Dr Gigi Chow

Archive for June, 2012|Monthly archive page

Adrenal Fatigue

In Hormonal Health on June 27, 2012 at 5:17 pm

What is Adrenal Fatigue?

Adrenal fatigue is a decrease in function of the adrenal glands that characteristically manifests as a reduced output or alteration in the diurnal pattern of adrenal hormone secretion including cortisol. People suffering from decreased adrenal function commonly complain of fatigue but may also experience sleep disruptions, weight changes, salt and/or sugar cravings, allergies, anxiousness, nervousness, low blood pressure and numerous other symptoms.

Who Experiences Adrenal Fatigue?

Saliva testing reveals that adrenal fatigue is widespread in the United States. Functional Medicine clinics have observed that over 85% of patients are experiencing some level of adrenal dysfunction or adrenal fatigue. Adrenal fatigue does not discriminate – it may be experienced by men as well as women, and it can occur at any age. Today many individuals in their early twenties are already experiencing adrenal fatigue.

What Causes Adrenal Fatigue?

Adrenal fatigue results from continuous or sudden stress. It may begin abruptly, or as a result of periods of prolonged, repeated stress. Sources of stress may be positive or negative and include (but are not limited to):

  • Recurrent disease and illness
  • Physical stress – injury, diet, surgery, tobacco/alcohol addiction, etc
  • Emotional stress – marriage, divorce, death of a loved one, strenuous work relationships, a new baby, financial insecurity, etc
  • Environmental stress – chemical pollution of air, water, food, etc

Phases of Adrenal Function and Fatigue:

Phase 1: Early adrenal fatigue-acute fight or flight i.e. the alarm reaction. A new situation is met with anxiety and surprise. A person intermittently secretes slightly higher levels of the adrenalin, the fight or flight hormone, in response to a slightly higher level of stress. The adrenal cortex is stimulated to produce additional cortisol and related hormones.

Phase 2: Evolving adrenal fatigue also called adaptation or resistance. It begins when the stress is constant enough, to cause sustained excessive levels of certain adrenal hormones. This is the body’s response to long term protection. It secretes further hormones that increase blood sugar levels to sustain energy and raise blood pressure. The adrenal cortex (outer covering) produces hormones called corticosteroids for this resistance reaction.

Phase 3: Established adrenal fatigue or exhaustion. The body’s ability to cope with the stress is now depleted. At this point, adrenal hormones drop from excessively high to excessively low and the body experiences adrenal exhaustion. Mental, physical and emotional resources suffer heavily. The body experiences “adrenal exhaustion”. The blood sugar levels decrease as the adrenals become depleted, leading to decreased stress tolerance, progressive mental and physical exhaustion, illness and collapse.

Adrenal support

Successful support and treatment protocols for all people suffering from decreased adrenal function include:

• Lifestyle modification to include exercise, healthy sleep patterns with ideal sleeping hours of 10pm – 9am, balanced diet high in vegetables and including healthy fats and proteins, frequent laughter and deep breathing exercises.

• Avoidance of food allergies/sensitivities, caffeine, alcohol, and refined sugars

Individualized treatment plans may include the following depending upon the saliva testing results (phase I, phase II or phase III):

• Supplementation of dietary cofactors necessary for adrenal function including Vitamins C, B5, B6 and E

• Adaptogen therapy including licorice, rhodiola, etc.

• Adrenal glandular supplementation

• Physiologic cortisol supplementation

• Phosphorylated serine (elevated cortisol levels only)

It is important to note that the different stages of adrenal fatigue may all present with the same symptoms, yet treatment protocols can be significantly different depending on the diurnal pattern and volume of cortisol production for each individual. Testing adrenal function is therefore a critical first step in devising the correct treatment plan .





Health in Our Saliva?

In Hormonal Health on June 27, 2012 at 3:42 pm

What health information can our saliva give us?

The majority of hormones (for example: cortisol, DHEA, progesterone, testosterone) in the blood exist in one of two forms: free (5%) or protein bound (95%). While 95% of the hormones in the body are protein bound, it is only the 5% free hormones that are biologically active.

In order for steroid hormones to be detected in serum i.e. in your typical blood draw, they must be bound to circulating proteins. In this bound state, they are unable to bind to receptors in our tissues which means that the hormones cannot carry out its intended effects (FYI: for hormones to carry out its intended purpose, it must be bound to a receptor. When the hormones are bound to circulating proteins, it means that they cannot bind to their target receptors). Therefore, hormones that are measured in serum or blood is considered inactive or non-bioavailable.

Saliva, on the other hand, measures the free, bioavailable hormone aka active levels in the body. Why is this?

When blood is filtered through the salivary glands, the bound hormone components are too large to pass through the cell membranes of the salivary glands. Only the unbound hormones pass through and into the saliva. What is measured in the saliva is considered the “free”, or bioavailable hormone, that which will be delivered to the receptors in the tissues of the body.  Therefore, saliva is the method of choice when assessing functional hormone levels.

The discrepancy between free and protein bound hormones becomes especially important when monitoring topical, or transdermal, hormone therapy. Studies show that this method of delivery results in increased tissue hormone levels (thus measurable in saliva), but no parallel increase in serum levels. Therefore, serum testing cannot be used to monitor topical hormone therapy.

Saliva testing is proving to be a very reliable medium for measuring hormone levels. Hormone levels in saliva accurately represent the amount of hormone delivered to receptors in the body, unlike serum which represents hormone levels that may or may not be delivered to receptors of the body. Clinically, it is far more relevant to test the amount of hormones delivered to the tissue receptors as this is a reflection of the active hormone levels of the body.




Chronic Stress and Hormonal Health

In Hormonal Health on June 27, 2012 at 3:06 pm

Stress can be mental, physical or emotional and there are often events or periods of time in our lives that we can point to as particularly stressful, such as a car accident, death of a loved one or job loss. In addition to these major events, there are many underlying “behind the scenes” factors that compile and contribute to a state of chronic stress. From infections, allergies, depression, overworking, guilt, and sleep deprivation, to toxic exposures, fluctuating blood sugars, and medications. We are constantly inundated with demands to our hormonal system.

Our bodies were built to handle isolated stressful events, and hormones including cortisol and DHEA
are an important part of that mechanism, however, the adrenal glands can only do so much. Just as you can’t continue to spend money from your checking account without working to put money in it, asking your adrenal glands to continuously produce stress hormones without giving them the opportunity to rest and regenerate will lead to hormonal bankruptcy!

Pregnenolone Steal

Have you ever heard the old idiom “Rob Peter to pay Paul”? When our bodies are working to maintain sufficient cortisol levels to help us deal with all of our chronic stressors, there comes a point where we will pull resources from other places. Pregnenolone is the primary precursor hormone for all of the steroid hormones including cortisol, DHEA, progesterone, testosterone, estradiol and more. As a result of the increased demand for cortisol, our bodies will shunt more of the precursor pregnenolone down the pathway that results in more cortisol, leaving less starting material available to produce the other hormones. As you can imagine, the hormonal imbalance that ensues contributes to the overall stress burden and compounds the original problem.

Estrogen Dominance

Pregnenolone is the “parent” molecule for all of the steroid hormones and it can follow two pathways: one leads to DHEA and eventually to the estrogens and testosterone, and the other leads to progesterone and eventually to aldosterone and cortisol. When the demand for cortisol is increased, the progesterone/ cortisol pathway can steal the pregnenolone, but then a shortage of progesterone can also occur as more and more cortisol is needed. This process contributes to a relative deficiency in progesterone compared to estradiol, a condition that we often refer to as estrogen dominance.

Our endocrine system is designed very much like all other creatures on this planet, we are equipped to handle acute stressful events; prepared to protect ourselves from danger or to flee from it. While we rarely find ourselves fighting off a predator in this modern era, the constant barrage of micro-stressful events such as traffic, social stresses etc. often result in a chronically stimulated adrenal response. While our caveman ancestors would likely have rested safe in a cave after fleeing from a saber tooth tiger, we rarely give our bodies the actual break it deserves and requires! Over time, our adrenal glands just can’t keep up the pace and their production of cortisol begins to falter.

Adrenal exhaustion can happen to some people after a single stressful event, and for others it occurs after a long series of micro-stressors. We are all different, and the length of time we can “keep up the pace” is different depending on individual constitution as well.



Adrenal Fatigue: The 21st Century Stress Syndrome. Wilson JL. 2001 Smart Publications