Adrenal fatigue

Adrenal fatigue — the effects of stress and high cortisol levels

by Marcy Holmes, Women’s Health NP, Certified Menopause Clinician & Marcelle Pick, OB/GYN NP

Here are the topics covered in this article:

• The role of healthy adrenal glands
• How chronic stress causes adrenal exhaustion
• The effects of adrenal fatigue — cortisol and DHEA
• Should you have your adrenals tested?
• Restoring adrenal health naturally

At Women to Women, our patients’ most common symptoms are fatigue, insomnia, weight gain, and depression. Does that sound like you? If so, your underlying problem could be adrenal fatigue.

Every woman who comes to our clinic with these symptoms gets an adrenal fatigue test, which consists of a series of tests of cortisol levels. And the results — in over thousands of cases — are remarkably consistent: only 10–15% have cortisol levels indicating healthy adrenal function, while 85–90% suffer impaired function, ranging from significant adrenal stress to complete adrenal exhaustion.

The effects of adrenal dysfunction can be profound: fatigue and weakness, suppression of the immune system, muscle and bone loss, moodiness or depression, hormonal imbalance, skin problems, autoimmune disorders, and dozens of other symptoms and health concerns.

The good news is that adrenal fatigue can almost always be relieved. Let’s look at the relationship between stress, high cortisol levels and adrenal fatigue, then consider how you can provide your adrenals with the kind of support they need to resolve unpleasant symptoms of adrenal imbalance.

The original, life-saving role of the adrenal glands

To understand how adrenal fatigue develops, it is helpful to understand the original, evolutionary function of the adrenal glands. The adrenals are walnut-sized glands located on top of each kidney, where they serve as important manufacturing centers for many of the body’s hormones. The innermost section of each gland produces adrenaline and noradrenaline, the hormones named after them. The layers outside the center, called the adrenal cortex, produce several other hormones, including cortisol, as well as DHEA, estrogen, progesterone, and testosterone.

Whenever you’re under “threat,” the fundamental task of your adrenal glands is to rally all your body’s resources into “fight or flight” mode by increasing production of adrenaline and cortisol. When they’re healthy, your adrenals can instantaneously increase your heart rate and blood pressure, release your energy stores for immediate use, shut down digestion and other secondary functions, and sharpen your senses.

Let’s emphasize two points about this healthy stress response. First, it takes priority over all other metabolic functions. Second, it wasn’t designed to last very long.

Stress and the adrenal glands

Unlike our ancestors, we live with ‘round-the-clock stimulation and stress. Instead of meeting occasional, acute demands followed by a period of rest, we’re constantly over-worked, under-nourished, over-stimulated, under-rested, exposed to environmental toxins, worrying about others — with no let-up.

It’s not just the dramatic life events that produce that familiar “stressed-out” feeling. Each and every challenge to the mind and body creates a demand on the adrenal glands. And the list of challenges is endless: lack of sleep, the commute to work, a demanding boss, the threat of losing your job, financial pressures, personality conflicts, yo-yo dieting, relationship turmoil, death or illness of a loved one, skipping meals, reliance on stimulants like caffeine and carbs, digestive problems, over-exercise, illness or infection or surgery, unresolved emotional issues from our past or present, and more! The result is adrenal glands persistently on “high-alert.”

The destructive effect of high cortisol levels

What is cortisol? In its normal function, cortisol helps us meet these challenges by converting fats and proteins into energy, keeping us alert, balancing electrolytes, calibrating heart beat and pressure, and counteracting inflammation. In the short run, that’s great — even protective and restorative. But paradoxically, sustained high levels of cortisol will gradually tear your body down.

Sustained high cortisol levels:

• destroy healthy muscle and bone
• slow down healing and normal cell regeneration
• co-opt parent molecules needed to make other vital hormones
• impair digestion, metabolism and mental function
• interfere with healthy endocrine function; and
• weaken your immune system.

The cumulative effects of such wear and tear can damage a woman’s body, mind, and spirit. Adrenal imbalance may be a factor in many conditions, osteoporosis including fibromyalgia, hypothyroidism, chronic fatigue syndrome, depression, arthritis, and more. It can also be associated with a host of unpleasant signs and symptoms, from acne to hair loss. (See our list of adrenal fatigue symptoms and related conditions.)

The loss of DHEA production

When the adrenals are chronically overworked and straining to maintain high cortisol levels, they lose the capacity to produce DHEA in sufficient amounts. DHEA (dehydroepiandrosterone) is an immediate precursor hormone to estrogen, progesterone, and testosterone. What that means is whenever DHEA is in short supply, women have a hard time balancing their sex hormones.

This happens because Mother Nature will always favor survival — our adrenals’ primary function — over reproduction — one of their secondary functions being production of sex hormones. And that’s why hormonal balance becomes increasingly problematic as stressed-out women approach midlife, when ovarian production of sex hormones declines naturally.

Over time, low DHEA leads to fatigue, bone loss, loss of muscle mass, depression, aching joints, decreased sex drive, and impaired immune function.

Testing for adrenal imbalance

Modern conventional medicine is truly wonderful at treating emergencies and disease-state conditions. Unfortunately, its emphasis on drug solutions tends to suppress or overlook early-stage symptoms, rather than treating their underlying causes. This can have the effect of delaying treatment until a disease state is fully developed. This is the case with conventional “spot” cortisol testing. In the conventional paradigm, a plasma cortisol level that falls anywhere within an extremely wide range is considered normal, and only those at the farthest extremes indicate full-blown disease.

To better understand what’s causing your symptoms of adrenal imbalance, we take more of a bird’s-eye view. At our practice we use a panel of simple saliva tests that measure cortisol output throughout the day, to track the adrenals’ 24-hour pattern, or diurnal rhythm. We hope to see cortisol at its peak in the morning to get you going, declining slowly and steadily throughout the day to sustain energy, then dropping off in the evening to allow you to drift off to sleep. This optimal pattern signifies healthy adrenal function.

In the early stages of adrenal dysfunction, the diurnal pattern is different. Cortisol levels are too high during the day and continue rising into the evening. This stage, sometimes called cortisol dominance, may last for years — even decades. In the middle stages, cortisol output may rise and fall unevenly throughout the day as the body struggles for balance against disruptions of caffeine, carbs, and stress, but levels are abnormal and typically much too high at night. In advanced stages the adrenals are exhausted from overwork, and cortisol never quite reach normal levels, a state sometimes referred to as adrenal insufficiency.

Here in the US, most conventional medical practitioners acknowledge only the extremes of these conditions, when damage to the adrenals has already taken place — Cushing’s syndrome and Addison’s disease). Within those wide extremes you can feel miserable, yet still be told your cortisol levels are “normal.” But by responding to early-stage signs and symptoms of adrenal imbalance, we can reverse the developing dysfunction and improve quality of life.

Should you get an adrenal test?

When a woman asks me about testing our usual response is, “If you feel happy and well, have steady energy and balanced emotions, sleep soundly seven to nine hours a night, wake up feeling rested, recover well from stress, and maintain a healthy weight without dieting, then your adrenals are probably doing just fine!”

If, on the other hand, your energy lags during the day, you feel emotionally off-kilter much of the time, sleep poorly or fewer than seven hours a night, can’t shed excess weight even while dieting, and routinely rely on caffeine or carbohydrates as “pick-me-ups” — these are all red flags indicating adrenal imbalance.

Natural adrenal support — how to restore healthy adrenal function

The first step is to have a full physical exam, to be certain there are no serious underlying medical issues causing your symptoms. In our experience, women with mild to moderate adrenal imbalance can gain significant improvement through these simple steps:

• Enrich your nutrition, reduce refined carbohydrates, and cut back on stimulants. For detailed advice and explanation, see our article on eating to support the adrenals.
• Consider nutritional supplements that support adrenal function. Start with a high-quality multivitamin–mineral complex rich in stress vitamins, minerals, and essential fatty acids. To learn how select herbs can improve adrenal resilience, see our article on phytotherapy for adrenal health.
• Reduce stress, exercise in moderation, and take more time for yourself. It’s helpful to make a list of your stressors, especially those that are ongoing or self-imposed.
• Get more rest. Your body needs time to heal!

Women with more entrenched symptoms, or those who have reached complete adrenal exhaustion, may need more intensive intervention. At our practice we use the steps outlined in our Personal Program for Adrenal Health, along with targeted support such as phosphatidyl serine, low-dose compounded DHEA, and deglycyrrhizinated licorice root. We listen carefully to our patients, and personalize therapy to correspond to each woman’s symptom profile and test results. (Please do not self-prescribe these substances, as they can have adverse interactions if used inappropriately.)

Finally, we can never underestimate the power of perceived stress. Guilt, pain from past hurts, self-destructive habits, unresolved relationship problems — your past and present emotional experience may be functioning as an ever-present stressor in your life. Dealing directly with these problems will be far more beneficial to your health than spending a lifetime compensating for the stress they create.

In all but the most extreme cases, we expect to see dramatic improvement in four to six months. With mild to moderate adrenal imbalance the turnaround can be faster. Remember, you may feel as though you’re just too tired to make changes now, but by moving forward in incremental stages, you will build the strength you need to stay with it. You will love how you feel when you do!

 

Original Publication Date: 02/12/2004
Last Modified: 08/23/2010
Principal Authors: Marcy Holmes, NP, Certified Menopause Clinician & Marcelle Pick, OB/GYN NP