Have you every come across the term adrenal fatigue? If you have an autoimmune condition, low energy, feel run down, are frequently unwell, or have unexplained weight gain you may well have read about it. Practitioners of natural medicine often refer to adrenal fatigue (or burn-out and adrenal exhaustion) as a likely cause for ill health.
I’ve always felt slightly uncomfortable with the concept of adrenal fatigue. It’s based on the assumption that if your adrenal glands (which help you manage stress by producing the hormones cortisol and DHEA – amongst other things) are pushed too hard they will eventually become ‘spent’ and stop working properly. It’s hard see the logic that these really important glands can become exhausted in such a way. Much of the information available when trying to understand the mechanisms behind this philosophy do not give adequate explanation, and to me it is just too simplistic a notion. However, because cortisol and DHEA play such an important role in how your immune system works, their manufacture and management needs to be taken seriously.
When I work with a client and suspect low (or high) adrenal hormone output I’m able to use functional tests to measure levels of the stress hormones cortisol and DHEA, as well as looking at how they are being metabolised. I’ll often also factor into the picture levels of the hormones oestrogen and progesterone too, as understanding the wider hormonal landscape can be extremely useful in pinpointing exactly what is going on with my client’s health and immune function (I plan to write about the roles of oestrogen and progesterone in immune function soon). This information is really valuable, and enables me to tailor my nutrition and lifestyle recommendations in a far more effective way, getting better results quicker. It is certainly true that many of my clients’ results come back with readings of low cortisol output.
However, my question is: If you have low cortisol is it because of adrenal fatigue? Have your adrenal glands really given up the ghost? And could this be why you have an autoimmune condition; feel exhausted; suffer from frequent infections; feel compelled to consume sugary, fatty comfort foods or caffeinated drinks?
The simple fact is that for your adrenal glands to simply stop having the capability to produce stress hormones you would have a serious health condition, such as Addison’s disease. However, for the majority of people who have issues with low cortisol, it’s not because the adrenal glands are unable to produce this hormone. Instead it’s because your body’s hormone feedback mechanisms have in fact adapted the way in which your stress hormones are produced. It’s about the body’s internal communication network. Deal with this, and balanced adrenal function – and the path to health – can be restored.
Having low cortisol can be a real problem for your health. That’s why it’s important to understand what’s going without making any assumptions. It plays an important role in regulating your immune system, so if levels become too low (or too high) it can lead to regular infections, chronic inflammation, autoimmune diseases or allergies.
So if low cortisol isn’t because your adrenal glands have gone on strike, what is the reason?
Firstly, it’s important to understand that your adrenal glands will only respond to instruction. They don’t think for themselves. The thinking is done by a part of the brain call the hypothalamus. The job of the hypothalamus is to receive and analyse information from numerous sources around the body; then act accordingly. The hypothalamus ultimately controls your temperature, blood volume, blood pressure, appetite and libido (the list goes on). It’s constantly computing information from hormone, neurotransmitter and immune system messengers. And it’s these immune system messengers that appear to influence the adaptation of an adrenal response, rather than your adrenal glands simply wearing out.
If the hypothalamus picks up a message of stress (from either physical or psychological origin) it will organize for a hormone messenger (called CRH) to travel to a place called the pituitary gland located at the base of the brain. The pituitary then makes its own hormone messenger (called ACTH), which in turn travels to the adrenal glands. It tells them to produce the hormone cortisol (along with other messengers including adrenalin). Cortisol then moves out to send it’s own messages to help the body respond to the stress (this might include elevating blood sugar levels to help make more energy ready to fight the physical or perceived stressor).
What are stressors?
A stressor is something that engages your adrenal glands to produce stress hormones. Examples include:
- A busy lifestyle, job or relationship that makes you feel overwhelmed or anxious
- Poor nutrition
- Lack of sleep
- Pain, illness or infection
- Toxic exposure
Possible immune system link to low cortisol number 1:
Over time, if the stressors remain in place, the hypothalamus will compute this via it’s many hormone, neurotransmitter and immune system messengers. It might think it reasonable to reset its response, because what was once a heightened sense of stress is now the new ‘norm’. For example, immune system messengers, possibly triggered from the production of cortisol, can instruct the hypothalamus to reduce production of CRH. Therefore, if there is less direct instruction at the top of the chain, the adrenal glands wont be prompted to make so much cortisol by virtue of the fact that there is less circulating ACTH.
Possible immune system link to low cortisol number 2:
All hormone messengers rely on being able to bind to receptors on their target gland or tissue to pass on their message, but if there are few receptors available then your hormone’s message wont be passed on. There are some immune messengers that actually bind to receptors on the adrenal gland, effectively taking the spot that ACTH is looking for. As ACTH is the hormone that instructs your adrenal gland to manufacture of cortisol, this could be a problem. This means that the overall production of cortisol is reduced.
The immune system and adrenal health
There is good evidence that both too little or too much cortisol can – over time and if left unmanaged – influence the workings of the immune system, and that inflammation can negatively impact on the optimal functioning of the adrenal glands and the important work of cortisol. This is why addressing your hormone health is one of the cornerstones to getting your immune health back on track.
Understanding the complexities can make it easier to tackle the root cause for any issue with low (or high) cortisol. The truth is that if adrenal dysfunction is a factor in poor health there are likely to be other areas to address too. Looking at the body from a functional perspective and considering the interplay between all body systems is key.
Addressing adrenal dysfunction
- Establish if this really is a problem by testing adrenal hormone output and metabolism.
- Consider and investigate other factors and stressors that might be impacting on adrenal function due to inflammation (such as infection, autoimmunity, overtraining or toxic exposure).
- Begin making dietary changes, focussing on reducing the stress response, improving cell communication, supporting the immune system and reducing inflammation.
- Address nutrient deficiencies that may be impacting on cortisol management and response.
- Consider the major impact of lifestyle factors on the stress response and put a plan in place to make positive change.
- Understand the importance of the mind/body connection to managing stress and find tools that work for you to make you emotionally healthy.
If you are interested in finding more about the impact of stress on your health you can read my blog series Stress & Health. Over the course of three articles, I look at the impact of stress on anxiety, digestion and the immune system.