By Anna M. Cabeca, DO, FACOG
“It seems to me to be necessary for every physician to be skilled in nature and to strive to know, if he wants to perform his duties, what man is in relation to the food and drink he consumes and to all his other occupations, as well as their effects on everyone else. Because if he does not know what effects these things have on man, he cannot know the consequences that result from them. If he does not pay attention to these things, or paying attention does not understand them, how can he understand the diseases which befall man? For man is affected by every one of these things and changed by them in numerous ways. The whole of his life is subjected to them, whether in health, convalescence or disease. Nothing else, therefore, can be more important than to know these things. (Hippocrates 450 BC.)
Wow, what a smart guy, this Hippo-something guy! He was basically saying not only that “you are what you consume” but that “you are what you do” as well. And he was saying that it behooves medical doctors to pay attention to nutritional and lifestyle factors when endeavoring to understand the “diseases that befall man.”
And in today’s world, as in the world of ancient Greece where Hippocrates lived and practiced medicine, there are some “diseases that befall man” (or woman) which today’s doctors often misdiagnose or do not fully understand. Two of these diseases or syndromes recently named “fibromyalgia” and “chronic fatigue syndrome” were only reluctantly given these names and a place in medical literature after patients suffered for many years with either no diagnosis at all or a diagnosis of a mental or emotional disorder.
For years male combat veterans have been diagnosed with “shell-shock,” “combat fatigue,” or more recently, “post-traumatic stress disorder.” An interesting historical fact in relation to this is that President John F. Kennedy took cortisol (a steroid hormone secreted from the adrenal glands) for much of his adult life after having his PT-109 torpedo ship destroyed by a collision with a Japanese warship in August 1943 during World War II. He rallied the survivors, rescuing one of them who was badly wounded, and received the following citation from the Navy: “For extremely heroic conduct as Commanding Officer of Motor Torpedo Boat 109 following the collision and sinking of that vessel in the Pacific War Theater on August 1–2, 1943. Unmindful of personal danger, Lieutenant Kennedy unhesitatingly braved the difficulties and hazards of darkness to direct rescue operations, swimming many hours to secure aid and food after he had succeeded in getting his crew ashore. His outstanding courage, endurance and leadership contributed to the saving of several lives and were in keeping with the highest traditions of the United States Naval Service.” Evidently, though, JFK experienced physical and/or emotional sequelae from this traumatic event, and in 1948 his doctor prescribed cortisol, which he took for the rest of his life, for Addison’s disease – withering of the adrenal glands. One has to wonder how much the trauma of World War II had to do with Kennedy’s Addison’s disease. Even back in 1948 some physicians, including the one who treated Kennedy, recognized that extreme stress or trauma could overwork the adrenal glands, rendering them sub-functional thereafter.
However, although disorders resulting from combat trauma were thus recognized fairly early in men, many female patients suffering from fatigue and muscle and joint pain went un-diagnosed. In essence, doctors threw up their hands and said either, “There’s nothing wrong with you,” or “Your disorder is psychological,” and many times prescribed antidepressant medications as treatment. Although these medications did help some patients with a fatigue syndrome, they did little to address the underlying causes of the fatigue, pain, insomnia, etc. For some reason, cultural or otherwise, many men were allowed to have a genuine stress-related physical diagnosis, while many women were relegated to diagnoses which made them sound hysterical or mentally weak. As chauvinistic as this seems (and likely was), those inequalities will not be further addressed here. The truth is, many men (especially combat veterans) as well as women were not then and still today are not being afforded the careful and thorough physical examinations and laboratory analyses which they need to identify their actual problem – which, not surprisingly, is often related to depletion of their adrenal glandular function. Relatively recently, after years of puzzling symptoms that doctors had a hard time diagnosing, the medical profession has recognized the diagnosis of “adrenal fatigue.”
It has long been known that the adrenal glands, which are located on top of the kidneys, secrete substances such as adrenaline and cortisol in response to danger, stress, or threat. This is an instinctive bodily response which alerts the autonomic nervous system, which regulates breathing, nerve sensitivity, and heart rate, to heighten its activity. It has also long been known that cortisol from the adrenals normally helps to counteract the effects of the stress or threat. For instance, it aids in the release of insulin, helps bring blood sugar back to normal levels, regulates blood pressure and immune function, and lessens inflammatory responses in the body. It also provides a quick energy fix, heightens mental alertness, and temporarily raises the body’s pain threshold. These temporary changes help a person meet the challenges successfully, and then the body usually returns to an autonomically normal state (slower breathing and heart rate, etc.). However, since cortisol’s purpose in the body is to respond to a temporary state of challenge, whenever the stress is constant or unmitigated for too long a period of time, the body remains in a state of hypervigilance, causing cortisol to accumulate to unhealthy levels in the body. At these excessive levels over a long period of time, cortisol ceases to be beneficial. A high cortisol level actually encourages the accumulation of fat around the middle and actually causes the body to begin metabolizing proteins from the muscles as energy sources, causing muscle pain, weakness, and fatigue. Also, levels of the beneficial steroid hormone DHEA, which is also secreted by the adrenals, begin to fall, since DHEA levels are inversely affected by cortisol levels.
This state of excess cortisol in the body is the earliest stage of adrenal fatigue. As described above, the body reacts poorly to the over-balance of cortisol, with weight gain, sweet cravings, and muscle weakness. However, the continuation of a high stress level causes the body to keep calling for more cortisol. This is the second stage of adrenal fatigue, as the adrenal glands become less able to pump out the amount of cortisol which the patient’s stress level continually demands. They don’t stop trying, though, and in the process they become weakened at the cellular level and thus less able to secrete adequate amounts of all of the vital hormones which they normally do. In women, if adrenal fatigue happens after menopause, it can greatly worsen menopausal symptoms, because many of the hormones secreted by the adrenals are inter-related with estrogen, progesterone, and pregnenolone, and now the balance has been tampered with. Also, an adrenal imbalance can adversely affect hormones secreted by the thyroid gland as well, since the adrenals communicate chemically with the thyroid.
The third stage of this stress-induced process is adrenal exhaustion – more pronounced than adrenal fatigue but still not so pronounced as to be called Addison’s disease, which is complete atrophy of the adrenals. During the adrenal exhaustion phase, cortisol output gradually declines significantly below suboptimal levels, because although the stress level demands more cortisol, the adrenals are no longer able to even try keep up with the demands.
These facts regarding the adrenals are important to those of us who want to maintain a healthy weight. During the initial phase of adrenal fatigue, weight often accumulates in all the wrong places and it is virtually impossible to lose it. Furthermore, if a person strenuously exercises too often, the stress placed up on the body by this in addition to all the other stresses can actually worsen the syndrome. However, if adrenal fatigue advances past stage one, often a person will begin to lose weight beyond a healthy point, and will now have a thin body type with too little fat. Although they may look thin and fit, their energy levels still remain low, as their body is still unhealthily metabolizing protein fuels from necessary muscle mass.
The conclusion of all these alarming facts, then? – well, just count how many times the word “stress” has been used in this article, and you will know – stress management is vital for healthy adrenal function, which is vital to our health, sexual function, and energy levels. So what can be done to aid stress management? First and foremost, a diet of mostly unprocessed foods with the right proportions of carbohydrates, protein, and fats (the right kind), and a wealth of alkalizing fresh vegetables and fruits. Also, be sure your diet and/or dietary supplementation includes a sufficient amount of zinc, which helps to support adrenal function. Next, examine your life for energy thieves and eliminate them. Stop doing things that don’t reward you and stay away from people or pursuits that drain your energies. Get a little extra sleep where possible and give yourself the luxury of a nap whenever possible. If a nap isn’t possible, at least indulge in a little vivid imagery of being in your favorite place in the world. Enjoy a regimen of mild daily exercise, and go for a walk in the woods when you can!
So Hippocrates was right on the money when he said that man is affected by these things and changed by them in numerous ways – “these things” being what we eat, drink, and consume, and “other occupations,” including leisure. Leisure and relaxation are just as important if not more important than our work demands. And strictly speaking, really our adrenal glands’ response to a given situation is what tells us whether to define it as work or as recreation! So listen – your adrenals are probably telling you something right now!
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