Adrenal Fatigue


From May of 2014 until May 2015 I was exhausted. Like, come home from a short easy run and have to lie down and take a nap or I thought I would die exhausted. At first I figured I was just being a wimp. I mean, I've worked night shift, I know what it's like to be tired. But when I started feeling I've-been-up-for-52-hours-straight-because-I-work-night-shift-and-now-I'm-traveling tired, along with feeling forgetful and not sleeping well, I knew something was wrong. 

The short version of the rest of this story is that it took FIVE health care providers (four doctors and a very smart naturopathic nurse practitioner) to figure out that I was recovering from mono. This was confirmed with lab tests. While I was super excited to have an answer to my bone-crushing fatigue, it was not the answer I wanted because there was no "cure." At many points throughout this journey, I actually wished for a disease that I could take a pill for so I could just feel better. Who does that?!? That at least would have a fairly simple and straightforward solution. I did not get what I wished for and instead got a virus (Epstein Barr virus or EBV) that sticks with you forever. My nurse practitioner also diagnosed me with adrenal fatigue and put me on some supplements that really helped me feel less tired. It took me much longer than I expected to overcome this and feel like myself again.  

What is Adrenal Fatigue?

The adrenal glands are part of the endocrine system and release hormones. They are responsible for releasing epinephrine and norepinephrine (your "fight or flight" hormones), cortisol (what helps you get up in the morning), aldosterone (regulates fluid balance), DHEA (a precursor to testosterone...yes ladies, you too need testosterone, just not too much), and sex hormones (progesterone, estrogen, and testosterone which regulate mood and libido)

The adrenals are just one piece in an entire system that controls our stress reactions in the body. This system is called the HPA Axis (Hypothalamic-Pituitary-Adrenal). Many different types of stress can activate the HPA axis. In normal healthy people the HPA axis is activated when needed and shut off when the stress is resolved.

One thing to be aware of is that our bodies are not good at distinguishing types of stress. It sees the run you take to clear your mind the same as running from a bear and skipping a meal the same as potential winter starvation. This can lead to excessive stress on the adrenals without realizing it and is why it's so important to be aware of what your body is telling you!

If you are under chronic stress, then eventually your body becomes resistant to cortisol and your adrenals need to pump out more and more to get a stress response in your body. This happens because of something called downregulation, your body turns off some of the receptors on your cells so your stress response is blunted. The term "adrenal fatigue" is misleading because in most cases your adrenals do not get tired and stop working, it's more an issue of your body stops being very sensitive to cortisol and takes increasing amounts to get an actual stress response. For more on that you can read this post, How Stress Is Ruining Your Health, where I explain more in-depth how this process works. 

What is cortisol?

Cortisol plays an important key role in regulating balance within the body. It helps to regulate:

  • Blood glucose levels
  • Immune response 
  • Blood pressure
  • Glucogenesis (glucose production from non-carb sources)
  • Circadian rhythm

A person with a properly functioning HPA access and well-balanced cortisol will have the highest levels in the morning. As the day progresses, cortisol levels should continue to drop until it reaches the low point around midnight. This enables melatonin, the counterpart to cortisol, to allow us to go to bed and shut off the HPA axis for about 8 hours each night. If you look at your phone or computer at night, the blue light from the screen will suppress melatonin and make it hard for you to sleep!

Symptoms of adrenal fatigue

Do you ever feel like you need a crane to get you out of bed in the morning?

Maybe you used to be super sharp and on top of it but now you're lucky if you remember to put on pants in the morning.

Perhaps your sleep is interrupted by your mind which has suddenly lost the ability to slow down and shut off for the night?

Are you so tired, but yet wired at the same time because if you stop you know that you'll sleep for days?

Do you get dizzy or lightheaded often? Are your emotions suddenly unpredictable? Do you alternate between craving sugar and salt all. the. time? Have you suddenly lost your fortress-like immune system?

If you are nodding your head yes then you might have adrenal fatigue. The good news is that you are not crazy and it is a real, treatable condition. The bad news is that most doctor's don't think it's a real thing. However, a naturopathic or integrative medicine provider will take you seriously.

This is where listening to and knowing your body is so important. If I had not continued to find a healthcare professional who took me seriously, I would still be calling in sick to work so I could sleep all day multiple times a month! If you think something is not right, then it’s not right. It can be frustrating to be brushed off by your doctor, but trust me, it's worth it to find someone who will listen to you.

What can be done to treat adrenal fatigue?

First of all, it's very important that you distinguish adrenal fatigue from other medical conditions. Many medical conditions can cause similar symptoms so it's important to rule out thyroid or other causes of your symptoms.

I also don't recommend self diagnosis when it comes to conditions like this. It is important to go to your healthcare provider armed with information so you can make informed decisions together about what is best for you and your situation. 

Treatment depends on which level of adrenal fatigue you are currently experi: 

Stage one: Intermittent periods of tiredness and some occasional sleep issues.

Stage two: Tired and wired. You go, go, go, but the minute you sit down you are done for. Coffee becomes something that you absolutely can't live without. Your sleep gets more interrupted.

Stage three: Tired, grumpy, and low sex drive. Your sex hormones are being sacrificed in order to keep your cortisol levels up and get you through the day.

Stage four: Time to call in the crane. Coping with daily life feels virtually impossible. Cortisol loses it's morning peak and remains flat-lined throughout the day.

Seeking medical attention is the most important thing in determining appropriate treatment. The labs and supplements you may need depend on what stage you are in and what symptoms you are experiencing. 

However, there are 3 steps that you can take to work towards healing your adrenal fatigue: 

1. Follow an adrenal friendly diet

When managing or recovering from any sort of illness, diet is extremely important. There are some foods that are particularly supportive to the adrenals and can help to get you back on your feet. First you must remove any foods that cause stress on your body, these foods include:

Caffeine: Caffeine interferes with your sleep cycle and the reason you feel awake after drinking it is because it induces a mild fight or flight response in your body. 

Sugar and sweeteners: Take special care to high-fructose corn syrup and artificial sweeteners as well. Avoid sugary foods, cereals, candy, sweets, etc. Also be aware that sugar is added to many packaged foods, so be sure to read your labels! 

Carbohydrates: Certain carbohydrates contribute to inflammation in your body and can be problematic for those with adrenal fatigue. While you may be craving carbs, eating too many will actually cause more stress and inflammation within your body. At the very least I suggest you avoid gluten and most (if not all) grains in order to minimize inflammation. 

Processed foods: Processed and packaged foods often have many preservatives and other chemicals that are hard to digest, cause inflammation, and cause damage to the lining of your gut. Limit these foods as much as possible, and if you do buy them, be sure to read the ingredients and aim to find items that are made up of mostly whole foods and that have the shortest ingredient list possible. 

Vegetable and seed oils: Vegetable oils such soybean, canola, and corn oil are very inflammatory and contribute to chronic stress and inflammation in your body. Try to stick with fats such as coconut oil, olive oil, butter, or ghee.  as Vegetable oils like soybean, canola and corn oil are highly inflammatory and can lead to adrenal inflammation. Try to only use

There are some very nutrient-dense foods that you'll want to add to your diet. These foods are relatively easy to digest and are packed with tons of nutrients which your body needs to heal. 

  • Coconut
  • Olives
  • Avocado and other healthy fats
  • Cruciferous vegetables (cauliflower, broccoli, Brussels sprouts, etc.)
  • Fatty fish (e.g., wild-caught salmon)
  • Free-range chicken and turkey
  • Bone broth
  • Nuts, such as walnuts and almonds
  • Seeds, such as pumpkin, chia and flax
  • Kelp and seaweed
  • Sea salt (not iodized table salt)
  • Fermented foods
  • Chaga and cordyceps medicinal mushrooms

These foods are nutrient-dense, low in sugar, have healthy fat, and plenty of fiber to help your body get the nutrients it needs to heal and continue to function optimally.

2. Supplements and herbs

Supplements and herbs can help to support your body both while it is healing and in your long term health. Please discuss any supplements with your own personal healthcare professional before starting or stopping anything I have recommended. They are particularly useful in getting some of the nutrients that may be more challenging to get in food form. I always recommend getting as many nutrients as you can from whole foods because that is the way your body prefers them. 

There are also certain things that can help support your energy levels as you are working on healing your body. 

Adaptogenic herbs ashwagandha, rhodiola rosea, schisandra and holy basil: Research indicates that adaptogen herbs may help to lower cortisol levels and mediate stress responses within the body. Using these herbs can help to alleviate some of stress on your body. 

Licorice root: Can help to increase the DHEA in your body. Pregnant women and anyone with heart, liver or kidney problems should not take licorice root and no one should take it for more than four weeks at a time

Fish oil (EPA/DHA): Fish oil is not my favorite supplement because it's sourcing can be questionable and the quality is often not great. However, as a short term supplement it can be great, especially if you don't have access to wild-caught fish that is rich in EPA and DHA. Getting plenty of omega-3s is critical in healing your body. 

B vitamins: B vitamins are critical in adrenal health and keeping your body's stress response healthy. If you have been on a high-fat, low-carb diet, you may be particularly deficient in B vitamins. These vitamins also play a role in your energy levels. Taking a high quality supplement will likely go a long way towards your recovery process. 

Vitamin C: Vitamin C has been found to have a positive impact on stress responses, reducing both the psychological and physiological impact of stress on the body

Selenium, Zinc, Magnesium, and Vitamin D: All of these vitamins and minerals are important for both proper thyroid and adrenal function and most Americans are likely to be deficient in them. 

3. Reduce Stress

Probably the most important part of all of this is to focus on reducing stress in your life. 

Make sure that you are resting when you feel tired and aim to sleep for at least 8 hour every night. Avoid staying up late and work on building rest into your day in other ways. The last you need if you have adrenal fatigue is high-intensity cardio that will continue to burn you out. Focus on restorative exercise such as yoga or meditation and take a few rest breaks throughout the day to calm yourself and remember to breathe. 

Be kind to yourself and work on avoiding negative self-talk. Focus on positive relationships and being around people who make you feel good. While this might make you roll your eyes, it's actually advice that is backed by science

Another way to decrease stress is to try essential oils. Oils such as wild orange and lavender have been scientifically proven to reduce your perceived stress levels after just five minutes of smelling them. Remember to always choose the best quality oils you can find, otherwise you are harming your health rather than supporting it.  

It is also thought that there is an emotional component to adrenal fatigue, so changing your perspective and attitude can be immensely helpful as well (I know, easier said than done). A little bit of self-care and YOU time can go a long way!

**Remember that while I am a healthcare professional, I am not YOUR healthcare professional and I do not know your unique situation. This post is meant for informational purposes only and is not considered a substitute for professional medical advice.** 

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Martha Rosenstein