Fluid Balance and Adrenal Fatigue Syndrome

Maintaining optimum fluid balance is important in achieving general good health. This is especially critical in Adrenal Fatigue Syndrome (AFS), where fluid dysregulation is a common occurrence, especially in the advanced stages.

Fluid imbalance presents in a continuum. Conventional medicine, unfortunately, are versed mostly when fluid imbalance reaches extreme opposites, with severe dehydration on one extreme and massive fluid overload at the opposite pole. Fluid overload clinically results in pulmonary edema, peripheral edema, and congestive heart failure. They are quickly resolved with administration of medications called diuretics that increase urine output to reduce body fluid load. Deficiency in fluid, or clinical dehydration, is clinically treated with fluid replacement.

Little attention is paid when fluid imbalance lies between the two extremes, when symptoms can be evident but laboratory tests are normal. This is especially evident for those in the fluid depletion side of the spectrum. In this subclinical state of dehydration, signs and symptoms are mild and subtle at best. It is often missed and ignored as important contributing factors to ailing health.

Antidiuretic Hormone

Antidiuretic hormone (ADH), also known as arginine vasopressin, is secreted from the posterior pituitary gland. After travelling to the kidneys, antidiuretic hormone binds to receptors on cells in the collecting ducts. It promotes reabsorption of water back into the circulation, reducing water output. Without ADH, water flows freely out in urine, as the collecting ducts are virtually impermeable to water. The most common disease of man and animal related to ADH is diabetes insipidus. This clinical condition arises from either dysfunction in the hypothalamus or in the kidneys. The major sign of either type of diabetes insipidus is excessive urine production, and thus accompanied by dry mouth and thirst. Fortunately, ADH dysregulation is seldom a problem encountered as the root cause of thirst and fluid imbalance in adrenal fatigue.

Urination and Adrenal Fatigue Syndrome

Many AFS sufferers have increased and frequent urination, no matter their amount of hydration. Here are three reasons why:

In the early stages of Adrenal Fatigue Syndrome, aldosterone levels first rise as the body tries to conserve water. As AFS progresses to advanced stages, aldosterone level tends to fall, resulting in low body fluid level. Next, low blood volume results and blood pressure falls. With reduced aldosterone, sodium retention is reduced, and fluid loss increases, leading to increased urine flow.

Severe short term stress increases adrenaline release as the body begins the “fight or flight” alarm response, which in turn increases the rate of urine flow.

Chronic stress increases HPA (Hypothalamic-pituitary-adrenal) axis stimulation to the adrenal glands, resulting in increased cortisol output from the adrenal cortex. Cortisol causes reduction in Anti-Diuretic Hormone (ADH), which increases urine flow as the production of urine is not held back by ADH in the body. To put it simply, high cortisol leads to low ADH.

It comes as no surprise that most sufferers of AFS are in a chronic stage of fluid depletion, either clinically or sub-clinically, with increased urination.

- See more at: drlam.com/blog/fluid-balanc...

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  • Interesting article cc120.

    I've just been reading about when adrenal issues cause aldosterone variations and the kidneys excrete too much salt, increasing the need for urination.

    It all ties together.

    I sometimes have to add a few grains of salt to plain water in order to help absorbtion. Otherwise I can drink a pint of water and still be thirsty.

    Flower007

  • Hi Flower007, as well as peeing too much during the day, my sleep was disturbed every couple of hours at night for the need to pee, and eventually, after seeing urinologist (I had to suggest the medication however) I was prescribed Desmopressin which shuts of the kidneys for 8 hours, thus allowing me to reach deep sleep. Previous to the medication, for an 8 year period, I was dehydrated with very woozy thought processes.

    From Dr Lam's site:

    Urination and Adrenal Fatigue Syndrome

    Many AFS sufferers have increased and frequent urination, no matter their amount of hydration. Here are three reasons why:

    •In the early stages of Adrenal Fatigue Syndrome, aldosterone levels first rise as the body tries to conserve water. As AFS progresses to advanced stages, aldosterone level tends to fall, resulting in low body fluid level. Next, low blood volume results and blood pressure falls. With reduced aldosterone, sodium retention is reduced, and fluid loss increases, leading to increased urine flow.

    •Severe short term stress increases adrenaline release as the body begins the “fight or flight” alarm response, which in turn increases the rate of urine flow.

    •Chronic stress increases HPA (Hypothalamic-pituitary-adrenal) axis stimulation to the adrenal glands, resulting in increased cortisol output from the adrenal cortex. Cortisol causes reduction in Anti-Diuretic Hormone (ADH), which increases urine flow as the production of urine is not held back by ADH in the body. To put it simply, high cortisol leads to low ADH.

    It comes as no surprise that most sufferers of AFS are in a chronic stage of fluid depletion, either clinically or sub-clinically, with increased urination.

    - See more at: drlam.com/blog/fluid-balanc...

  • Did you have low aldosteron or ADH cc120?

    Is this Diabetis Insipidus Cental DI?

    Flower007

  • Hi Flower007, I didn't have a test for anti-diuretic hormone, urinologist just prescribed the medication on symptoms alone.

    In Sept 2014 I had tests: HbA1c level (DCCT aligned) 5.3% (4.00-6.00%) and HbA1c level - IFCC standardised 34 (20-42).

    Which showed I wasn't diabetic, but a forum member pointed out that this result shows I should improve my diet, ie less sugar, etc, as am in risk of developing diabetes.

    Just looked at nlm.nih.gov/medlineplus/enc... to read about Diabetis Insipidus Cental DI which I've never heard of before, thank you.

    The symptoms all apply to me, and my urine can be concentrated sometimes, ie dark in colour.

    Have had various UE creatinine tests, in 2013: serum sodium was 138 (135-145) I had been taking desmopressin for 6 years at that point.

  • Sorry to hear this cc120.

    Yet another issue to deal wit.

    Flower007

  • Get labs done to check serum potassium, sodium, calcium. If you have fluid issues, you need a diagnosis, a real diagnosis. You need to know why your adrenal glands don't work well. They are controlled by the Pituitary. Low Thyroid causes fluid issues as does Hyper. I don't think it is all so simple.

  • Hi faith63, they did test these for me, and they were OK. I believe my adrenal problems arose from chronic stress and poor nutrition.

  • Ray Peat wrote:

    “Thyroid is needed for the adrenals to function well, and adequate cholesterol, as raw material. It’s popular to talk about ‘weak adrenals,’ but the adrenal cortex regenerates very well. Animal experimenters can make animals that lack the adrenal medulla by scooping out everything inside the adrenal capsule, and the remaining cells quickly regenerate the steroid producing tissues, the cortex. So I think the ‘low adrenal’ people are simply low thyroid, or deficient in cholesterol or nutrients.”

    — Raymond Peat, PhD

    raypeatforum.com/forum/view...

    I believe this to be true. I have been on all forms of steroids for my low cortisol and i felt no improvement, actually gained weight and bp and glucose got very high.

  • Hi faith63, thank you. My cortisol is high during the evening night, and low during the day. I believe I've had adrenal fatigue for at least 10 years. TSH 8 for 9 years, started to self medicate with NDT from end of last year. More energy but not as much improvement as I hoped. Cholestrol is a bit high. Have taken supplements for low iron, ferritin, b12, folate, vit d3, calcium. But iron went down, but ferritin 100 over range. Seeing endo August 2nd who hopefully will be more helpful/investigative than last endo.

  • I hope you have better luck than i . Endo's have been the most useless for me, out of all doctors i have see. They do not believe what we have read online.

  • I know faith63 :-), fingers crossed.

  • Elevated cholesterol can be caused by thyroid issues.

    Elevated ferritin can be caused by inflammation or infection which will decrease with the cause.

    If elevated ferritin recordings are continuous and progressive, it could be down to iron overload Hemochromotosis.

    Flower007

  • I believe I may have an inflammation or infection but my ESR reading, last year was 32 (1-20) so GP/endo didn't think it worth investigation further.

    I don't think I have a genetic problem like Hemochromotosis as the elevated ferritin was brought on by supplementation?

  • Thank you so much for posting this cc120. It is just what I am looking into at the present time and covers some of my sons problems as well.

  • You're welcome j_bee, my GP, after years of my complaining I couldn't get any quality sleep as always needing a pee in the night, even when I peed after 2 hours of sleep, I would require another pee after a further 2 hours, etc.

  • Again thank you cc120 for posting very interesting article on the complexities of fluid balance and Adrenal fatigue issues.

  • You're welcome mariolin, yes the article does help to highlight and clarify these specific issues.

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