Out of all the health issues my patients come to me with, fatigue is by far the most common. I witness the epidemic of extreme exhaustion on a daily basis.
Patients wake up feeling exhausted, craving cups of caffeine. They are irritable and "hangry" for salty or sugary foods. They can't lose weight, despite dieting and exercise, and have little to no sex drive. Their energy level crashes in the afternoon, but they often get a "second wind" before bed. Then they have trouble winding down in the evening, only to have another night of restless sleep.
Sadly, many think this is normal. That's because they look around and see everyone looking just as tired and miserable as they are. But just because something is common doesn't make it normal.
This is not normal — this is the epidemic of adrenal fatigue.
What are the adrenal glands?
Your adrenal glands sit on top of your kidneys, like little kidney baseball caps. They regulate many critical hormonal jobs in your body, including the release of your main stress hormone, cortisol.
Our bodies are built for stressful events, and throughout time they have adapted to them. We are here today because the human species can handle stressful events. If our ancestors were chased by a predator, the sympathetic response, our body’s fight-or-flight mode, would be activated. During this stress response, cortisol would be released, ramping up blood pressure and blood sugar, which were needed to cope with the stressful event.
When things calm down, cortisol secretion then decreases, along with your blood pressure and blood sugar levels. Normal balance is intact.
So what is adrenal fatigue?
Cortisol is neither bad or good — it just is. But problems occur when there's an imbalance in cortisol.
In a healthy individual, cortisol is higher in the morning and slowly flows lower throughout the day. Melatonin, your "sleepy time" hormone, is inversely proportional to cortisol. So when cortisol is high, melatonin is low and vice versa.
Adrenal fatigue happens when there's an imbalance in this cortisol rhythm: Cortisol is high when it should be low, low when it should be high, or always high or always low.
The secret to understanding adrenal fatigue is understanding its origin: your brain. Your brain tells your adrenal glands what to do through a complex web of communications called the hypothalamic-pituitary-adrenal axis (HPA Axis), or simply the brain-adrenal axis. Your hypothalamus releases corticotropin-releasing hormone (CRH), which tells the pituitary gland to release the adrenocorticotropic hormone (ACTH). ACTH then tells your adrenal cortex to release cortisol.
Adrenal fatigue is really a dysfunction of your brain’s communication with your adrenals — not the adrenal glands themselves.
What causes adrenal fatigue?
Our modern life, with its many ongoing stressors, can turn on your stress response and throw away the key. Unlike acute stress, for which we’re biologically hardwired, chronic stress turns on the fight-or-flight response without any rest.
If the stress response doesn’t leave, those cortisol triggers never stop. Some chronic stressors that can lead to adrenal fatigue include:
- autoimmune conditions
- emotional stress
- excessive exercise
- food intolerances
- microbiome dysfunctions
If you're struggling with adrenal fatigue, you're likely experiencing most of the following symptoms:
- You're slow to start in the morning
- You crave salty or sugary foods
- You have a low libido
- You're fatigued in the afternoon
- You get a "second wind" in the evening
- You can't stay asleep
- You experience dizziness when standing up quickly
- You get afternoon headaches
- You have blood sugar issues
- You have chronic inflammation
- Your nails are weak
- You're often moody
- You have difficulty losing weight
So, what's next? If you think you might have adrenal fatigue, I recommend these tips:
1. Consider having labs done.
One of the labs I run on patients is a 24-hour adrenal stress index — a salivary test that tracks your cortisol levels, HPA axis quality, and other hormone levels throughout the day — to get a comprehensive view of what’s going on in your particular case.
Because adrenal fatigue is mainly a brain-based issue, it's also important to rule out brain inflammation. In Signs You Might Have A "Leaky Brain" And What To Do About It, I go over the brain labs I often recommend.
2. Improve your chronic stressors.
Working on the stressors listed above — such as testing for food intolerances and removing toxins — will be essential to breaking the chronic stress cycle, regaining your health, and feeling like yourself again.
3. Eat calming food medicines.
The foods we eat will either perpetuate stress in our body or calm it down. Oysters and avocado are two of my favorite foods to help de-stress the brain and hormonal system.
4. Practice breathing exercises.
Breathing is a major factor in reducing stress. Take time throughout the day to become aware of your breath — it's a great way to diffuse stress levels and calm your brain-adrenal axis. I recommend mindfulness meditation or present moment awareness to my patients struggling with adrenal fatigue.
5. Start yoga or tai chi.
6. Try natural medicines.
Rehabbing the brain-adrenal connection takes time. What works for one person may not work for you, so it's important to discuss this with a qualified practitioner. Here are some general natural medicines that can help:
- Adaptogenic herbs: Ashwagandha, Rhodiola Rosea, Holy Basil, and Eleuthero Ginseng can have a regulating effect on cortisol rhythm.
- Magnesium: Magnesium is the original chill pill. It helps support the adrenal glands, relaxes stressed muscles and nerves, and promotes quality sleep.
- Methylation support: Taking activated forms of B12 and folate are effective ways to support healthy methylation pathways, which help balance the melatonin-cortisol rhythm.
- GABA support: Your calming, inhibitory neurotransmitter is GABA. Herbs like passion flower and amino acids such as theanine, glycine, and taurine can help calm you down by acting on the gabaminergic pathways in your brain.
7. Get enough sleep.
Make sure you're not staying up too late — you need to allow your brain and adrenals to recuperate overnight. Promote quality sleep by turning off the TV and smartphone a few hours before bed and reading a book instead.
8. Consider functional medicine.
Depending on your individual brain-adrenal dysfunction, you may need to work with a qualified practitioner to carefully replace a small portion of the levels of the missing adrenal hormones for a period of time. Specific amounts of DHEA and the precursor to cortisol, called pregnenolone, can stimulate your body to begin producing it naturally.
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