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Adrenal Crash and Recovery Cycle
By: Michael Lam, MD, MPH and Dorine Lam, RD, MS, MPH


The adrenal glands are the main stress modulation centers of the body. When stressors (either physical or emotional) overwhelm the adrenals ability to compensate, Adrenal Fatigue may ensue. This is usually a slow and insidious process that progresses through many years, though some can experience it after an intense episode of acute stress, such as death of a loved one, financial distress, or acute infection.

The job of returning the body to its normal function rests with the adrenals. This process is indeed complicated and convoluted, accompanied by many unpleasant symptoms. They are mediated primarily by hormones. The main ones are cortisol, adrenaline, estrogen, and androgen. The adrenals bear the brunt of this responsibility, as it secretes over 50 different hormones in an exact and very precise manner to maintain normal internal homeostasis. Adrenal hormones in turn affect other hormones in the body, ranging from thyroid hormones to serotonin to insulin. The state of dysregulation of these hormones results in unpleasant and abnormal physiological responses during an acute adrenal decompensation episode. It is the body's way of returning to a lower state of physiological function where conservation of energy becomes a primary focus for survival.

Adrenal crash is therefore the body's strategy of returning to a state of simple living dominated by bed-rest.

If the adrenal's compensatory emergency response effort is successful, the adrenal crash will eventually stop and the body will begin to stabilize and gradually return to its pre-crash state of function through what is known as the Recovery Phase. The Crash and subsequent Recovery Phase taken as a whole constitute the Adrenal Crash and Recovery Cycle. Unpleasant symptoms slowly disappear during the recovery cycle. If not successful, the body will continue to decompensate until such time as external help is rendered to support the adrenals and arrest the crash. In the absence of that, the body will naturally and slowly deteriorate, ultimately resulting in adrenal failure.

Total adrenal failure is a medical emergency, but there are several measurable degrees of Adrenal Fatigue before adrenal failure. These Adrenal Fatigue states (Adrenal Fatigue stages 1-4) usually progress with time and is triggered and exacerbated and marked by periodic adrenal crash and recovery cycles.

This paper will examine the adrenal crash and the recovery cycle in great details as they are found in each of the Adrenal Fatigue stages. Due to the lack of quantitative and laboratory investigative tools, findings presented here is primarily based on the clinician's perspective.

The Physiological Basis of Adrenal Crash

As mentioned above, Adrenal Fatigue is the body's strategy for returning to a simpler physiologic form of function as a way to conserve energy. The more advanced the fatigue, the lower the physiological basis. The most basic physiological state is prolonged bed rest. We call it hibernation in the animal kingdom. When an animal hibernates, it expends a minimal amount of energy. It comes as no surprise that those with adrenal crashes or in advance stages are often bed-ridden.

No organ is spared as the body down-regulates during a crash or as Adrenal Fatigue worsens and the body returns to a simple state. Multiple organ systems are involved. The first systems to turn off are those not required for basic survival. Reproduction is considered a luxury and not a vital function when survival is at stake. Libido as a result is lowered. The thyroid also goes into a slow down mode as the body attempts to reduce the basal metabolic rate (idle speed) to conserve energy. This naturally leads to sluggishness, constipation, and worsening fatigue. The gastrointestinal tract as a whole tends to slow down in its assimilation of food. Complex and processed foods become hard to digest and less is absorbed. Digestive enzymes and acid release are reduced. Gastric motility slows. As a result, foods do not churn as much compared to that of a normal healthy person. Poor digestion is common, accompanied by reduced absorption, increased gas, bloating, and constipation.

As this happens, the liver and kidney functions are also affected. Both are the clearing houses of the body's toxins. As liver function slows (though laboratory tests are usually normal), complete breakdown of metabolites becomes compromised. Overall, body clearance of such by-products tends to slow concurrently as toxic metabolite build up occurs as a result. Fat-based metabolites tend to find their way into areas of the body high in fat as they attract each other. Lipophilic organs (organs that like fat) such as the brain have a tendency to attract such fat based metabolites easily. Instead of a normal complete clearance out of the body on a timely basis, such metabolites tend to accumulate instead. Metabolites that accumulate in the brain can lead to and contribute to memory loss, confusion, anxiety, and brain fog. Normal brain function may be impaired if severe. Some accumulate in joints and muscles, leading to muscle pain of unknown origin and joint inflammation. The number of symptoms becomes overwhelming.

The down-regulation or return to simplicity will continue as long as the body sees it as a positive step to conserve energy for survival. As the body further slows down, muscle breaks down to generate energy, leading to an overall net loss of protein and muscle mass. When this happens, the body enters a catabolic state, with overall weight loss and muscle wasting. Fibromyalgia and chronic fatigue may ensue. Appetite reduces as the gastrointestinal tract motility slows. Those with sugar imbalances and insulin resistances are particularly vulnerable to a worsening state. Electrolyte imbalance becomes common. If the condition does not reverse, the body goes into an alarm reaction, activating the fight or flight response and release of adrenaline. Too much adrenaline can further propagate this viscous downward cycle. The normal negative feedback loop of hormones derails and soon a less stable positive feedback loop replaces it. Because positive feedback loops are inherently unsteady, the body moves closer to crashes with the smallest trigger. Ultimately, if not resolved, the body will collapse-a return to ultimate simplicity.

The myriad of physical symptoms mentioned above is convoluted and appear confusing. However, the progression is quite logical and clear if you see them as the body's way of slowing down. Indeed, like a domino effect, the shutting down process happens in steps. At the end, the body is reduced to bed rest. Ambulatory help for daily chores are required. Fatigue is extreme with the gastric system paralyzed, heart rate irregular, mental function clearly compromised, while the feeling of wired and tired abounds, as adrenaline is high when energy is low.

This continuum of down-regulation will not stop until the body finds its equilibrium. This is the point where energy demands slow to a point that matches the input. This is the point when the body finally feels it can survive and not threatened. Sad to say many are often bedridden at this state.

Understanding the above down-regulation and return to simplicity during an adrenal crash is very important not only to explain the various symptoms that concurrently arise defying conventional medical logic. It also serves as the basis of our understanding of why certain common remedies and approaches do not work but in fact make things worse when the body is in such a state. Lastly, it serves to guide us on recovery planning.

Anatomy of a Crash and Recovery Cycle

The complete crash and recovery cycle is broken down into two phases: the Crash Phase, where the body decompensates with worsening symptoms, and the Recovery Phase, where bodily function is gradually restored to the pre-crash level of function.

The most prominent symptom during the adrenal crash phase is fatigue and lack of energy. The sum of all dysfunctional and dysregulated hormonal and metabolic pathways ultimately results in reduced energy output as the main outcome. Gauging the energy level during the crash phase therefore gives us the most accurate indication of the severity of the crash over time. There are no laboratory tests that can quantify this objectively. The more intense and more symptoms coming from the adrenal crash, the deeper and more severe the crash.

The Recovery Phase is marked by a gradual return to pre-crash level of adrenal function and energy level. Symptoms of adrenal crash will reduce and spontaneously resolve as recovery proceeds. The Recovery Phase is further broken down into a stabilization period followed by one or more mini-recovery cycle, each consisting of a preparation period, a honeymoon period, and a plateau period. The three period flow in sequence resembles a set of steps going up. The overall successful recovery plan consists of multiple "S" curves in an upward sustained series without allowing any major downward crashes. This is illustrated in the graph above and it is comprised of the following:

Stabilization Period. Immediately after an adrenal crash and prior to the initial min-recovery leg up there usually is a stabilization period where the body ceases to decompensate and gradually arrive at a steady state of lower function. As we shall see later, this stabilization period carries an important and significant role in the overall Recovery Phase. The sensation is "the worse is over, but it can come back anytime".

Preparation period. This period normally lasts from 1 day to 6 weeks, depends on the stage of Adrenal Fatigue. The stronger the adrenal function, the shorter the duration. During this time, the body normally may not feel any significant energy difference even though nutrients have been administered, though there is a sense of improved control and reduce sense of impending doom. One continues to feel fatigue, but there is a subtle sense of improvement if one pays careful attention. This is the phase where the body builds its lost reserve and internally gets stronger. It is not uncommon to feel even worse from time to time.

Honeymoon Period. This usually follows immediately after the preparation period and can last a few days to 12 weeks if the preparation period is carried out properly. Again, the duration is highly dependent on the stage of Adrenal Fatigue. Generally speaking, the earlier the Adrenal Fatigue stage, the longer this period can last. The weaker the adrenals, the more tendency for this period to be short-lived unless under professional guidance. During this time the body is able to handle stress better. Fatigue reduces, palpitation frequently dissipates, and anxiety attack diminishes. Blood pressure starts to stabilize, brain fog starts to dissipate, and functional sleep returns. There might be mini-crashes and setbacks from time to time that last a few days. They are more tolerable compared to before, but recovery is faster. There is an overall sense of well being as if a burden has been lifted from one's shoulder. An overall sense of optimism returns.

Plateau Period. The body is stabilized. There is no set time frame for the duration of this period. Generally, it lasts a few weeks to a few months. In early stages of Adrenal Fatigue, this phase can go on for years and totally asymptomatic. In later stages of Adrenal Fatigue, the picture is much more dismal. Sufferers have to slowly adapt to an overall lower level of energy function. If the adrenal function is already at its maximum, one can be stuck at this phase for a very long time without upward progress. Many on self-guided programs would not be able rise to the next cycle due to the lack of foresight and planning. This is perhaps the most trying time, as impatience sets in. Most interpret the lack of continuation and sustained improvement as failure and become disappointed. Yet within this period often is embedded a resetting time where the body can be pushed to a higher level of function if take advantage of properly.

Most Adrenal Fatigue sufferers, especially those with advance weakness, go through multiple crash and recovery cycles over time. A careful analysis and comparative study of triggers and accompanying symptoms of each cycle over time serves as a good guide on overall adrenal function.

Have You had Your Crash Today?

Adrenal Fatigue sufferers are no strangers to "crashes". The crashes are usually the first alarm bell to ring early on in Adrenal Fatigue. At first they appear harmless, and can be as simple as a short period of exhaustion that recovers spontaneously after taking a nap or a sugar fix; or by way of a caffeine crash after the stimulatory effect of caffeine has worn off. With time, crashes become more intense and more prevalent. In severe cases, crashes can be triggered by something as simple as taking a longer than usual walk, and can last for months. They can vary greatly in intensity, depending on the stage of Adrenal Fatigue.

With each crash, the body usually recovers on its own. Internally, the body gets weaker with each crash. If not properly nurtured back to full function, these small crashes become more frequent, and more intense. Over time, as the body gets weaker, the recovery time also lengthens. The body enters stage 1 of Adrenal Fatigue and slowly gets worse, advancing to stage 2 and 3, and ultimately adrenal failure if no steps are taken to repair the damage.

Minor crashes can occur infrequently in the early stages of Adrenal Fatigue (stage 1 and 2), and every few days in late stage Adrenal Fatigue (stage 3 and 4). Major crashes usually only occur once every few years in early Adrenal Fatigue, but can occur as frequently as every few weeks in late stage Adrenal Fatigue such as adrenal exhaustion (stage 3). In such cases, the body never really gets a chance to fully recover. It goes through one crash cycle after another. If corrective steps are not taken to nurture the adrenals back to health, the body becomes preoccupied with fighting the crashes and trying to recover and function normally while being on the alert for the next crash. This constant state of alertness and repeated activation of the emergency system of the body to overcome crashes eventually drains the body of much needed energy, leading to a state of chronic fatigue and physical exhaustion.

In severe cases (adrenal exhaustion stage 3C or 3D or beyond), the sufferer may be bedridden in a state of what is described as "living hell" or "walking dead". On the outside they look normal. On the inside, they can hardly function. Conventional medicine's understanding of this state is unfortunately quite poor.

Common Causes of Adrenal Crashes

All adrenal crashes are precipitated by some form of stressor event, if one looks deep enough. Such events may be obvious (such as death of a loved one) or minor (such as taking a long walk). Small crashes might also delude detection. It is of paramount importance that the cause of each crash be fully investigated. The same stressor will likely trigger subsequent crashes. This is where an expert clinician's guidance is critical. History will likely repeat itself if no steps are taken understand what triggers the current crash and steps taken to prevent it from occurring again.

Examples of situational stressors that can trigger adrenal crashes include: overwork; dehydration; long road trips; vacation; dental procedures; infection, overexposure to sun, lack of sleep, sexual intercourse with ejaculation, drinking soda or coffee, medication withdrawals, especially steroids; thyroid medication sensitivity, especially T3; infection such as the flu or insect bites; overmedication such as the use of steroid and anesthesia with epinephrine, investigative procedures such as ACTH stimulation test. Other stressors trigger include: over use of stimulatory supplements, metal toxicity, excessive exercise, exposure to heat such as sauna or steam room, exposure to toxic fume, prolong standing, overly anxious, relationship difficulty, death of a loved one, long airplane or car trip, sexual intercourse especially with ejaculation, moving, overly aggressive detoxification such as enema, homeopathy, certain massages or acupuncture, excessive improper breathing and use of stimulatory breathing exercises, and excessive stimulatory entertainment such as watching an action movie or riding a roller coaster.

It is important to note that the more advanced the Adrenal Fatigue, the less intensity the stressor needs to be to trigger an adrenal crash. The body's reserve in advanced Adrenal Fatigue is already low and very close to hovering above the adrenal symptom threshold level. It does not take much to cross this threshold as the crash occurs.

Message from Dr. Lam

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About The Authors

Michael Lam, M.D., M.P.H., A.B.A.A.M., is a western trained physician specializing in nutritional and anti-aging medicine. Dr. Lam received his Bachelor of Science degree from Oregon State University, and his Doctor of Medicine degree from the Loma Linda University School of Medicine in California. He also holds a Master’s degree in Public Health. He is board certified by the American Board of Anti-Aging Medicine where he has also served as a board examiner. Dr. Lam is a pioneer in using nontoxic, natural compounds to promote the healing of many age-related degenerative conditions. He utilizes optimum blends of nutritional supplementation that manipulate food, vitamins, natural hormones, herbs, enzymes, and minerals into specific protocols to rejuvenate cellular function.

Dr. Lam was first to coin the term, ovarian-adrenal-thyroid (OAT) hormone axis, and to describe its imbalances. He was first to scientifically tie in Adrenal Fatigue Syndrome (AFS) as part of the overall neuroendocrine stress response continuum of the body. He systematized the clinical significance and coined the various phases of Adrenal Exhaustion. He has written five books: Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs, The Five Proven Secrets to Longevity, Beating Cancer with Natural Medicine (Free PDF version), How to Stay Young and Live Longer, and Estrogen Dominance. In 2001, Dr. Lam established as a free, educational website on evidence-based alternative medicine for the public and for health professionals. It featured the world’s most comprehensive library on AFS. Provided free as a public service, he has answered countless questions through the website on alternative health and AFS. His personal, telephone-based nutritional coaching services have enabled many around the world to regain control of their health using natural therapies.

Dorine Lam, R.D., M.S., M.P.H., is a registered dietitian and holistic clinical nutritionist specializing in Adrenal Fatigue Syndrome and natural hormonal balancing. She received her Bachelor of Science degree in Dietetics, holds a Master’s Degree in Public Health in Nutrition, and a Master of Science degree in Nutrition from Loma Linda University, in Loma Linda, California. She is also a board-certified, Anti-Aging Health Practitioner by the American Academy of Anti-Aging Medicine. She coauthored with Michael Lam, M.D., the books Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs and Estrogen Dominance and numerous articles on Adrenal Fatigue Syndrome. Her personal research and writing focuses on the metabolic aspect of Adrenal Fatigue Syndrome. She is married to Michael Lam and is an integral part of the telephone-based nutritional coaching team helping people overcome Adrenal Fatigue Syndrome.

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