The body has a marvelous system for dealing with acute stress, allowing us to meet challenges and perform at a high level both physically and mentally. But, chronic stress, day in and day out without respite, leads to burnout and numerous health problems, especially fatigue. Learning how to recognize and deal with chronic stress or adrenal fatigue is one of most important keys to great health.
The adrenal glands are located on top of the kidneys and when stressed they pump out the “fight-or-flight” hormones. If we had to march for days without food and water, it is the adrenal gland that would keep us going. Normally it comes into play during a time of stress, such as a mentally challenging time where we need extreme attention, in a fight, during infection or surgery, with sleep deprivation, or similar situations that stress our body.
The response to chronic stress – first defined by Hans Selye as occurring in three stages as alarm, resistance and finally exhaustion – typically results in abnormal adrenal performance and adrenal fatigue, as well as abnormal cognitive, metabolic, energy, endurance, immune and glycemic function.
“Adrenal fatigue” refers primarily to depletion of cortisol, which is an adrenal steroid hormone that helps raise blood sugar, regulate the immune system, control inflammation, affect the tone of the heart and blood vessels, and stimulate the brain. Cortisol is a diurnal (daytime) hormone, meaning it has wide swings in the levels from day to night. It normally peaks within 30-60 minutes after awakening in the morning, and then drops to a lower level throughout the day.
People with low cortisol often complain of fatigue. They frequently have a really hard time getting going in the morning and feel tired even though they slept plenty of hours. They might be overwhelmed by everyday chores and even enjoyable activities feel like a burden. Sometimes depression and low sex drive are symptoms of adrenal fatigue. Inability to handle stress is a common feature. They sometimes are prone to low blood sugar, getting weak, shaky, sweaty and light-headed if they go without eating for long. Or they might be prone to light-headed spells reflecting low blood pressure. Some are prone to frequent infections or prolonged time to recovery.
We often see patients complaining of daytime fatigue combined with insomnia. We call this “wired but tired”. These patients usually have low cortisol in the day with a spike toward evening – which is the reverse of the normal pattern. In many of these cases the nocturnal (night) hormone melatonin is also reversed, being low during the middle of the night when it is supposed to be at its peak.
Testing for Adrenal Fatigue
To evaluate adrenal output I recommend a salivary cortisol test in which the patient simply collects saliva at different times during the day, first at 30 minutes after awakening to catch the days peak level, then 12, 4 and 8 pm. In this manner we can see what the cortisol level is doing throughout the day and it is convenient for patients.
Adrenal fatigue is a controversial area in medicine. Not all physicians will recognize the diagnosis and the standard tests for cortisol might miss adrenal fatigue. Since cortisol normally varies so much through the day it is important to check the level at different times. We sometimes do serum testing or 24 hour urine collection to test for cortisol.
Treatment of Adrenal Fatigue
Treating adrenal fatigue involves lifestyle modifications that include improving diet, exercise, and stress management. Intensive exercise requires a lot of cortisol so often I have to “pull in the reigns” on my aggressive athletes until they recover. We usually suggest acupuncture and relaxing activities such as meditation, yoga or Tai chi that nourish the adrenal gland. I recommend all my patients undergoing treatment read “Adrenal Fatigue” by Dr James Wilson. It is well written and covers the topic thoroughly, especially the lifestyle issues.
The supplements used for adrenal fatigue are designed to support, fortify and restore adrenal function, and fall into 3 basic categories:
- Vitamins specific to enhance adrenal function and energy production – the IV vitamin infusion called Myers cocktail is particularly helpful
- Herbal extracts with adaptogenic properties designed to support healthy, balanced adrenal gland function
- Glandular extracts which are taken from adrenal gland tissue with the actual hormones taken out, providing the nucleic acids, proteins and building blocks for cortisol production
In severe cases we prescribe cortisol hormone in physiologic doses. In time the cortisol can usually be weaned off of as the adrenal gland recovers. Sometimes patients need cortisol forever, as the adrenal gland is not capable of recovery.
Treating adrenal fatigue is fairly straightforward, but perhaps the most difficult aspect is figuring out the underlying cause and correcting that, so that the adrenal is allowed to heal. For example, underlying infection, inflammation, toxins, etc can all produce a strain on the adrenal gland. It’s important to consider this when healing from adrenal fatigue.
In recent years we have come to appreciate that adrenal fatigue should often be more accurately described as adrenal dysfunction and the causative reason stems from impaired signals from the limbic system, which is the primitive part of the brain that controls the automatic stress response and signals the adrenal gland. After a traumatic stress the limbic system may get stuck in a “trauma loop” continuing to inappropriately send alarm signals to the adrenal gland. To learn more about this I recommend the book “Wired for Healing” and the associated Dynamic Neural Retraining System, the book “The Body Keeps Score”, and also a type of neurofeedback called Neuroptimization.
If you suffer from chronic fatigue, take heart, for there is hope. Adrenal fatigue is only one of many common reasons to feel so tired and a thorough functional medicine evaluation will usually lead to a solution.
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 245-6911 for an appointment or more information.