Adrenal fatigue syndrome is the term used to describe a set of symptoms that are thought to be caused by adrenal gland dysfunction. Adrenal fatigue is distinct from adrenal diseases like Addison’s disease or adrenal insufficiency.
What are the adrenal glands?
The adrenal glands are 2 walnut-sized glands that sit on top of each kidney. The adrenal glands are small but mighty! There are 2 main sections of the adrenals, known as the cortex and the medulla. The adrenals secrete the following hormones:
- Aldosterone: Aldosterone plays an important role in electrolyte/mineral (i.e. sodium, potassium) balance and blood pressure regulation.
- Cortisol: This is one of the main hormones people think about in regards to adrenal fatigue. This is because our bodies secrete cortisol in response to stress – physical, mental, or emotional stressors can all trigger cortisol secretion. Cortisol helps us get out of dangerous situations – it increases mental clarity, raises blood pressure, and increases blood sugar – all of these things help us when we need to run away from a bear or escape a burning building. BUT, these benefits can become problems if this effect is long term. Cortisol also plays an important role in immune system modulation, inflammation, the sleep/wake cycle, and metabolism of fats, proteins, and carbohydrates.
- DHEA: Dehydroepiandrosterone (known as DHEA) is the most abundant hormone in the body. It helps the body to synthesize many important hormones like progesterone, estrogen, cortisol, and testosterone.
- Epinephrine and Norepinephrine: AKA adrenaline and noradrenaline, respectively. These well-known hormones are responsible for initiating our “fight, flight, or freeze” response. This is the part of our nervous system we utilize when we are in stressful or dangerous situations. Adrenaline and noradrenaline increase blood flow to the muscles (to help us run away), slow down our metabolism (so we can preserve calories for survival), and constrict our blood vessels (this gets more blood to our brains, so we don’t pass out while we are trying to run away!). Like cortisol, all of these benefits are great in the short term, but if we are under chronic stress they can turn into problems.
What are symptoms of adrenal fatigue?
Now that you understand what the adrenal glands are and the functions of the hormones they secrete, you may have some good insight in to what may happen when these glands are not functioning optimally. This article discusses the complicated interplay between the adrenal gland hormones and the rest of the body. In this day and age, high stress levels are the norm for most people.
We may not be running from bears or escaping burning buildings regularly, (let’s hope not!), but many of us are abnormally busy and regularly consumed by worry about things we often can’t fully control like traffic, our family’s safety/future, job security, income, global/political issues, etc. When our bodies are in this chronically stressed state, our adrenals go into overdrive and can ultimately “burn out.” We simply aren’t meant to be pumping out cortisol and adrenaline all day long.
The symptoms of adrenal fatigue are:
- Fatigue – despite having a good night’s rest
- Blood sugar fluctuations – low tolerance to starchy foods, energy crashing after eating, frequently feeling “hangry” (irritable hunger)
- Lowered immune resilience – may show up as frequent illnesses
- Mood swings, irritability, anxiety, depression
- Feeling “tired but wired”
- Dependence on stimulants/caffeine
- Cravings for salt and/or sugar
- Stress intolerance, easily overwhelmed
- Brain “fog” or poor memory
- Metabolic issues – weight gain (especially mid-section) or less frequently weight loss
- Low libido
- Exercise intolerance or exhaustion ~1 hour after exercise (aka post exertional malaise)
- Digestion issues, food intolerances, poor assimilation of nutrients (you eat great but don’t feel the benefits)
- Back pain and/or joint pain
Why hasn’t my doctor talked to me about adrenal fatigue?
Mainstream medical doctors don’t acknowledge adrenal fatigue as an official diagnosis. I believe there are a few reasons for this:
- Adrenal fatigue is a relatively new idea – Sometimes it takes many years for a new diagnosis to be acknowledged by the mainstream medical community. Dr. James Wilson coined the term in “adrenal fatigue” in 1998 – this is relatively recent in the medical world.
- There’s no standard lab test – Basic blood tests for adrenal hormones are great for diagnosing serious adrenal diseases, but not sensitive enough to detect the more subtle hormone changes seen in adrenal fatigue. Because adrenal health is hard to measure via conventional labs, it is hard to verify the presence of adrenal fatigue. We will discuss alternative lab methodologies below.
- There’s no standard conventional treatment – There is no prescription medication for adrenal fatigue.
- It’s complex – No two patients present the same way, making diagnostic criteria and a standard of care for treatment challenging to develop.
In mainstream medicine, the closest diagnosis to adrenal fatigue is Chronic Fatigue Syndrome (CFS) which has many of the same symptoms as adrenal fatigue. This article from American Family Physician describes CFS – you can see the similarities in symptoms. “Severe fatigue lasting longer than six months, as well as presence of at least four of the following physical symptoms”:
- post-exertional malaise (fatigue after exertion)
- unrefreshing sleep
- impaired memory or concentration
- muscle pain
- polyarthralgia (joint pain)
- sore throat
- tender lymph nodes
- new headaches
It is a clinical diagnosis that can be made only when other disease processes are excluded. The authors go on to say “The etiology of chronic fatigue syndrome is unclear, is likely complex, and may involve dysfunction of the immune or adrenal systems, an association with certain genetic markers, or a history of childhood trauma (aka chronic stress).”
Thankfully functional medical doctors and naturopathic doctors are familiar with adrenal fatigue and should be able to offer guidance on what to do if it looks like you may have symptoms of adrenal fatigue.
How can I know if I have adrenal fatigue?
Even if you check off many of the symptoms of adrenal fatigue, it’s a good idea to get evaluated by a trained medical professional before self-treating. There are some other serious illnesses that have similar symptoms to adrenal fatigue that should be ruled out.
Some examples are:
- sleep apnea
- sleep disturbances
- infectious diseases
- nutrient deficiencies
There are a variety of ways to evaluate for adrenal fatigue. Most holistic practitioners prefer to use what is known as an Adrenal Stress Index (ASI) plus a Cortisol Awakening Response (CAR). This is a saliva test that patients perform at home. It includes 5 cortisol samples to measure levels at 5 different times of the day – on waking, 30 minutes after waking, around noon, afternoon, and nighttime.
This test also usually measures DHEA levels and some practitioners will add on sex hormones if it makes sense for the individual patient. This is the most comprehensive way to test for adrenal fatigue. This meta-analysis reviewed the use of several types of tests used for measuring cortisol in chronic fatigue patients. The Adrenal Stress Index was not tested. The Cortisol Awakening Response increase (CAR) and the Diurnal Cortisol Slope (DCS) were the most relevant.
Like the Adrenal Stress Index, these tests measure multiple cortisol readings within the same day. Since cortisol levels change so frequently, multiple samples are thought to be more informative. Adrenal Stress Index Lab Result:
A naturopathic doctor or functional medical practitioner will work with you to rule out serious issues that may look like adrenal fatigue, do an assessment for adrenal fatigue (both through symptom discussion and lab evaluation) and help you come up with a plan of action.
I have adrenal fatigue – what now?
The course of action for adrenal fatigue will vary depending on the stage of adrenal fatigue. Most holistic practitioners break adrenal fatigue stages into 3 stages.
Stage 1: Stimulation – characteristic symptoms:
- Often feel wired or anxious
- Hard to sleep, mind races at night before falling asleep and hard to go back to sleep when you wake in the middle of the night
- Difficulty concentrating and focusing on 1 task
- Body is tense
- This phase is often during or shortly after a physically or emotionally stressful time
Stage 2: Depletion – characteristic symptoms:
- Mixed energy levels fluctuating between tired and wired – often tired in morning but can’t wind down at night, or have spurts of energy and productivity and then crash later morning and early afternoon
- Rely on sugar and caffeine to keep energy levels up
- May experience a “second wind” in the evenings/nighttime
Stage 3: Burnout
- Feel exhausted most of the time
- Sleep no longer refreshing, wake up tired and remain tired most of the day
- More systemic imbalances start to show up – PMS, infertility, digestive issues, muscle and joint issues, thyroid issues, immune issues
Thankfully, there are a variety of lifestyle changes, herbs, and supplements that can alleviate the symptoms of adrenal fatigue – no matter what stage you’re in.
What are some options for alleviating adrenal fatigue?
Adrenal fatigue didn’t happen overnight, so it’s important to know that recovering from adrenal fatigue is a process. There’s no one magic pill that will fix this complex syndrome.
Learning how to manage stress is really critical. We all have different coping skills and tools for dealing with the stressors that we face. This study tested the correlation between levels of post-exertional malaise (PEM), CAR test outcomes, and Perceived Stress Management Skills (PSMS). Preliminary results showed that greater PSMS were associated with lower levels of post-exertional malaise and improved CAR outcomes. That’s a lot of acronyms to say that this study proved that those who manage stress better have more energy and healthier cortisol levels!
So,the first step is to consider adding to your arsenal of stress management skills. Consider things like meditation, yoga, being in nature, biofeedback, exercise (mild to moderate intensity), breath work, making art, connecting with loved ones, acupuncture, talking with a therapist, etc.
Lastly, don’t disregard the importance of getting good quality sleep. Adrenal fatigue sufferers often need more sleep than other individuals (more like 9-10 hours/night). Here are a couple of things that could help with relaxation if you have a hard time handling stress:
A healthy diet is a critical part of recovering from adrenal fatigue. Nutrient-poor diets that are high in sweets, caffeine, and empty calorie foods (i.e. processed/packaged foods, fast foods) actually place additional stress on your already stressed body. This creates more of a burden for your adrenals.
Caffeine intake can become a vicious cycle for many tired adrenal fatigue sufferers. While caffeine can provide some quick energy, it unfortunately does so partly by causing an increase in cortisol, further depleting the adrenal glands. This animal study actually showed that intake of energy drinks is so harmful that it actually induces apoptosis (cell death) inside the adrenal glands – pretty scary!
Meanwhile, a poor diet deprives your adrenals of the nutrients they need to function properly. Good nutrition helps your adrenals become more tolerant to stressors. Nutrient-dense foods like vegetables, fruits, good quality whole grains and meats are going to be helpful in an adrenal healing diet.
Because metabolism and blood sugar balance is one of the roles of the adrenal hormones, most adrenal fatigue sufferers are more sensitive to sugar and high carbohydrate foods like pastas and processed grains (i.e. cookies, chips). Your diet should be higher in protein and lower in carbohydrates to help stabilize your blood sugar. Protein, fat, and fiber help to stabilize blood sugar. Keeping blood sugar from swinging high to low, like it may do after eating sweet or high carbohydrate foods, is one critical key to adrenal healing.
If you struggle to get enough high-nutrient foods into your diet, consider a high quality multi-vitamin to supplement your diet. I like this one: Pure Encapsulations O.N.E. Multi.
Also, this Phyto Greens powder is great if you struggle to get enough fruits and veggies every day.
If you struggle with getting enough protein, especially in the morning, this high quality protein shake is a good option to consider integrating into your routine.
As mentioned above, the cascade of hormones we produce when we’re stressed causes our bodies to use nutrients that we need to make hormones and neurotransmitters. B vitamins, vitamin C, and magnesium are at the top of the list. This review demonstrates the connection of magnesium to the endocrine system. The authors state that “all elements of the limbic–hypothalamus–pituitary–adreno cortical axis are sensitive to the action of magnesium.”
Adaptogenic herbs are herbs that are thought to help our bodies adapt to stress. Many people use these herbs to help with adrenal fatigue recovery. This awesome study looked in depth at 3 adaptogenic herbs – rhodiola, eleutherococcus, and schizandra – and came to a couple of conclusions that substantiate the use of these herbs for improving stress tolerance. They concluded that “adaptogens may be regarded as a novel pharmacological category of anti-fatigue drugs that:
- induce increased attention and endurance in situations of decreased performance caused by fatigue and/or sensation of weakness.
- reduce stress-induced impairments and disorders related to the function of stress (neuro-endocrine and immune) systems.”
Nervines are another category of herbs that can be used to work on the nervous system side of adrenal fatigue. These herbs are thought to help regulate the fight/flight/freeze response mentioned above.
The adrenal glands are intricately involved in the body’s hormonal and nervous systems. The adrenals produce 5+ important hormones and are our first responders in our stress response. With high levels of stress being so common in our culture, adrenal fatigue syndrome is a common ailment.
Adrenal fatigue develops after periods of intense and/or prolonged mental, emotional, or physical stress. Adrenal fatigue is not recognized by mainstream doctors but functional or naturopathic doctors can do specialty testing to evaluate for adrenal fatigue. If it looks like you may have adrenal fatigue, diet and lifestyle changes are important to help with adrenal recovery.
- Adrenal glands produce cortisol, DHEA, aldosterone, epinephrine, (aka adrenaline) and norepinephrine.
- Adrenal hormones impact the whole body – especially the sex hormones (like estrogen, and progesterone), the thyroid gland, the brain, the fat tissue, the metabolism, and blood sugar (glucose and insulin) regulation.
- The main symptom of adrenal fatigue is fatigue (go figure), but adrenal fatigue also commonly causes issues with: sleep, mood, metabolism, stress tolerance, sex hormones, and immunity.
- Some of the symptoms of adrenal fatigue can actually be from other, more serious illnesses. These must be ruled out before you pursue adrenal fatigue treatment.
- The best way to test for adrenal fatigue is an Adrenal Stress Index + Cortisol Awakening Response.
- There are 3 stages of adrenal fatigue: Stimulation, Depletion, and Burnout.
- Recovering from adrenal fatigue requires a holistic approach including: stress management, diet, exercise, and may be supported by herbal and nutrient support.
Adrenal Glands – NCBI book: https://www.ncbi.nlm.nih.gov/books/NBK26/
Adrenal Gland Diseases: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391614/
Chronic Fatigue Syndrome: https://www.aafp.org/afp/2012/1015/p741.html
Adaptogenic Herbs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991026/
Adrenal Testing – Meta-Analysis: https://www.ncbi.nlm.nih.gov/pubmed/23916911
Stress management skills reducing post-exertional malaise: https://www.ncbi.nlm.nih.gov/pubmed/25049069
Caffeine – negative effects: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262569/
Caffeine – negative effects – 2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2257922/