A Functional Medicine Guide: Adrenal Fatigue
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.
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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.
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
How do you know if you have adrenal fatigue?
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
Struggling with these symptoms? Take our Adrenal Fatigue Quiz.
Tips For Overcoming Adrenal Fatigue
1. Ask your doctor about diagnostic labs
Because adrenal fatigue symptoms are so non-specific and could be indicative of other diseases such as depression, sleep apnea, fibromyalgia, and certain autoimmune diseases, it can be hard to make a medical diagnosis. Seeing a medical professional or endocrinologist to establish a baseline of what’s going on in the body is the first step to overcoming adrenal fatigue. In addition to conventional blood labs, I recommend:
- Adrenal fatigue labs: This is saliva test involves spitting into several vials throughout the day. It’s a lot of spit, but it gives you and your doctor a lot of information about your brain-adrenal function. When I did these labs, I learned I did indeed have adrenal (HPA) dysfunction, as I suspected.
- Microbiome labs: The microbiome refers to the community of trillions of bacteria and fungi in your gut. Because gut health is the foundation of total health, especially brain and hormonal health, it is important to discover what is going on and deal with any underlying gut problems such as leaky gut syndrome, candida overgrowth, and small intestinal bacterial overgrowth in order to recover from adrenal fatigue.
- Methylation labs: Methylation is a collection of biochemical actions in the body that happen 1 billion times every second. Healthy methylation helps to maintain a healthy brain, gut, hormones, and detox pathways, and also protects your DNA. However, some of us have genetic mutations that impair the methylation process. I have multiple methylation gene mutations, one of which is the MTHFR gene mutation, making me less able to absorb certain essential vitamins. This was useful information because I was then better able to supplement to make up for my nutritional deficiencies.
2. Intervene into your chronic stress
Another key element of adrenal fatigue treatment is managing 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 a while. 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 a while, you will break the chronic stress cycle to regain your health and feel like yourself again.
3. Bring down inflammation
Curcumin, a compound in the turmeric root, has potent antioxidant properties, as well as a neuroprotective quality. Bonus: It’s a mood-enhancer, too. In a randomized controlled trial, turmeric appeared to act as an effective option for depression, (1) which can occur concurrently with adrenal fatigue.
4. Eat nutrient-dense proteins
Oysters are packed with zinc, and having a balanced trace mineral ratio between copper and zinc can help with healthy neurotransmitter function and adaptogen to stress. Increased copper and decreased zinc have been shown to contribute to brain stress and anxiety. (2) Oysters—the superfood of the sea—are a great way to achieve this balance to help ease your stress levels and adrenal fatigue.
There is some truth to the notion that a post-Thanksgiving meal heavy on the turkey will put you into a “food coma.” The reason is the calming amino acid tryptophan in the turkey. Tryptophan is a precursor to the neurotransmitter serotonin, which helps you feel calm and better able to deal with anxiety. (3)
Grass-fed organ meats
Organ meats like liver are some of the best sources of nutrients needed to beat adrenal fatigue, like zinc and vitamin D. They also contain copious amounts of choline and other B vitamins needed for methylation. (5)
5. Eat more green superfoods
Plant foods like Swiss chard and spinach are rich in magnesium, the original nutritional “chill pill,” which helps to regulate and optimize communication in the brain-adrenal axis. (4)
This sulfur-rich vegetable also contains the beneficial B vitamin folate. Low levels of folate are linked to neurotransmitter impairment, which can lead to brain-hormonal problems. (5)
6. Eat healthy fats every day
Avocados contain beneficial B vitamins and monounsaturated fats that boost neurotransmitter production and brain health. This fatty superfruit also contains potassium, which naturally helps to lower blood pressure.
Bacterial imbalances in your gut can contribute to brain problems (6) because the gut and brain “talk” to each other through the vagus nerve. Kefir is rich in beneficial bacteria for your microbiome and also has fat-soluble vitamins A, D, and K2, which are important for brain health, so it helps out from both ends of this critical connection.
Coconut oil is super versatile – you can cook with it, put it in smoothies, or just eat it off a spoon as I do. It offers good fats like medium-chain triglycerides (MCTs) that can help with brain function. (7)
Omega-rich foods like Alaskan salmon can help decrease inflammation, which is crucial for brain and hormonal health.
7. 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.
8. Sip on herbal tea
This soothing, mild herbal tea isn’t actually from the tea plant. It’s made from an herb, Matricaria recutita, that has been shown to help decrease anxiety, depression, and stress symptoms in just a few weeks. (8)
Another non-tea “tea,” this one comes from the African red bush, typically known as Rooibos, and can have a balancing effect on cortisol. (9)
9. Practice mindfulness techniques
Reducing emotional stress using mindfulness tools like focused breathing can help you stay calm and soothe your brain-adrenal axis.
10. 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.
11. 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.
12. Spend more time outdoors
Because I have a job that’s indoors, I need to make it a point to get outside more often. I believe there is something coded in our DNA that gives each of us an affinity with the sun and fresh air so that we seek out these health-boosting influences. I also like to practice earthing, or walking barefoot outside, as much as I can to help de-stress. Something about that skin-on-earth connection feels literally grounding and refreshing.
13. Get vitamin D levels into a healthy range
Spending more time outside in the sun also helps boost levels of vitamin D, because your body manufactures this important vitamin/hormone when it senses the sun on your skin. Vitamin D is responsible for regulating over 200 genetic pathways, so make sure your levels are high enough. I recommend an optimal range of around 60 to 80 ng/ml. Ask your doctor about a simple blood test to help you keep track.
14. Learn to say “no”
This one is still hard for me. I don’t want to disappoint anybody and there is always more work to be done. But managing stress means creating space in your life to refuel, spend time with the people you love, and doing what you need to do for you and you alone. Don’t just pencil it in. It’s as important as anything else you do for your health, and maybe more so, especially for proper adrenal fatigue healing.
15. 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. That’s where functional medicine comes in. 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.
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- Sanmukhani J, Satodia V, Trivedi J, et al. Efficacy and safety of curcumin in major depressive disorder: a randomized controlled trial. Phytother Res. 2014;28(4):579-585. doi:10.1002/ptr.5025
- Russo AJ. Decreased zinc and increased copper in individuals with anxiety. Nutr Metab Insights. 2011;4:1-5. Published 2011 Feb 7. doi:10.4137/NMI.S6349
- Hudson C, Hudson S, MacKenzie J. Protein-source tryptophan as an efficacious treatment for social anxiety disorder: a pilot study. Can J Physiol Pharmacol. 2007;85(9):928-932. doi:10.1139/Y07-082
- Sartori SB, Whittle N, Hetzenauer A, Singewald N. Magnesium deficiency induces anxiety and HPA axis dysregulation: modulation by therapeutic drug treatment. Neuropharmacology. 2012;62(1):304-312. doi:10.1016/j.neuropharm.2011.07.027
- Coppen A, Bolander-Gouaille C. Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol. 2005;19(1):59-65. doi:10.1177/0269881105048899
- McMaster University. (2011, May 17). Gut bacteria linked to behavior: That anxiety may be in your gut, not in your head. ScienceDaily. Retrieved July 1, 2020 from www.sciencedaily.com/releases/2011/05/110517110315.htm
- Reger MA, Henderson ST, Hale C, et al. Effects of beta-hydroxybutyrate on cognition in memory-impaired adults. Neurobiol Aging. 2004;25(3):311-314. doi:10.1016/S0197-4580(03)00087-3
- Amsterdam JD, Shults J, Soeller I, Mao JJ, Rockwell K, Newberg AB. Chamomile (Matricaria recutita) may provide antidepressant activity in anxious, depressed humans: an exploratory study. Altern Ther Health Med. 2012;18(5):44-49.
- Schloms, L., Smith, C., Storbeck, K.‐H., Marnewick, J.L., Swart, P. and Swart, A.C. (2014), Rooibos influences glucocorticoid levels and steroid ratios in vivo and in vitro: A natural approach in the management of stress and metabolic disorders?. Mol. Nutr. Food Res., 58: 537-549. doi:10.1002/mnfr.201300463
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BY DR. WILL COLE
Dr. Will Cole, IFMCP, DNM, DC, leading functional medicine expert, consults people around the world via webcam and locally in Pittsburgh. He received his doctorate from Southern California University of Health Sciences and post doctorate education and training in functional medicine and clinical nutrition. He specializes in clinically researching underlying factors of chronic disease and customizing a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. Dr. Cole was named one of the top 50 functional medicine and integrative doctors in the nation and is the best selling author of Ketotarian and The Inflammation Spectrum.