The June 6, 1983 cover story of Time magazine was entitled Stress! The article called stress “The epidemic of the eighties” and identified stress as the number one health problem in the United States. The situation does not appear to have improved; on the contrary, the number of people affected by stress appears to have increased significantly.

A 1983 survey reported that 55 % of respondents felt great stress at least once a week. The survey was repeated in 1996. By then 75 % of those surveyed reported experiencing “great stress” at least once a week. A third said that they felt that way at least twice a week. A 2000 Communications Workers Union survey found that 85% of workers felt more stressed at work than five years previously. Only 5 % of those interviewed did not consider stress to be a problem.

Stress can be defined medically as any demand placed upon the body. Stress can therefore be something as simple as climbing a flight of stairs or it can be as complex as dealing with strained relationships. Stress can be related to a joyful occasion, such as a wedding, or it can result from a traumatic event, such as the death of a close friend or family member. Most people report pressures in their workplace as the greatest source of stress in their lives. Stress is not inherently good or bad. What determines whether stress is beneficial or harmful is one’s response to it. While many factors are involved, the body’s stress response is depends greatly upon two small triangular glands called the adrenals.

The term adrenal derives from the glands’ location. (Ad means“next to” and renal refers to the kidney). The glands sit atop the kidneys. Adrenal glands are comprised of two parts. The inner portion, called the medulla, is responsible for producing and releasing the chemicals that control the body’s response to threats, the “fight and flight response”. These hormones are called adrenaline (epinephrine) and noradrenaline (norepinephrine).

The actions of adrenaline and noradrenaline are often identical. Both increase the heart rate and open air passages. Both cause blood vessels in non-essential areas to narrow, causing a rise in blood pressure. Both cause the pupils to dilate.

Adrenaline elevates blood sugar by increasing the formation of glucose in the liver. It also causes fats to begin to break down for energy production. It inhibits non-essential activities such as digestion and the immune system’s response to challenges.

Noradrenaline plays an important role in the transmission of nerve impulses. This is important in preventing anxiety and depression.

The outer portion of the gland, called the cortex, manufactures at least twenty-five hormones, of three different classes.  Mineralcorticoids such as aldosterone regulate the body’s fluid and electrolyte balance. Androgens including dihydroepiandosterone (DHEA), testosterone, progesterone, and estrogen augment the hormonal production of the testes or ovaries. The adrenal cortex also produces glucocorticoids, of which cortisol (cortisone) is the best known. Cortisol helps maintain blood pressure and regulates the breakdown of proteins, fats, and carbohydrates. It also blocks the immune system’s inflammatory response to injury. Cortisol acts to maintain the body’s response to stress.

When exposed to a stressful event, such as meeting an unrestrained Doberman Pincer in the middle of a morning walk, the adrenal medulla springs into action and secretes adrenaline and noradrenaline. If the threat lasts more than a few minutes the adrenal cortex is called in to assist and cortisol levels rise.

The stress response is designed to be of short duration. It is designed with the expectation that one of two things will happen quickly. Either the threat will be successfully eliminated or death will occur. A prolonged shut down of “non-critical” bodily functions is neither expected nor intended.

Unfortunately, many people find themselves under constant stress. Adrenaline and noradrenaline are no longer required to fight or run, but simply to keep going. Cortisol is needed to keep on top of the perceived threat.

Doctors recognize two diseases caused by adrenal dysfunction. One, Cushing’s syndrome, is caused by sustained levels of abnormally high cortisol. This is usually due to a hormone-secreting tumor. Cushing’s syndrome is characterized by upper body weight gain, thinning of the skin, easy bruising, loss of bone strength, fatigue, muscle weakness, hypertension, diabetes, loss of sex drive, increased irritability, anxiety, and depression.

Adrenal failure is called Addison’s disease. Addison’s disease is characterized by chronic fatigue, muscle weakness, weight loss, low blood pressure, a darkening of the skin, increased irritability, depression, craving for salty foods due to increased salt loss, irregular menses, and hypoglycemic (low blood sugar) episodes.

There is, however, a third condition that is not currently an acceptable medical diagnosis. It is, therefore, rarely addressed. That entity is adrenal fatigue.

Adrenal fatigue is not defined by the abnormally high cortisol levels of Cushing’s syndrome, nor is it characterized by the extremely low hormonal levels of Addison’s disease. Adrenal fatigue is a condition in which the adrenal glands have become unable to keep up with the demands placed upon them.

The symptoms of adrenal fatigue are many. The most common include extreme fatigue or exhaustion, a failure to awake refreshed after a full night’ sleep, an overwhelmed sensation, a craving for salty and sweet foods, a lack of stamina, difficulty recovering from an injury or illness, difficulty concentrating (often described as a “brain fog”), indigestion, frequent infections, development or a flare of food or environmental allergies, premenstrual syndrome, menopausal difficulties, low blood pressure, extreme cold sensitivity, and feeling more energetic in the evening than early in the day.

Adrenal fatigue may occur when the body has required adrenal hormones to sustain the stress response for a prolonged period of time. It may be caused by a deficiency in the nutrients required for hormone production. In most cases it is a combination of both; the adrenals are often overworked and underpaid.

It follows, therefore, that if normal adrenal function is to be restored the demands placed upon the glands must be lessened and the resources available to them must be increased. Doing one without the other is unlikely to resolve the challenge.

Stress must be reduced at home and in the workplace. This involves four distinct steps. The first step is to improve the quality of rest being received. Sleep deprivation is a significant stress, so it is important that adequate amounts of sleep be obtained. The best indication that this has been achieved is that it is possible to awaken without relying upon an alarm. (A wake-up alarm is itself a significant stressor. Awaking without an alarm will not only ensure that sleep has been adequate, but will remove that source of stress.)

Management of work stress requires more than a good night’s sleep. Breaks within the work day are important. Many people begin working through lunch in an attempt to catch up, only to have their efficiency decline as a result. This often triggers a vicious cycle of putting in ever longer hours while producing fewer results and falling farther and farther behind.

The need for breaks in the work day is obvious in jobs that place physical demands upon the body. When I worked on the farm I was able to put in long hours primarily because the work was broken by mid-morning and mid-afternoon rest breaks and a relaxing, sit-down dinner (that city folk refer to as “lunch”). The need for breaks in an intellectually or emotionally demanding day is just as real, but it is often not perceived as important.

Three or four day holiday weekends spaced throughout the year are also beneficial in reducing work-related stress. It is unwise to use these built in breaks as “catch-up” time. As is the case with breaks within the work day, efficiency is improved by occasionally getting away from the task for a longer period of time. Seeking a relaxing and refreshing venue for an annual vacation is also of critical importance.  Too often, people push themselves harder while “on vacation” than while “on the job” and return to work more exhausted than when they left.

Secondly, interpersonal conflicts must be resolved. This often involves improving communication. One of the leading causes of strained relationships is a misattribution of a motive by one of the parties.

For example, one inPidual related that he became resentful of his supervisor when he heard her mutter “That figures!” after he had reported that a project had been delayed. He assumed that the comment had been directed at him – that she had made the comment because she believed him to be slow and incompetent. As time passed he found his job infinitely more stressful and reporting to work each day increasingly difficult.

Finally he decided to confront his supervisor about the remark. He learned that his supervisor actually valued his work highly and believed him to be an excellent employee. The remark had nothing to do with his job performance. It was simply that when he reported the delay she was near the end of a day in which nothing had gone as expected. Since the delay matched the rest of her day she had reacted by saying “That figures”. She apologized for making the remark without thinking about his reaction and he for jumping to the wrong conclusion. Their relationship was restored and he experienced renewed enthusiasm for his work.

The third step in easing stress is to clear non-essential events from the schedule. When you have too much on your plate the best solution is to remove some of the items. This may mean asking to be released from some commitments. It may mean not traveling to a nephews wedding or not participating in a community service project. While stepping back is difficult, it is essential to recovery.

The fourth step is closely related to the third. You must learn to say “no”. It is of no value to remove one event from your schedule only to fill it with another. This may even apply to a project at work. Although uncomfortable, it is much better to explain to an employer that you are not up to the task than to explain why you failed to complete it or did a poor job.

It is extremely important to discontinue the use of chemical stimulants, even if symptoms increase when doing so. Caffeinated coffees, teas, and soft drinks should be replaced by pure water or other non-caffeinated beverages. Stimulatory herbs such as guarana, bitter orange, and panax ginseng should be avoided. Pep pills, including those that contain decongestants like pseudoephedrine should also be avoided.

The adrenal glands should be supported in many ways. The first is to eat a wellness diet. This means to keep your diet colorful, to stick to foods that would remain edible at room temperature, to include oils, whole grains, and legumes, to keep meat portions small, to avoid refined foods, food additives, and preservatives, and to vary what you eat from day to day.

Physical activity should be performed, but it should not be at high intensity. Mild activity, such as walking at a moderate pace, can help diffuse emotional stress and ease the demands faced by the adrenals. Intense exercise, however, places even greater demands upon the glands and should be avoided until balance has been restored.

Laughter has been shown to support adrenal function. To be effective this must be full-blown laughter – laughing out loud. It is probably correct to say the louder the better. Pull out some tapes or movies that have caused you to laugh in the past and let yourself go.

Nutritional supports are critical to recovery. It's critical to be taking a comprehensive regiment that provides the basic nutrients the body requires for daily maintenance and repair.  Specific adrenal support is also needed.  No nutrient is more important to support adrenal function than vitamin C. Nearly all animals manufacture vitamin C; they do not need to obtain it from outside sources. When an animal is stressed for any reason, levels of vitamin C skyrocket. This is not surprising, for large amounts of vitamin C are stored in the adrenals and vitamin C is needed for the production and release of adrenaline and noradrenaline. It is also needed for the conversion of cholesterol to cortisol.

An average-size adult requires approximately 2,000 mg. of vitamin C daily for optimum health under non-stressful conditions. Stresses can dramatically increase the demand to 6,000 to 8,000 mg. daily. Cancer patients have been reported to consume up to 50,000 mg. daily.

Vitamin B5 (pantothenic acid) is one of the key nutrients required for the production of cortisol and other hormones that are manufactured in the adrenal cortex. Amounts of 500 mg. or more daily are often needed.

The nutritional needs of the adrenals go far beyond vitamin C and pantothenic acid. The amino acid tyrosine is a primary building-block of adrenaline and noradrenaline. The adrenal cortex manufactures at least twenty-five hormones, and each process requires different supports. Vitamins A, D, E, B2, B3, B6, B12, and folic acid are needed. So are minerals including magnesium, potassium, zinc, iron, copper, chromium, selenium, and manganese. Herbs that have shown to support adrenal function include licorice and ginger.

It would be a daunting task to supplement all of the necessary nutrients individually. That is why I recommend a comprehensive adrenal support product, AD Formula, to individuals exhibiting signs or symptoms of adrenal fatigue. AD Formula contains all of the nutrients listed above along with nucleoproteins, bromelain (an anti-inflammatory enzyme), and octacosenol, a non-stimulatory source of energy obtained from wheat germ. Two capsules are taken twice daily when the condition is mild, but as much as five capsules three times daily may be required when the condition is severe.

Advanced cases that have gone unaddressed for months or years may require hormonal support. DHEA is commonly recommended, but since it is a precursor to the sex hormones rather than cortisol it is rarely successful in alleviating the condition. Low amounts of hydrocortisone provide the greatest benefit, but are rarely prescribed by physicians, who are afraid of suppressing adrenal function by doing so.

Research, however, has demonstrated that doses of less than 20 mg. daily do not suppress normal adrenal function and do not cause the adverse effects commonly associated with the use of prednisone, dexamethasone, and other potent steroids.

Adrenal fatigue may well be the condition that defines the twenty-first century. While in medical school Hans Selye, a medical researcher who devoted much of his life to researching the effects of stress, observed that people often appeared “sick” long before any specific disease state could be identified. His professors scoffed at the idea of a “sick syndrome”, but Selye’s subsequent research demonstrated that what he called the General Adaptive Syndrome plays a significant role in the development of almost every known disease.

Selye’s General Adaptive Syndrome describes the body’s response to unrelenting stress. In an age of uncertainty and rising tensions, taking care of our adrenals should be a top priority. As always, instituting the needed supports before adrenal fatigue develops is preferable to waiting until the full-blown syndrome is present and then fighting to restore the body’s ability to respond to stress effectively.

Adrenal Fatigue Quiz

 Do you feel excessively fatigued?

 Would you describe yourself as physically and emotionally exhausted?

 Do you feel just as bad as or worse than the night before when you awaken after a full night’s sleep?

 Do you feel overwhelmed or unable to cope?

 Do you crave salty foods?

 Are you irritable or do you cry easily?

 Would you have trouble functioning without coffee, cola, or a “pep pill”?

 Do you feel more energetic in the evening than earlier in the day?

 Is your stamina low?

 Does exercise leave you feeling drained for hours or days?

 Do you seem to “catch” every cold or flu bug that comes your way?

 Are injuries slow to heal?

 Do illnesses seem to drag on indefinitely?

 Do you have difficulty concentrating as though you are living in a “brain fog”?

 Have you lost you sex drive?

 Do you suffer from poor digestion?

 Are you having more allergy symptoms than usual?

 Do you struggle more with premenstrual syndrome than you did in the past or, if menopausal, are you having more hot flashes or other symptoms?

 Has your blood pressure been low?

 Are you extremely sensitive to cold?

Scoring: 5 or less “yes” answers: Adrenal fatigue is unlikely 6 – 10 “yes” answers: Adrenal fatigue may be present 11 – 15 “yes” answers: You probably have significant adrenal fatigue 16 – 20 “yes” answers: You almost certainly are experiencing severe adrenal fatigue