Research Brief :
Adrenal Fatigue
Treatable, Rampant, Dangerous
and Underdiagnosed.
By Felicia M. Tomasko
Naturopath, nutritionist and adrenal specialist Dr. James Wilson, who coined the phrase adrenal fatigue, is not the only clinician insisting that numerous people with unexplained fatigue, weakness, insomnia or depression could have symptoms related to dysfunction of the adrenal glands. This syndrome has been explained in the medical literature for decades. Dr. Gerald E. Poesnecker described adrenal syndrome and published a book with the same name in 1993.
According to Dr. Wilson, adrenal fatigue, or chronic low output of adrenal hormones, is one of the most underdiagnosed syndromes of our modern life. This is also stated in a 2001 report in Critical Care Clinics, which identified adrenal problems as common and underdiagnosed, particularly in people who are critically ill.i
Adrenal fatigue refers to the wide array of symptoms experienced by people who have trouble finding relief, even after visiting several specialists. Some of the most problematic symptoms include debilitating fatigue, depression, sleep disorders, weight problems, immune system deficiencies, changes in skin color, muscle weakness, low blood pressure and inability to cope with stress.ii Adrenal problems are often incorrectly identified unless they fall on an extreme end of the continuum of dysfunction. This is either Addison’s Disease, which describes the worst of adrenal insufficiency, or Cushing’s, an excess of adrenal hormone production.
Our bodies have two triangular-shaped adrenal glands, sitting on top of each kidney. The adrenals are divided into two distinct segments. They each produce different hormones, and are often even thought of as different organs. The outer segment, called the adrenal cortex, manufactures and releases corticosteroids. These are hormones responsible for regulating the body’s salt and water balance (one is aldosterone) and the group of hormones known as steroids which influence metabolism, immunity, sexual development and function and our stress response. The adrenal medulla is the gland’s inner segment. The medulla produces catecholamines, which includes epinep-
hrine (also known as adrenaline), another hormone critical for the body’s stress response. Epinephrine increases blood pressure and heart rate to mobilize the body when needed in situations requiring immediate response.
The adrenal glands operate in concert with the rest of the endocrine system, particularly the hypothalamus and pituitary, which regulate metabolism as well as other physical functions. The three: hypothalamus, pituitary and adrenals, work so closely together that they are often referred to as the HPA axis. Since these glands are functionally connected, disruptions in one organ or area can throw off the usual operation of other glands or organs.
If we over-or under-produce the adrenal hormones, it can wreak havoc throughout the body, since the adrenal hormones have a variety of distributed effects. Conditions of adrenal insufficiency can be temporary or permanent. Some temporary causes of malfunction of the gland or inability to produce adequate hormones can include: stress (a frequent problem in our modern lives), infection, surgery and medication under-use or over-use.iii Use of steroids is often a contributing factor to adrenal dysfunction.iv
Disruptions in the body’s other hormonal systems (such as the hypothalamus or pituitary) can also contribute to adrenal insufficiency.v Chronic conditions have an important HPA axis and adrenal component, including fibromyalgia.vi There is also a stated relationship between HPA dysfunction and chronic fatigue syndrome, and the suggestion that reduced adrenal output contributes to the symptoms of chronic fatigue.vii
Clinicians and researchers point to the debilitating effects of chronic stress in the exacerbation of adrenal fatigue. Continual stress without adequate coping mechanisms can lead to burnout, and burnout is a phenomenon currently being studied for its relationship with chronic diseases, including dysfunction of the hypothalamus-pituitary-adrenal axis.viii Improper regulation of the HPA axis is involved in adrenal fatigue.
People with low adrenal function may be tempted to use stimulants such as caffeine to feel a boost of energy. Rather than providing an external source of energy, that artificial energy further depletes the adrenals, since caffeine works by stimulating the release of adrenaline. Coffee, caffeine, yerba mate, ephedra and other stimulants should be limited or avoided. Alcohol, because of its concentrated sugar content, is particularly problematic in adrenal fatigue since it disrupts the body’s ability to control blood sugar and should also be avoided to help the adrenals recover.ix
From an Ayurvedic perspective, strengthening the body as a whole and building ojas (innate strength and immunity) is vial for rebuilding fatigued adrenals. Foods that increase ojas, such as dates, raisins, coconut, organic dairy products, ghee, fresh fruits and vegetables can help replenish an exhausted endocrine system.
Herbs are particularly beneficial for strengthening the adrenal glands. Adaptogens are herbs that help to strengthen the nervous, endocrine and immune systems without being overly stimulating. Ashwagandha (Withania somnifera) is one of the most important Ayurvedic adaptogens. While the plant has been used traditionally for centuries, current research confirms the adaptogenic properties of ashwagandha. x,xi,xii
Some other adaptogenic herbs helpful for revitalizing the endocrine, nervous and immune systems include: bala (Tinaspora cordifolia), shatavari (Asparagus racemosus), amla or amalaki (Emblica officinalis) and pippali (Piper longum).xiii
Acupuncture and moxibustion treatments help to normalize the function the hypothalamic-pituitary-axis (HPA) and their associated glands.xiv,xv Since acupuncture removes obstacles to the flow of chi (vital energy) through the meridians of the body, it can help reduce fatigue and balance the interrelationships between the endocrine glands.
Since the adrenal glands are subject to influence by blood flow and alignment of the body, chiropractic adjustments can be helpful for balancing these glands. While many people report alleviation of symptoms, research in this area is sparse. Cell biologist Dr. Bruce Lipton, author of Biology of Belief, emphasizes the importance of the adrenal glands and the HPA axis in maintaining health and creating immediate response to situations. Excessive HPA activation inhibits the immune system. Since the HPA axis is involved in the body’s stress response, Dr. Lipton finds that autosuggestion, or positive suggestion is important for healing along with chiropractic adjustment.xvi
Supplementing the diet with essential fatty acids, the omega-3 oils found in flax, borage, purslane, evening primose and other oils and plants (as well as cold water fish), is helpful for recovering from adrenal fatigue.xvii Essential fatty acids are important for improving immune system function and recovering from the negative effects of stress.xviii
While in the midst of a situation of acute adrenal fatigue, people may crave salt, according to Dr. Wilson, because of the imbalance of the hormone aldosterone; people with adrenal fatigue have difficulty retaining salt. Adding a pinch of salt to a glass of water in the morning can help correct this.
Yoga practice is helpful both for balancing release of hormones of the endocrine system as well as treating some of the symptoms of adrenal problems. Asanas (yoga postures) effective for creating balance of the endocrine system are shoulderstand (sarvangasasa), plow (halasana) and headstand (sirsansana). Cobra (bhujanasana) and upward facing dog are both beneficial for gently stimulating the adrenal glands by massaging the area where the adrenals sit on top of the kidneys on the back.
A restorative practice is recommended to alleviate fatigue and provide a deep state of rest to the body. Supported restorative poses can also release tension associated with long-term exhaustion.
Even though fatigue is a common complaint, there are times when people with adrenal dysfunction may have difficulty falling asleep. In these cases, Dr. Wilson specifically recommends practicing calming forward folds such as paschimottansana (seated forward fold) or both sides of janu sirsasana (one leg seated forward fold, or seated head to knee pose).
Disorders of the adrenal glands have been formally recognized for decades. With our modern lifestyle, the effects of constant chronic stress and the use of stimulants can take a toll on our bodies, particularly our adrenal glands. To recover from an exhausted, burnt-out body, getting rest, improving resistance to stress, a rejuvenative yoga practice, meditation, avoiding stimulants and eating a balanced diet with a variety of fresh, whole foods is important for both recovery and prevention. Although the world around us can encourage fatigue, we have the ability to strengthen our bodies, minds and our very spirits.
For more information on Dr Wilson’s work, visit www.adrenalfatigue.org. For more information on the body’s hormonal system, read Dr. Scott Isaacs, Hormonal Balance, Your Guide to a Healthier Metabolism and Weight. For more information on chronic fatigue, visit www.chronicfatigue.org.
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iii Adrenal insuffiency from NIH, Patient Information Publications, NIH Clinical Center
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xvi Lipton, B. The Evolving Science of Chiropractic Philosophy. http://www.brucelipton.com/article/the-evolving-science-of-chiropractic-philosophy. Accessed August 19, 2006.
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