Transcription
AdrenalRecoveryDiagnosis and Treatment of Adrenal Fatigue
Acknowledgements Andrew Heyman, University of Michigan Dr. James L. Wilson, Author of Adrenal Fatigue, The 21stCentury Stress Syndrome Dr. Lena D. Edwards, researcher, lecturer and clinician Dr. Fernando Cortizo, AustralAsian Academy of Anti-AgingMedicine
Dr. Joe Esposito Certified Clinical NutritionistCertified Nutrition SpecialistDiplomate of the Gonstead SystemBoard Certified Naturopathic PhysicianDiplomate of the College of Clinical NutritionDiplomate of the American Board of Clinical NutritionFellow of the American Academy of Integrative MedicineDisclosureAffiliations:AlignLife NutraceuticalsAlignLife FranchiseVitaLogics Software
NutritionChiropracticLifestyle
We are STRESSED!19832002200420057Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Why Manage Adrenal Fatigue?An overwhelming portion ofyour patient base suffersfrom adrenal fatigueNo one else is helpingthese peopleDiversify your practice forincreased referrals / revenue8Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Outline1.2.3.4.5.6.7.Classic Patient PresentationHistory of HypoadreniaConventional Awareness of HypoadreniaThe Anatomy of the Adrenal GlandPhysiology of DysfunctionFunctional AssessmentPatient Management
General Adaptation SyndromeHans Selye (1907-1982)The sequence of physiologicalreactions to prolonged stressincludes: Alarm Resistance Exhaustion
HPA Axis
Organ Reserve
What Are theCommon Symptomsof Adrenal Fatigue19
Are you easilyoverwhelmed byevery day tasks thatwere once a breeze?
Do you get angryover thingsthat never used tobother you?
Are you havingweight gainaround the middle?
Is your sleep not as regularor restful as it once was?
Is it difficult for you toconcentrate on important tasks?
Do you cravefoods that youknow are unhealthyfor you?
Are you catchingmore coldsthan before?
Is you libidonot what itonce was?
Are you easilyirritated by friends orfamily members?
Do you feel as if you have no energy by themiddle of the afternoon?
Are you using coffee or sodato get through the day?
Are you drinkingmore alcohol torelieve stress?
Do aches andpains lingerlonger than theyonce did?
Outline1.2.3.4.5.6.7.Classic Patient PresentationHistory of HypoadreniaConventional Awareness of HypoadreniaThe Anatomy of the Adrenal GlandPhysiology of DysfunctionFunctional AssessmentPatient Management
It’s estimated that up to 80% of adultAmericans suffer some level of adrenalfatigue at some time during their life.p6. Adrenal Fatigue James L. Wilson
Severe Hypoadrenia Called Addison’s DiseaseAcknowledged by Conventional MedicineNamed after Sir Thomas Addison in 1855Can be life-threatening70% cases are from auto-immune disease30% from severe stress or other causes
Adrenal Fatigue Less severe than Addison’s but often debilitating Also known as non-Addison’s hypoadrenia, sub-clinicalhypoadrenia, neurasthenia and adrenal apathy. Not recognized as a distinct syndrome by conventionalmedicine Occurs when the amount of stress overextends the capacity ofthe body to compensate and recover from that stress or thecombined stresses
Factors Affecting AdrenalsSeen and Unseen Stresses Lack of RelaxationNegative Attitudes and BeliefsUnwanted unemploymentFearEmotional StressPsychological StressDeath of a loved oneWound HealingPrescriptions/non-prescription drugsMarital Stress ToxinsInfection: Acute/ChronicAllergiesOver ExertionSmokingLack of Sleep(Staying up late though fatigued)Lack of, or excessive exercisePoor Eating HabitsSugar and White Flour ProductsUsing Stimulants When Tired(Coffee / Caffeine)
Lifestyles Leading toAdrenal Fatigue College StudentSingle ParentUnhappy MarriageStressful Work ConditionsSelf-employed withstruggling business Drug or Alcohol Abuse All Work, Little Play
Stresses Add UpThe effects of stress are cumulative, even whenthe individual stressors are quite different.
Outline1.2.3.4.5.6.7.Classic Patient PresentationHistory of HypoadreniaConventional Awareness of HypoadreniaThe Anatomy of the Adrenal GlandPhysiology of DysfunctionFunctional AssessmentsPatient Management
Conventional Approach Fatigue is a common complaint in many chronic diseases thatadrenal hypofunction is not commonly a path a conventionalpractitioner will travel. Since Adrenal Fatigue is bestmanaged naturally it isignored and overlooked Ignoring this condition createschronic unnecessary healthproblems for millions of people
Conventional Approach Adrenal Fatigue does not have an ICD-9 code andtherefore doesn’t exist in medicine Politics of insurance companies, pharmaceuticalindustry and medical licensing board of their peerscreates pressures that keep medical physicians frominvestigating conditions that don’t have a “code”
Alternative Medicine Review, Volume 14, Number 2, 2009
OutlineClassic Patient Presentation1. History of Hypoadrenia2. Conventional Awareness of Hypoadrenia3. The Anatomy of the Adrenal Gland4. Physiology of Dysfunction5. Functional Assessments6. Patient Management
Anatomy of the Adrenal GlandsTwo small glandsthat sit directly ontop of each kidney.Ad- Renal47
Cortex
Different Sections of Adrenal Gland
Adrenal MedullaStimulated by sympathetic fibersHormones:Epinephrine – AdrenalineNorepinephrine – NoradrenalinEffects:-Dilate blood vessels- Dilate bronchi- Increase heart rate- Increase strength of heart beat“Fight or Flight”
HPA
56
Outline1.2.3.4.5.6.7.Classic Patient PresentationHistory of HypoadreniaConventional Awareness of HypoadreniaThe Anatomy of the Adrenal GlandPhysiology of DysfunctionFunctional AssessmentPatient Management
Different Sections of Adrenal Gland“The Cortex”
The Role of AldosteroneThe major hormone controlling sodium andpotassium levels affecting fluid balance withinthe bloodstream, cells and interstitial fluidAldosteroneKidneys Reserve Water / SodiumAldosteroneKidneys Secret Water / Sodium
Na Na Na Na Na Na Na K K K K K Na K K K Na Na Na K K K Na Na
Would An Increase in WaterFix the Fluid Imbalance?
Decreased Aldosterone Sodium in Interstitial FluidDecreased Sodium in the Interstitial Fluid WaterNa Should the patient drink more water?K K K K K Na K K K Na K K What would high water intake do to sodium concentrate in theinterstitial fluid?Na If sodium levels areK lowered what will Na happen with the sodium inthe cell?
What Would Happen to theBlood Pressure of a Person withDecreased Blood Volume?
Sign of Adrenal Fatigue Lowered Aldosterone Levels CausesOrthostatic (Postural) Hypotension
Different Sections of Adrenal Gland
The Sex HormonesThe adrenal gland provides the secretion of DHEAas well as testosterone, estrogen and progesterone.
Adrenal Gland Function in WomenOnly source of DHEA andtestosteroneAfter menopause, are themajor source of estrogen &progesterone69
Adrenal Gland Function in MenOnly source of DHEA,estrogen and progesteroneAfter andropause, are themajor source of testosterone70
The Adrenals Effect on Female HormonesSince testosterone is a prime factor in sex drive whywould Adrenal Fatigue cause a bigger impact in womanin regards to sex drive?Hot flashes is caused byquickly dropping estrogenlevels. How does AdrenalFatigue play a crucial rolein hot flashes?
73Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Different Sections of Adrenal Gland
The Role of Cortisol1. Metabolism of fats, protein and carbohydrates tomaintain blood glucose2. The main anti-inflammatory agent in your body3. Keeps immune system in check by preventing a hyperimmune response.4. Has an affect on behavior, mood and electrical activityof neurons in the brain.
Normalizes Blood Sugar(Keeps You From Crashing)1. What hormone is secreted when your sugar levelsincrease in the bloodstream (soda / bread)?2. How much insulin is secreted when the sugar load isexcessive?3. What happens to the sugar levels in the blood?4. What does your body secrete to increase the bloodsugar level?5. What will happen to the adrenal gland if this processcontinues all day, every day?
Well My Diet is Perfect ButI Have a Lot of Mental Stress?Same Thing Happens As If You Have a High Sugar Diet.Why?Your body isn’t able to differentiate from getting chased by atiger or getting frustrated when there is a line at the grocerystore.Secrets cortisol to increase blood sugar so you can run from atiger (or just get more frustrated being in a long line)
What Happens to Cravings WhenYour Cortisol Levels Crash?They Go Up!What Do You Crave?Sugar!What Hormone Does that Increase?Insulin!Does that promote fat burning or fat deposition?Fat deposition!
More CravingsMore InsulinMore Weight GainIncreases Aromotase EnzymeIncrease EstrogenDecreases ThyroidMore FatigueMore Sugar for FatigueMore Cravings(Rinse and Repeat)
Anti-Inflammatory Effect(Make booboos hurt less/makes breathing easier)Cortisol keeps inflammation and swelling in check-Insect bites-Allergy (eyes / bronchial tubes)Reduces inflammation classic to autoimmune diseases(and will reduce the immune response CAUSING the swelling)That is why Prednisone is used for auto-immune conditions.
Immune Modulation(Keeps immune cells from getting paranoid)When immune cells become hyper responsive they don’tdifferentiate antigens from normal tissue(good guys from the bad guys)What type of diseases occur when the immune system ishypersensitive or paranoid.Autoimmune DiseasesCortisol reduces the rate at which lymphocytes multiply andaccelerates their programmed cell death.
Immune ModulationWhat Happens When Cortisol Crashes?Immune System Upregulates (Th1)Increases Inflammatory Cytokines (IL-6, TNF-alpha)Activates microglial cells causing inflammation in the brainCauses hippocampal degeneration/atrophyPromotes autoimmune diseaseOne of the primary causes of fatiguewith hypoadrenia
Cardiovascular Support(Maintains blood pressure and strength of contraction)It accomplishes this by helping aldosterone regulate sodiumand potassium in the heart.Helps maintain adequate pressure to pump blood to all areas ofthe body.
Protects the CNS(Makes You Feel Good and Think Straight)Cortisol effects your mood, behavior and memory.High cortisol will actually cause atrophy of your hippocampus.
HPA
87
88Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
89Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
90
The Stress Hormone: Cortisol The Only Hormone that Increases With Age Can Elevate Blood Glucose by Up To 50%– HOW? “Cortisol causes mobilization of amino acids fromextrahepatic tissue, mainly from muscle. As aresult, more amino acids become available in theplasma to enter into the gluconeogenesispathway and promote the formation of glucose.”Guyton Textbook of Physiology p.84691
CatabolismRecent studies in isolatedtissue have demonstratedthat cortisol depressesamino acid transport intomuscle cells ”Guyton Textbook of Physiology p.84692
Outline1.2.3.4.5.6.7.Classic Patient PresentationHistory of HypoadreniaConventional Awareness of HypoadreniaThe Anatomy of the Adrenal GlandPhysiology of DysfunctionFunctional AssessmentPatient Management
How to Diagnosis Symptom Survey – Consultation Functional In-Office Testing– Blood Pressure Test– Pupil Dilation– Rogoff Sign Lab Testing– Salivary Cortisol (4)– DHEA94
Symptom Survey Simple Questionnaire Saves Time in your office Helps The Doctor and the PatientUnderstand the Causation95Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Functional In-Office Testing Quick, Free Assessments Builds Patient Awareness Increases Patient Compliance Confirms Need For Testing96
Functional In-Office TestingPUPIL TESTPatient will sit in a darkened roomfor 2 minutes. Then a light will beshined into the eye. The pupil shouldstay constricted for approximately2 minutes. If within 40 seconds thepupil begins to alternate betweendilation and constriction with dilationwinning the battle, then it is a signof hypoadrenia.(Arroyo, CF. Jour. And Rac., Jan 2, 1924, cxix, pg. 25)97
Functional In-Office TestingBLOOD PRESSURE TESTIn order to maintain proper pressure in thebloodstream when going from sitting tostanding the blood pressure should raiseor at least maintain current pressure. Moredramatically when going from lying tostanding, the blood pressure shouldsignificantly increase (10-20mm Hg). If apositive test, make sure you are wellhydrated and repeat the test. If it is positivewhen well hydrated, hypoadrenia is a likelydiagnosis.“Hypoadrenia usually spells hypotension.”(Harrower, Henry R. Endocrine Diagnostic Charts. Harrower Laboratory, Inc. Glendale, California, 1929, pg 79)
Functional In-Office TestingROGOFF SIGNPalpation or thumping ofthe thoracolumbar junctionproduces pain.99
Functional In-Office TestingSERGENT’S WHITE LINESRun the back of a ball point pen along the bare abdomen. Normally turnsreddish-pink within 30 seconds. If hypoadrenia is present, it will remainwhite for over a minute. Called Sargent’s White Line. Presentapproximately 40% of the time.100
Laboratory TestingSalivary Testing Cortisol x4 DHEA x1101Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
102
Advantage of Salivary Collection Non-invasive specimen collection Non-medical personnel (patient) can collectspecimen Increase patient’sinvolvement withhealthcare Cost-effective103Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Salivary Versus Serum104Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Salivary Cortisol Better Measure of Adrenal Cortical FunctionAnnals of Clinical Biochemistry
Normal ��s DiseaseAdrenal Fatigue Dr. James L. Wilson, p89106Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
What If I Take TransdermalHormone Replacement?Salivary levels will raise abovetesting range for approximately twomonths. You can NOT use salivary testingwhile applying progesterone creams, etc.Since transdermal hormones are transportedvia the skin to the lymph to all cells of thebody (not the blood), a blood test will notshow any change and is therefore alsounreliable assessment.Therefore, both salivary and blood testingwill be unreliable in regards to monitoringthe effects of therapy. You will need to usesymptomatic response.107Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Outline1.2.3.4.5.6.7.Classic Patient PresentationHistory of HypoadreniaConventional Awareness of HypoadreniaThe Anatomy of the Adrenal GlandPhysiology of DysfunctionFunctional AssessmentPatient Management
Why Does Low CortisolCause Salt Cravings?
Is It Okay To Use Salt?Recommend Powdered Kelp because it containsboth sodium and potassium. Kelp also containsiodine which can assist the thyroid which isusually dysfunctional when you have adrenaldysfunction. You can add sea salt to the KelpPowder as desired.
Vitamin CThe more cortisol secreted the more vitamin c isused is the cascade to create the hormone.The highest concentration of Vitamin C is in theadrenal gland.Necessary for both catecholamine synthesis andsteroidogenesis.Studies – 1,000mg 3x daily
Pantothenic AcidAdrenal dysfunction with inadequate levels of B5It will help regulate levels of cortisol that issecreted.Minimum of 500mg 3x a day
MagnesiumHelps Insulin Sensitivity - More Sensitive Insulin LessAbuse of CortisolPerform Magnesium CalibrationMg is a GABA antagonist which will promote growthhormone and melatonin. Melatonin helps create moresensitivity of the hypothalamus to cortisol helping thenegative feedback mechanism to turn off cortisol secretionMg reduces nocturnal ACTH secretion which is why Mghelps people get better sleep
Relora (Stress Relief ) Patented Formulation from California-based NextPharmaceuticals Combination of magnolia and phellodendron Anti-anxiety and anti-stress properties similar tobenzodiazapenes, yet non-sedating Anti-depressant properties Normalize DHEA and cortisol levels Low side effect profile / Dosage: 1 capsule TID
Relora (Stress Relief ) Patented Formulation from California-based NextPharmaceuticals Combination of magnolia and phellodendron Anti-anxiety and anti-stress properties similar tobenzodiazapenes, yet non-sedating Anti-depressant properties Normalize DHEA and cortisol levels Low side effect profile / Dosage: 1 capsule TID
Stage of Adrenal Damage Stage 1 - Normal Adaptation to Stress“Stressed and Wired” Stage 2 – Adrenal Fatigue“Stressed and Tired” Stage 3 – Adrenal Exhaustion“Tired Than Wired”116Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Stage 1 - Normal Adaptation to StressStressed and Wired Both Cortisol and DHEA Increase with stress Usually AsymptomaticNeed Adrenal Balance Program117Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Adrenal Balance Adaptagenic Adrenal SupportStress Relief (1 QD)(Rhodiola, Relora, Ashwagandha) Vitamin CActive-C (1 BID) Glycemic RegulationSugar Balance (1 TID)(All Programs Must Have Patient on a PharmaceuticalGrade Multivitamin with sufficient B-Vitamin intake)118Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Stage 2 – Adrenal Fatigue“Stressed and Tired” Cortisol Increases and DHEA declines Stressed, Anxiety Attacks, Mood SwingsNeed Adrenal Boost Program119Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
120Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Adrenal Boost Adaptagenic Adrenal Herbal SupportStress Relief (2 QD) Vitamin CActive-C (1 BID) Glycemic RegulationSugar Balance(1 TID) Pregnenolone (2 QD)121Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Stage 3 – Adrenal Exhaustion“Tired Than Wired” Both Cortisol and DHEA are low Depression and ExhaustionNeed Adrenal Restoration Program122Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
123Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
124Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Adrenal Restoration Adaptagenic Adrenal Herbal SupportStress Relief (2 QD) Vitamin CActive-C (1 BID) Glycemic RegulationSugar Balance(1 TID) Pregnenolone (2 QD) Adrenal GlandularAdrenal Restore (2QD) Herbal Sleep SupportSleep Aid (2QD)125Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
The Lifestyle Components Balance Blood Sugar– Increase Fiber &ProteinReduce Sugar/Carb Eliminate Stimulants Increase Exercise Relaxation Techniques– Abdominal Breathing– Progressive Relaxation– Meditation Increase Quality SleepDr. Joe EspositoAlignLife Nutraceuticals, LLC 2009126
Mental Exercises Good For Me / Bad For Me Energy Robbers (actions, people, things) Adapt to Situations (Change/Adapt/Leave)127Dr. Joe EspositoAlignLife Nutraceuticals, LLC 2009
Interested in More Information?Come to Booth 42 Become one of 20 clinics we will focus on nutritionintegration protocolsContact AlignLife Nutraceuticals (309) 807-4439 info@alignlifenutrition.com
Fatigue is a common complaint in many chronic diseases that adrenal hypofunction is not commonly a path a conventional practitioner will travel. Since Adrenal Fatigue is best managed naturally it is ignored and overlooked Ignoring this condition creates chronic unnecessary health problems for millions of people
