Bulletin #96

Hypoglycemia Association, Inc.
Box 165
Ashton, MD 20861-0165
(Founded in 1967)

Our bulletin is not meant to be medical advice. It is written by lay people, dedicated to helping those with hypoglycemia. All cases are individual. If you need medical advice, see your physician.

Adrenal Dysfunction

When John W. Tintera, M.D. was in medical school about 50 years ago, the students were cautioned not to marry while in school and further, not to select a spouse with allergies. Tintera did both, and the result was a doctor's discovery of adrenal dysfunction (hypoadrenocorticism), a stress condition.

He consequently learned that his wife had allergies, that she tended to abort, and that the calves used to chase her on the farm. This last, while amusing, was a valuable clue to one of her problems - loss of salt. They were then living in St. Louis where the summers can be very hot and humid and, during a particularly uncomfortable spell, Mrs. Tintera fainted. From his knowledge of physiology, Dr. Tintera knew to give her salt water to drink, after which she recovered and was even better than before the incident.

Dr. Tintera knew that among the chief functions of the adrenal cortex were the regulation of the mineral metabolism (sodium, potassium, chloride), the regulation of water balance, and the regulation of organic metabolism (utilization and distribution of carbohydrates, protein, and fat)and control of tissue reactions (such as hypersensitivity, allergic states, and collagen diseases) and the production of the sex hormones. He concluded that what his wife had was adrenal cortical incompetence. Because of this Dr. Tintera decided that his specialty would be in the field of endocrinology. (Of interest, after treatment, Mrs. Tintera eventually had several successful pregnancies.)

In his medical practice he had a special interest in treating the alcoholic patient. He found he could keep severely distressed alcoholics quiet with adrenal cortical extract (A.C.E.) injections. He tried A.C.E. on other patients with signs of adrenal insufficiency, and they began reporting many long standing symptoms with had either disappeared or were much alleviated. The chief complaints of these patients were often similar to those found in persons who are hypoglycemic. These chief complaints listed in order of prominence were:

1. Inability to concentrate
2. Excessive fatigue
3. Nervousness & irritability
4. Mental depression
5. Apprehensions
6. Excessive weakness
7. Lightheadedness
8. Faintness and fainting
9. Insomnia

He had to conclude that hypoadrenocortics do have hypoglycemia (or disturbed carbohydrate metabolism) although not necessarily the other way around.

Also reported were improvements in: arthritis, pain in shoulders and back muscles, allergies, premenstrual problems, headache, migraine, ringing of the ears, tension, depression, suicidal thoughts, nervousness, apprehensions, noticeable heart action, gastrointestinal problems, heat exhaustion, and inability in handling stress.

The typical glucose tolerance curve was the low flat curve which indicates hypoadrenocorticism, hypoglycemia, some form of allergy, gouty or rheumatoid arthritis, or schizophrenia. The following will suggest clues for self identification.

Skin thin and dry or scaly, pigmentation of temples, red palms or fingertips, cold clammy palms, exaggerated reflexes, angular appearance, long arms and legs. The span is greater than the height.

Inflammation of lymph glands of the neck (swelling, pain, or tenderness)

Blood pressure usually low (postural hypotension) on standing (105/60) and then elevated to (120 or 130/70 or 80) on reclining. This change from low to higher when lying down may be the reason why many patients find it difficult to fall asleep. It is conducive to falling asleep to lie in a semireclining position for 15 or 20 minutes. Another way to describe postural hypotension is that there may be a sudden drop in blood pressure to below normal upon suddenly arising from bed, or from standing still, causing temporary darkening of vision, dizziness, faintness, or fainting.

Thin-muscle type (this is called asthenic habitus). The typical person is also tall. A short person may have what we call "signs of tallness" - a moderately long neck, in index finger longer than the 4th, a 2nd toe longer than the big toe.

Sparse hair on body, but usually a bull head of fine and abundant hair. The typical persons are blond and blue eyed, or red headed. A tall, thin blonde with skin allergies can be diagnosed immediately.

Crowded lower teeth - with a high palatal arch (roof of moth)

Pain and tenderness over adrenal area when pressure is applied (called Positive Rogoff's sign).

Scanty perspiration (except under arms or hands and feet). This person may be a "salt loser" (the tendency is to lose salt and to retain potassium). The pattern of urination will be either very frequent in small amounts, or infrequent in large amounts. This person usually does not do well in the heat or in the summer, particularly in conditions of high temperature plus high humidity, plus low barometric pressure. At such times he gets puffy ankles or fingers. For the person with depleted adrenals sunbathing on the beach can have devastating results. The urine and perspiration of the salt loser is saltier than normal and there is consequently a greater salt concentration on the skin. Animals are attracted to this. The salt loser is attempting to function on low salt and does not understand why he feels faint, or is suddenly unable to function in the heat, or he feels his mind id cloudy and his energy gone. He may become very weak, tired, and depressed. Salt is needed for heart action, to make hydrochloric acid in the stomach and for the fluid around the cells. This extra-cellular fluid affects the proper function of muscles and cells. The nerve cells of the brain, and consequently all of our emotions, are affected by the salt levels. Adding salt to the food my be all that is needed for some patients. Others may need to also add salt to the drinking water.

Tintera wrote that salt is a diuretic (!) and that hypoadrenocortics retained fluid because the body is trying to hold in the salt. When enough salt is consumed the body will take what it needs and will excrete the rest. On sufficient salt ankle edema will usually disappear in three days. If it does not disappear in five to six days, potassium may also be needed. Vitamin B6 is also helpful for edema. Even other types of conditions, like kidney disease, need "some" salt and should have a moderate amount. It can be a serious mistake for an individual to avoid salt for no apparent reason. For any loss of body fluids - excessive perspiration or urination, vomiting or diarrhea - the lost salt must be replaced.

" To find the amount of salt needed, one gradually increases the salt intake until he finds the amount he feels best on - usually 2 to 10 grams or roughly 1/2 teaspoonful to 1 tablespoonful. After determining the amount, one can try to cut back and see if that is just as effective. Knowledgeable physicians now report that there should be no salt restrictions during pregnancy and also no diuretics used. If there is edema in pregnancy, extra salt brings about diuresis. The addition of a small amount of allowable juice provides glucose which aids in the absorption of salt. Some individuals may also need potassium. The use of salt does not cause hypertension, as is frequently claimed. (Ref: Richard H. Ahrens, PhD U.S. Dept of Agriculture, Dr. Ahrens is also Associate Professor of Nutrition, Univ. of Md. College Park, Md) A research physiologist wrote that sugar (but not salt) is one causative factor in hypertension.

Nutrition oriented advisors may suggest using a small amount of sea salt, but in the larger amounts that hypoadrenocortics need, too many trace minerals may be taken in. The name trace minerals means one should have only a trace of them. The main minerals, calcium, magnesium, sodium, potassium, iron, iodine, and zinc are needed in larger amounts. Diamond Crystal Kosher salt is plain sodium chloride without additives. When dissolved in water, it results in a clear solution indicating no additives. Salt, like other minerals, is essential to life and the person with undiagnosed adrenal dysfunction (who is therefore a salt loser) on a salt restricted diet may be slowly deteriorating as the result. In Addison's Disease, where there is a complete nonfunction (atrophy) of the adrenal cortex, the patient could suffer prostration, or die from excess perspiration or a diet high in potassium or low in sodium. Hypoadrenocortics, with incompetent adrenals, cannot take the well-meaning advice to "get your salt from celery and okra". There appears to be no natural food which contains more salt than potassium and therefor salt must be added to the diet. The hypoadrenocortic has what we describe as a "touch of Addison's Disease". This unfortunately is a condition not generally recognized.

The adrenals have a close connection with the sex glands. They produce about 25% of the female sex hormone in women and 65% of the male hormone in the man. The inability of the adrenals to produce the additional sex hormones may result in the flat chested "twiggy" female or the sparse- chest-haired male. In patients in their thirties or older there may also be an absence of hair on the lower two-thirds of the legs, which is not a result of wearing off by the trousers as is supposed.

There can be a great variation possible among the large numbers of adrenal steroids, causing a person's individual physical characteristics to vary widely from the typical. These variations may bring on precocious sexual development in boys and girls. They also cause changes in adults in psychological makeup and direction of sexual desire, or can actually produce feminism in men and masculinity in women.

It is safe to assume that any sick person has a liver problem. Hypoglycemic are said to have a liver involvement, and hypoadrenocorticism rarely exists without involvement of other glands and organs. The liver must detoxify each and every substance in the body before it is used by the body. This means not only medicines and drugs, but foods and our own body secretions. Depending on the degree of liver incompetence, it may or may not show up on laboratory tests. In addition, patients may eventually learn that they have malabsorption from the intestinal tract.

A discussion on stress should include recognition of Dr. Hans Selye. His classic work on stress, ("The Stress of Life, Hans Selye, M.D., McGraw- Hill Book Co., N.Y.) and his many other publications report "that our various internal organs, especially the endocrine glands and the nervous system, help to adjust us to the constant changes which occur in and around us." He calls this adjustment the General Adaptation Syndrome. He gradually concluded that the adrenals were the body's prime reactors to stress. He stated, "They are the only organs that do not shrink under stress; they thrive and enlarge. If you remove them, and subject an animal to stress it can't live. But if you remove them, and then inject extract of cattle adrenals (cortex), stress resistance will vary in direct proportion to the amount of the injection, and even be put back to normal." Likewise a person's stress resistance will vary with the competence of his adrenals, but continually stressing the adrenals finally depletes them.

For non-medical helps, it is absolutely necessary to remove the dietary stress, sugars, starches, caffeine, alcohol, drugs, and as much nicotine as possible. One must use ascorbic acid (Vit. C), salt, and fat - both saturated and unsaturated. Avoiding animal fats, as seems to be the popular thing to do, is avoiding the kind of fat that adrenal hormones and estrogen and androgen are made from. Outer stresses must be avoided or reduced - those including excessive heat, cold, overwork, lack of sleep, arguments, diseases, and the like. One should exercise, involving the adrenal area. Oxygen is necessary for the utilization of glucose by the body, and proper breathing must be practiced. Rest period and relaxation must be observed and also no later than 11 p.m. bedtime. Vitamins and especially ascorbic acid will help. The adrenals contain more Vitamin C (and cholesterol) than any tissue in the body. With all these helps, the hypoadrenaocortic can finally have a happy and useful life.