The effects of stress on the body are wide spread and can be partially explained by the effect that stress has on adrenal hormone production.  Through supporting the adrenal function it is possible to return the adrenals to normal function and reverse any issues that might have occurred as a result of stress.

Adrenal Dysfunction

There are two adrenal glands in the body, each one sits on top of each kidney.  Each adrenal gland is divided into two distinct areas:  the cortex and the inner medulla.  The adrenal cortex produces what are known as adrenocortical hormones, which are the basis for nearly 50 different hormones that are essential to life.  The Glucocorticoids help to control blood sugar (Cortisol), Mineralocorticoids help to control fluid levels in the body through electrolyte balancing (Aldosterone), and Androgens (DHEA-S and testosterone).  The medulla produces the Catecholamines epinephrine (adrenaline) and norepinephrine.  The adrenal glands are essential for life and the hormones produced by the adrenal glands are particularly important in regulating the body’s response to every day stress.

Adrenal Glucocorticoids
Glucocorticoids can raise glucose (sugar) levels in the blood.  During periods of fasting or extended periods of time between meals, such as sleeping, glucocorticoids help to maintain blood glucose levels within ideal ranges to support normal physiological function, like normal brain function. Glucocorticoids also have potent anti-inflammatory effects by decreasing the migration of inflammatory cells into sites of inflammation, stabilize mast cells and inhibit the release of pro-inflammatory substances.  

These adrenal hormones have a circadian rhythm that is regulated by hormones from the pituitary gland in the brain.  Normally a surge of glucocorticoids occurs about 6-8 hours of sleep waking the brain up.  There are several smaller peaks of glucocorticoids throughout the day to maintain energy levels.  Stress (psychological and physical), exercise, and hypoglycemia can all stimulate glucocorticoid secretion in a good or bad way.

Adrenal Mineralocorticoids 

Mineralocorticoids like Aldosterone, help to promote the renal retention of sodium and the renal excretion of potassium to maintain a normal plasma sodium/potassium ratio.  Maintaining this sodium/potassium ratio regulates the circulating blood volume and thus helps to maintain blood pressure.  

Adrenal Androgens

Adrenal androgens include testosterone, dihydrotestosterone (DHT), androstenedione, and dehydroepiandrosterone (DHEA). The biochemical pathways involved in the synthesis of androgens are common to both the adrenal cortex and gonads (ovaries and testes).  Most of the DHEA that enters the circulation is normally derived from the adrenal cortex, particularly in women.  The sulfated form of DHEA (DHEA-S) is also one of the best indicators to measure adrenal function.  Most androgens are transported by sex hormone-binding globulin (SHBG).

DHEA is a hormone that is still being studied to determine its effects.  It appears to have effects on metabolism, moods, heart function, skin tone, muscle function, and regulation of the other androgens.  Testosterone helps to maintain muscle bulk and tone throughout the body.

Adrenal Medullary Hormones

Adrenal medullary hormones are the catecholamines – epinephrine (adrenaline) and norepinephrine.  Both of these hormones are neurotransmitters in the sympathetic nervous system.  The adrenal medulla is a highly specialized part of the sympathetic nervous system and responds to stress by releasing epinephrine.  If epinephrine is released in significant amounts, it can initiate the "fight or flight" response, an adaptive response to perceived danger.

Epinephrine is produced in the adrenal medulla from norepinephrine by the enzyme phenylethanolamine-N-methyltransferase (PNMT).  The synthesis of PNMT in the adrenal medulla is induced by Cortisol.  Increased Cortisol and epinephrine levels are associated with hypertension, atherosclerosis, insulin resistance, and various other chronic disorders.

The General Adaptation Syndrome (GAS)

Hans Selye, past director of Experimental Medicine and Surgery at the University of Montreal, performed several studies to explain the effects of stress on adrenal function.  He developed a general theory to explain the typical response to stress and the adaptive mechanisms associated with the typical stress response.  Hans Selye called the physiological adaptive mechanism the "General Adaptation Syndrome" (GAS).  

Hans Selye presented the GAS as a model of stress adaptation that has provided insight into the pathogenesis of common stress-induced disorders.  It also has clinical utility in promoting the understanding of how to better manage stress-induced disorders.  

Hans Selye observed that: "The physician, in dealing with GAS may be faced with a patient with no clear-cut diagnostic pattern, but just vague feelings of ill health."  He stated that the "GAS provides a means to:

1. Recognize the environmental changes (emotional, mental, physical trauma) and change them if within the realm of possibility.
2. Determine the extent of general adaptation and local adaptation and evaluate the success of the patient in coping with these environments.
3. Assist by means of hygienic, endocrine, structural, nutritional, and metabolic therapy the patient's adaptation and restoration of homeostasis.” (Selye H: The Stress of Life. McGraw-Hill, 1956)

The Maladaptive Stress Syndrome (MSS)

Hans Selye provided the basic framework that has contributed to the evolving understanding of the responses the body has to nonspecific stress.  As more research has been done, a more comprehensive clinical model of the adaptive and maladaptive patterns of responses to stress has become known as the “Maladaptive Stress Syndrome” (MSS).

The Maladaptive Stress Syndrome is staged in four stages ranging from 0 to 3.  Stage 0 of the Maladaptive Stress Syndrome (MSS-0) is a normal response to stress and describes a healthy, well-adapted range of attention from hypovigilance to hypervigilance.  The level of vigilance is mediated by the autonomic nervous system, and the adrenal hormones – particularly by catecholamines.

• MSS-0 (Normal function) – The level of vigilance is regulated by the amount of circulating catecholamines.  The alternation between hypovigilance and hypervigilance is considered healthy if appropriate for the context in which they are present.  For example, hypovigilance is appropriate during rest and relaxation and hypervigilance is appropriate during a time when mistakes would be costly.  Hypovigilance is characterized by decreased mental concentration allowing for adrenocortical repair.  Increased mental concentration and suppression of unfocused motor activity characterizes hypervigilance.
• MSS-1 (Stage I, alarm) – This stage is characterized by a chronic excessive production of catecholamines and may have an increase in glucocorticoid production also.  It starts with an alarm being sounded in the body from trauma, heavy exercise, or from perceived stress, which then activates the sympathetic nervous system.  This causes a “fight or flight” reaction which becomes maladaptive when a “fight or flight” response is not appropriate.  If a person remains in MSS-1 long enough, they will progress to MSS-2.
• MSS-2 (Stage II, Suppression) – This stage is characterized by a chronic excess production of glucocorticoids, the catecholamines are still find in excess, and an activation of anti-inflammatory hormones with increased gluconeogenesis.  Immune system and inflammatory responses are suppressed.  The resistance phase is characterized by increased susceptibility to mycotic infections, depression, peptic ulcers, gastritis, hyperlipidemia, atherosclerosis, insulin resistance, diabetes, osteoporosis, neoplasia and other degenerative diseases.
• MSS-3 (Stage III, Exhaustion) – This stage is characterized by a chronic decrease in the production of adrenal corticoids and an intermittent (episodic) excess secretion of catecholamines.  MSS-stage 3 is the stage of chronic stress response typically known as "adrenal exhaustion." The exhaustion phase is accompanied by an increased susceptibility to hypotension, functional hypoglycemia, chronic fatigue and immune deficiency syndrome (CFIDS), fibromyalgia, environmental sensitivities, odor hypersensitivity, anxiety disorders and poor stress resistance.

General Treatment Measures – Stress Reduction is KEY

• Sleep – Get enough restful sleep at night.  When we get six to eight hours of restorative sleep at night, we allow our bodies the rest it needs to repair daily damage and fight infection. 
  
• Disturbances in adrenal function can lower levels of melatonin in the brain disrupting normal sleep.  Light therapy can help correct this to some degree, but other support may be necessary either by addressing the adrenals directly or using a pharmaceutical medication.
• Slow down – Increase activities that allow exposure to nature and taking time to “smell the roses”.  Once in MSS stage three, the best thing we can do is to allow ourselves to take a restful vacation.  This includes going to the beach or somewhere peaceful, allowing ourselves to take time to sit on the beach or on the grass and listen to our surroundings without worrying about anything else going on in our busy lives.
  
• Many times this is not feasible so finding activities that can be done weekly to allow time for you – a walk, a bubble bath, reading a good book, etc.  Something that no one else can bother you during and that you do not have to worry about anything.
• Exercise routine – Just walking around the block can help reduce stress on the body.  Stretching exercise like Yoga or Tai chi can help the body and mind calm down and let stress exit the body.
• Eat a healthy balanced diet – Increase consumption of fruits and vegetables.  Make sure that you are drinking enough water through out the day.  A general guideline is about 8-10 cups of water a day and 6-8 servings of fruit and vegetables a day (remember a serving is not very large, most snacks are 2-3 servings).  Eat small amounts of protein throughout the day to help blood sugar regulation, but to help with fat (energy) metabolism.
• Multi-vitamins – Multi-vitamins have essential nutrients that help support healthy adrenal function.  A good way to check if a multi-vitamin will digest well in the stomach is to take a ¼ cup of vinegar and put your multi-vitamin in the cup.  If it does not dissolve in 15 minutes then it is a poor vitamin source and you are just wasting your money.  A really good absorbable multi-vitamin will dissolve in just a few minutes.

Higher Level intervention – DHEA Therapy and herbal support

Prior to complete exhaustion of the adrenals, which is essentially Addison’s disease, DHEA therapy can be used to support and turn the adrenal function around.  Optimal ranges vary based on age and sex.  Lab ranges reflect normal population values and rarely give ranges for age and sex.

DHEA does have a dependency factor over long periods of use.  It is generally not recommended to use for long periods of time.  DHEA is only meant to be a supportive therapy and the goal is to eventually come off of it.  For this reason DHEA should only be taken with a doctor’s supervision.  Most of the over-the-counter supplements do not contain much DHEA only derivatives that have little to no affect on the body.  Only pharmaceutical grade DHEA is effective.

There are side effects that can occur with DHEA therapy, which include acne and aberrant hair growth, which can be decreased with a drop in the dose.

To complement DHEA therapy the use of several herbs can be used to enhance the effectiveness of the treatment.  These herbs should be used under medical supervision due to side effects and interactions that can occur.  The safest to use include licorice extract and ginseng.