When You’re Not Just Tired
Adrenal Dysregulation 101
“What’s wrong with me?” I remember thinking. “Why am I so incredibly tired — all the time? And irritable? Why can’t I focus? I have lost all motivation. This is not who I am.”
There’s tired and then there’s T-I-R-E-D.
No amount of sleep can remedy it. That first cup (pot?) of coffee is required for basic functioning. You’re sluggish much of the day, yet perhaps get a burst of energy just as you should be going to sleep. You’re procrastinating on projects, or even small tasks. Even following your healthy diet without fail isn’t helping.
If any of this sounds familiar, you could be way beyond “just” tired and instead, experiencing adrenal gland dysregulation. And you’re not alone.
It is estimated that over 50% of adult Americans will suffer from some level of adrenal dysregulation at some point in their lives. It’s primarily brought on by chronic stress, but many other factors and health conditions play into it including an inflammatory diet, lack of proper rest and existing chronic illness. Unfortunately, most will not seek treatment, or even be aware of the condition.
In our fast-paced, always-connected society, being run ragged seems to be the acceptable norm. Masking fatigue with caffeinated drinks, sugary foods or other stimulants to drag yourself out of bed and be somewhat effective in your daily life, or self-medicating with sleeping aids (prescription or otherwise) has become just another part of our daily schedules.
However, I promise you it doesn’t have to be this way. (I’ve personally been in the throes of adrenal dysregulation and have successfully crawled out — twice.) Read on to understand — and address — the root of the issue.
How Your Body Responds to Stress
It all begins in your brain, specifically your hypothalamus. In response to stress, certain hormones are released, trickling down to your pituitary gland, which then trigger your two adrenal glands to respond. While the adrenal glands (which sit on top of the kidneys) may be small, they are packing some of the most powerful hormones and neurotransmitters related to energy and stress response.
After being triggered by the pituitary, the adrenal glands first release epinephrine — also known as adrenaline, or the “fight or flight” hormone. Following is the release of cortisol. As the “make things happen” hormone, cortisol subdues the adrenaline rush and provides you with strength and stamina.
This response is meant to be short-lived. Ideally, it’s utilized for true physical threats that require immediate response in order to keep our bodies safe, such as running from an explosion, escaping a fire, etc.
However, with the everyday stressors we endure today — toxic relationships, financial hardships, overworking, inflammatory diets, lack of sleep, existing chronic illness — this stress response is continually activated, disrupting the proper rhythm of cortisol production for appropriate energy during the day and sleep at night.
Out of Rhythm
In a healthy, happy, adrenals-on-point individual, cortisol (and energy) levels should be highest around 8:00am (or about 30 minutes after waking) with a significant drop midday and then a continual taper to prepare for sleep at bedtime. This is known as a normal diurnal curve.
But this rhythm can become out of whack in any combination of ways. Some examples:
- your cortisol is too low in the morning = trouble waking up, even when you’ve gotten a full night’s sleep
- your cortisol spikes at night = a second wind at night, or insomnia
- your cortisol is lower than normal throughout the day = all day fatigue
- your cortisol is higher than normal at various points in the day = extra abdominal weight, difficulty sleeping, sugar cravings, GI issues
This not only causes the obvious issues with energy levels and sleep, it creates a whole cascade of negative physiological issues. This is because cortisol — beyond its role in the fight-or-flight response — has other very vital tasks, including:
- maintaining blood pressure and cardiovascular function
- slowing the immune system’s inflammatory response
- maintaining glucose levels
- regulating the metabolism of proteins, carbohydrates and fats
Adrenal dysregulation can also increase the permeability of your gut and change gene expression in immune cells making them more inflammatory.
Symptoms | Related Conditions
While some people can present without any obvious signs, most will likely have a sense that things just aren’t quite right. It’s difficult to draw any conclusions by experiencing just one of these symptoms or conditions; however, if many of these ring true it could be an indicator of some level of adrenal dysregulation.
Difficulty getting up in the morning
Increased time needed to recover from illness or injury
Continuing fatigue not relieved by sleep
Light-headed when standing up quickly
Craving for salt or salty foods
Mild depression/less enjoyment with life
Lethargy — not really awake until 10am; fading at 3 or 4pm, feeling best after dinner
Waking up multiple times during the night
Increased effort to do everyday tasks
Increased PMS — bloating, irritable, chocolate cravings
Worsening symptoms with skipped meals
Weight gain around the middle Increased fears/anxiety
Decreased ability to handle stress
Confusion/difficulty concentrating/memory issues
Feeling cold often
Irritability Seasonal Allergies Low blood pressure
Chronic fatigue syndrome
Type 2 diabetes
Other autoimmune and chronic disease
Know the Medical Landscape
Unfortunately, most conventional practitioners don’t diagnose adrenal dysregulation, or even acknowledge it as a condition, so it can be difficult to find treatment when going that route. The only accepted diagnosis related to adrenal dysregulation is Addison’s disease. In this very severe condition, the adrenal glands can have actual structural and physiological damage that could require life-long treatment with corticosteroids (powerful, synthetic cortisol with side effects including: high blood pressure, bone disease, poor immune system, high blood sugar, vision problems, white patches or sores, acne, swelling of the face, weight gain, and cognitive issues). Any adrenal insufficiency that doesn’t meet the criteria for Addison’s disease –cortisol levels in the blood and other markers that fall outside of normal, conventional laboratory reference ranges — is simply not acknowledged.
This heavy reliance on conventional lab values and methods alone for chronic, progressive conditions, is disheartening. Health is on a spectrum, it’s not absolute. You are not perfectly healthy one day and “sick” the next. In the case of your adrenal glands, this is especially critical. According to Dr. James L. Wilson, N.D., D.C., PhD “with each increment of reduction in adrenal function, every organ and system in your body is more profoundly affected.” When caught early, adrenal dysregulation can be easily treated with natural supplements and dietary changes.
In part, this lack of acknowledgement is simply terminology. It is very common to use the term “adrenal fatigue” when speaking about adrenal dysregulation with the theory that, at the early stages, your adrenal glands produce too much cortisol until they “fatigue” and then stop producing cortisol altogether in later stages. However, this isn’t physiologically appropriate. Adrenal dysregulation involves mechanisms beyond the adrenal glands (also includes the hypothalamus and pituitary), and the condition not only results in a lack of cortisol, it can result in levels that are either too high or too low. While adrenal dysregulation is more appropriate, the more accurate term for this condition is HPA (hypothalamus, pituitary, adrenal) axis dysregulation. It is also this term — HPA axis dysregulation — that is well-supported in peer-reviewed, medical research.
Finding the Help You Need
I believe when you better understand what stands in the way of your healing, you’ll be more motivated to take control of your health. So I hope you’ll take the knowledge above and use it to your advantage when you decide to seek help.
There are practitioners who understand and can assist who will do the appropriate functional testing (properly assessing the diurnal curve, comprehensive thyroid and gut health panels) and prescribe appropriate supplementation (e.g. vitamin B5, vitamin C and herbal adaptogens). And there are many diet and lifestyle changes you can implement on your own, including moving to an anti-inflammatory diet and finding mind-body techniques to manage stress.
If you want a comprehensive guide detailing the eight steps you need to take to start healing from adrenal dysregulation, you should download this free guide now.
In the meantime, take a deep breath (and a nap if you can), knowing that the path back to health is yours for the taking.
- Hudson, T., ND. (2016, May). Adrenal health — all day, all night. Lecture presented at Gaia Herbs Professional Solutions.
- Lam, M., MD, MPH. (2017, February 03). Why Conventional Medicine Rejects Adrenal Fatigue — Part 1. Retrieved February 21, 2017, from https://www.drlam.com/blog/why-conventional-medicine-rejects-adrenal-fatigue-part-1/10809/
- Silverman, Marni N., and Esther M. Sternberg. “Glucocorticoid Regulation of Inflammation and Its Functional Correlates: From HPA Axis to Glucocorticoid Receptor Dysregulation.” Annals of the New York Academy of Sciences 1261.1 (2012): 55–63.
- Vanuytsel, T., S. Van Wanrooy, H. Vanheel, C. Vanormelingen, S. Verschueren, E. Houben, S. Salim Rasoel, J. Toth, L. Holvoet, R. Farre, L. Van Oudenhove, G. Boeckxstaens, K. Verbeke, and J. Tack. “Psychological Stress and Corticotropin-releasing Hormone Increase Intestinal Permeability in Humans by a Mast Cell-dependent Mechanism.” Gut 63.8 (2013): 1293–299.
- Powell, N. D., E. K. Sloan, M. T. Bailey, J. M. G. Arevalo, G. E. Miller, E. Chen, M. S. Kobor, B. F. Reader, J. F. Sheridan, and S. W. Cole. “Social Stress Up-regulates Inflammatory Gene Expression in the Leukocyte Transcriptome via -adrenergic Induction of Myelopoiesis.” Proceedings of the National Academy of Sciences 110.41 (2013): 16574–6579.
- Kresser, C., MS, LAc. (2016, September 20). Clinician’s Guide to HPA Axis Dysregulation. Reading presented at In PRACTICE Practitioner Success Series in Kresser Institute for Functional and Ancestral Medicine.
- Wilson, J. L., ND, PhD. (2011). Adrenal fatigue: The 21st century stress syndrome. Petaluma, CA: Smart Publications.
Originally published at shellymalone.com on February 24, 2017.