Ronnie
Jedi
In my continued search for unstoppable headaches, I'm pretty sure I've hit upon the answer. My God, I don't know where to start! I do hope this will leed some to better health. Your doctor won't find this, It's up to you.
One of the most common clinical patterns seen in healthcare clinics is stress-related illness. Some healthcare practitioners report as high as 85% of their patients fitting this category. Persons with this condition have reactions to stress which are either causing their illness or aggravating it. Adrenal glands are the anti-stress glands of the body—the reserve which the body falls back on when it is faced with stressful situations. It is their job to enable your body to deal with stress from every possible source, ranging from injury and disease to work and relationship problems. Your resiliency, energy, endurance and your very life all depend on their proper functioning. Your adrenal glands respond to every kind of stress in the same way, whatever the source. Adrenal fatigue occurs when the amount of stress overextends the capacity of the body to compensate and recover from that stress or the combined stresses. Once this capacity to cope and recover is exceeded, some form of adrenal fatigue occurs. The number of stresses, whether or not you recognize them as stresses, the intensity of each stress and the frequency with which it occurs, plus the length of time it is present, all combine to form your total stress load.
There are four major categories of stress:
1. Physical stress—such as overwork, lack of sleep, athletic over-training, etc.
2. Chemical stress—from environmental pollutants, diets high in refined carbohydrates, allergies to foods and additives, endocrine gland imbalances (due to the interaction of all of the endocrine glands).
3. Thermal stress—over-heating or over-chilling of the body
4. Emotional and mental stress
Early studies by Hans Selye, M.D., identified a pattern of stress-related illness in both test animals and humans. Selye discovered a series of events that occur as a reaction to chronic stress. This series of events is known as the General Adaptation Syndrome (GAS). The GAS has three stages:
1. The alarm reaction. The body’s initial complex chain of physical and biochemical responses to stress brought about by the interaction of your brain, nervous system and a variety of different hormones, involving an increased amount of adrenal activity. Your body goes on full alert. The adrenals produce extra amounts of hormones. The adrenals are working harder to respond to an immediate stress situation. That is a function for which they are designed. There is actually an initial hyperadrenic response to stress. After the alarm reaction is over, you body goes through a temporary recovery phase that lasts 24-48 hours. During this time there is less coritsol secreted, your body is less able to respond to stress, and the mechanisms over-stimulated in the initial alarm phase by the involved hormones become resistant to more stimulation. In this let-down phase you feel more tired and listlessness, and have a desire to rest. If the stress is continued long enough, the adrenals will finally be overtaxed to the point of depletion as a reaction to this alarm state. Sometimes a person will seek a doctor’s help for the symptoms caused by this type of hypoadrenia.
2. The resistance stage. After a period of time of continued, severe stress, the adrenals begin to adapt and to re-build themselves. The adrenals have a great capacity for increasing their size and function. If one adrenal is surgically removed, the other adrenal can hypertrophy to twice its normal size, giving the person the same amount of adrenal tissue he previously had. This capacity for increased size and function is the basis for the resistance stage. The prolonged alarm reaction starts as a hyperadrenia which leads to a hypoadrenia which then progresses into another state of hyperadrenia as the resistance stage takes over. This phase of resistance can last months or even up to 15-20 years. The adrenal hormone coritsol is largely responsible for this stage. It stimulates the conversion of proteins, fats and carbohydrates to energy through gluconeogenesis so that your body has a large supply of energy long after glucose stores in the liver and muscles have been exhausted. Cortisol also promotes the retention of sodium to keep your blood pressure elevated and your heart contracting strongly. If the stress is prolonged and severe, it will continue beyond the resistance stage and into the third stage of the GAS. Dr. Selye and subsequent researchers produced this GAS pattern over and over, resulting in hemorrhaged adrenal glands, atrophied thymus glands (the chief gland in immunity), and biochemically devastated bodies of animals exposed to repeated stress. The adrenal glands were the pivotal glands in the countless experiments involving stress.
3. The exhaustion stage. The exhaustion stage of the GAS is a hypoadrenia to the point where the person loses the ability to adapt to stress. The adrenal cortical enlargement of the triad of chronic stress is due to the hypertrophy of the resistance stage. However, adrenal function in the exhaustion stage is severely limited. In the exhaustion stage, there may be a total collapse of body function, or a collapse of specific organs or systems. The body has little or no ability to resist any further stress. Two major causes of exhaustion are loss of sodium ions (decreased aldosterone) and depletion of adrenal glucocorticoid hormones such as coritsol, leading to decreased gluconeogenesis, rapid hypoglycemia, sodium loss and potassium retention. Simultaneously, insulin levels are still high. Body cells function less effectively in this condition as they rely heavily on a proper amount of blood glucose and the ratio of sodium to potassium. As a result, your body becomes weak. When energy is not available, every energy-requiring mechanism of the cell slows dramatically. This lack of energy, combined with the electrolyte imbalance produces a cell in crisis. This is when the person will surely seek a physician’s help because he or she has symptoms which will not go away. Most hypoadrenic persons seen clinically are in this third or exhaustion stage of the GAS. The anti-stress mechanisms are lost and there is no more reserve potential for the person to fall back on.
Life’s stresses at their worst come in the form of such cataclysmic events as the death of a loved one, an automobile accident or a serious illness. But stress can also take its toll in less obvious ways, like an abscessed or infected root canal tooth, a bout of the flu, intense physical exertion, a severe quarrel with a loved one, pressure at the workplace, an unhappy relationship, environmental toxins, poor diet, etc. If these smaller stresses occur simultaneously, accumulate or become chronic, and the adrenals have no opportunity to fully recover, adrenal fatigue is usually the result.
Your adrenal glands command powerful hormones to extend their influence throughout your body and your life. No bigger than a walnut and weighing less than a grape, each of your two adrenal glands sits on top of a kidney. From this location they not only significantly affect the functioning of every tissue, organ and gland in your body, they also have important effects on the way you think and feel. You cannot live without your adrenal hormones and how well you live depends a great deal on how well your adrenal glands function. The adrenal glands largely determine the energy of your responses to every change in your internal and external environment. Whether they signal attack, retreat or surrender, every cell responds accordingly, and you feel the results.
The hormones secreted by your adrenal glands influence all of the major physiological processes in your body. They closely affect the utilization of carbohydrates and fats, the conversion of fats and proteins into energy, the distribution of stored fat, normal blood sugar regulation, and proper cardiovascular and gastrointestinal function. The protective activity of anti-inflammatory and anti-oxidant hormones secreted by the adrenals helps to minimize negative and allergic reactions to alcohol, drugs, foods and environmental allergens.
After mid-life (menopause in women), the adrenal glands gradually become the major source of the sex hormones circulating throughout the body in both men and women. These hormones have a host of physical, emotional and psychological effects, from the level of your sex drive to the tendency to gain weight. Even the propensity to develop certain kinds of diseases and your ability to respond to chronic illness is influenced significantly by the adrenal glands. The more chronic the illness, the more critical the adrenal response becomes. The worse the overload relative to the ability of the body to respond is, the worse the adrenal fatigue is. Each person has a different capacity to handle the total stress load, and the capacity of each person varies over time and events.
Adrenal fatigue, or hypoadrenia, has been one of the most prevalent, yet rarely diagnosed conditions for over fifty years. Adrenal fatigue affects millions of people around the world in many ways and for many reasons. Despite being described in medical texts back in the 1800s, and despite a development of an effective treatment back in the 1930s, most “conventional” physicians are unaware that this problem even exists!
Hypoadrenia
The most common symptom seen by the hypoadrenic patient is that of low energy. The person may have barely enough energy to make it through the day, or may be tired all the time. Many middle-aged or older persons will attribute their low energy to “getting older.” A more accurate assessment of the situation is that they have had more years to accumulate stress’s adverse effects on their health.
A person may slow down a little as he gets older, but it is not normal for a person to be fatigued all the time merely because he is past 40, or even 80 years of age. Other physiological systems operating inefficiently may also cause fatigue or low energy, but any person in this category must have hypoadrenia ruled out as a primary cause for the lack of energy. Hypoadrenia and stress-related illness must also be suspected in any person whose symptoms begin after a stressful event, such as an accident, flu, pregnancy, etc. It is not necessary that the symptoms originate during or immediately following one of these stressful situations. They may develop several months later. Or there may not be a specific event, but merely prolonged exposure to stress.
The human system can take only so much abuse, and after years of abuse many people become lack the energy to do the things they did in their youth. This need not be the case, but it is accepted behavior in our society. People take such a change of life style for granted, never understanding the reasons behind the change and the associated long-term adverse effects on their health. If they would eliminate the unnecessary stresses in their life, they would be able to continue the same activities for a much longer period of time. But the body will only take so much abuse before it makes the person stop.
Hypoadrenia is not a readily identifiable entity, rather a collection of signs and symptoms, known as a “syndrome.” People with adrenal fatigue often look and act relatively normal. They may not have any obvious signs of physical illness, yet they are not well and live with a general sense of dis-ease or “gray” feelings. They often use coffee, colas, sugar, and other stimulants to get going in the morning and to prop themselves up during the day. These people may appear to be lazy and unmotivated, or to have lost their ambition, when in reality quite the opposite is true; they are forced to drive themselves much harder than people with healthy adrenal function merely to accomplish life’s everyday tasks.
People who suffer from adrenal fatigue frequently have erratic or abnormal blood sugar levels in the form of hypoglycemia. In fact, people who have functional hypoglycemia are usually suffering from decreased adrenal function. With hypoadrenia there is more of a tendency to experience allergies, arthritic pain and decreased immune response. The adrenals also have an effect on mental states.
As a result, people with adrenal fatigue show a tendency toward increased fears, anxiety and depression, have intervals of confusion, increased difficulties in concentrating and less acute memory recall. They often have less tolerance than they normally would and are more easily frustrated. When the adrenals are not secreting the proper amount of hormones, insomnia is also one of the likely outcomes.
Addison’s Disease, the extreme pathological form of hypoadrenia, was named for Sir Thomas Addison, who first described it in 1855. It is life-threatening if untreated and can involve actual structural and physiological damage to the adrenal glands. People suffering from Addison’s usually have to take corticosteroids for the remainder of their lives in order to function. Fortunately, it is the rarest form of hypoadrenia with an occurrence of only about 4 persons out of 100,000. Approximately 70% of cases of Addison’s disease are the result of auto-immune disorders. The other 30% arise from a variety of other causes, including very severe stress.
In the more serious cases of adrenal fatigue, the activity of the adrenal glands is so diminished that the person may have difficulty getting out of bed for more than a few hours per day. With each increment of reduction in adrenal function, every organ and system in your body is more profoundly affected. Changes occur in your carbohydrate protein and fat metabolism, fluid and electrolyte balance, heart and cardiovascular system, and even sex drive. Many other alterations take place at the biochemical and cellular levels. Even your body shape can transform when your adrenals are fatigued.
Normally functioning adrenal glands secrete minute, yet precise and balanced amounts of steroid hormones. But there are numerous factors that can interfere with this finely tuned balance. Too much physical, emotional, and/or psychological stress can deplete your adrenals, causing a decrease in the output of adrenal hormones, particularly coritsol.
The adrenal glands are often depleted from stress. Since the adrenal glands give the body something to fall back on in times of stress, when they are run down a person loses his reserve capacity and has lowered resistance to disease processes. When a hypoadrenic person becomes sick, he becomes sicker for a longer period of time, and with a greater likelihood for recurrence of the problem than if his adrenals were functioning at full capacity. This person gets into a chronic state of ill-health and that is when they show up in a practitioner’s office. But modern medicine does not recognize hypoadrenia as a distinct and fully recognizable syndrome. Modern medicine only officially recognizes the pathological Addison’s disease as hypoadrenia and not the functional hypoadrenia. Nevertheless, it can wreak havoc with your life.
Hypoadrenia is such a common complaint and occurs in so many other conditions, that today’s medical doctors rarely consider pursuing an adrenal-related diagnosis when someone complains of fatigue. Very few physicians have read and understood the entire range of medical journal reports that have been around for over one hundred years. Fifty years ago, physicians were far more likely than their modern counterparts to correctly diagnose this ailment. Information about non-Addison’s hypoadrenia has been documented in medical literature for over one hundred years but unfortunately, this milder form of hypoadrenia is missed or misdiagnosed in doctors’ offices every day, even though the patient clearly presents its classic symptoms. The fact that it usually remains undiagnosed does not lessen its debilitating influence on their health and feelings of well being.
Two reasons why conventional medical treatment for hypoadrenia is so hard to find is 1) Money: There are no patentable treatments for hypoadrenia produced by the pharmaceutical companies. There is no money to be made. 2) Politics: Since the 1970s, the FDA has “outlawed” and actively persecuted one of the chief natural remedies for hypoadrenia, an extremely safe remedy called adrenal cortical extract (ACE).
Symptoms
People will develop a variety of different complaints depending on which of the adrenal’s functions have been the most compromised and the general areas of susceptibility which they have inherited or acquired. The adrenals produce a variety of hormones, and it is quite likely that the same combination of symptoms will not be seen twice in a whole series of hypoadrenic patients. The body’s reaction to stress is different in different people. The symptoms will depend on the nature of the person and the nature of the hormone depletion. In chronic stress states, the lymphatic system, particularly the thymus gland, atrophies, and there is also a tendency for development of stomach and duodenal ulcers in these persons. The person with stress-related illness might also have symptoms from lowered output of the adrenal glucocorticoids: cortisol, corticosterone, and cortisone. Of these, cortisol is the most important.
Heart Sounds and Hypoadrenia
Another common finding during the physical examination of the hypoadrenic person is made during auscultation of the heart. Normally the first and second sounds of the heart make a “lub-dub” sound, with the first sound being louder than the second. If you record the heart sounds on a phonocardiograph Endocardiograph), the second sound should be one-third the intensity (height) of the first sound. In the hypoadrenic person, the second sound will be equal to or greater than the first sound in the pulmonary valve area. The same may be true in other valve areas also, but in hypoadrenia, at least, the pulmonary second sound is greater. This accentuated pulmonary second sound is due to the pulmonic valve slamming shut because of pulmonary hypertension. Epinephrine causes vasoconstriction throughout most of the body, including the lungs. In the lungs this vasoconstriction causes a shrinkage of the mucosa and decreased mucus secretion. Epinephrine also relaxes the bronchiolar musculature, creating a bronchodilation.
This is why epinephrine inhalers are so helpful for asthma sufferers. The bronchodilation, which normally occurs with epinephrine, cannot occur in a person with hypoadrenia. Instead, he gets a bronchoconstriction—a constriction of all the bronchial musculature with subsequent symptomatology. Likewise, the hypoadrenic person does not have the benefit of epinephrine’s action on the pulmonary capillaries and mucous membranes, with a resultant swelling of the mucous membrane and an increase in mucus production or secretion. In the hypoadrenic person, physical evidence of this is heard as the loud second heart sound at the pulmonary area. The bronchoconstriction, combined with the vasodilation and mucous membrane swelling, creates a back pressure in the pulmonary circulation that causes the pulmonary valve to slam shut, thus creating the louder second sound over the pulmonic valve.
Any person who has abnormal lung function, especially asthma or bronchitis, should be checked for hypoadrenia. This is particularly true if the person’s symptoms are relieved by using an epinephrine inhaler. The muscles related to the lungs (deltoid, serratus anterior, etc.) are usually strong in these persons. Many lung problems are related more to the adrenals than to the lungs. The sartorius and gracilis, etc. should be checked in any lung case.
Several years ago, it was reported that asthma was totally a psychosomatic illness. Patients were put under emotional stress and an asthma attack would ensue. Therefore it was concluded that the asthma problem was all in the patient’s head. If the adrenals are in the exhaustion stage of the GAS, they will be unable to respond to the added burden of emotional stress since there is no reserve available to fall back on. The epinephrine will not be available for normal function and the person will experience bronchoconstriction, swelling of the mucous membranes, and increased mucus production. The result is an asthma attack triggered by the increased emotional stress. The attack has nothing to do with the emotional stress except that the stress affects the adrenals. Fix the adrenals and the person can physically tolerate the emotional stress.
It is important to note that lung pathology, such as malignancy, tuberculosis, etc. will also create a loud second heart sound at the pulmonic valve area. Also, if there is an increased second heart sound only at the tricuspid valve area, this is usually indicative of liver congestion. There will be a weakness of the pectoralis major sternal, in these cases, and the sound can be normalized by treatment directed at the liver.
Hemmorhoids are another problem which is associated with blood pooling in the abdomen. A hemorrhoid is a vein which has pushed its way (or been pushed) to bulge outside the anal sphincter. The anal sphincter then becomes very tight, and the hemorrhoid, with the pressure of the abdominal and pelvic blood above it, and gravity pulling from below it, cannot get back inside the rectum. Treatment of hemorrhoids must be directed at two areas. First, the hemorrhoids must be treated locally, and second, the source of intra-abdominal and intra-pelvic pooling of blood must be corrected.
Most commonly, the cause of the blood pooling in the abdomen and pelvis is from hypoadrenia. But severe liver congestion can also cause portal hypertension and result in hemorrhoids. You must differentiate between liver and adrenal problems as the underlying cause of the hemorrhoids. For this reason, whenever a person complains of hemorrhoids, one of the first things to be done is listen to the heart. The person does not understand this, but you are listening for the relative loudness of the second sounds at the pulmonic valve area (for the adrenals) and the tricuspid valve area (for the liver).
In treating hemorrhoids locally, it is necessary to recognize that the hemorrhoidal veins can not get themselves back inside the rectum, due to the tightness of the anal sphincter. In order to treat the hemorrhoids successfully, the anal sphincter must be dilated. This is done by putting on a glove (not a finger cot) and, using a lubricant, inserting your index finger into the rectum. Stretch the anal sphincter with the index finger. Then insert the first two fingers and stretch the sphincter. Then insert three fingers and insert them slowly about as fat as they will reach. Finally (if the person is still on the table) insert all four fingers, stretching the sphincter up to the point which the size of the patient will tolerate.
This is a difficult procedure for the patient, but there will be an immediate and dramatic reduction in the extent of the hemorrhoids protruding through the anus. If done correctly, this procedure may only have to be performed once. Then again, you may only get one chance! Occasionally it is necessary to repeat the sphincter dilation once or twice in the future.
Varicose veins in the lower extremities are frequently caused by hypoadrenia for the same reasons that cause hemorrhoids. This can be seen in many pregnant women who only have a flare up of varicosities during pregnancy. It may be difficult to eliminate the varicosities, but it is possible to arrest their progression and to keep them in check throughout the pregnancy.
The pooling of blood in the abdomen and pelvis also creates and contributes to other symptoms. The patient with this problem will often complain of fullness or bloated feeling in the abdomen. Sometimes the sluggish circulation in the abdomen and pelvis actually affects digestion. Since the GI tract depends on an adequate supply of blood not only for its function, but for the absorption of nutrients, one can readily imagine how hypoadrenia can affect digestion. Symptoms of indigestion as well as inadequate absorption of nutrients can be caused or aggravated by hypoadrenia.
Other Symptoms of Hypoadrenia
One of the commonly overlooked sources of stress and resistant adrenal fatigue is chronic or severe infection. Adrenal fatigue is often precipitated by recurring bouts of bronchitis, pneumonia, asthma, sinusitis, or other respiratory infections. The more severe the infection, the more frequently it occurs or the longer it lasts, the more likely it is that the adrenals are involved. Adrenal fatigue can occur after just one single episode of a particularly nasty infection, or it can take place over time as the adrenals are gradually fatigued by prolonged or recurrent infections. If there are other concurrent stresses, such as an unhappy marriage, poor dietary habits or a stressful job, the downhill ride is deeper and steeper.
People who are involved in a weekly rotating shift have magnified stress because their bodies never have a chance to adjust to the new circadian rhythm produced by each sleep change. People on alternating shifts with less than three weeks between shift changes are continually hammering their adrenal glands. Every time the wake/sleep cycle is altered, it takes several days to weeks to establish a normal pattern for the new wake/sleep cycle.
The glucocorticoids are the body’s own anti-inflammatory hormones. Persons who have had inflammations such as arthritis, bursitis, or other joint problems which have been helped by the injection or oral ingestion of cortisone and cortisone derivatives are usually persons who have had insufficient production of these substances by their own adrenal glands. This is particularly the case in the person who was originally helped by cortisone treatment once or twice, but on whom further attempts at cortisone therapy were fruitless. Any person who has been benefited by a course of cortisone therapy should be examined for hypoadrenia. Not only is this true of the obvious reason that the adrenals’ cortisone output may be lowered, but also for the reason that cortisone therapy tends to lower adrenal gland output in the long run.
Cortisone causes a negative feedback to the pituitary, causing a diminished pituitary output of adrenocorticotropic hormone (ACTH). In prolonged cortisone therapy, the person’s adrenal glands will atrophy, even to the point of non-function. Since the adrenal cortical hormones are necessary for life, a person on cortisone products should never have them withdrawn rapidly, as this could cause a life-threatening crisis. When a person is withdrawn from cortisone, it should be done so very gradually, over a long period of time in order to allow the adrenal glands to rebuild themselves to an adequate level of activity.
The adrenal glands are also implicated in most types of allergies. Most allergies involve an inflammatory process. Frequently, the allergen is merely the straw that breaks the camel’s back. The allergen would not cause the person any trouble if he had an adequate level of his own adrenal production of the anti-inflammatory glucocorticoids. The same anti-inflammatory effect is important in limiting the lung congestion in asthma and bronchitis, as has been previously discussed.
As the adrenal glands become depleted, the blood glucose levels will tend to drop below normal levels. In an effort to counter this potential low blood glucose, the person will get cravings for anything which will rapidly increase the blood glucose. He will eat a candy bar, drink a cup of coffee, smoke a cigarette, or drink a soft drink. Everybody has their favorite “fix.” The abuse of alcohol, marijuana, and hard drugs fits this pattern as well. But the rapid rise in blood glucose provided by the “fix” only serves to re-initiate the whole cycle again.
The symptoms of the hyperinsulinism/hypoadrenia/hypoglycemia person are too numerous to mention here. Basically, though, epithelial tissue, nervous tissue, and the retina of the eye do not store glucose. Hence, these tissues are the most likely to be affected. Low blood glucose creates symptoms of blurred vision, headache, nervousness, unstable behavior, allergies, and on and on. Another symptom which is occasionally encountered in hypoadrenia is that of increased pigmentation of the skin. There may be unusual brown patches or areas of bronzing somewhere on the body’s surface. When the adrenal function is low, the pituitary responds by making ACTH. In the exhaustion stage of GAS, the ACTH effect on the adrenal is like whipping a tired horse. Since the adrenal can not respond to this pituitary drive, the pituitary keeps elaborating ACTH until its levels in the circulation are quite elevated.
The extra ACTH will affect other areas of the body. For example, ACTH has somewhat of an effect on the ovary, causing it to increase estrogen production. Also, ACTH has about 1/100th of the effect of melanocyte stimulating hormone (MSH), the pituitary hormone which stimulates melanocytes in the skin to produce the dark pigment melanin. In a severe hypoadrenia, the effect of bronzing or increased areas of pigmentation of the skin will sometimes be seen as a result of the ACTH mimicking the effect of MSH. Although this symptom is more common in the pathological hypoadrenia, Addison’s disease, it is occasionally seen in functional hypoadrenia as well.
Mercury and the Adrenal Glands
Mercury accumulates in the adrenal glands and disrupts adrenal gland function. Two primary nutrients for the adrenal glands are pantothenic acid and vitamin-C. A deficiency of pantothenic acid can lead to adrenal exhaustion (chronic fatigue) and ultimately to destruction of the adrenal glands. A deficiency of pantothenic acid also causes a progressive fall in the level of adrenal hormones produced. One of the largest tissue stores of vitamin-C is the adrenals; it is exceeded only by the level of vitamin-C in the pituitary. Physical and mental stress increases the excretion of adrenocorticotropic hormone. The increased adrenal activity, in turn, depletes both vitamin-C and pantothenic acid from the glands.
Humans cannot produce vitamin-C. They therefore attempt to replenish the needs of the adrenals by taking the vitamin from other storage locations in the body. If your overall ascorbate status is low, there may be an insufficient amount available to satisfy the needs of the adrenals. Under this condition, normal adrenal hormone response may become inadequate, leading to an inadequate immune function. Mercury builds up in the pituitary gland and depletes the adrenals of both pantothenic acid and vitamin-C. Stress and the presence of mercury will have a very negative effect on the adrenal production of critical steroids. The ability of the adrenal gland to produce steroids is called steroidogenesis and is dependent upon reactions mediated by the enzyme cytochrome P-450. Cytochrome P-450 reacts with cholesterol to produce pregnenolone, which is then converted to progesterone. Cytochrome P-450 can then convert progesterone to deoxycorticosterone which is then converted to corticosterone or aldosterone by other enzymes in the adrenals. These adrenal functions are also affected by metal ions.
All steroid hormones produced by the adrenal glands are derived from cholesterol through a series of enzymatic actions, which are all stimulated initially by ACTH. Steroid biosynthesis involves the conversion of cholesterol to pregnenolone, which is then enzymatically transformed into the major biologically active corticosteroids. cAMP is produced from adenosine triphosphate (ATP) by the action of adenylate cyclase. Adenylate cyclase activity in the brain is inhibited by micromolar concentrations of lead, mercury, and cadmium. One of the key biochemical steps in the conversion of adrenal pregnenolone to cortisol and aldosterone involves an enzyme identified as 21-hydroxylase.
Mercury causes a defect in adrenal steroid biosynthesis by inhibiting the activity of 21a-hydroxylase. The consequences of this inhibition include lowered plasma levels of corticosterone and elevated concentrations of progesterone and dehydroepiandrosterone (DHEA). DHEA is an adrenal male hormone. Because patients with 21-hydroxylase deficiencies are incapable of synthesizing cortisol with normal efficiency, there’s a compensatory rise in ACTH leading to adrenal hyperplasia and excessive excretion of 17a-hydroxyprogesterone, which, without the enzyme 21-hydroxylase, cannot be converted to cortisol.
The inhibition of the 21-hydroxylase system may be the mechanism behind the mercury-induced adrenal hyperplasia. Adrenal hyperplasia can stress the adrenal glands by their accelerated activity to produce steroids to the point that production begins to diminish and the glands will atrophy. The result is a subnormal production of corticosteroids. Both lead and mercury can precipitate pathophysiological changes along the hypothalamus-pituitary-adrenal and gonadal axis that may seriously affect reproductive function, organs, and tissues. Leukocyte production, distribution, and function are markedly altered by glucocorticosteroid administration. In Addison’s disease (hypofunction of adrenal glands), neutrophilia occurs 4-6 hours after administration of a single dose of hydrocortisone, prednisone, or dexamethasone. Neutrophilia is an increase in the number of neutrophils in the blood. Neutrophils are also called polymorphonuclear leukocytes (PMNs). Mercury not only causes a suppression of adrenocorticosteroids that would normally have stimulated an increase of PMNs, but at the same time also affect the ability of existing PMNs to perform immune function by inhibiting a metabolic reaction that destroys foreign substances. Still today, the ADA and other governmental agencies tell us that the mercury in your mouth, or from vaccinations, is perfectly safe. Scientists say this is a ridiculous statement that is in violation of science and common sense.
Adrenal Gland–Related Muscles
Dr. Goodheart identified five specific skeletal muscles which are related to adrenal gland function. These are 1) sartorius, 2) gracilis, 3) posterior tibialis, 4) gastrocnemius, and 5) soleus. There will be weakness in one or more of these muscles when the adrenal glands are malfunctioning. Because of the attachments of the sartorius and gracilis on the pelvis, (sartorius—anterior superior iliac spine; gracilis—pubic ramus), their weakness in persons with adrenal stress problems may allow the sacroiliac joint to subluxate posteriorly. The sartorius and gracilis stabilize the innominate (one side of the pelvis), holding it in an anterior direction. Many persons with hypoadrenia seek chiropractic help for the care of sacroiliac pain and/or low back pain which is due to the lack of pelvic stabilization normally provided by these muscles.
The sartorius and gracilis have a common insertion (along with the semitendinosis) on the medial side of the knee and rotate the tibia medially on the femur. When weakness of these muscles occurs, there is a loss of stability on the medial side of the knee. The sartorius and gracilis (along with the semitendinosis) act as dynamic ligaments, protecting and supporting the medial knee joint during various ranges of motion. Their function is particularly important in situations where the knee ligaments alone offer inadequate support.
It is very important to check for hypoadrenia in any person with knee problems. One can see how one hypoadrenic person will present with knee problems and another with back problems, and some persons will have both.
Due to the relationship of the posterior tibialis, gastrocnemius, and soleus to the stability of the foot and ankle, many hypoadrenic persons will complain of symptoms of tired feet, weak ankles, or aching calves. The posterior tibialis holds up the medial longitudinal arch of the foot, especially during gait. In some persons exhibiting hypoadrenia-related weakness of the posterior tibialis, the medial arch will drop, causing a pronation problem and strain to the foot and ankle. The one common factor in persons with the above-mentioned musculoskeletal complaints will be the weakness of one or more of the five adrenal gland related muscles accompanied by improvement of their symptoms following treatment of the adrenal glands.
The adrenal gland cortex produces three major categories of hormones:
1. mineralocorticoids,
2. glucocorticoids, and
3. gonadal (sex) hormones (testosterone, estrogen, progesterone, etc.).
Depending on the relative amount of depletion of each of these hormone groups, one will see varying symptoms in the person suffering from stress-related hypoadrenia.
Cortisol and Epinephrine
The adrenal cortex and the adrenal medulla are the two parts of the adrenal gland. Although each has separate functions, it is no mistake that they are placed next to each other anatomically, since some of the functions of one are dependent on the other.
Epinephrine is a vasoconstrictor. But for epinephrine to have its vasoconstricting effect on the body’s arterioles, it is imperative that cortisol be available. Cortisol sensitizes the arterioles to the constrictive action of epinephrine. If there is low adrenal cortical output and adequate coritsol is not produced, epinephrine will have a reduced effect in its function of constricting the blood vessels. These two hormones work together in affecting blood pressure. Therefore, in the hypoadrenic patient one of the major findings observed on physical examination is related to blood pressure.
Normally when a person goes from lying down to standing, the systolic blood pressure should elevate 4-10 mm Hg. (millimeters of mercury). In hypoadrenia, the systolic blood pressure from lying to standing will either stay the same or drop. This systolic drop is usually between 5 to 10 mm. Hg., but sometimes as much as 30-40 points. This is a classic sign in the hypoadrenic person which is known as the Ragland effect, or postural hypotension, and which is reported in over 90% of hypoadrenic persons. Blood pressure should always be checked in three positions: sitting, then lying, then standing. From recumbence to standing, the systolic blood pressure should rise 4-10 points. If the blood pressure drops, suspect functional hypoadrenia.
There are valves in the veins of the lower extremities which keep the blood from pooling in the feet when a person maintains an upright position. The fact that there are no valves in the veins of the abdomen and pelvis means that the only mechanism which prevents the blood from pooling there when the body goes from lying to standing is the vasoconstriction of the local vessels. If there is a low coritsol level, epinephrine can not function correctly and there will be inadequate vasoconstriction in response to upright posture. This causes the blood to pool in the abdomen and pelvis and the systolic pressure in the arm to drop. This same person may complain of dizziness or light-headedness, especially when arising from a seated or lying position. Or he may experience transient spells of dizziness during the day or he may be dizzy all the time. The patient may be complaining of headaches, which are due to the pooling of the blood in the abdomen and pelvis, interfering with the supply to the head. Frequently these persons have had totally normal neurological examinations or some have been diagnosed as having Meniere’s disease. Some are being treated unsuccessfully with manipulation to the upper cervical vertebrae. But all therapeutic approaches are ineffective in relieving the symptoms until the hypoadrenia is treated.
Some persons who have postural blood pressure dumping are being treated for hypertension. The hypertension is from another paradoxical body response. When the person changes positions from recumbence to standing and the systolic blood pressure drops 10, 20, 30 points, the body senses this low blood pressure and reacts. The body does not want all the blood pooling in the abdomen and pelvis because it decreases the amount of blood in the head and other areas. In an effort to change this situation, the body may elevate the systolic pressure to an extremely high level. The systolic blood pressure may go as high as 180 mm Hg. or more. Then, when the person changes positions from lying to standing, the systolic blood pressure will drop to only, say, 150 mm. Hg.
If the blood pressure is taken only in the seated position, the person will show a very high systolic pressure. But, when you change the person’s positions, he will show the dumping blood pressure on arising from recumbence to standing. These persons are often treated with diuretics when the real problem is with the adrenal glands. Combine this with the fact that many hypoadrenic persons are also dehydrated, as previously discussed, and you can see the senselessness of a diuretic approach in these cases.
Anatomy
The adrenals are orange-colored glands that sit on top of the kidneys near the spine, just underneath the last rib and extending down about an inch. The right adrenal is shaped something like a pyramid, whereas the left is shaped more like a half moon. Each gland is highly vascularized and is only about 1” high by 1¼” to 2” wide by ¼” thick, and weighs just 4 to 6 grams (about one-eighth to one-quarter ounce). They are usually heavier in females than in males.
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Although in contact with the kidney, there is no direct connection from the adrenals to the kidney—the arterial blood supply to the adrenal glands is separate from the kidneys. Both adrenal glands are only a very short distance from the aorta, the major artery of the body, and the vena cava, the major vein. This strategic placement allows for a very rapid adrenal response to hormonal messages transported via the blood. For example, Adrenal Corticotropic Hormone (ACTH) is a hormone messenger from the pituitary gland that tells the adrenal glands how much coritsol to secrete. Within a few seconds of receiving this message the correct level of coritsol is on its way form the adrenals to the rest of the body. The adrenals are also placed in close proximity to the liver, pancreas, major fat storage areas and the kidneys, as these are the organs that need rapid communication with the adrenals in situations requiring their immediate response to adrenal hormones.
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Regions of the Adrenal Glands
Each adrenal gland is composed of two endocrine components—a medulla (inner part) that constitutes 20% of the gland and a cortex (outer part) that constitutes the remaining 80% of the gland. The cortex consists of four zones. The medulla and each of the zones in the cortex each produce different hormones that serve a variety of functions in your body. The adrenal cortex and medulla, like the anterior and posterior lobes of the pituitary, are obtained from separate cells in the developing embryo. The medulla is derived from ectodermal neural crest cells, and the cortex is derived from mesodermal cells.
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The Adrenal Medulla
The functional unit of the adrenal medulla is the chromaffin cell, which functions as a neuroendocrine cell. In response to stimulation, chromaffin cells secrete the hormones epinephrine (adrenaline) and norepinephrine (noradrenalin) directly into the blood. Epinephrine and norepinephrine are important mainly in crisis situations. During a crisis, they work together to dilate bronchi (air passages of the lungs) and blood vessels to the muscles, increases heart beats and strength of contraction, and cause other physiological changes to help the body respond to the stressful situation via “fight or flight.” These adrenal hormones are responsible for the superhuman abilities that occasionally occur during a crisis. The medulla is involved in extreme stress and, within this context, epinephrine and norepinephrine both work with coritsol from the adrenal cortex.
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The Adrenal Cortex
Most of the ongoing daily regulation and modification of bodily processes arises from the adrenal cortex. The adrenal cortex is divided into four zones which each secrete different hormones that carry out specific functions throughout your body. 1) The outermost zone is the zona glomerulosa from which the hormone aldosterone is secreted, and consists of cells arranged in 'whorls' (glomeruli). Cells of the zona glomerulosa produce hormones called mineralocorticoids. Aldosterone is the major hormone controlling the sodium and potassium levels, and thus fluid balance, within your bloodstream, cells and interstitial fluids (the area between the cells).
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1) The outermost zone is the zona glomerulosa from which the hormone aldosterone is secreted. Aldosterone is the major hormone controlling the sodium and potassium levels, and thus fluid balance, within your bloodstream, cells and interstitial fluids (the area between the cells).
2) The next zone is the zona fasciculata in which coritsol is produced. Cells of this zone are arranged into fascicles separated by venous sinuses. Cells of the zona fasciculata produce glucocorticoid hormones. Cortisol controls or greatly influences the metabolism of fats, proteins and carbohydrates to maintain blood glucose within a narrow optimal range and keep it there even under stressful conditions. Cortisol also has many other important functions.
3) The innermost zone is the zona reticularis where progesterone, DHEA and its relatively inactive precursor, DHEA-S are produced. Although the sex hormones are made primarily by the gonads (ovaries and testes), the adrenal zona reticularis manufactures an ancillary portion of sex hormones for each sex and also produces male hormones in women and female hormones in men to keep the effects of the dominant sex hormones in balance.
In humans and other primates, between the zona fasiculata and the zona reticularis, there is a narrow space called the interface zone. Although the zona reticularis has traditionally been thought to produce the sex hormones such as the estrogens and testosterones, it is now believed that this interface zone is the actual site of production of most of the sex hormones. Because most adrenal research uses rodents and other non-primate mammals, little attention has been paid to this interface zone until recently.
These zones of your adrenal cortex collectively produce over fifty hormones. Most of these are intermediary hormones that only act as bridges to form other adrenal hormones. However, about a dozen hormones end up in your circulation and actively affect the rest of your body.
Physiology
The Regulation of Cortisol
The hypothalamus of the brain influences both portions of the adrenal gland but by different mechanisms. The Secretion of glucocorticoids from the adrenal cortex is regulated by negative feedback involving the corticotrophin-releasing hormone (CRH) secretion by the hypothalamus. CRH then acts on the anterior pituitary to stimulate adrenocorticotropic hormone (ACTH) secretion, which then stimulates the adrenal cortex into cortisol secretion. Although coritsol is secreted by the zona fasiculata in the adrenal glands, it is regulated primarily from the brain.
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Normally about 80% of blood cortisol is bound to a carrier protein called cortico-steroid-binding globulin. Another 15% is bound to albumin, and the remaining 15% exists free in solution. Cortisol secretion has numerous physiological effects, its main target tissues being the liver, skeletal muscle and adipose tissue. Cortisol is responsible for many of the life sustaining functions attributed to the adrenal glands. Many of the symptoms of adrenal fatigue arise from decreased coritsol levels in the blood or inadequate levels of coritsol during times of stress when more coritsol is needed.
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Excess cortisol secretion results in Cushing's Syndrome. This can either occur as a primary abnormality in steroid hormone production by the adrenal cortex, or as a result of overproduction of ACTH by the pituitary resulting in excessive stimulation of the adrenal cortex. Cushing's patients have thin arms and legs, due in part to the loss of muscle mass as a result of the protein-catabolic effects of excess cortisol, and also as fat is redistributed from the extremities to the trunk. There is an increase in fat in the face, the trunk, across the shoulder blades, and at the base of the neck. Connective tissue is lost from the skin, causing it to become thinner. As a result, blood vessels are located closer to the surface making the skin have a slight red appearance.
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The HPA Axis
The amount of coritsol circulating at any particular moment is regulated by a complex interaction between the hypothalamus (a regulatory part of the brain), the pituitary gland at the base of the brain, and the adrenal glands. This regulatory trio operates through a negative feedback system and is referred to as the Hypothalamus/Pituitary/Adrenal (HPA) Axis or HPA System. In your body, your hypothalamus is analogous to a thermostat, your pituitary to a relay switch, your adrenals to a furnace, and your body to a room. The amount of coritsol released is comparable to the heat released from the furnace. To a large extent you control the thermostat through the demands you place on your body. These demands arise from the physical situations your body has to deal with (diet, exercise, work, climate, etc.) and your reactions (emotional and physiological) to them.
The HPA Axis is one of the most important elements of the whole body process known as homeostasis, the process that maintains a steady internal bio-chemical and physiological balance in your body. The HPA Axis adjusts coritsol levels according to the needs of the body, under normal and stressed conditions, via a hormone called the Adrenal Corticotrophic Hormone (ACTH). ACTH is secreted from the pituitary gland in response to orders form the hypothalamus and travels in the bloodstream to the adrenal cortex. There it activates cells in all four zones to produce their various hormones.
Each zone generates different hormones as end products, but the process of making all hormones in all zones begins with ACTH biding to the walls of the adrenal cells. This initiates a chain reaction of intracellular enzymes that release cholesterol within the cell. The cholesterol is then used inside the adrenal cells to manufacture pregnenolone, the first hormone in the adrenal cascade. No matter which adrenal hormone is being produced, pregnenolone is the first hormone formed in the series. In the zona fasciculata, pregnenolone is processed to form cortisone and then coritsol. Cortisol, once manufactured, is released into circulation. It takes less than a minute after the initial stimulation by ACTH for newly synthesized coritsol to be circulating through your blood to every part of your body, including to your hypothalamus where the concentration of coritsol is being constantly measured.
Your hypothalamus, in its regulatory function, analyzes and integrates input form many different external and internal sources. This input includes information from brain centers about overall excitability, energy requirements of you body, and sensory data from your brain centers for hearing, seeing, smelling, touch and taste. Based on this information, your hypothalamus determines how much coritsol your body requires and subsequently releases its own hormones as messengers. The primary hormone messenger from the hypothalamus is Corticotrophin Releasing Factor (CRF) which signals the pituitary gland to secrete a specific amount of ACTH. Thus ACTH is sent from the pituitary to your adrenal glands to begin the process described above all over again. Alterations in ACTH levels, and hence coritsol levels, are made minute by minute using this negative feedback loop, modulated by other information received by the hypothalamus.
Cortisol, ACTH and aldosterone are not secreted uniformly throughout the day, but rather follow a diurnal pattern with the highest levels secreted at approximately 8:00 AM and the lowest between midnight and 4:00 AM. As a matter of fact, it is the rising coritsol level that helps us wake up in the morning. After its peak at approximately 8:00 AM, it downtrends through the rest of the day, often with a small dip in the afternoon between 3:00 and 5:00 PM. This curve of coritsol secretion however, is not a nice smooth curve, but is filled with episodic spikes that generally fit into an increasing and a decreasing pattern throughout the day and evening. Eating something, even a little snack, causes a small burst in cortisol levels. People who have regular snacks and meals keep their coritsol at higher levels for more of the day compared to people who do not snack. This is another reason to have regular healthy snacks in addition to regular meals if you have adrenal fatigue. Exercise also elevates coritsol levels similarly to food, so the combination of regular means, small snacks and exercise can do a lot to enhance depressed coritsol levels.
Some people with hypoadrenia have an overall low pattern of coritsol secretion with circulating coritsol levels lower than normal between 3:00 and 5:00 PM. Still others fluctuate throughout the day and can even vary from day to day so that their coritsol levels are unpredictable. They may go through part of their day with elevated coritsol levels, part of the day with low levels and part with normal levels. Although coritsol has its diurnal pattern of variations each day, it remains at an amazingly consistent level throughout your lifetime, under normal conditions. In later life, some people actually experience a small rise in coritsol. If this rise is excessive it may be related to some disorder. However, a rise in coritsol in response to stress is a natural reaction that actually protects the body in several ways.
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One of the most common clinical patterns seen in healthcare clinics is stress-related illness. Some healthcare practitioners report as high as 85% of their patients fitting this category. Persons with this condition have reactions to stress which are either causing their illness or aggravating it. Adrenal glands are the anti-stress glands of the body—the reserve which the body falls back on when it is faced with stressful situations. It is their job to enable your body to deal with stress from every possible source, ranging from injury and disease to work and relationship problems. Your resiliency, energy, endurance and your very life all depend on their proper functioning. Your adrenal glands respond to every kind of stress in the same way, whatever the source. Adrenal fatigue occurs when the amount of stress overextends the capacity of the body to compensate and recover from that stress or the combined stresses. Once this capacity to cope and recover is exceeded, some form of adrenal fatigue occurs. The number of stresses, whether or not you recognize them as stresses, the intensity of each stress and the frequency with which it occurs, plus the length of time it is present, all combine to form your total stress load.
There are four major categories of stress:
1. Physical stress—such as overwork, lack of sleep, athletic over-training, etc.
2. Chemical stress—from environmental pollutants, diets high in refined carbohydrates, allergies to foods and additives, endocrine gland imbalances (due to the interaction of all of the endocrine glands).
3. Thermal stress—over-heating or over-chilling of the body
4. Emotional and mental stress
Early studies by Hans Selye, M.D., identified a pattern of stress-related illness in both test animals and humans. Selye discovered a series of events that occur as a reaction to chronic stress. This series of events is known as the General Adaptation Syndrome (GAS). The GAS has three stages:
1. The alarm reaction. The body’s initial complex chain of physical and biochemical responses to stress brought about by the interaction of your brain, nervous system and a variety of different hormones, involving an increased amount of adrenal activity. Your body goes on full alert. The adrenals produce extra amounts of hormones. The adrenals are working harder to respond to an immediate stress situation. That is a function for which they are designed. There is actually an initial hyperadrenic response to stress. After the alarm reaction is over, you body goes through a temporary recovery phase that lasts 24-48 hours. During this time there is less coritsol secreted, your body is less able to respond to stress, and the mechanisms over-stimulated in the initial alarm phase by the involved hormones become resistant to more stimulation. In this let-down phase you feel more tired and listlessness, and have a desire to rest. If the stress is continued long enough, the adrenals will finally be overtaxed to the point of depletion as a reaction to this alarm state. Sometimes a person will seek a doctor’s help for the symptoms caused by this type of hypoadrenia.
2. The resistance stage. After a period of time of continued, severe stress, the adrenals begin to adapt and to re-build themselves. The adrenals have a great capacity for increasing their size and function. If one adrenal is surgically removed, the other adrenal can hypertrophy to twice its normal size, giving the person the same amount of adrenal tissue he previously had. This capacity for increased size and function is the basis for the resistance stage. The prolonged alarm reaction starts as a hyperadrenia which leads to a hypoadrenia which then progresses into another state of hyperadrenia as the resistance stage takes over. This phase of resistance can last months or even up to 15-20 years. The adrenal hormone coritsol is largely responsible for this stage. It stimulates the conversion of proteins, fats and carbohydrates to energy through gluconeogenesis so that your body has a large supply of energy long after glucose stores in the liver and muscles have been exhausted. Cortisol also promotes the retention of sodium to keep your blood pressure elevated and your heart contracting strongly. If the stress is prolonged and severe, it will continue beyond the resistance stage and into the third stage of the GAS. Dr. Selye and subsequent researchers produced this GAS pattern over and over, resulting in hemorrhaged adrenal glands, atrophied thymus glands (the chief gland in immunity), and biochemically devastated bodies of animals exposed to repeated stress. The adrenal glands were the pivotal glands in the countless experiments involving stress.
3. The exhaustion stage. The exhaustion stage of the GAS is a hypoadrenia to the point where the person loses the ability to adapt to stress. The adrenal cortical enlargement of the triad of chronic stress is due to the hypertrophy of the resistance stage. However, adrenal function in the exhaustion stage is severely limited. In the exhaustion stage, there may be a total collapse of body function, or a collapse of specific organs or systems. The body has little or no ability to resist any further stress. Two major causes of exhaustion are loss of sodium ions (decreased aldosterone) and depletion of adrenal glucocorticoid hormones such as coritsol, leading to decreased gluconeogenesis, rapid hypoglycemia, sodium loss and potassium retention. Simultaneously, insulin levels are still high. Body cells function less effectively in this condition as they rely heavily on a proper amount of blood glucose and the ratio of sodium to potassium. As a result, your body becomes weak. When energy is not available, every energy-requiring mechanism of the cell slows dramatically. This lack of energy, combined with the electrolyte imbalance produces a cell in crisis. This is when the person will surely seek a physician’s help because he or she has symptoms which will not go away. Most hypoadrenic persons seen clinically are in this third or exhaustion stage of the GAS. The anti-stress mechanisms are lost and there is no more reserve potential for the person to fall back on.
Life’s stresses at their worst come in the form of such cataclysmic events as the death of a loved one, an automobile accident or a serious illness. But stress can also take its toll in less obvious ways, like an abscessed or infected root canal tooth, a bout of the flu, intense physical exertion, a severe quarrel with a loved one, pressure at the workplace, an unhappy relationship, environmental toxins, poor diet, etc. If these smaller stresses occur simultaneously, accumulate or become chronic, and the adrenals have no opportunity to fully recover, adrenal fatigue is usually the result.
Your adrenal glands command powerful hormones to extend their influence throughout your body and your life. No bigger than a walnut and weighing less than a grape, each of your two adrenal glands sits on top of a kidney. From this location they not only significantly affect the functioning of every tissue, organ and gland in your body, they also have important effects on the way you think and feel. You cannot live without your adrenal hormones and how well you live depends a great deal on how well your adrenal glands function. The adrenal glands largely determine the energy of your responses to every change in your internal and external environment. Whether they signal attack, retreat or surrender, every cell responds accordingly, and you feel the results.
The hormones secreted by your adrenal glands influence all of the major physiological processes in your body. They closely affect the utilization of carbohydrates and fats, the conversion of fats and proteins into energy, the distribution of stored fat, normal blood sugar regulation, and proper cardiovascular and gastrointestinal function. The protective activity of anti-inflammatory and anti-oxidant hormones secreted by the adrenals helps to minimize negative and allergic reactions to alcohol, drugs, foods and environmental allergens.
After mid-life (menopause in women), the adrenal glands gradually become the major source of the sex hormones circulating throughout the body in both men and women. These hormones have a host of physical, emotional and psychological effects, from the level of your sex drive to the tendency to gain weight. Even the propensity to develop certain kinds of diseases and your ability to respond to chronic illness is influenced significantly by the adrenal glands. The more chronic the illness, the more critical the adrenal response becomes. The worse the overload relative to the ability of the body to respond is, the worse the adrenal fatigue is. Each person has a different capacity to handle the total stress load, and the capacity of each person varies over time and events.
Adrenal fatigue, or hypoadrenia, has been one of the most prevalent, yet rarely diagnosed conditions for over fifty years. Adrenal fatigue affects millions of people around the world in many ways and for many reasons. Despite being described in medical texts back in the 1800s, and despite a development of an effective treatment back in the 1930s, most “conventional” physicians are unaware that this problem even exists!
Hypoadrenia
The most common symptom seen by the hypoadrenic patient is that of low energy. The person may have barely enough energy to make it through the day, or may be tired all the time. Many middle-aged or older persons will attribute their low energy to “getting older.” A more accurate assessment of the situation is that they have had more years to accumulate stress’s adverse effects on their health.
A person may slow down a little as he gets older, but it is not normal for a person to be fatigued all the time merely because he is past 40, or even 80 years of age. Other physiological systems operating inefficiently may also cause fatigue or low energy, but any person in this category must have hypoadrenia ruled out as a primary cause for the lack of energy. Hypoadrenia and stress-related illness must also be suspected in any person whose symptoms begin after a stressful event, such as an accident, flu, pregnancy, etc. It is not necessary that the symptoms originate during or immediately following one of these stressful situations. They may develop several months later. Or there may not be a specific event, but merely prolonged exposure to stress.
The human system can take only so much abuse, and after years of abuse many people become lack the energy to do the things they did in their youth. This need not be the case, but it is accepted behavior in our society. People take such a change of life style for granted, never understanding the reasons behind the change and the associated long-term adverse effects on their health. If they would eliminate the unnecessary stresses in their life, they would be able to continue the same activities for a much longer period of time. But the body will only take so much abuse before it makes the person stop.
Hypoadrenia is not a readily identifiable entity, rather a collection of signs and symptoms, known as a “syndrome.” People with adrenal fatigue often look and act relatively normal. They may not have any obvious signs of physical illness, yet they are not well and live with a general sense of dis-ease or “gray” feelings. They often use coffee, colas, sugar, and other stimulants to get going in the morning and to prop themselves up during the day. These people may appear to be lazy and unmotivated, or to have lost their ambition, when in reality quite the opposite is true; they are forced to drive themselves much harder than people with healthy adrenal function merely to accomplish life’s everyday tasks.
People who suffer from adrenal fatigue frequently have erratic or abnormal blood sugar levels in the form of hypoglycemia. In fact, people who have functional hypoglycemia are usually suffering from decreased adrenal function. With hypoadrenia there is more of a tendency to experience allergies, arthritic pain and decreased immune response. The adrenals also have an effect on mental states.
As a result, people with adrenal fatigue show a tendency toward increased fears, anxiety and depression, have intervals of confusion, increased difficulties in concentrating and less acute memory recall. They often have less tolerance than they normally would and are more easily frustrated. When the adrenals are not secreting the proper amount of hormones, insomnia is also one of the likely outcomes.
Addison’s Disease, the extreme pathological form of hypoadrenia, was named for Sir Thomas Addison, who first described it in 1855. It is life-threatening if untreated and can involve actual structural and physiological damage to the adrenal glands. People suffering from Addison’s usually have to take corticosteroids for the remainder of their lives in order to function. Fortunately, it is the rarest form of hypoadrenia with an occurrence of only about 4 persons out of 100,000. Approximately 70% of cases of Addison’s disease are the result of auto-immune disorders. The other 30% arise from a variety of other causes, including very severe stress.
In the more serious cases of adrenal fatigue, the activity of the adrenal glands is so diminished that the person may have difficulty getting out of bed for more than a few hours per day. With each increment of reduction in adrenal function, every organ and system in your body is more profoundly affected. Changes occur in your carbohydrate protein and fat metabolism, fluid and electrolyte balance, heart and cardiovascular system, and even sex drive. Many other alterations take place at the biochemical and cellular levels. Even your body shape can transform when your adrenals are fatigued.
Normally functioning adrenal glands secrete minute, yet precise and balanced amounts of steroid hormones. But there are numerous factors that can interfere with this finely tuned balance. Too much physical, emotional, and/or psychological stress can deplete your adrenals, causing a decrease in the output of adrenal hormones, particularly coritsol.
The adrenal glands are often depleted from stress. Since the adrenal glands give the body something to fall back on in times of stress, when they are run down a person loses his reserve capacity and has lowered resistance to disease processes. When a hypoadrenic person becomes sick, he becomes sicker for a longer period of time, and with a greater likelihood for recurrence of the problem than if his adrenals were functioning at full capacity. This person gets into a chronic state of ill-health and that is when they show up in a practitioner’s office. But modern medicine does not recognize hypoadrenia as a distinct and fully recognizable syndrome. Modern medicine only officially recognizes the pathological Addison’s disease as hypoadrenia and not the functional hypoadrenia. Nevertheless, it can wreak havoc with your life.
Hypoadrenia is such a common complaint and occurs in so many other conditions, that today’s medical doctors rarely consider pursuing an adrenal-related diagnosis when someone complains of fatigue. Very few physicians have read and understood the entire range of medical journal reports that have been around for over one hundred years. Fifty years ago, physicians were far more likely than their modern counterparts to correctly diagnose this ailment. Information about non-Addison’s hypoadrenia has been documented in medical literature for over one hundred years but unfortunately, this milder form of hypoadrenia is missed or misdiagnosed in doctors’ offices every day, even though the patient clearly presents its classic symptoms. The fact that it usually remains undiagnosed does not lessen its debilitating influence on their health and feelings of well being.
Two reasons why conventional medical treatment for hypoadrenia is so hard to find is 1) Money: There are no patentable treatments for hypoadrenia produced by the pharmaceutical companies. There is no money to be made. 2) Politics: Since the 1970s, the FDA has “outlawed” and actively persecuted one of the chief natural remedies for hypoadrenia, an extremely safe remedy called adrenal cortical extract (ACE).
Symptoms
People will develop a variety of different complaints depending on which of the adrenal’s functions have been the most compromised and the general areas of susceptibility which they have inherited or acquired. The adrenals produce a variety of hormones, and it is quite likely that the same combination of symptoms will not be seen twice in a whole series of hypoadrenic patients. The body’s reaction to stress is different in different people. The symptoms will depend on the nature of the person and the nature of the hormone depletion. In chronic stress states, the lymphatic system, particularly the thymus gland, atrophies, and there is also a tendency for development of stomach and duodenal ulcers in these persons. The person with stress-related illness might also have symptoms from lowered output of the adrenal glucocorticoids: cortisol, corticosterone, and cortisone. Of these, cortisol is the most important.
Heart Sounds and Hypoadrenia
Another common finding during the physical examination of the hypoadrenic person is made during auscultation of the heart. Normally the first and second sounds of the heart make a “lub-dub” sound, with the first sound being louder than the second. If you record the heart sounds on a phonocardiograph Endocardiograph), the second sound should be one-third the intensity (height) of the first sound. In the hypoadrenic person, the second sound will be equal to or greater than the first sound in the pulmonary valve area. The same may be true in other valve areas also, but in hypoadrenia, at least, the pulmonary second sound is greater. This accentuated pulmonary second sound is due to the pulmonic valve slamming shut because of pulmonary hypertension. Epinephrine causes vasoconstriction throughout most of the body, including the lungs. In the lungs this vasoconstriction causes a shrinkage of the mucosa and decreased mucus secretion. Epinephrine also relaxes the bronchiolar musculature, creating a bronchodilation.
This is why epinephrine inhalers are so helpful for asthma sufferers. The bronchodilation, which normally occurs with epinephrine, cannot occur in a person with hypoadrenia. Instead, he gets a bronchoconstriction—a constriction of all the bronchial musculature with subsequent symptomatology. Likewise, the hypoadrenic person does not have the benefit of epinephrine’s action on the pulmonary capillaries and mucous membranes, with a resultant swelling of the mucous membrane and an increase in mucus production or secretion. In the hypoadrenic person, physical evidence of this is heard as the loud second heart sound at the pulmonary area. The bronchoconstriction, combined with the vasodilation and mucous membrane swelling, creates a back pressure in the pulmonary circulation that causes the pulmonary valve to slam shut, thus creating the louder second sound over the pulmonic valve.
Any person who has abnormal lung function, especially asthma or bronchitis, should be checked for hypoadrenia. This is particularly true if the person’s symptoms are relieved by using an epinephrine inhaler. The muscles related to the lungs (deltoid, serratus anterior, etc.) are usually strong in these persons. Many lung problems are related more to the adrenals than to the lungs. The sartorius and gracilis, etc. should be checked in any lung case.
Several years ago, it was reported that asthma was totally a psychosomatic illness. Patients were put under emotional stress and an asthma attack would ensue. Therefore it was concluded that the asthma problem was all in the patient’s head. If the adrenals are in the exhaustion stage of the GAS, they will be unable to respond to the added burden of emotional stress since there is no reserve available to fall back on. The epinephrine will not be available for normal function and the person will experience bronchoconstriction, swelling of the mucous membranes, and increased mucus production. The result is an asthma attack triggered by the increased emotional stress. The attack has nothing to do with the emotional stress except that the stress affects the adrenals. Fix the adrenals and the person can physically tolerate the emotional stress.
It is important to note that lung pathology, such as malignancy, tuberculosis, etc. will also create a loud second heart sound at the pulmonic valve area. Also, if there is an increased second heart sound only at the tricuspid valve area, this is usually indicative of liver congestion. There will be a weakness of the pectoralis major sternal, in these cases, and the sound can be normalized by treatment directed at the liver.
Hemmorhoids are another problem which is associated with blood pooling in the abdomen. A hemorrhoid is a vein which has pushed its way (or been pushed) to bulge outside the anal sphincter. The anal sphincter then becomes very tight, and the hemorrhoid, with the pressure of the abdominal and pelvic blood above it, and gravity pulling from below it, cannot get back inside the rectum. Treatment of hemorrhoids must be directed at two areas. First, the hemorrhoids must be treated locally, and second, the source of intra-abdominal and intra-pelvic pooling of blood must be corrected.
Most commonly, the cause of the blood pooling in the abdomen and pelvis is from hypoadrenia. But severe liver congestion can also cause portal hypertension and result in hemorrhoids. You must differentiate between liver and adrenal problems as the underlying cause of the hemorrhoids. For this reason, whenever a person complains of hemorrhoids, one of the first things to be done is listen to the heart. The person does not understand this, but you are listening for the relative loudness of the second sounds at the pulmonic valve area (for the adrenals) and the tricuspid valve area (for the liver).
In treating hemorrhoids locally, it is necessary to recognize that the hemorrhoidal veins can not get themselves back inside the rectum, due to the tightness of the anal sphincter. In order to treat the hemorrhoids successfully, the anal sphincter must be dilated. This is done by putting on a glove (not a finger cot) and, using a lubricant, inserting your index finger into the rectum. Stretch the anal sphincter with the index finger. Then insert the first two fingers and stretch the sphincter. Then insert three fingers and insert them slowly about as fat as they will reach. Finally (if the person is still on the table) insert all four fingers, stretching the sphincter up to the point which the size of the patient will tolerate.
This is a difficult procedure for the patient, but there will be an immediate and dramatic reduction in the extent of the hemorrhoids protruding through the anus. If done correctly, this procedure may only have to be performed once. Then again, you may only get one chance! Occasionally it is necessary to repeat the sphincter dilation once or twice in the future.
Varicose veins in the lower extremities are frequently caused by hypoadrenia for the same reasons that cause hemorrhoids. This can be seen in many pregnant women who only have a flare up of varicosities during pregnancy. It may be difficult to eliminate the varicosities, but it is possible to arrest their progression and to keep them in check throughout the pregnancy.
The pooling of blood in the abdomen and pelvis also creates and contributes to other symptoms. The patient with this problem will often complain of fullness or bloated feeling in the abdomen. Sometimes the sluggish circulation in the abdomen and pelvis actually affects digestion. Since the GI tract depends on an adequate supply of blood not only for its function, but for the absorption of nutrients, one can readily imagine how hypoadrenia can affect digestion. Symptoms of indigestion as well as inadequate absorption of nutrients can be caused or aggravated by hypoadrenia.
Other Symptoms of Hypoadrenia
One of the commonly overlooked sources of stress and resistant adrenal fatigue is chronic or severe infection. Adrenal fatigue is often precipitated by recurring bouts of bronchitis, pneumonia, asthma, sinusitis, or other respiratory infections. The more severe the infection, the more frequently it occurs or the longer it lasts, the more likely it is that the adrenals are involved. Adrenal fatigue can occur after just one single episode of a particularly nasty infection, or it can take place over time as the adrenals are gradually fatigued by prolonged or recurrent infections. If there are other concurrent stresses, such as an unhappy marriage, poor dietary habits or a stressful job, the downhill ride is deeper and steeper.
People who are involved in a weekly rotating shift have magnified stress because their bodies never have a chance to adjust to the new circadian rhythm produced by each sleep change. People on alternating shifts with less than three weeks between shift changes are continually hammering their adrenal glands. Every time the wake/sleep cycle is altered, it takes several days to weeks to establish a normal pattern for the new wake/sleep cycle.
The glucocorticoids are the body’s own anti-inflammatory hormones. Persons who have had inflammations such as arthritis, bursitis, or other joint problems which have been helped by the injection or oral ingestion of cortisone and cortisone derivatives are usually persons who have had insufficient production of these substances by their own adrenal glands. This is particularly the case in the person who was originally helped by cortisone treatment once or twice, but on whom further attempts at cortisone therapy were fruitless. Any person who has been benefited by a course of cortisone therapy should be examined for hypoadrenia. Not only is this true of the obvious reason that the adrenals’ cortisone output may be lowered, but also for the reason that cortisone therapy tends to lower adrenal gland output in the long run.
Cortisone causes a negative feedback to the pituitary, causing a diminished pituitary output of adrenocorticotropic hormone (ACTH). In prolonged cortisone therapy, the person’s adrenal glands will atrophy, even to the point of non-function. Since the adrenal cortical hormones are necessary for life, a person on cortisone products should never have them withdrawn rapidly, as this could cause a life-threatening crisis. When a person is withdrawn from cortisone, it should be done so very gradually, over a long period of time in order to allow the adrenal glands to rebuild themselves to an adequate level of activity.
The adrenal glands are also implicated in most types of allergies. Most allergies involve an inflammatory process. Frequently, the allergen is merely the straw that breaks the camel’s back. The allergen would not cause the person any trouble if he had an adequate level of his own adrenal production of the anti-inflammatory glucocorticoids. The same anti-inflammatory effect is important in limiting the lung congestion in asthma and bronchitis, as has been previously discussed.
As the adrenal glands become depleted, the blood glucose levels will tend to drop below normal levels. In an effort to counter this potential low blood glucose, the person will get cravings for anything which will rapidly increase the blood glucose. He will eat a candy bar, drink a cup of coffee, smoke a cigarette, or drink a soft drink. Everybody has their favorite “fix.” The abuse of alcohol, marijuana, and hard drugs fits this pattern as well. But the rapid rise in blood glucose provided by the “fix” only serves to re-initiate the whole cycle again.
The symptoms of the hyperinsulinism/hypoadrenia/hypoglycemia person are too numerous to mention here. Basically, though, epithelial tissue, nervous tissue, and the retina of the eye do not store glucose. Hence, these tissues are the most likely to be affected. Low blood glucose creates symptoms of blurred vision, headache, nervousness, unstable behavior, allergies, and on and on. Another symptom which is occasionally encountered in hypoadrenia is that of increased pigmentation of the skin. There may be unusual brown patches or areas of bronzing somewhere on the body’s surface. When the adrenal function is low, the pituitary responds by making ACTH. In the exhaustion stage of GAS, the ACTH effect on the adrenal is like whipping a tired horse. Since the adrenal can not respond to this pituitary drive, the pituitary keeps elaborating ACTH until its levels in the circulation are quite elevated.
The extra ACTH will affect other areas of the body. For example, ACTH has somewhat of an effect on the ovary, causing it to increase estrogen production. Also, ACTH has about 1/100th of the effect of melanocyte stimulating hormone (MSH), the pituitary hormone which stimulates melanocytes in the skin to produce the dark pigment melanin. In a severe hypoadrenia, the effect of bronzing or increased areas of pigmentation of the skin will sometimes be seen as a result of the ACTH mimicking the effect of MSH. Although this symptom is more common in the pathological hypoadrenia, Addison’s disease, it is occasionally seen in functional hypoadrenia as well.
Mercury and the Adrenal Glands
Mercury accumulates in the adrenal glands and disrupts adrenal gland function. Two primary nutrients for the adrenal glands are pantothenic acid and vitamin-C. A deficiency of pantothenic acid can lead to adrenal exhaustion (chronic fatigue) and ultimately to destruction of the adrenal glands. A deficiency of pantothenic acid also causes a progressive fall in the level of adrenal hormones produced. One of the largest tissue stores of vitamin-C is the adrenals; it is exceeded only by the level of vitamin-C in the pituitary. Physical and mental stress increases the excretion of adrenocorticotropic hormone. The increased adrenal activity, in turn, depletes both vitamin-C and pantothenic acid from the glands.
Humans cannot produce vitamin-C. They therefore attempt to replenish the needs of the adrenals by taking the vitamin from other storage locations in the body. If your overall ascorbate status is low, there may be an insufficient amount available to satisfy the needs of the adrenals. Under this condition, normal adrenal hormone response may become inadequate, leading to an inadequate immune function. Mercury builds up in the pituitary gland and depletes the adrenals of both pantothenic acid and vitamin-C. Stress and the presence of mercury will have a very negative effect on the adrenal production of critical steroids. The ability of the adrenal gland to produce steroids is called steroidogenesis and is dependent upon reactions mediated by the enzyme cytochrome P-450. Cytochrome P-450 reacts with cholesterol to produce pregnenolone, which is then converted to progesterone. Cytochrome P-450 can then convert progesterone to deoxycorticosterone which is then converted to corticosterone or aldosterone by other enzymes in the adrenals. These adrenal functions are also affected by metal ions.
All steroid hormones produced by the adrenal glands are derived from cholesterol through a series of enzymatic actions, which are all stimulated initially by ACTH. Steroid biosynthesis involves the conversion of cholesterol to pregnenolone, which is then enzymatically transformed into the major biologically active corticosteroids. cAMP is produced from adenosine triphosphate (ATP) by the action of adenylate cyclase. Adenylate cyclase activity in the brain is inhibited by micromolar concentrations of lead, mercury, and cadmium. One of the key biochemical steps in the conversion of adrenal pregnenolone to cortisol and aldosterone involves an enzyme identified as 21-hydroxylase.
Mercury causes a defect in adrenal steroid biosynthesis by inhibiting the activity of 21a-hydroxylase. The consequences of this inhibition include lowered plasma levels of corticosterone and elevated concentrations of progesterone and dehydroepiandrosterone (DHEA). DHEA is an adrenal male hormone. Because patients with 21-hydroxylase deficiencies are incapable of synthesizing cortisol with normal efficiency, there’s a compensatory rise in ACTH leading to adrenal hyperplasia and excessive excretion of 17a-hydroxyprogesterone, which, without the enzyme 21-hydroxylase, cannot be converted to cortisol.
The inhibition of the 21-hydroxylase system may be the mechanism behind the mercury-induced adrenal hyperplasia. Adrenal hyperplasia can stress the adrenal glands by their accelerated activity to produce steroids to the point that production begins to diminish and the glands will atrophy. The result is a subnormal production of corticosteroids. Both lead and mercury can precipitate pathophysiological changes along the hypothalamus-pituitary-adrenal and gonadal axis that may seriously affect reproductive function, organs, and tissues. Leukocyte production, distribution, and function are markedly altered by glucocorticosteroid administration. In Addison’s disease (hypofunction of adrenal glands), neutrophilia occurs 4-6 hours after administration of a single dose of hydrocortisone, prednisone, or dexamethasone. Neutrophilia is an increase in the number of neutrophils in the blood. Neutrophils are also called polymorphonuclear leukocytes (PMNs). Mercury not only causes a suppression of adrenocorticosteroids that would normally have stimulated an increase of PMNs, but at the same time also affect the ability of existing PMNs to perform immune function by inhibiting a metabolic reaction that destroys foreign substances. Still today, the ADA and other governmental agencies tell us that the mercury in your mouth, or from vaccinations, is perfectly safe. Scientists say this is a ridiculous statement that is in violation of science and common sense.
Adrenal Gland–Related Muscles
Dr. Goodheart identified five specific skeletal muscles which are related to adrenal gland function. These are 1) sartorius, 2) gracilis, 3) posterior tibialis, 4) gastrocnemius, and 5) soleus. There will be weakness in one or more of these muscles when the adrenal glands are malfunctioning. Because of the attachments of the sartorius and gracilis on the pelvis, (sartorius—anterior superior iliac spine; gracilis—pubic ramus), their weakness in persons with adrenal stress problems may allow the sacroiliac joint to subluxate posteriorly. The sartorius and gracilis stabilize the innominate (one side of the pelvis), holding it in an anterior direction. Many persons with hypoadrenia seek chiropractic help for the care of sacroiliac pain and/or low back pain which is due to the lack of pelvic stabilization normally provided by these muscles.
The sartorius and gracilis have a common insertion (along with the semitendinosis) on the medial side of the knee and rotate the tibia medially on the femur. When weakness of these muscles occurs, there is a loss of stability on the medial side of the knee. The sartorius and gracilis (along with the semitendinosis) act as dynamic ligaments, protecting and supporting the medial knee joint during various ranges of motion. Their function is particularly important in situations where the knee ligaments alone offer inadequate support.
It is very important to check for hypoadrenia in any person with knee problems. One can see how one hypoadrenic person will present with knee problems and another with back problems, and some persons will have both.
Due to the relationship of the posterior tibialis, gastrocnemius, and soleus to the stability of the foot and ankle, many hypoadrenic persons will complain of symptoms of tired feet, weak ankles, or aching calves. The posterior tibialis holds up the medial longitudinal arch of the foot, especially during gait. In some persons exhibiting hypoadrenia-related weakness of the posterior tibialis, the medial arch will drop, causing a pronation problem and strain to the foot and ankle. The one common factor in persons with the above-mentioned musculoskeletal complaints will be the weakness of one or more of the five adrenal gland related muscles accompanied by improvement of their symptoms following treatment of the adrenal glands.
The adrenal gland cortex produces three major categories of hormones:
1. mineralocorticoids,
2. glucocorticoids, and
3. gonadal (sex) hormones (testosterone, estrogen, progesterone, etc.).
Depending on the relative amount of depletion of each of these hormone groups, one will see varying symptoms in the person suffering from stress-related hypoadrenia.
Cortisol and Epinephrine
The adrenal cortex and the adrenal medulla are the two parts of the adrenal gland. Although each has separate functions, it is no mistake that they are placed next to each other anatomically, since some of the functions of one are dependent on the other.
Epinephrine is a vasoconstrictor. But for epinephrine to have its vasoconstricting effect on the body’s arterioles, it is imperative that cortisol be available. Cortisol sensitizes the arterioles to the constrictive action of epinephrine. If there is low adrenal cortical output and adequate coritsol is not produced, epinephrine will have a reduced effect in its function of constricting the blood vessels. These two hormones work together in affecting blood pressure. Therefore, in the hypoadrenic patient one of the major findings observed on physical examination is related to blood pressure.
Normally when a person goes from lying down to standing, the systolic blood pressure should elevate 4-10 mm Hg. (millimeters of mercury). In hypoadrenia, the systolic blood pressure from lying to standing will either stay the same or drop. This systolic drop is usually between 5 to 10 mm. Hg., but sometimes as much as 30-40 points. This is a classic sign in the hypoadrenic person which is known as the Ragland effect, or postural hypotension, and which is reported in over 90% of hypoadrenic persons. Blood pressure should always be checked in three positions: sitting, then lying, then standing. From recumbence to standing, the systolic blood pressure should rise 4-10 points. If the blood pressure drops, suspect functional hypoadrenia.
There are valves in the veins of the lower extremities which keep the blood from pooling in the feet when a person maintains an upright position. The fact that there are no valves in the veins of the abdomen and pelvis means that the only mechanism which prevents the blood from pooling there when the body goes from lying to standing is the vasoconstriction of the local vessels. If there is a low coritsol level, epinephrine can not function correctly and there will be inadequate vasoconstriction in response to upright posture. This causes the blood to pool in the abdomen and pelvis and the systolic pressure in the arm to drop. This same person may complain of dizziness or light-headedness, especially when arising from a seated or lying position. Or he may experience transient spells of dizziness during the day or he may be dizzy all the time. The patient may be complaining of headaches, which are due to the pooling of the blood in the abdomen and pelvis, interfering with the supply to the head. Frequently these persons have had totally normal neurological examinations or some have been diagnosed as having Meniere’s disease. Some are being treated unsuccessfully with manipulation to the upper cervical vertebrae. But all therapeutic approaches are ineffective in relieving the symptoms until the hypoadrenia is treated.
Some persons who have postural blood pressure dumping are being treated for hypertension. The hypertension is from another paradoxical body response. When the person changes positions from recumbence to standing and the systolic blood pressure drops 10, 20, 30 points, the body senses this low blood pressure and reacts. The body does not want all the blood pooling in the abdomen and pelvis because it decreases the amount of blood in the head and other areas. In an effort to change this situation, the body may elevate the systolic pressure to an extremely high level. The systolic blood pressure may go as high as 180 mm Hg. or more. Then, when the person changes positions from lying to standing, the systolic blood pressure will drop to only, say, 150 mm. Hg.
If the blood pressure is taken only in the seated position, the person will show a very high systolic pressure. But, when you change the person’s positions, he will show the dumping blood pressure on arising from recumbence to standing. These persons are often treated with diuretics when the real problem is with the adrenal glands. Combine this with the fact that many hypoadrenic persons are also dehydrated, as previously discussed, and you can see the senselessness of a diuretic approach in these cases.
Anatomy
The adrenals are orange-colored glands that sit on top of the kidneys near the spine, just underneath the last rib and extending down about an inch. The right adrenal is shaped something like a pyramid, whereas the left is shaped more like a half moon. Each gland is highly vascularized and is only about 1” high by 1¼” to 2” wide by ¼” thick, and weighs just 4 to 6 grams (about one-eighth to one-quarter ounce). They are usually heavier in females than in males.
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Although in contact with the kidney, there is no direct connection from the adrenals to the kidney—the arterial blood supply to the adrenal glands is separate from the kidneys. Both adrenal glands are only a very short distance from the aorta, the major artery of the body, and the vena cava, the major vein. This strategic placement allows for a very rapid adrenal response to hormonal messages transported via the blood. For example, Adrenal Corticotropic Hormone (ACTH) is a hormone messenger from the pituitary gland that tells the adrenal glands how much coritsol to secrete. Within a few seconds of receiving this message the correct level of coritsol is on its way form the adrenals to the rest of the body. The adrenals are also placed in close proximity to the liver, pancreas, major fat storage areas and the kidneys, as these are the organs that need rapid communication with the adrenals in situations requiring their immediate response to adrenal hormones.
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Regions of the Adrenal Glands
Each adrenal gland is composed of two endocrine components—a medulla (inner part) that constitutes 20% of the gland and a cortex (outer part) that constitutes the remaining 80% of the gland. The cortex consists of four zones. The medulla and each of the zones in the cortex each produce different hormones that serve a variety of functions in your body. The adrenal cortex and medulla, like the anterior and posterior lobes of the pituitary, are obtained from separate cells in the developing embryo. The medulla is derived from ectodermal neural crest cells, and the cortex is derived from mesodermal cells.
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The Adrenal Medulla
The functional unit of the adrenal medulla is the chromaffin cell, which functions as a neuroendocrine cell. In response to stimulation, chromaffin cells secrete the hormones epinephrine (adrenaline) and norepinephrine (noradrenalin) directly into the blood. Epinephrine and norepinephrine are important mainly in crisis situations. During a crisis, they work together to dilate bronchi (air passages of the lungs) and blood vessels to the muscles, increases heart beats and strength of contraction, and cause other physiological changes to help the body respond to the stressful situation via “fight or flight.” These adrenal hormones are responsible for the superhuman abilities that occasionally occur during a crisis. The medulla is involved in extreme stress and, within this context, epinephrine and norepinephrine both work with coritsol from the adrenal cortex.
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The Adrenal Cortex
Most of the ongoing daily regulation and modification of bodily processes arises from the adrenal cortex. The adrenal cortex is divided into four zones which each secrete different hormones that carry out specific functions throughout your body. 1) The outermost zone is the zona glomerulosa from which the hormone aldosterone is secreted, and consists of cells arranged in 'whorls' (glomeruli). Cells of the zona glomerulosa produce hormones called mineralocorticoids. Aldosterone is the major hormone controlling the sodium and potassium levels, and thus fluid balance, within your bloodstream, cells and interstitial fluids (the area between the cells).
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1) The outermost zone is the zona glomerulosa from which the hormone aldosterone is secreted. Aldosterone is the major hormone controlling the sodium and potassium levels, and thus fluid balance, within your bloodstream, cells and interstitial fluids (the area between the cells).
2) The next zone is the zona fasciculata in which coritsol is produced. Cells of this zone are arranged into fascicles separated by venous sinuses. Cells of the zona fasciculata produce glucocorticoid hormones. Cortisol controls or greatly influences the metabolism of fats, proteins and carbohydrates to maintain blood glucose within a narrow optimal range and keep it there even under stressful conditions. Cortisol also has many other important functions.
3) The innermost zone is the zona reticularis where progesterone, DHEA and its relatively inactive precursor, DHEA-S are produced. Although the sex hormones are made primarily by the gonads (ovaries and testes), the adrenal zona reticularis manufactures an ancillary portion of sex hormones for each sex and also produces male hormones in women and female hormones in men to keep the effects of the dominant sex hormones in balance.
In humans and other primates, between the zona fasiculata and the zona reticularis, there is a narrow space called the interface zone. Although the zona reticularis has traditionally been thought to produce the sex hormones such as the estrogens and testosterones, it is now believed that this interface zone is the actual site of production of most of the sex hormones. Because most adrenal research uses rodents and other non-primate mammals, little attention has been paid to this interface zone until recently.
These zones of your adrenal cortex collectively produce over fifty hormones. Most of these are intermediary hormones that only act as bridges to form other adrenal hormones. However, about a dozen hormones end up in your circulation and actively affect the rest of your body.
Physiology
The Regulation of Cortisol
The hypothalamus of the brain influences both portions of the adrenal gland but by different mechanisms. The Secretion of glucocorticoids from the adrenal cortex is regulated by negative feedback involving the corticotrophin-releasing hormone (CRH) secretion by the hypothalamus. CRH then acts on the anterior pituitary to stimulate adrenocorticotropic hormone (ACTH) secretion, which then stimulates the adrenal cortex into cortisol secretion. Although coritsol is secreted by the zona fasiculata in the adrenal glands, it is regulated primarily from the brain.
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Normally about 80% of blood cortisol is bound to a carrier protein called cortico-steroid-binding globulin. Another 15% is bound to albumin, and the remaining 15% exists free in solution. Cortisol secretion has numerous physiological effects, its main target tissues being the liver, skeletal muscle and adipose tissue. Cortisol is responsible for many of the life sustaining functions attributed to the adrenal glands. Many of the symptoms of adrenal fatigue arise from decreased coritsol levels in the blood or inadequate levels of coritsol during times of stress when more coritsol is needed.
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Excess cortisol secretion results in Cushing's Syndrome. This can either occur as a primary abnormality in steroid hormone production by the adrenal cortex, or as a result of overproduction of ACTH by the pituitary resulting in excessive stimulation of the adrenal cortex. Cushing's patients have thin arms and legs, due in part to the loss of muscle mass as a result of the protein-catabolic effects of excess cortisol, and also as fat is redistributed from the extremities to the trunk. There is an increase in fat in the face, the trunk, across the shoulder blades, and at the base of the neck. Connective tissue is lost from the skin, causing it to become thinner. As a result, blood vessels are located closer to the surface making the skin have a slight red appearance.
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The HPA Axis
The amount of coritsol circulating at any particular moment is regulated by a complex interaction between the hypothalamus (a regulatory part of the brain), the pituitary gland at the base of the brain, and the adrenal glands. This regulatory trio operates through a negative feedback system and is referred to as the Hypothalamus/Pituitary/Adrenal (HPA) Axis or HPA System. In your body, your hypothalamus is analogous to a thermostat, your pituitary to a relay switch, your adrenals to a furnace, and your body to a room. The amount of coritsol released is comparable to the heat released from the furnace. To a large extent you control the thermostat through the demands you place on your body. These demands arise from the physical situations your body has to deal with (diet, exercise, work, climate, etc.) and your reactions (emotional and physiological) to them.
The HPA Axis is one of the most important elements of the whole body process known as homeostasis, the process that maintains a steady internal bio-chemical and physiological balance in your body. The HPA Axis adjusts coritsol levels according to the needs of the body, under normal and stressed conditions, via a hormone called the Adrenal Corticotrophic Hormone (ACTH). ACTH is secreted from the pituitary gland in response to orders form the hypothalamus and travels in the bloodstream to the adrenal cortex. There it activates cells in all four zones to produce their various hormones.
Each zone generates different hormones as end products, but the process of making all hormones in all zones begins with ACTH biding to the walls of the adrenal cells. This initiates a chain reaction of intracellular enzymes that release cholesterol within the cell. The cholesterol is then used inside the adrenal cells to manufacture pregnenolone, the first hormone in the adrenal cascade. No matter which adrenal hormone is being produced, pregnenolone is the first hormone formed in the series. In the zona fasciculata, pregnenolone is processed to form cortisone and then coritsol. Cortisol, once manufactured, is released into circulation. It takes less than a minute after the initial stimulation by ACTH for newly synthesized coritsol to be circulating through your blood to every part of your body, including to your hypothalamus where the concentration of coritsol is being constantly measured.
Your hypothalamus, in its regulatory function, analyzes and integrates input form many different external and internal sources. This input includes information from brain centers about overall excitability, energy requirements of you body, and sensory data from your brain centers for hearing, seeing, smelling, touch and taste. Based on this information, your hypothalamus determines how much coritsol your body requires and subsequently releases its own hormones as messengers. The primary hormone messenger from the hypothalamus is Corticotrophin Releasing Factor (CRF) which signals the pituitary gland to secrete a specific amount of ACTH. Thus ACTH is sent from the pituitary to your adrenal glands to begin the process described above all over again. Alterations in ACTH levels, and hence coritsol levels, are made minute by minute using this negative feedback loop, modulated by other information received by the hypothalamus.
Cortisol, ACTH and aldosterone are not secreted uniformly throughout the day, but rather follow a diurnal pattern with the highest levels secreted at approximately 8:00 AM and the lowest between midnight and 4:00 AM. As a matter of fact, it is the rising coritsol level that helps us wake up in the morning. After its peak at approximately 8:00 AM, it downtrends through the rest of the day, often with a small dip in the afternoon between 3:00 and 5:00 PM. This curve of coritsol secretion however, is not a nice smooth curve, but is filled with episodic spikes that generally fit into an increasing and a decreasing pattern throughout the day and evening. Eating something, even a little snack, causes a small burst in cortisol levels. People who have regular snacks and meals keep their coritsol at higher levels for more of the day compared to people who do not snack. This is another reason to have regular healthy snacks in addition to regular meals if you have adrenal fatigue. Exercise also elevates coritsol levels similarly to food, so the combination of regular means, small snacks and exercise can do a lot to enhance depressed coritsol levels.
Some people with hypoadrenia have an overall low pattern of coritsol secretion with circulating coritsol levels lower than normal between 3:00 and 5:00 PM. Still others fluctuate throughout the day and can even vary from day to day so that their coritsol levels are unpredictable. They may go through part of their day with elevated coritsol levels, part of the day with low levels and part with normal levels. Although coritsol has its diurnal pattern of variations each day, it remains at an amazingly consistent level throughout your lifetime, under normal conditions. In later life, some people actually experience a small rise in coritsol. If this rise is excessive it may be related to some disorder. However, a rise in coritsol in response to stress is a natural reaction that actually protects the body in several ways.
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