“Help! I Want to Feel Better.” -Managing Adrenal Exhaustion
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Do you feel tired, suffer from lack of sleep, have joint pain or muscle stiffness, catch frequent flus or colds, feel anxious and depressed, have headaches, gastrointestinal disturbances, difficulty concentrating or remembering, or experience allergies? Do you have difficulty getting up in the morning, experience more fatigue from 3:00 p.m. to 5:00 p.m., and get a second wind in the evening? Do you or others see you as “not your old self”?
My patients tell me they have seen a physician, received all “normal” test results, but still knew they didn’t feel well. If this happens, you may have adrenal fatigue. What is adrenal fatigue? How is it diagnosed, and what are the solutions?
Adrenal fatigue affects an estimated 80 percent of people, yet it has been ignored and largely untreated by the medical community. Women’s health is especially impacted by adrenal fatigue, which has a broad spectrum of non-specific yet often debilitating symptoms, making it somewhat difficult to diagnose. Being physically run down and emotionally spent are some symptoms of adrenal fatigue.
The onset of this disease is often slow and insidious, and before it is diagnosed, people suffering from adrenal fatigue may be told they are stressed and need to learn to relax more. But there is more to the story. Today, adrenal fatigue can be accurately diagnosed and overcome by specific natural approaches.
People diagnosed with this condition need to know they are not alone. According to a 2007 study from the American Psychological Association, 33 percent of Americans feel they are living with extreme stress, 75 percent say that money and work are the leading causes of stress, and 48 percent feel that their stress has increased over the past five years.
Our increasing stress levels may be the culprit leading to adrenal fatigue. Understanding the adrenal glands’ role in the body’s response to stress sheds some light on how they become so worn down. When the brain senses stress occurring, the heart begins to race, causing hypervigilance and mental alertness; the body’s central nervous system has switched to fight or flight mode, ready to defend itself or run.
During this process, the adrenal glands (about the size of a grape and positioned on top of the kidneys) pump out adrenalin, cortisol, and other hormones that affect the heart, lungs, circulation, metabolism, and immune system. Heart rate and blood pressure increase, bringing more blood to your muscles and brain (to make split-second decisions). Blood sugar rises to increase fuel for energy, and the blood-clotting ability also increases to survive injuries. This is an important emergency function of the body, designed to be used sparingly. When the adrenal glands activate hormones to meet a stress response on a daily or weekly basis, the adrenals become depleted and your health is put at risk.
Women with adrenal fatigue may wonder why they don’t recover as quickly as they used to. Their body becomes adapted to the stress in their lives, and they are not as able to bounce back. Common causes of stress include work pressure, financial issues, death of a loved one, relocating, changing jobs, illness, marital disruptions, and concerns about children. Regardless of the cause, the fact remains that prolonged periods of high stress, imbalanced lifestyle (lack of sleep, too little exercise, and poor nutrition), and frequent physical exhaustion tax the adrenals. Adrenal fatigue occurs when the amount of stress overextends the capacity of the body to compensate and recover.
Adrenal fatigue should not be confused with another medical condition called Addison’s disease where the adrenal glands are not functioning. While Addison’s disease is often caused by auto-immune dysfunction, adrenal fatigue is caused by stress. Adrenal fatigue afflicts more people than Addison’s disease, but it is often not recognized and has become an epidemic of massive proportion. To truly diagnose adrenal fatigue, more sensitive specialized laboratory testing and meticulous review of the medical history is required.
The Stages of Adrenal Fatigue
Han Selye, MD, first described the general adaptation syndrome in the 1930s. Adrenal fatigue consists of four stages:
Stage One: Adrenal Stress
In Stage One, you may feel tired, wired and anxious, or both. You may have trouble falling to sleep, have a depressed immune system, experience headaches, aches and pains, and gastrointestinal symptoms.
Stage Two: Adaptation
If your stress continues, your body may adapt to it. Your body may not notice the elevation of hormones such as cortisol, insulin, nor-epinephrine, and adrenalin. This is a false sense of security. During this period, the body needs cortisol to overcome stress, and increased cortisol production can lead to obesity, diabetes, and other illnesses. Over time, the adrenals will be unable to meet the body’s ever-increasing demand for cortisol and will become depleted.
Stage Three: Adrenal Exhaustion
As the stress continues unabated, the first symptoms return with a vengeance. Other symptoms and illnesses begin to occur. The body loses its ability to cope and resist the stimuli it once handled with ease. You may develop allergies you never had before or get sick over and over again. Seemingly unrelated symptoms occur like increased fatigue, low libido, insomnia, PMS or menopausal symptoms, anxiety or irritability, heart palpitations, high blood pressure, weight gain, and more severe heartburn, brain fog, or irritable bowel syndrome. Severe sex hormone imbalances (estrogen, progesterone, and androgens) are a common precursor to adrenal failure. Total cortisol output is therefore reduced, and DHEA falls far below average. Hormones all have a relationship to each other and are often called “dancing hormones” as they react to the levels of other hormones and adjust to the needs of the body. When adrenal fatigue occurs in women, the signs and symptoms are often confused with PMS or menopausal symptoms. It is important for women to work with a physician who can help her sort out the hormone dilemma.
Figure 1. Interaction of Cortisol, pregnenolone and DHEA in normal subjects versus those in the four stages of adrenal exhaustion.
Stage Four: Physical Decline
Eventually your body’s ability to resist or adapt is compromised. New symptoms occur and the old symptoms increase in severity. Women are completely exhausted and may fall asleep easily but wake up during the night and have problems getting back to sleep. In this stage, we see all sorts of chronic illnesses like depression, low blood sugar, GERD (gastroesophageal reflux disease), and colitis. If you have a genetic predisposition for any type of autoimmune disease or a severe disease, the adrenal fatigue may trigger its onset at this time. These diseases can include rheumatoid arthritis, fibromyalgia, heart disease, multiple sclerosis, osteoporosis, cancer, or diabetes.
The Effect of Cortisol on Adrenal Fatigue
More energy is required when the body is under stress from any source, and cortisol is the hormone that increases our energy requirements. Cortisol works with insulin from the pancreas to provide adequate glucose to the cells for energy. In adrenal fatigue, more cortisol is secreted during the early stages (see Figure 1), increasing the risk of diabetes. In later stages (when the adrenal glands become exhausted), cortisol output is reduced, and blood sugar balance becomes a problem. Cortisol is a powerful anti-inflammatory agent. Its objective is to remove and prevent swelling and redness of nearly all tissues. As cortisol is diminished, an increase in inflammation is the result.
People with high cortisol levels are much weaker from an immunological point of view. Cortisol influences most cells that participate in the immune system reaction and suppresses white blood cells, natural killer cells, monocytes (specific white blood cells, leukocytes that protect against blood-borne pathogens and move quickly to sites of infection in the tissues), and macrophages (cells within the tissues that originate from monocytes) increasing women’s risk of infections and other diseases.
Cortisol contracts mid-sized arteries. People with low cortisol (as in the advanced stages of adrenal fatigue) have low blood pressure. High cortisol tends to increase blood pressure which is moderated by calcium and magnesium. People with adrenal fatigue cannot tolerate stress and will then succumb to severe stress. As their stress increases, progressively higher levels of cortisol are required. When the cortisol level cannot rise in response to stress, it is impossible to maintain the body in optimum stress response, and an increase in symptoms and a decline in overall health occurs. Your body is crying out for help and attention.
There is a Solution to Adrenal Fatigue
1. The good news is, adrenal fatigue can be cured by implementing healthy lifestyle guidelines and reducing and/or finding ways to manage stress. Decrease your stress by setting boundaries, delegating, and just saying “no.”
2. Live a healthy lifestyle that includes good nutrition, adequate exercise, and sufficient sleep (8 hours per night).
3. Have an Adrenal Test. It is simple and does not require a blood draw.
4. Follow the specific recommendations of your health practitioner regarding vitamins and supplements with adaptogens (natural herb products containing antioxidants that increase the body’s resistance to stresses) to help strengthen your body.
5. Consider acupuncture to correct your adrenal fatigue.
6. Based on your symptoms, overall health, and results of your adrenal test, your physician can determine the best approach to address your individual needs and support you in healthy lifestyle changes with lifestyle educators.
7. Get more pleasure from life. Have fun. Do things you love. Get out in nature. Most importantly, take time for yourself. This is not pampering. This is good health.
Dr. Sharon Norling is the only physician in the U.S. to be nationally board certified in integrative medicine, medical acupuncture, OB/GYN, and Functional Medicine. Her practice combines her extensive medical knowledge with the most recent advances in mind/body medicine. Her office is located at 32123 Lindero Canyon Road, Suite 210, in Westlake Village. To reach the office of Dr. Norling, please call 818-707-WELL (9355).
