Dr. John, Adrenal Fatigue and Exercise
- 05-14-2007, 08:38 PM
Dr. John, Adrenal Fatigue and Exercise
Ive asked similar questions to this before in other threads but never received a definitive reply, from you, or anyone else.
I know you deal with people who have adrenal fatigue and AF/thyroid issues and I was wondering on your recommendations for exercise and recovering enough for exercise.
UP until last august, I was avidly into bodybuilding and related activities. Had also started planning on doing a triathalon. Then August came and I crashed. Noticed the low test first, got on androgel. Then came the isocort in december, followed by armour in early january and cortef in early february.
Since january, I have not exercised or really been able to excercise besides a 30-40min casual walk a day. Its been almost four months, and even now, on 35mg of cortef and working my way around 2 grains armour I still feel eh.
At what point will I begin to exercise again? when, how, and in what way would you encourage this? Its always been a big part of my life and I miss it and am hoping to start back up again soon. The last time I tried (30min light elipse) I crashed real hard. temp the next morning was 96.5. I slept very poorly and felt shaking, hypoglycemic all day as well as 'strung out'.
- 05-15-2007, 03:17 AM
I'd be very interested to hear what the Doctor has to say about this also. I am in almost exactly the same boat (conditions and meds).
- 05-15-2007, 02:53 PM
Thanks for the input Dr. John. Actually we haven't gotten me completely tuned up yet (mostly fatigue) but things are improving and are a heck of a lot better than before. I suspect in my case it is because of feeling steadily worse for 18 years with the last 4 being much worse (probably going to take a while to turn things around). I'll make a note to ask you about it next appointment. I think the key for me now is just very slow and steady progress in adding activity.
05-16-2007, 10:47 AM
im actually in the same boat. I meant that I was hoping to do a triathathon LAST AUGUST, before I 'crashed'. Now, its hard to manage cutting the lawn, or walking for more than half an hour. Im wondering how I go about slowly adding exercise back in, and when? At 35mg of cortef, I know my dose is 'up there' a bit. And ive now managed to get my armour over 2 grains, but my temps are still low...actually lower than they were at times at .5 and 1 grain. but i know im not 'pooling' anymore because i dont have the hypo/hpyer feelings going on.
So, should i still be holding off exercise (its been 4 months) or can i start trying lifting and cardio? and what should i do to 'brace' my body before attempting?
05-16-2007, 02:15 PM
Scottyo it may will be your this sick do to your training so I would think more about getting better then workingout. Read this thread at MESO.
#118 by Dr. Mariancio.
Adrenal fatigue is analogous to an overtrained muscle. The muscle still can work. However, it is weaker and may lose muscle mass because the owner of the muscle has not had adequate rest or nutrition to build the muscle either in strength or endurance. This is a principal known to bodybuilding. Any stress, positive or negative, results in stimulation of the adrenal glands to produce its hormones and to grow. Without adequate rest and nutrition, the adrenals (like a muscle) wears down and has more difficulty in producing its hormones.
When given a short period of rest (such as some sleep or lack of activity for a few hours), the adrenals can rally and produce enough hormones so that blood tests of cortisol, for example, are normal or even high (when stressed). But ultimately, the adrenals can be shown to have periods when it has difficulty producing cortisol and the other hormones. I liken this to the adrenals “sputtering” - as a car engine sputters when the electrical system (analogous to the adrenal glands) is not working well. The amount produced is usually not below the reference range of the blood test. If below the reference range, the adrenals have failed and you have adrenal insufficiency, which is life threatening. In adrenal fatigue, a person still makes enough cortisol to live - though their life is suboptimal (e.g. chronically bedridden, depressed, fatigued, etc.).
In other posts he talks about becoming sick do to over training do a search there and read them.
05-16-2007, 02:40 PM
Here is the post I was looking for.
#150 (permalink) 04-28-2006, 12:40 PM
Doctor of Medicine Join Date: Nov 2005
Location: Monterey, California, USA. See Profile for contact info.
Adrenal fatigue = OVERTRAINING
Originally Posted by eliteballa3 "Why is my DHEA so low"
im relooking over my lab rsults and my dhea is 212 range is 180-1250 why is it so low and what can i do about it i do have a ton of dhea at my house.
Lab findings consistent with adrenal fatigue include:
1. low normal cortisol
2. low DHEA
3. low to low normal progesterone
4. low sodium
5. low potassium
6. high albumin
Bodybuilding is a severe nervous system, endocrine system, immune system stress.
The bodybuilding literature has numerous articles about the need for rest to allow muscles to recover from the damage induced by weight training, to grow in adaptation to the progressively higher stress levels due to progressively higher weights used. It is important to avoid OVERTRAINING - since overtrained muscles may fail to adapt to the stress and shrink rather than grow. Some of the top bodybuilders give each muscle about a week of rest between intense weightlifting exercises.
What is not often realized is that the nervous system, endocrine system, and immune system also have to rest and recover from the stress of weight lifting. Central to this are the adrenal glands - which is a component of all three systems. Just as one's muscles fatigue, the adrenals fatigue in response to weight lifting.
One symptom of adrenal fatigue is hunger or a sensation of low blood sugar - since one's body has more difficulty during adrenal fatigue in producing blood sugar and in burning fat and protein for energy. Many people get the munchies after weight traning and gain a lot of fat rather than muscle.
Other symptoms include the sensation of being "burned out", lack of sex drive, impaired attention, depression or anxiety, insomnia, etc.
Adrenal fatigue is a sign of OVERTRAINING.
Adrenal fatigue indicates one has not recovered their neuroendocrine and immune system well enough before embarking on another round of weight lifting stress.
Each person has a unique time for recovery of the adrenal glands.
One cannot goad or force the adrenal glands to recover faster. The elements of treatment are time and stress reduction.
The treatments of adrenal fatigue essentially reduce the adrenal glands' workload/stress, thus allowing them to rest while one is still active and stressed in life. But the adrenal glands will still need time to recover.
Often, a common time frame for recovery from moderate adrenal fatigue is about 6 months of rest.
More severe adrenal fatigue (e.g. where one cannot exercise or at worse, where one is essentially nonfunctional and bedridden) may take up to two or more years of total rest without stress to fully recover.
Reducing one's stress during the recovery period is highly important to improve the rate at which the adrenal glands recover from fatigue. Some bodybuilders take periodic time off from bodybuilding (e.g. some take at least 6 weeks off) to recover from signs of overtraining (e.g. hitting a wall or plateau, feeling burned out, etc.).
It is interesting how many bodybuilding products contain stimulants (such as caffeine). These not only work in the brain, but they also goad the adrenal glands to work harder against the stress of weight lifting. These stimulants, however, are a significant stress, to the adrenal glands. Eventually, adrenal fatigue may occur. One adrenal fatigue occurs, the stimulants stop working or don't work well at all.
Any statement I make on this site is for educational purposes only and will change as medical knowledge progresses. It does not constitute medical advice, does not substitute for proper medical evaluation from physician, does not create a doctor/patient relationship or liability. If you would like medical advice, please make an appointment. Thank you.
05-17-2007, 10:20 AM
I dont doubt that that was part of the cause. But I have been away from exercise for 4 MONTHS now. How much longer am I going to have to 'recover'? Even before those 4 months, I had stopped working out hard since mid-august. Im wondering what Dr. John's input on the length and method of recovery is?
05-17-2007, 01:02 PM
06-05-2007, 01:16 AM
MMMM.......just me doing more research.....my SHBG is not high....does this rule out adrenal fatigue... i also had a 3yr hiatus from the weights....
06-05-2007, 07:45 AM
Hint when ever xylene is low ssupect estrogen imbalances and gluthione depletion..glycine is not going to fix it as they say but rather correcting estrogen imbalnace and raising gluthioine levels
06-05-2007, 10:08 AM
When suspecting that this is a way to go, would it not make sense to try first tonns of probiotics, just in case.
For example I take Primal Defense, one pill daily instead of recomended 3.
Someone who suspects problems in this area could tripple the recomended dose of 3 pills daily for 3 months and see what happens. I look at least as cost effective possibility.
Information About the Organic Acid Test (OAT)
In which conditions is the test useful?
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Depending on test results, suggestions can include:
Diet supplementation, primarily with nutrients which increase the quantity of beneficial bacteria (e.g. lactobaccilli) in the GI tract
Oral antifungal or antibacterial (anaerobic) medications
Vitamins and Antioxidants
Reduction of exposure to toxic chemicals
Benefits of the Organic Acid Test
Measures 65 important compounds for overall health
Focuses on detecting yeast and bacteria byproducts that have been implicated in many disorders
Requires a first morning urine sample only
Consultation on results is included with each test from The Great Plains Laboratory
Test with the experts - The Great Plains Laboratory holds one patent (*) on this test and two others pending.
06-06-2007, 12:27 PM
ahhh this is a deffinite topic i want to go over with Dr. SHippen.
06-07-2007, 02:12 PM
i did the whole anti-fungal diet with nystatin plus HUGE loading of probiotic supps...and continue to use the probiotics.
hasnt really helped my subjective feeling much. still have bad adrenal fatigue (up to 42.5mg cortef) and up to 2.75grains armour and my temp still steady around 98.1...not going up.
so not sure what to say. Also, as an update....still no working out yet since January. WTF?
06-07-2007, 07:23 PM
06-13-2007, 04:20 PM
I had my Dr. check them and low and behold I am bad now I am on .1 mgs. of Florinef. My fatigue is gone I can now go outside and not feel sick do to the heat. I am back at the Old Persons Club working out in there gym again and feeling better after going in 3 days a week for 90 mins. Man I can't tell you how much better I feel.
Here is a cut and paste for the link.
Regulation and Actions of Aldosterone
Adrenal Fatigue and Craving for Salt
As mentioned in the “Anatomy” section, aldosterone is manufactured in the zona glomerulosa of the adrenal cortex. Like coritsol, aldosterone follows a diurnal pattern of secretion with its major peak at around 8:00 AM and major low between midnight and 4:00 AM. Also like coritsol, its production and secretion increases and decreases in response to stimulation of the adrenal cortex by ACTH. This means that aldosterone levels generally rise in stressful situations. However, aldosterone is not part of the negative feedback loop controlling its release. Instead, it depends on the negative feedback loop in which coritsol levels trigger ACTH activity. This means that coritsol determines the amount of ACTH which controls production of both coritsol and aldosterone with aldosterone having no say in the matter.
The only thing the cells that produce aldosterone can do to regulate production is to alter their sensitivity to ACTH. Therefore, after about 24 hours, the adrenal cells of the zona glomerulosa become less sensitive to the demands of ACTH and stop manufacturing more aldosterone. The amount of circulating aldosterone then begins to decrease, even though the ACTH levels are high and the need for increased amounts of aldosterone may continue. This decreased production continues until the cells of the zona glomerulosa recover their sensitivity to ACTH, but in the meantime the decreased aldosterone leads to many of the symptoms of adrenal fatigue.
Aldosterone is the most important mineralocorticoid, but corticosterone and desoxycorticosterone are also included in this category. The effects of aldosterone depletion can be observed in a large number of hypoadrenic persons. Aldosterone depletion may create one or more different symptoms which are specifically related to the diminished mineralocorticoid levels.
In the chronically stressed person, the levels of sodium and chlorides in the urine should be measured as well as the specific gravity in the urine. Chlorides in the urine are measured by Koenisburg’s test. This test also provides information of the sodium levels being excreted in the urine. Excessive sodium in the urine is one of the first clues that a person has a hypoadrenic problem.
Aldosterone is responsible for the maintenance of fluid (water) and the concentration of certain minerals (sodium, potassium, magnesium and chloride) in the blood, the interstitial fluid (area between the cells) and inside the cells. Working with other hormones such as anti-diuretic hormone from the pituitary and rennin and angiotensin I and II from the kidneys, aldosterone keeps the fluid balance and salt concentration intact, in roughly the same concentration as sea water. In the blood and interstitial fluid, sodium is the most dominant of the four minerals. Inside the cells, potassium has the highest concentration. These four minerals are called electrolytes because they carry minute electrical charges. These electrolytes are very important for proper cell function and fluid properties and they must remain in a relatively constant ratio to each other and to the body fluids. Small deviations in their ratios to each other, or to their concentration in the body fluids, means alterations in the properties of the fluid, the cell membrane and the biochemical reactions within the cell. In fact, most of the physiological reactions in the body depend in some way on the flow or concentration of electrolytes.
Aldosterone, in times of stress is the major director of these relationships by its influence on sodium and water concentrations. Although this interaction is somewhat complex, the overall process is easy to understand if you just keep an eye on the sodium in relation to aldosterone. As the concentration of aldosterone rises, the concentration of sodium rises in the blood and interstitial fluid. Wherever sodium goes, so follows water.
In adrenal fatigue, the craving for salt is a direct result of the lack of adequate aldosterone. As mentioned above, aldosterone controls sodium, potassium and fluid volumes in your body. When aldosterone secretions are normal, potassium, sodium and fluid levels are also normal. When aldosterone is high, sodium is kept high in the fluids circulating in your body.
However, as circulating aldosterone levels fall, sodium is removed from your bloodstream as it passes through the kidneys and is excreted in the urine. When sodium is excreted it takes water with it. Initially, there is some loss of volume of your body fluids but it does not become severe unless the condition worsens. Once your circulating sodium level drops to about 50% of its original concentration in body fluids, even a small loss of sodium or sodium restriction in your diet begins to have severe consequences. Tiny fluctuations in blood sodium concentration have a significant effect o blood volume when sodium is depleted to this level.
When the sodium supply of the blood is not replenished by eating salt-containing foods or liquids, sodium and water is pulled from your interstitial fluids into the blood to keep your blood sodium levels and water volume from getting too low. If too much salt or fluid is pulled from the interstitial fluids, the small amount of sodium in the cells begins to migrate out of the cells into the interstitial fluid.
The cell does not have a great reserve of sodium because it needs to maintain its 15:1 ratio of potassium to sodium. As the sodium is pulled from the cell, water follows the sodium out.
This leaves the cell dehydrated as well as sodium deficient. In addition, in order to keep the sodium/potassium ratio inside the cell constant, potassium then begins to migrate out in small quantities. However, each cell has minimum requirements for the absolute amounts of sodium, potassium and water necessary for its proper function. When these requirements are not met, cell function suffers, even if the proper ratio is maintained.
If you are suffering from moderately severe adrenal fatigue, you must be careful how you re-hydrate yourself. Drinking much water or liquid without adequate sodium replacement will make you feel worse because it will dilute the amount of sodium in your blood even further. Also, your cells need salt to absorb fluids because sufficient sodium must be inside the cell before water can be pulled back across the membrane into the cell.
When you are already low on body fluids and electrolytes, as you are in this situation, you should always add salt to your water. Do not drink soft drinks or electrolyte-rich sports drinks, like Gatorade, because they are high in potassium and low in sodium, the opposite of what someone with low coritsol levels who is dehydrated needs. Commercial electrolyte replacement drinks are designed for people who produce an excess of coritsol when exercising, not people who are low on coritsol and aldosterone. Instead, yo are much better off having a glass of water with ¼ - 1 teaspoon salt in it, or eating something salty with water to help replenish both sodium and fluid volume.
In a nation of people suffering from adrenal fatigue, the fast food restaurants come to the rescue. Such restaurants use an excessive amount of salt in their foods; a custom left-over from the old road houses where lots of salt was used in the food to stimulate appetites and whet the thirst (for alcohol, the biggest profit item). Although not a good solution, it supplies “emergency” rations daily to people living in marginal health. It averts the crisis and replenishes their supplies for another few hours.
When your aldosterone levels are low and you are dehydrated and sodium deficient, you may also crave potassium because your body is sending you the message that your cells are low on potassium as well as sodium and water. However, after consuming only a small amount of potassium containing foods or beverages (fruit, fruit juice, sodas and commercial electrolyte replacement drinks), you will probably feel worse because the potassium/sodium ration will be further disrupted.
What you really need in this situation is a combination of all three, water, salt and potassium in the right proportions. One of the easiest ways to accomplish this is to drink small repeated doses of water accompanied by a little food sprinkled with kelp powder. Kelp powder contains both potassium and sodium in an easily assimilated form. Depending upon taste and symptoms, extra salt can be added. Sea salt is a better choice than regular refined table salt, because it contains trace amounts of other minerals in addition to the sodium. Another choice is to drink a vegetable juice blend containing some celery and chard and diluted with purified water.
Usually, within 24-48 hours, your hydration and electrolyte balance will have stabilized enough that you can proceed to an adrenal-supporting diet. You must continue to be careful to drink salted water or vegetable juices 2-4 times during the day, varying the amount of salt according to your taste, and you should avoid potassium-containing foods in the morning when your coritsol and aldosterone levels are low. Never eat or drink electrolyte-depleting or diuretic foods and beverages such as alcohol and coffee, especially if you have been out in the sun or are otherwise dehydrated. One of the problems people with adrenal fatigue constantly deal with is a mild dehydration and sodium depletion.
When there is inadequate aldosterone, the kidney allows sodium, chlorides and water to spill into the urine, and maintains ionic balance by retaining, rather than excreting, potassium. Some of these low aldosterone persons present with symptoms of dehydration. The appearance of the tongue is one of the easily monitored indicators of dehydration. Normally, one should feel considerable slickness when running a finger down the protruded tongue of a person. It should slide easily across the tongue like a cube of ice across a wet piece of waxed paper. If the tongue is rough like sandpaper, or if you feel friction, with your finger catching or sticking to the tongue’s surface, it is an indication of inadequate tissue hydration. The person needs more water intake.
The person may report excessive urination, up to 15 or 20 times daily. Likewise, due to the effect of aldosterone on the sweat glands, the person may report excessive perspiration or perspiration with little or no physical activity. The common factor in all of these persons is a weakness of sartorius, gracilis, posterior tibialis, gastrocnemius, or soleus, and a background of some type of stress.
A person with lowered aldosterone may also demonstrate other symptoms. For a nervous system action potential to take place there must be an adequate supply of sodium on the outside of the cell membrane and an adequate supply of potassium inside the cell. They must be balanced. If this balance is undermined by a loss of sodium and retention of potassium, the nervous system will find it difficult to propagate normal action potentials and maintain itself at a good functional level. This may result in a wide variety of symptoms, including muscle twitches and even cardiac arrhythmias (heart palpitations).
With a chronic sodium-potassium imbalance, the person will show the sign of a paradoxical pupillary reflex. Normally, shining a light into a person’s eye will cause the pupil to constrict. This papillary constriction to light should be able to maintain itself for at least 30 seconds. In the hypoadrenic person (especially in the exhaustion stage of the GAS) you will find one of three things:
1. The pupil will fluctuate opened and closed in response to light.
2. The pupil will fluctuate opened and closed in response to light. (This is a deliberate opening and closing, not the minor flutter or twitch of the normally encountered hippus activity.)
3. The pupil will initially constrict to light, but it will dilate paradoxically with continued light stimulation of less than 30 seconds. This patient will frequently complain of eyes that are sensitive to light (such as when going from indoors to outside on a sunny day) or will be seen wearing sunglasses whenever outdoors or even indoors under bright light.
Another problem related to lowered mineralocorticoid levels in hypoadrenia is a paradoxical, non-pitting edema of the extremities. When the patient with hypoadrenia spills sodium and water into the urine and perspiration, and has a tendency to be dehydrated, we would hardly expect him to show signs of holding water, such as edema. But that is exactly what we do see in some hypoadrenic patients.
With the body spilling large amounts of extracellular sodium and likewise retaining intercellular potassium, we can see how an osmotic differential could develop in the patient’s tissues. If the osmotic difference (created by the increased potassium seeking its intercellular position and the lowered extracellular sodium levels) is severe enough, the body will most often attempt to correct this osmotic imbalance by allowing extracellular fluid to enter the cells. (It is also possible that the body could kick the potassium out of the cell and into the extracellular fluids, and although this occasionally occurs, we rarely see signs of this in the blood potassium levels.) The body is trying to dilute the potassium in the cell with water, to bring the system into osmotic equilibrium. The cells take on water, and the patient has swelling.
Often, these patients are placed on a diuretic by an unenlightened physician whose only basis for this prescription is the patient’s symptoms. The diuretic in these patients rarely helps the condition and often aggravates the tendency toward dehydration. Further, many diuretics act as adrenal (aldosterone) inhibitors, adding even more stress to the adrenals and tending to make the patient worse in the long run.
Even in adrenal fatigue, the body is still wonderful, beautiful and incredibly wise. It is our society, our maladaptation to the stresses of modern life, and our poor judgment that need to change. We may not be able to change society but we can learn to use better judgment when it comes to taking care of ourselves and to respond to stress in healthier ways.
06-15-2007, 11:20 AM
Aldosterone 4ng/dL (<or=28)
Something do not look right on my blood test. The range says the less the better.
What was your aldosterone before you started on Florinef
What is the desirable range (not the one posted by labs).
Wonder why LEF do not have aldosterone in their blood testing?
Are we talking blood or urine test?
I looked at Quest Endo manual page 18
they have a low and high range
I checked what LabCorp says
Recumbent: 1.0-16.0 ng/dL
Standing: 4.0-31.0 ng/dL
Adrenal vein: 200.0-800.0 ng/dL
06-15-2007, 12:41 PM
My Aldosterone sitting up right was 8 range <or = 28 ng/dl and my Renin was 1.5 range sitting is 0.65 to 5.0 ng/mL/hr. My Sodium was 133 range 132 to 149mmol/l
Potassium was 3.8 range 3.5 to 5.5 mmol/l
I am Secondary and most Secondarys will be low on both Alsosterone and Renin Primarys will be low on Alsoterone and higher on Renin. You need to stop adding Sea Salt for a time before this test.
See this link the guys at STTM have done a low of work on this.
and read this link near the bottom of the link.
06-15-2007, 03:27 PM
That on Florinef?
What was it before Florinef?
What value would make you happy?
Thanks for the links.
Could you, please coment on a way the Aldosterone range is written?
<or = 28 ng/dl
This suggest the less the better, zero would be a perfect per that range!!!??
Florinef raises Aldosterone.
06-15-2007, 04:24 PM
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