This is Dr. Lam. The signs and symptoms of Adrenal Fatigue are wide and varied. Many people approach their doctor's office complaining of fatigue and lethargy. This is very common, but many of them also has accompanying signs that is difficult to identify or understand and these can include things like hypoglycemia, low body temperature, palpitation, unexplained hair loss, constipation with diarrhea, reduced sex drive, lightheadedness, and reduced energy in the morning, despite having a good night's rest. Usually many doctors, especially those conventionally trained, are quite confused and at a loss to understand what is going on, because the symptoms seem to be so convoluted and so massive. A complete work-up is usually done and if that fails to give you any idea, then it may be wise to consider Adrenal Fatigue as one of the causes. Adrenal glands sits on top of the kidney and is responsible to control the stress that we deal with in our life. When the stress overwhelms our body's ability to handle it, then adrenal glands become dysfunctional and arises a condition called Adrenal Fatigue. This is very different from a medical condition called Addison's disease, where the body is actually in a very, very low state of function because of deficient and malfunctioning adrenal glands. So the Adrenal Fatigue is really a subclinical in a state before you get to Addison's disease and most conventional medical doctors are not really fully knowledgeable on that. Let's take a step back. To understand the adrenal glands, as you can see here, many hormones are made, including pregnenolone, progesterone, DHEA, cortisol, the family of estrogen, as well as androgens. Now, among these, the most important is cortisol. Cortisol is a wonderful hormone, it helps us to deal with stress. At the same time, it has a dark side, because it also causes the muscle breakdown and it causes a lot of other problems when it is not well balanced. It is cortisol irregularity that causes many of the symptoms and ensuing responses that give rise to many, many symptoms. While the most common causes of Adrenal Fatigue and the triggers are stress, either on the physical or emotional basis, there are many other conditions that we have in life that could also trigger this, including chronic illnesses of many kind, chronic infections, chronic pain, depression, glutens intolerance, malabsorption syndromes, toxic exposure to a chemical, sensitivities, surgeries, sleep deprivations, over-exercise, over-sugar in the diet. These are all triggers of Adrenal Fatigue. As you can see here, during Adrenal Fatigue, first, the cortisol levels start to go up as the adrenal tries to put out more cortisol to deal with stress. But after a while, it starts going down, because it's kind of already maxed out, and when it starts going down, then Adrenal Fatigue progresses into further stages. Other precursor hormones, such as DHEA, as well as pregnenolone, also experience similar declining curve as Adrenal Fatigue progresses. There are four stages to Adrenal Fatigue. Stage 1 is "alarm reaction," or the "fight of flight" response. At this stage, most people don't feel it, it's asymptomatic. The body basically needs to have more cortisol, it makes more cortisol because it has the reserve, and it deals with the stress of life, and then you move on. You may be a little tired and then you just have a little coffee drink or a little donut and you will be able to continue on. Stage 2 is called "resistance response," and that is when anxiety starts to set in, you become more irritable, insomnia becomes more common, it's more difficult to fall asleep. There's also becoming more, easy to get infections. Women can get PMS and menstrual irregularities and this is where the body says it needs a little bit more than it's able to handle, and it starts to decompensate. The cortisol output reaches its maximum and there's occasional mild fatigue, something that a nap or a vacation can take care of. Therefore, in stage 1 and stage 2, most people don't even realize how severe it is and seems to do quite well. If this is not taken care of, then the body enters stage 3, what we call "adrenal exhaustion." In adrenal exhaustion, there are four phases and as you progress through the phase A through D, the situation becomes worse. This is usually the first time that the patients would see their doctor. Unfortunately most doctors would either give them thyroid medication or anti-depressants, or send them home to relax. An intensive work-up usually done at this point and usually comes back negative. Stage 3B is characterized by the ovarian adrenal thyroid axis imbalance, where there's a concurrent hypothyroidism that's subclinical, concurrent estrogen dominance, as well as Adrenal Fatigue. If this does not get better, then stage 3C becomes the prominent, which is at this equilibrium state, and this is when the body really goes into alert, full alert, and the autonomic nervous system is activated. At this time, the adrenalin is flooded through the body and there are many, many symptoms, such as palpitations, and undesirable symptoms that can cause the person to really decompensate and feel really bad. Many are not able to get up for a long time and have to be bedridden to a certain degree and not able to start holding a job full time. If that is not taken care of, then ultimately the Adrenal Fatigue goes into a failure stage and that can become a medical emergency and the person is in bad state. Here's a graph of a typical Adrenal Fatigue progression. As you can see here, there's a gradual decline, the timing here actually can vary from months to years, but the person basically goes through various stages of stage 1, then go into stage 2, and gradually become more symptomatic, and then come back. Then as things hit, they get worse and worse and worse over time. Unfortunately, conventional medicine miss Adrenal Fatigue because the diagnosis criteria are really set for Addison's disease and does not pick up subclinical problems, so that is an issue. A saliva test can be useful, but at this time, the clinical correlation needs to be very well looked into, because sometimes the clinical correlation is not very clear as well. If you just take one snapshot, it's usually not very indicative and is very hard to interpret. So laboratory is not a very, very good diagnostic criteria and the most important is to find somebody who knows Adrenal Fatigue to take a detailed history because the history will tell the story. One of the reasons why Adrenal Fatigue is so confusing is because there are a lot of paradoxical reactions, or reactions that you don't think should happen, but it actually happens that defy conventional medical knowledge. Here's a list of some of them here, as you can see, such as fluctuating blood pressure, when the medicine is given, it's supposed to get better, but they get worse. So these are all issues that are very common that you see in Adrenal Fatigue. Women, in particular, are more effective, especially with ovarian adrenal thyroid axis imbalance and its characteristics of stage 3B, because in the woman, these three glands form a triad and imbalance of one can lead to the imbalance of the other ones. So a lot of times you have a woman come in with symptoms of estrogen dominance, clinical hypothyroidism, as well as Adrenal Fatigue, all presenting in a convoluted picture. The key, of course is to deal with the cortisol, because as long as the cortisol is dealt with, then all the other organs usually fall into place, especially the thyroid, as well as the ovarian system. Recovery from Adrenal Fatigue requires a total body approach using lifestyles, dietary exercises, the nutritional supplements. Some of the tips include removal of the stressors, asleep before 10 PM is the best, avoid coffee and caffeine beverages, and avoid TV, computers, and anything that can drain you unnecessarily. Exercises should be titrated in accordance with the body's needs, so that you don't get overly drained. Starting with adrenal breathing exercise, then move on to adrenal restorative exercises, then you can rebuild the body from internal outwards with adrenal yoga exercises to match the body's needs. Nutritional supplementations include many, many—the arsenal can include vitamins, minerals, herbs, glandulars, and hormones, and the key is to be able to have the right kind of supplement delivered properly. One of the dangers of self-navigation is the wide-spread use of shotgun approach, employing a lot of different nutritional support without consideration and this is a common mistake. Diet considerations, including eating breakfast well, eat more than three meals a day; avoid grains, as well as sugar. The three most common mistake in adrenal recovery is improper use of nutritional supplements, inexperienced healthcare provider, and excessive use of prescription drugs. As you can see, Adrenal Fatigue is a complicated condition, and the more serious it is when the more advanced adrenal state weakness occurs. A total body approach to recovery is possible and many people do get better. The key is to have the right practitioners. I hope this article has been helpful to you. The entire article can be read free of charge at my website, www.DrLam.com. If you have any questions, you can ask me there at my website, or if you need personalized attention, you can call my office.