Nitty, Gritty Hormonal Details | The Health Battle: Part III
You've heard my Stress Story once, twice, or... okay, at least twenty times if you've been reading this blog for a while. But some points of my story bear repeating today because a severe adrenal fatigue diagnosis has forced me to really reflect upon the details of my story in order to address the depth of what stress has done to my body and specifically, to my hormones.
In the year leading up to my daughter's birth, I worked around the clock — from about 7 AM until one in the morning — in a high-pressure job in the heart of the Big Apple. After hours, I would move my tired, pregnant body and my laptop from my office in midtown to my bed in TriBeCa to continue working. I knew I should be letting myself rest, relax and restore to do the important work of creating a human. Yet night after night, the clock ticked into the AM hours as I battled a never-ending to-do list that was perpetually incomplete. Tears were often involved, and I was a completely run down mess by the time I went on maternity leave two weeks before my due date.
Once my daughter was born, I was awake around the clock, just like every mother in the history of the human race. However, because of my inability to adequately breastfeed (I did not produce enough milk, ever, in 22 months), every feeding was sad and stressful. Luckily, I enjoyed joyful moments bonding with my girl to buoy me in between feedings.
But then my relationship troubles began. Emotionally charged discussions became a bedtime ritual, after my daughter was peacefully asleep and my Ex finally returned home from work (usually an after-hours event, client dinner or both). For at least eighteen months, I went to bed distraught almost every single night, my eyes swollen from crying. To distract and numb my pain and feelings enough to be able to sleep, I created a habit of scrolling on my phone until I passed out — often with my phone in hand or under my pillow. Yeah, not good.
When my naturopath heard all of the nitty, gritty details of this story and the astounding amount of stress I shouldered for four years, adrenal fatigue was her first suspicion.
As I shared in part two of this Health Battle series, our adrenals are our fight-or-flight regulators. When our senses alert us to stress or danger, the adrenals produce a number of hormones, including adrenaline to equip us with a higher pain threshold and a rush of blood to our major muscles and heart; and cortisol to trigger the liver to release glucose into the blood. That way, we are supplied with the necessary energy to fight or run from the tiger (or other perceived danger, physical, emotional or psychological). Adrenal fatigue results in improper hormone production, which can throw off everything in the body from sleep patterns, to sex drive, to digestive function, to emotional state.
The results of a full round of bodily fluid tests, including a simple ASI saliva test, revealed that the four most influential hormones affecting my health right now are cortisol, DHEA, insulin and sigA. This post details what these hormones are, how they are (or are not) functioning in my body, and what we are doing to attempt more homeostasis and healing.
Cortisol is released in response to stress and low blood-glucose concentration, and helps us resist our stressors and maintain stable emotions. However, it should only be released into our bodies periodically, not constantly, as becomes required in response to chronic stressors.
Cortisol counteracts insulin, acts as a diuretic and is also responsible for creating memories of short-term emotional events so that we know what to avoid in the future. Abusing this function damages learning ability and memory.
The normal range of cortisol output is 22-46 nM. My total cortisol output is 19, which is very low, making it hard for my body to regulate my blood sugar levels. But most interesting to me is the pattern in which I produce cortisol, because it is the exact opposite of what I should be doing.
My cortisol level is significantly depressed in the morning between 6-8 AM, which is precisely when our cortisol levels should be at an all-time high for the day (the normal early morning range is between 13-24 and I am at 8).
Throughout the day, my cortisol level hovers within the normal range, but opposite to the normal curve.
At bedtime, or between 10 PM-midnight, my cortisol spikes, which is precisely when it should drop to signal to my body that it's bedtime.
The fact that my cortisol levels are so contrary to a normal, functioning schedule is a key piece to my weight balance puzzle because:
- My body habitually floods my blood stream with cortisol at bedtime, making it hard for me to fall asleep.
- Even once I am asleep, my elevated cortisol level prevents me from getting the deep rest that I need, and because there is no tiger to run from and my body is not moving, I don't need — and am not using or burning off — any of the glucose produced by that late-night spike.
- With this pattern, my cortisol reserves are used up overnight, leaving me with too little cortisol in the morning to signal to my body that it is time to wake up and get going. Getting me up is worse than waking a teen.
- Finally, I am exhausted during the day and neither equipped to exercise with any vigor, nor make healthy food choices.
That cycle feeds itself.
As soon as my naturopath explained all of this to me, I sighed with relief. This result aligned perfectly with the stressful tiring reality I described at the beginning of this post, and the symptoms I've been experiencing because of this reality (described in more detail in the second post in this series). But I am grateful to now be able to ground myself in a diagnosis that makes sense, and a long-term healing plan that I trust will restore my health, energy and zest for life (it's already helping!).
When it comes to cortisol, that healing plan is specifically addressing my wake up and wind-down hours in order to retrain my body and hormones toward more natural habits.
Upon waking, I drink a strong cup (two teabags covered and steeped for 15 minutes) of licorice root tea. The plant hormones in licorice root mimic the effects of cortisol, which helps alert my body that it's time to wake up, providing the 'get up and go' that I naturally lack at the moment.
At bedtime, I take a combination of melatonin, phosphatidylserine and magnesium to chemically signal to my body that it's time to wind down. The bedtime screen-numbing habit I developed to avoid my emotions and fall asleep must go, because the light emanating from a screen (or screens, let's be honest) does not allow melatonin to do its job. Even a small amount of light (like the light from a charging device) can interfere, preventing my already confused body from confirming that it is time to sleep.
So, I'm working to replace the screen-to-sleep habit with a deliberately calming, soothing new bedtime routine. This transition has been a mini mental battle every night (iPhones are addictive and ingrained habits are hard to break!), even though I know and understand how important it is to my health and healing. Because doctors recommend nine hours of sleep when healing from severe adrenal fatigue, 10 PM is my bedtime.
That means shutting down at 9 PM, with all screens put away in another room for the night to give me one hour to slow my pace, create calm and show myself some presence and love. I drink a cup of chamomile tea, do some meditation or yoga, and read until I fall asleep.
It's much better to fall asleep on a book than on a phone transmitting wireless signals.
DHEA is a natural steroid that is also produced by the adrenals and is key to hormone balance and feeling good (i.e. maintaining a stable, clear-headed, joyful and energetic mood). We must have adequate levels of DHEA for our bodies to produce the hormones we need when we need them.
Unfortunately, as with cortisol, my DHEA levels are significantly depressed: I am at a 2 and the normal range is 3-10 ng/ml. Again, as with cortisol, these depressed levels result from prolonged exposure to stressors which decrease adrenal hormone output over time.
Depressed DHEA levels can cause extreme fatigue, decrease in muscle mass, decrease in bone density, depression, aching joints, loss of libido and lowered immunity. Sound familiar? Yes, that is correct: basically everything I have been experiencing.
DHEA supplements are available to remedy low levels of DHEA, but my naturopath is taking a different route because while my levels are low, they are still within a range that we may be able to affect without taking the supplements. Additionally, some of the benefits of what I'm doing to right my cortisol levels will overlap to improve DHEA levels and function.
Plus, in a shockingly simple fashion, a great way to naturally boost DHEA levels is to cultivate joy and spirituality in one's life. #SimpleNotSimple, if you are suffering from extreme fatigue, depression and the exact symptoms that result from low levels of DHEA (also as with cortisol, a cyclical problem to have). But it makes self-love and self-care so much more important, and justifies prioritizing self-care in my life, if such a justification were necessary.
But it seems that sometimes, it is. A good friend recently told me that I had the rest of my life to focus on myself, but only one chance to give my daughter a wonderful childhood, as though my attempts to prioritize my wellness are selfish. She is wrong. Children are fully aware if their parents are not fully present, or if they are suffering mentally or emotionally. If I don't take care of myself right now — my naturopath estimates that this full healing process will take about a year — I will be giving my daughter only a fraction of the mother she could have for the rest of our lives together. Addressing this healing now (while simultaneously celebrating her toddler years, of course) is of the utmost importance to me, so as to enable a healthy, whole later. Which is why I choose growth and cultivating joy.
Lucky for me, cultivating joy in my life since moving to New Hampshire is possible in a myriad of ways: pursuing activities and people that bring me pleasure; connecting with old and new friends (like my summer synchronized swimming club, "The Syncho Sisters," or the ladies in the weekly dance class I teach); focusing on things I like or am proud of about myself; exercise; seeking and accepting love, nurturing and affection from myself and others; being outside to enjoy the nature that surrounds me; exploring what spirituality means to me right now; and play. Yes, play.
I can do that. In fact, I can do at least a couple of these things each day.
Insulin is secreted by the pancreas to lower blood glucose, which is the piece that starts to pull this hormonal puzzle together.
- High levels of stress cause the adrenals to release cortisol...
- ... which in turn triggers the liver to release glucose into the blood in preparation to either fight or flee...
- ... which in turn calls the pancreas into action to produce insulin to regulate the flood of glucose.
So my test results make perfect sense, yet again, because my insulin levels (both fasting and non-fasting) are borderline elevated. Chronic stress activates this process far more often than our bodies are designed for, and because cortisol counteracts insulin, and my cortisol levels are so low (due to worn out adrenals), it is no surprise that my insulin levels are high.
My fasting levels were only slightly elevated, but my non-fasting (at or around the time of eating) levels were significantly elevated.
That means the food and drink I was consuming — too much sugar, processed food, white flour and carbohydrates (foods our bodies interpret in the same way as sugar) — was flooding my blood with excess glucose, calling more insulin into action (a physical stressor in itself).
Chronic stress can also thwart the effects of insulin and can lead to insulin resistance, which I need to be extremely wary of, because diabetes runs on the paternal side of my family; a tradition I'm not interested in carrying on!
This is a battle fought entirely via my diet. I must take this result seriously and listen to what my body is telling me with severity: it cannot handle the sugars, dairy and processed crap at all. In order to heal, I must design my diet with compassion for my overall well-being. Not to be "skinny" or a "fit mom." Not to follow a diet or a trend or to answer society's need for me to "get my pre-baby body back." I must take control in order to be strong, healthy and in balance.
I saved mucus for last. Gross, right? Nah. Mucus is a hero.
Secretory IgA (SIgA) is the main immunoglobulin in mucus secretions, which is associated with chronic stress and the strength of the body's mucosal immunity. It is produced by the intestinal cells in a process that tends to peak in childhood and decline at about sixty years old. My overall production of SigA is low (yes, a recurring theme with my results): less than five mg on a range of 5-25 mg/DL (normal between 10-20).
As explained by Food Matters, "Many people think of mucus as being in the nose and sinuses, but actually there is much more in the gut. A sticky lining of mucus is our first-line defense against gastro-intestinal pathogens like bacteria, food proteins, parasites, fungi, toxins and viruses.
Simply put, the SIgA antibodies prevent micro-organisms, food proteins and carcinogens from binding to the surface of absorptive cells. Effectively, they attach themselves to invading nasties, trap them in mucus and stop them from going anywhere. They then [neutralize] any damaging toxins given off and help ensure the invaders are shown the door via [feces]. Clever little system.
The antibodies also 'tag' foods as acceptable to the body and this suggests why low SIgA levels can be the key to developing and progressive food allergy and intolerance.
Leaky gut is also related since, if levels are low, repair of mucosal tissues can be compromised."
So, voila! SigA is the key to my food intolerances. Which is why, after a few months — generally about four to six months — I will be able to retry the foods that bothered me during the elimination diet because my body should become more tolerant as my SigA levels rise.
So, how to make them rise? This may come as a surprise (*deep sarcasm*), but the answer is to lower my stress levels and make lifestyle changes when it comes to my diet. That is to say, eating every 3-4 hours to ensure that my blood sugar levels remain balanced, avoiding refined carbs, taking supplemental probiotics and digestive enzymes, and support the immune system as much as possible (hello, oil of oregano and echinacea!).
Especially in combination with my low cortisol levels — meaning I have trouble keeping my blood sugar balanced as it is — it really is imperative that I take this seriously.
Food Matters also recommends "beta glucans and digestive enzymes with targeted vitamins, minerals, fatty acids and amino acids. Nutrient-wise, we know that choline, essential fatty acids, glutathione, glycine, glutamine, phosphatidylcholine, Vitamin C and Zinc are all required in some way or another for efficient production of SIgA so it makes sense at least to [optimize] those."
So, that is the full picture of what I am working with when it comes to this health battle. Fortunately, it is interconnected and therefore, improving one piece strengthens another, and the treatments often overlap.
I have to fake it 'til I make it to some extent and do the things that are hard to do — exercise when I feel exhausted, eat clean when I just want to grab something easy (and processed), make time for some self-care when I don't really care — if only for a few minutes throughout each day. Exercising these dormant physical and mental muscles sometimes feels impossible to start, or to continue, or to re-start, but I must.
The best part is that all of this is a nudge, a jumpstart to my body to remind it that it knows what to do. So, at some point in the next year, a transition will happen and my body will take back over.
I hope this post helped you to better understand what adrenal fatigue can do to our bodies, but more importantly I hope it shed some light on the fact that there is hope. Restoring our hormonal balance is entirely possible with food, exercise, sleep, stress management and some select supplements.