What are the adrenals?
The adrenal glands are 2 small glands that rest on top of both kidneys. Each gland has two parts – the medulla and the cortex.
The adrenal cortex has 3 layers. The zona glomerulosa produces mainly aldosterone. Aldosterone helps to regulate salt and water in the body while also contributing to the regulation of blood pressure. Its role is to keep the needed sodium and water in the body and rid it of excess potassium via the kidneys. The zona fasciculata involves the production of hydrocortisone or cortisol. Cortisol is involved in blood sugar regulation in that when the body is in a state of fasting it stimulates gluconeogenesis in the liver to increase blood glucose levels. It works opposite of insulin. Additionally, Cortisol is highly involved in our stress response. The zona reticularis produces androgen precursors that when secreted and sent to the testes or ovaries they are converted to testosterone.
The adrenal medulla produces epinephrine and norepinephrine, which play a large role in the “fight or flight” response to stress. These are originally produced from the amino acid tyrosine. Epinephrine quickly responds to stress by increasing your heart rate and sending blood to your brain and muscles while also stimulating glucose production in the liver. All of these actions help to get you prepared for a stressful situation. It is designed to only be used in situations of danger, like for example, running from a bear. For many people these hormones are being produced at a much higher rate than they were intended due to our overly stressful lives, so to our body, we are always preparing for danger. Feeling stressed over time can result in high blood pressure, blood sugar imbalances, and can take a toll on the adrenal glands.
How does the adrenals become imbalanced?
1. Addison’s Disease
Addison’s Disease is a slow progressing autoimmune response where the immune system is attacking the cortex. Addison’s Disease affects about 1 in 100,000 and men and women equally. Symptoms can include weight loss, increasing fatigue, depression, salt craving, and you may even see dark tanning of the skin. Addison’s Disease is diagnosed by blood levels of cortisol, sodium, potassium and ACTH levels. People with Addison’s can live relatively normal lives but will likely have to be on medication to replace missing hormones the adrenals are not producing. They may be told to increase their salt intake due to levels being low and be prescribed Fludrocortisone Acetate to balance sodium and potassium in the body. DHEA has been shown to be helpful as well as Vitamin D to combat the autoimmune process.
2. Cushing’s Syndrome
Cushing’s Syndrome is caused when the body has been exposed to Cortisol for an extended period of time. This can occur from the long term use of corticosteroids to treat many inflammatory diseases. Also it can occur from the overproduction of cortisol in the body. Signs and symptoms can include obesity in the midsection, thin skin that bruises easily, insulin resistance and increased cardiovascular risks. Pituitary adenomas (a benign tumor in the pituitary gland) oftentimes cause Cushing’s Syndrome. It over produces ACTH which leads to excess cortisol. Benign adrenal tumors can raise Cortisol levels as well. Diagnosing Cushing’s involves history and physical exam, tests and imaging to determine the source of the overproduction of cortisol. Oftentimes a tumor can be removed to eliminate the source of the excess hormone.
3. Adrenal Fatigue
Most often when we refer to the adrenal glands we are talking about concerns of adrenal fatigue. It is the collection of symptoms often caused by prolonged stress and causes the adrenal glands to function less optimally. Adrenal fatigue is not commonly recognized in the conventional medical community, but as Naturopathic Physicians we see symptoms of adrenal fatigue very often in practice.
Symptoms such as difficulty waking in the morning even with sufficient sleep, feeling tired mid afternoon, becoming overwhelmed easily, craving sugary or salty foods, and not bouncing back quickly after being sick are some of the most common symptoms. Sometimes it can feel as though it is difficult to get through the day, and oftentimes people with adrenal fatigue will consume caffeine to complete normal daily tasks and activities. Due to its response to stress, cortisol is the main hormone involved in adrenal fatigue. During stress cortisol can remain elevated, which in turn results in suppression of the immune system making it difficult to bounce back after illness.
Normal cortisol levels are higher in the morning and gradually decline into the evening to allow us to sleep. After long periods of stress, an imbalance of Cortisol can occur which can result in it staying elevated in the evening. This can lead to low levels in the morning resulting in low energy upon waking. Determining levels of cortisol throughout the day is best done through salivary testing. This is done through a specialty lab in combination with DHEA-s, a hormone that aids in the production of Cortisol.
Treatment to balance cortisol levels and help reduce these symptoms can be helpful with the use of herbs called adaptogens that help the body naturally balance levels of cortisol throughout the day. Diet, lifestyle changes, and nutritional supplementation are also used. Stress management is very important as well in the treatment of adrenal fatigue. It is vital that we learn how to control the way we perceive stress in our daily lives to encourage the proper production of cortisol and not put further stress on the adrenal glands
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