The Beginner's Guide to Natural Living
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Dr. Angela Agrios, ND
My very talented Naturopathic Doctor
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Los Angeles, CA (Pacific Palisades)

Adrenal Fatigue
Naturopathic Medicine Treatment
Interview with Dr. Angela Agrios, ND
My personal naturopathic doctor. Dr. Agrios is in Los Angeles and
accepts office and phone appointments.

The Adrenal Glands and Stress
The adrenal glands are part of your endocrine system. Endocrine is a medical term that just means hormone system. Your adrenal glands anatomically live on top of your kidneys on both sides and make hormones like cortisol and DHEA, aldosterone. Cortisol is a really important hormone—it has lots of jobs in the body. One of them that we’re really familiar with is helping you deal with stress that comes your way. So when you hear about that “fight or flight” type of reaction, that’s actually mediated by cortisol. So if you don’t have enough cortisol, you actually can’t motivate and address that situation really adequately.

Adrenal Glands and Cortisol
Another thing that’s really important that cortisol does is it helps someone maintain blood sugar regularities: we’d all love to eat every few hours if we could, but sometimes there’s situation where we just don’t eat for more hours, you know, five or six hours—and so it’s the cortisol during that time that signals your liver to release your stored sugar, called glycogen, so that you can maintain blood sugar regularity. Lastly, cortisol is really important for helping you maintain inflammation appropriately in your body. So if you don’t have adequate cortisol levels, you’ll tend to see over-reactivity in your immune system, and so that’s a problem you’ll see. It manifests as allergies, and sometimes, in a severe condition, as an autoimmune case.

Adrenal Fatigue Symptoms
Adrenal fatigue is something that’s actually very common in our society. I don’t think people know, though, the term very well, but the symptom profile is very common, and it comes about because of chronic stress essentially. This can be mental and emotional stress from chronic studying as a student; it can be very high career stress for years and years; it can be having physical disability, so someone who has a physical condition, a health problem, for years—that will often tax the adrenals. And another one that’s huge in our society is diet: coffee pushes, so to speak, the adrenal glands to make more hormone, and they get tired. And sugar’s another big one—a lot of the refined carbohydrates in sugar really stress out our adrenal glands.

Adrenal Fatigue Causes
When we have adrenal fatigue, what we’ll see is fatigue, interestingly enough. People cannot wake up in the morning—it becomes very difficult to get going in the morning. There’s not good stamina throughout the day; people feel like they want to take naps, or they’re just tired. People will just come in saying, “I’m tired, I don’t know what’s wrong with me, nothing shows up on my blood work and I’m just tired.” What we’ll also see is an inability to regulate blood sugar, so people will get shaky—all the symptoms of hypoglycemia—and sweaty sometimes if you don’t eat frequently enough, shaky, irritable. You’ll also start to see a lot more inflammation reactions like allergies—it’s very common for someone who’s never had allergies in their life, and all of a sudden, adrenal fatigue happens, sets in, and hay fever will manifest, sometimes skin reactions they’re allergic, like atopic dermatitis, or eczema reactions. This can happen when the adrenals are fatigued because there’s not enough cortisol to keep down inflammation.

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Adrenal Gland Function and Autoimmune Disease
In extreme cases, you can see initiation of autoimmune diseases or worsening of autoimmune diseases—this is very possible. But these are all things we start to see with adrenal fatigue. And you’ll also see interesting food cravings: you’ll start to see more sugar craving, both because of the low energy, and also because you can’t regulate your blood sugar well, because the cortisol is needed to help the liver release glycogen, which is your sugar storage. And then salt cravings happen because low aldosterone has happened—you can’t maintain adequate blood pressure, and so you’ll crave more salt to keep your blood pressure up.

Adrenal Fatigue Diagnosis
So when patients walk into my office, and they’re complaining of symptoms like extreme fatigue, or difficulty waking up in the morning, or they’re having interesting sugar cravings or salt cravings that didn’t used to be there—particularly in the afternoon—or they’re all of a sudden having allergies that they didn’t used to have (and this can be both seasonal things like hay fever, it can also be a lot of skin reactivity, you’ll start to see dermatitis-types of reactions, eczema even—things like that); low blood pressure and dizziness is another common symptom. When I start to see that profile of symptoms, I immediately start to suspect adrenal fatigue. To confirm this, I’ll have someone take a saliva test, and the reason I prefer saliva for cortisol and DHEA testing is because adrenals actually have a diurnal rhythm that’s natural. So when a person who has normal adrenal function wakes up in the morning, that curve should be the highest so they can actually wake up. And then as the day goes on, that cortisol slope should be falling, and it should bottom out in the evening so that they can sleep well.

DHEA Levels and Adrenal Gland Function
What we’ll typically see with adrenal fatigue is actually that the DHEA levels fall first, and then when a person is very fatigued, the cortisol levels start to fall—so rather than being at the peak in the morning, it’s lower, and if they’re really tired, they can be flat-lined all throughout the day. If I take a blood sample from someone to assess the cortisol and DHEA, I’m only getting one spot in time throughout that day, and so it doesn’t allow me to see the function from morning to evening, which is really helpful to actually assess what part of adrenal fatigue that a person is in.

Adrenal Fatigue Treatment and Diet
So once I’ve realized my patient has adrenal fatigue, my primary goal is to help them completely recover their adrenal gland function. I do this with a combination of recommendations: first of all, diet is very important—it’s really crucial to eliminate or greatly minimize caffeine intake. Sugar is another problem, so sugar and refined carbohydrates will stress out the adrenal glands, and I ask my patients to greatly reduce these in their diet as well. Sleep is very important: you need to really rest and rehab during this adrenal recovery period. And having a little bit more joy and play I find is also very useful in helping patients recover.

Adrenal Fatigue Supplements
On a supplement level, vitamin B5, vitamin C, and the mineral magnesium are extremely useful. I’ve also found in my practice using what are known as “adoptogen botanicals” such as Siberian ginseng, rhodeola, are completely wonderful—Ruthenia, which is also known as Ashwagandha, is another wonderful herbal botanical that can be used to rehabilitate the adrenal glands. If adrenal gland function is greatly compromised, as in there’s extreme adrenal fatigue, it’s also often very useful to add in glandular adrenal extract from animals. This was used traditionally by eclectic, naturopathic doctors in the past, and this is a very useful therapy, so that’s in cases of extreme adrenal fatigue.

Adrenal Fatigue Naturopathic Medicine Treatment Success
I’ve treated a lot of patients with adrenal fatigue, and I’ve had great success treating them. It’s really fun for me, as a doctor, to start to see things dissipate like their morning exhaustion goes away, their afternoon crashes go away—they have a lot more energy in general. They can start to exercise because they have more stamina; skin reactivity will start to go away, so things like hives, or eczema, or other skin rashes that were manifesting are no longer a problem. Seasonal allergies that were a problem no longer are. This is really the beauty of natural medicine.

Interview with Dr. Angela Agrios, ND

Also See: Dr. Angela Agrios, ND Naturopathic Doctor Health Series