The epidemic of exhaustion affecting so many Americans today may have at its root a condition that is common and easy to correct—yet that condition often goes unrecognized by medical doctors. The culprit is adrenal fatigue (AF).

Adrenal glands produce stress hormones in response to stressful situations. With AF, the hormone response mechanism is so overwhelmed that it becomes ineffective. AF is usually triggered by long periods of mental, emotional or physical stress, and it is worsened by poor nutrition and unhealthful lifestyle choices.

In my estimation, 20% of Americans suffer from some degree of AF. And I find that this disorder often causes—or contributes to—the development of numerous other illnesses, particularly chronic fatigue syndrome and diabetes. When AF is correctly diagnosed and treated, the other conditions often are relieved as well.

Stress Hormone Factory

Located on top of each kidney is a crescent-shaped adrenal gland. The hormones these glands secrete affect blood pressure, heart rate, metabolism, liver function, immunity and the body's response to stress. Although the adrenal glands produce many hormones, two in particular become depleted in cases of AF—dehydroepiandrosterone (DHEA) and cortisol.

  • DHEA. The body converts DHEA into estrogen and testosterone. Abnormally low DHEA levels may contribute to cardiovascular disease, autoimmune disorders, poor resistance to infection, diabetes, weight gain, osteoporosis, sexual dysfunction, menopausal symptoms and mood disorders. DHEA also plays a role in aging.
  • Cortisol plays an important role in fighting infection...stabilizing blood sugar...controlling the body's use of proteins, carbohydrates and fats.. and regulating the sleep cycle. Cortisol is secreted at higher levels during the fight-or-flight response to stress, providing a burst of energy, heightened alertness and decreased pain sensitivity. But when cortisol levels are elevated for long periods, production by the adrenal glands drops. Insufficient cortisol can make you prone to fatigue, infection, allergies, diabetes and thyroid dysfunction.

Depletion of DHEA and cortisol adversely affects the way your body handles stress, inflammation, blood sugar regulation, energy production, immune response and cognitive function. That's why AF can be a contributing factor in a surprising number of ailments. A weakened immune response plays a part in cancer as well as in recurring infections, particularly of the respiratory tract. And poor regulation of blood sugar can contribute to both diabetes and alcoholism.

Making The Diagnosis

Conventional medical doctors often don't recognize AF—even though the condition was described in medical literature in the early 20th century. It was known then as hypoadrenia, which means low- or under-functioning adrenal glands.

If you show signs of AF, your best bet for diagnosis and treatment is to see a holistic doctor. For a referral, consult the American College for Advancement in Medicine (888-439-6891, In addition to assessing your symptoms, the doctor may perform…

  • Saliva testing to measure cortisol levels. This test is more accurate than a blood test. A pattern of low cortisol levels throughout the day indicates AF. I ask patients to collect saliva samples in test tubes upon waking...before lunch... in the late afternoon.. and before bed. Cortisol levels are normally highest in the morning and decrease throughout the day. People with severe AF usually have below-normal cortisol readings during at least two of the four time periods. I also use a saliva test that measures the DHEA level in the morning, when it is normally highest.

Saliva testing of cortisol levels is used by many research institutions, particularly to assess the effects of stress. Several commercial labs offer saliva hormone testing including Quest Diagnostics, the nation's largest conventional medical lab, which is used by medical and naturopathic doctors. To use Quest, you must have a prescription for the test from a doctor. A lab I have used for years that usually doesn't require a doctor's order is ZRT in Beaverton, Oregon (866-600-1636, www.salivatest. com). The adrenal function test, including four cortisol samples and a morning DHEA reading, costs $150, which is not covered by insurance. If your state does not allow residents to order lab testing directly (check the list on the ZRT Web site), you can order the kits at the same price through my clinic (call 858-450-7120).

  • Blood pressure measurements, taken three times-first while you lie on your back, then when you sit upright and again when you stand up. Normally, systolic (top number) and diastolic (bottom number) blood pressure will increase between 5 mm Hg and 10 mm Hg from the first reading to the third. If blood pressure drops, it may indicate AF-the adrenal glands may not be producing the stress hormones needed to maintain blood pressure.
  • Pupil testing, performed in a darkened room. A practitioner shines a flashlight from the side across one eye, and the pupil should continue to get smaller. With AF, the pupil first contracts and then dilates again.

Healing Strategies

Lifestyle changes and treatment reduce symptoms in most people with AF in four to six weeks. In severe cases, full recovery may take several months. My advice…

  • Curb stress. A hectic lifestyle sets the stage for AF. Are you working too hard? Is your job emotionally draining? Are your relationships unsatisfying? Try to alleviate stress and seek out emotional support.
  • Get enough rest. Go to bed by 10 p.m., and aim for eight to nine hours of sleep nightly. On weekends, nap for an hour or two.
  • Eat right. People with AF are prone to blood sugar swings that sap energy, so it is imperative to eat breakfast. I also recommend between-meal snacks, such as whole-grain toast or whey protein drinks. My favorite is Jay Robb's Whey Protein, which is naturally sweetened. It is available at major health-food stores and at (877-529-7622). Almonds, walnuts and macadamia nuts are good snack foods, since they provide protein for blood sugar stabilization.

Aim for 2,400 mg of sodium daily. Limit caffeinated beverages, such as coffee, tea and cola, to one cup daily because caffeine stimulates the already overtaxed adrenal glands. Avoid alcohol, which contains simple sugars.

  • .Exercise in moderation. Too little exercise is harmful, since exercise helps balance stress hormones. But over-exercising worsens fatigue.

General guideline: If you're exhausted after your workout or feel more worn-out than usual the next day, you're doing too much. Start by walking 15 minutes daily. As your adrenal glands recover, you can gradually increase to 45 minutes of moderately intense exercise daily.

  • Avoid lung irritants. Cigarette smoke, air pollution and allergens can worsen AF by stimulating cortisol release. If you smoke, please quit. Avoid secondhand smoke, and reduce exposure to allergy triggers with a high-efficiency particulate air (HEPA) filter.
  • Clear up infections. Acute and chronic respiratory infections as well as other types of infections can exacerbate AF symptoms. To speed recovery, work with a holistic doctor, who can recommend natural immune boosters, such as the herb astragalus.

Adrenal Fatigue Symptoms

Patients with AF typically experience low energy or exhaustion (even after a good night's sleep), plus one or more of the following…

  • Light-headedness upon standing up.
  • Mood swings, especially irritability.
  • Decreased ability to cope with stress.
  • Low libido.
  • Poor concentration.
  • Impaired memory.
  • Slow recovery from illness.
  • Low back pain.
  • Salt and/or sugar cravings.
  • Inability to lose or gain weight, despite calorie reduction or increase.

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