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Wired & Tired: The Modern Epidemic of Adrenal Exhaustion

Do you wake up feeling tired, craving that first cup of coffee to get you going? Maybe you are having a hard time getting to sleep, or staying asleep? Or do you simply feel like you don’t sleep deeply, confirmed by your fitbit, which reports you are surfacing multiple times in the night? Worst of all, maybe you are being treated for hypothyroidism, but your fatigue never seems to go away. If you resonate with any of the above, you could be suffering from what has become a modern epidemic: adrenal exhaustion. Our adrenal glands produce hormones that help manage our energy levels, balance blood sugar levels, and help us to handle stress. These tiny glands that sit on top of our kidneys are part of a critically important biofeedback loop involving the hypothalamus, pituitary and adrenal glands (called HPA axis). This highly sensitive feedback loop manages our minute-by-minute daily responses to stresses that we face, from a cold virus we may be battling, to domestic arguments, to running late to work. Under normal circumstances, our adrenal glands can handle the daily stresses that we face. However, if a person is under constant physical, mental or emotional stress for an extended period of time, the adrenals may become weak and unable to produce adequate amounts of critical hormones, especially a hormone called cortisol. Cortisol levels increase to wake us up in the mornings, then gradually decline throughout the day so that we are tired when it is time to sleep. When stressed, our adrenals produce extra cortisol, which then activate the body’s physiological stress responses. These include increasing blood pressure, increasing the release of blood sugar or glucose into the bloodstream, acting as an anti-inflammatory, and increasing neurological activity. Initially prolonged stress will cause the adrenals to produce excess cortisol. The excess cortisol levels circulating in the bloodstream can cause the “wired but tired” symptoms that many of our patients report: energy surges followed by crashes during the day and difficulty falling asleep and staying asleep at night. Over an extended period of time, however, cortisol levels overall will drop as the adrenals lose the ability to keep up. Paradoxically, the body will often respond to abnormally low levels of circulating cortisol with adrenaline. These adrenaline surges once again disturb sleep. Low cortisol levels cause symptoms that include moderate to severe fatigue that may fluctuate at certain times of the day (particularly 2pm and 3-5pm), hypoglycemia, sugar or salt cravings, depression or moodiness, low blood pressure, recurrent infections & inflammatory responses, brain fog, and a decreased ability to manage or handle stress. If you identify with some of these symptoms, you might wonder why your doctor never mentioned adrenal fatigue to you. Unfortunately, conventional medicine lab testing only recognizes abnormal cortisol levels in the two extremes--Cushing’s Disease (in which cortisol levels are extremely high) and Addison’s Disease (in which cortisol levels are critically low or nearly absent).

Usually doctors will end up testing for thyroid issues in patients who present with chronic fatigue symptoms. This can create one of two scenarios: a person may actually suffer from hypothyroidism, and start thyroid treatment. They may feel some improvement for a period of time, but have persistent adrenal exhaustion symptoms. Second, the person may have no conventionally diagnosed hypothyroid symptoms, and continue to suffer from symptoms that doctors fail to diagnose or explain. Often the person is told their symptoms are “in their head” and prescribed an antidepressant and/or a sleep aid. Fortunately, in the world of functional or holistic medicine, adrenal fatigue is increasingly recognized and tested. Saliva cortisol testing can measure cortisol levels four key times during the day--morning, noon, evening, and night--which allows a doctor to tailor any treatment that might be needed. A variety of natural adrenal supplements are used to treat adrenal exhaustion. In mild to moderate stages, vitamin supplementation and adaptogenic herbs such as licorice, siberian ginseng, and ashwagandha are commonly used. High doses of vitamin C at a ratio of 2:1 ascorbic acid to bioflavonoids are often recommended, together with pantothenic acid. For more advanced stages, it is usually best to work with a functional medicine practitioner or naturopathic physician, who might prescribe glandular extracts or even hydrocortisone. Lifestyle changes that help promote sleep, reduce overall stress levels, and encourage healthy exercise also are important.

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