THE FOLLOWING EXCERPT IS FROM THE 5th EDITION OF IN FITNESS AND IN HEALTH BY DR. PHIL MAFFETONE

Simplifying Stress

Stress is such an incredibly powerful influence that even if you are doing everything right in terms of diet, nutrition and exercise, it can still crush your efforts to stay healthy. Prolonged periods of too much stress can contribute significantly and directly to many conditions, ranging from reduced quality of life to deadly diseases such as cancer, heart disease, Alzheimer’s and many others. It contributes to fatigue, bacterial and viral infections, inflammatory illness, blood-sugar problems, weight gain, intestinal distress, headaches and most other disorders. Stress-related problems account for more than 75 percent of all visits to primary-care physicians and are responsible each day for millions of people needing to take time off work and school. So stress comes with a monetary price tag as well as a toll on your health.

Charles Darwin said it’s not the fittest who survive, nor the most intelligent, but those who can best adapt to their environment. Today, we refer to this adaptation as coping.

It’s important to remember that stress is a normal part of life and health, and excess stress is not without a remedy. The body has a great coping mechanism for stress — the hormones of the adrenal glands and related nervous system function. However, when the adrenal glands are overworked, bodywide problems can result.

Before discussing the adrenal glands and how we can help protect ourselves from stress, I want to describe what stress is. To simplify stress, I will address the three main types: physical, chemical and mental/emotional. These types of stress can have many different effects. Moreover, each individual responds differently to various combinations of types of stress.

Physical Stress

Physical stresses are strains on the mechanical body. Overworking your muscles is an example of a physical stress. Slight physical stress is what makes exercise beneficial, and is an example of how some stress can help promote health. However, too much physical stress without adequate recovery can potentially result in many problems. Another physical stress is wearing shoes that don’t fit right; while you don’t always feel it in your feet, it may cause problems elsewhere in your body. Likewise, dental stress can affect more than your mouth, often causing stomach dysfunction, shoulder, neck or head pain. Other physical stresses include poor posture, eye strain, and many other situations that adversely impact the mechanical body. Physical stress can result in physical problems, but also in chemical or mental/emotional problems.

Chemical Stress

Chemicals from any source can affect body chemistry and cause stress. This includes dietary and nutritional imbalances such as too much or too little food or nutrients, excess caffeine or drugs, and ingestion of chemicals from food and water supplies. Other sources of chemical stress include those in the air — second-hand smoke, indoor and outdoor air pollution and many others. Chemical stresses can cause indigestion, fatigue, insomnia, or even physical and emotional problems.

Mental and Emotional Stress

Mental and emotional stress is the type with which most people are familiar. This includes tension, anxiety and depression. Mental stress may contribute to pain, moods of anxiety or depression, and loss of enthusiasm or motivation, and can lead to physical and chemical problems as well. Mental stress also affects cognition, including sensation, perception, learning, concept formation and decision-making.

Stress can come from anywhere: your job, family, other people, your emotions, infections, allergic reactions, physical trauma and exertion, even the weather. Remember, not all stress is negative. Since it evokes a reaction in the body, the outcome may be a positive one — the benefit of exercise is one example. By mildly stressing your body, over time and through adaptation, your body performs better. But that same stressor — your workout — can become negative if you go too far beyond the body’s ability to recover from it.

Usually people are stressed in more than one area, and frequently by all three types. And, stress is cumulative. The response to a physical stress from the weekend’s yard work may be amplified by Monday’s chemical stress of too much coffee or the wrong foods, further compounded with a family-related mental stress on Tuesday and another with the boss on Wednesday. All of this will affect your performance at an important meeting on Friday.

The weather is also a potential stressor, with certain people more vulnerable. Weather stress may affect us physically, chemically or mentally. Extremes in temperature or humidity, very low barometric pressure, and the sun are stressors. Seasonal Affective Disorder (SAD) is a good example of how the weather at certain times of year (typically in the fall and winter) can have a dramatic effect on many people.

Some people accumulate so much stress they lose track of it, which becomes more of a stress. The first thing to do with stress is to make sure you’re aware of it. The remedy? Write it all down.

Making Your Stress List

Being more aware of your physical, chemical and mental stress is a big step for improving health. Reducing or eliminating individual stresses is easier if you write them down on paper. On a page, make three columns, one each for physical, chemical and mental stresses. In each category, write down your stresses. This may take several days to complete since you probably won’t think of all your different stresses right away. When you’re done, prioritize by placing the biggest stress of each category on top. Then, work on reducing or eliminating one stress at a time. Or, if you can handle it, work on one stress at a time from each category. Reducing or eliminating unnecessary stress from your life will give your body a better chance to cope with other stresses you may not be able to change right now.

As you make your list put a star by the stresses over which you have some control. This may include unhealthy eating habits like rushing or skipping your meals, drinking too much coffee or not taking time to exercise.

Simply draw a line through those stresses that you can’t control. If there’s nothing you can do about them anyway, don’t worry about them for now. Many people expend lots of energy on stresses they can’t or won’t do anything about. This may include job stress or the weather, though in reality, almost any stress can be modified or eliminated — it’s just a question of how far you’re willing to go for optimal health. As time goes on, you may want to reconsider some of the items you’ve crossed off. You’ll realize that changing jobs is a must, or moving to a more compatible climate is necessary for your health.

Once you can “see” your stress listed on paper, it will be easier to manage. Start with your starred stresses first, because you have control over them — not that it’s always easy. Circle the three biggest stresses from the starred list and begin to work on them. You may be able to improve on some and totally eliminate others. Some will require habit changes. It’s a big task, but one that will return great benefits. When you’ve succeeded in eliminating or modifying each one, cross it off your list and circle the three next most stressful ones, so you always have three to work on.

In addition to your stress list, you’re probably familiar with other strategies for dealing with stress, though you may not use them. Here’s a reminder:

• Learn to say “no” when asked to do something you really don’t want to do. Ask yourself if you really want to do this.
• Decide not to waste your time worrying about the past or the future. That’s not to say you should ignore the past or not plan for the future. Live in the present.
• Learn some relaxation techniques, and perform them regularly. The most powerful one is respiratory biofeedback described previously. An easy walk by your self can also be a great way to relax.
• When you’re concerned about something, talk it over with someone you trust.
• Simplify your life. Start by eliminating trivia. Ask yourself: “Is this really important?”
• Prioritize your busy schedule; do the most important things first. But don’t neglect the enjoyable things. Before getting out of bed in the morning, ask yourself: “What fun things do I have planned for today?”
• Know your passion and pursue it.

What’s most important about stress is that too much of it interferes with rest. Or more accurately, recovering from excess stress requires more rest. If you don’t get enough rest, usually in the form of sleep, the effects of stress will continue accumulating. One of the questions to ask yourself is whether you’re getting enough sleep, considering the amount of stress you have. As you will see, one of the symptoms of excess stress is insomnia.

Case History

Dave had numerous complaints — physical, chemical and mental. A Wall Street executive, he was building a new home and had spring and fall allergies that nearly incapacitated him each year. Dave spent more than two weeks making and pondering his stress list. After discussing all the issues with family and friends, he decided to make some changes. Dave and his family sold their partially built house, moved to a nicer climate, and he secured a job with less stress. Though the pay was less, so were the taxes and other stresses. Within six months, Dave felt 15 years younger. Even his family was healthier, and they felt closer.

By learning to take control of the various types of stress in your life, you can improve the quality of your life, reduce the risk of dysfunction and disease, and also help your adrenal glands regulate stress. Maintaining proper adrenal function is central to optimal fitness and health.

The Adrenal Glands

No matter what type of stress you encounter during your life journey — be it physical, chemical or mental/emotional — your body has an efficient mechanism for coping. This is the important job of the adrenal glands. On the top of each kidney, these small glands work with the nervous system to regulate the important coping mechanisms, including the “fight or flight” reactions. The adrenal glands accomplish their work through the production of certain hormones, making them not only essential for stress coping and optimal human performance, but also for life itself. These hormones help with stress regulation, sex and reproduction, growth, aging, cellular repair, electrolyte balance and blood-sugar control.

The nervous system also helps in coping with stress. This occurs through messages sent throughout the brain and nervous system, and through two other important stress hormones, epinephrine and norepinephrine.

Cortisol is the key adrenal stress hormone, and commonly measured by simple blood and saliva tests. When your body is under high stress, cortisol levels can increase dramatically, and when the stress passes it returns to normal levels. In chronic stress states — the continuation of stress without relief — high cortisol levels can become dangerous. This can adversely affect the brain, especially memory, create blood sugar problems, reduce fat-burning, suppress immune function, lowering the body’s defense against not just cold and flu but any infections, and cause intestinal distress. Long-standing stress can result in a “burning out” of adrenal function, with a serious loss of normal hormone production. In this state, cortisol levels become dangerously low, along with other hormones made by the adrenals.

The sex hormones, including estrogens, progesterone and testosterone, are also important adrenal hormones that help both males and females maintain proper sexual function and reproductive health. The adrenals also make dehydroepiandrosterone, or DHEA, which is the precursor to the estrogens, and testosterone.

The General Adaptation Syndrome

Our knowledge about stress and adrenal function began in the early 1900s, when famous stress-research pioneer Hans Selye began to piece together the common triad of signs resulting from excess adrenal stress. They include adrenal-gland enlargement, depressed immunity and intestinal dysfunction. Selye eventually showed how the adrenals react when confronted with excess stress. This General Adaptation Syndrome has three distinct stages.

Stage 1: The first stage begins with the alarm reaction, in which there is an increase in adrenal hormone production. This is an attempt by the adrenals to battle the increased stress. If it is successful, adrenal function returns to normal. During this stage, a variety of mild symptoms may occur: spotty tiredness during the day, mild allergies or even some nagging back, knee or foot pain. If, over time, the adrenals fail to meet the needs of the body to combat the stress, they enter the second stage, called the resistance stage.

Stage 2: During this period, the adrenal glands themselves get larger through a process called hypertrophy. Since the increased hormone production of the first stage couldn’t counter the stress, the glands enlarge in an attempt make even more cortisol to do the same. During this stage, more advanced symptoms may occur, including fatigue, insomnia and more serious back, knee or foot pain. Most people with stress problems are stuck in this stage. But if the stress persists and is still not controlled, the adrenals eventually can enter the third stage, called exhaustion.

Stage 3: If a person enters this stage they are exhausted. The adrenal glands are unable to adapt to stress and are unable to produce adequate levels of hormones, including cortisol. The person is usually seriously ill, physically, chemically or mentally.

This discussion is not about adrenal disease, rather, the gray area between normal adrenal function and disease. Addison's disease occurs when the adrenal glands are unable to produce sufficient cortisol to sustain life. It can occur in men and women of all age groups; symptoms include severe weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin. The disease is also called adrenal insufficiency, or hypocortisolism.

Are You ‘Stressed Out’?

Excess adrenal stress — or an insufficient adrenal response to adapt to stress — is a common problem. It is often the result of chronically overstimulated adrenal glands, in some cases to the point of exhaustion. The popular lingo is usually the notion that you’re “stressed-out.” If you’re in business, “burn-out” is the common name, with “nervous breakdown” used in the past. If you’re an athlete, it’s called “overtraining.” Whatever the name, it’s essentially the same problem of adrenal dysfunction, with serious implications for fitness and health that can seriously reduce quality of life.

Ten common symptoms of adrenal dysfunction are listed below. Check off any that pertain to you. They can be caused by other imbalances in the body. But taken together, they make up the most common symptoms of adrenal dysfunction.

❏ Low energy. This is common especially in the afternoon, but could happen anytime, or all the time. The fatigue can be physical, mental or both. When the adrenals are too stressed, the body uses more sugar for energy, but can’t access fat very well for energy use. This can significantly limit your energy.
❏ Dizziness upon standing. Standing up from a seated or lying position can make you dizzy because not enough blood is getting to the head quickly enough. Check your blood pressure while lying down, and then immediately after you stand. If you suffer from adrenal dysfunction, you will notice the systolic blood pressure (the first number) doesn’t rise normally — it should be higher when you’re standing by about 6 to 8 mm.
❏ Eyes sensitive to bright light. Adrenal stress often causes light sensitivity in your eyes. You may need to wear sunglasses or have difficulty with night driving because of the oncoming headlights. You may even misinterpret this as having bad night vision. Some people find their nearsightedness (ability to see distances) improves after improving adrenal function.
❏ Asthma and allergies. Whether you call it exercise-induced asthma, food allergies or seasonal allergies, they are similar symptoms of adrenal dysfunction.
❏ Mechanical imbalance. Problems in the low back, knee, foot and ankle are often associated with adrenal problems. These areas can become mechanically unstable and produce symptoms such as low-back pain, sciatica and excess pronation in the foot, leading to foot and ankle problems.
❏ Stress-related syndromes. The problems referred to as burnout, stressed-out, overtraining (overexercising) and nervous breakdown are almost always the result of adrenal exhaustion. While occasionally these problems become serious enough to warrant medication or hospitalization, adrenal dysfunction occurs long before this point.
❏ Blood-sugar-handling stress. With adrenal dysfunction, the body is unable to properly control blood sugar. Symptoms include constantly feeling hungry, being irritable before meals or if meals are delayed, and having strong cravings for sweets or caffeine.
❏ Insomnia. Many people with adrenal dysfunction fall asleep easily (often because of exhaustion) but wake in the middle of the night with difficulty getting back to sleep. This may be due to high levels of cortisol occurring at the wrong time (levels should be low during sleeping hours). Many people say they wake up in the night to urinate. But it’s usually the adrenal problem that awakens them, and then they get the urge to urinate.
❏ Diminished sexual drive. This is a common symptom of adrenal dysfunction due to low levels of the hormone DHEA, which makes estrogen and testosterone. (Low levels of these hormones can also adversely affect the strength of bones and muscles.)
❏ Seasonal Affective Disorder (SAD). This is common problem, especially in the fall and winter. As the hours of daylight lessen and the temperature drops, many people go into a mild state of hibernation. The metabolism slows, and the body and mind become sluggish, sometimes resulting in a mild or moderate depression. (This corresponds with a combination of stresses: the weather, lack of sunlight and even the start of the holiday season — people don’t eat well, are less active, and weight gain is common.)

Recognizing these 10 common symptoms of adrenal dysfunction can be useful in your self-assessment. You may also want to test some of your adrenal-hormone levels with the help of a professional. The best test for adrenal hormones measures cortisol and DHEA, and is performed over the course of a typical day and evening, rather than just a single test.

With an awareness of the signs and symptoms of adrenal stress, you can make some appropriate lifestyle changes to improve adrenal function and possibly solve many of your problems. Earlier I discussed the importance of making your stress list. Now, let’s look at some of the other factors related to improving adrenal function: diet, exercise and lifestyle. Many of these have been addressed in earlier chapters but presented here in the context of adrenal dysfunction.

Diet and Adrenal Stress

One of the most important dietary factors related to adrenal stress is the consumption of refined carbohydrate and sugar. This includes hidden sugars in many foods. How much is too much? Perform the Two-Week Test if you’re not sure.

Caffeine is a common source of adrenal stimulation, a main reason people consume it. Coffee, tea and colas are the main sources. If you have an adrenal problem, assess your caffeine intake. For many, no caffeine is best; for others, a single cup or two of coffee or tea may be tolerable. You must determine, as objectively as possible by listening to your body, how much caffeine you can tolerate.

Always eat a healthy breakfast. This includes protein but void of refined carbohydrates. An egg-based meal can be the cornerstone of an ideal breakfast.

People with adrenal stress often need to snack between the three main meals, even every two hours in the early stages of recovery. Healthy snacking habits were previously discussed. Low-carbohydrate snacks include almonds and cashews, cheese, vegetables and hard-boiled eggs. Avoid fruit juice.

Nutrients for Adrenal Stress

Your nutritional needs may vary with adrenal stress. These include factors to help the immune system, gut and the adrenal glands themselves. Since the hormonal system is very complex, it’s recommended that you seek the input of a health-care professional to correct a hormonal imbalance. Below are some possible supplemental nutrient needs:

• For many types of adrenal stress, especially those that cause insomnia, zinc may be useful. Studies show this important mineral can help lower high cortisol levels that accompany adrenal stress. Taken right before bed, for example, zinc may improve sleep patterns. A metallic taste in your mouth may mean that you’re taking too much zinc, so be careful with zinc supplementation.
• Choline is a nutrient commonly needed by some people with adrenal stress, in part due to the relationship of choline with the nervous system. Individuals who are always on the go, overworked and trying to do too much are examples of those who may benefit from choline. Small amounts several times a day may be very helpful. The best source of choline in the diet is egg yolks. Those with asthma symptoms generally need even more choline.
• Intestinal dysfunction almost always accompanies adrenal stress. This issue is discussed in Chapter 31.

Exercise and Adrenal Stress

In general, easy aerobic activity is helpful for all except the person in the end stage of adrenal exhaustion. In this case rest may be most important until adrenal function begins to improve. Anaerobic exercise can worsen adrenal problems at any stage.

If you do not already exercise, a 20- to 30-minute easy walk, five times per week, is a great adrenal therapy. If you already work out, maintain easy aerobic exercise, such as walking. It will build the small aerobic muscle fibers, promoting more fat-burning and increasing circulation, both of which will help adrenal function.

Avoid all anaerobic workouts, including weight-lifting and any exercise that raises the heart rate above your aerobic level. Once adrenal function is improved, anaerobic exercise can be resumed, though the balance of aerobic and anaerobic exercise must be maintained as discussed in previous chapters.

In addition to these factors, other lifestyle issues are worth considering:

• A relaxing massage, such as a Swedish massage, can help reduce high cortisol levels. Avoid massages that cause pain, which could increase stress.
• Sunlight on the skin and through the eyes is important to proper adrenal function and can help improve dysfunction. Do not stare directly into the sun; just spending time outdoors provides sufficient photo stimulation through the skin and eyes. Natural, full-spectrum light from the sun can help the brain which influences adrenal function. Window glass, prescription and non-prescription glasses and contact lenses can filter out the stimulating part of the light spectrum. If you normally are exposed to little or no sun, take a walk during your lunch break to get some natural light (even on a cloudy day). For indoor use, consider replacing your regular light bulbs and tubes in locations where you spend considerable time with full spectrum lights.
• Evaluate your sleeping habits. Are you getting at least seven to eight hours each night? If not, you may need more. Adrenal stress increases the need for recovery. Decide what changes are needed to ensure that you are getting enough sleep.
• Research shows that enjoyable music can lower high cortisol levels. Play music while in your car, at work or at home. Choose music you like but avoid the radio with its stressful commercials and commentary. Play the music you liked during the more stress-free and happiest times of your life.
• Various meditation methods can counter stress, especially respiratory biofeedbac.

Other Natural Hormones

Hormones play a major role in your physical, chemical and mental well-being. The key to optimal hormonal performance is balance, and adrenal health is primary. Three important hormones, important for and produced by both men and women, include the estrogens, testosterone and progesterone. As you age, and with increased stress, the production of these hormones is diminished. This occurs especially when cortisol rises, diminishing the production of DHEA, and subsequently, diminishing estrogen, testosterone and progesterone.

If you think your hormones are diminishing, the first step is to assess them. Salivary hormone tests are performed by many health-care professionals. If your hormones are not balanced (some may be high while others are low), the next step is to consider all the adrenal-related issues discussed in this chapter. Replacing your natural hormones with synthetic versions has been a topic of major controversy due to dangerous side effects, and should not be a first option. Many people can restore normal hormone function by improving adrenal gland function, which usually includes other issues discussed in this book. When this is not sufficient, natural hormone supplements may be necessary.

Estrogen
This most well known of hormones is actually a group of about 20 compounds. The most important estrogens are estrone, estradiol and estriol. The different estrogens have unique roles in the body. For example, estradiol is the most stimulating to the breast, and is the estrogen related to increased risk of breast cancer. Estriol protects against breast cancer. Normal production of both by the body is the right balance. A variety of benefits are attributed to the effects of natural estrogens, including prevention of hot flashes, better memory and concentration, slowing of the aging process, and reduced depression and anxiety.

Synthetic estradiol (Premarin) is the estrogen that places you at high risk for breast cancer. This is due to the fact that it’s not broken down in the liver as quickly as your own natural estrogens (affecting the cells for a longer time). Premarin, made from the urine of pregnant horses, simply doesn’t function exactly like the estrogens made in the human body. In addition to natural estradiol, other natural estrogens have synthetic companions and are marketed under various brand names.

One of the common risks of taking synthetic estrogen is the higher dosage compared to what your body would normally produce. The most common symptom of too much estrogen in your system is water retention. This can lead to breast tenderness and swelling, weight gain and headaches. Excess estrogen can also lower blood sugar and increase your cravings for sweets. Too much estrogen also increases your risk of uterine cancer and gall bladder disease.

While the idea of synthetic estrogen replacement is often “sold” to patients by touting the benefits of building strong bones, estrogen doesn’t actually do this. Rather, it decreases the rate of bone loss that occurs naturally throughout life. The hormones that have the greatest impact on new bone growth — something your body is always doing — are progesterone and testosterone.

Progesterone and Testosterone
Unlike estrogen, which is a group of hormones, progesterone is the only hormone in its class. Progesterone has many functions in the body. It improves sleep, builds bone mass, protects against breast and uterine cancer, improves carbohydrate tolerance, helps burn fat, prevents water retention, increases sex drive and in many people has a calming effect on the nervous system.

Provera is a synthetic version of progesterone, one that is given to many women. However, it doesn’t have the same functions as the natural hormone. While natural progesterone acts like a diuretic, Provera can increase salt and water retention, and increase body fat. Too much of this synthetic hormone can cause bloating, depression, fatigue, increased hair on the body, and increased weight gain. Provera can also cause your body to diminish its own production of natural progesterone, forcing you to rely more on outside sources. Other synthetics can cause birth defects, epilepsy, asthma and heart problems.

It’s important to note that both estrogen and progesterone work together. In a real sense, they balance each other when in their natural state. Taking one form without the balance of the other often creates stress.

Testosterone is also a naturally occurring hormone made by both men and women. This hormone is important for healing, helps build and maintain muscles and bones, increases sex drive and overall energy, and is a very important hormone for other areas of the metabolism. The synthetic version is methyltestosterone, with side effects including hormonal imbalance, intestinal distress, increased cholesterol, hair loss, depression, anxiety, and others.

Getting Yours Naturally

The ideal scenario is to have your body make the types and amounts of hormones necessary for you. That amount varies from day to day and year to year (even from minute to minute). If reduced health interferes with this delicate mechanism, imbalances can occur. I can’t emphasize enough that preventing and correcting hormone imbalance by improving adrenal function and overall fitness and health is the most effective and best first option.

If you have signs and symptoms related to hormone imbalance, measuring your hormone levels, by testing the blood and/or saliva, is very important. A re-evaluation of the same tests will help you know whether improved lifestyle habits or any replacement therapy is successful.

If you’re still producing too little hormone after trying all the healthy habits discussed in previous chapters (especially balancing dietary carbohydrate, fat and protein), taking natural hormones to replace what you’re not making may be the next best option. It’s important to ask your health-care professional about these alternatives — as many are by prescription. For more information, contact the Women’s International Pharmacy (800-279-5708, www.womensinternational.com), Hopewell Pharmacy (800-792-6670, www.hopewellrx.com) or other reliable sources.

Some non-prescription products are also available. Pro-Gest, for example, is a natural progesterone cream that can be absorbed through the skin rather than taken by mouth (your liver breaks down much of the natural hormone taken orally). For those who require both natural estrogen and progesterone, a product called OstaDerm cream is also a non-prescription preparation of both natural hormones.

For menopause, premenstrual syndrome, or other hormone-related imbalances, the use of natural hormones can improve your quality of life. What’s most important is to understand that no one has to live with the pain, displeasure and discomfort that too many doctors have told patients are normal with aging.

Case History

Sally was in her early 40s and had a variety of hormone-related symptoms, including hot flashes, insomnia and body-fat increase, all beginning over the previous two years. Her doctor wanted her to start taking synthetic hormones, but she was uneasy since her family history included breast cancer. My first choice was to try to get Sally’s adrenal function improved, as tests showed her cortisol and DHEA levels to be far from normal. After several months of making lifestyle changes, Sally’s symptoms improved by about 50 percent. At this time, I recommended she begin using a natural progesterone cream, once per day after showering. Within three months, Sally began feeling better, and within six months, felt more like she did when she was 30.

Stress induced adrenal dysfunction is one of the major problems associated with a wide range of fitness and health problems. Improving adrenal function can quickly resolve many common signs and symptoms that reduce quality of life.
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