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Perhaps you feel listless and unmotivated, or just down. You might feel an inexplicable weakness and achiness in your muscles. Maybe you’re sleeping all the time or waking up tired. But mainly you feel overwhelmed by profound exhaustion.

In this instance, an integrative medical practitioner may diagnose you with adrenal fatigue, though a regular doctor might not. Who’s correct?

The conventional medical view is that only abnormally low levels of adrenal hormones — low enough to indicate a rare illness called Addison’s disease — are cause for concern. Treatment for exhaustion typically starts with blood tests for Addison’s, followed by tests to rule out low iron, low hemoglobin, and ­thyroid problems.

If these levels are nor­mal, exhaustion may be attributed to untreated depression or fibromyalgia. Treatment will likely focus on symptom relief rather than underlying causes.

I agree with mainstream practitioners that adrenal fatigue doesn’t rise to the level of a discrete illness. But I also share the integrative view that problems can arise from a poorly functioning adrenal system. In my opinion, adrenal health is best measured on a spectrum.

The adrenal glands help us process stress, and adrenal fatigue may be the result of chronic, severe stress that has overmatched these glands. They haven’t shut down, as in Addison’s disease; they are just very tired from working around the clock.

When we’re healthy and rested, the adrenal glands can mount an efficient stress response as needed. This starts with a burst of energizing adrenaline, followed by a slower release of cortisol that helps the body process the adrenaline.

During an average stress response, adrenaline’s effects last mere minutes. Cortisol levels may remain elevated for up to 24 hours.

Yet these days, the sense of stress may last far more than 24 hours. We might be activated for days, weeks, or even years.

After an extended period of constant activity, the adrenals lose their ability to produce adrenaline and cortisol in a predictable pattern. At this point, the chronic anxiety of constant activation turns to fatigue and sluggishness. We go from being on high alert to feeling like we’re wading through mud.

I view this state of depletion as a natural, predictable outcome of long-term stress. The adrenals need a break, and some support, while the entire body heals.

How to Support the Adrenals

1. Start with sleep.

Much of our fatigue, achiness, fuzzyheadedness, and even depression can be explained by the lack of deep sleep that results from the long-term elevation of the stress hormones.

When stress hormones run high, sleep gets wonky. We may fall asleep easily because we’re so tired, but then we wake up between 2 and 4 a.m., ruminating and unable to fall back asleep because our baseline cortisol levels are too high.

If this situation advances to true adrenal fatigue, and cortisol tanks, then we may sleep too much — though it’s not refreshing. Oversleeping disrupts REM and deep-sleep cycles, which further disrupts the rhythm of stress hormones.

Whether you’re wound up or exhausted, your best tool for regaining good sleep is timing. Aim for a regular bedtime and keep the amount of sleep in the seven-to-eight-hour range. This gives hormonal patterns a chance to reset. (See if you’re making any of these 10 common sleep mistakes and discover ideas to overcome them.)

2. Consider supplements.

Several traditional adaptogenic herbs can help support recovery from long-term stress by recalibrating the stress response. These include ashwagandha, an Ayurvedic herb; eleuthero, a relative of ginseng; schisandra; and my favorite, rhodiola.

Helpful nutrients include vitamins such as A, B6, B12, C, and E; minerals such as zinc and selenium; and calming nutraceuticals like L-theanine and phosphatidylserine. Many practitioners recommend licorice root, which can mimic stress hormones, allowing the adrenal glands to take a break.

3. Try essential oils.

Essential oils are a safe, gentle intervention for low energy. Lavender, ylang-ylang, and chamomile — which help calm the nervous system — can be especially supportive when you’re experiencing high stress and your adrenals are in overdrive. In later, more sluggish stages of burnout, I like more energizing oils: bergamot, peppermint, and rosemary. (See “What You Need to Know About Essential Oils” for more.)

4. Be kind to yourself.

If you’ve been driving yourself hard for a long period — or if life has simply presented you with a series of challenges that are too daunting for any one person — remember that exhaustion is not an indication that you did something wrong. It simply means your body needs and deserves a rest. The best thing you can do now is to kindly give yourself a break.

This article originally appeared as “On Deep Fatigue” in the December 2022 issue of Experience Life.

Henry Emmonds
Henry Emmons, MD

Henry Emmons, MD is an integrative psychiatrist and the author of The Chemistry of Joy, The Chemistry of Calm, and Staying Sharp. He is the cofounder of NaturalMentalHealth.com.

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