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Health Blog

The MSN Healthcare Health Blog offers news and analysis on weight loss, fatigue, personal health, and health news. It includes contributions from Dr. Mark Neumann and others. Click now.


4 Adrenal Fatigue Stages [WITH SYMPTOMS LIST]

Mark Neumann

adrenal fatigue stages.jpg

If you find yourself feeling constantly burnt out, you may be suffering from adrenal fatigue. Health practitioners have outlined four stages of adrenal fatigue, with an increase in severity at each stage. During the various stages, neurotransmitter and hormone levels can fluctuate dramatically. These stages and the progression of adrenal fatigue may vary from person to person; however, this outline is intended to provide a broad view of what may be experienced.  

Most people who suffer with adrenal fatigue never make it to the last stage in which one experiences adrenal exhaustion. Instead, most people realize there is something wrong and fully recover from stage one or stage two without adrenal fatigue being properly diagnosed. It’s important to understand the way that the body’s systems interact during each stage. With this information, you can pinpoint where you’re at and determine an appropriate treatment plan.

What is Adrenal Fatigue?

We live in a world that values hard work, but this can often translate to a lack of sleep and a reliance on substances like caffeine. Being stressed is a nearly inevitable part of our fast-paced culture. While it’s one thing to be tired after a long day of work, if you are regularly experiencing chronic stress and fatigue, you may be suffering from adrenal fatigue. Chronic fatigue can impact your daily life, making it hard to even do the simplest of tasks. It’s a crippling disorder that is characterized by constant, persistent exhaustion despite getting rest. 

When we’re exhausted and stressed, we tend to reach for sugary foods to keep us going. Chronic fatigue and chronic stress may be more common and have more of an impact on your health than you realize. In fact, over 1 million people in the United States suffer from extreme cases of chronic fatigue. This feeling of being exhausted or “burnt out” may be caused by adrenal fatigue, which can occur as a result of chronic stress and adrenal insufficiency.  

The adrenal glands, which sit on top of your kidneys, release a number of important hormones. They are also in charge of producing cortisol, which is a stress-related hormone that plays a part in regulating energy and blood sugar. Cortisol triggers the “fight or flight” response to stress which allows us to spring into action in a dangerous situation. It usually rises in the morning when you wake and slowly decreases throughout the day.  

When you’re feeling stressed out, the adrenal glands release cortisol, which responds to a slower immune system and a change in blood pressure. However, chronic stress or anxiety can over-work your adrenal glands so that they may not be able to produce enough cortisol. This phenomenon is called adrenal insufficiency. Adrenal fatigue is thought of as a milder form of adrenal insufficiency.

Frequent exposure to high levels of stress also impairs learning and memory, exhausts the body’s physical resources, and makes people more susceptible to depression.  

Common symptoms of adrenal fatigue include:

●        chronic fatigue

●        nervousness

●        digestive issues

●        body aches

●        light-headedness

●        low blood pressure

●        weight gain or weight loss

●        hair loss

In more severe cases of adrenal insufficiency, you may experience:

●        depression

●        nausea

●        vomiting

●        diarrhea

●        low blood pressure

●        hyperpigmentation

What is Stage 1 Adrenal Fatigue?

Stage one of adrenal fatigue is also known as the “alarm reaction” phase, which marks the body’s immediate reaction to a stressor. This stressor may be an imminent physical threat, or something like a job interview. 

During this stage, the body responds aggressively to stress with an increase in anti-stress hormones, including cortisol and dehydroepiandrosterone (DHEA). The adrenal glands are able to handle the stress and the demand for the hormones remains within normal range. While the production of hormones may be slightly impacted, the body is usually able to produce enough DHEA and cortisol to compensate. If you were to get lab results during this stage, you would see elevated levels of cortisol, DHEA, insulin, epinephrine (adrenaline) and norepinephrine.

What are Stage 1 Adrenal Fatigue Symptoms?

During stage 1, you may experience fatigue, but this should be fairly mild, usually occurring in the morning and midafternoon. During the alarm reaction phase, there are no physical or physiological dysfunctions that are clinically detectable. Although you may not reach your peak performance, normal daily function is certainly expected.  

Most people will reach for coffee, sugary snacks, chocolate, energy shots, or foods high in carbohydrates as a quick fix to counteract their fatigue. These, although unhealthy, may be considered a “normal” part of daily life and end up masking the early signs and symptoms of adrenal fatigue. Those who rely on coffee to kick start their day may already suffer from adrenal fatigue without knowing it.

What is Stage 2 Adrenal Fatigue?

As you continue to experience high levels of stress, your body continues to react to it. Stage two of adrenal fatigue is known as the “resistance response” phase. When you put your body under constant or severe stress, your cortisol levels will continue to rise while your DHEA levels gradually start to decrease. As your stress-response system continues to become overwhelmed, the adrenals will start to struggle.  

Resources needed to produce sex hormones are being diverted to produce stress hormones like cortisol. However, your endocrine system is still fairly capable of producing the hormones you need. The thyroid gland is often impacted at this stage as well, causing people to visit their physicians for the first time. The physician may prescribe thyroid replacement, but hormonal adjustments may also be recommended.

What are Stage 2 Adrenal Fatigue Symptoms?

During this phase, you will be able to carry out normal daily activities; however, your fatigue will be far more pronounced by the end of the day and you will start to feel the effects of the overexertion of the adrenals. You will also likely feel like your body requires more rest than usual to recover. Despite having a full night’s rest, you will not feel refreshed in the morning.  

As your adrenals continue to become overwhelmed and struggle, you may experience body aches, depression, disrupted sleep patterns, digestive issues, elevated blood pressure, hyperventilation, heart palpitations, irritability, loss of appetite, jitteriness, nervousness, menstrual irregularities, and a feeling of coldness. Infections may become recurrent, and you may become more reliant on stimulants to enhance your energy and elevate your mood. Another symptom is weight gain despite exercise and diet.  

A common feeling during this phase is “wired but tired”, where you can maintain alertness during the day but crash hard in the evening. That said, you’ll also be more susceptible to anxiety and insomnia, as it will be harder to fall asleep and your quality of sleep will decrease. Because of this, it’s easy to develop an unhealthy reliance on coffee and other stimulants.

What is Stage 3 Adrenal Fatigue?

If the stress triggers aren’t reduced, your body will enter into the third stage of adrenal fatigue, also known as “adrenal exhaustion”. During this stage, adrenal function will be significantly weakened due to the body’s high demand for cortisol that the adrenals are unable to keep up with. As the output of cortisol gradually declines, the body will shut down nonessential functions in an attempt to conserve energy and ensure survival. A state of near adrenal failure can occur as hormone levels continue to drop, causing the body to go into a full-blown shut down mode.  

The body will resort to breaking down muscle tissue to produce energy. This signals the systematic slow-down of the body. During this phase, recovery time is longer and the body may never fully recover to the pre-crash baseline energy level.  

Digestion slows down and the metabolic rate will decline to conserve body weight. You may feel like you’re unable to get out of bed, or that you only have small bursts of energy. Eventually, the HPA axis will collapse, which means the essential neuroendocrine feedback loops will be unable to return the body to a state of homeostasis.

What are Stage 3 Adrenal Fatigue Symptoms?

During this stage, blood sugar levels plummet, which leads to a further inability to handle stress. It will also exacerbate mental, emotional, and physical exhaustion. This is sometimes referred to as “adrenal crash” or “adrenal burnout”. Symptoms will typically interfere with day-to-day activities and will drive the individual to seek professional help and/or medical treatment. 

However, you should still be able to hold a job and continue a relatively normal life. However, low levels of important hormones can impact your quality of life. You’ll likely feel tired regularly, lack enthusiasm, and have a lower sex drive.  

Your body’s tolerance for exercise is reduced and chronic fibromyalgia may appear. Brain fog and insomnia may become more prevalent as toxic metabolites begin to accumulate throughout the body. Symptoms of depression and anxiety will intensify and may become chronic. The productive hours in the day will gradually decrease to the point of only being able to spend a few hours outside of bed. This phase can last for several months to years.

What is Stage 4 Adrenal Fatigue?

The fourth and final stage of adrenal fatigue is adrenal failure. Though it is rare, this final stage results in a total failure of the adrenals in response to stress. When confronted with stress during this stage, the body is susceptible to cardiovascular collapse and even death. Even the smallest stressor can trigger adrenal failure.  

During this stage, the adrenals have essentially ceased to function and there is little that can be done to restore homeostasis within the body. At this point, the difference between HPA axis dysfunction and adrenal insufficiency (Addison’s disease) is very small in terms of their manifestation. If left untreated, the progression of this stage can be fatal.

What are Stage 4 Adrenal Fatigue Symptoms?

During the fourth and final stage, symptoms include severe diarrhea and vomiting, sudden penetrating pain in the abdomen, legs, or lower back, dehydration, loss of consciousness, and low blood pressure. You may also experience apathy and a loss of interest in the world around you. Recovery from this stage takes ample patience, time, and often a complete change in lifestyle.  

What Can You Do?

Unfortunately, most conventionally trained physicians are still unaware of adrenal fatigue because it’s difficult to diagnose through traditional blood tests. Instead, most patients are sent away with antidepressants after a short experimental trial of hormonal replacement therapy, which usually fails. Studies have shown that stress management is a key factor in reversing the damage caused by abnormal hormone production in the adrenal glands.  

The best form of recovery will be multifaceted. Meditation and relaxation practices can have a big impact on adrenal fatigue, as well as several supplements which have been proven to help support healthy adrenal gland function and help ease mental stress and anxiety. 

Here is our list of the top ways to fight adrenal fatigue and get your adrenals back on track: 

1. Meditate

Don’t underestimate the power of sitting quietly! Mindfulness meditations can have a huge impact on your health. Even just taking a small amount of time for yourself to become aware of your breathing is a simple and easy way to de-stress and calm your brain-adrenal axis.  

If you’re not already an avid meditator, you’ve probably heard of it and thought it’s a little too “woo woo” for you. You might be surprised to learn that there are actually tons of studies backing up the benefits of meditation on adrenal hormones, heart rate, blood pressure, mood, and endorphin levels. One study examined participants who went on a three-month meditation retreat by studying their mediation scores in relation to their cortisol levels. The mindfulness score measured each person’s tendency to let go of distressing thoughts and attend to different sensory domains.  

Among participants, high mindfulness scores were correlated with low cortisol levels. This means that the stress hormones, the physical signs of aging, and fight-or-flight reaction (like heart rate and blood pressure) are lower in individuals who regularly meditate.  

Another study revealed that the benefits of meditation include a release of endorphins similar to what you might experience after a run. So basically, you can get a runner’s high without even running! The good news? It’s just like working out, in that the more you practice, the better and stronger your meditation muscles become and the more stress your body will be able to handle without having to disrupt your adrenal function.  

2. Take Supplements

Ascorbic acid, also known as vitamin C, is well-known for its health benefits and is widely used. Vitamin C plays an essential role in activating collagen producing enzymes. Collagen is a key structural protein found in skin, blood vessels, and other tissues. Vitamin C is also necessary for the activation of carnitine for energy production.  

In stressful situations, vitamin C stores can be rapidly depleted. Research has shown that daily vitamin C supplementation can lower blood pressure, help cortisol levels normalize faster, and cause participants to feel less stressed. Other studies have shown that people who take vitamin C supplements do not show the expected physical and mental signs of stress when subjected to acute psychological challenges. They also bounce back from stressful situations faster than those with low levels of vitamin C in their blood.  

For more information on vitamin C for adrenal fatigue, including which supplements to take and what dosage is right for you, check out this article: 9 Best Supplements for Adrenal Fatigue.

3. Try the Adrenal Fatigue Diet

You’ve heard it before: food is medicine. So, it shouldn’t come as a surprise that your diet is the first line of defense against adrenal fatigue. When we’re exhausted and stressed, we tend to reach for sugary foods to keep us going. The adrenal fatigue diet is a natural approach to lessening the stress on the adrenal glands. 

You may experience adrenal fatigue when your adrenal glands cease to function properly. The adrenal fatigue diet is a food-based strategy that promotes proper functionality of the adrenal glands, increases healthy nutrients in the body, improves stress levels, and promotes a healthy blood pressure. The goal of the adrenal fatigue diet is to naturally increase your energy levels so your body doesn’t burn stored nutrients. The adrenal fatigue diet is an attractive solution because it does not require a trip to the doctor or naturopath, will likely not cost more than your current grocery bill, and will benefit your overall health in a number of other ways. 

An adrenal fatigue diet involves two basic principles. First, avoid any foods that will worsen your adrenal fatigue. Second, try to eat foods that will help your recovery. This also means eating at the right times, consuming nutritious whole foods, and avoiding any foods that you have intolerances or sensitivities to. 

Adding high-quality healing foods to your diet that support adrenal health and reducing or avoiding those that may exacerbate adrenal-depletion symptoms are the most effective ways you can start recovering from adrenal fatigue.

To learn more about what you should and shouldn’t be eating, read this article on the adrenal fatigue diet: 11 Best Foods for Adrenal Fatigue + Adrenal Fatigue Diet Plan.

4. Take an Adrenal Supplement

Supplements are a great way to get your adrenals back on track. For example, Andren-all is a nutrient cocktail your body will love. It’s a combination of nutrients including Vitamin A, Vitamin C, Vitamin E, Vitamin B6, Vitamin B12, Niacin, and Pantothenic Acid. It also contains: Adrenal concentrate, licorice and healing herbs. 

These nutrients help adrenal fatigue by protecting the body against stress and supporting healthy energy levels. This in turn will help you stay focused throughout the day.  

While there are a wide range of vitamins you can take to help your adrenals, we’ve narrowed down our top 9 – check them out here: 9 Best Supplements for Adrenal Fatigue.

5. Make a Bedtime Routine

It may sound silly, but having a “bedtime’’ can make a huge difference for your health. Going to bed at the same time every night teaches your body when it’s time to sleep, which will hopefully help you fall asleep faster and increase the quality of your sleep.  

To get yourself into a routine, also try to do the same things’ at the same time every night. For example, change into your pyjamas, wash your face, and brush your teeth at 9:30 every night. This will signal to your body that it’s time to relax and unwind. Another tip: don’t use technology before bed. Blue light from our devices affects us more than you might think, so try to power down and unplug an hour or two before bed.

6. Do Yoga

Yes, at this point you’re totally becoming a hippie. But if it’s going to reverse your adrenal fatigue, why not embrace it? Practicing yoga is a great way to recover while helping you deal with stressful circumstances. It’s a holistic approach that will help to replenish your worn out adrenal glands.  

To use yoga for adrenal fatigue recovery, focus on restorative yoga. Unlike sweaty workout style classes, this style of yoga allows you to slow down, lengthen your breath and allows your body to enter into ‘rest and digest’ mode. This means you’ll be out of ‘fight or flight’, giving your sympathetic nervous system a welcome break.  

The trick is the deep breathing which triggers relaxation. Your brain shifts from lots of brain activity to a more relaxed state where serotonin is released, a calming, mood-regulating hormone. From here, you will continue toward an ultra-restorative brainwave state, where your thoughts will slow. The good news is that these restorative yoga poses can be done from the comfort of your own home, as long as you can find a warm, dark, quiet spot.