Adrenal health

Adrenal imbalance — the effects of stress and high cortisol levels

by Marcelle Pick, OB/GYN NP

Here are the topics covered in this article:

• The role of healthy adrenal glands
• How chronic stress causes adrenal exhaustion
• How high cortisol affects health
• Restoring adrenal health naturally

“If only I had the energy I used to...” We’ve probably all said these words at some point, and I hear them in my practice on a daily basis. Fatigue is something I’ve noticed that many women succumb to, seldom questioning whether or not they can get to the root of it. My patients are skeptical when I assure them that as long as there are no other major health issues causing their fatigue, we can absolutely get them back to feeling as energetic and vibrant as they did in their younger years.

Every woman who comes to our clinic with these symptoms undergoes a series of tests that evaluate markers of stress, including cortisol and DHEA levels. And the results — in over thousands of cases — are remarkably consistent: only 20–25% have cortisol levels consistent with healthy adrenal function, while 75–80% suffer impaired function, in various patterns ranging from mild to more serious. While you may have heard the popular terms “adrenal fatigue,” “adrenal exhaustion,” or “adrenal burnout” used, at Women to Women, we generally refer to the spectrum of impaired adrenal function as adrenal imbalance or adrenal dysfunction.

What we’re seeing, however, is an epidemic of women with subclinical adrenal hypo- or hyperfunction — that is, adrenal glands are putting out stress hormones at levels that are inappropriate, too low or too high, in relation to what’s needed. This may sound mild enough, but the effects can be profound: fatigue and weakness, suppression of the immune system, muscle and bone loss, moodiness or depression, hormonal imbalance, skin problems, hair loss, autoimmune disorders, insulin resistance, and dozens of other symptoms and health concerns — some very serious.

But there’s light at the end of the tunnel, I promise! If it’s time to take an honest look at your adrenal health, you’ve come to the right place. There are many natural treatment options at your fingertips, options that can help you gently heal and restore your overall stress response. Let’s look at the relationship between stress, high cortisol levels and adrenal imbalance, then review support measures you can take to resolve your symptoms.

The original, life-saving role of the adrenal glands

To understand how adrenal imbalance develops, it is helpful to consider the original, evolutionary function of the adrenal glands. The adrenals are walnut-sized glands located on top of each kidney, where they serve as important manufacturing centers for many of the body’s hormones. The innermost section of each gland produces adrenaline (which you may know as epinephrine), and noradrenaline (also called norepinephrine). The layers outside the center, called the adrenal cortex, produce several other hormones, including cortisol, as well as DHEA, and the sex hormones estrogen, progesterone, and testosterone.

Along with several other key responsibilities, your adrenal glands’ primary purpose is to help you survive in the face of a threat, rallying all your body’s resources into “fight or flight” mode by increasing production of adrenaline and cortisol. Healthy adrenals instantaneously increase your heart rate and blood pressure, release your energy stores for immediate use, shut down digestion and other secondary functions, and sharpen your senses. But since they are programmed to respond to every kind of stress — physical, emotional, perceived, psychological, environmental, infectious, or any combination of these — a woman under chronic stress can strain her adrenal glands. And when the adrenals are chronically overextended, she can end up with issues like thyroid imbalance, weight gain, insomnia and severe fatigue.

Let’s emphasize two points about this healthy stress response. First, it takes priority over all other metabolic functions. Second, it wasn’t designed to last very long.

Stress and the adrenal glands

Unlike our ancestors, we live with ‘round-the-clock stimulation and stress. Instead of meeting occasional, acute demands followed by a period of rest, we’re constantly over-worked, under-nourished, over-stimulated, under-rested, exposed to environmental toxins, worrying about others — with no let-up.

It’s not just the dramatic life events that produce that familiar “stressed-out” feeling. Each and every challenge to the mind and body creates a demand on the adrenal glands. And the list of challenges is endless: lack of sleep, the commute to work, a demanding boss, the threat of losing your job, financial pressures, personality conflicts, yo-yo dieting, relationship turmoil, death or illness of a loved one, skipping meals, reliance on stimulants like caffeine and carbs, digestive problems, over-exercise, illness or infection or surgery, unresolved emotional issues from our past or present, and more! The result is adrenal glands persistently on “high alert.”

The destructive effect of high cortisol levels

What is cortisol? In its normal function, cortisol helps us meet these challenges by converting fats and proteins into energy, keeping us alert, balancing electrolytes, calibrating heart beat and pressure, and counteracting inflammation. In the short run, that’s great — even protective and restorative. But paradoxically, sustained high levels of cortisol will gradually tear your body down.

Sustained high cortisol levels:

• destroy healthy muscle and bone
• slow down healing and normal cell regeneration
• co-opt parent molecules needed to make other vital hormones
• impair digestion, metabolism and mental function
• interfere with healthy endocrine function; and
• weaken your immune system.

The cumulative effects of such wear and tear can damage a woman’s body, mind, and spirit. Adrenal imbalance may be a factor in many conditions, including fibromyalgia, hypothyroidism, chronic fatigue syndrome, depression, arthritis, and more. It can also be associated with a host of unpleasant signs and symptoms, from acne to hair loss. (See our list of adrenal imbalance symptoms and related conditions.)

Natural adrenal support — how to restore healthy adrenal function

Fortunately, there are many natural steps you can take to restore healthy adrenal function. But to rule out the possibility of any serious underlying medical issues causing your symptoms, we recommend you have a full physical exam. In our experience, women with mild to moderate adrenal imbalance can gain significant improvement through these simple steps:

• Eat in tune with your natural cortisol curve. Enrich your nutrition, reduce refined carbohydrates, and cut back on stimulants. For detailed advice and explanation, see our article on eating to support the adrenals.
• Consider nutritional supplements that support adrenal function. Start with a high-quality multivitamin–mineral complex rich in stress vitamins, calming minerals, and essential fatty acids. To learn how select herbs can improve adrenal resilience, see our article on natural treatments for adrenal imbalance.
• Reduce stress, exercise in moderation, and take more time for yourself. It’s helpful to make a list of your stressors, especially those that are ongoing or self-imposed.
• Get more rest. Your body needs time to heal!

Women with more entrenched symptoms, or those who have reached complete adrenal exhaustion, may need more intensive intervention. At our practice, we use the steps outlined in our Personal Program for Adrenal Health, along with targeted support such as low-dose compounded DHEA and deglycyrrhizinated licorice root. We listen carefully to our patients, and personalize therapy to correspond to each woman’s symptom profile and test results. (Please do not self-prescribe these substances, as they can have adverse interactions if used inappropriately.)

Finally, we can never underestimate the power of perceived stress. Guilt, pain from past hurts, self-destructive habits, unresolved relationship problems — your past and present emotional experience may be functioning as an ever-present stressor in your life. Dealing directly with these problems will be far more beneficial to your health than spending a lifetime compensating for the stress they create.

In all but the most extreme cases, we expect to see dramatic improvement in four to six months. With mild to moderate adrenal imbalance the turnaround can be faster. Remember, you may feel as though you’re just too tired to make changes now, but by moving forward in incremental stages, you will build the strength you need to stay with it. And you will love how you feel when you do!

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Last Modified Date: 04/15/2011
Principal Authors: Marcy Holmes, NP, Certified Menopause Clinician & Marcelle Pick, OB/GYN NP