Not infrequently, I see new clients who state that they have a condition known as "adrenal fatigue." As an internist, I know that conventional medicine does not recognize adrenal fatigue as a disease. Adrenal gland destruction, through an autoimmune attack, is known as Addison's disease. The symptoms are classic: bronzing of the skin, low blood pressure, hypoglycemia, extreme fatigue. This condition is potentially fatal and requires lifelong treatment with the bioidentical hormone known as cortisol or hydrocortisone. Addison's is diagnosed based on the clinical symptoms but also on a ACTH stimulation test. In patients with "adrenal fatigue", the stimulation test may be "normal." So, if a patient doesn't have adrenal destruction, ie, Addison's disease, does this mean they are normal?
My take on this is, not necessarily.
The words "adrenal fatigue" may not be recognized as a disease by conventional medicine, but adrenal hypofunction, documented by low salivary cortisol, hypoglycemia, fatigue, low blood pressure, and an increased susceptibility to IBS, aches and pains (fibromyalgia symptoms), allergies, chemical sensitivity, is a real condition for many people. The stimulation test is done with a high dose of ACTH-far higher than normally produced by the body, so it only means that under extreme stimulation the adrenals can rise to the occasion and make cortisol. To that I say, So What? We are not speaking of extreme situations in most cases. We want to know whether a patient makes an adequate amount of cortisol under normal life conditions and whether this is a cause of their profound fatigue. The saliva tests are well documented to be an accurate method of determining free cortisol levels over time; they are far more sensitive to free cortisol levels at the normal physiologic range than are the blood tests and stimulation tests.
While the condition may not be recognized by most physicians, they still try to treat it's symptoms. I still see patients who have been treated with amphetamines, Ritalin, Provigil, antidepressants, muscle relaxants, and powerful sleep-inducing drugs without a diagnosis of the problem or an understanding of it's cause by their well-meaning physicians.
I think, after treating many patients with this syndrome, that the cause is actually multifactorial: poor nutrition due to lack of essential vitamins and nutrients in our American diet, chronic stress leading to a stress-resistant/stress-adapted state in the brain and adrenal glands resulting in an inadequate output of cortisol, a lack of knowledge of stress-relieving techniques such as breath-work, activating the relaxation response, exercise, prayer or meditation, and in women of peri-menopausal age, often I find a deficiency of progesterone-an important precursor of cortisol. If progesterone is low, cortisol is often low as well.
I diagnose this syndrome by a careful patient history, testing of free cortisol levels with a salivary test at several times during the day, ruling out other illnesses that can present with fatigue or fibromyalgia-like symptoms: Folate, B12 or iron deficiency, vitamin D3 deficiency, estrogen and progesterone deficiency, testosterone deficiency, hypothyroidism, autoimmune disease, statin or other fatigue-inducing drugs, and other conditions such as environmental toxicity.
Once diagnosed correctly, "adrenal fatigue" can be successfully treated. The treatment is very effective and involves:
1. Reduction of stressors. Get rid of the toxic relationships, job stress, and financial stress that is the root of the problem.
2. Stress Management. Learn to handle the stress you cannot eliminate. This may involve learning the relaxation response, learning to do some simple breathwork, cognitive therapy, learning to meditate, getting a hobby, making some friends, going back to church, joining AA, beginning an exercise program, and so on.
3. Nutritional Supplements. From a nutritional supplement standpoint, the patient requires high doses of B vitamins in a bioidentical form, particularly Methyl-folate, methyl-B12, B6, B5, and high doses of Vitamin C. For severely ill patients, I recommend intravenous therapy with these nutrients.
4. Adaptogens. We can boost the body's ability to tolerate stress with herbs known as "adaptogens." These include Rhodiola, Ashwagandha, Ginseng, Holy Basil, and Shizandra. The common effect of these herbs is that they allow one to tolerate higher levels of stress without fatigue or physical damage. They tend to raise low levels of cortisol and lower excessively high levels. These are usually only needed on a short term basis if one works on correcting nutritional deficiencies and removing the root causes of the problem (unrelenting stress and inability to deal with it). Licorice is a useful herb in that it increases the retention of cortisol by the body. Phosphatidyl Serine can be helpful in reducing cortisol levels if levels are excessive leading to insomnia. The herb Relora can help in patients with high cortisol.
5. Hormonal Balancing. We detect deficiencies and return levels to optimal; this removes a significant biological stressor and provides progesterone to make cortisol.
6. Diet: Generally a low refined-carbohydrate, high-protein, adequate healthy fat, organic, Paleolithic diet is best for patients with this condition.
I know this is a real condition from personal experience as well as from my training in integrative medicine and from caring for patients. I was severely deficient in cortisol in 2005 with severe fatigue and I now have a normal cortisol response--after extensive work on nutrition, learning to properly handle stress, maintaining an exercise routine, balancing my hormones, and even a job change. I had classic adrenal hypofunction as an emergency medicine doctor(high stress, no sleep, poor nutrition) and recovered back to normal by taking the advice I am giving you now.I hope you have learned a bit more about this condition from my blog and that you realise it can be successfully treated. If interested in learning more, please contact my office, read the books mentioned on my webpage resource section, or send me an email.
Dr. Joseph Kaye