Stress is one of the largest understated health problems in our country.1 Every chiropractor understands the important role the autonomic nervous system (ANS) plays in stress, and which adjustments enhance sympathetic/parasympathetic balance, decrease nervous tension, and produce relaxation and calm.
However, many may not be as familiar with the function of the hypothalamic-pituitary-adrenal (HPA) axis, which is intimately related to the ANS and influences production of adrenal hormones that regulate stress adaptation. Chronic or excessive stress can overtax the ability of the HPA axis to respond adequately, which results in suboptimal adrenal function (adrenal fatigue). Unlike the relatively rare Addison disease,2 adrenal fatigue is a widespread problem that manifests as a unique circadian energy/fatigue pattern.3 By addressing adrenal fatigue in stressed patients, chiropractic can achieve deeper changes that increase patient well-being, vitality, and the ability to handle stress. In addition, adjustments hold better once the HPA axis and adrenal hormones are balanced.
Begin by listening for the common signs and symptoms of adrenal fatigue:
- Difficulty getting up and being fully awake in the morning, even after a full night’s sleep
- Caffeine is often necessary to get going and stay going
- Energy lows occur midmorning and/or midafternoon
- Increased energy from 6 p.m. (dinner) to around 9 p.m. — often feeling the best of the day
- Experience a second wind from 11 p.m. to 2 a.m.
- Most refreshing sleep is from 7 to 9 a.m., given the opportunity to sleep in
- Crave salt or salty foods
- Often also exhibit many signs and symptoms of hypoglycemia due to cortisol’s role in gluconeogenesis
- Difficulty bouncing back from stress or illness
- Decreased sex drive
If these are present, there are three quick clinical tests to confirm suboptimal adrenal function: iris contraction, postural low blood pressure, and Sergent’s white line.4
A positive test result can be followed with lab tests to establish baseline cortisol levels. My preference is the salivary hormone test, which patients can do during their regular daily routines. It measures salivary cortisol levels (more indicative of tissue levels than serum levels5) at four times during the day, usually at 8 a.m., noon, 4 p.m., and bedtime. Many labs can also measure salivary estrogen, progesterone, testosterone, and DHEAS.
Much can be done to help chiropractic patients with adrenal fatigue, even when the severity is so great that they cannot hold down jobs or function well in daily life. The core of effective treatment is a combination of lifestyle and dietary modifications plus specific dietary supplements designed for adrenal fatigue. Spinal adjustments that release tension are helpful and about 25% of patients with adrenal fatigue have fixations at T-11 through L-2 motor units. Diathermy with the heads placed over the adrenals can also aid adrenal function.
Lifestyle recommendations include minimizing sources of stress, one or two brief rests during low-energy times of day (preferably lying down), sleeping in until 9 a.m. whenever possible, eating at regular intervals, and engaging in enjoyable, revitalizing activities. Dietary choices are important with emphasis on easily digestible protein, unrefined carbohydrates, and good quality fats or oils in every meal and snack, plus five to six servings of fresh vegetables daily. Frequent small meals help avoid getting too hungry and help keep blood sugar levels more normal. It is also important to eat by 10 a.m. and again before noon. Patients should avoid caffeine, alcohol, sugar and white flour. Ask your patients to read Adrenal Fatigue: The 21st Century Stress Syndrome and it will save you time by answering their questions and providing detailed lifestyle and dietary information to aid recovery.
The right dietary supplements are integral to full recovery in all but the mildest cases of adrenal fatigue. Chief among these are glandular extracts. In more than thirty years of professional experience, I have found that a combination of hormone-free, porcine extracts from the adrenals, hypothalamus, pituitary, and gonads works best. This provides the essential building blocks for repair and maintenance of the HPA axis, especially the adrenal glands. Herbs that balance the HPA axis function include ashwagandha,6 maca,7 Eleutherococcus senticosus,8 and licorice.9 They are especially beneficial when taken together, promoting a sense of balance and well-being during the day, and then calm and restful sleep when taken at bedtime. Specific nutrients are essential for normalizing and maintaining adrenal hormone cascade function, including relatively large quantities of niacin, vitamin B6, pantothenic acid, vitamin C, and magnesium, among others.10, 11, 12, 13 Vitamin C should be pH-balanced, to avoid aggravating the physiological acidity that occurs during adrenal fatigue, and sustained release for optimal clinical effect.
During a regular or briefly extended office visit, you can use this protocol to listen for signs and symptoms of adrenal fatigue, assess adrenal function, and start your patient down the road to recovery.
- Tangri R. What Stress Costs. http://www.clarityseminars.com/stress_clinical_research.html
- Liotta EA. Addison Disease Jun 7, 2010; http://emedicine.medscape.com/article/1096911-overview
- Wilson JA. Adrenal fatigue: the 21st century stress syndrome. Petaluma: Smart Publications.; 2001. 43p.
- Wilson JA. Adrenal fatigue. the 21st century stress syndrome. Petaluma: Smart Publications; 2001. 82p.
- Riad-Fahmy D, Read GF, Walker RF. Salivary steroid assay for assessing variation in endocrine activity. J Steroid Biochem. 1983;19(1A):265-72.
- Archana R, et al. Antistressor effect of Withania somnifera. J Ethnopharmacol. 1999;64:91-3.
- López-Fando A, Gómez-Serranillos MP, Iglesias I, et al. Lepidium peruvianum chacon restores homeostasis impaired by restraint stress. Phytother Res. 2004 Jun;18(6):471-4.
- Panossian A, Wikman G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol. 2009 Sep;4(3):198-219.
- Al-Dujaili EA, Kenyon CJ, Nicol MR, Mason JI. Liquorice and glycyrrhetinic acid increase DHEA and deoxycorticosterone levels in vivo and in vitro by inhibiting adrenal SULT2A1 activity. Mol Cell Endocrinol. 2010 Dec; 22.
- Patak, P, Willenberg HS, Bornstein SR. Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocrine Res. 2004 Nov;30(4):871-5.
- Groff JL, Gropper SS, Hunt SM. The water soluble vitamins: Advanced nutrition and human metabolism. Minneapolis: West Publishing Company; 1995. 221-37p.
- Murck H, Steiger A. Mg2+ reduces ACTH secretion and enhances spindle power without changing delta power during sleep in men—possible therapeutic implications. Psychopharmacology (Berl). 1998 Jun;137(3):247-52.
- Yoshida E, Fukuwatari T, Ohtsubo M, Shibata K. High-fat diet lowers the nutritional status indicators of pantothenic acid in weaning rats. Biosci Biotechnol Biochem. 2010;74(8):1691-3. Epub 2010 Aug 7.
For more than thirty-five years, Dr. Wilson has dedicated himself to helping people regain their health and vitality, and to promoting a deeper understanding of the physiology underlying stress. His book, Adrenal Fatigue: The 21st Century Stress Syndrome, is used as a university textbook, and many of the clinical tools he developed to help stressed patients are available at icahealth.com, including his original Adrenal Fatigue Questionnaire.