Article by Brent Murphy

What is adrenal fatigue? (also known as adrenal insufficiency, adrenal burnout or hypoadrenia)
Adrenal fatigue occurs when the adrenal glands, situated above the kidneys, become overworked or damaged, usually from long-term exposure to stress. As a result of being overworked they secrete reduced amounts of the adrenal hormones, the main ones being cortisol, aldosterone, pregnenolone, DHEA (dehydroepiandrosterone) and adrenaline. The most important of these is cortisol, because when this is lowered the body will no longer be able to deal with stress.

What are the symptoms of adrenal fatigue?
The main symptom of adrenal fatigue is tiredness and chronic (long-term) fatigue (especially in the morning and between 3 and 5 pm). Other associated non-specific symptoms include chronic pain (especially upper back or neck), mild depression, anxiety, reduced stress-coping ability (e.g. trembling under pressure), unexplained hair loss, insomnia, inability to lose weight (even though seriously trying to), poor blood sugar control (up or down), frequent infections, reduced sex drive, feeling better suddenly for a brief period after a meal, a craving for fatty, salty or high-protein foods, great difficulty getting up in the morning, worsening of allergies, reduced memory/concentration, alternating diarrhoea and constipation, and indigestion.

What causes adrenal fatigue?
The onset of adrenal fatigue is slow and insidious (see adrenal fatigue progression diagram). Chronic stress is the main cause of adrenal fatigue, since stress causes the adrenals to produce huge amounts of adrenal stress hormones. This continues until the adrenals burnout and the supply of vital stress and anti-fatigue hormones is depleted. As a result, chronic fatigue and the abovementioned symptoms of continued stress-exposure begin. Most adults experience adrenal fatigue of varying severity at some time in their lives. Other causes of adrenal fatigue are constant anger (a short fuse), chronic inflammation, chronic infections (as with Giardia and Helicobacter pylori, which give rise to inflammation), chronic pain, excessive exercise, low blood sugar, surgery, lack of sleep, excessive sugar, caffeine or alcohol intake and toxin exposure (such as smoking or environmental pollutants).

Adrenal fatigue progression
Stage 1: Stress reaction (flight or fight response), also known as early fatigue stage
In this stage, the body reacts to stress to reduce stress levels. Since the adrenals have not burnt out yet, they mount a powerful anti-stress and stress-coping response – they secrete more adrenaline and cortisol. There is a corresponding reduction in DHEA production at this time. This huge cortisol response, coupled with reduced DHEA, results in a high cortisol/DHEA ratio. This ratio can result in raised blood sugar, diabetes, infections (including candida and herpes), bone demineralisation (and osteoporosis), water and salt retention (leading to elevated blood pressure), muscle wasting and an inability to lose weight. After some time the adrenals will experience difficulty in meeting the body's ever-increasing demand for cortisol.

Stage 2: Resistance response
With chronic stress exposure the adrenals are unable to keep up with the body's demand for cortisol. At this point cortisol output will start to decline from a high to a normal level. While the morning, noon and afternoon cortisol levels may become low during this stage, the nighttime cortisol level is usually normal. A phenomenon called a pregnenolone steal (also called cortisol shunt) sets in at this stage. Cortisol production becomes the predominant pathway of hormone production as the body favours the production of this hormone. Other hormones such as pregnenolone, DHEA, testosterone and oestrogen are less favoured and their production will decline. As a result, total pregnenolone and DHEA output is reduced but total cortisol output continues to be maintained at a more-or-less normal level.

Stage 3: Exhaustion
At this point the adrenals become so fatigued that they are no longer able to keep up with the increased demand for cortisol production. This may happen over a few years. Total cortisol output is therefore reduced, and DHEA falls far below average. The nighttime cortisol level is usually reduced. Severe sex hormonal imbalances (oestrogen, progesterone, and androgens) are common and a precursor to adrenal failure.

Stage 4: Failure
Eventually, the adrenals are totally exhausted. Patients at this stage have a high chance of cardiovascular collapse and death.

Adrenal fatigue versus adrenal non-function
Adrenal fatigue (very common) should not be confused with another medical condition called Addison's disease where the adrenal glands do not function (very rare). While Addison's disease is often caused by auto-immune dysfunction, adrenal fatigue is caused by stress.

Why conventional medicine has difficulty diagnosing adrenal fatigue
Many doctors are unfamiliar with adrenal fatigue because it is difficult to diagnose subclinical adrenal fatigue using traditional blood tests. Normal blood tests are designed to detect the severe and absolute deficiency of adrenal hormones known as Addison's disease. This disease afflicts only 4 out of 100 000 people and is often the result of autoimmune disease or infection. Blood tests are also useful to detect extreme excessive levels of adrenal hormones in a condition known as Cushing’s disease.

Adrenal hormones are low in the case of adrenal fatigue, but still within the ‘normal’ range and not low enough to warrant the diagnosis of Addison's disease by regular blood tests. In fact, adrenal hormones can be half of the optimum level and still be labelled ‘normal’. Such a ‘normal’ level of adrenal hormones does not mean that the patient is free from adrenal fatigue. Often doctors are not taught the significance of subclinical adrenal fatigue. Blood tests that are not sensitive enough to detect subclinical adrenal fatigue are misleading. As a result, patients tested for adrenal function are told they are ‘normal’ but in reality their adrenal glands are performing suboptimally, with clear signs and symptoms, as the body cries out for help and attention.

Adrenal fatigue afflicts more people than Addison's disease. It is not recognised and has become an epidemic of massive proportion. To truly diagnose adrenal fatigue, more sensitive laboratory testing and meticulous attention to symptoms and patient history are required.

Daily consumption of the following herbal and nutritional medicines help with adrenal fatigue

• Korean ginseng 5:1 extract 200 mg – an adaptogen that enhances energy and improves adrenal function. The term adaptogen refers to Korean ginseng’s buffering ability, i.e. its ability to stimulate an underactive adrenal, but slowdown an overactive adrenal gland. Korean ginseng also protects nerve function and enhances memory and coping ability during times of stress. Korean ginseng will help treat the blood-sugar irregularities and low blood pressure that occur with underactive adrenal glands.
• Liquorice 6:1 extract 500 mg – slows down the breakdown of cortisol in the body, allowing the adrenals time to recuperate. Liquorice also protects against the acidic indigestion associated with adrenal fatigue and burn-out.
• Echinacea 4:1 extract 200 mg – echinacea is a potent adrenal stimulant, and also helps fight infections (such as candida) that commonly occur with adrenal fatigue.
• Rhodiola rosea, also known as ‘arctic root’ or ‘golden root’, is another good adrenal supportive herb, particularly during times of stress. Rhodiola is a powerful adaptogenic herb and offers broad non-specific effects supporting overall body function particularly via adrenal stress. Being an adaptogen means it can support both an under- or over-active adrenal gland.
• Chromium polynicotinate 200 mcg – helps prevent the blood-sugar irregularities and fatigue caused by an underactive adrenal gland.
• Vitamin B1 (thiamine) 25 mg – clinical evidence shows that Vitamin B1 counters the adrenal insufficiency that occurs as a result of trauma such as surgery.
• Vitamin B5 (calcium pantothenate) 50 mg – calcium pantothenate, in the form of coenzyme A is closely involved in adrenal cortex function and has come to be known as the anti-stress vitamin: It acts as an enzyme to facilitate the production of all adrenal anti-stress hormones.

• They experience unexplained abnormal fatigue (such as those suffering from chronic fatigue syndrome) or from tiredness coupled with any three or more of the symptoms listed above, under ‘What are the symptoms of adrenal fatigue?’, or
• They fall into a high-risk group by being exposed to continuous high levels of stress (such as a high-stress job), particularly if combined with other causes such as those listed above, under ‘What causes adrenal fatigue?’ or
• They have low DHEA and cortisol hormone levels. This is determined by a saliva or blood test. The ideal test is a saliva test, as this measures free, unbound hormones, unlike the blood test which measures bound hormone levels. DHEA can be measured at any time of the day. Cortisol should be measured shortly after waking, again at midday and again at bedtime.