Is Adrenal Fatigue a Gluten Problem?

Can Gluten Cause Adrenal Fatigue?  

Adrenal fatigue, also known as adrenal insufficiency or adrenal burnout, is a topic that is garnering more and more attention.  Because of increasing stress levels in a large portion of the population, doctors and scientists are appreciating the important role that stress plays on illness and health. But how exactly does stress have to do with the adrenal glands? And more importantly, what role does gluten play in the development of adrenal fatigue? This article will dive into these questions as well as covering the following information:

• What are the adrenal glands, and how do they work?
• What is the difference between adrenal fatigue and adrenal insufficiency?
• What are symptoms of adrenal fatigue or adrenal insufficiency?
• How are stress and adrenal function related?
• Can gluten cause adrenal disease?
• Natural tips to overcome adrenal fatigue

Adrenal gland function overview

Before we dive into our discussion of the key question at hand, it is helpful to take a step back to understand how the adrenal glands work.

The adrenal glands are small, triangular-shaped glands located on top of both kidneys. They produce hormones that help regulate metabolism, immune system, blood pressure, and response to stress.

The adrenal glands consist of two parts, each with separate endocrine functions:

1. Cortex: the outer region and also the largest part of an adrenal gland. It is divided into three separate zones, each responsible for producing specific hormones.
2. Medulla: located inside the adrenal cortex in the center of the adrenal gland. It produces “stress hormones,” including adrenaline and noradrenaline.

Adrenal cortex

The adrenal cortex produces the following hormones:

1. Glucocorticoids (primarily cortisol): Help to regulate blood sugar, promote and inhibit gene transcription in many cells and organ systems, and help the body to fight inflammation.
2. Mineralocorticoids (primarily aldosterone): Help regulate body water balance by controlling the flow of electrolyte transport across epithelial surfaces, particularly kidney (renal) conservation of sodium in exchange for potassium.
3. Androgens (primarily dehydroepiandrosterone or DHEA and androstenedione): precursor hormones that are converted in the ovaries into female hormones (estrogens) and in the testes into male hormones (androgens).

Adrenal Medulla

The adrenal medulla controls hormones that initiate the body’s “flight or fight” response. The primary hormones secreted by the adrenal medulla include epinephrine (adrenaline) and norepinephrine (noradrenaline).

When the body senses stress, these hormones cause the heart rate and force of heart contractions to increase, which in turn increases blood flow to the muscles and brain, relaxes airway smooth muscles, and assists in glucose (sugar) metabolism. Epinephrine and norepinephrine also control the constriction of blood vessels, which influences blood pressure.

When the body is in a chronic prolonged stress state, blood flow is directed away from the GI tract, and prioritized toward the brain and muscles.  In this way, chronic stress slows and hinders digestion – an important point for those with gluten induced intestinal inflammation.

What is Adrenal Insufficiency?

Adrenal insufficiency is a disorder that occurs when the adrenal glands don’t make enough of certain hormones. It can affect the body’s ability to respond to stress and maintain other essential life functions. Adrenal insufficiency can be primary, secondary, or tertiary:

• Primary adrenal insufficiency: often called Addison’s disease, occurs when the adrenal glands are damaged and cannot make enough cortisol and sometimes aldosterone.
• Secondary adrenal insufficiency: occurs when the pituitary gland doesn’t make enough adrenocorticotropin (ACTH), which is a hormone that tells the adrenal glands to make cortisol. This can cause the adrenal glands to shrink over time and ultimately stop working.
• Tertiary adrenal insufficiency: occurs when the hypothalamus does not make enough corticotropin-releasing hormone (CRH), which is a hormone that tells the pituitary to make ACTH. Like secondary adrenal insufficiency, this can cause the adrenal glands to not make enough cortisol, and stop working over time.

If you suspect adrenal insufficiency, it is important that you follow up with your doctor to have your ACTH, CRH, cortisol, and aldosterone levels measured.  Medical imaging can also be helpful to help with an accurate diagnosis.

Symptoms of Adrenal Insufficiency 

Symptoms of adrenal insufficiency tend to come on slowly and gradually, which makes them less noticeable for many people. Common symptoms of adrenal insufficiency include the following:

• chronic fatigue
• muscle weakness
• loss of appetite
• weight loss
• abdominal pain

Less commonly, adrenal insufficiency can also cause the following symptoms:

• nausea
• vomiting
• diarrhea
• low blood pressure that drops further when you stand up, causing dizziness or fainting
• irritability and depression
• joint pain
• craving salty foods
• hypoglycemia, or low blood glucose
• irregular or no menstrual periods
• loss of interest in sex
• darkening of skin in folds and on joints

Stress and Adrenal Function

To understand stress and adrenal function, it is important to understand cortisol.  Cortisol is one of the primary steroids that helps the body adapt and cope with stress.  For this reason, it is sometimes referred to as the body’s natural alarm system.  Cortisol is a diurnal hormone that follows a rhythmic secretion.  Cortisol levels are highest in the morning because cortisol is responsible for waking us up from a good night’s sleep.  Cortisol levels naturally decline throughout the day, and are lowest at night so that we are capable of falling asleep. 

The exception to this rhythmic excretion occurs with stress.   When the body is stressed, the adrenal glands release greater amounts of cortisol. In a healthy person who experiences moderate levels of occasional stress, cortisol levels initially rise to aid in the stress response.  After the stress is resolved, the cortisol levels return to normal.  

The Problem With Chronic Stress

When the body is  chronically stressed, cortisol levels stay elevated.  This longer term elevation can have a number of deleterious effects on the body.  Some of which include:

• • Fatigue
  • Weight Gain
  • Water Retention
  • Muscle Loss
  • Bone Loss
  • Elevated Blood Pressure
  • Elevated Blood Sugar
  • Low Libido

This process should not be confused with Cushing’s disease.  Cushing’s is a form of hypercortisolemia caused by a tumor on the pituitary gland.  Where chronic stress can also cause an increase in cortisol levels, the increase is not permanent.  If the chronic stress continues to persist, the adrenal glands can become “fatigued”.  When this happens, cortisol levels can begin to drop below healthy levels leading to the symptoms of adrenal insufficiency.  

Think of adrenal fatigue as a dynamic cyclic deterioration of the adrenal gland reserves that initially manifests with cortisol elevation, but over time, cortisol levels drop and ultimately lead to an individual’s inability to adapt or cope with stress.  This spectrum of cortisol fluctuation is what makes it so hard for doctors to identify the problem.  Conventional training typically only focuses on calling low cortisol Addison’s disease, and high cortisol Cushing’s.  So when patients don’t fit in the perfect box of one or the other, they are often dismissed.

With All This Talk About Stress – What Exactly is Stress?

According to the National Library of Medicine, 

“Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous.  Stress is your body’s reaction to a challenge or demand. In short bursts, stress can be positive, such as when it helps you avoid danger or meet a deadline. But when stress lasts for a long time, it may harm your health.”

It is important to note that the body does not just feel stress from physical and emotional factors, like work deadlines and busy schedules. The body also experiences stress from external biochemical factors that negatively impact health, like toxins, infection, illness, and other factors that cause an inflammatory response, like the ingestion of gluten in those who are sensitive. This means that those with celiac disease or gluten sensitivity are causing stress in their bodies when they eat foods that contain gluten.

Can Gluten Cause Adrenal Disease? 

We know that gluten can cause stress on the body, and that chronic stress can impair adrenal function, but can gluten cause adrenal disease?

While research is still examining this relationship, a number of studies have suggested a positive association. It is thought this relationship is driven by influence of celiac disease on the endocrine system. One study found a highly increased risk of Addison’s Disease in individuals with celiac. Another study found more than 15% of patients with Addison’s disease also had celiac disease or evidence of gluten sensitivity. Several screening studies from multiple countries have indicated that patients with autoimmune adrenal failure or Addison’s disease should be screened for celiac disease, even if symptoms are not present.

Furthermore, some research has suggested that a gluten free diet may improve symptoms and markers of adrenal disease.

Gluten Induced Nutritional Deficiencies and the Adrenal Glands

We know that celiac disease and gluten sensitivity can lead to a number of key nutrient deficiencies. These deficiencies can influence adrenal function as many are necessary for proper adrenal function. 

In fact, research has shown that the following key nutrients are critical to adrenal health and cortisol regulation:

• • Vitamin B1 (Thiamine)
  • Vitamin B2 (Riboflavin)
  • Vitamin B3 (Niacin)
  • Vitamin B5 (Pantothenate)
  • Vitamin B6 (Pyridoxine)
  • Vitamin B9 (Folate
  • Vitamin B12
  • Choline
  • Vitamin D
  • Vitamin C
  • Magnesium
  • Zinc
  • Boron

In addition, research has indicated that certain nutrients are required for the synthesis of the important catecholamines adrenaline and noradrenaline, including vitamin C, vitamin B6, tyrosine, iron, copper, and magnesium. 

What Should You Do if You Suspect Adrenal Fatigue?

So how do you treat adrenal insufficiency? In short, you want to nurture your adrenals by managing sources of stress. This doesn’t just mean emotional stress, but “good” stress like exercise, too. The following are steps to take if you suspect adrenal fatigue:

• • Get adequate sleep: aim for 7-8 hours per night
  • Exercise only to tolerance only: consider walks, yoga, etc.
  • Eat a clean diet: remove refined carbohydrates and sugar, focus on fresh whole foods and high quality protein and fats
  • Limit or remove lifestyle and environmental toxins: for example, use an air purifier, clean up personal care and household cleaning products, etc.
  • Drink plenty of clean water: consider a water filter to ensure you aren’t ingesting harmful toxins (note: the Environmental Working Group has a helpful tool to assess water quality by zip code, as well as resources for finding the best filter)
  • Limit emotional stress: address known sources of stress in your life

Conclusion

Adrenal insufficiency is a common condition that can be driven by chronic stress and may be more common in those with celiac disease. If you are experiencing symptoms of adrenal fatigue, take steps to reduce stress in your life, be sure to follow a strict gluten free diet, and consider supplementation to support your adrenal function.