Shelley Rubalcava was working 60 hours a week as the regional general manager for a major retail chain in Los Angeles. She was commuting 70 miles to and from her job each day — usually in rush-hour traffic. As if work wasn’t enough pressure, she was caring for her uncle, who suffered from liver failure, and her grandfather, who had just had a stroke. Her friends were amazed. They called her “the Energizer Bunny.”
But while Rubalcava was running around on hyperdrive, the collateral damage to her system was accumulating. Sugary pick-me-ups, caffeine-laden sodas and copious amounts of coffee were getting her through the day. And, she wasn’t sleeping enough.
Then, just as she was starting a new job and moving in with her boyfriend, her uncle and grandfather died within weeks of each other. Rubalcava was beyond exhausted: “I would wake up in the morning, tell myself I feel like crap, and then just keep going,” she says.
What finally stopped her in her tracks was a nasty cold that lingered throughout the autumn of 2005. She started coming home from work and crawling straight into bed, waking only the next morning and going straight back to work.
One afternoon, one of her employees found her asleep in a back storeroom. When Rubalcava finally went to the doctor, she was diagnosed with infectious mononucleosis and put on a heavy-duty round of steroids.
Instead of getting better, she got worse. “That was the turning point,” she says. “I was running on empty, and the steroids just zapped me. My body just stopped.” She began sleeping more than 20 hours a day. “I would tell myself, ‘Shelley, just get up! Get up! Just go to the bathroom, and then you can come right back to bed.’”
“It was like a conscious coma,” she says. “My mind was aware, but I just didn’t have enough energy to do anything.”
During the next three years, Rubalcava visited more than 25 doctors in Los Angeles, filling a huge banker’s box with lab tests, charts and MRI scans. One doctor told her she might have a tumor; another said the cause was poor circulation. Finally, Rubalcava found a holistic doctor who told her she was suffering from severe adrenal fatigue. Simply put, Rubalcava had run her body’s energy-production system into the ground.
The Doctor Debate
Adrenal fatigue — or non-Addison’s hypoadrenia, as it is known in some circles — is not a widely accepted diagnosis in medical schools or among most conventional physicians. It is not Addison’s disease, a rare condition in which the adrenal glands completely fail. Rather, it’s a milder syndrome in which the adrenal glands slow and sputter, like a computer bogged down with too much spyware.
Adrenal fatigue doesn’t have a popular or profitable drug attached to it. It doesn’t even have an International Classification of Disease (ICD) number, which all doctors’ offices and insurance companies use to process claims. “Get together 20 random physicians, and I doubt if you’ll find one who has heard of it,” says Jacob Teitelbaum, MD, medical director of the national Fibromyalgia and Fatigue Centers and author of Beat Sugar Addiction Now! (Fair Winds Press, 2010).
And yet, an emerging, disparate group of doctors is attempting to raise public consciousness about what they believe is an epidemic of adrenal fatigue in the United States. One of these doctors is James Wilson, ND, PhD, author of Adrenal Fatigue: The 21st Century Stress Syndrome (Smart Publications, 2001). When Wilson considers the way most Americans live — economic stress, the 24/7 workday, the popularity of caffeine and sugar, ever-growing traffic congestion, and so on — he sees the potential for a lot of worn-out adrenal glands.
“When I describe the condition to big crowds of people, I can see about two-thirds of the heads in the audience nod in agreement with what I’m saying,” says Wilson. “That’s not very scientific, but it gives you an idea of how common this really is.”
More than 80 percent of the population suffers from this syndrome, according to Marcelle Pick, RNC, MSN, OB/GYN, NP, author of Are You Tired and Wired? Your Proven 30-Day Program for Overcoming Adrenal Fatigue and Feeling Fantastic Again (Hay House, 2011). And yet, she adds, many in the medical community do not recognize the condition because “in our medical system, you have a diagnosis: You’re either sick or you’re well, and there is no in-between.”
“We in Western medicine don’t know how to recognize a problem until it has manifested as a ‘disease,’” concurs Frank Lipman, MD, author of Revive: Stop Feeling Spent and Start Living Again (Simon & Schuster, 2009). “It’s a lot like brake pads — until brake pads have worn down completely, you don’t know that they are wearing down.”
Whether or not you accept adrenal fatigue as a syndrome, it is certainly a matrix of symptoms that many experts agree are reaching epidemic proportions — and the basis of it is hormonal disruptions resulting from chronic stress. Wilson and Teitelbaum do believe that if humans continue their frenetic pace for a few more millennia, our endocrine systems will eventually evolve to keep up with us. But for now, the doctors agree, our adrenal glands are stuck in prehistoric mode.
“Our adrenals evolved to trigger fight-or-flight reactions so that we could fight off a saber-toothed tiger and handle these big chemical jolts once every four to six weeks,” explains Teitelbaum. “They were meant for life-threatening situations, and we’re not at all designed to get these jolts of cortisol every time we think about pending deadlines, or somebody pulls out in front of us in traffic. Some people are so stressed they give themselves more than 100 jolts of cortisol every single day.”
Why Being Wired Makes You Tired
To understand the connection between chronic stress and adrenal fatigue, it helps to know a little more about the body’s two adrenal glands. Each of them weighs about as much as a grape and sits atop each kidney. Their job is to release tiny, precise amounts of chemicals, including cortisol, adrenaline, testosterone, estrogen, aldosterone and DHEA. These chemicals, individually and in concert, help the body in many ways, including responding to stress, maintaining libido, and serving as one of the main control centers of the immune system.
When the body feels a little nugget of stress, the adrenal glands release a tiny chemical cocktail that energizes the body, heightens memory and increases your pain threshold. While empowering in the short term, this chemical infusion can be devastating if frequently repeated. When people are stressed out for days or weeks or months, the body is continually flooded with cortisol and adrenaline, which ultimately results in heightened blood-sugar levels, increased blood pressure and decreased immunity to disease.
If stress continues unabated, the body enters a second phase of adrenal fatigue, when the adrenals simply get exhausted. They just can’t supply cortisol and adrenaline at the same level of production.
If you reach this point of adrenal overwhelm, you’ll begin to feel fatigued, achy and mentally foggy. In order to trigger the kind of adrenaline high to which you’re accustomed, you might up your intake of stimulants and sugar. But your reaction to stimulants like caffeine will be short-lived, and the pancreas is quick to tamp down sugar rushes with shots of insulin.
That insulin forces blood-sugar levels to plummet, which would normally tell the adrenal glands to release a little more cortisol, giving you some temporary pep. But if the adrenals are depleted, then blood sugar just stays low. You feel even more compelled to reach for that next can of soda, just to keep soldiering on.
“If you have adrenal fatigue, probably the worst thing you can do is consume caffeine and sugar,” says Teitelbaum. “Which is, of course, what most people do, because they tell themselves they just have to keep going, no matter the cost.”
In addition to devastating chronic exhaustion, adrenal dysfunction (as Pick often refers to adrenal fatigue) can ultimately increase your risk of developing a host of conditions, including depressed immunity and autoimmune disorders, digestive problems, cardiac issues, blood-sugar dysregulation, thyroid problems, and wider-ranging hormonal imbalances, says Pick.
Because so few doctors recognize the condition, finding a sympathetic physician can be tricky. Go to a mainstream doctor with complaints of under-performing adrenals and a cortisol test may be ordered, says Wilson. But this test is calibrated to detect Addison’s disease. “On the standard cortisol test,” he explains, “you can have 6 micrograms per deciliter, or less than a third of ‘normal,’ and still come back ‘normal’ on the test.” As a result, most mainstream docs aren’t prepared to address adrenal problems until they are quite advanced.
Wilson prefers combining a written questionnaire that lists symptoms of adrenal fatigue with a saliva test, which measures DHEAS, cortisol and levels of sex hormones.
When treating adrenal fatigue, says Pick, the instinct may be to supplement with missing hormones. The real answer lies, however, in correcting the underlying imbalance that is creating the problem. “We have a very reductionist approach to medicine and a very polypharmy approach to our symptoms,” she says. In other words: “The belief is, if you can’t sleep, you need a sleeping pill.”
Adrenal fatigue is generally treated, she asserts, with time-honored naturopathic remedies, good nutrition and lots of self-care. “The way to deal with most of the patients who come to see us today is through lifestyle medicine,” agrees Lipman. (See “Natural Fixes” below.)
Shelley Rubalcava agrees. “You have to reevaluate your life, and not allow things that are out of your control to overwhelm you,” she says. Today, Rubalcava actively protects her adrenal health with more yoga, more meditation, and more quiet time alone. “And I don’t push myself,” she says. “If I start feeling overwhelmed, stressed or sick, I clear all my appointments and take a day to myself and rest. I’m never going back to the way I was. I learned the hard way that my health is just too important.”