Low grade inflammation is widely documented in the research literature as an indicator of impending health problems and well established as a factor underlying many health disorders.  Those with hidden, low-grade, non-specific inflammation often fall victim to reverting to stress-related disorders.

The current stressors in the U.S., such as the economic downturn, the concerns over healthcare reform and the direction of the country, are the types of multiple cumulative stressors influencing people’s health.  I am seeing an increased number of people with dysregulated adrenal function, chronic fatigue syndrome, fibromyalgia and thyroid dysregulation.  My personal observation is that it is comparable to the increase in stress related disorders seen after the 9-11 attacks on the United States.

In a large, prospective study reported in a January 2008 article in the Archives of General Psychiatry, measuring indicators of the altered stress response 1, 2 and 3 years after the 9/11 terrorists attacks indicated long-term, ongoing stress associated health problems. The authors of the 2008 article eloquently explain:

Because acute stress reactions often accompany underlying stress-related physiologic arousal initially, they may mark the onset of physiologic processes that ultimately affect cardiovascular health.  The allostatic load theory posits that activation of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis sets off a neurohormonal cascade that supports coping initially but threatens health if it persists after the event has passed.

The authors conclusions support my clinical findings with many patients as I’ve discussed in a previous article.

Stress-related disorders can be brought on by one major stressor or by many concurrent less intense stressors in a short time period.  Either way, the allostatic load imposed by constant activation of the sympathetic nervous system can overload the adaptive coping mechanisms of people predisposed to stress-related disorders.  Those more prone to inability to adapt to stressors normally are often those that already have simmering health problems.

People with low-grade inflammation typically have the following:

1. Adult blood laboratory test results with:
   • high-normal ESR level of about 9-12 mm/hr
   • high-normal high-sensativity CRP of about 0.8-1.0 mg/dl
   • fibrinogen levels over 300mg/dl
   • often the total T3 to reverse T3 ratio is less than 10
2. Waist-to-hip ratio greater than 1:1 for adult male or greater than 0.8:1 in adult female
3. Rapid heartbeat
4. Elevated salivary cortisol levels in the morning, early afternoon and evening
5. Chronic tightness of the upper trapezius and neck muscles
6. Pain and tenderness over the area of the adrenal glands may be elicited with moderate pressure applied in that area of their backs
7. When light is shed into the persons eye, the pupils may not hold a contraction.
8. pH measurement of first morning urine is 5.8 or lower

Together, all of these signs are indications that low-grade inflammation may be an underlying factor in the processes involved in numerous disease conditions, including stress-related disorders.  Low-grade inflammation is one component of adrenal dysregulation.  In addition, low grade inflammation is often present in people whose diet consists of minimal amounts of dark green leafy and brightly colored vegetables.

Many people could benefit from following the anti-inflammatory Therapeutic Lifestyle guidelines.  I have mentioned those guidelines in some of my blog posts.  I encourage you to implement some of all of them especially if you are dealing with a major stressor or multiple stressors.  If you think you are already suffering from a stress related disorder, consult a doctor that can properly diagnose and implement the appropriate treatment to restore your health.

Let me know how I can help.  We are located in the mid-peninsula in the San Francisco bay area.  We also offer phone consultation for those outside the area.

Dr Husbands is a Chiropractor, a Certified Clinical Nutritionist, an Anti-Aging Healthcare Practitioner and a Functional Medicine Doctor. For more information, visit http://www.drhusbands.com.

Copyright © 2009; Douglas Husbands, DC, CCN, ABAAHP. All rights reserved.

Are you stressed or tired all the time these days?  With the rising unemployment, many people are dealing with difficult financial situations.  Even those that are still employed are experiencing added stress from additional workload due to reduction in force or worry that they’ll lose their jobs.  What are you doing to manage the stress?  Our bodies have coping mechanisms primarily handled by our adrenal glands but health problems may develop if adrenal dysfunction occurs.  Stress management in these times is very important.  I would like to share some stress management techniques below.  But first, I’d like to mention trends regarding stress.

I decided to write about stress because I have noticed that many of my current patients are suffering from some degree of adrenal fatigue. The last time I saw this high of a percentage of people who have adrenal fatigue signs and symptoms was during October to November of 2001.  This was a month or two after the 9/11 terrorist attack on the United States.  Is the current economy affecting people’s health due to stress?

Though I have not yet seen research studies measuring the effects of this recent economic downturn, I expect to see prospective studies coming out within the next few years regarding health problems associated with this present stressor.   I certainly see an increase in patients consulting me for stress and/or adrenal fatigue.

According to a June 2002 article in the American Journal of Epidemiology, there were increased use of cigarettes, alcohol and marijuana in New York and Manhattan after the 9/11 attack.  These are poor coping techniques for stress reduction due to a major stressor.

Rather than letting stress take its toll on your body, here are some stress management techniques.  Do any combination of the following:

• Deep slow breathing
• Tai Chi exercise
• Weight training exercise
• Aerobic exercise
• Short, completely-uninterrupted naps
• Focused deep relaxation training techniques, such as hypnosis
• Drink plenty of water
• Body Massage

If you do find that you are unable to cope with stress, or you are concerned about health problems that are associated with stress, it’s best to consult a doctor with experience in helping people resolve stress and adrenal fatigue related health conditions.

Dr Husbands is a Chiropractor, a Certified Clinical Nutritionist, an Anti-Aging Healthcare Practitioner and a Functional Medicine Doctor. For more information, visit http://www.drhusbands.com.

Copyright © 2009; Douglas Husbands, DC, CCN, ABAAHP. All rights reserved.

Some of the patients I have treated for chronic fatigue have consulted multiple doctors before the underlying cause of their chronic fatigue was finally correctly diagnosed and treated.  Here’s an account of one of those patients:

Two months after my baby was born, I began to feel tired all the time.  Even though I had 8 hours of sleep at night, I woke up still tired and found it hard to get up in the morning.  Sometimes, I woke up with some pain on both hands, knees, ankles, or feet.  I saw 5 doctors, including an internist, an endocrinologist and a rheumatologist.  I had numerous lab tests, but none of them found anything conclusive.  The rheumatologist in Redwood City thought I should wait for 6 months for my body to normalize and readjust from the hormonal changes from pregnancy and the stress of caring for an infant.  The internist referred me to a psychiatrist.  I perceived it as a polite way of saying “it’s all in your head”.  I refused to see a shrink.  After 6 months with no improvement, I went to see a holistic doctor in Palo Alto.  He recommended nutritional supplements for energy and brain function, but I saw little improvement.  I finally consulted Dr Husbands who not only properly diagnosed chronic fatigue syndrome, but also addressed the underlying causes.

Signs and Symptoms

Whether you can relate to these patients who have consulted multiple doctors, or you suspect you are suffering from chronic fatigue, proper diagnosis and treatment are what you need.  There are several underlying causes of chronic fatigue, one of them is adrenal fatigue.  This is not recognized by many conventional doctors.  Here’s a list of signs and symptoms of adrenal fatigue-associated chronic fatigue syndrome (CFS).

• Difficulty getting to sleep at night
• Waking up at 2 or 3 AM for no apparent reason with difficulty going back to sleep
• Difficulty waking up by 7 or 8 AM even though you’ve gone to bed by about 10 PM
• Your deepest sleep being 1-2 hours before you wake up in the morning
• Not feeling rested when you wake
• Just feeling awake at about 10 AM even though you’ve been up for 3 hours
• Inability to exercise without feeling “wiped out” for the next 2 to 3 days
• Lack of stamina
• Multiple areas of muscle tenderness and pain
• Salivary adrenal tests show low total cortisol output and low DHEA-sulphate (DHEA-S)

Diagnosis

CFS is a common manifestation of adrenal fatigue.  My approach for diagnosis and treatment is based on a functional medicine and clinical nutrition perspective.  My diagnostic process includes:

• salivary cortisol testing
• salivary DHEA-S testing
• functional medicine examination
• conventional evaluation of medical history and examination established for CFS

Typically, these doctors that were consulted by these patients did not test salivary cortisol and DHEA-S levels.   If they did, they used the blood or urine cortisol and DHEA testing methods.  In research studies and in my clinical experience, I found salivary testing is the most accurate and reliable.   Since cortisol levels change significantly depending on the time of day, we should find out your cortisol levels at certain times of the day.  The normal daily range of cortisol output at specific times of the day is known.  Since morning cortisol levels should be at their highest after we wake up, with a dramatic drop by noon, and a gradual decrease until midnight, it is best to take 4 saliva samples during a normal day to ascertain each individuals output.  I often see altered cortisol response and DHEA-S levels which often correlate very closely with each individual’s signs and symptoms.  On the other hand, if cortisol is measured by one blood or urine test, only the cortisol for one time of the day will be reflected.  This is simply unreliable.

Last but not the least, here’s an excerpt from an article in my blog about adrenal fatigue:

It is very important to determine if someone is presently in an elevated cortisol pattern or if someone is in a stage of relative adrenal exhaustion because the treatment for each stage is quite different.  If you treated someone in the stage of adrenal exhaustion as if they were in an elevated cortisol pattern, you could significantly harm the person by further suppressing cortisol output.  Likewise, if you treated someone “locked” into an elevated set point of cortisol output as if they were in the stage of adrenal exhaustion, you could induce high blood pressure and other significant problems in that individual.  For this reason, salivary laboratory testing  of cortisol and DHEA-S is often essential.

Dr Husbands is a Chiropractor, Functional Medicine doctor, and a Certified Clinical Nutritionist. He sees patients in San Carlos, California. He offers phone consultation for those outside the San Francisco Bay Area. For more information visit Dr Husbands’s website.

Adrenal-related health disorders are far more prevalent than recognized.  Chronic Fatigue Syndrome and Fibromyalgia are forms of adrenal gland dysfunction, and there are other disorders where adrenal gland dysfunction is the root cause. Many people with adrenal-related disorders go undiagnosed or are misdiagnosed every day.  A vast majority of them have seen multiple doctors in their quest for diagnosis and solution.  Some have had to settle with living with their health condition, while a few finally get properly get diagnosed and treated.  Among those properly diagnosed, some never get the proper treatment and/or are simply given treatment for the symptoms.

Many physicians think that the deficiency of cortisol only results in Addison’s disease, which is the condition of near or total failure of cortisol secretion.  Likewise, many physicians physicians only recognize that the extreme elevation of cortisol as Cushing’s syndrome.  Moderate long-term, moderate elevations of cortisol are far more common than Cushing’s syndrome.

In my article titled, “Got Stress?  It May Be Adrenal Fatigue” I covered the definition, stages and diagnosis of Adrenal Fatigue.  In this article, I will cover the Functional Medicine treatment methods of each stage.  I will start with an overview of the stages.

Stages of Adrenal Dysfunction

The First Stage: – Alarm

The alarm stage, which is also known as the arousal stage, occurs at some type of immediate stress or acute emergency situation.  This is a healthy protective response.

The Second Stage: Resistance

The stage of resistance involves our body adapting to stress by changing the set point of the nervous system and a rise of cortisol by the adrenal glands.  The body (and brain) gets stuck in a response such that it acts like everything is an emergency situation.  This second stage can persist for days, months or years depending on the individual, and the severity or cumulative total of stressors in a given period of time.  It almost always lead to the final stage of adrenal dysfunction.  In this stage, a key adrenal hormone called DHEA (Dehydroepiandrosterone) tends to become depleted.  In addition, thyroid gland function often starts to go awry.

The Final Stage: Exhaustion – Adrenal Fatigue

The stage of exhaustion involves the depletion of the adrenal glands ability to make cortisol and other key hormones such as DHEA.  This stage is also called Adrenal Fatigue.  This stage occurs with many people who have had a major stressor that their body never recovered from, or with multiple cumulative stressors eventually taking their toll on the body.  Examples of common cumulative stressors are: allergies, smoking or consistent exposure to second-hand cigarette smoke, lack of sleep, poor diet, lack of or excessive exercise, many prescription and nonprescription drugs, caffeine, dissatisfaction with work and relationships, and lack of relaxation.  When adrenal fatigue occurs, thyroid gland dysfunction often progresses to hypothyroidism.

Treatment Methods

The treatment of adrenal fatigue syndrome depends on the stage of the adrenal dysfunction and the severity of adrenal fatigue.

Treatment for Stage 2 – Adrenal Gland Resistance

The treatment goal is to reset the adrenal glands, specifically the hypothalamic-pituitary-adrenal axis (HPA), to lower the output of cortisol to normal levels and bring DHEA to normal levels.  A multi-faceted approach is the most effective way to restore normal adrenal function.  It can take anywhere from 6 to 18 months, depending on the state of adrenal dysfunction.

1. Control Blood Sugar (Cortisol levels are greatly influenced by blood glucose levels.  As blood glucose levels dip below 70 mg/dl, cortisol rises until blood glucose is stabilized. )
2. Down Regulating Cortisol and the HPA Axis
3. Normalize DHEA levels
4. Balance the Body’s Stress Response
5. Decrease Conversion of Adrenal Hormones to Estrogens
6. Decrease Food and Environmental Allergies
7. Increase Cellular Energy Production
8. Decrease Inflammation
9. Modulate Structural/Neurological Influences on Cortisol Output

Treatment for the Final Stage – Adrenal Fatigue

1. Control Blood Sugar (Cortisol levels are greatly influenced by blood glucose levels.  As blood glucose levels dip below 70 mg/dl, cortisol rises until blood glucose is stabilized. )
2. Normalize DHEA levels
3. Balance the Body’s Stress Response
4. Decrease Conversion of Adrenal Hormones to Estrogens
5. Decrease Food and Environmental Allergies
6. Increase Cellular Energy Production
7. Decrease Inflammation
8. Modulate Structural/Neurological Influences on Cortisol Output
9. Lifestyle management (including relaxation, emotional response, and sleep, work, and eating patterns)
10. Support healthy cortisol production through:
    1. Herbs, Pregnenolone, Cortisol and DHEA<
    2. Vitamins and Minerals
    3. Adrenal Glandular Extracts
    4. Diet
    5. Exercise

These treatments are effective because they address and/or correct the processes that caused the problem.  If you or someone you know have questions about adrenal gland dysfunction, fibromyalgia or chronic fatigue syndrome don’t hesitate to call us at (650) 593-4447.

Dr Husbands is a Doctor of Chiropractic, a Certified Clinical Nutritionist, an Anti-Aging Healthcare Practitioner and a Functional Medicine Doctor.  For more information, visit http:/www.drhusbands.com.

Copyright © 2009; Douglas Husbands, DC, CCN, ABAAHP. All rights reserved