Adrenal Fatigue
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Cortisol is your body's central stress hormone, produced by the adrenal glands — and when stress keeps it elevated for too long, the adrenals can eventually weaken and burn out. That state, also called hypoadrenia, is adrenal fatigue.
Cortisol: the stress hormone at the center of it
The hormone cortisol is produced in the adrenal cortex in response to adrenocorticotropic hormone (ACTH), produced in the pituitary gland. Cortisol plays an important role in regulating blood sugar, energy production, inflammation, the immune system and healing.
Cortisol is the only hormone in the human body that increases with age. It is also one of your steroid hormones. Cortisol and DHEA are both made by your adrenal glands, which also make most of your steroid hormones after menopause.
What cortisol does in your body
Cortisol has many important functions in your body:
Balancing blood sugar
Cortisol helps regulate your blood sugar.
Weight control
Cortisol plays a central role in controlling your weight.
Immune system response
Cortisol shapes how your immune system responds.
Bone turnover rate
Cortisol influences the rate at which bone is broken down and rebuilt.
Stress reaction
Cortisol drives your body's reaction to stress.
Sleep
Cortisol helps govern your sleep.
Protein synthesis
Cortisol affects how your body builds protein.
Mood and thoughts
Cortisol influences your mood and your thinking.
The pituitary–thyroid–adrenal system
Cortisol affects the pituitary, thyroid and adrenal glands working together as a system.
Conditions linked to abnormal cortisol levels
When cortisol is out of balance, a wide range of conditions can follow. Abnormal cortisol levels are associated with:
Menopause
Abnormal cortisol levels are associated with menopause.
Chronic fatigue syndrome
Abnormal cortisol levels are associated with chronic fatigue syndrome.
Fibromyalgia
Abnormal cortisol levels are associated with fibromyalgia.
Depression
Abnormal cortisol levels are associated with depression.
Impotence
Abnormal cortisol levels are associated with impotence.
Anorexia nervosa
Abnormal cortisol levels are associated with anorexia nervosa.
Panic disorders
Abnormal cortisol levels are associated with panic disorders.
PMS
Abnormal cortisol levels are associated with premenstrual syndrome.
Infertility
Abnormal cortisol levels are associated with infertility.
Sleep disorders
Abnormal cortisol levels are associated with sleep disorders.
Osteoporosis
Abnormal cortisol levels are associated with osteoporosis.
Heart disease
Abnormal cortisol levels are associated with heart disease.
Too much cortisol — and too little
If your adrenal glands are producing too much cortisol, you may develop conditions such as weight gain, especially around the abdomen, depressed immune function with all of its consequences, accelerated aging and stomach ulcers.
If you have too little cortisol, you may suffer from chronic fatigue, exhaustion and a disease of the endocrine system called Addison's disease.
How stress drives cortisol up
Cortisol is elevated in response to stress — and the adrenal glands are not particular: any kind of stress will do. The stress can be physical, environmental, chemical or imaginary. The human brain is hard-wired with automatic responses to protect the body from harm, and all forms of stress produce the same physiological consequences.
That includes environmental stress (heat, cold and noise), chemical stress (pollution, drugs), physical stress (overexertion, trauma, infection), psychological stress (worry, fear) and biochemical stress (nutritional deficiencies, refined sugar consumption). All of these different sources of stress are additive and cumulative in their effects.
Cortisol and the weight-loss problem
Recently, a lot of attention has been directed to the effects of excess cortisol on weight gain and on the difficulty in losing weight. Collectively, the various diet plans being promoted by a long list of diet gurus have a failure rate of approximately 93 to 97 percent. There are several reasons for this. One is clearly the difficulty in achieving behavioral modification in the face of easy availability of the wrong kind of foods, inherently sedentary lifestyles, and intense media programming. Another reason is that your hormones work against you, from the weight loss perspective — and high cortisol levels are one of the culprits.
When the adrenals burn out
All of the hormones in your body work together. In order for you to have good health, they all have to be balanced and at an optimal level. When your adrenal glands are in a state of emergency, you don't feel well. You may find yourself reaching for coffee, soft drinks or sugar for sources of energy — and this makes matters worse.
If your adrenals stay hyper-stimulated, they eventually weaken or burn out. This is why your DHEA and cortisol levels are so low, and also one of the reasons that your progesterone levels are not optimal.
Stress reduction comes first
Stress reduction is an essential part of all efforts to normalize cortisol: stress is the stimulus that caused the cortisol levels to get out of hand to begin with. Each individual should explore and find the stress reduction techniques that work best for themselves — meditation, physical activities and attitude changes are good paths to explore. Without stress reduction, all therapeutic and support measures will eventually fail.
Rest, diet, and supplements
This may sound obvious, but rest must be managed and scheduled as a deliberate strategy, choice and course of action — otherwise it gets forgotten in the busyness of life.
A low glycemic diet is important. Sugar handling stress increases cortisol levels, and elevated cortisol in turn aggravates the sugar handling situation, contributing to the development of high insulin levels and ultimately diabetes. Nutritional supplementation is very valuable in restoring normal cortisol levels.
How we diagnose and treat adrenal fatigue
We diagnose adrenal fatigue based on a careful history, a physical exam and a four-point diurnal salivary cortisol hormone test. Our treatment program incorporates lifestyle modifications, relaxation techniques and a few supplements and prescriptions to assist your adrenal recovery and alleviate your symptoms. For most people, weight loss, exercise and supplements will improve their cortisol levels.
About the author
Allen Smolenski, M.D.
Emergency Medicine physician and founder of Coastal Medical Clinic in Surfside Beach (2009). After losing nearly 60 pounds himself — and placing third in his class at the 2008 NPC Natural Northern USA Bodybuilding Contest — he completed a fellowship in Anti-Aging and Regenerative Medicine through the A4M, and now helps patients across the Grand Strand optimize their hormones, metabolism, and long-term health.
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