No one likes to be thought of as easily broken, yet “brittle” is sometimes used to describe a clinical state characterized by large and sudden swings of adrenal exhaustion symptoms from one extreme to another.
The term Brittle Diabetes is used, for example, to describe massive and extreme swings in blood glucose levels from one extreme to another – more than the normal swings one experiences during the day – especially from one meal to another. Such extreme swings are larger and less predictable than in non-diabetics. They lead to either hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) swings.
The possibility of a similar theme occurrence in the setting of Addison's disease is not well established. A few cases have been reported where recurrent Addison’s crisis occurs, requiring multiple hospitalizations in hypoadrenal crisis. It appears to be strongly related to non-compliance and social disruptions.
There has also been a case of reported hypoadrenalism followed almost immediately by the development of hyperthyroidism. It is unclear how one event leads to another. Thyrotoxicosis is a hypermetabolic state, but it is unusual for hyperthyroidism in a setting of hypoadrenal function, where the body is generally in a hypo-metabolic state.
The adrenal glands rest on top of each kidney and are responsible as the main stress control center of the body. When stress is perceived, the body activates the NeuroEndoMetabolic (NEM) response. Cortisol, our body’s main anti-stress hormone, is regulated by the adrenal glands. In time of stress, cortisol output from the adrenal glands are put on overdrive through the HPA hormonal axis. This neuroendocrine pathway has been well studied.
Adrenal fatigue is a term assigned to described a state of low adrenal function where sufferers exhibit some signs of sub-clinical Addison’s Disease such as fatigue, hypernatremia and other adrenal exhaustion symptoms. However, laboratory studies are normal, and patients are often sent home. It is thought that chronic stress leading to overburden of the adrenal glands is the etiology. Fatigue is the main hallmark symptom of adrenal fatigue.
However, not all symptoms of adrenal fatigue can be attributable to adrenal function. In advanced stages, there are clear signs and symptoms of metabolic disturbances involved as well, including heart palpitations, food sensitivity, paradoxical reactions, brain fog, and pain of unknown origin. Other systems and organs appear to be involved and intertwined with the clinical presentation that often defies conventional medical logic. The weaker the body, the higher the prevalence of such happenings.
Indeed, our body’s stress response system is complex well beyond simply neuroendocrine system and the adrenal glands. Clearly, the metabolic pathways are also an intricate part of our body’s stress response.
A small number of adrenal fatigue sufferers exhibit an unstable state of adrenal function where cortisol output, while generally low, appears to swing from one extreme to another back and forth for no apparent reason. It is as if the adrenal regulatory system has been broken. The body swings between a state similar to Cushing’s Syndrome (extreme high cortisol) and clinical or subclinical Addison’s Disease (extreme low cortisol).
Let’s take a look at an example case. Mary is a 42 year old female that was in good health until she complained of gradual onset of fatigue and adrenal exhaustion symptoms. Complete laboratory workup shows that her adrenal functions are normal by conventional standards, except that the serum cortisol level is low.
She is prescribed hydrocortisone orally. Her fatigue improves, but her menstrual flow becomes heavier. Her doctor suspects it may be a sign of estrogen excess brought on by partial conversion from cortisol, and starts her on natural progesterone cream 20 mg topically.
Over time, dosage is increased to over 350 mg a day in order to regulate and normalize menstrual flow. It appears as if the body has developed resistance or tolerance to hormone replacement and more is therefore needed. She is also given some thyroid replacement when she complains of low energy - which is helpful.
Over time, however, her adrenal exhaustion symptoms return and worsen gradually despite medications, while she becomes “wired and tired” as the night approaches. She describes being tired but unable to fall asleep. As she complains more to her doctor, more progesterone is prescribed - for its calming and sedative effect - to help her to go sleep and keep her menstrual flow normal.
She tries to get off the hydrocortisone, and is successful doing it slowly over a two year weaning off period. Her menstrual period becomes more manageable with less heavy bleeding.
She lowers her progesterone over a 30 day period from an average of 350 mg to 50 mg per day. As a result, she goes into progesterone withdrawal. Clinical symptoms point to a body that becomes low in cortisol. These include: extreme fatigue, vomiting, shortness of breath along with symptoms of sympathetic overtone.
Her physicians suspect that part of the progesterone she was on has been shunted to make cortisol which in turn helps her fatigue. When external progesterone is reduced, her body’s cortisol needs remain unchanged while the supply is low. She then goes into a downward spiral that resembles Addison’s crisis.
She describes waking up in the morning with low cortisol adrenal exhaustion symptoms: feeling cold, shaky, breathless, anxious, depressed, hypoglycemic, a dull ache in the liver area, lymph stagnation, salt craving, low energy, low blood pressure, nausea, vomiting, diarrhea, abdominal pain, and migrating pain of unknown origin.
To feel better, she starts to ingest salt water along with breakfast and begins a slow walk to increase circulation. This routine calms her. Her hypoglycemic symptoms reduce with breakfast, and her strength improves as energy rises. She starts moving to get blood going and get stronger. She is able to then affect bowel movement and the liver ache reduces.
This process from a low cortisol to normal cortisol state clinically takes between one to two hours to complete. She is able to do some kitchen chores, and household work. If she overdoes her activities, she feels her fatigue return quickly.
A new set of symptoms surfaces, however. If she exerts herself, in addition to fatigue returning, the body swings into a hyper cortisol mode. This includes adrenal exhaustion symptoms such as: transient hypertension, memory loss, headache, feeling hot, low extremity edema, irritability, anxiety, muscle weakness, glucose intolerance, increased thirst, and increased urination.
Sometimes she feels “hot”, requiring a shower to “cool” the body down. She also takes large amount of phosphatidyl serine, a nutritional supplement that has some cortisol balancing properties. After a shower, she stabilizes, but may now start trembling - requiring magnesium to stabilize her. After taking magnesium and stabilizing, she is drained and has to lay down and take a nap.
When symptoms suggestive of high cortisol come on, they tend to be fleeting, lasting a short time at first, with the body eventually reverting back to a low cortisol state. Over time, the prevalence of high cortisol tends to increase in frequency and intensity. Clearly, the regulatory mechanism is dysfunctional or dysregulated. It is almost like the body is in a ‘yo-yo” state, moving from one extreme (low cortisol) to the other (high cortisol).
Excessive stress, overdoing exercise, a new environment, inadequate sleep, a diet high in sugar, and insufficient fluid all contribute and exacerbate such brittle cycles in frequency and intensity. These types of adrenal exhaustion symptoms can occur multiple times a day.
Squatting for a prolonged period of time may be required to help the body maintain a steady state of circulation, blood pressure, prevent lymph stagnation (especially in the lower extremity), and reduce sympathetic tone.
Multiple specialists are sought, but no one can help. She is eventually abandoned.
The clinical state where the body experiences repeated swings from a stage of high cortisol to low cortisol and back quickly is referred to as brittle adrenals.
The pattern resembles that of a roller-coaster ride that can occur multiple times during the day. The body is drained nutritionally and hormonally in its effort to effect self rebalancing. Over time, the body is unable to adjust and becomes destabilized. The HPA is dysregulated. The body has lost its ability to self regulate and fine tune itself in terms of cortisol output. It is like taking a shower with alternating hot and cold water that is beyond one’s control – but the desired warm water is never found. Fortunately, this is rare.
Unfortunately, for the sufferer, such extreme swings in cortisol output also destabilizes the body’s metabolic pathways. Blood sugar regulation becomes problematic, and electrolyte imbalance follows along with fluid dysregulation. Like a light switch that has been flipped on and off multiple times continuously – eventually it breaks.
The body is unable to adjust in a timely manner to provide the cushion to handle the extreme hormonal variance. The effort drains the body and resilience is reduced.
Such hormonal swings between two extremes, the high cortisol state and the low cortisol state, are a nightmare in the making. This is similar to brittle diabetes, where a person’s blood sugar can quickly go from high to low for no apparent reason.
Laboratory tests of cortisol levels, if tracked regularly over time, may show peaks and valleys of cortisol output consistent with the swings in symptoms for those in severe state. Most, however, have normal laboratory output despite swings in symptoms being experienced.
Sufferers are unable to conduct a normal life in such as state. Swings between anxiety and depression, low appetite and hunger, low sodium and low potassium, constipation and diarrhea, and low and high magnesium are just some of the vacillating states experienced multiple times during the day.
When the cortisol is high, one resorts to using phosphatidylserine, antihistamine, and anti-inflammatory drugs – bringing some relief. When the cortisol is low, salt water, electrolyte replenishment, and vitamin C can be helpful. Unfortunately, these are simply symptomatic patches and the cycle repeats itself multiple times during the day.
Ultimately, this unrelenting roller coaster ride renders the body captive to a state of extreme weakness. Toxic reactive metabolite buildup can lead to hypersensitivity reactions, congested extracellular matrix, and receptor site damage.
This process usually starts slowly but tends to gather steam as the body becomes weaker over time. Vital signs can become unstable. Multiple and frequent visits to the emergency room become the norm, often only to be told all is well and sent home to “relax”.
Sufferers are eventually bed-bound, because the liver and extra cellular matrix will become congested over time. Overall, the body becomes flooded in a sea of toxins with reactive metabolite overload (RMO). The body’s defense is to activate the reactive metabolite response (RMR) as a last resort to reduce toxic metabolites. Multiple organs and systems are put on overdrive to remove as much reactive metabolites as quickly as possible.
Intra-cellular communications and extracellular matrix congestion and burden increases. Inevitably, RMR will lead to additional reactive metabolites being generated. As the body’s toxic load increases, it eventually enters a positive loop of ever reducing stability.
Unless multiple laboratory cortisol levels are being drawn and tracked multiple times throughout the day (to track the fluctuating burden on the adrenals), doctors are universally lost to understand and eventually give up.
This brittle adrenal phenomena is not exclusively seen in those with apparent progesterone overload, such as what is described in the case study presented above. Taking a step back, it is seen most commonly in a body that is weak to begin with at the foundation level, though it may not clinically evident.
Other triggers of brittle adrenal include abrupt withdrawal from natural progesterone, inappropriate use of steroids, vaccine toxicity, rampant systemic inflammation, stealth infections, and end stage AFS.
Needless to say, those with brittle adrenals or adrenal exhaustion symptoms resembling this must quickly seek professional help. Most conventional physicians are at a loss as far as knowing what to do - other than treat symptoms.
Recovery from adrenal exhaustion symptoms is possible with a comprehensive plan to stabilize the body’s adrenals, slowly returning cortisol output into balance and reestablishing feedback loops so the body can self regulate.
Reactive metabolite volume must be kept under control, while extracellular matrix decongested. This is a very slow process that requires clinical skills, patience, understanding, and some trial and error, because the body is very unstable. The slightest wrong move can worsen the situation - even in the best of clinical hands.
