Functional Medicine Treatment Options for Adrenal Disorders: Specialty Testing, Nutrition, Supplements

The adrenal glands are tiny hormone-producing powerhouses that are essential for survival. This article will discuss what the adrenal glands are, including their role in the body, and the top health issues related to the adrenal glands. We’ll then discuss functional medicine testing for the top adrenal conditions and complementary and integrative medicine options, including diet, supplements, and herbs, for adrenal health.

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What are The Adrenal Glands?

Our body has two adrenal glands, which are small glands that sit atop each kidney. They release hormones in response to various stressors. The adrenal glands have two main sections: the adrenal cortex and the adrenal medulla.  

What Is the Role of the Adrenal Glands in the Body?

Producing hormones is the main function of the adrenal glands. The adrenal cortex has different layers, with each layer making a different hormone. In the zona fasciculata, the hormone cortisol is made. Cortisol has many roles in the body, including modulating inflammation, blood sugar, blood pressure, and more. When the hypothalamic-pituitary-adrenal (HPA) axis is activated, the adrenal glands release cortisol. In another layer of the adrenal glands, called the zona glomerulosa, aldosterone is made. Aldosterone is a hormone that regulates the electrolytes sodium and potassium from being excreted or withheld by the kidneys; this, in turn, affects blood pressure. Lastly, in the zona reticularis, DHEA and other androgenic steroid hormones are made. This is important because DHEA is a precursor to estrogen and testosterone in men and women.

The adrenal medulla, or inner part of the adrenal gland, is where the fight or flight hormones epinephrine and norepinephrine are made. Epinephrine and norepinephrine have the ability to increase blood pressure, heart rate, and muscular contraction of the heart and aid in blood sugar metabolism.

What are the Top Health Issues Related to Adrenal Glands?

The top health issues related to the adrenal glands include HPA axis dysfunction, Cushing’s syndrome, and Addison’s disease. Let’s look at each of these health conditions.

HPA Axis Dysfunction

When the body undergoes stress, the HPA axis activates in order to release hormones, including cortisol, to combat the stress. The hypothalamus controls temperature regulation, heart rate, mood, senses stress, and, in response, releases a hormone to the pituitary gland. The pituitary gland, a gland that regulates reproduction, growth, and metabolism, receives the hormone from the hypothalamus and, in response, releases its own hormone to the adrenal glands. The adrenal glands receive the pituitary hormone and, in response, will begin releasing its own hormones to combat the stress. This pathway, the HPA activation under stress, was created when humans were primitive and only had acute, short stress, the stress of running away from an animal, etc. Therefore, activation of this pathway was meant to be short-lived. However, in today’s world, many people are under chronic stress. When the HPA axis is activated for a certain period of time, the hypothalamus thinks it's a mistake and downregulates the HPA axis activity. This is what has previously, and mistakenly, been named “adrenal fatigue.” It was previously thought that after chronic stress, the adrenals “burn out,” become “fatigued,” and aren’t able to produce the hormones. However, this is not true. The adrenal glands can always produce hormones (unless there are certain medical conditions, including Addison’s disease, that we’ll discuss below). What is happening is there is a miscommunication between the hypothalamus and adrenal glands, where the hypothalamus is not activating the HPA axis as it should. In addition to stress, HPA dysregulation can occur due to inflammation and micronutrient deficiencies. Signs and symptoms include fatigue, “tired but wired” feeling, mental fogginess or “brain fog”, weight gain in the hips and stomach, poor sleep, increased cravings for sugar and salty foods, hormone imbalances, hair loss, and weak nails.

Cushing’s Syndrome

Cushing’s syndrome is a disease characterized by excess cortisol production in the adrenal glands. Cushing’s syndrome can develop due to tumors of the pituitary, adrenal, lung, pancreas, or thymus gland. Additionally, overuse of glucocorticoid medications, often used in autoimmune diseases, asthma, and other inflammatory diseases, can lead to Cushing’s syndrome. Symptoms include high blood pressure, diabetes, weight gain in the face, referred to as “moon face,” weight gain in the back of the neck, referred to as “buffalo hump,” and poor wound healing.

Addison’s disease

Primary adrenal insufficiency, also called Addison’s disease, occurs when the adrenal glands fail to produce or produce a small amount of cortisol and sometimes another hormone, aldosterone. The main cause of Addison’s disease is autoimmunity; however, cancers, infections, and pituitary conditions can also cause the disease. Symptoms of Addison’s disease include fatigue, stomach pain, loss of appetite, weight loss, salt cravings, low blood pressure with potential fainting, nausea, vomiting, diarrhea, muscle and joint pain, low blood sugar, irritability, depression, loss of body hair, areas of darkened skin, and sexual dysfunction. In certain cases, Addison’s disease onset is quick and can cause what is referred to as an Addisonian crisis: confusion, severe weakness, pain in the legs or low back, severe abdominal pain with severe vomiting, and diarrhea that can lead to dehydration, delirium, and low blood pressure. An Addisonian crisis can be life-threatening and needs immediate medical care.

Functional Medicine Labs That Can Help Individualize Treatment for Patients with Adrenal Glands Health Conditions

Many functional medicine labs can help with individualized treatment for patients with adrenal conditions. Below are two of the most commonly tested.

Cortisol and DHEA Testing

Cortisol is affected in all three of the discussed conditions in this article. Cortisol can be tested in the blood, urine, and saliva. Cortisol testing in the blood, such as the Boston Heart Diagnostics Cortisol test, assesses cortisol levels at the time of the blood draw. Blood testing is the standard of care for evaluating and diagnosing Addison’s disease and Cushing’s syndrome, as both of these conditions have grossly abnormal levels. However, for HPA Axis dysfunction, saliva or urine testing is more appropriate. This is because, in the blood, cortisol is bound to carrier proteins which can make it inactive. Saliva and urine cortisol tests check for free cortisol levels, making it a more accurate measurement. Additionally, it’s important to get more than one measurement of cortisol since it’s released at different amounts during different times of the day. Doctor’s Data offers a Diurnal Cortisol Test which takes four samples to assess cortisol levels throughout the day.

Additionally, another hormone, DHEA, made in the adrenal glands, is often low in Addison’s disease. DHEA is a precursor to sex hormones, including testosterone and estradiol, and also serves as a neurosteroid. DHEA can and is often found, on salivary panels along with cortisol, such as Doctor’s Data Adrenal Function Profile. Additionally, DHEA can be checked in the blood and urine, often as a part of urinary hormone tests such as the DUTCH Complete by Precision Analytical.

Micronutrient Testing

Many pharmaceutical drugs have the potential to deplete nutrients in the body. Corticosteroids are drugs often used in Addison’s disease and can significantly increase the risk of osteoporosis as they change the way the body uses certain micronutrients like vitamin D. Because of this, micronutrient testing may be advised to ensure levels of vitamins and minerals are reaching adequacy. As stated above, micronutrient deficiencies can also contribute to HPA dysfunction. Spectracell’s Micronutrient Panel is a great choice that assesses over 30 markers related to micronutrient levels.

Best Nutrition for Adrenal Glands Health Conditions

There are many different diets and dietary guidelines available. Let’s look at evidence-based dietary recommendations for adrenal conditions.

High Sodium Diet for Addison’s Disease

In those with Addison’s disease that produce little to no aldosterone, a high-sodium diet may benefit them since Aldosterone is a hormone that regulates blood pressure by adjusting sodium and potassium levels. With little to no aldosterone in the body, sodium levels will drop, and potassium will be elevated. Foods higher in sodium include poultry, burgers, eggs, and egg dishes.

Balancing Blood Sugar for HPA Dysfunction

Since HPA dysfunction can lead to blood sugar imbalances, focusing on foods that can aid in stabilizing blood sugar can be helpful. Eating good quality fats and protein sources can tremendously help to regulate blood sugar. Additionally, eating fibrous foods, including beans, sweet potatoes, Brussels sprouts, and figs, can also help to stabilize blood sugar levels.

Top Supplements and Herbs for Patients with Adrenal Glands Health Conditions

The catalog for supplements and herbs is vast. Let’s explore evidence-based supplement and herb recommendations for HPA axis dysfunction, Cushing’s syndrome, and Addison’s disease.

DHEA for Addison’s Disease

DHEA is a hormone primarily made in the adrenal glands. As previously mentioned, DHEA is a precursor to testosterone and estrogen and affects both sexual and cognitive functioning. DHEA levels are often low in Addison’s disease, like other hormones made by the adrenal glands. In a study done on 106 participants with Addison’s disease were given 50 mg of DHEA daily for 12 months. Markers of fatigue, well-being, bone mineralization, body composition, and cognitive functioning were assessed. Results showed improvement in bone mineral density in the femoral neck (femur or leg bone), improvements in energy and self-esteem, and an increase in lean body mass.

Dose: 50 mg daily

Duration: 1 year or more; levels can be monitored in the blood

Vitamin D for Adrenal Conditions

Vitamin D is a fat-soluble vitamin primarily made from the rays of the sun. A study was done in the Nutrients journal assessing for vitamin D deficiencies in those with Cushing’s syndrome and then assessing the effects of vitamin D supplementation. Results showed that vitamin D deficiencies were more common in those with Cushing's syndrome as compared to controls. Additionally, vitamin D supplementation had positive effects on those with Cushing’s syndrome, including cholesterol and insulin sensitivity.

Dose: 150,000 iu of Vitamin D3

Duration: This dosage is referred to as a “loading dose”; a high dose given once. Blood levels should be monitored to evaluate levels and assess when another dose is needed.

Vitamin D supplementation may also be warranted in Addison’s disease. Corticosteroids, drugs often used in the treatment of Addison’s disease, can deplete vitamin D. Thus, testing vitamin D levels can allow for proper supplementation.

Lastly, vitamin D can also be beneficial for HPA dysfunction. Supplemental vitamin D can aid in lowering inflammation and regulating the immune response, two mechanisms that are often altered by HPA dysfunction.

Ashwagandha for HPA Dysfunction

Ashwagandha is a traditional Ayurvedic herb known as an adaptogen, or herb that helps the body adapt to stress. A study was done on 64 people assessing stress and cortisol levels. They were split into two groups, one group was given Ashwagandha, and the other group was given a placebo. Results showed significant reductions in stress as indicated on stress-assessment scales and significant reductions in serum cortisol levels.

Dose: 300 mg Ashwagandha root 2x/day

Duration: 45 days

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Summary

The adrenal glands are important glands essential to life. These two little glands are hormone-producing powerhouses, making many different hormones that affect different body systems. Functional medicine testing can help to assess these hormones and also micronutrient deficiencies that are often the result of treatments for adrenal conditions. Complementary and integrative medicine can aid in creating a personalized treatment plan appropriate for the patient based on these results that will improve quality of life.