Overcome Stress to Support Recovery
In many alcoholics, stress and the subsequent adrenal fatigue contributes to a compulsive desire for alcohol. In some cases, impaired adrenal function can create or exacerbate chronically low blood glucose levels, which may motivate the consumption of foods (sugar and refined carbohydrates) or substances (alcohol, drugs, or caffeine). In others, the adrenals become fatigued by the chronic substance abuse, which drives hormonal irregularities that motivate alcoholic or addict behavior in a similar fashion.
We have already discussed the blood sugar-addiction scenario here and here, but until recently have largely ignored the importance of adrenal health in the substance abuse treatment. Well, no time like the present to rectify my error and set the record straight on adrenal health and addiction!
But, before we get too far into the research discussing adrenal cortical activation and addiction, we need to quickly review the adrenals and how an always-on-the-go lifestyle impacts the human body.
The Changing Face of Stress
Stress has existed since the dawn of man, but the face of stress, or the stressors to which we are exposed, has changed dramatically. Our ancestors were most often stressed by predators, injury, or inclement weather, which threatened their ability to survive. The continued need to evade prey or adapt to a changing environment produced a physiological adaptation that encouraged the rapid mobilization of energy from storage in life-or-death situations.
However, the majority of stress we face today is psychological or social in nature – work deadlines, financial obligations, and personal relationships – which threaten our mental, emotional and spiritual wellbeing. Unfortunately, the human body, still highly adept at processing physical stress, has not had an adequate amount of time to develop the proper mechanism for handling modern day stress, which may contribute to ill health and disease.
The Stress Response
The biological mechanism for stress management was developed by Hans Selye, which he named the General Adaptive Syndrome (GAS). According to Selye, the GAS develops in three stages – alarm, resistance, and exhaustion. During the alarm stage, nervous impulses descend from the hypothalamus through the autonomic nervous system stimulating the adrenal glands to release adrenergic hormones – epinephrine, or adrenaline, and norepinephrine, or noradrenaline – the immediate effects of which are increased smooth muscle contraction, increased blood pressure, and the release of glucose into the blood, collectively known as the “fight-or-flight” response. In the resistance phase of the GAS, the pituitary gland, under the influence of the hypothalamus, secretes adrenocorticotropic hormone, or ACTH, which induces the adrenal glands to produces glucocorticoids, specifically cortisone. Cortisol stimulates the release of glycogen, lipids, and amino acids from the liver, fat cells and muscle tissue in order to help replenish what was depleted during the alarm phase of the GAS. According to Selye, most of the physiological manifestations of alarm – tissue breakdown, reactive blood sugar (hypoglycemia), erosion of the stomach lining, and the effects of adrenal hormone secretion – disappear or are actually reversed during resistance. It is believed that the stress response of our ancestors stopped with resistance, which allowed the body to recover from any harm that may have been caused when confronting stress.
However, if stress persists and is psychological in nature, the body enters into the third phase of the GAS, exhaustion, which is characterized by chronically elevated cortisol levels with an increased risk of weight gain, immunosuppression, depression, anxiety, lack of energy, and an inability to concentrate. Modern man, under chronic psychological or social stress, often enters and sometimes completely exists in exhaustion, which many believe is the reason why the prevalence of lifestyle disease has increased dramatically over the past century.
Shawn Talbott, author of The Cortisol Connection, makes the analogy that resistance is when we are “stressed” while exhaustion is when one is “stressed out”. According to Talbott, being stressed induces an adaptive response where cortisol levels go up and then come down in the appropriate manner3. Being stressed out suggests an inability to mount a normal stress response where cortisol levels stay flat above baseline so that overall exposure is higher.
For more on stress and stress management, please refer to my post titled The Science of Stress and Addiction
Adrenal Fatigue – Disease of the Modern Man
Hypoadrenia, often referred to as adrenal fatigue, is a deficiency in the functioning of the adrenal glands. Too much physical, emotional, environmental or psychological stress can deplete your adrenal glands, which may contribute to the reduced output of vital hormones, particularly cortisol, that contribute to a host of symptoms that may interfere with health. Stress fatigues the adrenals when their cumulative effect is greater than the body’s ability to manage and recover from them. It can come on suddenly, precipitated by a single traumatic event – accident, illness, or the death of a loved one – or may develop gradually in response to a generally stressful lifestyle. It occurs in stages whose symptoms, what is felt, usually precede the signs, visible changes in appearance or measurable changes in identified through laboratory testing. Each person has a unique capacity for stress, which varies over time and in response to certain events.
Signs and symptoms of adrenal fatigue, include:
- Difficulty getting up in the morning
- Continuing fatigue not relieved by sleep
- Craving for salt or salty food
- Increased effort to do every day tasks
- Decreased sex drive
- Decreased ability to handle stress
- Increased time to recover
- Light-headed when standing up quickly
- Mild depression
- Less enjoyment or happiness with life
- Increased PMS
- Symptoms increase if meals are skipped or inadequate
- Thoughts less focus, more fuzzy
- Memory less accurate
- Decreased tolerance
- Decreased productivity
Conditions related to adrenal fatigue include chronic fatigue, fibromyalgia, heart disease, hypoglycemia, rheumatoid arthritis, and chronic and recurrent respiratory infections. In many alcoholics, adrenal fatigue and the resulting hypoglycemia predispose a person to the compulsive desire for alcohol. In other cases of alcoholism, the adrenals become fatigued by the continued use of alcohol. It has been found that adrenal support greatly enhances the treatment protocol for alcoholism (More on this shortly).
The most severe form of adrenal dysfunction is Addison’s disease, a condition in which the adrenal glands have completely stopped producing cortisol, as well as other adrenal hormones such as aldosterone. Addison’s disease is most often the result of an autoimmune reaction whereby antibodies produced by the body destroy “self” cells of the adrenal glands triggered, which may be triggered by viral infections, drugs, smoking, food and stress.
Addiction and Adrenal Fatigue
Active alcoholics have a blunted stress-response to non-ethanol induced stress. However, abstinent alcoholics often have an attenuated glucocorticoid response, which raises cortisol secretion and contributes to adrenal fatigue. When confronted with stress, specifically social stress or alcohol exposure, cortisol secretion is reduced in abstinent alcoholics, which is predictive of a return to drinking.
Supporting adrenal function may greatly enhances the treatment protocol for alcoholism.
Holistic Treatment of Adrenal Fatigue
The holistic treatment of adrenal fatigue includes dietary and lifestyle modification, in addition to supplementation. Concerning diet, the main goal is to stabilize blood sugar and limit the consumption of stimulating substances to reduce the amount of stressed placed on the adrenals so that they can heal appropriately. Maintaining a relatively low-carbohydrate diet that incorporates an ample amount of protein and fat will best support stable blood sugar and adrenal repair.
Carbohydrates can be classified as sweet or sugary, starchy, or non-starchy, which generally correspond to fruits, grains and vegetables. Sweet and sugary carbohydrates provide a quick spike in energy, blood sugar, which eventually swings in the other direction in dramatic fashion. Sweets and sugary carbohydrates also include products made from white flour, which should be greatly avoided. Fruit is okay when consumed in moderation and later in the day. Starchy carbohydrates are found mostly in grains and root vegetables, which can promote adrenal health when they are unrefined and consumed in meals that contain both protein and fat. Non-starchy carbohydrates include all vegetables not already mentioned and should be consumed liberally.
Fats can be grouped by their molecular structure – saturated, monounsaturated, or polyunsaturated – which serve different functions in the body and in promoting adrenal health. Saturated fat consumption should be limited, but it is the preferred cooking oil or fat when using high temperatures. Fats to use while cooking at high temperatures or for long periods of time include butter, coconut oil, and animal fat. Monounsaturated fats, like those found in olive oil, should be consumed raw and when used for low temperature cooking. Other sources of monounsaturated fats include avocados and nuts. Monounsaturated fats can be consumed more freely than saturated fats, but they should still be used sparingly and with meals that contain the appropriate macronutrient balance. Polyunsaturated fats are typically classed as either essential or unessential based on whether or not the body can produce them independently. Essential fatty acids are the ones we need to be concerned most with because they must be obtained from food sources. They can be classified as either Omega-6’s or Omega-3’s, which we need to consume in a ratio of 4:1 or greater – 1:1 would be ideal. Unfortunately, processed foods contain excessive amounts of Omega-6 essential fatty acids so we need to place an added emphasis on consuming Omega-3 rich foods like fatty fish, walnuts, and flax seeds in order to obtain the most beneficial proportion.
High quality protein comes from meat, fish, fowl, and eggs. Avoid processed proteins such as lunchmeats, processed cheeses, faux meats and textured vegetable protein because they are highly refined, hard to digest and often contain substances that may interfere with adrenal health. Low levels of hydrochloric acid may also exist in individuals with adrenal fatigue so supplementing with digestive enzymes may prevent excess gas, bloating or heaviness after a protein rich meal.
When the adrenals are fatigued, cortisol levels drop lower than normal and it becomes more difficult for the body to maintain normal blood sugar levels. For those with adrenal fatigue, this means that when we eat is just as important as what we eat. A few guidelines to help guide then “when” of eating for adrenal function, include:
- Eat soon after waking, preferably no later than 1 hour.
- Eat an early lunch, somewhere around 11:00 or 11:30am.
- Eat a nutrition snack between 2 and 3pm.
- Eat your evening meal between 5 and 6pm.
- Eat a few bites of a high quality snack just before bed if hunger develops.
Lifestyle modification should be aimed at reducing stress to reduce the amount of stress place on the adrenal glands so that they are better able to heal. Listing all the positive and negatives in one’s life and identifying the “energy robbers” is a good exercise to helping to pinpoint what hidden obstacles may be interfering with adrenal health. Maintain a positive perspective and learn to take advantage of some unstructured time greatly improves mood and our ability to enjoy time with family and friends. Get plenty of sleep, anywhere between 8 and 10 hours each night. Practice yoga, meditation, or any variety of breathing exercises to promote relaxation and relieve stress.
Dietary supplements that play an important role in the healing of adrenal fatigue, include vitamin C, vitamin E, B complex vitamins, magnesium, calcium, and a host of trace minerals like manganese, zinc, selenium, molybdenum, chromium, copper and iodine. Contact me for source and dosage information.
Stress and adrenal fatigue is a pernicious condition in which a general sense of being unwell and fatigue permeate an individual’s life. It can make seemingly simple, everyday tasks unmanageable while increasing emotional instability and interpersonal strife. The impact of adrenal fatigue is amplified for those recovering from substance abuse disorders and disregarding their treatment may interfere with a holistic, mindful recovery program. Start supporting adrenal function today so that you can get busy living the life you deserve.