Just living with an illness such as chronic Lyme is stressful enough — add in the responsibilities of day-to-day life, and stress can be overwhelming.
Your brain reacts to stress via your adrenal glands. You actually have two, one on top of each of your kidneys. The middle portion of the gland secretes the hormone epinephrine, better known as adrenaline. The outer portion of the adrenal gland secretes cortisol. These two stress hormones define how you will react to stress of any sort.
Adrenaline is the hormone that prepares you for confrontation. Just the thought of conflict accelerates pulse, quickens reflexes, and sharpens mental function. The chances of survival in a real emergency are dramatically increased with the changes initiated by adrenaline.
Adrenaline secretion is connected to the autonomic nervous system, which also includes the sympathetic (stimulating) and parasympathetic (calming) nervous systems. The autonomic nervous system regulates functions in the body, which happen automatically, such as heartbeat and breathing. It is heavily influenced by emotions and upper-level thought. If your brain is agitated, then your entire body becomes agitated.
If your body were a car, adrenaline would be your accelerator. If you ease up on the pedal most of the time and push it to the floor only when really necessary, stress is not going to be an issue. But if life causes you to push hard on the accelerator all the time, sooner or later it’s going to catch up with you. Just having a chronic illness applies a certain amount of pressure to the accelerator that is beyond your control.
Cortisol is the hormone that directs the resources of the body to where they are needed for the given circumstances. When life is calm, cortisol secretion follows a gentle circadian (night and day) rhythm that balances all functions in the body. During acute stress, increased cortisol secretion follows surges of adrenaline. Increased cortisol prepares the body for stress by shifting resources away from everyday concerns (digesting food, repairing damage, immune function) toward handling imminent conflict.
The body is designed to handle normal day-to-day stresses that come and go, but when stress is unrelenting, the results can be quite destructive.
Constant adrenaline surges followed by sustained elevations in cortisol divert resources away from maintenance and healing functions. Immune functions become overwhelmed and dysfunctional. This inevitably causes the body to break down.
If stress doesn’t let up, the adrenal glands become hyper-reactive (adrenal hyperactivity), and the stress response comes quicker and is more intense. The end result is insomnia, fatigue, high blood pressure, anxiety, mental fatigue, and loss of ability to cope with stress.
If you push down on the pedal hard enough and long enough, secretion of adrenal hormones becomes dysfunctional. The body continues to be driven by high adrenaline release, but cortisol secretion starts to wane, and the resources of the body can no longer keep up. Total collapse is inevitable. Some people call it “adrenal fatigue”. A person with dysfunctional cortisol secretion has absolutely no energy and sleeps too much. Fatigue no longer improves with rest or sleep. Low blood pressure, slow pulse, and depression of mood are typical.
Solutions for Adrenal Dysfunction
If adrenal dysfunction describes your life, right now adrenaline is not your friend. It’s like a car with a poorly tuned engine — the harder you push on the gas pedal, the more the engine is going to sputter and stall.
Let up on the pedal. Your approach to life needs to be calm and collected. Calm must be cultivated; it doesn’t just happen. Note that the high points in life (being excited) can raise adrenaline just as much as the low points (feeling stressed out).
You have a stress threshold that precipitates symptoms. Try to maintain stress below that threshold. As your recovery progresses, you will be able to push down on the pedal a bit harder and enjoy a bit more freedom.
Shake off the little concerns, and let someone else worry about them. So many of the visible threats are not really threats at all. Let them go. Stop worrying about things you can do nothing about. Save your energy for the things that really matter.
Avoid arguments you can’t win. Just walk away. Arguments raise your adrenaline levels and often waste your time. Pick your battles well — both at home and at work. This is a tough one, but you must learn to do it.
Make a pact with others close to you. Spouses, children, friends, and co-workers—no arguments. Work out disagreements civilly. Recognize that your illness can be as frustrating to them as it is to you.
Reduce unnecessary stimulation. Turn off the news, and filter media. What’s happening on the other side of the world or possibly even down the street is not your concern if it does not directly affect your well-being or help you achieve your goal. Focus on things that enhance your motivation and raise your energy in a positive way.
Turn the volume down a notch. Literally. Listen only to quiet, relaxing music for a change. And sometimes just pure quiet is best.
Turn off your brain. Reducing the flow of thoughts and simultaneously relaxing the body takes practice. But practice pays off; your body and mind will learn to respond more rapidly and deeply. There are many resources available for learning these skills. Possibly one of the most comprehensive is The Stress Reduction and Relaxation Workbook, 6th edition, by Martha Davis, Elizabeth Robbins Eshelman, and Matthew McKay. The workbook catalogs and introduces most of the different techniques for learning relaxation. Also, there are almost unlimited smartphone and tablet apps that can help you master relaxation.
Take adaptogenic herbs. Adaptogens are a special class of herbal substances known for improving stress resistance. Adaptogenic herbs that are part of the core protocol include Cordyceps, Reishi, and eleuthero. The following adaptogenic herbs have special value for normalizing adrenal function (See Appendix A for dosing and more information on these and other beneficial herbs).
One therapy you want to avoid for adrenal dysfunction is taking adrenal hormones. Some physicians routinely prescribe some form of cortisone and/or DHEA for adrenal dysfunction or insufficiency. Taking adrenal hormones eases symptoms initially, but in the long run, it suppresses natural secretion of adrenal hormones even further and worsens adrenal dysfunction. The only situation where chronic use of adrenal hormones is indicated is when adrenal tissue has been damaged to the point of being totally nonfunctional.
The HPA Axis
At a higher level, adrenal function is regulated by the hypothalamus, an almond-sized structure located at the base of the brain. The hypothalamus is responsible for regulating change; it’s basically the thermostat of the body. The hypothalamus also exerts control over the thyroid gland and the ovaries/testes by way of the pituitary gland. Together they make up the central hormonal pathway of the body called the hypothalamic-pituitary-adrenal axis, or HPA axis, for short.
The autonomic nervous system and the HPA axis together control variations of normal functions in the body, including body temperature, thirst, hunger, weight, glucose and fat metabolism, physical manifestations of mood, sleep, fatigue, night and day rhythms, blood pressure, heart rate, and gastrointestinal function. Everything that happens in the body is connected to these two pathways.
The stress of chronic illness not only disrupts adrenal function, but also thyroid function and reproductive hormone functions. Though medical therapy is sometimes indicated, restoring balance in the entire HPA axis is important for normal health.
Thyroid Dysfunction
The thyroid gland controls metabolism in the body. The hypothalamus, via the pituitary gland, controls secretion of thyroid hormones. This connection makes thyroid function part of the HPA axis. Virtually everything that happens in the body is tied to the HPA axis, and balancing the HPA axis is extremely important for normal health and recovery from disease.
Hypothyroidism (low thyroid function) is the most common form of thyroid disease. It is a complex disorder, and dysfunction can occur in a variety of ways. The gland can basically burn out from exposure to stress factors. Also, antibodies can damage the gland and block thyroid hormone from working (an autoimmune condition called Hashimoto’s thyroiditis). Iodine is necessary for the formation of thyroid hormones, and low iodine can lead to low thyroid hormone production and the formation of a goiter. Cysts and even cancer can form in the thyroid gland, compromising function.
Hypothyroidism is more common in women. There are hereditary tendencies that run in families. Associations have been made with wheat consumption and insulin resistance. Certain foods, known as goitrogens, can cause increased risk of hypothyroidism by blocking uptake of iodine. Common goitrogens include cruciferous vegetables, soy and soy products (including fermented soy), peanuts, and strawberries (mentioned in Chapter 24, Digestive Dysfunction). Generally, goitrogens are only a problem when frequently consumed raw.
Many toxins, including fluoride, chlorine, mercury, dioxins, and insecticides have been implicated as causative in thyroid disease. Toxins and the rise in nuclear radiation may be contributing to the steady rise in thyroid disease occurring over the past century. Stress is definitely a factor. Trauma to the neck and chest can initiate thyroid disease. A link with microbes, both viruses and bacteria, is certainly possible.
Possibly the most important factor in treating thyroid disease is finding a provider who understands the necessity of treating the patient, rather than just treating the numbers. If you are diagnosed with hypothyroidism, your healthcare provider may discuss the following options for therapy.
Prescription Medications for Hypothyroidism
Levothyroxine (Synthroid, Levoxyl, Tirosint). The most commonly used standard for treating hypothyroidism is levothyroxine. Though synthetically derived, levothyroxine is bio-identical human T4, the most abundant thyroid hormone in the body. Most people do very well with this form of thyroid replacement, but some people do not convert T4 into the active thyroid hormone, T3. These individuals tend to do better with natural porcine thyroid hormone.
Natural porcine thyroid (Armour Thyroid, Nature-Throid). This natural product is derived from the thyroid glands of pigs. The fact that it contains all forms of thyroid hormone in proper ratios provides an advantage for some patients. Porcine thyroid, however, is not bio-identical to human thyroid. With time, some people will develop antibodies to the porcine hormone, and the medication will lose effectiveness. Note that dosing of different thyroid medications is not equivalent — 100 mcg of levothyroxine is equal to 60-65 mg of porcine thyroid.
Human T3 (Cytomel). Human T3 is a good option for select patients. It is usually combined with levothyroxine to mimic normal balance of thyroid hormone secretion.
Natural Supplements Supporting Thyroid Function
Iodine supplements. Iodine supplementation is a controversial topic. Too little iodine (about 20% of Americans are considered deficient) can lead to goiter and hypothyroidism, but too much can actually aggravate thyroid disease. The current recommended daily allowance (RDA) is 150 mcg per day, but many experts recommend more, especially if you do not use iodized salt. Sea vegetables (seaweed) are commonly recommended as a natural iodine source, and it is true that sea vegetables offer the most bioavailable form of iodine, but the iodine content is highly variable between different sources. If you decide to supplement with more than the RDA, you may want to ask your healthcare provider about testing iodine levels, especially if you have active thyroid disease.
L-tyrosine. Thyroid hormone is made from iodine molecules attached to the amino acid, l-tyrosine. Supplements can help support normal thyroid function. L-tyrosine supplements are generally not necessary with a healthful diet.
Ashwagandha. This adaptogenic herb not only balances the HPA axis, but also stimulates thyroid gland activity (but does not act like thyroid hormone or interfere with thyroid medications). See Appendix A for complete information about Ashwagandha.
Menopause
Menopause is a natural process, not a disease. Even with the best of health habits, menopause still occurs. It is the natural consequence of midlife cessation of ovarian function.
The hormonal fluctuations associated with menopause disrupt the HPA axis and autonomic function. Resulting reactions include body thermostat variation, hot flashes, sleep disturbances, changes in fat distribution, heart rate changes, and often fatigue. Perimenopause, the stage leading up to menopause, can include all the above symptoms, but also irregular and sometimes heavy menstrual periods.
When menopause occurs on top of chronic illness, such as chronic Lyme, it can throw the body into a tailspin.
The best approach to menopause is a comprehensive approach. Good health practices in general ease the transition through menopause. Herbal therapies can make menopause more bearable. Ashwagandha reduces hot flashes and balances the HPA axis. The herb, Vitex (Vitex agnus-castus), restores progesterone secretion and normalizes the menstrual cycle. It also counteracts PMS. It is excellent for perimenopause (see Appendix A for more information about this herb).
Natural progesterone cream applied to the skin daily (available over-the-counter) opposes estrogen dominance and helps prevent heavy periods during perimenopause. Natural progesterone also reduces menopausal symptoms and slows bone loss.
After menopause, bio-identical estrogen replacement (with progesterone) properly administered in small doses can be life altering (it requires a prescription from a licensed healthcare provider).
Andropause
The so-called cessation of testosterone production by males is less well defined. A healthy male is designed to maintain robust testosterone levels until the end of his life. Not being able to do so is a definite sign of poor health. It makes sense; if the body is not healthy, reproductive function is one of the first things to shut down.
Treating low testosterone production related to poor health with a driving anabolic steroid (testosterone) that pushes the body even harder can be downright dangerous. It is not surprising that testosterone replacement therapy has been associated with many health concerns, including increased risk of stroke and heart attack.
Testosterone replacement should be approached carefully and with the lowest dose possible to achieve benefit. Testosterone replacement suppresses natural testosterone secretion.
A better approach (albeit one that takes more time) is improving health habits and supporting normal glandular (testicular) function with herbal therapy. Most guys with low testosterone who change their way of life respond very favorably.
Herbs that support optimal testicular function and ideal male muscle mass (women can benefit from these same herbs also) include epimedium and rhaponticum (see Appendix A). Wait until your recovery is well progressed before using these herbs, however, as they can be stimulating.