Adrenal Fatigue
The Adrenal Glands
The Medula and Cortex
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.
I have experience constant trauma from 6 auto accidents in a 10 year period, constant pain from spinal injury from the accident, and a failing marriage. I have experienced constant fatigue that I fight by getting up and move regardless of how I feel, I have a heart rate that will all of the sudden out of the blue shoot up to about 180 then slowly go back to normal (it happens only a few times a year but scares me), I have periods of being so cold to the bone, that I cannot get warm, recently I began to become sensitive to the sun and high heat that makes me feel sick and faint.
What can I do to keep myself healthier. I do the exercise, eat well, no sugar or caffeine, and use prayer for meditation. No doctors can help me because they say I am healthy but I want these symptoms to stop. There has to be something else I can do while I am in trama to help my adrenals. Any suggestions?
That is a lot of accidents! My first thought about your pain and racing heartbeat is to consider spinal injuries & inflammation causing an autonomic dysfunction. Your brain tells your heart to slow down or speed up through the “sympathetic chain” of nerve ganglion that run down along the spine. If you have medical benefits, I suggest finding a good physical medicine and rehabilitation (PM&R/Physiatrist) M.D. who will check out your heart and spine and then probably refer you to a physical therapist.
Chiropractic might be very helpful too, but you need to be very careful about who you see — some use unproven energy medicine techniques that may be too subtle and others may want to over-treat you to make more money. Chiropractors that do not teach you exercises and stretches and just want you to lie on the table and receive passive care are also bad news.
If you have run out of medical benefits for the accidents, I suggest finding a warm (NOT hot/Bikram) yoga class. Ice your back in the traditionally sore places for 20 minutes afterwords every time to reduce inflammation! Gentle warm yoga is probably a good idea even if you do have medical benefits left.
For your adrenals, I recommend good quality SLEEP: 7.5-9 hours per night. Get up before 9AM every day. Be in bed by midnight (10-11PM is better). Avoid stimulation for 1-2 hours before bed. Reading or soft music is OK, but nothing electronic (TV/Internet/games). Make sure your room is very dark and quiet (use earplugs if there is noise). Avoid all stimulants like coffee/tea/colas after noon.
Also you can try a good herbal adrenal support supplement. Something with some or all of the following: Ashwaganda, Holy Basil, Rhodiola, & Shisandra. Vitamin C and pantothenic acid (B5) are also good adrenal nutrients. Find a good supplement store near you and talk to an experienced staff person. Keep your supplements simple though! Just like passive care (massage or chiropractic adjustments), alone, they will not make you better. You can try them for 2-3 months and then reevaluate.
THIS IS KEY: Also develop awareness about your “identification” with the health issues. If you are repeating to yourself and others things like: “I am a sick person” or “I am an injured person” or “this is terrible” or “I am a victim of these multiple accidents”, it can make it MUCH harder to find and stay on a recovery path. Remind yourself MANY times a day that you are more than your medical condition, and firmly place your mental focus on positive events and steps toward recovery–and step away from the victim path.
Hi my name is Alexandra and I am beyond desperate for some advise, recently I have had two urine 24 hr tests and they showed my cortisol level at 23 thousand which I was told was extremely high, but that’s it, no information no follow up nothing, I live with constant pain in my joints and muscles like I have been bashed , I am constantly so very tierd and sleepy and no rest is enough, I am moody, angry and sad all in one and generally not coping with life , and I have six children who are running things more or less and I think this is sooo wrong please I beg you what is wrong with me where do I go I now there is something wrong but no answers.
Alex
It sounds like you bought a lab test without a doctor being involved. I generally don’t recommend this, because many patients will end up worried over abnormal results and don’t know what to do. This is why it’s best to order testing from a doctor that is familiar with the test and who will guide you to effective treatments. So my advice to you is to take these and all your other lab test results to a licensed doctor in your area and get some professional advice.
The normal values for urinary cortisol are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what’s normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.
Cortisol level in a 24-hour urine sample Adult
Normal: Less than 100 micrograms (mcg) or less than 276 nanomoles (nmol)
High values
* One cause of Cushing’s syndrome is Cushing’s disease, a condition caused by a noncancerous tumor of the pituitary gland (adenoma).
An adenoma causes the pituitary gland to make too much of the hormone adrenocorticotropic hormone (ACTH), which in turn causes the adrenal glands to make too much cortisol.
* ACTH can be made by other conditions, such as cancer of the lung. This high ACTH level causes the adrenal glands to make more cortisol.
* The adrenal gland can develop tumors (benign or cancerous) that make cortisol and cause Cushing’s syndrome.
* A high blood cortisol level can be caused by severe liver or kidney disease, depression, hyperthyroidism, or obesity.
* Conditions such as recent surgery, illness, injury, or whole body infection (sepsis) can cause high cortisol levels.
Reasons you may not be able to have the test or why the results may not be helpful
* Having physical or emotional stress.
* Being pregnant. This can cause urine cortisol levels to be high.
* Having low blood sugar (hypoglycemia).
* Eating, drinking, or exercising before the test.
* Taking medicines, such as estrogen, amphetamines, or corticosteroids.
* Not collecting exactly 24 hours of urine.
I took neurotransmitter test about a month ago and it showed my cortisol to be high throughout the day my morning was 16 the other two readings were 12 & 8 my before bed was 8 which is very high. Also my dhea was 973 the range was 70-573 . My norepinephrine was elevated also. I have been dizzy for a yr with anxiety, loss of concentration, brain fog , no longer motivated, but my sex drive has gone up. Also I cant fall asleep and the sleep I get is not refreshing with migraines.All doctors wants to do is put me on ssri. Do i have adrenal fatigue? Im going crazy
Sounds interesting and atypical Jason. An SSRI is not going to fix the problem. I need to “see” the complete lab results and have you fill out detailed paperwork before I can formulate and opinion and a plan for you. And since it sounds like you are looking for my naturopathic health advice… If you become a patient of mine, then you get good advice and I get compensated for helping you. Everyone’s happy.
Hi my name is Sarah and I am 19 years old, and my symptoms sound something along the lines of stage 2 and 3 already! I am in college so I am definitely very stressed out but then I started taking adderall about 2 months ago because I was recently diagnosed with ADHD. I think it was after I started taking the adderall that I started going from stage 2 to 3… Up until about a week ago (when I was still in school, I am on winter break now) I started to develop migraines, hypoglycemic symptoms (flushing of the face and feeling dizzy) right after I ate a big meal or late at night, I’d be sooo irritably tired but never able to sleep and even if I did sleep it was never satisfying as I’d still be tired or have interrupted sleeping patterns and etc, in addition.. my menstrual cycle has been completely out of wack (10-20 days late at a time when I used to be quite regular), and just today I started noticing some abnormal facial hair growth! Oh and in addition to that, I was having severe body aches and tightness… and now the sides of my mouth are cracking really bad (what I have read to probably linked to low vitamin d, which I read might be because of low estrogen levels that I cant absorb vitamin d?)… anyways.. is it possible that I’ve already exhausted my adrenal glands?? For the past couple months I knew something was wrong with me because I felt so tired, irritated, and just… miserable! But I just kind of shrugged it off as side-effects of the adderall and just the overall stress of school, finals, and what not.. but I but the things you have mentioned above sounds VERY relevant to me.. but i just cant believe that this could happen to me when I am only 19.. I know that stimulant medication cant be good for this… but what should I do to cope with my ADHD symptoms?.. Oh and also.. I have always had a weak immune system ever since I was born.. could that be linked with any of this at all? Please help!! Thank you in advance!!!
Oh and just to the symptoms ive recently began to have.. I would be FREEEZING when everyone else would be fine =/ so i definitely started to have a lower body temp and resistance to cold and etc.. and constipation.. unless I took the adderall which would cause me to kind of have the runs.. i guess the lesser of two evils?
I would get tested. The symptoms above described my addisons perfectly. I’m 22. My doctor thinks the ADHD meds I am on kept me going.
My name is Rebecca I am a34 year old female. When I was 16 I was diagnosed with Epstein Bar Virus. I had one of the worst cases my dr ever saw. It lasted almost 9months and I missed almost my entire junior year of high school. I mention this because I haven’t felt normal since before this time in my life.
After having my second child in 2000 I began to feel worse. Every dr I had would always start a physical exam and say oh my what a thyroid and run the typical tests only to get normal range results. There was only one dr in 2004 that said I don’t care what the blood test say and sent me for further testing with a endocrinologist. The endo dr started with a 24 hour urine test and a blood test. She said that my blood was normal but my urine showed evidence of HASIMOTOS. She also did a fine needle biopsy she told me it yielded no healthy cells. She started me on levothyroxine and followed up with blood work. I felt 100x worse on this medication and she said your blood work is normal and I shouldn’t mess with my medication. I constantly asked how do you know my results are better my blood work has always been normal. When I couldn’t get the answers I felt were appropriate I quit seeing the endo dr and stopped all my meds. In 2009 my primary dr started me on thyroid armour this actually made me feel better but in 2011 my symptoms came back 10 fold, I then went to a sleep dr who started to diagnose me with non rem narcolepsy. But before he labeled me he sent me to a sleep physiologist who told me my “flight or fight” was broken. He started me on some breathing exercises and this never made me feel better. I am at my wit’s end on what to do next.
My symptoms are:
Fatigue, I can sleep for days and feel like I never slept. chronic diarrhea, i dont eat because it all runs right through as if not even digested. high bad cholesterol, low good cholesterol,
Any suggestions would be greatly appreciated!
Thank
Rebecca
Some of my other symptoms are: cold hands and feet, I feel chilled when I shouldn’t be, loss of hair, my eye lashes and eye brows even shed, I don’t have much hair on my body either, being of a Italian heritage I should be hairy like the rest of my family but I am not.
Right now my dr has taken me off my thyroid meds for a few weeks so I can get a thyroid uptake scan done. I have not been off my meds since I started them in 2009. She put me on adderall to help with my fatigue about a week before I stopped the thyroid meds. It seams to help but now I’m very constipated and I actually have a appetite this is very odd to me. I used to never eat because i never felt hungry now I feel as if I don’t eat I will get sick. I wouldn’t say I over eat or anything but instead of no breakfast I now eat a banana or a cup of cereal, and for lunch a half of sandwich instead of no lunch, I still don’t eat all my dinner but at least I am eating. I did have to up my dosage of adderall this week I’m on my second week of no thyroid meds and feeling very tired and worn out again. Some days I feel so tired that it makes me feel sick. I ache all over, feel nauseous, get really mean and snippy, and I feel like cannot go on one more minute unless I lay down. I absolutely hate this feeling even though this is not new or due to the change in meds I am most defiantly not willing to just deal with it. It is the main cause for me to be searching medical advice and solutions. I trully am at my witty end!
Your doctor using ADHD meds to treat you fatigue is a very questionable decision–especially in a confirmed thyroid patient. I think you need more advanced thyroid blood tests (eg: FT4, FT3, TSH, and especially RT3). I use the RT3 test to diagnose patients who are converting the T4 to abnormal RT3 instead of the normal T3–which is very common in adrenal fatigue. Since that you are off your meds, now is the perfect time to run these blood tests. If your doctor wont do it, find someone who will. I practice in Washington State and can prescribe tests here. If you live in another state, get them done and I can help you interpret them through remote appointments. Be well!
Hi Rebecca. I’m sorry you have not gotten the help you needed. Sounds like you’ve gotten quite the run around. Advanced thyroid testing and salivary Cortisol/DHEA-S testing is indicated in your case. You can send me a direct email (DoctorT@trmorrisnd.com) if you’d like to make an appointment in Seattle (or remotely via Skype/Phone/email). Check out my services page first so you know my rates. Be well!
Thank you very much for your response. I will see my dr this morning and ask her to run the tests you suggested. I should be getting my thyroid uptake scan results also during this appointment. Hopefully something will be found.
Very interested in adrenal fatigue r/t long term
Adderall use. Would like a private consultation.
Thank you.
You can send me a direct email (DoctorT@trmorrisnd.com) if you’d like to make an appointment in person (or remotely via Skype/Phone/email). Check out my services page for my rates.
What if you can’t find a doctor who is willing to do any testing beyond a single resting cortisol and ACTH test? I had these tests done 2 weeks ago and they were normal. However, I have all of the symptoms of stage 3 adrenal fatigue. Not to mention being hypothyroid since 1974. I am doing a saliva cortisol/DHEA-S test this weekend on my own. I am also desperate to be heard and finally find relief from these horrendous symptoms. I have to admit…at Christmas my friend, who is a veterinarian, gave me some prednisolone and I took about 7 mg in the morning and 3mg in the afternoon for 2 days and those were the best 2 days in my life in around 30 years! Please…any help or advice is greatly appreciated. Thank you!!
I’m glad you are running the saliva Cortisol/DHEA-S tests. I suggest you get some professional help to interpret the test results. If they look normal, we should think about some more advanced thyroid tests–that conventional endocrinologists have been painfully slow to adopt. If you are in the Seattle area, we can make an appointment. If not, you can email a PDF or fax them to me, and then we can do a Skype/phone or email appointment. My contact information and services are found on my website. Be well!
Thank you for your reply. I do have an Rx for the following tests which I have to take to a local lab for a blood draw: Free T4, Free T3, TSH, Reverse T3 (serum), Thyroid Antithyroglobulin antibody, TPO antibodies and serum ferritin. I also ordered these test online on my own. I would be happy to contact you after they are done and FAX you the results. Thank you again in advance!