{"id":1666,"date":"2015-11-25T22:33:36","date_gmt":"2015-11-26T05:33:36","guid":{"rendered":"http:\/\/docmuscles.com\/?p=1666"},"modified":"2018-02-05T01:58:25","modified_gmt":"2018-02-05T01:58:25","slug":"adrenal-insufficiency-adrenal-fatigue-pseudocushings-syndrome-oh-my","status":"publish","type":"post","link":"https:\/\/www.docmuscles.com\/adrenal-insufficiency-adrenal-fatigue-pseudocushings-syndrome-oh-my\/","title":{"rendered":"Adrenal Insufficiency, Adrenal Fatigue, PseudoCushing’s Syndrome – Oh My!"},"content":{"rendered":"<p>Adrenal Fatigue? Adrenal Insufficiency? \u00a0Cortisol? PseudoCushing’s Syndrome? \u00a0What do these terms mean and why are they all over the internet these days? And, what do they have to do with your weight loss?<\/p>\n<p>This was our topic this evening on PeriScope. \u00a0Katch Dr. Nally speak about this topic with rolling comments at <a href=\"https:\/\/katch.me\/docmuscles\/v\/8c6928d8-b2ab-364a-b11c-e994fe3d12b5\" target=\"_blank\" rel=\"noopener\">Katch.me\/docmuscles<\/a>. \u00a0Or you can watch the video below:<\/p>\n<div class=\"jetpack-video-wrapper\">\n<div class=\"ttfmake-embed-wrapper aligncenter\" style=\"max-width: 960px;\"><iframe loading=\"lazy\" title=\"What's the difference between adrenal fatigue, adrenal insufficiency and pseudocushing's syndrome? @docmuscles\" src=\"https:\/\/player.vimeo.com\/video\/146981517?dnt=1&app_id=122963\" width=\"320\" height=\"568\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture; clipboard-write\"><\/iframe><\/div>\n<\/div>\n<p>If you’re not sure about what this is, you\u2019re not alone. I think I’ve heard the term “Adrenal Fatigue” at lease four times a day for the last three months. \u00a0If you ask your doctor, they’ll probably scratch their heads too. \u00a0The funny thing is that “Adrenal Fatigue” isn’t a real diagnosis, but it is all over the internet and it shows up in the titles of magazines in the grocery store every day. \u00a0There’s even and “Adrenal Fatigue For Dummies” so it must be real, right?! \u00a0<img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"1676\" data-permalink=\"https:\/\/www.docmuscles.com\/adrenal-insufficiency-adrenal-fatigue-pseudocushings-syndrome-oh-my\/adrenal-fatigue-for-dummies\/\" data-orig-file=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2015\/11\/adrenal-fatigue-for-dummies.jpg?fit=397%2C499&ssl=1\" data-orig-size=\"397,499\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Adrenal Fatigue for Dummies\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2015\/11\/adrenal-fatigue-for-dummies.jpg?fit=239%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2015\/11\/adrenal-fatigue-for-dummies.jpg?fit=397%2C499&ssl=1\" class=\"alignright size-medium wp-image-1676\" src=\"https:\/\/docmuscles.files.wordpress.com\/2015\/11\/adrenal-fatigue-for-dummies.jpg?w=239&resize=239%2C300\" alt=\"Adrenal Fatigue for Dummies\" width=\"239\" height=\"300\" srcset=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2015\/11\/adrenal-fatigue-for-dummies.jpg?w=397&ssl=1 397w, https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2015\/11\/adrenal-fatigue-for-dummies.jpg?resize=239%2C300&ssl=1 239w\" sizes=\"auto, (max-width: 239px) 100vw, 239px\" \/><\/p>\n<p>No. \u00a0It isn’t a real diagnosis. \u00a0It is a conglomeration of symptoms including fatigue, difficulty getting out of bed in the morning, and “brain fog” that have been lumped together to sell an “adrenal supplement.” (Sorry, but that’s really what it is all about.) \u00a0Do a Google search and the first five or six sites describing adrenal fatigue claim the solution is taking their “special adrenal supplement.”<\/p>\n<p>I know what you’re thinking, “Your just a\u00a0main stream, Western Medicine doctor, Dr. Nally, you wouldn’t understand.” \u00a0Actually, I do understand.<\/p>\n<p>Adrenal fatigue has risen in popularity as a “lay diagnosis” because many patients show up at their doctors office with significant symptoms that actually interfere with their ability to function, and after all the testing comes back negative for any significant illness, they are told that they are normal. \u00a0But the patient still has the symptoms and no answer or treatment has been offered. \u00a0It’s discouraging. . . very discouraging.<\/p>\n<p>That’s because the symptoms are actually the body’s response to chronic long term stress. \u00a0Many of my patients, myself included, have found themselves \u201cstuck\u201d in their weight loss progression, feeling fatigued, struggling to face the day, with a number of symptoms including cold intolerance, memory decline, difficulty concentrating, depression, anxiety, dry skin, hair loss, and even infertility in some cases. \u00a0Is it poor functioning adrenal glands? No, your feeling this way because the adrenal glands are actually doing their job!!<\/p>\n<p>If the adrenal glands weren’t working you’d experience darkening of the skin, weight loss, gastric distress, significant weakness, anorexia, low blood pressure, and low blood sugar. \u00a0The symptoms are actually called Addison’s disease and it is actually fairly rare (1 in 100,000 chance to be exact). \u00a0So what is causing the symptoms you ask?<\/p>\n<p>There are a number of reasons,\u00a0but one that I am seeing more and more frequently is \u201c<em>Pseudo-Cushings\u2019s Syndrome.<\/em>\u201d <em>Pseudo-Cushing\u2019s Syndrome<\/em> is a physiologic\u00a0hypercortisolism (over production of cortisol) that can be caused by five common issues:<\/p>\n<ol>\n<li>Chronic Physical Stress<\/li>\n<li>Severe Bacterial or Fungal Infections that Go Untreated<\/li>\n<li>Malnutrition or Intense Chronic Exercise<\/li>\n<li>Psychological Stress \u2013 including untreated or under-treated depression, anxiety, post-traumatic stress, or dysthymia (chronic melancholy)<\/li>\n<li>Alcoholism<\/li>\n<\/ol>\n<p>The psychiatric literature suggest that up to 80% of people\u00a0with depressive disorders have increased cortisol secretion (1,2,3). \u00a0<img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"512\" height=\"501\" data-attachment-id=\"481\" data-permalink=\"https:\/\/www.docmuscles.com\/hpa-stress-response\/\" data-orig-file=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2014\/07\/hpa-stress-response.png?fit=512%2C501&ssl=1\" data-orig-size=\"512,501\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"HPA Stress response\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2014\/07\/hpa-stress-response.png?fit=300%2C294&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2014\/07\/hpa-stress-response.png?fit=512%2C501&ssl=1\" class=\" wp-image-481 size-full aligncenter\" src=\"http:\/\/docmuscles.files.wordpress.com\/2014\/07\/hpa-stress-response.png?w=639&resize=512%2C501\" alt=\"HPA Stress response\" srcset=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2014\/07\/hpa-stress-response.png?w=512&ssl=1 512w, https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2014\/07\/hpa-stress-response.png?resize=300%2C294&ssl=1 300w\" sizes=\"auto, (max-width: 512px) 100vw, 512px\" \/>People with significant stressors in their life have been show to have an increased corsiol secretion. Chronic\u00a0stress induces hyperactivity of the <em>hypothalamic-pituitary-adrenal axis<\/em> causing a daily, cyclic over production of cortisol and then normalization of cortisol after\u00a0resolution\u00a0of the stressor. \u00a0This cortisol response is not high enough to lead to a true <a href=\"http:\/\/www.mayoclinic.org\/diseases-conditions\/cushing-syndrome\/basics\/definition\/con-20032115\" target=\"_blank\" rel=\"noopener\"><em>Cushing\u2019s Syndrome<\/em><\/a>, but has the effect of the symptoms listed above and begins with limiting ones ability to loose weight.<\/p>\n<p>I’m convinced that this is becoming more and more prevalent due to the high paced, high-stress, always on, plugged in, 24 hour information overload\u00a0lives we live.<\/p>\n<p><strong>What is cortisol?<\/strong> It is a steroid hormone made naturally in the body by the adrenal cortex (outer portion of the adrenal gland). Cortisol is normally stimulated by a number of daily activities including fasting, awakening from sleep, exercise, and normal stresses upon the body. Cortisol release into the blood stream is highest in the morning, helping to wake us up, and tapers into the afternoon. Cortisol plays a very important role in helping our bodies to regulate the correct type (carbohydrate, fat, or protein) and amount of fuel to meet the bodies physiologic demands that are placed upon it at a given time (4,5,6).<\/p>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"510\" data-attachment-id=\"480\" data-permalink=\"https:\/\/www.docmuscles.com\/hpathyroid\/\" data-orig-file=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2014\/07\/hpathyroid.jpg?fit=400%2C510&ssl=1\" data-orig-size=\"400,510\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"HPAThyroid\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2014\/07\/hpathyroid.jpg?fit=235%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2014\/07\/hpathyroid.jpg?fit=400%2C510&ssl=1\" class=\" wp-image-480 size-full aligncenter\" src=\"http:\/\/docmuscles.files.wordpress.com\/2014\/07\/hpathyroid.jpg?w=639&resize=400%2C510\" alt=\"HPAThyroid\" srcset=\"https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2014\/07\/hpathyroid.jpg?w=400&ssl=1 400w, https:\/\/i0.wp.com\/www.docmuscles.com\/wp-content\/uploads\/2014\/07\/hpathyroid.jpg?resize=235%2C300&ssl=1 235w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/>Under a stress response, cortisol turns on\u00a0<em>gluconeogensis<\/em> in the liver (the conversion of amino acids or proteins into glucose) for fuel. Cortisol, also, shifts the storage of fats into the deeper abdominal tissues (by stimulating insulin production) and turns on the maturation process of adipocytes (it makes your fat cells age – nothing like having old fat cells, right?!) \u00a0In the process, cortisol suppresses the immune system through an inhibitory effect designed to decrease inflammation during times of stress (7,8,9). \u00a0If this was only occurring once in a while, this cascade of hormones acts as an important process. \u00a0However, when cortisol production is chronically turned up, it leads to abnormal deposition of fat (weight gain), increased risk of infection, impotence, abnormal blood sugars, brain fog, head<br \/>\naches, hypertension, depression, anxiety, hair loss, dry skin and ankle edema, to name a few.<\/p>\n<p>The chronic elevation in cortisol directly stimulates increased insulin formation by increasing the production of glucose in the body, and cortisol actually blunts or block-aids the thyroid function axis. Both of these actions halt the ability to loose weight, and\u00a0drive weight gain.<br \/>\nCortisol also increases appetite (10). \u00a0That\u2019s why many people get significant food cravings when they are under stress (\u201cstress eaters\u201d). Cortisol also indirectly affects the other neuro-hormones of the brain including\u00a0CRH (corticotrophin releasing hormone), leptin, and neuropeptide Y (NPY). High levels of NPY and CRH and reduced levels of leptin have also been shown to stimulate appetite and cause weight gain (10-11).<\/p>\n<p><strong>How do you test for <em>Pseudo-Cushing\u2019s Syndrome<\/em>? \u00a0<\/strong><\/p>\n<p>Testing can be done by your doctor with a simple morning blood test for cortisol. If your cortisol is found to be elevated, it needs to be repeated with an additional 24 hour urine cortisol measurement to confirm the diagnosis. If <em>Cushing\u2019s Syndrome<\/em> is suspected, some additional blood testing and diagnostic imaging will be necessary. \u00a0Pseudo-Cushing syndrome will demonstrate a slightly elevated morning cortisol that doesn’t meet the criteria for true Cushing’s type syndrome or disease.<\/p>\n<p><strong>How do you treat it?<\/strong><\/p>\n<p><strong>First<\/strong>, the stressor must be identified and removed. \u00a0Are you getting enough sleep? \u00a0Is there an underlying infection? Is there untreated anxiety or depression present? \u00a0Are you over-exercising? \u00a0These things must be addressed.<\/p>\n<p><strong>Second<\/strong>, underlying depression or anxiety can be treated with counseling, a variety of weight neutral anti-depressant medications or a combination of both. \u00a0Many of my patients find that meditation, prayer, and journaling are tremendous helps to overcoming much of the anxiety and depression they experience.<\/p>\n<p><strong>Third<\/strong>, adequate sleep is essential. \u00a0Remove the television, computer, cell phone, iPad or other electronic distraction from the bedroom. \u00a0Go to bed at the same time and get up at the same time each day. Give yourself time each day away from being plugged in, logged in or on-line.<\/p>\n<p><strong>Fourth<\/strong>, mild intensity (40% of your maximal exertion level) exercise 2-3 days a week was found to lower cortisol; however, moderate intensity (60% of your maximal exertion level) to high intensity (80% of your maximal exertion level) exercise was found to raise it (12).\u00a0\u00a0A simple 20 minute walk, 2-3 times per week is very effective. \u00a0Find a hobby that you enjoy and participate in it once or twice a week. \u00a0Preferably, a hobby that requires some physical activity. The activity will actually help the sleep wake cycles to improve.<\/p>\n<p><strong>Fifth<\/strong>, follow a low carbohydrate or ketogenic diet. \u00a0Ketogenic diets decrease insulin and reverse the effect of long term cortisol production. \u00a0Ketogenic diets a have also been shown to decrease or mitigate inflammation by reducing hyperinsulinemia commonly present in these patients (13).<\/p>\n<p>So, the take home message is . . . take your adrenal glands off of overdrive.<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Pfohl B, Sherman B, Schlechte J, Winokur G. Differences in plasma ACTH and cortisol between depressed patients and normal controls. Biol Psychiatry 1985; 20:1055.<\/li>\n<li>Pfohl B, Sherman B, Schlechte J, Stone R. Pituitary-adrenal axis rhythm disturbances in psychiatric depression. Arch Gen Psychiatry 1985; 42:897.<\/li>\n<li>Gold PW, Loriaux DL, Roy A, et al. Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing\u2019s disease. Pathophysiologic and diagnostic implications. N Engl J Med 1986; 314:1329.<\/li>\n<li>Ely, D.L. Organization of cardiovascular and neurohumoral responses to stress: implications for health and disease. Annals of the New York Academy of Sciences (Reprinted from Stress) 771:594-608, 1995.<\/li>\n<li>McEwen, B.S. The brain as a target of endocrine hormones. In Neuroendocrinology. Krieger and Hughs, Eds.: 33-42. Sinauer Association, Inc., Massachusetts, 1980.<\/li>\n<li>Vicennati, V., L. Ceroni, L. Gagliardi, et al. Response of the hypothalamic- pituitary-adrenocortical axis to high-protein\/fat and high carbohydrate meals in women with different obesity phenotypes. The Journal of Clinical Endocrinology and Metabolism 87(8) 3984-3988, 2002.<\/li>\n<li>Wallerius, S., R. Rosmond, T. Ljung, et al. Rise in morning saliva cortisol is associated with abdominal obesity in men: a preliminary report. Journal of Endocrinology Investigation 26: 616-619, 2003.<\/li>\n<li>Epel, E.S., B. McEwen, T. Seeman, et al. Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat.<br \/>\nPsychosomatic Medicine 62:623-632, 2000.<\/li>\n<li>Tomlinson, J.W. & P.M. Stewart. The functional consequences of 11_- hydroxysteroid dehydrogenase expression in adipose tissue. Hormone and Metabolism Research 34: 746-751, 2002.<\/li>\n<li>Epel, E., R. Lapidus, B. McEwen, et al. Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior.Psychoneuroendocrinology 26: 37-49, 2001.<\/li>\n<li>Cavagnini, F., M. Croci, P. Putignano, et al. Glucocorticoids and neuroendocrine function. International Journal of Obesity 24: S77-S79, 2000.<\/li>\n<li>Hill EE, Zack E, Battaglini C, Viru M, Vuru A, Hackney AC.\u00a0Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest.\u00a02008. Jul;31(7):587-91.<\/li>\n<li>Fishel MA et al.,\u00a0<span id=\"scm6MainContent_lblArticleTitle\">Hyperinsulinemia Provokes Synchronous Increases in Central Inflammation and \u03b2-Amyloid in Normal Adults.\u00a0<i>Arch Neurol. <\/i>2005;62(10):1539-1544. doi:10.1001\/archneur.62.10.noc50112.<\/span><\/li>\n<\/ol>\n<span class=\"inf_infusionsoft_bottom_trigger\"><\/span>","protected":false},"excerpt":{"rendered":"<p>Adrenal Fatigue? Adrenal Insufficiency? \u00a0Cortisol? PseudoCushing’s Syndrome? \u00a0What do these terms mean and why are they all over the internet these days? And, what do they have to do with your weight loss? This was our topic this evening on PeriScope. \u00a0Katch Dr. Nally speak about this topic with rolling comments at Katch.me\/docmuscles. \u00a0Or you …<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[280,453,74,241,454,4,231,382,435,436,228,239,356,461,462,358,316,389,81,168,457,464,1,56,197],"tags":[465,466,45,527,132,133,3,401,6,35,7,8,36,44,344,137,919,11],"class_list":["post-1666","post","type-post","status-publish","format-standard","hentry","category-definitions","category-depression","category-exercise","category-exercise-myth","category-fatigue","category-health","category-hormones","category-hunger-management","category-immune-system","category-immunity","category-insulin-resistance","category-ketogenic","category-ketogenic-lifestyle","category-leptin","category-leptin-resistance","category-low-carb-lifestyle","category-metabolic-syndrome","category-nutritional-values","category-obesity","category-stress","category-stress-reduction","category-sugar","category-uncategorized","category-weight-loss","category-wellness","tag-adrenal-fatigue","tag-adrenal-insufficiency","tag-carbohydrate-restriction","tag-carbohydrates","tag-cushings-disease","tag-cushings-syndrome","tag-diet","tag-fatigue","tag-ketogenic","tag-ketogenic-diet","tag-ketosis","tag-low-carb","tag-low-carb-diet","tag-obesity","tag-periscope","tag-pseudo-cushings-disease","tag-pseudocushings-syndrome","tag-weight-gain"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Adrenal Insufficiency, Adrenal Fatigue, PseudoCushing's Syndrome - Oh My! - DocMuscles<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.docmuscles.com\/adrenal-insufficiency-adrenal-fatigue-pseudocushings-syndrome-oh-my\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Adrenal Insufficiency, Adrenal Fatigue, PseudoCushing's Syndrome - Oh My! - DocMuscles\" \/>\n<meta property=\"og:description\" content=\"Adrenal Fatigue? 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