Crash Management

Symptoms of an Adrenal Crash

Not all adrenal crashes and recovery cycles are symptomatic. Those with stage 1 and early stage 2 adrenal fatigues may not even be aware, especially if there are sufficient adrenal reserves at hand to compensate and ensure normal daily function. On the other hand, symptoms are universally present for those in stage 3 and 4 adrenal fatigue when they crash, and their symptoms vary greatly in severity.

Symptoms of adrenal crash represent a sudden intensification or abrupt onset of the many already existing pre-crash adrenal fatigue symptoms, such as

• Drastic reduction in energy and increased fatigue.
• Muscles don't regenerate and are lost to provide sugar to the brain, with drastic increase in brain fog and dizziness.
• Low blood sugar and frequent hypoglycemic episodes with lightheadedness as sugar regulation becomes dysfunctional.
• Major change in mood stability leading to depression, anxiety, irritability, and rage.
• Lower immune function leading to more infections, shingles and slower recovery.
• Loss of the steroid hormone precursors DHEA, leading to low testosterone or imbalanced estrogen and progesterone levels. These hormonal changes are often seen in women as significant estrogen dominance symptoms appear; such as water retention, hot flashes, insomnia, bloating, sugar cravings, and emotional changes. In men, libido is lost.
• Poor digestion from the constant decrease of metabolism, with irregular bowel movements, constipation, irritable bowel.
• Uncontrolled stress response triggered by adrenaline rush with exaggerated symptoms such as anxiety, depression or physical shaking for a period of time after a stressful situation or sugar crashes. People will also start to perceive situations to be more stressful than they are, due to the exaggerated responses.
• Fibromyalgia with joint pain as the body enters a catabolic state.
• Hypothyroidism due to the inhibition of thyroid hormone activation and also suppression of the controlled release of hormone from the thyroid. Dry skin and weight gain is common.
• Chronic fatigue from the constant stress stimulation and insomnia. The sensation of being "wired and tired" is common, with inability to fall asleep.
• Metabolic imbalance and sugar dysregulation, with bouts of awakening in the middle of the night with cold sweats, palpitations, and hunger pangs.
• Arthritis flare-ups from the poorly regulated inflammatory pathways.
• Acne and hair loss from imbalance in hormones and poor immune response.
• Immune imbalances and decreased immune function, frequent infection, and poor healing.

You need not have all of these symptoms to have an adrenal crash. Sometimes, you only have a few of them, but they are usually severe. Sometimes the degree of decompensation can be quite mild and minor. Other times, they can be severe and major. Generally speaking, the more intense the symptoms, the more severe is the crash. Crash intensity can be classified into five levels which will be explained later. One can experience any degree of adrenal crash at any stage of adrenal fatigue.

Adrenal Crash Intensity

Clinically, adrenal fatigue Crashes are classified into 5 levels based on subjective evaluation. Levels 1 and 2 are considered minor crashes with good recovery potential, while levels 3, 4, and 5 are considered major crashes and have a much less certain Recovery Phase.

• Level 1 - loss of 10-19% of immediate pre-crash baseline level of adrenal function in terms of energy, metabolic imbalance such as hypoglycemia, and emotional function such as irritability. Typically, there is a sense of being more tired than usual, more irritable, and a sense of being hungry earlier than normal. Normal outside work as well as household chores can be completed, though a sense of tiredness is felt at the end of the day. A nap can be extremely helpful and the sense of recovery is felt after rest.
• Level 2 - loss of 20-29% of immediate pre-crash baseline level of function in terms of energy, metabolic imbalance such as hypoglycemia, and emotional function such as irritability. Typically, there is a definite reduction in energy, but that can be compensated practically by a nap or laying down for 30 minutes. Emotional stability is less, and easily irritated. When it is time to eat, there is a sense of relief. The ability to perform normal outside activities such as a job or regular household chores is compromised, but can be forced to be completed if needed to. Even with a nap and rest during the day, the body is tired and not quite the same. The body is under strain.
• Level 3 - loss of 30-39% of immediate pre-crash baseline level of function in terms of energy, metabolic imbalance such as hypoglycemia, and emotional function such as irritability. Typically, the energy level is low throughout the day. Even with rest and a nap, the body remains very tired. There is moderate reduction in the ability to perform all outside activities as well as household chores. One feels like staying home all day and not just for a few hours to rest. Anger, short tempered, and rage is common. The body craves sugar for energy at times. Insomnia is worse, and in many cases, accompanied with cold sweats, heart palpitations and dizziness.
• Level 4 - loss of 40-49% of immediate pre-crash baseline level of function in terms of energy, metabolic imbalance such as hypoglycemia, and emotional function such as irritability. Typically, there is severe fatigue throughout the day. Unable to do most household chores, and the body feels totally drained. Emotionally depressed and too weak emotionally to get angry. Food or supplements that generates energy before may make things worse. Unable to get to do outside chores is a key characteristic. Those who are working will be unable to go to work. Even sounds from the TV can be irritating. Once in bed, it's hard to get up other than to go to the kitchen to prepare food.
• Level 5 - loss of greater than 50% of immediate pre-crash baseline level of function in terms of energy, metabolic imbalance such as hypoglycemia, and emotional function such as irritability. Bedridden most of the time, getting up only to accomplish the basic personal hygiene chores. It's not unusual to require assistance for ambulation or taking a shower or changing clothes.

One can have any number of minor or major crashes during any stage of adrenal fatigue.

Crash Management

The key to managing an adrenal crash is to reduce the crash velocity, lessen the intensity, and administer proper nutrients at the right time to propel the system into recovery as soon as possible.

Minor adrenal crashes (loss of 10 percent to 29 percent of energy) usually go unnoticed in Stage 1 and 2 of Adrenal Fatigue. All crashes are noticeable in Stage 3 and 4 of Adrenal Fatigue. Major crashes involving a loss of 30 percent or more of energy can be devastating at any stage.

The more advanced the Adrenal Fatigue, the less reserve is present in the body, and therefore, the faster the crash. The same stressor that takes a few days to trigger a crash in those with Stage 1 and 2 Adrenal Fatigue may only take a few hours to cause the same damage in those with Stage 3 and 4 Adrenal Fatigue. Crash intensity is also greatly magnified in terms of symptomatology, the weaker the adrenals, the cruder the way the emergency systems are activated.

Proper crash management requires individualized attention. Everyone is different, and there are no standardized protocols. What may be fitting for one person may actually make another person worse. The following are key areas to be addressed during crash management:

1. Physical Activity. Usually this means immediate reduction of unnecessary physical activity and an increase in rest. Exercise in particular, needs to be adjusted to match the energy state of the body. In early Adrenal Fatigue, a crash usually presents itself in nothing more than mild fatigue. Exercise increases adrenaline release and blood circulation, which might result in a short-term energy boost. Unless this is followed by adequate rest, over-exercise can drain the body and trigger follow-up crashes. Complete rest in bed, on the other hand, is not necessarily the best either. A personalized program of Adrenal Restorative Exercises and Adrenal Breathing Exercises is very helpful. As the body is very sensitive to even the slightest stress, one must be careful to adjust the intensity and frequency to match the body's state to avoid triggering further crashes. For example, 80 percent breathing intensity may not be tolerated during a crash and should be adjusted down to 50 percent or less. Improper breathing techniques, such as prolonged holding, or shallow breathing can also increase sympathetic tone and trigger further adrenal crashes.
2. Dietary Adjustments. Hypoglycemia and metabolic imbalances are common during an adrenal crash. Proper dietary adjustment focuses on stabilizing blood sugar by balancing the amount of carbohydrate, protein, and fat in the diet. Gastric assimilation is often compromised during a crash. The proper delivery system of macro-nutritional form needs to be considered to facilitate absorption and nutrient delivery to the cell. For example, raw milk may be superior to regular milk, and raw egg is better than cooked egg in such cases. Those who have had severe crashes might not be able to tolerate regular food and therefore need to be on a special chicken broth and raw colostrums for foundational nutritional support. Severe cases might actually need hospital admission for total parental nutrition.
3. Electrolyte Adjustments. A common symptom of Adrenal Fatigue is salt craving due to the sodium imbalance caused by hormonal dysfunction. This imbalance is usually worse during a crash.The rebalance process needs to be carefully titrated and controlled to avoid making the situation worse. Too much sodium relative to water may lead to hypertension and too little water may lead to dehydration and compound the crash. Too much water relative to sodium may lead to dilutional hyponatremia. Unfortunately, laboratory values may be normal during the crash and will not be abnormal until the crash is well advanced. Those on diuretics or medications who have a history of high blood pressure need to be especially careful. Symptoms such as nausea, vomiting, headache, malaise, and foggy thinking are common. Severe case may actually need hospital admission.
4. Nutritional Supplement Adjustments. Administration of nutrients during an adrenal crash requires careful consideration. Blindly taking the same dosage of supplements during a crash as before the crash can worsen the fatigue. The state of the body is very different during a crash. Animals under stress, for example, needs up to ten times more vitamin C compared to normal. Some of the key determinants of the amount of nutrients to take during a crash include biological constitution, clearance state, history of paradoxical reaction and autonomic system sensitivity. For example, those with low clearance state will benefit greatly if nutrients are temporarily reduced during the crash. On the other hand, increasing the nutrient level during a crash or immediately thereafter can be beneficial to those with normal clearance states as the body needs more during a stressful crisis. Taking advantage of this can turn a potentially devastating crash into a sweet honeymoon, a welcome event for all. We will discuss this more below.

Due to the inherent complexity, management is best left to the experienced clinician. Even then, some trial and error is expected due to poorly understood underlying physiology.