Adrenal fatigue is an incompletely understood condition characterized by a range of symptoms, all of which could be the result of something else. Of course, this makes the condition hard to diagnose, and in fact some physicians do not think the condition even exists at all. However, Adrenal Insufficiency is a well-known condition, and is thought to be the most severe form, whereas adrenal fatigue is thought to be the process which leads to full-blown adrenal insufficiency. The adrenal glands produce multiple hormones, but the primary one involved with adrenal fatigue is low cortisol. The most common symptoms of low cortisol are: fatigue and various food cravings such as salt and sugar. Less common, but certainly not rare symptoms associated with adrenal fatigue would be: difficulty awakening after a night’s sleep (probably due to poor sleep quality), inability to handle physical or emotional stress, a tendency to over-use stimulants like caffeine, a weakened immune system, low libido, and weight gain.

Cortisol is the hormone our bodies make daily to help us cope with stressors. For a person with little or no stress, the levels of cortisol are low all night long to allow restful sleep, and then in the early morning, cortisol is released by the adrenal glands. The level goes high then slowly recedes during the day, a process known as a “diurnal rhythm”. This is normal, but it is also normal for this person to have an elevation of cortisol during the day if there is some acute stressful event. After the stressful event is resolved, the cortisol returns to the normal diurnal rhythm. But what happens if the stress is chronic? Chronic stress could result from a chronic illness, a terrible job, or anything else that never goes away. In addition, some people are so sensitive their bodies can perceive something as simple as not eating breakfast daily as chronic stress since this leaves the body with no intake of food for over 12 hours.

One of the reasons some physicians have difficulty believing this condition even exists is that the measurement of cortisol has been difficult to do in a meaningful way. A serum cortisol level would have to be drawn multiple times in a day to track how close the patient is to the diurnal rhythm since the normal level varies

by time of day. It is difficult to get 4 or more blood draws in the same day to measure cortisol or have a patient collect all of their urine for a specified time period. Salivary testing is a more convenient, more accurate and cost-effective way to check for the diurnal cortisol rhythm. The patient merely collects a small saliva sample at 4 specified times during the day, and the levels are measured by a lab. The pattern shown from the levels at different times of the day can determine if you have adrenal issues.