Adrenal Insufficiency - The "Invisible Illness"

It could be causing your chronic fatigue, depression and anxiety, your doctor is unlikely to have heard of it and it will probably get misdiagnosed as stress. Well for those of you crippled with stubborn symptoms like these, NHR lifts the lid on the latest suspect implicated in the "21st century blues".

Adrenal insufficiency (AI) or hypoadrenocorticism as it is known in medical circles is fast becoming an epidemic problem in western countries yet the medical profession has been slow to recognize its prevalence. AI is a lifestyle-related illness that can strike at any age and affects two tiny triangular structures located on top of the kidneys called the adrenal glands responsible for regulating our response to stress, calming the immune system, balancing body fluids and controlling blood sugar. Over time AI makes these glands underactive so they produce insufficient amounts of the stress hormone cortisol (a steroid hormone that helps us to respond in emergencies, control the body's use of fats, proteins, and carbohydrates, suppresses inflammatory reactions in the body, and affects immune system functions) and aldosterone (a steroid hormone that controls sodium and potassium in the blood).1 The resulting adrenal "burnout" can throw the body into a chronic tailspin that can lasting years and causing profound fatigue, an inability to deal with simple stress, fight allergies and infections or tolerate sugary foods all without apparent cause…

AI is the classic invisible illness and can masquerade under all sorts of "dustbin diagnoses" from simple stress and anxiety, depression, allergies, hypoglycaemia and even "neurosis" without ever being identified by your GP. The problem is that most doctors are only trained to identify the most progressive form of the disorder known as Addison's disease and are reluctant to admit that less serious but nonetheless chronic forms exist. Addison's is a potentially life-threatening condition usually caused when either the immune system attacks the adrenal glands or the brain fails to produce adequate adrenal gland stimulating-hormones and results in extreme weakness, weight loss and ultimately fatal shock during periods of stress.1 Once identified Addison's sufferers must take supplemental oral hydrocortisone and aldosterone hormone for the rest of their lives. 2

Thankfully Addison's disease is statistically quite rare affecting around 1 in every 100,000 people3 but this has caused many doctors to remain off guard to the dangers of the "borderline symptoms" of AI. The confusion among health professionals is not for a lack of early warning signs as when it strikes AI produces a constellation of debilitating symptoms like an inability to concentrate, excessive fatigue and weakness, nervousness and irritability, mental depression, apprehension, weakness, light-headedness and insomnia4 However many of these symptoms are consistent with other diseases making diagnosis a precarious business. For this reason your typical AI sufferer may have struggled for many years taking the usual prescription antidepressants, tranquillizers and antibiotics with little relief before they received a definitive diagnosis of AI. Indeed many frustrated AI sufferers know what it feels like to be treated as a hypochondriac by their doctors after being failed by various drugs because their symptoms don't appear to be consistent with any particular disease. What's more if left untreated a patient with AI has a dismal prognosis for quality of life most likely complaining of vague mental and physical symptoms for the rest of his life.

Fortunately AI sufferers do exhibit landmark food cravings that should alert any knowledgeable physician to their poor adrenal function. The hypoglycaemic symptoms accompanying AI for instance produces intense sugar cravings and the loss of sodium in the urine accompanying low aldosterone increases appetite for salty foods. Saturated fats too are often craved as building blocks to the steroid hormones that AI sufferers are so often deficient in. Other tell tale signs of AI are low blood pressure on standing producing light-headedness and fainting, hyper pigmentation of the skin (discolouration), swollen fingers or ankles (water retention) and hair loss. Yeast overgrowth or thrush tend to occur in tandem with AI because loss of salt in the urine allows body alkalinity to rise and pathogens like Candida alb cans to breed. Nausea, vomiting and diarrhoea can also be a feature in AI.

The good news is that despite all the diagnostic ambiguities testing for AI has come leaps and bounds in recent years. Originally if a doctor suspected Addison's the only options were a combination of suppression tests (where the patient was given a dose of steroid drugs to inhibit the gland and then monitored to see how quickly they would recover from it) and a battery of blood tests to monitor hormone and blood sugar levels. Fortunately nowadays there exists a range of inexpensive non-invasive saliva-tests that can be ordered by your doctor or nutritionist and conducted in the privacy of your own home.

The current climate of reticence in the medical establishment however means that these tests will most likely go unused by most NHS doctors. This couldn't have come at a worse time since the epidemic of AI appears to be largely determined by 21st century changes to our lifestyle, healthcare and eating habits making the condition more significant now than it has ever been before.

By far the greatest risk factor for AI is prolonged stress aided by a diet rich in sugar, caffeine, alcohol and nicotine and low in B and C vitamins. Unrelenting stress alone means that eventually after perhaps years without any problems suddenly the adrenals will not be able to match your requirement for stress hormone and may fail. What's more excess sugary foods over time can cause the pancreas to start to overproduce insulin causing blood glucose levels to crash. This forces the adrenals into a cycle of pumping out surplus cortisol to unlock back-up stores of glucose in the liver as an emergency fuel source. Ordinarily this is a natural biochemical reflex but when it continues unabated from an overeliance on refined carbohydrates the adrenals can become exhausted and AI sets in much to the confusion of the victim. What's more sugar actually robs the body of the very B and C vitamins that the gland requires to manufacture corticosteroids. Modern drugs too like synthetic corticosteroids (prednisone, dexamethasone) which slow the adrenal gland's natural production of these hormones can induce AI. In fact the abrupt cessation of high dose steroids is well known to induce full blown Addison's in many individuals.5 What's more overuse of societies "little pleasures" like caffeine, alcohol and nicotine and B and C vitamin deficiencies can all precipitate adrenal weakness.6

Treatment of AI usually consists of strategies to restore normal adrenal hormone production. Thankfully unlike in Addison's disease steroid hormone replacement with hydrocortisone or aldosterone is not always necessary in AI. If hormone is required usually very low dosages are given or "physiological amounts" which imitate the glands natural output of corticosteroids. Although both drugs are very safe and side effect free these very low dosages ensure that the occasional nausea that sometimes accompanies their use does not trouble the AI patient.

Fortunately in most cases AI can be treated with natural high street therapies that help to rebuild exhausted adrenal glands and in as little as 3-6 months help them make a full recovery. This is done by ensuring that the glands are supplied with sufficient cofactors to manufacture, preserve and prolong the life of those all important corticosteroid hormones cortisol and aldosterone. Vitamins B3 (as niacin 50-500mg/day), B5 (as the coenzyme panthethine 300mg/day) and B12 (as the coenzyme methylcobalamin 5mg/day) for instance are critical for proper manufacture of corticosteroid hormones whereas Vitamin C (in dosages of 1-2g/day) is essential to prevent the spoilage of the "stress hormone" adrenaline. Liquorice extract too is a favourite with AI sufferers as it prolongs the life of cortisol which reduces the burden on tired adrenal glands to pump out more hormone.7 Surprisingly some of the usual health recommendations are void here and you will also have to lay off exercise and actually increase your salt intake! Unnecessary physical strain can only tire weak adrenals and delay recovery whereas table salt comes highly recommended while the gland is unable to produce sufficient "salt-retaining hormone" - aldosterone. Of critical importance here is to avoid using stimulants like caffeine, alcohol and nicotine which will tire overtaxed adrenals and rob the body of B and C vitamins required for recovery. Finally elimination of sugars and refined carbohydrates and following the Atkins diet can dramatically reduce symptoms by releasing the adrenals from the effects of rebound blood sugar crashes. High protein and fat diets that digest slowly and release their energy over many hours spare the adrenals unnecessary work to unlock glucose reserves 4-6 hours after eating when blood sugar is low.

If you think you might be affected by Adrenal Insufficiency you should begin by speaking with your doctor about it. If your doctor is not convinced and you still suspect a problem then you might want to consider finding a Private physician specializing in endocrine disorders like Dr Gordon Skinners nationwide practice (see below). Alternatively you could write to the (i) British Society for Allergy, Nutritional and Environmental Medicine, (ii) The British Naturopathic Association or (iii) The British Association of Nutritional therapists who maintain registers of naturopathic physicians and nutritionists familiar with AI testing in your area and will be able to offer you a referral

Contacts
Consultant Endocrinologist Dr Gordon Skinner Telephone 0121 449 8895
The British Association of Nutritional Therapists Telephone 0208 208 2401
British Society for Allergy, Nutritional and Environmental Medicine Telephone 01547 550 380
British Naturopathic Association Telephone 08707 456 984

References
1. Endocrinology - Underactive Adrenal Glands/ Addison's Disease - Methodist health Care System, Houston Texas. http://www.methodisthealth.com/endocrin/index.htm
2. National Adrenal Diseases Foundation. www.nadf.com
3. Figures from the Addison's and Cushings International Federation. http://www.nvacp.nl/page.php?main=5
4. Adrenal Dysfunction - Bulletin #96 Hypoglycaemia Association, Inc. Box 165 Ashton, MD 20861-0165 (Founded in 1967)
5. Medline Plus. Medical Encyclopaedia. Exogenous Adrenal Insufficiency. http://www.nlm.nih.gov/medlineplus/ency/article/000370.htm
6. Adrenal Weakness. http://www.naturalways.com/adrenal.htm
7. Liquorice raises urinary cortisol in man. Epstein et al. J Clin Endocrinal Metab 1978 Aug. 47 (2): 397-400