Low energy. Foggy thinking. Sleeplessness when you’re supposed to be asleep, and drowsiness when you need to be alert. Going down the list of symptoms attributed to adrenal fatigue is like reading a diary of how I’ve been feeling lately. Irritable. Check. Anxious. Check. Sluggish. Check. Until now, I just thought these were side effects of several months of heavy deadlines and personal obligations that were wearing me out and stretching me thin.
And maybe they are.
Then again, maybe I’m suffering from adrenal fatigue, a little-known, highly controversial, nonclinical diagnosis of all the above symptoms and then some, blamed on malfunctioning adrenal glands due to prolonged periods of stress.
The term, coined in 1998 by James Wilson, who holds doctorates in human nutrition, chiropractic and naturopathic medicine, has actually been referred to by various names for the better part of the last century, all of which amount to a collection of common symptoms not readily measured by traditional Western medicine. “I have seen so many patients who feel like fools by the time they come to see me, because they have talked to multiple doctors and have had blood tests that reveal nothing, and they are being told nothing is wrong with them,” Wilson says. “But something is clearly wrong—they are exhausted and anxious, sleeping more than eight hours a night, but still waking up fatigued.”
The majority of people Wilson treats can remember when they were not walking zombies, when they had energy in reserve and enjoyed going out with friends and taking on new work projects with enthusiasm. But something happened to these people along the way, along their path toward a brighter career, bigger ambitions, stronger relationships, greater challenges.
“These people have crashed and burned,” Wilson says. “They were going, going, going—then suddenly, they run into a wall. Maybe it’s a divorce or illness; something pushes them over the edge and they don’t recover. They go from highly functional people to dragging themselves out of bed each morning and going through the motions of the life they used to love.”
What you or I might chalk up to overextending ourselves, succumbing to the stress of work deadlines or accepting the inevitable reality that our bodies slow down as we age, Wilson sees as something else entirely. Adrenal fatigue is not normal, he emphasizes, and should not be an accepted part of living a full life. You can take control and find your energy again. You just have to know the right way to start.
Though the condition sounds a lot like chronic fatigue syndrome (CFS), the diagnoses are separate. CFS generally comes on without warning and is more akin to fibromyalgia in its symptoms of aching muscles and joints; adrenal fatigue is generally attributed to elevated levels of stress in a person’s life and marked by unstable amounts of energy. (What the two conditions do share is the reluctance by mainstream medicine to acknowledge their existence.)
The control center for your energy, according to the adrenal fatigue theory, stems from your adrenal glands, the walnut-size organs just above your kidneys responsible for producing more than 30 hormones in your body, including cortisol, adrenaline and aldosterone, all of which play a hugely important role in energy regulation. In the proverbial fight-or-flight example, you suddenly come under attack by tigers—or more likely in today’s world, an angry client—so your adrenal glands release epinephrine and norepinephrine (also known as adrenaline), hormones that make you more alert, and cortisol, a hormone that converts protein into glycogen for immediate energy. In the distant past, that adrenaline-cortisol combo gave you your best shot at escaping those big bad tigers. Today, it helps you stay sharp when your meeting gets heated and you need to defend your position.
But if it’s not just one meeting but a host of meetings or a pressure-cooker environment that’s got you working 60-hour weeks and skipping vacation, pretty soon your adrenal glands are working overtime to pump out the hormones necessary to keep you engaged in battle, and so fatigue begins to set in. Your glands can no longer keep up with the demand you’re placing on them, and your hormone output drops, allowing those daily stressors to slowly wear you down.
“If your adrenal glands’ function is even slightly impaired, you will start to see a whole host of physical problems, including chronic exhaustion, a less-responsive immune system, diminished sex drive and changes in the way your body metabolizes fat,” says Eric Bakker, a naturopathic doctor in Hawkes Bay, New Zealand, and an expert on adrenal disorders.
Adding to the challenge, and despite their pivotal role in managing energy, adrenal glands are highly sensitive to even the smallest changes in diet, health and environment, says Bakker, so it doesn’t take a whole lot to make them go haywire. A family death, an argument with your spouse, a winter cold—all these unrelated events count on your adrenals to help you cope. If they are already maxed out from a high-pressure lifestyle, these calls for reinforcement may be the final blow to your suffering glands. You become lethargic and weak, irritable and high-strung. Your sense of malaise is such that you decide it’s time to ask your doctor for help. Anxiously you await the results from your exam’s blood test. Better to know what illness you’re suffering from and face it head-on, you think. The lab calls. Good news! You’re fine, they tell you. Must be all in your head.
“I am so tired of doctors telling patients, ‘It’s all in your mind,’ ” Bakker says. “I want to say to them, ‘No, actually, it’s in your back, just above your kidneys.’ Non-Addison’s hypoadrenia, or adrenal fatigue, is not a psychological illness like depression. It has very real physical roots.”
Burden of Proof
That’s the first story. The second story goes like this: You have been pushing your limits too hard for too long. You take on additional responsibilities at work because you like the sense of achievement; you volunteer at your child’s school; you’ve signed up for an evening business seminar to take your company to the next level. You think you are Superman. You are not. You begin to feel tired when you wake up in the morning, even after a solid night’s sleep. You find yourself losing your temper at the slightest thing. You catch and cannot shake a hacking cough.
This is your body’s alarm system telling you to cool your jets. You are not clinically ill and you do not require a trip to the endocrinologist or even the psychologist. You are simply emotionally spent and if you’d just allow yourself a week or a month of working sane hours with less pressure and indulge in stress-busting activities such as yoga and massage, your condition will ease.
“The rub is that the health issues these people are describing are in no way measurable through lab tests,” acknowledges Dr. Daniel Toft, an endocrinologist at Northwestern Memorial Hospital in Chicago. “We can’t define it because we can’t measure it, and we can’t treat it with medicine because there’s no evidence medicine is needed. Yet it’s clear they don’t feel well and you want to help them.” But in medicine, Toft says, “you either have a disease or you don’t. If the lab tests are coming back saying cortisol levels are fine, then I can’t tell you, as a doctor, that you have an adrenal issue.”
And that’s the problem with adrenal fatigue, also referred to as adrenal imbalance or dysfunction: The symptoms, though anecdotally plentiful, are not reflected in the findings of a traditional blood analysis. If they were measurable, ironically, you wouldn’t have adrenal fatigue at all.Instead, doctors would likely put you in one of two camps—either as a sufferer of Addison’s disease, in which a person is severely deficient in cortisol production, or with Cushing’s syndrome, where cortisol output is extremely high. But because the apparent hormonal fluctuations of people with adrenal fatigue do not register on these tests, the medical community is reluctant to acknowledge its existence.
“It’s a case of Western medicine taking 50 years to catch up to the current thinking about health,” asserts Marcelle Pick, a health practitioner and author of Are You Tired and Wired? “Western medicine deals only in black and white, but most of us live in a world of gray. Addison’s and Cushing’s are serious, rare illnesses. Most people are two steps away from those diagnoses, but they are experiencing very real symptoms that warrant treatment.” Pick, an OB-GYN nurse practitioner who co-founded the Women to Women health clinic in Yarmouth, Maine, more than 25 years ago in an effort to provide a more holistic approach to health, maintains that Addison’s requires such large swings in cortisol production in order to register on blood tests that the subtleties of hormonal fluctuations from adrenal fatigue aren’t detectable. She suggests testing cortisol through saliva tests, which may pick up on smaller changes in levels, but some doctors discount them as unreliable.
Adding to the challenge: Symptoms of adrenal fatigue and adrenal disorders in general are broad and could be applied to a host of other diseases as well, including depression and hypothyroidism. “The symptoms of endocrine disorders are very vague,” says Dr. Rebecca Fenichel, an assistant professor of medicine at NYU School of Medicine. “You may feel weakness, exhaustion, nausea—but these symptoms could be used to describe numerous other medical conditions, which is why we require some sort of biochemical evidence for what you are experiencing.” Without a blood test confirming that a patient’s complaints are indeed related to adrenal function, there is little an endocrinologist can do.
For the sufferer, the search to validate the experience of energy depletion can become all-consuming. Why is your brain still fuzzy after three cups of coffee? Why are you lying in bed awake now, when you were too tired to keep your eyes open in your afternoon meeting? Why do you feel lightheaded when you stand up, even though you just ate lunch? Why, why, why? When you’re accustomed to controlling your life and calling the shots, it can be maddening to fall victim to feelings of fatigue that are out of your control.
A Better Balance
Regaining your energy begins with the catchword mindfulness, says Pick. “Most people think they’ve gotten themselves into such a deep hole with stress and feeling so exhausted, it’s going to take a total overhaul to get their lives back,” she says. “People think, ‘I can’t quit my job. I can’t ditch the kids. I’m stuck.’ ” Her recommendations: “Start by taking two minutes a day to just sit somewhere quietly and enjoy being in the present.” Think that advice sounds cliché? Doesn’t matter. Just do it. This is your moment. You work hard. You live by the clock all day long. So for a few minutes, turn off your phone, BlackBerry, TV and computer… and just breathe. Yogis have been doing it for thousands of years. The likelihood of finding a yogi with adrenal fatigue? Slim to none.
Of course, bigger lifestyle changes will make a bigger impact on your energy levels. Moderate exercise can help you sleep more soundly, make you feel happier and boost your immune system, says Pick. Begin by taking 15-minute walking breaks during your day (a great way to take a breather from the office, or create a space between the end of your workday and the beginning of your home life). Keep your heart rate below 90 beats per minute, Pick advises, in order for the exercise to be rejuvenating, not depleting. Gradually increase the intensity of activity until you feel comfortable doing something aerobic (biking or jogging) for 20 minutes, several days a week. The short duration helps you fit it into your schedule—stressing over when you are going to find time to de-stress with exercise defeats the purpose!
Sleep is a critical component of recovery from adrenal fatigue, and one of the most challenging: The harder you try to fall asleep, the more elusive sleep can become. Pick advises shutting down all electronics—TV, cellphone, computer, iPad—an hour before you plan to go to bed. (The screen lights stimulate the brain to stay alert, she says.) Rest assured, the lost productivity on a work proposal will be more than made up for by a quality night’s shut-eye. Also important: Develop a pre-bed ritual of brushing your teeth, washing your face, reading a book or listening to music for a few minutes. Establishing a pattern of activities that culminates in sleep will help your body pick up on sleep cues more readily. And finally, if you’re lying in bed and you still can’t doze off, think about something else. Re-create a memory of a beautiful, relaxing place you’ve been to (or want to go), or if you must, get out of bed and make a list of whatever work or personal problems are keeping you up. “Keep the bed for sleeping and pleasant thoughts,” Pick says.
During the day, leave yourself visual reminders of your goal to stress less. Place notes on your bathroom vanity, your computer, your work phone receiver and the landing page of your smartphone that say “Just Breathe.” “It helps people re-prioritize,” says Pick, who estimates 60 to 70 percent of her patients have some degree of adrenal imbalance. “We live in a results-driven culture where people are constantly judging themselves by how much money they’ve made, what their job title is and how hard they work.” This highly competitive environment forces people to be focused on the future (what I’m going to achieve) or the past (what I’ve done), with very little time spent focusing on the here and now. “Living that way, your body is chronically stressed,” Pick says. “You never unplug. That ongoing sense of anxiety causes cortisol to be continually produced, with no parasympathetic response to keep it in balance.”
Wilson agrees. “Stress is highly individual. Some people are more resilient to it than others, while others don’t think they’re stressed at all—but their cortisol levels are through the roof,” he says. “Stress isn’t a scar you can see on the surface, but it takes a serious toll on your health.” In addition to carving out time each day to sit quietly and focus on deep breathing, Wilson emphasizes the importance of diet, especially eating early and often to keep sugar levels balanced throughout the day. Cutting out (or at least reducing) sugar and caffeine may also help (See “Eat For Energy!” sidebar.)
Like most holistic practitioners, Wilson and Bakker also suggest dietary supplements to aid adrenal recovery, a practice met with skepticism by the medical community, because no scientific journal has proved their effectiveness. The Endocrine Society cautions patients that because the U.S. Food and Drug Administration does not regulate supplements the way they do prescription meds, there is no guarantee that what you buy contains the ingredients listed, nor do adrenal supplements need to go through rigorous tests to prove their safety. What’s more, according to The Endocrine Society, if you take adrenal hormone supplements when you don’t need them, you may cause your adrenal glands to stop working—then once you discontinue the supplements, the glands may remain dormant for months. It should be noted, however, that there are no reports of serious illness from taking adrenal supplements.
The other eyebrow-raiser is that most supplements are sold by the practitioners who advocate their use. Wilson is aware of the criticism, but maintains that the success of his supplements, made from a unique blend of glandular extracts, give clients reason enough to come back for more. He believes they can effectively kick-start the hormonal production cycle.
It seems strange, given the absence of a true medical diagnosis, to talk about treating a condition that may or may not exist. But the truth is, for someone who has checked the boxes describing symptoms of adrenal fatigue, he or she doesn’t care about the technicalities of whether it’s real or qualifies for an entry into med school textbooks. All that matters is that there is a plan in place to help life return to normal. “For most people, making these dietary and lifestyle changes can greatly increase their energy levels and restore a balance to their body’s hormones,” Bakker says. “The point isn’t to argue over whether or not adrenal fatigue exists; it’s to help people who are suffering to get their lives back.”
Know the Symptoms
These are all signs of adrenal fatigue, say experts who support the condition.
Ø low cortisol levels
Ø low aldosterone levels
Ø salt cravings
Ø sugar cravings
Ø low blood pressure (dizziness when standing up, getting out of bed or the bath)
Ø electrolyte imbalance
Ø irregular heartbeat
Ø increased thirst
These two diseases are serious, say endocrinologists. Here’s what to know:
Addison’s: Marked by exceptionally low cortisol levels, sufferers of Addison’s disease may experience dizziness due to an inability by the body to retain salt. In extreme situations, patients with Addison’s are at risk of death. Endocrinologists believe Addison’s is caused by an autoimmune deficiency or infection, and is controllable only through drug intervention.
Cushing’s: People with this syndrome have an abnormally high level of cortisol, which elevates blood pressure and causes physical changes such as a rounder face and purplish stretch marks all over the body. Cushing’s can sometimes be caused by taking a steroid medication for unrelated issues. Depending on the patient, the condition can be treated by changing medication or through surgery or even radiation.
Eat for Energy!
The right mix of nutrients is key for combating any kind of fatigue. For optimal energy, follow adrenal expert James Wilson’s rules:
Ø Eat a wide variety of whole, natural foods.
Ø Combine a healthy monounsaturated fat such as olive oil, a protein and a carbohydrate source at every meal.
Ø Eat plenty of vegetables.
Ø Sprinkle salt on your food. (If you have high blood pressure, hypertension, diabetes or heart issues, talk with your doctor before adding extra salt to your diet.)
Ø Choose mainly whole grains as your source of carbohydrates.
Ø Mix grains with nuts, beans and seeds for a complete protein.
Ø Avoid fruit in the morning.
Ø Cook grains and vegetables with a tablespoon of olive oil, or toss with olive oil after cooking.
—Adapted from Adrenal Fatigue: The 21st Century Stress Syndrome by James Wilson, Ph.D.