Why Am I So Tired?

By Dr. Frank Aieta, N.D.

“Why am I so tired?” This is a question I hear almost daily in my practice from patients. Fatigue is probably the number one complaint amongst most new patients that I see. Almost all of these patients will present with the same complaint, “Doc, no matter how much sleep I get at night I still feel tired in the morning.” Or “the worst time of the day for me is around 2 or 3 in the afternoon, I could just fall asleep right on my desk.” Accompanying this fatigue in most of these patients is a lack of motivation and depression; they have no energy to do anything and many rely heavily on caffeine or other stimulants just to make it through the day. Many of these patients have been to numerous doctors with the most common answer being, “Oh, you must be depressed, take this antidepressant and you’ll feel fine.” Some patients may present to my office already on an antidepressant, feeling even more tired. If they are not depressed than what is wrong with these people? Most of these patients are suffering from a condition called adrenal insufficiency (low adrenal function). This condition is rarely recognized by conventional medical doctors because it can have numerous causes and is diagnosed mainly through the patient’s signs and symptoms and not by any specific test. Also the treatment is not through the use of drugs or surgery but is best treated with a change of diet, lifestyle and through the use of nutritional supplements and herbs. To understand this condition we must first discuss what the adrenal glands are and their function in the body.

The adrenals are small glands that sit on top of the kidneys and their role in the body is very important. These powerful little glands manufacture and secrete steroid hormones such as cortisol, estrogen and testosterone that are essential to your health and vitality. They not only significantly affect the functioning of every tissue, organ and gland in your body; they also have important effects on the way you think and feel. Actually, without the hormones the adrenals produce you would die. Adrenal insufficiency is produced when your adrenal glands cannot adequately meet the demands of stress. The adrenal glands enable your body to respond to every kind of stress (whether it’s physical, emotional or psychological) through these hormones that regulate energy production and storage, heart rate, blood sugar balance, muscle tone, and other processes that enable you to cope with the stress. Stress can come in the form of an emotional crisis such as the death of a loved one, a physical crisis such as major surgery, or any type of severe repeated or constant stress in your life, your adrenals have to respond. If they don’t, or if their response is weak, you will experience some degree of adrenal insufficiency and fatigue.

In adrenal insufficiency, your adrenal glands function, but not enough to maintain your normal, healthy homeostasis. Their output of hormones has been diminished by over-stimulation. This over- stimulation can be caused either by a very intense single stress or by chronic or repeated stresses that have a cumulative effect. When a person’s adrenal glands have a low reserve, they are unable to make adequate amounts of a key stress hormone called cortisol. In consequence, people with low adrenal output and reserve tend to be tired and depressed, are more susceptible to colds, flu and other infections, tend to have prolonged infections, and are much more vulnerable to allergies and arthritis among other things. Many of the patients that I see with low adrenal function tell me that they are prone to bouts of anxiety, nervousness, temper flare-ups and can even get panic attacks. The reason for this is that adrenal hormone is necessary to maintain adequate blood sugar. In people with low adrenal reserve, blood sugar drops quickly during stress because there is not enough cortisol to maintain it. To rescue the body from death the body pumps adrenaline, this can raise blood sugar but can also cause acute or severe anxiety. I also find that most patients will turn to sugary snacks for a quick burst of energy but later end up feeling extremely tired but nervous and jittery at the same time as their blood sugar drops. Traditional doctors may treat these symptoms with anti-anxiety medications, which leave the patient feeling even more lethargic.

If this sounds like you or someone you know you’re probably dying to find out how to treat this condition. Unfortunately there is no magic pill that can correct this problem but instead many different things must be done in order to treat it. The treatment consists mainly of diet and lifestyles changes as well as the use of natural herbs and nutrients. The first step in treating adrenal fatigue is to establish a normal routine. Our adrenal hormones are secreted on a 24 hour pattern called a circadian rhythm so routine is a crucial part of treatment. When I say routine I am talking about eating at the same time, waking at the same time, going to bed at the same time and sleeping 8 hours or more at night. Also eliminating unnecessary stressors from our daily life is also important. Skipping meals, going a long time without eating or not eating enough, is an enormous stress on the body. Consuming certain types of foods can also be stressful to our systems. With each patient I will identify any food allergens or intolerances and remove them from their diet. It is also important to consume protein at each meal and really limit sugar and refined carbohydrates, causing blood sugar to fluctuate putting additional stress on already weak adrenal glands. Exercise is also a very important part of stress reduction. I typically recommend more calming exercises for people suffering from low adrenal function like Tai Chi, Yoga, or even walking. Over exercising can further worsen a person’s condition so I tell my patients to stop well before they are tired and slowly work up to more intense exercise as they gain more energy. Some of the best nutrients for the adrenal glands are b-vitamins, specifically one called pantothenic acid, vitamin C, zinc, and magnesium. I also use many different herbs called adaptogens to help rebuild and support the adrenal glands and help the body deal with stress more efficiently. My favorites are licorice root and various types of ginsengs, to name a few. In patients with more severe adrenal insufficiency I may use natural cortisol replacement therapy for a short period of time in addition to the vitamins and herbs to help speed up the process and give patient enough energy to get motivated to do some of the diet and lifestyle changes.

Most Naturopathic physicians are well trained in treating this type of disorder using the methods I have outlined above, so there are doctors out there that can help.

A good place to find a Naturopathic physician in your area is to visit the website: www.naturopathic.org and put your zip code into the “Looking for a Naturopathic Physician?” search engine.