Adrenal Fatigue
Adrenal Fatigue: What You Truly Need to Know
What IS Adrenal Fatigue?
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Adrenal fatigue is a term that is controversial as it is often labelled as a "myth" and "not a real condition". This is because it isn't recognized by the medical community as it isn't a diagnosed medical condition. The adrenal fatigue theory was initially coined by a naturopathic doctor to describe the effects of chronic stress on the adrenal glands causing them to be fatigued and unable to produce a sufficient amount of the stress hormone cortisol.
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However, the term adrenal fatigue is a misnomer as we now know that in a majority of cases, there is nothing wrong with the adrenal glands themselves; rather the issue is due to a miscommunication between the brain and adrenal glands known in technical terms as Hypothalamic-Pituitary-Adrenal (HPA) axis dysfunction or to put it simply; brain-adrenal dysfunction. This results in a timing issue where the production of the main stress hormone cortisol by the adrenal glands is out of sync with its natural rhythm throughout the day leading to symptoms of adrenal fatigue which will be discussed later in further detail.
Therefore, adrenal fatigue is a distinct health condition that is separate from medical conditions that are diagnosed by doctors and endocrinologists such as adrenal insufficiency / Addison's disease where the adrenal glands don't produce enough cortisol. This is also known as primary adrenal insufficiency and secondary adrenal insufficiency occurs if the problem started somewhere else in the body such as the pituitary gland. The other medical condition is Cushing's syndrome where the adrenal glands produce too much cortisol.
The Function of Adrenal Glands
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Your adrenal glands are located above your kidneys and they consist of the adrenal cortex which is the outer portion and the adrenal medulla which is the inner portion. Both of these compartments secrete a variety of hormones such as the steroid hormones cortisol and DHEA from the cortex and adrenaline/noradrenaline from the medulla. These hormones are all involved in your body's stress response or also known as the "fight-or-flight" response but for simplicity, we will primarily focus on the main stress hormone cortisol.
Cortisol has a variety of roles within your body and it is often associated with the fight-or-flight response due to its ability to provide your body with a quick boost of energy from a variety of stored energy sources within your body such as carbohydrates, protein, and fat. Other functions of cortisol include regulating the immune system, helping to suppress inflammation, and regulating the sleep-wake cycle.
Causes
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When we think of stress, we often think of it in a negative context. However, acute stress is necessary for our bodies to adapt and thrive and can be beneficial to our overall health. This concept is also known as hormesis. (1) A good example would be exercising which creates an acute stress response in the body.
While acute stress can be beneficial, problems can occur when acute stress turns into long-term chronic stress as a result of our modern-day lifestyles. The 3 main sources of chronic stressors are emotional, dietary, and inflammatory stress. Emotional stress could be from having a demanding job, relationship issues, or adverse childhood experiences (ACEs). Dietary stressors could be things like food sensitivities or consumption of high carbohydrate and sugary foods leading to a loss of blood sugar control. Finally, inflammatory stressors may be due to physical injuries such as joint or muscle pain or they could be from "hidden" sources such as gut infections from parasites, yeasts, and harmful bacteria as well as chemical exposures from environmental toxins such as heavy metals.
In the face of a stressful situation regardless of the source, the brain instructs the adrenal glands to release cortisol so that the body can respond to stress. When the appropriate amount of cortisol has been released, there is a feedback loop back to the brain that signals sufficient cortisol has been released so there is no need to produce additional cortisol.
While this is great for an acute situation, chronic persistent stressors will over time override the natural feedback loop mechanism leading to a breakdown in communication between the brain and adrenal glands. This will result in the adrenal glands producing an inappropriate amount of cortisol either too high or too low at any given moment, causing adrenal fatigue.
Symptoms
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Some of the common symptoms of adrenal fatigue that people may experience include:
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Feeling "tired but wired" at night and having difficulty falling asleep.
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Struggle to get out of bed in the morning and need coffee to get going.
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Having an afternoon slump generally between 2-4 pm.
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Struggle to remember things, have difficulty focusing, and lack mental sharpness (brain fog).
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Unable to maintain an exercise routine due to excessive soreness after exercise and increased joint/muscle aches.
Diagnosis
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Functional testing can be done either through saliva or urine samples with multiple samples taken throughout the day to assess the daily cortisol rhythm. There are 3 stages of adrenal fatigue which will be summarised briefly:
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Stage 1 is the initial stage where the total cortisol output for the day is increased and the daily cortisol rhythm remains elevated.
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Stage 2 is the intermediate stage where total cortisol produced for the day begins to drop from stage 1 to a "normal" level. Cortisol rhythm throughout the day can be erratic and all over the place like a roller-coaster.
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Stage 3 is the advanced stage where the total cortisol produced drops even further from stage 2 and remains at a low level. The daily cortisol rhythm also follows a similar pattern and remains flatlined.
Treatment
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If you suspect that you have fatigue, it is always important to visit your doctor for an initial assessment to rule out other serious causes of fatigue as there can be many reasons for fatigue. If your doctor has ruled out other causes of fatigue, you can then decide to proceed with treatment from a functional medicine perspective.
The overall goal of treating adrenal fatigue is to reset the brain-adrenal axis so that proper communication is restored between the brain and adrenal glands leading to a natural cortisol rhythm throughout the day. It involves treating the underlying causes of adrenal fatigue that come from 3 primary sources which are emotional, dietary, and inflammatory stress.
Emotional Stress
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While we can't avoid stress, we can cultivate positive habits that help us to manage stress so that it doesn't overwhelm us. Some helpful tips include engaging in regular relaxation practices such as meditation, breathwork, and taking a walk in nature. For example, breathwork can help to improve our overall mood and energy levels.(2) Maintaining a healthy sleep routine such as going to bed and waking up at set times and also getting natural light exposure first thing in the morning can also be beneficial in resetting the cortisol rhythm.
If there are significant current or previous life stressors that go beyond the scope of day-to-day stress, a more targeted approach in the form of psychological therapies may be needed such as cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR).(3)
Dietary Stress
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A diet that emphasises healthy fats and adequate protein, and is predominantly low in sugar and refined carbohydrates such as the Mediterranean diet is essential in restoring balance to the brain-adrenal axis. This is because a diet that is high in sugar and processed carbohydrates can result in a maladapted chronic stress response leading to unstable blood sugar levels.(4) In addition, common food sensitivities such as a reaction to gluten and dairy may also be possible sources of stress for the body so a short-term elimination diet can be helpful to rule these out.
Several types of supplements could also be used to augment a dietary approach. Common nutrients such as a high-quality multivitamin, vitamin C, and magnesium can help to nourish the adrenal glands. Adaptogens are a specific category of supplements that increase the body's resiliency against the effects of chronic stress. They can affect the brain-adrenal axis and help to normalise cortisol levels; so if you have high cortisol levels the adaptogens will gradually lower it and vice versa if you have low cortisol levels.(5) Some of the commonly used adaptogens include ashwagandha, ginseng, eleuthero, and rhodiola.
Inflammatory Stress
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If you have discomfort due to physical injuries, getting it treated through various physical therapy modalities e.g. physiotherapy, chiropractic, and massage therapy will reduce the degree of physiological stress on the body. Additionally, while physical activity and exercise are recommended to maintain overall health and well-being, a tailored approach would be needed especially if you are in stage 2 or 3 of adrenal dysfunction as overexercising will create additional strain to an already stressed-out system.
There are also "hidden" sources of inflammatory stress that need to be considered which come from gut infections such as parasites, harmful bacteria, or yeasts and/or environmental chemical exposure such as heavy metals and other pollutants. These can be tricky to navigate as you may not have any symptoms at all or have vague, non-specific symptoms. Fortunately, functional testing using the Microbiome Mapping Test and Organic Acids Test could be used to assess the state of your gut health and overall detoxification capacity respectively. Specific functional medicine protocols would then be implemented depending on the results of these tests.
Conclusion
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Even though our modern-day environment can be stressful and challenging at times, you can begin to implement some of the diet and lifestyle strategies outlined above to ensure that your body is resilient to the effects of chronic stress.
If you are interested in a guided approach that includes functional testing and a personalised diet, lifestyle, and supplementation protocol for adrenal fatigue, our 100 Days Plan would be a good starting point where we can work with you to restore balance to your body and regain your vitality
References​
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1. Zimmermann, A., Bauer, M. A., Kroemer, G., Madeo, F., & Carmona-Gutierrez, D. (2014). When less is more: hormesis against stress and disease. Microbial cell (Graz, Austria), 1(5), 150–153. https://doi.org/10.15698/mic2014.05.148
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2. Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell reports. Medicine, 4(1), 100895. https://doi.org/10.1016/j.xcrm.2022.100895
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3. Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633. https://doi.org/10.1080/20008198.2020.1729633
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4. Seal, S. V., & Turner, J. D. (2021). The 'Jekyll and Hyde' of Gluconeogenesis: Early Life Adversity, Later Life Stress, and Metabolic Disturbances. International Journal of Molecular Sciences, 22(7), 3344. https://doi.org/10.3390/ijms22073344
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5. Todorova, V., Ivanov, K., Delattre, C., Nalbantova, V., Karcheva-Bahchevanska, D., & Ivanova, S. (2021). Plant Adaptogens-History and Future Perspectives. Nutrients, 13(8), 2861. https://doi.org/10.3390/nu13082861