Chapter 1: What is Adrenal Fatigue?
~Written by Amber Canaan, RN, CHC
Your alarm clock goes off, and it's time to get up…again. It's a new day and another opportunity
to make your mark on the world. Instead of springing out of bed, you hit snooze. Then you hit it
again, and again, until finally, you drag yourself out of bed, throw a K-cup in the Keurig and
blindly fumble around the refrigerator for creamer. As the spoon clinks against the side of the
mug, you mentally count the days until Friday and silently curse, realizing that it's only Tuesday.
Ah, the coffee is so good, and by the time the mug is halfway drained, you feel your batteries
charged enough to begin your day in a relatively stable mood.
Off you go; the office awaits. Newly acquired energy from your first coffee was enough to get
you to cup number two, and you're out the door. You grab a biscuit at the drive-thru if you have
time. Otherwise, most days, you probably forget breakfast altogether. You run on caffeine and
carbs at the office until about 9:30 or 10 am, when your energy levels tank again, and you head
for your third cup of joe.
As the minutes slowly tick by, you continuously review your mental to-do list in your brain,
wondering if you're forgetting anything. You find yourself reading and re-reading the same
paragraph over and over, not understanding the words. You begin to feel snacky, so you head to
the vending machine, choosing a bag of Fritos and a Snickers bar for later. For the fourth time
this morning, you refill your coffee mug as you head back to your desk and munch mindlessly
until lunchtime. You finally finish that paragraph and wonder where your next vacation should
be; goodness knows, it’s time for one!
As your mind floats around in the Caribbean, a coworker invites you to go to lunch, a thankful
reprieve, knowing that the sunshine and fresh air will help you wake up. The conversation over
lunch at your favorite Mexican restaurant revolves around your manager, whose impossible
standards are a constant source of stress to you both. You discuss your friend’s marital
problems, revolving around lack of any real sex life, and you are unfortunately able to relate. In
the back of your mind, you wonder why conversations always seem so depressing, but then
quickly realize that they mirror your life right now. You conclude that they must be normal, and
everyone’s lunch conversations probably sound like this.
Back at the office, your lunch supplies enough energy to carry you to mid-afternoon, but by 3 pm
you're making another pot of coffee (which your coworkers thank you for!). Mentally, you
record how many cups you have per day; is it five already? Who knows? They say people who
drink coffee live longer, right? Probably not, but still, it sounds good.
The Snicker’s bar you bought earlier is the perfect complement to what seems to be your 80th
ounce of coffee today, and it's smooth sailing until 5 pm and the drive home. By 6 pm, when you
walk in the door, your energy lifts and you feel better than you have in hours. You enjoy a nice
dinner with your family, help the kids with their homework, and by 9 pm, it feels like someone
pulled the plug. You're exhausted, and you know you should go to bed, but it's the only time
you've had to yourself. Everyone else is asleep, and you stay up, watching television or surfing
social media. You can barely keep your eyes open.
“Just five more minutes,” you say to yourself. You’re so exhausted; surely, it won't be long until
you turn in. Five minutes turn to 30, and then an hour has passed. The fatigue begins to lift little
by little, and you don't even realize until you look at the clock that it's 11 pm, and you’re lying
there wide awake. You’ve missed your window of opportunity to sleep.
You quietly crawl out of bed, not to disrupt your sleeping spouse, and head to the couch where
you proceed to watch three more episodes of Outlander. Mental reminders sound every few
minutes that you really should get some sleep because you’ll regret it tomorrow. You dismiss
them, however, because you're wide awake. Finally, by 1 am, you start to feel the pull of sleep
again. This time, you decide you’ll listen. You lay the phone down and crawl into bed, praying
that the few hours you have are enough to make you feel human in the morning.
Before you know it, the alarm clock goes off again; and no, it wasn't enough sleep. Another hour
or two would be perfect, but that will have to wait until Saturday (if you're lucky). For now, life
and stress await you with every ring of your alarm. Another 80oz of coffee, and you’ll feel
human for one more day. Just two more months until vacation; eight weeks; about 62 days, you
can make it, right?
If this sounds all too familiar to you, these are the symptoms associated with adrenal fatigue. For
many people, fatigue is the top complaint leading to doctor visits. While other conditions also
have fatigue as a side effect, the fatigue that comes from a decline in adrenal function has a
uniquely distinctive pattern, like in the scenario, just mentioned. Difficulty waking up, midmorning
and mid-afternoon slump, energy in the evenings, and again late at night.
Adrenal Fatigue is a highly controversial condition whose legitimacy is debated throughout the
medical community. Another name for the disorder is HPA Axis Dysfunction, which we'll use
interchangeably throughout this book. Proponents of the condition understand that there's a wide
range of people with real symptoms but who don't fit the diagnosis of adrenal insufficiency,
which we will discuss in detail in just a bit.
Those who accept adrenal fatigue as a real condition believe that chronic stress taxes the adrenal glands by the overstimulation of cortisol. Over time,the adrenals can't maintain their normal function, producing less of the hormones that keep us healthy and feeling good. Bloodwork reveals a normal adrenal function in these individuals. Still, supporters of adrenal fatigue contend that a small decrease in adrenal function is all you need to cause side effects such as:
• Fatigue
• Trouble going to sleep
• Difficulty waking up and not feeling rested
• Cravings, both sweet and salty
• Brain fog and difficulty concentrating
• Decreased motivation
• Inability to handle stress
• Increased energy levels later in the day
• Excessive use of stimulants such as caffeine and sugar
• Weakened immunity
To fully understand the condition, let's take a more in-depth look at a few of these symptoms.
Fatigue and Sleep Problems
Logically, if you’re feeling tired, it should be easy to go to sleep. However, individuals
experiencing adrenal fatigue have the opposite experience. Adrenal fatigue often begins with a
stressful life event. Your body’s natural response to stress is to secrete higher levels of cortisol
and adrenaline to help cope with the stressor. These elevated hormone levels disrupt your body’s
natural sleep cycle, leading to increased energy levels in the evenings, as we described in the
illustration earlier in the chapter. Instead of going to sleep at an appropriate time to get a restful
eight hours, those with adrenal fatigue stay up later, unable to sleep.
As adrenal fatigue progresses, cortisol levels begin to lower, which reduces blood sugar levels as
well. While this might sound like a good thing, since diabetes and insulin resistance is on the
rise, it causes your body to wake you up in the night for a snack, or earlier in the morning than
you would otherwise get up, further cutting your sleep time. For many people, adrenal fatigue
results in symptoms of low blood sugar, when a condition known as reactive hypoglycemia
develops. We’ll discuss this in detail in chapter five.
In addition to the lack of sleep, lower neurotransmitter levels, such as adrenaline and
norepinephrine, leave those with adrenal fatigue feeling exhausted throughout the day. Lower
levels of these neurotransmitters contribute to feelings of lack of motivation and inability to
support decent energy levels without copious amounts of coffee, sugar, or other stimulants.
Stress Management
In times of stress, whether physical, emotional, or mental, our bodies release a variety of
hormones that allow us to handle stress appropriately. As adrenal fatigue progresses and the
adrenal glands secrete stress hormones, our bodies cannot respond appropriately.
Have you ever found yourself in a situation where you felt completely overwhelmed at the
smallest stressor? If so, this is precisely what we're referring to. The inability to handle stress in
any form results from your adrenal glands producing inadequate amounts of these hormones.
Cravings
Cravings due to adrenal fatigue come in the form of both sweet and salty, but for two different
reasons. To wake you up and give more energy, at times, you may experience sugar cravings.
Unfortunately, the blood sugar spikes and crashes and negates any energy boost you experience
in the short term, not to mention weight gain.
Salty cravings result from a decrease in aldosterone production. Aldosterone is a substance
secreted by the adrenal glands that help our bodies regulate fluid and mineral balance. When
your aldosterone levels decrease, your body's ability to control fluid and mineral balance also
decreases. Many times, minerals such as sodium, magnesium, and potassium are excreted in
higher amounts through the kidneys with excessive urination. To get more sodium into the body,
you begin craving salty snacks: potato chips, salted peanuts, and other similar foods.
Energy at Odd Hours
A person with normal, healthy functioning adrenal glands experiences their highest cortisol
levels first thing in the morning (peaking around 8 am), and they slowly decrease as the day
wears on. Elevated levels of cortisol in the morning help you feel awake, alert, and ready to
tackle the day.
Unfortunately, individuals with adrenal fatigue experience different shifts in cortisol levels
throughout the day. With this condition, levels may not peak first thing in the morning,
explaining why you find yourself dragging out of bed. Also, instead of a slow and gradual
decline throughout the day, cortisol levels spike at odd times. The most common times for
cortisol levels to spike is around 6 pm and 11 pm, as our earlier illustration showed.
Excessive Use of Stimulants
To combat the fatigue from inadequate sleep and crazy cortisol cycles, many with adrenal fatigue
reach for coffee, energy drinks, and other stimulants to wake them up and keep them going
throughout the day. The problem in this method lies in the fact that the more you rely on these
stimulants for that extra perk in your step, the less effective they become. Perhaps you’ve
experienced this yourself. Or maybe you know someone who started with a single cup of coffee
in the morning and progressed over time to drink a whole pot by noon. Your body grows
accustomed to the caffeine and creates a tolerance to it, so as the situation worsens, you begin
requiring more for the same effect.
Lowered Immune System
Cortisol, although blamed for many ills such as increased belly fat and an inability to lose
weight, serves as an anti-inflammatory at the proper levels. When your adrenal glands stop
producing cortisol in the right amounts, your body lacks the appropriate anti-inflammatory
effects that cortisol offers. If your body produces too much cortisol, it weakens your immune
system, because your body doesn’t realize it should be fighting. If your body makes too little
cortisol, the anti-inflammatory effect weakens, and your immune system may become overreactive
to pathogens (and even your own body). When this occurs, chronic inflammation and
autoimmune diseases develop.
Other symptoms of adrenal fatigue that vary depending on how long your adrenal glands have
been struggling include:
• Anxiety and depression
• Respiratory issues such as allergies and asthma
• Dark circles under your eyes
• Dry skin
• Dizziness
• Joint pain
• Loss of muscle tone
• Decreased libido
• Low back pain
• Poor circulation
• Weight gain
The Problem with Stress
With stress levels at an all-time high, approximately one-third of Americans report living in
“extreme stress,” and half of all Americans report increased stress levels over the past five years.
As rates of chronic stress continue to rise, our bodies are paying the price. For many of us, our
daily coffee consumption is enough to give a clue to the problem.
Stress in and of itself is not bad. All sorts of situations in our lives cause stress, both positive and
negative events, and circumstances. Workplace stress is a leading cause of stress in the United
States, leading to negative consequences such as missed work. The American Institute of Stress
estimates that 83 percent of workers experience work-related stress, and over one million people
miss work every year as a result. When employees call in sick simply because they need a mental
break, mental health days, or absences, cost employers $300 billion each year. Even worse, stress
causes approximately 120,000 deaths and is often caused by cardiac events such as heart attacks.
Chronic stress is also a contributing factor in many diseases such as arteriosclerosis, diabetes,
high blood pressure, premature aging, and cancer!
In general, the American population lives in a state of moderate, and in some cases, severe stress.
Adults between the ages of 30 to 49 are the most stressed group, likely from the pressures of
simultaneously raising families and earning a living. Living in a constant state of stress, when
cortisol and adrenaline levels are consistently high, lead to adverse health problems and
symptoms, including:
• Extreme irritability
• Trouble sleeping
• Feelings of tiredness or fatigue
• Lack of focus and concentration
• Physical symptoms such as headaches, gastric disturbances, appetite changes
• Racing thoughts
• Decrease or loss of sex drive
• Decreased self-esteem
• Lowered immune system and increased susceptibility to infections of all kinds
The Great Debate & History of Adrenal Fatigue
Depending on who you ask, adrenal fatigue may or may not even exist. Many medical doctors,
including endocrinologists, look at the adrenal glands as more of a black and white, healthy, or
diseased state of health. Either they work or they don’t. For this reason, many in the medical
field do not accept adrenal fatigue as an actual diagnosis.
Where did the idea of adrenal fatigue even come from, if the medical system doesn’t recognize
it? I’m so glad you asked! In 1998, a naturopathic doctor by the name of Dr. James L. Wilson
proposed a radically new condition, a middle ground of sorts between healthy adrenal glands,
and adrenal insufficiency. At this moment, the term "adrenal fatigue" was born. Dr. Wilson
explained that chronically high-stress levels cause an imbalance and inconsistent release of
cortisol in the bloodstream, accounting for fatigue and oddly timed energy spurts throughout the
day. However, despite what many in the world of natural and alternative medicine believe as a
reasonable conclusion, no definitive tests exist to prove the existence of the condition.
There are no definitive numbers as to how many people suffer from adrenal fatigue since it's not
a recognized medical diagnosis that anyone tracks. Unlike cancer, heart disease, and diabetes, no
one tracks the number of people who head to their doctors' offices every year with symptoms of
adrenal fatigue. That diagnosis never enters into their medical records. Some natural and
alternative medicine practitioners estimate that as many as 80% of American adults suffer from
these symptoms. Many are told, however, that their lab work is normal, and nothing is wrong.
This is the difference in a pathological diagnosis and a functional problem. With a pathological
diagnosis, lab values are outside of the normal ranges, either too low or too high. With abnormal
lab results, doctors have an easier time pinpointing a diagnosis. However, when lab values are
normal, but a person has an array of unexplained symptoms, a functional problem exists. Lab
values on the lower or upper end of normal may technically still fall in the "normal" range. Yet
lab values for that individual may fall outside of their normal ranges, and thus symptoms
develop. Medical practitioners such as functional, integrative, and naturopathic doctors are more
open to broader interpretations of "normal" and "abnormal" test results, realizing that each
patient is different. Just because lab results fall within the normal range doesn’t mean that a
person’s body isn’t begging for help!
An Unrecognized Epidemic
Regardless of what lab work shows, every year untold thousands of people schedule
appointments with their doctors with symptoms of fatigue, difficulty sleeping, difficulty losing
weight, low libido, and an overall feeling of being unwell. For many of these people, labs come
back normal, and these patients "appear" on paper to have normal functioning adrenal glands.
The next place many doctors look is at their thyroid, and in many cases, it appears to function
normally as well. Recommendations to get more sleep, reduce stress, eat better, and exercise are
given quickly as the patient is ushered out the door. These patients leave their doctor's office
with more questions than when they first walked through the doors, frustrated at wasting time
and money in finding answers to their symptoms. If questioned about the possibility of adrenal
fatigue, many medical doctors simply say that it's not a real diagnosis. The existence of normal
lab work proves that their adrenal glands are functioning correctly. If pressed further, more lab
work may be ordered to check for underlying auto-immune diseases like fibromyalgia or even
cancer. When those tests come back clean, these patients are back at square one. Other
conditions with similar symptoms include anemia, sleep apnea, depression, anxiety, irritable
bowel syndrome (IBS), and diabetes. The presence of normal labs does not invalidate the
symptoms plaguing these patient’s day in and day out. Something is physiologically wrong,
causing lingering fatigue and other symptoms.
Instead of treating the symptoms, natural and alternative medical providers believe the
underlying cause is chronically stressed adrenal glands. Adrenals that are tired of the constant
workload of high stress, who aren't functioning at their best yet aren't entirely diseased and not
functioning at all. Our bodies exist in a delicately balanced equilibrium, and even slight
fluctuations cause physical symptoms. Unfortunately, many symptoms such as fatigue, difficulty
sleeping, and difficulty losing weight are considered standard parts of aging.
Why does health have to be black and white? Why not treat it as a spectrum and recognize
declines in body systems, as the scale tips away from health and toward disease? Wouldn't
identifying these slight changes and addressing them as they happen lead to a life of greater
health, added years to our lives, and overall higher satisfaction and enjoyment of life?
As we progress through this book, you'll discover how adrenal fatigue affects every aspect of
your life, from your endocrine and reproductive health to your ability to regulate insulin levels
and lose weight. We'll also present solutions to help your body heal and regain the energy and
wellbeing currently missing from your life.
