What is Adrenal Fatigue?

Are you constantly tired but can't explain why? Do you feel overwhelmed by stressful situations and find yourself lacking in the strength and vitality that you used to enjoy? Do you struggle to get out of bed in the mornings even after a long sleep? If so, there is a good chance that you are suffering from a condition named Adrenal Fatigue.

Adrenal Fatigue is a stress-related condition that occurs when your adrenal glands, hypothalamus and pituitary gland (together – the HPA axis) are functioning below their optimal level. Although you might not have heard of the adrenals, they perform several vital roles in maintaining your health. Most importantly, they control your body's response to stress by releasing hormones like cortisol, DHEA and epinephrine, which are used to regulate your heart rate, immune system, energy storage and more.

When the adrenal glands are overstimulated for a long period of time, they begin to weaken. Typical causes of Adrenal Fatigue include long term stress from jobs, relationship problems or evenchronic disease. Eventually, the adrenals weaken so much that they are unable to respond adequately when we need them. At this point, many Adrenal Fatigue sufferers report symptoms like a feeling of constant tiredness, lack of enthusiasm and mild depression. Sleeping long hours does not help – they wake up just as tired as when they went to bed. And they often resort to large caffeinated drinks, sugary sodas or other stimulants to get through the day.

Adrenal dysfunction is not recognized by modern medicine until it becomes life-threatening, when the adrenal glands virtually cease to function in an autoimmune condition named Addison's disease. But what many doctors (at least the unenlightened ones) fail to realize is that millions of us suffer from sub-optimal adrenal performance. Simply put, the adrenals and several other internal organs are still doing their job, but just not as well as they should. This might not qualify us for a trip to the ER, but it is certainly a major issue for those of us who suffer from it.

So how can we treat adrenal fatigue? It's not as simple as popping a pill, but it is certainly possible. By making some simple changes to your lifestyle and giving your adrenal glands the time they need to recover, you can get your energy levels back to the right level. But first, let's take a quick look at what Adrenal Fatigue is and how we can recognize it.

What is Adrenal Fatigue? (Dr. James Wilson)
Adrenal Exhaustion (Dr. Christiane Northrup)

WHAT DOES ADRENAL FATIGUE LOOK LIKE?

Adrenal Fatigue results in a wide range of symptoms, which is why it is often called a syndrome. However, in simple terms Adrenal Fatigue can be defined as:

A group of symptoms that occurs when the adrenal glands and HPA axis function below the optimal level

Each of these symptoms can be connected to a deficiency in one or more of the hormones produced by the adrenal glands. There is some debate over whether 'adrenal fatigue' is the most appropriate term for this condition. Some health professionals refer to it as adrenal stress or HPA axis dysfunction. Whichever term you see, rest assured that we are speaking about the same thing. The term adrenal fatigue is the one most commonly used.

The most common symptom of Adrenal Fatigue is fatigue, but this is quite different from the regular fatigue that you might be used to. Adrenal Fatigue sufferers experience difficulty getting out of bed each morning, even after a long sleep. There is one exception though – many Adrenal Fatigue sufferers get a boost in their energy levels late in the evening, a phenomenon which is related to their disrupted cortisol cycle.

They also report a general lack of enthusiasm, difficulty 'lifting' themselves for important occasions, and an inability to cope with stressful situations. When the adrenals become fatigued, they lose their ability to produce stress hormones – the ones that we use for our 'fight-or-flight' response. That means that many Adrenal Fatigue sufferers report feeling strangely 'flat' when they should be excited. They also struggle to maintain the acute focus and high energy levels that stressful situations often require.

Other symptoms of Adrenal Fatigue include a craving for salty foods, low blood sugar, respiratory complaints, allergies, low sex drive and weight gain. All can be traced back to a sub-optimal level in one of the hormones produced by the adrenal glands. You can read more about the symptoms of Adrenal Fatigue here.

WHAT HAPPENS WHEN OUR ADRENALS ARE FATIGUED?

You might be able to recognize the symptoms of Adrenal Fatigue, but what is actually happening to our bodies when we experience it? Historically, Adrenal Fatigue (or hypoadrenia) was recognized and defined by its symptoms. These days, thanks to modern lab testsand a better understanding of human anatomy, we can pinpoint exactly what happens when a patient is suffering from adrenal insufficiency. This helps health care professionals to diagnose and treat Adrenal Fatigue much more effectively.

Understanding the HPA axis is crucial to understanding Adrenal Fatigue. The adrenals exist as part of a network of three organs, collectively known as the HPA axis, that dictate the levels of hormones in our bodies. These organs are the hypothalamus, the pituitary gland and the adrenal glands.

In a stressful situation, the hypothalamus sends a message to the pituitary gland, which in turn sends a message to the adrenal glands. This prompts the adrenals to release stress hormones like cortisol and epinephrine, which act to increase our blood sugar, raise our heart rate and increase our blood pressure. Within seconds, our body is ready and prepared for whatever is causing us stress. This is known as our 'fight-or-flight' response.

This stress response evolved to protect us from predators and other immediate threats. However it is not designed to react to the constant low-level pressures of modern life, which cause a much longer-term increase in the level of stress hormones.

The adrenal glands can recover quickly from a short burst of stress hormone production. But if the stress continues for a long period of time, they quickly become depleted of the base materials (cholesterol, pregnenolone) that they need. There are coping mechanisms that allow them to manage for a while (e.g. the 'pregnenelone steal', where production of sex hormones is reduced to allow more stress hormone production), but eventually your levels of adrenaline and cortisol have to drop.

You can see how Adrenal Fatigue is a multi-stage process. First we see a rise in our stress hormones to unsustainable levels. After some time, our body reacts by reducing the levels of our sex hormones it produces in order to keep our stress hormones elevated. And then, eventually, even the stress hormones start to fall as our adrenal glands become unable to cope with the burden that we have given them.

The lower levels of cortisol and adrenaline, combined with the disruption in the daily cortisol cycle, are what cause many of the symptoms of Adrenal Fatigue. The tiredness, inability to focus, disrupted sleep cycles and more can all be traced back to our levels of these stress hormones. Other symptoms like low sex drive are related to the disruptions in our hormone cascade that result from HPA axis dysfunction. And seemingly unrelated symptoms like frequent urination or cravings for salty foods can be linked to lower levels of aldosterone, another adrenal gland hormone.

Taking these disparate symptoms and piecing them together requires experience and knowledge of the way our endrocrine system works. Fortunately, modern lab testing (particularly the cortisol saliva test) offers us a very useful diagnostic tool. However, correctly interpreting the test results is important as the lab reference ranges tend to be extremely wide. Your healthcare professional should be experienced in recognizing and diagnosing cases of Adrenal Fatigue.