The Physical Response to Stress

The functions of adrenalin and noradrenalin are to;

  • Increase in the rate and strength of the heartbeat resulting in increased blood pressure
  • Blood is shunted from the skin to the skeletal muscles, coronary arteries, liver, and brain
  • Rise in blood sugar
  • Increased metabolic rate
  • Bronchi dilate
  • Pupils dilate
  • Hair stands on end
  • Clotting time of the blood is reduced i.e. the blood thickens.

Adrenal exhaustion

In response to chronic longterm physical and emotional stress, including the stress of a chronic inflammatory disease, the body produces excess cortisol and adrenalin. This is known as hyperadrenalism. As certain nutrtional supplements are precursers to adrenalin and cortisol, if the dietary intake of these nutrients is insufficient, after prolonged periods, the body can no longer produce sufficient cortisol and adrenalin. This is known as adrenal exhaustion. Adrenal exhaustion describes the inability of the adrenal gland to respond to the pituitary glands call to increase hormone production. It is similar to type 2 diabetes whereby the body can no longer produce insulin. From a naturopathic perspective the causative factor of type 2 diabetes is nutritional deficiency.

There are three stages of adrenal exhaustion; 

Stage 1

The first stage also called hyperadrenalism, is characterised by abnormally high cortisol levels and low DHEA levels. Symptoms of high cortisol include insomnia, sugar cravings, confusion, weight gain, hot flushes, water retention, glucose intolerance and muscle wasting. Cortisol also decreases serotonin and melatonin levels which may cause depression and insomnia, respectively. Cortisol is also immunosuppressive which may result in a compromised immune system resulting with frequent infections, chronic inflammatory conditions and autoimmune disease. High cortisol also can inhibit the metabolism of T4, a thyroid prohormone produced by the thyroid gland, into its active T3 form. This can create a thyroid hormone imbalance known as reverse T3 dominance which can further exacerabate your adrenal symptoms.

Stage 2

During stage two DHEA remains low while cortisol supplies will hover in the low-normal range leaving you feeling tired and stressed, but functional.

Stage 3

During stage 3 cortisol level are deficiency throughout the day. The naturopathic treatment principal is to tonify the nervous system and tonify the adrenal gland to regulate cortisol and adrenalin levels. Adaptogens have an amphoteric action on the adrenal gland meaning they can increase cortisol levels in cases of deficiency and reduce adrenal hormones in cases of excess.

Do You Have Adrenal Exhaustion?

Adrenal exhaustion can develop after lengthy periods of intense physical or emotional stress when chronic overstimulation of the glands leave them unable to meet your body's needs. Conventional endocrinologists and tests diagnose only extreme dysfunction in the adrenals, such as the potentially fatal condition, Addison's disease, where the adrenals essentially shut down. There is no drug treatment for adrenal exhaustion. Drugs will only worsen it in fact.

Symptoms of adrenal exhaustion

  • Excessive fatigue and exhaustion
  • Non-refreshing sleep (you get sufficient hours of sleep, but wake feeling tired)
  • Nightmares
  • Feeling of being overwhelmed
  • You live at night, having most energy in the evening
  • Difficulty concentrating
  • Chronic infections and weakened immune system
  • Food or environmental allergies
  • Premenstrual syndrome
  • menopausal symptoms including hot flushes (the adrenal should take over production of oestrogen after the ovaries have given up)
  • Cravings for salty and sweet foods
  • Poor digestion
  • Low blood pressure
  • Night sweats
  • Hyperpalmahydrosis

Why is sweating a symptom of adrenal exhaustion ?

One function of adrenalin is it causes peripherovasoconstriction, thereby redirecting blood flow internally to the muscles. In the absence of adrenalin, such as in adrenal exhaustion, the result is the opposite, peripherovasodilation. Peripherovasodilation promotes sweating.

The adrenal gland and the circadian rhythm

The adrenal gland does not secrete its steroid hormones at a constant level throughout the day. The hormones are actually released in a cycle with the highest value in the morning and the lowest value at night. This 24-hour cycle is called the circadian rhythm. An abnormal adrenal rhythm can influence many functions of the body.

1. Energy Production - Abnormal adrenal function alters the ability of cells to produce energy. People who have difficulty rising in the morning, or who suffer with a low energy levels, often have abnormal adrenal function and blood sugar imbalance.

2. Muscle and Joint Function - Abnormal adrenal rhythms inhibit tissue healing. Reduced tissue repair and increased tissue breakdown can lead to muscle and joint breakdown with chronic pain.

3. Bone Health – The circadian rhythm of the adrenal gland determines bone building. Elevated morning and evening cortisol levels inhibit bone building making bones more prone to osteopoenia and osteoporosis.

4. Immune system - White blood cells cycle in and out of the spleen and bone marrow for special conditioning (possible nourishment and instruction) according to the cortisol cycle. Stress suppresses the immune response on the surfaces of our body as in lungs, throat, urinary and intestinal tract by causing a reduction in the surface antibody (called secretory IgA). This reduces resistance to infection and inflammation.

5. Sleep - High cortisol levels at night and in the morning. Negatively affect the ability to enter REM sleep cycles, i.e. regenerative sleep. Chronic lack of REM sleep can reduce the mental acuity and induce depression.

6. Skin - Skin regenerates during sleep. Excess cortisol at night prevents skin regeneration.

7. Thyroid - The level of cortisol at the cell level controls thyroid hormone production. The root of hypothyroid symptoms such as fatigue and low body may be due to adrenal insufficiency.

8. Grain Intolerance - About 12-18% of the population, specifically those with Celtic, Germanic, and Nordic derivation suffer from a genetic intolerance to grain. Consuming the grains can cause as adrenal stress response, increased cortisol and reduced DHEA.

Food allergy and adrenal exhaustion

Adrenal exhaustion is implicated in food allergy. Exposing a child to a food allergen will often result in an immediate symptom i.e. diarrhoea or skin rash. Take the food away and the symptom will disappear. However, constant exposure may not result in symptoms. This is because every time a child is exposed to an allergen the body sees this as a stress on the system. As a result of this perceived “stress” the adrenal glands produce adrenal hormones including adrenalin, noradrenalin, cortisol and aldosterone.

High levels of adrenalin can result in hyperactivity disorders and high levels of cortisol suppress the immune system. Like corticosteroids, cortisol is also an immune suppressant. Therefore, the instant symptoms that the child previously experienced when trying a new food are no longer experienced as the immune system is suppressed. This is the mechanism whereby stress is said to suppress the immune system. As the adrenal gland can no longer keep up with the demands the secretion of adrenal hormones diminishes, resulting in adrenal exhaustion.

Whether or not children actually outgrow allergies is controversial. From a naturopathic perspective you don't grow out of allergies. If your allergy has disappeared because you made lifestyle and dietary changes then that a more positve sign.

Traditional Chinese Medicine (TCM) and adrenal exhaustion

Adrenal exhaustion has similar symptoms to Yin deficiency. Yin and Yang Yin and Yang is the foundation of diagnosis and treatment in Traditional Chinese Medicine. All physiological processes, signs and symptoms can be explained according to Yin and Yang.

Four possible states of imbalance of Yin and Yang

  1. Preponderance (Excess) of Yin
  2. Preponderance (Excess) of Yang
  3. Weakness (Deficiency) of Yin
  4. Weakness (Deficiency) of Yang

When Yin Yang are in dynamic balance and relating harmoniously, there are no symptoms to observe. When Yin and Yang are out of balance, they become separated and symptoms develop. Each of these states is determined by specific symptoms.

For example:

a.) Yin does not cool and nourish Yang so Yang rises leading to headaches, red face, sore eyes, sore throats, nosebleeds, irritability, manic behavior.

b.) Yang does not warm and activate Yin leading to cold limbs, hypo-activity, poor circulation of blood, pallour, low energy.

In general, treatment principals are to:

  1. Tonify Yang
  2. Tonify Yin
  3. Disperse excess Yang
  4. Disperse excess Yin

Deficiency of Yin leads to excess Yang resulting in feelings of "empty heat". This is known as Deficiency Heat, also called False Heat. There are similarities between the symptoms of Yin deficiency and adrenal exhaustion. Whilst symptoms vary between person to person there appears to be a common thread. According to TCM, individual symptoms indicate a particular organ pathology.

Symptoms of Yin Deficiency

  • Mallar flush (flushed cheeks/hot flushes)
  • Afternoon fever
  • Night sweats
  • Five hearts hot {(wu xin fan re) heat sensation in the palms of the hands, the soles of the feet and the chest}
  • Dry mouth

According to TCM organ patholgy, additional symptoms determine which organ is affected and this helps us properly diagnose and treat the patient. Combining TCM and naturopathic philosophies will allow the practioner to better treat this condition. In fact if you are an acupuncturist trying to treat Yin deficinecy with herbs and acupuncture, and do not give the correct dietary advice, it is a waste of time. You must always remove the causative factors of disease and this is where the strength of naturopathy lies. On the other hand however, I believe Chinese Herbal Medicine offers the most powerful adrenal tonics available and acupuncture is invaluable.

If there is Heart Yin deficiency there will also be;

  • Anxiety and restlessness
  • Palpitations
  • Insomnia
  • Dream disturbed sleep
  • Easily startled
  • Poor memory

If there is Kidney Yin Deficiency there will also be;

  • Dizziness
  • Tinnitus
  • Vertigo
  • Sore lower back

If there is Lung Yin Deficiency there will also be;

  • Dry cough possibly with blood tinged sputum
  • Dry throat and/or mouth
  • Hoarseness

If there is Stomach Yin Deficiency there will also be;

  • Epigastric pain
  • Poor appetite
  • Constipation

Adrenal exhaustion and Yin deficiency- Crossover

If you observe the naturopathic symptoms of adrenal exhaustion you can see there there are similarities with TCM patterns of Yin deficiency. Now revisiting these you can class the symptoms of adrenal exhaustion according to a TCM pattern of disharmony.

Naturopathic symptoms of adrenal exhaustion and their TCM diagnosis

  • Excessive fatigue and exhaustion Non-refreshing sleep (you get sufficient hours of sleep, but wake feeling tired)
  • Insomnia (Heart Yin deficinecy)
  • Nightmares (Heart Yin deficiency)
  • Feeling of being overwhelmed (Heart Yin deficiency)
  • You live at night, having most energy in the evening (Yin Deficinecy)
  • Difficulty concentrating (Heart Yin Deficiency or Kidney Yin deficiency)
  • Chronic infections and weakened immune system (Lung Yin /Wei Qi) deficinecy)
  • Food or environmental allergies (Liver Blood Deficiency- blood and yin are interchangeable)
  • Premenstrual syndrome or menopausal symptoms including hot flushes,(the adrenal DHEA should take over production of oestrogen after the ovaries have given up) (Yin deficiency)
  • Cravings for salty foods (Kidney Yin deficinecy)
  • Cravings for sweet foods (Spleen Qi deficiency)
  • Poor digestion (Stomach Yin deficiency)
  • Night sweats (Yin deficiency)
  • Hyperpalmahydrosis (Yin deficiency)


Naturopathic treatment for adrenal exhaustion

The following advice is imperative.

Avoid Stimulants

As much as you may want them, stimulants are not the answer! Caffeine places further stress on the adrenals to work harder and produce more hormones resulting in yet further depletion the adrenal hormones. This includes ‘natural stimulants" such as guarana. Although if you have to guarana may be a better temporary option when burning the midnight oil as, whilst it is a central nervous system stimulant, it is not a nervous system irritant.

Balance Your Blood Sugar

Sugar and simple carbohydrates put stress on the adrenal glands due by rapidly shifting blood sugar levels. By switching to vegetables, fruits and proteins, and high fibre carbohydrates in the form of whole grains, blood sugar remains more stable, providing less strain on the adrenal glands. To maintain proper adrenal function, it is imperative to control your blood sugar levels. An excessive ratio of carbohydrates to protein results in excess secretion of insulin, which often leads to intervals of hypoglycemia (low blood sugar).

Stress tolerance goes down when you're hungry. In an attempt to normalise blood sugar the body stimulates the adrenals to secrete increased levels of cortisol and adrenalin. This contributes to chronic cortisol depletion and consequently, adrenal exhaustion. In order to stabilise blood sugar, you must maintain a balance between two hormones, glucagon and insulin, which are produced by the pancreas. Protein in the diet induces the production of glucagon.

Carbohydrates in the diet induce the production of insulin. Insulin promotes fat production. When excess carbohydrates are eaten in the form of sugars, potatoes and pasta, the body produces large quantities of insulin and little glucagon. When insulin is high and glucagon is low, the adrenals are called upon to produce excess cortisol as a back-up response to help raise blood sugar. This occurs at the expense of the adrenal glands, contributing to adrenal exhaustion.

Dietary advice for adrenal exhaustion

  • Eat a small meal or snacks every three to four hours
  • Eat within the first hour upon awakening.
  • Eat before becoming hungry. If hungry, you have already allowed yourself to run out of fuel (low blood sugar/ hypoglycemia), which places additional stress on the adrenal glands
  • The optimal level of insulin to glucagon is achieved by a diet that contains carbohydrates balanced with proteins in a ratio of approximately two to one. This basically means meat should take up 1/3 and low GI carbohydrates 2/3 of the plate i.e. roast beef and vegetables (not potatoes). If the carbohydrate is rice or potatoes, they should only take up 1/3 f the plate and meat 1/3 also.
  • A small amount (1 tsp) of cold pressed vegetable or seed oil will slow down the absorption of glucose into the bloodstream.
  • Eat Protein