Understanding Adrenal Fatigue
What do the stages of adrenal fatigue mean?
Although the decline in adrenal function occurs in a progressive fashion, three “stages” of adrenal exhaustion are commonly used to describe a patient’s condition.
As the adrenal glands first come under chronic stress, the outer part of the adrenal gland called the adrenal cortex begins to produce and secrete a great quantity of cortisol, the “stress hormone.” This increased cortisol production “steals” pregnenolone, the hormone needed to produce other hormones in the adrenal cortex, most notably DHEA.
In Stage 1 of adrenal exhaustion, daily cortisol output is elevated and DHEA levels begin to decline. Since DHEA metamolizes into sex hormones, specifically estrogens and testoterone, imbalances in these critical hormones can occur.
As chronic stress continues unabated, the adrenal glands can no longer maintain the daily levels of cortisol output. In Stage 2 of adrenal exhaustion, daily cortisol output falls to “normal” levels, and DHEA levels decline even further. Low or borderline low morning, noon or afternoon cortisol levels and nighttime cortisol levels are often seen in Stage 2 of adrenal exhaustion.
As chronic stress continues to weaken the adrenal glands, daily cortisol levels fall even farther. In Stage 3 of adrenal exhaustion, cortisol levels are low and DHEA fall even lower. There is an increased probability of low nighttime cortisol levels as well as low readings throughout the day. In Stage 3 of adrenal exhaustion, a patient is subject to serious hormonal imbalances.
Associated symptoms of impaired adrenals
- Weakness
- Unexplained hair loss
- Nervousness
- Irritability
- Mental depression
- Difficulty gaining weight
- Apprehension
- Hypoglycemia
- Inability to concentrate
- Excessive hunger
- Tendency towards inflammation
- Moments of confusion
- Indigestion
- Poor memory
- Feelings of frustration
- Alternating diarrhea and constipation
- Osteoporosis
Common causes of adrenal stress
- Anger
- Fear
- Worry/anxiety
- Depression
- Guilt
- Overwork/physical or mental strain
- Excessive exercise
- Sleep deprivation
- Light-cycle disruption
- Going to sleep late
- Surgery
- Trauma/injury
- Chronic inflammation
- Chronic infection
- Chronic pain
- Temperature extremes
What are the consequences of adrenal fatigue?
In all stages of adrenal exhaustion (even Stage 3), cortisol levels are elevated relative to DHEA levels. There are many health consequences associated with a high ratio of cortisol to DHEA that affect your:
- Blood Sugar Control
- Immune Function
- Detoxification Capabilities
- Tissue Health
- Hormone Balance
What cortisol does:
- Mobilizes and increases amino acids, the building blocks of protein, in the blood and liver
- Stimulates the liver to convert amino acids to glucose, the primary fuel for energy production
- Mobilizes and increases fatty acids in the blood (from fat cells) to be used as fuel for energy production
- Counteracts inflammation and allergies
- Prevents the loss of sodium in urine and thus helps maintain blood volume and blood pressure
- Maintains resistance to stress (e.g., infections, physical trauma, temperature extremes, emotional trauma, etc.)
- Maintains mood & emotional stability
Hormone Levels
Hormones levels are commonly affected when immune dysfunction, infections and toxicities are present in the body. The added stress on the body shunts a large portion of the building blocks for hormones from making things like progesterone to making cortisol, our “stress hormone”. In females especially, we often can gauge overall inflammation in the body by the severity of our menstrual cycles. Severe symptoms of PMS could mean significant low-grade inflammation throughout the body..
When it comes to lab testing, a good hormonal panel should include the male and female hormones estrogen, progesterone and testosterone. Your adrenal status can be assessed by checking your DHEA and cortisol levels. Under acute stress, cortisol will elevate as a protective mechanism in what we traditional call the “fight or flight” response. Cortisol makes glucose readily available for use in the tissues, heightens your awareness and focus, and acts as an anti-inflammatory hormone when it is released in the appropriate amounts and at the appropriate times. However, when cortisol remains too high for too long, we might see weight gain, blood pressure dysregulation, risk for osteoporosis, muscle weakness and mood swings. This is why monitoring and managing cortisol levels while the body is under chronic stress is critical to your treatment.
Another hormone that is important to monitor is DHEA. DHEA is like the mother of male and female hormones. From DHEA our body can make testosterone and estrogen. When the body is under a lot of stress, the precursor for DHEA, pregnenolone, can be directed more towards making stress hormones such as cortisol, instead of DHEA. In this case, the building block of DHEA is insufficient to make male and female hormones. When testing for these hormones, we often work with a company called ZRT. Their website is located here: http://www.zrtlab.com/test-specialties/stress-hormones/.
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- Top 4 tests to run
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The Best Ways to Treat Chronic Adrenal Fatigue Syndrome
Chronic fatigue syndrome (CFS) is a debilitating and often misunderstood condition. There is no one-size-fits-all approach to treating CFS, but there are a number of effective treatments that can help improve your quality of life.
The first step is to determine if you have CFS. The diagnostic criteria are fairly straightforward, and most doctors will be able to diagnose CFS based on your symptoms. If you are diagnosed with CFS, the next step is to determine which treatment approach is best for you.
There are a number of different treatment options available, and each has its own benefits and drawbacks. Some of the most common treatments for CFS include:
- Rest
- Exercise
- Medications
- Therapy
Each of these treatments has its own benefits and drawbacks, and it is important to choose the best option for you. It is also important to be patient while you are waiting for the best treatment option to become available.
There is no one-size-fits-all approach to treating CFS, but with the help of a qualified doctor, you can find the treatment that is best for you.
Natural Hormone Treatments
- DHEA: DHEA levels naturally start to decline after the age of 30, this is precisely when many adults start to experience weight gain, sluggishness, lowered libido and other symptoms. DHEA is also a precursor to testosterone and is one of leading causes of low ‘T’ in men and women. DHEA is not typically necessary in people under the age of 30.
- Progesterone: The top hormone for females because of it’s ability to modulate and balance all of the other hormones. Progesterone is also a key precursor to other steroid hormones including cortisol, testosterone and certain estrogens (estriol, estradiol and estrone).
- Estradiol: Lower estradiol is common in pre-menopausal women who may be experiencing fluctuating hormone levels, anovulatory (no ovulation), irregular cycles or in women using hormonal contraception (none noted). Symptoms of low estrogen include hot flashes, night sweats, vaginal dryness, low libido, bone loss and/or mood swings.
- Testosterone: Like men, women with low testosterone levels often experience chronic fatigue, a stunt in their libido and a decreased sense of well-being. So, low ‘T’ effects everyone!
- Cortisol: Also known as the stress hormone, should rise in the morning to get you moving and then drop at night to support restful sleep. In an individual without significant stressors, cortisol is highest in the morning shortly after awakening (optimal level 4-6 ng/ml). Typically, cortisol steadily drops throughout the day and reaches the lowest level while asleep at around 2 am (optimal level 0.7-1.0 ng/ml just before bed). However, in many people, this circadian rhythm is flattened which indicates adrenal dysfunction.
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