Adrenal Exhaustion happens when the adrenal glands are unable to effectively secrete enough cortisol. (click here for my article on cortisol 101) There are three stages of adrenal fatigue (or exhaustion).
Stage 1 Adrenal Exhaustion is distinguished by an increase in output of ACTH by the anterior pituitary gland, increased adrenocortical stimulation, increased cortisol output and an increased probability of pregnenolone steal and decreased DHEA. Each stage is progressively associated with reduced cortisol production and increased adrenaline. (1)
Stage II Adrenal Exhaustion is marked by the transition from increased to decreased cortisol output. This stage is characterized by continuing high levels of ACTH and thus: adrenocortical stimulation, normal total cortisol output, low or borderline low morning, noon or afternoon cortisol levels, normal nighttime cortisol level, and an increased probability of pregnenolone steal and a further decrease in DHEA. This is a transitional phase in which although ACTH stimulation remains high or even increases, the adrenal output of cortisol declines due to the adrenal fatigue associated with continued hyper stimulation. (1)
Stage III Adrenal Exhaustion is an advanced stage of adrenal exhaustion characterized by decreased total cortisol output. This stage is characterized by continuing high levels of ACTH and thus adrenocortical stimulation, low total cortisol output, and increased probability of a low nighttime cortisol level and pregnenolone steal and even further decrease in DHEA. The adrenal glands are now exhausted to the point that even though there is ongoing hyperstimulation (high ACTH); they continue to lose their capacity and reserve to produce enough cortisol. The eventual result is a crash of the hypothalamic-pituitary-adrenal axis (HPAA) in which essential neuroendocrine feedback loops are unable to return the system to homeostasis.(1)
What is the Cause of Adrenal Exhaustion?
1. Prolonged periods of stress:
Multiple stressors happening at the same time, such as financial problems, emotional issues, environmental concerns, cultural difficulties, poor eating habits, too many stimulants, overworking, inadequate sleep – to name a few.
2. A traumatic event or acute stressor
3. A combination of both acute and non-acute stressors
Many Common Symptoms of Adrenal Exhaustion are similar to those of depression.
- Feelings of impending doom
- Feeling like someone is “pulling the plug”
- Feelings of apprehension (in that you may not be able to handle the demands of the day or in the near future)
- Extreme tiredness (typically in the morning hours it seems impossible to get out of bed and tackle the day)
- Feelings of Fear
- Anxiety and or Panic
- Feeling like nothing is worth it. You contemplate “giving up”
- You think too much about winning the lotto (there is truth in this humor!)
What do many medical health care professionals tell you about Adrenal Exhaustion?
- “There is no such thing as adrenal exhaustion – it’s not a medical condition.”
- “It’s all in your head. Let me refer you to a psychologist and or psychiatrist.”
- “Here is a prescription for an anti-depressant, sleep medication, a mood stabilizer, beta blocker and or tranquilizer (in the benzodiazepine family)”
Adin’s Comments:
SSRI’s (anti-depressants), sleep medications, tranquilizers and beta blockers and mood stabilizers, can and do, have their time and place for certain applications. Unfortunately, these drugs may be mal-prescribed and only help to mask the problem and not address the etiology of the problem. For adrenal fatigue, the etiology is the lack of cortisol production! You may not need anxiety medications or mood stabilizers if you modulate your cortisol and adrenaline levels. Many people watch their own anxiety vaporize right before their eyes when cortisol levels are restored to normal cortisol levels. In many cases – bye bye visits to the shrink!
If you are lacking cortisol production, increased amounts of the excitatory neurotransmitters may increase adrenaline, which will cause intermittent bouts of anxiety and fatigue. In laymen’s terms, adrenaline decreases as cortisol levels increase. If you do not have enough cortisol, an oversupply of adrenaline will be circulating in your bloodstream and cause anxiety. The anxiety will last until your cortisol levels rise high enough to start to help counter it; the anxiety or panic attack will subside after the adrenaline has been cleared and metabolized in the body.
Important chemical reaction to remember: ACTH (adrenaline) backs down as cortisol levels increase.
How do I help my doctor to help me restore my adrenals and cortisol production?
If your doctor does not believe in adrenal fatigue syndrome - find another one who has experience treating it. Alternatively, you may be able to find an adrenal fatigue expert who looks at the whole picture and then works as a patient liaison to help your physician come to a greater understanding for effective treatment.
If you are locked into a particular doctor due to health insurance or financial constraints, you’ll need some resources to educate your doctor. Please feel free to reference this article and other resources I have listed at the bottom of this page.
Below are some samples of general protocols for Adrenal Fatigue, however these should be implemented under the care of a qualified practitioner.
Protocols for Adrenal Fatigue
1. First and foremost, order the adrenal saliva test through a lab, such as Diagnos-Techs or BioHealth, to determine your current adrenal fatigue/adrenal exhaustion status. An MD, DC or ND will be able to order this test for you. Adrenal testing is best completed on a normal workday to ensure accuracy. Pre-menopausal women may need to get this test done at different stages in her cycle to ensure accuracy.
To see what this test involves read my blog on “How To Test Your Cortisol Levels”
General Nutrition and Lifestyle protocols:
I recommend reducing your intake of caffeine, sugar and alcohol .Eating mostly organic foods, gett enough quality sleep, take time for a massage at least once per month and exercise with appropriate intensities. Meditation, yoga, tai chi or chi gong exercises, sauna (steam preferably) or anEpsom salt bath can support the adrenals and calm your nervous system. Do not shy away from the healthy fats, as they are the building blocks of hormones. If high stress continues, it will start depleting precious hormones. Believe it or not, cholesterol will help slow down hormone leaching in cases of adrenal fatigue.
Suggestions for Lifestyle Changes:
- Identify the plugs and drains in your life.
- Do not commit to people, activities or things that drain your energy.
- Get plenty of sunshine and boost your mood. Vitamin D is a very important vitamin, synthesized by the sun or received through supplementation (Occasionally test for Vitamin D3 deficiency and use D3 supplements if needed)
- Get support from your friends and accept nurturing and affection
You may benefit from one or more herbs and supplements during the daytime to help you minimize your stress levels, such as:
- Chamomile Tea
- Relora
- Magnesium
- Inositol Powder
- L-5 MTHF form of folic acid
- A quality Multi-Vitamin
- Supplemental Vitamin C – up to 3 grams in divided doses (build up to tolerance as it can cause a laxative effect)
- B Vitamin Complex both AM and PM
- Numerous forms of traditional Chinese herbal formulas for adrenal support (I use a company called TCM Zone, so I do not have to worry about contaminated herbs)
- There are also some Americanized forms of adrenal formulas I like, one of the being Adreset by Metagenics which contains Cordyceps, Asian ginseng root and Rhodiola root extract.
- Electrolytes (one easy way to get trace minerals is through putting a pinch or two of Celtic Sea Salt in a 8-24 ounces of water.
- Liquorice Root Extract (use only for stages II and III, as liquorice increases the half life of cortisol)
In the meantime, if you feel you are stressed out – don’t wait!
Contact us and de-stress through one of our customized adrenal fatigue elimination programs. Additionally, one of the most effective ways to get yourself out of adrenal fatigue is to have a properly designed exercise program at Premier Personal Training.
Resources: BioHealth Diagnostics
Below is a sitemap of my other articles on adrenal fatigue:
http://siliconvalleyfit.com/excess-or-deficient-cortisol/
http://siliconvalleyfit.com/protocols-for-low-cortisol-and-adrenal-exhaustion-stage-2-and-3/
http://siliconvalleyfit.com/yet-another-case-study-of-adrenal-fatigue/
http://siliconvalleyfit.com/how-to-test-your-cortisol-levels/
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{ 4 comments… read them below or add one }
Just got saliva testing back and my numbers were not great.
6a.m.- 8a.m. 9 depressed 13-24
11-1p.m 8 normal 5-10
4-5p.m 5 normal 3-8
10-midnight 5 elevated 1-4
Total SIgA less than 5 depressed
Estrone was elevated 89 range for 50-59 26-64
cortisol DHEA correlations was in Zone 4 Maladapted phase 11
Dehydroepiandrosterone 1 Depressed Ref values 3-10mg
Have gained 10 pounds in a 3 month period. 5 in the last month.
Eat Gluten free, dairy free, mostly sugar free, soy free,
Very frustrated. Do eliptical 6 days a week for 45-60hr. different intervals
weights 3 times a week at a gym, trainer set up a program. Have worked out like this for last 4 years.
Please give me some thoughts please. Meeting with Dr. Jeffery Gladd in Fort Wayne, Indiana.
Thanks so much!
Debbie,
According to your saliva test, you have inverted cortisol. Your cortisol should be at its highest (within the normal range) in the morning and lowest (within normal) in the evening. DHEA is commonly low in adrenal fatigue due to cortisol stealing pregnenelone, which in turn decreases DHEA.
If you are female, testing hormones can be more complex and I would need a fuller clinical picture to comment intelligently. Just a side note on hormones, avoid testing just one like estrone. You’ll want a comprehensive blood panel so you can fit the pieces of the puzzle together with your Doctor.
You are doing too much cardio both in frequency and duration (regardless of intervals). This is can be a fantastic way to trash your adrenals. Also, the time of day in which you do your cardiovascular sessions can be a huge factor.
Lastly, it is common to have inverted cortisol that precedes the ladder stages of adrenal fatigue. It’s great to hear you are taking action now before it gets worse.
In health,
Adin
Hello! This is one website packed with useful information and I appreciate that. I will be getting some tests done soon myself.
What really interested me was the comment left by debbie. I believe I have inverted cortisol too. It would only make sense. I am always most tired in the morning (which would signify higher cortisol/low adrenaline) then at night I get wired up like you wouldn’t believe. Which I’m assuming is low adrenaline high cortisol.
My question is, can a change in eating habits alone trigger this? I really noticed my adrenal fatigue symptoms getting worse when I stopped eating between the hours of 8am-3pm, and got most my food after work, all the way till night before going to bed. I essentially stopped eating at work for a couple years, and noticed my fatigue slowly getting more and more extreme.
Am just now thinking about it. But doesn’t food kinda maintain all these hormones? If your body starts getting food at the wrong times of day (especially at night) something is telling me this has wreaked havoc on my hormones. Plus I think beta blockers and norvasc had a lot to do with it. Have been on these meds for a few years too and I think inderal is making my adrenal fatigue worse.
Problem is, when I stop the inderal I get a rush of adrenaline/anxiety naturally. I can stop for a couple days, by the second day though I always need to take a little bit for the adrenaline rush. Right now I’m down to about .5mg of inderal, and am not sure how to get off it. If I jump off the inderal, and take a supplement to raise cortisol like isocort, can then help get me off the inderal? I really believe its slowing down my recovery or making it worse all together. Thanks!
“..can a change in eating habits alone trigger this?” Yes, however — there can be multiple causes for this and very rarely is it there just one cause. For example, you can eat the best quality organic foods and if you sleep poorly, all sorts of problems can occur.
If you skip meals — especially breakfast, cortisol levels will rise and you can expect blood sugar regulation issues.
Are beta-blockers making your adrenal fatigue worse? It’s hard to say without knowing you, but many people are prescribed beta blockers for anxiety — not because of any cardiac issue. Beta blockers for anxiety can be a great stall until you find other strategies that can prevent it or deal with the etiology. Sounds like you could use some help with some doctors (typically concierges doctors that focus on prevention and or other natural health practitioners that could give you a other opinions and treatment options.