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Feeling tired lately? Not just want-to-go-to-bed-early tired, but so weary that you struggle through your workouts or can scarcely muster the energy to drive to the gym or tie your shoes for a run? Depleted cortisol levels may be to blame.

Cortisol is a hormone secreted by the adrenal glands, small triangular glands located on top of both kidneys. Cortisol’s main job is to mobilize your body’s response to emotional, physical, or psychological stresses, whether they arise from an injury, from a bad day at work or from an awful commute. Hence cortisol’s reputation as “the stress hormone.”

Cortisol is powerful stuff, and great to have available in a pinch. Get overly stressed on a regular basis, though (a condition known as chronic stress), and your adrenal glands go into overdrive. They obligingly churn out increasing quantities of the hormone, which tends to inhibit the release of other hormones, including many of those that are key to digestion and healing.

Having constantly elevated cortisol levels can, over time, lead to a variety of ailments, including weight gain and a weakened immune system. And eventually, if your overtaxed adrenal glands go too long without getting a chance to rest and recuperate, they can get worn out — so worn out that they lose their ability to create even normal, baseline levels of cortisol. The result? You get fatigued. Very fatigued.

A “Real” Problem?

Ask your doctor about adrenal fatigue and you may just get a blank stare or be told it doesn’t really exist. This is because mainstream medicine does not yet recognize adrenal fatigue as an official health condition.

“The conventional medical model is a disease-based model,” explains James Wilson, ND, DC, PhD, author of Adrenal Fatigue: The 21st Century Stress Syndrome. “But adrenal fatigue isn’t a disease — it’s a subfunctioning of the adrenal glands.” And so, he explains, the condition isn’t even on the radar of many conventional docs.

There is a recognized disease in which the adrenal glands fail almost completely: Addison’s disease, which affects about one in 100,000 people. Doctors treat it with synthetic cortisol and diagnose it with a simple clinical test in which they inject patients with ACTH — the body’s chemical signal to release cortisol — and then measure the strength of the ensuing cortisol response.

The problem with this test, according to Wilson, is that it’s all or nothing. Only patients who are found to be almost incapable of producing cortisol are diagnosed with Addison’s disease. Everyone else, including anyone whose adrenal glands are quite weak, but not weak enough to be life-threatening, is considered healthy. In other words, “You’re normal until you take one more step off the cliff and then ‘suddenly’ you have Addison’s disease,” says Wilson.

This loser-take-all diagnosis may soon change, though, with preventive treatment methods becoming more widely embraced. Medical researchers are now observing chronically low cortisol levels (called hypocortisolism) in patients with a host of stress-related diseases and disorders other than Addison’s disease. These include posttraumatic stress disorder, chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis, asthma and even some allergies.

Symptoms and Solutions

Wilson notes that long before it causes disease, adrenal fatigue can produce a host of disruptive signs and symptoms. In addition to persistent fatigue, these include subclinical depression, low sex drive, hypoglycemia (low blood sugar) and weakened immune response to infections. “The symptoms of adrenal fatigue are many and varied,” Wilson explains, “because cortisol goes to virtually every part of the body. So when cortisol levels drop, lots of different systems are likely to be affected. There’s no single sign or symptom that indicates, ‘Aha! We have adrenal fatigue.’”

Long before it causes disease, adrenal fatigue can produce a host of disruptive signs and symptoms. In addition to persistent fatigue, these include subclinical depression, low sex drive, hypoglycemia (low blood sugar) and weakened immune response to infections.

One of the most frustrating aspects of adrenal fatigue is that its dragged-down symptoms can do a real number on your fitness regimen. When you’re feeling tired, depressed or always fighting off a cold, maintaining your workout routine can be darn near impossible. But ironically, the best way to fight adrenal fatigue is to — you guessed it — exercise.

Moderate exercise not only strengthens weakened adrenal glands but also stimulates the immune system, eases stress, improves mood and addresses just about every other direct and indirect consequence of adrenal fatigue, according to Wilson. A study in the journal Endocrinology (July 2003) found that regular exercise increased the size and cortisol output capacity of the adrenal glands in mice.

But not just any type of exercise will do. Wilson suggests a moderate program that equally balances cardio and strength training. The general consensus is that although both types of exercise have been shown to increase cortisol production individually, a tag-team approach is likely to be most beneficial.

Breaking the Cycle

Working out can be difficult if you already suffer from adrenal fatigue, because you simply may not feel that you have the energy. So it’s important that you do whatever you can to overcome that inertia.

To begin with, “exercise at a time of day when you tend to feel comparatively good,” Wilson says. It may sound obvious, he notes, but it’s important because people with adrenal fatigue tend to experience a consistent fatigue pattern, with high energy points around noon and 6 p.m. By timing your workouts to coincide with your personal high points (whenever they occur), you can break the Catch-22 cycle that keeps you down.

You also need to closely gauge your reaction to your workouts and adjust them as needed. For instance, if you suddenly hit the wall in the middle of a particular session, don’t push yourself. Do a shorter or easier workout than the one you planned, or, if necessary, call it a day, rest up and try again tomorrow. If you’re finding that your typical training sessions are taxing you more than usual, cut back. “If you become inordinately fatigued within 90 minutes after your workout,” notes Wilson, “or if you’re more tired the next morning after a workout, that’s a sign you’ve overdone it.”

Finally, try to maintain the frequency of your exercise. Aim for easy workouts that allow you to train at least four times a week. Gradually, as your adrenal glands recover, you’ll be able to do longer and more intense workouts. And that will help bring your whole body up to speed.

Adrenal Evaluation

Suspect you might be suffering from adrenal fatigue? Take a salivary cortisol test to find out. Several laboratories do these evaluations by mail, and they don’t require a prescription. (For a list of labs, go to www.adrenalfatigue.org.) You simply collect your saliva in a vial four times a day and send the vials to the laboratory for analysis. Average cost is $60. Results arrive in about two weeks.|

Adjust for Your Adrenals

Because adrenal fatigue is caused by a too-taxing lifestyle, it usually takes lifestyle changes to resolve the problem. Here are the priorities to emphasize:

HEALTHY EATING: Hypoglycemia, or low blood sugar, is a common problem for adrenal fatigue sufferers, so your eating should be designed around supporting consistent blood-sugar levels. That means no skipping breakfast. Make a point of eating small, frequent meals throughout the day, and maybe having a light, healthy snack before bedtime. Each meal should include a good dose of healthy carbohydrates (blood sugar comes from carbs), but try to focus on low-glycemic-index foods like brown rice and vegetables, which produce a steadier, longer-lasting glucose elevation than high-glycemicindex foods, particularly those made from refined flours and simple sugars. (For a list of low-glycemic foods, go to www.glycemicindex.com.)

SLEEP: If you have adrenal fatigue, shoot for at least eight hours of sleep each night, and strive to get to bed fairly early. According to Wilson, when people with adrenal fatigue stay up late, they tend to get a “second wind” — often around 11 p.m. Then they may end up staying awake for hours. The reasons for this phenomenon aren’t clear, but Wilson speculates it’s because of a natural, small increase in cortisol secretion around that time, which can make falling asleep more difficult.

STRESS MANAGEMENT: A couple of proven techniques — reframing and relaxing — can be used to reduce the stress that inflames adrenal fatigue. Reframing is the art of consciously evolving negative thoughts into neutral or positive ones. This might mean challenging negative assumptions and tendencies to assign blame, or it might be as simple as choosing to reflect on positive things instead of brooding on the things you dread. Learned Optimism, by psychologist Martin E. P. Seligman, PhD, offers a variety of methods for developing a more positive outlook through reframing. Simple relaxation exercises, such as visualization, meditation or even just lying still and focusing on your breathing for a few moments, can also have a profound effect.

MODERATE TRAINING: Getting adequate exercise is essential to general health, but putting excessive physical strain on the body can also tax already-depleted adrenal glands. If you’ve been pushing yourself harder than what feels good — and feeling the effects of adrenal fatigue — dial back the intensity for a while and give your adrenals adequate time to refuel. When you resume, aim for gradual, incremental increases in intensity and be sure you have built in adequate recovery time.

This article has been updated. It originally appeared in the March 2005 issue of Experience Life magazine.

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