Clinically, we all ask the endocrine questions during our case history taking. Are you sleeping ok? Do you feel tired all the time? Have you noticed any untoward changes in your hair, your skin, your weight? Are you feeling much more thirsty? Are you feeling too hot, too cold? These cover many different symptoms and pathologies and if any of them don’t add up, we know to refer to other medical professionals for further investigation and treatment.
But what of those subclinical ones, changes that are sitting in the background, induced by life patterns. Borderline type 2 diabetic, adrenal fatigue, chronic overtraining. Is there any advice we can safely give that could help that person and make sure they don’t fall over the edge and need medical intervention?
Cushing syndrome describes the signs and symptoms produced due to prolonged and excessive cortisol exposure (from overstimulation of the adrenal glands due to pituitary gland issues).
These include [1,2]:
- Centralised (around the torso) weight gain
- Fat pads on the back of the neck and clavicle,
- Thinning of the skin
- Bone loss
- Glucose insensitivity
- Memory changes and concentration issues
Some of these symptoms may look remarkably like the effect of prolonged stress on many people who will be presenting to us as patients.
Another cause of adrenal fatigue is over training in athletes. To them, if some is good, then more is better. The flaw in this logic is that, past a certain point, more becomes destructive, with the body no longer able to deal with the training load, leading the athlete to slow down, more tired and more prone to injury and illness. So they push harder, train longer and eventually run the risk of systemic collapse. The hormonal response in this depends on the sex and makeup of the person in question but in all cases, there may be evidence of adrenal fatigue, insulin resistance and muscle metabolisation [3]
Type II diabetes, or late onset occurs when the body becomes resistant to insulin and is often caused by obesity. Typical symptoms include increased thirst, increased frequency of urination and increased hunger. The effects of diabetes in any form are multi factorial, leading to potential peripheral neuropathy, damage to the eye sight, systemic organ failure and increased healing times in the skin. This is most commonly treated through a combination of diet, exercise and medication if necessary.
The commonality between these conditions is the recommendations offered for recovery and healing. If a patient is suffering from Cushing Syndrome they are advised to take a low carbohydrate, low calorie, high potassium diet [2]. In diabetes, the patient is told to lose weight, change their dietary patterns and reduce their carbohydrate intake significantly. In a recovering athlete, they need to reduce the stress on the body, look at their dietary patterns and ensure they have sufficient protein in their diet to allow full muscle and immune system recovery. Magnesium is also recommended as it has been shown to lower cortisol, help improve mood swings, improve glucose sensitivity and help manage blood pressure [4]. Omega 3 oils have been indicated as beneficial in helping deal with the mental effects of cortisol and as such, can help with cognitive processes in all the above cases.
The message, time and again, is that a lower carbohydrate diet is beneficial. There is little evidence we need carbohydrate to the extent that we need proteins and fat. It is a highly efficient source of fuel but one that needs to be used rapidly, otherwise it is metabolised into fat in the liver. With athletes, it is important that they receive sufficient energy to support their performance and healing but some believe that this should be achieved by increasing their fat intake. Quite how much carbohydrate is still in discussion but the consensus appears to be drifting to less than 100g for sedentary people (strict advocates would suggest lower). For athletes it is harder to factor, since they are burning so much more but they might consider fueling around training sessions and health status with fat as the dominant energy source.
Take home tactics?
- Magnesium supplementation (250mg per day)
- Significantly less carbohydrate
- Omega 3 oils
Simple and with reduced adrenal stimulation, very successful.
References
1: http://en.wikipedia.org/wiki/Cushing’s_syndrome
2: Pathophysiology Made Easy, Lippincott, Williams and Wilkins 2006
3: http://en.wikipedia.org/wiki/Overtraining
4: G. Paolisso, A. Scheen, F. D’Onofrio, P. Lefèbvre (1990), ‘Magnesium and glucose homeostasis’, in Diabetologia, 33: 511-514
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