Adrenal fatigue
Adrenal fatigue — the effects of stress and high cortisol levels
by Marcy Holmes, Women’s Health NP, Certified Menopause Clinician
Here are the topics covered in this article:
Our patients’ most common symptoms are fatigue, insomnia, weight gain, and depression. Does that sound like you? If so, your underlying problem may 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 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.
The good news is that adrenal fatigue can almost always be relieved. Let’s look at the relationships between stress, high cortisol levels and adrenal fatigue, and then we’ll look at how you can give your adrenals more support.
The original, life-saving role of the adrenal glands
To understand how adrenal fatigue develops, it is important to understand the original, evolutionary function of the adrenal glands. The adrenals are walnut-sized glands located on top of each kidney, and are important control centers for many of the body’s hormones. The outer layer of the gland, called the adrenal cortex, produces hormones including cortisol, DHEA, estrogen and testosterone. The centers of the glands produce adrenaline, the hormone named after them.
The basic task of your adrenal glands is to rush all your body’s resources into "fight or flight" mode by increasing production of adrenaline and other hormones. When healthy, your adrenals can instantly increase your heart rate and blood pressure, release your energy stores for immediate use, slow your 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 constant stress. Instead of occasional, acute demands followed by rest, we’re constantly over-worked, under-nourished, exposed to environmental toxins, worrying about others — with no let-up.
Every challenge to the mind and body creates a demand on the adrenal glands. And the list of challenges is endless: lack of sleep, 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, unresolved emotional issues from our past or present and more. The result is adrenal glands that are constantly 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 proteins into energy, releasing glycogen and counteracting inflammation. For a short time, that’s okay. But at sustained high levels, cortisol gradually tears your body down.
Sustained high cortisol levels destroy healthy muscle and bone, slow down healing and normal cell regeneration, co-opt biochemicals needed to make other vital hormones, impair digestion, metabolism and mental function, interfere with healthy endocrine function; and weaken your immune system.
Adrenal fatigue may be a factor in many related conditions, including fibromyalgia, hypothyroidism, chronic fatigue syndrome, arthritis, premature menopause and others. It may also produce a host of other unpleasant symptoms, from acne to hair loss. (Please click here to see a 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 (the full name is dehydroepiandrosterone) is a precursor hormone to estrogen, progesterone, and testosterone, and is necessary to moderate the balance of hormones in your body. Insufficient DHEA contributes to fatigue, bone loss, loss of muscle mass, depression, aching joints, decreased sex drive, and impaired immune function. (For more information, read our article on DHEA.)
Testing for adrenal fatigue
Conventional medicine is truly wonderful at treating disease-state conditions. Unfortunately its focus on drugs also tends to suppress early-stage symptoms rather than treat their underlying causes. This can have the effect of delaying treatment until a disease state has developed. This is true in the case of adrenal fatigue cortisol testing. In the conventional standard of care, any cortisol level within a very broad range is considered normal, and anything outside that range indicates disease.
In our practice, we measure cortisol levels at several points in the day to track the adrenals’ day–night pattern (called the “diurnal rhythm”) using a panel of simple saliva tests. We hope to see cortisol elevated in the morning to help you get going, lower but steady throughout the day to sustain energy, then fall in the evening to support restful sleep.
In the early stages of adrenal dysfunction, cortisol levels are too high during the day and continue rising in the evening. This is called “hyperadrenia.” In the middle stages, cortisol may rise and fall unevenly as the body struggles to balance itself despite the disruptions of caffeine, carbs and other factors, but levels are not normal and are typically too high at night. In advanced stages, when the adrenals are exhausted from overwork, cortisol will never reach normal levels (“hypoadrenia”).
Conventional medicine will detect only the extremes of these conditions, when damage to the adrenals has already occurred (Cushing’s disease and Addison’s disease). Within those extremes, you can feel miserable and still be told your cortisol levels are normal. But by responding to early-stage symptoms of adrenal fatigue, we can reverse the developing dysfunction.
Should you get an adrenal test?
In general, if you feel happy and well, have steady energy and 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 well.
On the other hand, if your energy lags during the day, you feel emotionally unbalanced much of the time, you sleep poorly or less than seven hours a night, can’t lose excess weight even while dieting, use caffeine or carbohydrates as “pick-me-ups” — these are all red flags indicating adrenal insufficiency.
Natural adrenal support — how to restore healthy adrenal function
The first step is to have a full physical exam to rule out disease or other factors. In our experience, women with mild to moderate cases of adrenal fatigue can see significant improvement through these steps:
- Dietary changes to enrich your nutrition and reduce carbohydrates and stimulants. We also recommend the addition of high-quality nutritional supplements, including essential fatty acids from fish oil.
- Stress reduction, including moderate exercise and taking more time for yourself. It’s helpful to make a list of your stressors, especially those that are constant.
- Get more rest. Your body needs time to heal.
Women with more severe symptoms, or those who have reached complete adrenal exhaustion, usually need greater intervention. At our practice we use the steps outlined above with the added natural support of phosphorylated serines, low-dose compounded DHEA, ginseng, and deglycyrrhizinated licorice. We personalize the therapy to each woman’s symptoms and test results. (We urge you not to self-prescribe these substances, as they can have adverse health effects. Please click here to learn more about DHEA supplements.)
It’s important to emphasize the role of emotional factors. Guilt, pain from past hurts, self-destructive habits, unresolved relationship problems — your past and present emotional experience may serve as an ever-present stressor. Dealing with these problems directly is much more beneficial than trying to compensate for the stress they create, in the same way that "an ounce of prevention is worth a pound of cure."
In all but the most extreme cases, we expect to see dramatic improvement within about four months. For mild to moderate adrenal fatigue the turnaround can be much faster. Remember, you may feel too tired to make changes now, but by moving forward in stages, you’ll build the strength you need to stay with it. You will love how you feel when you do!
Our Personal Program is a great place to start
The Personal Program promotes natural adrenal balance with nutritional supplements,
our exclusive adrenal support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-808-0849. We're here to listen and help.
We’re always happy to welcome new patients to our medical clinic in Yarmouth,
Maine, for those who can make the trip. Click
here for information about making an appointment.
Original Publication Date: 02/12/2004
Last Modified: 08/17/2009
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician