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After taking care of patients for the past 25 years, I’m accustomed to the pushback that comes with adrenal problems. I get it—when you’re tired but wired, like I was in my mid-30s, the last thing you want is for some doctor to say that you need to ditch the coffee or vegan scones. As one patient put it, “Dr. Sara, you’ll have to pry that coffee mug out of my cold, dead fingers if you want me to give it up.” Um, OK.
But that’s what works when it comes to healing your adrenals. I know because I’ve been there, with certifiable adrenal dysregulation based on symptoms and laboratory confirmation, and the feeling of being overwhelmed, weight-loss resistant, depleted and too tired for sex, irritable, and most definitely addicted to caffeine.
But when you persist in jacking up your adrenal function, it’s akin to taking out a high-interest loan that you’ll need to repay sometime soon (see symptoms below). It was only when I applied the basic tenet of functional medicine to my own life that I began to heal: Remove the factors that cause imbalance, and add the factors that create balance.
What You Need to Know About Your Adrenals
Your adrenal glands are about the size of a pencil eraser and sit on top of your kidneys like sentries, on guard and ready to release cortisol, the fight-flight-freeze hormone, when you’re stressed or under threat.
When I first started helping women and men with their hormones back in the early '90s, I didn’t know that the root cause of nearly every hormone problem was adrenal dysregulation.
It’s important to understand this point, because creating natural hormone balance begins with cortisol—which means nourishing the adrenals, even when you feel too depleted to do so. The alternative is an adrenal crash, and no one wishes that on you.
Signs of Adrenal Dysfunction
Have you experienced any of these symptoms in the past six months?
- Feeling like you’re constantly racing from one task to the next
- Feeling wired yet tired
- A struggle to calm down before bedtime or getting a second wind that keeps you up late
- Difficulty falling asleep or disrupted sleep
- Anxiety or nervousness—you can’t stop worrying about things beyond your control
- Frequent screaming or yelling—you're quick to feel anger or rage
- Memory lapses or feeling distracted, especially under duress
- Sugar cravings—you need “a little something” after each meal, usually of the chocolate variety
- Increased abdominal circumference, greater than 35 inches (the dreaded abdominal fat—not bloating)
- Skin conditions such as eczema or thin skin (sometimes physiologically and psychologically)
- Bone loss (perhaps your doctor uses scarier terms, such as osteopenia or osteoporosis)
- High blood pressure or rapid heartbeat
- High blood sugar (maybe your clinician has mentioned the words pre-diabetes or even diabetes or insulin resistance)
More than three to five symptoms indicate that you likely have a problem with dysregulated adrenal function. I advise testing as the next step, ideally with diurnal dried urine or saliva testing. Note that these are symptoms of high cortisol; the symptoms of low cortisol, which may occur within the same day, can be found in my first book, The Hormone Cure.
As you age, cells become more resistant to cortisol, which jacks up your serum levels and may be associated with lower cortisol inside your cells. These two imbalances—in the blood and in the cells—means that you may feel tired (low cortisol) yet wired (high cortisol).
Keep in mind that your control system for adrenal function, which I call the “Hypothalamic-Pituitary-Adrenal-Thyroid-Gonadal” (HPATG) axis, is complex yet wise. If you suspect or know that you have adrenal issues, collaborate with a functional medicine professional to work with the innate intelligence of your body.
The Foods You Should Avoid
When it comes to healing your adrenals, the idea is to lower stress or reduce the perceptions of stress, or both. Here's what you should steer clear of:
Caffeine raises cortisol and reduces insulin sensitivity in your cells. And many people, including me, are genetically slow metabolizers of caffeine. I need to keep my intake of caffeine to less than 200 mg day (ideally, none at all) in order to fall asleep at a decent hour.
Sleep is crucial to healing your adrenals: There’s a beginning, middle, and end to the “adrenal repair” conversation every night, and if you miss some of that repair, it will show up later as symptoms or lack of resilience.
2. Sugar and artificial sweeteners
Eating sugar cranks up (then down) your blood sugar, and the effect may be more exaggerated if you have adrenal dysregulation. The effect between sugar and cortisol is bidirectional: Stress increases your level of cortisol, which makes blood sugar rise—a nifty trick of evolution that allows you to fight off or flee a predator.
Because of the relationship between cortisol and blood sugar, you can get into a vicious cycle of worsening blood glucose and adrenal dysregulation if you don’t manage your blood sugar well by eating foods that stabilize it, like clean protein, fat, and fiber.
3. Food intolerances, including gluten, dairy, and soy
Food intolerances trigger the stress response in your body. The irony is that many food intolerances are toward foods that have addictive properties, so it can take an iron will to remove them from your food plan.
This is not a situation in which moderation is your friend. If you’re unsure about food intolerances, try an elimination diet or perform serum testing with a functional medicine professional.
Of course, this list is abbreviated; keep in mind there are other considerations. For instance, a very low carbohydrate diet can raise your cortisol and tax your adrenals. Toxic people who suck you dry are a major cause of adrenal dysregulation. And alcohol? Mold? Being stuck in a job or marriage you don’t love? Sigh. Let’s save those for another article.
What You Should Be Eating
1. Eat clean, nutrient-dense protein at the right dose for you.
That means not too much and not too little. For most women, that’s 20 to 30 grams of protein per meal, or 75 to 100 grams per day. People who are more active need more protein.
When I was trying to lose weight before getting married, I went on a very low carb diet and didn’t lose weight but worsened my thyroid and adrenal function instead.
2. Add maca to your shake.
I love when a stressed-out woman with anxiety symptoms and low sex drive tells me she feels better after adding 1 to 2 teaspoons of maca powder to her morning protein shake.
From Peru, maca is an adrenal adaptogen (i.e., helps you adapt to your environment, both internal and external) that has been shown to help anxiety, depression, low sex drive, sleep, and to reset the control system, the HPATG. If you get too much maca, it can stimulate the breast tissue and cause tenderness.
Another option is ashwagandha, which I get in powdered form from Banyan Botanicals. It’s an Ayurvedic herb that helps you reset cortisol so it’s neither too high nor too low and improves stress resilience. I take it to sleep at night.
3. Eat healthy fats every day.
You’ll find in my daily food plan a few staples: marine fat, usually from cold-water, low-mercury fish like salmon and halibut. Coconut oil, rich in medium-chain triglycerides that don’t require special processing by the gallbladder to be assimilated. And extra dark chocolate, which is chock-full of monounsaturated fats necessary for a smart brain and has been shown to reset cortisol. Yum!
The Bottom Line
I struggled for many years with adrenal dysregulation, in part because I didn’t learn about it in medical school but also because I thought my lack of energy was some sort of moral failing—and I’m a doctor! Don’t let that happen to you. Investigate the biological underpinnings of your symptoms, starting with adrenal issues since they are the root of nearly every hormone imbalance that I’ve seen in practice.