by Vicki Wade, PharmD
brought to you by Bellevue Pharmacy, a ProjectAWARE
Have you recently experienced a major stress in your life, be it
illness, job, death, children, etc? After this stress, have you
felt as though you just cannot seem to get yourself together, or
at least back to where you used to be? Are you usually tired when
you wake up, but still "too wired" to fall asleep at night?
Is it hard for you to relax or to get exercise? Do you find that
you get sick more often and take a long time to get well? If so,
then you, like many other Americans may be experiencing symptoms
of Adrenal Fatigue.
Adrenal fatigue is not a new condition. People have been experiencing
this condition for years. Although there is increasing physician
awareness, many are not familiar with adrenal fatigue as a distinct
syndrome. Because of this lack of knowledge, patients suffer because
they are not properly diagnosed or treated.
Adrenal fatigue is a condition in which the adrenal glands function
at a sub-optimal level when patients are at rest, under stress,
or in response to consistent, intermittent, or sporadic demands.
The adrenal glands are two small glands that sit over the kidneys
and are responsible for secreting over 50 different hormones—including
epinephrine, cortisol, progesterone, DHEA, estrogen, and testosterone.
Over the past century, adrenal fatigue has been recognized as Non-Addison’s
hypoadrenia, subclinical hypoadrenia, neurasthenia, adrenal neurasthenia,
and adrenal apathy.
Generally patients who present with adrenal fatigue can often
be heard saying, "After______, I was never the same."
The onset of adrenal fatigue often occurs because of financial pressures,
infections, emotional stress, smoking, drugs, poor eating habits,
sugar and white flour products, unemployment and several other stressors.
After experiencing many of these events over a long period of time,
the adrenal glands tend to produce less cortisol, the body’s
master stress hormone. Cortisol’s main role in the body is
to enable us to handle stress and maintain our immune systems. The
adrenal gland’s struggle to meet the high demands of cortisol
production eventually leads to adrenal fatigue.
Patients with adrenal fatigue have a distinct energy
pattern. They are usually very fatigued in the morning, not really
waking up until 10 AM, and will not usually feel fully awake until
after a noon meal. They experience a diurnal lull in their cortisol
(the stress hormone produced by the adrenal gland) and as a result,
they feel low during the afternoon, generally around 2-4 PM. Patients
generally begin to feel better after 6 PM; however, they are usually
tired after 9 and in bed by 11 PM These patients find that they
work best late at night or early in the morning.
Some key signs and symptoms of adrenal fatigue include salt cravings,
increased blood sugar under stress, increased PMS, perimenopausal,
or menopausal symptoms under stress, mild depression, lack of energy,
decreased ability to handle stress, muscle weakness, absent mindedness,
decreased sex drive, mild constipation alternating with diarrhea,
as well as many others.
Although there no specific tests that will provide a true diagnosis
of adrenal fatigue there are tests that may contribute to an assessment,
such as a postural hypotension test, an AM cortisol test, or an
ACTH stimulation test. It is customary for a physician to assess
the adrenals together with thyroid tests to rule out insufficiency,
which sometimes occurs in long-standing hypothyroidism.
A single determination of plasma cortisol or 24-hour urinary free
cortisol excretion is not useful and may be misleading in diagnosing
adrenal insufficiency. However, if the patient is severely stressed
or in shock, a single depressed plasma cortisol determination is
highly suggestive. An elevated plasma ACTH level in association
with a low plasma cortisol level is diagnostic.
Treatment for adrenal fatigue is relatively simple. Lifestyle
modifications can be initiated to treat this condition. Simple changes
such as more laughter (increases the parasympathetic supply to the
adrenals), small breaks to lie down, increased relaxation, regular
meals, exercise (avoiding any highly competitive events), early
bedtimes and sleeping until at least 9 AM whenever possible can
all benefit those experiencing adrenal fatigue.
A diet that would be conducive to treating adrenal fatigue includes
one that combines unrefined carbohydrates (whole grains) with protein
and oils (nuts and seeds) at most meals—olive, walnut, fiber,
flax and high-quality fish oil. It is also important for patients
to eat regular meals, chew food well, and eat by 10 AM and again
for lunch. Patients should look to avoid any hydrogenated fats,
caffeine, chocolate, white carbohydrates, and junk foods. Diets
should have a heavy emphasis on vegetables. It may be of additional
benefit that patients add salt to their diet, especially upon rising
and at least a half-hour before their lowest energy point of the
day. (Preferably, 1/8 to 1/2 teaspoonful of sea salt, Celtic salt,
or sea salt w/kelp powder added to an 8 oz glass of water). In adrenal
fatigue, one should not follow the USDA’s Food Guide Pyramid,
as these patients tolerate fewer carbohydrates and need more protein.
The addition of nutritional supplements may also offer additional
benefits to patients experiencing adrenal fatigue. They should consider
the addition of:
- Vitamin C 2,000-4,000 mg/day Sustained Release
- Vitamin E w/mixed tocopherols 800 IU/day
- Vitamin B complex
- Niacin (125-150 mg/day) – as inositol hexaniacinate
- B-6 (150 mg/day)
- Pantothenic acid (1200-1500 mg/day)
- Magnesium citrate (400-1200 mg)
- Liquid trace minerals (zinc, manganese, selenium, chromium,
molybdenum, copper, iodine)– calming effect
- If depression is present – Add SAM.e 200 mg bid;
DL-Phenylalanine (DLPA) 500 mg bid
Some herbal remedies that have been noted as possible therapies
include Licorice, Ashwagandha, Maca, Siberian Ginseng, Korean Ginseng.
Note: Licorice can and, if taken over time, does have a propensity
to elevate blood pressure. It should not be used in persons with
a history of hypertension, renal failure, or who currently use digitalis
preparations such as digoxin.
Under the supervision of a physician hormone supplementation with
DHEA, Pregnenolone, and Progesterone may also offer some benefits.
There are several glandular extracts on the market that contain
adrenal, hypothalamus, pituitary, thyroid, and gonadal that are
also often recommended. Sometimes the initiation of hydrocortisone
(Cortef®) may be necessary as a replacement hormone when cortisol
is not being produced by the adrenals. While the initiation of corticosteroids,
such as hydrocortisone may have quick and dramatic results, they
can sometimes make the adrenals weaker rather than stronger. As
a result, the initiation of hydrocortisone is usually a last resort.
It is important to note that patients may have to undergo treatment
for 6 months to 2 years.
While a cortisol measurement may be helpful to confirm any thoughts
or ideas that a patient may have decreased adrenal function, typically
blood cortisol levels would be tested along with blood levels of
potassium, and sodium. If the pituitary gland is the cause of adrenal
failure electrolyte levels are usually normal. Practitioners usually
pay attention to extremely low cortisol levels, which generally
diagnoses Addison’s disease—a condition in which the
adrenal glands are completely depleted, also considered a medical
If you think you may be experiencing adrenal fatigue, please contact
one of the consultant pharmacists at Bellevue
Pharmacy at 1-800-728-0288 to schedule an adrenal fatigue consultation.