Women these days are living extremely stressful lives as they try to balance home life, work, relationships and children, leaving little time for self-care. Chronic stress can manifest in many ways – some people have difficulty sleeping, while others are chronically fatigued or have anxiety or depression.
When we have an intense stressful moment or fear, a hormone called adrenalin is secreted from the adrenal glands, which are situated above the kidneys. Our heart beats faster, our blood pressure rises and our muscles tense up. At the same time, our breathing quickens and blood sugar levels rise to provide us with instant energy. This is what is known as the ‘fight or flight’ response, and signals that our body perceives danger and is getting ready to deal with it.
The adrenals also release another hormone called cortisol to assist this natural physiological reaction to stress. This hormone also increases heart rate, blood sugar levels, blood pressure and constricts the arteries. Cortisol is longer acting in the body than adrenaline.
This inbuilt prehistoric response to stress was never designed to occur over long periods of time. Cortisol has negative effects when too much is produced through the day in response to stress.
The problem is that in our modern lives, factors such as job pressures and emotional ups and downs sometimes cause us to live in a state of stress for long periods.
Everyone reacts to a stressor differently and has a different tolerance level. The way that stressful event manifests in your body depends on your genetic make-up, diet and exercise routine and physical surroundings.
Under actute stress that is short acting, several physiological events can occur such as a heightened inflammatory response, blood sugar problems, headaches, palpitations, anxiety, sweating etc.
Our bodies are complex organs and so is our stress response. There is supporting research spanning nearly 100 years addressing the effects of stress – heat stress, shock stress, job stress, etc. Although much of it focuses on states of heightened Hypothalamic-Pituitary-Adrenal (HPA) axis activity and ‘hypercortisolism’ (excess cortisol), during the past few years research is now highlighting hypocortisolism and its equally damaging effects on our body and health.
Symptoms of stress
Symptoms of stress can vary enormously from person to person. Some experience anxiety related symptoms such as chest pains, panic attacks an insomnia, while others experience depression and fatigue to sweating to the start of hormone imbalances.
Modern life is full of demands, pressures, hassles, deadlines and frustrations on various levels – family, relationships, work. For many people, stress can be an everday event that it has become a way of life. Stress doesn’t always have to be bad. In small doses, it can help you perform under pressure and motivate you to do your best. But when you’re constantly running on your adrenal reserve and in emergency mode, your mind, body and soul can pay the price. You can protect yourself by recognizing the symptoms and signs of stress and taking steps to reduce its sometimes damaging effects, especially on our hormones.
Physical symptoms may include:
- Digestive changes, such as becoming more prone to diarrhoea or constipation
- Neck or backache
- Loss of appetite or overeating
- Increased use of tobacco or alcohol
- Muscle twitches or spasms
- An increase in sick days or absenteeism
- Lowered libido
Psychological symptoms may include:
- Tension or anxiety
- Lack of concentration
- Increased irritability
- Feelings of being overwhelmed
- Performance problems.
If stress continues over a long period without being addressed, we become more likely to develop health problems such as ulcers, fatigue, skin diseases and recurrent infection.
The good news is there is support available for all types of stress and all types of people; following a healthy diet (this is for everyone), taking suitable supplements and herbs, grief counselling, meditation, yoga, exercise, talking to a friend and so on. Refer to the links below for some tips on managing stress.
Hypocortisolism (adrenal fatigue)
States of low cortisol do exist, and the appropriate terminology is hypocortisolism, not ‘adrenal fatigue’. In fact, hypocortisolism affects 20 to 25% of people with stress-induced health problems.
Chronic stress often leads to hypocortisolism, (once coined ‘adrenal fatigue’), usually causing exhaustion, which is associated with debilitating fatigue and weight gain. This could be why you may feel tired most days. Low cortisol or ‘hypocortisolism’ often leads to poor blood sugar control, cravings and binge eating, as you try to pick up your energy levels. In technical terms, hypocortisolism is a condition which describes a state of either a flatline diurnal cortisol secretion pattern or a suboptimal elevation in cortisol in response to a stressor.
It is crucial to distinguish between these two terms, as if we are to continue to assume low cortisol is always due to ‘adrenal failure’, then treatment is impossible! The cause must always be found….WHY is cortisol low in the first instance?
The adrenal glands are part the ‘symphony of the inter-relationship of hormones and systems’. They do not and cannot act independently from other hormones, the nervous system, immune system, etc.
How do low cortisol states arise?
The following are only a few of the proposed models of how low cortisol states may arise:
- Hypocortisolism arises as an adaptive self protective mechanism after prolonged states of hypercortisolism (excess cortisol)
- Impairment of receptor sites within the nervous system
- Glandular organ resistance to messenger hormones (to CRH, ACTH, cortisol etc)
- Adrenal gland trauma, injury, infection, toxic exposure (drugs, heavy metals etc)
- As a protective mechanism during an acute or chronic infection so as to allow the immune system to do it job by fighting off the viral, bacterial, or fungal invader
- Arginine Vasopression (AVP) has been shown to affect the adrenal glands response to the ACTH message, and in some circumstances, it can act to silence the stimulatory action of ACTH on the adrenal glands.
- Abnormal number or function or polymorphisms of the glucocorticoid receptors.
Research has shown that the most common cause of low cortisol states is hyper-reactivity of the HPA axis to the negative feedback induced by hypercortisolism. In laymen terms, cortisol rises in response to stress, the nervous system reacts by lowering cortisol, but the control is never fully removed once the brake has been applied.
Factors affecting cortisol secretion patterns
- foetal environment (developing baby in utero)
- childhood environment
- personality type
- quality of the stressor
- certain pharmaceutical medicines
- chronic diseases
- socioeconomic status
- menopausal status
- and even time of year!
Conditions associated with hypocortisolism
Research has found the following conditions to be strongly associated with hypocortisolism:
- chronic fatigue syndrome
- irritable bowel syndrome (IBS)
- chronic pain syndromes
- mood disorders (depression, seasonal affective disorders)
- cancer (breast, colon, ovarian)
- nicotine withdrawal
- postpartum (after having a baby)
- mouth ulcers
- hypothalamic amenorrhoea
- Underactive thyroid function
- autoimmune diseases….and more.
Someone can have low cortisol without having Addison’s disease.
It is important to get to the cause of the low cortisol state so the appropriate diagnosis and treatment can be recommended. Certainly herbal adadptogens, glandulars, and nutrient supplements may play important roles, however they will ultimately not solve the problem if the cause of the hypocortisolism is never diagnosed and treated.