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Newsletter » Stress-Related Illness and the Adrenal Glands
Newsletter May 14/03
Stress-Related Illness and the Adrenal Glands
Stress-related illnesses are very common today. Patients in
this category have a reaction to stress, which is either causing their illness
or aggravating it. It is well known that the adrenal glands are the anti-stress
glands of the body -- the reserve tank the body falls back on when faced with
stressful situations.
When the hypoadrenic patient becomes sick, he becomes sicker
for a longer period of time, and with a greater likelihood for recurrence of the
problem than if his adrenals were functioning at full capacity.
The patient gets into a chronic state of ill health and that
is when we see him in our office.
There are four major categories of stress:
1.. Physical stress - such as overwork, lack of sleep,
over-training in an athlete, etc.
2.. Chemical stress - from environmental pollutants, diets
high in refined carbohydrates, allergies to foods and additives, endocrine gland
imbalances (which implicate the adrenals due to the interaction of all of the
endocrine systems.)
3.. Thermal stress - overheating or over chilling of the
body
4.. Emotional and mental stress
Early studies by Hans Selye, M.D., identified a pattern of
stress-related illness in both test animals and humans. This pattern is called
the "triad of chronic stress." This series of events is known as the General
Adaptation Syndrome (G.A.S.). The three stages of G.A.S. are: 1) the alarm
reaction, 2) the resistance stage, and 3) the exhaustion stage.
1.. The alarm reaction. The body's initial response to
stress involves an increased amount of adrenal activity. The adrenals produce
extra amounts of hormones. The adrenals are working harder to respond to an
immediate stress situation. That is a function for which they are designed.
2.. Resistance stage. After a period of time of continued,
severe stress, the adrenals begin to adapt and to re-build themselves. The
adrenals have a great capacity for increasing their size and function. If one
adrenal is surgically removed, the other adrenal can hypertrophy to twice its
normal size, giving the person the same amount of adrenal tissue he previously
had.
This capacity for increased size and function is the basis
for the resistance stage. The prolonged alarm reaction starts as a hyperadrenia,
which leads to a hypoadrenia, which then progresses into another state of
hyperadrenia, as the resistance stage takes over. If the stress is prolonged and
severe, it will overwhelm even this resistance stage adaptation, and the
adrenals will eventually lose their ability to respond. The patient's adaptation
to stress will continue beyond the resistance stage and into the third stage of
the G.A.S.
3.. Exhaustion stage. The exhaustion stage of the G.A.S. is
a hypoadrenia to the point where the patient loses the ability to adapt to
stress. The adrenal cortical enlargement of the triad of chronic stress is due
to the hypertrophy of the resistance stage. However, adrenal function in the
exhaustion stage is severely limited. The body has little or no ability to
resist any further stress. This is when the patient will surely seek a doctor's
help because he or she has symptoms which will not go away. Most of the
hypoadrenic patients we see are in this third or exhaustion stage of the G.A.S.
The anti-stress mechanisms are lost and there is no more reserve tank potential
for the patient to fall back on.
Fatigue, Low Energy, Tiredness
The adrenal glands are the body's reserve tank. The most
common symptom we see in the hypoadrenic patient is that of low energy. The
patient may have barely enough energy to make it through the day, or may be
tired all the time. Many middle-aged or older patients will attribute their low
energy to "getting older." A more accurate assessment of the situation is that
they have had more years to accumulate stress's adverse effects on their health.
A person may slow down a little as he gets older, but it is not normal for a
person to be fatigued all the time merely because he is past 40, or 60, or 80.
We must also suspect hypoadrenia and stress-related illness in
any patient whose symptoms begin after a stressful event. How often have you
heard that so-and-so "was never the same after the accident, flu, pregnancy,
etc."? Or how often do patients tell us in their history that they began
experiencing their symptoms during marital turmoil, after the death of a loved
one, or after recuperating from surgery?
It is not necessary that the symptoms originate during or
immediately following one of these stressful situations. They may develop
several months later. Or there may not be a specific event, but merely prolonged
exposure to stress. How many men in their twenties do you see playing softball
and going out afterwards drinking beer until all hours of the morning three
times a week?
How many do you see who are 30 or 35? The human system can
take only so much abuse, and after years of abuse many people become the
so-called "arm chair athletes." This need not be the case, but it is accepted
behavior in our society.
People take such a change of life style for granted, never
understanding the reasons behind the change and the associated long-term adverse
effects on their health. If they would eliminate the unnecessary stresses in
their life, they would be able to continue playing softball three nights a week
(and occasionally drinking beer till dawn) for a much longer period of time. But
the body will only take so much abuse before it makes the person stop.
Adrenal Gland Related to Muscle
Dr. Goodheart has identified no less than five specific
muscles, which are related to adrenal gland function. These are: 1) sartorius,
2) gracilis, 3) posterior tibialis, 4) gastrocnemius, and 5) soleus.
Many patients with hypoadrenia seek our help for the care of
sacroiliac pain and/or low back pain, which is due to the lack of pelvic
stabilization normally provided by these muscles.
Due to the relationship of the posterior tibialis,
gastrocnemius, and soleus to the stability of the foot and ankle, many
hypoadrenic patients will complain-of symptoms of tired feet, weak ankles, or
aching calves.
The adrenal gland cortex produces three major categories of
hormones: 1. mineralocorticoids, 2. glucocorticoids, and 3. gonadal (sex)
hormones (testosterone, estrogen, progesterone, etc.)
Depending on the relative amount of depletion of each of these
hormone groups, we will see varying symptoms in people suffering from
stress-related hypoadrenia.
We will discuss the symptoms created by each group separately.
Mineralocoricoids
Aldosterone is the most important mineralocorticoid, but
corticosterone and desoxycorticosterone are also included in this category. The
effects of aldosterone depletion are observed in a large number of hypoadrenic
patients. Aldosterone depletion may create one or more different symptoms, which
are specifically, related to the diminished mineralocorticoid levels. The
patient may also have musculoskeletal symptoms or fatigue, as discussed above,
and a combination of other symptoms related to adrenal dysfunction.
When there is inadequate aldosterone, the kidney allows sodium
(and chlorides and water) to spill into the urine, and maintains ionic balance
by retaining, rather than excreting, potassium. Some of these low aldosterone
patients present with symptoms of dehydration. If the tongue is rough like
sandpaper, or if you feel friction, with your finger catching or sticking to the
tongue's surface, it is an indication of inadequate tissue hydration.
Another problem related to lowered mineralocorticoid levels in
hypoadrenia is a paradoxical, non-pitting edema of the extremities. When the
patient with hypoadrenia spills sodium and water into the urine and
perspiration, and has a tendency to be dehydrated, we would hardly expect him to
show signs of holding water, such as edema. But that is exactly what can occur
in some hypoadrenic patients.
Often, these patients are placed on a diuretic by an
unenlightened physician, whose only basis for this prescription is the patient's
symptoms. The diuretic in these patients rarely helps the condition and often
aggravates the tendency toward dehydration. Further, many diuretics act as
adrenal (aldosterone) inhibitors, adding even more stress to the adrenals and
tending to make the patient worse in the long run.
Sodium restriction in the patient in the exhaustion stage is
probably ill-advised. However, instead of adding salt as a source of sodium, we
rather recommend more natural sources of organic sodium. We would supplement the
patient with Plant Derived Colloidal Minerals (American/Canadian Longevity).
Adrenal Sex Hormone
The adrenal glands make male hormones in the female and female
hormones in the male. Actually, the adrenals produce both male and female
hormones in each sex. Any masculinizing in the female or feminizing in the male
can be due to adrenal stress-related states.
The only source of estrogen in the male is his adrenal glands
while the pre-menopausal woman has a usually abundant estrogen supply from her
ovaries.
It is more common to see female patients with secondary sexual
characteristics of men than vice versa, although we encounter both. Women with
excessive body hair, particularly on the face, or men with gynecomastia, seem to
be the patients who seek help for their problems most readily. These symptoms
result from excessive production of the sex hormones by an overactive adrenal
cortex. The common medical approach to the woman with facial hair is to
prescribe prednisone or some other cortisone derivative in an effort to suppress
the pituitary drive of the adrenal, thereby hopefully decreasing the output of
testosterone.
Although this sometimes relieves the symptoms, the patient
must put up with the side effects, both seen and unseen, of the cortisone
derivative. If we look at the patient from a holistic, long-range viewpoint, we
can see the likely imprudence of such therapy.
A far better approach is to aid the patient in his ability to
adapt to stress by identifying and eliminating (as much as possible) the sources
of stress, and by treating the adrenal glands (and the entire endocrine system)
with the nutritional and other natural therapies at our disposal.
During menopause, as the estrogen levels begin to decrease,
the adrenals are supposed to increase their production of estrogen to help make
up for part of the estrogen deficit. In many patients menopause hits "like a ton
of bricks." Menopause frequently takes place very rapidly, not allowing the
adrenals adequate time to increase their capacity to meet the increased estrogen
requirement. This is further complicated by the fact that many of these patients
are already on the verge of adrenal exhaustion.
The menopausal hypoadrenia patient will have a variety of
symptoms --from just feeling poorly to severe psychosis. This is because the
adrenals are not able to take the extra load that has been dumped on them
without any warning by the ovaries. Any patient who has a rapid menopause with
accompanying symptoms must be checked for hypoadrenia. The patient may complain
of low back pain that started about the time of menopause, or a knee problem, or
eyes which began to become sensitive to light, and so on.
Pregnancy is quite a stressor for many women. A common
occurrence, however, is the woman who, upon reaching her third trimester of
pregnancy, says that she all of a sudden "feels better than I have felt in
years." This is often the case when the first two trimesters were particularly
difficult.
The fetus's adrenal glands mature to the point of being able
to produce hormones at about the beginning of the third trimester. If the mother
is in the exhaustion stage of the G.A.S., it is not uncommon for the baby's
adrenals to try to make enough adrenal hormones for both the baby and the
mother. The mother feels great. The baby's adrenals are really supporting the
mother's adrenals. But the baby's adrenal glands are being stressed before it is
even born! The results are doubly negative. The baby is born in a state of
adrenal depletion and often exhibits symptoms of hypoadrenia. These symptoms may
be varied, but two of the more common symptoms are allergies and recurrent
infections. Remember also that during chronic stress states, the thymus and
other lymphatic structures atrophy, lowering the capabilities of the body's
immune mechanisms.
Likewise, with the support of the baby's adrenals pulled out
from under her, the mother is dropped back into a state of adrenal exhaustion.
This accounts for the common occurrence of "post partum blues" or even
psychosis. Quite frequently, both mother and child must be treated for
hypoadrenia.
Glucocorticoids
The patient with stress-related illness might also have
symptoms from lowered output of the adrenal glucocorticoids: cortisol,
corticosterone, and cortisone. Of these, cortisol is the most important.
These hormones cause a variety of reactions, which increase
the blood glucose levels. A brief review of the simple factors affecting blood
glucose will put the adrenal glands' role into perspective.
After ingestion of food, the blood glucose levels rise. This
rise causes the beta cells of the pancreas to produce insulin, which lowers the
blood glucose by carrying it into the cells where it can be used or stored. As
the blood glucose subsequently decreases, the adrenals are stimulated to release
glucocorticoids in order to prevent glucose levels from dropping too low and too
fast.
A rapidly rising blood glucose level whips the pancreas into
rapidly producing more insulin. A rapidly dropping blood glucose or outright low
blood glucose whips the adrenals into rapidly producing more glucocorticoids.
The most common factor we see interfering with the normal
function of this system is the diet high in refined and concentrated
carbohydrates. Repeated ingestion of foods in this category causes repeated
rapid elevations in the blood glucose, hence overwork of the pancreas in its
insulin-producing capacity.
The resultant hyperinsulinism causes the blood glucose levels
to rapidly drop following the initial rapid rise. This rapid drop puts an extra
load on the adrenals and pushes them to make the glucocorticoids necessary in
order to prevent hypoglycemia. Over a period of time, a person eating a diet
high in refined and concentrated carbohydrates may deplete the insulin-producing
cells of the pancreas and become diabetic, or may stress the adrenals to the
point of exhaustion, or both.
As the adrenal glands become depleted, the blood glucose
levels will tend to drop below normal levels. In an effort to counter this
potential low blood glucose, the person will get cravings for any agent, which
will rapidly increase the blood glucose. He will eat a candy bar, drink a cup of
coffee, smoke a cigarette, or drink a soft drink. It might be added that the
abuse of alcohol, marijuana, and hard drugs fits this pattern as well. But the
rapid rise in blood glucose provided by the "fix" only serves to re-initiate the
whole cycle again.
The symptoms of the hyperinsulinism - hypoadrenia -
hypoglycemia patient are too numerous to mention here. Basically, though,
epithelial tissue, nervous tissue, and the retina of the eye do not store
glucose. Hence, these tissues are the most likely to be affected. Low blood
glucose creates symptoms of blurred vision, headache, nervousness, unstable
behavior, allergies, and so on and so on.
It is interesting to note that several of the books that are
available on the subject of hypoglycemia suggest that a trial period on a
hypoglycemia diet often brings relief of symptoms in patients who have all of
the classical signs of low blood sugar, yet have normal 6-hour glucose tolerance
tests.
Experience dictates that this occurs in people who are on the
verge of hypoglycemia, but whose 6-hour glucose tolerance tests appear normal
because the blood glucose levels are being maintained at the expense of
depleting the adrenal glands. The symptoms, which the patient displays, are
usually those of hypoadrenia, not hypoglycemia, although there is obviously a
great deal of overlap in the specific symptoms created by these two problems.
Many patients and many doctors are great advocates of fasting.
Yet many of these same people have considerable difficulty
when on a prolonged fast. They will always rationalize the problems encountered
on a fast as being due to the body detoxifying. However, many of these people
are really showing symptoms of hypoadrenia during their fasts, and actually may
be doing themselves more harm than good.
Cortisol and Epinephrine
The adrenal cortex and the adrenal medulla are the two parts
of the adrenal gland. Although each has separate functions, it is no mistake
that they are placed next to each other anatomically, since some of the
functions of one are dependent on the other.
Epinephrine is a vasoconstrictor. But for epinephrine to have
its vasoconstricting effect on the body's arterioles, it is imperative that
cortisol be available. Cortisol sensitizes the arterioles to the constrictive
action of epinephrine. If there is low adrenal cortical output and adequate
cortisol is not produced, epinephrine will have a reduced effect in its function
of constricting the blood vessels.
These two hormones work together in affecting blood pressure.
Therefore, in the hypoadrenic patient one of the major findings observed on
physical examination is related to blood pressure.
Normally when a patient goes from lying down to standing, the
systolic blood pressure should elevate 4-10 mm. Hg. {millimeters of mercury). In
hypoadrenia, the systolic blood pressure from lying to standing will either stay
the same or drop. This systolic drop is usually between 5 to 10 mm. Hg., but
sometimes as much as 30-40 points. This is a classic sign in the hypoadrenic
patient which is known as the Ragland effect, and which has been reported in
over 90% of hypoadrenic patients.
Blood pressure should always be checked in three positions:
sitting, then lying, and then standing. From recumbence to standing, the
systolic blood pressure should rise 4-10 points. If the blood pressure drops,
hypoadrenia is suspect. There are valves in the veins of the lower extremities,
which keep the blood from pooling in the feet when a person maintains an upright
position. The fact that there are no valves in the veins of the abdomen and
pelvis means that the only mechanism, which prevents the blood from pooling
there when the body goes from lying to standing is the vasoconstriction of the
local vessels. If there is a low cortisol level, epinephrine cannot function
correctly and there will be inadequate vasoconstriction in response to upright
posture. This causes the blood to pool in the abdomen and pelvis and the
systolic pressure in the arm to drop.
This same patient may complain of dizziness or
light-headedness, especially when arising from a seated or lying position. Or he
may experience transient spells of dizziness during the day or he may be dizzy
all the time. The patient may be complaining of headaches, which are due to the
pooling of the blood in the abdomen and pelvis, interfering with the supply to
the head.
Frequently these patients have had totally normal neurological
examinations or some have been diagnosed as having Meniere's disease. Some are
being treated unsuccessfully with manipulation to the upper cervical areas. But
all therapeutic approaches are ineffective in relieving the symptoms until the
hypoadrenia is treated.
Some of the patients who have postural blood pressure dumping
are being treated for hypertension. The hypertension is from another paradoxical
body response. When the patient changes positions from recumbence to standing
and the systolic blood pressure drops 10, 20, or 30 points, the body senses this
low blood pressure and reacts. The body does not want all the blood pooling in
the abdomen and pelvis because it decreases the amount of blood in the head and
other areas.
In an effort to change this situation, the body may elevate
the systolic pressure to an extremely high level. The systolic blood pressure
may go as high as 180 mm. Hg. or more. Then, when the patient changes positions
from lying to standing, the systolic blood pressure will drop to only, say, 150
mm. Hg. If the blood pressure is taken only in the seated position, the patient
will show a very high systolic pressure. But when you change the patient's
positions, he will show the dumping blood pressure on arising from recumbence to
standing.
These patients are often treated with diuretics when the real
problem is with the adrenal glands. Combine this with the fact that many
hypoadrenic patients are also dehydrated, as previously discussed, and you can
see the senselessness of diuretic approach in these cases.
Practitioners have observed patients who had continuous bloody
noses due to high blood pressure. In the midst of acute nosebleeds, the
patients adrenals were treated, their blood pressure dropped, and the
nosebleeds stopped immediately.
Heart Sounds and Hydroapenia
Another common finding during the physical examination of the
hypoadrenic person is made during auscultation of the heart. Normally the first
and second sounds of the heart make a "lub-dub" sound, with the first sound
being louder than the second. If you record the heart sounds on a
phonocardiagraph (such as the Endocardiagraph), the second sound should be
one-third the intensity (height) of the first sound. In the hypoadrenic person,
the second sound will be equal to or greater than the first sound in the
pulmonary valve area. The same may be true in other valve areas also, but in
hypoadrenia, at least, the pulmonary second sound is greater.
This accentuated pulmonary second sound is due to the
pulmonary valve slamming shut because of pulmonary hypertension. Epinephrine
causes vasoconstriction throughout most of the body, including the lungs. In the
lungs this vasoconstriction causes a shrinkage of the mucosa and decreased mucus
secretion.
Epinephrine also relaxes the bronchiolar musculature, creating
a bronchodilation. This is why epinephrine inhalers are so helpful for asthma
sufferers. The bronchodilation, which normally occurs with epinephrine cannot
occur in a patient with hypoadrenia. Instead he gets a bronchoconstriction -- a
constriction of all the bronchial musculature with subsequent symptomatology.
Likewise, the hypoadrenic person does not have the benefit of
epinephrine's action on the pulmonary capillaries and mucous membranes, with a
resultant swelling of the mucous membrane and an increase in mucus production or
secretion. In the hypoadrenic patient, physical evidence of this is heard as the
loud second heart sound at the pulmonary area. The bronchoconstriction, combined
with the vasodilation and mucous membrane swelling, creates a backpressure in
the pulmonary circulation that causes the pulmonary valve to slam shut, thus
creating the louder second sound over the pulmonary area.
Any person who has abnormal lung function, especially asthma
or bronchitis, should be checked for hypoadrenia. This is particularly true, if
the patient's symptoms are relieved by using an epinephrine inhaler. The muscles
related to the lungs (deltoid, serratus anterior, etc.) are usually strong in
these patients. Many lung problems are related more to the adrenals than to the
lungs.
Treatment for Hypoadrenia
To correct Hypoadrenia, several things must be considered. Any
structural interferences must be removed, the patient must be supported
nutritionally and emotionally, and any underlying stress factors must be
addressed.
Structure: All structural faults must obviously be corrected.
Structural misalignments will actually contribute physical stress to the patient
by decreasing biomechanical efficiency. There is a dual importance in correcting
structural and mechanical faults in the stressed patient. It is in this regard
that many non-manipulative practitioners miss a golden opportunity to help speed
their patients recoveries by not employing manipulation. A simple postural
analysis will clearly point out the need for correcting structure in these
patients.
Another structural effect of stress, which can initiate a
vicious cycle and become a contributing stress in itself, is that of grinding of
the teeth. Many people clench their teeth when confronted with a stressful
situation. Over a long period of time, this clenching and grinding of the teeth
can develop into severe temporomandibular joint (TMJ) problems. To break this
vicious cycle, dental intervention is sometimes necessary.
Chemistry: the hypoadrenic patient usually requires a
glandular preparation. Most often this is the protomorphogen or the whole tissue
concentrate. Adrenal hormone should be avoided whenever possible, due both to
its short-term and long-term side effects. Some of the products containing
adrenal tissue are: