Although not taught in medical school…
and not universally recognized by conventional medical professionals, symptoms of adrenal fatigue materialize in many conversations between patients and their primary care doctors. Depending on the level of adrenal fatigue, symptoms can range from feeling wired but tired to utter exhaustion.
In order to understand adrenal fatigue, we first need some background on our adrenal glands and how our bodies respond to stress. Divided into two main sections, the outer adrenal cortex and the inner adrenal medulla, the adrenal glands sit on top of our kidneys. The adrenal cortex manufactures hormones that control salt regulation (aldosterone), sugar regulation (cortisol), and also some sex hormones, such as DHEA. The adrenal medulla makes epinephrine, more commonly known as adrenaline, or the “fight or flight” hormone.
When our brain senses a stressor, whether this is a physical stressor, such as an injury, or a psychological stressor, such as an approaching deadline at work, our body activates two pathways. First, we release adrenaline, which is a very quick response. This triggers our body’s “fight or flight” response. Second, we release cortisol, which is a slower response, and can help us to deal with our stressor in a more sustained way, such as increasing the sugar and fats in our blood stream to be used as energy.
As humans have evolved, these pathways have been essential in our survival – from escaping wild animals to surviving the conditions of war zones – our stress response pathways provide many benefits. Problems arise when chronic stress results in constantly activated stress pathways. Chronically elevated cortisol leads to increased fat storage (specifically around the belly), elevated blood pressure, elevated blood sugars, memory loss, depression, a poorly functioning immune system and feeling “wired, but tired”. High cortisol levels also lead to low sex hormone levels, such as estrogen and testosterone. Occasionally, the body may be unable to continue to produce the high amounts of cortisol and cortisol levels will then drop, leading to the feeling of exhaustion.
In our current society, most of us feel constantly stressed – we work too much, we sleep too little, we are forced to find food that is “quick,” which usually means lacking in nutrients, and we have a hard time finding time to exercise, relax or just have fun. All of these things can lead to symptoms of adrenal fatigue.
Is there a test for adrenal fatigue? Yes – a saliva test that measures DHEA and cortisol several times over 24 hours can be used to diagnose adrenal fatigue. This test typically costs patient $100-$200. Doctors who have special training in integrative or functional medicine typically order and interpret these tests.
A future blog post will cover strategies to prevent and treat adrenal fatigue.