Adrenal Dysfunction and Adrenal Fatigue

Diagnosis and Treatment of Adrenal Dysfunction
Q&A with James L. Wilson, N.D., D.C., Ph.D.
Introduction: Dr. James L. Wilson is the bestselling author of Adrenal Fatigue: The 21st Century Stress Syndrome. He received his Ph.D. in Human Nutrition from the University of Arizona, with research in Cellular Immunology, is one of the original founders of the Canadian College of Naturopathic Medicine, currently serves as President of Future Formulations, LLC and is on the Advisory Board of the American Chiropractic Association Council on Nutrition.
Q: In your book you state that hypoadrenia—or adrenal fatigue—is a problem of monstrous proportions that is largely unrecognized by the medical establishment. Even enlightened, complementary medicine practitioners often overlook the role of the adrenals. Why is that?
A: One of the major functions of the adrenal glands is to respond to stress and maintain physiological homeostasis so that the body can continue to function in a healthy way. These “glands of stress” must react to every kind of stress, including those of physical, emotional, psychological, biochemical, hormonal, thermal, chemical and biological origins, and the functioning of every tissue, organ and gland in the body is significantly affected by adrenal activity. But practitioners all too often don’t think seriously about the adrenals.
Q: When should practitioners look at adrenal function?
A: Adrenal function should be investigated in any chronic illness, either as a primary cause, or as secondary to the stress of illness itself. It is often the missing link for the chronically ill patient who, no matter what intervention is made, cannot seem to fully recover. The good news is that recovery from adrenal fatigue is not only possible, but highly likely with proper treatment, which includes a sophisticated and targeted program of glandulars, adaptogenic herbs, and nutrients.
Even in illnesses as common as the flu, if symptoms linger, low adrenal function should be considered. For example, during the Spanish flu epidemic in 1919, according to the Archives of Internal Medicine, doctors autopsied 126 patients who had died in the flu epidemic. Of these, 103 showed adrenal gland atrophy and shriveling consistent with adrenal exhaustion, and another 3 cases had adrenal hypertrophy and swelling consistent with a state of extreme stress. The adrenals were exhausted in their effort to restore balance to the body during overwhelming infection, to the point that their depleted state was physically detectable upon autopsy and significantly contributed to their death. That is quite remarkable.
Q: What endocrine glands are involved in the stress response?
A: The major players are the hypothalamus, pituitary and adrenal glands (HPA axis). In experimental psychology, there is a saying: “The hypothalamus rules the world.” This gland is really the four-star-general of the endocrine system. As the keeper of physiological balance, it regulates sleep, weight, satiation, hunger, thirst, and the stress response. The hypothalamus must sense the stress and signal a response through the pituitary, but the adrenals must provide the hormones for adaptation to the stress. Cortisol and the other hormones secreted by the adrenal glands go to every tissue, gland and organ in the body, in direct proportion to the total amount of stress sensed by the hypothalamus.
As clinicians, we have seen again and again the impact stress has on the immune system. Immune function is profoundly affected by adrenal activity. All white blood cells of the immune system have cortisol receptors that modulate the immune response when activated. This means that when levels of cortisol are too low or too high, immune competence is impaired.
Q: What are some common clinical and laboratory indicators of adrenal fatigue?
A: The daily energy pattern is a key indicator. Morning fatigue is one of the most common symptoms of adrenal fatigue. People with adrenal fatigue wake up tired despite sleeping for 8 or more hours. Even after they get up they often do not feel fully awake until later in the morning, or until they have had a caffeinated beverage or some other stimulant. They usually experience an afternoon low between 2-5 PM, but by about 6 PM or with their evening meal they get a new burst of energy. They may even experience a second wind at about 11 PM and cannot go to sleep until 1-2 AM.
Although there are many causes of fatigue, I know of no other cause that produces a fatigue pattern like this. Other common indicators include symptoms of hypoglycemia, a need for caffeine, decreasing ability to bounce back from stress or illness, decreased focus or concentration, decreased libido, and delayed recovery from an acute illness, especially respiratory illnesses.
Q: What other markers do you see most commonly in hypoadrenia?
A: I often see recurrent lung and bronchial infections when there is adrenal fatigue. Because the adrenal glands help regulate the sodium and potassium balance, especially during stress, a craving for salt is often a clue to low adrenal function. People with adrenal fatigue have difficulty producing adequate cortisol levels, and as a result they also often suffer more from allergies, chemical intolerances, environmental sensitivities, and poor wound healing. Patients also often complain of a general feeling of unwellness.
Adrenal fatigue is often associated with chronic illnesses. The chronic illness itself is a large stress physically, emotionally and psychologically, and is often accompanied by social and sometimes lifestyle changes that contribute additional stress. Not surprisingly then, I find adrenal fatigue common in patients suffering from chronic illnesses such as fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis, autoimmune disorders, asthma, cancer, AIDS, and other serious illnesses.
Q: Can you tell us about a few of the tests you recommend?
A: Laboratory tests are helpful to confirm the presence of adrenal fatigue, however, blood levels of circulating cortisol are excessively broad and often do not detect low adrenal function. The ACTH challenge test also misses adrenal fatigue in most cases except those that are very, very severe.
The best laboratory test to use is the salivary cortisol test. I recommend a 1 day collection, taken at 4 different times, as a baseline. There are several laboratories that do salivary cortisol testing and it is covered under Plan B of Medicare. During the salivary cortisol test, I also ask the patient to record the date and time of each saliva sample on a separate sheet, what signs and symptoms they were experiencing at the time they gave each sample, their food and beverage intake for that day, as well as any events that may have occurred during that day that might affect their cortisol levels. This information is very useful to help me to more accurately interpret the test results.
I also test for the other steroid hormones with the same test kit, including DHEAS, progesterone, estrogen and testosterone in order to more comprehensively interpret the test and provide adequate treatment.
Q: What are the mainstays of treatment?
A: The combined use of certain dried glandular extracts, and highly targeted, specific vitamins, minerals and herbs in the correct form and amount, accompanied by lifestyle improvements, has been the best way I have found to help patients with adrenal fatigue. Glandular extracts contain nucleic acids and nutrients in a concentrated form that provides all the proper building blocks needed by the glands for healthy function and hormone production. These extracts can be utilized by the adrenals and other endocrine glands involved in the stress response to achieve deep healing. In contrast, synthetic hormones tend to suppress the function of glands over time, since they override the normal feedback loops that the body uses to regulate hormone levels.
When I began combining dried glandular extracts I was able to start achieving positive outcomes I had never achieved using them singly. A combination of glandulars that support all the glands involved in the stress response (hypothalamus, gonads, adrenals, pituitary and thyroid) seems to work best. This combination is usually taken 2-3 or more times per day in conjunction with the nutrients and herbs that facilitate proper, healthy adrenal response.
Q: What are the key vitamins, minerals and nutrients?
A: It's important to provide all the nutrients that are used in the adrenal cascade of hormone production. For instance, the adrenals use more vitamin C than any other organ or gland in the body. It is the only tissue I know of that can actually store small amounts of vitamin C for short periods of time. During any stress, the demand for vitamin C skyrockets. The problem for people with hypoadrenia is that they tend to be too acidic, and regular vitamin C (ascorbic acid) is also acidic. So when people suffering from adrenal fatigue take ascorbic acid, their bodies try to neutralize the acidity by drawing on the circulating magnesium or calcium stores. This reduces the amount of magnesium and calcium available to the tissues of the body. This is especially bad for people with adrenal fatigue because they are almost universally deficient in magnesium and often deficient in calcium. I suggest a buffered vitamin C, preferably one using mineral ascorbates.
Pantothenic acid is another nutrient critical to the conversion of glucose into energy and is needed in abundance as a part of acetyl CoA at the beginning of the Krebs cycle to make ATP (cellular energy). Magnesium is also involved in this process and is often considered to be the “sparkplug” of the cell. Niacin is necessary to many reactions that are important in helping the body make energy. Large amounts of niacin are necessary because niacin is a cofactor for all NAD and NADPH reactions critical for several steps in the adrenal cascade. Up to 150 milligrams of niacin may be needed daily. The entire B complex is essential in varying quantities throughout the adrenal cascade, but they must be balanced with each other properly in order to adequately support adrenal function. Organic trace minerals, such as manganese, zinc, selenium, molybdenum, chromium, copper and iodine are also needed, and typically have a calming effect on the body which can help alleviate the jittery, exhausted state that some people with adrenal fatigue experience. The best sources of trace minerals are sprouts, young plants, algae and sea vegetables, and the trace mineral supplements made directly from them. Use sea salt liberally.
Q: You emphasize special herbs in supporting adrenal function.
A: A few herbs have a very beneficial effect on the HPA axis. The ones I have found to be most clinically effective include the Ayurvedic herb, Ashwagandha; the Chinese herb, Eleuthero (formerly called Siberian ginseng); Licorice root; and Maca. Although there has not been a lot of scientific study on Maca in adrenal function, the other three herbs are well known adaptogens. Licorice, in particular, helps keep cortisol in its active form. Ashwagandha is an ancient Indian herb with a history of therapeutic use dating back to at least 1000 BC, probably because of its direct beneficial effects on adrenal tissue and function. It has been prescribed as a tonic, is anti-inflammatory, and is an Ayurvedic treatment of choice for joint inflammation. Some studies have shown Ashwagandha to be capable of normalizing cortisol levels. Eleuthero is good for both sexes, and has a wide range of activities that support and rejuvenate adrenal function. It has been used by Russian deep-sea divers and Olympic athletes, and by cosmonauts for stress and increased vitality.
Other herbs such as Ginger and Ginkgo biloba are also sometimes helpful as ancillary herbs. Ginger root is another adrenal adaptogen that helps modulate cortisol levels, increase energy, and stimulate digestive enzyme secretions for proteins and fatty acids. Ginkgo leaf is a powerful antioxidant that sequesters free radical production, protecting the adrenal glands which suffer tremendous oxidative stress when producing excess cortisol during the stress response. Ginkgo also contains several bioflavonoids that improve blood flow, and it has been shown to lessen tissue damage from inflammation and shock. Its unique qualities often make it useful in an adrenal recovery program.
Lifestyle is important. Try to get to sleep early, before 10 PM, and sleep until 8 or 9 AM, if possible. Minimize stress in your life. Take breaks in which you lie down, not just sit down – being horizontal is more restorative than resting upright. Proper nutrition is also very important. In every meal or snack eat a generous amount of protein combined with non-hydrogenated oil or fat and an unrefined starchy carbohydrate. These three together provide the best energy for people with adrenal fatigue. Avoid fruit in the mornings, emphasize alkaline foods, including five or six servings of vegetables daily. Additional salt is usually necessary.
Some form of mild, noncompetitive exercise is very useful, even walking. In one study, people in their eighties who simply walked up and down a hall four times a day improved all their physiological functions.
Q: Do you have any final thoughts about adrenal fatigue?
A: Sure. Successful treatment includes changes in diet, lifestyle, and proper dietary supplements. The most exciting fact is that recovery from adrenal fatigue is not only possible, but highly likely with proper treatment.

Multiple Adaptogenic herbs are included in Isagenix’s “Ionix Supreme”.

These include Ashwaganda, Rhodiola Rosea, Eleutherococcus, Maca, Schizandra, Tribula Terrestris, Rhododendron Caucasicum, Wolfberry, and Shilajit . All of these support the adrenals, besides the minerals, vitamins, and fruit extracts.