Friday 30 September 2016

Running on empty... 21st-century stress syndrome

Tired of being tired? Lacking get up and go? Relentless schedules, caffeine addiction and emotional stress are the catalysts for a collection of symptoms known as adrenal fatigue. We get the low-down on the 21st-century stress syndrome

Published 07/07/2015 | 02:30

Adrenal fatigue is a 21st century syndrome
Adrenal fatigue is a 21st century syndrome

Did you wake up tired this morning (even after eight hours' sleep)? Did you need a strong coffee in order to feel semi-human? Does your body feel achy and sore? Do you get light-headed when you stand up quickly, or maybe you have cold hands and feet and a propensity to carry weight around your middle?

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If this is beginning to sound familiar, you could be suffering from adrenal fatigue, which is brought on by excessive and prolonged stress and is common among harried executives who have more appointments in a day than they have hours of sleep in a night.

The adrenals are the walnut-sized glands that sit on top of the kidneys. They are known as the body's shock absorbers and they secrete a number of different hormones, including adrenaline, cortisol and norepinephrine, which help the body respond to stress.

The trouble is that the travails of modern life mean many of us are under sustained stress. We are less inclined to take hour-long lunches, we feel guilty if we leave the office at 5pm and often we don't acknowledge emotional burdens until it's too late. This is why adrenal fatigue is euphemistically known as 'burn out' and otherwise known as "the stress syndrome of the 21st century".

Stress hormones are necessary for optimal body functioning; however, those suffering from adrenal fatigue secrete more of these hormones than they need. They're in fight-or-flight mode even when their bodies should be in rest-and-digest.

Think of the adrenal glands as a furnace. In a healthy person, this furnace runs smoothly. In adrenal fatigue cases, it spits, sputters and takes a while to get going in the morning… Blood levels of cortisol should spike by an average of 50pc approximately 20-30 minutes after waking up. It's known as 'cortisol awakening' and it is what gives us our get up and go in the morning.

Those with adrenal fatigue have a much more subdued cortisol response and often need a double espresso to kick-start the furnace.

Other symptoms include lack of focus and poor memory, low blood pressure (generally in the later stages) and inability to shift weight (stress hormones trigger the body to burn calories from carbohydrates and lean muscle instead of fats).

Adrenal fatigue sufferers also tend to have tension in the neck and back of the shoulders along with regular headaches. They crave salty foods and often have swollen ankles, which are worse in the evening.

Muscle twitching, unexplained back or knee pain and heart palpitations are common too.

Dr Eric Berg, author of The 7 Principles of Fat Burning (and whose YouTube video on adrenal fatigue is well worth a watch), says adrenal ­fatigue personalities have less tolerance for certain personality types "particularly the incompetent, slow drivers and people that make mistakes".

James L Wilson, author of Adrenal Fatigue: The 21st Century Stress Syndrome, says it is often precipitated by "recurring bouts of bronchitis, pneumonia, asthma, sinusitis, or other respiratory infections".

Dublin-based acupuncturist and naturopath Kevin Callan, who works alongside the Elbowroom Stress Clinic (the-elbowroom.com), says he consistently detects an under-functioning digestive system in adrenal fatigue cases. "Not so far as blood in stools, it's more IBS-like. Wind and bloating, sensitivity to carbs, diarrhoea, constipation, right up to Crohn's [disease] and diverticulitis."

Another knock-on effect of sustained stress and adrenal fatigue is a phenomenon known as 'pregnenolone-steal'.

Pregnenolone is a precursor hormone which is used by the body to make both stress and sex hormones. However, in times of stress, the body uses most of it for stress hormone production. "The body is saying, 'don't flirt, I need cortisol to survive'," explains Dr Patrick Magovern of the Drummartin Clinic (drummartinclinic.ie).

Symptoms of pregnenolone-steal include lack of libido, vaginal dryness and even adult acne.

"Adrenal fatigue is one of those labels that get applied to people with fatigue and unexplained symptoms," continues Magovern. "In conventional medicine, we tend to be very binary. It's zero or one. You can't say someone is a little bit pregnant.

"So we say a person has Cushing's [overactive adrenal glands] or Addison's [underactive adrenal glands] - however, there is probably an in between."

It should be noted that adrenal fatigue is not recognised by traditional doctors and endocrinologists. Professor Gerald Tomkin, consultant endocrinologist at the Beacon Clinic (beaconconsultantsclinic.com), says there is no evidence that "those suffering from the various symptoms described and attributed to this syndrome secrete more or less adrenal hormones".

He further argues that there have been no scientific trials to date.

"Patients who have adrenal failure and who are on replacement therapy with hydrocortisone feel completely well, so a trial to cure these people with hydrocortisone would be easy to do and would prove that the syndrome is adrenal in origin. I do not know of a trial that has been done, but alternative medicine has little time for scientific proof!

"Conventional medicine is not very binary," he continues. "We accept that there is a huge amount we do not know [but] that should not allow others to make statements as if they know without producing evidence."

On the other hand, integrative doctors and alternative practitioners are adamant that adrenal fatigue is as legitimate as it is common.

In the earlier stages of his career as a practicing GP, Magovern used to dismiss anything other than traditional medicine as "quackery".However, as he struggled to treat patients with complaints such as low energy, chronic pain and migraine, he was encouraged to start seeking alternatives for those whose blood tests suggested that all was well.

He went on to study modalities such as acupuncture, bio-identical hormone therapy and nutritional medicine, and today he offers his patients an integrative, holistic alternative that goes to the root of the problem.

Dr Sara Gottfried, author of The Hormone Cure, embarked on a similar journey. She left traditional medicine to set up her integrative practice 10 years ago.

"In my medical training, I learned about tumours of the adrenal glands, and what to do if a patient had an extreme excess of cortisol or complete failure of the adrenals," she explains. "I had been trained to identify the weeds and dead plants, but not to look for the early and subtle signs of ailing to come, which is the basis of adrenal fatigue or dysregulation.

"Most mainstream doctors don't look for gradations in adrenal problems, and it seems that the only doctors who are aware of adrenal dysregulation are the ones who developed the problem themselves," she adds.

Proponents of adrenal fatigue say the blood-test values for cortisol imbalances are too broad. Dr Berg notes that the adrenal glands have an "enormous functional reserve" before it clinically manifests. This is why integrative doctors prefer to perform a series of tests alongside bloods.

Magovern prefers to use saliva testing when testing for cortisol while Gottfried relies on saliva and dried urine.

Sometimes, the personality type is one of the first indicators. Many experts agree that there are typical adrenal fatigue characteristics. James L Wilson says an adrenal fatigue sufferer "does not get enough rest and relaxation to enjoy life", "drives him/herself constantly" and "is never satisfied or is a perfectionist, who is under constant pressure (especially with few outlets for emotional release)".

Callan reminds that stress is accumulative. "It's generally a Type A, all-or-nothing personality who isn't mindful about what they eat. They are either overwhelmed or stressed over a long period, or a stressful period in work or a bereavement tips them over the line and the coping glands fail to cope effectively."

Often we think of deadlines and relentless schedules when we think of stress. Dr Berg reminds us that emotional stress takes even more of a toll than around-the-clock work. "Emotional stress, like losses, can hit the adrenals 1,000 times more than actual physical stress," he says, "and that's why the loss of a loved one can turn into a major problem with your health."

Those suffering from adrenal fatigue need to embark on a lifestyle overhaul.

"The particular kind of rest you need when you have adrenal fatigue comes not so much from lying down, but from standing up for yourself, and from removing or minimising the harmful stresses in your life," says Wilson.

There are countless specialised supplements on the market - which is partly why the traditional medical community is suspicious - but the truth is that there is no quick fix.

"It's a lifestyle-defining diagnosis," explains Callan. "Changes have to be made daily, incrementally, and over a long period of time." Adequate rest is key. Those suffering from adrenal fatigue tend to peak at 6pm. They get tired at 9pm or 10pm, but they often push on until they get a second burst of energy at 11pm. Bedtime is generally around the 1am mark, hence they are often described as "tired but wired".

Callan advises that they start a regular sleeping schedule, waking up and bedding down at the same time each day, while Magovern stresses the importance of getting to bed before midnight.

Often the diet needs to be radically altered too. Caffeine is considered to be especially troublesome. However, Prof Tomkin argues that it "has mostly a central effect and… the effect on the adrenal is probably secondary and of little importance".

Refined sugars and alcohol are thought to be major catalysts, too.

"They need to cut down on empty foods that create stress on the body and blood sugar needs to be kept balanced," explains Callan. "Spiking with refined sugars or leaving too long in between meals drives the adrenal glands too hard."

Magovern adds that the adrenal gland is among the organs with the highest concentration of vitamin C in the body. He suggests adding foods that contain vitamin C to the diet and, if blood sugar is low, drinking half a teaspoon of pink Himalayan salt in a glass of water in the morning. Other experts suggest adding the juice of half a lime.

Switching to a diet of unprocessed whole foods can make all the difference. Foods containing vitamin B12, which is used for the synthesis of adrenal hormones, should be added to the diet, along with the minerals selenium, zinc and magnesium.

Elsewhere, good fats like olive and coconut oil, nuts and avocado will balance your blood sugar naturally.

Many alternative practitioners recommend a class of herbs known as adaptogens for adrenal fatigue. These include ashwagandha, rhodiola, ginseng, schizandra and maca. Adaptogens are indeed powerful, but they are also highly potent, and should not be taken lightly. The correct dosage is generally determined through trial and error and many of them are contraindicated for those on SSRIs or MAOIs. Consult with a trained integrative doctor first.

Sufferers may also notice that they are tired an hour after heavy or intense exercise. This is because it can overstimulate the already overburdened nervous system. Low-intensity exercise is the best option when in the early stages of recovery. Think walking and light stretching alongside gentler schools of yoga (Yin yoga in particular) and other relaxation methods.

The trick is not to run before you can walk. "I make a pact with my patients that they do just 70pc of what they feel they can safely get away with," says Magovern. "Otherwise they think 'I'm feeling great' and the next day they are like a ragdoll."

Callan reminds that recovery is about facing up to your limitations.

"In western society, we are not taught to cut our cloth to our measure," he says. "When we drive a car more, we know we need to service it more. Yet when we up our own productivity, we expect to run at the same capacity.

"It takes time to recover from adrenal fatigue but the beauty is that you can have a whole new life where you know what it is to live consciously and within your boundaries."

What is adrenal Fatigue?

Although adrenal fatigue is not necessarily a recognised condition by a lot of medical practitioners, the role of a dietitian is to help with symptom management, regardless of diagnosis.

Nutrition and lifestyle choice are key to feeling better. A few areas need more focus than others, such as hydration, frequency of eating and ensuring that all meals and snacks are balanced.

• Hydration is paramount - even 2pc dehydration affects mental acuity. Optimising fluid intake will improve both mental and physical function. Everyone needs about 25-35ml for every kilogram that they weigh each day.

• Frequency of eating is extremely important. Many people suffer from 'hangry' - a word used to describe feeling angry when hungry. Eating three meals of equal size, as well as adding in snacks if there are long gaps between meals, is central to ensuring energy levels and mood are kept more steady. The little-and-often approach will also help someone to avoid sugar cravings as we tend to reach for quick-releasing carbohydrates when our sugar levels dip.

• Having a balanced diet means eating balanced meals. Often, I start a presentation asking 'Do you eat a plate of potato for breakfast?' and people look at me like I have two heads. However, if you eat only carbohydrate at breakfast, you are doing exactly that. For example, porridge made with oats and water, or toast with jam. When trying to optimise your energy levels, it is incredibly important to ensure that you have more than three food groups with all meals. Protein and fibre should be a focus at all meal and snack times. So instead, why not make your porridge with milk and add some nuts/seeds and berries? Or perhaps swap the jam for some eggs?

• The relationship between exercise and susceptibility to infection is a bit of a J-shaped curve. It's important to get some form of exercise daily to ensure that your immune system is strong. But, as any athlete will know, prolonged exercise can negatively impact your immune function

• Sleep disturbances can be ameliorated with the help of some dietary changes. There is a lot to be said for a hot milk at the end of the day...

• Sleep hygiene is also incredibly important. It's best to stay away from artificial light, particularly your phone and laptop, in the lead-up to bedtime. Exercising in the morning and getting into a routine prior to bedtime will also help improve sleep quality.

- Nutritionist Orla Walsh

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