Adrenal Fatigue Part I: A Holistic Western Perspective

Adrenal Fatigue.

You’ve heard it mentioned, you might have read about it, maybe you’ve even wondered if it could explain some of your symptoms. Currently, western medicine doesn’t consider it a formal diagnosis but, more and more, holistically minded healthcare providers are beginning to explain a set of common and often confusing symptoms through this lens. As a Chinese Medicine Practitioner I am pleased to see this recognition beginning to trickle into western thinking because Chinese Medicine has understood this pattern for millennia by another name, and it is as relevant now as it has always been.

Though conventional medicine has little to offer by way of treatment for those suffering with adrenal fatigue, Chinese Medicine has a time-tested wealth of knowledge and tools to revitalize exhausted adrenal glands. Western science explains Adrenal Fatigue Syndrome (AFS), as described by James Wilson PhD, as a “group of related signs and symptoms (a syndrome) that results when the adrenal glands function below the necessary level.”

There is reluctance within the conventional medical community to accept this as a formal diagnosis (meaning it is billable to insurance companies) due to its elusive nature when it comes to measurable testing.

If you have signs and symptoms that point to under active adrenal function but this doesn’t show up in your blood work, your doctor will not be able to diagnose it as a problem of the adrenal glands. That’s fairly straight forward. If your adrenal hormones (specifically cortisol) DO measure at lower than normal levels, it will be diagnosed as Adrenal Insufficiency, the medical treatment for which is typically hormone replacement. The problem with hormonal testing and AFS is at least two-fold. First, our adrenal hormones fluctuate throughout the day; they should be highest around 6-7 am and lowest around midnight. Our bodies are cyclical and it is essential that these levels rise and fall throughout the day in according to your circadian rhythm as well as external stimuli. Blood testing for adrenal problems using cortisol as a marker is typically done once in a day and if the results come back as “within normal range” it only means that at whatever time you had your blood drawn your cortisol levels were appropriate for that time of day. This is in no way indicative of healthy cortisol levels at other times in the day.

The second issue I see with adrenal blood testing is that the standard medical range for “normal” cortisol levels is so wide that in order for something to show up as abnormal there must be a dramatic over or under production at that time. By the time this is the case the person being tested is already quite ill. It is my experience that we can identify an adrenal deficiency using diagnostic techniques Chinese Medicine has given us long before any blood test can confirm this.

Adrenal Fatigue Syndrome is best understood as the point at which your adrenal glands are operating “within normal range” sometimes but not consistently or on the low end of normal. From a holistic perspective, we know that the adrenals do not need to reach the critical low of Adrenal Insufficiency for the body to start experiencing uncomfortable symptoms, and everyone has a different threshold for becoming symptomatic. Conventional Western medicine is designed to identify and slow the progress of Disease and provides damage control. It is not designed to optimize health. Chinese Medicine fills this gap for us by offering an understanding of Health and by giving us tools to support, maintain, and optimize this state of wellness. We know that that there is a huge range from “healthy” hormone levels that show up on blood tests to red flagged dangerous levels. Nothing is black and white. There is no “health” versus “disease”. It’s all a spectrum and it is important to understand this if we want to improve the daily experience we have of our health.

My experience has taught me that long before an imbalance or insufficiency of cortisol is able to be detected in blood work the adrenals have begun to decline in function. Hormone levels might start to drop or become erratic. The interplay between cortisol and adrenaline becomes unbalanced and inappropriate for the activities we are performing or time of day. This can only be recognized by very sensitive testing techniques that are taken at regular intervals throughout your day and use a combination of blood, saliva and sometimes urine testing. Unfortunately for those suffering this type of testing is not a standard medical practice and one must seek out specifically trained holistic practitioners to find someone who will do it. While I am very happy that these adrenal testing techniques are finally being developed and showing tangible evidence of adrenal fatigue, I still prefer to use other traditional Chinese Medicine diagnostic techniques to discover this information. The body is capable of confirming for us that the adrenal energy is low if we know how to interpret the signs. Fortunately, Chinese Medicine provides us with the knowledge we need to interpret and support the body’s ability to recover from this declining adrenal function. I’ll describe these techniques later in our discussion.

Adrenaline (also known as Epinephrine) is the hormone that our adrenal glands produce when we are being chased by a bear. Or when we realize our alarm clock didn’t go off and we wake up with our heart jumping through out chest. Or when we drink too much coffee. An adrenaline surge indicates that our nervous system is going from its resting state into an emergency state, meaning that our sympathetic nervous system has been activated. In a helpful context we need that adrenaline surge when there is an emergency, the adrenal glands provide the perfect hormone for the body to get out of a dangerous situation quickly. Run from the bear, get to work as quickly as possible and well, the coffee situation isn’t necessarily helpful but it still happens.

Adrenaline increases blood flow to the muscles and limbs, giving the strength to fight or flight effectively, causes pupillary dilation to let more light in and increases our blood sugar levels to provide us with the energy we need in that moment. We can think of Adrenaline as a very Yang influence on the body. It is active and generates an explosive response. Adrenaline is like the match that lights the fire. It’s quick and has a short lived effect, but if the circumstance that brought it on continues, our bodies call in the second line of defense to keep us revved up. A series of hormonal signals between the brain and the adrenal glands trigger the release of Cortisol. This is another hormone released by the adrenal glands that acts to prolong the effects of adrenaline so if we haven’t gotten out of danger yet we have more strength and time to do so. Cortisol levels will remain elevated until the threat passes.

At this point, we ideally go from this hyperactive sympathetic nervous system state back into a calm, balanced resting state as our parasympathetic nervous system kicks back in. This is what happens in someone who has strong, optimally functioning adrenal energy. Now remember, it was the brain’s perception of danger that triggered the adrenals to lurch into action. This means that just because the threat or stressful moment has actually passed, until our brains have become convinced of this safety they will not necessarily send the signal to stop the cortisol surge. This means any kind of stress keeps cortisol pumping. In someone who is experiencing a degree of Adrenal Fatigue this process of returning to a calm parasympathetic state won’t often go smoothly. When one has experienced prolonged periods of stress, trauma, overwork or perhaps a long-term illness or injury that involved a long recovery, and their adrenal glands have been responsible for pumping out adrenaline and cortisol with almost no break over a long period of time, they will eventually become depleted. For the adrenal glands, this means that as the body tries to shift gears they can become erratic in their production of stress hormones, producing adrenaline and cortisol at inappropriate times of day or night. This often leaves people feeling tired and wired.

In a chronic Adrenal Fatigue sufferer, the body is unable to produce healthy amounts of adrenaline and/or cortisol at times when they are needed. This means waking up in the morning can be very difficult, meeting daily tasks can be an uphill battle, and the adrenals can lose their ability to respond to the brain’s signals instructing the release these stress hormones. People can suffer from poor quality sleep, insomnia, anxiety, fatigue, lethargy and depression when this starts to happen. Often, reproductive hormonal imbalance will result from this erratic production of stress hormones, leading to different gynecological symptoms in women or reproductive dysfunction in men. Because in “fight or flight mode” the body directs blood flow away from the digestive system and into the limbs, if one has existed in this state for a long time the digestive power will start to decline. Often the pattern of Irritable Bowel Syndrome is established or other digestive difficulties. The immune system also suffers with adrenal fatigue. Commonly, systemic inflammation and pain become all-consuming symptoms as a result of a lowered immune system and other hormonal imbalance. One might experience chronic aches, pains and joint swelling because white blood cells are responsible for cleaning up inflammation and play a big role in our immune system health. With a long term imbalance of stress hormones all of these systems are negatively affected.

As a result of this chronic state of high alert, when there is an actual emergency and the body would normally enter “fight or flight mode” temporarily, the adrenals are not always capable of responding. This can mean that if there is a surge of adrenaline an AFS sufferer might become dizzy, nauseated, jittery, sweaty, fatigued or just generally sick feeling as a response. This, of course is the opposite of the desired response to an adrenal surge that leaves a healthy person feeling suddenly energized and clear and able to get out of a bad situation. Similarly, in people with AFS caffeine can produce these same negative effects, skipping the enjoyable energetic part and going straight to feeling terrible and jittery because caffeine is just a way for us to stimulate our adrenals into this “fight or flight” state.

• Allergies: an over sensitivity to certain foods and environmental allergens can be an indicator of over-taxed adrenals. This has to do with an imbalance or weakness in your immune system as a result of chronic “fight or flight” and inflammation. If you suffer from seasonal allergies, food allergies, or frequent cold symptoms, you might need to recharge your adrenals.

• Dizziness or light headedness: this can happen when standing up quickly causing your blood pressure to drop suddenly. Constant saturation with stress hormones can cause your system to have a hard time regulating blood pressure. When your blood pressure drops suddenly as a result of a change in position, you’ll feel like you could too. When you feel more light headed this could be a result of blood deficiency. Chronic inflammation in the digestive system can lead to reduced nutrient absorption, which can prevent our bodies from creating more blood cells. When you are anemic or blood deficient, you will often feel light headed or dizzy.
• Sensitivity to light and sound: if you can’t go from a dim room into the sunlight without feeling temporarily blinded and uncomfortable, this is an adrenal fatigue symptom. Weakened adrenal glands and an inability of the pupils of your eyes to constrict quickly (or at all) go hand in hand. If you always reach for sunglasses on overcast days, your pupils might be letting in too much light due to poor contraction as a result of tired adrenals. Similarly, a strong startle reaction and intolerance of loud noises is a sign that your nervous system and adrenals are over stressed.
• Sleep issues: difficulty falling asleep, staying asleep, or a failure to wake up feeling rested in the morning are common signs of adrenal fatigue and a chronic sympathetic nervous system state.
• Craving salt: if you crave salty foods, it is commonly due to overactive kidney and adrenal function. This will cause you to lose too much sodium and mineral content via sweat and urine.
• Low energy: Waking up feeling tired, consuming caffeine to get going, crashing in the afternoon and getting a second wind at night is a common pattern for AFS sufferers. The tendency to wind down at night with alcohol or other depressant is common, often exacerbating this cycle of inappropriate and erratic adrenaline and cortisol production.
• Low Libido: stress hormones have a strong impact on reproductive hormones, and all of it greatly influences ones sex drive (and function). This is relevant for all genders. If you notice that your libido or sexual function is not as strong as it once was, adrenal stress could be a big part of the problem.
• Reduced Athletic Performance: difficulty sustaining muscle strength, reduced endurance, recurrent injuries, slowed recovery time, and chronic inflammation are all common symptoms of AFS in athletes
• Frequently Sick: if you find yourself catching every cold that comes through and have multiple infections throughout the year, you may have an imbalanced or suppressed immune system. When the adrenals are over-stressed and constantly secrete cortisol it will have the effect of depressing your immune system, making you more vulnerable to infection.
• Body Pain: particularly in the lower back, pelvis, knees, ankles and feet are a common symptom of exhausted adrenals. This has to do with chronic inflammation and is best explained from a Chinese Medicine perspective, but is recognized as a strong pattern by any healthcare practitioner that works with AFS.
• Anxiety and Depression: of course mental health is a complicated topic and it is rare that an imbalance has just a single cause. If you suffer from anxiety, panic attacks, lethargy or depression and experience other adrenal fatigue related symptoms, it is most likely that your exhausted adrenal glands and stress hormones are contributing strongly to these mental health challenges.
• Extreme Exhaustion: when your body and adrenals have given more than they have been able to recharge, you will be bone tired.
• Blood Sugar Regulation Problems: often AFS sufferers find it an uphill battle keep their blood sugar balanced and comfortable. The body is always looking for a source of energy in the absence of adequate adrenal energy, and runs through fuel quickly. Often people find that eating small meals high in protein helps to offset the blood sugar challenges.
• Hormonal Imbalance: Chronic inflammation, “fight or flight mode”, and flooding of stress hormones can lead to symptoms of infertility, in women menstrual challenges, PMS, menopausal discomfort, and for men lowered testosterone and erectile dysfunction.

• Brain Fog, ADD, Trouble Focusing, Poor Memory: because of the communication between the brain and the adrenal glands that should be happening, these two organ systems closely influence one another. Between generalized fatigue, chronic inflammation, and poor communication as a result of prolonged adrenal stress, AFS suffers commonly experience frustrating cognitive symptoms.

In part two of this blog series we’ll discuss these mechanisms from a Chinese Medicine perspective and see how clearly this ancient medicine lines up with this holistic western approach. I will get into diagnostic techniques that are used during a Chinese Medicine evaluation to confirm adrenal deficiency as well as our approach to healing these over-taxed, all important glands. We’ll talk about different strategies you can implement at home to start the healing process yourself, as well as how to know when you might need to seek out a Chinese Medicine Practitioner for extra support.

If you find yourself relating to more than a few of the symptoms and scenarios discussed above, please keep an eye out for Adrenal Fatigue Part II: A Chinese Medicine Perspective.