Welcome to Don’t Let Adrenal Fatigue Impact Your Life. The term “adrenal fatigue” was formulated in 1998 by a naturopathic doctor by the name of James Wilson. This syndrome was explained as a collection of related symptoms caused by insufficient adrenal gland function. In other words, when the adrenal glands operate inadequately, complications arise, and adrenal fatigue syndrome can develop. Usually the onset of adrenal fatigue is attributed to either prolonged stress, chronic infections, hormonal imbalances, immune responses, and/or metabolic changes. Those suffering may not present any physical signs of pathologic illness but will still feel generally fatigued, have trouble cognitively with brain fog, and experience strong food cravings. Sleep does not solve this exhaustion, so it is common to see increase in the intake of coffee, sugar, and other stimulants to sustain energy throughout the day. Unfortunately, these habits are counterproductive to adrenal fatigue.
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Don’t Let Adrenal Fatigue Impact Your Life
Now I will be going over more detail on how these habits affect this complicated phenomenon throughout this presentation. But first, what do the adrenal glands even do? The adrenal glands are two glands located above the kidneys and are made of two different parts. Both are responsible for hormone production but differ greatly. The first part is called the adrenal cortex. The adrenal cortex produces hormones such as cortisol and something called aldosterone that are central for life. Cortisol works to regulate our metabolism, our immune system, and stress response. Aldosterone helps control blood pressure and proper cardiovascular function. The second part, called the adrenal medulla, produces what are called non-essential hormones, or ones that are not vital for life. This does not mean that this component of the adrenals is not important however. The adrenal medulla is incredibly valuable for dealing with physical and emotional stress and contributes to the fight or flight response of our parasympathetic nervous system. The most notable chemical messenger produced in this part of the adrenal is called adrenaline. The adrenal glands also produce the sex hormones estrogen and progesterone, as well as various neurotransmitters such as dopamine. When the proper production of these hormones is disrupted, adrenal fatigue can develop.
Let’s talk about the symptoms of adrenal fatigue. Because of the multitude of responsibilities these little glands have, adrenal fatigue can manifest very differently depending on each and every individual. Some signs of adrenal insufficiency, dysfunction, and fatigue include:
- Persistent and non-specific fatigue
- Struggle waking up in the morning
- Imbalanced energy levels throughout the day
- Difficulty handling stress
- Food cravings (particularly salt)
- Weakened immune system (frequent infections or allergies)
- Unexplained body aches and joint pain
- Depression and anxiety
- Dark circles under the eyes
- Impaired recovery after physical activity
- Low blood pressure
- Poor circulation and numbness
- Light-headedness or dizziness
- Weight gain and fluid retention
- Decreased libido
If you are dealing with a number of these symptoms, this talk may give insight into why, and you may want to do the testing for adrenal function that I will be discussing during this presentation.
Contrary to popular belief, stress hormones such as cortisol and adrenaline are a good thing! When released appropriately they provide mental clarity, physical strength, and overall brain and muscle efficiency. Have you ever heard of the term “adrenaline rush?” This term refers to your body appropriately responding to stress by activating its fight or flight mechanism. This can be used to propel you out of danger, help someone in a pressing situation, or conquer a fearful situation. However, when your body unloads adrenaline when you are not in a tasking situation and you feel a sudden adrenaline rush like heat that runs through your body when you’re just sitting at your desk working at the computer, then that is your body showing you that it’s using its stress hormones incorrectly. On the other hand, chronic stress that is constant and unrelenting suppresses adrenal functional. As the adrenal glands become unable to continue producing cortisol needed to recover. Stress can be caused by a number of things such as:
- Unresolved biomedical dysfunction such as infections, hormonal balances, or chronic illness
- A poor nutritional diet
- Lack of sleep
- Stimulants such as caffeine or energy drinks
- Work/life imbalance
- Over-training physically (people who are addicted to exercise and are over-exercising could be affecting their adrenal glands in a negative way)
- Emotional or physical trauma
The body’s response to stress includes a surge of cortisol, a boost of energy, an increase in blood sugar, slowed immune response, and the breakdown of stored protein and carbohydrates. As you can tell, in an emergency this is a good thing because it keeps us going and able to handle the stress of the difficult situation. But when this does not stop, and we never go into a rest or digest mode then the system can wear out – blood sugar remains too high and insulin does not function normally, we cannot build muscle well, and our immune system cannot protect us optimally and we get sick more often. So, the rise and inevitable drop in stress hormones impact the thyroid by slowing thyroid production and disrupting the conversion of thyroid hormones to their active and usable forms. If the thyroid does not operate properly, then many of the common symptoms of adrenal fatigue are present as well such as fatigue, depression, weight gain, muscle aches, brain fog, and low libido. Unfortunately, due to the similarities in symptoms of both hypothyroidism and adrenal fatigue, the two conditions can be easily confused. These glands are seen to work together due to their collective roles in supplying essential hormones throughout the body. It is not uncommon for those suffering from thyroid dysfunction to also have weakened or dysfunctional adrenal glands.
Now this picture below shows you both the thyroid pathway to produce the thyroid hormone and the adrenal pathway to produce cortisol. You’ll notice that at the top of the picture it says the hypothalamus on both sides. Whether you’re trying to produce cortisol down the cortisol pathway or whether you’re trying to produce thyroid down the thyroid pathway, you’ll see the top organ is called the hypothalamus. The hypothalamus is in our brain. Whenever you produce hormones in the endocrine system it’s sort of like following the bouncing ball – one organ produces a hormone and that hormone goes to another organ through the bloodstream and tells that organ to put out another hormone and that hormone goes to another organ and tells that organ to put out another hormone…you get the idea that it’s sort of a “passing the ball” to finally produce the hormone that you’re after.
What you’re looking at is the pathway toward cortisol and the pathway toward thyroid hormones. The hypothalamus for the cortisol pathway puts out CRH (cortisol-releasing hormone). The hypothalamus can also put out TRH (thyroid-releasing hormone). Those hormones then go to the pituitary gland which is also in your brain, and the pituitary will put out ACTH (adrenal corticotropic hormone) down the cortisol pathway and will put out TSH (thyroid-stimulating hormone) down the thyroid pathway. These hormones then go to the end point gland, the adrenal gland to put out cortisol or to the thyroid to put out what’s called T4. T4 is an inactive hormone that needs to be converted to active T3.
What I want people to understand is if your stress is always elevated and you’re always producing more and more cortisol, some of the hormones within the cortisol pathway, even the very first one (cortisol-releasing hormone) will inhibit the production of thyroid-stimulating hormone. The production of cortisol itself is the end hormone will inhibit the production of thyroid-stimulating hormone, it will also inhibit the conversion of inactive T4 to active T3. What I’m pointing out to you is if the adrenal gland is dysfunctional it could be the cause of your hypothyroidism, and the symptoms of both issues or predominantly the thyroid dysfunction include fatigue, cold-intolerance, weight gain, memory problems, poor concentration, depression, hair loss, dry skin, and even infertility for folks still in the reproductive age.
Thyroid deficiency is incredibly common. It goes undetected by many of the standard thyroid tests by as much as 80% of the time! Most endocrinologists examine patients solely on their TSH (thyroid-stimulating hormone) level, which is produced in the pituitary gland in the brain and NOT in the thyroid gland. But they do not, many times, order further testing, and they ignore other important markers of imbalance. This misunderstanding leads to skewed lab results and failure to diagnose thyroid dysfunction accurately. And of course, they’re not even testing your adrenal gland! Comprehensive thyroid testing includes measurements of the following hormones. A full panel should include TSH (thyroid-stimulating hormone), free T4, free T3, something called reverse T3, and then also your immune system could be producing antibodies against your thyroid gland – there are some called thyroglobulin antibodies and there are others called thyroid peroxidase antibodies created by your immune system against your own thyroid cells. These are a sign that your immune system is creating antibodies against your own thyroid gland, showing that you have an autoimmune thyroid disease. Without looking at all of these factors and thyroid function, the prescribed treatment may be unfit for the person. For example, if a patient is advised to take synthetic hormones for hypothyroidism and are still experiencing fatigue, then they may want to revisit some further testing including antibodies against their thyroid or evaluate the function of their adrenal gland and see if that is really the cause of their thyroid dysfunction.
Now with today’s conventional medical model, there is no formal adrenal fatigue testing. This is where functional medicine becomes crucial for an accurate and comprehensive diagnosis of your adrenal function. Functional medicine is a systems-oriented approach that employs a personal medicine approach to identify, understand, and treat the underlying cause of the disease. Therefore, a functional medicine practitioner takes the signs of adrenal fatigue very seriously. Being that this disorder can be both a cause and a result of an imbalance within the body, some of the many signs of adrenal dysfunction practitioners will look for include:
- Thyroid imbalances
- Unexplained weight changes
- Low or high blood pressure
- Unstable blood sugar
- Hair loss
- Blurred vision
- Anxiety or feeling wired
- Depression or lack of motivation due to exhaustion
One of the common diagnostic tools for adrenal testing is the cortisol saliva test. With this test, a person actually spits some saliva into a small tube to collect a saliva sample numerous times throughout the day of their testing so as to get multiple time periods of cortisol levels. There’s an awakening right when the person first wakes up, there’s a late morning, there’s an afternoon, there’s an evening, and there’s a late-night sample at the later hours of the evening. Everyone should have a natural circadian rhythm to their cortisol level. It should be the highest first thing in the morning on awakening so that we can get up and increase our energy from sleep. It should be lowering slowly throughout the day to its lowest point at night right before going to bed so that we can sleep well.
Adrenal fatigue progresses through four different stages of advancement. Symptoms increase in frequency and severity throughout each of these different stages. I’m going to take us through these stages. The phases of adrenal fatigue go as follows: stage one is called alarm reaction, stage two is called resistance response, stage three is called adrenal exhaustion, and stage four is an actual pathologic disease called Addison’s disease. This disease is not very common in the population, however, president John F. Kennedy actually had Addison’s disease where his adrenal glands completely failed on him. Up next, we will discuss each phase of this process in detail.
The first stage of adrenal fatigue is often called alarm reaction or the fight or flight response. It is characterized by cortisol levels that may be high in one or two of the times that could be tested when you spit in the tube with the salivary test. Or, they could all also be normal as the system in stage one is still able to correct the cortisol level appropriately. During this phase, the body’s ability to adapt physiologically to stress is still normal. This stage describes the body’s immediate reaction to a stressor. At this time, there is very little physical or physiological dysfunction noticeable. Fatigue is considered mild, it may not sustain as a problem all day long. Sleep patterns are typically disturbed, and uptake of caffeine, sugar, and carbohydrates is usually present because the person is feeling wired and tired and trying to keep themselves going. This stage is often categorized as the feeling of exactly that – being wired but tired.
In fact, most people enter this stage of adrenal fatigue many times in their lifetimes. Most of us can probably remember a time in our lives when stress was temporarily elevated and yes, we felt wired and tired and could not sleep well. But the time of extreme stress ended, and our system quieted down again, our nervous system quieted down, and we were able to get back to our normal feelings and sleep well again. A person in this first stage may have mildly abnormal salivary cortisol level or again the test may be completely normal.
Stage two is called the resistance response. This is where the adrenals begin to lose their ability to keep up with the body’s demand for cortisol. During this stage, fatigue becomes much more noticeable and extends beyond the morning, early afternoon, and even into the evening. The body will need more rest than usual to recover and will very rarely feel refreshed when waking up in the morning after a night’s sleep. Infections, insomnia, anxiety, mood swings, decreased sex drive, and irritability in this stage are much more common. And physiologically, our physiology cannot compensate very well anymore and hypertension, thyroid dysfunction, and blood sugar imbalances like pre-diabetes start to become a problem. This is where people begin to recognize their symptoms and seek medical attention typically. There are substantial drops in important hormones such as DHEA and testosterone, in exchange for the continual cortisol production. This is a concept called cortisol steal. When your cortisol is always elevated, you can’t produce the appropriate other hormones, particularly sex hormones like estrogen, testosterone, and DHEA. This phase can last a couple of months up to several years. The cortisol saliva test will typically show elevated cortisol levels, low or normal DHEA hormone (DHEA or dehydroepiandrosterone is one of your vitality hormones), and an abnormal ratio of DHEA to cortisol.
Above is an example of the salivary cortisol test and what you might see in someone in stage two of adrenal fatigue. First of all, you get a response, a reading, and a measurement for what’s called the cortisol awakening response. When we wake up in the morning and you’ve been sleeping, your brain and body quiet, you need to wake up! Your adrenal glands are supposed to normally have a large increase in cortisol outflow in order to wake us up, wake up our brain, and get us moving. You notice in this example, this person’s increase after awakening their cortisol rose by at least 50% and you’ll see in the graph that the person in this example’s cortisol awakening response is normal and it goes up drastically when they first wake up. They show more cortisol in their saliva when they first wake up in the morning.
The other thing you’ll notice is that when we look at the graph to the right, there are little black squares that tell you each saliva test from 7:00 – 9:00 AM, from 11:00 AM – 1:00 PM, from 3:00 – 5:00 PM, and then from 10:00 – 12:00 AM. Each one of the black boxes is the saliva measurement of cortisol in that particular person. What you see is that their morning awakening cortisol was normal, but every other time they tested it throughout the day the cortisol level was high and above the normal range. You notice their adrenal gland is over producing cortisol and they’re always feeling wired and tired, the adrenal gland is dysfunctioning. Down below, the DHEA level in this person is low/normal. Over to the right, the DHEA cortisol ratio is abnormally low. These are the findings of the stage two the resistance response phase.
In stage three as the adrenal glands are becoming continually less and less effective, the body ever increasing need for adrenal hormones remain unchanged while the stress is still going on and present. Stage three is true adrenal insufficiency and the body recognizes the decline in cortisol output and focuses on conserving its energy for survival. To do this, the body begins to slow down and also starts to break down existing muscle tissue in order to use it for energy. In adrenal exhaustion, chronic fatigue is common as well as other things such as reduced exercise tolerance, longer recovery times after any activity, brain fog, insomnia, depression, increased infections, weight gain, lack of sex drive, less productive during the day, and increased need to rest. If not treated, the body further loses homeostasis (the ability to maintain stability or function through changes). Luckily, it is extremely uncommon to progress this beyond this “burnout” to the final/fourth stage of adrenal progression to adrenal failure. But in adrenal fatigue and adrenal exhaustion, much of the body’s stress hormones, sex hormones, and neurotransmitters are very low representing the crash after suffering from stress for a long period of time.
Let’s talk about what you might see in the salivary cortisol test. What you see here is another example of the cortisol salivary test and the first time the person spits into the tube first thing in the morning is called that cortisol awakening response. This time we’re seeing the cortisol response first thing in the morning is not elevated. This person is not able to produce enough cortisol to get them going in the morning and it does not have an expected 50% increase in cortisol output. The adrenals are just dysfunctional and are not putting out enough cortisol first thing in the morning, so they feel exhausted.
As you look to the right, you see that the normal ranges should be higher in the morning and then slowly drop down throughout the day. This person’s levels are all pretty flat and low for the most part. Some of them are in the normal standard deviation range, but you’ll see a flattening of the levels across in a horizontal pattern. This person’s DHEA level is actually okay but their DHEA to cortisol ratio is extremely low. You’ll notice that this person is showing even more dysfunction than the stage two was. That’s the whole point of this – that things are progressively getting worse.
Now as I mentioned, it is uncommon to enter the final stage of adrenal fatigue called adrenal failure, but it is possible. It is also dangerous, and it is very important to recognize if it’s happening. For most people if it’s happening, they’re going to end up in an emergency room because the adrenal becomes completely exhausted. The severe advancement of adrenal fatigue can manifest very similarly to the clinical adrenal sufficiency disease called Addison’s disease. And the symptoms of Addison’s disease include:
- Sudden pain in the lower back, legs, and abdomen
- Digestive distress such as vomiting and diarrhea
- Severe dehydration
- Very low blood pressure
- Loss of consciousness
- Very high risk for cardiovascular collapse
Obviously, someone is down and in an emergency situation if they’re having adrenal failure. Although these symptoms are much more obvious, there is still the change of misdiagnosis in the ER. This is incredibly important to recognize the signs and see a trusted physician and be in the appropriate place.
Once adrenal fatigue enters this stage, the change of becoming fatal is possible. And again, it is very uncommon for the average person to progress to this level of adrenal failure but is not unheard of because John F. Kennedy, one of our most famous presidents, did have Addison’s disease.
Fortunately, there are plenty of ways to reverse adrenal fatigue. There are many that are available and accessible to you because they’re mostly lifestyle changes. Some include:
- Dietary changes
- Adrenal supporting supplements and adaptogens
- Reduce adrenal stress and overall stress in one’s life
- Minimize depleting exercise (exercise that is too intense)
- Increase rest or a more restorative type of movement like yoga or walking in the woods
- Maintain a regular sleep schedule
- Adequate hydration
- Heal existing infections
- Practice meditation
In Chapter 4 of my book, “Make a DENT in Chronic Disease,” I discuss the sympathetic (fight or flight) versus the parasympathetic (rest and digest) nervous systems and the adrenal gland and how our daily environment and emotion response to stress is what drives the dysfunction of our adrenal gland. I also provide concrete and implementable ways for people to improve their daily lives, to decrease stress, improve adrenal function, and optimize health. To get my book, a person can go to directly to Amazon.com or to my website discoverhealthfmc.com and link from there to the book on Amazon.
A diet full of processed grains, vegetable oils, and sugars, much like the Standard American Diet (SAD), is known to stress the adrenal glands. Conversely, a nutrient-rich diet including healthy fats and fiber helps support adrenal health and can aid in adrenal fatigue recovery. In particular, these foods are especially impactful in the fight against adrenal fatigue:
- Healthy fats such as coconut oil, coconut milk, avocado, olives, olive oil, nuts, seeds, grass-fed butter, fatty fish like salmon, and grass-fed meats. These are an incredible tool in stabilizing blood sugar and we will be explaining why this is such an important factor for recovery up next.
- Vegetables also are awesome to provide vitamins, minerals, and phytonutrients to nourish the whole body including the adrenals
- Fermented foods for their probiotics
- Protein especially in the morning. It is recommended to consume approximately 40 grams of protein in the morning to provide support to the adrenal glands throughout the day because remember your largest output of cortisol should be in the morning.
Now what foods should you absolutely exclude?
- Sugar and sweeteners
- Starchy carbohydrates
- Processed foods particularly processed meats such as cold cuts
- Hydrogenated oils
Let’s talk about the role of blood sugar. The increased levels of cortisol that result from the early stages of adrenal fatigue also raise our blood sugar extremely quickly. This high level of glucose or blood sugar in your blood stream upsets your body’s balancing act, resulting in a dump of insulin into your system. This insulin orders our cells to take up as much sugar as possible to regain safe blood sugar levels. Insulin also signals our bodies to store extra glucose for later use. However, if our diet continues to provide more sugar than our body ever needs to use weight gain, inflammation, and health complications develop. It is very important to address blood sugar stability when healing adrenal fatigue due to its pivotal role in the energy production process.
Vitamins are necessary for most of the body’s natural processes. Minerals are essential for hormone production and utilization. A few of the most important vitamins and minerals to supplement for adrenal dysfunction include the following:
- Sodium – natural salts like Himalayan pink sea salt not necessarily iodized salts. Aldosterone is also a hormone responsible for salt regulation and is typically reduced by adrenal fatigue.
- Vitamin C – not only is this a powerful antioxidant that works to protect the body from free radicals, but vitamin C is also an essential building block for adrenal gland recovery.
- Many of the B vitamins, particularly B5, B6, and B12, are especially involved in cell metabolism, energy production, and fatigue reduction.
- Vitamin D – this vitamin is especially important for adrenal fatigue as it increases the enzyme needed for the production of adrenal hormones.
- Magnesium – energy levels are maintained by magnesium. Deficiency results in fatigue, depression, and many other adrenal fatigue-like symptoms.
- Probiotics – improve digestion, immunity, aid in vitamin absorption and hormone production.
It is most important to follow a professional’s guidelines specific for you for proper supplementation due to the deficiency, severity, and stage of your adrenal fatigue. If you feel as if you fit the symptoms of adrenal dysfunction, it would be best to seek out a functional medicine provider or other provider that is familiar with how to order and interpret an adrenal salivary cortisol test. Most traditionally trained primary care providers are not familiar with this testing, so you’re going to need to possibly seek out someone beyond your primary care provider.
Adrenal fatigue and sleep dysfunction are closely related. Due to the body’s natural schedule of cortisol secretion, cortisol levels naturally rise and fall throughout the entire day. Adrenaline and cortisol both increase alertness and affect sleep schedules in a number of ways. You may experience trouble falling asleep, you may wake up in the early hours of the morning, or you may suffer with both of these issues. The best recommendations other than stress relief for regaining a proper sleep routine include:
- Creating a sleep schedule for going to sleep and waking and being consistent with it
- Resting when you feel tired as much as you can
- Aiming to sleep between 8 – 10 hours per night
- Avoiding staying up too late or being stimulated too close to bedtime
- Turning off all computers, TV, and cellphones at least an hour before bedtime
- Turning down lights
- Listening to meditative music or reading a book when getting ready to go to sleep
The obvious problem around adrenal fatigue is stress. There’s no surprise that stress relief is one of the most important factors in optimal recovery. Some recommendations to manage stress include:
- Use essential oils (lavender for example)
- Practice mindfulness meditation
- Practice yoga (we offer Gentle Introductory Level yoga class 9:00 – 10:15 AM on Friday mornings)
- Deep breathing
- Spend time with people you care about and love
- Take down time to relax
- Listen to enjoyable music
- Read a good book
- Drink tea
- Go for a leisurely, gentle walk in the woods
- Get a massage
Thank you so much for learning about adrenal fatigue with me! We all at Discover Health Functional Medicine Center are passionate about sharing these topics with people who are eager to transform their lives and finally achieve optimal health. If you think of any question later, be sure to join our Discover Health Facebook group, where you can always post your questions. And if you feel you may need to have testing of your adrenal function, reach out to us at discoverhealthfmc.com or call the office directly at 603-447-3112. We are always here to support you!
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