by Dr. Will Cole
If you read about health, you’ve probably heard of something called “adrenal fatigue.” Some sources talk about it like it is a common and serious problem. Others say it isn’t a real thing at all. So what gives? What is adrenal fatigue, it is real, and might you have it?
First let’s consider what your adrenals are. These endocrine glands that sit on top of your kidneys regulate many critical hormones that do important work in your body, such as secreting cortisol, a primary stress hormone. We need cortisol in emergency situations, so we can shift into fight-or-flight mode for survival purposes. When the body perceives stress and releases cortisol, you experience measurable increases in blood pressure, blood sugar, and energy. After the threat has passed, your body calms itself back down, returning your vitals to normal again.
The problem is that modern life tends to be stressful not just in emergency situations but all the time. Unlike acute stress, for which we’re biologically hard-wired, chronic stress turns on the fight-or-flight response without turning it off again, so blood pressure and blood sugar stay high and we remain in an elevated state. Of course, this can only go on for so long. At some point, our ability to keep releasing cortisol gets tapped out, after being triggered so often and for so long. The result? Adrenal fatigue.
Adrenal fatigue is different than other adrenal gland problems. It is more common and also more difficult to pin down, but functional medicine practitioners have gotten pretty good at recognizing it and testing for it. Here are some of the chronic stressors that I have found can lead to adrenal fatigue.
- Excessive exercise
- Toxin exposures
- Emotional stress
- Autoimmune conditions
- Food intolerances
- Chronic gut infection
These stressors can cause cortisol to remain high for a long time, tiring out your poor adrenal glands. When this happens, symptoms are likely to include at least some of the following:
- Trouble falling asleep or staying asleep
- Blood sugar fluctuations
- Changes in blood pressure
- Low immune system
- Digestive issues
- Brain fog
- Increased allergies
- Weight fluctuations
- Decreased sex drive
So yes, adrenal fatigue exists, and functional medicine’s focus is not just to treat symptoms but to address the underlying biochemical mechanisms that are at play. What is causing your adrenal fatigue? The secret to understanding adrenal fatigue is understanding its origin: your brain.
Your brain tells your adrenal glands what to do through a complex web of communication called the hypothalamic-pituitary-adrenal axis (HPA axis). Your hypothalamus releases corticotropin-releasing hormone (CRH), which tells the pituitary gland to release the adrenocorticotropic hormone (ACTH). ACTH then tells your adrenal cortex to release cortisol.
This may sound complicated, and it is, but the bottom line is that adrenal fatigue is really a dysfunction of your brain’s communication with your adrenals (HPA axis), not the adrenal gland itself. Adrenal fatigue is nuanced and multifaceted and is drastically under diagnosed. Because this is not a situation that can be easily “fixed” by a pharmaceutical, modern medicine doesn’t have an easy solution, given its standard model of labeling a disease and matching it with a corresponding drug. This is why so many people struggle with adrenal fatigue and don’t even know it.
But functional medicine has a different model and can diagnose adrenal fatigue with a personal history coupled with lab tests. There are three main stages of adrenal fatigue: The first stage is marked by a high cortisol, which can be detected by a cortisol test. The second stage is characterized by normal (falling) cortisol levels, which makes it difficult to detect. The third phase of adrenal fatigue is when the adrenals are no longer able to produce sufficient cortisol, which is where we see low cortisol on labs. If it turns out you have adrenal fatigue – or suspect you do – here is the solution:
1. Get a comprehensive diagnosis with labs
One of the labs I run on my patients is a 24-Hour Adrenal Stress Index, a salivary test which tracks your cortisol levels, HPA axis quality, and other hormone levels throughout the day to get a comprehensive view of what’s going on in your particular case. This can be very useful in determining the condition of your adrenal glands.
2. Remove as many chronic stressors in your life as you can
Removing or limiting excessive exercise, toxic exposure, emotional stress, and addressing autoimmune conditions is essential to breaking the chronic stress cycle, regaining your health, and feeling like yourself again. It’s time to take it easy and practice some serious self-care.
3. Get individualized care and treatment.
A health program should be tailored to your specific needs and lab results. Chronic stress manifests in many ways, and treatment for adrenal fatigue must fit into your personal model. However, although individual protocols will vary, many will include specific herbal remedies and, in many cases, carefully replacing a small portion of the exact level of the missing adrenal hormones. Specific amounts of DHEA and the precursor to cortisol called pregnenolone will stimulate your body to begin producing those substances again naturally.
If you want to learn more about your own health case please check out our free health evaluation. We offer in person as well as phone and webcam consultations for people across the country and around the world.
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