Adrenal Fatigue – An Introduction

Lots of people talk about adrenal fatigue, and to hear people talk you’d think it’s as common as belly buttons. That might actually be the case, given that modern society seems designed to push your adrenals to the limit and then some. So let’s talk about what this actually means.

What Your Adrenals Do

Your adrenals glands are a matched pair of little glands that sit like hats on top of your kidneys, hence the name ad-, or above, -renal, or kidney. They are endocrine glands, meaning they secrete hormones directly into the blood stream to have widespread effects on your body. There are two parts to the adrenals, the cortex, or outside layer, and medulla, or middle.

The adrenal cortex does the thing that we typically associate with our adrenal glands, which is produce steroid hormones. These include aldosterone, which regulates salt and water balance; cortisol and cortisone, which are really at the heart of adrenal fatigue; and androgens like DHEA and androstenedione, a precursor to testosterone.

The adrenal medulla, or middle section of the adrenals, produces the catecholamine fight-or-flight hormones adrenaline and noradrenaline. These are also called epinephrine and norepinephrine.

Your adrenals are intimately linked to circadian rhythms and daytime waking, as well as fear and stress response. They are designed to keep you functioning and help you stay safe. Herein lies the difficulty.

In a more ancestral environment, fear would come from a situation like say spotting a dangerous predator, or fighting off an invading horde. This would cause a massive release of epinephrine and norepinephrine to open the blood vessels to your muscles so you can run from the threat, shut down gut activity because you have more important things going on, increase blood flow to your eyes so you can see the threat, and increase your heart and respiratory rates so that you are primed and ready to deal with this situation. Then, you fight or flee (both of which are highly physical activities).

After the situation is over, cortisol helps your system to normalize after that big burst of activity, helped, of course, by the intense muscle activity that was involved in fighting or fleeing. Are you seeing the problem?

Why do Adreanals get Fatigued?

In modern life, our most common adrenalin surges come from work deadlines, impossible task lists, the evening news and the near-constant overwhelm of the modern world. You will notice that none of these things have the intense physical release that helps your body to balance, and also these are daily and often multiple times per day occurrences. It isn’t a fight or flee situation anymore, it’s a constant grinding acceleration.

Our valient little adrenals try desperately to keep up with this, but it’s hard. It’s hard for everyone, but it’s made worse by things like ambition, anxiety, perfectionism, competitiveness, and pretty much every other trait that is valued in modern Western society. Also, I have to point out, every trait that is characteristic of people with the MTHFR polymorphisms – we are often hyper-focused, ambitious, obsessive, perfectionistic, or competitive.

This leads to overstimulation of these glands and eventual burn-down as they overuse resources, and tire themselves out.

Main symptoms of Adrenal Fatigue

Adrenal fatigue is a long, slow process that starts with overwork, not enough rest, and over-functioning and ends with barely being able to keep up with normal life or even, in extreme cases, becoming bedridden.

It can take months or more often years of overdoing it before you really notice that you aren’t keeping up, and then the rebuilding time can be just as long.

The most common symptom of adrenal fatigue is fatigue that can become debilitating. Other symptoms include difficulty waking up or getting out of bed in the morning, physical weakness, lightheadedness when you stand up too fast, water retention or puffiness, dark circles under your eyes, insomnia or sleep disturbance, and melasma, or hyperpigmentation of the skin.

As it progresses, day and night rhythms become imbalanced with many people reporting a burst of energy around bedtime, difficult sleep until the wee hours, and then an inability to get up in the morning or they get into a state that feels never truly awake and never truly asleep.

At the very extreme end of adrenal fatigue, there is Addison’s disease, an autoimmune form of adrenal failure. This and other forms of primary adrenal failure often require hospitalization and emergency treatment for “adrenal crisis.” Most people don’t get to this point, but stay in the not-emergency but not-functioning part of the adrenal mess.

The best way to test your adrenal function in this context is by testing salivary cortisol every 4 hours through a 24-hour period. This can show you how your cortisol is rising and falling in the day relative to how it is supposed to be rising and falling.

Next episode we’ll talk about the stages of adrenal fatigue, and then we’ll get into what to do about it.