An Introduction to Adrenal Fatigue

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 adrenal 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 bloodstream to have widespread effects on your body. The adrenals have two parts: the cortex, the outer layer, and the medulla, or middle.

The adrenal cortex produces steroid hormones, which we typically associate with our adrenal glands. These include aldosterone, which regulates salt and water balance; cortisol and cortisone, which are 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, also known as epinephrine and norepinephrine.

Your adrenals are intimately linked to circadian rhythms, daytime waking, and fear and stress responses. 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, 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 normalize after that big burst of activity, helped, of course, by the intense muscle activity involved in fighting or fleeing. Are you seeing the problem?

An Introduction to Adrenal Fatigue, or Why Are They So Tired?

Frankly, nobody needs an introduction to adrenal fatigue because most of us have it to some degree. Modern life is hard on our poor little adrenals. Our most common adrenaline surges in modern life 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 balance, and also, these are daily and often multiple times per day occurrences. It isn't a fight-or-flight situation anymore; it's a constant grinding acceleration.

Our valiant 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 that every trait 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 burnout 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 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, which can become debilitating. Other symptoms include difficulty waking up or getting out of bed in the morning, physical weakness, lightheadedness when standing up too fast, water retention or puffiness, dark circles under the 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 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 to test salivary cortisol every 4 hours for 24 hours. This can show you how your cortisol is rising and falling during the day relative to how it is supposed to be rising and falling.