I'm Exhausted. Do I have Adrenal Fatigue?

There has been a lot of talk lately about Adrenal Fatigue. I am seeing more and more of it in my practice; this is not a good health trend.

 

Adrenal Fatigue comes from "burning the candle at both ends." Someone who experiences a constant high stress state for long periods of time while simultaneously not taking care of themselves (not sleeping enough, eating the wrong foods, too much sugar/caffeine, exercising too much for the amount of sleep they are getting, etc). When you are in your 20's, the body has a certain amount of reserve energy (in TCM we refer to this as Jing) that can be used under just such occasions, like using a credit card. By they time people enter their 40's and 50's, if they continue at this pace, their reserves become empty (they accrue a lot of debt and max out their credit cards) and people become exhausted; no amount of sugar or caffeine can get them going.

 

From a Western perspective, when the body feels stress, the adrenal glands, which sit on top of the Kidneys, release a chemical called cortisol that gives us the burst of energy needed to get through the stressful situation. It gives us that little boost that allows us to handle an overwhelming meeting or meet a deadline. When the stress passes, the cortisol levels drop back down, and we return to normal functioning. Occasional boosts of cortisol are fine, the problem comes from keeping cortisol levels high all the time, while simultaneously using stimulants (which put even more stress on the adrenal glands), not sleeping enough and/or not eating nutritious foods. If someone is in a constant state of stress, or "fight or flight," their adrenal glands are pumping out a constant flow of cortisol. If they are not simultaneously getting sufficient sleep and eating nourishing foods to replenish, eventually the adrenals can't handle it any more and they stop working. This is Adrenal Fatigue.

 

Typical symptoms are:

 

• Feeling tired even after sleeping through the night
• Exhaustion
• Food cravings, especially for salt, sugar or other refined carbs
• Caffeine no longer helps you get through your day but you can't live without it
• Feeling easily overwhelmed
• Foggy headedness
• Low or no libido
• unexplained weight gain or difficulty losing weight

From a Traditional Chinese Medicine (TCM) perspective, the Jing that I mentioned earlier is our "Essence," it is inherited from our parents at conception; the state of their Jing plays a part in the quality of ours. If your parents were stressed out with low Jing when you were conceived, you may have less Jing than someone who had healthy parents. The Jing is related to the Kidneys, so how well your Kidneys function (the Chinese understanding of Kidneys) plays a part in how quickly or slowly you deplete your Jing.




According to TCM, the Liver is most affected by stress. The Liver gets its support and nourishment from the Kidneys (organs which include the physical Kidneys, the adrenal glands, the thyroid gland, the ovaries/prostate and other glands in the endocrine system). When the Liver is over stressed, it takes more Qi from the Kidneys than its fair share. Over time in order for the Liver to keep functioning (the Liver is what keeps us moving through our day) it keeps draining energy (Qi and Jing) from the Kidneys  and they eventually they konk out, leading to Qi Collapse, which is the equivalent of Adrenal Fatigue.


Obviously it is best to avoid Adrenal Fatigue to begin with by sleeping 7-9 hours per night, eating foods that nourish the body (rather than just quell the hunger) and managing stress with acupuncture, exercise, yoga, meditation, tai chi, qigong, etc. However, if you already have Adrenal Fatigue, there are options out there to help bring you back to health:

• Remove stress to the best of your ability. When you are exhausted, even gentle yoga can sometimes be too much, but meditation, even just 3 minutes at a time, can be a very powerful stress reducer. It can be a simple as observing the sensation of your belly rising and falling as you breathe. Whenever the thoughts start to get louder, notice that you are thinking and return your attention to your breath. Repeat this as many times as it takes. Meditation is not about getting to that "blissed out quiet space" it is about training the mind to have a single focus. It takes practice, but it is something that doesn't take a lot of physical effort and can have a large payoff.
• Ask for help. This can be challenging for many people, but often this is what has gotten you here in the first place. Ask for help from your spouse, friends, parents, children. Let go of the image of the pace that your life used to move at and see if you can move at a slower pace. Your task for the day might just be to feed yourself. If your house is messy, let it be messy for a little while until you are feeling better, or enlist the help of someone else. If you continue to tax your body, even with little things, the road to health is much longer.
• Eat good foods. Nourish your body with cooked vegetables, grass-fed/pasture raised meats and poultry, easy to digest grains like rice, quinoa, millet (cooked with a ratio of at least 3 cups water to 1 cup grain). Eat small meals and chew well to allow for the best absorption. Bone broths are also great. Try to avoid sugar, artificial sweeteners and caffeine since these will just leave you more depleted. Honey is okay, especially raw, in small doses, like in tea. There are also many Qi tonic herbs that you might find useful, like astragalus, ginseng, rhodiola, or ashwagandha. Talk to an herbalist to try to find the best ones for you to use.
• Sleep. Sleep is when the body repairs itself, so if you need to nap, do so if you can. If you can't sleep well, try a warm bath before bed or spray some lavender on your pillow. Acupuncture, homeopathy and herbal medicine may also help, but it is important to meet with a practitioner who can guide you to the correct treatment for your particular sleep issues.

It is important for you to see your doctor or a Functional Medicine doctor to get a diagnosis and check to see if you need supplemental cortisol as well. There are many herbal formulas, both Chinese and Western, that might be useful for sleep, energy and stress reduction which will also aid in your recovery. You don't need to be so tired all the time. With the proper treatment, you should improve over time to where you once again feel like you can live your life.

 

Acupuncture and the Heart

This is the time of year when people are flooded by messages of love. Valentine's Day can either be a day full of love and joy, or a day full of woe and disdain. I'm choosing this post to discuss the Heart, especially the emotional aspect, how it is viewed by Chinese Medicine and how it can affect our health.




Like with the Western understanding of anatomy and physiology, one of the Heart's main jobs is to pump blood through the body, creating warmth and circulation, from the core of our body out to the extremities. However, unlike the Western understanding of anatomy and physiology, Chinese theory sees the Heart as having additional properties. According to Traditional Chinese Medicine, the Heart houses the Spirit which in Chinese is the same word as the Mind--Shen. In TCM the Mind and the Spirit are seen as the same and what happens in the Mind/Brain/Spirit, happens in the Heart. The Spirit is what makes us who we are, what animates us, the light within us. This Sprirt, or Shen, is seen through the eyes--that sparkle (or lack of sparkle) indicates the quality of a person's Spirit.




This is why positive or negative thoughts will affect the Heart; whether you are thinking positively or negatively about yourself or someone else, it will have an effect on the Heart. Although Joy (or lack of Joy) is the emotion usually associated with the Heart, all emotions, even those that are associated with the other internal organs (Joy/Heart, Anger/Liver, Fear/Kidneys, Worry/Spleen, Sadness/Lungs)are felt by the Heart. Since the Heart feels all of the emotions and the Heart pumps blood through the body, the energy and effects of those thoughts and emotions are carried throughout the body and affect our health. How many times have you felt worry in your stomach (paired with the Spleen), or anger or frustration resulting in a tight neck and upper back (Gallbladder channel, which is paired with the Liver)?



It is common to speak about the Body/Mind/Spirit connection--this is the ultimate expression of that.




When the Heart is in balance we feel appropriate amounts of Joy. If there is excess Joy, or "too much" Joy, that translates to symptoms of mania. If there is insufficient Joy, or lack of Joy, you see one of the many manifestations of depression (each organ has a type of depression associated with it --a post for another day).




The Heart is the Fire element. When there is too much Heart heat (either Fire or Yang) a person often feels ungrounded, agitated or anxious. You can also feel Heart palpitations, racing or spontaneous sweating with panic attacks. These can also be due to insufficient Heart Qi or Blood. This agitation can disturb the Spirit which can then interrupt sleep, making it difficult to fall or stay asleep, sometimes causing restless sleep. Insomnia is the result of a disturbed Spirit "wandering around" at night rather than settling in for the night.




If you are feeling anxious, manic, agitated, joyless or are having trouble sleeping, chances are your Heart energy is out of balance and you could use some acupuncture. Seeing your local acupuncturist for an accurate diagnosis is best, but in the mean time, see if you can fill your heart with love, kindness and compassion, from yourself, to yourself. Kindness toward yourself is a very powerful way to nourish your Heart and feel Joy.

Can Acupuncture Help You With Your New Year's Resolutions?

I'm not a big believer in New Year's Resolutions, mostly because, as I wrote in Resolution or Reflection, it is the wrong time of year for anything to stick. That being said, many people do make resolutions at this time of year that commonly have to do with their health: lose weight, get fit/ exercise more, eat better, quit smoking, quit diet soda (yes please!!), quit drinking, walk every day, run a marathon, relax more, get healthier, etc. These are all things that are important and often very challenging to do because they take time. How many times have you made a resolution and a month later (or a week later) it is already broken?

When it comes to your health, it should be a marathon, not a sprint. Health is something that builds slowly over time because it needs to sustain you; it is not something that is just for today. If you quit smoking it is not just for this week, you don't want to smoke ever again (hopefully). Diets fail because once the diet is over the weight comes back on. A lifestyle change is much more effective for long term results and feeling better over all, even if you are taking it one day at a time. Acupuncture can help you with many of these resolutions because acupuncturists help you look at your overall health to assist you in feeling the best you can feel.

Quitting smoking/drinking/diet soda:
Acupuncture calms the nervous system and helps ease cravings making it less effort to quit. It also supports the Lungs and can help your body get rid of the phlegm that accumulates as the body heals from the damage that smoking causes. Acupuncture supports the Liver which aids in the detox process, helping your body get rid of the build-up of chemicals that smoking, drinking and diet soda (or diet anything) can create. The fewer chemicals in your body, the better you feel. Acupuncture has been used to treat addiction in this country for decades to help people quit whatever substance it is they are wishing to quit. It treats both the physical symptoms as well as the psychological ones without side effects. However, you must want to quit; if you don't fully commit to quitting, you won't succeed.

Losing weight:
Unfortunately acupuncture is not the "magic bullet" that makes the weight just fall off your body. Sorry about getting your hopes up. However, acupuncture can help improve your metabolism to help your digestion and your ability to process food. Lack of hunger is not a sign of health, it is a sign that your body is out of balance. When hunger is too strong, acupuncture can help regulate that, as well as food cravings. Acupuncture can also help with stress. One reason that people gain weight is stress, not just due to "stress eating," but also stress slows down your metabolism making it much harder to lose weight. Your acupuncturist can also make dietary suggestions about foods that best support your particular imbalance and support your eating the best foods for your body.

Exercising more:
While acupuncture can't make you walk into the gym, it can support the work you do there. It can help relive sore muscles and help you heal from injuries. Plus acupuncture can help improve your energy so that you can work harder without feeling exhausted afterward (if you do feel exhausted after exercise you need to slow down and do less. Read more about that here).

If you are struggling with your New Year's resolutions, talk to your local acupuncturist. She or he might be able to help you be a better you for the entirety of the New Year.

How to Tame Menopausal Symptoms Naturally

I'd like to start by stating that Menopause is not a disease that needs to be "cured." It is something that every woman goes through at some point in her life, either naturally or due to surgery or chemotherapy. What your experience of Perimenopause and Menopause is depends on the state of balance in your life and in your health; the more balanced you are, the fewer and milder the symptoms you will experience. However, you are probably reading this post because you are experiencing at least one symptom, so let's get down to it.

Like I said, the key to taming Menopausal symptoms is balance. Stress, poor diet, lack of appropriate exercise, and poor sleep can all play a part in taking you out of balance, so try to take control of what you can.  If it is within your power to make better choices (go to bed earlier, ask for help, take a yoga class, go for a walk) then try to do that to the best of your ability. Stress happens, what matters is how you handle it.

In terms of diet, start with a healthy diet, rich with dark green, leafy vegetables, berries and other fruit, as well as other seasonal vegetables, like squash, pumpkin and root vegetables. Small amounts of grass-fed beef, pasture raised chicken and eggs, brown rice, quinoa and legumes will round out the basics. Eat organic and non-GMO when possible. To specifically target menopausal symptoms, which you can read about in my previous post, you will want to eat foods that build Yin and Blood.

Foods that Build Blood:

• Barley, oats, rice
• Apricots, cherries, dates, figs, raspberries, grapes
• Beets, collards, kale, swiss chard, spinach, yellow squash
• Aduki beans, black beans, kidney beans
• Eggs (especially the yolk), beef, liver, octopus, oyster
• Mushrooms

Foods that Nourish Yin:

• Millet, alfalfa sprouts
• Asparagus, sweet potato, string beans
• Cranberries, strawberries, lemons, limes, mulberries
• Aduki beans, black beans, black soybeans (ideally fermented), black sesame seeds, walnuts
• Clam, duck, oyster, pork, eggs (especially the yolk)
• Rosehip, algae, seaweed, marjoram, nettle, salt (high quality sea salt)

If your symptoms are mostly heat related (hot flashes, night sweats, irritability), also adding cooling foods like melon, cucumber, mint and yogurt can help tame the heat. Even if you are running warm however, be cautious with too many cold or iced foods or beverages in the cold weather. You don't want to put out your digestive fire, just cool the rising heat. Keeping most of the food in your diet cooked and warm, but not hot or spicy (see the "avoid" list below). If you live in Hawaii or somewhere else that is warm all the time, you can get away with more cooling foods to balance the warmth of the environment. Here in the Northeast U.S. (where as I am writing it is currently snowing) cooked foods will be better.

Other useful foods and supplements are:

• Organic, non-GMO fermented soy products-- miso, natto, tempeh
• Flaxseeds, licorice, black cohosh: they have phytoestrogens or plant estrogens which may be helpful in balancing the drop in estrogen that happens at menopause.
• Pycnogenol-- can help with hot flashes and night sweats
• Omega 3 foods-- Flax, chia, hemp, salmon, anchovy, walnut
• Vitamin D3 (especially for depression, mood swings, irritability, and especially in colder Northern climates in Winter). Adults can take 2000-4000 IU daily when sun exposure is minimal.

For additional support, avoid the following:

• Alcohol--it produces dampness and heat in the body (you don't need any additional heat).
• Stimulants like coffee or black tea; green or herbal tea is okay.
• Spicy foods like cayenne, dried ginger, cinnamon, black pepper, mustard, horseradish, chili. These increase internal heat and make you sweat (you don't need any help in that department).
• Artificial sweeteners and sugar. These increase inflammation in the body, which can produce more heat as well. They are also just not good for you.

Acupuncture and yoga can also be very helpful when it comes to managing the symptoms of Perimenopause and Menopause. They can help you sleep better, manage stress and balance your hormones so that you feel better and can better cope with daily life.

Perimenopause--The Fiery Beast

Perimenopause is that time in a woman's life when your fertile days are limited. During this in between stage, women are usually still getting periods, sometimes regularly, sometimes more frequently, sometimes less frequently. Hormonal shifts can cause all sorts of symptoms, which can be explained from a Traditional Chinese Medicine (TCM) point of view.

Through a woman's menstrual life she loses blood every month, sometimes in large amounts. Because of this, most women tend to run a little Blood Deficient. Her body has less than a month to make up for the blood loss and if her diet is low in blood building foods (dark green leafies, beef, beans, eggs, grapes, figs, dates), over time this insufficiency becomes more pronounced. Typical symptoms are:

• dry skin and hair
• vision problems (floaters, dry eyes, blurred vision)
• constipation
• empty-headedness/whole-head headaches
• fatigue during or after your period
•  palpitations
• anxiety

Generally symptoms of Blood Deficiency involve some sort of dryness, since there is insufficient blood to moisten and nourish the body (hair, skin, muscles, internal organs) appropriately. As a woman moves toward menopause, the symptoms of dryness intensify as she becomes more and more deficient. When there is not enough moisture to cool the body, heat rises.

When people think of typical Menopause (capital M) symptoms they think of hot flashes, night sweats, trouble sleeping, brain fog and mood swings. Of course there are other possible symptoms, but these are the biggies. During perimenopause, you are moving in that direction; there is still enough Blood to have a period, but they may be occurring less often or have a lighter flow. Exceptions to this are when there are fibroids present (Blood Stagnation) which cause the blood flow to be very heavy, almost hemorrhaging for some women. But generally speaking, there is a trend toward drying out and heating up. Some women start to get hot flashes or night sweats in the premenstrual days, or have insomnia for those few days before the bleeding starts. This, of course, is in addition to any normal PMS symptoms she may be having. Like PMS, these symptoms typically subside once the bleeding starts.

It is the shift from Blood Deficiency to Yin Deficiency that marks the end of Menstruation and beginning of Menopause. Yin is the body's cooling substance that balances Yang's fire. When the Blood is that empty, the dryness goes deeper and develops into a Yin Deficiency and this is when the signs of heat...well, heat up. Many common symptoms include:

• hot flashes (with or without sweating, day or night)
• night sweats
• insomnia--usually falling asleep is fine but there is frequent waking, due to heat, sweating, stress/anxiety or for no obvious reason
• bursts of anger or mood swings
• feeling generally warmer or every afternoon feeling like you are running a low fever
• lower tolerance to heat in the environment
• vaginal dryness and/or general skin and hair dryness
• anxiety

The good news is that this is not necessarily your destiny. You might experience some, all or none of these symptoms. Many women's periods stop and they never have a single sweat or flash. However, any difficulty you have premenstrually (in terms of amount and severity of symptoms) will mimic any difficulty you may have in the transition to menopause; basically if you have easy periods, chances are high that you will have an easy transition from Perimenopause into Menopause. If you don't, beware the Fiery Beast! Luckily there are many natural options to look to for help and support, including Acupuncture, Chinese Herbal Medicine and Diet.

Next time I will be writing about dietary options for taming the symptoms of Perimenopause. If you would like to sign up to receive email notifications of my posts, please click this link to sign up. You can unsubscribe at any time.

PMS and acupuncture

Premenstural Syndrome, or PMS, typically occurs in the second half of the menstrual cycle, between Ovulation and Menstruation. It can last anywhere from a few minutes to 14 days, depending on the severity of the imbalance causing it. Imbalances can be caused by excess (usually stagnation of Qi or Blood) or deficiency, or both. Please review my previous post to learn about how a "normal" period is supposed to happen.

Premenstrual symptoms occur because of imbalances that are in the body already; they become heightened just before the period when Qi and Blood is building. If the symptoms are due to deficiency (insufficiency) it is because there is not enough Qi, Blood, Yin or Yang to support normal function. If the symptoms are due to excess (usually either caused by heat or stagnation), the build is increasing the excess thereby exacerbating the symptoms.

The Liver Qi is the motive force that causes the blood to flow during menstruation. Pain is often due to stagnation of Liver Qi. When Liver Qi is stuck or stagnant, it causes many common premenstrual symptoms, such as: headaches/migraines, TMJ or teeth clenching, breast tenderness, cramps, irritability/short temperedness, depression, bloating and restless sleep, just to name a few. Stagnation can occur due to excess (there are too many cars trying to drive down one lane on the road) or deficiency (there isn't enough gas in the tank for the car to run and it stops, causing a back up behind it). The best cure for stagnation is movement, but you want to make sure not to over do it, especially if your stagnation is due to deficiency; it will make it worse. Looking at other symptoms can help determine the type of your stagnation.

If your symptoms are accompanied by fatigue, bloating, sweet cravings, clumsiness and/or loose bowel movements, chances are your stagnation is due to deficiency. This type of stagnation will be made worse with exercise. The best course of action would be to increase the amount of rest you are getting, both with sleep and down time during your day. If you do exercise, gentle yoga, tai chi, walking or something low key is best, so as not to over tax your body. Also, eating warm, sweet foods to nourish your Qi. This is not an invitation to eat a tray full of fresh baked brownies (sorry), but to eat foods that have the sweet flavor, like sweet potatoes, pumpkin, carrots, squash, oatmeal, chicken, rice, salmon, turkey, licorice, fresh ginger and cardamom. If you also have symptoms of hot flashes, night sweats or insomnia in the days before menstruation, that is also due to deficiency but deficiency with heat, so be cautious with the warming herbs (ginger, cardamom). You would do better with foods like millet, asparagus, seaweed, lemon, lime, egg and cranberry.

If your symptoms are accompanied by severe lower abdominal pain, irritability, quick temper, mind racing, trouble falling asleep and intense premenstrual migraines, your stagnation is probably due to excess. This type will respond well to exercise, especially more strenuous exercise, like running, swimming, vigorous yoga, mountain climbing, basically exercise that really gets your heart pumping.

This is just a very basic, general overview; to get your specific diagnosis, see your local acupuncturist. Acupuncture can relieve stagnation due to deficiency and excess or when there is a combination of the two.  Not only can acupuncture address the physical symptoms, but also the emotional symptoms--mood swings, irritability, sensitivity or weepiness. If you find yourself suffering before your period every month, regular acupuncture treatments can help keep you in balance so that the symptoms are minimized or gone completely.

Premenstrual Syndrome (PMS)-- East meets West

The bane of many women's existence: PMS. Life seems to be going along fine and then "Aunt Flow" comes to visit and brings with her all sorts of physical, mental and emotional discomfort. Over the next few months I will be posting about different aspects of PMS, or Premenstrual Syndrome, but I will not be posting alone. I am joining forces with Naturopathic Doctor Joshua Lloyd, from Groton Wellness, to provide you with the most information possible: an Eastern and Western Holistic point of view. The discussion will be broken down into 3-4 parts so that the information will be easier to digest, and hopefully will leave you with some tools and understanding to help manage any symptoms you or a loved one might be suffering.

Let's start with what a balanced menstrual cycle looks like from a Traditional Chinese Medicine (TCM) perspective.

From the start of menstruation, the Liver Qi moves the Blood out of the Uterus (Bao Gong) and the  Sea of Blood (Chong Mai) empties. The blood flows smoothly, tapers off and stops over the course of 3-7 days. The blood is bright red without clots. There should be no pain or discomfort and it should not drain your energy; basically life should go on relatively normally, aside from the fact that you are bleeding. Once the bleeding stops, the body begins to rebuild Blood and Yin so that you are not left at a deficit. Approximately 7 days later ovulation happens from the swell of Kidney Yin becoming full and shifting into Yang. The next two weeks are ruled by Qi and Yang, which must stay full and keep moving. Then the Heart sends the Blood down the Bao Mai (Vessel) to the Uterus (Bao Gong-- Palace), which is then moved out by the Liver Qi, and declining Yang becoming Yin, causing menstruation. The cycle is complete.

Notice that there is no mention of cramps, irritability, breast tenderness, fatigue, bloating, insomnia, etc. These symptoms are not part of a "normal" menstrual cycle, they are an indication that the body is out of balance. Bleeding should start, go on for a few days then end, all without any other symptoms.

That being said, most women in this day and age do not experience this version of the menstrual cycle. Most women experience some symptoms at various times during the month, both physical and emotional, which are caused by the above process not going as it should. If Qi, Blood, Yin or Yang are insufficient or excess, there will be problems, ranging from irregular menstruation, periods that are too heavy or too light (or non-existent), infertility as well as numerous other issues. One of the most common problems, with regard to the menstrual cycle, is Liver Qi stagnation, which presents itself most frequently between ovulation and menstruation. The next few posts will explore this issue in greater detail, focusing on physical, mental and emotional issues that often arise during this time. Every woman is different and can present differently during this premenstrual time. There are symptoms that are directly related to hormonal shifts and also symptoms that might seem unrelated but are really part of the same pattern. Any imbalance that exists during the rest of the month will become more pronounced premenstrually, and depending on the severity of the imbalance,  can really (thankfully temporarily) upset a woman's life.

My goal for the next few posts is to help you understand this premenstrual time a little better, from both an Eastern and Western point of view, to help you cope with your symptoms and to eventually guide you to improve your overall health. If you have any specific questions that you would like to have answered in these posts by either myself or Dr. Lloyd, please email me at jagoglia@integrativetherapeutics.com or Dr. Lloyd at drlloyd@grotonwellness.com.


Dr. Lloyd is a naturopathic doctor who graduated with his degree in naturopathic medicine from Bastyr University in Seattle, WA.  Bastyr is one of only four nationally-accredited naturopathic medical schools.  Before medical school, he graduated with high honors from the University of New Mexico with a Bachelor of Science degree in Exercise Science.  He has an extensive research background that he uses to stay on the cutting edge of natural therapeutics and natural remedies.

Dr. Lloyd treats patients of all ages with a wide variety of health concerns, including Lyme disease, chronic inflammatory complaints, cardiovascular problems, thyroid and adrenal troubles, sleep problems, digestive complaints, and mental health concerns. He utilizes a comprehensive approach to help alleviate symptoms while investigating and correcting the causes of declining health.