If you have been feeling overwhelmed and you are becoming increasingly tired, then you may not be producing enough of an important hormone called cortisol. When your adrenal glands do not produce enough cortisol then you also may experience poor sleep, brain fog, a low mood and a poor immune system. If this continues for more than a couple of weeks then you might be experiencing a situation called adrenal fatigue, and you may need more help, than simply getting some more rest.
“Adrenal Fatigue”, or Adrenal Burnout, is the term used to describe a dysregulation of the HPA hypothalamus, pituitary and adrenal (HPA) axis. The Hypothalamus-Pituitary-Adrenal (HPA) axis acts as a control centre for the body’s own stress response. When we experience stress, in any form, the HPA axis initiates a hormonal cascade which eventually results in the production of our stress hormone, cortisol, to be released from our adrenal glands. This is a perfectly normal physiological response, causing the raised cortisol to send messages throughout the body, for example triggering the release of glucose into the blood to ensure the brain, heart and muscles are supplied with sufficient fuel (to run away from the source of stress). Functions such as digestion and reproduction are regarded as secondary at times of stress; survival is the body’s priority. We were designed to cope well with stress but when it accumulates then this is when we start running into trouble.
To help us understand it further, a useful analogy is that of a zebra grazing on the plains of Africa. If the zebra becomes under threat from a predator such as a lion, its digestive system shuts down, glucose is sent to its muscles to enable it to run away as fast as possible. Once the zebra is safe again and the threat (lion) has moved on, the zebra returns to grazing calmly once off, having burnt the glucose as fuel. In all mammals, the HPA axis has a number of feedback loops which allows the body to normalise the production of stress hormones such as cortisol.
This process, known as “habituation” (a kind of adaptation), prevents your body from becoming over stimulated by a more chronic source of stress. However, some people are unable to properly adapt to the daily stress they face, particularly if the stress is much more significant than simply a traffic jam on the way to work. Therefore, when the HPA axis is no longer able to adapt to daily stressors appropriately, this is when the symptoms of “adrenal fatigue” become an issue. Scientific research tells us that failure of the HPA axis to adapt to chronic stress is associated with a wide range of physical and mental health outcomes, including exhaustion, depression, anxiety, low self esteem, and central fat accumulation. Chronic fatigue and PTSD patients often experience low cortisol levels.
As individuals we are all unique with different levels of response to the same stressors, and a lifestyle that might cause HPA axis dysfunction in some may be completely manageable for others. Evidence shows that people who are prone to over thinking and focusing on past stressors have a reduced ability to adapt to repeated stress, and for others a single night of sleep deprivation has been shown to impact the body’s ability to adapt to stress as well.
Today’s busy, non-stop and often over-stimulating society often provides a source of “drip feed” stress for some. From the moment our alarm wakes us from a deep sleep (often not long enough or interrupted to be fully restorative) our bodies are subjected to forms of stress. From racing around sorting the children before school drop off, getting stuck in traffic en route to work, a big meeting or performance review at work, too much screen time and not enough time to relax. Physical stress, pain and inflammation as well as over exercising can also contribute to the body’s stress response with a significant physiological impact.
We often use the term “load”, as people tend to equate the term “stress” with life changing events such as bereavement or divorce and somehow don’t feel their situation is viable. It is helpful to understand that there are daily stressors contributing to our stress and tolerance “load” which contributes to Adrenal Fatigue, or Adrenal Burnout. Your body’s ability to respond and adapt appropriately to stress will significantly affect how your body responds to chronic stressors over time.
The adrenals don’t technically become “fatigued” but they eventually produce less cortisol over time as the hypothalamus stops stimulating them as they should. This is typically represented by a high level of cortisol to start, which drops to low cortisol, although some stressful events are traumatic enough to send the HPA axis straight into low cortisol output (or even trigger autoimmunity). Some people may also experience a reversal of the circadian rhythm of cortisol output, where their cortisol is low in the morning and high in the evening, a typical presentation with symptoms of poor sleep. Any level of imbalance in cortisol due to chronic HPA axis activation falls into the umbrella term of “adrenal fatigue”. Failure of the HPA axis to respond appropriately to acute stress is another cause of symptoms.
Adrenal Fatigue can impact on the immune system, acting as a trigger for autoimmune conditions as well as an imbalance in hormone levels with a significant impact on fertility hormones and thyroid function (stress affects the ability of the body to convert thyroid hormone into its active form). When experiencing a stress response, the body regards digestion and reproduction as less of a priority – the focus is on survival. We have all experienced a “nervous tummy” at one time or another. Long term stress can therefore often contribute to digestive problems, as well as impacting on reproductive hormones, often demonstrated by low progesterone and the menstrual cycle.
Symptoms of Adrenal Fatigue are wide ranging, and can appear vague but we tend to look for the following:
- Unrefreshed sleep
- Fatigue & low energy
- "Tired but wired"
- Low blood pressure
- Cravings for salt
- Inability to tolerate stress
- Night waking
- Sensitivity to cold
- Poor immunity
- Digestive symptoms such as constipation and/or diarrhoea
- Menstrual irregularities
- Reduced sex drive
- Poor memory
Often someone may visit their GP and all blood test and investigations come back “normal” but the symptoms remain. Adrenal Fatigue is not currently recognised by the medical community, and only the condition Addison’s Disease (seriously low levels of cortisol production), can be diagnosed by a GP. However, that doesn’t mean the symptoms associated with HPA axis imbalance aren’t real. As functional medicine practitioners, we are able to address varying levels of adrenal dysfunction and support the body accordingly.
Thankfully there are a number of nutrients and herbs that can be helpful to support the body recover from Adrenal Fatigue. For example, protein is important for supporting blood sugar regulation. As cortisol production and blood glucose management are closely linked, they impact each other and can contribute to a further load on the body’s adrenal system.
Adaptogenic Herbs are a fantastic tool we have to help to support the body’s response to stress. Adaptogens are herbs that work in accordance with the body’s requirements. These include Ashwaganda, Siberian Gingseng, Holy Basil (Tulsi), Rhodiola, Astragalus and Licorice Root. Other nutrients such as Vitamin C and B vitamins are important for helping to improve the body’s responses to stress and efficient functioning of the HPA axis. Magnesium, often referred to by naturopaths as “nature’s tranquiliser, is used by the body in significant quantities at times of stress and often becomes deficient. It is also a useful nutrient in helping the body relax so can be beneficial for someone experiencing raised cortisol levels.
It is of course essential to make lifestyle changes, in addition to dietary changes, to help temper the stress response if you suspect you are experiencing some level of adrenal fatigue. We are able to arrange functional testing of hormones such as cortisol, DHEA and progesterone to determine whether stress is triggering a physiological response and then support the body accordingly. This testing enables us to provide a completely individualised health plan to support recovery from adrenal dysfunction.