Adrenal Low

If you scored high in the ‘Adrenal Low’ section of the Health Score Quiz, please read this article as it contains some useful information and resources to help you.

What are the adrenal glands?

The adrenal glands are small glands that sit on top of the kidneys. They make up part of a more complex interaction of glands and hormones known as the Hypothalamic Pituitary Adrenal Axis (HPA). The glands in the brain are called the hypothalamus and the pituitary gland. This axis looks at how these glands are communicating with each other to produce hormones that have a significant impact on how we feel on a day-to-day basis.

The adrenal gland is made up of the adrenal cortex found on the outer layer and the adrenal medulla, located deeper within the adrenal gland. The cortex helps to produce hormones like cortisol, aldosterone, DHEA and sex hormones, whereas the medulla helps to produce hormones like adrenaline.

The HPA axis is involved in the production of hormones, typically in response to our body’s circadian rhythm (24-hour internal body clock) and stressors. Thus, these glands and hormones respond to internal cues such as the current level of hormones in the body, our body clock, inflammation, oxidative stress, immune challenges as well as our external cues like light, stress, meal timing, sleep etc to help regulate adrenal hormone production. This can have a significant impact on our physical and mental energy.

What do adrenal hormones do?

Mineralocorticoid hormones like aldosterone act upon the kidney and influence blood pressure. When one is making lower levels of these hormones it can cause one to increase the level of potassium being retained/reabsorbed and sodium being excreted, resulting in decreased volume within the blood vessels and thus decreases in blood pressure or issues managing low blood pressure.

Cortisol is the main glucocorticoid hormone and increases in response to stress. Cortisol can influence our metabolism, immune system, growth and reproduction, cardiovascular function and more.

Cortisol when chronically reduced can negatively impact the effectiveness of the immune system and the ability for the immune system to remain balanced. Low cortisol states are also a factor in a reduced ability to manage inflammation in the body as well.

When cortisol increases it also increases the production of glucose from proteins and fats in a process known as gluconeogenesis, but at the same time decreases the glucose uptake in certain areas of the body, this is to help maintain adequate supplies of glucose for the brain. In low cortisol individuals it is possible that hypoglycaemic (low glucose) states can develop and these individuals may have a harder time regulating blood glucose, feel they need to eat more frequently or wake in the night due to periods of low glucose. Not only does the low cortisol directly result in lower energy, but the habits and impact on sleep often exacerbate impaired energy further.

The primary adrenal androgen is DHEA. DHEA can then be converted to other hormones in the peripheral tissues, gonads (testes and ovaries). DHEA coverts into a variety of androgenic hormones, one of which being testosterone. For females the adrenal glands are the main source of testosterone production, likewise males in puberty. In post puberty males, the levels of testosterone produced in the adrenals is very low compared to that of what the testes are producing. In females, high body fat can increase the production of androgen hormones within the fat tissue itself, hence high fat levels in females can contribute to issues such as PCOS & facial hair growth. It is possible that low adrenal function can have a major impact on the balance of sex hormones in males and females, thus adrenal function & stress should be considered in any sex hormone imbalance.

The inner area of the adrenal gland (medullar) is where we make what are known as catecholamines, such as adrenaline. These are produced as part of the “fight or flight” response, aka stimulation of the sympathetic nervous system. These hormones help to increase blood pressure, blood flow, heart rate, glucose levels etc to increase alertness and readiness for the immediate stress. This shift in the nervous system will downregulate areas like digestion, which are seen to be no longer important at that moment in time. This means less blood flow to the digestive system and a down regulation of acids and enzymes that support digestion. This is a primary system for acute stress and rarely has a chronic insufficiency, unlike cortisol, DHEA and aldosterone which are more inclined to become chronically depressed and lead to chronic symptoms.

What is Addison’s Disease & Cushing’s Disease?

Two clinically diagnosable conditions associated with the adrenal glands are Addison’s disease and Cushing’s disease.

Cushing’s disease results from an increase in adrenocorticotropic hormone (ACTH) from the pituitary gland which stimulates the adrenals to make extremely high levels of cortisol. This is often the result of a pituitary tumour but can also result from excessive production of corticotrophin releasing hormone (CRH) from the hypothalamus.

Addison’s disease is also known as primary adrenal insufficiency. This clinical condition results in not enough cortisol and/or aldosterone being produced to function, resulting in a bed ridden state, extreme fatigue, weight loss, extremely low blood pressure and potentially loss of consciousness. It may result from inadequate levels of ACTH or CRH and often requires hormone replacement therapy.

These are clinical conditions that require medical support from specialists in this area and it is not the purpose of this health assessment to be diagnosing these types of clinical conditions, instead we are focused on sub-clinical imbalances that result more from chronic nutrition and lifestyle imbalance.

Unfortunately, the conventional mindset is that you either have perfectly working adrenals or a clinical condition and nothing in between. This is evidently not the case and we have supported a number of clients with sub-clinical imbalances in these areas through a Functional Medicine approach.

Is “Adrenal Fatigue” Real?

One “diagnosis” that gained traction in the alternative, functional and integrative medicine worlds has been that of Adrenal Fatigue. A lot of this developed off the back of Hans Selye’s general adaptive syndrome theory, of which there are three stages:

1. Alarm Phase
2. Resistance Phase
3. Exhaustion Phase (this is the one associated to “Adrenal Fatigue”)

This theory was based upon his observations in animal studies when exposing animals to physical stressors like over-exertion and cold temperatures. Life events are something that can also lead onto such adaptive changes.

Researchers have debunked Adrenal Fatigue as a diagnosis; however, I think a lot of this comes down to a terminology issue more than anything else. Can your adrenals fatigue? Chances are no. Glands don’t just fatigue in the same way you might expect a muscle to fatigue! Can your adrenals become sub clinically dysfunctional leading to lower levels of cortisol being produced or can changes occur to our immune system of inflammation levels that contribute to changes in the function of the adrenal glands, leading to lower levels of cortisol being produced? Yes, I believe so.

So, for me the term “Adrenal Fatigue” is misleading and unhelpful language. However, that does not mean that subclinical (non-Addison’s disease) imbalances cannot occur. The question is, what is causing that imbalance to occur. For me, when the adrenal glands are operating at a sub-optimal level and symptoms of low adrenal function are present, the question is always why and what else is going on in the body and in their environment at that time.

Symptoms associated to low adrenal hormone output

As someone who scored high in the Adrenal “low” section, it is likely that you are experiencing symptoms associated with a reduction below the normal adrenal hormone levels. These symptoms include:

• Issues with low blood pressure or periods of dizziness when standing
• Craving salty foods
• Low energy
• Low mood
• Inability to exercise intensely or feeling exhausted after or even during training
• Headaches
• Increased chronic pain and inflammation
• Reduced cognitive function
• Sweet food cravings or a need to eat frequently to help maintain energy
• Falling asleep fine, but waking in the night intermittently
• Needing to sleep in the day and significant energy dips in the day not associated to food choices

Appropriate testing for sub-clinical adrenal issues

Below I am looking at tests that may be useful for those with non-clinical adrenal issues. Hence this is not what is recommended if trying to rule out Addison’s disease or Cushing’s Syndrome. If symptoms are so significant in this area those conditions need to be ruled out by your primary healthcare provider or an endocrinologist. The below testing is more about looking for more functional imbalances. This picks up on the many that are not diagnosable as having a condition like Addison’s or Cushing’s, but still have imbalances in the adrenals/HPA axis and may benefit from understanding where those imbalances might be and to what significance they are.

I also have to say that adrenal testing is not something I do a great deal of, as the symptoms of sub-clinical adrenal issues are usually enough for me to go on and the important step is to often look at what might be driving the adrenal issues in the first place. Thus, I will spend a lot of time working on nutrition, lifestyle, stress management, past traumas and also ruling out other physiological imbalances that might be dysregulating the adrenal glands and some of their hormones, such as immune imbalances, infections, inflammation and more.

Sub-clinical adrenal test options

• 4-point cortisol test (saliva) or 4-point cortisol and cortisone test (dried urine)
• DHEA-sulphate (blood/urine)
• General blood haematology & biochemistry, ensuring that it contains sodium and potassium to assess their ratio

Conditions associated with low cortisol levels, thus may warrant testing

• Atypical depression
• Seasonal affective disorder
• Postpartum depression
• Panic attacks
• Generalised anxiety disorder
• Bipolar II disorder
• Chronic fatigue syndrome

We are also working on online programs and e-books to help provide additional information, guidance and services beyond what we already provide on our website and in our 1-2-1 sessions. Please sign up to our newsletter list to stay informed about future products and services that we will be offering, as well as being the first to get any new content that we are adding to the site or otherwise.