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Adrenal fatigue

MagazineApril 2009 (Vol. 20 Issue 1)Adrenal fatigue

Q) Please tell me how to treat adrenal fatigue and whether there is a test to check the function

Q) Please tell me how to treat adrenal fatigue and whether there is a test to check the functionof the adrenal glands.-Anne Close, via e-mail

A) While conventional medi-cine calls it 'Addison's dis-ease', alternative medicine does acknowledge adrenal fatigue, but finds it difficult to disting-uish from chronic fatigue syndrome (CFS) or ME (myalgic encephalo-myelitis).

The symptoms of full-blown adrenal fatigue tend to develop gradually; the most common ones are fatigue, muscle weakness, weight loss, vomiting, diar-rhoea, headache, sweating, changes in mood and personality, and joint and muscle pain. Frequent signs are salt cravings, changes in skin pigmentation and goitre.

The simplest check for Addison's is a laboratory test that stimulates the adrenals with synthetic hormone, then checks to see if cortisol (the 'stress hormone' produced by the adrenals) is produced. If cortisol levels are too low, it's likely that you have the disease. Ultrasound and MRI are also used as backup diagnostics.

Use of the term 'adrenal fatigue' (AF) originated with books such asDr James Wilson's Adrenal Fatigue: The 21st Century Stress Syndrome (Smart Publications, 2001). Wilson believes that AF affects four in five people at some stage in their lives. The idea is that severe or long-term stress causes the adrenals to continuously produce cortisol, thus exhausting the system and disabling its normal response to stress. The cause is thought to be a range of problems-from depression, brain fog, nervousness, anxiety and exacerbated premenstrual tension (PMT) to allergies, carbohydrate crav-ings, muscle/joint pain and tender-ness, and irritable bowel syndrome. The main symptom, however, is fatigue that is not remedied by sleep, along with general unwellness and no pep.

These symptoms are difficult to disentangle from CFS/ME. In fact, it's recently been found that there may be a biochemical basis for all of it. CFS patients have abnormally low levels of corticotropin-releasing hormone (CRH) which, in turn, is linked to low levels of adrenal hormones (Srp ArhCelok Lek, 2003; 131: 370-4). What's more, CFS/ME sufferers have low levels of cortisol, a further confirmation of the link (Endocr Rev, 2003; 24: 236-52).

As recently as 10 years ago, CFS was dismissed as being 'all in the mind'. That all changed in the 1990s as a result of research by the US Centers for Disease Control and Prevention (CDC), which now acknowledges that CFS is a genuine condition, affecting as much as 2.5 per cent of the population (BMC Health Serv Res, 2003; 3: 25).

The CDC also recognizes that CFS is hard to pin down, but has narrowed its official diagnosis to "six or more consecutive months of severe fatigue that is reported to be unrelieved by sufficient bed rest and that is accom-panied by non-specific symptoms, including flu-like symptoms, general-ized pain and memory problems".

Although there's no specific lab test for CFS, there is a battery of at least16 tests to exclude the more obvious causes of fatigue. As such a blunder-buss approach is clearly unsatisfactory, much of the research effort is going into finding one simple test for CFS.

To this end, Australian researchers have found anomalies in the red blood cells of CFS patients as well as changes in platelet volume, neutrophil counts and neutrophil-to-lymphocyte ratio. They also found differences in the various amino acids found in the urine (Exp Biol Med [May-wood], 2007; 232: 1041-9).

The Belgians have uncovered two further differences in CFS patients: an inflammatory response in the white blood cells; and changes in activation of T and NK (natural-killer) cells (Neuro Endocrinol Lett, 2007; 28; epub ahead of print).

Scientists in Osaka have reported a 75-per-cent diagnostic success rate with visible and near-infrared spectros-copy of blood samples (Nippon Rinsho, 2007; 65: 1051-6).

So, given these possibilities, a future commercial lab test for CFS may well be on the cards.As for treatment, the Belgians believe that CFS could be treated by antioxidants, which are able to inhibit (NF)-kappa-beta; this includes agents such as curcumin (found in the spice turmeric), N-acetyl-cysteine, quercetin, silymarin (milk thistle), lipoic acid and omega-3 fatty acids (Neuro Endocrinol Lett, 2007; 28; epub ahead of print).

Although none of these has yet been tested on CFS in clinical trials, other supplements and therapy have shown evidence of working (see box below).

What works for chronic fatigue

- NADH (nicotinamide adenine dinucleotide), a coenzyme related to vitamin B3 (niacin): dosage: 5 mg/day (P R Health Sci J, 2004; 23: 89-93)

- Melatonin: dosage: 5 mg/day (Eur J Neurol, 2006; 13: 55-60)

- l-Carnitine: dosage: 1-3 g/day (Neuropsychobiology, 1997; 35:16-23)

- Liquorice (Exp Clin Endocrinol Diabetes, 2002; 110: 257-61): dosage: 200 mg three times a day. Make sure the supplement is standardized to 22-per-cent glycyrrhizin, and watch your blood pressure as liquorice can cause it to rise

- Ginkgo biloba or Panax ginseng (Pharmacol Sci, 2003; 93: 458-64): dosage:

100 mg twice a day

- Graded exercise and cognitive behaviour therapy (Psychol Med, 2004; 34: 991-9): exercise programme: very slow treadmill beginning at 1 mph or less, exercise bike or walking, starting at five minutes on three days a week, building up to 20-30 minutes on four to five days a week.


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