I received the best compliment the other day when a patient of mine said to me, “You’re the only person/doctor who has ever been able to help me”.
This patient was teary-eyed as she delivered the compliment. She is literally sick & tired, overweight and fighting for control over her emotions. I have known this person for 3 years. While she has always been interested in what I do as a Chiropractor and has popped into my office from time to time to address aches and pain, but she has never followed through on a care plan and has said “no thank you” each time I recommended some level of preventative maintenance / wellness care.
A couple of years ago, she suffered a stress fracture of her foot. That was a huge blow to her as she is a fitness instructor and essentially works out every day (all day long) with her clients and classes. Almost immediately after the fracture, she began gaining weight. Anyone can see how that could happen. Take someone who burns calories all-day long at a high rate and stick them in a chair – it’s bound to happen right?
She spent almost 3 months in an orthopedic boot and when she was finally able to get back to work, she found herself overweight, fatigued, a little depressed, but excited to get back into shape.
Now, one would think…and she thought, that just by getting back into her old routine would fix everything. It didn’t. In fact, she began to feel worse: more fatigued, more emotional. She put on more weight and began to feel even worse about herself – her self-esteem was taking a hit. She saw an MD who told her she had low thyroid and put her on thyroid meds and injected her with bio-identical hormones. She was excited for the changes that were promised, but they never came. Then she turned to this doctor’s nurse, who was a self-proclaimed nutrition and fitness expert, who encouraged her to follow a diet and work out plan (remember this patient is a fitness instructor and already works out all day long) that she was selling out of a cross fit gym. Instead, of helping this patient, this approach worsened her condition as she continued to gain weight and her energy and health was paying the price.
Eventually her Ob/Gyn referred her to an endocrinologist. The endocrinologist felt the compounded thyroid hormone was the problem and switched her to a synthetic one because he feels Hashimoto’s Thyroiditis is best treated with synthetic hormones (versus natural ones). It was months after this visit, that she was in my office, asking for my help.
As I listened to her give me this history it painted a very vivid picture of someone with adrenal stress (aka adrenal fatigue, adrenal exhaustion). And, it is my opinion that the adrenal exhaustion triggered the Hashimoto’s thyroiditis (an autoimmune disease). It is also my opinion, that the foot fracture was just the straw that broke the camel’s back. It caused stress – a lot of stress: she stressed about not being able to work and make a living, she stressed about her own inactivity, being inactive in and of itself was a stressor, she stressed about the weight gain, But, there were other stressors in her life… you know a husband, kids, grandchildren, and just day to day life. But that high stress had been going on her body for years before this incident and my first clue to that was when her fractured foot didn’t heal well. (High stress hormones cause excretion of calcium and poor bone growth.)
Although Hashimoto’s hypothyroidism can cause fatigue, I have no doubts she is also suffering from adrenal fatigue, a condition in which the body has difficulty meeting the demands of everyday stress. Adrenal fatigue or exhaustion is often associated with too much stress from a busy lifestyle and lack of sleep, however other factors may lead to adrenal fatigue:
Below are factors besides chronic stress and lack of sleep that can lead to adrenal fatigue. If you have Hashimoto’s hypothyroidism addressing these factors can also help you better manage your Hashimoto’s Hypothyroidism.
- Eating too much sugar and processed carbohydrates. When you eat something sweet or very starchy it causes your blood sugar to spike and then plummet. Your adrenal glands must then release stress hormone to raise it. When blood sugar swings up and down repeatedly it may fatigue the adrenals. Once people have adrenal fatigue they often suffer from low blood sugar, or reactive hypoglycemia, as well. Aim for a lower glycemic, whole foods diet that does not spike your blood sugar, as well as healthy fats, protein, and plenty of fiber.
- Using caffeine and other stimulants.Caffeine, energy drinks, cigarettes, diet pills, and other stimulants cause extra release of stress hormones and can fatigue the adrenal system.
- Overtraining. Exercise is vital to good health, but over-exercisingcan inflame and deplete the body, taxing the adrenal glands. If your performance during workouts is suffering and you feel tired, you may be overdoing it and fatiguing your adrenal glands.
- Food intolerances. Eating foods that trigger an immune reaction can tax adrenal function. One of the more common food intolerancesis gluten, a protein found in wheat, rye, barley, and oats (unless they are gluten-free oats). Dairy, eggs, soy, corn, and yeast are other foods that can cause inflammation and fatigue the adrenal glands. You can do an elimination/provocation diet to find out which foods you are sensitive to.
- Gut infections. Many people have overgrowths of yeast, fungus, and bacteria due to poor diets. These infections lead to chronic inflammation both in the gut and throughout the body, which can contribute to adrenal fatigue.
- Unmanaged autoimmune disease. More people have autoimmune disease than cancer and heart disease combined. Autoimmunity is when the immune system attacks and destroys a part of the body, such as the thyroid gland (Hashimoto’s hypothyroidism), the pancreas (Type I diabetes), or the nervous system (multiple sclerosis). You can have an autoimmune reaction causing symptoms that has not yet been identified as a disease because not enough tissue has been destroyed. Unmanaged autoimmunity keeps the immune system on red alert, which can fatigue the adrenals over time. You can use lab testing to screen for autoimmune reactions.
- Brain inflammation. Chronic inflammation in the body from poor diet, chronic stress, autoimmunity, and other problems can inflame the brain. Common symptoms of brain inflammationinclude brain fog, low brain endurance and slow mental speed. Ask my office about nutritional compounds and strategies that can calm brain inflammation.
Symptoms of adrenal stress are many, because the adrenals (like its buddy, the thyroid) can affect every system in the body and may include:
- Slow going in the morning
- Headaches, splitting headaches especially in the afternoon
- Decreased immunity; difficulty bouncing back from stress or illness or get colds or respiratory illnesses frequently.
- Poor healing
- Sleep issues. Difficulty falling asleep, staying asleep and waking up feeling exhausted even after you had enough sleep and vivid dreams.
- Mood swings
- Sugar, salt and caffeine cravings, (find yourself wanting coffee or caffeinated drinks mid-day? It could be your adrenals)
- Irritability or lightheadedness between meals (a blood sugar and adrenal problem).
- Eating to relieve fatigue (another blood sugar problem).
- Dizziness when moving from sitting or lying to standing (adrenal function affects your blood pressure).
- Gastric ulcers, ulcers in the stomach can be caused by the adrenals
- Allergies have developed or worsened
- You are slow to get going in the morning
- Eating to relieve fatigue
- Low blood pressure or large swings in blood pressure
- You feel tired for no reason.
- You have trouble getting up in the morning, even when you go to bed at a reasonable hour.
- You are feeling rundown or overwhelmed.
- You have low libido.
- You’ve experienced weight gain, especially around your middle, despite your attempts to keep in shape.
- You have mood swings or feel blue or cry for no apparent reason.
- You have begun experiencing headaches, muscle tightness and pain.
- You are having muscle cramps or twitches.
- Your body is sore and fatigued after exercise or you are experiencing poor muscle recovery, without a change or increase in your exercise routine.
- You are experiencing rapid heart rate or you are aware of your heart beating OR your heart rate is very slow.
- You feel breathless from time to time.
- You are having anxiety or panic attacks.
- There has been a change in bowel movements such as constipation or diarrhea.
- You are experiencing hypothyroid symptoms or you’ve needed your thyroid hormone increased.
- You’ve had changes in your menstrual cycles or are experiencing PMS or menopausal symptoms which have changed with the onset of fatigue.
A Little More about Adrenal Glands
The adrenals are two little glands, about almond size that sit on top of the kidneys. The adrenals secrete adrenalin and norepinephrine, dopamine, glucocorticoids, mineralocorticoids and androgens. These are the stress hormones and are critical to every day function.
Of this group of hormones, Cortisol is the star. It regulates blood sugar levels, increases body fat, defends the body against infections and helps the body adapt to stress. It also helps to convert food into energy and is anti-inflammatory.
Weak adrenals can cause hypothyroid symptoms alone without any problem in the thyroid gland itself. In such cases, working on the adrenals themselves may be the key to improving thyroid function. But, in this patient’s case, the adrenal problem highlighted an autoimmune thyroid issue that has been laying silently…until the adrenals mucked up the system.
So, What Will We Do?
Here’s the tricky thing about adrenal stress – you saw the list of causes – These causes must all be addressed simultaneously because they are also all the things that make Hashimoto’s worse. You can’t ignore them or pretend like they aren’t there and we have to deal with all of them. Addressing some of the issues won’t even give you partial results…for this interconnected system, it really is an all or none approach. I’m fortunate to get the opportunity to help this patient. After all her starts and stops, she’s very discouraged, and yet still willing to give me this opportunity to help. Help and better health I did promise, but I warned her it won’t be fast.
First, I’m testing this patients stress hormones – all of them. Once I get her test results back. I’ll help this patient treat her adrenal issues with organic food (let thy food be thy medicine) and specific supplementation based on her test results and current symptomatology. I will be simultaneously addressing gut health and digestion, blood sugar balance, sleep patterns and I will also advise her on exercise (less – much less) and stress management.
Secondly, we will give it time. The problem is a complicated one, but one that can be solved as long as we address all the components at the same time being careful not to tip the scales too far one way or the other. It will take 3 months to start to resolve her symptoms and feel like we’ve gotten good at this balancing act. But, it will take a least an additional 3 months to really heal the endocrine system and ensure that one little thing (stressor, change in diet, life event) won’t throw the whole system out of whack again. That’s the most difficult part in working in functional medicine is that once patients feel better, they think they are healed. They forget that it took months if not years for their endocrine system to back fire and it will takes months and up to a year to get it functioning normally again.
That said, part two of this blog won’t be ready for about 6 months’ time – stay tuned!
FYI: Did you know… that treatment with T4, like Synthroid or Levothyroxine, can actually cause adrenal problems. If someone has adrenal insufficiency, then they are at risk for thyroxine making the problem worse! Even if the adrenal insufficiency is not that bad, it may have an effect on thyroid conversion, tissue uptake, and thyroid response. And not in a good way. This comes from the warning label for Synthroid, but is true of all synthetic T4 drugs:
“Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium. Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone.”
What this means, in plain English, is that in cases of hypothyroidism, the adrenals need to be evaluated before putting patients on thyroid replacement hormone. How many people with Hashimoto’s and hypothyroidism do you think have adrenal insufficiency?
https://cfids-cab.org/cfs-inform/Neuroendocrin/tsigos.chrousos02.pdf – Adrenal stress leads to Hashimoto’s
http://www.karger.com/Article/Abstract/87001 -HPT and HPA responses during repeated stress
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Hashimoto’s Thryoiditis, Izabella Wentz, Wentz LLC publishing, 2013