Looking to the adrenal glands to help us achieve better health for our client is something that is often forgotten. The adrenals play an integral role in an ones health, yet in today’s society, we disregard this and subsequently many of us suffer from the side effects of our lifestyle choices.
By adopting a biopsychosocial model approach to our clients or patients, we are able to initiate lifestyle changes that will ensure the adrenals are functioning efficiently, allowing for a balanced homeostatic state within the body. By evaluating nutritional, physical and psychological states, we can help clients achieve optimal health in order for them to be better able to deal with the everyday stressors we all encounter.
I suspect there are many clients and patients with underperforming adrenal systems. A typical example of adrenal dysfunction is the client who is regularly physically or emotionally stressed, in poor physical condition, suffering from a recurrent low immune system, with an inability to produce enough consistent energy to get through a day. As a manual therapist or personal trainer, we are able to influence adrenal function and the overall state of homeostasis within the body by advising clients on their exercise and diet regimes.
The Adrenal System
The adrenal glands are located adjacent to the kidneys, liver, spleen and pancreas. The reason they lie so closely to these organs and the arterial system is that when required, they can be activated and have a rapid effect throughout the entire body.
The adrenal glands are made up of two separate areas: the cortex and medulla. The cortex is the larger portion of the gland (making up roughly 80 percent). The cortex is responsible for producing the steroid hormones, corticosteroids. The corticosteroids produced by the cortex include:
- Glucocorticoids - The most important hormone produced is cortisol. The role of cortisol is to regulate glucose metabolism, control metabolism fat, protein and carbohydrate. Cortisol helps increase blood sugar levels and helps to provide energy for use by the body very rapidly.
- Mineral Corticoids - The most important hormone produced is aldosterone. The role of aldosterone is to control salt and water balance in the body. It also plays a role in blood pressure.
- DHEA (known as dehydroepiandrosterone) - This hormone is the starting point for the production of estrogen and testosterone. It works in opposition to cortisol. DHEA plays a role in energy, sleep, Post Menopausal Symptoms (PMS) and sex drive. When cortisol levels remain chronically high due to a constant state of stress, DHEA levels will be depressed. The medulla is the smaller part of the gland (making up roughly 20 percent) and secretes two major hormones: adrenaline and noradrenalin.
- Adrenaline - Known also as epinephrine, it is involved in the fight, fright and flight response. It acts to increase blood pressure, expansion of blood vessels, increase blood glucose levels and heart rate.
- Noradrenalin - Known also as norepinehprine, it opposes the effects of adrenaline and acts to constrict blood vessels, etc.
The flight, fright and/or fight response is the body's natural reaction to survival when exposed to perceived stress. The human body is unable to differentiate between different forms of stress. Therefore, it sees all stress as the same, whether this ranges from a life threatening stress to the stress created by sitting in traffic for two hours. Emotions such as anger, anxiety and frustration are some of the more common triggers for this response. The flight, fright and flight mechanism triggers many physiological reactions within the body. One of the more important reactions is the release of the corticotrophin releasing hormone by the pituitary gland, which stimulates the release of cortisol and adrenaline from the adrenal glands.
These hormones (cortisol and adrenaline) have a stimulating effect upon the body, allowing it to carry out the necessary tasks for survival. (See above for the role of cortisol and adrenaline.) The body will continue to release adrenaline until the stress trigger subsides. However, the body may continue to have high levels of cortisol for some time following the stress trigger. This consequently will have some physiological effect on the individual.
While some stress is important for the body, the problem with living in today’s society is that many of us are in a constant state of stress, and physiologically we are in a state of constant overdrive. Our adrenals are being asked to constantly perform without reprieve, and we run the risk of fatiguing our system, therefore affecting our overall health and homeostasis. What does this means to our patients or clients?
Following the stimulation of the flight/fright and fight response, the body naturally thinks it needs to refuel and re-stock those stores that were used for survival. We therefore have an increased appetite and will typically increase our food intake to restore these lost stores. This physiological response bodes well in the body if the stress we were exposed to actually resulted in us physically exerting energy. This response only starts to become a problem when the stress is due to sitting on the train and becoming anxious, frustrated and angry because we are running 45 minutes late for work. In situations like this, we are unable to physically release any energy, yet we still have an increased appetite, will eat more food and store any unused energy in the body. We may also begin to feel this in the form of developing very tight and tense muscles, which can result in any number of musculoskeletal complaints (i.e., headaches, sore neck and shoulders, etc).
Typically, when we are stressed, our blood sugar levels will drop, and the body will try to keep up with this by increasing it's blood glucose levels. As our blood sugar levels increase, insulin is released by the pancreas. Certain foods such as sugary lollies, biscuits, cake and soft drinks and caffeine will hit the blood stream more rapidly, causing an even greater release of blood glucose and insulin. Eventually, the body may lose the ability to handle these sugar ups and downs, and we may begin to develop a resistance to insulin, also known as Syndrome X. Syndrome X is believed to be associated with many other health problems.
Constantly asking the body to deal with stress may also lead to adrenal malfunction, which may result in the development of Addison’s disease or Cushing’s syndrome. Addison’s disease is associated with the under activity of the adrenal glands, and Cushing’s syndrome an over activity of the adrenal system. (For more information on these diseases, see the list of Internet references at the end of this article.)
Signs and Symptoms of Stress
- Increased appetite
- Cravings for food (i.e., chocolate, sweets, pastry, breads, caffeine, alcohol)
- Mid afternoon slump
- Low immune system
- Digestive problems
- Muscle aches and pains
- Hair loss
- Irregular or absent periods
- Reduced mental awareness
- Social withdrawal
- Slow metabolism
- Low sex drive
- Tiredness, fatigue, lethargy
Nutritional Approach to the Adrenal System
By evaluating the nutritional profile of our clients, we are able to make simple dietary changes that will enable them to better deal with everyday stressors. This includes the following guidelines:
- Avoid Dieting - Restriction of calorie intake can cause the body to go into survival mode, which may cause a reduction in the metabolism, which may also increase eating habits. This is a familiar pattern for those who regularly crash diet rather than adopting a healthy eating pattern for life. Typically, when you lose weight quickly, most of this is via water, muscle and bone. Research has shown that if you lose more than 10 percent of your bodyweight, your metabolism will adapt and decrease by as much as 15 percent.
- Eat Regular, Small Meals - Consuming five to six smaller meals a day rather than the typical three large meals will ensure a stable blood glucose level throughout the day, which will send the body a message that it is not under stress. Eating smaller meals more regularly (every three hours) boosts the metabolism, decreases cortisol levels by roughly 17 percent and allows for a more steady state of emotions. Also, you should always wait 20 minutes after eating a meal before considering eating more. Food takes time to be digested, and those who eat too quickly will often overeat and cause a spike in cortisol and insulin levels. Lastly, try and consume your meals in a state of relaxation. Eating in a peaceful environment will minimize the release of stress hormones. If you are regularly eating on the run, your body will think it is in a state of stress, and your ability to digest the food may be affected, therefore affecting the absorption of valuable nutrients.
- Eat Breakfast - Breakfast is possibly the most important meal of the day. Early in the morning, your cortisol levels are high in order to get your body up and running. Eating breakfast rather than consuming a coffee will help to maintain a steady blood glucose level. Those who consume coffee for breakfast only increase their cortisol and blood glucose levels, leading to an increase in the release of insulin, which will increase appetite and promote the storage of food to fat.
- Eat Fiber - Increase soluble and insoluble fiber intake. Soluble fibers are found in fruits, nuts, vegetables and beans and help to better manage blood sugar levels and regulate cholesterol. Insoluble fiber can be found in wholegrain and nuts and will help with the general digestion. Beans such as Soya, butter, lentils, kidney beans and chick peas are preferred. Nuts such as Brazils, almonds, cashews, pistachio, peanuts and seeds such as sunflower, sesame, linseeds (flax) and pumpkin will help to promote a healthy digestive system.
- Proper Food Selection - We should be aiming to reduce our intake of refined carbohydrates and sugars, as well as including a portion of protein in every meal (vegetable or animal). Swap refined carbohydrates (white flour, white rice, pasta) to whole carbohydrates (rye, oats, brown rice, corn pasta). Grains such as brown rice, oats, rye, buckwheat, barley and whole wheat are preferred.
Protein causes satiety and helps slow the process of digestion and controls insulin levels. Avoid a diet heavily weighted in protein because excessive amounts of protein may cause the body to go into a state of ketosis.
Protein from an energy perspective requires more body energy to burn than carbohydrates and fats. Roughly requiring 20 percent of the body’s energy intake to metabolize compared to 10 percent for carbohydrates and two percent for fats.
Reduce saturated fats (found in red meat and dairy products) and increase essential fat intake. Essential fats are Omega 3s and 6s and are found in nuts, seeds and oily fish. They help to boost metabolism, reduce inflammation and reduce the likelihood of insulin resistance.
Try to limit the dairy intake and go for organic free range eggs.
Vegetables and fruits that have been shown to be beneficial include:
Always try to avoid artificial sweeteners and soft drinks.
Coffee and tea act as stimulants and increase the release of cortisol and adrenaline in the body. Individuals will often go for these caffeinated drinks when they are feeling a slump in energy levels (typically mid afternoon). This results in even greater amounts of blood glucose being released into the blood, causing more insulin release and further stressing the body. For those whose diets are fuelled by caffeinated drinks, they should try and reduce this intake or they risk developing adrenal fatigue and insulin resistance.
Supplements that have been shown to be beneficial include:
- Vitamin C
- B vitamins
- Vitamin E
- Omega 3s & 6s
- Coenzyme Q10
- Alpha Lipoic Acid
- Essential amino acids
Try and avoid stimulant herbs such as guarana as they act to stimulate the adrenals
- Coffee (instant, percolated, filtered, espresso)
- Soft drinks (caffeinated)
Stimulants cause the release of cortisol, which in turn triggers the release of insulin. Regular stimulant intake can lead to adrenal fatigue, insulin resistance and Syndrome X.
Caffeine is also addictive, also stimulates the release of bad fatty acids in the blood and is rapidly absorbed into the body. This further increases one's chances of developing an adrenal problem.
- Fresh fish
- Meat (grass/pasture fed)
- Eggs (organic)
- Red wine
- Spices (oregano, ginger)
- Extra virgin olive oil (organic)
- Refined grains
- Wheat grains
- Grain/Flour products
- Meat (Grain fed)
- Most packaged foods
- Most processed foods
- Deep fried food
- Trans fat i.e. margarine
- Corn/Safflower/Sunflower/Soybean oil
Exercise that involves a combination of weight training and cardiovascular is preferred. Exercise helps to burn off energy, increase muscle mass and metabolism, prevent insulin resistance, reduce the negative effects of cortisol, improve insulin sensitivity and improve body shape.
For more information, check out the following web sites:
- Chek, P. How to Eat, Move and Be Healthy, Chek Institution Publication, USA, 2004
- Liebenson, C. Rehabilitation of the spine: A practitioner’s manual. 2nd edition, Lippincott Williams & Wilkins, London, 2006
- Glenville, M. Fat around the middle, Kyle Cathie Ltd, UK, 2006
- Glenville, M. Mastering Cortisol, Ulysses Press, UK, 2006
- Guyton & Hall, Textbook of Medical Physiology, 9th Edition, W.B. Saunders & Company, Sydney, 1996