Adrenal fatigue syndrome is a collection of nonspecific, debilitating symptoms, and is a result of the adrenal glands functioning below their normal capacity. It is a condition that progresses slowly, with the most obvious symptom being unrelenting fatigue that is no better after sleep. Stimulants such as caffeine are needed to combat the fatigue and general feeling of ‘not being well’.
Adrenal fatigue is a condition that lies on a continuum between Addison’s disease, which is a rare auto-immune condition in which the adrenal glands don’t produce enough steroid hormones, and, at the other end of the scale, Cushing’s disease, which is often caused by a pituitary tumour, where excess cortisol is produced.
As adrenal fatigue progresses and adrenal function diminishes, the body experiences changes in many areas. The metabolism of fat, protein and carbohydrates is affected; the cardiovascular system and the balance of electrolytes and fluid are altered; the libido diminishes, and many other cellular changes occur. Because the human body always wants to remain in homeostasis (where the internal environment is stable and relatively constant), it will make compensations for the changes that are occurring during the progression of adrenal fatigue, but there will be consequences for doing so.
There are 4 stages of adrenal fatigue:
1. Alarm phase
This is the fight or flight response where the body reacts to whatever is causing stress. Cortisol and adrenaline are released from the adrenal glands due to stimulation from ACTH, a hormone released from the pituitary gland, and there can be a decrease in the production of DHEA, a steroid hormone that is a precursor to all the major sex hormones. In this phase, there are no symptoms per se, except for feeling more tired. You are still able to function normally and carry on with your normal routine.
2. Resistance phase
During this phase, cortisol levels begin to fall due to the body’s high demand and the inability of the adrenals to keep up supply. This is the beginning of the adrenals becoming exhausted.Daytime cortisol levels are mostly low, while at night, the level is usually normal. Other signs and symptoms begin to occur such as anxiety, irritability, insomnia, thyroid dysfunction, recurrent infections, and in women, changes to the menstrual cycle.
During this phase, there will be a reduction in the production of sex hormones in favour of cortisol production. This is known as the pregnenolone steal. The result of this is the reduction of pregnenolone, while the normal output of cortisol is still occurring. However, the daily cycle of cortisol is abnormal, with low levels in the morning.
There is no set time frame for the resistance phase, and it is characterised by occasional mild fatigue.
3. Adrenal Exhaustion
During this phase, cortisol production is reduced and the body can’t keep up with demand. The output of cortisol is reduced, with low evening levels, and the body cannot maintain homeostasis. DHEA levels also fall. Symptoms that were experienced in the first two phases become chronic, and imbalances in the endocrine system occur.
As the condition worsens, severe fatigue sets in due to the body trying to maintain homeostasis. Other symptoms and imbalances manifest in the form of blood sugar imbalances, low blood pressure, anxiety, heart palpitations, feeling wired and tired, and adrenaline surges as a result of the physiological response to thoughts, especially stressful ones.
As hormone levels fall to below the minimum levels needed for normal bodily functioning, the body will preserve what is available for the most important body functions. Extreme low energy is experienced at this point as the body moves into survival mode. The inability to get out of bed to perform the most basic of tasks is characteristic of this phase, and professional help is required in this serious near-failure state.
In this phase, the adrenals are totally exhausted and fatigue becomes extreme. Normal homeostasis is lost and the body experiences a range of symptoms including nausea, vomiting, weight loss, muscle weakness, electrolyte imbalances, and more. The body starts to break down. If no help is sought at this point, the condition may progress to become fatal.
Because every person has a different set of circumstances in their life, and each one of us is a different individual, the progression of adrenal fatigue varies from person to person. For some, the progression through the different stages will take longer, for others, it will be shorter.
If you think that you may have adrenal fatigue, it is always recommended that you obtain help from a qualified practitioner to ensure the correct measures are put in place for your recovery.