Healing Adrenal Fatigue

In last week’s Health Tip I described the exhausted state of Patricia, dragging herself through the day and crashing completely in the afternoon. At first, Patricia was oddly supercharged in the evening, unable to relax or sleep. Later, this energy burst vanished and she simply couldn’t sleep.

She was tired all the time.

Before her visit with us at WholeHealth Chicago, Patricia had had quite a few diagnostic tests, all of which came back normal. Since her doctors didn’t believe in the existence of adrenal fatigue, no one bothered to measure her cortisol levels, which were, to put it mildly, pathetic (scroll down to view the graph).

Now it was time to start treatment, and in this Health Tip I’ll share our approach.

Supplements

You’ll see a lot of supplements on health food store shelves with variations of “adrenal support” on the label. As happens with many people standing before rows and rows of supplements, you may find yourself a bit dazed, a deer in the headlights, asking “Which one? Which one do I get?!” Usually people buy far more than they actually need.

Adrenal glandular  These products all contain dried adrenal gland, similar to the dried thyroid gland of Armour thyroid and Nature-Thyroid. Using animal glands to jump-start human glandular deficiencies has been a conventional treatment for decades, and one that fell into disuse when the pharmaceutical industry created synthetic versions. If you’re interested in reading more about glandular therapies, a couple of years ago I wrote two Health Tips on the subject (here and here). I always liked the idea that the original textbook on glandulars was a joint project of the University of Chicago and the AMA.

In my practice, I recommend the product by Integrative Therapeutics, two capsules every morning for three to six months depending on your clinical response.

Adrenal support  These products contain one or more herbs, the most important being Siberian ginseng, classified as an adaptogen because it’s one of several herbs that help the body adapt to stress. Siberian ginseng has actually undergone extensive clinical testing that shows it improves your ability to respond to stressful situations. Other adrenal support herbs include American ginseng (also called Panax), licorice, wild yam, and the Chinese herb bupleurum.

I’ve been recommending ITI’s ADREN-PLUS for more than two decades and am impressed by its reliability. Take two capsules every morning for 3 to 6 months depending on your clinical response.

Combo product  You can take a single product that combines the glandular with the herbal blend. This is pretty much for convenience only since the combined price roughly equals the two others. Again, the dose is two capsules every morning for 3 to 6 months, although many patients choose to continue taking it as a maintenance supplement to help them deal with stress as it arises in the future.

Nutrition

This is not at all difficult. You want to eat to avoid stressing your already pooped adrenals. The main villain is hypoglycemia (low blood sugar), which actually triggers a fight-or-flight response. Therefore:

• Don’t skip meals
• Make sure every meal contains some protein, complex carbs (ideally from vegetables), and healthy fats (olive oil, coconut oil, avocado, grass-fed butter). Strike from your menu sugar and sugary foods, simple carbs (refined flour foods), and processed foods. If you’re not sure what that means, read on.
• Reject the classic bad breakfast: coffee and anything sweet (doughnuts, pastries, French toast, pancakes).
• Start a program of high-nutrient eating. For breakfast, hardboiled or soft-cooked eggs, fresh fruit, half a sweet potato, and spinach sautéed in olive oil. For other meals, include salads packed with veggies and high-quality meats. Make your own dressings for salads and vegetables. Steam cauliflower or broccoli and toss with dressing or make Asian-spiced stir-fried cabbage. You get the picture.
• Your adrenals regulate sodium (salt) metabolism. Unless you’re on a specifically salt-restricted diet, you can be on the generous side with salt. I recommend an iodized salt over the popular sea salt products as these frequently contain no iodine. Your thyroid needs iodine to manufacture its hormone and you don’t want to become low-thyroid because you’ve made yourself iodine deficient.

Stress reduction

To me, swallowing a few supplements and eating healthfully are pretty straightforward. However, your issues with adrenal fatigue were most likely triggered by a lengthy period of unchecked stress. Learning to de-stress? Now that can be difficult.

As a start, you’ll need to press the Pause Button in your life and spend some serious time on personal reflection. Your adrenal fatigue is simply a message from your body asking you to reconsider the paths you’re following and the choices you’ve made. To ignore the meaning of the physical messages from your body is like turning off your phone when someone’s frantically texting you that your house is on fire.

Sometimes all you need is a few sessions with a therapist to talk about what got you where you are and explore the first steps to get you emotionally stronger again. You really don’t need months and months of psychotherapy for this (insurance rarely covers it anyway), most policies cover a few sessions with a therapist, and that might be all you need. At WholeHealth Chicago, therapist Karen Fayden can help launch you in a new direction.

In addition, you might want to check out our Monthly Mindfulness Group.

Prescription drugs

Sometimes a patient with severe adrenal fatigue simply doesn’t respond to the supplement program as well as hoped. Usually, these are people with long-term stress issues and long-term exhaustion whose cortisol curve is virtually flat-lined at the bottom of the graph.

Cortef (hydrocortisone) is the medicinal version of the hormone cortisol. At some time in your life you probably rubbed hydrocortisone cream on your skin for an inflammation since it’s sold over-the-counter and is a go-to favorite among dermatologists. Cortef is simply the tablet version. Your dose of Cortef parallels the way your adrenal glands release it, higher (usually 10 mg) in the morning, smaller (5 mg) in the afternoon. You’d use Cortef for 4 to 6 months before tapering off.

Florinef (fludrocortisone) is a special form of the same adrenal hormone, but tweaked slightly so that it allows your body to retain more salt. Florinef is prescribed when an adrenal fatigue patient has issues with excessively low blood pressure or gets lightheaded when moving from a seated to a standing position (called orthostatic hypotension). The dose is quite small (0.1 mg) and is generally used for a few weeks or months.

Alternative therapies

In traditional Chinese medicine, what Western medicine would call adrenal fatigue is referred to as kidney deficiency, usually kidney yin, but sometimes kidney yang or a combination of both. Treatments include acupuncture and herbal formulas (called tonics) to tone the kidneys. Our WholeHealth Chicago practitioners Cindy Kudelka, Mari Stecker, and Helen Streitelmeier have all done extensive work with these deficiency syndromes.

Classical homeopathy prescribing has addressed adrenal fatigue symptoms for more than 200 years using a different word—neurasthenia–an old term for chronic exhaustion. Homeopathic prescribing is done on an individualized basis. There’s no one-size-fits-all approach. Over her decades of clinical experience, our homeopath Sujatha Mannal has done extensive work with the neurasthenic syndromes.

Patricia herself has been doing quite well, though restoring her energy to normal levels took a little longer than I had hoped. She was anticipating that the supplements would make everything all right in a couple of weeks. I had to tell her that with the tsunami of stresses she’d experienced, her case was a bit more complicated.

Ultimately, she needed a few weeks of the prescription adrenal meds (Cortef and Florinef) and some short-term counseling to help cope with the trauma of her loss. At least now Patricia can refer to her adrenal fatigue in the past tense. “Remember when I was exhausted all the time? At least that’s over!”

Be well,
David Edelberg, MD