Nature of the Hypoadrenal
(Chronic Fatigue) PatientBefore discussing the treatment of hypoadrenalism used at our Center, let's consider the nature of the person who is most likely to develop this disorder and the manner in which it is produced. If I could describe the hypoadrenal patient in one single word, that word would be sensitive. He is cognizant of all that is going on around him, and he perhaps feels an overconscientious sense of responsibility about those near and dear to him and even about the whole world. This person's nervous and glandular systems are delicately balanced; yet he is willing to take the cares of the world on his own shoulders.
However, such a nature, by itself, is not sufficient to cause adrenal insufficiency. In my own estimation, a hereditary weakness of adrenal structure must be present for this condition to manifest. There are many sensitive persons who, though they fit this description, nevertheless have sufficient glandular vitality to avoid adrenal hypofunction. On the other hand, we do find persons who are by nature not perfectionists or are not inclined to drive themselves, yet suffer from this ailment. In these persons, it would appear that the hereditary weakness is so strong that even a relatively normal amount of stress is sufficient to trigger adrenal hypofunction.
To understand the hypoadrenal patient further, it is necessary to understand exactly what stresses cause this condition in susceptible persons. When I was in medical school, I was taught that the adrenal gland helps us with our "flight or fight" demands. You probably have heard of cases in which persons under excitement or stress have been able to accomplish feats of tremendous strength and endurance well beyond their normal physical abilities. These are all moderated by the effect of the adrenal gland, which is a storehouse of hormones that can be dumped into the circulating blood to stimulate body function if needed. If the need is great enough, large amounts can be dumped, which can produce for short periods a prodigious degree of physical strength and endurance. Afterwards, however, a period of rest is needed to replenish the depleted hormones from these glands so they will be prepared to produce this dumping action when needed again.
Classical Example of Adrenal Action
The classical example of this acute stress is the cave man who encounters a saber-toothed tiger. When he sees this dangerous animal, his adrenal glands pour forth a great abundance of the required hormones into his bloodstream. He could use this sudden strength either for fight or for flight. He could either turn on the tiger with superhuman strength and attempt to subdue it, or he could take flight and through the use of adrenal support run faster and further than he had ever run before. Finally, after he reaches safety or subdues the beast (assuming the tiger was not victorious), he rests or recuperates, gasping to draw in large amounts of oxygen in an attempt to replenish his supply of this vital gas. He is now exhausted and his body requires rest for a few hours or even a day or two if the drain on his adrenal glands is to be rectified.
It is postulated by most authorities on this subject that this, in general, was the specific function for which this gland was used. However, many other stresses are applied to the body for which its secretions are useful and even vital. Some of these stresses, however, are of such a nature that they do not provide the proper periods of rest for the recovery of the gland; this type of unremitting stress tends to cause hypoadrenalism.
Types of Stress
The various forms of stress to which man is susceptible can be broken down into those of a physical, a chemical, or an emotional nature.
Among the physical stresses, we include extreme cold or heat, overly dry or humid air, trauma of various kinds--for example, a broken leg, broken ribs, crushed hand or surgery--and almost any form of physical entity that causes the basic body function to make adaptations beyond the rather narrow limit of homeostasis (physiologic equilibrium due to a balance of functions and chemical composition).
Chemical stresses include the various types of toxins due to infections, and toxic substances that may come in any chemical form--carbon tetrachloride, lead, mercury, gasoline fumes, cigarette smoke, or even alcohol in abundance. Any chemical substance that the body must detoxify is a stress on the adrenal gland. These can also include allergies in those susceptible to them and things not often considered as stresses such as immunizations and prescription drugs.
Emotional stresses are so multitudinous that I can name only a few examples. Parents that don't understand you, children that don't mind you, a husband that drinks, a lazy wife, a boss who is hard to get along with, employees that don't do their jobs properly--all can cause adrenal stress. But situations don't cause strain on the adrenal system; our internal reactions to these situations do. In other words, people around us don't cause our adrenal insufficiency; our reactions to these people and stressful situations are the culprit.
Three Factors Needed to Produce
Chronic Fatigue SyndromeAll these stresses may lay the foundation for hypoadrenalism. However, at least three factors must be present to produce hypoadrenalism in the average person.
The first of the three factors is the nature of the stress. The adrenal gland, designed to help us during stressful periods, tends to atrophy with nonuse, and it grows stronger with proper use. Thus, the adrenal gland doesn't exhaust itself by reacting to stress; it actually becomes stronger if the stress is applied in a reasonable fashion and needed periods of rest allowed for regeneration. What does exhaust the gland is if the stress is so applied that its effect is unremitting and no proper time is provided for the adrenal gland to accomplish its normal regeneration.
The second factor is our response to stress, and the third is the degree of hereditary influence. Let me give an example to show these three points. Hypoadrenalism (Chronic Fatigue Syndrome, Fibromyalgia, SBS, etc.) frequently occurs in a person who has cared for a loved one through a long, extended illness. Let's take, for instance, a woman whose husband has developed cancer and has been operated on unsuccessfully. The physicians have given up all hope, but the man has a sturdy constitution and he lives on for maybe a year or two before he finally succumbs. The family is not wealthy and cannot hire nurses or other help to care for him, so his wife must care for him. She is often up day and night, watching out for his needs. The man she has loved for many years is now gradually changing. He is little by little withering and dying before her eyes. His emotional nature often changes and he becomes a very difficult person to live with. There are times she would like to scream at him; yet she knows that this is not socially acceptable, so she holds it in. She can't get her proper rest. She doesn't eat properly because the whole situation has made her lose her appetite. So she snacks on foods that don't supply her body with the vital elements she especially needs at this time. Her adrenal glands, the willing servants that they are, keep pouring out hormones to sustain her during this time. Unfortunately, they, like her, get little respite.
As time goes on the stress is now unremitting and constant. Although the glands can recuperate during sleep to some degree, her rest is less than normal and her glands have little time for their own regeneration. But they are valiant friends; they don't give in. They keep functioning and working well beyond their normal requirements.
Finally, death comes to her husband, but stress is not over for her. She must deal with the undertaker and then the lawyers. Then come the government, inconsiderate relatives and the other people who disturb or even prey on a recent widow.
During all this additional stress, her steadfast adrenal glands keep working their best to produce the substances she needs to keep going. Finally, she is able to rest. The undertaker, the relatives, the lawyers and even the government are satisfied. At last she can relax. What about her adrenal glands? They are exhausted. They too now demand a well-earned rest. As soon as the stresses are removed and the adrenal glands aren't needed to the extent they once were during heavy stress, their function slows to enable regeneration for the preservation of the whole physical system. Our widow suddenly feels tired and exhausted. At this point, she may or may not develop hypoadrenalism. Much depends on the basic hereditary integrity of the adrenal glands. She may well go into a period of depression and of exhaustion. If the glands are basically strong and healthy, she will recuperate and be able to go on with her life in a reasonable time. If the glands are inherently weak, she may develop chronic hypoadrenalism. The glands become so exhausted, so weakened that even with the rest they now receive they aren't capable of regenerating to their normal state. They still function, or the woman would die, but they function at a far lower level than they did before the prolonged period of stress; much lower than the level needed for a contented normal daily existence.
We have just reproduced a classic case of functional hypoadrenalism. Although there are many other ways of producing this syndrome, certain specifics can be derived from this case history about the nature of the stress most likely to produce this condition.
First, although the stress itself isn't necessarily great, it is generally unremitting. Also, we sensitive humans aren't able to overcome it, either because of a sense of responsibility or because of our own emotional dependency. For example, even though it was exhausting her adrenal glands, there was really nothing else for this wife to do but to take care of her husband. For her own physical well-being, she could have abandoned him, turned him over to relatives if such existed, or tried to get the state to take care of him. These actions may have prevented her developing hypoadrenalism, but her own sense of responsibility would not have allowed it. In my experience, most stresses that produce hypoadrenalism come from doing what we believe to be our duty. If we are to prevent hypoadrenalism in those who are susceptible, we must teach them to learn to control their response to this and other forms of stress.
Besides unremitting stress, the second factor necessary for adrenal insufficiency is our own emotional response to this stress. In this day and age, we can't escape stress; not even unremitting stress. From the radio, television set, and newspapers, we are constantly bombarded by stress-producing news. The events in the world today occur too rapidly for our adaptive systems to absorb and adjust. These stresses alone can produce hypoadrenalism in a susceptible person. A stress--especially one due to emotional factors--isn't a stress because it is applied to us. It is a stress because of our reaction to it. The real stress is our reaction to the stimulation.
This of course is not true of most chemical and physical stresses, only those of an emotional nature. Even with chemical or physical stresses, however, there can be an emotional component that can greatly increase damage. For example, if the fear of a disease and what it might entail is superimposed on the disease itself, an additional stress is produced that may affect the body more than just the disease. This is often true of physical stresses. A knee injury to an athlete that prevents him from playing in an important game, or causes him to lose income, may readily produce far more stress than the actual injury on his glandular system.
Our attitude--what I call acceptance of the stress--is often equally or even more important in producing reaction than is the stress itself. In the example of the woman with the dying husband, if she could have rearranged her life, much of her later trouble could have been prevented. She could have called in relatives to help care for her husband on various nights, enabling her to get her sleep. She could have arranged her own life so that her diet was more adequate for her needs, thereby reducing the nutritional stress on her body. She could have eaten the foods and nutrients that are best able to build up and support the adrenal glands during her difficult period. With more knowledge she could have changed her basic attitude toward her husband at this time, to a complete acceptance of his condition and of his unavoidable death.
The third and perhaps most important factor in hypoadrenalism, but unfortunately the one we are least able to change, is heredity. After nearly forty years of treating these patients, it is my belief that some adrenal glands are almost incapable of becoming exhausted, no matter what the stress or in what manner it is formed or accepted. On the other hand, I know that there are people who, no matter how well protected, are fated to have some degree of hypoadrenalism at some time in their lives. Most of our cases fall somewhere between these two extremes.
I believe that, even though there is an adverse hereditary factor, the average susceptible person, if he takes care to follow the regimen we recommend, can avoid functional hypoadrenalism. Also, the average hypoadrenal patient is capable of responding readily to proper treatment, thus returning to normal function.
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