Why Am I So Flippin’ Tired? Adrenal Fatigue Goes Under the Microscope, Part 1

I have an obsession. It’s with chronic fatigue. You see, I am a perfectionist, an over-sad businesswomanachiever-never-give-up-run-myself-into-the-ground-to-get-the-job-done-and-prove-myself kind of person. Character flaw or strength? My mother always tells me I’m just like my grandmother, either full steam ahead, or flat on my back. It’s true. And I prefer to be full steam ahead at all times. Life is short.

At age 17, I was minding my own healthy overachieving business, taking full-time college classes while still a senior in high school, living in an apartment in Minneapolis, working at a health food store in Maplewood, and training hard for my upcoming black belt test in karate in Roseville, when I came down with mononucleosis. I was bed-ridden for a full month. I was too tired to even breathe and developed walking pneumonia to boot. Towards the end of my 4-week illness, one of my first outings was a motorcycle ride with my Dad on a gorgeous spring day around Lake Calhoun. After 30 minutes I was almost too weak to hold on, and my low back was screaming in pain. It’s a strange memory that has always stayed with me. Beauty, exhilaration, and pain, all bound up in the same moment. I bounced back, rallied through my classes, got my black belt, finished 8 years of college, got my own motorcycle, and started my own business, Healing Response Acupuncture & Integrative Medicine. But I was never the same. I was always tired. And so were all my patients! And being the overachiever that I am, I became obsessed with helping ALL of us.

Adrenal fatigue has become a popular diagnosis for us hard-working, stress-out busy active people. Understanding the impact of stress on the body, and the role of the adrenal glands in overall health is very important. This first installment of my blog series on the adrenals is the basic education I find myself explaining day in and day out to many of the patients who walk in my door and want answers. But simply treating the adrenal glands is often not enough to help people achieve radical well-being (what people on the island of Fiji call “normal”). That’s Part 2, so stay tuned.

What Are the Adrenals?

The adrenals are the small glands sitting above the kidneys. As part of the endocrine system, they are the body’s stress-handling glands that produce and secrete the hormones adrenaline and cortisol, among others. What eventually leads to adrenal fatigue is the chronic overproduction of cortisol due to perceived ongoing stress. Some people can dwell in this state for many, many, years while others reach a point where the adrenals say “no more,” and instead of over-producing cortisol, they under-produce this essential hormone, leading to true adrenal burnout. Symptoms of adrenal fatigue exist in both scenarios, over-production and under-production, of cortisol.

Functions of Cortisol in the Body

Cortisol has many functions, and is necessary for survival and baseline health. Just like cholesterol, cortisol is neither good or bad. It is only when cortisol levels are out of balance that health problems arise. Cortisol helps regulate blood sugar levels, raises blood pressure, stimulates liver detoxification, promotes the production of digestive enzymes, plays an important role in regulating immune function and inflammatory pathways in the body, aids in metabolism, and is required for the brain to store short-term emotionally related memories and retrieve information.

Cortisol is in the steroid hormone family, along with DHEA, estrogen, progesterone, and testosterone. These steroid hormones are all made from the same building block: cholesterol. It’s important to understand that because these hormones are all made from the same raw material, if one of them is out of balance, it can throw the others out of balance as a result.

Cortisol Rhythms, Sleep, and Anxiety

In a healthy person, cortisol is secreted in the largest quantity in the morning, and then iStock_000005581302XSmallproduction slowly decreases throughout the day.  Imbalances of cortisol come in different patterns. Some people may wake up with low cortisol levels, and as their stress builds throughout the day, their cortisol levels continue to rise, becoming too high at night and affecting sleep. For others, cortisol levels may drop in the middle of the day, causing afternoon energy crashes. In some cases, cortisol is consistently high all day, or consistently too low all day. These imbalances in normal cortisol rhythms can be a key factor in the inability to fall asleep, restless sleep, waking up with anxiety, or generalized anxiety and the unpleasant sense of a constantly racing mind.

The Progesterone/Cortisol Connection

In order for cortisol to be produced, the body converts cholesterol into pregnenalone, pregnenalone into progesterone, progesterone into either de-oxy-progesterone or 17a-hydroxy-progesterone, which then get converted to cortisol (there’s a healthy dose of organic chemistry for you!).  This is important because, when the body is in a chronic state of stress, it continuously shunts progesterone down the pathway of making large amounts of cortisol. This causes progesterone levels to go down, which leads to an imbalance in estrogen/progesterone ratios. And that is why adrenal imbalances cause other hormone imbalances, PMS, infertility, and even increased risk of miscarriage.  Women entering into peri-menopause or menopause, will have symptoms that are more severe, the greater their adrenal imbalance is, for the same reason.


High cortisol also leads to lowered levels of testosterone for both men and women (who need this hormone, but in smaller amounts).   Simply giving someone replacement testosterone does not correct the underlying problem of poor adrenal function.  While a person may feel better on testosterone replacement for 2-3 months, usually, the beneficial effect wears off until these other issues are addressed, or the dose continues to get bumped. A very good book on this topic is The Cortisol Connection, by Shawn Talbott.

Stress  & Digestive problems

Simply stated, when stressed, digestive enzyme secretion slows, or stops completely. Digestive enzymes are made in the pancreas, and secreted into the stomach before and during meals. These enzymes break down proteins, fats, and carbohydrates in the stomach, before the food enters the small intestine. When enzyme production is affected by stress, food tends to sit in the stomach longer than normal. This causes the food to “ferment” which irritates the lining of the stomach. Over time, chronic irritation of the lining of the stomach can lead to heartburn. Why? Because the first enzyme injected into the lower portion of the stomach is hydrochloric acid. Dumping acid on an inflamed tissue is like pouring salt in a wound, thus the stomach lining lets out a loud shriek, and sends the acid upwards into the throat, leading to acid reflux and heartburn.

Sadly, most acid reflux and heartburn cases are incorrectly diagnosed as an over-production of acid, and the prescribed therapy is “acid blocking” medication. Acid blocking medication will neutralize the stomach acid, but then what happens? Food doesn’t get properly broken down, causing more irritation to the stomach lining. And, since hydrochloric acid is essential for absorbing minerals such as calcium, long-term use of acid blocking medication will lead to a deficiency of calcium and other important minerals, adversely affect the body’s pH and bone health. When I hear Tums marketing itself as a source of calcium, I vomit a little every time.

The problem continues. When food isn’t properly broken down in the stomach, undigested proteins end up in the small intestine. This puts an ongoing burden on the small intestine which can trigger what is often referred to as “leaky gut syndrome” where the intestinal wall becomes weak, allowing proteins to penetrate the gut lining, enter the blood stream and trigger an immune response against the “foreign invaders”.  The longer this goes on, the more likely a person will develop food sensitivities to a variety of foods.

Another implication of impaired enzyme production and improper breakdown of proteins is decreased protein and amino acid absorption. Amino acids are essential in muscle growth and repair, therefore, a deficiency can lead to muscle weakness and muscle fatigue during exercise and longer recovery time after workouts.

The Fallout

Is this your cupboard?

Cortisol imbalances create a system-wide impact on the body, interfering with sleep, digestion, nutrient absorption, hormonal balance, mood, cognition and energy that perpetuates into more problems as people reach for caffeine, sugar, and simple carbohydrates in an attempt to boost energy levels just to survive their day, then turn to addictive sleep aids to address worsening sleep and insomnia. As people’s ability to handle stress flies out the window, anxiety, depression, and overwhelm escalate, leading to dependence on anti-depressant and anti-anxiety tools, prescribed or otherwise. Nobody wants to be in this position. People feel helpless as they watch their health crumble away, but sadly Western medicine doesn’t offer much.  It can’t, because this is an endocrine system imbalance, not an endocrine disease. These imbalances in cortisol will most likely not show up on any blood test. Thyroid levels and other hormone levels may all test in the normal range as well.  So doctors reach for their prescription pad, jotting down things like Ambien, Zoloft, Wellbutrin, Xanax, Prilosec, Tums, before sending you out the door.

Luckily, I now have a way of assessing which systems in the body need help, and a way to test exactly which vitamins, minerals, herbs, and foods will help restore healthy function back to the entire system. More on that in Part 2, but always feel free to contact me for immediate information through my website at www.healingresponse.net, or amy@healingresponse.net.

P.S. My energy levels are WAY better, and the only “thing” that I’m taking for my adrenals are dried organic apricots (the adrenals require copper among other nutrients for proper function, and apricots are a good source) and Pink Salt by Premier Research Labs. Yes, the right kind of salt is actually very good for you!


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