Adrenal Fatigue: The 21st Century Stress Syndrome by James L. Wilson and Jonathan V. Wright
After mid-life (menopause in women), the adrenal glands gradually become the major source of the sex hormones circulating throughout the body in both men and women. These hormones themselves have a whole host of physical, emotional and psychological effects, from the level of your sex drive to the tendency to gain weight.
People who suffer from adrenal fatigue frequently have erratic or abnormal blood sugar levels in the form of hypoglycemia. In fact, people who have functional hypoglycemia are usually suffering from decreased adrenal function. With hypoadrenia there is more of a tendency to experience allergies, arthritic pain and decreased immune response. Most women who have low adrenal function have more premenstrual tension as well as increased difficulty during menopause. The adrenals also have an effect on mental states. As a result, people with adrenal fatigue show a tendency toward increased fears, anxiety and depression, have intervals of confusion, increased difficulties in concentrating and less acute memory recall. They often have less tolerance than they normally would and are more easily frustrated. When the adrenals are not secreting the proper amount of hormones, insomnia is also one of the likely outcomes.
As their condition worsens, it lays the foundation for other seemingly unrelated conditions such as frequent respiratory infections, allergies, rhinitis, asthma, frequent colds and a number of other health problems such as fibromyalgia, chronic fatigue syndrome, hypoglycemia, adult onset diabetes, auto-immune disorders and alcoholism.
The level of the adrenal stress hormone cortisol is a common measure of stress. It is important to remember that all stresses are additive and cumulative. That is, the number of stresses, whether or not you recognize them as stresses, the intensity of each stress and the frequency with which it occurs, plus the length of time it is present, all combine to form your total stress load.
One of the commonly overlooked sources of stress and resistant adrenal fatigue is chronic or severe infection. Adrenal fatigue is often precipitated by recurring bouts of bronchitis, pneumonia, asthma, sinusitis, or other respiratory infections.
Anyone who does not get enough rest and relaxation to enjoy life, who drives him/herself constantly, who is never satisfied or is a perfectionist, who is under constant pressure (especially with few outlets for emotional release), who feels trapped or helpless, who feels overwhelmed by repeated or continuous difficulties, or who has experienced severe or chronic emotional or physical trauma or illness is probably already suffering from some degree of adrenal fatigue.
They often suffer from Syndrome X (a complex of signs and symptoms that includes glucose intolerance, increased triglycerides, low HDL cholesterol, insulin resistance, hypertension, central obesity, and accelerated atherosclerosis). These disorders reflect the effects of stresses that produce elevated cortisol levels. However, sometimes this phase is followed in time by a drop in cortisol levels to below normal, as the adrenals fatigue and are less able to respond to the stress.
Primary Components of Lifestyle Leading to Adrenal Fatigue Lack of sleep Poor food choices Using food and drinks as stimulants when tired Staying up late even though fatigued Being constantly in a position of powerlessness Constantly driving yourself Trying to be perfect Staying in double binds (no-win situations) over time Lack of enjoyable and rejuvenating activities Examples of Lifestyles Leading to Adrenal Fatigue University student Mother with two or more children and little support from family or friends Single parent Unhappy marriage Extremely unhappy and stressful work conditions Self-employed with a new or struggling business Drug or alcohol abuser Alternating shift work that requires sleep pattern to be frequently adjusted All work, little play Examples of Life Events Leading to Adrenal Fatigue Unrelieved pressure or frequent crises at work and/or home Any severe emotional trauma Death of a close friend or family member Major surgery – with incomplete recovery or subsequent persistent fatigue Prolonged or repeated respiratory infections Serious burns – including severe sunburn Head trauma Loss of stable job Sudden change in financial status Relocation without support of friends or family Repeated or overwhelming chemical exposure (including drug and alcohol abuse)
If you eat primarily pre-prepared or processed foods and not many vegetables or raw fruits, you can be sure your adrenal glands are not getting the nutrients they need to function optimally and to respond well in a crisis.
especially devastating effect on the adrenals. Written about in older medical literature and still seen frequently by astute physicians, adrenal fatigue is often precipitated by recurring bouts of bronchitis, pneumonia, asthma, sinusitis, or other respiratory infections. The more severe the infections, the more frequently they occur, or the longer they last, the more likely it is that the adrenals will be over-worked.
Children born to mothers already suffering from adrenal fatigue and children who experience severe stress in the womb (including those given above) typically have lower adrenal function. Because of this, from birth on, they have less capacity to deal with stress in their own lives and so are more prone to adrenal fatigue throughout their lives.
Chronic fatigue syndrome, fibromyalgia, alcoholism , ischemic heart disease, hypoglycemia, rheumatoid arthritis and chronic and recurrent respiratory infections all usually involve decreased adrenal function. In the cases of chronic fatigue syndrome and fibromyalgia, substantial evidence is now emerging that these syndromes may result from unusual infectious microorganisms that are not detected by the typical laboratory tests. Special, sophisticated lab tests such as polymerase chain reaction (PCR) tests can, however, detect these invaders. A growing number of peer reviewed papers are now confirming the presence of these microorganisms in these particular illnesses.
In many alcoholics, adrenal fatigue and the resulting hypoglycemia predispose the person to a compulsive desire for alcohol. In other cases of alcoholism, the adrenals become fatigued by the continual use of alcohol. In either case, adrenal fatigue is an intimate component of most alcoholism. Adrenal support greatly enhances the treatment protocol for alcoholism . See the section entitled “Drinks To Avoid” for more detail.
If there is a lack of cortisol from the adrenals in the fetus during development, the lungs don’t develop properly and early problems in the lungs are more frequent and more serious.
The tip-off that there is a low adrenal component to any of these illnesses is a longer than normal recovery period with decreased stamina and excess fatigue.
A doctor’s acute skills of observation, physical examination and deductive reasoning, which used to be considered his most essential diagnostic tools, have now been replaced by reliance on narrowly interpreted lab tests and lists of numerical diagnoses allowable by insurance plans.
Darken the room and sit in a chair in front of a mirror. (See illustration “Iris Contraction Test for Hypoadrenia”). Then shine a flashlight across one eye (not directly into it) from the side of your head. Keep the light shining steadily across one eye and watch in the mirror with the other.
The pupil normally remains contracted in the increased light. But if you have some form of hypoadrenia, the pupil will not be able to hold its contraction and will dilate despite the light shining on it. This dilation will take place within 2 minutes and will last for about 30-45 seconds before it recovers and contracts again. Time how long the dilation lasts with the second hand on the watch and record it along with the date. After you do this once, let the eye rest.
you know how to use your blood pressure measuring device, lie down quietly for about 10 minutes and then take your blood pressure while still lying down. (See illustration “Blood Pressure Test for Adrenal Fatigue”). Next, stand up and measure your blood pressure right after you stand. Normally
ballpoint pen and lightly stroke the skin of your abdomen, making a mark about 6” long. Within a few seconds a line will appear. In a normal reaction, the mark made by the pen is initially white but reddens within a few seconds. If you have hypoadrenia, the line will stay white for about two minutes and will also widen. This test, although not always positive in people with hypoadrenia (about 40% of cases), is a slam dunk confirmation of the presence of hypoadrenia.
Saliva hormone levels are more indicative of the amount of hormone inside the cells where hormone reactions take place. Blood, on the other hand, measures hormones circulating outside the cells, and urine measures the spill over of hormones out of the blood and into the urine. Although blood and urine hormone tests have
For a list of laboratories that do accurate and reliable saliva testing, as well as a list of doctors familiar with this test, see our website at http://www.adrenalfatigue.org
also usually measure DHEA-S levels with the saliva test as well because the adrenals are the primary source of DHEA-S (but not necessarily DHEA). Adrenal fatigue syndrome often involves decreased DHEA-S. The DHEA-S level is a direct indicator of the functioning of the area within the adrenal glands that produces sex hormones (the zona reticularis). Saliva tests for testosterone, the estrogens, progesterone and other hormones can also be done, if needed, and may be of value in working with adrenal fatigue. Testosterone and DHEA-S levels are two of the most reliable indicators of biological age. Testosterone and DHEA-S levels below the reference range for the person’s age may be indicators of increased aging. If the cortisol levels are also decreased, the 3 tests together further indicate chronically decreased adrenal function.
The particular kind of rest you need when you have adrenal fatigue comes not so much from lying down, but from standing up for yourself, and from removing or minimizing the harmful stresses in your life.
7) There are particular nutritional supplements that can be beneficial. Often melatonin (0.3 – 1.3 mg.) taken 30 minutes before bedtime helps establish normal sleep patterns. Calcium citrate (500 mg.) taken with 50 mg. of 5-hydroxytryptophan (5HTP) at night before retiring is also relaxing and helps many people sleep through the night. Trace mineral tablets taken at the evening meal also help relax the body. Adrenal extracts taken ½ hour before bedtime often help those with adrenal fatigue fall asleep and remain asleep. If your adrenal fatigue is moderate or severe, try this one first.
8) The hypothalamus is very important in regulating sleep. Although accurately testing hypothalamic function is complicated, a simple test you can do yourself is to try taking 1-4 tablets of hypothalamus extract and 10-40 mg. of manganese before bedtime and see if your sleep improves. Sometimes the hypothalamus tablets need to be combined with the adrenal extracts to normalize sleep
9) There are also several herbs commonly used to promote better sleep such as hops (whole plant), catnip (leaves), valerian (root) and licorice (root). Although not known as a sedative, the herb ashwagandha can help indirectly through its ability to normalize cortisol and sex hormones, both of which can produce sleep disturbances.
The adrenal hormone cortisol helps keep blood sugar at adequate levels to meet your body’s demands for energy. However, when your adrenal glands are fatigued, cortisol levels drop lower than normal. This makes it more difficult for your body to maintain normal blood sugar levels. As a result, people with adrenal fatigue (hypoadrenia) tend to also have low blood sugar (hypoglycemia).
Conversely, foods high in potassium such as fruit (especially bananas and dried figs) make adrenal fatigue worse.
Many people with adrenal fatigue also have lowered levels of the hydrochloric acid (HCL) necessary to properly break down protein foods in the stomach.
The solution is to take a digestive aid with meals that provides supplementary HCL along with other factors such as pepsin, trypsin, papain and/or digestive enzymes that help your body to properly break down protein.
Drinking salted water just after you wake up can help you to function better in the early morning. Having another glass with a snack at around 2:00 PM can also lessen or sometimes prevent the lows typically experienced in adrenal fatigue between 3:00 to 4:00 PM.
Vitamin C Loading Test. On day one take 500 mg. of ascorbic acid with 250 mg. of bioflavinoids. Increase your ascorbic acid by 500 mg. and your bioflavinoids by 250 mg. every hour until your bowel movements become somewhat loose and runny. Once you have achieved this level, then reduce your ascorbic acid by 500 mg. and your bioflavinoids by 250 mg. This is usually the amount of vitamin C your body needs at this time. The most common point for this to occur is about 2,000 to 4,000 mg. (2-4 grams) for people with adrenal fatigue, but I have known people that required 15,000 to 20,000 mg. (15-20 grams) a day in order to reach this point. Typically, the more chronic and severe your illness, the more vitamin C is necessary.
is important to choose the right vitamin E supplement. Vitamin E, in chemical terms, is a “tocopherol.” Most vitamin E supplements sold in health food and grocery stores are in the form of d-alpha-tocopherol. Although this is a natural form of Vitamin E, it is only a fraction of the complete vitamin E complex. It is the least expensive to manufacture and the most profitable. Therefore, it is not surprising that the majority of companies promote this type of vitamin E, making it the most available type of vitamin E on the market.
Have 800 IU of mixed tocopherols vitamin E per day with meals.
These include zinc, manganese, selenium, molybdenum, chromium, copper, iodine and a host of other minerals in micro amounts.
Some dietary supplements are excellent sources of fiber such as psyllium seed, multi fiber mixtures and a preparation I designed called “Squeaky Clean”* that contains 8 different types of fiber combined with other factors necessary to the health of your digestive tract.
Licorice Root (Glycyrrhiza glabra) – The herb best known for supporting adrenal function is licorice. Yes, the ingredient that gives that common black twist of candy its flavor is beneficial for your adrenal glands. Licorice is an anti-stress herb known to increase energy, endurance and vitality and act as a mild tonic.
Ashwagandha Root and Leaf (Withania somnifera) – Ashwagandha is an ancient Indian herb with a
Korean Ginseng Root (Panax Ginseng) – Panax ginseng is an herb more suitable for men than for women. Although it has been shown to help increase cortisol levels, my experience is that while men can usually take Panax ginseng with mild to significant benefits, women should be careful in its use. This type of ginseng, especially Korean Red, can have adverse effects in some women, similar to the adverse effects they experience with excess DHEA.
Siberian Ginseng Root (Eleutherococus senticosus) – Siberian ginseng, although not from Siberia and not strictly a ginseng, is good for women as well as men. It has a wide range of activities that help support and rejuvenate adrenal function, increase resistance to stress, normalize metabolism, and regulate neurotransmitters (which are important in modifying the stress response). It counteracts mental fatigue and is known to increase and sustain energy levels, physical stamina and endurance. With its antidepressant properties, Siberian ginseng has demonstrated its ability to calm anxiousness, improve sleeping, diminish lethargy, lessen irritability and induce a feeling of well-being. It has been used by Russian workers, deep-sea divers and Olympic athletes for better performance and by cosmonauts for stress and disease resistance, increased vitality and to counter depletion of the adrenal stress hormones. In addition it has been shown to normalize blood sugar, stimulate antibodies to bacteria and viruses, increase resistance to environmental pollutants, improve absorption of some B vitamins and decrease vitamin C
Ginger root (Zingiber officinale) – Ginger root is another adaptogen for the adrenals that helps modulate cortisol levels, normalize blood pressure and heart rate; burn fat; increase energy and metabolic rate, and stimulate digestive enzyme secretions for proteins and fatty acids. Ginger is great for nausea of any kind and has been used historically for morning sickness during pregnancy. It also decreases lethargy during convalescence from an illness and has been used for centuries for many different health purposes.*
Ginkgo leaf (Ginkgo biloba) – The adrenals suffer tremendous oxidative stress when under stress themselves, especially when producing excess cortisol during the stress response. This leads to a significant increase in free radicals within the same adrenal cells that make the needed hormones. If free radicals generated in this process are not neutralized, the production of hormones is slowed and tissue damage increases within the adrenal cells. Ginkgo is a powerful anti-oxidant that sequesters free radical production,
Footnotes * I have designed an “Adrenal Exhaustion Formula” that contains correctly balanced proportions of B vitamins, including a non-flushing niacin, combined with more vitamins, minerals and other nutrients balanced to work in synergy to optimize adrenal function. Check the adrenal website for details. * A list of supplement manufacturers and suppliers is given in a constantly updated list on our website
These extracts have been the cornerstone of effective therapy for adrenal fatigue since they were first developed. There are several brands available in both tablet and liquid form. The liquid is generally more powerful than the tablet, however it is more costly. I usually use the liquid in moderate to severe cases, and tablets in milder cases. Dosage for the adrenal cortical extract tablets is 6-12 per day, depending upon severity, taken in three to four intervals throughout the day. Dosage for the liquid form is usually one vial under the tongue 2 to 3 times weekly or as directed by your physician. In severe cases, it may need to be more frequent. Although these extracts are classified as dietary supplements, they must usually be purchased through a physician.
Adrenal cell extracts nourish and help rebuild your adrenal cells. As these cells recover, they can once again produce the proper amount of the various hormones needed for the many functions performed by your adrenal glands. By this means they tend to normalize adrenal function. In contrast, corticosteroids, whether natural or synthetic, tend to reduce or shut down the activity of your adrenal glands. This happens because your brain senses the presence of these cortisol substitutes and, in response, withholds the signal (ACTH) it would otherwise send to your adrenal glands to make more adrenal hormones. (See illustration –“Cortisol vs. Adrenal Cortical Extracts”). Thus corticosteroids suppress the functions of your adrenal glands, over-riding the normal feed back loops that regulate and balance adrenal hormones. In spite of the fact that this action can produce dramatic initial improvements in your symptoms, these symptomatic improvements come with a heavy price.
For one thing, synthetic corticosteroids are up to 17 times more powerful than the natural form of cortisol. If taken in excess of the physiological needs of the body (above the equivalent of 20 mg of cortisol per day), which many prescriptions are, their unfortunate side effects are many and far-reaching. Even after a course of just a few days of corticosteroid medication, it takes several days to several weeks for adrenal function to return to normal. When taken for a long period of time, the adrenals may require anywhere from several months to 2 years to revive and produce their own cortisol again. Sometimes they never fully recover.
When it is low, it is a good idea to supplement with DHEA if you are a male. Approximately 25 mg. to 200 mg. is the accepted and normal dosage range for men.
It is my clinical experience that women often do not do well on DHEA unless their adrenals are very fatigued. Levels as low as 10-25 mg. have produced symptoms of excess DHEA such as facial hair and acne. A safer and more successful way of raising DHEA levels in women is to have them take either progesterone or pregnenolone, although some studies of women with chronic fatigue syndrome or lupus have found benefit from using 200 mg. of DHEA/day.
In the adrenal cascade, pregnenolone is the first hormone to be made from cholesterol and progesterone is the second. Both can be converted into several other adrenal hormones besides DHEA, including the sex hormones, aldosterone and cortisol. Thus, taking replacement hormones like pregnenolone and progesterone that occur early in the adrenal cascade lets your body’s wisdom choose which other hormones it will make from them, according to your body’s needs. With adrenal fatigue, the sex hormone levels often fall because your adrenal glands are not able to manufacture adequate levels of hormones. One function that sex hormones serve is to act as antioxidants that help prevent the oxidative damage caused by cortisol. So the lower the sex hormones, the more damage there is to tissues, especially when you are under stress. This oxidative damage is one of the key factors in rapid aging. Either pregnenolone or progesterone can better be used to raise the hormonal levels in both men and women, and decrease some aspects of adrenal fatigue. By bypassing the very complex and energy consuming steps required of your adrenals to make pregnenolone or progesterone from cholesterol, your adrenals do not have to work nearly so hard to keep your hormone levels adequate.
both these hormones have been used very successfully to diminish premenstrual syndrome (PMS). This is not surprising considering that the most common cause of PMS seems to be too little progesterone and/or too little magnesium. Progesterone is made in both the ovaries and the adrenal glands. Women suffering from adrenal fatigue often have lower saliva progesterone levels and increased PMS. The addition of oral pregnenolone or natural progesterone cream is often needed for relief of PMS and female complaints common in adrenal fatigue.
With pregnenolone 10-40 mg. per day is usually sufficient, taken orally, and 20-30mg. (1/4 – ½ tsp.) per day of progesterone when applied as a cream to the skin.
An excellent book that covers this topic is by Dr. John Lee, What Your Doctor May Not Tell You About Menopause.
The blood picture sometimes shows a mildly elevated (11,000-15,000 cu.mm.) or decreased (< 3,000 cu.mm) number of white blood cells.
Mildly increased sedimentation rate (ESR) Increased total serum globulin Increased lymphocytes Increased LDH isoenzyme #1 Decreased lymphocytes with neutrophils increased = chronic bacterial infection Increased lymphocytes with neutrophils decreased = chronic viral infection
Lack of sleep can also increase circulating estrogen levels, upsetting the hormonal balance. This is in addition to the decreased alertness and concentration that most people experience when missing an inordinate amount of sleep. Lack
1) Your basal body temperature, taken before rising in the morning, is below 98.2°F (oral) or 97.2°F (underarm).
Taking a hypothalamus extract may help normalize your thyroid as well as your adrenal function when they need a little fine-tuning. Sometimes your thyroid only requires the addition of a nutritional supplement containing the proper nutrients in a form that can be easily absorbed and utilized efficiently by the thyroid. This usually allows the thyroid to rebound in 2-3 months. Check the website for suggestions on natural thyroid supplements.
Output of adrenal sex hormones and their precursors also decreases with age. A decline in DHEA and testosterone levels accounts for many of the degenerative processes of aging. In fact, the levels of these two hormones in males track the progression of biological aging more closely than do any other markers. As we lose the available DHEA and testosterone, we become less able to counter the intense effects of cortisol in the cells. With age, cortisol levels remain relatively steady,
Also like cortisol, its production and secretion increases and decreases in response to stimulation of the adrenal cortex by ACTH. This means that aldosterone levels generally rise in stressful situations. However, aldosterone is not part of the negative feedback loop controlling its release. Instead, it depends on the negative feedback loop in which cortisol levels trigger ACTH activity. This means that cortisol determines the amount of ACTH which controls production of both cortisol and aldosterone with aldosterone having no say in the matter. The only thing the cells that produce aldosterone can do to regulate production is to alter their sensitivity to ACTH. Therefore, after about 24 hours, the adrenal cells of the zona glomerulosa become less sensitive to the demands of ACTH and stop manufacturing more aldosterone. The amount of circulating aldosterone then begins to decrease, even though the ACTH levels are high and the need for increased amounts of aldosterone may continue.
Working with other hormones such as anti-diuretic hormone from the pituitary and renin and angiotensin I and II from the kidneys, aldosterone keeps the fluid balance and salt concentration intact, in roughly the same concentration as sea water. In the blood and interstitial fluid, sodium is the most dominant of the four minerals. Inside the cells, potassium has the highest concentration. These four minerals are called electrolytes because they carry minute electrical charges. These electrolytes are very important for proper cell function and fluid properties and they must remain in a relatively constant ratio to each other and to the body fluids. Small deviations in their ratios to each other or to their concentration in the body fluids means alterations in the properties of the fluid, the cell membrane and the biochemical reactions within the cell. In fact, most of the physiological reactions in the body depend in some way on the flow or concentration of electrolytes. Aldosterone, in times of stress is the major director of these relationships by its influence on sodium and water concentrations.
When the sodium supply of the blood is not replenished by eating salt containing foods or liquids, sodium and water is pulled from your interstitial fluids into the blood to keep your blood sodium levels and water volume from getting too low. If too much salt or fluid is pulled from the interstitial fluids, the small amount of sodium in the cells begins to migrate out of the cells into the interstitial fluid. The cell does not have a great reserve of sodium because it needs to maintain its 15:1 ratio of potassium to sodium. As the sodium is pulled from the cell, water follows the sodium out.
If you are suffering from moderately severe adrenal fatigue you must be careful how you re-hydrate yourself. Drinking much water or liquid without adequate sodium replacement will make you feel worse because it will dilute the amount of sodium in your blood even further.
When you are already low on body fluids and electrolytes, as you are in this situation, you should always add salt to your water. Do not drink soft drinks or electrolyte rich sports drinks, like Gatorade™, because they are high in potassium and low in sodium, the opposite of what someone with low cortisol levels who is dehydrated needs.
proportions. One of the easiest ways to accomplish this is to drink small repeated doses of water accompanied by a little food sprinkled with kelp powder. Kelp powder contains both potassium and sodium in an easily assimilated form. Depending upon taste and symptoms, extra salt can be added.