Adrenal Fatigue

The adrenal glands each have two layers that secrete different sets of hormones. The inner layer (the adrenal medulla) secretes epinephrine (adrenalin) and norepinephrine. These two immediate “fight or flight” hormones are released in large amounts in response to sudden major stressors, low blood sugar and exercise. Together epinephrine and norepinephrine raise blood pressure, mobilize glycogen and fat stores to increase blood sugar, and dilate blood vessels in the large skeletal muscles to prepare them for major action.

The outer layer of the adrenal gland, (the adrenal cortex) secretes steroid hormones which are made from cholesterol. Cortisol is by far the major hormone product of the adrenal cortex. It is called a “glucocorticoid” because of it’s effects on raising blood sugar (glucose) in response to stress. Healthy cortisol levels have a natural diurnal cycle, with normal levels being highest around 7AM and lowest levels occurring around midnight. This morning cortisol high is intended to wake you up and prepare you for your day.

The adrenal cortex also secretes aldosterone (which helps raise blood pressure by preventing sodium loss in sweat and urine) and “androgen” hormones such as androstenedione and DHEA (dehydroepiandrosterone) which give adults the secondary sex characteristics of body hair, increased muscle mass, and increased sex drive. DHEA is also the primary building block for the major sex hormones: estrogen and progesterone in females; and testosterone and dihydroxytestosterone in males.

Cortisol: The Master Stress Hormone
Like epinephrine and norepineprine, cortisol is also released in response to stress. It gives the body an extra energy burst as well as making the body more tolerant to pain and inflammation—handy if the stress is likely to cause physical trauma as was so often the case before modern times. In moderation, cortisol bursts temporarily increase immune system function, help maintain higher blood pressure and regulate insulin levels. Unfortunately, this system was well designed for our hunter-gatherer ancestors for whom stress was probably rarer, realer and more short lived.

The body is not able to distinguish between real stress and the “modern emergencies” that include: constant noise, cell phone calls, dinging email and IM warnings, high-speed transportation, modern work, modern relationships, and the crush of people we experience every day in modern cities. When someone is under virtually constant stress, the adrenals do not get a chance to stop high cortisol production. Modern humans experience near-constant stress, and so high cortisol levels have become what we now mistakenly call “normal.” People with chronic pain also have especially high cortisol levels, because pain is a big stressor to the body. Frequent lack of adequate sleep also raises cortisol release, and excessive cortisol itself disrupts normal sleep patterns, creating a propensity toward staying up late and feeling very tired in the morning–no matter how much sleep was had. Because a tired person does not handle stress as well as a well-rested person, the cycle can easily snowball and get worse.

The adverse effects of chronically high cortisol levels lead down the road toward all of the modern health epidemics: diabetes, high blood pressure, heart disease, cancer and obesity. Chronically high cortisol levels also causes bone thinning (osteoporosis) and make muscles and connective tissue (tendons, ligaments, inter-vertebral discs) weak and fragile. High cortisol also slows cell regeneration and with it the body’s ability to heal and regenerate. Long term, high cortisol also depresses the immune system–which can make one more susceptible to colds, flus, other illness, cancer, and chronic infections like intestinal candida and Epstein-Bar virus. Chronically high stress and cortisol levels are also implicated in autoimmune disease and food allergies. Cortisol also hinders digestion by diverting blood flow away from the digestive tract and otherwise slowing the regeneration of stomach and intestinal linings. Long-term high cortisol also decreases cellular insulin sensitivity which is why type II diabetes and “truncal obesity” (abdominal weight gain) are so predominant today—even in children.

Adrenal Fatigue
This sad and standard-issue modern life scenario of high cortisol levels assumes that the tiny adrenal glands can keep on producing cortisol endlessly. The problem is that they can’t, and the picture gets even worse when the adrenal glands begin to conk out: adrenal fatigue and failure.

Adrenal fatigue occurs when the adrenal glands are no longer able to adequately hormonally respond to stress. Cortisol, DHEA, and other hormones are produced in abnormal amounts (either high or low) and adrenal fatigue sufferers experience many of the problems that come with chronically high cortisone levels. Adrenal fatigue is usually caused by chronic stress, whether that stress is mental, emotional, physical, or environmental (e.g. infection, exposure to toxins, nutritional deficiency).

Adrenal fatigue can be described as occurring in four distinct stages: defined in terms of hormone output. Although poorly recognized by the allopathic medical system, adrenal fatigue can be easily measured with blood or saliva tests. Below are the four stages in detail:

Stage 1: Alarm Reaction
This is what we commonly call the “fight-or-flight” response and is a healthy reaction in which the body reacts aggressively to a stressor, or stressors, and mounts a strong anti-stress response to overcome them. The adrenal glands increase their output of stress-mediating hormones including cortisol and DHEA and at this stage the output is well within the gland’s normal capacity. At this stage no major symptoms are present after the immediate event and physiological dysfunction is undetectable.

Stage 2: Adrenal Fatigue
With chronic or severe stress, the capacity of the adrenal glands to cope is eventually exceeded and they begin to struggle to meet demands for cortisol and DHEA production. In stage 2, cortisol levels are constantly elevated but DHEA levels start to decline and this imbalance causes the symptoms that begin to emerge at this stage. The individual will still be able to carry out their normal routine but they likely to experience increasing levels of highs and lows, and have more fatigue at the end of the day requiring more rest and sleep to recover. Unfortunately, with higher cortisol levels sleep itself becomes less refreshing, so the person often wakes up tired–a key adrenal warning sign.

Most people in stage 2 also experience some degree of hypoglycemia following meals. Other symptoms that may also appear include: anxiety, irritability, and insomnia. Coffee and other stimulants begin to become very attractive to people in stage 2, and the majority of working adults in the modern world are probably in stage 2.

Stage 3: Adrenal Exhaustion
If the sources of stress are not reduced, adrenal function will decline further. At this stage, the adrenal glands are unable to keep up with the body’s constant demands for cortisol, and this too now begins to decline: both DHEA and cortisol may now be low on diagnostic tests. The decline in cortisol production is usually gradual, but steps must be taken to avoid progression to stage 4. At stage 3 the body slows down, or begins to shut down, many of its non-essential functions (e.g. sex drive and reproduction) with the main focus on the conversion of energy for survival. The patient will experience increasingly severe aches and pains, muscle weakness, easy infections easy & slow to heal injuries, loss of exercise tolerance, and more distinct brain fog, insomnia and depression. Toxins may also build up as the body’s detoxification processes slow. In the adrenal exhaustion stage people will almost certainly be struggling with daily living and may even be unable to take care of themselves. Most fibromyalgia and chronic fatigue patients have distinct adrenal exhaustion.

In the exhaustion stage, thyroid function and (T4-T3 conversion) may also start to decline and bring with it even more symptoms such as slowed metabolism, weight gain, lower body temperature, constipation, reduced resistance to cold, depression, and more irritability and brain fog. Adrenal exhaustion patients are almost invariably self-medicating with heavy caffeine use–which only steepens the downfall of the adrenal glands. Standard allopathic medical care for the complaints of those in adrenal exhaustion usually involves: prescription stimulants, anti-anxiety medications, sleep drugs and powerful antidepressants. Of course, it is easy to see that all these measures are merely masking symptoms, missing the cause, and ultimately only making matters worse.

Stage 4: Adrenal Failure
Eventually, the tiny adrenal glands can become exhausted and stop functioning. It usually takes many, many years and an extremely driven person to reach the ignominious failure stage. Almost all patients will seek medical help before adrenal failure becomes a serious possibility. At this stage, the patient’s condition is akin to adrenal insufficiency (Addison’s disease). In adrenal failure, hormone output is so low that there is a high risk that even essential metabolic processes cannot be maintained. Most people never get this far because advanced adrenal exhaustion will take someone out of the modern rat race before full-on failure can develop.

The recent advent of high-carb/low-nutrient food, highly stimulating prescription drugs (Prozac, Effexor, Adderall, etc.), anti-anxiety and sleep medications and supercharged caffeinated beverages combined with especially stressful lives have unfortunately made adrenal exhaustion and failure more accessible and more likely in everyone.

What You Can Do
If you feel that you are experiencing the symptoms of adrenal fatigue, consider getting your adrenal hormone levels tested. Where-ever you fall on the scale of adrenal fatigue, in today’s world it pays to take care of your adrenal glands with adequate sleep, relaxation, exercise and nutrition. In my experience, many people further along the adrenal fatigue spectrum would also benefit from prescription herbs and targeted, high-dose nutrients (“nutriceuticals”).

If you would like to get your adrenal hormone levels tested, or if you would just like advice on how to best support your adrenal glands, I am available for private consultations. I am also developing curriculum for a three-hour community class on adrenal support. Let me know if you’d like to be included on my mailing list for updates on class availability.

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