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HEALTH CONCERN? BioHealth Health Concerns

The Adrenal Hormones

Contributing Author: Kalish, Daniel D.C.

Daniel KalishFor two decades Daniel Kalish, D.C. has successfully treated patients with hormone imbalances, food cravings, fatigue, depression, digestive distress, and many other health complaints. Dr. Kalish founded The Natural Path Clinic California, where he led a staff of physicians, nutritionists, chiropractors, psychotherapists, physical therapists, personal trainers, massage therapists and acupuncturists for more than ten years. He currently maintains an active international phone consultation practice with patients and trains physicians in natural medicine. He has designed health programs for countless professional athletes including the world’s top skateboarders, hockey players, elite runners, tri-athletes, golfers, tennis players and world-class weight lifters. Download his ebook Your Guide to Healthy Hormones.

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While most publicity on hormones has focused on estrogen and progesterone, the adrenal hormones may well play the most crucial role in female hormone imbalance. These hormones, including cortisol and DHEA, are secreted by a pair of ductless glands above the kidneys in response to stress. When women experience too much stress for too long, the ovarian hormones are eventually affected. In fact, it is common that the stress response triggers female hormone imbalance and its symptoms.

The Role of Cortisol
Cortisol, one of several hormones produced by the adrenal glands, plays a pivotal role in the hormonal system. Cortisol helps regulate blood pressure and cardiovascular function, as well as the metabolism of proteins, carbohydrates, and fats. Cortisol is secreted in response to any stress in the body, physical or psychological, leading to a breakdown of muscle protein, which releases amino acids into the bloodstream that are then converted by the liver into energy. Cortisol also mobilizes glycogen (stored glucose or sugar) from the liver to generate energy.

The body has an elaborate system for controlling cortisol secretion. Stress typically triggers the release of hormones that increase production of cortisol, among other hormones, to prepare the body for action and protect it from damage in the event of traumatic injury. After the stressful event has passed, the hormone levels return to normal. With chronic or repeated stress, however, the body continues to produce cortisol. If the call on the adrenal glands to produce cortisol perpetuates, the glands eventually weaken, leading to adrenal fatigue and ultimately exhaustion or adrenal burnout, which can increase body fat and cause fatigue and depression among other symptoms.

Adrenal Exhaustion
With stress, a surge of cortisol prepares the body to fight off an attack or flee. For millennia this mechanism operated under conditions that would be followed by long periods of rest and full recovery. Today, however, we are essentially locked in a culture-wide “fight or flight” state. I have found my new patient’s poor diets, lack of exercise and sleep, and long work hours leave bodies in a chronic state of stress, with many restorative functions continually sacrificed or impaired.

If elevated stress continues for months or years, higher-than-normal cortisol levels can no longer be maintained, and the hormone levels start to plummet. In laboratory tests of my patients I have repeatedly seen the first sign of adrenal exhaustion, a drop in DHEA accompanying high cortisol – a sign that other hormones are being affected. In patients that are even more stressed I see Stage 2 of adrenal exhaustion, the once-high cortisol levels now drop with even lower DHEA. Finally in Stage 3 of adrenal exhaustion, both cortisol and DHEA become dangerously low.

Most women feel good in Stage 1 of adrenal exhaustion. Although they are under stress, their cortisol levels remain high, and this provides a rush of energy as the body burns through its hormonal reserves. This state is reflective of modern American culture, in which achievement-oriented and overworked people have become the norm.

Women with genetically strong adrenal glands can carry on in Stage 1 for many years or even decades, while others crash and burn early on. Most people don’t slow down until they experience some type of health problem or emotional crisis that forces them to re-evaluate their pace of living. My clinical experience has shown that this happens around the time patients move from Stage 2 (which does not feel good, but is survivable, fueled with enough caffeine and sugar) to Stage 3, when it becomes clear that something is wrong.

Stage 3 patients may be tired all the time, unable to lose weight as in the past, or be depressed. As a woman progresses from Stage 1 to 3 of adrenal exhaustion, her female hormone symptoms will predictably worsen. Irregular menstrual periods, PMS, and early menopause are common among my patients experiencing a breakdown of adrenal reserves. Most women with peri-menopausal or menopausal symptoms are in Stage 2 or 3 of adrenal exhaustion. A woman in Stage 3 who enters peri-menopause will find what was once a couple of rough days each month turns into “menopausal madness.”

Adrenal exhaustion compromises the body’s ability to compensate for acute stress, leaving the person feeling lethargic, fatigued, and susceptible to chronic illness. An abnormal adrenal rhythm also impacts:

  • Skin regeneration, causing wrinkles and premature aging
  • Sleep quality, leading to trouble falling and staying asleep
  • Bone health, which creates osteopenia or bone loss
  • Muscle and joint function, leading to achy arthritis-type joint pain and neck, shoulder, and lower back pain
  • Immune function, leading to frequent illness

In short, adrenal hormone production is an indicator of overall body function, and an imbalance in this system is a sign of chronic illness. It is therefore vital to address any adrenal malfunction in women displaying menopausal symptoms.

The Role of DHEA
Another adrenal hormone that needs to be kept in balance is dehydroepiandrosterone, commonly known as DHEA. This hormone is produced through the action of the hormone pregnenolone and is also a precursor to estrogen. When we are healthy and unstressed cortisol and DHEA levels remain stable. Deviations mean that the body is compensating for underlying stress.

When DHEA production is disturbed under stress, there is a breakdown in its conversion to estrogen and therefore stress can impact estrogen levels, leading to hormonal symptoms. At the same time, while under stress, pregnenolone is diverted to produce cortisol, which can lower progesterone, further exacerbating the female hormone symptoms. The entire system of female hormones is thus disrupted.

To make matters worse, under normal circumstances DHEA production, which peaks in the mid-20s, declines steadily from the early 30s so that the average 75-year-old has only 20 percent of the DHEA of a woman of 25. Cortisol levels, meanwhile, tend to increase with age, so women are quite likely to have a cortisol-DHEA imbalance by the time they reach menopause. In fact, it is normal to have cortisol levels rise in response to dropping estrogen levels that occur at peri-menopause.

Unfortunately, as is the case with estrogen and progesterone, many women supplement with DHEA without first determining their individual needs. This potent steroidal hormone is widely available as an over-the-counter dietary supplement that has been advertised as promoting weight loss and longevity and preventing disease. But it is often taken in unregulated amounts that can lead to serious side effects. As with all hormones, DHEA should be taken only as directed by a health professional who has determined the correct dosage based on lab testing. Cortisol boosting supplements are also popular right now and many of my patients have unsuccessfully tried them, because they did so without adequate lab testing to determine what is required. These cortisol related supplements help temporarily, leading to further problems down the road.

Adrenal Hormones and Chronic Stress
We all experience stress in our lives, much of it related to lifestyle. Many women have to juggle demanding jobs and family responsibilities, leaving them physically and emotionally exhausted by the end of the day. Others may be caring for ailing parents. Financial hardship and strained relationships also create major prolonged stress, which is complicated by health-related issues such as poor diet, irregular sleep patterns, chemical toxicity, injury, or infection. Anxiety and fear are also sources of stress, such as the recent fear of terrorism in this country. Stress is usually caused by multiple factors.

Some people are naturally better at handling stress, and have healthier adrenal hormone function as a result. But when the adrenal glands are overstressed and weakened, it is important to address the causes, possibly through further testing for undiagnosed medical conditions. In most cases some type of lifestyle modification is called for. As Americans sleep less, eat more fast food on the run and lead more sedentary lives glued to computer screens and cell phones, their ability to handle daily stress and lead balanced lives has diminished. It’s no wonder so many American women complain of the symptoms of menopause!

There are three important stages to consider with regard to stress: perception, response, and internalization. These mark the “flow” of our stress response, and the ways in which we manage and evaluate them are crucial. When stress occurs, the first thing we do is perceive it. Next, we respond to it. Last, we internalize the stress.

It is the internalization of stress that is key. Stress that is internalized negatively will have lasting effects. For this reason, we must find effective individual techniques for stress reduction. People are unique, and the ways they reduce stress reflects this. For some, effective stress reduction could be yoga. For others, it is running or golf. It may be meditating or gardening or keeping a journal. Many people benefit from education, such as classes, books, or seeing a therapist or psychologist. Stress reduction is essential to achieving emotional and spiritual health, which will directly affect your physical health and well-being.

Adrenal Hormones and Weight Gain
Cortisol is a glucocorticosteroid hormone. This is a fancy way of saying cortisol levels shift in response to what you eat. If you eat too much sugar or too many carbohydrates excess insulin and then excess cortisol are released leading to increased fat storage and weight gain. Excess cortisol is thus linked to increased fat storage and obesity. Moreover, a recent study on eating disorders found that women who secreted higher levels of cortisol under stress had a greater tendency to snack on high-fat food than those who secreted less.Women who insist they can’t take off excess weight after menopause often have valid reasons for their complaint, because adrenal dysfunction slows down metabolism and increases body fat. High cortisol also has been linked to low thyroid function and lowered metabolic rate — issues central to many women’s menopausal concerns.

Adrenal Hormones and Mood Disorders
An overactive stress-response can bring on depression, anxiety, and panic attacks, while underactivity has been associated with fatigue, lethargy, and apathy —symptoms of depression. There is a strong relationship between cortisol secretion patterns and mood fluctuations.

People suffering from depression often show a disruption in their circadian (daily) rhythm of cortisol fluctuations, resulting in abnormally high morning and midnight levels of the hormone, precipitating sleep disruption and a variety of mood disorders. Research studies have shown that as many as seven out of ten patients with depression have an enlarged adrenal gland — approximately 1.7 times larger than healthy subjects — growth that has resulted from increased stress hormone production.

Many of my patients whose past treatments have failed to restore proper hormonal balance have had problems metabolizing or eliminating hormones. If your liver has become inflamed by the use of alcohol, prescription drugs or by a poor diet then you will likely have a poor response to hormone treatments.

This type of internal organ stress is referred to as hidden inflammation — for obvious reasons. When an internal organ is inflamed, the symptoms may mask the true underlying cause. For example, inflammation of the stomach can feel like chest pain or neck pain; intestinal inflammation can feel like low back pain.

Hidden Inflammation and Stress
An appropriate treatment plan for adrenal hormone imbalance often includes low dosages of DHEA, supplements such as pregnenolone and minerals including magnesium and calcium. It also may include changes in diet and exercise and various forms of stress reduction. Most of my patients have found dietary changes to be central to achieving hormone balance. Our current dieting trends tend to promote weight loss by increasing cortisol and we end up thinner and feeling more stressed out. Of course when we go off the latest “diet” and eat normally we calm down and gain back all the weight! I see this pattern every single day in my patients.

In all the thousands of women I have tested, the gastrointestinal system is the body system that most frequently suffers from chronic inflammation. This includes the stomach, small intestine, and colon. Symptoms of inflammation in the digestive organs may be vague or hard to interpret, but about half the women I’ve examined thoroughly have at least one undiagnosed digestive tract infection causing inflammation, which elevates cortisol and triggers female hormone problems.


Dr. Kalish: Kathryn offers a classic example of adrenal burnout. When she came to see me, she was overweight, excessively fatigued and feeling very stressed. She had been having panic attacks for some time.

Kathryn: I’ve always been a very high-strung, controlling person. I was always the overachiever who did things better and faster. Right out of college, I got a stressful job with a prominent accounting firm. The hours were grueling, the stress unavoidable, especially for me. About three years after starting my job, I had gained a considerable amount of weight and was having frequent panic attacks. I even landed in the emergency room a few times. When I wasn’t worked up about something or other at work, I was exhausted. All I ever wanted to do in my free time was sleep. I was only 25 years old. Something was wrong.

 Dr. Kalish: Kathryn had been under constant stress for quite some time, and it was finally getting to her. Between the long hours she was putting in at work, her lack of exercise and poor diet, she was setting herself up for adrenal exhaustion. I explained to Kathryn that our bodies are designed to handle stress by releasing cortisol, which prepares the body to protect itself. But the body needs time to return to normal after the stressful situation is over. The problem with Kathryn and with many Americans is that she was under constant stress – her body never had time to recover. It was not surprising that under chronic stress Kathryn was experiencing weight gain, fatigue, and panic attacks. Sometimes this is referred to as feeling “wired and tired.”

Kathryn: I understood what Dr. Kalish was telling me. It made sense. It also became obvious that something was seriously out of balance in my body. Dr. Kalish had me do a series of saliva tests to determine my stress hormone levels. Once we got the results back, he was able to help me determine what supplements I should take, as well as what dietary and lifestyle changes would help to lower my stress.

 Dr. Kalish: Even before we had set up Kathryn with the supplements necessary to reprogram her hormones, I recommended that she follow the Kalish Solution Diet, which would eliminate gluten and emphasize protein, vegetables, non-gluten carbohydrates, and healthy fats. In addition, I recommended that she give up her customary glass or two of red wine every night, and instead drink more water.

Kathryn: Dr. Kalish’s dietary suggestions were very useful. I followed them religiously and noticed results very early on. I was experiencing less fatigue and I eventually started to lose weight. Dr. Kalish also suggested I go to a counselor to help me deal with the stress and anxiety that I had been experiencing. I now go to a counselor once a week, and find it very useful to release some of my tension. I still get stressed sometimes, but my therapist, along with my hormone treatment, have made these instances few and far between, and I now have more tools to combat the stress when it rears its ugly head.