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Adrenal Exhaustion

Adrenal exhaustion is a term used in Naturopathy to describe the final stage of the General Adaptation Syndrome (GAS), a theory of stress response, developed by Han’s Selye in 1935. He observed that the body naturally attempts to adapt when exposed to an endogenous or exogenous stressor. The initial stage of GAS is referred to as the alarm stage or the flight-or-flight response. It is characterized by stimulation of the sympathetic nervous system and the hypothalamus-pituitary-adrenal (HPA) axis and subsequent release of cortisol.

This is followed by a stage of increasing resistance to the stressor or, more precisely, adaptation of the body designed to return to normal. However, when the stressor does not remit and overwhelms the body’s ability to return its normal state, the exhaustion stage (the third stage of GAS) results where the body becomes depleted and signs of systemic damage can develop. The body becomes unable to maintain a normal hormonal response to stress and it is unable to return to its normal state; consequently, exhaustion ensues.

Key Signs and Symptoms

Response to stress manifesting within an individual is influenced by the hormonal and nervous systems. With chronic, long-term stress exceeding a person’s ability to adapt, the circulating hormones do not return to their normal levels. At first they become hyper-aroused and then they decline and in time provide a blunted response to stress.
Allostatic load is the term used to represent the accumulation of changes that occur within the body as a result of prolonged stress. High allostatic load is associated with high cortisol levels and may result in:

  • depression and anxiety
  • chronic alcoholism, drug abuse, accidents, eating disorders or suicide
  • high blood pressure
  • acceleration of atherosclerosis
  • digestive problems
  • impaired immunity
  • increased insulin resistancel and visceral fat
  • increased risk of metabolic syndrome
  • reproductive hormones and thyroid hormone disturbances
  • impaired cognitive functioning
  • sleep disturbances
  • delayed wound healing
  • increased bone demineralisation due to prolonged high cortisol levels.
  • energy deficient state or chronic fatigue may develop
  • fibromyalgia, chronic fatigue syndrome, hypothyroidism may result.

Natural therapies

  • A healthy and well-balanced diet along with exercise and a sensible lifestyle may help reduce imbalances in the stress response cascade which may prevent adrenal exhaustion from developing.
  • Protein foods, potassium-containing foods such as bananas and apricots, wholefoods and eating at regular time intervals are recommended to keep body chemistry balanced. Avoiding simple carbohydrates and alcohol may be beneficial for helping the body withstand prolonged stress.
  • Stimulants such as caffeine should be reduced or avoided to prevent further drain on the adrenals.
  • B vitamins and vitamin C may help support adrenal function while Ubiquinol and magnesium may help support energy production in the body. Omega-3 fatty acids or fish oils are required for healthy brain and nervous system function.
  • Herbs to restore adrenals health are traditionally indicated in cases of prolonged stress to help the patient’s body cope with the current stressors that are impacting upon them. Considerations may include Panax ginseng (Korean ginseng), Eleutherococcus senticosus (Siberian ginseng), Rhodiola rosea (Rhodiola), Withania somnifera (Winter cherry), Rehmannia somnifera (Rehmannia) and Glycyrrhiza glabra (Licorice).
  • Calming herbal medicines are also traditionally indicated to help support and calm the nervous system in patients experiencing chronic stress. Depending on individual patient presentation several herbal medicines may be considered such as Hypericum perforatum (St. John’s Wort), Passiflora incarnata (Passion flower), Avena sativa (Oats), Valeriana officinalis (Valerian) and Lavendula officinalis (Lavender).
  • Stress management: Eliciting the ‘relaxation response’ (pioneered by Professor Herbert Benson) reverses the negative effects of prolonged stress and helps the body restore the balance. Meditation is one effective way to induce the relaxation response with psychological and physiological benefits being cumulative with routine practice.
  • Many studies confirm the effectiveness of relaxation for stress reduction with benefits such as:
    • decreased anxiety and depression
    • improved sleep and general wellbeing
    • greater coping capabilities
    • improved immune function
    • reduced blood pressure, heart rate and serum cholesterol.
  • Regular exercise has been shown to be beneficial for most stress-related complaints, potentially by helping balance the hormonal irregularities caused by prolonged stress. Studies suggest that regular exercise acts as an antidepressant, relieves anxiety and aids sleep in many patients under constant stress.
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