Adrenal Fatigue - Canpweb
DMAR Intuitive Integrative MedicineAssessing and TreatingAdrenal FatigueDeborah Maragopoulos MN FNP-BCcopyright 2014 DMaragopoulos
Adrenals: Mediator of Stress Atop of kidneys Ad-RenalsMediator of response to environmentThe only endocrine gland that responds to Hormonal stimulusNeural stimulusHumoral Stimuluscopyright 2014 DMaragopoulos
copyright 2014 DMaragopoulos
Adrenal Stimuli Hormonal hypothalmaic-pituitary axis drivenby a negative feedback system ofglucocorticosteroids and androgens (cortisol,cortisone, and DHEA)Humoral blood born stimuli like electrolyteimbalance to release mineral-corticosteroids(aldosterone)Neuronal CNS directly drives ANS responseto release peptides (adrenaline andnoradrenaline)copyright 2014 DMaragopoulos
Hypothalamic-Pituitary-Adrenal Axis Stress response induces hypothalamic production ofproopiomelanocortin (POMC)- a 242 AA polypeptidePOMC breaks down to cortico releasing hormone (CRH)in response to low glucocorticoids, hypoglycemia, fever,stressPOMC also breaks down to thyroid releasing factor(TRF), glucose releasing factor (GRF), melanocytestimulating hormone (MSH) and endorphinsCRH stimulates pituitary release of adrenocorticotrophichormone (ACTH) - a 30 AA polypeptideACTH stimulates adrenal cortex release of cortisol withnegative feedback loopcopyright 2014 DMaragopoulos
copyright 2014 DMaragopoulos
Real or Perceived StressSame Reaction Phase I: CNS stimulates adrenal medulla release ofadrenalinePhase II: ACTH stimulates adrenal cortex release ofcortisol Cortisol stimulates pancreatic release of glucagon which releasesstored glycogen from liver and musclesGlycogen broken down to glucose which stimulates pancreaticrelease of insulinInsulin escorts glucose into cells to fuel fight or flight responsePhase III: cortisol converted into anti-inflammatorycortisonePhase IV: DHEA rises in response to rising cortisol tometabolize protein and fat to repair tissue damaged inthe flight or fightcopyright 2014 DMaragopoulos
copyright 2014 DMaragopoulos
Stress affects Everything Adrenals use resources from liver and ovaries tomake corticosteroidsResources for POMC will be driven towards CRHto stimulate ACTH at the expense of TRH, GRF,MSH, endorphinsStress taxes the adrenals, then the pancreas,then the thyroid, while disrupting circadianrhythm and depleting endorphinscopyright 2014 DMaragopoulos
copyright 2014 DMaragopoulos
Adrenal control of Blood Pressure Stress induces HPA axis to stimulate hormonal release of mineralcorticoid AldosteroneAldosterone targets kidney tubules to increase sodium and waterabsorption and increase potassium excretion increasing bloodvolume and BPIf blood volume or BP too high kidneys produce renin to stimulateangiotensin cascade and lower blood volume by diuretic effect ofincreased water and sodium excretionDecreased serum sodium and increased potassium also stimulateshumoral release of aldosteroneWhen blood volume and blood pressure is high, heart producesatrial natriuretic peptide (ANP) to inhibit adrenal aldosteroneproductioncopyright 2014 DMaragopoulos
copyright 2014 DMaragopoulos
Cortisol Circadian Rhythm Normalizes at 2-3 months of ageHighest during day, lowest at nightNormal fall in afternoon (siesta)Bursts throughout day: At dawnPost-prandialExerciseStress reactioncopyright 2014 DMaragopoulos
copyright 2014 DMaragopoulos
Abnormal Circadian Rhythm Cortisol suppresses melatonin: insomniaHigh cortisol high DHEA: acute stressresponseHigh cortisol low DHEA: chronic stressresponseIf low daytime cortisol: adrenal fatiguecopyright 2014 DMaragopoulos
DHEA: dehydroepiandrosterone Zona reticulum produces DHEA19 carbon steroid: adrenal androgen3 β hydroxysteroid dehyrogenase converts DHEA intotestosterone and then into estrogenConverts into 17 carbon ketosteroid in first hepaticbypass: active hormone (7-keto DHEA)Converts into androstendione causes secondary sexcharacteristicsAdrenarche begins age 6-7 through 13-15 precedeslinear growth spurt by 2 years, as well as rise of sexsteroidscopyright 2014 DMaragopoulos
DHEA Diurnal Rhythm DHEA production thought to be stimulated byACTH, but actually follows cortisol productionDHEA unconjugated half-life 30 minConjugated in liver to DHEA-S to last 24 hoursDHEA: essential to fat/protein metabolism,promotes tissue rejuvenation, skin, bone,muscle-skeletal and smooth musclecopyright 2014 DMaragopoulos
Adrenal Fatigue Most common complaint is unusual fatigueUsually follows a major stressor- energy upwhile dealing with event, crashes afterwardsEarly deficiency: fatigue begins about 3pm andcannot recover without caffeine and sugarChronic deficiency: pt wakes up with fatiguecopyright 2014 DMaragopoulos
Symptoms of Adrenal Fatigue Low energy, mental fatiguePoor resistance to stressEmotional labialityDizziness with position changeHeadachesAllergiesCold intoleranceFood cravings: sugar and fat if low cortisol, saltif aldosterone also lowcopyright 2014 DMaragopoulos
Signs of Adrenal Fatigue Loss of scalp hairIncreased body hair in early stress then loss ofpubic hair chronic DHEA deficiencyMidline weight long term stress induces insulinresistanceStriae from rapid high corticosteroid productionbefore declineHyperpigmentation/ vitiligoPoor muscle toneAuricular calcificationcopyright 2014 DMaragopoulos
Testing Adrenals BP test have pt lie down for five minutes, take supineBP, then immediately stand pt upBP should rise 20 points diastolic and systolicInsufficient rise of BP adrenal stressNo rise adrenal deficiencyBP lowers adrenal fatiguecopyright 2014 DMaragopoulos
Adrenal Lab Studies Blood Cortisol: most useful to diagnose Cushing's orAddison's, check early am, rises with the stressACTH: in ratio to cortisolDHEA-S: more accurate, but reflects hepatic functionso if low, confirm with am unconjugated DHEASaliva: tissue levels can determine circadianadrenal functioncopyright 2014 DMaragopoulos
Treatment of Adrenal Fatigue Sleep in dark to normalize circadianrhythms, daytime naps if neededEat well balanced diet, do not skipbreakfast, avoid sugar and use scopyright 2014 DMaragopoulos
Adrenal Adaptogens Ashwanganda- vitalizer, calms CNS, reducesmental and physical fatigue (300-600mg/day)Astragalus- supports immune function, not foracute infection, use long term, improvescardiac circulation (300-600mg/d)Eleuthero- balances corticosteroid production(200-400mg/d)copyright 2014 DMaragopoulos
More Adaptogenic Herbs Ginseng- moderates cortisol production viaACTH regulation thus enhancing DHEA,raising energy and libido, improves immunity(300-600mg/d)Licorice- supports adrenals, aldosteroneeffect, increases conversion of testosterone toestrogen (200-400mg/d)Rhodiola- maintains healthy adrenalcatecholamine activity, cardioprotective,supports healthy glucose metabolism (100200mg/d)copyright 2014 DMaragopoulos
Glandulars Glands of animals usually bovine or lamb takenin powder, capsule or elixir formStudies show that supplemental glandularuptake by the target gland until glandrejuvenatedAfter 6 months liver treats supplement as toxinSupports and balances adrenal function Whole adrenal- 300-600mg/dAdrenal cortex- 160-320mg/dcopyright 2014 DMaragopoulos
Nutraceuticals to support Adrenals Vit B5- panthothenic acid: needed for proper functionof adrenal glands, helps convert fat, prot, carb intoenergyVit B6- as activated P5P (pyridixal 5’ phosphate):supports carb, prot, fat metabolism, facilitates releaseof glycogen, balances aldosteroneVit C- antioxidant, needed for proper adrenal functionPhosphatidyl serine: regulates HPA axiscopyright 2014 DMaragopoulos
Integrative Nutritional Support Genesis Gold supports entire endocrinesystem (adaptogens and micronutrientcofactors to support adrenal function aswell as balance HPA axis)Sacred Seven amino acid blend supportsproper hypothalamic function, use forthree months if HPA axis compromised ormore than one endocrine gland deficiencycopyright 2014 DMaragopoulos
Bio-identical Hormones Cortisol transdermal 1-3mg bid-tid not afterdusk, 6 d/wk 2-3 month therapy and wean offslowlyDHEA SL 12.5-50mg am, 6d/wk for 8 weeks,then wean by one more day off per week every4-8 weeks until offProgesterone transdermal 50-100 mg bid inluteal phase, 25mg qhs if symptomatic infollicular phase, break 3d/month w/menses. Ifmenopausal: 50-100mg qhs-bid, off 3days/monthcopyright 2014 DMaragopoulos
Case Study: 57y/o female artist“crashed” c/o low energy, anxiety, weepiness, nausea, musclespasms, weakness, blurry visionG3 P2 SAB1, smoker 1ppd x 30 years, Hep C, seesrheumatologist for FM who recently Rx dyazide for HBP,on synthroid 100mcg x 20 yrs, cryoglobinemia, BHRT: E21mg TD, P4 50mg TD, no suppsHPI: lost 18# in 1 yr due to stress, had to move in withdaughter in LA, out of work for months, down with flu x2wks, never recovered & began physical labor - nightshifts x 10wks, since then has crashedcopyright 2014 DMaragopoulos
Physical Exam 66”, 152#, 146/84, 82Orthostatic BP lying 130/80, standing120/74Mesomorphic build w/ loss of muscle tone,loss of dermal collagencopyright 2014 DMaragopoulos
Assessment Adrenal fatigueHypothyroidHypothalamic imbalanceMenopausalMild HTNcopyright 2014 DMaragopoulos
Treatment Plan Blood: chem, cbc, endocrine panelGet back on Genesis Gold 9gm qam to providefoundational support for endocrine systemADR 2 caps bid (adaptogenic/glandular)Then 1 wk later start Adrenal Cortex drops 1dropperful am, ½ dropperful 3-5pm, not afterdark!Switch from dyazide to Norvasc 5mgStart vision board for “dream job”copyright 2014 DMaragopoulos
Intuitive Integrative Medicinecopyright 2014 DMaragopoulos
Psycho-spiritual approachAdrenals reflect 3rd ChakraBalance of Power Emotion and Will balance in Third ChakraSymptom of modern life Reality of Stress is a matter of perceptionIssue of Evolving Human Consciousness Choosing Love over Fearcopyright 2014 DMaragopoulos
1 wk F/U Labs: nl LFT DHEA-S 41 ug/mlTSH 2.25, fT4 1.55 fT3 3.0Vit D3 24.8FSH 70, LH 371 wk on Norvasc BP 126/78copyright 2014 DMaragopoulos
Recommendations DHEA SL 50mg 6d/wkVit D3 liquid 5000iu w/ fatInc BHRT dose: E2 2.5mg & P4 100mg qd,contin x 3moCounseled regarding “powerlessness”Let go of old story! Invite New!copyright 2014 DMaragopoulos
Third Chakra Spiritual Healing Help patient make conscious effort toChoose Love over FearLive in moment rather than living in past (regret)or living in future (worry)Be Open to Receive Joycopyright 2014 DMaragopoulos
PC appt: 2 months later BP running 120-130/78-88Inc hormones helped weepinessEnergy good, sleeping more deeplyHad to put old dog down, sad but knew death precedesbirth (extensive counseling over the yrs w/pt)Reconnected with old artist friend and now working withhim at her dream jobReally happy, self esteem raised, couldn’t do it w/oadrenal support!Still not at full physical strengthcopyright 2014 DMaragopoulos
Recommendations Add Proenhance AA 3gm qhs to inc HGHand muscle strengthRecommend to take breaks during the dayto prevent crashStay on adrenal support, DHEA, GGPlan to wean down adrenal cortex in threemonthsRecheck blood in 3 monthscopyright 2014 DMaragopoulos
Nutraceutical Resources Hormone and Hypothalamic Support:Genesis Gold and Sacred Seven http://genesisgold.com/wholesale- 396.htmlor call 805-640-3340Supplement Companies I use: Prolabs (Adrenal Cortex, Proenhance)http://www.progressivelabs.com/Pure Encapsulations (ADR)http://www.pureencapsulations.com/copyright 2014 DMaragopoulos
Deborah Maragopoulos MN FNP-BCCreating Joyous Transformations –Body, Mind, & Soulcopyright 2014 DMaragopoulosGenesis Health Products, Incwww.genesisgold.com
Adrenal Fatigue Most common complaint is unusual fatigue Usually follows a major stressor- energy up while dealing with event, crashes afterwards Early deficiency: fatigue begins about 3pm and cannot recover without caffeine and sugar Chronic deficiency: pt wakes up with fatigue
Adrenal fatigue is a stress condition that may inflict many of us from time to time. One of the best ways we can tackle it is through eating more of the healing foods that promote stronger adrenal health. 1. Lemon Many people with adrenal fatigue have a high acid body and lemon is the
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Adrenal Fatigue sufferers Free Gift! Dorine Lam, MS, MPH, RDN Dr. Michael Lam, MD, MPH. Page 2 Page 3 Introduction These recipes are designed for those battling Adrenal Fatigue Syndrome (AFS). It is an attempt to rebuild the body’s nutritional baseline through a fundamental facet of life: food. As a
Mar 28, 2017 · 1. Identify the definition of Chronic Fatigue Syndrome (CFS) and Fibromyalgia syndrome (FMS) 2. Recognize underlying hormonal patterns at play in both Chronic Fatigue and Fibromyalgia 3. State the importance of proper adrenal support in the successful treatment of both illnesses 4. Identify some of the common signs and symptoms of adrenal .
“adrenal fatigue” Adrenal Crisis When a patient is suspected of su ering from adrenal insu ciency and concurrently shows signs of possible adrenal crisis (typically, persistent vomiting with profound muscle weakness, low blood pressure or even shock, extreme sleepiness or even coma) the patientFile Size: 1MBPage Count: 8
illnesses such as adrenal fatigue. Treating and Beating Adrenal Fatigue: Boost your Adrenal Function and Feel 10 Years Younger A Special Report by Dr. Rodger Murphree The adrenals are a pair of pea-sized glands located atop each kidney. The ad-renal gland consists of two sections: the medulla (inner portion) and the cortex (outer portion).
Adapted from Netter Adrenal carcinoma Adrenal adenoma Pituitary adenoma Adrenal cortical hyperplasia Dorsal fat pad Ecchymoses Thin skin Thin arms & legs Poor wound healing Moon face Striae Pendulous abdomen C O R T I S O L Cushing Syndrome ACTH-producing tumor Hydrocortisone Excess
Principles of Animal Nutrition Applied Animal Science Research Techniques for Bioscientists Principles of Animal Health and Disease 1 Optional Physiology of Electrically Excitable Tissues Animal Behaviour Applied Agricultural and Food Marketing Economic Analysis for Agricultural and Environmental Sciences Physiology and Biotechnology option Core Endocrine Control Systems Reproductive .
