By Jacob Teitelbaum
Does this sound like you: irritable when you’re hungry, sudden periods of intense food cravings, exploding over little mistakes or problems? Welcome to the world of adrenal exhaustion.
Our adrenal glands make the stress hormones, adrenaline, and cortisol. Excess stress can exhaust your adrenal gland, leaving you feeling anxious and irritable, tired—sometimes with insomnia, addicted to sugar, and overweight. In fact, many people in marriage counseling and those seeing divorce attorneys often have adrenal exhaustion. Cortisol causes insulin resistance and can contribute to weight gain. This chemical also maintains blood sugar during stress. Because of this, adrenal exhaustion results in lower blood sugars and can trigger episodes of anxiety and irritability.
Your Adrenal Stress Handler Glands
Your adrenal glands sit on top of each kidney and are actually two different glands in one. The central portion of the gland makes epinephrine (also known as adrenaline) and is controlled by the part of your brain called the autonomic nervous system. This allows adrenaline to be activated in less than a second during times of stress (think of a gazelle as it sprints when it sees a lion—or you when someone cuts you off in traffic). This part of the nervous system is often in overdrive for people under heavy, and sometimes daily, stress—even contributing to such symptoms as hot and cold sweats; cold, sweaty hands; and panic attacks.
The outer part of the adrenal gland is called the adrenal cortex and makes many important hormones. These kick in more slowly than adrenaline, and support your body’s ability to handle stress over long periods of time. These include:
Cortisol. The adrenal glands increase their production of cortisol in response to stress. Cortisol raises your blood sugar and blood pressure and moderates immune function. This is the key hormonal deficiency associated with adrenal exhaustion, and the one we will primarily focus on.
Dehydroepiandrosterone (DHEA). Although its mechanism of action is not clear, DHEA is the most abundant hormone produced by the adrenal cortex. DHEA-S levels normally decline with age, but may drop prematurely in adrenal exhaustion. Patients often feel much better when their DHEA-S levels are brought to the optimal range. This hormone, though available in over-the-counter form, is best used under the guidance of a holistic practitioner, as too much can cause facial hair growth, even in women!
Aldosterone. This hormone helps to keep salt and water in the body, and helps to control blood volume and blood pressure.
Testosterone. Half of a woman’s testosterone comes from the adrenals, so adrenal exhaustion can cause testosterone deficiency with loss of libido.
Why Your Physician Looks at You Cross Eyed
A major cause of confusion is not knowing that adrenal fatigue is different from the medical condition called adrenal insufficiency (also called Addison’s Disease). The latter is associated with an almost complete failure of the adrenal glands and is considered a life-threatening emergency— complete with having to wear a Med Alert Bracelet.
In the past, Addison’s Disease used to occur predominantly as a result of tuberculosis, but nowadays is caused mostly by autoimmune illnesses. This is what your physician is taught to think of when someone mentions adrenal weakness or insufficiency. Most physicians have never heard of adrenal fatigue or exhaustion, and when you mention this they think you mean life-threatening Addison’s disease. So they look at you like you’re crazy. In fact, you are most likely going to be told that you are simply either depressed or that there’s nothing wrong with you– often with the implication from the physician being that if they don’t know what’s wrong with you, you’re crazy!
So, in standard medicine you either have a total, life-threatening adrenal failure, or completely healthy adrenals. It’s black or white—there is no in-between. For adrenal blood tests, you have to be in the lowest 0.001 percent before it’s considered abnormal. Because of this, most people suffering from adrenal exhaustion get no help from conventional doctors.
Adrenal exhaustion is largely a disease of modern life. Because there is no test that defines this condition, it is not life threatening, and there is no expensive medication to treat it. There has been very little published research in this area, and our understanding of it is based predominantly on the clinical experience of health practitioners. Nonetheless, holistic practitioners around the country (see Holistic-Board.org) are finding that this problem is growing at an alarming rate.
Why Is Adrenal Exhaustion Becoming More Common?
If you think back to high-school biology, you may remember something called the fight or-flight response, which occurs during times of stress. During the Stone Age, when a caveman met an animal that wanted to eat him, the caveman’s adrenal glands activated the adrenal adrenaline and cortisol systems and they either fought or ran. This reaction helped the caveman survive, and he was able to burn off the excess hormones through the fight or the run, and then had a couple of weeks or months to recover before facing the next major stress.
In the 21st century, people often experience these same stress reactions every few minutes. For example, picture driving to work, and being late while you are delayed in heavy traffic. Every time you hit ared light or pull up behind a car that has slowed down, your adrenal glands’ fight-or-flight reaction goes off and floods your brain with cortisol and adrenaline. Then it goes off again at work when you find your boss waiting for you. Not to mention when that guy cuts you off in traffic on your way home, or you see somebody with road rage on your tail.
The stress of the recent recession has been another major stress as some people take on extra work to make ends meet, and others stress over having no work at all. Having a severe illness or taking care of a family member can also tax your adrenals. The stress reaction going off repeatedly during the day can then trigger adrenal exhaustion over time.
Another major contributor to our stress levels? The 24-hour news networks. When I was younger, the media mantra was “Sex Sells.” Now it has changed to “Fear Sells.” We are inundated with a constant flow of “news” that includes war, death, politics, fear, and more fear.
The Sugar Rollercoaster
The main job of cortisol is to maintain blood sugar during stress, when your body is burning sugar for quick energy. Because of this, when people have adrenal exhaustion, they get symptoms of low blood sugar. The hallmark symptom? Anxiety or irritability when hungry. Have you heard the phrase “Feed me NOW or I’ll kill you”?
These symptoms lead you to look for something to eat—especially sugar— in the same way that somebody who is suffocating fights for their next breath. Sugar gives you a quick burst of energy, and your brain tells you “if you eat sugar right now, you’ll be ok.” So if you’re driving down the road and you tell your honey you’re hungry, and they tell you there’s a nice restaurant half-hour up the road, and you tell them they’ll be dead by then—you likely have low blood sugar from adrenal exhaustion.
Cortisol: Too high, too low, or both?
Your body makes a steady amount of cortisol on a daily basis, which in turn, helps to keep your body regulated. However during times of stress, cortisol levels can double or triple, leaving you with excess amounts that may not be burned off.
During the initial phase of chronic stress, cortisol levels are often elevated. This can result in weight gain, along with anxiety, depression, and even loss of bone density. As adrenal exhaustion progresses over years, cortisol levels can then drop too low; this is when people start feeling fatigued, and irritable when hungry.
An important function of your body is to maintain cortisol levels that are high in the morning (around 18 to 22 mcg/dL) for optimal energy, and low at bedtime (less than 5 mcg/dL ) so you can sleep. This day/night cycle is called the circadian rhythm.
In adrenal exhaustion, we often see that cortisol levels are too low during the day, leaving you exhausted and with low blood sugars. We also find they are too high at night, leaving you wide awake at bedtime. Because of this and despite needing treatment to increase cortisol levels during the day, some people also need natural remedies at night to lower cortisol levels—using Ashwaganda and Phosphatidylserine supplements—so they can sleep.
Jacob Teitelbaum, MD, is a board certified internist and nationally known expert in the fields of chronic fatigue syndrome, fibromyalgia, sleep and pain.