Adrenal Fatigue & Inflammation

Chronic fatigue and mood imbalances are two of the most common health concerns my patients initially present with. The diagnostic test I consider most essential in evaluating these concerns to guide treatment is a diurnal salivary cortisol test fondly referred to in my office as “the spit test”. The patient takes home the test kit and provides saliva samples in little tubes throughout the day and evening before sending the kit off to the lab. What we learn from this testing is incredibly helpful in understanding the impact that chronic stress may be playing a patient’s health experience as well as understanding potential risks to the patient’s health down the road.

“Adrenal fatigue” is the common term used to describe a dysfunctional cortisol pattern, but it’s not that great of a term. A better term is HPA axis dysfunction as it is inclusive of the various patterns of inappropriate stress hormone output that occur after prolonged periods of stress.

Photo by: Jean Wimmerlin

Photo by: Jean Wimmerlin

When a person is experiencing intense physical or emotional stress, their brains perceive it as something from which to fight or flee. The brain then triggers an onslaught of stress hormone output which allows the individual to get the heck out of the (real or perceived) danger zone. But since your biochemistry evolved before IRAs, nuclear war threats, college tuition and healthcare deductibles, many of our fight-or-flight responses are routinely activated and rarely turned off. Imagine leaving your high-power blender on 24/7 and never turning IT off… talk about over-heating and crapping out early… You would never do this because you know you’d end up needing a new blender pretty quickly. It’s no wonder many of us are exhausted and emotionally labile given that we’ve been leaving our internal blenders on for the past several years, am I right??

There are dozens of important effects of prolonged stress including the aforementioned mood and energy issues, but I would like to focus on a less-discussed but equally-important consequence: immune dysfunction.

Sample patient’s diurnal cortisol pattern: note the rapid drop from mildly deficient first-morning cortisol into the “blue” or deficient state until nighttime where the cortisol levels begin to inappropriately rise again.

Sample patient’s diurnal cortisol pattern: note the rapid drop from mildly deficient first-morning cortisol into the “blue” or deficient state until nighttime where the cortisol levels begin to inappropriately rise again.

Your immune system is the complex, highly-trained, personal military in your body that reacts to all things noted to be bad or “not-belonging”. Your immune system protects you from germs, toxins, and funny-looking cells (like cancer cells). It has a whole bunch of artillery that it uses to address the problems it sees, and the consequences of an attack are collectively termed “inflammation”. Inflammation has historically been used to describe the acute swelling of part of the body - say your ankle when you roll it or the goose egg on your head when you bump it. But the truth is, we have a lot more inflammation happening in our bodies now all the time, and a lot of it is a result of stress, poor diet, chronic illness, and other factors. While inflammation is important to be able to trigger so that your immune system can do its job, it can be uncomfortable and can also get out of control if it’s not kept in check. Guess what one of your body’s key hormones to help control and modulate this inflammatory storm is?…… you guessed it! CORTISOL. That’s right. The hormone that helps you flee from lions and the astronomical bill you got from your mechanic last week is also the hormone that helps ensure that inflammation doesn’t get out of control. This is why steroid medications like prednisone (a cortisol look-alike) are so effective. They are able to shut the inflammation valve completely off.

This hormone system works great when we are under big stress short-term. Your kiddo makes it through their final exams staying up half the night and eating junk, and as soon as that two-week stress-fest is over, they get super sick because their anti-inflammatory hormone has gone back to a normal human level. Great. It’s protective in this way. BUT, if we are suffering high-stress experiences for longer periods of time, or if our bodies enter into a “chronic stress pattern” (which is when your body is so used to running from lions that even when the lions finally leave the picture your body doesn’t stop running), all of the sudden that cortisol output stops having the same effect on our immune system. This is termed “cortisol resistance”. Now we’re getting all of the adverse side effects of cortisol output but not the benefits. Eventually, we start to under-produce cortisol. Many of my patients are “in the blue” a.k.a. the deficient zone of cortisol output by the time they make it to my office for their first visit. Their HPA axis has entered an advanced pattern of dysfunction.

Research has been accumulating over the past several years showing strong link between HPA axis dysfunction and chronic inflammatory diseases like rheumatoid arthritis, multiple sclerosis, Crohn’s disease, diabetes and depression** . This means that feeling fatigued and moody is only the start of the issue here. We want your cortisol output rhythm to be optimal to ensure that your body’s natural defense mechanisms are able to adequately protect you rather than literally wear you down.

The treatment for HPA axis dysfunction varies based on the type of abnormality seen on testing as well as what appears to be the primary cause of dysfunction. My “big three” categories of treatment include:

1) Identifying and reducing current stressors, even if it’s just by a little bit. Stress reduction exercises like artistic expression, daily play-time and meditation are enormously helpful for this.

2) Removing cortisol-demanding dietary triggers like sugar and caffeine as much as possible to reduce the demand for a cortisol response.

3) Working with your naturopath to find an herbal/nutrient restoration formula that is right for your individual case. Not all supplements proposed to help with “adrenal fatigue” are helpful to all patients. If you take the wrong type of formula, you may end up feeling worse instead of better. Typically, a program will include a blend of synergistic herbs chosen based on the type of dysfunction present (some of the most common include Panax ginsing, Eleutherococcus, Rhodiola, Occimum, Glycyrrhiza…) along with nutrients like active forms of B vitamins and vitamin C.

HPA axis resotration alone may be enough to improve the function of your immune system. If the case is severe or “time is of the essence”, direct immune support like probiotics, beta-glucans or other immune herbs may be selected as well for a well-rounded and effective program.

In Health,

Dr. Otto





**Some forms of depression now thought to be largely mediated by inflammatory processes