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You’re exhausted all day, but at night you can’t sleep. You’re relying on coffee to get you through the day, and crave carbs and sugar. You feel bloated. You don’t have the energy to do your normal exercise.
If you ask “Dr. Google” what these symptoms mean, you’ll likely be led to adrenal fatigue.
But if you ask most medical doctors, you’ll get a totally different answer: they’ll tell you adrenal fatigue isn’t real.
So what’s the truth?
The problem is that the symptoms of adrenal fatigue are 100% real, but the name “adrenal fatigue” isn’t accurate. And this can lead to a lot of confusion about the condition, the root cause, and how to heal from it.
What Is Adrenal Fatigue?
The term “adrenal fatigue” has been in use in alternative medicine since the 1990s. For years, the standard theory of adrenal fatigue went something like this:
Chronic stress causes the adrenal glands to produce high levels of cortisol (your body’s main stress hormone). Over time, the adrenal glands can’t keep up with the constant demand for more cortisol, and they get fatigued. Cortisol levels begin to drop. Eventually, you wind up with symptoms of low cortisol.
To be clear, this was always just a theory used to explain the non-specific symptoms that came alongside chronic stress, such as sleep disturbances, weight gain, fatigue, and sugar cravings.
Today, we know this theory isn’t true.
If you have low cortisol levels, it’s not because your adrenal glands need a nap! The adrenal glands don’t get worn out and stop producing stress hormones. In fact, according to Dr. Brooke Kalanick, ND, advanced hormone testing has shown most people with the symptoms of adrenal fatigue don’t have low cortisol levels at all.
So what really causes the symptoms of adrenal fatigue?
Meet The Hypothalamic-Pituitary-Adrenal Axis
To understand what’s really behind the symptoms of adrenal fatigue, you need a quick lesson in biology. Your stress response is controlled by the Hypothalamic-Pituitary-Adrenal Axis (aka the HPA-Axis).
Your hypothalamus is a small region in the brain that coordinates the actions of the autonomic nervous system and the pituitary gland. It is always assessing what’s going on in the body. The pituitary gland is the conductor of the endocrine system, and talks to all of the other glands in the body (including the adrenal glands).
Essentially, the pituitary gland takes messages from the hypothalamus, and tells the endocrine system how to respond.
Stress—both physical and mental—activates the HPA-Axis and leads to the creation of stress hormones like cortisol, norepinephrine and adrenaline.
I like to think of the HPA-Axis as being a big red button. Every time you encounter stress, it’s like a lever comes down and presses the button. Your body reads the situation (thanks to your hypothalamus), and the pituitary gland tells your body to begin creating cortisol and other stress hormones to help you appropriately respond to the stress.
This is generally a good thing. It’s this stress response that allows you to run away from danger or lift a car off a baby. And while it has a bad reputation, cortisol actually helps to turn off inflammation and promote healing (that’s why we use cortisol creams and corticosteroids to treat inflammation!).
However, when the “button” is being pushed over and over again, there are negative consequences. And because we live in a modern, high-stress world, your HPA-Axis button is likely being pushed many, many times each day.
What Happens When You’re Sounding The Alarm All The Time
We all know the story of the boy who cried wolf: the moral is, if you constantly sound the alarm, people eventually stop listening.
The same is true of your body.
When the HPA-Axis is constantly being activated by stress, it doesn’t get “worn out” and stop producing cortisol as the original adrenal fatigue theory suggested. Instead, your body stops responding to the cortisol being created. The cortisol is coursing through your body yelling “alert! alert!” but your body has quit listening.
This is called “glucocorticoid resistance” and it’s similar to what happens with insulin resistance, which ultimately can lead to diabetes. Your cells become less sensitive to the effects of cortisol.
As a result, you can develop symptoms of low cortisol (even if cortisol levels remain normal or elevated) and cortisol patterns can become irregular, rising and falling when they shouldn’t. It’s this that causes the very real symptoms of “adrenal fatigue.”
The bottom line is adrenal fatigue isn’t ultimately a problem with the adrenal glands, it’s a problem more deeply rooted in the brain and how the body responds to stress.
Because of this new understanding, a more appropriate name for adrenal fatigue might actually be HPA-Axis Dysregulation.
Why It Matters What We Call Adrenal Fatigue
To me, it doesn’t matter if you call it HPA-Axis Dysregulation, glucocorticoid resistance, or adrenal fatigue, as long as we are talking about the same physiological cause of symptoms.
The problem with the name adrenal fatigue is it implies the adrenal glands get “tired”, and research has demonstrated this isn’t what happens. That means many doctors and practitioners will balk if you bring up adrenal fatigue, even if you’re experiencing real symptoms.
But also, understanding the root cause of the symptoms of adrenal fatigue is what will lead to better treatment and relief from symptoms. Treatment shouldn’t focus on treating the adrenal gland itself, but instead should be about supporting a healthy stress response.
Testing for HPA-Axis Dysregulation
There’s no definitive test for HPA-Axis Dysregulation. You can have your hormone levels tested, but if you don’t have past hormone testing to compare it to, it can be hard to interpret what your current levels might mean. Both high and low cortisol levels can be a sign of HPA-Axis dysfunction, but even people with cortisol levels that fall in the “normal” range can have symptoms.
The good news is treating suspected HPA-Axis Dysregulation is very low risk and high reward. What you’ll need to do to heal isn’t going to cause harm, even if you aren’t actually having issues with your HPA-Axis.
If you want to start experimenting with specific supplements, that’s when it’s time to get tested and work with a practitioner who can help guide you. The general suggestions I make are safe for pretty much anyone to try.
Why Doesn’t Everyone Have HPA-Axis Issues?
We know HPA-Axis issues are caused by exposure to stress, and we’re all stressed out, right? So why doesn’t everyone have HPA-Axis Dysregulation?
It’s true that almost everyone experiences some level of stress, and most of us encounter lots of daily little stressors like traffic, bills, and sick kids. But in my experience, it’s less about the stressors we face and more about how we respond to them.
If you’re a Type-A perfectionist (full disclosure: this is my personality type), you’re more likely to have a greater stress response to these everyday stressors than a more laid-back person. With my own clients, I’ve noticed that the majority of the people with HPA-Axis issues are the Type-A folks!
But this is actually a good thing.
Most of can’t change very much about the amount of stress we face. I can’t remove all stress related to my children and business and live on a desert island, and even if I did, that new life would come with its own stressors.
But I can change how I respond to the stress I face. Learning to better manage stress has been life-changing for me, and if you’re struggling with adrenal fatigue symptoms, I know it can be for you too.
How To Treat “Adrenal Fatigue”
Remember, everytime we experience stress, it’s like the lever comes down and hits the button on the HPA-Axis “big red button.”
Little stressors, like someone cutting you off in traffic or another unnecessary meeting at work, shouldn’t send the lever down. But if you’re constantly facing these stresses without any relief, even the little things can “press the button.” (Have you ever had the experience of gritting your teeth through the stress all day, only to EXPLODE at something small? Like your daughter not putting her shoes on?)
But there are also stressors we create for ourselves. Self-imposed ideas about how hard you need to work, how much you should weigh or exercise, how clean your house needs to be, and how much rest you need can all add to the burden on your HPA-Axis.
So what can you do about it?
First things first, you have to give up the hustle mentality. Your worth as a human is not determined by how hard you work. This is especially important for chronic overworkers, people who train or workout regularly, and those who think they need to be on a diet.
Your worth as a human is inherent. It can’t be earned or taken away from you.
Secondly, implement more self care (and not the bubble bath type). Real self care means resting when you need to, asking for help, and treating yourself the way you would your best friend. Routinely caring for yourself means you’re better equipped to handle the little stressors without a full-blown stress response.
This isn’t easy work, and it won’t happen overnight. But it’s the key to staying healthy in the modern world.
5 Tips For Healing Adrenal Dysfunction
The internal work you’ll need to do to change how you perceive stress is the most important step to heal from HPA-Axis dysfunction. But it won’t make you feel better instantly. It takes time to break down old patterns and build new ones.
These suggestions can help you take care of your body when you’re experiencing the symptoms of HPA-Axis dysfunction.
1. Ditch Restrictive Diets & Plans
Strict Paleo, The Keto Diet, and Intermittent Fasting are often just more stress to your body. Any benefits you might gain from them are outweighed by the stress you feel about “staying on the wagon.”
(And remember a diet by any other name is… still a diet.)
Instead of focusing on what you need to cut out, following rules, or counting macros, try focusing on what you can add in. Always meet a minimum caloric requirement of 2,000 calories per day (as recommended in my book, Coconuts and Kettlebells). Eat plenty of nutrient-dense foods and carbohydrates that nourish your body and spirit.
2. Quit Chronic Cardio & Intense Workouts
Intense workouts can be really beneficial, and even fun. But if you’re dealing with HPA-Axis Dysfunction, intense exercise isn’t doing your health any favors. The stress these workouts put on your body only fans the flames.
Instead of intense workouts, shift to trying more chill, restorative ways of moving your body: yoga, walking, or swimming. Yes, sometimes just resting is what you actually need! If the thought of even going for a walk is exhausting, honor your body with rest.
3. Nix Caffeine
Caffeine is a stimulant, and has been shown to increase cortisol and adrenaline at rest. When you’re struggling with HPA-Axis Dysfunction, your body doesn’t need more stimulation.
If you’re thinking “I can’t get through the day without coffee!”, that’s a really good sign your body is over-taxed and needs rest and care, not caffeine.
I know that just the idea of cutting out coffee can truly feel scary. You don’t need to go cold turkey. Even simply reducing the amount of caffeine you have can help, and especially nixing it past lunchtime.
4. Sleep As Much As You Can
Sleep is when your body resets and heals. Prioritizing sleep is one of the most important steps for healing HPA-Axis dysfunction.
Don’t drag yourself out of bed to get to the gym in the morning. And if you’re a parent, grab any chance to sleep you can. The chore or workout you were going to do while the baby napped can wait and will likely only put you further in the hole of “adrenal fatigue.”
Do you wake up exhausted but can’t fall asleep at night, or fall asleep fine but wake up in the middle of the night? Those are common signs of HPA-Axis Dysfunction. Going to sleep and getting up at a consistent time can help, as well as getting sun in the morning and avoiding screens and blue light after dark.
5. Supplement to Support Your Adrenals
While you likely won’t need a ton of expensive supplements to heal, there are some key nutrients that are important to supplement with to support your adrenals:
- Vitamin D + K2
- Magnesium (this mineral is essential for hundreds of functions and is easily depleted by stress)
- Vitamin C (an important antioxidant that supports the adrenals!)
- Tyrosine (this is an amino acid that is the precursor to neurotransmitters like norepinephrine, and can be depleted by stress)
You also may want to experiment with adaptogens.
What will work best for you is individual to you and your body. If you have been struggling with adrenal fatigue for some time, I recommend trying a multi-herb supplement, such as Integrative Therapeutics Cortisol Manager (sleep and stress support), or Integrative Therapeutics HPA Adapt (cognitive and anxiety support).
Note: If you’re pregnant or breastfeeding, discuss any new supplements you plan to take with your medical provider first. Generally, adaptogens are considered safe, but they’re not a replacement for addressing the root causes of your HPA-Axis problems.
My favorite way to incorporate adaptogens into my routine is with Four Sigmatic drinks. They have delicious hot cocoas, teas, and elixirs made with adaptogens. They’re an easy swap for coffee in the morning and they have options to help wind down at bedtime, too (the Reishi mushroom elixir is magic!)
Yes, You Can Recover From Adrenal Fatigue
The name “adrenal fatigue” might not be accurate, but the symptoms are very real. With a better understanding of what actually causes those symptoms, there is hope for feeling better.
I also encourage you to consider what lead up to HPA-Axis Dysregulation in the first place. Do you have unrealistic expectations for yourself? Are you taking care of you? Are you training too much? Eating too little? Working too hard? Not managing stress appropriately?
Where can you start asking for help?