“Exhaustion is my reality. At four o’clock, I’m wiped, totally wiped.”
Patricia is forty-three, happily married as far as marriages go, one kid, steadily employed in the usual American less-than-satisfying corporate job, good eating habits, and, until recently, health club a few times a week. Now she’s too tired for that. By appearance, she’s dragging. Circles under the eyes and she needs to blink a couple of times to bring a thought to the surface. One tired-out lady.
She brought in blood tests from her primary care doc and everything looked fine. Blood count, metabolic profile (checking for diabetes, kidney, liver disease), thyroid function, iron level. Her PCP even did screening tests for mono, autoimmune inflammation, and because it’s the new hot topic, Lyme. At a Sleep Lab, she was told there was no evidence of a sleep disorder.
NADA. Nothing. She quietly absorbed the mantra of contemporary medicine, “We can’t find anything wrong with you. Your tests are normal. Do you think you might be depressed?”
She didn’t think she was depressed except contemplating if feeling like this was the hand she’d be dealt with for the rest of her life. Really, if she had the energy to call a babysitter, she’d love to go out with her husband. Other symptoms had developed along the way as well: she was “cold” all the time, dry skin and hair, libido a distant memory, and PMS? Don’t ask!
THE 4 PM CRASH GIVES US A CLUE
Although Patricia never had been an energizer bunny in the morning, now she wakes up feeling like she hadn’t slept at all. To snap her brain into gear for work, these days she downs a couple of extra-shot lattes. She knows she’ll function at 2/3rds capacity until 3 or 4 in the afternoon when she’s so tired, she’d pay anything for 30 minutes in a recliner, her office door closed and the phone off. Then, a few hours later, at 8 or 9 in the evening much to her annoyance since it’s just before bedtime, she’ll get this strange burst of energy, just enough to interfere with sleep. Just recently even this energy burst is history.
I told her I thought the problem was in her adrenal glands: two walnut sized structures sitting atop her kidneys. If you put your hands on your hips, your thumbs will be just about where your adrenals are located (and the adrenals are about the same size as your thumbs).
Your adrenals are actually two separate glands: the first, called the medulla is within, surrounded by the second, the adrenal cortex. Picture a plum cut in half. The seed of the plum, the medulla; the fruit, the cortex.
Both the medulla and the cortex are your responders to “stress”. The medulla, connected to your brain and nervous system, your first responder, works really fast. Threatened by a mugger?
Brain>adrenal medulla>a release of adrenalin makes you a temporary superwoman. (“Here’s a faceful of pepper spray, punk!”) Fight/flight, adrenalin, that’s the adrenal medulla.
Your adrenal cortex, second responder, is slower, and indirectly connected to your brain through your pituitary gland, that master gland sitting proudly in your skull just beneath your brain that also controls your thyroid and ovaries (or testes, depending on your gender).
The adrenal cortex deals with chronic stress and its several hormones regulate metabolism, especially glucose for energy, reduce inflammation, and control blood pressure by balancing sodium.
Your adrenal cortex is good for one day of work before it needs to be recharged. Its hormone, cortisol, starts your day at a high level then dwindles out by evening. It trusts that you’ll sleep at night in order to be at the top of its game in the morning. Think of it as a one day battery that you recharge while you sleep.
Since you don’t really encounter major stresses, like muggers, on a daily basis, it’s your adrenal cortex that is more involved with your day-to-day life stresses. But, and here’s the big ‘but’, when you’re under non-stop constant stress, your adrenal will get pooped out. Exhausted, tired, fatigued. And since adrenal normally starts winding down in the late afternoon, if you’re a victim of “adrenal fatigue”, it’s in afternoon with especially low cortisol levels that you’ll first feel symptoms.
But it’s important to understand, when you’re a victim of adrenal fatigue, there’s nothing wrong with your adrenal glands. They’re just overworked. Running on empty. If they could talk, they’d plead, “Overworked! Underpaid! Give us a rest! We need a vacation!”
So typically, adrenal fatigue occurs as a consequence of unchecked physical or emotional stress, and to cut to the chase, Patricia had more than her share during the previous year. Her mother died of ovarian cancer after a long illness, and Patricia being the only adult of the family in the area, she was the main caregiver. Patricia’s father had needed her help constantly. Her husband had been “a rock”, but her two children needed her, and then there were the demands of work. She’d been stretched so thin she would have snapped but instead sat numbly in front of her TV sipping pinot grigio, waiting for bedtime.
Adrenal fatigue is not a difficult diagnosis if your doctor has it on her ‘check-for-this’ list. The difficulty that patients face is that most conventionally trained endocrinologists don’t believe adrenal fatigue is real. My guess is they can’t tolerate a diagnosis that emerged from natural medicine practitioners and the best book on the subject, “Adrenal Fatigue: The 21st Century Stress Syndrome” was written by a (Heaven forfend!) chiropractor, J.L. Wilson. There are several “Adrenal Fatigue Questionnaire” websites online you can take for a perfectly good DIY start. The Women’s Health Network one is very straightforward but both genders are susceptible to adrenal fatigue.
When you schedule with a WholeHealth Chicago practitioner, your adrenal test report will look something like this.
The line graphs levels of salivary cortisol collected from morning to evening. This is a classic picture of adrenal fatigue. We’ll also be checking thyroid and ovarian or testicular function as generally all your endocrine system can drag along on “empty” and need support.
So Patricia’s Adrenal Stress Profile was quite low. Her thyroid and ovaries were barely hanging in there as well.
Next week, I’ll outline my approach that would allow poor Patricia to get her life back. For a start, here are our best supplements for Adrenal Fatigue:
- Adrenaliv Energy Support (Xymogen) Two capsules every morning
- Ashwaganda (Pure Encapsulations) One capsule every morning
- Holy Basil (Gaia Pro) One capsule every morning).
Be well,
David Edelberg, MD