What is Adrenal Fatigue?

Adrenal glands sit on top of the kidneys and secrete the hormones- cortisol, adrenaline, and DHEA .Your adrenal glands are the organs that handle stress. Handling stress is like handling a bank account – your “adrenal bank account”. If you have a lot of adrenal reserve, it means that you can spend on the account. Therefore, many people can spend early in life; however, as we grow older, we have to pay more attention to our reserve and replenishment so as to increase those adrenal reserves, Therefore you need to live within your means. That means choosing diet, lifestyle, and sleep habits that replenish the reserve.

Cortisol levels are generally high in the morning as we wake from a prolonged period of sleep, with an increase of up to fifty percent in the twenty to thirty minutes after waking. This is known as the ‘cortisol awakening response’. Then, as the day progresses, our cortisol levels naturally begin to drop in a fairly constant and regular fashion that is termed a diurnal rhythm, ending up as low in the late evening. This allows the body to keep a regular sleeping pattern, with the cortisol level dropping for periods of sleep, then replenishing during the following morning.

The body can also detect and change the timing and cycle of cortisol production and release for certain individuals. A great example is those individuals who work night shifts. In these cases, the pattern and timing of the release of cortisol is reversed to allow for higher levels throughout the late evening and early morning hours. For those of you who travel long distances, a similar rearrangement occurs when we experience jetlag.

Cortisol levels are not just dependent on the time of day. Stress also plays an important role. The exact response depends on the type of stress, whether its short-term acute stress or long-term chronic stress. For short-term stressors like an argument or a fall, we will see a brief spike in cortisol. For longer term stressors like work stress or illness, we see a consistently higher level of cortisol at all times of the day.

How does all this relate to Adrenal Fatigue? Well, those long-term stressors can eventually deplete the nutrients and precursors that we need to produce cortisol and other hormones. In other words, chronic stress will raise your cortisol levels for a while, but eventually your body is unable to continue producing cortisol in such high amounts. At this point we start to see declines in not only cortisol, but also key hormones and neurotransmitters like aldosterone, testosterone, epinephrine and more. Additionally the diurnal rhythm of cortisol production is often disrupted, resulting in late-evening spikes that cause insomnia.

This dysregulation of hormone production is the ‘burnout’ that follows long periods of stress. The body is no longer able to regulate cortisol levels effectively, which leads to symptoms like fatigue, a lack of enthusiasm, insomnia, and a general lack of vitality. We can check for a person’s cortisol response by using a salivary test called Adrenal Stress Index. Refer to the two graphs. The first one shows a normal cortisol response where levels are highest in the morning and gradually declining towards evening. The second graph shows the cortisol response to chronic stress; where cortisol levels have declined in the morning and are beginning to rise in the night time.

How can we reverse the effects of long-term stress and regain our energy levels? A combination of good nutrition, supplementation, and effective stress management techniques can quickly result in some significant changes. In the longer term, eliminating the causes of stress is crucial for a full recovery.

The impact of stress is unique to each patient, it can manifest through a range of symptoms and laboratory values. Comprehensive analysis is required to identify the stress response stage and support each patient’s unique needs.

Although specific recommendations differ based on the stage of stress resistance as shown in the table, below are a few considerations:

1. Obtain regular exercise

2. Establish regular bed times and obtain sufficient sleep

3. Practice relaxation activities (yoga and meditation)

4. Consider smoking cessation programs

5. Avoid or limit alcohol and sugar consumption

6. Identify and remove food intolerances

	Early Stage	Mid Stage	Late stage
Symptoms	High stress Anxious or agitated Sleeplessness Tired but wired Higher pulse	Moderate stress Tired	Fatigues/exhausted Very tired in the evening Difficulty falling asleep and staying asleep Low pulse
Lab Values	Increase in levels of Cortisol, DHEA, Blood Pressure and Blood glucose	Serotonin declines	Decrease in Cortisol, DHEA, Serotonin and Blood pressure
Botanical medicine and supplements	Ashwagandha L-Theanine Magnolia Phosphatidylserine	Rhodiola Holy Basil Eleuthero Ashwagandha Maca	Vit B1 Vit B2 Vit B5 Vit B6 Forskolin Licorice Root Late stage sleep support Melatonin Glycine L-Theanine 5- HTP