\u201cExhaustion is my reality. At four o\u2019clock, I\u2019m wiped, totally wiped. So tired I could sleep at my desk.\u201d<\/p>\n\n\n\n
Patricia is 33, happily married as far as marriages go, one kid, steadily employed in the usual American less\u00adthan\u00adsatisfying corporate job, good eating habits, and, until recently, a health club goer a couple\/three times a week. Now she\u2019s too tired for that. Just looking at her, you can tell she\u2019s dragging. Circles under her eyes and she needs to blink a couple of times to bring a thought to the surface.<\/p>\n\n\n\n
One tuckered out woman.<\/p>\n\n\n\n
Patricia brought in blood tests from her primary care doc and everything looked fine. Blood count, metabolic profile (checking for diabetes and kidney or liver disease), thyroid function, iron level. He even did screening tests for mono, autoimmune inflammation, and, because it\u2019s the new hot topic, Lyme. At a sleep lab, she was told there was no evidence of a sleep disorder.<\/p>\n\n\n\n
Nada. Nothing. She exhaustedly absorbed the mantra of contemporary medicine: \u201cWe can\u2019t find anything wrong with you. All your tests are normal. Do you think you might be depressed?\u201d<\/p>\n\n\n\n
Patricia told me she didn\u2019t think she was depressed, though contemplating feeling like this for the rest of her life could send her in that direction. Really, if she had the energy to call a babysitter she\u2019d love to go out with her husband.<\/p>\n\n\n\n
The 4 pm crash gives us a clue My bet was on her adrenal glands, two walnut-sized structures that sit atop the kidneys. If you put your hands on your hips, your thumbs will be just about where your adrenals are located.<\/p>\n\n\n\n Your adrenals are actually two separate glands. The first, called the medulla, is within, surrounded by the second, the adrenal cortex. Envision a plum. The seed of the plum is the medulla, the fruit the cortex. Both the medulla and the cortex are your front-line responders to stress. However, the medulla, connected to your brain and nervous system, is your first responder and it works really fast.<\/p>\n\n\n\n Threatened by a mugger? Signals from your brain to your adrenal medulla trigger a burst of adrenalin that turns you into a temporary superwoman. (\u201cHere\u2019s a face full of pepper spray, punk!\u201d<\/a>)<\/p>\n\n\n\n The adrenal cortex, indirectly connected to your brain through the pituitary–the master gland that also controls your thyroid and ovaries (or testicles, depending)–is the slower, second responder. The cortex deals with chronic stress, and its several hormones regulate metabolism (especially glucose for energy), reduce inflammation, and control blood pressure by balancing sodium.<\/p>\n\n\n\n Your adrenal cortex is good for a day\u2019s work before it needs to be charged up at night. Think of it as a one-day battery you recharge during sleep. Its hormone, cortisol, starts the day at a high level and then dwindles out by evening. It trusts that you\u2019ll sleep at night in order for it to be at the top of its game in the morning.<\/p>\n\n\n\n Since you don\u2019t encounter many major stressors in a day, like a mugger or having to lift a car off someone, it\u2019s the adrenal cortex that\u2019s more involved in the daily stress you experience. But–and here\u2019s the big but–when you\u2019re beset by relentless low-grade stress your adrenals will poop out. Exhausted, tired, fatigued. And since adrenal function normally starts winding down in the late afternoon, if you\u2019re experiencing adrenal fatigue it\u2019s at this time with your especially low cortisol levels that you\u2019ll first feel symptoms.<\/p>\n\n\n\n Your adrenals are fine\u2014they\u2019re just overworked Typically, adrenal fatigue occurs as a consequence of unchecked physical or emotional stress. To return to Patricia, she\u2019d had more than her share during the previous year. Her mother had died of ovarian cancer after a long illness, and with Patricia an only child her father had needed her help constantly. Patricia\u2019s husband had been \u201ca rock,\u201d but her young daughter needed her, and then there were the work demands. She\u2019d been stretched so thin she would have snapped, but instead sat numbly in front of the TV sipping pinot noir, waiting for bedtime.<\/p>\n\n\n\n Adrenal fatigue is not a difficult diagnosis if your doctor has it on her mental \u201ccheck\u00adfor\u00adthis\u201d list. The challenge patients face is that most conventionally trained endocrinologists don\u2019t believe adrenal fatigue is real. My guess is they can\u2019t tolerate a diagnosis that emerged from natural medicine practitioners. The best book on the subject, Adrenal Fatigue: The 21st Century Stress Syndrome<\/em><\/a>, was written by a (heaven forfend!) chiropractor, James L. Wilson, DC.<\/p>\n\n\n\n The anti\u00adalternative website quackwatch.com <\/a><\/u>lists adrenal fatigue among its unproven \u201cfad diagnoses,\u201d joining candida overgrowth, Gulf War Syndrome, and multiple chemical sensitivity. The even more unsympathetic Endocrine Society (I inadvertently typed \u201cEndocrime\u201d) dismisses adrenal fatigue as a myth<\/a>.<\/p>\n\n\n\n Their intellectual curiosity is a shameful less than zero.<\/p>\n\n\n\n Dr. Wilson created a questionnaire<\/a> that you can take, but keep in mind that a lot of the symptoms listed are not specific for adrenal fatigue. The idea behind the quiz is for you (and your doctor) to at least consider adrenal fatigue as a diagnostic possibility and order further tests.<\/p>\n\n\n\n An easy functional medicine test for adrenal fatigue When you look at the test results at these two links, you\u2019ll wonder how endocrinologists could be so dense. Here\u2019s a graph showing normal cortisol levels, taken from saliva specimens in the morning, at noon, and in the afternoon and evening.<\/p>\n\n\n\n And here\u2019s the graph of a person with all the symptoms of adrenal fatigue.<\/a><\/p>\n\n\n\n Patricia\u2019s adrenal stress profile was pretty much a flat line. Classic adrenal fatigue.<\/p>\n\n\n\n If you think you could have adrenal fatigue, schedule with one of our functional medicine specialists: Dr. Alaina Gemelas, Dr. <\/a>C<\/a>aley Scott<\/a>, or our newest WholeHealth Chicago physician Neeti Sharma, MD.\u00a0Next week, I\u2019ll outline our approach to help worn out Patricia get her life back.<\/p>\n\n\n\n Be well, \u201cExhaustion is my reality. At four o\u2019clock, I\u2019m wiped, totally wiped. So tired I could sleep at my desk.\u201d Patricia is 33, happily married as far as marriages go, one kid, steadily employed in the usual American less\u00adthan\u00adsatisfying corporate job, good eating habits, and, until recently, a health club goer a couple\/three times a week. […]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[28,2,531,45,2333,50,296,130,3,2334,246],"tags":[179,469,1059,425],"class_list":["post-13666","post","type-post","status-publish","format-standard","hentry","category-alternative-therapies","category-blog","category-case-studies","category-f","category-functional-medicine","category-healthy-lifestyle","category-inflammation","category-integrative-medicine","category-knowledge-base","category-naturopathic-medicine","category-thyroid-adrenal-sex-hormone-issues","tag-adrenal-fatigue","tag-cortisol","tag-functional-medicine","tag-hormones"],"yoast_head":"\r\n
<\/strong>Although Patricia had never been an energizer bunny in the morning, now she wakes up feeling like she hasn\u2019t slept at all. To snap her brain into gear for work, these days she downs a couple of extra shot lattes. She knows she\u2019ll function at two thirds capacity until 3 or 4 in the afternoon, when she becomes so tired she melts like a warm ball of Silly Putty. Then, a few hours later, at 8 or 9 (much to her annoyance, since it\u2019s just before bedtime), she\u2019ll get a strange burst of energy, just enough to interfere with sleep. Recently, though, even this energy burst is history.<\/p>\n\n\n\n
<\/strong>It\u2019s important to understand there\u2019s nothing actually wrong with your adrenal glands. They\u2019re just running on empty. If they could talk, they\u2019d plead, \u201cOverworked! Give us a rest! Charge us up! We need a vacation!\u201d<\/p>\n\n\n\n
<\/strong>However, unless your doctor thinks of ordering the simple test that measures cortisol levels in your saliva (which reflect the function<\/em> of your adrenal glands) you could go undiagnosed for years. The best functional medicine test to evaluate your adrenal function is a take-home kit containing four empty plastic vials. You collect saliva at 8 am, 12 pm, 4 pm, and 8 pm and FedEx (envelope in kit) your specimens to the lab. Some insurers now cover at least part of this test, so expect an out-of-pocket of around $100.<\/p>\n\n\n\n
David Edelberg, MD<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"