Setting Adrenal "Fatigue" Straight

Adrenal dysfunction refers to adrenal mal-functioning. Commonly however, adrenal dysfunction is blanketly referred to as ‘adrenal fatigue’ instead. The term adrenal fatigue is inaccurately used to refer to any of the stages of adrenal dysfunction. Correctly, it should strictly refer only to the third stage of adrenal dysfunction. Adrenal dysfunction is composed of 3 stages which were best described by Hans Selye some 70 years ago. He called the series of stages ‘the general adaptation syndrome,’ described here.

Stages of Adrenal Dysfunction

Stage 1: Arousal

      Both cortisol and DHEA increase with episodic stress, but recovery returns to baseline

      This may be asymptomatic     

Stage 2: Adaptation

      Cortisol is chronically elevated and DHEA declines

      Symptoms of stress arise such as anxiety attacks, mood swings, depression

State 3: Exhaustion

    Adrenal insufficiency yields low cortisol and DHEA levels

      Patients present with depression and fatigue

Patients can present with a variety of symptoms of adrenal gland dysfunction including: fatigue, low energy, weakness, moodiness, anxiety or depression, muscle and bone loss, hormonal imbalance and skin problems, to name a few. Also common is an over-reaction to stress in which a minor event causes a disproportionate reaction of anger, irritation or sadness.

What cause adrenal dysfunction

Perhaps the most obvious of all the causes of adrenal fatigue is chronic stress. I have alluded to this before however I’d like to point out here that the term ‘stress’ can refer to physical or psychological stress. For example, physical stress could include: toxins, infections, nutrient deficiencies, hormone imbalances, allergies and certain prescription medications. Psychological stress could be events such as: a divorce, an unhappy marriage, a stressful job, a difficult family life, or a lack of social or familial support. It could also come in the form of imagined stress. For instance, re-living past trauma or worrying about what people may be thinking of you, still takes the same toll on your body as any other stressful current event would. The fact is, the body doesn’t know the difference between a psychological stress – real or imagined – and a physical emergency. To the body, stress is stress; whether  physical or psychological or both.  They  are all equally detrimental to the adrenals. Another of the many causes of adrenal fatigue is poor diet. A diet high in sugar, simple carbohydrates, food preservatives, alcohol or stimulants like caffeine, leads to adrenal dysfunction. These foods cause the blood sugar to spike and in order to regulate glucose levels the adrenal cortex must produce excess cortisol. Over time, this leads to adrenal dysfunction.

Assessment and treatment of adrenal dysfunction:

The most common laboratory evaluation I use for adrenal fatigue is a 4-point salivary cortisol test. Salivary cortisol concentrations reflect the free, biologically active fraction of cortisol in the plasma and provide results that are of greater diagnostic significance than plasma total concentrations alone (Peters and Walker).

I have developed what I refer to as ‘the 3 legged’ and ‘the4 legged’ approach to treating adrenal dysfunction. At the most basic level, the first leg of my approach covers modifications in nutrition and lifestyle. Eating organically grown, phytochemically dense food that is devoid of fillers and preservatives is a must. Meals need to have a low glycemic load and good sources of clean protein. The majority of your plate (about 2/3) must be composed of vegetables, and a few servings of low glycemic load fruits can be included as well. Chewing food appropriately and hydrating well are also important. Next in leg 1 is the lifestyle component. This includes exercise that is appropriate for the stage of adrenal dysfunction. A person in stage 1 adrenal dysfunction with high cortisol levels would need more of an aerobic program, whereas someone in stage 3 needs more gentle movement that will not cause further stress to the body. I also address the level of stress in one’s life and how to best modify it. It is crucial to have hobbies that are enjoyable and a relaxation protocol that really works for each particular patient. The second leg involves tailored nutraceuticals that help heal and reverse the adrenal dysfunction. This can include nutraceuticals like a B-Complex with B6 in the activated or P-5-P form, 5-MTHF, biotin, omega 3 fatty acids, vitamin C and zinc. These are all the well researched vitamins and minerals that help heal the adrenals. The 3rd leg is adaptogens. Adaptogens are herbs and botanicals that help the body adapt to the stressors and also may facilitate communication between the adrenals and the higher centers of the brain. The 4th  and optional leg is hormonal supplementation. Hormonal supplementation can help the adrenals recover more quickly and may assist both the brain and adrenals to re-establish their balance and connection together. The most commons hormones I use are DHEA and pregnenolone in very low doses. I only use hormones along with the other 3 legs. Luckily, in many cases we may only need the first 3 legs to bring the patient back to balance.

A Final Word

In conclusion, the most important aspects of addressing adrenal dysfunction are to stage the patient and understand the root cause of the dysfunction. Then, and only then, can a personalized approach utilizing functional medicine tools be tailored to the individual needs of each patient.With focus and attention to the nutritional content of the diet, lifestyle modification, supplementation with vitamins, minerals, adptogens and possibly hormones, the good news is that it is fully possible to achieve a complete recovery from adrenal dysfunction.