Root Cause Solutions for Healing Your Adrenals
Part One: Understanding the Big Picture of Energy Production
I’d like to pay homage to our adrenals in this series of articles, the source of our physiological life force energy, and teach you how to nourish them back to their full potential. Supporting adrenal function, as part of a comprehensive energy recovery strategy, will catapult you into the high energy and vitality you deserve.
Adrenal fatigue has become a popular diagnosis these days, and while the adrenals are right there at the hub, orchestrating the production of energy our bodies need constantly, and taking hits from our complicated lives, blaming it all on the adrenals can over simplify the overarching cause of fatigue. Over-simplifying our problems, while convenient in the moment, may very well lead to increased frustration, a sense of failure, and more time lost feeling lousy. So we’ll look at the adrenals specifically, and we’ll also spend some time looking through the larger lens of how the adrenals participate in the production of energy in the body.
The Big Picture: The Brain-Thyroid-Adrenal-Mitochondrial Axis (BTAM Axis)
Wow, that’s a mouthful! I did say, “the big picture.” But hang in there with me, this is cool stuff. And you need to know how it all works for sustainable healing. This system is all about supporting the work and energy demands of your body.
It all starts with the brain. Our brains are constantly processing information about the state of our lives, what’s going on with our bodies, minds, and emotions, what work needs to be done, and our need for energy to support it. All of this information gets processed through the hypothalamus and into the pituitary gland, which makes ACTH (adrenocorticotropic hormone) and TSH (thyroid stimulating hormone). The amount of ACTH and TSH produced is influenced by the brain’s perceived need for work and energy. These hormones, in turn, communicate this information to the thyroid and adrenal glands.
The control center for both the adrenals and thyroid is the brain. The hypothalamus and pituitary glands within the brain sense the hormone levels produced by the adrenals and thyroid, in addition to the infinite amount of information coming into the brain about what you need: are you highly stressed, calm, ill, in danger, recovering, or in a really great place? All of these signals unite within the control centers of the hypothalamus and pituitary to manage your need for thyroid and adrenal inputs. The stimulating hormones, ACTH and TSH, travel to their respective glands, and impact the synthesis of adrenal and thyroid hormone levels in either direction depending on their output from the pituitary. It is a fine, elegant, and tightly regulated balance.
The adrenal glands, located on top of both kidneys, regulate the supply of carbon atoms derived from our food (in the form of glucose and fatty acids) that are eventually transformed into usable chemical energy in our bodies. This process is analogous to the supply of natural gas or electricity that comes in to power the heat and air-conditioning in our homes. The adrenals do their work by adjusting the levels of hormones: cortisol (to fulfill our need for glucose and fatty acids—our carbon atom supply) and aldosterone (to regulate the circulatory power to transport them throughout the body).
The thyroid is like the thermostat in your home. You set it where you want it to be and it sends that signal to your heating and air-conditioning unit, which ultimately does the thermostat’s bidding. The thyroid, following instructions from the brain about what your body needs, will set the metabolic rate—the amount of work done by the cells and tissues of the body—much like a thermostat. Your thyroid hormones deliver this demand to the genes within each of your cells, which then turn up or down the work of the cell.
Chemical Energy: the Powerhouse Mitrochondria
The ultimate goal of the BTAM axis system is to manage the chemical energy (ATP—adenosine triphosphate) manufactured in the mitochondria. We depend on a robust supply of chemical energy to drive all processes of the body. Chemical energy is made within the billions of tiny organelles, contained within virtually every cell, called mitochondria. The amount of energy produced in our bodies depends entirely on need, as perceived by our brains, and is orchestrated by our genes, environmental influences, and the complex and vast physiologic resources that we devote to fueling ourselves. Every action, function, growth, repair, thought, and experience requires energy, and these needs will be communicated and ultimately become manifest within those tiny, powerhouse organelles we know as mitochondria.
What can go wrong:
While ATP production is driven by our complex physical, mental, and emotional needs, its synthesis is supported by the many essential nutrients, that come from our food, to run the chemistry. Things can go wrong with this system. Excesses of stress, illness, nutrient deficiencies, toxins, and autoimmunity can damage the brain control centers as well as the glands, ultimately derailing the signaling necessary to manufacture and deliver the energy, in the form of ATP, that you need.
Stress Physiology 101: A Closer Look at the Role of Adrenal Cortisol in Energy Production
The orchestrated effort our bodies undertake to make energy available to us is often referred to as the stress response. The stress response is the way our bodies manage the work needed to support us through life’s challenges. During our day-to-day lives, stress is part of our standard operation, or simply the work and energy required to stay alive, always making the needed resources available to us for basic function and survival, moment-by-moment, even when we are asleep, even when we don’t feel “stressed.” In its extreme form stress protects us from excesses of danger, though our stress systems are engaged at all times.
The stress of awakening:
Consider what is required of us to wake up in the morning after a night of sleep. Waking up is one of the most physiologically demanding things we do in the course of our daily lives and requires a lot of energy. Our bodies begin to prepare for this most strenuous process long before we are consciously awake. Sleep becomes lighter. Our output of hormones and neurological activity shifts. Our circadian clock sends information to the hypothalamus about timing for our first awakening. The hypothalamus signals the pituitary gland, which releases ACTH, which travels to the adrenal glands, where the adrenal cortex is signaled to produce cortisol, DHEA and aldosterone, the hormones of work and stress resilience. Cortisol is typically at its highest level of the day at the time of awakening, preparing us for the strenuous effort required when going from deep, quiet, still sleep to full awakening, upright posture, and action. Cortisol is the primary adrenal hormone involved in the stress response of day-to-day action and homeostasis, and blood levels rise under conditions of prolonged high need. It is a workhorse that supports the energy we need for wakefulness and action by increasing production of sugar and fats, our reservoir of carbon atoms used to produce energy.
Cortisol levels are a good measure of the magnitude of our stress response at any given time, and after peaking at the time of awakening, should steadily decrease over the course of the day, with the lowest levels at night when it is time to sleep again. As the sensors in our adrenal glands receive information from the brain about what our needs are at any given time (via ACTH from the pituitary), the amount of cortisol released will change and levels will remain elevated, or spike during the day, if there are events of sufficient intensity to place increased demands on the body.
Prolonged Stress Keeps Adrenal Function on Overdrive
When we are chronically stressed, we need more energy to support our efforts and state of being, and cortisol levels remain elevated, above their usual levels. When high levels of cortisol persist, we can lose the normal circadian rhythm of cortisol, which under normal circumstances are higher early in the day, then descend gradually to their lowest levels at night, when we’re ready for rest and sleep. In conditions of prolonged stress, when elevated levels of cortisol may persist, the body continues to be vigilant on our behalf, maintaining the resources available for our survival. This genius system is perfect for supporting us when we’re traumatized, injured, or faced with a big challenge, assisting us as we move forward in our lives toward resolution. When the stress response persists, without resolution, or when our perceptions and stories about the challenge persist, the very resources that otherwise support us, become problematic.
The resources that we need to survive, like everything, are toxic in excess. Blood sugar levels remain elevated and metabolism slows, leading to weight gain, excess belly fat and damage to structural proteins (a process called glycation). This can lead to diabetes and is an important progenitor of chronic inflammation and aging of tissues. Cortisol in excess over extended periods of time, suppresses our immune function, leading to greater susceptibility to infection and cancer, and has toxic effects on the brain, impairing memory and cognitive function. The functional problems associated with excess cortisol make a very long list and include fatigue, insomnia, depression, anxiety, pain, recurrent infections, and obesity.
Perhaps the most insidious and misunderstood consequence of prolonged stress is the loss of resilience to adrenal function, leading to suboptimal responses to future stressors. We’ve known since the 1950’s, with the work of Hans Selye, that the adrenals are limited in their ability to adapt to stress through hormone production. In Selye’s model, the “General Adaptation Syndrome,” which holds true today, our physiology responds to stress in three phases: Alarm, Resistance, and Exhaustion. Eventually, after prolonged periods of stress, with sustained elevations in levels of adrenal hormones, cortisol, DHEA and aldosterone, the system moves toward a loss of adaptation. The adrenals can no longer sustain the high hormone levels that are called for by the brain as it continued to deliver the signal to the adrenals that the stress trigger is present. Adrenal hormone levels will ultimately decline, and there becomes a systemic loss of resilience to stress. When the critical role the adrenals play in the BTAM axis is compromised, energy production cannot be sustained. This becomes the crash and burn of adrenal fatigue.
This loss of adrenal resistance to stress is often referred to as “adrenal fatigue,” or “adrenal exhaustion.” In essence, the adrenals lose reserve, the resources they require to sustain hormone levels. When the stress response becomes prolonged, the demands of the body become greater, resources become diminished, and the system cannot sustain itself. The adrenals require nourishment just like all other parts of the body. When the stressed body is in a state of prolonged vigilance, the nutrients that sustain its function are depleted.
What Adrenal Fatigue Feels Like
People experience adrenal fatigue in a multitude of ways, but some of the common denominators are: loss of energy, loss of sense of resilience, loss of tolerance to exertion and exercise, low blood pressure, light headedness, body aches, cognitive dysfunction, poor sleep, and loss of sense of wellbeing.
In Chinese Medicine, adrenal fatigue is referred to as “kidney chi deficiency.” The goal of acupuncture treatments, Chinese herbs, and lifestyle recommendations is to rekindle this key source of life source energy. In Functional Medicine, the approach to adrenal fatigue is to unload the adrenals from the excessive demands and challenges put before them, and to nourish them with appropriate nutrition, sleep, movement, breath, and balance.
Loss of adrenal resilience leads to a new balance:
However wise and adaptive the stress response is, harm can come when it becomes prolonged, or when we become disempowered in the face of it. Balance becomes restored around a new set point, or new “normal.” We refer to this as allostasis. Balance may be restored, but unless the challenges are addressed and resolved, and the body is supported with the nourishment that it needs to sustain itself, the new set point will continue to move toward the danger zone. But in the face of it all, the body does its best for us. There is an enormous amount of chronic stress-induced dysfunction in our society, and the origin of the problem is within us, within our persistent behaviors that tax the body (poor diets, lack of sleep, sedentary lifestyle), as well as our minds—the mind and its over-thinking, creating stories, and catastrophising, the mind that believes it is never enough, the mind that perceives that stress is bad, rather than a sign that one’s life is out of balance; the mind that has no tools for ameliorating the stress response, and managing the stressors that present themselves.
The genius in the energy system:
Often times the brakes are put on the BTAM axis because our survival depends on it. Catastrophe, trauma, and high levels of perceived stress all call upon our body to conserve energy. Our body in its great wisdom will bring us to our knees for the sake of ourselves. We must stop, release all effort, honor our bodies, and allow healing to occur during these times. Don’t kill the messenger, understand the context of the message.
In addition to chronically high levels of stress, some other important reasons for the BTAM axis system to break down include inflammation, autoimmunity, nutrient deficiencies, toxicities from heavy metals, pesticides, or molds. These must be addressed and corrected for this vital control of energy production to proceed normally. Working with a Functional Medicine advisor will help you with this process.
The Thyroid and Adrenals Work in Concert
As you can see, the thyroid and adrenals work closely with one another and both clearly have a profound effect on energy production. When someone is tired and their levels of adrenal and thyroid hormones do not seem adequate to meet their needs, rarely is there trouble with just one gland or the other. In fact, the problem is usually a more global situation found upstream of the glands, such as nutrient deficiency, autoimmunity, inflammation, or severe emotional or physical stress. It is always a mistake to treat just one aspect of the larger dysfunction, which is why in Functional Medicine we look at the system of energy production and all of its elements as one larger whole.
Putting fuel on the fire:
I frequently see people in my practice who have been treated for hypothyroidism, without having their adrenal dysfunction addressed, and they continue to feel tired in spite of thyroid hormone replacement. To tackle an energy deficit problem by treating the thyroid gland alone, which is a common practice, is usually a grave mistake. Turning up the thermostat will not result in more energy output if the adrenals are struggling or if there are fundamental upstream issues such as nutrient deficiencies or inflammation. It will, however, place increased demand on an already struggling system, which could ultimately lead to greater problems. Some people feel better initially on thyroid replacement therapy, only to relapse or become much worse when the larger problem has not been addressed.
Likewise, when the thyroid has been damaged by inflammation and thyroid hormone production becomes deficient, just replacing thyroid hormone as a corrective strategy misses the much bigger picture: that inflammation is systemic and the damaged thyroid is just the most visible victim of a globally vulnerable system. If the thyroid has become damaged by inflammation from autoimmunity, so have the adrenals, so has the brain, and so have the many vital tissues of the body. Most people with autoimmune thyroiditis do not recover their full energy and vitality with thyroid hormone replacement alone. They do, however, when the larger root cause is corrected.
Coming up next week: In Part Two of this series we’ll look at comprehensive strategies for healing the adrenals and the larger energy systems of the body. Stay tuned.