Wednesday, June 27, 2012

Adrenal fatigue

Stress - anxiety - palpable across the room, emanates from her  pores. Everything is going wrong at the same time. Unfortunately, this is not new. There has been no  response to everything I've thrown at her. The tell-tale Babesia symptoms:  night sweats, flu-like feelings, air hunger, have not budged

I prescribe a dose of Cortef/cortisol.

Adrenal fatigue is not a real diagnosis according to the Mayo Clinic. Look for real diagnoses like fibromyalgia or depression the web page suggests. No science.

There are decades of published, peer-reviewed research showing alterations in adrenal function in depression, chronic fatigue syndrome, fibromyalgia and other related conditions. The results are abnormal, but confusing and difficult to make sense of.

Adrenal function is regulated by a system of feedback loops. One structure in the brain, the hypothalmus, sends a message to another part of the brain, the pituitary, which in turn sends a message to the adrenal glands. The system is called the Hypothalmic-Pituitary-Adrenal axis. Abbreviated HPA axis. The brain is able to sense whether enough adrenal hormones are made and take corrective actions.

The same system works for thyroid and reproductive hormones.

Over-worked adrenals, secreting  "stress" hormones such as cortisol and adrenaline, are unable to keep up with the demands placed on them. The whole HPA system becomes sick in variable ways.

Adrenal fatigue is associated with chronic debilitating illness like chronic Lyme disease.

The adrenal gland is complex in anatomy and function, releasing a wide array of hormones which I will not address here.

Organized medicine likes blacks and whites. There is no gluten sensitivity, only Celiac disease or not. Likewise, only extreme adrenal disorders, Cushings and Addison's disease are accepted. Black and white. No shades of gray.

The adrenal fatigue syndrome is associated with a plethora of symptoms :  Total  exhaustion. Lack of endurance. Anxiety, panic attacks and depression. Dizziness. Dizziness with standing. Aches and pains. Brain fog. Inability to cope with trivial stress. Fatigue more prominent in morning - or -evening. Second wind at night. Insomnia.  Salt and/or sugar cravings. Weight gain. And numerous others.

Testing of saliva, urine and blood may give confusing results.

Cortisol levels peak level at around 8 am. There is a slight spike at 4 am. Otherwise, levels  decline and stay low throughout the day and into the night.

For this reason cortisol should usually be given in the morning.

I have found measuring DHEA, another adrenal hormone, which can be supplemented,  to be helpful.

For the most part, the diagnosis is clinical.

The immune system works better with small doses of cortisol called "physiologic", even though it is a "steroid." High doses of steroids suppress the immune system and must be avoided.

A little cortisol hopefully takes pressure off the overworked, dysfunctional, HPA, system. Hopefully the hormone can be gradually withdrawn as the disease abates. Tapering must be done slowly as the sleepy adrenals wake up.

The above patient needs to reduce stress, get more rest and eat a nutritious diet. She is a tough case.




16 comments:

Jen said...

Thank you for your blog! The adrenal fatigue perfectly described me prior to my treatment for Lymes. I wish more doctors had your openness to thinking more broadly when it comes to Lymes!

Unknown said...

She will probably tolerate treatment a little better with the cortef on board. At least that is what happened with my young adult son.

Lyme Victim said...

Try having one adrenal removed, going through menopause and having Late Stage Lyme...yet my provider will not give the cortef. Have used supplements and herbs with some success but undo stress still makes me crash. Feel like I am walking a tightrope and one wrong move puts me off balance.

Mirela Zeicu said...

No one really believed what I felt, and what I felt all these years... is just pure pain, I have been many times to the point where I considered life useless and went through terrible bouts of depression and anxiety but then again I just had to move forward because there is no other way.

How can we overcome adrenal fatigue?

Boala Lyme

keylymepie said...

This sounds like what's going on with me. I've been on quite a few combos for each of the co-infections, but I really haven't had any progress. In fact I continue to decline.

Maybe I should ask my doctor about adrenal fatigue, although I would strongly hesitate to take any more medications. Perhaps there are some natural solutions.

Unknown said...

Did you see the review article that includes a new category, "gluten sensitive", in addition to celiac disease and wheat allergy? There may be hope after all of primary practitioners acknowledging complexity (the research scientists I know already do).
http://www.biomedcentral.com/1741-7015/10/13

Diane said...

Hi LymeMD,

I've been following your great blog for a long time. I have chronic Lyme and the tea party of uninvited others germs.

First, concerning your most recent post, I have severe problems with cortisol and have for awhile now, but I'm a lot better. It just takes awhile for me, because I was bad of. (I also had severe hypothyroidism.) Thank you for spreading the word about adrenal fatigue and for your wonderful work helping Lyme folks.

Second, and the reason I'm posting is to ask a question that is unrelated to the adrenals (?), but I know of no other way to contact you. Two friends have bad mid-body (generally the chest area) vibrating from inside. Do you have ideas of what could cause this? It's very distressing for them. Both are in the midst of getting chronic Lyme treatment from genuine LLMD's.

Thank you!

vtherbalist said...

Plant medicines (adaptogens) have been studied to aid in adrenal exhaustion and have helped folks with lyme and other chronic fatigue symptoms.

A Russian research doctor, Dr. Nikolai Lazarev defined an adaptogen as an agent that allows the body to counter adverse physical, chemical or biological stressors by raising nonspecific resistance toward such stress, thus allowing the organism to ‘adapt’ to the stressful circumstances.

Couple of medline searches came up with this:
“...adaptogens can be defined as a pharmacological group of herbal preparations that increase tolerance to mental exhaustion and enhance attention and mental endurance in situations of decreased performance. The beneficial stress-protective effect of adaptogens is related to regulation of homeostasis via several mechanisms of action associated with the hypothalamic-pituitary-adrenal axis and the control of key mediators of stress response such as molecular chaperons (e.g. Hsp70), stress-activated c-Jun N-terminal protein kinase (JNK1), Forkhead Box O transcription factor DAF-16, cortisol and nitric oxide (NO).” [ "Evidence-based efficacy of adaptogens in fatigue" Panossian A etal., 2009 , Curr Clin Parmacol.]

And one other worth looking at: "Nutrients and botanicals for treatment of stress" Head KA., 2009. Altern Med Rev.

Great blog! Plant medicines can help!

Pearl said...

In my desperate research to figure out what was wrong with me, I came across Adrenal Fatigue Syndrome (AFS). I found a chart that listed in 5 columns the symptoms of Cushing's, part way to normal, normal, part way to Addison's (AFS), and Addison's. I had 18 of the 19 symptoms of Adrenal Fatigue. I even developed discomfort and soreness in my left kidney/adrenal gland.

I eventually concluded I had significant magnesium deficiency and then more symptoms led me to discover,late stage Lyme. I do not remember a single web page describing Adrenal Fatigue Syndrome that mentioned Lyme Disease as one of the causes. They only mentioned excessive stress.

I believe it could help a lot of Lyme sufferers if AFS web sites would mention Lyme Disease and provide useful links, such as to ilads.org or Burrascano's symptom checklist.

Michael the Tec said...

I suffer badly from hypoglycemia and my enquiries revealed that this effect is caused by Adrenal fatigue, or burnout, the cure for which is plenty of rest and the cutting out of carbohydrates. In fact, a low carb diet will usually cure all symptoms of adrenal fatigue, including general fatigue, brain fog, insulin swings, depression and lethargy. This does not mean adopting a protein diet but does mean lowering one's intake of simple carbs. The results include less fatigue and more energy, no more brain fog or any of the other debilitating conditions.

barbara schmitt said...

Dear LymeMD,
Hope you are okay in the midst of the horrible storm...I am writing in quiet desperation from the state of CO. Long story short, I was diagnosed with Lyme and bartonella this last May,after visiting CA in July of 2011, where I rescued two fetal kittens thrown out of a car window. They were flea infested and soon so was I...came back to CO with nightmarish skin lesions that no MD could identify. I was then diagnosed with Schnitzlers vasculitis resulting from the infection. I need a physician with your wisdom and experience desperately. I waited on a physician wait list for 8 months to be treated and was put on IV vancomycin and then "released". I have since gotten c-diff three times and counting...No doctor in my state wants to become involved. I am certain my brain is involved. I am now experiencing menopause at age 40. My gall bladder was erroneously removed after Rochepin was administered initially (before I got on wait list for a Lyme MD). I am so ill and so hopeless. Is there any circumstance under which you would accept a new patient??? I still have numerous and almost certain, strong symptoms of either Lyme, Bartonella, or both, or more coinfections. I wish I could invent a new word to convey to you how sincerely and earnestly I would benefit from your wisdom, perspective, and experience...Is it at all possible? I'll be checking back/praying to hear from you...
Thank you bushels and bushels for considering...

Signed,
DESPERATE IN CO (boobalasue@gmail.com)

Verity said...

I have much the same situation as DESPERATE IN CO. I live in the Sierra Foothills 50 miles east of Sacramento and am unable to find any LLMD. I have had Igenx tests and I do have Lyme, but no one to help. This is the second time I have been bitten, first was in May, '11 next was last July. I have tried any and every Dr. found on the net, recommended by others and anyone else I could find. I'm desperate as well. ANY suggestions would be so welcome. Thank you
Verity
cendom@sbcglobal.net

Marilyn Lawson said...

Dr. Stricker is in San Francisco. I've been his patient (chronic Lyme/Babesia) since 2008. He's very knowledgable, but I don't know how long the wait is to become a patient. His practice is Union Square Medical Assoc. There are two other doctors, Ginger Savely and a new dr., Dr. Maderis.

WorksW/Facts said...

Michael the Tec is spot on. I suffered from adrenal insufficiency 10 years ago. I thought at the time that I was going through withdrawal from a prescription sleeping pill. It wasn't until recent stressors crashed my adrenals recently that I figured out that back then it was mostly adrenal insufficiency. Even though I did not know what was going on back then, I mostly figured out what I had to do to recover by listening to my body. Now, since I know what it is that I am dealing with, I know why the steps I took before worked for me. If you know the jobs of an adrenal gland, then you know how to alleviate those jobs that yours perform so a lot of the recovery can start immediately and rapidly. They help regulate blood glucose levels, so cut back on any foods that will spike your blood glucose and eat small meals of the safe foods frequently (every 2 hours). They help regulate your body's fluid levels, so consume a fair amount of himalayan sea salt (not white iodized salt) along with plenty of spring water (avoid toxins) spaced throughout the day so as to stay hydrated. Avoid as much stress as possible as this taxes this taxes the adrenal when they react with increased cortisol. Stress can come in many forms i.e. emotional, physical, heat/cold, sleep deprivation (be to sleep before 10:00 p.m.), toxins in the food along with other substances you ingest or put on your body, etc. Research all the types of stress on the body. They regulate your body temperature so try to avoid temperature extremes and stay within a temperature that which your body is most comfortable. They help with methylation aka detoxing your body so try to avoid toxins in every form. Well, you get the picture. "KNOW YOUR ADRENALS and act accordingly." ~copywrite Marsha Jonas I'm sharing a diet with you that is when you are not severely adrenal fatigued: http://www.tvernonlac.com/adrenal-fatigue-diet.html When I was really bad, though, I started out on little more than organic bone broth and squash and worked other foods into my diet as I progressively got better as it is better to support and heal your adrenals naturally than to turn to adrenal hormone replacement unless to do so would be unsafe and reckless, IMHO.

Gretchen Bryan said...

I am being treated gor lyme. Also my endocrinologist has been watch my case. I recently went on Korlym. Hate the fatigue, but love that my anxiety attacks have been reduced. Now maybe i will be able to take my lyme treatment and be able to relax and sleep and with time lick this.

Gretchen Bryan said...

I am being treated gor lyme. Also my endocrinologist has been watch my case. I recently went on Korlym. Hate the fatigue, but love that my anxiety attacks have been reduced. Now maybe i will be able to take my lyme treatment and be able to relax and sleep and with time lick this.