Adrenal Disorders (Addison’s Disease & Cushing’s Syndrome)
Dietary and Lifestyle Management Strategies
The following dietary and lifestyle considerations may support healthy adrenal function (Miller 2007).
Avoiding simple carbohydrates. Cortisol increases the levels of glucose in the blood and low glucose levels signal the adrenals to produce more cortisol (Anderson 2008). Low levels of glucose can occur when meals are skipped or taken at irregular intervals, or by eating foods rich in simple carbohydrates, since simple carbohydrates are metabolized and absorbed faster by the body. This quick absorption triggers a quick spike in blood glucose levels, which subsequently declines quickly as insulin levels rise. This can trigger the stress response mechanism and increase cortisol levels (Anderson 2008; Taubes 2001). Hence, eating meals at regular intervals and consuming foods rich in fiber, which slows carbohydrate absorption, may prevent the increase in cortisol levels caused by quickly absorbed carbohydrates.
Proper glucose control is paramount not only for mitigating sugar-induced spikes in stress hormone levels, but for controlling and preventing a myriad of age-related diseases. Life Extension recommends a comprehensive approach to glucose control and weight management that takes several important, but often overlooked factors into account. A comprehensive, strategically developed approach to glucose and weight management is outlined in the Life Extension magazine article titled The Nine Pillars of Successful Weight Loss, and in the Life Extension protocol on Obesity.
Dieting properly. Chronic stress is associated with increased cortisol levels, which promote overeating and increases in abdominal fat (Gade 2010). Studies indicate that the brain limits weight gain above a set point, which is ultimately regulated by the levels of leptin, a hormone that regulates energy intake and expenditure. When one exceeds their set point, high leptin levels tell the hypothalamus that energy storage (ie, weight) is adequate and appetite is suppressed (Gade 2010). However, when dieting, the blood levels of leptin are decreased, which notifies the brain as to the presence of the decreased energy storage. The brain then reacts by increasing appetite and decreasing metabolism. Consequently, “yo-yo dieting” (an endless cycle of losing and gaining weight due to poor control of calorie intake) can disrupt the hormonal feedback to the brain and improperly disrupt appetite and metabolism (Gade 2010). On the other hand, well-planned diets that supply the body with all its essential nutrients can be useful for controlling weight, reducing stress, and improving performance. A clinical study evaluating the effect of calorie restriction for 1 month in otherwise healthy overweight women aged 20-36 found that, along with an average weight loss of almost 13 lbs, there was a significant decrease in blood pressure, heart rate, and cortisol concentration, improved hand-eye coordination, and no evidence of increased physiological or psychological stress (Buffenstein 2000).
Limiting stimulants. Consumption of stimulants, such as energy drinks, has been linked to the perception of stress (Pettit 2011). Caffeine is known to exacerbate the stress response and to increase cortisol production. Therefore, caffeine should be consumed in moderation or avoided by people exposed to chronic stress or with impaired adrenal function (Anderson 2008). Nicotine exposure in habitual smokers also increases serum cortisol levels (Gilbert 2000).
Exercising. Exercise stimulates the production of cortisol and other glucocorticoids from the adrenals (Anderson 2008). As such, people who exercise regularly, such as athletes undergoing endurance training, are continuously exposed to high levels of glucocorticoids. However, studies have shown that regular exercise can modulate the HPA axis whereby people undergoing regular exercise are less sensitive to the effects of elevated glucocorticoid secretion (Anderson 2008; Duclos 2003). In fact, a clinical study showed that physical conditioning, as performed by moderately- and highly-trained runners, was linked to a reduction in adrenal-pituitary activation (Luger 1987). Interestingly, another study evaluating the effect of exercise intensity on the HPA axis in moderately-trained men showed that low-intensity exercise resulted in a reduction of circulating cortisol levels (Hill 2008). These studies suggest that low- to moderate-intensity exercise could be beneficial in Cushing’s syndrome.
Maintaining a positive outlook and good self esteem. Low self esteem and loneliness are known to increase cortisol levels, while maintaining a positive outlook on life and a good social support system is associated with lower stress hormone levels (McEwen 2006).
Sleep. Along with chronic stress, sleep deprivation is a common cause of high cortisol levels (Reini 2010). Disturbed sleep, overactivity of the HPA axis, and metabolic disturbances are often observed in people with Cushing’s syndrome, insomnia, and depression (Balbo 2010). High glucocorticoid concentrations in Cushing’s syndrome have a deleterious effect on sleep (Balbo 2010). Sleep deprivation can have a direct effect on the HPA axis and may be an important risk factor leading to stress-related disorders. Some studies have shown that lack of sleep in healthy people can lead to mild increases in cortisol levels, and that restful sleep can slightly decrease the cortisol levels (Meerlo 2008). Thus changing one’s lifestyle to get adequate sleep at regular intervals may help prevent HPA axis disturbances and stress-related disorders.