Adrenal Fatigue

What is adrenal fatigue? You might have it and not know it!

By Kim Crawford, M.D. Last updated: January 25, 2018
what is adrenal fatigue

What is adrenal fatigue?

what is adrenal fatigueWhen someone is left untreated from symptoms of fatigue, symptoms can increase and produce adrenal fatigue. But what is adrenal fatigue?

Adrenal fatigue is a result of adrenal glands which function first way above and then eventually way below their necessary level.

Adrenal fatigue is most commonly associated with intense or prolonged stress. It can also arise during or after acute or chronic infections, especially respiratory infections such as influenza, bronchitis or pneumonia. Also, it can occur due to excess use of stimulants. These can include sinus medications, prescription weight loss medication, and even ADHD medication.

It can happen due to excess caffeine, -especially energy drinks. What is adrenal fatigue? It’s a burnout. It’s an adrenal gland burnout, plain and simple. The burnout starts high and ends low regarding adrenal function.

Conventional doctors (myself included) often pooh-pooh this diagnosis. “What is adrenal fatigue” is a classic question on the A4M oral boards. You bet it’s real. Just ask the people who suffer from it. Are you asking what adrenal fatigue is? If so, this will explain all the details and give you a good kick start to getting better. Read on and don’t worry! It is curable.

A.F. 101 – Intro to Adrenal Fatigue

With adrenal fatigue, you may not have visible signs of a physical illness. You constantly feel tired, unwell, or have “gray” feelings. Those with adrenal fatigue are likely using a stimulant regularly like caffeine or soda to become “awake”. This makes matters worse since excess stimulants often cause adrenal fatigue and worsen it.

Over the past century, adrenal fatigue has had various names, such as non-Addison’s hypoadrenia, sub-clinical hypoadrenia, neurasthenia, adrenal neurasthenia, and adrenal apathy. A large amount of U.S citizens and others around the world experience adrenal fatigue. However, it is yet to be recognized by conventional medicine as a syndrome. This is when Anti-aging doctors like myself “come to the rescue.” In fact, of all the Dr.Kim Crawford “consults” I do, the top two are for weight loss and adrenal fatigue.

Your life can be turned upside down from adrenal fatigue. When an advanced stage of adrenal fatigue is present, adrenal gland activity is so low getting out of bed each day can be unbearable. With each increment of reduction in adrenal function, every organ and system in your body are more profoundly affected. I’ll get describe the stages. If you think you have this ailment, you can figure out “where you are.” Instead of asking what is adrenal fatigue, you’ll be saying either “I don’t have” or “I do have” adrenal fatigue.

If you have adrenal fatigue, changes occur in your carbohydrate, protein and fat metabolism, fluid and electrolyte balance, heart and cardiovascular system, and sex drive. Many other alterations take place at the biochemical and cellular levels.  This response is due to the ultimate decrease in adrenal hormones that occurs with adrenal fatigue. At best, the body will try to keep up with decreased function of the adrenal glands, but will not recover without treatment.

What causes adrenal fatigue?

As previously mentioned, adrenal fatigue occurs when your adrenal glands cannot meet the demands of stress and then a decrease in functioning occurs. Adrenal glands help your body’s response to various types of stress. This is achieved through hormones which regulate energy production and storage, immune function, heart rate, muscle tone, and other processes that enable you to cope with the stress.

loose weight during menopauseNo matter what type of stressful event occurs; emotional, physical, or psychological, your adrenals have to respond to the stress and maintain homeostasis.

If their response is inadequate, you are likely to experience some degree of adrenal fatigue. Your adrenal glands function during adrenal fatigue, but it is not enough to maintain optimal homeostasis.  This is because their output of regulatory hormones diminishes, usually by over-stimulation.

Over-stimulation of your adrenals can be caused either by a highly stressful event, or a constant stressor that has the same effect. I reviewed the many causes, but remember any sort of physical of emotional stress can trigger adrenal fatigue.

For example, if you are an athlete, especially a bodybuilder, overtraining will do it. If you are going through a divorce, that will do it too. Just about anything that is a stress to your system can trigger adrenal fatigue.

Who is susceptible to adrenal fatigue?

Adrenal fatigue can happen to any person, male or female, who is experiencing an illness, life crisis, or a continuing difficult situation. Any of these things can drain the adrenal resources of even the healthiest person. However, there are certain factors that can make you more susceptible to adrenal fatigue. This can include poor lifestyle choices such as an unhealthy diet, sleep loss, chronic illness, prolonged stressful work hours, or a chronic illness or repeated infections.

If you have been to your doctor with symptoms of fatigue, sleep disturbance and they tell you there is nothing wrong, chances are that your doctor doesn’t know the answer to “what is adrenal fatigue.” Since sleep deprivation tends to cause mood disturbances, chances are the only treatment offered was a prescription for anti-depressants. If this is you, I really hope you will reach out to me so I can help you.

What Stage of Adrenal Fatigue might you be in?

Stage one Adrenal Fatigue:

menopause belly fat

In stage one, you are under a lot of stress; physical, psychological, or both. Your cortisol levels are very high. If we check a morning fasting cortisol, it will be high too. Another important hormone put out by the adrenals is DHEA. At this stage, your DHEA levels are generally normal.

So let’s talk about the stress. It might actually be an enjoyable type of stress. Maybe you have a new, exciting relationship or job. On the new job, it’s stressful, but you’re having a ball, and you feel alive.

Perhaps you are loving the excitement of something new. However, your adrenal glands are cranking out the cortisol. Accompanying cortisol, adrenal glands are too producing catecholamines epinephrine and to a lesser extent, norepinephrine. You might be feeling “high on life” for a while with your high cortisol levels.

On the other hand, you may have a negative stress experience like an illness, divorce or financial problems. This type of stress is certainly not enjoyable but produces the same physiologic reaction at this stage, high cortisol.

menopause weight gain solutionsHigh Cortisol Impact

High cortisol will eventually depress your immune system, make you feel fatigued and interrupt your sleep. What is adrenal fatigue? It’s something that causes disability and long term illness if not treated.

You might JUST be going through menopause and the sleep issues caused by drops in progesterone. These issues coupled with hot “flushes” and a little extra coffee start you down the road of adrenal fatigue. I see this a lot.

These latter scenarios are certainly not enjoyable but will also put you into the high-cortisol stage of adrenal fatigue. Either way, if you don’t sufficiently rest and recharge, your adrenals will get overtaxed. This will result in a decrease in cortisol levels, and this is when most people notice there’s a problem.

Translation: The real heavy duty fatigue generally occurs when cortisol has been “cranking” and then the adrenals wave the white flag and decrease production of this and other adrenal hormones. This is when people usually go to their doctor and get the famous anti-depressant prescription. I’ll discuss this below because the doctor likely doesn’t know about adrenal fatigue, fibromyalgia, and a bunch of other things we A4M docs know!

When I evaluate people (I evaluate patients and AWS members or those of you who request a consult) I suspect of having adrenal fatigue I want to know, on a scale of 1-10, where energy levels are all day. I want to know how you feel when you get up, mid- morning, lunchtime, mid-afternoon, dinner-time, after dinner and at bedtime. Honestly, I can spot adrenal fatigue miles away.

A level of 1 means you can’t get out of bed without significant effort and a 10 means you feel fantastic. In stage one, people feel pretty good energy-wise (8-10 all day).

Stage two Adrenal Fatigue:

lose menopause belly fatIn stage two of adrenal fatigue, your cortisol levels are peaking, and adrenal glands are now pumping out excess DHEA.

Excess DHEA doesn’t cause issues. However, you might also be pumping out more of the adrenal hormone aldosterone. If this is the case, you will retain salt and fluids, causing some noticeable water retention.

Somewhere during this stage, high cortisol levels start to cause sleep interruption if it hasn’t happened in stage one already. Usually, at this point, people tend to add more caffeine or other stimulant energy sources to their diets. This stimulant further stresses the adrenals.

High cortisol causes weight gain and especially gain of belly fat. Often menopause is coincident with this, so we have the unexplained weight gain and belly fat of menopause which is quite common. Many women who contact me asking how to lose weight during menopause simply need lept/ghrelin adjustment which is easy to do. Also, women almost always need a cortisol reduction. Now, back to discussing signs of stage two. This is also when your sex drive starts to go away.

At this moment, people know they have some sort of health problem. Energy levels drop to a 6-7 out of 10 with mid-afternoon being typically the worst time of day.

Stage three Adrenal Fatigue:

unexplained weight gain in woman Sleep is definitely affected at this stage of the game. Sleep is interrupted, and when you wake up, you don’t feel refreshed.

Even when you get “enough sleep time” you never have any feeling of normal energy levels.

On lab testing, we see DHEA levels falling and cortisol levels starting to fall as well.

The adrenals are waving a white flag here. Eventually, feeling lousy all the time and/or the sleep deprivation drive people to see a doctor.

A nonAnti-aging doctor will not give you the proper diagnosis of adrenal fatigue 99.99% of the time. He/she will “hear” that you aren’t sleeping, you’re gaining weight and maybe falling into depression from the sleep deprivation.

This is just what I was talking about before. The doctor “figures out” that you’re in a state of depression. So, you leave with a prescription for an anti-depressant. Two weeks later you are still not sleeping and still feel fatigue. Additionally, you’re now feeling “numb” from the anti-depressant. How much did that advice cost you?

Stage four of Adrenal Fatigue:

curbing sugar cravingsAt this stage, your adrenal glands are in need of rescue. You are one burned out puppy. This stage is one of low cortisol, low DHEA, low aldosterone and an inability to function.

Some people require bioidentical hydrocortisone. Most are fine with everything I recommend for treatment discussed in the adrenal fatigue supplements article and the adrenal fatigue diet.

It is a must to take both of the adrenal supplements plus DHEA and to follow the behavioral treatment strictly. Now, you are feeling just awful with energy levels of a 1-3. There is no night-time “energy bounce.”

I get it. You feel awful. I have treated many many people, and I too have dipped down into stage 2-3. I stay on “adrenal support” due to the demands of my life as do many of my hard-charging patients and AWS clients.

How common is adrenal fatigue?

midlife weight gainThere are no recent studies to list. However, there is a one that is still recognizable.

In 1969, Dr. John Tinterra, who specialized in low adrenal functioning, stated he found that around 16% of the public could be classified as severe. However, if all indications of low cortisol were included, the percentage would be more like 66%.

Keep in mind that this was done before today’s era of dual incomes, while caring for kids and aging parents, 9/11 and other attacks, and all the other common stressors we see today.

After practicing Anti-aging medicine for many years, “decreased energy” is always among the top three complaints leading someone to seek out my care. When I ask new patients (versus my blog readers) if they know about adrenal fatigue they usually are unfamiliar with it. However, they are true believers after 2-3 weeks of my treatment. That’s for sure!

Find Out if you are Experiencing Adrenal Fatigue:

needs foods that give you energy

You may be experiencing adrenal fatigue if you regularly notice one or more of the following:

Constant tiredness for no apparent reason meaning you’ve had a normal physical exam and “regular bloodwork.”

You have trouble getting up in the morning, even when you go to bed at a reasonable hour.

Much of the time, you crave unhealthy snacks. You have sugar cravings which are linked to high cortisol levels. You have even tried to figure out how to curb sugar cravings. Well, here you go!

You have more energy at 6 PM than you have all day. This is a symptom of what is adrenal fatigue stage 1.5.

More often than not, you are feeling rundown or overwhelmed.

You have difficulty bouncing back from stress or illness.

You have interrupted sleep and when you awaken you always want “more.”

how to curb cravingsNo matter what you do, you cannot lose weight.

This is actually quite common. I find many people who have me do labs and a consult for weight control who are in stage one of adrenal fatigue which is more suitably known as adrenal stress.

These people often crave sugar, have stressful lives, and/or they are menopausal.

They respond beautifully to cortisol reduction methods. Email me or find me on chat if you think this might be you!

How do we diagnose adrenal fatigue?

The choice method of testing for adrenal fatigue is through saliva. Saliva offers a great, non-invasive way to look at the adrenal hormones, namely cortisol and DHEA, at various points over the course of the day.

It is much easier to see how the cortisol levels vary and if they are following the normal pattern throughout the day. This happens to be the method NASA uses for their testing. However, as you read this and perhaps “see” yourself, I will tell you the majority of the time I don’t need salivary cortisols to make this diagnosis. I do it with a good history and blood testing. This is not a problem unless there is a big confusion about the diagnosis.

So now what?

adrenal fatigue treatmentIf you are reading this and thinking “wow, this is me,” we still need to “rule out” other things that can cause fatigue from anemia to hepatitis to kidney issues and so on.

Have you been to your doctor? If yes, and you have had an exam and lab testing which left your doctor scratching his head, then you are “safe” to get the adrenal kit.

If you have not seen your doctor, I would advise you to do so or do lab work and consult with me before just assuming that this is the issue. (Even though it likely is).

If we’re sure of the diagnosis, you can put yourself on the proper diet, gentle exercise, stress reduction and supplements program I recommend.


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