Got Stress? It May Be Adrenal Fatigue

What could be the root cause of the following symptoms?

  • Difficulty sleeping even when tired (“tired and wired”)
  • Waking up at 2 or 3 am and can’t go back to sleep
  • Difficulty waking up and feeling tired though you’ve slept 7-8 hours
  • Getting deep sleep at 1-2 hours before waking up in the morning
  • Feeling finally awake at 10 am though you got up at 7
  • Low thyroid function
  • Unresponsive thyroid function even with treatment of hypothyroidism
  • PMS (bloated, “crabbiness”, constipation, cramping and chocolate cravings)
  • Lack of libido, infertility
  • Increased perimenopause and menopausal signs and symptoms
  • Inability to lose weight even with regular exercise
  • Inability to gain muscle mass even with weight training
  • Chronic Fatigue Syndrome
  • Emotional irritability, instability, decreasing motivation and depression
  • Light-headed/dizzy when standing up from lying position or bending
  • Poor wound healing
  • Frequent colds, flu and infections
  • Decreased athletic performance
  • Lack of stamina
  • Increased likelihood of heart attack and decreased likelihood to survive a heart attack
  • General feeling of “unwellness”

It is adrenal gland dysfunction.  Maladaptation to stress is the key to this axis going out of whack.

The Stress Response

Hans Selye is the scientist credited with bringing the concept of stress to the forefront of public and scientific thought.   In his book, The Stress of Life, he covers what he called the General Adaptation Syndrome (GAS).  GAS is a useful model summarizing hormonal and physiologic interactions.  GAS has three stages:

  1. Alarm reaction – This is known as the fight or flight response.  This stage involves activation of our sympathetic nervous system to give us the ability for quick physical and emotional action in life threatening situations.  This also stimulates secretion of cortisol by the adrenal glands.
  2. Resistance – This stage involves our body adapting to stress by changing the set point of activation of the sympathetic nervous system and secretion of cortisol by the adrenal glands.
  3. Exhaustion – This stage involves the depletion of the adrenal glands ability to make cortisol and other key hormones.  In this stage many of the symptoms above will begin to occur.

Not all stress is harmful.  It is when our systems are overwhelmed by stress and then maladaptation occurs that is harmful.

What is Adrenal Fatigue and How Does It Occur?

Cortisol allows the body to respond to and recover from stress.  It is produced by the adrenal glands, specifically the adrenal cortex of the adrenal glands, which are activated in response to stress.

Maladaptation to stress occurs over time with either in an elevated set point of cortisol release, or in a depleted stage as the problem progresses where not enough cortisol is released.  The symptoms above are often seen at some stage of imbalanced cortisol output.  It may be after a relatively short period of multiple stressors (such as any combination of moving, getting married or divorced, death of a family member or close friend, loss of a child, and a major injury within a year).  It may be after many years of poor diet and lifestyle habits, surgery, and reliance on pharmaceuticals that lead to depressed cortisol output.

When the adrenal glands get to a stage where they unable to make adequate cortisol to respond to normal stress of everyday life it is referred to as adrenal fatigue or adrenal exhaustion.  There are different levels of inadequate cortisol output once symptoms appear.  When complete shutdown of cortisol output occurs, this results in death.

Diagnosis of Adrenal Fatigue

Proper diagnosis includes a thorough medical history and examination and cortisol levels testing.  Cortisol can be measured in the blood, urine or saliva.  The most accurate method is through saliva.  This is controversial to many conventionally trained physicians, but research studies support that salivary testing is the most accurate method.

Morning cortisol levels should be at their highest after waking up, then it drops dramatically by noon followed by a gradual decrease until midnight.  Thus, it is best to take 4 saliva samples to determine your cortisol output.  I often see altered cortisol response which correlates very closely with each individual’s signs and symptoms.

The treatment for an elevated cortisol pattern is different from the treatment of adrenal exhaustion.  It is very important to determine your condition for the appropriate treatment.  The wrong treatment could result in harmful consequences, such as further suppressing cortisol output or inducing high blood pressure.  Only a doctor who is trained and experienced in resolving this disorder should be consulted for proper diagnosis and treatment.

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