Long-term behavioural problems in adolescents linked with low stress hormone levels. Why?

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The adrenal glands sit on top of the kidneys, and are the chief glands in the body responsible for the body’s response to stress. In short, when our brain senses stress it signals the adrenal glands to produce hormones such as adrenaline (ephinephrine) and cortisol. These hormones allow the body to respond to stress. Once the stress is gone, the adrenals will generally reduce their hormone production and are then, we hope, ready to respond to the next challenge.

I was interested to read of a recent study which looked at the cortisol levels in adolescents suffering with ‘behavioural problems’ [1]. Here, in essence, are the findings of the research:

If the behavioural problems started relatively recently, cortisol levels tended to be high.

If the behavioural problems started some time ago (in earlier childhood), cortisol levels tended to be low.

The idea put forward to explain this is that, over time, the body learns to down-regulate the production of cortisol from the adrenal glands.

This might be true, but there’s an alternative explanation too.

The adrenal glands only have a finite capacity to do their job properly. Just like the liver can only cope with so much alcohol and the brain can only do so much ‘thinking’ in a given period of time, the adrenals have the potential over time to weaken. In natural medicine there is a bit of a vogue for identifying and treating this problem, and the condition is often termed ‘adrenal fatigue’ or ‘adrenal weakness’.

I, personally, believe in this phenomenon. Over the years, I have seen many individuals with supposedly vague health issues who appear to not have responded to traditional or even natural approaches. A hallmark feature of these individuals is fatigue. In particular, additional stress or challenge in the form of anything from emotional stress to strenuous exercise can cause individuals to get much more tried or ‘crash’, quite quickly.

One phenomenon that I find almost always has adrenal fatigue as its root is ‘burnout’. Here, usually hard-driving individuals who are used to getting a lot done in the average day can, almost overnight, go into a state of low energy and low mood that may take a long time to emerge from. Some of the most prominent symptoms of adrenal weakness include:

Adrenally weakened individuals tend to be tired. They often lack the vitality they once took for granted. They quite often have to force themselves through the day, and may prop themselves up with caffeine to give them the energy they need to complete whatever tasks they face. As time goes on, these individuals often feel the need to take more sleep. However, it is not uncommon for an adrenally compromised person to feel very tired on waking, irrespective of how much sleep they get.

Easy fatigue and lack of resilience
Adrenally weakened individuals often have little in the way of energy ‘reserve’. Not only do they generally feel tired, but they often get tired out or exhausted quite easily. For individuals with adrenal compromise, any additional stress, be it of a physiological and/or emotional nature, on the body can cause real energy lows. A busy week at work, the stress associated with a child’s illness, or a couple of late nights can be all it takes to bring energy crashing down.

One activity which tends to bring this concept to the fore is exercise. Individuals with good adrenal function tend to feel buoyed up and energised by exercise. While adrenally weakened individuals may feel emotionally satisfied to have taken exercise, the fact is it can lead them to feel tired and ‘wiped out’ the same day or the day after.

Adrenally compromised individuals can often get a ‘boost’ of energy in the mid-late evening, which can cause them to have difficulty getting off to sleep. Also, they can be prone to dropping their blood sugar level in the night, which essentially turns on the body’s stress response. This can cause waking in the night, typically at 3.30 – 4.30 am. Individuals can find themselves quite alert at this time, and may find that they are unable to get back to sleep again until about half and hour before the alarm goes off.

Low blood pressure
Stress is often thought to cause raised blood pressure. However, long term stress through its effects of adrenal function can actually lead to low blood pressure (hypotension) in time. Adrenally weakened individuals often have a blood pressure of 110/70 mmHg or less. These individuals also tend to have a blood pressure which drops on standing from a seated or lying position. This condition, the medical term for which is ‘postural hypotension’, can cause occasional dizziness on standing.

Salt craving
Some individuals with adrenal weakness will crave salt. Probably what is going on here is that the body is looking to salt to help replenish sodium which is not being retained due to a lack of aldosterone and/or other hormones.

Sugar craving
Adrenally compromised individuals can often crave sugary foods such as biscuits or chocolate. This is usually a sign of the episodes of low blood sugar they are prone too.

An increased tendency to allergic conditions such as hay fever and asthma

The need to eat regularly
Individuals with adrenal weakness tend to need to eat regularly to keep them from feeling weak, light-headed or ‘shaky’. If the body is not being fuelled from the outside (by eating), the body needs to generate sugar from the breakdown of stored fuels in the body such as glycogen in the liver. If the adrenal glands are weakened, it is possible that stress hormones such as cortisol are not made in sufficient quantities to enable adequate amounts of sugar to be mobilised in this way.

One way of assessing adrenal function is via salivary samples which are analysed for cortisol and, often, another adrenal hormone known as DHEA. If there is evidence of adrenal weakness on such testing, then supporting the adrenal glands can, over time, really help to restore lost energy and vitality.

Some of the approaches that I have found to be important in practice include ensuring adequate rest and sleep, the avoidance of strenuous exercise, regular eating of a truly nutritious diet (I find a diet rich in protein works best here), and nutritional supplementation. In particular, some medicinal herbs including rhodiola, liquorice, ginseng and withania do seem to help the adrenal glands function better and recover more quickly.

The best resource I have come across in terms of raising awareness regarding adrenal fatigue and offering constructive advice on how to manage this issue is www.adrenalfatigue.org


1. Ruttle PL, et al. Disentangling psychobiological mechanisms underlying internalizing and externalizing behaviors in youth: Longitudinal and concurrent associations with cortisol. Hormones and Behavior 2011;59(1):123-132

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