There is a lot in the media, especially social media, about ‘adrenal fatigue’ these days. Adrenal Fatigue is not a recognized illness, not an actual diagnosis, but there is such a thing as Adrenal Insufficiency, and there are adrenal deficiencies. Likewise, there are also hyperadrenal illnesses.
If you are diagnosed with Adrenal Insufficiency, this is a very serious illness that needs immediate and constant treatment. Illnesses classified as actual Adrenal Insufficiency include Primary and Secondary Addison’s Disease and Congenital Adrenal Hyperplasia (of which there are several forms). Each form of Addison’s and CAH have unique attributes, but basically, all are in danger of Adrenal Crisis (sometimes called Addisonian Crisis). At the end of this article will be crucial information for Adrenal Crisis signs and intervention. There are other endocrine illnesses that can result in Adrenal Crisis, such as Growth Hormone Deficiency (GHD).

There is no ‘template’ to these illnesses; due to the extreme changes that can occur from just one single abnormality in hormone production and each hormone and gland’s correlation to nutrients, enzymes and acids in the body, most patients do not fit a textbook mold, which can make diagnosis even more difficult. It can also make treatment difficult as there are no protocols for a situation that is unique. But – there are guidelines.

The Adrenal Glands, of which there are two, sit atop the kidneys. They produce numerous hormones – over 50, of which the most important in the context of these illnesses are Cortisol and Aldosterone. Although Norepinephrine and Epinephrine (adrenaline) are important, they are not the focus of Adrenal Insufficiency. Cortisol and Aldosterone are necessary to sustain life, and when they are lacking and an Adrenal Crisis occurs, they can quickly be responsible for death.

What does cortisol do?
Cortisol is a life-sustaining hormone. Cortisol helps regulate blood sugar, metabolism, the immune system, heart and blood vessels, and central nervous system activation, to name a few. When a person’s body is stressed either physically or emotionally, cortisol is extremely important and is what keeps us alive during these times.

STRESS. That needs more explanation.

Stress is such a buzz word lately. We are not talking about mortgage due-car payment late-kids are sick kind of stress; although that WILL affect your cortisol levels, and greatly. But stress includes physiological stress. Stress on the body from illness, such as a cold, fever, injury, headache, physical labor, running, etc. During a stressful event, your cortisol levels multiply up to 10x. If your body does not make enough cortisol for normal function of your body, you have to replace it. Then, if you face a stressful situation – whether it is something listed above, or even an argument with a loved one, you need to take way more medication than you normally would take to make up for the 10x increase your body cannot make. If you cannot do this, you will collapse and could possibly die. You just don’t have enough cortisol, and the circulatory system starts shutting down. It is similar to a gas tank running on fumes. You may have enough gas to get to the corner station, but if a dog runs out in front of you and you have to step on it and swerve, you may use all of what you have left up in an instant. And then the car dies.

Taking cortisol for other ailments such as asthma, etc., for long lengths of time can cause steroid dependency. Your body quits making it because it doesn’t think it needs to anymore. You can then become adrenally insufficient, and require cortisol supplementation for the rest of your life. If you don’t have enough, you can have an Adrenal Crisis. If you don’t take extra during times of stress when your body would normally make extra, you can have an Adrenal Crisis. If you don’t make cortisol and you don’t take your glucocorticoid medication for 72 hours, you can have an Adrenal Crisis and potentially die.

To replace cortisol, patients are placed on Hydrocortisone, Prednisone, or Dexamethasone. Hydrocortisone (or HC) is the medication of choice for Primary and Secondary Addison’s Disease, and Dexamethasone is the medication of choice for Congenital Adrenal Hyperplasia, although there are variations due to severity and tolerance. The dosage is usually several times a day, oftentimes mimicking the body’s own rhythm of how it makes cortisol naturally, with additional doses needed in times of physiological and emotional stress. In the event of an Adrenal Crisis, an emergency injection of Solu-Cortef or Dexamethasone is needed immediately, even if the patient is being transported to the ER. Do not wait for the Emergency Room, this could cost a person their life.

Aldosterone is a mineralcorticoid. If you have high blood pressure, you may have heard of Aldosterone, as it is oftentimes the cause if you have too much. But with salt-wasting Adrenal Insufficiency, you have hardly any, or none at all. Patients with Primary Addison’s normally suffer from what is know as “Salt Wasting” and do not have enough Aldosterone. The most common form of Congenital Adrenal Hyperplasia is due to an enzyme deficiency called 21-Hydroxylase, and is nicknamed “Salt Wasting CAH.” These patients have hardly enough, if any, Aldosterone. What does Aldosterone do??

Aldosterone regulates blood pressure, salt and water balance in the body, and potassium. Without enough Aldosterone, a patient’s blood pressure can drop very quickly to shock state. Without having enough salt, the patient can become seriously dehydrated. Along with dehydration, the body starts shutting down. All systems start shutting down until the patient reaches circulatory collapse (SHOCK), when the only thing left is the heart circulating blood and the kidneys barely assisting in the blood circulation. Once the patient reaches this state, it is a life threatening event. Only emergency intervention can save the patient’s life.

To replace Aldosterone, patients are prescribed Fludrocortisone (brand name Florinef). There is no other medication, nor is there any herbal or homeopathic medication to assist with increasing Aldosterone production and levels. However, some patients are able to keep their sodium and electrolyte levels normal by taking salt tablets, using extra salt (sea salt and pink Himalayan salt are most recommended), electrolyte replacements, etc. In the event of an impending Adrenal Crisis, or if the patient feels dehydrated or faint, immediate salt ingestion is usually called for.

It must be stressed that these are just short, cursory, laymen explanations and there is much, much more involved in these processes, and the symptoms and consequences are many times more.

Although both Addison’s Disease and CAH are known for the hallmark of low or no cortisol and in salt-wasting forms the additional lack of Aldosterone, this is not always the case. “Adrenal Insufficiency” on it’s own can also be one of these non-textbook cases which only exhibit low aldosterone, but normal cortisol. Or, it can be cyclical low cortisol. These cases are even more frustrating, as you may not need daily medication – in fact, it can be detrimental, as overuse of glucocorticoids (cortisol supplementation) can lead to Cushing’s Syndrome. Cushing’s Syndrome is different from Cushing’s Disease, which is caused by a tumor. Cushing’s Syndrome can also be cyclical. Some people may have test results showing adequate amounts of cortisol, but they have a problem with cortisol binding to its receptors and being carried to the organs and targets that need it, or there may be an issue with the feedback receptors. You can see how complicated not only the diagnosis, but the treatment can be.

No matter which of these diagnoses you have received, or on working on receiving, from a holistic and nutritional standpoint one of the most important things you can do is to help your Adrenal Glands not overwork and become sicker, and not use up the precious hormones that you may produce in insufficient quantities. Even though you may take medication, helping your body be healthier and your organs and glands work as best they can will help your medication do its job better. In life threatening conditions like these, it is never recommended to stop your life-sustaining medications unless a licensed specialist who is monitoring your care recommends it. But, since there are many symptoms to manage with these illnesses, as well as other illnesses and conditions that can manifest due to the consequences of the diseases, the best thing you can do for yourself is to live the healthiest you can, help your body be the healthiest it can, and be very cognizant of signs and symptoms on a daily basis when your physician is not present.

When it comes to the Adrenal Glands how do we do this?
Proper nutrition is a very important part of living and being healthy. Proper nutrition means more than ‘eating’ healthy foods, but eating foods that are healthy and beneficial to your particular situation and avoiding foods that will exacerbate symptoms or promote the development of secondary or other illnesses. For example, excess cortisol often causes high blood glucose, so avoiding foods with sugar, carbohydrates, and foods high on the glycemic index would be prudent. Obviously, lowering your cortisol level would be key to the problem, but adding additional sugars for the body’s endocrine system to deal with would stress your body even more. You would not want to eat foods that promote cortisol production or that have glucocorticoid properties, you would want to eat foods that lower cortisol, or supplement your body’s ability to lower or properly utilize cortisol on it’s own, like adaptogen herbs. Or, perhaps you have an additional illness, so both situations have to by analyzed to properly address both of them. A good nutritionist can help you evaluate your health situations and come up with a nutritional plan that involves food, nutraceuticals (supplements) and even herbs. For people with low or no aldosterone, nutrition is one of the most important factors. Obviously, water, sodium and potassium are nutritionally provided elements. It is extremely important to not only take your Fludrocortisone, but to watch the amounts of salt, water and potassium you ingest. Not eating enough salt is still dangerous, even on Fludro. And although you need to watch eating too much potassium if you are not on Fludro, you actually have to eat slightly more potassium if taking it. And your water intake needs to be at appropriate levels for the amount of Fludro, salt and potassium you are taking each day. Again, quite complicated, and the routine you establish can change based on hormone production, weather, etc. Again, complicated.
Situations that cause the cortisol you have to be used quite quickly should be avoided, especially when you have an issue with regeneration of cortisol in a timely manner. Likewise, situations which cause cortisol production to be stunted should be avoided. These situations include illness, traumatic accidents, traumatic emotional stress, and the like. Obviously many of these situations cannot be avoided voluntarily, but we can work at keeping the risk low. Staying away from sick people, using hand sanitizer, taking antivirals, not being a daredevil are highly recommended for people with Adrenal Insufficiency, OR who are taking replacement or supplemental cortisol. For people with low or no aldosterone, staying out of excess heat, saunas, etc. are highly recommended.

Life management skills are extremely part of the holistic plan in taking care of your adrenal glands so that they take care of you. Some suggestions are:
• Whenever possible, delegate, simplify or eliminate. You don’t have to do everything – and by learning to appropriately delegate, you are creating a social network. By simplifying, you can save costs, you can feel better, and you can have more time to enjoy life. By learning to eliminate, you learn to realize what is important and necessary. Delegate, simplify, eliminate.

• Learn to be flexible and resilient. Things don’t always go by plan, and sometimes they end up better than expected. Know that everything happens for a reason, and the way it is meant to be. Accept it, adapt and bend. If you don’t bend, you will crack.

• Live life and do the things you enjoy. Not much explanation is needed here, but I will elaborate – as long as it is legal and does not hurt anyone, do the things you enjoy.

• Embrace predictability and order. Plan as much as possible, while still being flexible. For example, plan your meals and cook much of it ahead of time on a ‘good day.’ Don’t worry everyday about what bills are due, but get a day planner and designate a bill paying day. Make a schedule for cleaning house, doing laundry, answering correspondence, etc. With adrenal illness, it is important to have time before and after an event, and to not have surprises be sprung on you. Planning can provide all of these needs. Be sure you plan some down time and time for yourself first and foremost before writing in any other appointments or tasks.

• Meditation, massage, acupuncture and other forms of energizing and healing relaxation can help you. Begin by practicing meditation on a daily basis – start with a short period of time for reflection and work into a full, spiritual meditation program. Enjoy acupuncture on a regular schedule developed with a acupuncturist with whom you’ve discussed your condition and goals. Schedule a massage and spa day at least once a month, and work into a different schedule if you find it is helping you. Learn how to do massage along with your partner and take turns; both giving and receiving are relaxing and beneficial!

• Avoid multitasking. Above all, avoid multitasking. Focus on one thing at a time, complete it the best you can, and move on to the next thing with the confidence that you have done the best you can – an avoided taxing your adrenal glands, or worst case scenario, avoided an Adrenal Crisis.

If you know someone with Adrenal Insufficiency or another adrenal illness, remember that you don’t need to know all of the physiological ins and outs of Adrenal Insufficiency, unless you want to. What you DO need to know is:

•This is a life threatening illness.

•Where the patient’s emergency medication is (even if you are not there, but are able to tell somebody).

•What to tell persons in authority – that the patient is STEROID DEPENDENT. This is not only important because it will save their life, but STOPPING steroids without proper ‘weaning’ can cause a life or death situation, as well.

•That the person does not need to be around sick people, or stressful situations, or put into exerting situations.

•That they need support, as do their caregivers.

While there is no cure for Adrenal Insufficiency, you can help your body be healthy and help the medications you are required to take, by working with a nutritionist to develop a Wellness Plan specific to your issues. You can change your lifestyle to avoid situations that may tax your adrenals and either require medication dosage changes or affect the proficiency of your medications. These situations may then require additional medications, which affect other physiological functions in your body. Help your body help itself, and help your adrenals help YOU.

Author's Bio: 

Lisa C. Baker, CNC, RNHP, is a certified Nutritional Counselor, and also holds a certificate in Complementary and Integrative Health. She is a member of the American Nutritional Association, the International Association of Natural Health Practitioners, International Institute for Complementary Therapists, and is a Registered Natural Health Practitioner by the IANHP.

Mrs. Baker is a musician and recording artist, a mother of one, and resides in Muskogee, Oklahoma with her husband and their kitties.