ADRENAL FATIGUE
(by Rick Fischer, C.H.H.C., h.T.M.A.P.)



Adrenal conditions are largely ignored in Western medicine, despite a tremendous number of health problems stemming from adrenal insufficiency / adrenal hypo-function and burnout. Stress is very often at the root of such disorders. This article looks at how the 3 stages of stress (developed by Nobel prize nominee Dr. Hans Selye, the "father of stress research" and who coined the term 'stress') lead to increasing stages of adrenal insufficiency / fatigue. Further we look at some of the most common health symptoms (physical and psychological) that can result during each stage. We'll also address here how one can have low cortisol and all the symptoms of adrenal fatigue yet actually still have adequate adrenal functioning. 

The adrenal glands consist of two parts, the medulla and the cortex. When a threat or stressor occurs, the medulla sets off the flight or fight response along with increasing the body's blood sugar, blood flow to muscles and the brain and lungs, increasing the rate of breathing, and pouring out adrenaline. The cortex produces cortisol (an anti-inflammatory hormone) and regulates immune, metabolic, and mineral balancing functions.

Stressors come in all shapes and sizes, and can include any of the following: direct physical threat, physical trauma, emotional trauma, toxic and heavy metal toxicity, lack of sleep, anxiety, poor diet (including over-consumption of sugars and refined carbs and/or deficiencies in Vitamins B and C), coffee, alcohol, infections and illness, prescriptions drugs, pregnancy, and excessive exercise.  It's important to note that, when it comes to emotional stressors, the body reacts the same whether the threat is real or just imagined. Worry about some future event that may never even happen, for example, can create stress and over-tax the adrenals.

Let's return for a moment to the work of Dr. Hans Selye, who's widely accepted model of General Adaptation Syndrome explains the 3 stages of stress - alarm, resistance, and exhaustion. These 3 stages further align with his work around maladaptive stress syndrome (MSS). Just as with stress, MSS has 3 stages as well - alarm, suppression, exhaustion - yet these stages deal specifically with adrenal function. Let's take a look at what happens in each of these stages. ​

The first stage of stress is the alarm stage. This is known as the fight or flight reaction, and a burst of adrenaline and cortisol is released. Strength and energy increases in order to deal with the event at hand. This corresponds with the first stage of MSS, known as MSS1. When the stress is dealt with quickly, the body is able to return to normal rather quickly in a healthy manner (usually within a few hours). With today's fast-paced hectic lifestyles, most people find themselves in a fairly constant MSS1 state.

If the stress is not properly dealt with however, then stress turns into the resistance stage. The unresolved stressor/threat keeps the body continually 'on-guard' in a state of emergency and eventually reduces the body's ability to effectively defend itself.  Adrenaline release subsides, but cortisol continues to be released in high amounts, along with neurotransmitters epinephrine and norepinephrine. When this ongoing defence attempt continues, disease sets in, and the sufferer becomes prone to symptoms such as fatigue, concentration lapses, and irritability. In terms of the adrenals, this is the suppression stage of MSS2. The adrenals are getting worn out and additional common symptoms include depression, anxiety, lack of appetite, and even possibly diabetes (due to insulin resistance).  Progesterone decreases, while androgen production increases, leading to an increase in estrogen and testosterone.

The third stage of stress is the exhaustion stage (corresponding with the exhaustion stage of MSS3). The body has run out of resources to maintain it's energy, and the body 'crashes'.  This is experienced as adrenal exhaustion or "adrenal burnout". Mentally, physically, and emotionally, the person has nothing left. Blood sugar levels decrease, cortisol production drops, stress tolerance drops, illness sets in, and the body collapses. The immune system is suppressed, feelings of depression increase (as serotonin activity has been compromised), and fatigue is apparent. Individuals at the burnout stage exhibit serotonin depletion (affecting reduced appetite, reduced sexual urges, poor sleep, and reduced memory) and/or dopamine (reward driven part of the brain) depletion.  Other common conditions that occur with MSS3 include chronic fatigue, fibromyalgia, atypical depression, apathy, hypoglycaemia, light-headedness, lack of focus, and irritability. The immune deficiency caused by severe stress (such as the death of a spouse) can result in cancer or other fatal diseases (underscoring the importance of recognizing the cause of one's stress and moving toward releasing it). At this stage, after adrenal exhaustion, the hippocampus part of the brain becomes very vulnerable, and both thinking and memory are likely to become impaired - further increasing anxiety and depression. It's common for individuals suffering from low adrenal function to withdraw from certain areas of life.  Another thing that occurs with many adrenal burnout patients is that prolactin levels drops, and with this drop are corresponding low serotonin and oxytocin levels. All these factors can really play havoc on close relationships as the patient begins functioning in a depressed state of apathy and dis-attachment.

According to the book 'The Everything Guide to Adrenal Fatigue' by Dr. Maggie Luther, the following are the common and true symptoms of adrenal gland dysfunction:

  • difficulty getting up in the morning
  • strong salt cravings or strong sugar cravings (usually one or the other, not both)
  • daytime fatigue that is not relieved by any amount of sleep
  • lowered or no libido
  • difficulty handling stress, decreased productivity
  • increased emotional symptoms including anxiety, irritability, depression
  • trouble recovering from illnesses, chronic infections
  • lightheadness when standing quickly, ongoing ringing in the ears
  • worsening of symptoms if meals are skipped
  • lack of focus, "brain fog", memory loss
  • exhaustion in the morning, crashes in the early afternoon, energy bursts after dinner at night


(Other common symptoms may include headache, nausea, vomiting, dehydration, confusion, frustration, insomnia, joint pain, weight loss (after burnout), and decreased appetite.)

 
What is interesting is how the above list resembles the symptoms of copper toxicity. Copper toxicity, while certainly not the only cause of adrenal burnout, is nonetheless a common contributor. Copper toxicity is a build up of high amounts of bio-unavailable copper in the body, a silent epidemic affecting millions and, most predominantly, women. Copper piping, birth control usage, vegetarian diets, and estrogen all contribute to rising levels of copper in the body. A high level of bio-unavailable copper is has an excito-toxicity effect on the mind which increases the stress on the body which then, over time, and directly affects (weakens) the adrenals. What are the primary symptoms of copper toxicity? Not surprisingly, they are almost identical to those of adrenal burnout!  The primary symptoms of late stage copper toxicity include:

  • fatigue and exhaustion
  • mood swings
  • depression, PPD, irritability and anxiety
  • brain fog and spaciness
  • concentration and memory problems
  • withdrawal and decreased libido
  • lowered immunity
  • hormonal fluctuations and estrogen dominance
  • bi-polar, paranoia and schizophrenia
  • insomnia


Copper toxicity and adrenal burnout go hand in hand, each contributing to the other, and each exhibiting very similar symptoms, physically and psychologically.

Before beginning the discussion on ways to improve the adrenals, the following salient points written by Dr. Maggie Luther in her book 'The Everything Guide to Adrenal Fatigue' very effectively describe a few of the key issues regarding adrenal burnout symptoms. The following excerpts are from her book, which, for anyone dealing with adrenal fatigue or burnout or wanting to understand this condition better, is a highly recommended and comprehensive book on the topic.

Regarding insomnia:
"One main contributor to poor sleep quality is the health of your adrenal glands. When you push yourself during the daytime, eventually you burn out your adrenals, which can cause a disturbance to the natural rhythm of the sleep-wake cycle.  Eventually cortisol spikes are seen prior to bed, around 10P.M., or in the middle of the night between 1-3A.M., causing insomnia."

Regarding irritability:
"Irritability is a feeling that often stems form not being able to do something. This state of feeling commonly comes from unaccomplshed goals, inability to finish a task to completion prior a deadline, or having unrealistic deadlines.  Some individuals also experience simultaneous challenges with emotional expression, often stemming from childhood. This can also contribute to feelings of irritability. When your adrenal system is fatigues, you revert to more immature states."

Regarding brain fog:
"Brain fog, mental fatigue, and inability to focus are common symptoms of an undernourished cellular and mitochondrial system, weakened nervous system, and heightened stress response. Over time, the acute effects of cortisol, which includes improving improving your ability to focus and helping with retention of short-term memory, flatlines and your brain becomes overwhelmed with the amount of cortisol and neurotransmitters bombarding it, day in and day out."

So, what's the answer to healing the adrenals? Well, it really depends on what stage of MSS you're at. A person with exhausted adrenals will naturally want to find ways to boost their energy, through stimulants such as coffee, herbs such as ginseng, or pre-workout boosters. However, this is can be counterproductive as it is akin to taking a whip to an exhausted horse - you'll make the horse move a bit, but eventually the horse will just collapse. Instead, the adrenals need to rest, long enough to rejuvenate. Generally, regardless of stage, and in addition to resting, steps that will support the adrenals include:

  • identifying and removing/rectifying any factors such as heavy metal toxicity, food sensitivities, parasites…and of course stress
  • restoring and repairing healthy gut function
  • improving liver function


Also, as mentioned, it may be that your adrenals are functioning fine but that your cortisol is low for other reasons, and I'll get to this later.  First though, let's continue with addressing the 3 stages of MSS.

In MSS1, you can still get away with short term stimulation of the adrenals, in healthy ways, though of course it is always best to let the adrenals rest. At this stage however, you could get away with using stimulating herbs such Asian Ginseng (energizing, boosts vitality in the aged), American Ginseng (slightly less stimulating and can help balance the adrenals), Eleuthero (energizing, boosts mental clarity, supports immune function and emotional resilience during stress), spices, and even limited caffeine when necessary (though never fully advisable). The aforementioned being said, it's important to remember that the more the adrenals are stimulated without enough recovery time, the more likely you are to progress into MSS2.

During MSS2, you would certainly want to avoid stimulating herbs. Therapy needs to centre around calming down the adrenals. Asian ginseng is not advisable as it is too stimulating. American ginseng is a slightly better alternative as it is not as stimulating, though it too at this stage is best avoided. Holy basil (promotes a more balanced stress response and keeps adrenals from overreacting), schisandra (supports immune system while calming the heart and spirit), ashwahgandha (an adaptogen that can be both stimulating but more relaxing and calming), licorice (great to use when cortisol production is high, though it should be avoided in people with high blood pressure), rhodiola, wild yam and milk thistle can all be beneficial at this stage. Just as with MSS3, relaxing therapies, stress management techniques and lifestyle management for better balance need to be adopted.

At MSS3, the key is to let the adrenals fully rest. They need to be 'put to bed' so to speak. Stimulating supplements, hard exercise, and stress will all exacerbate the condition and will not allow your adrenals the recovery that they need. Focus on scaling back your activities, getting at least 8 hours (or more) sleep per night, emphasizing stress reduction activities such as massage, light yoga, deep breathing, taking time to smell the flowers… and understand that this stage of adrenal exhaustion will take a longer term committed effort in order to heal. This is the time to simplify your life as much as possible. Eat plenty of fresh, whole foods, with extra emphasis on magnesium (calming) and potassium, while avoiding sodium (the primary stress mineral).  I discuss a more complete dietary approach to assisting the adrenals in my book The Healing Workbook.  


RECOVERY

When it comes to healing your adrenals, the approach will differ depending on how severe the fatigue/burnout.  In the early stages (MSS1), adrenal glandulars and stimulating herbs can be fine.  However, this approach is dangerous the closer one gets to MSS3.  At this stage (burnout), adrenal glandulars are too stimulating. They can easily boost one's energy in the short term, however this is a false sense of energy and only leads to further adrenal fatigue later in life. The quick return in energy can also give one a false sense of recovery and the person might quit before being properly rejuvenated.  Don't let your adrenals fool you.  Just because you are feeling better, doesn't mean you're out of the woods in terms of recovery.  When supporting your adrenal glands, remember that they will require a bare MINIMUM of three months of adrenal therapy (when exhaustion is not severe). It is more common to need six months to a year; and for women who are totally burned out or have post traumatic stress syndrome, their adrenals may take as long as two years to fully rejuvenate while diligently following a program.


It's possible to fast-track adrenal (energy) improvement through the use of adrenal formulas and stimulants (though the latter is not recommended).  However, there is a danger in trying to fast-track the return to energy, especially for people with higher levels of stored copper (toxicity) and toxic metals.  The stimulation provided by such support can make a person feel better energetically, but can lead to the mobilization of excess copper and/or toxic metals.  This is dangerous when the detox pathways have not yet been opened and bile production is low (as is usually the case in this stage). Without adequate bile to help excrete the copper / metals, these toxins simply get mobilized and then redeposited elsewhere in the body, often now in the brain which can then lead to serious psychological reactions as well as a worsening of some physical symptoms.  For this reason the person's minerals levels should be monitored through HTMA during the process of copper/metal elimination and adrenal restoration.  HTMA also provides a great indicator of adrenal strength through the sodium to magnesium ratio and the sodium and potassium levels.  Balancing these various minerals will help in the improvement of adrenal issues.



LOW CORTISOL FOR OTHER REASONS


Though it's easy to always blame low energy on our adrenals, in some cases it's possible that your adrenals are functioning completely fine but that your cortisol levels are still low.  Our mitochondria (the power center of our cells) play a key role in the conversion of cholesterol to cortisol.  If you have mitochondrial dysfunction, this conversion becomes impaired. Things like oxidative stress and nutrient deficiencies can impair the mitochondria from doing its job here. We could circle back here once more to stress. One of the key nutrients lost under stress is magnesium, and magnesium is essential 'fuel' for the mitochondria. Most people are low in magnesium, and other nutrients too, regardless of how healthy we try to eat. And none of us are immune completely from the effects of toxic metals which also impair conversion. So, while these factors can also affect adrenal output, it's possible that the adrenals are still functioning fine yet there is an impairment at the mitochondrial level in the conversion of cortisol. 


Also to consider is that, since cortisol weakens the activity of the immune system, the body at times will actually force a suppression of cortisol production to counter-act an infection or chronic inflammation.  Lipopolysaccharides (also called endotoxins or abbreviated as LPS) are found in gram-negative bacteria and usually found in the greatest concentrations in the gut where they are safely stored. However, if a person has leaky gut for example, this can cause a release of LPS into the body systemically which then also (leads to inflammation and) has a lowering effect on cortisol. 


Regardless of the cause, be it significant adrenal hypofunction, or a cause unrelated to the adrenals, the low cortisol level is a major culprit in the symptoms of fatigue, depression, impaired cognitive function, and even social withdrawal.