DR. ROLLINS: Why am I so tired & fatigued? | PostIndependent.com

DR. ROLLINS: Why am I so tired & fatigued?

Scott Rollins
Free Press Health Columnist
Sleepy Businessman
Getty Images/Fuse | Fuse

In today’s complex world it seems we are always “fighting tigers” or “running from bears” and our adrenal gland is paying the price. A poor diet with too much sugar, starch, and caffeine will make matters worse. Add poor sleep to the mix and our recipe for adrenal fatigue is complete!

The adrenal glands make our stress hormones. They are located on top of our kidneys and when we are stressed they pump out our “fight-or-flight” hormones. If we had to march for days without food and water, it is the adrenal gland that would keep us going. Normally, the adrenal gland comes into play during a time of stress, such as a mentally challenging time where we need extreme attention, in a fight, during infection or surgery, with sleep deprivation, or similar situations that stress our body.

With “adrenal fatigue” we are mostly referring to cortisol, which is a steroid hormone that helps raise our blood sugar, regulate our immune system, control inflammation, affect the tone of the heart and blood vessels, and stimulate the brain. It plays a very important role in energy production and many people with chronic fatigue are low in their production of cortisol.

The response to chronic stress — first defined as occurring in three stages by Hans Selye as alarm, resistance and exhaustion — typically results in abnormal adrenal function and adrenal fatigue, as well as abnormal cognitive, metabolic, energy, endurance, immune and glycemic function.


People with low cortisol often complain of fatigue. They frequently have a really hard time getting going in the morning and feel tired even though they slept plenty of hours. They might complain of being overwhelmed with everyday chores and even enjoyable activities feel like a burden. Sometimes depression and low sex drive are symptoms of adrenal fatigue. Inability to handle stress is a common feature. They sometimes are prone to low blood sugar, getting weak, shaky, sweaty and light-headed if they go without eating for long. Or they might be prone to light-headed spells reflecting low blood pressure. Some people are prone to frequent infections or prolonged time to recovery.

Addison’s disease is the conventional medical syndrome of low cortisol, in which people produce no cortisol at all. Without cortisol replacement they will die. Adrenal fatigue refers to people that can make enough cortisol to sustain life, but not nearly the optimal amount to promote health and wellness.

Cortisol is a diurnal (daytime) hormone, meaning it has wide swings in the levels from day to night. It is normally at its peak within 30-60 minutes after awakening in the morning, and then drops to a lower level throughout the day. Stress, and things like eating, will cause an increase in the cortisol level.

We often see patients complaining of daytime fatigue combined with insomnia. We call this “wired but tired.” These patients usually have low cortisol in the day with a spike toward evening — which is the reverse of the normal pattern. In many of these cases, the nocturnal (night) hormone melatonin is also reversed, being low during the middle of the night when it is supposed to be at its peak


Standard testing might include giving an IV infusion of the pituitary hormone that normally stimulates more cortisol production (ACTH), then measuring to see if cortisol doubles or triples in the bloodstream. This is called an ACTH stimulation test. Another method is to measure cortisol in a 24-hour urine collection as a means to quantify the amount made over time.

We often recommend a salivary cortisol test in which the patient simply collects saliva at different times during the day, such as 8 a.m., noon, 4 and 8 p.m. In this manner we can see what the cortisol level is doing throughout the day and it is very convenient for patients. It also minimizes the possibility of stress causing a sort of false elevation in cortisol beyond what we think is a baseline — driving to the lab and getting poked with a needle will normally raise cortisol!

Adrenal fatigue is a controversial area in medicine. Not all physicians will recognize the diagnosis and the standard tests for cortisol might miss adrenal fatigue. Since cortisol normally varies so much through the day it is important to check the level at different times.


Treating adrenal fatigue involves lifestyle modifications that include improving diet, exercise, and stress management. We usually suggest acupuncture and relaxing activities such as meditation, yoga or tai chi. I recommend all my patients undergoing treatment read “Adrenal Fatigue” by Dr James Wilson. It is well written and covers the topic thoroughly, especially the lifestyle issues.

The supplements used for adrenal fatigue are designed to support, fortify and restore adrenal function, and fall into three basic categories:

• Glandular extracts, which are taken from adrenal gland tissue with the actual hormones taken out, providing the nucleic acids, proteins and building blocks for cortisol production

• Herbal extracts with adaptogenic properties designed to support healthy, balanced adrenal gland function

• Vitamins designed to enhance energy production and adrenal function

In severe cases we will add cortisol hormone in physiologic doses. In time, the cortisol can usually be weaned off of as the adrenal gland recovers. Sometimes patients need cortisol forever as the adrenal gland is not capable of recovery.

If you suffer from chronic fatigue, take heart for there is hope. Adrenal fatigue is only one of many common reasons to feel so tired and a thorough functional medicine evaluation will usually lead to a cure.

Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 970-245-6911 for appointments or more information.

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