Defining Adrenal Fatigue
Adrenal fatigue is not a new condition. People have been experiencing this condition for years. Although there is increasing physician awareness, many are not familiar with adrenal fatigue as a distinct syndrome. Because of this lack of knowledge, patients suffer because they are not properly diagnosed or treated.
Dr. James L. Wilson coined the term "adrenal fatigue" in 1998 to identify a group of signs and symptoms that people experience as a result of suboptimal adrenal gland function when people are at rest, under stress, or in response to consistent, intermittent, or sporadic demands. The adrenal glands are two small glands that sit over the kidneys and are responsible for secreting over 50 different hormones—including epinephrine, cortisol, progesterone, DHEA, estrogen, and testosterone. Over the past century, adrenal fatigue has been recognized as Non-Addison’s hypoadrenia, subclinical hypoadrenia, neurasthenia, adrenal neurasthenia, and adrenal apathy.
Generally patients who present with adrenal fatigue can often be heard saying, "After______, I was never the same." The onset of adrenal fatigue often occurs because of financial pressures, infections, emotional stress, smoking, drugs, poor eating habits, sugar and white flour products, unemployment and several other stressors. After experiencing many of these events over a long period of time, the adrenal glands tend to produce less cortisol, the body’s master stress hormone. Cortisol’s main role in the body is to enable us to handle stress and maintain our immune systems. The adrenal gland’s struggle to meet the high demands of cortisol production eventually leads to adrenal fatigue.
People with adrenal fatigue have a distinct energy pattern. They are usually very fatigued in the morning, not really waking up until 10 AM, and will not usually feel fully awake until after a noon meal. They experience a diurnal lull in their cortisol (the stress hormone produced by the adrenal gland) and as a result, people with adrenal fatigue feel low during the afternoon, generally around 2-4 PM. People with adrenal fatigue generally begin to feel better after 6 PM; however, they are usually tired after 9 and in bed by 11 PM . People with adrenal fatigue usually find that they work best late at night or early in the morning.
Adrenal Fatigue Signs and Symptoms
People with adrenal fatigue have a distinct energy pattern. They are usually very fatigued in the morning, not really waking up until 10 AM, and will not usually feel fully awake until after a noon meal. They experience a diurnal lull in their cortisol (the stress hormone produced by the adrenal gland) and as a result, people with adrenal fatigue feel low during the afternoon, generally around 2-4 PM. People with adrenal fatigue generally begin to feel better after 6 PM; however, they are usually tired after 9 and in bed by 11 PM . People with adrenal fatigue usually find that they work best late at night or early in the morning. Other key signs and symptoms of adrenal fatigue include
- decreased ability to handle stress,
- muscle weakness,
- absent mindedness,
- mild depression,
- mild constipation alternating with diarrhea,
- decreased sex drive,
- salt cravings,
- increased blood sugar under stress,
- increased PMS,
- perimenopausal, or menopausal symptoms under stress, as well as many others.
Diagnosing Adrenal Fatigue
Although there no specific tests that will provide a true diagnosis of adrenal fatigue there are tests that may contribute to a proper assessment for adrenal fatigue. Tests to assess adrenal fatigue may include:
- Cortsol Blood Test. Cortisol is the adrenal gland-secreted hormone that plays the most significant role in the body’s stress response. Therefore, the typical blood test for adrenal fatigue consists of measuring a person’s cortisol levels four times a day to measure the cortisol circadian rhythm. Cortisol levels normally fluctuate throughout the day and night in a circadian rhythm that peaks at about 8 AM and reaches it lowest around 4 AM. While it is vital to health for the adrenals to secret more cortisol in response to stress, it is also very important that bodily functions and cortisol levels return to normal following a stressful event. Unfortunately, in our current high-stress culture, the stress response is activated so often that the body does not always have a chance to return to normal. This can lead to health problems resulting from too much circulating cortisol and/or from too little cortisol if the adrenal glands become chronically fatigued (adrenal fatigue). Some physicians might take a AM Cortisol test to diagnose adrenal fatigue. While this might provide some insight, a single blood draw of cortisol levels, is like a snapshot reading and doesn't establish how the cortisol rhythm is functioning throughout the day.
- Cortisol/DHEAS Saliva Test. This test measures the levels of the stress hormones DHEAS and cortisol and provides an evaluation of how cortisol levels differ throughout the day. The test involves simply spitting into a test tube. Cortisol is measured four times - in the morning (8 AM), noon, evening (4 PM) and night (best between 11 PM and midnight). Other steroid hormones, such as estrogen, progesterone, DHEAS and testosterone can be measured along with cortisol in the 8 AM saliva sample, if desired. The National Institutes of Health (NIH) and the World Health Organization (WHO), recognize saliva cortisol testing as being very accurate. Some insurance plans also cover saliva cortisol testing.
- An ACTH Stimulation Test (AKA ACTH Stim Test or Cortrosyn Stimulation Test). The ACTH Stim Test measures the level of cortisol in the blood. There is an established range for what is considered normal. An ACTH stim test result that shows excessive levels of cortisol or too little cortisol can indicate that a person has a medical condition that needs to be treated. Some of the medical conditions that can be diagnosed using the ACTH stimulation test include Addison's disease, adrenal insufficiency, Cuushing’s disease and pituitary gland dysfunction. The ACTH stimulation test results can be difficult to interpret when used alone. This is why physicians use this test along with other tests to make the best diagnosis possible. Once an ACTH stim test has been performed, the results can be used in conjunction with the results of a cortisol test to determine if a true adrenal fatigue (or adrenal insufficiency) exists. An elevated plasma ACTH level in association with a low plasma cortisol level is indicative of adrenal gland fatigue.
- A Postural Hypotension Test. Postural hypotension (also known as orthostatic hypotension) is a drop in blood pressure that occurs upon rising from a horizontal position. To do this test, you will need a blood pressure cuff. Lie down and rest for 5 minutes. Take a blood pressure reading while still horizontal. Then, stand up and take another reading. Normally, your blood pressure should rise 10-20 points. If it drops, particularly by 10 points or more, hypoadrenia is indicated. Generally, the bigger the drop, the greater the adrenal insufficiency. It should also be mentioned that low blood pressure in general is also an indicator of exhausted adrenals when present in conjunction with the other symptoms of adrenal gland fatigue.
- Iris Contraction Test. This test is more subjective and not quantitative like a Cortisol/DHEAS test or a ACTH stimulation test, however it can be used to supplement other test for adrenal fatigue diagnosis. For this test you will need a weak flashlight or penlight, and a mirror. In a dark bathroom or closet, wait a minute for your eyes to adjust to the dark. This will allow your pupils to dilate (open) fully. Then, shine the flashlight into your eyes, and watch the reaction of your pupils for at least 30 seconds. The light should cause your iris to contract, making your pupils (the dark spot in the center of your eye) smaller. Normally, they should stay that way, but if you have adrenal gland fatigue, the iris will be weak and will not be able to hold the contraction, it will either waver between contracted and relaxed, or will contract initially, but then open up after 10-30 seconds. As with the postural hypotension test, the degree to which you "fail" this test is an indicator of the degree of adrenal insufficiency you are experiencing.
- Sergent's Adrenal White Line Test. This test has historically been used to indicate severe adrenal fatigue and Addison's Disease. With a dull end of a spoon, or round end of a pen “draw” a line across your belly. In moderate to severe cases of adrenal fatigue, the line will stay white, and even get wider over the course of time, while a "normal" reaction would be for the line to almost immediately turn red. Milder cases of adrenal fatigue may not exhibit this sign
Note: It is customary for a physician to assess the adrenal glands together with thyroid tests to rule out thyroid insufficiency, which can exhibit similar symptoms to adrenal fatigue.
Adrenal Fatigue Treatment
Treatment for adrenal fatigue revolves mostly around lifestyle modifications that have positive effects on stress hormones. These include incorporating stress reduction and stress management techniques into the daily lifestyle, eating regularly, eating healthy, minimizing processed foods, sugars and stimulants such as caffeine, exercising daily, and sleeping until at least 9 AM whenever possible.
Adrenal Fatigue Diet
A diet that would be conducive to treating adrenal fatigue includes one that combines unrefined carbohydrates (whole grains) with high quality protein and oils (nuts and seeds) at most meals—olive, walnut, fiber, flax and high-quality fish oil.
Here are 11 easy rules to follow to help ease adrenal fatigue symptoms:
- Eat a wide variety of whole, natural foods. Eating a variety of ealthy foods, like low glycemic carbohydrates and lean protein can provide the body with the proper macronutrients, mircronutrients, essential nutrients; and help keep blood sugar levels stable.
- Eat at the right times and regularly. If you have adrenal fatigue, when you eat is almost as important as what you eat. By eating natural, high quality food at frequent, regular intervals, you can help avoid low drops in blood sugar and make a difference in your adrenal health and energy levels. One of the major dietary mistakes made by people with low adrenal output is not eating soon enough after waking. If you have adrenal fatigue, it is very important that you eat before 10:00 am. This is vital in helping to replenish the waning stored blood sugar supply after the previous night's energy needs. An early lunch, preferably before noon, is better than a late lunch because your body quickly uses up the morning nourishment and is ready for more. Between 11 and 11:30 am is usually the best time for lunch. You should also eat a nutritious snack between 2 and 3 pm to sustain yourself for the cortisol dip that typically occurs between 3 and 4 pm. Your evening meal should be eaten between 5 and 6 pm. A few bites of a high quality snack before bed can help get through sleep disturbances.
- Eat lean good quality protein. Examples include lean cuts of meat, fish, fowl (turkey and chicken breast), eggs, dairy and various plant sources (soy and other legumes, nuts and seeds). Try to avoid processed proteins such as packaged lunch meats and processed cheeses. Proteins generally have more nutritional value and are easier to digest when eaten lightly cooked or raw.
- Eat mainly whole grains as your source of carbohydrate. Eating whole grains also help stabilize blood sugar levels, while also keeping your full and regular.
- Combine grains with legumes (beans), or legumes with seeds or nuts to form a complete protein. These type of foods help people with adrenal fatigue.
- Combine a healthy fat, protein and carbohydrate source with every meal. Food combining in this way will keep blood sugar levels stable.
- Eat lots of vegetables, especially the brightly colored ones. Vegetables provide essential vitamins, minerals, antioxidants and a high amount of fiber. It is a good idea to vary how you prepare vegetables, because different nutrients are made available through different cooking methods.
- Avoid fruit in the morning. Fruits contain a significant amount of fructose and potassium, which is a detrimental combination for those with exhausted adrenals.
- Add healthy essential ils to your diet. Mix 1-2 tablespoons of fresh essential oils (cold pressed olive, grape seed, safflower, flax, etc.) into grains, vegetables and meats daily. Essential oils are heart healthy, and can also provide energy for the body.
- Salt your food to a pleasant taste. Some of the symptoms of adrenal fatigue are actually caused by your body's needs for salt. In most cases of adrenal fatigue, salt (in moderation) benefits those who add salt to their diet. Unless you are one of the rare people with adrenal fatigue and high blood pressure, add some salt to your food especially upon rising and at least a half-hour before their lowest energy point of the day. Preferably, 1/8 to 1/2 teaspoonful of sea salt, Celtic salt, or sea salt w/kelp powder added to an 8 oz glass of water. These are the kinds of salts contain the most valuable nutrients.
- Cut our foods and substances that can trigger adrenal fatigue symptoms. People with adrenal fatigue symptoms should try to avoid caffeine, chocolate, processed carbohydrates, hydrogenated fats, and junk foods.
Supplementation to Fight Adrenal Fatigue
The addition of nutritional supplements may also offer additional benefits to patients experiencing adrenal fatigue. They should consider the addition of:
- Vitamin C 2,000-4,000 mg/day Sustained Release
- Vitamin E w/mixed tocopherols 800 IU/day
- Vitamin B complex
- B-6 (150 mg/day)
- Niacin (125-150 mg/day) – as inositol hexaniacinate
- Pantothenic acid (1200-1500 mg/day)
- Magnesium citrate (400-1200 mg)
- Liquid trace minerals (zinc, manganese, selenium, chromium, molybdenum, copper, iodine)– calming effect
Some herbal remedies that have been noted as possible therapies include:
- Ginseng (Siberian or Korean)
- Licorice, Note: Licorice can and, if taken over time, does have a propensity to elevate blood pressure. It should not be used in persons with a history of hypertension, renal failure, or who currently use digitalis preparations such as digoxin.
If depression is present – Add SAM.e 200 mg bid; DL-Phenylalanine (DLPA) 500 mg bid
Supplementation with DHEA, Pregnenolone, and Progesterone under the supervision of a physician hormone may also offer some benefits in treating or preventing adrenal fatigue. There are also several glandular extracts on the market that contain adrenal, gonadal, hypothalamus, pituitary, and thyroid, that are also often recommended. Sometimes the initiation of hydrocortisone may be necessary as a replacement hormone when cortisol is not being produced by the adrenals. While the initiation of corticosteroids, such as hydrocortisone may have quick and dramatic results, they can sometimes make the adrenals weaker rather than stronger. As a result, the initiation of hydrocortisone is usually a last resort. It is important to note that patients may have to undergo treatment for 6 months to 2 years.
About the Author
Jeff Behar, MS, MBA is a well known author, champion natural bodybuilder, is a recognized health, fitness and nutrition expert, personal trainer, and life coach with over 30 years of experience in the health, fitness, disease prevention, nutrition, and anti agingfields.
As a recognized health, fitness and nutrition expert, Jeff Behar has been featured on several radio talk shows, TV, and featured in popular bodybuilding publications such as Flex and Ironman. Jeff's work has appeared all across the web, in books, and in peer reviewed scientific journals.
Jeff Behar is also the founder of the very popular www.MuscleMagFitness.com and www.MyBesthealthPortal.com health and wellness information websites; two of the largest 24/7 online web portals providing 24/7 news and information about top health, medicine, wellness, fitness, diet, nutrition, weight loss and anti aging issues that are being discussed today.