Thursday, March 26, 2015

"Adrenal Fatigue", intense exercise and the Paleo diet

Adrenal Fatigue, or the more aptly named HPA axis dysfunction, has seemingly taken the online world by storm.  There are countless support groups, online lifestyle programs, and dietary interventions aimed at preventing adrenal fatigue, but so far we have a fairly limited knowledge of what adrenal fatigue is.  Sure, there is the general notion that as people light the candle at both ends too frequently their autonomic nervous system goes haywire, but what is truly causing it to go haywire?  Are we dealing with a situation where a person's perception of stress has gone wonky, are they exhausting the adrenals to the point they no longer have the raw materials to make cortisol when they experience stress, or is something interfering with the signal?

Honestly, I don't know that everyone experiences the same thing, but looking at biology and the stress response can give us clues to what is considered the most common pathway to adrenal fatigue in the Paleo world: overexercise and nutritional deficiency.  When you look at the symptomology of adrenal fatigue, you get a picture of the systems that are affected:
  • Electrolyte balance
    • Hypotension, dizziness, headaches, frequent urination, cramps
  • Immune system
    • Frequent respiratory infections, prolonged length of infection, parasitic infections
  • Digestive disturbances
    • IBS, loose stools, gas/bloating, parasitic infections
  •  Blood glucose control
    • Low or high blood glucose, irritability, fatigue/low energy
  • Neurological
    • Muscle twitching, heart palpitations/arrythmias, brain fog
  • Hormonal
    • Thyroid issues, sex hormone issues, irritability
While this is merely a small list of the things that people with adrenal fatigue experience, we can use it to look for commonalities between these systems and compare them to some of the things we may expect to see in a person who decides to cut out certain foods from their diet and partake in intense exercise modalities.  This allows us to identify some factors, particularly nutritional, that could be playing a causative role in adrenal fatigue.  Ironically enough, some of these same factors may predispose sedentary over-eaters to the exact same symptoms.

The typical culprit framed for the intense exercise/Paleo diet link to adrenal fatigue is low carbohydrate consumption, but upon further research, I believe other factors related to the type of carbohydrate to be at play.  Many also indicate a link between low carbohydrate intake in general and low thyroid output, but  I don't really feel this link is entirely comprehensive as well.  I do believe carbohydrates, or rather, carbohydrate metabolism, is a central player in this phenomenon.  Where I part ways with this line of thought is when the solution is throwing carbohydrates at the problem.  I believe that merely throwing carbohydrates at the problem can make it much worse if you look at the way cells work.

Understanding cells

Before we move further, it's important to understand how your cells work. All of your cells are constantly interacting with their environment by identifying environmental conditions and performing the biological function that they are programmed to do under those environmental condition via your genes.  For example, when the beta cells in your pancreas identify an increase in blood glucose, they secrete the hormone insulin in to your bloodstream which causes other cells in the body to take in glucose.  Most biological functions occur in this manner, a manner similar to the way the heating system in your house adjusts the temperature.

The thermostat in your house is programmed to the desired temperature and when it senses the temperature drop below that point, it signals your furnace to increase the heat.  An ignitor in your furnace turns on and gas is blown past the ignitor which turns it in to a flame that can distribute heat through the heating duct.  Failure in the system can occur if:
  1. The thermostat doesn't sense the temperature or is improperly programmed
  2. The ignitor fails to turn on, preventing the conversion of fuel to fire
  3. The gas flow doesn't turn on or is obstructed.
This analogy holds for the microscopic physiology of the cell as well as what's happening during adrenal fatigue.  Things like lowering stress, getting better sleep, meditating, and other ways of manipulating lifestyle are, in essence, changing the setting of the thermostat.  Specific enzymes and their cofactors that perform functions within the HPA axis as well as other, related, systems are the ignitor which can be handled with nutritional supplementation.  Finally, the gas flow can be looked at as energy in the system and is most often related to carbohydrate consumption.  While I feel most programs meant to deal with adrenal fatigue take care of resetting the thermostat and increasing gas flow, most fail to address the failed ignitor.

Over-stoking your furnace

While I see no harm and much benefit to changing the setting of the thermostat through meditation, proper exercise, and good stress management, I don't feel the problem is truly being addressed by simply doing these things.  Stress is unavoidable, and it's my opinion that being able to deal with high levels of stress from time to time is important.  I don't feel simply removing all of the stress in one's life is in the best interest of the individual.

On the other side of the equation, simply increasing carbohydrate consumption can be disastrous if not done properly.  There is a lot of clinical evidence supporting this notion and the refeeding syndrome is simply the clinical manifestation of what happens when you increase gas flow in your furnace without addressing the ignitor.  Going back to the furnace analogy, imagine if the heating system in your house kept calling for gas and the gas kept flowing but the ignitor didn't turn on.  Your house would quickly fill up with gas, a far from ideal situation.  In the refeeding syndrome, introducing carbohydrates before all of the nutrients/cofactors needed to utilize carbohydrates properly have been restored leads to symptoms of vitamin deficiency and electrolyte imbalance(1, 2).  In other words, your heating system is filling your house up with gas, not heat.  Bad idea.

A better approach to dealing with this issue is to adjust the thermostat by bringing stress back to a manageable level through lifestyle change, fix the ignitor by replenishing the enzymes and cofactors that are necessary to kick it on, and then gradually increase carbohydrates to a level that is suitable to your activity level.  The first and third parts are easy, but what are the important steps in fixing the ignitor?  The immediate thought is to simply begin supplementing with vitamins and minerals, but it's not as simple as that.  Unfortunately, this is the direction most people go in and progress drags along slowly for several reasons.

First, many of the things you do in everyday life impact nutrient status, and you are going to have to avoid or cut back on some of these things to restart your ignitor.  If you have adrenal fatigue, you are likely avoiding some of these things but may be doing others.  Second, There are multiple steps in getting nutrients in to cells that become an issue.  This includes absorption, maintaining high levels in the bloodstream, and getting them in to your cells.  While there are many nutrients that are important in restarting your ignitor, there is a large amount of scientific evidence linking one specific nutrient to all of the systems mentioned above, and strong evidence that a deficiency in this nutrient quickly induces stage 1, followed by stage 2, adrenal fatigue.  Deficiency in this nutrient is highly dependent on carbohydrate intake, and deficiency can occur both in people who exercise too intensely and don't ingest enough carbohydrates as well as people who eat tons of carbohydrates while living a sedentary lifestyle.  We will cover that nutrient and all of the ins and outs of it, after the jump.

Next Blog