Warning Signs of Adrenal Fatigue

Warning Signs of Adrenal Fatigue

One of the most common health complaints today is the experience of fatigue and lethargy. If you have fatigue along with other symptoms such as difficulty concentrating, insomnia, inability to lose weight, feeling anxious, allergies, or brain fog, Adrenal Fatigue Syndrome (AFS) may be at the root of the problem. adrenal fatigue phoenix

Adrenal Fatigue consists of many nonspecific but debilitating symptoms. The onset of this condition is often slow and insidious. Sufferers are told that they are stressed and need to learn to relax more. Yes, we all know that “stress kills” to a large extent. But, the question is how?

The real truth is that stress and Adrenal Fatigue are not a mysterious entity at all. Our body has a built-in mechanism to deal with it. Being able to handle stress is a key to survival, and the control center in our bodies is the adrenal glands.

Adrenal Fatigue Syndrome is one of the most prevalent conditions. Most people experience it at one point or another. However, most conventional physicians are not taught about Adrenal Fatigue in medical school. As such, they are not prepared to take Adrenal Fatigue as a serious threat to health. adrenal fatigue phoenix

This condition was seldom considered as a dysfunctional sickness. Instead, people think of Adrenal Fatigue Syndrome as a condition related to stress. Thus, the solution was to tell the person to “relax” and take anti-depressants. This does not solve the underlying issue and over time, the condition worsens. Adrenal Fatigue Syndrome is not a medical condition recognized by mainstream institutions. Invariably, the adrenal glands are structurally normal. Low cortisol, the most common associated finding, may be caused by factors outside the adrenal glands.

Do not confuse Adrenal Fatigue Syndrome with another medical condition called Addison’s disease. Addison’s disease has adrenal glands that are not functioning according to conventional endocrinologists’ standards. Addison’s disease is often caused by an auto-immune dysfunction. Adrenal Fatigue Syndrome is caused by stress or other factors. These can include dysregulation of the HPA axis, nervous system problems, immune system problems, and metabolic-nutritional problems. It is a complex condition with complex clinical presentation, depending on the stage of dysfunction. Those in neuroscience may prefer to label this condition Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation. This is due to the strong association with dysfunction of the HPA axis. Forward looking endocrinologist may be more comfortable with calling this condition Non-Adrenal Illness Affecting Adrenal Function because of the associated low cortisol output which does not meet the diagnostic criteria for Adrenal Insufficiency.

Conventional medicine only recognizes Addison’s disease as hypoadrenia. As such, it is not surprising if your doctor is unfamiliar with this condition. Adrenal Fatigue Syndrome is a sub-clinical non-Addison’s form of adrenal dysfunction. Because there are many causes, Adrenal Fatigue Syndrome is a more accurate name. The addition of “syndrome” implies no definitive cause. It would be up to the physician to determine the list of symptoms and signs appropriate to the syndrome. adrenal fatigue phoenix

We will be using the terms Adrenal Fatigue Syndrome and Adrenal Fatigue interchangeably because Adrenal Fatigue is the most commonly used terminology recognized and used by the public.

Signs and Symptoms of Adrenal Fatigue

  • Tendency to gain weight and unable to lose it, especially around the waist.
  • High frequency of getting the flu and other respiratory diseases.
  • Infections that tend to last longer than usual.
  • Tendency to tremble when under pressure.
  • Reduced sex drive.
  • lightheaded when rising from a horizontal position.
  • Unable to remember things.
  • Lack of energy in the mornings and in the afternoon between 3 to 5 pm.
  • Feel better suddenly for a brief period after a meal.
  • Often feel tired from 9 – 10 pm, but resist going to bed.
  • Need coffee or stimulants to get going in the morning.
  • Cravings for salty, fatty, and high protein food such as meat and cheese.
  • Increased symptoms of PMS for women. Periods are heavy and then stop, or are almost stopped on the 4th day, only to start flow again on the 5th or 6th day.
  • Pain in the upper back or neck with no clear reason.
  • Feels better when there is less stress, such as on a vacation.
  • Difficulties in getting up in the morning.
  • Lightheaded.
  • Mild depression.
  • Food and or inhalant allergies.
  • Lethargy and lack of energy.
  • Increased effort to perform daily tasks.
  • Decreased ability to handle stress.
  • Dry and thin skin.
  • Hypoglycemia.
  • Low body temperature.
  • Nervousness.
  • Palpitation.
  • Unexplained hair loss.
  • Alternating constipation and diarrhea.
  • Dyspepsia.

If you have many of these signs and symptoms, it is time to consider Adrenal Fatigue as a possible cause. None of the signs or symptoms by themselves can definitively pinpoint Adrenal Fatigue. However, when looked at collectively, these signs and symptoms form a specific picture of a person under stress. These signs and symptoms are often the end result of acute, severe, chronic, or excessive stress. The body is unable to reduce such stress.

The ability to handle stress, physical or emotional, is a cornerstone to human survival. Our body has a stress modulation system in place, known as the neuroendometabolic (NEM) stress response. The adrenal glands are part of this response system. When these glands become dysfunctional, our body’s ability to handle stress is reduced.

Adrenal Gland Basics

The adrenal glands are two small glands, each about the size of a large grape. They are on top of the kidneys. Their purpose is to help the body cope with stress and help it to survive. Each adrenal gland has two compartments. The inner compartment is the adrenal medulla. The adrenal medulla modulates the sympathetic nervous system through secretion and regulation of two hormones called epinephrine and norepinephrine. Epinephrine and norepinephrine are responsible for the fight or flight response.

The outer compartment is the adrenal cortex. The adrenal cortex comprises 80 percent of the adrenal gland and produces over 50 different hormones. These hormones make up three major classes – glucocorticoids, mineralocorticoids and androgens. adrenal fatigue phoenix

The most important glucocorticoid is cortisol. When cortisol is lowered, the body will be unable to deal with stress. This happens in Adrenal Fatigue.

Mineralocorticoids modulate the delicate balance of minerals in the cell, especially sodium and potassium. An example is aldosterone. It thus regulates our blood pressure and the fluid in the body. Stress increases the release of aldosterone, causing sodium retention. This results in water retention and high blood pressure. Potassium and magnesium are lost in the early stages of Adrenal Fatigue. Magnesium is involved in over 300 enzymatic reactions in the body. When the body lacks magnesium, cardiac arrhythmias and other symptoms may arise.

The adrenal cortex is also responsible for producing all the sex hormones, although in small amounts. One exception is DHEA, a weak androgenic hormone that is made in large amounts in both sexes. DHEA, together with testosterone and estrogen, are made from pregnenolone.

Pregnenolone also leads to the production of progesterone. It is one of the intermediary steps in the making of cortisol. Pregnenolone is thus one of the most important intermediate hormones in the hormonal cascade. A prolonged deficiency in pregnenolone will lead to reduced glucocorticosteroids and mineralocorticoids. This can occur in Adrenal Fatigue

Cortisol (The Hormone of Death)

Often times cortisol is dysregulated during the stages of Adrenal FatigueThe most important anti-stress hormone in the body is cortisol. Cortisol protects the body from excessive Adrenal Fatigue through:

Normalizing blood sugar levels

Cortisol increases blood sugar levels in the body. Cortisol works in tandem with insulin from the pancreas to provide adequate glucose to the cells for energy. More energy is needed when the body is under stress, from any source, and cortisol is the hormone that makes this happen. In Adrenal Fatigue, more cortisol is secreted during the early stages. In the later stages of Adrenal Fatigue (when the adrenal glands become exhausted), cortisol output is reduced.

Reducing inflammation

Cortisol is a powerful anti-inflammatory agent. When we have a minor injury or a muscle strain, our body’s inflammatory cascade is initiated. Cortisol is secreted as part of the anti-inflammatory response. Its goal is to remove and prevent swelling and redness of tissues. These anti-inflammatory responses prevent mosquito bites from enlarging, bronchial stress, and eyes from swelling shut from allergies.

Suppressing the immune system

People with high cortisol levels are much weaker from the immunological point of view. Cortisol influences most cells that take part in the immune reaction, especially white blood cells. Cortisol suppresses white blood cells, natural killer cells, monocytes, macrophages, and mast cells. It also suppresses Adrenal Fatigue.

Regulating blood pressure

Cortisol contracts mid-size arteries. People with low cortisol have low blood pressure. They do not respond to other body agents that constrict blood vessels. Cortisol tends to increase blood pressure.

Dealing with stress

People with Adrenal Fatigue cannot tolerate stress and succumb to severe stress. Higher stress levels require higher levels of cortisol. When the cortisol level cannot rise in response to stress, it is impossible to maintain the body in optimum stress response. adrenal fatigue phoenix

Cortisol sustains life via two opposite, but related, kinds of regulatory actions. It releases and activates the existing defense mechanisms of the body. At the same time, it shuts down and modifies the same mechanisms to prevent them.

Cortisol Regulation

Adrenal Fatigue can impact the stress response system of the bodyThe hypothalamus-pituitary-adrenal (HPA) axis controls the adrenal glands. There is an existing negative feedback loop that governs the amount of adrenal hormones secreted under normal circumstances. For example, the HPA axis adjusts cortisol levels according to the body’s need via a hormone called Adrenal Corticotropic Hormone (ACTH). The pituitary gland secretes ACTH in response to signals from the hypothalamus. When the ACTH binds to the walls of the adrenal cells, a chain reaction occurs within the cell. The adrenal cells release cholesterol. Cholesterol is then converted into to pregnenolone, the first hormone in the adrenal cascade. After this, cortisol is released into the blood stream. It travels in the circulatory system to all parts of the body and back to the hypothalamus.

Cortisol and ACTH are not secreted uniformly throughout the day. They follow a diurnal pattern. The highest level secreted at around 8:00 a.m. in the morning. Cortisol then start to decline throughout the day. Episodic spikes during the day can also occur when the body is stressed. Certain foods can elevate cortisol as well. The cortisol level is at its lowest between midnight and 4:00 a.m.

Common Causes of Adrenal Fatigue

Chronic stress is common in western society. The most common causes of stress are work pressure, changing jobs, death of a loved one, moving homes, illness, and marital disruption. Adrenal Fatigue occurs when the amount of stress exceeds the capacity of the body to compensate and recover.

Many sufferers of Adrenal Fatigue experience anger as a response to stressStressors that can lead to Adrenal Fatigue include:

  • Anger
  • Chronic fatigue
  • Depression
  • Chronic illness
  • Excessive exercise
  • Chronic infection
  • Fear and guilt
  • Chronic pain
  • Gluten intolerance
  • Low blood sugar
  • Mal-absorption
  • Mal-digestion
  • Toxic exposure
  • Severe or chronic stress
  • Surgery
  • Late hours
  • Sleep deprivation
  • Excessive sugar in diet
  • Excessive caffeine intake from coffee and tea
  • Chronic infected root canal

One of the most overlooked causes of Adrenal Fatigue is chronic or severe infection. This gives rise to an inflammatory response. Such infection can occur sub-clinically with no obvious signs at all. Parasitic and bacterial infections including Giardia and H. pylori are often the main causes. adrenal fatigue phoenix

How Stressors Affect the Body

When stressed, the body reacts by mounting a stress response. The bodies stress response is also known as the neuroendometbolic stress response system. It contains 6 circuits that help to regulate stress: hormonal, metabolic, detoxification, inflammatory, neuroaffective, and cardionomic. Each of the circuits is regulated by a different set of organs of systems in the body. These 6 different circuits help to regulate the stress in the body, however, if stress is chronic, then symptoms may start to arise as different circuits and their respective organs become dysregulated. It stimulates the sympathetic nervous system. This is also called the “fight or flight” response as the body arms itself to face what it perceives as a danger. The adrenal medulla secretes epinephrine. The HPA axis also releases ACTH, which causes the adrenal cortex to increase production cortisol. adrenal fatigue phoenix

Hormonal Circuit

Stress and the body are often responsible for Adrenal Fatigue symptomsThe hormonal circuit is made up of the ovaries, adrenals, and thyroid organs. When stressed continuously, cortisol levels may rise to such a high level that the adrenal becomes exhausted. At the same time, DHEA, a hormone produced in the adrenal glands, will start to decrease from stress. With chronic stress, there is decompensation of DHEA with a concurrent rise of cortisol. As a result, the ratio of cortisol to DHEA increases. adrenal fatigue phoenix

As with most hormonal systems, there is a negative feedback system in the body to limit the production of each hormone. The same occurs in the case of cortisol, with one exception. During prolonged or acute stress, the body perceives that its survival is at stake. Excessive cortisol output actually blunts the negative feedback response. Instead, cortisol production increases. This is the body’s way of coping with ongoing stress. adrenal fatigue phoenix

When stressed, our cortisol level rises in an environment where the negative feedback system is dampened. While this is happening, our DHEA level continues to drop. The result is a high cortisol to DHEA ratio and:

  • Reduced insulin sensitivity, reduced glucose utilization, and increased blood sugar, which leads to diabetes.
  • Reduced secretory IgA (the main cellular defense factor), natural killer (NK) cell and T-lymphocyte activity which lead to increased chances of getting infections such as Herpes, yeast overgrowth, and viral infections.
  • A block in calcium absorption results in an increased loss in bone mass. The demineralization of bone occurs, leading to osteoporosis.
  • Increased fat accumulation around the waist and protein breakdown. This leads to muscle wasting, an inability to reduce weight.
  • An increased in water and salt retention, leading to high blood pressure at first, with low blood pressure as the condition worsens.
  • Estrogen dominance, leading to PMS, uterine fibroids, and breast cancer.

Stress Response from a Hormonal Perspective

How the body manufactures and responds to hormones is affected by Adrenal FatigueAt work, what happens if your boss screams at you? Let us now examine some of the effects within our body from a hormonal perspective:

  • Your hypothalamus signals your pituitary gland to release ACTH.
  • ACTH will stimulate the adrenal medulla to secrete epinephrine and the adrenal cortex to secrete cortisol.
  • Your cortisol level will increase and convert more stored glycogen into blood sugar for energy. Energy is also increased from the release of epinephrine from the adrenals.
  • Your heart rate will increase (from the epinephrine).
  • You will tend to sweat more (from the cortisol).
  • Your muscle tension will increase (from the cortisol and epinephrine).
  • Diverting blood away from your gut, results in slowed digestion.
  • Your bladder and rectum muscle may relax.

When the above physiological response occurs over a long duration, then Adrenal Fatigue is the result. This can also occur under traumatic acute stress.

Adrenal Fatigue Progression

Adrenal weakness progresses through stages as the body de-compensates. It is the body’s strategy to return to a state of simplicity from a life that is too complex for the body to handle.

Stage 1: Alarm Reaction

In this stage, the body is alarmed by the stressors and mounts an aggressive anti-stress response to reduce stress levels. Some doctors call this the Early Fatigue stage.

Stage 2: Resistance Response

With under chronic or severe stress, the adrenals eventually are unable to keep up with the body’s demand for cortisol. Cortisol output will start to decline from a high level back to a normal level, while ACTH remains high. The adrenals start to become exhausted. Morning, noon, or afternoon cortisol levels are often low. Nighttime cortisol level is usually normal. Anxiety starts to set in, and the person becomes irritable. Insomnia becomes more common, as it takes longer to fall asleep. There are also frequent awakenings as well. Infections can become recurrent. PMS and menstrual irregularities surface. Symptoms suggestive of hypothyroidism (such as a sensation of feeling cold along with a sluggish metabolism) become prevalent. adrenal fatigue phoenix

Often the body is unable to keep up with the demands on the adrenal glands during Adrenal FatigueA phenomenon called pregnenolone steal (also called cortisol shunt) sets in. The body starts to favor cortisol production over other hormones. Other hormones such as pregnenolone, DHEA, testosterone, and estrogen are less favored and start to decline. As a result, total pregnenolone output is reduced but the total cortisol output continues at a normal level. The daily diurnal cycle of cortisol shows a dysfunctional pattern. Cortisol is low in the morning, when it is needed the most. Nighttime cortisol is usually still normal. adrenal fatigue phoenix

There is occasional mild fatigue. A nap or some time off work usually can help the recovery process greatly. adrenal fatigue phoenix

Stage 3: Adrenal Exhaustion

Despite rising ACTH, the adrenals cannot keep up with the body’s demand for cortisol. This may happen over a few years. Total cortisol output is reduced, and DHEA falls far below average. The nighttime cortisol level is usually reduced as the HPA axis “crash”. The body is unable to maintain homeostasis. Early in this stage, mild symptoms characteristic of the first and second stages of Adrenal Fatigue become persistent or chronic (Phase A). As the condition gets worse, multiple endocrine axis imbalances tend to occur (Phase B). This manifests in the form of ovarian-adrenal-thyroid (OAT) axis imbalance in females and adrenal-thyroid axis imbalance in males. The body is in a constant state of mild to moderate fatigue in phase A and B.

As the body continues its downward path of impaired function, it gathers steam. The body becomes compromised in trying to maintain the fine controls of homeostasis. Normal equilibrium is lost. The body enters a state of reactive disequilibrium (Phase C). Severe fatigue is the norm for those with Phase C.

Adrenal Fatigue forces the body into maintenance mode where it struggles to maintain balanceYour body will try to maintain equilibrium with the activation of the autonomic nervous system (ANS). However, the body is too fatigued. Other pathways of the NEM stress response are damaged as well. impaired metabolic, clearance, and detoxification pathways give rise to paradoxical, unpredictable, and exaggerated outcomes. Reactive sugar imbalances, fragile blood pressure, postural hypotension, heart palpitations, POTS, dizziness, anxiety reactions, being “wired and tired,” periodic adrenaline rushes, fragile fluid state; such as hypersensitive dilutional hyponatremia, sudden onset of anxiety, and a sensation of impending doom are common.

There is a strong mind-body connection. Every thought process invokes a physiological response. Many of these symptoms represent what a “reactive sympathoadrenal response.” This response is the result of an over-activation of two components of the ANS – the sympathetic nervous system (SNS) and the adrenomedullary hormonal system (AHS). These two components constitute the sympathoadrenal system (SAS). the body bathes in a sea of epinephrine and norepinephrine, when the SAS is over-activated due to stress. These two hormones are responsible for many of the above-mentioned symptoms. adrenal fatigue phoenix

As the body’s key hormones fall below the minimum required reserve for normal function and output fails, the body may down-regulate the amount needed to preserve what is on hand for only the most essential body functions. This near-failure state (Phase D) is quite serious and requires professional attention. This is a state of extreme low energy as the body tries to conserve to survive. Normally helpful nutrients may backfire with paradoxical responses being the hallmark. Those in Phase D are usually bedridden most of the time. Normal daily chores need ambulatory help. Traditional macro-nutritional approaches may be helpful. But, the body may continue to decompensate. In these cases, a carefully titrated micro-nutritional program may be necessary to help the restore the body. adrenal fatigue phoenix

Stage 4: Failure

Eventually, the adrenals are totally exhausted. In this stage, the line between Adrenal Fatigue and clinical Addison’s disease can be blurry.

Typical symptoms of Addison’s disease may start to emerge. Fatigue becomes extreme. Other symptoms include weight loss, muscle weakness, loss of appetite, nausea, vomiting, hypoglycemia, headache, sweating, irregular menstrual cycles, depression, orthostatic hypotension, dehydration, and electrolyte imbalances. The body appears to have lost its normal homeostasis and is breaking down. If not attended to, the natural progression of this condition may be fatal.

The following diagram shows how Adrenal Fatigue progresses with time through the stages. This is not for diagnosis purposes. Adrenal Fatigue is not a recognized medical condition by mainstream institutions. This diagram helps to paint a broad picture of what is seen clinically. Each person’s progression varies tremendously and is dependent on a wide variety of factors.


Adrenal Fatigue is a decrease in the adrenal glands ability to carry out its normal function. The chief symptoms are fatigue, excitability, or depression.

Adrenal Fatigue is caused by chronic stress from any source (including emotional, physical, mental, or environmental) that exceeds the body’s capacity to adjust to the demands placed on it by stress. It is a condition that afflicts children as well as adults. It can be diagnosed by laboratory tests, if only the physician pays greater attention.

Adrenal glands can be restored to optimum health by adhering to healthy living principals. Proper rest, specific nutrition, proper diet and stress reduction are key components to Adrenal Fatigue treatment.

Most people who suffer from Adrenal Fatigue also have multiple endocrine imbalances. Some examples include sub-clinical hypothyroidism, insulin resistance, and estrogen dominance. These need to be optimized as well. Adrenal fatigue treatment is a process akin to running a marathon. The process is long, but it can be done one step at a time. Most will find some improvement in a matter of weeks, depending on the degree of preexisting damage and the clinical skills of the health professional. Because the amount of hormonal balancing is intricate and is highly sensitive, the process can take anywhere from three months to three years under the best of hands. It is a long marathon, and recovery should not be expected in a matter of weeks. Frustration and disappointment are common and normal. Patience is key. During the recovery process, most people will go through a roller coaster type ride with advances and setbacks.

Using the correct amount of nutritional supplement can speed up the recovery process. While there are many nutrients that can help adrenal fatigue treatment, only a few are needed at any moment. Nutrients, if not dosed properly, can become toxic and make the Adrenal Fatigue worse. A shotgun approach seldom works and can in fact backfire if the adrenal is not able to take in the nutrients at the right rate, time, and dose. adrenal fatigue phoenix

It is best to take it one step at a time under professional guidance to ensure the right step is taken at the proper time. This is especially true for advanced cases. Laboratory tests can be helpful, but are not critical in most cases. The key is a knowledgeable clinician who takes the time to understand your body with its signals and cries for help. A complete nutritional and lifestyle approach that helps the adrenal gland to normalize itself, along with ongoing adjustments in terms of nutritional supplementation to assist the adrenal during this recovery is the key.

– credit Dr Lam

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