Fight, flight, or phantom fatigue?
Human history has seen the slow relentless migration from a physically demanding but simpler way of life to a hot-wired, high-stakes game of mental challenge and response that is played at breakneck speeds. For many of us, this has become daily life in the United States, and it seems to be making us sick.
We are only now beginning to understand the mysterious and dangerous effects of modern life upon human health. We have found that these effects are mediated primarily by a pair of tiny glands that ride upon our kidneys.
The adrenal glands are the body’s center for action in response to stimuli such as fear, anger, surprise, excitement, emotional trauma, infections, physical pain, and even stressful muscle exertion and fasting. (1) As civilization has evolved into an often emotionally stressful but sedentary service-based work that we now perform, the demands on our adrenals have piled high. These glands, once mostly an assistant to upper-level management, have become a central figure in the control of our health, and in many of us they are buckling under the load.
Those little glands are pumping 24 hours a day. In fact, elevated levels of the corticosteroids (hormones) that they produce are often present in more than 30 million Americans, including pregnant women, athletes, and people with depression, alcoholic patients, malnourished individuals, and patients with panic disorders. (2)
We have two adrenal glands, one atop each kidney. Each gland is actually two separate glands that have different structures, embryonic origins, and hormonal secretions. The formation of the adrenal gland is not complete until the end of the third year of age. (3)
The adrenal medulla–the inner gland–secretes hormones that prepare us for extreme physical response by increasing the heart rate and its contractions, facilitating blood flow, and increasing blood pressure. This part of the gland develops early in the fetus from the primitive (sympathetic) nervous system. It is activated as a sympathetic nervous system response and is largely responsible for the hormones necessary to support “fight-or-flight” readiness.
The outer gland–the adrenal cortex–takes instruction from the pituitary gland. The adrenal cortex secretes hormones known as steroids or corticosteroids. Their secretions regulate sodium and potassium balance, glucose metabolism, and sex steroids. They govern blood pressure; suppress inflammatory reactions; control the use of fats, proteins, and carbohydrates; and exert effects on the development of male characteristics in male or female bodies.
The adrenal glands, inner and outer, secrete hormones in response to stress. The more stress, the more secretion. The more prolonged the stress, the more elevated the level of adrenal hormones in our bloodstreams.
Elevated hormone evels can lead to, among other things, hairiness of the face and body, acne, a deepening voice, high blood pressure, weakness, muscle aches, spasms, and common complaints such as upperbody obesity, a rounded face, thinning arms and legs, fragile and thin skin, severe fatigue, irritability, anxiety, and a reduced sex drive.
Does this sound like a list of symptoms we all exhibit? This is not surprising, considering our lifestyle and our physiology.
What is surprising is how little medical attention is actually paid to these powerhouses and, for that matter, to their entire environmental grid, known as the endocrine system. It is difficult to obtain in-depth information on the adrenals and their counterparts in any publicly consumable format. Even medical texts offer only a few standard syndromes and remedies. Almost nothing has been published about the exhaustion that must come from overstimulation of the system.
Adrenal health, apparently, is not a popular specialty, regardless of our obvious dependence on these glands and what appears to be a growing set of symptoms cropping up across a broad cross-section of our population. For example, as of July 2002, there were only 176 active endocrine surgeons in the United States. (4) Yet the adrenal glands are so elemental to our continued good health that loss of the steroids they secrete would lead to death in just a few days. (5)
To the nonmedical eye, it would seem that these glands deserve far more press than in the past. In fact, they appear to be a major factor in some of our most insidious and mysterious diseases, which are generally accepted as stress-related.
For example, researchers in Germany and Switzerland have linked levels of adrenocorticotropic hormones (secreted by the outer adrenals cortex) with what medical professionals call chronic fatigue syndrome (CFS). (6) CFS seems to affect at least as many as 500,000 people annually, mostly well-educated women in their 30’s and 40’s, (7) yet there is no specific laboratory or clinical test for it. Even now, CFS remains a poorly understood and poorly treated phenomenon in the United States.
Another “mystery” disease closely tied to general endocrine and, specifically, adrenal dysfunction is fibromyalgia, a chronic illness characterized by widespread musculoskeletal aches, pains, and stiffness, general fatigue, and symptoms that wax and wane over time. This disease is debilitating and affects approximately 3 to 6 percent of the people in the United States. Again, more women than men are affected. (8)
Yet the cause of fibromyalgia is unknown. It is treated with a patchwork of medical responses ranging from dismissal of the patient’s complaints to prescriptions of painkillers, sleep hypnotic agents, and antidepressants, with no one clear diagnosis or treatment to be found.
Both CFS and fibromyalgia are diseases of the autoimmune system, as is systemic lupus erythematosus. “Lupus,” characterized by chronic inflammation, can affect many parts of the body. It is most commonly diagnosed between the ages of 15 and 45; it affects about 1.5 million Americans–oddly again, mostly women. (9)
The term autoimmune disease refers to a varied group of more than 80 serious chronic illnesses. For reasons that are not fully understood, about 75 percent of autoimmune diseases occur in women. (10) Anxiety disorders, now also linked to the hypothalamic-pituitary-adrenocortical (HPA) axis, are also more prevalent in women than in men. (11)
Are the adrenal glands, a well-known factor in stress response, a major factor in these diseases? Surprisingly, we simply have not looked closely enough to know. The answer seems not to be a conspiracy or even an inadequacy of medicine, but perhaps has more to do with diversity of systems and a lack of centralization of the field of study.
Dr. Noel Rose, professor of molecular microbiology and immunology and pathology at Johns Hopkins University, states (12):
Anatomically, autoimmune disease is very diverse, and that is why we see specialists in so many areas of medicine studying autoimmunity. They may be rheumatologists who are interested in joints, they may be dermatologists who are interested in skin, they may be cardiologists who are interested in the heart, they be gastroenterologists who are interested in the gastrointestinal tract, but the common etiology [of] all of these diseases–Crohn’s disease, lupus, rheumatoid arthritis–is autoimmunity.
Unfortunately, for the millions of patients with these disorders, there is no central field of study of medicine known as “autoimmunology.” Instead, autoimmune disease arises and disappears in a wide array of medical studies, with no central force except perhaps a few disparate organizations that are trying to remedy the problem by providing information. Medical professionals can take advantage of the information if they know it is available and if they have the time, the understanding, or even the incentive to do the reading.
It is even more discouraging that we can readily purchase–and, in fact, are encouraged to do so–any number of hormone stimulants and suppressors by prescription or over the counter without a clear idea of what that stimulation will actually do. We can get sex hormones and steroids to keep us youthful and physically attractive, or we can buy cortisone, DHEA, pregnenolone, or human growth hormone to make us slim or to give us more energy. We can buy stimulants to activate our adrenal response and sedatives to quiet them, all of this amidst the tumultuous sea of stressors that is daily modern life. Is it any wonder that we are getting sick?
People experiencing a general malaise that no one can manage to diagnose or understand can read, do the research, and then take questions to a health care professional who possesses good skills and an open mind. Patients must encourage the health care provider to consider the malaise relevant and important. Hormones should not be taken to manage life changes, belly fat, or natural aging. Instead, people can find a truly effective way to cope with life’s problems.
Little is known about the complex adrenal system and the overarching endocrine system. Until that gap is remedied, we can look for strategies for minimizing stress.
The Facts Behind Corticosteroids
The adrenal cortex produces two types of steroid hormones: androgens and corticosteroids. Cortisol (hydrocortisone) is important to the body because it affects the metabolism, relieves inflammation, and boosts the immune system. The normal output of cortisol is about 20 milligrams a day. The rate of output varies in the morning and evening.
Synthesized corticosteroids are often used to treat rheumatoid arthritis and tendonitis, and they can be used in combination with cyclophosphamide to treat vasculitis.
The occurrence of adverse effects of corticosteroids depends on the length of the treatment, the dosage, and the way they are administered. Short-term use has been associated with heart palpitations, hot flashes, insomnia, and excess sweating. Patients who have been taking corticosteroids for long periods of time often experience muscle atrophy and swelling of the face.
(1.) Kapit, W., Macey, R.I., Harper, E. M. Physiology. HarperCollins, 1987.
(2.) University of Virginia Health System.
(3.) Human Anatomy.
(4.) Introduction to endocrinology and endocrine surgery.
(5.) Pathophysiology of the Endocrine System. Colorado State University.
(6.) American Medical Association. News in Brief. December 16, 2002.
(7.) What is chronic fatigue syndrome? National Institutes of Health, National Institute of Allergy and Infectious Disease. May 2004.
(8.) Fibromyalgia. National Library of Medicine Service.
(9.) Lupus. Mayo Clinic. January 7, 2004.
(10.) Autoimmune disease. The American Autoimmune Related Disease Association.
(11.) Etiology of Anxiety Disorders. A Report of the Surgeon General.
(12.) Rose, N. R. Baltimore, Md. John Hopkins University.
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