Why Am I So Tired?

J.R. is a 27 yr old female who presented the above complaint. How often do we feel that way -- fatigued without knowing why? In this case, a few questions helped elucidate the probable cause of her adrenal fatigue. 

Adrenal fatigue is very common in our modern world. Some practitioners estimate more than half of us will experience its symptoms during our lifetimes, yet it is still not a recognized diagnosis by conventional medicine. Adrenal fatigue is a form of hypofunctioning of the adrenal gland (the gland most responsible for our physiologic response to stress). It is not as severe as Addison ’s disease, the complete collapse of the adrenal response. Standard blood tests for measuring and stimulating the production of cortisol are not sensitive enough to diagnose adrenal fatigue.  The laboratory parameters of “normal” recognize only the extreme 2 percent of very low or high.  The best test is a saliva sample four times during the day to demonstrate the normal curve of higher levels in the a.m. with falling levels at noon, evening and bedtime.   DHEA, another adrenal hormone, is also typically measured.  The failing adrenal will lose this curve.  This often results in symptoms of:

·     Morning fatigue—You don’t really “wake up” until 10 a.m. even though you have been up since 7 a.m. 

·     Afternoon "low" (feelings of sleepiness or clouded thinking) from 2 to 4 p.m

·     Difficulty falling asleep or early a.m. awakening

·     Craving salty foods

·     Mild depression

·     Lack of energy or stamina

·     Lightheadedness when initially standing up

·     Decreased ability to handle stress

·     Frequent sighing

My patient J.R. reported that her unrelenting fatigue had started almost 18 months earlier when she had married, left her job and home in Philadelphia and took on the responsibility of three step children. She was normally a person who worked out three days a week at the gym, balanced a corporate job and still had energy to play tennis.  Lately, she was having to push herself to even get to the gym. She noticed increased belly fat and her sleep routine was off. She was drinking Starbucks in the morning and taking Sominex at night. 

After the simple saliva test and thyroid evaluation she was started on a protocol of supplements especially vitamins C, B6, pantothenic acid and E as well as adaptogenic herbs. These are herbs which help the adrenals to cope with stress. They include Rhodiola, Siberian Ginseng, Ashwaganda and Schizandra. In addition, low dose licorice root is productive to the cortisols as well. Pregnenolone and DHEA are precursor hormones which can be safely used to allow the glands to recover and produce the necessary steroid hormones cortisol, testosterone, and others. Because J.R. was so severely low in cortisol, we also elected to use physiologic doses of Cortef (a prescription hydrocortisone). The low doses are safer than the potent Prednisolone sometimes used for inflammatory disorders. This allowed the adrenals to rest and recover. 

Due to the adrenal fatigue, the thyroid was also sluggish so iodine, selenium and magnesium were added. 

In addition to supplements, we also addressed stress reduction techniques:  yoga made a better personal option to her pumped up weigh training classes, dietary changes were to stop skipping meals and allow more frequent, smaller meals, laughing more and scheduling more fun relaxation time. 

Over a period of six to nine months, most adrenal glands will fully recover. In J.R.'s case, she found she did not need the prescription Cortef after three months and she weaned the DHEA and pregnenolone after several more months. The "stress fat" she had packed on around the middle was more stubborn but responded to desiccated thyroid once the adrenals had recovered. Hopefully, she now has better tools for coping with future stress crises and will recognize the symptoms of adrenal fatigue earlier to take action. 

For more information, go to: Dr. Forrest Smith, M.D.