greeks and Egyptians used it following their basic premise that "like heals like." Technology and medical endocrinology evolved this therapy by isolating specific hormones at the source of the glands’ activities (just as we extracted the active pharmaceutical drugs from whole plants). These new drugs are more potent, but they also have more potential for dangerous side effects than the whole glands.

For example, desiccated thyroid gland was first utilized in the late 1800s to help people with goiter and low thyroid function. Then thyroxine (T4) was isolated and used, but many doctors still preferred the whole gland as it was felt to be better absorbed and utilized by the body. Later, the other thyroid hormones, triiodothyronine (T3) and calcitonin were discovered, but these were always part of the whole gland. Today, both individual synthetic hormones and measured active thyroid tissue are used to support or replace thyroid activity.

In the early 1920s, insulin was isolated by Sir Frederick Banting and Charles H. Best, who received the Nobel Prize for their discovery. Insulin has been a lifesaver for many diabetics, but it is also a potentially dangerous drug because it has such a narrow range of safe uses. Overdoses can cause very low blood sugar and shock. Insulin is destroyed in the gut, so it must be injected. It is possible that when extracts of pancreatic tissue are used as supplements, as with other glands, certain molecules protect the active hormones from the digestive juices, and some of these substances actually get into the body. The whole pancreas gland, which had previously been used, is certainly safer than insulin, but pancreas itself is not thought to be strong enough to treat diabetes once it is established.

In the case of treating conditions associated with adrenal fatigue, adrenal glandulars are often suggested for people who experience fatigue, stress, environmental sensitivities or allergies, infections, and hypoglycemia. The symptoms that come from low blood sugar are probably more related to adrenal than to pancreas, and supporting the adrenals with freeze-dried adrenal at 50–100 mg twice daily, along with other stress-supporting nutrients, such as the B vitamins, may be helpful. For extremely low cortisol, some physicians find it useful to super-dose with as much as a gram of adrenal glandular with B-vitamins for a period of a few days to kick start the adrenals back to optimal function. This approach would not be recommended for someone who has elevated cortisol, but could be very helpful for those who are experiencing the overwhelming symptoms of low cortisol.

In my 15+ years in this industry, I have come to rely heavily upon third party data, but have also learned to not rule out clinical experience even when research is lacking. And the clinical experience of hundreds of physicians points to the fact that adrenal extracts works extremely well in treating adrenal fatigue and the associated maladies.

In the next post I’ll introduce you to some other very powerful options from the plant kingdom in supporting the HPA axis and sluggish adrenals.

Managing Stress-Related Disorders, Part 2: "Stressed and Wired"

Americans as a lifestyle maintain a state of hyper arousal of the adrenal glands. In this condition the cortisol and other stress molecules are upregulated. This state of arousal is an important survival mechanism for emergency situations, but chronically high cortisol is catabolic and sets that stage of all manner of dysfunction and disease.

For starters, high cortisol causes a chronic state of agitation, irritability, anxiety, nervousness, and even panic attacks. This can affect sleep patterns, increase cardiovascular risk factors, decrease the libido, impair the memory and learning patterns, cause muscle wasting, and reduce reproductive function, to name just a few.

Nutritional Management of Elevated Cortisol: B-vitamins
The B-vitamin family is important in any adrenal support program, because the B-vitamins help to support the neurological system and the adrenal glands themselves and change the way a patient interprets the stress. Folate, for example, ranging from as little as 200 mcg to as much 15 mg, has shown anti-depressive effects. Folate and B12 deficiency has long been associated with depression. B-vitamins are involved in norepinephrine, dopamine, and serotonin synthesis, and are coenzymes in the synthesis of adenosylmethionine (SAM), and shown to have antidepressive properties.

One note of interest is that folate in the form of folic acid does not cross the blood/brain barrier. There is only one form of folate that does, and that is the end metabolite of folate metabolism, 5-methyltetrahydrofolate (5-MTHF). It is important that any B-vitamin complex you are using for depression and/or anxiety contains this form of folate.

Studies in animals have shown that a deficiency in another important B-vitamin, pantothenic acid (B5), mimicked metabolic changes seen in adrenal insufficiency. Administering B5 increases the production of corticosteroids. In humans, it normalized the response to ACTH and deficiency led to reduced resistance to stress.

Vitamin B6 is also essential, in that it is important to the metabolism of most amino acids. It also converts tyrosine to dopamine for epinepherine synthesis and protects from homocystiene overproduction. A derivative, homocystiene lactone, can inhibit ACTH release.

Likewise, the B-vitamin, myo-inositol, has been shown to be remarkably effective by itself in the treatment of panic attacks, obsessive compulsive disorder, and depression. In one study comparing the effects of myo-inositol against the drug, Fluvoxamine, for panic disorder, the myo-inositol “reduced the number of panic attacks per week by 4.0 compared with a reduction of 2.4 with Fluvoxamine. Nausea and tiredness were more common with Fluvoxamine.” J Clin Psychopharmacol 2001 June;21(3)335-9

The American Journal of Psychiatry reported that inositol in doses of 6g/day and 12g/day “is a potential treatment for depression in both open and double-blind placebo controlled trials.” Double-Blind, Placebo-Controlled, Crossover Trial of Inositol Treatment for Panic Disorder, J Benjamin, et al, Am J Psychiatr, 152: 1084-1086

Myo-inositol is especially beneficial in overall nervous system function because it is an important naturally occurring component of cell membranes. Myo-inositol plays a major role in cell signaling by functioning as a precursor of an intracellular second messenger system. This system is especially important in the brain. For example, serotonin and norepinehprine receptors are linked to the inositol second messenger system.

Magnesium
Another micronutrient deficiency that can have an adverse effect on the stress response is magnesium. According the Journal of the American College of Nutrition, magnesium deficiency intensifies adverse reactions to stress. Such reactions are mediated by excess release of catecholamines and corticosteroids, and low magnesium and calcium levels increase the release of stress hormones, which further lower tissue magnesium, creating a snowball effect. Likewise, magnesium plays a role in maintaining healthy levels of the myo-inositol pool in the body.

Herbal Support for Stressed and Wired
A revered “vitalizer” and rejuvenative tonic in Ayurveda (Charaka Samhita 1000 BC), the herb ashwagandha has been traditionally used for stress tolerance, vigor and stamina, convalescence, nervous exhaustion, fatigue, geriatric debility, physical and mental stress, and insomnia, while no side effects have been reported.

Another remarkable rejuvenating herb, holy basil, has anti-stress activity, including a normalizing affect on the CNS. It has been shown to reduce incidence of gastric injury induced by cold stress and restraint stress. It also inhibits the lipoxygenase and cyclooxygenase prostaglandin pathways, antagonizes histamine, and decreases acid and pepsin output, enhances gastric mucosal strength, and helps normalize the stress-response.

Ayurvedic literature attributes a “non-specific increased resistance”to the herb bacopa (also known as brahmi), and has been traditionally used to revitalize the nerves, brain cells, and the mind. It helps to strengthen the adrenals and purify the blood, and in animal testing it improves adaptations in sensory, motor, and motivational systems. In humans bacopa exhibits beneficial effects on anxiety and mental functions (mental fatigue). The effects on the CNS may be mediated through stimulation of gamma-aminobutyric (GABA)ergic and cholinergic systems.

What to Use When
A B-vitamin complex featuring the active form of folate, and/or a high-potency B5/B6 formula is foundational for stress protection and the early signs of adrenal stress, typically presenting in the form of anxiety and high cortisol levels. Additionally, an herbal complex featuring bacopa, ashwagandha, and holy basil can be added for complementary support in helping to rejuvenate the body and support the CNS. If the anxiety becomes severe, one should consider the use of a myo-inositol and magnesium complex to control anxiousness and regulate the mood.

There are a number of other herbal-based remedies as well for the other stages of stress, and we will discuss those in the next post.

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Stress formulas to consider:

Glycogenics

Cortico B5B6

Cenitol

Exhilarin

Mastering Stress Related Disorders

Stress-related disorders has been called America’s number one health problem because it sets the stage for so many other health problems. Stress has been linked to heart disease, cancer, neurological problems, depression, sleeplessness, changes in blood sugar and body composition, and a host of other maladies.

It is interesting to note that those who have a positive outlook on life and generally feel that things just always seem to work out also generally enjoy better health phyically and emotionally. However, those who feel that life is hard and that fortunate breaks are few and far between suffer more health problems. Those who focus on bad news and tend to revolve their lives around the predictions of economists and so on are those who also tend to have the most negative outlooks and tend to suffer more health challenges.

The current statistics on stress taken from Stress.org are as follows:

• 43% of all adults suffer from stress (probably a very conservative number)
  
• As much as 90% of all visits to primary care physicians are for stress-related complaints and/or disorders
  
• Stress has been linked to ALL leading causes of death
  
• National turbulence causes stress to escalate. Doctor visits related to stress went up 40% after 9/11, and current economic concerns have increased the stress load significantly.

Selye’s 3 Stages of Stress
There are 3 stages of the stress response, as identified by Dr. Hans Selye, who pioneered much of the work that has led to our current understanding of the body’s stress response and the disorders that can ensue under chronic stress. The three stages are:

1. Arousal, which is characterized by a rapid release of catecholamines and a slower release of corticosteroids.
   
2. Adaptation, which is characterized by a sustained increased levels of corticosteroids and alarm molecules. This stage often leads to altered glucose tolerance, blood pressure, thyroid hormone and sex hormone metabolism.
   
3. Exhaustion, often characterized by degenerative diseases due to the adverse influence of chronic high levels of corticosteroids and alarm molecules.
   

According to Selye's theory, anything that causes stress endangers life unless it is countered by an adequate adaptive response. If the stress is severe and/or prolonged enough, the body often cannot counter sufficiently, and all manner of maladies can result.

The list of maladies caused by chronic stress is too long to list completely, but here is a partial list:

• Fatigue
• Loss of libido
• Inflammatory disorders like autoimmune disease and allergies
• Apathy
• Chronic pain
• Restless sleep
• Heart attack and increased risk for CVD disease
• Inability to cope with mild and routine stressors in everyday life
• Agitation/irritability
• Depression
• Impaired memory/learning
• Digestive disorders
• Poor immunity
  

What Stress Does Metabolically

Stress pretty much disrupts everything. It increases insulin, cortisol, ephineprhine and norepinephrine, while diminishing all the sex hormones. It also increases oxidative stress and inflammatory mediators, which can set the stage for profound degenerative changes throughout the body.

The thesis for Robert Sapolsky’s excellent book, Why Zebras Don’t Get Ulcers, is that stress in its acute state is necessary and not harmful to the body. When a herd of zebras is confronted with a danger like a predator, for example, the sympathetic dominant state kicks in and stress hormones skyrocket in order to engage all the body systems in preserving life and escaping danger. But when the predator is outrun, they immediately go back to their baseline autonomic state and all is well. The basis for the human stress-related disease, however, is the high percentage of time spent in the sympathetic dominant state, and that chronic state of alarm sends molecules constantly racing throughout the body that can have extremely detrimental consequences when exposed to them long term.

For example, one study in the American Journal of Epidemiology 2003 showed that there was a clear correlation between the risk of breast cancer in women and stressful life events such as divorce/separation and the loss of a husband. Similarly, the British Medical Journal in 2002 showed that “people who reported persistent stress due to high work demands, low job security, or few career opportunities had the same level of risk for fatal heart attacks as people who smoke and do not exercise.”

Dealing with Stress
There are a number of ways to help the body to cope with stress more capably. Moderate exercise, relaxation techniques such as those correlated with prayer/meditation, biofeedback and deep breathing, and diet all play an important role. Also, practicing thankfulness and focusing on what is right in one's life has also been associated with relieving depression and generating a more positive outlook, as has getting involved in humanitarian efforts and community service. Of course, getting out from under chronically stressful situations is the best method of dealing with stress, but that is not always possible in today’s world of fast-paced job demands and dysfunctional families.

Many people simply do not have the reserves to deal with even small amounts of stress, and for them a multi-faceted approach of the above list along with therapeutic supplementation is in order. Certain micronutrients can help the body to interpret the stress differently, and certain combinations of novel botanical agents along with specific micronutrients can help support the hypothalamus/pituitary/adrenal (HPA) axis and invigorate a lack-luster stress response.

The nutritional approach to stress-related disorders will be the focus of the next couple of posts. Stay tuned.