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Adrenal Fatigue PDF Print E-mail
What is adrenal fatigue (also known as adrenal insufficiency, adrenal burn-out or hypoadrenia)?
Adrenal fatigue occurs when the adrenal glands, situated above the kidneys, become overworked or damaged, usually from long-term exposure to stress. As a result of being overworked they secrete reduced amounts of the adrenal hormones, the main ones being cortisol, aldosterone, pregnenalone, DHEA (de-hydroepiandrosterone) and adrenaline. The most important of these is cortisol, because when this is lowered the body will no longer be able to deal with stress. 
What are the symptoms of adrenal fatigue?
The main symptoms of adrenal fatigue are tiredness and chronic (long-term) fatigue (especially in the morning and between 3 and 5 pm). Other associated non-specific symptoms include chronic pain (especially upper back or neck), mild depression, anxiety, reduced stress- coping ability (i.e. trembling under pressure), unexplained hair loss, insomnia, inability to lose weight (even though seriously trying to), poor blood sugar control (up or down), frequent infections; reduced sex drive; feeling better suddenly for a brief period after a meal; a craving for fatty, salty or high-protein foods; great difficulty getting up in the morning; worsening of allergies; reduced memory/concentration; alternating diarrhoea and constipation; and indigestion. 
What causes adrenal fatigue?
The onset of adrenal fatigue is slow and insidious. Chronic stress is the main cause of adrenal fatigue, since stress causes the adrenals to produce huge amounts of adrenal stress hormones. This continues until the adrenals burn out and the supply of vital stress and anti-fatigue hormones is depleted. As a result, chronic fatigue and the above-mentioned symptoms of continued stress-exposure begin. Most adults experience adrenal fatigue of varying severity at some time in their lives. Other causes of adrenal fatigue are constant anger (a short fuse), chronic inflammation, chronic infections (as with Giardia and Helicobacter pylori, which gives rise to inflammation), chronic pain, excessive exercise, low blood sugar, surgery, lack of sleep, excessive sugar, caffeine or alcohol intake and toxin exposure ( such as smoking or environmental pollutants).
Adrenal fatigue progression
Stage 1: Stress reaction (fight or flight response), also known as early fatigue stage
In this stage, the body reacts to stress to reduce stress levels. Since the adrenals have not burnt out yet, they mount a powerful anti-stress and stress-coping response – they secrete more adrenaline and cortisol. There is a corresponding reduction in DHEA production at this time. This huge cortisol response, coupled with reduced DHEA, results in a high cortisol/DHEA ratio. This ratio can result in raised blood sugar, diabetes, infections (including candida and herpes), bone demineralisation (and osteoporosis), water and salt retention (leading to elevated blood pressure), muscle wasting and an inability to lose weight.
After some time the adrenals will experience difficulty in meeting the body’s ever-increasing demand for cortisol.  
Stage 2: Resistance Response
With chronic stress exposure the adrenals are unable to keep up with the body’s demand for cortisol. At this point cortisol output will start to decline from a high to a normal level. While the morning, noon and afternoon cortisol levels may become low during this stage, the night-time cortisol level is usually normal. A phenomenon called a pregnenalone steal (also called a cortisol shunt) sets in at this stage. Cortisol production becomes the predominant pathway of hormone production as the body favours the production of this hormone. Other hormones such as pregnenalone, DHEA, testosterone and oestrogen are less favoured and their production will decline. As a result, total pregnenalone and DHEA output is reduced but total cortisol output continues to be maintained at a more-or-less normal level.  
Stage 3: Exhaustion
At this point the adrenals become so fatigued that they are no longer able to keep up with the increased demand for cortisol production. This may happen over a few years. Total cortisol output is therefore reduced, and DHEA falls far below average. The night-time cortisol level is usually reduced. Severe sex hormonal imbalances (oestrogen, progesterone, and androgens) are common and a precursor to adrenal failure. Stage 4: FailureEventually, the adrenals are totally exhausted. Patients at this stage have a high chance of cardiovascular collapse and death. 
Adrenal fatigue versus adrenal non-function:
Adrenal fatigue (very common) should not be confused with another medical condition called Addison’s disease where the adrenal glands do not function (very rare). While Addison’s disease is often caused by auto-immune dysfunction, adrenal fatigue is caused by stress.  
Why conventional medicine has difficulty diagnosing adrenal fatigue:
Many doctors are unfamiliar with adrenal fatigue because it is difficult to diagnose sub-clinical adrenal fatigue using traditional blood tests. Normal blood tests are designed to detect the severe and absolute deficiency of adrenal hormones known as Addison’s disease. This disease afflicts only 4 out of 100 000 people and is often the result of autoimmune dysfunction or infection. Blood tests are also useful to detect extreme excessive levels of adrenal hormones in a condition known as Cushing’s disease.Adrenal hormones are low in the case of adrenal fatigue, but still within the ‘normal’ range and not low enough to warrant the diagnosis of Addison’s disease by regular blood tests. In fact, adrenal hormones can be half of the optimum level and still be considered ‘normal’. Such a ‘normal’ level of adrenal hormones does not mean that the patient is free from adrenal fatigue.
Blood tests that are not sensitive enough to detect subclinical adrenal fatigue are misleading. As a result, patients tested for adrenal function are told that they are ‘normal’ but in reality their adrenal glands are performing sub-optimally, with clear signs and symptoms, as the body cries out for help and attention.Adrenal fatigue afflicts more people than Addison’s disease. It is not recognised and has become an epidemic of massive proportion. To truly diagnose adrenal fatigue, more sensitive laboratory testing and meticulous attention to the symptoms and patient history are required. 
People should seek advice if they fall into the following three categories:
They experience unexplained abnormal fatigue (such as those suffering from chronic fatigue syndrome) or from tiredness coupled with three or more of the symptoms listed above under “What are the symptoms of adrenal fatigue?” or
They fall into a high-risk group by being exposed to continuous high levels of stress (such as a high-stress job), particularly if combined with other causes such as those listed above, under “What causes adrenal fatigue?” or
They have low DHEA and cortisol hormone levels. This is determined by a saliva or blood test. The ideal is a saliva test, as this measures free unbound hormones, unlike the blood tests which measure bound hormone levels. DHEA can be measured at any time of the day. Cortisol should be measured shortly after waking, again at midday and again at bed time.
Recovering from adrenal fatigue
1. Removal of the stressors. 
This is the most important step. Emotional stressors such as relationship or financial problems need to be dealt with and normalized.
2. Sleep. 
One of the most important aspects to overcoming adrenal exhaustion is to have enough rest. It is important to go to sleep by 10 pm every night because our adrenal glands kick in for a "second wind" to keep us going from 11 pm to 1 am which puts tremendous stress on the adrenals. When we rest early, our adrenals are fully rested and the high gear is avoided. Between 10 pm and 1 am, our adrenals work the hardest to repair the body. We should also try to sleep in until 8:30 am or 9: 00 am if possible. This is because our cortisol level rises to its peak from 6:00 am to 8:00 am in order to wake us up and get us going for the day. Waking up too early will only serve to increase the stress on the adrenal glands, which will have to produce more cortisol when it is already exhausted.
If you have a tendency to wake up at 2 to 3 am and find that you are unable to fall back to sleep, that is a sign of excessive stress. In this case, you may wish to consider a time-release melatonin together with 5-hydroxytryptophan (5-HTP), adrenal extracts, and trace mineral tablets. Another wonderful relaxant and sleep aid is magnesium. Some common herbs that enhance sleep are valerian root, hops (whole plant), and liquorice root.
3. Avoid Coffee or Caffeinated Beverages. 
Coffee and tea act as stimulants and interrupt sleep pattern. Herbal tea is acceptable because it does not contain caffeine. Avoid TV and Computers as watching television or working at the computer may prevent the melatonin level from rising to induce sleep. If you are one of these people, you should turn off your television or computer by around 8 pm at night.
4. Exercise. 
This is a wonderful stress reducer and a tremendous oxygen booster. Exercise reduces depression, increases blood flow, normalizes the levels of cortisol, insulin, blood glucose, growth hormones, thyroid, and generally makes you feel much better. Exercise 20 to 30 minutes a day, dividing each session into 10-minute blocks. Simple exercises such as brisk walking, or climbing stairs are easy to do and can be done almost anywhere. Vary your routine so that exercise becomes fun.
5. Nutritional Supplementation. 
It is prudent to optimize the adrenal gland functions. Supplements such as DHEA, pregnenalone, low dose natural cortisol, bio-identical progesterone, or a cortisol enhancing agent such as liquorice root extract can be used. A balance of vitamins and minerals such as buffered Vitamin C, Vitamin B Complex and Anti-oxidants should be taken for optimal adrenal function.
Please note that these supplements should ideally be taken under the guidance of a physician or health care practitioner.
It is very important to understand that a shot-gun approach to taking nutrients seldom works and may even create more harm than good. The use of nutritional supplementation in overcoming adrenal fatigue needs to be individualized based on each person's history, background and metabolism.
The body's ability to process and assimilate nutrients is often compromised when experiencing adrenal exhaustion. Therefore, your health care practitioner will recommend blood tests which are a good indicator of the reserve the adrenals have before application of any supplementation.
During the recovery process the body’s metabolism changes, it is therefore crucial to match the dose of supplementation to the system’s re-adjustment throughout the process for maximum effect.
6. Diet.
A poor diet is one of the leading causes of adrenal fatigue. Without a diet that is bio-chemically and metabolically compatible with the needs of a damaged adrenal gland, complete recovery is simply not possible. 
When our cortisol levels are at their peak between 6 am to 8 am we may have no appetite and may skip breakfast because we are not hungry. Skipping breakfast is not a good idea because when your blood sugar drops the adrenals are instructed to secrete cortisol to increase blood sugar levels and to allow the body to function. It is therefore important to have a healthy breakfast soon after waking and not later than 10 a.m. This will prevent the body being put in a position to play "catch-up" for the rest of the day.
It is best to follow a low glycaemic index diet throughout the day which is rich in fresh fruits and vegetables. Try aim for six smaller meals that are spread out over the day (rather than three large meals) as these will keep your blood sugar levels stable.
If blood sugar is not kept stable, insulin secretion may become dysfunctional, resulting in a hypoglycaemic state in the middle of the night. Symptoms are characterized by nightmares, anxiety, and night sweats. When this occurs, the body will have to activate the adrenals to secrete more cortisol in order to raise the blood sugar back to its normal level. This will eventually put an excessive burden onto the already fatigued adrenal gland if carried on year after year.
In Conclusion 
The road to adrenal recovery is not a linear path because of the complexity of our internal hormonal and stress-regulation system. 
Most people who suffer from adrenal fatigue also have multiple endocrine imbalances including sub-clinical hypothyroidism, insulin resistance, and oestrogen dominance. These need to be addressed as well. Because the amount of hormonal balancing is intricate and is highly sensitive, the process may take anywhere from three months to three years. Most will find some improvement in a matter of weeks, depending on the degree of pre-existing damage and the clinical skills of the health professional. Adrenal recovery is a process akin to running a marathon; the process is long, but it can be done easily and painlessly, one step at a time.