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ADRENAL DYSFUNCTION IN FUNCTIONAL MEDICINE

you should discuss your doctor before following any recommendation. This is for general information only

🔹 Overview

In functional medicine, adrenal dysfunction is viewed not just as a disease of the adrenal glands, but as a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, a dynamic neuroendocrine system responsible for managing the body’s response to stress, energy metabolism, immune balance, and circadian rhythm.

🔹 Terminology

  • Adrenal Fatigue: Popular but controversial term often used in alternative and functional medicine to describe a subclinical state of chronic stress-induced HPA axis dysregulation.
  • HPA Axis Dysfunction: A more accepted term within scientific and integrative frameworks, describing altered signaling among the hypothalamus, pituitary, and adrenal glands.

🔹 Functional Medicine Perspective

Functional medicine considers adrenal dysfunction as a spectrum of maladaptive stress responses, influenced by:

  • Chronic emotional or physical stress
  • Poor sleep and circadian rhythm disruption
  • Nutrient deficiencies
  • Gut dysbiosis
  • Inflammation
  • Blood sugar dysregulation

The goal is to understand the underlying causes of stress and HPA axis imbalance, not merely to treat hormone levels.

🔹 Phases of Adrenal Dysfunction (as described in functional medicine)

  1. Alarm Phase
    • High cortisol, DHEA initially normal or elevated
    • Symptoms: anxiety, insomnia, increased heart rate, sugar cravings
  2. Resistance Phase
    • Cortisol starts to decline, DHEA drops
    • Symptoms: fatigue, brain fog, weakened immunity, irritability
  3. Exhaustion Phase
    • Low cortisol and DHEA
    • Symptoms: burnout, depression, low blood pressure, hypoglycemia

Note: These phases are descriptive frameworks, not formally recognized diagnostic entities in conventional medicine.

🔹 Clinical Signs & Symptoms ADRENAL DISEASE

  • Fatigue (especially morning)
  • Difficulty getting up in the morning
  • Cravings for salty or sweet foods
  • Mood changes: depression or anxiety
  • Decreased resilience to stress
  • Lightheadedness, especially on standing
  • Poor sleep quality
  • Hormonal imbalances (e.g., low libido, menstrual irregularities)

🔹 Diagnostic Approach

Functional medicine prefers non-invasive, multi-timepoint salivary or urinary hormone tests to assess:

  • Cortisol rhythm (morning peak, evening decline)
  • DHEA levels
  • Cortisol awakening response (CAR)

These may be complemented with:

  • Nutrient panels (B vitamins, magnesium, vitamin C)
  • Inflammatory markers (hs-CRP)
  • Thyroid function tests
  • Blood sugar regulation (HbA1c, fasting insulin)

❗Note: Mainstream endocrinology recognizes Addison’s disease and Cushing’s syndrome but does not formally acknowledge “adrenal fatigue.” Critics argue the functional model lacks robust scientific validation.

🔹 Management in Functional Medicine

( this is for general information only. Please discuss with your doctor before following these of recommendations)

1. Lifestyle Interventions

  • Stress reduction: Mindfulness, breathwork, yoga, therapy
  • Sleep hygiene: Circadian rhythm support, consistent sleep schedule
  • Exercise: Gentle movement (e.g., walking, yoga), avoiding overtraining

2. Nutritional Support

  • Anti-inflammatory diet: Whole, unprocessed foods
  • Balanced macros: Emphasis on stable blood sugar
  • Adrenal-supportive nutrients:
    • Vitamin C, B5, B6
    • Magnesium
    • Adaptogens (ashwagandha, rhodiola, holy basil)

3. Botanical and Supplemental Support

  • Adaptogenic herbs: modulate stress response
  • Phosphatidylserine: supports cortisol regulation
  • Licorice root: may extend cortisol half-life (use cautiously)
  • DHEA supplementation: under practitioner supervision, if low

🔹 Evidence Summary

StudySummary
Heaney et al., 2018 (J Hum Hypertens)Chronic stress can result in a maladaptive HPA axis response, with downstream effects on metabolic and cardiovascular health.
Stomby et al., 2017(Nutrients)Lifestyle interventions including diet, sleep, and stress management can favorably impact cortisol rhythms.
Gleeson et al., 2022 (J Endocr Soc)Questioned the validity of adrenal fatigue as a diagnostic entity, emphasizing need for more rigorous studies but acknowledged patients experience real symptoms.

🔹 Summary

  • Functional medicine sees adrenal dysfunction as HPA axis dysregulation, not gland failure.
  • It is understood as part of a systems biology model involving the brain, endocrine glands, immune system, and gut.
  • Individualized care, focusing on lifestyle, nutrition, and targeted support, is key.
  • While controversial in conventional circles, the functional approach addresses a common clinical syndrome of chronic stress and fatigue that patients experience and often seek help for.

✅ Practical Consideration for Clinicians

Validate the patient’s symptoms.

Rule out true adrenal insufficiency (ACTH stimulation test if suspected ).

Use HPA axis-friendly interventions that are low-risk and evidence-aligned.

Monitor outcomes via symptom tracking, sleep, mood, and energy, not only cortisol values.