Supporting the Adrenals
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Adrenal support is a complex and controversial topic. Conventional medicine and integrative/holistic disciplines disagree hotly regarding the prevalence, nature and diagnosis of adrenal insufficiency as well as about safe and advisable treatment. Meanwhile, Ayurveda, which does not recognize the existence of the adrenals at all, so far as classical texts are concerned, remains serenely above this controversy. In this article we will explore what adrenal insufficiency is, how it is seen Ayurvedically, and how it may prevented and managed in the Ayurvedic context.
Conventional medicine recognizes both acute and subclinical adrenal insufficiency. Acute adrenal insufficiency, known as Addison's disease, is a life-threatening illness. (1) Subclinical adrenal insufficiency represents a stage prior to the onset of Addison's disease and may persist at a low level for months or years until a major physiological stressor tips it into acute manifestation. (1) Adrenal insufficiency may arise as a primary illness as an organ specific auto-immune disorder or may be secondary to a systemic infection. Consumptive diseases such as tuberculosis and AIDS as well as liver disease like Hepatitis C are quite common causes of secondary adrenal insufficiency (2, 3, 4). A variety of drugs can lead to adrenal insufficiency, especially corticosteroids, which suppress the adrenals via the body's feedback mechanisms and may thus lead to shrinking of the adrenals (1). Both acute and subclinical adrenal insufficiency can be biochemically diagnosed by measuring cortisol levels.
Meanwhile, integrative and naturopathic practitioners recognize a condition described as 'adrenal fatigue'. As a result of chronic stress, the adrenals are considered to function sub-optimally, although this is at a level that cannot be diagnosed by conventional cortisol level tests. The Mayo clinic website notes that 'adrenal fatigue is not a medically recognized diagnosis' (5), whereas MJ Ghen and CB Moore in an article published in the Journal of Integrative Medicine detail the adrenal fatigue hypothesis. After outlining the commonly accepted symptoms of adrenal insufficiency as weakness, fatigue, weight loss, and anorexia, often accompanied by low blood pressure, salt cravings, gastrointestinal symptoms, and hyperpigmentation, (1,6), they add that, " Non-specific symptoms are commonly seen in marginally deficient patients. These may include poor mental clarity, decreased sexual function, decreased libido, and just not 'feeling right' " (6). In addition to the standard causes of adrenal insufficiency these authors add stress, menopause, electromagnetic fields--such as from computers-- toxins such as tobacco, alcohol, street drugs, heavy metals, sugar, coffee, pollution, pesticides, herbicides, and fungicides and dietary stressors, especially white flour (6).
From an Ayurvedic standpoint, the adrenals are not addressed in our classical texts, nor is cortisol level testing a part of the ashtavidha pariksha or list of eight traditional diagnostic methods. Yet a syndrome very similar to Adrenal Fatigue is carefully portrayed in these same texts. 'When the ojas is diminished the person is fearful, weak, always worried, having disorders in the sense organs, deranged lustre and mental ability, rough and emaciated." (7).
"Ojas undergoes decrease in quantity by anger, hunger, worry, grief, exertion. With such a decrease the person becomes fretful, debilitated, worries much again and again with out apparent reason, feels discomfort in the sense organs, develops bad complexion, bad mentation and dryness" (8). The texts also mention that rukshapana (intake of dehydrating alcoholic beverages), bhaya (fear), prajagara (staying awake at night), abhigata (trauma), abhisanga (infections) and visha (poisons such as tobacco, coffee, white sugar, white flour, pesticides etc.) are causes of ojokokshay or diminshed ojas (9, 10).
Recognizing that ojokshay and adrenal fatigue may be analogous conditions expressed in different universes of discourse, let us look at how we can offer adrenal support in an Ayurvedic context.
First of all, please discourage your patient from using adrenal extracts that he or she may have purchased online or obtained from another practitioner. These products act exactly like corticosteroids in impairing adrenal function and causing adrenal insufficiency (1). In terms of the 'adrenal insufficiency' paradigm, it is important for patients with these symptoms to make lifestyle changes by eliminating toxins such as caffeine and white sugar. For archived Vine articles offering suggestions in implementing these lifestyle changes see Alakananda's tagged Ayurveda Articles. By the same token, in terms of ojokshay, we must begin by eliminating the causes such as excess alcohol consumption and poisons, especially caffeine, nicotine and uppers. The amount of fish in the diet should be examined carefully as a potential source of heavy metal poisoning. Staying awake at night is extremely stressful to the adrenals, which operate on a diurnal cycle designed for days of activity and nights of rest. Similarly, prajagara or vigil is an important cause of ojokshay. Wherever possible, the schedule should be adjusted to permit night sleep rather than day sleep. Ongoing traumatic or stressful situations should also be addressed.
In place of an adrenally exhausting diet high in refined flour products and sugary baked goods, an Ayurvedic diet emphasising whole grains, legumes and vegetables will support both ojas and the adrenals. Typically, this diet is likely to have a vata-soothing emphasis although adjustments will have to be made based on individual prakruti and vikruti.
Ayurvedic stress management strategies can be used, including gentle yoga with emphasis on shivasana, calming pranayamas like nadi shodhan and of course meditation. Daily self-abhyanga with Ashwagandha-Bala oil or appropriate dosha specific massage oil will also help relieve stress, balance vata and strengthen ojas. Shirodhara may be helpful based on the individual picture. It there is a lot of anxiety shirodhara will be helpful whereas if listlessness is a main feature it is best to avoid shirodhara for the time being.
Adaptogenic herbs with an affinity for the adrenals include Ashwagandha, tulsi, and licorice, which latter is endowed with aldosterone-like qualities (11, 12, 6, 13). For restoration of ojas, the treatment is "drugs of jivaniya gana, milk, meat juice etc." (8). Ashwagandha is among the most outstanding of the jivaniya herbs and forms the foundation of treatments aimed at restoring ojas and enhancing adrenal function. Stress Ease is a combination containing Ashwagandha, designed to address many of the symptoms associated with adrenal fatigue or ojokshay including fatigue, exhaustion and stress. Tulsi tea, or a tea of tulsi and licorice will also be valuable (avoid licorice if blood pressure is elevated). Cow's milk, recommended in the texts for increasing ojas, can be drunk at night with a teaspoon of Ashwagandha and a pinch of Pippali or can be made into ojas drink (see recipe below.) A non-dairy ojas drink can be made for those with sensitivities to cow's milk. Non vegetarian patients can take chicken soup as a jivaniya food and vegetarians can take urad dal and mung dal soups for the same purpose.
Ojas drink Almond Restorative Drink
Serves 1, Sattvic; V-P-K+
Soak together overnight: 10 raw almonds & 1 cup pure water
In the morning, drain off the water. Rub the skins off the almonds.
Bring to a boil: 1 cup milk (unhomogenized if possible) (milk is highly rejuvenative when digested)
Pour the milk in the blender with the drained & peeled almonds and:1 tablespoon organic Rose (rejuvenative)
1 tsp ghee (rejuvenative)
1/8 tsp organic cardamom (increases digestion)
pinch of Pippali (prevents Kapha provocation)
1/2 tsp of sweetener (increases lactose digestion)Blend until smooth.
Non-dairy almond drink
Soak together overnight: 10 raw almonds & 1 cup pure water Soak 20 raisins in 1 cup pure water overnight or several hours.
Put the raisins AND their soak water in the blender with the drained & peeled almonds and:1 tablespoon organic Rose (rejuvenative)
1 tsp ghee (rejuvenative)
1/8 tsp organic cardamom (increases digestion)
pinch of Pippali, (prevents Kapha provocation).Blend until smooth.
In the Ayurvedic paradigm, sufficient and healthy ojas is the key to immunity, strength and resilience. In the biomedical paradigm, adequate cortisol levels similarly support immunity and stress resilience. Subclinical adrenal insufficiency and ojokshay are similar in causes, symptoms and herbal treatments. In supporting healthy levels of ojas we can feel confident that the adrenals will likewise be supported in their function of providing stress resilience and wellbeing. With removal of causative factors along with judicious use of jivaniya herbs such as Ashwagandha and rejuvenative diet and lifestyle practices, normal stress resilience can gradually be restored and maintained.
Bornstein SR, Predisposing Factors for Adrenal Insufficiency N Engl J Med 360:2328, May 28, 2009 Review Article
harma S K; Tandan S M; Saha P K; Gupta N; Kochupillai N; Misra N K:Reversal of subclinical adrenal insufficiency through antituberculosis treatment in TB patients: a longitudinal follow up. The Indian journal of medical research 2005;122(2):127-31.
Nemechek P, Wahl D, Sackuvich L; Evidence of subclinical adrenal insufficiency in patients with AIDS, CDC class III International Conference on AIDS. Int Conf AIDS. 1996 Jul 7-12; 11: 331 (abstract no. Tu.B.2378).
Huy A Tran, Shuzhen Song: Exacerbation of hepatitis C induced subclinical hypoadrenalism by Interferon-alpha2beta: A case report Cases J 2008, 1:157doi: 10.1186/1757-1626-1-157
http://www.mayoclinic.com/health/adrenal-fatigue/AN01583
MJ Ghen, CB Moore; implications of adrenal insufficiency Int J Integr Med, 2000
PV Sharma tr. Charak Samhita Su XVII 73 Chaukambha Orientalia 1994
Srikantha Murthy tr. Ashtanga Hridayam Su XI 39-40.
Charak Samhita, Su XVII 76-77
Srikantha Murthy tr. Ashtanga Hridayam Su XI 39-40, translator's note.
Ostrander S, Schroeder L. Super-Learning 2000. New York: Delacorte Press, 1994, pp. 363-379.
D Winston, S Maimes Adaptogens: Herbs for Strength, Stamina, and Stress Relief 2007
Singh, Narendra, Tulsi ,the mother medicine of nature International Institute of herbal medicine, Lucknow 2002
Alakananda Ma M.B., B.S. (Lond.) is an Ayurvedic Doctor (NAMA) and graduate of a top London medical school. She is co-founder of Alandi Ayurveda Clinic and Alandi Ayurveda Gurukula in Boulder Colorado, as well as a spiritual mother, teacher, flower essence maker and storyteller. Alakananda is a well known and highly respected practitioner in the Ayurveda community both nationally and internationally.
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