The adrenal glands are the main stress control system of the body. Adrenal fatigue is a decrease in the gland's ability to carry out this normal function. It is commonly caused by chronic stress from any source (including emotional, physical, mental, or environmental) that exceeds the body's capacity to adjust appropriately to the demands placed on it by the stress. Stressors that can lead to adrenal fatigue include anger, chronic illness, depression, surgery, high sugar intake, over exercise, sleep deprivation, chronic or acute infections including Giardia and H. pylori, and repaired root canals, just to mention a few.

Signs and Symptoms of Adrenal Fatigue include tendency to gain weight and the inability to lose it, especially around the waist; high frequency of getting the flu and other respiratory diseases with symptoms that tend to last longer than usual; tendency to tremble when under pressure; reduced sex drive; lightheadedness when rising from a laying down position; brain fog; lack of energy in the afternoon; reliance on coffee to get the day started; fibromyalgia, chronic fatigue, cravings for salty and fatty food; hypoglycemia, chronic pain of unknown origin; and feeling better during a vacation. None of these signs or symptoms by itself can definitively point to adrenal fatigue. When taken as a group in context of an otherwise healthy person, these signs and symptoms do form a specific adrenal fatigue syndrome or picture—that is of a person under stress and the body's failing physiological response to such a burden. Adrenal fatigue as a debilitating condition is not recognised by conventional medicine and is thus missed by most conventionally trained physicians.

Four Stages of Adrenal Fatigue

Adrenal fatigue progresses through four advancing stages with increased severity of symptoms with each stage.

Stage 1: Alarm Reaction (Flight or Fight response). In this stage, the body is alarmed by the stressors and mounts an aggressive anti-stress response to overcome the stressors. This anti-stress response is mediated by an increase in anti-stress hormones like cortisol. The amount of anti-stress hormone required is well within the body's output capacity. Fatigue is usually quite mild and usually occurs in the morning on awakening or in the mid-afternoon. No physical or physiological dysfunction is clinically noticeable. Normal daily function is expected, though peak performance cannot be achieved.

The adrenal glands are usually the first in order of endocrine function to breakdown in a stressful environment that has overwhelmed the body's normal compensatory response. Unfortunately, this sub-clinical state is seldom recognized as a pathological condition. Acceptable social compensatory actions such as coffee intake often mask the underlying problem: the adrenals are put into over-drive to cover the early signs and symptoms of fatigue. The insulin-producing portion of the pancreas is also affected. Blood sugar becomes imbalanced, resulting in low energy. This dysfunction is temporary patched by intake of quick fixes such as high sugar content soda drinks, energy potions, and high carbohydrate foods such as donuts. Many even consider this state "normal" as part of living in the modern society. Those who require coffee to "kickstart" the day may already be in this stage and not be aware of it.

Stage 2: Resistance Response. With chronic or severe stress, the adrenals are eventually unable to keep up with the body's demand for cortisol. Adrenal fatigue now enters the second stage. Normal daily functions are still able to be carried out, but the sense of fatigue is pronounced at the end of each day as the body needs more rest than usual to recover. Despite full night's rest, the body does not feel refreshed in the mornings. Anxiety starts to set in, and the person becomes easily irritable. Insomnia becomes more common, as it takes longer to fall asleep. There are also frequent awakenings as well. Infections become more recurrent. PMS and menstrual irregularities surface, and symptoms suggestive of hypothyroidism (such as a sensation of feeling cold and sluggish metabolism) become prevalent. The thyroid glands are usually affected at this stage. Sluggishness, feeling cold, and weight gain centrally despite exercise and diet are the predominant symptoms that usually bring patients to their physicians for the first time. Thyroid replacement is routinely prescribed. Ovarian hormones, synthetic or bio-identical, are considered. However, the vast majority who undergo such hormonal adjustment remain symptomatic over time and treatments usually fail. Many see their physician for the first time in this stage. Conventional medical workup is ordered, but results are inevitably within range. Patients are sent home with no concrete program for recovery. Many are prescribed anti-depressants at this stage. The many warning signs of the body continue to be ignored as most rely on more stimulants to keep their mood up. Those who require multiple cups of coffee to sustain themselves may well be entrenched at this stage without knowing it.

Stage 3: Exhaustion. As adrenal function weakens further, the body's need for adrenal hormones remains unabated if stress is not reduced. The adrenals are no longer able to keep up the ever increasing demand for cortisol production needed to overcome stress and become exhausted. Cortisol output starts to decline. This usually happens gradually. The body enters a stage where the primary goal is conversion of energy to ensure survival. Systematically, the body enters a slow-down mode and starts generating energy from tissues. This catabolic stage results in muscle breakdown and protein wasting. Chronic fatigue is common. Exercise tolerance is reduced. Concurrently, chronic fibromyalgia appears. Toxic metabolites accumulate throughout the body, leading to brain fog and insomnia. Depression becomes severe and constant. As this stage progressed, metabolic, immunological, and neurological single organ systems dysfunction characteristic of stage 2 spread to involve multiple organs. This is evidenced by multiple endocrine axis dysfunctions, including ovarian-adrenal-thyroid axis imbalance in female and adrenal-thyroid axis imbalance in male.

If it is not attended to, the body further weakens and enters a state of disequilibrium with loss of homeostasis. As the body tries to repair itself with limited tools, there are wild exaggerated and paradoxical autonomic-driven reactions, characterized by adrenaline rushes, labile blood pressure, and hypoglycemic episodes after meals, and anxiety attacks. A state of near adrenal failure eventually occurs as the pool of hormones reaches a low level to prime the adrenals. Without basic levels of hormones, the body goes into full-blown mode to shut down as much non-essential function as possible to conserve its energy in order to survive. Libido is suppressed, digestion slows down, and metabolic rate declines to conserve weight. Those afflicted find themselves bed-ridden most of the time, and have energy that lasts for only a short time.

What seperates stage 3 from earlier stages clinically is that the patient often cannot function smoothly throughout the day, no matter how hard they try. Something is wrong, and the body's cry for help becomes stronger. Productive hours of the day progresssively decreases. It is not unusual for those at this stage to have only a few hours of productive time a day, while the rest of the time is spent in bed resting.

Stage 4: Failure. Eventually, the adrenals are totally exhausted. Patients at this stage have a high chance of cardiovascular collapse and death. When adrenal fatigue has advanced to this stage, the line between it and Addison's disease, also called adrenal insufficiency, can be blurred. While the etiology of conditions may be different, the ultimate clinical presentations can be quite similar as they both represent a continuum of decompensation in adrenal function. At this stage, severe advance adrenal crisis manifestation can be very similar to and akin to an addisonian crisis, or acute adrenal insufficiency. This is a recognized medical condition. Symptoms of this include sudden penetrating pain in the lower back, abdomen, or legs, severe vomiting and diarrhea, dehydration, low blood pressure, and loss of consciousness. Addisonian crisis is rare, and in most cases, symptoms are severe enough that patients seek medical treatment before a crisis occurs. However, in about 25 percent of patients, symptoms first appear during an addisonian crisis. If left untreated, an addisonian crisis can be fatal.

Although adrenal dysfunction and its various stages were recognized as distinct clinical syndromes since the turn of the 20th century, most conventional physicians are still unfamiliar with this condition because it is difficult to diagnose it effectively through traditional blood tests. Most patients are sent home with anti-depressants after a short trial of hormonal replacement that usually fails.