Adrenal Fatigue – Is Chronic Stress Affecting Your Health?

By Dr. Julie Neal, ND

How are you handling the heat this summer? Hot temperatures can be difficult for many people, especially those with adrenal fatigue. Patients with adrenal health issues tend to feel more tired in the summer months. They have more temperature intolerance, difficulty with thermoregulation, and dehydration.

The alternative medicine community has been using the term “adrenal fatigue” for years however, this terminology is actually not substantiated in medical literature. Unless you have an autoimmune condition called Addison’s disease, where the adrenal glands stop producing cortisol, your adrenal glands don’t actually get fatigued. Instead, our adrenal glands respond to stress with an up-regulation of cortisol and adrenaline, we go into overdrive, fight or flight, and this begins a cascade of other reactions that dysregulate the nervous system and endocrine system.

When stress becomes chronic, the body can produce cortisol and adrenaline at inappropriate times, such as before bed when we are trying to fall asleep. With long-standing stress, cortisol production can decrease, but it is not because the adrenals can’t produce the hormone. Other mechanisms such as cortisol resistance, cortisol insensitivity and down-regulation of cortisol receptors come into play as the body tries to create a protective mechanism against long-term high stress.

The more accurate medical term for adrenal fatigue is actually HPA Axis Dysregulation – a dysregulation in the hypothalamus-pituitary-adrenal axis. If you do a PubMed search on adrenal fatigue, there are very few research studies, whereas a search for HPA Axis provides thousands of articles correlating stress to various health conditions. According to Aviva Romm, MD, adrenal fatigue is a misnomer that should be called Allostatic Load, another term that means wear and tear on our body from chronic stress. She believes that chronic stress, environmental toxins, electronic overstimulation, the effect of antibiotics damaging our gut microbiome, and poor diets, all contribute to inflammation and allostatic load that taxes our adrenal glands and other organs.

How do you know if your adrenals are taxed?

In general, a person with adrenal fatigue typically feels tired, overwhelmed, stressed and unrefreshed after a good night sleep. Other possible symptoms include:

  • Fatigue (can be anytime during the day but often a significant lull in energy between 3-5pm in the afternoon)
  • Difficulty falling asleep and staying asleep (can have frequent nighttime waking and difficulty falling back to sleep)
  • Mind racing at night or in the middle of the night
  • Brain fog, concentration and memory problems
  • Hypoglycemia or shaky in between meals
  • Cravings for salty and sugary foods (often to get a boost of energy)
  • Feelings of anxiety and overwhelm
  • PMS, exhaustion before the menstrual cycle
  • Decreased stamina for physical exercise or feeling wiped out after exercise
  • Wanting or needing to take a nap during the day
  • Low libido
  • Difficulty losing weight, especially around the abdomen

It should be noted that symptoms of fatigue can also be due to nutritional deficiencies such as low iron, hypothyroidism (low thyroid function), chronic underlying viral infections such as Epstein Barr Virus (the virus associated with Mononucleosis) and many other conditions.

How do you test cortisol levels?

There are a number of ways to test cortisol including serum blood tests, salivary collections and urine collections. Serum blood testing is inexpensive and can be run with other blood work to rule out low thyroid, low iron and other reasons for fatigue. The downside to serum testing is that it gives you a measurement at one point in time, usually 8am in the morning, and often this reading comes back normal. Cortisol levels can vary widely throughout a 24-hour day depending on stress levels, thus one reading is in the morning is not ideal for getting a full picture.

Other methods of testing such as saliva and urine testing do provide a more comprehensive picture of daily cortisol rhythm by collecting measurements 4-5 times throughout a day. Having 4 or 5 measurements also helps determine the most appropriate treatment for balancing adrenal gland function. The doctors at Boulder Natural Health use the Adrenal Stress Index Test by Diagnostechs Laboratory and the Dutch Adrenal Test from Precision Analytical Inc. for saliva and urine cortisol testing.

What can I do to start healing my adrenal glands and balance my stress hormones?

While eliminating all stress is impossible in this modern world, we can support our body’s management of the stress response.

Stress Management – The name of the game with healing adrenal gland dysfunction is reducing your stress. Finding ways to manage your stress is truly the foundation for healing. Supplements and diet changes alone will not solve the problem. If you do not address the behavioral and lifestyle problems causing your stress you will never fully recover.

Balance Your Blood Sugar – Hypoglycemia is a real problem for patients with cortisol issues and fatigue. Hypoglycemia causes the adrenals to pump out more cortisol to compensate for low blood sugar.

Align Yourself with the Sun’s Natural Circadian Rhythm – This means go to bed when the sun goes down, wake up when the sun comes up, and bring yourself into alignment with the natural daily rhythm of light and dark.

Resolve Any Other Inflammation in the Body – When the body is distracted by other sources of inflammation such as digestive issues like food allergies, leaky gut, dysbiosis, SIBO, candida, it becomes more difficult to balance adrenal hormones. It is important to resolve any other inflammatory processes in order to balance adrenal hormones.

Sources:

Kresser, Chris. “RHR: The Myth of Adrenal Fatigue.” Chris Kresser, Chriskresser.com, 19 Aug. 2017, chriskresser.com/myth-of-adrenal-fatigue/.

Room, Aviva. “Adrenal Fatigue: Is It a Real Thing?” Aviva Romm MD, 18 July 2018, avivaromm.com/adrenal-fatigue-real-thing/.