If you think you may have adrenal fatigue, it’s important to know which of the adrenal fatigue stages you are in because the treatment options will vary from state to stage. First of all, adrenal fatigue staging is done after a doctor - usually a naturopathic doctor does a saliva test called an adrenal stress index. This test will show you your cortisol levels during 4 times of the day - morning, around noon, later afternoon, and nighttime. It should also test your DHEA levels, DHEA is another hormone produced by the adrenals. Blood cortisol and DHEA levels cannot be used to assess which of the 3 adrenal fatigue stages you are in.
Stage 1 Adrenal Fatigue: Stimulation
We call this stage the stimulation stage. Stage 1 of adrenal fatigue is the one people are least likely to seek help for because they usually don’t feel too bad. In this stage people sometimes describe feeling alert and energized. It often comes about during and after a time of stress or anxiety.
Imagine the feeling of anticipating a big event the following day - you aren’t very hungry, you can’t sleep well, your mind is racing, your body is tense, you might feel excited or anxious. These feelings come from elevated epinephrine or adrenaline and elevated cortisol. But instead of having those feelings come and go quickly after the event has passed, Stage 1 adrenal fatigue sufferers may feel like this for many months at a time.
Eventually, the adrenals will tire of creating excess adrenaline and cortisol for so long and will be unable to sustain this production. That leads us to stage 2.
Stage 2 Adrenal Fatigue: Depletion
The hallmark of stage 2 is a feeling of depletion. The adrenaline and cortisol that was acting as a potent fuel in Stage 1 will now be produced in fits and spurts. So in this stage people will have periods of higher anxiety alternating with periods of fatigue. Or they may feel bursts of energy during a few hours of the day and then crash in the afternoons. Energy levels and moods will be very inconsistent so cravings for caffeine and sugar will be intense. I often find patients in this state will feel that need coffee in the mornings and wine at night. It’s hard for them to wake up and also hard to wind down.
Since DHEA levels are also starting to get depleted, symptoms of sex hormone imbalance may also start to show up. Sex hormones are estrogen, progesterone, and testosterone. That leads us to stage 3.
Stage 3 Adrenal Fatigue: Burnout
Stage 3 is when the adrenals are out of fuel. Adrenaline, Cortisol, and DHEA levels will all be low. Most people in this stage will feel fatigued most of the day and will have a generally flat affect. Everything feels hard. Coffee and sugar may still produce a little energy, but not as much as they once did. The low adrenal hormone levels can contribute to things like PMS, infertility, menopausal challenges, low thyroid, and poor digestion. It probably comes as no surprise that stage 3 is often when people seek support because they simply cannot function as they once did.
So there you have it. Those are the 3 adrenal fatigue stages. You may be able to tell based on your symptoms which stage you are in but I still highly recommend that you get tested so you can start your road to recovery with the most targeted protocol possible. It is easier to recover from stages 1 and 2, but even stage 3 adrenal fatigue is reversible.
As I mentioned earlier, the course of treatment will depend on the stage of adrenal fatigue you are in.
We made you a great cheatsheet resource! It will provide clarity on the different stages of adrenal fatigue and the types of supplemental treatment that is appropriate for each stage. Did you know that supplementing the wrong type of natural compound at the wrong stage of adrenal fatigue can actually lead to more burnout? You definitely want to avoid this. Learn the in's and out's on supplementing for your stage by clicking the image below.