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HEALTH CONCERN? BioHealth Health Concerns

The Importance of Adrenal Health in Athletic Performance

Contributing Author: Tranchitella, Tracy N.D.

TracyTracy Tranchitella, N.D. is a Doctor of Naturopathic Medicine who specializes in providing nutritional and homeopathic consultations, lifestyle counseling, botanical medicine and women's health assessments and detoxification programs. She graduated in 1998 from the Southwest College of Naturopathic Medicine (SCNM) in Tempe, Arizona. Currently, she lives and practices in Temecula, California. Dr. Tranchitella is licensed in the State of California and a member of the American Association of Naturopathic Physicians (AANP) and the California Association of Naturopathic Physicians (CANP).

» Website: Sunrise Medical


Athletes often subject their bodies to far greater levels of stress in the pursuit of their goals than the average person.  While in some ways this may be a necessary part of athletes’ training regimens, it can have far-reaching ramifications on many aspects of their health.

Many of the ramifications start with the adrenal glands, which can be thought of as the stress management centers of our bodies.  The inner part of the adrenal gland secretes epinephrine and norepinephrine (once known as adrenaline and noradrenaline) in response to nervous system stimulus, while the outer adrenal cortex puts out cortisol, our “stress hormone,” DHEA, testosterone, estrogen, progesterone (reproductive hormones) and aldosterone (which regulates water and sodium balance).

Cortisol plays a role in hundreds of different functions within the body.  It affects the way proteins, fats and carbohydrates are metabolized, mediates inflammation within the body, influences detoxification capability, modulates immune function and assists in the regulation of blood sugar and cellular energy production, to name just a few. 

When the body is under stress, cortisol will increase as a compensatory mechanism.  Stress in this context may be mental or emotional, or may come in the form of physical stressors such as rigorous training, infections, toxicity, unbalanced nutrition and blood sugar regulation, chronic pain, inflammation and allergies. 

There are three stages in a chronic stress response, starting with cortisol and filtering through to other hormones and systems of the body.

Stage I
The body increases cortisol production in an attempt to counter the extra stressors.  This is a normal occurrence, and can be protective for the body.  Stressors increase, cortisol increases, stressors go away, cortisol falls back to normal levels and we go happily about our lives.

The problem is that many of us live in conditions of chronic stress and when the stressors do not recede, the adrenals keep trying to pump out more cortisol.  Therefore, in stage I, cortisol levels are high.  Many people in stage I feel pretty good, as they are on overdrive.  Unfortunately, this artificially elevated feeling of energy and well-being will not last.

Stage II
At this stage, the stress response is becoming chronic.  Cortisol levels have been running high and the adrenals are getting tired.  Gradually, as the adrenals run out of steam, cortisol levels start to fall.  As cortisol levels come down, there will be a period of time when, on paper anyway, they appear normal.  However, at this point, we will see DHEA levels drop.

DHEA is another hormone produced by the adrenal glands.  Cortisol and DHEA are interdependent, and DHEA’s function is to protect against the catabolic (breaking down) effects of cortisol.  Therefore, if DHEA levels fall, that protective mechanism is lost and cortisol can be damaging regardless its level.  So in stage II, the cortisol:DHEA ratio is significant.

Stage III
This stage is known as adrenal exhaustion.  Cortisol is low, DHEA is low, and by now this person is feeling fatigued and run-down, is not recovering well after exercising, has undue inflammation, is more susceptible to injury and illness and is jeopardizing fitness and performance gains.  At this level of adrenal exhaustion, training programs may have to be modified and therapies put into place to allow for recovery and regeneration.  Aside from altering training, other underlying stressors should be evaluated such as toxicity, infections and nutritional issues.

Adrenal health and reproductive hormones
The other major issue that arises during chronic stress is that our reproductive hormones are affected.  The adrenals contribute 35% of our reproductive hormones pre-menopause, and up to 50% post-menopause, so the contribution of the adrenals should not be overlooked.

Pregnenolone is a precursor to all of the adrenal hormones, including the reproductive hormones.  As the demand for cortisol increases, more of the pregnenolone is used for making cortisol; therefore, less is available for DHEA, progesterone, estrogen and testosterone.  Levels of these reproductive hormones decline, which may result in PMS, irregular menses, amenorrhea (no menses), infertility, miscarriage, loss of bone density and other conditions.

Evaluating adrenal health
How do we know if our adrenals are suffering the effects of chronic stress?  A simple saliva test can tell us the answer.  Cortisol should be measured at different times during the day, as it has a natural diurnal rhythm, starting high in the morning to provide more energy and tapering off at night to allow the body to shut down for rest and recovery and for the immune system to kick in and do its nightly housekeeping work.

Estrogen, progesterone and testosterone can also be measured via saliva testing. 

How to help your adrenals
You can moderate several lifestyle factors to help your adrenal glands.  Nutritionally, stable blood sugar is key and results from eating small meals frequently (every three hours), eating some protein with every meal to avoid insulin surges and minimizing foods high on the glycemic index.  Caffeine is also a major source of stress for the adrenals and should be avoided where possible.

Sleep is a much-overlooked aspect.  Physical rest and repair happens between 10 p.m. and 2 a.m., with psychic regeneration occurring between 2 a.m. and 5 a.m.  Staying up late deprives the body of those important hours.  Athletes in particular need seven to eight hours per night; however, they often compromise on sleep while trying to fit in their training, work and family commitments.  Remember, the immune system is active at night so sleep deprivation can contribute to immune compromise.

High cortisol levels at night can prevent sleep, so those with insomnia or trouble shutting down at night should explore that as a possible cause.

Rigorous exercise is a major stress on the adrenals.  For many athletes, this is nearly impossible to avoid, but can be helped by ensuring adequate rest and recovery periods (avoid overtraining) and by incorporating rejuvenative types of exercise such as yoga.

Several micronutrients are supportive to adrenal health and ensuring adequate amounts of all vitamins and minerals is important.  Vitamin C and B-complex work directly on the adrenals.  The mineral chromium helps the adrenals through its regulatory effect on blood sugar.  Essential fatty acids can help counter excess inflammation within the body that may arise from adrenal imbalance.

Herbal remedies also help a lot.  Licorice stimulates the adrenals, and should only be used where cortisol levels are low.  Licorice should not be used long term, by people with high blood pressure, or by women with high risk of estrogen-dependent cancers (licorice can be estrogenic).  Ginseng can support adrenal health and energy levels.  Korean ginseng is more stimulating and energizing, while Siberian ginseng is more balancing and modulating.  Ashwaghanda and Rhodiola are both balancing herbs that are safe for use in cases of high or low cortisol.

In some cases, pregnenolone and DHEA may be used in supplemental form.  These are steroid hormone precursors, so they are not appropriate for everyone and should be taken under the supervision of a qualified health professional.  The benefit of pregnenolone and DHEA is that they can refill the deficiencies in the adrenal pathways left from increased demand on cortisol, leaving more raw materials available to make estrogen, progesterone and testosterone.

Beyond that, pregnenolone and DHEA also help reset the communication between the brain and the adrenals, which often is muddled in times of chronic stress.  This results in the adrenals working better on their own rather than continuing to depend on supplements.

Summing up
For such small glands, the adrenals are very important to our health and well-being.  For athletes, it is crucial that they are functioning well to be able to sustain the amount of work that their bodies are put through.  If you are constantly fatigued, if your ability to recover from hard workouts seems compromised, if you find yourself with recurrent infections or illness, or if your female hormones seem out of whack, it may be time to evaluate your adrenal health and get back on track.