Adrenal Fatigue

Ignoring Adrenal Fatigue Symptoms will Cost You!

By Kim Crawford, M.D. Last updated: November 10, 2017
adrenal fatigue symptoms

Do you have adrenal fatigue symptoms?

I’ll bet you came to this blog to see if your personal symptoms match adrenal fatigue symptoms. Well, guess, what? It is estimated that up to 80% of us have some degree of adrenal fatigue and could benefit from some adrenal fatigue supplements or other types of support. Some fatigue or severe mid-afternoon slump is the hallmark of this disorder.

adrenal fatigue stagesQuite often the fatigue is so severe it makes people feel as if they can’t “function properly.”

Because fatigue is such a commonly reported symptom, this syndrome is very often missed or misdiagnosed by physicians.

However, many other symptoms contribute to this diagnosis.

There are 4 different stages of adrenal fatigue which I’ll review.

Each stage is marked by “typical symptoms,” but any of the health symptoms I’ll list below can occur at any time. Let’s review them alphabetically.

ALL Possible Adrenal Fatigue Symptoms

Allergies—development of new ones and worsening of old ones.

Anxiety which can be varied from vague to actual panic attacks (not common).

Autoimmune disorders such as celiac, rheumatoid arthritis and lupus.

Leaky gut.

Cravings for sugar, fat or salt.

Depression which is often related to sleep deprivation.

Fatigue which is usually more pronounced in the morning and afternoon.

Hormonal imbalances of all types.

Immune system suppression leading to more colds and cases of flu.

Libido is notably lower.

Lightheadedness when you get up from sitting or lying down.

Menopausal symptoms such as hot flushes and night sweats are more pronounced.

PMS (technically called PMDD) symptoms increase.

Skin issues from too oily to too dry to rashes.

Sleep issues: (Any or all) Hard to fall asleep; multiple awakenings; unrefreshed sleep meaning you have difficulty waking up in the morning, despite a full night’s sleep.

Stress-handling abilities reduce.

Memory is noticeably worse.

Weakness which is just a vague feeling of not being able to do as much as you used to do but occasionally includes true muscular weakness.

Oddly enough, those suffering from adrenal fatigue often get a burst of renewed energy around 5-7 p.m., become sleepy around 9 p.m. and don’t go to bed, with another “second wind” at 11 p.m. which makes falling asleep an issue. All stimulants used, whether they are drinks, decongestants or diet pills, will make this disorder worse. Stop consuming all stimulants. The only pick-me-ups allowed are natural energy supplements such as acetyl l carnitine.

Is adrenal fatigue affecting you?

Before I review the four stages of adrenal fatigue, I want to share with you why I’m so interested in helping you get better from your AF. First of all, like all good over-achievers, I had this issue and had to figure it out myself—not one colleague was familiar with it. I have to be on guard that I don’t “overdo everything.” That’s just my personality. Therefore, I stay on adrenal support and especially good aromatherapy. Are you like this too? Even if you’re not, I bet you have a lot of demands in your life, don’t you?

adrenal fatigue symptomsWell, in my opinion, life is more demanding now than it was 20 years ago. Keeping up with emails, texts, and social media takes a lot of energy. Not to mention, none of which existed 25 years ago.

Here is the other reason this problem fascinates me. Before I started this website, I sorted through thousands of patient charts. I was looking to catalog the top issues with which my patients all first came to me.

I knew weight and stress were both highly common issues, but it didn’t register immediately how much “lack of energy” was. A good 50% of patients were at stage two adrenal fatigue or worse!

Of the 50%, all were functioning “normally” meaning meeting all obligations while not feeling peak, to say the least. It then hit me that just about everyone had this problem; this certainly includes people who were juggling careers, families and taking care of elderly parents (no small task). So, when you’re done with this article, do use the search at the bottom and find what you need to get better. I even have an article presenting the specific adrenal-healing anti-inflammatory diet you need. You can get better and stay better—ask ME! Now, let’s continue exploring the symptoms of adrenal fatigue as they occur in different stages of the syndrome.

Stage one of Adrenal Fatigue:

At this stage of the game, you are under medium to high stress which is physical, psychological or both. Perhaps, the stress has now passed, and you’re left with the after-effects. Your cortisol levels will be quite high. A fasting cortisol will be reliably high and is a good screening test. Another important hormone produced by the adrenals is DHEA. A third is a salt-preserving hormone called aldosterone. At this stage of adrenal fatigue, your DHEA and aldosterone levels are normal.

A quick word about your stress. You might be experiencing stress due to something which is enjoyable and doesn’t feel stressful. Perhaps you have an exciting job where your opinion is valued, you travel a lot, eat and sleep “on the run” but you don’t care. However, your adrenal glands care.

Even with “excitement stress” your adrenal glands will still crank out the cortisol.

experiencing l-carnitine benefits

Along with cortisol-cranking, your adrenal glands are also producing too many catecholamines.

These catecholamines are called epinephrine (adrenaline) and nor-epinephrine (nor-adrenaline).

You might be “riding a life high” for a while with your high adrenaline and cortisol levels.

Alternatively, you may more easily identify that you are or were “under stress” because of a “negative stress experience” such as illness, divorce or financial difficulties.

This type of stress is by no means enjoyable, but it causes the same physiologic reaction. So, what’s the issue then with having a high cortisol if you can have it and not “feel it?”

The Impact of High Cortisol:

High hormone cortisol will lead to immune system depression which (short term) leads to more colds and cases of flu and then (long term) leads to auto-immune illness and cancer. It can also make you feel fatigued. It will interrupt your sleep. Exactly what is adrenal fatigue? It’s something that causes short term fatigue and sleeplessness but long term disability if not treated.

It can creep up on you out of nowhere. For example, maybe you’re going through menopause. You’re losing sleep due to progesterone loss and having estrogen-loss-hot flushes waking you up too. To follow, you increase coffee intake in the morning and further stress your adrenals with a couple of shots of energy drinks in the afternoon. Your cortisol inches up, giving you belly fat. Due to this, you go on a diet further stressing your adrenals.

Does this sound at all familiar? Remember I can help you with any of these health issues! This high-cortisol stage of adrenal fatigue is easy to treat so if you’re “here,” please “hop on it.” It won’t just go away. If you don’t sufficiently rest and recharge, your adrenals will “not be happy.” You will head into stage 2 and, quickly, 3 of adrenal fatigue which is where we start seeing a decrease in cortisol levels. This is when most people notice that “Houston, we have a problem.”

Let’s talk about how experienced doctors evaluate energy levels in AF-suspected patients. We need to know where energy levels are all day and ask people to rank levels on a 1 to 10 scale. Specifically, we want to know how you feel when you first get out of bed, at mid-morning and then, at lunch time. We want to know how you are doing mid-afternoon (the typical big-slump-time), at dinner, about 2 hours after dinner and right before you go to bed.

I can spot adrenal fatigue miles away. Sure, we do salivary testing when needed, but, most of the time, it’s just a waste of money to confirm what is obvious. The only thing where all other typical labs are normal and you have this type of fatigue/other symptoms would be a biotoxin (usually mold) illness. Back to adrenal fatigue-

A level of 1 means you can barely get out of bed. A level of 10 means you feel fantastic enough to run a mile flat-out. In stage one, people feel pretty good energy-wise, giving no real fluctuations from being a level 8-10 all day.

Stage two of Adrenal Fatigue:

When you hit stage two of adrenal fatigue, your hormone cortisol levels are at their peak. Your adrenal glands are now pumping out excess DHEA. While extra DHEA doesn’t appear to cause issues, there is something else occurring that definitely does. If your adrenals are also pumping out more aldosterone, you’ll see that in action. You will retain salt and water, causing noticeable fluid retention. In fact, sometimes tight rings and puffy ankles are the first adrenal fatigue symptoms some people report. However, soon afterward, sleep issues and fatigue do hit.

Somewhere during stage two, high cortisol levels in the body will start to will cause fatigue and usually sleep interruption as well. This is when people tend to add more caffeine or other adrenal-zapping stimulants to their diets. At this stage, your sex drive starts to go away as well.

At this juncture, people are aware that “something is wrong.” Energy levels drop to a 6-7 out of 10 with mid-afternoon being typically the worst time of day.

Stage three of Adrenal Fatigue:

symptoms of adrenal fatigueThe real heavy duty fatigue occurs when cortisol has been “cranking” and then the adrenals decrease the production of it and the other adrenal hormones.

At stage three, you are continuously experiencing lousy sleep. In addition, you have deficient energy with only that night time bump or two I talked about earlier in the article.

Sleep is definitely affected at this stage of the game.

Your sleep is super-interrupted, and when you wake up, you don’t feel refreshed.

You want to smack that alarm and go back to sleep for hours. Even when you get “enough sleep” your energy is just awful in the morning. These are the real classic symptoms of adrenal burnout. On laboratory testing, we see DHEA levels decreasing and cortisol levels starting to fall as well. If someone obtains aldosterone levels, they begin to decrease too. That is what causes the lightheadedness upon positional change.

Eventually, feeling this lousy all the time sends people to see a doctor. A non Anti-aging/Functional Medicine/Integrative Medicine doctor will not give you the correct diagnosis of adrenal fatigue the vast majority of the time. He/she will “hear” that you aren’t sleeping, probably gaining weight (due to being too tired to exercise) and maybe falling into depression from the sleep deprivation. You’re also anxious about not being able to keep up with your responsibilities.

The doctor “figures out” that you’re in a state of depression/anxiety. So, out comes the prescription pad and you leave the office with a prescription for an anti-depressant. Has this actually happened to you? I have scores of patients and AWS consult clients who received this treatment. Two weeks later you still feel fatigue and are not sleeping. However, in addition, you’re now feeling “numb” from the anti-depressant. It’s not your doctor’s fault if they are a general practitioner as their education only allows them so much. They tried. I am just glad you’re here now!

Stage four of Adrenal Fatigue:

This stage is one of low cortisol, low DHEA, low aldosterone and an inability to function. Many people require bioidentical hydrocortisone. Some are fine with everything I recommend for treatment. Remember to eat the specific adrenal fatigue diet. Now, you are feeling simply awful with energy levels ranging 1-3. There is no “energy bounce.” You can barely function.

You feel like cr*p. I understand fully. I too have dipped down into stage 3—not 4, but 3 is next-to-awful. Personally, I stay on “adrenal support” due to the demands of my life as do many of my AWS clients and private patients. 

You will get better. I would feel totally remiss if I didn’t mention everything you need to get better is available in the adrenal fatigue treatment kit.


  1. Thanks for making this super clear!

  2. Great read! I got to stage 4 and let me tell you, it was no fun, nor was helpful trying to ask my PCP about my symptoms. I was reading your article about hormones and it all kind of clicked! I realized my hormonal issues were stemming from my poor drained out adrenal glands. Thank you for sharing your information!

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