The term adrenal fatigue has been getting a lot of attention in alternative health circles and very little attention in mainstream medicine (well, if you count negative attention that is). How can an organ “fatigue?” That tinkers on the realm of quackery, at least that is what I thought when I heard about it 15 years ago. If you search the internet for adrenal fatigue, you will find quite a few websites that call it a fake disease, something invented by alternative healthcare practitioners to make money. Was the diagnosis of Irritable Bowel Disease much different not so many years ago? Many medical professionals believed that it was an “all in your head” disease. And those of us who suffer from IBS certainly know that pain, bloating, gas, constipation and diarrhea is not something that you are making up to get attention.
I’ve done quite a bit of research on adrenal fatigue and have experienced it myself, as well as many of my patients. Let’s take a closer look to see just what adrenal fatigue is. This will be the first of several articles in a series on adrenal fatigue.
The Hormones
The Fight or Flight Hormones Give You the Burst of Energy to Run for Your Life or to Stay and Fight
Adrenal fatigue is a laymen’s term to describe a dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis.(Guilliams & Edwards, 2010). The adrenal gland is a small organ that sits on top of your kidneys and consists of an outer portion called the cortex and an inner portion called the medulla. The cortex produces cortisol (a hormone related to the stress response), aldosterone (a hormone involved in fluid regulation), and dehydroepiandrosterone (DHEA), (a hormone used to produce small amounts of sex hormones). The medulla (the inner portion of the adrenal gland) produces the fight or flight hormones called adrenaline and noradrenaline. These fight or flight hormones work together with cortisol to provide a burst of energy to get you out of the burning building or to run from a ferocious tiger (or to successfully merge into traffic during the 5 o’clock rush hour). We have all felt that familiar surge of adrenaline-for example, you are calmly driving along, listening to your favorite song on the radio. You look in your rear view mirror and attempt to change lanes, and all of a sudden, out of nowhere, a car honks beside you from your blind spot. You swerve back to your original lane, and are left with a pounding heart, butterflies in the stomach, cold sweat, and rapid breathing. Noradrenaline helps with this response. Adrenaline and noradrenaline are immediate responses to a threat. Cortisol from your adrenal cortex is also released, but it requires a series of steps.
Cortisol’s Role in The Stress Response
Under normal conditions, the secretion of cortisol follows a circadian rhythm (your body’s 24 hour time clock). Meaning cortisol levels start out higher in the morning-which wakes you up with the sunrise. As the day continues, cortisol levels slowly drop, reaching the lowest point at night, signaling that it is time for bed.(Chan & Debono, 2010). The brain plays a major role in telling the adrenals how much cortisol is needed through a complicated hormonal cascade. A very simplified explanation of this would be the hypothalamus (a portion of the brain) releases a hormone (corticotropin releasing hormone or CRH), which communicates to the pituitary gland (a gland attached to the hypothalamus) to release another hormone (adrenocorticotropic hormone or ACTH), which then tells the adrenal cortex to release cortisol.(Smith & Vale, 2006) Cortisol has other functions in the body as well. It determines the type and amount of carbohydrate, protein and fat your body uses, especially when under stress. Your body prefers glucose as a quick energy source and under stress, the body must use protein to make it. This can have an impact on blood sugar control and weight regulation when cortisol levels are elevated over time. It also controls fluid balance and blood pressure. Under stress, your blood pressure rises in order to deliver plenty of oxygen throughout the body for fight or flight. It is involved in bone growth, the production of the reproductive hormones, anti-inflammatory and proinflammatory conditions, influences your mood, impacts thyroid hormones and many other vital activities. Almost every system in your body is impacted by imbalances in cortisol and other hormones due to HPA-axis dysfunction!
When a stressor is encountered, this system goes into hyper drive and floods the body with cortisol. Once the stressor is over, the high level of cortisol feeds back to the brain to indicate that, OK, we’ve got enough cortisol here, so you can go back to normal production.(Smith & Vale, 2006) The stressor is over and you should make a full recovery.
What Happens to Cortisol When You Are Chronically Stressed?
But what happens when the stressor never stops, but is instead chronic in nature? Such chronic stress is a given in today’s society and our ability to manage it is simply falling short. Let’s say you are just starting a new job and you are working 60 hours a week to keep up with your fellow colleagues and your boss’s demands for performance. During this time, your cortisol production is high. You may feel pumped up and energetic, able to function on 5-6 hours of sleep, with little consequences. You wake abruptly in the morning to the blaring sound of your alarm clock and you grab a donut and coffer for breakfast, and head off into rush hour, day in and day out.
Your body can’t keep going like this for long. You start to notice that you have to rely on caffeine, sugar and other stimulants to manage the level of performance that you started out with. Then just as with all of us, come other stressors in your life-maybe nursing ailing parents, or welcoming new additions to the family, or being involved in a dysfunctional relationship
Eventually, you’re unable to keep going. You start experiencing chronic fatigue, depression, anxiety, gastrointestinal problems and health issues that were maybe a nuisance before, but have now started to interfere with your quality of life.
Impact of High Levels of Cortisol Over Time
When you started your new job, you were high on energy because your adrenal glands were pumping out large amounts of cortisol. However, chronic exposure to cortisol harms the body and can disrupt the feedback system to the brain. (Zhu et al., 2014). When this complicated system of hormones and their communication with the brain is broken, you begin to experience changes in nervous system function, behavioral and immune function, leading to disorders such as depression, post-traumatic stress disorder, anxiety disorders and metabolic disorders.(Kinlein, Wilson, & Karatsoreos, 2015). Eventually, even though you started out with high cortisol levels, over time, cortisol will become depleted. This condition is often referred to as burnout. (Kakiashvili, Leszek, & Rutkowski, 2013)
The mainstream conventional medical community typically only pays attention to the adrenal glands if they are in extreme over production of cortisol (Cushings syndrome) or under production of cortisol (Addison’s disease). Even though you may not have these two diagnosable conditions, your adrenal problems can really interfere with your quality of life.
How is it that two people can experience the same stress but have different emotional and physiological responses? Well, some people are more vulnerable to stress. This is determined by biological, social, behavioral, and environmental factors that are influenced over a lifespan.(Mcewen & Gianaros, 2010).
So basically, the adrenal glands don’t really fatigue per say, but because of the chronic stress that we experience, this complex system within the HPA axis can go awry, eventually leading to many of today’s fastest growing health problems. There is a large body of literature indicating the reality of HPA axis dysregulation or so called adrenal fatigue, and in my opinion, it is real. If you want to find out if you may have this condition read the next article in this series seven symptoms that may indicate you have adrenal fatigue. (hyperlink)
