Adrenal Fatigue Syndrome and Prescription Drugs: A Missing Link?

You won’t find it on WebMD or in the Harvard Medical School Family Health Guide. And if you raise it with your doctor you may hear those dreaded words, “Nothing is wrong with you. Your tests are normal.”

What is this elusive health issue? It’s Adrenal Fatigue Syndrome (AFS) – a very real health problem affecting an estimated 80% of the US adult population according to Dr. Ann Manby, ND. For an overview on AFS, check out Adrenal Fatigue Syndrome: Overview, Symptoms, Causes, Natural Treatments, and Medicine. Briefly, AFS results from tired adrenal glands. These glands produce the hormones cortisol and adrenaline, essential for your body’s ability to manage stress. One of the most common causes of AFS is good old chronic stress. When your adrenals are worn out, your body suffers. Fatigue, brain fog, depression, frequent infections, digestive problems – all of these symptoms and more can indicate AFS. Furthermore, AFS is associated with a spectrum of chronic illnesses. In a vicious cycle, the stress of these illnesses tax your adrenals and your adrenals, in turn, cannot adequately help your body to manage the stress of chronic illness, increasing the overall toll on your body and adrenals.

Prescription Drugs and AFS

Adding insult to injury, prescription drugs we take to treat illness add even another level of stress to the body. Two of these prescription drugs – in fact arguably two of the most widely-prescribed drugs of all – may be specifically implicated in AFS.
Statins and oral contraceptives. [Please note: In addition to birth control, oral contraceptives are used to manage health issues such as dysmenorrhea, breast cysts, endometriosis, and even acne.] The links between AFS and these drugs are frustratingly not substantiated by clinical studies. As Dr. Manby and Dr. James Wilson, author of Adrenal Fatigue: The 21st Century Stress Syndrome, point out, working with AFS feels like you’re up against a huge wall of denial when it comes to conventional medicine and medical research. Conventional medicine recognizes the two extremes of adrenal-related health problems – Addison’s disease where you underproduce adrenal hormones; and Cushing’s Syndrome where you overproduce. But there’s no gray area covering more moderate distress of the adrenals. “Consequently there’s no research,” groans Dr. Manby, “No studies to back it up – it just doesn’t exist. There’s only observational documentation from practitioners.”

Statin-Adrenal Connection

Despite the lack of clinical studies, the statin-adrenal connection is hard to ignore. You’ve probably heard some of the concerns raised about statin use, mostly linked to statin depletion of the body’s energizer, Co-enzyme Q10 or ubiquinone. Yet less discussed is how statins’ express purpose, lowering cholesterol, may in itself be harming your body, including your adrenal glands. You see, cholesterol is actually an essential material for your body. It’s in your brain, your liver, your cell membranes – all over. It’s also the precursor for many important substances in your body – one of which is cortisol. “In my mind there is no doubt that trying to drive LDL cholesterol levels down to 60’s and 70’s is linked to AFS,” emphasizes Dr. Manby. “If you shove down cholesterol, you’re causing problems since it’s upstream from your cortisol production.”

Dr. Wilson agrees that there is a logical connection. He’s heard of cases where pushing cholesterol lower than 130 has limited the production of important hormones such as cortisol. And while one study published in the journal Intensive Care Medicine in 2006 noted that low HDL cholesterol levels was predictive of adrenal failure in patients with liver disease,there are very few articles documenting the relationship. What is documented is that many people suffering from AFS have extremely low cholesterol levels. A chicken and egg situation – the association is there. But much work remains in understanding how AFS leads to low cholesterol or how low cholesterol contributes to AFS. Bottom line: If you are taking prescription drugs to lower your cholesterol, consider monitoring your cortisol production and staying alert to any symptoms of AFS. Dr. Wilson has found that with his AFS patients who are taking statins, supplementing with CoQ10 has made a difference. As he explains, that in itself reduces the stress the body is experiencing from CoQ10-depletion.

Estrogen Dominance, Birth Control And Cortisol

In general, more women are diagnosed with AFS than men. Dr. Manby points out that this may be due to the double burden of homemaker/career woman many women face, or simply due to the fact that more women may seek help for AFS. But there’s another reason that may help clarify both why so many women suffer from AFS and how oral contraceptives can make it worse. It comes down to estrogen. Estrogen both stimulates the adrenal production of cortisol and stimulates the production of corticosteroid-binding globulin (CBG), a protein that binds with cortisol rendering it unable to cross cell membranes. A healthy body manages to keep an equilibrium between estrogen and cortisol. But many women have too much estrogen in their body – a condition known as estrogen dominance. Some women naturally produce more estrogen than what is optimum. Some women ingest and absorb it, or chemicals that mimic estrogen, in polluted food, air, water and even skincare products. But we also put estrogen in our body quite consciously through hormone replacement therapy and oral contraceptives. When we do this, we end up putting a greater tax on the adrenals. The extra estrogen stimulates the adrenals to produce more cortisol while, simultaneously, the estrogen inhibits cortisol’s activity by stimulating the production of CBG, making it necessary to produce even more cortisol. Whew, what an adrenal gland treadmill we’ve created! Research has documented exactly this: Oral contraceptives increase the amount of CBG, placing a greater strain on the adrenal glands.

Menopause and the Adrenals

Also, menopause places a further burden on the adrenals. As Dr. Laurie Steelsmith, author of Natural Choices for Women’s Health, puts it, “When your ovaries are going through a career change, it’s your adrenal glands that have to pick up and take over where the ovaries left off.” Your adrenals make the same hormones your ovaries do, just not as much. But with menopause your adrenals become the sole provider and end up working overtime. As Dr. Wilson notes on his website, due to many of the reasons noted above, “epidemic proportions of women are entering perimenopause and menopause already suffering from varying levels of Adrenal Fatigue.” And menopause’s increasing demands on the adrenals only makes it worse.

Help For Tired Adrenals

Drs. Manby and Steelsmith both love adaptogenic herbs like ashwaganda, rhodiola, cordyceps and ginseng for nurturing the adrenals. These herbs are called adaptogens because they help your body adapt to stress. Steelsmith has used these herbs successfully to help women transitioning through menopause and Dr. Manby recommends rhodiola to women who use oral contraceptives. But Dr. Manby cautions that recent research is showing that ashwaganda and rhodiola have the peculiar property of stimulating cortisol production at lower dosages and limiting cortisol production at a higher dosage. Testing your cortisol levels and dosing accordingly is absolutely necessary if you are using adaptogens. Dr. Manby also advises that AFS sufferers take a comprehensive approach to supplementation: “Any little stressor you take out helps”. Anything you can do to nurture your body, ease digestion and in the end reduce stress will diminish the demand on your adrenals.

Conclusion: Think of Your Adrenals When Considering Prescription Drugs

In general prescription drugs tax your body – but sometimes it’s a necessary tradeoff. If you can avoid taking them, in particular statins and oral contraceptives, do yourself and your adrenals a favor and hold off. If you need to stick with them, follow Dr. Manby’s advice and look for other ways to give your adrenal glands a little extra TLC and a little less work – like high-quality supplements.

  • Marik, Paul E, “Adrenal-exhaustion syndrome in patients with liver disease,” Intensive Care Medicine, 2006.
  • Personal Communication with Jessica Kaskey, assistant to Dr. James Wilson.
  • Caticha, O. et al. “Estradiol Stimulates Cortisol Production by Adrenal Cells in Estrogen-Dependent Primary Adrenocortical Nodular Dysplasia”. Journal of Clinical Endocrinology and Metabolism, 1993.
  • Felig, Phillip and Lawrence A. Frohman, Endocrinology and Metabolism. McGraw-Hill Professional, 2001.
  • Caticha et al.
  • “Transdermal estrogen does not affect levels of cortisol in the blood or saliva” Nature Clinical Practice Endocrinology and Metabolism (2007) 3, 619
  • Viewed 7/29/08.

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