Reduced energy, impaired thinking, libido, hypoglycaemia, poor sleeping patterns and difficulty in losing weight all stand out as common problems in adrenal fatigue. On a basic level, this condition (sometimes called adrenal insufficiency) comes as a results of the adrenal glands failing to meet the demands placed upon them and occurs following a period of excessive stress. The above symptoms are typical of those suffering and, whilst there are no formal figures, I estimate that adrenal fatigue affects 1 in 10 of my clients to varying degrees. So why haven’t you heard of it?
More than seven decades after Hans Selye first began to identify an autonomous reaction of the adrenal glands to external stressors, these crucial organs are still largely ignored by the medical/pharmaceutical industry. Unlike thyroid conditions, which are treatable with various combinations of the many patented T3 and T4 synthetics, there have been no equivalent drugs that can restore adrenal function to its natural level. Put simply, there is no profit available for any pharmaceutical companies. What’s more, as the pharma giants are massive contributors to the costs of educating new doctors, adrenal fatigue remains destined to remain omitted from the agenda for the foreseeable future.
The function of the adrenal glands is a complicated science. There are a number of important substances secreted by these pyramid-shaped glands which include aldosterone from the adrenal cortex (which affects body hydration), adrenaline from the adrenal medulla (responsible for energy and alertness). However, most diagnosis of adrenal fatigue centres around the more measurable steroid hormones cortisol and DHEA, produced in the adrenal cortex. In healthy individuals, these hormones rise in the morning to wake a person and then progressively fall from mid-afternoon to allow unwinding and sleep. They work together to balance your decision-making, your energy levels, your blood sugar, your immune system function, your sex hormones and almost every system you care to mention. Because cortisol has major effects on the immune system and blood sugar levels, and because DHEA is the base substance from which your body makes oestrogen and testosterone, the effects of adrenal imbalance can be difficult to pin down and categorize.
It is the medical view that adrenal function comes in just three flavours; normal, Cushing’s Disease (extreme excess of both cortisol and DHEA) and Addison’s Disease (extreme, potentially-fatal deficiency of both cortisol and DHEA). The reality is that adrenal dysfunction does not respect the textbooks that try to compartmentalise it. Cortisol and DHEA sometimes do excessively rise and fall together, but this is rarely the case; different tissues within the adrenal glands can fail at different rates, thus there is no reliable path to recognise. This is why the adrenal medulla (responsible for the release of adrenaline) is almost always over-active, compensating for an underactivity in the adrenal cortex (responsible for the release of cortisol and DHEA).
So how does this occur? Firstly, adrenal fatigue is a consequence of the external environment and one’s response to it. This especially refers to the stress response. When we detect a stressful situation (in previous times, this meant catching a glance of a lurking predator, nowadays results from being being cut up by a careless SUV driver or receiving a harsh email from a work colleague), the central nervous system activates, stimulating the instant secretion of adrenaline from the adrenal medulla, while the brain sends a hormone called ACTH to the adrenal cortex. This hormonal stimuli causes the release of cortisol and DHEA. In the first instance, this system increases alertness, increases the heart rate and generally prepares the body for action. It is the ‘fight or flight’ reaction. As adrenaline dissipates, the classic stress of compensation phase kicks in; it is at this point that cortisol dominates.
This reaction works fine unless it is activated too regularly. If this is the case, the reaction becomes over-exaggerated. The adrenal glands over-release adrenaline, and then cortisol, whenever they receive a signal from the brain. In the classic categorization of adrenal fatigue, this situation corresponds to Stage One Adrenal Fatigue, and almost all of us enter this at various points during periods of stress, such as a week of prolonged and consecutive stressors. This would typically result in increased tiredness at the end of each day, becoming flustered quickly, and being shaken easily by loud noises. Affected individuals remain thoroughly functional and, provided the stressors are removed, adrenal function reliably returns to normal.
However, if it is not, an individual will enter Stage Two. This is characterised by a constant over-secretion of stress hormones, especially cortisol – the stress switch is permanently flicked to the ‘on’ position. Whilst still able to function in the working world, individuals in this state will often find they are tense, forgetful, unmotivated, constantly suffering with colds, have wounds/ulcers that heal slowly, may struggle to digest food and will notice an increase in blood pressure and in bodyfat (especially around the abdomen). The higher stress hormones will keep the body alert later into the evening, and typically these individuals will take considerably longer to fall asleep, despite how tired they feel. To overcome this now-ingrained response at the adrenal glands, a total removal of stressors and increased nourishment for the adrenal glands must be maintained to allow hormonal secretions to slowly return to ideal levels.
If the stressors are not removed, then the individual will inevitably move into Stage Three Adrenal Fatigue. This could take weeks, months or even years, but this is defined by a sharp fall in the secretion of adrenal hormones The tissues that are responsible for their manufacture ‘burn out’ from sustained overuse. Whilst it is almost always cortisol production that is affected, DHEA levels can also collapse in this way (confusingly enough, the symptoms in these situations often mimic a crash in cortisol). An excess of stress hormones will seriously drain the resources of any individual yet, because they are essential for energy production, a deficiency leaves a person even more tired. ‘Death warmed up’ is often a phrased used by clients in this state. Blood pressure will also be lowered in most cases, allergic reactions may occur with more frequency, and salt cravings are likely.
The overworked tissues responsible for the production of stress hormones cannot keep pace with the requirement, which sees cortisol (or DHEA) levels remain deleteriously low all day. Often, these overworked tissues will compensate for under-performing by continuing to release stress hormones well into the night. This creates a paradox whereby an individual cannot summon enough energy to function properly during the day, yet cannot sleep at night. Rather than having assumed an unhealthy response, the tissues are now unable to perform their role; this is naturally a more serious condition.
In practice, the labelling of the various stages of adrenal fatigue are mere umbrella terms. Although often used by practitioners familiar with the condition, I do not tend to use them in my clinic. With the almost unlimited array of variations in cortisol/DHEA/aldosterone/sympathetic nervous activity, each individual’s experience of adrenal fatigue is always likely to differ from their neighbour’s. It should also be pointed out that, while the majority of adrenal fatigue cases can be traced through the various stages of sustained stress, the cause is sometimes an infection. Adrenal function is often temporarily suppressed during the early stages of infection (this occurs through cytokine signalling at the hypothalamus, and promotes both resting and a boost in immune response) and there are occasions when hormonal output from the adrenals does not resume it’s normal pattern. Immune system support and/or addressing hypothalamic function is implicated here.
In any case, the good news is that it is possible to fully restore functional and healthy adrenal function. In theory, it is a simple case of resting the damaged tissues to allow them to heal – this means reducing the load placed on them (reducing stressors, and increasing rest and time for sleep) and, normally, assisting them meet the load (supplementing with vitamin C, pantothenic acid, adrenal extracts, licorice root, hydro-cortisone or DHEA). If you are going to take supplements that effect adrenal hormones, this should only be done following suitable testing and under the supervision of someone familiar with adrenal function.
Cortisol can be fortified by licorice root, as it extends the half-life of the hormone and boosts its potency. I have got good results using licorice root extract (standardised to 20% glycerrhizinic acid) at various dosages. Cortisol can also be fortified through hormone replacement (using bio-identical hydrocortisone), with different doses required for different situations; although 10-20mg is often most appropriate from my experience, there can be serious ramifications when hydro-cortisone is mis-used and should be reserved for cases only when required. Many individuals respond very well to adrenal extracts, although some do not.
When DHEA supplementation is indicated, 10-40mg is often all that is needed to restore a client to top form. Used correctly, hormones can be an effective way of helping the adrenal glands; used for too long or in too high a dose, they can suppress the hypothalamic-pituitary-adrenal axis. After a period of time, normally 6-8 weeks, the supplements can be decreased in small intervals and, providing there is no return of malady, discontinued altogether. This normally occurs over several months. Supporting adrenal function with Vitamin C, Vitamin B5 and licorice root can be extremely important, as is the removal of psychological stressors. Caffeine, alcohol, tobacco and sugar should all be removed.
In practice, this process is often bereft with problems. The affect this has on blood sugar levels, mental response, sex hormones and all the other bodily systems means that intervention can have multiple interactions. Disturbances in stress levels over any period of time will reliably effect many different areas of metabolism, especially digestion. Digestion is intrinsically linked to the function of the liver, and the function of the digestive tract and the liver play a role in the load that the adrenals experience. There is also a significant two-way interaction between the immune system and the adrenal glands. The affect that cortisol:DHEA ratio has on estrogen and testosterone levels should also not be overlooked, especially in females (whose hormonal interaction is more complicated).
With a firm understanding of both adrenal function and the interactions in an around the human body, it is possible to navigate an efficient route back to optimum health. There are a number of difficulties I regularly face in restoring the adrenal function in various individuals, primarily bio-chemical individuality and that of obtaining the co-operation of mainstream doctors (who are typically very cagey when in unfamiliar territory). Thorough assessments (blood/saliva/etc) throughout the course of treatment is a wise move.
Naturally, prevention is better than any cure, and the increasing incidence of adrenal fatigue only serve to show how important it is for any individual to prioritise the reduction of stress in their daily lives.