In the last blog article we discussed the role of the adrenal glands in the body and the health consequences that can occur when they become out of whack. In this article, we will take a look at how we are able to find out if someone has adrenal dysfunction and what steps they can take to help correct the imbalance.
Cortisol Should Follow A Predictable Rhythm
The adrenal glands are rather predictable in the way that they produce cortisol, one of the most important hormones in the human body. The adrenal glands produce cortisol all throughout the day, with the largest amounts released first thing in the morning, and then again at around noon, 4:00-5:00pm and around 10pm. In theory, the cortisol released should follow a diurnal rhythm with the cortisol released first thing in the morning at the highest level and each corresponding surge of cortisol being less than the previous one. The bedtime cortisol level should be at the lowest level.
Testing For Adrenal Dysfunction
The gold standard for testing cortisol is to do four blood draws at the corresponding times of the day where cortisol activity is predicted to be the highest. However, it is not reasonable to collect blood in a lab in the evening or around bedtime so this option is not great unless in the hospital setting. The next best option to measure a person’s cortisol rhythm is through salivary cortisol testing. This method is great as it can be done in the comfort of one’s own home. Instead of blood collection, one would collect their saliva in tubes provided in a kit by their naturopathic doctor. The kit is then sent off to a specialized lab equipped to analyze salivary hormone samples. Turnaround for results are usually within 7-10 days from when the lab receives samples.
The results come back in an easy to interpret graph, with the patient’s cortisol levels compared to reference data for each corresponding collection data point. It is then easy to tell where one’s strengths and weaknesses are throughout the day. Do you ever feel that you could just curl up under your desk and take a nap mid-day? Well, it may be possible that on your cortisol rhythm, that your mid-day cortisol is lower than the expected reference value. Another nice feature of the cortisol test is testing the total cortisol load or how many cortisol a person produces in a given day. The lower or higher (outside the reference range) the cortisol load, the worse ones adrenal problems are.
Cortisol Abnormalities May Cause Problems
Often times many cases of insomnia are due to elevated levels of cortisol. Remember that cortisol helps us to stay alert and energetic, so if bedtime cortisol is too high, we will not be able to reduce our energy in time to fall asleep. Many individuals who come see me with insomnia often remark that they “have a hard time shutting their brains down” when trying to sleep. This could be due to aberrant cortisol elevations at bedtime. Similarly, if you are one that feels groggy, unrefreshed and occasionally nauseated when you wake in the morning, your cortisol levels could be too low. In either case, a salivary cortisol test will help to detect these abnormalities.
Long-term Stress Can Cause Adrenal Fatigue
Face it – most of us have too much on our plates. We are stressed out not only by our jobs but also our financial situation, relationships, children and our health. Over time, without some form of treatment, this will lead to a decrease in the available pool of cortisol and other stress hormones that should be on standby to help in these stressful situations. The majority of patients who come see me in my practice have an underproduction of cortisol and other adrenal hormones, sometimes called “adrenal fatigue.”
Adrenal fatigue is not widely recognized by allopathic physicians, nor is it an official diagnosis. However, naturopathic physicians understand the vast importance of the adrenal glands and the many roles that its hormone products play in the human body. Symptoms of adrenal fatigue vary from person to person but can include fatigue, weight gain, insomnia, mood changes, joint and muscle pain, dizziness, brain fog and blood sugar dysregulation. Now that we know how to diagnose adrenal dysfunction clinically let’s now talk about how we can get the health of the adrenal glands restored.
Adrenal Gland Restoration
By far, two of the most important players in adrenal gland restoration include vitamins B5, otherwise known as pantothenic acid, and vitamin C. These two vitamins are crucial for adrenal health. In fact, the adrenal glands contain a huge amount of vitamin C within them. As you might know, vitamin C also plays a role in our immune system. So when we become stressed, we use up lots of vitamin C from the adrenal glands, thereby lowering our immune system and making us more susceptible to contracting an illness. Vitamin B5 similarly is also found in abundant amounts in the adrenal glands and is necessary to help produce and regulate many of the hormone products of the adrenals. Without adequate stores of vitamin B5, again which may used up rapidly when we have been under stress, we cannot make cortisol and other adrenal hormones.
There are a plethora of herbs that the naturopathic doctor has at his/her disposal to help with a variety of illnesses. Herbal medicine is very powerful and can help to treat many different hormonal imbalances as well. Specific to the adrenal glands, I often prescribe my patients adaptogenic herbs. The word adaptogen literally means “helps your body adapt better to stress.” These herbs are great because they are non-specific in nature. This means that they only do what your body wants to do with them. For example, if you have an overproduction of cortisol, seen in acute cases of stress, then adaptogens are great to lower this response. If you have too little cortisol, then adaptogens can help to raise your cortisol levels over time. Examples of adaptogens include licorice (no, not the candy!), ashwaganda, eleuthrococcus and rhodiola. All of these adaptogens have been widely studied in their relationship to adrenal health. Clinically, they are staples in the naturopathic doctors medicine cabinet to help restore adrenal health.
Stronger Adrenal Boosters
When adrenal fatigue has reached more critical levels or if a patient’s symptoms may not be resolved with just vitamins and/or adaptogens, I often turn to adrenal cortical extract (ACE) or low dose hydrocortisone for their adrenal boosting effects. ACE is usually freeze-dried adrenal gland extract from animal sources (unfortunately, we don’t have human sourced adrenal gland), like cow or pig. The glandular products contain all the hormones and co-factors necessary to help synergize and give the adrenal glands the boost that they need. Low dose hydrocortisone is a bioidentical hormone, meaning that it is like the hormone cortisol found in our bodies. When given at appropriate times throughout the day (usually those times where cortisol production should be highest), low dose hydrocortisone can provide an even greater boost than ACE. I have seen both work very well in varying degrees of adrenal fatigue. Often times patients will need to stay on some combination of vitamins, adaptogens and either ACE or low dose hydrocortisone for at least three to six months in order for their adrenal glands to start recovering.
Other Approaches to Restoring Adrenal Health
One of the most important things anyone can do to help restore their adrenal glands or prevent adrenal stress in the first place is to eat at regular intervals throughout the day. This prevents wide fluctuations in your blood sugar throughout the day and prevents the unnecessary release of cortisol from your adrenal glands. Remember that one of cortisol’s main jobs is to help break down fuel to use in times of hypoglycemia (low blood sugar).
I often recommend eating protein at every meal, especially at breakfast, and eating a meal every 4-5 hours. Likewise, one of my rules of thumb is to always combine carbohydrates and protein together. So instead of having a bagel in the morning and nothing else, it would be wise to combine the bagel with an egg or have a protein shake. This prevents your blood sugar from climbing too high and then crashing an hour to two later. How many of you find that you are hungry and reaching for a snack before lunch or that you need a second cup of coffee or energy drink to help pick you up? This could be due to reactive hypoglycemia, where your blood sugar levels dip below the normally acceptable levels. This can also lead to many unwanted symptoms including nausea, dizziness, shakiness or mood swings.
Establish A Consistent Sleep Pattern
Hands down, going to bed and getting up at the same time is one of the best methods to help regulate cortisol rhythms. If you do nothing else to help to start restoring your adrenal glands, this would be a great first step. Our bodies and adrenal glands want to follow a similar pattern each day. Make a plan to put all electronic devices away, turn off the TV and get into bed at around the same time each night. You should also plan on getting 6-8 hours of sleep per night. Some people need a little more, some a little less. Ideally, you should go to sleep somewhere between 9 and 11pm, depending on your circumstances.
Night-shift and swing-shift workers often have the hardest time regulating their cortisol rhythms because they are always going to bed and waking up at different times. One would expect their cortisol rhythm to be all over the map when collected throughout a typical day. These individuals would benefit from trying to go to bed and get up each day at the same time according to their work schedule.
These are just a few tips and tools that I provide my patients to start them on a path to restoring the health of their adrenal glands. After reading through these articles on adrenal health, do you think you might have adrenal fatigue? The adrenal glands are undoubtedly one of the most important parts of our body and we should really do all we can to help take care of them. This includes reducing our stress, making sure to get adequate sleep, regulate our blood sugar and use natural supplementation when necessary to give them the fuel they need to function better.