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Excerpts By: Dr. Michael Lam, MD, MPH; Dr. Justin Lam, ABAAHP, FMNM

One of the most common health complaints today is the experience of fatigue and lethargy. If you have fatigue along with other symptoms such as difficulty concentrating, insomnia, inability to lose weight, feeling anxious, allergies, or brain fog, Adrenal Fatigue Syndrome (AFS) may be at the root of the problem.

Adrenal Fatigue consists of many nonspecific but debilitating symptoms. The onset of this condition is often slow and insidious. Sufferers are told that they are stressed and need to learn to relax more. Yes, we all know that "stress kills" to a large extent. But, the question is how?

The real truth is that stress and Adrenal Fatigue are not a mysterious entity at all. Our body has a built-in mechanism to deal with it. Being able to handle stress is a key to survival, and the control center in our bodies is the adrenal glands.

Adrenal Fatigue Syndrome is one of the most prevalent conditions. Most people experience it at one point or another. However, most conventional physicians are not taught about Adrenal Fatigue in medical school. As such, they are not prepared to take Adrenal Fatigue as a serious threat to health.

This condition was seldom considered as a dysfunctional sickness. Instead, people think of Adrenal Fatigue Syndrome as a condition related to stress. Thus, the solution was to tell the person to "relax" and take anti-depressants. This does not solve the underlying issue and over time, the condition worsens. Adrenal Fatigue Syndrome is not a medical condition recognized by mainstream institutions. Invariably, the adrenal glands are structurally normal. Low cortisol, the most common associated finding, may be caused by factors outside the adrenal glands.

Your doctor is likely unfamiliar with this condition. Adrenal Fatigue Syndrome is a sub-clinical non-Addison's form of adrenal dysfunction. Because there are many causes, Adrenal Fatigue Syndrome is a more accurate name. The addition of "syndrome" implies no definitive cause. 

Signs and Symptoms of Adrenal Fatigue
  • Tendency to gain weight and unable to lose it, especially around the waist.
  • High frequency of getting the flu and other respiratory diseases.
  • Infections that tend to last longer than usual.
  • Tendency to tremble when under pressure.
  • Reduced sex drive.
  • lightheaded when rising from a horizontal position.
  • Unable to remember things.
  • Lack of energy in the mornings and in the afternoon between 3 to 5 pm.
  • Feel better suddenly for a brief period after a meal.
  • Often feel tired from 9 - 10 pm, but resist going to bed.
  • Need coffee or stimulants to get going in the morning.
  • Cravings for salty, fatty, and high protein food such as meat and cheese.
  • Increased symptoms of PMS for women. 
  • Pain in the upper back or neck with no clear reason.
  • Feels better when there is less stress, such as on a vacation.
  • Difficulties in getting up in the morning.
  • Lightheaded.
  • Mild depression.
  • Food and or inhalant allergies.
  • Lethargy and lack of energy.
  • Increased effort to perform daily tasks.
  • Decreased ability to handle stress.
  • Dry and thin skin.
  • Hypoglycemia.
  • Low body temperature.
  • Nervousness.
  • Palpitations.
  • Unexplained hair loss.
  • Alternating constipation and diarrhea.
  • Dyspepsia.

If you have many of these signs and symptoms, it is time to consider Adrenal Fatigue as a possible cause. None of the signs or symptoms by themselves can definitively pinpoint Adrenal Fatigue. However, when looked at collectively, these signs and symptoms form a specific picture of a person under stress. These signs and symptoms are often the end result of acute, severe, chronic, or excessive stress. The body is unable to reduce such stress.

The ability to handle stress, physical or emotional, is a cornerstone to human survival. Our body has a stress modulation system in place, known as the neuroendometabolic (NEM) stress response. The adrenal glands are part of this response system. When these glands become dysfunctional, our body's ability to handle stress is reduced.

Common Causes of Adrenal Fatigue

Chronic stress is common in western society. The most common causes of stress are work pressure, changing jobs, death of a loved one, moving homes, illness, and marital disruption. Adrenal Fatigue occurs when the amount of stress exceeds the capacity of the body to compensate and recover.

Stressors that can lead to Adrenal Fatigue include:
  • Anger
  • Chronic fatigue
  • Depression
  • Chronic illness
  • Excessive exercise
  • Chronic infection
  • Fear and guilt
  • Chronic pain
  • Gluten intolerance
  • Low blood sugar
  • Mal-absorption
  • Mal-digestion
  • Toxic exposure
  • Severe or chronic stress
  • Surgery
  • Late hours
  • Sleep deprivation
  • Excessive sugar in diet
  • Excessive caffeine intake from coffee and tea
What Happens to the Body when Cortisol Is Lowered Due to Adrenal Fatigue?
  • Reduced insulin sensitivity, reduced glucose utilization, and increased blood sugar, which leads to diabetes.
  • Reduced secretory IgA (the main cellular defense factor), natural killer (NK) cell and T-lymphocyte activity which lead to increased chances of getting infections such as Herpes, yeast overgrowth, and viral infections.
  • Increased inflammation in the body resulting in muscle and joint aches/pains.
  • A block in calcium absorption results in an increased loss in bone mass. The demineralization of bone occurs, leading to osteoporosis.
  • Increased fat accumulation around the waist and protein breakdown. This leads to muscle wasting, an inability to reduce weight.
  • An increased in water and salt retention (swelling), leading to high blood pressure at first, with low blood pressure as the condition worsens.
  • Estrogen dominance, leading to PMS, uterine fibroids, and breast cancer.
Adrenal Fatigue Protocol

Adrenal Fatigue can be reversed. You may need to allow 6 months to 2 years for the recovery process to take place. These are some of the important steps.

Removal of stressors
This is the most important step. It is important to deal with stressors such as marital, family, relationship or financial problems.

Sleep
It is important to go to sleep by 10 p.m. every night. Why? This is because our adrenal glands kick in for a "second wind" to keep us going from 11 pm to 1 am. This puts tremendous stress on the adrenals. When we rest early, our adrenals are rested. Between 10 p.m. and 1 a.m., our adrenals work the hardest to repair the body. We should also try to sleep in until 8:30 a.m. or 9: 00 a.m. if possible. This is because our cortisol level rises to its peak from 6:00 a.m. to 8:00 a.m. to wake us up and get us going for the day.

In later stage Adrenal Fatigue, the level of cortisol falls and we feel tired. It will be more difficult to wake up. If we wake up too early, this will only increase stress on the adrenal glands, which will have to produce more cortisol.

If you are unable to sleep, your physician may recommend a natural sleep supplement such as L-theanine, Melatonin or Magnesium.

Avoid Coffee or Caffeinated Beverages
Coffee and tea can act as stimulants and interrupt sleep pattern. Herbal tea is okay because it does not contain caffeine

Avoid TV and Computers
Some people may be photosensitive. Watching television or working at the computer may prevent melatonin levels from rising to induce sleep. Turn off your phone, television and computer by 8 p.m.

Exercise
This is a wonderful stress reducer and a tremendous oxygenator. Exercise reduces depression, increases blood flow, normalizes level of cortisol, insulin, blood glucose, growth hormones, thyroid, and makes you feel generally much better.

Exercise is a key component to adrenal recovery if done right. The key is to adjust the level of exercise in accordance to your capacity and do the proper amount at the right time. Over-exercise is a trigger for adrenal crash. More is not necessary better when it comes to exercise and Adrenal Fatigue. The more advanced your Adrenal Fatigue, the less you should exercise vigorously. Vigorous exercise can lead to a catabolic state and worsen Adrenal Fatigue. Those with severe adrenal weakness should start with gentle adrenal breathing exercises. Progress to adrenal restorative exercises, then to special adrenal yoga exercise series. Discuss proper exercise with your physician.

Nutritional Supplementation

In an adrenal recovery program, it is prudent to consider optimizing the adrenal gland functions. An optimal balance of vitamins and minerals for optimum adrenal function can include:

Vitamin C
500 mg to 3,000 mg of vitamin C with bioflavonoid and synergistic co-factors is beneficial. Vitamin C is one of the gentlest of all adrenal supporting nutrients.

Glutathione
Glutathione to enhance the effectiveness and cellular bio-availability of vitamin C, E, alpha lipoic acid, and carnitine. Specifically, glutathione acts as a liver detoxifier. It helps recycle inactive oxidized vitamin C back to its reduced active form in the body after vitamin C has served its function.

Vitamin B5
Most hormones in the adrenal gland need co-enzyme A for production. Co-enzyme A is a product of vitamin B5

Vitamin E
400-800 I.U. of Vitamin E is another important nutrient. It is involved in at least six different enzymatic reactions in the adrenal cascade.

Vitamin D
5000 I.U of Vitamin D is a good nutrient to support hormonal synthesis.

Adrenal glandulars, extracts and herbs
Adrenal glandular, adrenal extract and herbals such as ashwagandha root, licorice root, Korean Ginseng, Siberian Ginseng, ginger root, and ginkgo leaf can be helpful for short term due to their effectiveness and adaptogenic properties.  Only use under the direction of your physician. 

Please schedule with Dr. Watkins for your full Wellness Evaluation if you feel you are suffering from this condition and would like to be evaluated for diagnosis and treatment.