Sarah Giardenelli, ND, MSOM, LAc, is a certified naturopathic doctor and licensed acupuncturist.

One of the most common concerns among my patients is fatigue. Often, they want to know if they have “adrenal fatigue.”

Simply put, adrenal fatigue is a collection of signs and symptoms resulting from the adrenal glands functioning sub-optimally after a period of stress.  This could be from emotional stress, illness, or an unbalanced lifestyle.  The most common symptoms are fatigue that is not relieved by sleep, lethargy, feeling unwell, and a depressed mood.  While this collection of signs and symptoms has always existed, the term – or, “adrenal fatigue” syndrome – still is not officially recognized by conventional medicine.  However, conventional medicine does appreciate the adverse effects of stress on the body and hormonal function.  These effects manifested as bodily symptoms are really what’s being referred to by the name “adrenal fatigue.”

The adrenal glands are walnut-sized organs that sit on top of the kidneys.  They secrete hormones and neurotransmitters that are important for regulating a number of processes in our bodies. Chief amongst these hormones is cortisol.  Cortisol is also known as the stress hormone as its main function is to help our body return to homeostasis following acute stress.  In normal individuals, cortisol is secreted most in the morning and little is secreted at night.  The release of cortisol provides energy so a person can get up and go when they awaken, and the drop at night facilitates sleep.

Man in bed trying to sleep with a pillow

The effects of cortisol are profound, are felt throughout the entire body and impact several homeostatic mechanisms.  Cortisol is regulated in the body by the hypothalamic-pituitary-adrenal (HPA) axis.  Essentially, the stress response triggers the release of hormones from the brain, which in turn, causes the release of cortisol from the adrenal glands.  Cortisol helps to regulate blood sugar and electrolyte balance, and modulates inflammation and the immune system.  While this system is designed to deal with stress, long term stress and irregular spikes in cortisol levels causes the glands to lose their ability to compensate and yields changes in metabolism, fluid/electrolyte balance, the cardiovascular system, immune system, memory and mood.

My stressed Northern Virginian patients often attempt to compensate for the fatigue by consuming a lot of caffeine during the day and unwinding with alcohol at night.  Unfortunately, both lead to an increase in cortisol which can tax the already burdened adrenal glands and lead to disrupted sleep at night.  In turn, poor sleep habits additionally tax the adrenal glands and disrupts overall balance in the body.  While caffeine and alcohol consumption in moderation may be fine for some, it can be kryptonite for those who are dealing with adrenal fatigue.

As a Naturopathic Doctor,  I intend to identify and address the root cause of disease.  Most commonly, the root cause of adrenal fatigue – or, fatigue in general – is chronic, unresolved stress.  Chronic stress might be related to not having stress management skills in place, a persistent negative attitude, or working in a stressful or unhappy work environment.  However, chronic stress is not just mind-induced; stress in the body or triggering of the HPA axis can also result from lifestyle imbalances, such as overwork, over-exercise, lack of sleep, poor diet, and over consumption of caffeine or alcohol.  Chronic stress can also be a result of an underlying illness, infection, or toxic burden.

While there are a number of nutrients and herbals that can help a person recover from the effects of adrenal fatigue, without identifying the cause, the issues will not fully resolve.  One of my great joys as a clinician is to work as a partner with people in their health.  I love helping them to identify the factors that are impeding them from fully engaging in their lives, establishing a plan to get them back on track, and then watching as their lives are transformed.


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