Adrenal Fatigue Explained: This is Karen’s Story

Karen was the third person to see me in the past couple of weeks with nearly the same medical history.  She is a registered nurse who worked until the birth of her now 15-month-old child.  Her symptoms started post-partum.  She developed neck and upper back pain followed by tingling in the right shoulder blade area that would come on, last a few minutes, then go away, triggered by activity such as walking.  The symptoms started in March 2016, then in May, two months later, she underwent Lasik surgery for her vision which she described as “always blurry.”  Though declared a successful procedure by her ophthalmologist she has “battled” with her eyes since that time.  They feel dry, and she continues to have problems with vision.  In October, she decided to start a low carbohydrate, nutrient-dense Paleo-oriented diet.  But after starting the diet she felt a sense of muscle exhaustion in her right arm which eventually spread to the face and leg on the same side, then both sides of the body.  She had numbness as if it was “below the skin,” then, she started hurting everywhere.  She thought perhaps a specific food might have triggered the symptoms, but when she tried to pinpoint it she could not find anything specific which, if eliminated, made her feel better.

She went to her doctor. Initially, the thought was that Karen had multiple sclerosis or another autoimmune disease. Her Brain MRI was normal, which made MS unlikely, but her blood tests were positive for two antibodies associated with autoimmunity. When she visited with a rheumatologist he felt like the blood tests were spurious and there was no disease he could attribute to the results. That doctor suggested consultation with a neurologist. She followed through and the neurologist explored depression and fibromyalgia as possible diagnoses, but admitted he was not convinced of either. He suggested a treatment trial with a drug approved for both conditions, even though he had no idea what he was treating. Karen declined the offer.

Though she denied depression, Karen admitted she struggles with anxiety. When she returned to her doctor she placed Karen on the steroid medication prednisone though with no clear diagnosis. Hesitatingly, Karen took the medication for a month and her symptoms improved. But she tapered herself off the prednisone because of fear of side effects. Her symptoms returned. In the interim she and her husband moved to St. Louis and there she saw a second rheumatologist who seemed to dig deeper into her problem, but the consultation ended without a diagnosis. Even a second eye doctor could not identify any eye-related abnormalities.

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Women’s Adrenal Glands

Cortisol, DHEA, and another hormone, adrenaline, are the three main hormones secreted by the adrenal glands in response to stress. In the short run, they provide protection to the body against a variety of threats—anything perceived by the unconscious brain as potentially dangerous—from infection to a hungry lion, particularly if you happen to be a hunter-gatherer (our remarkably close ancestor). It is cortisol, DHEA, and adrenaline that allow the bystander to lift a car when a child is suddenly pinned underneath. There is a rise in cortisol in the morning for all of us whose adrenals are functioning normally. This rise prepares our bodies for the things we might encounter during the day. In contemporary life that might mean navigating the morning rush to get our children to school and ourselves to work on time. It might mean the normal reaction to a bug bite or a cut on the skin, surgery, or childbirth. It might mean worry about a sick parent. It can even be a reaction to a fast food meal. In a nutshell, there are social, psychological, and physical stressors, and in all cases the brain reacts similarly. The nervous system sends a signal to the adrenal glands to produce these protective hormones. This is, in fact, what we sometimes refer to as our “sympathetic nervous system” response, aptly nicknamed “fight or flight.”

But what happens when this fight or flight response is always turned on? What happens to people who consciously and unconsciously exist in this state of stress due to a variety of circumstances that characterize their lives? To answer this question, it is first important to understand that the body always strives for a state of balance between all the functional systems that govern how we work as human beings. This includes our digestive system, our immune system, our hormone-producing system, and the systems that govern energy production, among others. We call this state of balance “homeostasis.” The human body operates by constantly detecting perturbations, slight imbalances, and adjusting in minor ways to maintain function.
When Stress Is More Than The Body Can Handle

A second important concept is that of “allostatic overload.” This is the tipping point when the sum of all stresses is more than the body can handle. When allostatic overload is reached, the body shifts to an entirely new state, for survival, even when patients like Karen experience this adaptation as detrimental. We have all met these people. They are the over-achievers, the multi-taskers, who handle children, job, and relationships on little sleep, no exercise, and insufficient nutrition. That is, they handle it until the house of cards comes crashing down. They are survivors of childhood trauma who encounter new stressors in adulthood from which they can no longer adapt. The causes of this breakdown may not be so obvious. In this hierarchy of needs, alongside physical preservation the remainder of the physical need of nutrient absorption and hydration, reproduction, and healing, all require input from the counterpart to the sympathetic nervous system, called the parasympathetic nervous system, nicknamed “rest and digest.” In truth, survival requires a balance of both sympathetic and parasympathetic activity. Yet many people like Karen too often exist in this state of fight or flight. Initially, high levels of cortisol and adrenaline spike blood sugar because there is a high demand for energy. These hormones promote muscle strength and agility over tissue repair, heighten our immune response for defense, and (for survival) disrupt our sleep. The same hormones make us less sensitive to pain. Fight or flight is not the time for sleep, digestion, reproduction, or to be stifled injury. After all, no one would stop to nap, get a bite to eat, procreate, or be immobilized by pain when being chased by a lion. But when the body reaches that tipping point it forces the person into a state of adrenal exhaustion. In this state cortisol is abnormally low throughout the day, DHEA-S is low, and often other hormones like thyroid (the “master” hormone of metabolism), and sex hormones are low, as well. It is not surprising that when Karen’s doctor gave her prednisone, a drug that acts like the cortisol produced by the adrenal gland, she felt better, even though she was right to stop it.

Help for Karen calls for a different kind of healing, one that is not standard teaching in medical schools or post-graduate training, and one that does not fit our Western Medical Paradigm that matches a “pill for an ill.” It is the same reason that conditions like fibromyalgia still have skeptics within the medical community. Our standard tools for evaluation cannot easily measure the symptoms spectrum of muscle pain, fatigue, brain fog, and poor energy, and we don’t know where else to look. It’s time for a change. When it comes to adrenal fatigue we cannot ignore the truly physical nature of this condition. We know intuitively that stress affects our risk of infection and heart attack, and ground-breaking research conducted by Centers for Disease Control and Kaiser Permanente showed that adverse events in early childhood significantly raise the risk of many diseases later in life.

But we need to define stress more broadly, not just in terms of our psychological and social world, but stress in terms of the food we eat (sugar, processed foods, and nutrient imbalances), the toxins we are exposed to (drugs, chemicals, and heavy metals), the shifts in the microorganisms that contribute to a healthy gut (which we now know is linked to a variety of diseases, including multiple sclerosis and Parkinson’s disease), the infections and allergic responses (such as those that can raise the risk of dementia, including Alzheimer’s disease). For Karen, her healing journey began with understanding her complete life story, not just an analysis of her current symptoms. This comprehensive timeline helped to identify all the triggers contributing to her final tipping point, and the mediators that kept her on that trajectory. Her treatment plan required that we address changes in lifestyle, perform laboratory testing to correct biochemical and microbial imbalances, and gain a deeper understanding of her unique genetic vulnerability. Healthcare providers see people like Karen every day in their practice. The lesson here is that providers of the 21st century need to re-tool their toolbox. We must change our understanding of how illness occurs, integrate lifestyle medicine into routine care, and use these new laboratory tests like a map to find those who get lost in the woods so that we may guide them back to vibrant health.