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mental health mondays :: i'm with the gland [part 1]

probably a candidate for adrenal fatigue
have you ever stopped to ponder the miracle and curse that is computer technology? your home computer, your phone, your laptop, most recently your tablet. if you're reading this, you're making use of something in this realm. every day, you use a computer more powerful than the one that launched the apollo rockets to play angry birds. but just as remarkable as the power of the technology we have out our literal fingertips every day is how immensely fragile it is. last week, an errant cat hair fluttered into my computer's insides, which prevented the motherboard from recognising the ram on start-up. a couple of blasts of compressed air later and everything was fine, but it is a little disconcerting to know that so much of my life relies on something that can be thrown into chaotic disarray by a cat hair.

what scares me more is that the thing that i rely on for absolutely everything in my life- my brain- isn't a whole lot more resilient. i guess it's obvious that cat hairs aren't going to be the death of me, but the fact is that my brain- and yours and everyone's- is shockingly vulnerable to very minor changes in its environment. which is why, if you believe in god, you'd have to agree with depeche mode that he has "a sick sense of humour", because what sort of loving deity would place something so delicately balanced in a system as inherently unstable as a human body?

one of the nasty little secrets about psychiatry, which isn't so much a secret as it is something that's just never discussed, is that even the people who do the most advanced research on the human brain don't have a much better idea of what's going on in there than a layperson who reads a few pamphlets. eight years of university has equipped these noble folk with a lexicon of part names and the best information on what people think is going on in there, but not much else. a lot of times, when coming up with theories, they're just taking a stab in the dark. at your brain.

as you might expect, in a field as uncertain as the study of the brain, there are a lot of competing theories as to what causes disorders. it seems clear enough that there is a link between certain neurotransmitters- serotonin, epinephrine and dopamine mostly- and various long-term disorders and therefore most medications are designed to manipulate the flow and availability of those transmitters. unfortunately, no one has much of an idea as to why our bodies suddenly become deficient in these neurotransmitters, or why we stop absorbing them properly. we keep backing up the cause-and-effect chain, but no one has managed to get to the psychiatric god particle: why does our brain start pulling this shit to begin with?



one theory that has gained support among practitioners of alternative medicine is that we'd do better to search for the answer outside the brain, in the body's major glands, which control a lot of the flow of hormones and transmitters. and so for the next few weeks, that's what we'll be looking at here on mental health mondays: what if your brain disorder isn't in your head?

ho ho ho imma screw you up wicked
first up, let's consider your adrenal glands. about the only thing that most people know about the adrenal glands is that they produce a substance called adrenaline [although i guess now you're supposed to call it epinephrine] that pumps you full of energy and makes you act like a douche, unless you're a mother of young children in danger, in which case it makes you throw cars and other cool superhero stuff. those who've had heart problems, respiratory conditions or bad allergic reactions may also be aware that it's used as an emergency first-line medication to get your basic systems up and running again. in fact, if you've received an adrenaline shot, getting up and running is probably going to be your reaction, even if you were on death's door a few minutes earlier. it's powerful stuff.

the truth is that adrenaline/ epinephrine affects almost every part of your body all the time, it's just that you only become aware of it when there's a big burst. most of the time, our adrenal glands are just puffing away, keeping everything working without getting any attention whatsoever. in fact, even though we know about the magical properties of adrenaline in excess, chances are we know very little about how it's produced.

[i'll be honest about how uninformed i am. until i started researching this piece, i thought my adrenal glands were in my armpits. i don't know why, but i always thought they were related to sweat glands. perhaps because perspiration is such an obvious sign of an adrenaline surge. and i suppose it's possible that my adrenal glands are in my armpits, but that would make my anatomy pretty screwed up, because they should be located on top of my kidneys. what's truly embarrassing is that it's one example of where science made it easy: what do you call it when your kidneys shut down? renal failure. ad-renal. get it? took me long enough.]

alternative health practitioners- naturopaths, homeopaths and some traditional doctors- have posited that some mental disorders are caused by what they term "adrenal fatigue". the idea is that your adrenal glands, which are crucial in the body's stress reponse [the famous "fight or flight" reaction], are getting pounded so often by your overly stressed lifestyle that they're reacting much like a car whose driver keeps slamming on the brakes.

there is a certain "truthiness" to this theory- it just sounds right. after all, our suspect neurotransmitters epinephrine and dopamine are produced through the adrenal glands. they also produce cortisol, which activates the body's "anti-stress pathways", meaning it's stuff that helps you cope. they are front line soldiers in the body's battle with stress. it seems easy to believe that, if you're under a considerable amount of stress, you're in danger of wearing out the parts of you that process it, much like the brake pads on that unfortunate car. but are things really so straightforward?

it's hard to tell.

there is certainly no doubt that the adrenal glands can malfunction. they can either overwork or, slightly more commonly, they can under-work. the bulk of cases of under-performing adrenal glands are caused by an autoimmune disorder called addison's disease. autoimmune disorders are one of those "sick sense of humour" things. it's where your body's immune system can't recognise its own cells and starts to kill them off because it thinks they're an intruder. like all autoimmune diseases, addison's requires long-term, ongoing treatment or it can be fatal. all doctors accept the existence of addison's disease, but things get confusing when they have to agree on the subject of "adrenal fatigue" or "adrenal insufficiency"- basically adrenal glands that are functioning less than they should, but above the threshold where it's considered dangerous and where it clearly doesn't qualify as addison's disease.

for practitioners of alternative medicine, adrenal fatigue is a real condition, caused by your body jamming on the proverbial brakes too often. it's marked by literal fatigue, regardless of the amount of rest one gets and by very uneven energy- huge spikes followed by incapacitating crashes. [part of the role of adrenals is to regulate blood sugar.] in addition, it is claimed worn-out adrenal glands make people less able to deal with stress and therefore more prone to things like acute anxiety and, rapid, uncontrollable mood swings.

why is no one studying the adrenaline to stupid ratio?
the fact is that there are few reliable studies on the subject and most information you find on line is from anecdotal, non-professional sources. you could forgive the medical community for being a bit skeptical. on the other hand, it's very difficult to take the medical community seriously when they start acting like a paranoid schizophrenic of her meds. as a reaction to theories of adrenal fatigue, the normally well-respected endocrine society came out with a "myth vs. fact" pamphlet on adrenal fatigue that borders on the hysterical. seriously, there are people on street corners in montreal telling me about the end of the world who sound more balanced than the people who wrote this pamphlet. what's worse is that there are deeply misleading statements that could hurt patients. for instance, it refers to saliva tests for adrenal fatigue in a derogatory way, implying that they are fake and stating straight up that they are not based on science. in fact, saliva tests for adrenal function are supported by science and you don't even need to take my uninformed word for it- the u.s. food and drug administration accepts them as valid.

the problem here is that one side seems uninterested in martialing science to its cause, whereas the other appears dishonest. so with both sides so full of shit, what's a person to do?

well, a good place to start is by checking everything to see how it's working. go to your doctor, tell him or her that you want some tests to determine how your endocrine system is functioning. most doctors aren't going to deny you that. they're happy to recommend the standard battery of blood tests [possibly even a saliva test] to see if everything is kosher. so to speak. i'm not sure if human glands can ever be kosher.

once you've had the tests, get a copy. i've made a habit of doing this ever since i was accidentally given a copy of a series of blood tests. they're remarkably easy to understand and if you have any problems, you'd be shocked how much quality information there is on deciphering lab tests on the internet. with my blood tests, the official word was that all was normal. however, when i looked at what the numbers actually were, the markers pointed to borderline anemia. that wasn't even what the test was for, it was just an incidental thing that cropped up. was it a serious problem? of course not. but at least then i knew that i should take steps to correct my diet before it ended up becoming a serious problem. the same goes for a lot of things that show up in a lab test. you may not reach the clinical threshold for adrenal insufficiency, but that doesn't mean that you're functioning at 100%.

if you are found to have an adrenal insufficiency, your doctor will likely recommend treatment with steroid injections. so if you're an olympic athlete with adrenal issues, you're pretty much screwed. for the rest of us, steroids may work fine. you can't take them long term, or at least you shouldn't, because that many kickstarts can damage your heart, but they can jolt the system into working order again.

for cases that aren't serious enough to require steroids, most doctors [assuming they recognise it as an issue at all, which is why you want to see the numbers yourself] will tell you that you'll want to manage what you eat, how much you exercise, when you eat, etc. as with many things, a good diet and healthy lifestyle can do a lot to resolve problems. i liked what this article had to say on the subject and although it's lengthy, dr. lam has conveniently highlighted the key points and conclusions in different colours, so that even those with adhd can muddle through.

you could try dietary supplements, but i will grant the endocrine society that they do have some very legitimate fears about the quality of natural medicines. when it comes to taking some kind of supplement or herbal remedy, you should treat it exactly as you would medicine- ask questions, do your research and if you can't find the answers you need, don't take it. when searching, keep in mind that you want to find something that regulates your adrenal function, not something that boosts it. your adrenal glands may need a boost, but it's crucial that whatever you're taking "knows when to stop". otherwise, you're just setting yourself up for a problem in the other direction.

another thing that you might want to do is find ways to lobby for this kind of thing to actually get studied. drug companies aren't particularly interested in researching anything that can be managed through a healthy diet and nutritional supplements. but it seems important to know at what point we should be addressing issues with our adrenal glands, even if the problem doesn't make the clinical threshold. better to head these things off at the pass, as it were.

so that's it for our look at the adrenal glands. next week, we continue this series with "your thyroid and how it's trying to kill you".

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