Adrenal fatigue occurs when the adrenal glands become unable to meet the stress demands on the body. Stressors occur in many forms, and most often adrenal fatigue is caused by ongoing stress in a person’s life. However, a particularly intense stressful event can also trigger it.

What is adrenal fatigue? First let’s start with what adrenal fatigue isn’t. Adrenal fatigue isn’t the classic medical diagnosis of Addison’s disease, which is complete failure of the adrenal glands which necessitates life long hormone replacement.

Rather, adrenal fatigue is an under-functioning of the adrenal glands - they no longer perform as expected. This manifests in a number of ways, most commonly as overwhelming fatigue, non-restorative sleep, exercise intolerance, weight gain and other symptoms.

Adrenal Function

The adrenal glands are located on top of the kidneys. Directly wired to the nervous system, the adrenals respond instantaneously to any form of stress.

They release several different types of hormones - some that regulate electrolytes, some that regulate the fight or flight response, and some that regulate inflammation and blood sugar. 

The adrenal hormones that we’re most concerned with in adrenal fatigue are cortisol and DHEA, or dehydroepiandrosterone. Cortisol is our body’s natural anti-inflammatory, and DHEA is a precursor to estrogen and testosterone.

A normal healthy stress response leads to elevated levels of cortisol and DHEA. This is the body’s way of adapting to stress.  However, after months or even years of intense stress, eventually the adrenals cannot meet the demands that stress places on the nervous system and body overall.

Adrenal Fatigue

Eventually, cortisol and DHEA levels begin to fall. However, symptoms of adrenal fatigue can show up before this occurs.

When a person has adrenal fatigue, they may be fatigued to the point that a good night’s sleep won’t restore their energy. They may be dependent on sugar and caffeine for energy to get through the day.

Adrenal fatigue occurs along a spectrum - it’s not an on/off condition.  This is partially why a person can go months and even years feeling “off” but then suddenly cannot perform at all.

Causes

Unresolved stress can be to blame for adrenal fatigue.  Most typically this occurs from mental emotional stress.  School, work, relationships, you name it - if stress isn’t handled properly this puts a tremendous burden on the adrenals to manufacture stress hormones.

Physical stress is another major cause for adrenal burnout. Athletes are of course very prone to adrenal fatigue. In fact, adrenal fatigue is the underlying factor behind overtraining syndrome.

Signs of this include lethargy, elevated resting heart rate, poor endurance, inability to recover, disrupted sleep, abdominal weight gain and many other symptoms.

Conditions that contribute to adrenal burnout include:

• High sugar diets
• Chronic gut infections
• Chronic injuries
• Pain
• Mental-emotional stress

When the body isn’t given adequate opportunity for recovery - when mental stress is relentless, when no days are taken off from training, when diets are high in sugar, when gut infections go untreated, or when chronic injuries cause ongoing pain, the adrenal glands eventually cannot produce enough cortisol and DHEA to help the body tolerate these stressors.

Symptoms

• Exercise intolerance
• Abdominal weight gain
• Overwhelming fatigue
• Unrestorative sleep
• Caffeine and sugar dependence
• Stress intolerance, inability to handle stress
• High salt craving
• Alert late at night - “tired but wired” feeling
• Weak immune system
• Aches and pains

Diagnosis

There’s a right way and a wrong way to figure out if you have adrenal fatigue. I have many patients come into the clinic who’ve gone to their primary medical doctor, wondering if they have adrenal fatigue and asking to be tested.

Most conventional doctors aren’t trained in this area - so they’ll order a blood cortisol test (which is always normal in adrenal fatigue) and tell the patient there’s nothing wrong with them.

Blood tests aren’t accurate enough to detect adrenal fatigue with enough specificity. The proper way to diagnose it is by using a saliva hormone test. We use a test that has the patient collect saliva at certain times throughout the day, so that we can see the pattern of cortisol release.

Saliva tests are much more accurate at pinpointing disturbances in cortisol levels; they also can be used to measure other important adrenal hormones like DHEAS.  Together with the patients symptoms, the degree of adrenal fatigue can be established and treatment can be delivered.

Treatment

Treating adrenal fatigue is complex. A person needs to undergo several lifestyle changes to allow the adrenals to get some rest so they can recover.

These include fixing sleep issues, dealing with mental emotional stress, fixing the diet to remove sugar, and perhaps the most difficult for athletes is taking a break from intense training. All of these changes decrease the ongoing stress that the adrenal glands have to deal with on an ongoing basis.

Restoring normal adrenal function takes time.  In most cases, at least six months of focused treatment is necessary. Treating adrenal fatigue isn’t like treating a problem with conventional medicine - you can’t take a few pills and suddenly your symptoms are gone. It takes some focused treatment and time allow the body’s normal adrenal hormone rhythms to be restored.

Our next blog will cover more of the specifics of treating adrenal fatigue - which natural medicines are used, how to use them and how to track your progress.