What Is Adrenal Fatigue? Is It A Real Condition?

Do you feel wired but tired, sleepy during the day but wide awake at night? What about unexplained weight gain, temperature fluctuations, or lowered immune function? If you thought these were normal signs of aging, I have good news for you. They are not! These symptoms are common red flags for a syndrome often called Adrenal Fatigue, which is easily corrected with diet, supplements, and some lifestyle adjustments.

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What is Adrenal Fatigue?

Adrenal fatigue is a syndrome that describes a constellation of symptoms commonly associated with high levels of constant stress. When the body is in chronic stress mode, cortisol, the stress hormone, is pumped out to help combat the stress. Unfortunately, this can lead to hormone imbalances, affecting numerous parts of your body.

It's important to note that Adrenal Fatigue isn't a recognized "medical diagnosis" in conventional medicine. However, it is a very common diagnosis in Integrative and Functional Medicine.

Some doctors refer to Adrenal Fatigue as "Adrenal Dysfunction," "Adrenal Exhaustion," or "HPA Axis Dysfunction."

*(HPA = hypothalamus-pituitary-adrenal. HPA is the "mother center" of all hormone regulation in the body)

Adrenal Glands

The adrenal glands are two small glands that sit on top of the kidneys. Each one is about the size of a fortune cookie. They are responsible for secreting hormones like adrenaline and cortisol that help regulate your metabolism, blood pressure, and stress response (aka "fight or flight").  

Adrenal fatigue is thought to occur when a constant level of stress causes the adrenal glands to become "fatigued" and no longer able to produce enough cortisol to keep up with the demands of the body.

What Causes Adrenal Fatigue?

The primary cause of adrenal fatigue syndrome is chronic high stress paired with a maladaptive stress response.

Ideally, cortisol levels should peak in the early morning and decline throughout the day, reaching its lowest level around midnight.

But constant stress can cause HPA axis dysfunction and alterations in cortisol levels in the body throughout the day, often leading to low levels or a flattened cortisol curve throughout the day.

Working nights or lack of sleep during regular hours can also cause cortisol levels to shift.

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How Does Cortisol Affect Adrenal Fatigue?

Almost all tissues in your body have glucocorticoid receptors. Because of this, cortisol, the body's primary stress hormone, can affect nearly every organ system in your body. Optimal cortisol levels are necessary for maintaining homeostasis.

If you have consistently high or low cortisol levels, it can have negative impacts on your overall health as well as causes HPA Axis dysfunction/Adrenal Fatigue.

Common Adrenal Fatigue Symptoms

• Feeling Wired and Tired: Adrenal Fatigue patients commonly wake up exhausted and depend on caffeine to keep them awake throughout the day. Their energy levels tend to crash in the afternoon, but they often get a "second wind" before bed and find they can't wind down or sleep soundly, perpetuating the cycle.
• Weight Gain: Cortisol levels rise during stress to assist fight or flight functions. If you have chronic stress or irregular sleep schedules, your adrenals can take a beating and overproduce cortisol. Over time, high levels of continuous cortisol have been shown to increase belly fat and appetite.
• Temperature fluctuations: Body temperature fluctuates during times of stress and relaxation.
• Sleep disturbances: Cortisol helps regulate sleep patterns and helps the body cope with everyday stress. Normal cortisol levels rise during the early morning hours and are highest at about 7 a.m. They should drop very low in the evening and during early sleep. But if you are in a constant state of stress or on a disrupted sleep schedule, your adrenals can produce too much cortisol causing disturbances in sleep patterns.  
• Decreased Immune Function: When we're stressed, the immune system's ability to fight off infections is reduced. Too much cortisol pumping through our body creates systemic inflammation and an overworked immune system. This decreases the body's lymphocytes — the white blood cells that help fight off infection. The lower your lymphocyte level, the more at risk you are for viruses, including the common cold and cold sores.

Specialty Labs to Test for Root Cause of Adrenal Fatigue

• Cortisol awakening response - The Cortisol awakening response (CAR) is a salivary test that is easy to do at home. It assesses the change in cortisol upon waking and is a surrogate marker for adrenal gland function. An increased CAR can indicate increased stress and HPA axis dysfunction.
• Salivary cortisol levels - diurnal cortisol curve - the cortisol curve is a salivary test that is easy to do at home. It measures cortisol levels throughout the day. Cortisol should be highest in the morning upon waking and lowest at night before sleep. A flattened curve can indicate adrenal fatigue.
• Comprehensive hormone test - comprehensive hormone testing, like the DUTCH test, gives a broader overview of hormone and HPA axis function. It measures cortisol levels and other HPA axis hormones like estrogen, progesterone, testosterone, melatonin, and thyroxine.
• Micronutrient test - micronutrients like B vitamins, zinc, magnesium, and calcium can become depleted due to chronic stress. Micronutrient testing can help identify any low levels and aid in targeted supplementation.

How Do We Treat Adrenal Fatigue?

Nutrition

Integrative and Functional medicine prefers a food-first approach. An anti-inflammatory nutrition plan focusing on whole foods rich in vitamins and minerals is commonly prescribed to support overall health and hormone function.  

It's also essential to avoid processed foods laden with chemicals. Many chemicals can further disrupt endocrine function and worsen hormonal imbalances.

Caffeine is a fast-acting stimulant that works on your central nervous system. It can increase the stress response and further elevate cortisol levels.

Emerging evidence suggests a reciprocal link between circadian rhythms and alcohol metabolism. Alcohol has been shown to disrupt the circadian rhythm, altering cortisol levels over time.

If you are suffering from Adrenal fatigue symptoms, it is vital to not ingest caffeine within six hours of bedtime due to its long-lasting effects and avoid alcohol altogether.

Herbs and Supplements

Adaptogenic Herbs

Adaptogenic herbs, like ashwagandha, licorice root, and Rhodiola, are commonly used to help reduce stress and balance cortisol levels. Teas that contain lavender, chamomile, or lemon balm are calming and can be added to a bedtime routine (2).  

Traditional Chinese Medicine Herbal Formula Suan Zao Ren Tang

Suan Zao Ren Tang (SZRT) has been used for centuries to treat insomnia. Due to its effectiveness, many studies with over 1,454 individuals were tested. The findings demonstrated that SZRT used as a monotherapy was superior to Diazepam alone in terms of PSQI score and clinically effective rate of insomnia. This formula is a safe and commonly used preparation to help patients fall asleep naturally while working on fixing their HPA-Axis dysfunction.

Lifestyle Changes

Lifestyle changes (2) remain the hallmark treatment modality for Adrenal Fatigue. Since chronic stress is often the root cause, it is essential to find supportive and adaptive ways to deal with stress and help the body complete the stress cycle and move into a state of health.  

Many stress management techniques help reduce stress and lower cortisol levels. (2) Meditation, mindfulness, breathwork, yoga, and cognitive-behavior therapy can help reframe stress and alter the body's physical and mental response to stress.

The critical thing to remember about stress management techniques is that they all work, so it's more about finding which one works best for you.

Other lifestyle changes like getting out in nature and prioritizing sleep can help to balance cortisol levels and other hormone levels throughout the day. Lastly, it's important to get daily exercise. Exercise helps reduce stress, regulate cortisol levels, and helps complete the stress cycle to get you out of "fight or flight." (2)

Summary

Adrenal fatigue is a term used to describe a constellation of symptoms that result from a constant state of stress. It is a controversial diagnosis in conventional medicine but is commonly used in Integrative and Functional Medicine to describe changes that can occur due to a persistent maladaptive response to stress.

Symptoms can be reversed with lifestyle and diet changes that support healthy stress responses and lifestyle.