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 changes in how your body handles stress? If you thought these were normal signs of aging, there might be more to consider. These symptoms are sometimes associated with a condition often referred to as Adrenal Fatigue, which some believe can be managed with diet, supplements, and lifestyle adjustments.

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What is Adrenal Fatigue?

Adrenal fatigue is a term used to describe a group of symptoms that some people associate with high levels of constant stress. When the body is in a state of chronic stress, cortisol, the stress hormone, is released to help manage the stress. This can potentially lead to hormone imbalances, affecting various 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 term used in Integrative and Functional Medicine.

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

*(HPA = hypothalamus-pituitary-adrenal. HPA is involved in 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 (also known as "fight or flight").  

Adrenal fatigue is thought by some to occur when a constant level of stress causes the adrenal glands to become "fatigued" and potentially less effective at producing cortisol to meet the body's demands.

What Causes Adrenal Fatigue?

The primary cause of what is often referred to as adrenal fatigue syndrome is believed to be chronic high stress paired with a maladaptive stress response.

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

But constant stress can potentially lead to HPA axis dysfunction and changes 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. Maintaining balanced cortisol levels is important for overall well-being.

If you have consistently high or low cortisol levels, it may impact your overall health and contribute to what some refer to as HPA Axis dysfunction or Adrenal Fatigue.

Common Adrenal Fatigue Symptoms

• Feeling Wired and Tired: Individuals who believe they have Adrenal Fatigue often report waking up exhausted and depending on caffeine to stay awake throughout the day. Their energy levels may 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 experience chronic stress or irregular sleep schedules, your adrenals may be affected, potentially leading to increased cortisol production. Over time, high levels of continuous cortisol have been associated with increased belly fat and appetite.
• Temperature fluctuations: Body temperature can fluctuate 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 may produce more cortisol, potentially causing disturbances in sleep patterns.  
• Decreased Immune Function: When we're stressed, the immune system's ability to manage infections may be reduced. High cortisol levels can contribute to systemic inflammation and an overworked immune system. This may decrease the body's lymphocytes — the white blood cells that help fight off infection. Lower lymphocyte levels can increase susceptibility to 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 Approach Adrenal Fatigue?

Nutrition

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

It's also considered beneficial to avoid processed foods laden with chemicals. Many chemicals can potentially disrupt endocrine function and may worsen hormonal imbalances.

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

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

If you are experiencing symptoms associated with Adrenal fatigue, it may be helpful to avoid caffeine within six hours of bedtime due to its long-lasting effects and consider reducing alcohol consumption.

Herbs and Supplements

Adaptogenic Herbs

Adaptogenic herbs, like ashwagandha, licorice root, and Rhodiola, are sometimes used to help manage stress and support balanced cortisol levels. Teas that contain lavender, chamomile, or lemon balm are calming and can be added to a bedtime routine.  

Traditional Chinese Medicine Herbal Formula Suan Zao Ren Tang

Suan Zao Ren Tang (SZRT) has been used for centuries to support sleep. Some studies with over 1,454 individuals have explored its effects. The findings suggested that SZRT used as a monotherapy was more effective than Diazepam alone in terms of PSQI score and clinically effective rate of insomnia. This formula is a commonly used preparation to help individuals fall asleep naturally while addressing HPA-Axis function.

Lifestyle Changes

Lifestyle changes are often considered a key approach for managing symptoms associated with Adrenal Fatigue. Since chronic stress is often thought to be a contributing factor, it is important to find supportive and adaptive ways to manage stress and help the body move into a state of well-being.  

Many stress management techniques may help reduce stress and support balanced cortisol levels. Practices such as meditation, mindfulness, breathwork, yoga, and cognitive-behavior therapy can help reframe stress and alter the body's physical and mental response to stress.

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

Other lifestyle changes like spending time in nature and prioritizing sleep can help to support balanced cortisol levels and other hormone levels throughout the day. Lastly, it's important to engage in regular physical activity. Exercise can help manage stress, support balanced cortisol levels, and help complete the stress cycle to move out of "fight or flight."

Summary

Adrenal fatigue is a term used to describe a group of symptoms that some believe 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 may be managed with lifestyle and diet changes that support healthy stress responses and overall well-being.