Adrenal Depletion: The Most Commonly Missed Cause of Fatigue
By Joseph Mercola, MD* •
January 25, 2012
Leading health & nutrition educator Joseph Mercola, MD, provides a primer on the causes and symptoms of adrenal burnout, an inexpensive test you can do at home, and natural ways to give your adrenal glands a healthy boost. This article, reproduced with kind permission from Dr. Mercola's educational website (Mercola.com), was first published Sep 5, 2009. See footnote* for links to more.
The Cause of Fatigue Most Often Missed or Misdiagnosed by Doctors
Your adrenal glands are each no bigger than a walnut and weigh less than a grape, yet are responsible for one of the most important functions in your body: managing stress.
“The adrenals are known as ‘the glands of stress,’” writes James Wilson in his book Adrenal Fatigue: The 21st Century Stress Syndrome. “It is their job to enable your body to deal with stress from every possible source, ranging from injury and disease to work and relationship problems. Your resiliency, energy, endurance and your very life all depend on their proper functioning.”(1)
When your adrenal glands are fatigued, a condition known as adrenal fatigue or adrenal exhaustion, your entire body feels it, and suffers from extreme exhaustion as well.
It’s estimated that up to 80% of adults experience adrenal fatigue during their lifetimes, yet it remains one of the most under-diagnosed illnesses in the United States.(2)
The Optimal Function of Your Adrenal Glands
Your body has two adrenal glands, located just above each of your kidneys. As part of your endocrine system, your adrenal glands secrete more than 50 hormones, many of which are essential for life and include:
Glucocorticoids. These hormones, which include cortisol, help your body convert food into energy, normalize blood sugar, respond to stress and maintain your immune system’s inflammatory response.
Mineralocorticoids. These hormones, which include aldosterone, help keep your blood pressure and blood volume normal by maintaining a proper balance of sodium, potassium and water in your body.(3)
Adrenaline. This hormone increases your heart rate and controls blood flow to your muscles and brain, along with helping with the conversion of glycogen to glucose in your liver.
Together, these hormones and others produced by your adrenal glands control such body functions as:
• Maintaining metabolic processes, such as managing blood sugar levels and regulating inflammation
• Regulating your body’s balance of salt and water
• Controlling your "fight or flight" response to stress
• Maintaining pregnancy
• Initiating and controlling sexual maturation during childhood and puberty
• Producing sex steroids such as estrogen and testosterone.(4)
Ironically, although your adrenal glands are there, in large part, to help you cope with stress, too much of it is actually what causes their function to break down.
In other words, one of your adrenal glands’ most important tasks is to get your body ready for the “fight or flight” stress response, which means increasing adrenaline and other hormones. As part of this response, your heart rate and blood pressure increase, your digestion slows, and your body becomes ready to face a potential threat or challenge.
While this response is necessary and good when it's needed, many of us are constantly faced with stressors (work, environmental toxins, not enough sleep, worry, relationship problems and more) and therefore are in this "fight or flight" mode for far too long - much longer than was ever intended from a biological standpoint.
The result is that your adrenal glands, faced with excessive stress and burden, become overworked and fatigued.
Some common factors that put excess stress on your adrenals are:
• Anger, fear, anxiety, guilt, depression and other negative emotions
• Overwork, including physical or mental strain
• Excessive exercise
• Sleep deprivation
• Light-cycle disruption (such as working the night shift or often going to sleep late)
• Surgery, trauma or injury
• Chronic inflammation, infection, illness or pain
• Temperature extremes
• Toxic exposure
• Nutritional deficiencies and/or severe allergies.(5)
Signs and Symptoms of Adrenal Fatigue
When your adrenal glands become depleted, it leads to a decrease in certain hormone levels, particularly cortisol. The deficiencies in certain adrenal hormones will vary with each case, ranging from mild to severe.
In its most extreme form, this is referred to as Addison’s disease, a condition that causes muscle weakness, weight loss, low blood pressure and low blood sugar, and can be life threatening. Fortunately, only about four persons per 100,000 develop Addison’s disease, which is due to autoimmune disease in most cases but can also develop after very severe stress.(6)
At the other end of the spectrum, as well as in between, lies adrenal fatigue (also known as hypoadrenia).
Though the symptoms are less severe than in Addison’s disease, symptoms of adrenal fatigue can be debilitating. As Wilson writes:
“Non-Addison’s hypoadrenia (adrenal fatigue) is not usually severe enough to be featured on TV or to be considered a medical emergency. In fact, modern medicine does not even recognize it as a distinct syndrome.
Nevertheless, it can wreak havoc with your life. In the more serious cases of adrenal fatigue, the activity of the adrenal glands is so diminished that the person may have difficulty getting out of bed for more than a few hours per day.
With each increment of reduction in adrenal function, every organ and system in your body is more profoundly affected.”(7)
Classic signs and symptoms of adrenal fatigue include:
• Fatigue and weakness, especially in the morning and afternoon
• A suppressed immune system
• Increased allergies
• Muscle and bone loss and muscular weakness
• Cravings for foods high in salt, sugar or fat
• Hormonal imbalance
• Skin problems
• Autoimmune disorders
• Increased PMS or menopausal symptoms
• Low sex drive
• Lightheadedness when getting up from sitting or lying down
• Decreased ability to handle stress
• Trouble waking up in the morning, despite a full night’s sleep
• Poor memory.
Additionally, people with adrenal fatigue often get a burst of energy around 6 pm… Followed by sleepiness at 9 pm or 10 pm, which is often resisted. A “second wind” at 11 pm is then common, which often may keep you from falling asleep until 1 am.(8)
Further, those with adrenal fatigue often also have abnormal blood sugar levels and mental disturbances, such as increased fears and anxiety, and rely on coffee, soda and other forms of caffeine to keep them going.
As the name implies, the most common symptom of adrenal fatigue is unrelenting fatigue, a feeling of being run down or not able to keep up with your daily demands.
And because fatigue is such a common symptom, the syndrome is very often missed or misdiagnosed by physicians.
The Common Medical Test for Adrenal Function Cannot Diagnose Adrenal Fatigue
Adding to the problem of misdiagnosis is the fact that doctors typically use an ACTH (adrenocorticotropic hormone) test to check for problems with your adrenal glands. However, the test only recognizes extreme underproduction or overproduction of hormone levels, as shown by the top and bottom 2% of a bell curve.
Symptoms of adrenal malfunction, meanwhile, occur after 15% of the mean on both sides of the curve. So your adrenal glands could be functioning 20% below the mean (average), and your body experiencing symptoms of adrenal fatigue, and the standard test won’t recognize it.(9)
The test that will recognize adrenal fatigue, in all of its stages, is a salivary cortisol test.
This is an inexpensive test you can purchase online and do at home, as no prescription is needed. However, if you suspect you have adrenal fatigue, a knowledgeable natural health care provider can help you with diagnosis and treatment.
Natural, and Simple, Steps to Recover From Adrenal Fatigue
It takes time to burn out your adrenal glands, and as you might suspect it also takes some time to recover. You can expect:
• Six to nine months of recovery time for minor adrenal fatigue
• 12 to 18 months for moderate adrenal fatigue
• Up to 24 months for severe adrenal fatigue(10).
The good news is that natural treatments are very effective for this syndrome, and with time, patience, and the tips that follow it is possible to recover.
1. Probably the single most important area is to have powerful tools and strategies to address the current and past emotional traumas in your life. Prayer, meditation and meridian tapping techniques can be very helpful here. If you were to focus only on one area it would be best to concentrate in this area as this really is the central key to restoring your adrenal health.
2. Listen to your body and rest when you feel tired (this includes during the day by taking short naps or just lying down).
3. Sleep in (until 9 a.m. if you feel like it).
4. Exercise regularly using a comprehensive program of strength, aerobic, core, and interval training.
5. Eat a healthy nutrient-dense diet like the one described in my nutrition plan, according to your Nutritional Type [metabolically, different people are genetically inclined to perform better on different proportions of protein, carbs and fat].
6. Avoid stimulants like coffee and soda, as these can further exhaust your adrenal glands.
Further, to maintain proper adrenal function it is imperative to control your blood sugar levels.
If you are eating the right foods for your Nutritional Type, your blood sugar levels should balance out, and the following guidelines will also help:
• Eat a small meal or snack every three to four hours
• Eat within the first hour upon awakening
• Eat a small snack near bedtime
• Eat before becoming hungry. If hungry, you have already allowed yourself to run out of fuel (low blood sugar), which places additional stress on your adrenal glands.
You may also want to see a physician well versed in bioidentical hormone replacement, and get tested to see if you could benefit from the use of DHEA.
Note: This information (© 1997-2011 Dr. Joseph Mercola. All Rights Reserved) has not been reviewed by the FDA. It is general information, based on the research and opinions of Dr. Mercola unless otherwise noted, and is not meant to prevent, diagnose, treat or cure any condition, illness, or disease. It is not intended to replace a one-on-one relationship with a qualified healthcare professional and is not intended as medical advice. It is always very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team
DHEA is a natural steroid and precursor hormone produced by the adrenals, and levels are often very low in people with adrenal fatigue. Keep in mind, of course, that DHEA is not a quick cure, and should not be used as a sole treatment.
Treating adrenal fatigue requires a whole-body approach, one that addresses the excess stress and unhealthy lifestyle habits that wore out your adrenals in the first place.
Interestingly, the very first step in normalizing sex hormones, either male or female, is to first address the adrenal hormone system. For example if you were to only measure female hormones and then replace them with bioidentical hormone therapy, you will virtually be guaranteed to fail because the weakened adrenals will never allow the hormones to equilibrate properly.
Because your adrenal health is so important to your overall health and well-being, I highly recommend you work with a knowledgeable natural health care practitioner to find out if you have adrenal fatigue and then remedy it.
The tips above are an excellent starting point, however, and can be used by nearly everyone to help give your adrenal glands a healthy boost.
1. Wilson, James. Adrenal Fatigue: The 21st Century Stress Syndrome. Smart Publications, pg. 3, 2002.
2. Wilson, James. Adrenal Fatigue: The 21st Century Stress Syndrome. Smart Publications, pg. 6, 2002.
3. MayoClinic.com “Addison’s Disease” (Accessed June 11, 2009)
4. National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development,
“Adrenal Gland Disorders” (Accessed June 11, 2009)
5. "Understanding Adrenal Function" August 27, 2000, Mercola.com (Accessed June 11, 2009)
6. Wilson, James. Adrenal Fatigue: The 21st Century Stress Syndrome. Smart Publications, pg. 7, 2002.
7. Wilson, James. Adrenal Fatigue: The 21st Century Stress Syndrome. Smart Publications, pg. 7, 2002.
8. Veracity, Dani. “Recovering From Adrenal Fatigue: How Your Body Can Overcome Chronic Stress and Feel Energized Again.” Natural News, April 6, 2006 (Accessed June 11, 2009)
9. Veracity, Dani. “Recovering From Adrenal Fatigue: How Your Body Can Overcome Chronic Stress and Feel Energized Again.” Natural News, April 6, 2006 (Accessed June 11, 2009)
10. Veracity, Dani. “Recovering From Adrenal Fatigue: How Your Body Can Overcome Chronic Stress and Feel Energized Again.” Natural News, April 6, 2006 (Accessed June 11, 2009)
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