Adrenal Exhaustion

To cope with stress, Nature equips every newborn with a pair of fresh young adrenal glands, packed full of vitamin C, potassium, zinc, pantothenic acid (B5) and essential fatty acids. Each adrenal gland is nestled on the upper inner surface of each kidney and consists of an outer larger portion, called the cortex, and an inner portion referred to as the medulla.

Although the cortex and medulla are integrated by structure, these two regions are completely separate in function.

The medulla produces adrenaline and noradrenaline, which prepares the body for physical effort and response to stress. The cortex produces cortisol and aldosterone, which are vital in maintaining balance and homeostasis of the body chemistry under stress. The cortex also produces sex hormones, such as those produced in the testes and ovaries. The adrenal cortex is capable of synthesizing over 60 steroid hormones, including gonadocorticoids (progestogens, estrogens, androgens), mineralcorticoids (mainly aldosterone) and the glucocorticoids (cortisol).

Cortisol is a major player in the body's response to stress and directly influences the metabolism of sugar, protein and fat. The glucocorticoids are so named because of their actions in raising blood sugar. During a stressful event, cortisol helps sustain blood sugar concentration by temporarily preventing the entrance of glucose into all tissues except the brain and the spinal cord. In addition, it forces the breakdown of muscle and other organs into amino acids, which it then helps convert into glucose for extra fuel.

Up-regulation of the Hypothalamus-Pituitary-Adrenal (HPA) axis during athletic competition causes cortisol to rise with a simultaneous decrease in DHEA (not good). Cortisol can interfere with growth and recovery by increasing the rate of protein breakdown, especially if and when it remains chronically elevated, as it does in the over-trained athlete, the chronically ill, the anxiety-prone personality type or the sedentary individual who adapts to stress by over-eating.

High cortisol levels are immunosuppressive and destroy sexual function and libido. Elevated cortisol has been implicated as a causative factor in substance abuse, smoking, alcoholism, anorexia nervosa, impairment of memory and age-related neuronal damage.

It is also associated with altered cardiac rhythm patterns.

Stress of any kind, including injury, extreme heat or cold, pain, viral infection, chronic disease, intense exercise, or the emotions of anxiety, fear, depression, grief, frustration and anger, causes the release of ACTH (adrenocorticotropin hormone), a polypeptide located in the anterior lobe of the pituitary.

ACTH activates cortisol secretion from the adrenals, which cooperates with norepinephrine and epinephrine in preparing the body "for fight or flight". Norepinephrine and epinephrine (also known as noradrenaline and adrenaline) are classified as catecholamines or neurohormones.

Norepinephrine and epinephrine are both synthesized in the adrenal medulla from the amino acid tyrosine and serve as neurotransmitters in the brain and in the autonomic nervous system.

Response to stress, as defined by the late physiologist Hans Selye, is a built-in mechanism designed to protect us from damage. Selye defined human reaction to any form of stress as a General Adaptation Syndrome (GAS), and proposed that GAS consisted of three stages of progression, including

(1) the alarm phase
(2) the adaptation phase and
(3) the exhaustion phase.

Diseases and injury mainly appear in the exhaustion phase, when due to depletion and lowered resistance, the body loses the ability to manage the effects of stress.

An example of the alarm phase is when a muscle in the body is constantly overworked. Soreness is common, followed by stiffness and inflammation. In a state of optimum health, if the body is strong, well rested and well nourished with whole food and dietary supplements, such symptoms will quickly pass and the muscle will return to its previous state of wellness. This provides evidence of an intelligent and self-regulating healing mechanism at work and inherent to the body.

If however, the muscle is continuously overworked AND combined with additional unresolved financial, relationship or work related stress, it will eventually start to adapt and accommodate itself to all of the repetitive stress factors present, in order to cope with the demands of the stress in ways beyond those of the alarm stage. Eventually, the body as a whole will also begin adapting in the same manner, at which point the second or 'resistance stage' comes into play.

The resistance stage does not normally present any specific set of symptoms at first and can last for many years, even decades. In fact, resistance stage adaptation will last for as many years as the body's resources and reserves will allow while the body continues with its prime directive and attempts to heal itself. Depending on individual genetic make-up, and things like quality of diet, quantity of rest and sleep, current emotional trauma, injury, illness, medication and surgery, one's ability to continue to adapt and resist can vary significantly from person to person. This explains why two different people faced with apparently identical challenges can and often do respond quite differently.

Most people get used to the resistance stage and associate symptoms like fatigue, chronic pain, headaches and the accumulation of body fat with 'age', but nothing could be further from the truth. What appears to be 'normal' is in fact a deviation from what is possible when health of mind and body is present, a 'fall from grace' so to speak. It's a false norm predicated by the business of disease management and experienced by a modern population of sedentary adults subsiding on what I consider to be one of the worst diets in the world - a diet of affluence, lust and decadence (what were once vices are now habits).

As we continue to cope with the many subtle and complex varied stresses of life in the fast lane, be they structural, biochemically or emotional, it is at the end of resistance stage, when a person's adaptive mechanisms begin to fail, that the final stage of Selye's model results in the 'exhaustion stage'. At this point our ability to cope with stress diminishes to the point where chronic disease sets in.

To really understand the progression of the general adaptation syndrome, let's once again consider the overworked muscle. When the muscle is first overworked the alarm stage manifests as pain, stiffness and perhaps inflammation.

If this stress of overwork becomes chronic and the symptoms of the alarm stage are ignored or 'covered' with medication, then during the resistance stage which follows, the muscle will become increasing less elastic and more fibrous, placing stress on sites where tendon is attached to bone.

This creates additional problems of pain, interferes with athletic ability and places undue stress on the joints.

Left untreated the muscle will eventually enter into the exhaustion stage, with impediment, calcification, erosion of collagen & cartilage, and inflammation eventually giving way and possibly degenerating into fibromyalgia,, fibroplasia, fibrositis, muscular rheumatism and arthritis.

In one way, health can be defined by the interaction between what we are adapting to and the reserves and potential resources we have to work with. Tip the scales in the wrong direction for too long, and we burn out. Tip the scales up in favor of health and restoration, with adequate rest, optimum sports nutrition and progressive routine exercise and we win the battle against exhaustion and disease…today.

Photo by Avelino Calvar Martinez from Burst

As always, stay well and live free

Dr.C