Adrenal Fatigue: Understanding Cortisol

This is a condition that really doesn’t discriminate between healthy and unhealthy individuals.  I have had countless patients end up at my door with relentless fatigue when they believe they live a healthy lifestyle.  They workout, they don’t eat excessive carbs, they have successful jobs, and they take their daily supplements!  Then why are they SO tired all the time?!  These cases are almost always issues with cortisol production and the ability of the adrenals to keep up with stress.  Athletes especially can be affected by this issue because of overtraining, chronic stress, or lack of appropriate recovery.  Sometimes less is more, but let’s take a look at what actually happens in someone with adrenal fatigue.

Adrenal Glands: You’ve go these two little organs that sit on top of your kidneys that are responsible for releasing epinephrine and norepinephrine, aldosterone, cortisol, sex hormones, and precursors such as DHEA.  Cortisol is a steroid hormone that is responsible for all kinds of things in the body including:

  • mobilizing protein stores
  • water excretion and electrolyte balance
  • mobilizing fatty acids from adipose (fat tissue)
  • precursor to cortisone (and anti-inflammatory agent)
  • directing immune function
  • stimulation/inhibition of gene transcription
  • affecting bone calcium
  • affects behavior, mood, and hormones
  • affects numerous CNS biochemistry

Basically, it has a hand in tons of things.  Like most body chemistry, it is definitely not on an isolated island!  When stress levels are high, the demand for cortisol production goes up.  However, the building blocks are things like progesterone and pregnenolone which are needed for the production of other hormones.  When your body starts stealing these building blocks to keep up with stress, it will eventually let your other hormones like estrogen and testosterone suffer in order to keep up.  This is important because many people are known to have hormone imbalance, but if you never assess the adrenals, how do you know this isn’t the reason?  If it is, then the answer is not hormone replacement, the answer is stress reduction that will in turn lower cortisol demand.

When you start thinking about how important hormones are to the body, one may ask why on earth your body would make that kind of sacrifice?!  The simple answer is that our body is still expecting stress to be a short-lived event driven by a life or death incident.  In that moment, we would sacrifice anything in order to get out alive.  We never adapted a mechanism to take care of chronic stress.  Stress that never goes away. Stress that takes all we have.  Stress that leaves us feeling defeated at the end of the day and dread the start of the next.  Am I ringing any bells here?  Life is HARD these days!  We have all kinds of stress!  Work!  Kids! Relationships!  But, we also have stresses that people don’t think about like food sensitivities, sleep deficit, overtraining at the gym, and infections.  There are ALL stress to the body.

This is how people can function from day to day, still go to the gym, think they are doing it all, and still feel like crap.  When I run cortisol panels, it’s not uncommon for me to find cortisol levels that are in no way keeping up with the demand.  There are symptoms many complain about:

  • hypoglycemia
  • chronic fatigue
  • ligament/cartilaginous injuries
  • depression/anxiety (this one I see a LOT!)
  • insomnia
  • irritability
  • short term memory issues
  • pain that persists
  • poor wound healing and workout recovery
  • frequent colds
  • hypothyroidism (tons of my ladies out there have this along with adrenal fatigue!)
  • PMS
  • infertility
  • menopause symptoms (can we say hot flash club?!)
  • insulin resistance
  • fat around the trunk

The test for this is pretty simple, but it’s important to have it checked multiple times throughout the day.  So, many physicians will test it once.  That is not helpful unless there is pathology.  We are looking for optimal function.  Therefore, we want to see a high number in the morning and a gradual decrease until it bottoms out at night so you can go to sleep!  If we don’t see that, we need to assess where we are in order to know where to go from there.  In the early stages, people will make too much.  They usually don’t come in for help at this stage because they are “keeping up” as far as they’re concerned.  By the time we hit stage 2 or stage 3, we are starting to not be able to keep up and we start stealing those building blocks from other hormone pathways.  THIS IS USUALLY WHAT BRINGS THEM IN!  On top of fatigue, they now have stray hairs growing in random places, excessive fat that won’t budge, inability to recover from their workouts, trouble sleeping, up and down emotions, loss of sex drive.  At this point, we can’t just fix it with food, typically.  We need to “help your body over the hump” so it can catch up and produce enough cortisol again on its own.  This not only takes time, it takes lifestyle changes that may include cutting things out that are contributing to stress.  This is the toughest thing for patients to do.  If they don’t workout as much, say no to responsibilities, sleep more, etc, they feel LAZY!  You wouldn’t call a cancer patient LAZY!  This is taking care of yourself, and I can’t stress it enough (no pun intended).

If this sounds like you, and you like help, my door is open.  The saliva test I use to measure cortisol, DHEA, hormones, and melatonin is around $200 and it is done at home.  Doesn’t get much easier than that for a little piece of mind and direction.

6 thoughts on “Adrenal Fatigue: Understanding Cortisol

    • As far as I am aware, there are no supplements containing cortisol. If there were, and someone were to have low cortisol levels and take cortisol, they wouldn’t be solving the underlying reason why there is low cortisol in the first place. If there are issues causing low cortisol, then those same issues are affecting other things like thyroid and hormone health. They would likely end up needing pills for those issues, too. I am not opposed to supplements that support adrenal health, but knowing which ones and how much depends on specific levels of cortisol that would need to be tested.

  1. Ava Breniser

    Interesting. My MD ordered an adrenal blood test (I have not had it done yet). Must be done at 8:00 am at the Hospital.

    • Ava-
      Blood cortisol is not the same as an adrenal evaluation from a functional medicine doctor. It will only indicate a pathology of the adrenals and not function. You may want to reconsider the type of evaluation depending on what you are looking for!
      Dr. Angela

    • Sorry for the delay! I haven’t been blogging in a while! You do not have to work with me to order the test, but it would require an appt to establish need, etc.

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