Stress is not an uncommon feeling for most of us; in fact, the American Institute of Stress reports that 55% of us experience stress on a daily basis. When trying to figure out how to manage stress, we must understand the stress response in the body. We cannot talk about the body’s stress response without discussing the adrenal glands, as our adrenal glands are responsible for creating and releasing our stress hormones. This article will discuss what the adrenal glands are, including their role in the body and how stress can affect them. We’ll then look at common daily stressors and symptoms that can result from chronic stress. Finally, we’ll evaluate different labs that we can use to assess the impact of stress on the adrenal glands and integrative treatment options, including diet, supplements, herbs, mind-body techniques, acupuncture, and more.

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What are The Adrenal Glands?

The adrenal glands consist of two small glands that sit atop the kidneys. Their job is to release hormones in response to a variety of stressors.

What are The Adrenal Glands Role in The Body?

The adrenal glands can be divided into two sections called the adrenal medulla and the adrenal cortex. There are three different layers in the adrenal medulla: zona fasiculata, zona glomerulosa, and zona reticularis. The zona fasciculata is where the hormone cortisol is made. Cortisol can have many effects on the body, including increasing blood sugar, blood pressure, modulating inflammation, and more. The zona glomerulosa is responsible for the creation of aldosterone. Aldosterone has a significant impact on blood pressure since it regulates the amount of sodium and potassium in the body by controlling the amount that these electrolytes are either excreted or retained by the kidneys. Finally, the zona retiucularis is where androgenic hormones, including DHEA, are created. DHEA serves as a precursor to testosterone and estradiol. However, it is also metabolically active on its own, being labeled a “neurosteroid” due to its ability to modulate neurotransmitters, affect inflammation of the brain, and neuronal longevity.

In the adrenal medulla, epinephrine and norepinephrine, appropriately labeled our “fight or flight” hormones, are made. Both of these hormones can have impacts on blood sugar, heart rate, the strength of muscular contraction of the heart, and blood pressure.

How Does Stress Affect Our Adrenal Health?

The actions, and thus production and release of hormones by the adrenal glands, are controlled by the Hypothalamic Pituitary Adrenal (HPA) axis. The HPA axis is activated under stress. When stress occurs, whether it be physical, mental, emotional, or perceived stress, the center in the brain, called the hypothalamus, senses that stress. When it does, it releases a hormone to the pituitary gland that alerts it of the stress. The pituitary gland responds by releasing its own hormone to the adrenal glands. The adrenal glands will then elicit the appropriate hormonal release for the stressor. For example, perhaps you need to run away from a threat; increasing your blood pressure will help to deliver oxygen and nutrients to your muscles so they can work more efficiently. A rise in blood sugar will deliver sugar, or glucose, to those muscles, which can then be converted into ATP: the body’s main energy source. DHEA will aid in cognitive functioning, helping you to think clearer as you run away.

The HPA axis has a brilliant design. However, the caveat is that it must be used and functioning appropriately. The creation of the HPA axis in our bodies was done when stress was always a short-term event: running away from an animal, hunting, etc. In today’s world, however, many of us have chronic stress that leads to chronic activation of the HPA axis. When this occurs, the hypothalamus in the brain thinks this chronic activation must be a mistake, and then it down-regulates the HPA axis. Many people once called this “adrenal fatigue” with the idea that the adrenal glands were working hard to combat chronic stress that they eventually tired out and could no longer produce hormones. We know, however, that this is not true. The adrenal glands (with the exception of Addison’s disease) will always be able to produce their hormones. What does occur is a miscommunication in the HPA axis, where the hypothalamus does not appropriately stimulate its use; this is what we refer to as HPA axis dysfunction. In HPA dysfunction, hormones may still be released, but they may be released in larger or smaller amounts. This is especially significant in relation to cortisol since cortisol is not only a stress hormone, but it also controls our body’s circadian rhythm or sleep-wake cycle. Outside of the stress response, cortisol should be released in the morning, as it aids in waking us up. The level of cortisol should peak just after waking, and then it should begin its downward trend for the rest of the day until nighttime comes when it should be its lowest. This allows melatonin, our nighttime hormone, to be released. In HPA dysfunction, however, this cortisol curve may not follow this pattern. Cortisol release can be sporadic and vary in both the amount and timing of release.

What Are Common Daily Stressors That Affect Our Adrenal Health?

Common daily stressors that affect our adrenal health include lifestyle and emotional factors and nutrition. Lifestyle factors that can affect our adrenals include sleep disruptions, such as having a baby, or circadian rhythm disruptions, including shift work. Emotional factors that can contribute to stress include the death of a loved one, a difficult breakup, working at a job that you hate, or having trouble in school. Nutritionally, eating a diet high in processed foods and sugars is more likely to be devoid of necessary nutrients. Eating a healthy diet is always important, but it's especially key to supporting adrenal health. When the HPA axis is continuously stimulated, micronutrients, including vitamin C, B vitamins, magnesium, and zinc, are being used more frequently and are in higher demand. Eating a well-rounded diet can help to avoid deficiencies in those micronutrients.

Symptoms of Adrenal Dysregulation

Symptoms of adrenal dysregulation may include:

• A tired but wired feeling
• Weight gain, especially in the abdomen
• Weight loss
• Difficulty falling or staying asleep
• Cravings for sugary and salty foods
• Hair loss
• Soft nails
• Menstrual irregularities, including missing periods, shorter and longer cycles
• Puffy or water retention feeling
• Brain fog and difficulty concentrating

Functional Medicine Labs That Can Help Individualize Treatment Options for Patients With Adrenal Dysregulation

Functional medicine labs that can help to assess adrenal dysregulation include labs that test the HPA axis and micronutrient testing.

HPA Testing

There are many testing options to evaluate the status of the adrenal glands. Cortisol is the body's primary stress hormone. However, it also controls the body’s circadian cycle or sleep-wake cycle. Cortisol released according to the circadian cycle is on a curve called the cortisol curve. Doctor’s Data Diurnal Cortisol test evaluates the cortisol curve by assessing four cortisol levels throughout the day. Elevated stress levels, or chronic stress, can impact this cortisol curve, causing cortisol levels to be irregular in both amount and timing of the release. The HPA Profile by Sanesco & NeuroLab is another excellent choice for evaluating the functioning of the HPA axis. This test assesses four cortisol levels throughout the day but also gives levels of various neurotransmitters and another adrenal hormone, DHEA.

Micronutrient Testing

As discussed above, many micronutrients are required and in high demand during HPA activation, including b-vitamins, magnesium, vitamin C, and zinc. Micronutrient tests include all of these vitamins and minerals as well as many others in one convenient test.

Nutrition for Adrenal Dysregulation

Nutrition for adrenal dysregulation should focus on high levels of micronutrients since, as discussed above, many micronutrients are at risk of depletion under stressful conditions. Additionally, the hormone cortisol can cause blood sugar to be released and may lead to blood sugar dysregulation. Thus, a diet for adrenal dysfunctions should place emphasis on high micronutrient content and blood sugar balancing. One such diet that fits these requirements is the Mediterranean Diet. The Mediterranean diet consists of fruits, vegetables, minimally processed whole grains, fatty fish, olive oil, nuts, seeds, herbs, and spices. This diet is recommended for those with diabetes due to its blood sugar benefits and, because of the wide variety of foods, contains an array of micronutrients, making it an excellent choice for adrenal dysregulation.

Supplements and Herbs That Help Reduce Stress and Balance Adrenals

There are many supplements and herbs that can help balance adrenal dysregulation. Here are some of the most commonly used supplements and herbs:

Ashwagandha

Ashwagandha is a plant that has been traditionally used in Ayurvedic medicine. Ashwagandha is categorized as an adaptogen that helps the body adapt to stress. A study done on 64 people showed that Ashwagandha supplementation can reduce levels of stress, as indicated by stress surveys, and reduced cortisol levels when compared to placebo.

Dose: 300 mg Ashwagandha root 2x/day

Duration: 45 days

Magnesium

Magnesium is used in high amounts by the adrenal glands, and research has shown magnesium deficiency is associated with stressful conditions. It is thought that magnesium is utilized to combat oxidative stress induced by physiological stress, and thus magnesium can be easily depleted when chronic stress is present.  

Dose: Dosage can be determined by testing magnesium levels.

Duration: Duration will also be determined through magnesium levels entering into the normal reference range.

Vitamin D

Vitamin D is a fat-soluble vitamin and effective at reducing stress, as it has been shown to reduce cortisol levels. Additionally, research has shown vitamin D deficiencies correlated with HPA dysfunction.

Dose: The dose of vitamin D should be determined by testing vitamin D levels.

Duration: Duration of supplementation will be determined by following vitamin D levels via testing.

Mind-body Techniques for Stress Relief

Yoga, breathing exercises, and meditation are all great mind-body modalities for stress relief. Yoga is a physical exercise that also has mental and spiritual effects. Research supports the use of yoga for stress relief, as yoga has been shown to reduce physiological and physical markers of stress. Meditation is another mind-body technique effective at managing stress. Meditation can be done in different ways, from focusing on a particular object, word, or saying, or being mindful of the moment. A review done on meditation and stress showed meditation practices can reduce cortisol levels and blood pressure. Breathing exercises can also be beneficial for stress. There are many different types of breathing exercises, but deep breathing specifically can lower the release of cortisol. A meta-analysis with over 700 people showed breathing exercises were effective at lowering markers of stress.

Acupuncture for Stress Relief

Acupuncture is a modality that has been used for over 5,000 years in Chinese medicine. It involves using tiny needles to stimulate the flow of “qi,” the body’s energy source. Acupuncture may be an effective therapy for stress relief. A study was done assessing acupuncture's effectiveness in reducing stress in over 100 college students. The participants were split into two groups, one group receiving true acupuncture treatment and the other group receiving sham treatment. Participants received the given therapy once a week for 12 weeks. Results showed those receiving acupuncture had greater reductions in stress, as indicated by stress surveys given before and after treatment.

Cognitive-Behavioral Therapy (CBT) for Stress Relief

Cognitive-behavioral therapy (CBT) helps people to retrain their thoughts and eliminate negative thought patterns that are affecting their health. CBT helps people to navigate through stress by teaching them to build resiliency. A review of 345 studies done on the effectiveness of CBT in various stress-related disorders, including depression, anxiety, breast cancer, chronic fatigue syndrome, and more, showed that CBT was an effective stress management tool.

Exercise and Movement for Stress Relief

Exercise and movement come in many forms, from walking to weight lifting, aerobics, and swimming. Many forms of exercise can help reduce stress by inhibiting the release of the fight-or-flight hormones epinephrine and norepinephrine. Additionally, exercise boosts feel-good hormones called endorphins that support a healthy and stable mood.

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Summary

Stress is a common phenomenon that most of us experience on a daily basis. Our bodies, by nature, are designed to handle acute stress. However, chronic stress can have detrimental effects on our body’s stress response. Functional medicine testing can help to evaluate the state of our stress response by testing our adrenal function and micronutrients. Integrative medicine offers many solutions to recover and restore a proper stress response, including nutrition, supplements, herbs, exercise, acupuncture, mind-body techniques, and cognitive behavioral therapy; there is an option no matter what type of therapy your patient prefers!

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