Adrenal Fatigue – Fact or Fiction?
Are you sick and tired of being sick and tired? Been diagnosed with fibromyalgia or chronic fatigue? Have brain fog? Had a large amount of stress in your life or an illness/injury and never really felt the same since? Crave carbohydrates or salt and get low blood sugar feelings at times? Find yourself waking up at 2-3 am wide awake for an hour?
These are all signs of a mystery epidemic called adrenal fatigue. When I talk to my fellow internal medicine MD’s they all think I am talking about Addison’s disease, the complete autoimmune induced failure of the adrenals. Yet this is more of a dysregulation or imbalance than a true failure though it can progress from adrenal fatigue to adrenal failure.
The adrenals are walnut-sized glands that sit on each kidney and have two layers. Originally they were called suprarenal glands because of their location. The inner layer, the medulla, secretes epinephrine and norepinephrine and is an extension of the sympathetic nervous system that controls your fight or flight response. The larger outer portion, called the cortex, secretes mainly cortisol and DHEA though it also secretes chemicals to regulate sodium, potassium and water balance. The adrenals follow a circadian pattern for cortisol regulation and too little or too much can both have dire consequences and lead to diseases such as Cushing’s syndrome. However, the system can become dysregulated and the normal pattern gets ‘confused’ and the feedback mechanisms can become overridden then fail to respond appropriately. Cortisol peaks in the am to get you out of bed then falls during the day towards sleep to assist in restorative sleep. The adrenal pattern can have either an altered circadian pattern or overall below functioning-both lead to misery.
DHEA is the most abundant hormone in the body and may correlate with the aging process and low levels are found in most illnesses. DHEA has been used to try to measure biological aging rather than chronological age yet this is not always the case. As with everything in the body, nothing can be viewed in a vacuum and it is the balance of the symphony that is the key, not just a single value in isolation. The way to think about the adrenals and the analogy I teach to my clients is that the adrenals act like Jackson Lake or any reservoir with a dam. If the water is flowing too much out of the dam (high cortisol), then eventually the water behind the dam (DHEA) will run low enough that the water will not come out anymore. And this feels like fatigue and depression.
One of the most important roles of your adrenal is to communicate and support the thyroid response. Cortisol helps to convert inactive T4 thyroid hormone to the active T3 thyroid hormone- see last column in TVN for complete thyroid overview. The thyroid and adrenal are the keys to balance and vitality, particularly for women. And if you have very little cortisol/DHEA or too much cortisol that magic equation of thermodynamics-calories in equal calories out- will never balance! And guess what-you feel tired yet wired at times, can’t lose weight, have poor sleep and feel inflamed. One client had all of these and I asked her what she thought was wrong. “I guess I am just getting old” was her response-she was 39!
Adrenal fatigue can have 3 stages-stage 1 is a relative overactivation of the adrenals and happens during or immediately after stress- either physical or mental. Cortisol is typically elevated during this time with DHEA normal. Stage 2 is highlighted by what looks like normal circadian cortisol patterns yet overall level low and the DHEA is now depleted. The fatigue starts in, joint pain can be present, menstrual cycles become irregular, the ‘cortisol roll’ around your belly starts, your mood drops, and sleep becomes less restorative. If you make it to stage 3 then you are in real trouble. The reservoir is dry and no water comes out of the dam-sick and tired of being sick and tired.
The bad news is that adrenal fatigue is everywhere and affects all of us at one time or another. We are usually able to bounce back out of the hole yet some never recover. If you lose your job, get divorced, lose a family member (this includes your pet) or have a prolonged illness-worse is caregiver stress where you remain hyper vigilant every moment-then your cortisol flows too fast for the dam to fill back up and you end up in stage 3. And remember, this is not something you can ‘exercise your way out off’. Too much physical stress/exercise further depletes you and I tell my clients to ‘put some back in your stress savings account.’ When you feel a little better, do 90% instead of your usual 120% of workouts to build back up your reserve.
The good news is that there is a model to assess what stage you are in and how to get you back to your desired state of full energy, optimal body weight, restful sleep and overall balance. The process is not expensive and doesn’t involve medication-or 30 vitamins. However, there are many scams out there on the Internet like with everything health wise so use care in your choices. Do your homework (some doctors don’t like you to go to the internet and learn things-I love it) then discuss with your healthcare practitioner if there is an approach that is acceptable to both of you. Treating adrenal fatigue and helping people recover their lives is very easy and satisfying. So I would say adrenal fatigue is fact-not fiction. Remember, it is the symphony of health you are trying to balance to achieve optimal vitality-balance the thyroid, adrenal, hormones being supported by a healthy gut.
Mark Menolascino MD, MS, ABIHM, ABAARM, IFMCP