Adrenal fatigue (more scientifically accepted as adrenal dysfunction) has become a common term used by health practitioners and patients. Adrenal fatigue/adrenal dysfunction is particularly prominent in the functional medicine space as a way to describe a group of symptoms recognized in individuals who are under long-term psychological, physical, and emotional stress. 

Ahhh stress, can’t we all relate?!

Stress is a normal facet of daily life, and to feel overwhelmed by it here and there is common. However, stress can even be healthy in small amounts. 

In a perfect world, our body appropriately responds to these stressors without significantly compromising other biological functions, but as we all know, when our stress threshold is reached, problems arise.

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Do you…

  1. Feel unrefreshed in the morning after a full night’s sleep?  

  2. Deal with chronic fatigue or constant aches and pains?

  3. Find yourself unable to stay asleep or fall asleep despite feeling exhausted (tired and wired)

  4. Feel worse after a workout?

  5. Notice weight gain, particularly around the midsection despite no changes to diet and exercise?

You are not alone. You are NOT going crazy. Adrenal fatigue or adrenal dysfunction, a condition in which there is a miscommunication of the body’s stress response, can be the source of many health issues. 

In this post we dive into this highly controversial and sometimes confusing condition and provide 4 simple, actionable steps to reduce your fatigue and get your adrenal function firing again!

What is Adrenal Fatigue?

First and foremost, let’s clear the air on “is adrenal fatigue a real thing?!”

The term ‘adrenal fatigue’ is not medically accepted and has been criticized in the medical community (and rightfully so) for it’s misleading name. The phrase ‘adrenal fatigue’ implies a condition in which overworked adrenal glands eventually “fatigue” out and stop working to produce hormones.  

This is simply not the case and an inaccurate depiction of how the body works. Unless in the case of a rare autoimmune condition called Addison’s disease or “Adrenal insufficiency” that affects one in 100,000 people yearly.[1]

Adrenal fatigue and hypothalamic-pituitary-adrenal (HPA) axis dysregulation happens when problems are occurring upstairs, AKA your brain, which causes signaling of hormone production to get off kilter. This imbalance is not the same as adrenal glands completely losing their ability to function. 

To understand the intricacies of adrenal fatigue and HPA axis dysregulation, let’s take a step back and cover some of the basics of the adrenal glands and how the body’s stress response functions (when working correctly of course).

Adrenal Gland Function

The adrenal glands are triangular-shaped glands that sit on top of your kidneys. The role of these guys is to produce and release hormones into the bloodstream that then travel to various areas of the body. These hormones are produced in response to stress that is organically sensed by our command center, THE BRAIN!

Not only do the adrenal glands respond to stress, but they are also involved in hormonal balance, brain function, blood sugar balance, gastrointestinal function, and more. 

Stress Hormones Produced in the Adrenal Glands

The adrenal glands produce many hormones such as epinephrine (adrenaline) and norepinephrine (noradrenaline) that act in response to short, acute bouts of stress. An example would be when you’re speeding on the highway, and you see a cop on the side of the road with his speed radar, which leads you to slam on your breaks. Your heart starts beating faster, your palms sweat, and you’ve got butterflies in your stomach. That’s adrenaline seeping through your bloodstream! 

However, in the context of long-term physical, emotional, psychological stress, the hormones cortisol and dehydroepiandrosterone (DHEA) steal the show. We get valuable data about the effects of chronic stress when looking at these two hormones. 

Cortisol

Cortisol is thrown around frequently in the health and wellness space so it may be a term with which you’re familiar. 

Cortisol is one of our “fight or flight” hormones that is produced quickly in response to a stressful situation. Cortisol levels fluctuate throughout the day and should follow a consistency diurnal pattern. In a perfect world, you will see a natural rise of cortisol in the morning and a gradual decline as the day goes on.  

Is cortisol bad?

No! Cortisol is not inherently bad. Cortisol helps you jump out of bed in the morning and get after your day. Cortisol also saves our lives when it’s do or die. Literally!

Whether you are running from a bear in the woods, mentally stressing about how many calories you had that day, or doing a time trial of your 5k, the body perceives stress. The body does not know the difference between a person in true danger and one worrying about ordinary daily life. 

Stress is stress and the body will do WHATEVER it needs to to get out of that situation safely. Cortisol is your trustworthy pal/co-pilot till you die. 

Signaling of cortisol starts in the hypothalamus and goes a little like this…

Hypothalamus produces corticotropin-releasing hormone (CRH) which signals to the pituitary gland to secrete adrenocorticotropin hormone (ACTH). ACTH then tells the adrenal glands to make and release cortisol hormones into the blood.

Now, when stress levels are well managed, the hypothalamus and pituitary gland detect when the proper amount of cortisol is circulating in the blood. This leads to the increasing or decreasing production of CRH and ACTH and thus increasing or decreasing cortisol levels.

In the case of HPA axis dysfunction when perceived stress is constantly present, ACTH

will cause elevated levels of cortisol and begin to deplete DHEA

production (often termed the “pregnenolone steal”). High cortisol could last years in an effort to combat stress, but may eventually lead to an adaptation within the HPA axis, resulting in reduced cortisol production, aka hypocortisolism. [2] 

DHEA

Another hormone involved in this delicate stress response is DHEA, short for dehydroepiandrosterone. DHEA is one of the most abundant circulating steroid hormones produced in the adrenal glands and valued for its protective effect.When the brain signals for the adrenal glands to produce cortisol, DHEA is made along with cortisol in response to stress. 

A recent 2017 study reported that long-term stress, especially in childhood, can result in HPA dysregulation in adult life with abnormal basal and stress levels of the HPA hormones, including cortisol and DHEA. [3] 

DHEA comes as a package deal with cortisol to balance the effects of cortisol’s potentence. It can essentially act as cellular antioxidant to hinder the potentially harmful effects of cortisol on cells.

Now that we are clued in about adrenal dysfunction in the context of HPA axis function, let’s dive deeper into HPA axis dysregulation and its contribution to adrenal dysfunction. 

HPA Axis Dysregulation

As mentioned, the hypothalamus, pituitary glands, and adrenal glands are continually communicating to keep hormones in balance. This is especially true when we face a stressful situation, such as the ones described earlier. 

After experiencing high levels of stress over a long period of time, the body uses protective mechanisms that it uses to try to protect us from the effects of that high cortisol that would result from that stress. 

SO rather than the adrenal glands giving up on you in the case of chronic high stress, the problem really begins upstream at the level of the hypothalamus in the brain. 

The Progression of Adrenal Fatigue 

There are theories describing how a stress-induced HPA-axis functions compared to a normal HPA-axis. These theories seek to explain how the patterns of low or high cortisol and DHEA patterns work.[4] Current theories suggest: 

  1. In the beginning stages of adrenal dysfunction, cortisol and DHEA are pumped out in high volume to meet the demands of the body and combat the perceived stress of the brain. Therefore, HPA axis dysfunction early on results in elevated cortisol and DHEA.

  1. As the body becomes adapted to chronic stress, that becomes the body’s “new normal.” Cortisol stays elevated while DHEA begins to drop, followed eventually by a drop in cortisol as stress persists.

    1. A 2013 study done to investigate whether levels of DHEA and DHEA-S differ in individuals who report perceived stress at work compared to individuals who report no perceived stress at work, and the mean DHEA-S levels were 23% lower in the subjects who reported stress at work compared to the non-stressed group.[5] 

  1. The body eventually becomes exhausted and the body’s negative feedback loop (decrease in function) signals for the adrenals to downregulate cortisol production and DHEA because it senses an overload of this potent hormone! 

This dysregulation of communication to stop producing cortisol and DHEA is where the term “adrenal fatigue” get’s it name, but as mentioned, this is a result of signaling from the hypothalamus, pituitary gland, and adrenal glands, versus a mechanical issue of the adrenal glands being unable to produce the hormone.

Causes of Adrenal Dysregulation.

Are you always trying to do more, more, more?

Whether it be refusing to say no to anything and everything asked of you or exercising in some capacity multiple times per day in effort to achieve your dream body, these are just some of the common drivers of hitting burnout or experiencing a dysregulation of the HPA axis. 

Listen, it’s not necessarily your fault if you’ve gotten to this point. Our society is overly demanding of our time and energy. We inadvertently devalue rest/recovery and we glorify productivity. 

Slowing down is for the weak, right?!

Wrong! We actually only get stronger when we rest and recover from our stressors!

Common stressors that serve may be the underlying root cause of HPA axis dysfunction include:

  • Life stress such as work, family, and social stress

  • Overtraining (often seen in Crossfit athletes, runners, cyclists, triathletes, or other high intensity sports)

  • Undereating (an aspect of relative energy deficiency in sport REDs)[6]

  • Inflammation

  • Obesity

  • Poor quality and duration of sleep

    • There are few things more restorative and protective than the proper amount of sleep.

    • Compromising sleep to wake for your early workout or stay up late scrolling on your phone and a disaster for proper HPA axis functioning

  • Traumatic Brain Injury (TBI) [7] 

  • Genetic polymorphisms in the following genes [8]

    • Nr3c1, which encodes a glucocorticoid receptor protein

    • Nr3c2, which encodes a mineralocorticoid receptor protein 

    • FKBP5 

    • CRFR1, which encodes the CRF receptor 1 protein 

    • CRF-BP, which encodes CRF binding protein 

    • GABRA6, which encodes the GABA receptor subunit alpha-6 protein 

    • OPRM1, which encodes the mu opioid receptor protein 

    • SLC6A4, which encodes a serotonin transporter protein 

Related reading: 

Consequences of Adrenal Dysfunction:

It would take all day to list the many potential complications of long-term stress that results in adrenal dysfunction, but some of the most common issues (especially in active individuals) include a compromised gut microbiome, some of the most common issues (especially in active individuals) include a compromised gut microbiome, obesity and blood sugar issues, impaired reproductive function, and menstrual irregularities, just to name a few. 

Increased Risk for Other Health Conditions

HPA axis has been linked to other conditions including:[9] 

  • Panic disorder

  • Hyper/hypothyroidism

  • Central obesity (metabolic syndrome)

  • Diabetes mellitus

  • Fibromyalgia

  • Chronic fatigue syndrome

  • Rheumatoid arthritis

  • Asthma, eczema

Compromised Gut Microbiome

Research shows that stressors throughout life lead to significant, community-wide differences in the microbiota.[10] 

Both gastrointestinal physiology and the microbial community can become affected, which very much matters! 

Why do you ask? Well, microbes in the gut are responsible for producing, recognizing, and responding to hormones and neurotransmitters, which can compromise the mucosal immune system, making it easier to be infected by opportunistic bacteria and have negative responses to food.

A recent animal study found that exposure to a stressor significantly changes the bacterial profile in our gut, leading to reduced the levels of Lactobacillus, a protective intestinal bacteria that has been associated with infection prevention.[11] 

Obesity and Blood Sugar Issues

The link between HPA dysregulation, obesity, and blood sugar issues (pre or diagnostic Type 2 diabetes)  can be accounted for in part by sky-high cortisol levels that have been driven from prolonged high environmental stress.

Impaired Reproductive Function

Ladies, have your cycles become wonky, painful, or gone totally MIA?

Stress has an enormous impact on the female reproductive system. Unlike men whose hormone levels act similarly from week to week, females deal with an obvious confounding factor, reproduction, that causes hormones to fluctuate throughout the month.

What may seem like insignificant stress to you can result in wonky changes to hormones that change the length, frequency, and symptoms of your menstrual cycle. In the case of chronic high stress and adrenal dysfunction, ovulation can be suppressed, resulting in a lack of period.

Related reading: 7 Chemicals & Foods that Cause Hormonal Imbalance

Amenorrhea

Amenorrhea or a lack of a period for 3 or more months in a row is common in females with adrenal dysfunction. 

Think about it this way, having a regular functioning menstrual cycle allows you to ovulate (release as egg) to be fertilized by sperm to make a baby. Yay!

But if your body is under an immense amount of chronic stress where the body is in full blown survival mode, the brain signals to the ovaries, “Hey down there, shut it down! The risk is too high!”  In other words, the body is under way too much stress trying to stay alive, let alone carry a developing fetus.

“Wow, no period! That sounds amazing, especially since I do not want to get pregnant!”

Not so fast… Nowadays, doctors are referring to the menstrual cycle as the body’s fifth vital sign. 

Yes, that means the status of Aunt Flow’s monthly visit is more than just your ability to get pregnant, rather it is as essential as your body temperature, your heart rate, your blood pressure, and your respiration rate.

Even if having children of your own is not part of your life plan, having the proper hormone levels to have a period allows for other biological processes in the body to function properly such as:

  • Temperature regulation

  • Bone support

  • Thyroid functioning

  • Weight management

  • Cardiovascular health

  • Athletic performance

AND MORE!

When amenorrhea is driven by significant amounts of physical, mental, and emotional stress, this is referred to as functional hypothalamic amenorrhea (FHA). In FHA, high levels of cortisol turn off hormonal signaling that facilitate reproduction.

Adrenal Fatigue Symptoms  

If you answer yes to these questions (if you answer yes to one, you likely answer yes to more) you are prone to developing HPA axis dysfunction. 

  1. Do I feel anxious throughout the day, especially in stressful situations?

  2. Do I have a difficult time falling and/or staying asleep?

  3. Do I stay up late using electronic devices such as phone, computer, TV, or tablet/ipad?

  4. Do I wake up early to workout after less than 6 hours of sleep?

  5. Do I skip breakfast despite exercising early?

Every single person will experience different symptoms depending on their genetic makeup, lifestyle, and the phase of adrenal dysfunction the body is experiencing. Adrenal dysfunction symptoms also often run parallel with many other physical health conditions. For this reason, testing is vital as it allows for proper and safe treatment to take place. 

Symptoms of Cortisol Excess [12] 

  • Sugar craving

  • Abdominal obesity

  • Insulin resistance

  • Weakness

  • Feeling shaky between meals

  • Irritability

  • Hypertension

  • Easy bruising

  • Amenorrhea

  • Erectile Dysfunction

  • Oily skin

  • Sleep disturbances (difficulty falling or staying asleep)

Symptoms of Cortisol Deficiency [12]

  • Chronic weakness

  • Fatigue

  • Decrease stress tolerance

  • Alternating diarrhea and constipation

  • Salt craving

  • Muscle or joint pain 

  • Low blood pressure

  • Anemia 

Tips for Treating Adrenal Dysfunction

Whether you’re a first responder/shift worker and your body is thrown off from its natural circadian rhythm OR you’re a person who inherently deals with or struggles to manage stress, try these tips to help get to the root cause of your adrenal fatigue.

  1. Avoid Intermittent Fasting 

In today’s culture, we tend to find the latest trend and run with it. It’s easy to get caught up in adopting a new diet or eating style when you see your friends and family with success. 

Intermittent fasting would fall into this category as it can work for some and not others. There are some clinical situations where intermittent fasting can be more harmful than beneficial, and adrenal dysfunction is one of them. In a body where cortisol levels are either way too high or way too low, stressing the body and putting it into starvation mode can augment the problem. 

  1. Cut Caffeine by 12:00 pm

Are you waking in the morning and walking straight to the coffee pot? Think again; caffeine causes the production of adrenaline and cortisol, our fight or flight hormones. 

This is definitely not what we need when stress is already off the charts. 

If you struggle to get through a workout without coffee or can get through your midday lull with it, it’s time to reevaluate. Not only is it essential to eat breakfast with your morning cup, cutting it off by noon (or earlier if you can) can help to lower cortisol and improve sleep. Other caffeine sources to pay attention to include: candy, energy drinks, some teas, and pop. 

Try swapping your afternoon coffee with:

  • Turmeric golden milk

  • Herbal tea

  • Sparkling water

  1. Replace High-Intensity Workouts with Restorative Exercise

Putting your body through vigorous exercise is exactly what NOT to do. 

The reason being is that high-intensity exercise is a high cortisol producing activity and when levels are high day after day, this hormone begins to negatively affect the body.

More restorative exercise such as yoga, pilates, or walking that relax muscles and reduce stress  will allow the body to reach a state of “rest-and-digest” versus continually being in “fight-or-flight” that high-intensity workouts cause, especially after a stressful work day when stress is already maxed for the day.  

  1. Balance Blood Sugar

There is a direct link between cortisol levels and high blood sugar. High stress results in high cortisol levels which increases glucose (sugar) levels in the blood. By consuming top hormone imbalancing foods such as refined carbohydrates and added sugars without adequate protein, healthy fats, and vitamins/minerals, blood sugar balance and adrenal function becomes even more dysregulated. 

Try opting for more nutrient-dense and fiber-rich plant-based carbohydrate sources such as organic potatoes, brown rice, quinoa, lentils/beans, and vegetables for example and pair with high-quality protein and healthy fat sources. 

Ensuring you have an adequate amount of protein at meals and snacks is key for managing blood sugar. 

Nutrient-Dense Carbs

  • Fruit

  • Vegetables (except nightshades)

  • Oats

  • Brown Rice

  • All potatoes

  • Quinoa

  • Amaranth

  • Millet

  • Buckwheat

  • Starchy vegetables [i.e, parsnip, squash, rutabaga, squash]

  • Lentils/Beans

  • Cassava/tapioca

Quality Organic Protein 

  • Chicken

  • Turkey

  • Organic free-range eggs

  • Grass fed/finished beef

  • Venison, Elk, any wild game

  • Lamb

  • Veal

  • Wild caught fish (cod, salmon)

  • Sardines

  • Low-mercury tuna 

  • Collagen Peptides

  • Grass Fed whey or plant-based protein powder

Healthy Fats

  • All nuts and nut butter (peanut, almond, cashew, pecan, walnut, pistachios)

  • All seeds (i.e pumpkin, sunflower, flax and chia)

  • Olives

  • Olive oil

  • Avocados

  • Avocado Oil

  • Ghee

  • Coconut/coconut oil

  1. Practice Mindfulness and Meditation

One of the most effective, yet unconventional ways to down-regulate the HPA axis and thus reduce cortisol is with mindfulness and meditation. 

Mindfulness and meditation have been shown to:

  • Lessen perceived stress

  • Downregulate central inflammatory pathways [13]

  • Improve immune regulation

Consider using an app such as Headspace (this is the one we use), Calm, or anything else you can find. We’ve even found the meditations in the Peloton app to be really good. 

Testing for Adrenal Dysfunction 

There are some testing options to determine whether you’re dealing with adrenal dysfunction. A comprehensive hormone test using dried urine samples can give valuable data on your personal hormone levels and patterns throughout the day. 

A salivary cortisol profile can also be useful for measuring the level of the stress hormones cortisol and DHEA. This is helpful in giving a clearer picture of HPA axis communication and the impact stress is having on communication to the adrenal glands.

Most people assume that adrenal fatigue means you inherently have low cortisol, but for some this is not the case. Elevated cortisol is common in the early stages of HPA axis dysfunction when someone is newly exposed to high levels of stress.  

Conventional cortisol testing typically takes a fasting reading in the morning, which is only one snapshot of cortisol throughout the day. 

Cortisol patterns may look great until the afternoon, but after lunch is where the levels get off kilter. 

It is a good idea to invest in comprehensive hormone testing from a trained practitioner vs merely using conventional cortisol tests in a lab to assess your cortisol patterns.  

And there we have it! 

Hopefully you now have a better understanding about what adrenal fatigue or “dysfunction” actually is. With this understanding we can begin making various lifestyle changes such as eating balanced meals, increasing quality and duration of sleep, not overexercising with intense workouts, and incorporating meditation into your daily routine, just to name a few. 

It’s important to understand that there is no pill to fit this ill. Healing a stressed body will not be fully addressed by using antiinflammatory supplements (though they can be a great addition) unless the foundational things listed above are put into place. 

If things still feel off despite making a few changes, you may want to consider investing in the guidance of a practitioner to assess your hormones and diet and make individualized recommendations to get to help get the root of your constant fatigue, stress, anxiety, and chronic inflammation. If you would like to get in touch with us and set up virtual coaching, you may do so here: virtual coaching packages.

Maybe you feel like your stress is pretty well managed and your testing does not confirm any issues relating to your adrenal function. Food may be the root of your issues, and learning about an elimination diet to get a handle on inflammation could be the thing for you. 

References

  1. https://rarediseases.org/rare-diseases/addisons-disease/#:~:text=Approximately%201%20in%20100%2C000%20people,million%20of%20the%20general%20population.

  2. https://www.pointinstitute.org/wp-content/uploads/2012/10/standard_v_9.2_hpa_axis.pdf 

  3. https://pubmed.ncbi.nlm.nih.gov/27577885/ 

  4. https://pubmed.ncbi.nlm.nih.gov/17615391/ 

  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3756071/ 

  6. https://blogs.bmj.com/bjsm/2018/05/30/2018-update-relative-energy-deficiency-in-sport-red-s/

  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491704/

  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860380/

  9. https://pubmed.ncbi.nlm.nih.gov/19488073/

  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303636/

  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105248/, https://www.sciencedirect.com/science/article/abs/pii/S1286457902015447?via%3Dihub 

  12. Lord, Laboratory Evaluations for Integrative and Functional Medicine 2nd edition, 2012.

  13. https://www.biologicalpsychiatryjournal.com/article/S0006-3223(16)00079-2/fulltext