Understanding Adrenal Fatigue

If you struggle with chronic stress, whether it is chronic emotional, mental stress or physical stress, or toxic overload or gut imbalances, you may be on your path to adrenal dysfunction. Unfortunately, I’ve just covered most people with those categories. If you’re one to feel wired but tired, or just plain exhausted day-in and day-out, then you may want to keep reading.

What is adrenal fatigue?

Adrenal fatigue stems from overworked adrenal glands due to a hyperactive stress response. As I’ve mentioned before in previous blog posts, the stress response is a great system when your life is in danger, but with today’s current lifestyle the stress response gets triggered multiple times a day (i.e. when stuck in traffic, work stress, a deadline, cramming too many things into a day, fight with a friend, etc.), leading to a hyperactive stress response that never gets back to baseline (where you can properly rest and digest).

This hyperactive stress response is common in fibromyalgia, chronic fatigue, as well as with many other autoimmune conditions (like Hashimoto’s for example). This response causes the adrenal glands to work hard all the time and the continual bombardment of stress on the adrenals forces them to try to pump out cortisol at a high rate, continuously. The adrenals never get a res period until they “burn out”. This also leads to secretion of cortisol in abnormal patterns (and we will talk about cortisol below).

With chronic stress, foot triggers, blood sugar imbalances, nutritional insufficiencies, gut imbalances, toxic overload, immune disruptions and stealth infections, inflammation often results. Unfortunately, inflammation also alters the adrenal response, causing low cortisol secretion and DHEA-sulfate secretion (these are the two main adrenal hormones). This inflammatory-based alteration in the adrenals is often shown in patients with chronic inflammatory diseases. 

To better understand adrenal fatigue, let’s dive into the process of the stress response

Stress places the demands on the body which is then primarily met by the activation of 2 systems, causing the “stress response” – the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. The SNS oversees secreting the catecholamines norepinephrine and epinephrine, which have a stimulating effect on the body. This is when your heart rate increases, blood pressure increases, pupils dilate, you experience poor digestion, etc. The HPA axis oversees secreting the major hormone cortisol. Stress is a central player in functional alterations of the hypothalamic-pituitary-adrenal-thyroid-gonadal axis, and when under stress, we often make poor food choices, which furthers any hormonal and nutritional imbalances (whether it is where you’re not eating enough or eat too much). The constant demand of our adrenals also leads to changes within the thyroid as well, but that will be for a later topic.

What does cortisol do in the body?

Cortisol has many functions within the body, including:

• Stimulates the liver to convert amino acids to glucose (under stress, the body wants/needs glucose to help fight)

• Stimulates increased glycogen in the liver

• Mobilizes fatty acids into the blood

• Increases coagulation

• Suppresses parts of the inflammatory response

• Prevents the loss of sodium in urine

• Maintains resistance to stress

• Maintains mood and emotional stability

• Increases alertness/wake time so you have the energy for the day

• More

What are DHEA and DHEA-S? What are their functions?

Dehydroepiandrosterone (DHEA) and Dehydroepiandrosterone Sulfate are steroid hormones mainly made in the adrenal cortex. DHEAS is the most abundant steroid in humans and serves primarily as a precursor molecule that is circulated to peripheral tissues throughout the body. DHEA and DHEAS are also synthesized directly in the nervous system, where they appear to help:

• Protect against harmful agents, like viral, bacterial, and parasitic infections

• Build muscle mass and healthy bone

• Promote hormone production (DHEA is a precursor for estrogen and testosterone)

• Keep body fat low

• Lower “bad” cholesterol

• Counteract the harmful effects of prolonged cortisol exposure (like immune suppression)

• Aid in the conversion of T4 to T3 for thyroid

So, what happens to the adrenal glands during these stressful times?

There are 3 stages, also known as Selye’s general adaptation syndrome.

STAGE 1 – AROUSAL

During this stage, both cortisol and DHEA increase with episodic stress, but recovery occurs and the person can get back to baseline levels. This is a stage we want to be in – where we can recover from stress quickly and have optimal levels of cortisol and DHEA.

STAGE 2 – ADAPTATION

During stage 2, cortisol becomes chronically elevated, but DHEA declines as not enough can be made to keep up with the demand. This is when people start to feel “stressed and wired” and may experience anxiety attacks, mood swings, and depression. There is an increase in cortisol, epinephrine, and norepinephrine. Alterations in glucose tolerance, blood pressure, thyroid, and sex hormone metabolism and more can occur. An increase in cortisol may decrease the manufacture and activity of progesterone, estrogens, DHEA, and testosterone, leading to what is deemed as the “cortisol steal”. At this stage you feel like you’re going pedal to the metal and your foot is pressing down on the accelerator and you can’t seem to stop.

Conditions associated with HPA axis arousal and elevated cortisol

• Severe chronic disease

• Melancholic depression

• Anorexia nervosa

• Panic disorders

• OCD

• Chronic excessive exercise

• Memory impairment

• Malnutrition

• Type 2 diabetes

• Hypothyroid (hashimoto’s thyroiditis)

• Central obesity

• Osteoporosis

• Immune suppression

• GI dysfunction

• PCOS, endometriosis, and infertility

Symptoms of elevated cortisol

• Irritability/anxiety or…fatigue/low energy

• Night sweats/muscular tremors

• Poor sleep/sleep disturbance/hot flashes

• Increased susceptibility to infection (cortisol effect on immune suppression)

• Shakiness between meals/sugar cravings (cortisol and blood sugar connection)

• Weight gain around the middle

• Afternoon fatigue, caffeine cravings and sugar cravings at about 3-4pm

• Allergies, food reactions, hives

• Cravings for salty or fatty foods or carbs (starches, baked goods)

• Brain fog

• Difficulty sticking with a diet or exercise plan, trouble with “willpower”

• Digestive problems

• Eczema

• Fatigue after eating

• Chronic overwhelm

• Hormone problems of any type, including PMS, infertility, endometriosis, PCOS, bothersome menopausal symptoms

• Insomnia

• Low sex drive

• Stubborn weight, being overweight or difficulty gaining weight

• Waking up tired even if you’ve slept all night

STAGE 3 – EXHAUSTION

At this point in time, your adrenals are burnt out to the point that BOTH your cortisol and DHEA levels are now chronically low and you’re now “stressed and tired” not “stressed and wired”. Depression often pops up along with the feelings of major fatigue.

Conditions associated with depressed HPA axis and depressed cortisol

• Atypical depression

• Seasonal affective disorder (SAD)

• Postpartum depression

• Panic attacks/generalized anxiety disorder

• Bipolar II disorder

• PTSD

• CFIDS (Chronic fatigue Immune Dysfunction Syndrome)

• Fibromyalgia

• Autoimmune disease

Symptoms of depressed cortisol

• Fatigue, apathy, unmotivated

• Absent-minded/poor concentration

• Increased sleep but poor quality

• Increased susceptibility to inflammation and allergies (not infections)

• Depression, worse in evening

• Early onset perimenopause or menopause

• Muscle pains

• Hypoglycemia: dizzy, irritable, or sleep if going without food for 4-5 hours; symptoms relieved by food

• Frequent colds, bronchitis, sinus infections, UTIs or yeast infections, cold sores, or herpes outbreaks

• Increased aches, pain, inflammation

• Low blood pressure

• No appetite in the morning

• Slow recovery from illness

• Sugar and carb cravings

• Tendency to feel better or have more energy toward evening

• Decreased concentration and memory

• Excessive need for caffeine

• Fatigue, exhaustion, fatigue upon waking

• Increased fear and apprehension

• Loss of ambition, low motivation

• Low sex drive

• Scattered thinking

• Short fuse, irritability

So, what can you do to recover from adrenal fatigue? Let’s get to that…

Nutrition and lifestyle strategies for adrenal fatigue

There are several potential root causes for adrenal fatigue and each person will have a different root cause, so it’s important to work with a practitioner who can tailor a treatment strategy to your individual needs. However, here are some common implementations in general.

OVERALL DIETARY APPROACHES

• Follow a low glycemic load diet that utilizes foods with a low glycemic impact

  • This can be through a modified Mediterranean approach

  • It helps balance blood sugar (which will help avoid any extra inflammation in the body)

  • Includes foods that are higher in fiber and low in simple sugars

  • This dietary pattern incorporates quality fats in balance

  • Includes phytonutrient-packed foods (eat the colors of the rainbow with your produce selection)

• Consider an elimination diet – this helps you figure out any food triggers that may be leading to inflammation in your body

• Avoid foods that testing shows are “sensitive” foods (like the MRT/LEAP test that I offer clients)

• Avoid refined carbs and eating carbs “naked”

  • Go for whole grain, complex carbohydrates and make sure you consume them with quality protein and fats (nuts, seeds, high-quality oils) at all meals

• Do not allow your blood sugar to dip low – this puts a strain on the adrenal glands

  • Make sure you have a moderate carb diet (up to 50% of total calories) and make them complex carbs from whole foods only

  • Eat regularly (every 3-4 hours)

  • Avoid intermittent fasting or going long periods of time without eating

  • Consume higher protein in the morning and high carbs at your evening meal

• Limit/avoid stimulants like caffeine, refined carbs (sugar, flour, bread, fruit juice), chocolate, processed foods in general

• Get in plenty of salt that’s not from processed or packaged foods

ADDRESS ANY NUTRITIONAL INSUFFICIENCES

Some big nutrient players that are crucial to have sufficient levels of for optimal adrenal function include:

• Vitamin C – needed in organs that synthesize catecholamines, including the brain and adrenal glands

  • Food sources: parsley, kiwi, tomatoes, cantaloup, guava, papaya, strawberries, red peppers, sweet yellow peppers, white potatoes, rose hips, acerola cherries, chili peppers, blackcurrants, citrus fruits, cruciferous vegetables (caution with hypothyroidism)

• Essential fatty acids (omega-3 and omega-6; balanced ratio) – a deficiency is linked to low plasma cortisol

  • Food sources: nuts and seeds, avocados, whole grains, fatty fish, eggs, olives and olive oil, coconut oil, omega-3 supplements, Brussels sprouts and broccoli, grass-fed meats, grass-fed butter, ghee

• Zinc – low levels are seen with stress

  • Food sources: oysters, lamb, pumpkin seeds, hemp seeds, grass-fed beef, chicken, chickpeas, lentils, cocoa powder, cashews, almonds, kefir or yogurt, mushrooms, spinach, avocado, eggs

• Pantothenic acid (B5) – deficiency causes impaired adrenocortical function and abnormal stress response

  • Food sources: mushrooms, liver, endive, wild Atlantic salmon, bluefin tuna, peanuts, sunflower seeds, guava, wheat germ, potatoes, lobster, avocado, lentils, whey protein, camembert cheese, eggs, sun dried tomatoes, cauliflower

• Magnesium – deficiency causes elevated HPA set-point and stress increases the need for magnesium

  • Food sources: nuts and seeds, legumes, fiber-rich whole grains, greens, avocados, bananas, papaya, blackberries, green peas, sweet corn, potatoes, dark chocolate, mackerel

• Supplements may be necessary for some individual to replete nutrient levels or lower cortisol – this varies based on the individual. Sometimes glandulars are used after test results confirm low cortisol.

ADAPTOGENS

These are botanicals that normalize function and improve the response of an organism to stress. Different adaptogenic herbs may be more appropriate in specific hyper or hypo-cortisol situations. Overall, adaptogens appear to have a balancing effect on the HPA axis through various mechanisms.

GENERAL LIFESTYLE TIPS

• Get in exercise

  • Move the body, but not too strenuous/don’t overexert – this puts too much stress on the adrenal glands and can increase cortisol secretion (which we want to avoid)

• Make sure to have adequate rest

  • Sleep 7-10 hours a night and practice good sleep hygiene

  • Implement relaxation and downtime during your day

  • Include laughter and play into your day

• Relaxation is key

  • Add deep breathing, meditation, yoga, journaling, etc. into your day

  • Take many breaks through the day to tell the body that it is safe and the stress mode can be shut off

  • Utilize other stress management techniques like Qi-gong, tai-chi, and therapy

• Get fresh air and sunlight each day

OTHER CONSIDERATIONS

There are many potential root causes to adrenal fatigue and it is important to address other factors that may be at play. If you only supplement and work at supporting the adrenals without correcting other areas that may be out of balance, then you aren’t doing your body any favors and it will be difficult to truly correct adrenal fatigue.

Your gut microbiome is one area of consideration. If it is unbalanced, if there is inflammation, and/or leaky gut is present, it puts a ton of strain on the adrenals. Any efforts to heal the adrenals will be countered by the continual stress from the gut.

There may be other hormonal problems. Hormones pull from one another, and it is necessary to balance the other hormones (thyroid and sex hormones) as part of the protocol of healing. Hormone replacement may be necessary for some.

Be patient. It takes time and chances are, you will begin to feel better, overdo it, and then set yourself back. Make sure that you go slow and allow your body to truly recover.

In conclusion

With the current standards in society, chronic stress is a common problem for many. If it isn’t, there are still other factors that become stressors to the body (toxic load, illness, imbalanced gut microbiome, etc.). Over time, these stressors put a strain on our adrenals and can ultimately lead to burnout along with various symptoms and conditions.

If you are someone who struggles with chronic stress, or believe that you may have adrenal fatigue, make sure to get in touch with a practitioner who can help you recover in a way that addresses your underlying root cause(s). As a Integrative and Functional Nutrition Certified Practitioner and Registered Dietitian Nutritionist, I can help you get to the root cause of your adrenal dysfunction so that you can get on the road to healing and feeling your best. Schedule a discovery call today to learn more and get started. Click here to book a discovery call.