The adrenal glands have a big job. They’re responsible for producing, secreting and regulating specific hormones in your body, including cortisol. They work constantly and have a huge functional capacity — just like your heart or lungs. The term “adrenal fatigue” has been used to explain a group of symptoms that are said to occur in people who are under long-term mental, emotional, or physical stress.

What is Adrenal Fatigue?

The term “adrenal fatigue” is a bit misleading. The adrenals are glands, not muscles that can be fatigued.  However it is far easier to say adrenal fatigue rather than hypothalamic pituitary axis dysfunction.

Adrenals are glands that sit on top of the kidneys. They are responsible for producing cortisol, epinephrine, and norepinephrine. These hormones are produced when we are under stress, either physical or emotional.

Cortisol should spike early in the morning then come down in the afternoon and evening. The below chart shows the upper and lower limits of cortisol throughout the day. Urinary free cortisol is a measurement of the cortisol in the urine that is not attached to other substances. Free cortisol represents the active form of the hormone. The urine measurement directly reflects the blood level of cortisol. It can also be tested in the saliva but it can be more difficult to fill a tube with saliva versus just peeing on a strip of paper for the dried urine test. It is not worth measuring cortisol in the blood due to the very short half life of cortisol.

The normal range is 10 to 100 mcg/24 h. Normal value ranges may vary slightly among different laboratories. Note: mcg/24 h = micrograms per 24 hours

What are the symptoms of adrenal fatigue?

The symptoms of adrenal fatigue can vary depending on the individual, and they may overlap with other medical conditions. Some common symptoms associated with adrenal fatigue include:

  • Fatigue and low energy levels
  • Difficulty falling or staying asleep
  • Brain fog or difficulty concentrating
  • Mood swings, anxiety, or depression
  • Cravings for salty or sweet foods
  • Low blood pressure
  • Digestive issues, such as bloating or constipation
  • Muscle weakness or pain
  • Reduced libido
  • Weakened immune system, leading to increased susceptibility to infections

What are four stages of adrenal fatigue?

There are 4 stages of adrenal fatigue. It is important to measure cortisol throughout the day to understand which stage you are in as treatment varies according to each one.

  1. Alarm stage: In this stage, the body is experiencing acute stress, such as a sudden illness, injury, or emotional trauma. During this stage, the adrenal glands respond by releasing high levels of cortisol and adrenaline
  2. Resistance stage: If the stress continues, the body enters the resistance stage, in which the adrenal glands continue to produce high levels of cortisol in order to cope with the ongoing stress
  3. Exhaustion stage: If the stress persists for a long period of time, the adrenal glands may become overworked and begin to produce insufficient levels of cortisol, leading to symptoms such as fatigue, anxiety, and difficulty sleeping
  4. Burnout stage: In this final stage, the adrenal glands are no longer able to produce enough cortisol to meet the body’s needs, leading to a state of chronic fatigue and a weakened immune system

What to do if you suspect you have adrenal fatigue?

  1. Get tested. Make sure you do either a dried urine test or saliva test. Testing cortisol in the blood is not ideal as the half life is very short – this makes it inaccurate
  2. Identify the major stressors in your life and try to lessen them. This may mean making lifestyle changes such as meditation (even 5 minutes twice daily – can make a huge difference) or yoga.
  3. Eat a healthy diet composed of whole, clean, unprocessed foods
  4. Prioritize quality sleep
  5. Consult with a functional medicine doctor about which herbal remedies are best for you. This can be different for each person depending on what stage of adrenal fatigue they are in. This is also why it is so important to test first
  6. Get regular exercise. Even walking around the block or out in a park will be extremely beneficial
Adrenal Fatigue Dr Julia Ward

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