by Dr. Will Cole
My patients come to me with many different health issues, but the most common one by far is fatigue. I witness the epidemic of extreme exhaustion on a daily basis, as my patients tell me how they wake up feeling exhausted and depend on caffeine to keep them awake throughout the day. They are irritable and “hangry” (hunger that makes them feel angry), crave salty or sugary foods, or both. They have trouble losing 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 and find they can’t wind down or sleep soundly, perpetuating the cycle.
Sadly, many think this is just the way people feel, and that it must be normal because everyone else seems to feel the same way. But just because something is common doesn’t make it normal. Feeling constant, unrelenting fatigue is not normal. In fact, it is one of the primary symptoms of adrenal fatigue.
All about your 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, but one of their primary jobs is to control the release of your main stress hormone, cortisol. Cortisol is essential for survival.
Our bodies are built for stressful events. When our ancestors were chased by predators, the sympathetic nervous system responded by switching the body into fight-or-flight mode. During this stress response, the adrenal glands release cortisol, which increases blood pressure and blood sugar for faster response and better survival. When the predators were gone, cortisol decreased, and so did blood pressure and blood sugar levels. Normal balance was restored. However, ongoing stress (that feels like predators to your brain) doesn’t turn it back off.
So what is adrenal fatigue?
In a healthy individual, cortisol is higher in the morning to help with waking, and slowly lowers 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 is an imbalance in this cortisol rhythm. Cortisol is either low when it should be high, high when it should be low or always low or always high.
But the problem isn’t isolated in your adrenals. In fact, 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?
Some chronic stressors that can lead to adrenal fatigue include:
- autoimmune conditions
- bacterial infections
- emotional stress
- excessive exercise
- food intolerances
- microbiome dysfunctions
If you’re struggling with adrenal fatigue, you’re likely experiencing most of the following symptoms:
- Slow to start in the morning
- Cravings for salty or sugary foods
- Low libido
- Fatigue in the afternoon
- A “second wind” in the evening
- Inability to stay asleep
- Dizziness when standing up quickly
- Afternoon headaches
- Blood sugar issues
- Chronic inflammation
- Weak nails and brittle hair
- Difficulty losing weight
If you think you might have adrenal fatigue, I recommend these actions:
1. Ask your doctor about diagnostic labs.
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 my previous article, I go over the brain labs that I often recommend.
2. Intervene into your chronic stress.
Pinpoint your key areas of stress and work to modify them, whether that means testing for food intolerances, detoxifying your environment, or just letting yourself heal by clearing your schedule for awhile. You can never eliminate all stress in life but if you can be sure to work in periods of rest and relaxation so stress levels can subside for awhile, you will break the chronic stress cycle to regain your health and feel like yourself again.
3. Enjoy stress-busting food medicines.
The foods you choose will either perpetuate stress 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.
You breathe all day long, but doing it consciously and with focused awareness is a powerful practice for reducing the stress response. Take time throughout the day to become aware of your breath and you’ll diffuse stress and reboot the brain-adrenal axis. I also recommend mindfulness meditation or present-moment awareness to my patients struggling with adrenal fatigue.
5. Start a yoga or tai chi ritual.
Bring practices of intense alertness and stillness into your life and you’ll nip stress in the bud. Yoga and tai chi are two of my favorite ways for balancing and managing the stress.
6. Try natural medicines.
Rehabbing the brain-adrenal connection takes time and what works for one person my not work for you, so it’s important to discuss natural medicine therapy with a qualified practitioner who can make personalized recommendations based on your needs. However, here are some general natural medicines that can help mitigate stress:
- Adaptogenic herbs: Ashwagandha, Rhodiola Rosea, Holy Basil, and Eleuthero Ginseng can have a regulating effect on cortisol rhythm.
- Magnesium: Works to help support the adrenal glands, relaxes stressed muscles and nerves, and promotes quality sleep. It can also help keep you regular.
- 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: GABA is your calming, inhibitory neurotransmitter and 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. Sleep more.
In order to allow your brain and adrenals to recuperate overnight, you need to get enough sleep. Promote quality sleep by turning off the TV and smartphone a few hours before bed and reading a book instead. Most professionals recommend at least 7 hours per night for adults.
8. Give functional medicine a try.
Depending on your individual brain-adrenal dysfunction, you may need to work with a qualified practitioner to assess your condition and 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, but you need professional guidance to determine how much and how often.
If you want to learn more about your own health case please check out our free health evaluation. We offer in person as well as phone and webcam consultations for people across the country and around the world.
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