The Stages of Adrenal Fatigue Syndrome
Every person has some form of stress in their life, whether it is good stress (eustress), the beneficial stress that keeps you excited or nasty stress (distress) that negatively affects you and, left unchecked, can develop into chronic illness. The general adaptation syndrome (GAS) and the role that your adrenal glands and their hormones play in the physiological adjustments your body must make in response to your internal and external environment. Adrenal fatigue has three phases: alarm reaction, resistance response, and adrenal exhaustion. All three steps respond the same whether the stressor is real or perceived; our body creates the same answer and physiological adjustments (Wilson, 2001).
Stage 1: Alarm Reaction, the “Fight-or-Flight-or Freeze” Response
This stage is the early onset of mild fatigue, low energy, and the body’s response to any physical, emotional, or biochemical changes arising from the interaction of the brain, nervous system, and stress hormones. Brain norepinephrine output increases in this state, leading to arousal and alertness. We also notice an elevated production of ACTH, which stimulates the adrenal cortex in producing more cortisol, DHEA, pregnenolone, and aldosterone hormones. The production and release of these hormones will cause an elevation in blood pressure, heart rate, oxygen intake, and more blood flow to the muscles to provide nutrients and oxygen to “fight-or-flight.” The alarm reaction phase usually only lasts a short duration. Once the stress is over, your elevated norepinephrine levels last a few minutes to a few hours, followed by other stress hormones, like cortisol, lasting hours to a few days, depending on the significance of the stress. This stage occurs quite often, with individuals not reporting symptoms besides feeling tired and turning to more caffeine, caffeinated energy drinks, sugary snacks or high carbohydrate treats for more fuel to get through the day (Lam & Lam, 2012, pp. 51–52) (Wilson, 2001, pp. 287–289) (Michael et al., 2012, pp. 2–3) (Luther, 2015, p. 63).
Stage Two: The Resistance Reaction
The resistance reaction phase induces the neuroendocrine response, which puts the HPA axis on overdrive to help your body fight a stressor even after the fight-or-flight response has worn off. The adrenal hormone cortisol and other corticosteroids continue being secreted by the adrenal cortex, which is mainly responsible for the stage. Although the HPA Axis starts to be overburdened at this stage, it still needs to be functional. During this stage, cortisol stimulates the conversion of carbohydrates, protein, and fats to energy (gluconeogenesis). Hence, the body has an ample energy supply long after glucose stores in the liver (glycogen) and muscle (glycogen) are depleted, and it assists in sodium retention to keep blood pressure elevated.
Moreover, it also helps lessen inflammation while calming the nerves during stressful events. This mechanism simultaneously acts as both an acceleration and braking system via various pathways, assuring our ability to handle the stress successfully and still have normal physiological functioning. A prolonged resistance reaction phase can significantly affect your digestive health, sleeping patterns, and irritability while increasing the risk of significant diseases (including hypertension, Type-2 diabetes, and cancers) and result in the final GAS stage: exhaustion (Lam & Lam, 2012, p. 52) (Wilson, 2001, p. 290) (Michael et al., 2012, pp. 3–4).
Stage 3: The Exhaustion Phase
This stage is also called Neuroendocrine Exhaustion as the neuroendocrine system is now at full tilt, with a substantial drop in DHEA production and total cortisol output dropping below normal, possibly leading to a complete collapse in some bodily functions, specific organs and systems as this stage progresses. At this stage, the HPA Axis becomes dysfunctional and eventually burnt out, leaving individuals unable to meet and deal with emotional crises or inability to perform any strenuous task; muscle tissue starts to break down, and the ability to fight infections due to the downregulation of the immune system occurs. As this stage advances, the body's nervous and endocrine system progressively becomes more dysregulated. Two primary etiologies of exhaustion during this phase are the loss of sodium ions (reduced aldosterone), potassium retention and the adrenal glucocorticoid hormones (cortisol). This causes your cells to function ineffectively in this condition, as they depend on the proper blood glucose amount and sodium and potassium ratio. Chronic and persistent stress tremendously strains your body's organ systems, leading to exhausted adrenal glands that also affect your heart, blood vessels, immune system, and kidneys, manifesting a total collapse and can even result in death in extreme cases (Lam & Lam, 2012, pp. 61–66) (Michael et al., 2012, pp. 3–4) (Wilson, 2001, pp. 291–292).
Most authorities like Selye (1936), who first described GAS theory, and then in the 1950s where his research defined the three stages of GAS, to modern-day Practitioners and Alternative and Complementary doctors agreed on the three phases. Michael Lam, an expert in AF, takes it a step further by segmenting phase three into four more minor subheadings.
Phase 3C – Disequilibrium, and Phase 3D – Near Failure (Lam, n.d.). Lam stage three is subcategorized into four distinct sections or symptoms:
Stage 3A indicates that one or more body systems have weakened, so the affected system's pathological subclinical or clinical state surfaces. The organ system that is constitutionally the weakest or most sensitive is usually the first to exhibit the most prominent weakness. Common symptoms, although mild in this stage, include hypoglycemia, low blood pressure, brain fog and recurrent infections. These symptoms present the onset of underlying system dysregulation, specifically the HPA Axis (Lam & Lam, 2012, pp. 71–92).
Stage 3B individuals will experience downstream hormonal axes issues and become more dysregulated. These imbalances are the hallmarks of set 3B, the HPA Axis and another important axis in regulating stress is the hypothalamus-pituitary and gonad/ovary HPG axis and the ovaries, adrenal and thyroid glands (OAT) Axis. This axis is an essential regulator of stress and menses. We observe the weakening of the adrenal gland and start noticing concurrent thyroid malfunction, low libido in both men and women and irregular menstrual cycle. An underactive thyroid often irritates adrenal weakness, demonstrating that a healing protocol must address both adrenal dysregulation and thyroid malfunction. In addition, an ovarian hormonal imbalance, such as estrogen dominance, often worsens any preexisting subclinical or clinical hypothyroidism. OAT Axis dysregulated symptoms suggest concurrent estrogen dominance (ovarian), fatigue (adrenal), and hypothyroidism (thyroid). Due to the overlapping of these three organ systems, evaluating the root causes and a healing protocol can be challenging (Lam & Lam, 2012, pp. 93–115).
Stage 3C As you move into this stage, the adrenal continues to decompensate, and the body continues to weaken and lose homeostasis and equilibrium. By this stage, most individuals have sought medical help. The body's systems are jeopardized in 3C adrenal exhaustion. The central regulatory systems from internal equilibrium are the nervous and endocrine systems. While both methods may be compromised throughout, entering this phase has them enter a steep slope of declining functions. With your body's internal thermostat dysfunctional, individuals develop panic attacks, heart palpitations, dizziness, lightheadedness, waking up and unable to fall back asleep, and the onset of a fragile emotional state. The autonomic nervous system dysfunction (ANS) is responsible for many Stage 3C symptoms (Lam & Lam, 2012, pp. 117–131).
Stage 3D By this stage, your body has reached near exhaustion. Your body is in full survival mode, with the continuing downregulation further reducing vital hormonal output, magnifying a downward vicious cascade. Your cortisol output is meagre, while your adrenaline (epinephrine and norepinephrine) floods the body. The body is in disarray with insufficient hormones to regulate various bodily organs and ANS dysregulation. We observe that individuals in this stage have rapid weight loss, reduced gastric assimilation, and muscle wasting as the body enters a shutdown mode to conserve energy further. At this stage, the adrenals have lost their capacity to serve as the body's stress control center and become hypersensitive. Moreover, for reasons we do not fully understand, they react negatively to any attempt to jump-start them. At this stage, conventional medicine is suggested (Lam & Lam, 2012, pp. 133–134).
References
Lam, M. (n.d.). [DrLam Coaching]. Retrieved October 7, 2023, from https://www.drlamcoaching.com/articles/4-stages-of-adrenal-fatigue/
Lam, M., & Lam, D. (2012). Adrenal fatigue syndrome. Reclaim your energy and vitality with clinically proven natural programs (1st ed.). Adrenal Institute Press.
Luther, M. (2015). The Everything Guide to Adrenal Fatigue: Revive energy, boost immunity, and improve concentration for a happy, stress-free life (1st ed.). Everything.
Michael T. Murray. (2012). Stress, anxiety and insomnia- what the drug companies won't tell you and your doctor doesn't know (First ed.). Mind Publishing.
Wilson, J. L. (2001). Adrenal fatigue: The 21st century stress syndrome (Illustrated ed.). Smart Publications.
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