720 North Tustin Avenue
Suite 104
Santa Ana, CA 92705-3606
Phone: (714) 565-1032
Fax: (714) 565-1035

Jeremy E. Kaslow, MD, FACP, FACAAI Physician and Surgeon
Board Certified Internal Medicine

NOTICE TO CONSUMERS
Medical Doctors are licensed and regulated by the Medical Board of California
(800) 633-2322
www.mbc.ca.gov

Adrenal Dysfunction

The adrenal glands are small but very powerful glands that sit atop each of your kidneys located in the middle of your back.  They are really two separate organs combined into one location - the outer portion called the adrenal cortex and the inner portion called the adrenal medulla.  The focus of this text is on the adrenal cortex.

The cortex serves primarily a hormonal function - among the main functions of the adrenal cortex are the regulation of the mineral metabolism (sodium, potassium, chloride), water balance, metabolism (utilization and distribution of carbohydrates, protein, and fat), allergic and immune reactions (such as hypersensitivity, allergies, and autoimmune diseases), and production of the male and female hormones (progesterone, testosterone, estrogens, DHEA, etc.).

Some of the signs of adrenal insufficiency are often similar to those found in persons who are hypoglycemic.  Some of the more common complaints reported include:

    • Inability to concentrate
    • Excessive fatigue, especially in the morning (hard to get going…)
    • Nervousness and irritability
    • Mental depression
    • Apprehensions
    • Excessive weakness
    • Lightheadedness, especially upon standing up quickly
    • Faintness and fainting
    • Insomnia
    • Frequent infections
    • Intolerance to stress
  • Patients with low adrenal cortex function may have hypoglycemia (or disturbed carbohydrate metabolism) although not all hypoglycemic patients have low adrenal function.  A low flat glucose tolerance curve obtained from an oral glucose tolerance test suggests hypoadrenocorticism but can also reflect reactive hypoglycemia, some form of allergy, gouty or rheumatoid arthritis, or schizophrenia.

When patients receive support for their adrenal cortex (such as with Adrenal Cortex Extract injections), they often report improvements in arthritis, pain in shoulders and back muscles, allergies, premenstrual problems, headache, migraine, ringing of the ears, tension, depression, suicidal thoughts, nervousness, apprehensions, noticeable heart action (palpitations), gastrointestinal problems, heat exhaustion, and an inability in handling stress.

The following physical findings suggest low adrenal function.

  • Skin thin and dry or scaly, pigmentation of temples, red palms or fingertips, and cold clammy palms.
  • Deep Tendon Reflexes are exaggerated.
  • Lymph Gland inflammation of the neck (swelling, pain, or tenderness).
  • Blood Pressure is usually low, and drops upon standing (105/60) and then elevated to (120 or 130/70 or 80) on reclining (postural or orthostatic hypotension). This change from low to higher when lying down may be the reason why many patients find it difficult to fall asleep.  It is conducive to falling asleep to lie in a semi-reclining position for 15 or 20 minutes.  Another way to describe postural hypotension is that there may be a sudden drop in blood pressure to below normal upon suddenly arising from bed, or from standing still, causing temporary darkening of vision, dizziness, light-headedness, faintness, or fainting.
  • Body Conformation is of the thin muscle-type (this is called asthenic habitus). The typical person is also tall with an angular appearance but a shorter person may have what we call "signs of tallness" - a moderately long neck, an index finger longer than the 4th (ring) finger, and a 2nd toe longer than the big toe.  There are long arms and legs, and the arm span is greater than the height.
  • Hair is sparse on the body but there is usually a full head of fine and abundant hair. The typical person is blond and blue eyed, or red headed. A tall, thin blonde with skin allergies can be diagnosed immediately.
  • Dentition shows crowded lower teeth with a high palatal arch (roof of mouth).
  • Pain and tenderness over adrenal area of mid-back when pressure is applied (called Rogoff's sign).
  • Urination is either very frequent in small amounts or infrequent in large amounts.  This person usually does not do well in the heat or in the summer, particularly in conditions of high temperature, high humidity, and low barometric pressure.
  • Scanty perspiration (except under arms or hands and feet). This person may be a "salt loser" (the tendency is to lose salt and to retain potassium). The urine and perspiration of the salt loser is saltier than normal and there is consequently a greater salt concentration on the skin. Animals are attracted to the salt on the skin, and often the low adrenal patient will be a favorite of animals to lick.
  • Ankle and/or Finger Swelling. John Tintera, M.D. was an early pioneer in recognizing and treating adrenal insufficiency.  He wrote that salt is a diuretic and that hypoadrenocortics (patients with low adrenal cortex function) retain fluid because the body is trying to hold onto the salt.  When enough salt is consumed, the body takes what it needs and excretes the rest.  If the ankle edema is due to insufficient salt, the edema will usually disappear in three days after taking adequate salt.  If it does not disappear in five to six days, potassium may also be needed.  Vitamin B6 is also helpful for edema not only because it has a diuretic effect but also supports the adrenal cortex.
  • The Importance of Salt

For the person with depleted adrenals sunbathing on the beach can have devastating results.  The salt loser that attempts to function on low salt does not understand why he feels faint, or is suddenly unable to function in the heat, or he feels his mind is cloudy and his energy gone.  He may become very weak, tired, and depressed.  Salt is needed for the electrical function of the heartbeat, to make hydrochloric acid in the stomach, and for the fluid around the cells.  Sodium is the principal fluid outside of the cell (extra-cellular fluid) and as a result affects the proper function of all cells.  The nerve cells of the brain, and consequently all of our emotions, are affected by the salt levels.  Adding enough sodium chloride (salt) to the diet may be all that is needed for some patients.

Even other types of conditions, like kidney disease, need "some" salt and should have a moderate amount.  According to Richard H. Ahrens, Ph.D. of the USDA and an Associate Professor of Nutrition at the University of Maryland, salt use does not cause hypertension as is frequently claimed.  There should be no salt restrictions during pregnancy and no diuretic use.  If there is edema in pregnancy, extra salt brings about diuresis.  It can be a serious mistake for an individual to avoid salt for no apparent reason.  For any loss of body fluids - excessive perspiration or urination, vomiting or diarrhea - the lost salt must be replaced.  A person with undiagnosed adrenal dysfunction (who is therefore a salt loser) on a salt restricted diet may be slowly deteriorating as the result.

There appears to be no food that naturally contains more sodium than potassium and therefore salt must be added to the diet.  This is why Gandhi led the revolution in India.  Salt is essential to life.  In Addison's Disease, where there is a complete non-function (atrophy) of the adrenal cortex, patient's can suffer from prostration, die from excess perspiration or a diet high in potassium or low in sodium.

To find the amount of salt you need, gradually increase your salt intake until you find the amount you feel best on - usually 2 to 10 grams or roughly 1/2 teaspoonful to 1 tablespoonful. After determining the amount, try to cut back and see if that is just as effective.  The addition of a small amount of sugar actually helps you absorb salt. In fact this is the basis for many popular electrolyte replacement products like Gatorade.  Some individuals may also need potassium.

There are several types of salt – table salt, Sea salt, Himalayan, etc.  Many may suggest using sea salt, but in the larger amounts that hypoadrenocortics need, there is some question of possible overdose on trace minerals.  The name trace minerals means one needs only a trace amount.  The main minerals and electrolytes such as calcium, magnesium, sodium, potassium, phosphorus, iron, iodine, and zinc are needed in larger amounts on a regular basis.  Diamond Crystal Kosher Salt is plain sodium chloride without additives.  When dissolved in water, it results in a clear solution indicating no additives.  Himalayan Salt is unique in its crystal properties and has a different taste than other salts.

Adrenal Steroids

The adrenals have a close connection with the sex glands, the ovaries and testes.  The adrenal cortex produces about 25% of the estrogenic hormones in women and 65% of the androgenic hormones in the man.  The inability of the adrenals to produce the additional sex hormones may result in the flat chested female or the sparse chest-haired male.  In patients in their thirties or older may also have an absence of hair on the lower two-thirds of the legs, which is not due to being worn off by the trousers as is supposed.

There can be a great variation possible among the large numbers of adrenal steroids, causing a person's individual physical characteristics to vary widely from the typical.  These variations may bring on precocious sexual development in boys and girls. They also cause changes in adults in psychological makeup and direction of sexual desire, or can actually produce feminism in men and masculinity in women.  This of course does not have anything to do with sexual orientation.

Hypoadrenocorticism rarely exists without involvement of other glands and organs.  The liver must detoxify each and every substance in the body. This includes not only medications and drugs, but also hormones produced by your own body.  Thus the effectiveness of the adrenal in part depends on the efficiency of the liver.  The laboratory tests commonly called "liver function tests" in fact do not tell how the liver is functioning but rather only tell if the liver is inflamed or injured.

Stress and the Adrenals

It is absolutely necessary to remove the dietary stress, sugars, excess or processed starches, caffeine, alcohol, stimulant drugs, and as much nicotine as possible. To rejuvenate the adrenal cortex extra vitamin C, salt, and fat - both saturated and unsaturated is needed. Avoiding animal fats, as seems to be the popular thing to do, is avoiding the kind of fat adrenal hormones, estrogens and androgens are made from. The adrenals contain more vitamin C and cholesterol than any tissue in the body. Avoid or reduce excessive heat, cold, overwork, lack of sleep, arguments, diseases, and the like. Oxygen is necessary for the utilization of glucose by the body, and proper breathing must be practiced. Rest periods and relaxation is necessary with a bedtime no later than 11 p.m.

A discussion on stress should include recognition of Dr. Hans Selye. His classic work on stress (The Stress of Life, McGraw- Hill Book Co., N.Y.) and his many other publications report "that our various internal organs, especially the endocrine glands and the nervous system, help to adjust us to the constant changes which occur in and around us. He calls this adjustment the General Adaptation Syndrome. Selye concluded that the adrenals were the body's prime reactors to stress. He stated that the adrenals "…are the only organs that do not shrink under stress; they thrive and enlarge. If you remove them, and subject an animal to stress it can't live. But if you remove them, and then inject extract of cattle adrenals (cortex), stress resistance will vary in direct proportion to the amount of the injection, and even be put back to normal." Likewise a person's stress resistance will vary with the competence of his adrenals, but continually stressing the adrenals finally depletes them.

As with all chronic conditions, there are five things that must be addressed in order to be successful:

  • Give the body the nourishment it needs to heal itself. n this case, vitamins C, B5, and B6, salt, and select minerals are often required.  More specific nutritional support is usually necessary at least in the initial treatment phase.
  • Avoid those things or activities that will make you worse. Stress, sugar, and caffeine top the list.
  • Detoxify or de-infect something that needs to be removed from the body in order to heal. Hypoglycemia, as is the case in many patients, often is associated with yeast overgrowth from excess sugar intake.
  • Release unresolved emotional conflicts.
  • Align and Restore Neural Pathways and Structures

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