STAGE 3 Adrenal Exhaustion
The following will explain Stage 3 Adrenal Exhaustion. It will let you know which supplements you should be taking based on those results and recommend diet and lifestyle considerations that will improve your overall health. However, for specific recommendations and dosages, you should speak with a practitioner.
If you follow the recommended supplement protocol as well as the diet and lifestyle information in this packet you should see a noticeable improvement in your health.
Explanation of Adrenal Exhaustion
Cortisol and DHEA levels provide an accurate assessment of how well your adrenal glands are functioning. Healthy, properly functioning adrenal glands are imperative for vibrant, optimal health.
When the adrenal glands become fatigued due to chronic stress, many health consequences can result.
What is chronic stress?
Adrenal exhaustion begins to occur when stresses become chronic in nature, meaning that they are present day after day. The causes of the chronic stress range from skipping breakfast every day and only eating a salad for lunch to having exposures to mercury to infections in the digestive tract to conducting life at a frenzied pace each day.
It is extremely important to address whatever is causing your chronic stress so that the treatment protocol that you have been given can successfully restore proper function to your adrenal glands.
What do the stages of adrenal exhaustion mean?
Although the decline in adrenal function occurs in a progressive fashion, three “stages” of adrenal exhaustion are commonly used to describe a patient’s condition. As the adrenal glands first come under chronic stress, the outer part of the adrenal gland called the adrenal cortex begins to produce and secrete a greater quantity of cortisol, the “stress hormone.” This increased cortisol production “steals” pregnenolone, the hormone needed to produce other hormones in the adrenal cortex, most notably DHEA.
In Stage 1 of adrenal exhaustion, daily cortisol output is elevated and DHEA levels begin to decline. Since DHEA metabolizes into sex hormones, specifically estrogens and testosterone, imbalances in these critical hormones can occur. In women progesterone levels are often impacted to a greater degree by chronic stress than estrogen levels, leaving them “estrogen dominant.”
As chronic stress continues unabated, the adrenal glands can no longer maintain the daily high levels of cortisol output. In Stage 2 of adrenal exhaustion, daily cortisol output falls to “normal” levels, and DHEA levels decline even further. Low or borderline low morning, noon or afternoon cortisol levels and normal nighttime cortisol levels are often seen in Stage 2 of adrenal exhaustion.
As chronic stress continues to weaken the adrenal glands, daily cortisol levels fall even farther. In Stage 3 of adrenal exhaustion, cortisol levels are low and DHEA levels fall even lower. There is an increased probability of low nighttime cortisol levels as well as low readings throughout the day. In Stage 3 of adrenal exhaustion, a patient is subject to serious hormonal imbalances.
What are the consequences of adrenal exhaustion?
In all stages of adrenal exhaustion (even Stage 3), cortisol levels are elevated relative to DHEA levels. There are many health consequences associated with a high ratio of cortisol to DHEA that affect your:
Supplement Protocol Recommendations
The protocol for Stage 3 Adrenal Exhaustion is essential to improving your current state of health as you will see by the supplement descriptions.
DHEA reverses immune suppression caused by excess cortisol levels, thereby improving resistance against viruses, bacteria and fungus, yeast, parasites, allergies, and cancer. It increases muscle mass and decreases percentage of body fat. It prevents osteoporosis and heart attacks, while improving energy, vitality, sleep quality, premenstrual symptoms and mental clarity. Additionally, it accelerates recovery from any kind of acute stress, for example insufficient sleep, excessive exercise, mental strain, etc.
As is the case with DHEA, pregnenolone levels decline with age. Many physicians and scientists believe that replacement of pregnenolone to youthful levels is an important step in the treatment of aging and symptoms of aging.
Other benefits of pregnenolone include stress reduction and increased resistance to effects of stress, improvement of mood and energy, reduced symptoms of PMS and menopause, improved immunity, and repair of myelin sheaths.
The Adrenal Repair Diet
The Adrenal Repair Diet is designed to improve the health of everyone, regardless of their health complaints. By following this diet, you will feel better physically, have more energy, eliminate cravings, improve sleep quality, and lose weight.
In my experience, there are three “musts” for each of us to attain our optimum health through diet. We must (1) determine the balance of macronutrients (proteins, carbohydrates, and fats) right for us and only choose the highest-‐quality food available; (2) eliminate gluten, soy, and pasteurized dairy for two months, and (3) maintain stable blood sugar.
There are three variables when considering proper macronutrient ratios: 1) genetics, 2) how damaged your metabolism is, and 3) energy requirements. It is important to keep in mind that activity level on a given day can require adjustments to your macronutrient ratio.
Genetic predisposition is an important factor, given the variation in what our ancestors ate, based on their physical environments and the types of food available. This work has been clearly explained in The Metabolic Typing Diet by William Wolcott and The Nutritional Solution by Dr. Harold Kristal and James Haig. Simply put, some people require high-‐carbohydrate diets to be healthy, while others require larger-‐than-‐average amounts of protein and fat.
If your metabolism is damaged, you will need to adjust your macronutrient ratios. For example, if you have chronic health problems, you will need to consume more high-‐quality raw fats and proteins while you are healing. These nutrients provide the raw ingredients that aid in structural repair of damaged cells. Carbohydrates are used primarily as fuel, not for structural repair, although it is always important to have the right amount of starchy carbohydrates in your diet. If you eliminate all carbohydrates, your cortisol level will be affected, which could lead to a hormonal imbalance.
Your individual energy level also will dictate your macronutrient ratio. If you are like many Americans and lead a sedentary life (thanks to modern conveniences such as computers and televisions), you will want to be sure to eat fewer carbohydrates. These serve as fuel to the body, and if you are eating more than you are burning, you will push your insulin level up which will lead to unstable blood sugar and a host of health problems. If, on the contrary, you are an active person who exercises several hours a week, you will need to eat more carbohydrates to fuel your body.
Foods to Avoid
Gluten intolerance is the most common food problem I have encountered in the thousands of patients I have worked with. It can be a serious health complaint causing a variety of symptoms.
Although not everyone is gluten-‐intolerant, I have found that everyone benefits from a two-‐month gluten-‐free diet, because it forces us to eat less of the processed, refined foods that contain gluten, and more unprocessed foods such as organic vegetables, quality proteins, fats, and healthy carbohydrates. People who are gluten-‐intolerant need to modify their gluten consumption for life. For the rest, the two-‐month period is sufficient, after which gluten-‐containing grains can be reintroduced into a healthier diet.
Eating gluten-‐free means avoiding all foods containing gluten, including wheat, rye, spelt, bulgar, semolina, couscous, triticale, and durum flour. Gluten can be hidden, so read labels carefully. Be wary of modified food starch, dextrin, flavorings and extracts, hydrolyzed vegetable protein, imitation seafood, and creamed or thickened products such as soups, stews, and sauces.
Starchy foods that are allowed include amaranth, arrowroot, buckwheat, corn, millet, potato, quinoa, and rice. Oats are tolerated by most gluten sensitive people, but are controversial as to their actual gliadin content; so be careful with oats. To be cautious avoid oats for the first two weeks and then try them and watch carefully for symptoms.
Approximately half my patients who are sensitive to gluten are also allergic to soy and soy products. Part of this may stem from the ways in which soy has been genetically modified, and the frequency with which it is used as a food additive. I have my patients avoid all concentrated soy protein products for the initial two months, including tofu, tempeh, soy protein powders, and bars that contain soy protein. Most people tolerate the small amounts of soy proteins found in soy sauce or whole soy beans.
Food reactions to pasteurized dairy products are the most easily detected. These products are pasteurized milk, cheese, yogurt, and cottage cheese – but not eggs. There are two potential problems with dairy products: lactose intolerance, which is an inability to digest the carbohydrate or sugar portion of milk, and milk allergy, which is a reaction to the protein in milk. Pasteurization and homogenization destroys the enzymes in milk that help us digest it, the healthy bacteria in milk that help keep the gut working well, and the beneficial fats in dairy, rendering what could be a very nurturing and healing food a potentially harmful product.
While pasteurized dairy is to be avoided, raw dairy may be introduced after two weeks of a diet free of dairy. After two weeks, most people will be able to tell if they are sensitive to dairy by drinking a large glass of whole raw milk first thing in the morning on an empty stomach. If you have no digestive symptoms from doing this, then you can likely consume raw dairy products. Raw butter has butyric acid, which along with the healthy bacteria in butter helps heal the GI tract in dramatic ways.
Now that I’ve discussed which foods you should avoid (gluten, soy, and pasteurized dairy) let’s look at the foods that are okay to eat. Remember, the goal is to find the right combination of foods that will allow you to achieve optimum health by balancing your macronutrient ratios of proteins, carbohydrates, and fats.
It is very important that you eat adequate protein at each meal. The variety of protein sources and quality are important factors. Limit protein consumption to sources that are organic, hormone-‐free, free-‐range, grass-‐fed, and “wild” in the case of fish. Use only fresh meats; avoid those that are processed and packaged. It is important to divide the day’s total protein over the course of the day. An easy starting point to calculating the amount of protein you need is to divide your ideal body weight (in pounds) by 15 to get the ounces protein to be consumed per day. You will need to adjust this amount up or down depending on your metabolic type, health of your metabolism, and activity level.
Beef, pork, lamb: Eat each meat one or two days a week
Fish: Eat a variety of grilled, steamed, baked, or poached, but do not bread or deep-‐fry. Limit canned tuna to rare occasions. Ask for “wild” fish.
Poultry: Eat a variety of chicken, turkey, Cornish game hen, in a mix of dark and white meat. Do not bread or deep-‐fry. Acceptable cooking methods are grilled, steamed, baked or roasted.
Eggs: Eat as often as three days a week. The yolk has nutrients that are denatured when cooked through, so eat eggs soft-‐boiled, sunny side up, or over-‐easy when you can.
Nuts: These may be used as a protein snack source. Raw and organic are preferable.
Cheese: All cow’s milk products need to be eliminated for the first two weeks. Choose goat and sheep cheeses and goat’s milk yogurt as alternatives if your specific plan allows. After two weeks, you may introduce raw (unpasteurized) dairy into your diet.
Carbohydrates include vegetables, fruits, grains, and beans. The best carbohydrates to eat are rich in vitamins. Carbohydrates with low nutrient value should be avoided.
Nutrient-‐rich vegetables provide an abundance of the vitamins and minerals that sustain your body. Again, quality and variety are key. Your body is most nourished with high-‐quality organic produce. Many therapeutic nutrients such as antioxidants and flavinoids are associated with the properties that give vegetables their color, so make sure you are eating a good range. Eating vegetables raw or lightly cooked helps maintain vitamin and mineral content and makes them easier to digest.
Green vegetables: Eat an abundance of these. They are high in minerals and low in calories. Some examples include swiss chard, kale, collard greens, bok choy, beet greens, spinach, and salad greens. Dark-‐green steamed vegetables are superior to salad greens.
Yellow and orange vegetables: Eat these in small portions and always balance with green vegetables and protein. Some examples include yams, winter squash and carrots.
Onions, garlic, and tomatoes: Eat these as desired, unless allergic.
Whole fresh fruits are allowed in moderation. These include berries, citrus, melons, apples, and pears. Your best fruit choices are berries – such as strawberries, blueberries, and raspberries – along with melons and grapefruit. Avoid bananas and grapes because they can play havoc with your blood sugar; as well as dried fruit, which may contain harmful preservatives.
Only gluten-‐free grains are allowed, including amaranth, arrowroot, buckwheat, corn, millet, potato, quinoa, and white or brown rice. There are now rice breads and millet breads available for toast and sandwiches, as well as rice, corn and quinoa-‐based pastas.
Beans are an excellent source of carbohydrate and can be eaten as frequently as every meal.
It is important to have some fat at each meal, and as with all food groups, it is important to give your body a variety. Choose from walnut, extra-‐virgin cold-‐pressed olive, sesame, cod liver, coconut, and real butter. Raw butter is ideal because it possesses healing qualities. The occasional use of safflower and sunflower oils is okay. Avoid all margarines, hydrogenated and partially hydrogenated oils, as well as canola oil and mayonnaise. Butter, coconut oil and olive oil are the most stable with heating but temperatures are still best kept as low as possible when cooking.
Water is the best beverage to drink. Our bodies are 70 percent water, and it is considered a nutrient, optimizing digestive function and elimination of toxins from your body.
It’s best to avoid caffeine, fruit juices, and alcoholic beverages, especially beer, which contains gluten. If you are a daily caffeine consumer, don’t quit right away. Start by making improvements in your diet and exercise patterns, and the need for the extra boost caffeine provides will fade over time.
Food Allergies and Rotation Diets
Food allergies are becoming a more widely recognized health problem. Often it is not clear which foods are causing reactions. When I have patients who are experiencing food allergies or sensitivities, I suggest that they do a simple lab test to determine the specific foods they are allergic to, and then go on a rotation diet.
Sleep, Rest and Recovery
Getting adequate sleep is crucial for physical repair and regeneration. Sleep, rest, and recovery are directly linked to our 24-‐hour adrenal hormone cycle. When the sun rises, cortisol levels peak; they taper off as the sun sets, reaching their lowest level three hours after dark. This daily fluctuation is intended to help our bodies know when to be active and when to rest.
Ideal rest occurs between 10 P.M. and 6 A.M. Sleep during the hours of 10 P.M. and 2 A.M. repairs our bodies. Immune cells are released to seek out and destroy cancer cells, bacteria, viruses, and other harmful agents. If cortisol levels are elevated during this phase, maximum recovery will not be achieved. Between 2 and 6 A.M., sleep lets our bodies enter a stage of psychic regeneration, and the immune system is supported by chemicals released by the brain.
Exercise helps take off weight, increase energy and prevent depression. It also can be a source of stress if not done properly. Cardiovascular exercise raises cortisol, which can be helpful when done as part of an integrated health program. However, excessive cardiovascular exercise, along with a highly stressful lifestyle, can make hormone problems worse. Resistance training, on the other hand – strength training with weights – increases human growth hormone production and lean muscle mass. The increased muscle mass will in turn burn fat 24 hours a day. Therefore, your individual exercise requirements will depend on your hormone status and how much body fat and lean muscle you have right now. A properly designed exercise program will include relaxation exercises if you are stressed, resistance training if you need to improve your strength, stretching to resolve muscle tension patterns, and cardiovascular exercise to improve overall fitness. If you are in Stage 3 of adrenal burnout, you may require some time healing your adrenal glands before you do heavy cardiovascular exercise. Also, specific sports such as tennis, golf, running, or cycling benefit from specific stretches and strength training to improve performance and prevent injury.
There are three important stages to consider with regard to stress: perception, response, and internalization. It is the internalization of stress that is key. Stress that is internalized negatively will have lasting effects. For this reason, we must find effective individual techniques for stress reduction. For some, effective stress reduction could be yoga. For others, it is running or golf. It may be meditating or gardening or keeping a journal. Many people benefit from education, such as classes, books, or seeing a therapist or psychologist. Stress reduction is essential to achieving emotional and spiritual health, which will directly affect your physical health and well-‐being.
Emotional and spiritual health
Emotional and spiritual well-‐being has played a primary role in the health of every one of the patients I have treated. Our emotional health revolves around our ability to communicate with others and maintain intimacy with those we love. In our culture, very few people are highly skilled and focused on developing truly intimate relationships. It requires practice and hard work. Some people discover the spiritual part of themselves through organized religion; others find it through a less formal belief system or practice. Achieving satisfying emotional and spiritual health will directly affect your physical health and well-‐being. For most of us, this is the most important and challenging step toward optimum health.
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Rich Jacobs is a Board Certified Integrative and Functional Nutrition Practitioner who specializes in resolving gut, insomnia, low libido, fatigue and fat issues. He uses a holistic approach and functional lab work to identify root causes such as hormone imbalances or gut pathogens that could be impacting your health.