The Real Deal on Adrenal Fatigue
Hey guys! Diane from Balanced Bites here to talk a bit about a really, really common topic in our stressed-out world. We’ve covered this a bunch in TWO Balanced Bites podcast episodes, which you can listen to for free via iTunes – Adrenal Fatigue – Part 1 (Episode #15) and Adrenal Fatigue – Part 2, listener questions (Episode #39).
You hear the expression thrown around a lot if you’re in the health and fitness community or reading books, blogs and listening to podcasts on health-related topics. It’s very common that we, as everyday Americans and athletes/CrossFitters even moreso, experience varying levels of restful sleep, energy, digestive function, immunity and the ability to recover from exercise. With so many stressors in our daily lives, not to mention the things we add on top as pleasure that are actually stressors, it’s no wonder we’re in a bit of a pickle when it comes to achieving healthy endocrine balance.
I have a close relationship with the condition of adrenal fatigue as I have suffered from it, at varying levels, over the last four years. While training for my first half-marathon here in San Francisco in July of 2007, I was experiencing what seemed to be very mysterious changes in my energy and moods. I was following a low-fat diet for the duration of my training under the nutrition advice of a Registered Dietitian who specialized in sports nutrition. The program included plenty of whole grains, dairy, some nut butter, very lean meats, vegetables and fruit – and would add up to as much as around 2,500 calories per day. Without eating much fat, that’s a LOT of food. I was eating at least six times a day. At the time, I was training anywhere from 60-120 minutes, primarily performing steady-state cardio exercise or sometimes interval training with minimal strength training included. This was a pretty far departure from the training I had done most of my life prior to beginning the half-marathon training. Needless to say, this was not a smart choice for my body.
While completing training runs adding up to around 20-25 miles per week, I would also attend three or four cardio kickboxing classes per week on top of that. I distinctly remember attending a couple of those classes, which I had always done for the fun of it, and not being able to smile. My energy was just flat. It was like the air in my tires was gone and I couldn’t even muster up the gusto to finish the classes anymore. And these were classes I was even certified to teach, that’s how much I loved them. As if that wasn’t enough, I would frequently pick up a second cup of coffee for the day either before or after the kickboxing class (we’re talking 6/7pm here folks) to go home after the gym and work late into the evening on side-projects from my day job. Talk about burning the candle at both ends! I was very lean and felt amazing when I looked in the mirror and saw 6-pack abs for the first (and possibly only) time in my life, but my body was telling me that it wasn’t happy. And I wasn’t listening. I didn’t know that what I was experiencing was something real that was a direct result of the diet and lifestyle I was choosing to lead – thinking it was making me healthier!
What I finally learned after my exhaustion:
- People who train hard and look lean are not always healthy.
- Eating fat will not make me fat
- Working out smarter, not harder is often the way to achieve performance and aesthetic goals.
- Sleep is the cornerstone of being able to eat well, train well and to allow the body to re-set stress levels and lose body fat.
I felt like I had discovered The Holy Grail. Creating a lean healthy body actually required a lot less effort than I thought.
What is stress?
Stress is a specific response by the body to a stimulus, such as fear or pain, that disturbs or interferes with normal physiological equilibrium. Stress can be physical, mental or emotional strain or tension and can be an occurrence (chronic or acute) or a causative factor in a state of dis-ease.
Key players in the endocrine game of stress & adrenal function:
Two, triangular shaped glands that sit on top of your kidneys, consisting of an inner medulla and an outer cortex. The adrenal medulla produces and secretes epinephrine (adrenaline, a fast-acting hormone), norepinephrine (noradrenaline), and a small amount of dopamine in response to stimulation by sympathetic preganglionic neurons. The adrenal cortex mediates the stress response through the production of steroid hormones: mineralocorticoids and glucocorticoids, including aldosterone and cortisol respectively as well as DHEA and sex hormone precursors.
The hormone released in response to any kind of systemic stress. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat, protein and carbohydrate metabolism. (Wiki)
Hypothalamus-Pituitary-Adrenal Axis (HPA Axis):
The system of communication between the neuro-endocrine glands that dictates our responses to stress as well as our circadian rhythm.
Neurotransmitters, Excitatory & Inhibitory:
Neurotransmitters are chemical messengers that transmit signals from neurons to their target cells across synapses. The way each neurotransmitter is classified is based upon which receptors they activate. Some typically excitatory neurotransmitters include glutamate, dopamine, acetylcholine, epinephrine (adrenaline), norepinephrine (noradrenaline) and histamine. Some typically inhibitory neurotransmitters include serotonin (95% of which is made in the gut, according to Elizabeth Lipski), GABA, glycine and adenosine.
Hippocampus & Circadian Rhythm:
The gland that regulates circadian rhythm, our bodies’ roughly 24-hour cycle in biochemical, physiological, and behavioral processes.
When the neuro-endocrine pathways are well-balanced…
In a perfect world, we wouldn’t have extreme imbalances in this system of messages at all. We might experience acute bouts of an imbalance, but we’d quickly come back to a homeostasis and appropriate cortisol levels and rhythm throughout the day (high in the morning, tapering off to low in the evening). In balance, we have adequate amounts of serotonin in a healthy gut to promote the production of melatonin at night – the counter regulatory hormone to cortisol that manages our sleep cycle while cortisol manages our wake cycle. When we are able to fall asleep at night easily, wake up in the morning easily and feeling rested and have good energy throughout the daytime, we are in good balance. When stress takes over, that’s when the balance is lost.
How stress affects your system.
The diagram below illustrates a stress response we might have that we are aware of, such as a traffic jam when we’re on our way to an important meeting. It’s important to note that similar stressors can affect different people in different ways depending on the constitution of the person as well as that person’s state of mental, emotional and physical well-being at the time the stressor is introduced. For example, two people may be in the same traffic jam, but one is perfectly happy to sit and listen to his Paleo Solution Podcast for an extra 20 minutes, while the other is about to be late for an important job interview. The chain of events that happens in reaction to the traffic jam in each person’s system will be very different as a result. Additionally, this response can be happening on a systemic level on a daily basis if you are eating food that you don’t tolerate – your weekly gluten-bomb cheats that you think aren’t so bad… they are. and your body is trying to recover from the inflammation in your gut without reprieve.
A repeatedly excitatory response to this kind of stressor, or even a chronic internal stress such as malnutrition or gut irritation/leaky gut, can push your immuno-endocrine system completely off balance. It should become apparent just how critical our nutrition, proper doses of exercise, gut health, thoughts, emotions, perceptions and reactions to life stressors really are when we’re talking about keeping the messages being sent to our adrenal glands in check.
A Look at the Problem: It’s Not Your Adrenal Glands’ Fault
The single biggest contributing factor to adrenal fatigue (or an altered adrenal profile, as I like to call it) is stress. It sounds simple enough, but the reality is that stress comes in so many varieties and forms that it’s impossible to avoid all together. What we must do is identify the forms that we can best control in our lives and work on making diet and lifestyle modifications to work on lowering the stress-load on our systems. We can also work on finding better ways to help our bodies to manage the stressors that we do experience that we cannot eliminate.
Contributors to the stress that leads to adrenal fatigue can be lifestyle stressors including but not limited to: lack of sleep, poor food choices, use of stimulants, pulling “all-nighters” or “pushing through” a day despite being tired, perfectionism, staying in no-win situations for too long, over training, lack of fun or stress-relieving practices. Those who are: students, medical professionals, single parents, unhappily married, unhappy or unsatisfied at work, are self-employed or starting a new business, abuse drugs or alcohol, have alternating shift schedules or who are the “all work and no play” types have lifestyles that lead to adrenal fatigue. Furthermore, life events that can lead to adrenal fatigue include: unrelieved pressure or stress at work, any crisis or severe emotional trauma, death of a loved one, major surgery, extended or chronic illness, sudden change in life situations such as loss of a job or moving without much friend or family support in a new location and repeated or extended chemical exposure. (Wilson, 17-18) The problem of stress might not be such an issue if we weren’t compounding many stressors over the course of days, weeks, months and years without much downtime for our systems. So, while the condition of adrenal fatigue can come on suddenly as triggered by a traumatic or severe life event, most commonly it is experienced after a gradual, cumulative effect of multiple stressors.
If the adrenal glands ability to make cortisol is not to blame, then what is?
If a person has completed an Adrenal Salivary Index (sometimes called and Adrenal Stress Index or ASI) test and there is output of cortisol over the course of the day that is not simply low at each measured time, then the adrenals are capable of producing cortisol, they are just “off” in how they are releasing it in response to the messages they receive from the Hypothalamus-Pituitary-Adrenal Axis (HPA Axis). It’s pretty uncommon to see a test result that’s simply low across the board, typically there’s at least one spike in a person’s levels. So, what does that mean? The adrenals are doing what they’re asked to do by the higher order functions of our bodies, but that may not be the desired action in terms of a healthy volume and balance for our cortisol throughout the day.
This brings us back to the HPA Axis and our good friend, Balance.
The way we can bring our adrenal health back in line is to balance out the types of messages our Hypothalamus is sending to our adrenal glands via the HPA Axis. Imagine this action is a bit like a teeter totter…
Symptoms of an Altered Adrenal Profile
- inability to recover appropriately from exercise (you should feel tired post-workout for MAYBE 20-30 minutes, then you should feel just fine – if you are dragging for hours or the rest of the day, you overdid it!)
- headaches with physical or mental stress
- weak immune system & allergies
- slow to start in the morning
- gastric ulcers
- afternoon headaches
- feeling full or bloated
- craving sweets, caffeine or cigarettes
- blurred vision
- unstable behavior
- becoming shaky or light-headed if meals are missed or delayed
- cannot stay asleep or cannot fall asleep
- dizziness when moving from sitting to standing or lying to standing
- transient spells of dizziness
- hemorrhoids, varicose veins
What can you do about it?
- Avoid draining people or situations. Learn to say NO to things!
- Do not over-train: (training vs draining, working out vs working IN, READ: Paul Chek’s book “How to Eat, Move and Be Healthy” for more on this)
- Do restorative exercises: see Paul Chek’s book – listed above – Qigong, meditation, restorative breathing, walking, very light/restorative yoga. Depending on your status, if you are going to lift weights, keep it moderate weight and low reps- not high intensity over long periods of time.
- Whenever you are not enjoying your life, assess whether you can:
- 1. change the situation
- 2. change yourself to fit the situation
- 3. leave the situation
- Keep a gratitude list.
- Play! With family, friends, pets.
- Read: “Are you driving your life or is your life driving you?”
- A well-balanced (for you!) Paleo diet – focus on quality proteins and fats, add starch pre and/or post workout as-needed for energy and recovery
- A variety of organic vegetables and fruit
- EFAs (omega 3 fatty acids) to manage inflammation and quiet the loop that feeds into higher cortisol production
- Add mineral sea salt to food / water
- Balanced meals – judge your “success” by how you feel entering your next meal (starving, shaky, low blood sugar?!)
Supplements & Nutrients in your food on which to focus:
Vitamin C – Citrus, strawberries, kiwi, cruciferous vegetables and green leafy vegetables are good food sources. This potent antioxidant has been shown to induce an anti-inflammatory response to prolonged exercise and stress and mitigates the rise of cortisol and subjective response to physiological stress in human studies. Generally a high-dose supplementation is recommended short-term and to bowel-tolerance. (Life Extension, 17)
Vitamin B5 (or only a complex as noted below) – Helps to activate the adrenal glands and deficiency results in adrenal insufficiencies characterized by “fatigue, headaches, sleep disturbances, nausea and abdominal discomfort.” (Life Extension, 17)
Vitamin B Complex– Liver, meat, seafood (wild/pasture raised, grass-fed sources), seeds, mushrooms are good food sources. All B vitamins are critical for the entire adrenal cascade – lower your dosage with recovery and focus only on foods. (Bauman, 2010) (Wilson, 199)
Magnesium Glycinate or Malate - Green leafy vegetables, pumpkin seeds, sesame seeds (also tahihi) salmon and halibut are good food sources. Magnesium is “essential to the production of the enzymes and the energy necessary for the adrenal cascade.
Omega 3 – Fatty cold water fish: salmon, mackeral, herring, some tunas, etc. are good food sources. In supplemental form, fermented cod liver oil from GreenPasture.org is the one that I recommend.
Licorice root extract (DGL) – no more than 1000mg of glycyrrhizin/day – when cortisol is lower than normal rhythm or output should be. (Life Extension, 17) This is also easily taken via licorice root tea before 3pm.
Acetylcholine – To support poor circadian rhythm function (tired & wired/can’t sleep), supporting brain and neurotransmitter function. (Walsh, T-nation)
L-theanine – As a calming amino acid, works by increasing GABA which is a relaxer and creates a sense of well-being in the brain. (Life Extension, 16)
Seriphos (Phosphorylated Serine) at bedtime. Short-term to re-regulate sleep cycles.
Ashwaganda root & leaf, Panax ginseng, Siberian ginseng,Ginger root – adaptogenic herbs that can help to modulate cortisol levels, normalize blood pressure, heart rate and increase metabolic rate by stimulating the production of digestive enzymes for protein and fat.
Ginkgo biloba - a powerful antioxidant that helps to calm free-radical production and thereby protect the adrenals from the imbalance of inputs to the hypothalamus that the free-radical damage would create. (Wilson, 193-207)
If you are curious about your own adrenal health status…
Contact a naturopath, chiropractor, certified nutrition consultant or other practitioner in your area to find out if they can run an adrenal salivary index test for you.
Kharrazian, Datis. Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal. Garden City, NY. Morgan Jame Publishing. 2010.
Life Extension: Disease Prevention and Treatment. Hollywood, FL. Life Extension Media. 2003.
Murray, Michael. Encyclopedia of Nutritional Supplements: The Essential Guide for Improving Your Health Naturally. Roseville, CA. 1996.
Sapolsky, Robert M. Why Zebras Don’t Get Ulcers. The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping. New York, NY. St. Martin’s Press. 2004.
Walsh, Bryan and Sean Croxton. The Truth About Adrenal Fatigue. Blog Talk Radio. http://www.blogtalkradio.com/undergroundwellness/2010/10/07/the-truth-about-adrenal-fatigue-with-dr-bryan-walsh. 2010
Wilson, James L., N.D., D.C. Ph.D.. Adrenal Fatigue: The 21st Century Stress Syndrome. Petaluma, CA. Smart Publications. 2001.