Some of the most common health complaints today are ongoing fatigue and lethargy, yet often, finding a cause and a solution for these issues can be elusive. If you have fatigue along with other symptoms such as difficulty concentrating, insomnia, inability to lose weight, feeling anxious, allergies, or brain fog, Adrenal Fatigue Syndrome (AFS) may be at the root of these problems.
Adrenal Fatigue is the non-Addison’s form of adrenal dysfunction, a condition where the body’s stress response cannot keep up with life’s chronic stressors. The ability to handle stress, physical or emotional, is essential for human survival. The human body has a stress modulation system in place, known as the NeuroEndoMetabolic (NEM) stress response. And the adrenal glands are a pivotal part of this response system.
The adrenals are two small glands located on top of the kidneys. They’re responsible for the production of more than 50 different hormones that affect almost every organ and system in the body. So, when these glands become dysfunctional, your body's ability to handle stress is reduced.
The adrenals produce cortisol, often called “the stress hormone.” Chronic stress causes an ongoing, high demand for cortisol, which can eventually cause the adrenal glands to become unable to produce enough. This means they will struggle to carry out their many jobs, resulting in the symptoms and problems associated with adrenal fatigue.
Adrenal fatigue is a complex condition with equally complex clinical presentations that depend on the condition’s stage and on your own body.
Adrenal Fatigue Syndrome is a common condition, and most people experience it at one point or another. However, most conventional physicians are not taught about adrenal fatigue in medical school. As such, they are not prepared to take adrenal fatigue as a serious threat to your health.
Many providers do not recognize “adrenal fatigue” as a real condition. They argue that the adrenal glands becoming “fatigued” and not having the ability to produce stress hormones like cortisol lacks scientific support. Conventional medicine typically acknowledges only extreme adrenal conditions - Addison’s disease, where no cortisol is produced, and Cushing’s disease, with excessive cortisol production. This leaves no recognized diagnosis for those who might have somewhat low but not completely depleted cortisol levels.
People in this so-called gray zone might experience symptoms of fatigue, sleep issues, muscle aches, weight gain, and mood swings. However, these symptoms are common in other conditions like depression, hypothyroidism, fibromyalgia, anxiety, and sleep apnea. Consequently, healthcare providers often attribute these symptoms to these more established diagnoses instead of adrenal fatigue.
Supporters of adrenal fatigue view it as a mild to moderate form of adrenal insufficiency depending on the stage of severity. They believe that chronic stress can lead to “overworked” adrenal glands, lowered cortisol levels, depleted nutrient stores, and lower levels of key hormone precursors, resulting in adrenal fatigue, which is a less severe but chronic form of adrenal disruption.
Currently, there is a new working theory of the NeuroEndoMetabolic (NEM) Stress Response, which offers a model of how the organs and systems in the body respond to prolonged stress, producing a range of symptoms similar to the ones seen in adrenal fatigue.
The NEM stress response is a model that illustrates how the body responds to stress. It is an interconnected network of six systems of related organs - the neuroaffective, hormonal, metabolic, cardionomic, inflammation, and detoxification responses - that work together to help the body adapt to stress.
When the body is under constant stress, the adrenal glands, part of the hormonal response system, continuously produce cortisol. Over time, it is theorized that these glands struggle to keep up with the demand, leading to common adrenal fatigue symptoms like fatigue, salt cravings, sleep difficulties, palpitations, inability to lose weight, etc.
Furthermore, if the stress continues unabated, other systems within the NEM stress response might also be affected. For instance, chronic stress could lead to metabolic imbalances, inflammatory responses, and impaired detoxification - all of which could exacerbate the symptoms of adrenal fatigue and contribute to a cycle of worsening health. Therefore, the concept of adrenal fatigue can be seen as aligning with the broader, systemic view of the body's response to stress as outlined in the NEM stress response model.
It’s important not to confuse Adrenal Fatigue Syndrome with another medical condition called Addison's disease. In Addison's disease, your adrenal glands are nonfunctional according to conventional endocrinology standards.
The causes of these two conditions are also vastly different. Addison's disease is often caused by an auto-immune dysfunction, while Adrenal Fatigue Syndrome is caused by stress or other factors.
Conventional medicine only recognizes Addison's disease as a form of hypoadrenia. As such, it is not surprising if your doctor is unfamiliar with this condition. Adrenal Fatigue Syndrome is a sub-clinical, non-Addison's form of adrenal dysfunction. Because there are many causes, Adrenal Fatigue Syndrome is a more accurate name. The addition of "syndrome" implies no definitive cause.
Adrenal fatigue can be very individual. Symptoms can vary from person to person and the severity of individual symptoms can also vary as the condition progresses. Here’s a list of the most common symptoms among people with adrenal fatigue.
If you have many of these signs and symptoms, it is time to consider adrenal fatigue as a possible cause. None of the signs or symptoms by themselves can definitively pinpoint adrenal fatigue. However, when looked at collectively, these signs and symptoms form a specific picture of a person under stress. These signs and symptoms are often the end result of acute, severe, chronic, or excessive stress when the body is unable to reduce such stress.
Chronic stress is common in Western society. Adrenal fatigue can occur when the amount of stress exceeds the body’s capacity to compensate and recover.
Unfortunately, life itself can be stressful. At any one time, you could be facing a number of situations that cause stress, from work pressures and job changes to illnesses, marital problems, or environment changes. Pain, physical illnesses, and chronic health problems can also cause physical stress on the body.
At this stage, studies indicate that prolonged stress can bring on fatigue in the adrenal glands and AFS. Some stressors that may put you at risk of this condition are:
One of the most overlooked causes of adrenal fatigue is chronic or severe infection, which gives rise to an inflammatory response. These infections can occur sub-clinically with no obvious signs at all. Parasitic and bacterial infections including Giardia and H. pylori are often the main causes.
Adrenal fatigue has been recognized as a distinct clinical syndrome since the turn of the 20th century. But most doctors are unfamiliar with this condition. That is because this condition is difficult to identify by traditional blood tests. Normal blood tests detect mainly severe changes in adrenal hormones, such as with Addison's Disease.
For example, if you go to your doctor with adrenal symptoms, your doctor may order an ACTH (adrenocorticotropic hormone) challenge test. This test recognizes extreme underproduction or overproduction of hormones. It measures the top and bottom 2 percent of a bell curve. In other words, identifying a condition requires your adrenal function to be extremely low (the bottom 2 percent).
However, many people report symptoms of non-Addison’s adrenal malfunction with a 15 percent deviation from the mean on the bell curve. Therefore, the adrenal glands could be functioning anywhere from 15 to 48 percent below the norm and not be detected by the ACTH test.
To sum it up, adrenal hormones are low in the case of adrenal fatigue. But they are still within the "normal" range and not low enough to warrant a diagnosis of Addison's disease.
There are many routine laboratory tests for fatigue. Unfortunately, most are not diagnostic, and normal values do not necessarily mean that the body is free of illness. Abnormal values are not necessarily diagnostic either. There are many advanced functional tests available, but they also have issues with accuracy and can be misleading if not correlated with the overall clinical picture.
One way to screen for adrenal fatigue is with laboratory studies of surrogate markers for adrenal function. In this case, the tests would look at cortisol and DHEA levels. These two give a general picture of the body and determine if it’s in an anabolic (build-up) or catabolic (breakdown) state. However, again, this is not diagnostic.
Another way to test your adrenal health is to measure the level of free cortisol and DHEA in your saliva. Again, this is not diagnostic. These tests can also be misleading if performed in isolation, which is why several tests are often recommended to give an overall picture through time.
DHEA can be measured anytime throughout the day.
However, getting an accurate picture of cortisol levels can be a little more complex. Cortisol fluctuates throughout the day. It is highest in the morning and lowest in the evening. This means you need to get multiple samples to map the daily diurnal curve of free cortisol in the body relative to DHEA levels.
You can do this by taking 4 samples of cortisol at 8 am, noon, 5 pm, and before bedtime if you’re doing saliva tests.
Once you’ve taken the tests, it’s important that the results are interpreted correctly. Here are some common results and what they mean:
You also need to match the different cortisol values with the body's symptoms throughout the day. Otherwise, a saliva test is of limited value and can in fact be misleading.
Due to these issues, laboratory tests should be undertaken carefully, in the right setting, and only when needed. It is not uncommon to have adrenal fatigue symptoms with "normal" laboratory results, and vice versa.
This is why laboratory tests are best used as supporting tools under the guidance of the right health professional. They should not be relied on as a sole gauge of adrenal function and therapeutic options.
A good history by an astute and experienced clinician is by far the best and most accurate way to ascertain adrenal fatigue status. Repeated saliva cortisol testing can also be very helpful during this process.
Some basic blood lab tests to rule out other causes of fatigue can include:
Adrenal fatigue can be reversed with the right help and guidance. The recovery time is different for everyone, but most take 6 months to 2 years to start feeling well again.
These are some of the important steps you will need to take for adrenal fatigue recovery:
This is the most important step in adrenal fatigue recovery. It is important to reduce or eliminate stressors such as marital, family, relationship, or financial problems. Here are some general ways to reduce stress:
Sleep is one of the most important aspects of adrenal recovery and general health. Generally speaking, it’s important to go to sleep by 10 p.m. every night when you’re working on your adrenal recovery.
This is because your adrenal glands operate on a regular schedule. Between 11 p.m. and 1 a.m. in the morning, they reactivate for a “second wind”, which can put added stress on your body. Avoiding this late-night re-activation period is pivotal to letting your adrenal glands rest. This will also give your adrenals time to repair the body, as most of this work is performed late at night while you are sleeping.
It’s also important to sleep in until 8:30 a.m. or 9: 00 a.m. if possible. Cortisol levels peak between 6:00 a.m. to 8:00 a.m. to wake you up and get you going for the day. So, if you wake up too early, this will only increase the stress on the adrenal glands, which will have to produce more cortisol.
Sleep quality is also important when you have adrenal fatigue. Here are some ideas for better sleep:
Coffee and tea can act as stimulants, require more cortisol production, and interrupt sleep patterns, so they should be minimized or avoided while recovering from adrenal fatigue. Try herbal tea instead, because it does not contain caffeine.
This is a wonderful way to reduce stress, oxygenate your body, and aid with adrenal fatigue recovery. Exercise reduces depression, increases blood flow, and normalizes cortisol, insulin, blood glucose, growth hormones, and thyroid levels. It also makes you feel generally much better.
Here’s a quick guide to exercising when you have adrenal fatigue:
As your adrenal fatigue improves, more regular exercise can be incorporated into your routine. Regular exercise should cover the following three categories:
In an Adrenal Fatigue Syndrome recovery program, nutritional supplements can help optimize the adrenal gland function.
A good balance of vitamins and minerals for optimal adrenal function can include:
500 mg to 3,000 mg of vitamin C with bioflavonoids and synergistic co-factors is beneficial when you have adrenal fatigue.
Vitamin C is one of the gentlest of all adrenal-supporting nutrients and is key to helping the adrenals produce hormones. Here’s how to take it safely and effectively:
Glutathione by intravenous or by liposomal oral delivery can help enhance the effectiveness and cellular bio-availability of vitamin C, E, alpha lipoic acid, and carnitine. It also acts as a liver detoxifier and helps recycle inactive oxidized vitamin C back to its reduced active form in the body after vitamin C has served its function.
Most hormones in the adrenal glands need coenzyme A for production. Coenzyme A is a product of vitamin B5, so you need to ensure that your body has enough of this vitamin. This is a key ingredient for your adrenals to function optimally, so take around 500-1000 mg twice a day.
400-800 I.U. of Vitamin E is another important nutrient as it’s involved in at least six different enzymatic reactions in the adrenal cascade.
1000 to 5000 I.U of Vitamin D is a good nutrient to support hormonal synthesis. Check your vitamin D levels to make sure they are optimal, ideally above 60 ng/mL.
Magnesium is important for nerve and muscle function. It can help to alleviate symptoms like unstable blood sugar levels, high blood pressure, and aches, and it is also important for the creation of protein, one of the building blocks of all the tissue in your body. It is great for relaxation of the gut and also benefits good sleep. Take a good blend of magnesium citrate, glycinate, and taurate for optimal absorption. Around 200 to 800 mg is often recommended.
Adrenal glandulars, adrenal extracts, and herbs can be helpful in the short term. Some helpful substances to try are:
These substances are usually better for those with mild Adrenal Fatigue Syndrome. However, you should always talk to a doctor before starting any new supplements. AFS can cause increased sensitivity to supplements and unexpected reactions.
If you have moderate to advanced adrenal weakness, these supplements should be used with extreme caution, as they can behave as stimulants and increase cortisol production, which can cause serious health concerns when the adrenals are already severely depleted. This may give a short-term sense of well-being in advanced stages, but it could backfire long term.
Supplementing with steroids such as natural hydrocortisone or cortisone acetate in doses of 2.5 to 5 mg two to four times a day can be an effective way to replenish depleted adrenals.
However, these steroids should only be used for a short time, for those with severe adrenal fatigue, with medical supervision. Taking them over the long term can cause tolerance and dependency issues.
Fortunately, there are many gentler and non-addictive natural compounds that help adrenal function. With the help of an experienced clinician, this approach is seldom necessary.
If you experience hormonal imbalances with adrenal fatigue, then it may be tempting to take hormone replacements. However, this approach isn’t always helpful unless you heal the adrenals first. These hormones can mask the underlying problem, and ultimately worsen the overall condition. This applies to both synthetic and bio-identical hormones.
Extra nutrients that you may want to consider include:
It is important to understand that the “shotgun approach,” of taking many different supplements at the same time, seldom works and often backfires over time. This is especially true if you’re in an advanced stage of adrenal fatigue. The use of nutritional supplementation in overcoming adrenal fatigue needs to be individualized, based on your history, background, metabolism, sensitivities, and detoxification system.
Improper selection, dosage, and timing of nutritional supplementation is the number one cause of adrenal fatigue recovery failure. Unless adrenal fatigue is in its mildest form, selecting the right compound, dosage, and delivery system to match the stage of adrenal fatigue is best left to an experienced clinician.
Food is one of the most important aspects of an effective adrenal fatigue recovery plan. Food helps supply your body with energy as well as the nutrients it needs to function at its best, heal, and repair any damage.
Here’s how to eat to manage AFS:
Skipping breakfast is not a good idea when you have adrenal fatigue. Many people struggle to eat breakfast. This is because cortisol levels peak from 6 a.m. to 8 a.m, which can dampen the appetite. Yet your body needs sugar for energy, so a small snack is better than nothing at all and will provide the needed energy even though there is no urge to eat.
In addition to breakfast soon after waking, here are the best times to eat during your days:
This eating pattern will help to keep your insulin levels stable throughout the day. Otherwise, insulin secretion can become dysfunctional, resulting in a hypoglycemic state in the middle of the night or long-term insulin problems.
When this occurs, the body will have to activate the adrenals to put out more cortisol to raise the blood sugar back to its normal level. This can put an excessive burden on the already fatigued adrenal glands.
Glucose is a simple sugar found in food. It is an essential nutrient that provides energy for the proper functioning of the body's cells. The sugar levels in your body are controlled by insulin, often called the hunger hormone. When your blood sugar levels drop below a certain level, your insulin drops as well and you feel hungry.
Be aware that sharp drops in blood sugar levels trigger the release of cortisol, so it is best to avoid this, when possible. You can do this by:
Processed foods of all kinds should be avoided when you have adrenal fatigue. These foods are often full of chemicals, simple sugars, unhealthy fats, and sodium, all of which are detrimental to your health. These foods deplete your already low nutrient reserves. They also cause inflammation and blood sugar spikes and crashes, which can worsen fatigue, and they put a strain on your detoxification system.
It’s vital to eat a balanced, healthy diet when you have adrenal fatigue. This means balancing the amount of proteins, fats, and carbohydrates that you eat.
Your diet should be high in raw foods that are low on the glycemic index. This means focusing your diet on:
Sample Dietary Plan of 2000 calories a day:
It’s vitally important that you make changes carefully and work with a medical professional who’s aware of adrenal fatigue during this process.
Especially advanced AFS causes your body to become sensitive and fragile. In this state, it can react badly even to healthy changes, causing additional stress and strain. This will not only impact your overall condition, but it will also force your adrenals to produce more cortisol, which is exactly what you don’t want.
This is particularly true for supplements, glandulars, and herbs, as these are powerful substances that can easily cause side effects or reactions. So, if you want to avoid side effects such as paradoxical reactions, during which your body reacts the opposite of how it should, then make sure you work with a professional who can guide you through this recovery process.
Adrenal recovery often takes months or years, and it is essential that you have an effective plan you can stick with for this time.
Adrenal fatigue is a decrease in the adrenal glands' ability to carry out its normal function. The chief symptoms are fatigue, excitability, and depression, and it can affect anyone, from children to adults. Here are some of the main points that you need to know about this condition:
The good news is that, over time, you can restore your health. Discover your optimal adrenal health with Dr. Lam's Adrenal Fatigue Recovery Program! Dive into this course that guides you on supplement usage, beneficial exercises, diet choices, and reveals insights from Dr. Lam's own journey. Empower yourself to make informed decisions and sidestep common setbacks. Join now!
Master Adrenal Fatigue: Find Relief with Adrenal Stress Control!
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Allen, Loyd, V, “Adrenal Fatigue”, International Journal of Pharmaceutical Compounding, vol. 17, no. 1, 2013, pp. 39-44, https://pubmed.ncbi.nlm.nih.gov/23627245/
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