Adrenal Fatigue: What It Is & How To Fix It
What is adrenal fatigue?
One of the most frequent issues I see in my clinic is chronic stress and fatigue. In fact, patients complaining of fatigue make up more than 20% of all primary care visits and 75-90% of all primary care visits have been reported to be related to stress. (1) (2) What is stress and how does it affect the body? When we think of stress we may think of something negative, such as an emotional stressor or “distress” of some kind, but stress can also be positive like excitement, competitiveness or passion. Negative stress can come from within the body, from food sensitivities or hidden stressors like parasites and fungus. Different types of stressors can impact the body similarly. Our bodies are designed to weather stress and stay balanced primarily with the help of our adrenal glands. The adrenal glands help us respond to both internal and external stressors by releasing an appropriate amount of cortisol, which gives us the energy to get through the stress and then recover to a balanced hormonal state. When any type of stress becomes too great or chronic we start to see a problem with how the adrenal glands are adapting to this stress. This is called hypothalamic-pituitary-adrenal (HPA) Axis dysfunction, more commonly known as “adrenal fatigue.”
What would happen, for example, if you were in the woods and were suddenly confronted by a bear? Your brain would send a message to your adrenal glands to quickly produce more blood sugar and raise your heart rate and blood pressure to help you escape the situation. This is a good thing and what the stress response is designed to do. But, what happens if you’re a mom with three kids, working a full-time job with a long commute, volunteering for the school, eating an inflammatory diet and not getting enough sleep? Your body interprets this kind of stress as the same type that occurs when confronting a bear. Over time, this chronic demand on your stress response system makes it less responsive and sets you up for chronic disease and conditions such as diabetes, heart disease, accelerated aging, and chronic fatigue.
What do our adrenals do?
The adrenal glands are almond-size organs that sit right on top of our kidneys. Even though they are small in size, they pack a big punch and are responsible for many bodily functions. As already mentioned, the main job of the adrenal glands is to provide the body with energy during a stressful time and to maintain resistance to stress. When adrenals are healthy, they release cortisol in appropriate amounts. In addition to energy, a balanced amount of cortisol provides us with the following benefits:
· Promotes burning of body fat
· Maintains mood and emotional stability
· Directs Secretory IgA – the immune response in our gut
· Modulates blood sugar
· Modulates inflammation and allergies
· Helps regulate electrolyte balance, which affects blood pressure and water retention.
What happens when our HPA axis becomes dysfunctional?
The HPA axis can become dysfunctional in two ways, from a stressor and from a circadian rhythm response. When the adrenal response is healthy, we wake up refreshed and have the energy to tackle our projects during the day. We don’t experience energy swings and can sleep soundly at night. We are also less prone to allergies, sickness, female hormone issues like PMS or menopausal symptoms, insulin resistance or depression and anxiety. We have good control of inflammation in the body and don’t store fat around our midsection. When confronted with a stressful situation or crisis, we can rise to the occasion and not feel depleted afterward, as cortisol levels return to normal. If we don’t have a healthy adrenal stress response, cortisol may stay elevated and then, over time, decrease, leaving us feeling “wired but tired” or in an exhausted state all day.
When we are stressed, the brain sends a series of neuro-hormonal signals to the adrenal glands to release cortisol, adrenaline (epinephrine) and nor-adrenaline (norepinephrine). The primary role of cortisol is gluconeogenesis, which just means that it creates glucose (sugar) in the bloodstream for the body to use as energy to survive the crisis. In a healthy response, once the crisis is over, the amount of circulating cortisol then signals the brain, in a feedback loop, to shut off the signal to the adrenal glands that tells them to keep producing more cortisol. With prolonged stress, this signal doesn’t turn off. Cortisol then becomes catabolic and starts to break down every tissue in the body. On the flip side, too little cortisol can disrupt the metabolic processes and also leave us feeling depleted. The bottom line is that too much cortisol or too little can contribute to a variety of symptoms and chronic conditions.
What are some of the problems with imbalanced cortisol levels?
Imbalanced cortisol levels can lead to a great variety of health problems, including:
· Increased anxiety, depression, mood swings and irritability–because, instead of using glucose for fuel, with enough stress the body will start to use amino acids (from protein) which makes amino acids less available to make our brain chemicals or neurotransmitters
· Increased “leaky gut” –because depletion of amino acids in the gut, especially glutamine, breaks down the gut wall lining leaving us more vulnerable to food sensitivities and poor absorption of our food, depletion of vitamins and minerals like magnesium, zinc and carnitine
· Increased insulin resistance and predisposition to pre-diabetes
· Increased fat storage of the excess glucose
· Inhibited vitamin D activity, which prevents calcium absorption, leading to increased breakdown of bones (osteopenia and osteoporosis)
· Altered thyroid function–inhibition of the conversion of thyroid hormone T4 to its active form T3
· Decreased serotonin (feel good neurotransmitter)
· Suppressed immune function leaving us more vulnerable to colds, flu, etc.
· Increased sodium retention- high blood pressure
In addition to an appropriate amount of cortisol secreted throughout the day, a healthy HPA axis should also have an appropriate circadian rhythm. What this means is that the normal release of cortisol should have a certain pattern throughout the day and follow a rhythm that closely mimics the rising and setting of the sun. In the morning, as the sun rises, our cortisol levels should be at its’ highest, which helps us get out of bed. By nighttime, cortisol should be at its’ lowest, which allows our melatonin to rise, and helps us to get a good night’s sleep. Problems with sleeping and waking can happen when this rhythm is disturbed. Very often, I see high cortisol levels at night instead of in the morning, which makes it nearly impossible to get to sleep and stay asleep.
What types of symptoms are common with adrenal fatigue?
If you have adrenal fatigue, you may see some or all of these symptoms;
· Morning exhaustion, even after a good night’s sleep
· Afternoon fatigue after lunch or late afternoon
· “Second wind” late at night
· Lowered immunity, frequent sickness
· Low sex drive
· Need for sugar, carbs, or coffee to combat fatigue
· Decreased stress tolerance
· Salt cravings
· Getting dizzy or lightheaded when you stand up
· Sex hormone imbalance
· Sleep disturbances
· Weight changes
· Salt and sugar cravings
· Anxiousness or nervousness
· Low blood pressure
· Poor recovery time from exercise or travel
· Short term memory issues
What are the causes of adrenal fatigue?
Any type of significant internal or external stressors will affect the adrenal glands and leave us vulnerable to chronic illness and symptoms. The main causes of stress come from:
· Emotional or Physical Stress—emotional stress such as grief, loss, fear, anger, anxiety or physical stress from over-training or from a sedentary lifestyle, surgery or injury
· Dietary Stress—from overeating, food allergies, dieting or eating foods that are causing blood sugar swings
· Hidden Inflammation- from bacteria, parasites, or fungus, as well as from eating inflammatory foods like gluten and dairy.
What are the different stages of adrenal fatigue?
The three stages of adrenal fatigue, or HPA axis dysfunction, were developed by Hans Selye and are known as the General Adaptation Syndrome (GAS). They are:
1. Alarm Reaction
2. Resistance or Adaptation
3. Adrenal Fatigue/insufficiency
The Alarm Reaction, or Stage 1, is where one might feel “wired but tired.” You feel exhausted but just can’t sleep. Here, cortisol is elevated and DHEA may be normal or low. As cortisol stays elevated, this leaves you in a constant “fight or flight” mode. In this stage, there will be an increase in heart rate, blood pressure, and blood sugar. Your body is in a high stress response state, so things not necessary for survival, such as digestion and reproduction, will take a back seat. This is why people with fertility problems may need to look upstream, so to speak, at what else may be inhibiting their reproductive process. When blood sugar remains high, to give us the energy to survive, it can lead to insulin resistance, pre-diabetes or resistant weight loss.
If stage 1 is left unchecked, it can progress to stage 2, or the Adaptation Stage. There is increased cortisol in circulation from stage 1, and the brain senses this, so it begins to slow down the production of cortisol. Testing may show normal or decreased cortisol levels, while DHEA continues to drop. Symptoms in this stage may include fatigue, weight change, increased allergies, low blood pressure, sleep disruptions, salt and sugar cravings, anxiousness or nervousness. This can happen to people of all ages, from children to elderly people.
As Stage 2 continues, the adrenals eventually become exhausted, leading to Stage 3, where there will be low cortisol and DHEA throughout the day. In this stage, people feel exhausted all day long and have great difficulty getting up in the morning. Short-term memory is affected and there is a longer recover time from exercise or travel. Caffeine, sugar, and snacks are often used more frequently to boost energy, which only stresses the adrenals more.
To be clear, HPA axis dysfunction is not a disease but a problem with the communication system from the brain to the adrenal glands going awry. In contrast, Addison’s disease results from a loss of both cortisol and aldosterone secretion due to the near total or total destruction of both adrenal glands. With Addison’s disease, there are symptoms associated with adrenal fatigue but they are much more severe and require hospitalization. It is believed that Addison’s disease is primarily an autoimmune condition, and it is diagnosed with a blood test to check for anti-adrenal antibodies as well as elevations in the adreno-corticotropin-releasing hormone (ACTH). Conversely, Cushing’s disease is a rare condition caused by an excess amount of cortisol being produced in the body. Some of the symptoms of Cushing’s disease include weight gain, high blood pressure, muscle weakness and changes in mood and concentration.
How do we test for adrenal fatigue?
Adrenal hormones can be tested through either saliva or urine testing. Both saliva and urine measure the “free” or available hormones of cortisol throughout the day. Urine testing can also measure the metabolized or total amount of cortisol being produced by the adrenal glands. Here, we are measuring adrenal gland function, not disease.
Treatment for adrenal fatigue
How long does it take to recover from adrenal fatigue?
Full recovery from HPA Dysfunction or adrenal fatigue can take anywhere from three months to two years, depending on the severity and how long the condition has existed. Your adrenals are stressed the most by emotional stress, followed by diet, and, finally, by the hidden stressors I listed earlier. Treatment is targeted at removing or decreasing the stressors—emotional, physical, nutritional or hidden—and then correcting the hormonal imbalance and nutritional deficiencies.
What to address first?
From a lifestyle standpoint, one needs to address the emotional stressors first in order to really flip the switch and start the healing process. Life stressors need to be evaluated and a strategic plan developed to mitigate them. What is causing the most stress in your life and how can you get support here? For some, that may mean a job change, a leave of absence, or a separation from a destructive relationship. Emotional support through counseling or therapy may be helpful as well as techniques to decrease stress, such as mindfulness meditation, yoga, Heart Math, acupuncture, massage and/or exercise appropriate for your stage of adrenal fatigue.
Getting more and better sleep
It is important to be in bed by 10:00 P.M. or earlier. Consistent sleep each day, ideally between 10 P.M. and 6 A.M., matches our natural circadian rhythm. Physical repair and regeneration takes place during this time. Try to get as close to that as possible. The quality of sleep between 2A.M. and 10 A.M. is not the same! Set fixed times for sleep, even on weekends, and resist the urge to sleep in. Don’t set yourself up for a Monday morning sleep hangover.
Nutrition- blood sugar balance is key
Regarding nutrition, one of the biggest stressors on the adrenal system is blood sugar imbalance. When we eat sugar or foods that turn into sugar—such as baked goods, grains, alcohol and high sugar fruit—it causes stress on the adrenals by demanding that it produce more cortisol. In addition, skipping meals may also cause blood sugar swings, as cortisol has to kick in to create more glucose for energy in the bloodstream. In the healing phase, it’s best to eat on a regular schedule, every 3-4 hours, and always include a healthy fat, fiber, and protein at every meal or snack. This will help keep blood sugar levels steady and the body’s alarm system turned off.
Other big nutritional stressors include caffeine and food allergies or sensitivities, such as those to gluten and dairy. Both ingesting caffeine and eating foods that you are sensitive to will increase adrenalin, making it difficult for the body to rest. Alcohol causes blood sugar swings and can be an additional stressor on your liver, which typically doesn’t function as well with adrenal fatigue. These foods need to be taken out, at least for a period of time, to give your system time to balance and heal.
Look for hidden stressors
Finally, hidden stressors, such as a parasite, intestinal bacterial overgrowth, fungal growth or chronic inflammation and pain can further stress the adrenals, weakening the system. A stool test can usually find parasites, pathogenic bacteria or overgrowth. Chronic inflammation can be seen by looking at C-reactive protein (CRP) levels on a blood test.
Herbal, hormonal and supplemental support
Adaptogenic herbs, hormones and/or supplements can also be used to balance cortisol levels. Adaptogenic herbs help the body to adapt to stress and return to a normal state. These adaptogens can help tone down an overactive system and boost an underactive one, thus normalizing the HPA axis, which is why they are often used first in an adrenal program.
Common Adaptogenic herbs include: ashwaghanda, rhodiola, licorice root extract, maca, ginseng, eleuthero, reishi mushroom and astragalus.
If herbal support is not enough, then pregnenolone and DHEA can be used. Pregnenolone is the hormone that is a precursor to cortisol and is used to boost cortisol when it is depleted. DHEA is sometimes used together with pregnenolone when DHEA is depleted.
The adrenal glands contain one of the highest concentrations of Vitamin C in the body. Vitamin C, along with vitamin B5, also helps to make adrenal hormones, including cortisol, so both of these are necessary supplements to assist in healing the adrenal glands.
In conclusion, adrenal fatigue may be the underlying cause of many symptoms, including chronic fatigue. However, it is not often acknowledged or treated in the allopathic model of care. HPA axis dysfunction can affect many bodily functions and systems, including metabolism, thyroid, bone, gut and immune health, to name a few. Balanced adrenals are critical to feeling energetic and being able to maintain a healthy weight and steady mood. Treatments to support adrenal fatigue involve working with many lifestyle changes, but especially stress and sleep management while addressing nutrition and diet. Adaptogens, hormones and supplements may be necessary to assist in the healing process.
1. Ambulatory Care Use and Physician Visits. www.cdc.gov/nchs/fastats/docvisit.htm. Accessed July 6, 2016.
2. America's #1 Health Problem. http://www.stress.org/americas-1-health-problem/. Accessed July 6, 2016.