Many people do not know much about the adrenal glands - what they do, or how they work. More education and awareness is needed regarding the adrenal glands, because they are so critical for maintaining optimal health.
Most traditional doctors do not recognize "adrenal fatigue," which I refer to as "adrenal dysregulation." These doctors believe that the adrenal glands are either functioning fine, or they are totally busted. They believe that there is an issue only when the adrenal glands are either completely shut down ("adrenal insufficiency" / Addison's Disease), or when there are very excessive amounts of adrenal hormones being produced (as seen in Cushing's Syndrome). However, many Functional Medicine Doctors and Naturopathic Doctors understand that there is a period of dysregulation that begins prior to the appearance of either of these extreme disease states (this pre-disease state is called "adrenal fatigue" or "adrenal dysregulation").
My strong opinion is that the body does not progress from an optimal state to a state of total derangement overnight. It usually takes years for this process to be fully recognized, and can include a very subtle downhill slide.
What are the adrenals?
The adrenal glands are two pea-sized glands that sit on top of your kidneys. They control and help regulate a plethora of bodily functions, including the following:
-Energy and stamina
-The Sleep/Wake cycle
-Immunity and Inflammation
-Hydration and Fluid Balance
-Hormones - the adrenals are involved in producing over 50 hormones!
Since the adrenals are so involved in keeping the body balanced, the symptoms of adrenal dysregulation are many, and vary widely. Just a few of the symptoms of adrenal dysregulation may include:
-Fatigue, including difficulty waking up
-Weight loss or gain
-High or Low Blood Pressure
-Anxiety and/or panic attacks
-Muscle Loss and weakness
-Loss of libido
-Allergies and/or Food Intolerances
-Light headedness, especially upon standing
-Dizziness and feeling off balance
-Extreme adrenal dysregulation can manifest as POTS (Postural Orthostatic Tachycardia Syndrome), as well as Fibromyalgia.
What causes adrenal dysregulation?
-Stressful or traumatic events, including death of a loved one, divorce, marriage, move, change in careers, and childbirth.
-Periods of chronic stress, like having a stressful career, or being in a toxic relationship.
-Physiological stress, such as infections, the presence of toxins, mold, poor diet choices, and malnutrition.
The following contribute to adrenal dysregulation:
-Excessive caffeine intake, beyond the equivalent of 1-2 cups of coffee per day (none or 1 per day preferred)
-Inadequate sleep and rest
-Excessive or intense exercise
-An inverted circadian rhythm - staying up late and waking up late
-Some medications, including SSRI's
-Excessive supplementation of isolated nutrients (example: vitamin D, magnesium, etc)
-Toxin load (via body products, toxic environment, etc)
How can you help nourish and heal your adrenals?
I always recommend working on diet first. Rework your diet to eliminate processed foods, sugar, alcohol, and caffeine. Increase good fats, produce, and high quality protein. Do an elimination diet to look for any food intolerances.
If the adrenals are very tanked, eating frequently may be required to maintain adequate blood sugar levels, even if one is not feeling hungry. When I was going through my "adrenal crisis" stage, I had to eat every 1-2 waking hours in order to limit extreme hypoglycemic symptoms. If you feel better after having a snack, that is a clue that you may need to snack more often. More of my thoughts on diet here. Snack ideas here and here.
Next, start working on digestion, so that you can properly assimilate nutrients from your food. More here.
Stressed adrenals require lots and lots of rest and sleep (and then some!). Some people may be able to replenish their adrenals with 7-8 hours of sleep per night. More exhausted adrenals may require more sleep. When I was dealing with exhausted adrenals, I was having to sleep 12 hours per night, plus 2 small naps during the day, just to be able to function minimally around the house. When in doubt, rest.
Work on re-balancing your circadian rhythm. This is very important for balancing your hormones and for adrenal health. More here.
Additional supplementation may be needed, including vitamin C (the adrenal glands have the largest concentration of vitamin C in the body, which shows how important it is for the health of the adrenals), B vitamins, and electrolytes such as Sodium, Potassium, and Magnesium. I recommend getting mineral supplementation from food or food based sources whenever possible, versus high amounts of isolated synthetic nutrients, especially without first doing testing. Whole Food vitamin C is usually good for most to supplement. B vitamins can be found naturally in bee pollen, and beef liver (cooked or dried powder). Sodium is beneficial for the adrenals via Himalayan or Celtic sea salt, and Potassium can be found in high amounts via coconut water and nettle herbal infusions. Magnesium supplementation is usually best during the first stage of adrenal fatigue, with an emphasis more on Sodium and Potassium in the latter stages. When in doubt, first do testing of your individual mineral levels (more below).
Sometimes, rest and diet change is not enough to fully heal the adrenals. If progress is not being made, or is frequently halted, look into underlying issues, such as infections, or the presence of heavy metals. In future posts, I will be providing more information on common infections, such as Lyme and other tick-borne bacteria, viruses such as Epstein-Barr, as well as mold, and heavy metal toxicity.
Stage of adrenal fatigue and dysregulation:
When experiencing a stressful event, or when feeling overly stressed, the body goes into an alarm stage, and begins increasing cortisol and/or adrenaline to keep you alert. This is good for acute situations when, say, you are being chased by a tiger. Being in a stage of chronic stress is not good for long periods of time, and the body begins to break down.
When in this stage, it is important to bring high cortisol down, by decreasing and limiting your stressors. This may include taking fewer hours at work (even if it means a tighter budget at home), eliminating intense exercise routines, getting out of a toxic relationship, and learning how to say "no" so as to not over-commit yourself. Plan time for rest, relaxation, and fun. Do gentle exercises such as walking. If needed, try adaptogen herbs that lower cortisol, such as ashwagandha and holy basil.
If stress and cortisol is not lowered after the initial stage, the cortisol and / or aldosterone levels may start to fluctuate. You may begin requiring increasing levels of caffeine to function and not feel overly fatigued throughout the day. Cortisol may then go too high at night, with alcohol needed nightly to wind down. Insomnia is a symptom of high nighttime cortisol.
After this, the adrenals may start to "exhaust" and will further reduce output of cortisol and aldosterone. Fatigue will increase, which may no longer respond to caffeine, and you may begin experiencing other awful symptoms such as are listed at the beginning of this article. The body usually begins increasing the output of adrenaline as a final effort to "stay afloat," and goes into a true "fight or flight" stage. At this point, if symptoms are ignored, the body may "crash." A "crash" is a sudden onslaught of symptoms, a way of the body "screaming" that it can no longer be ignored.
This is usually when you begin visiting doctors in an effort to determine what is wrong. Unfortunately, traditional doctors are not taught about adrenal dysregulation, and most will state that your labwork is all "in range," and send you home. Some will prescribe anti-depressants, either because they are not sure what is going on, or they believe your symptoms are emotional (anxiety/depression). Note that anxiety and depression are common symptoms of adrenal dysregulation, as the hormones needed to maintain mood become imbalanced as part of this dysregulation process.
How to test for adrenal dysfunction:
The saliva cortisol test will show your diurnal cortisol pattern throughout the day. Note that most doctors will not order this test (unless they are a functional medicine or a naturopathic doctor). Fortunately, you can order this test yourself, without a doctor's order. When I was sick for years and had exhausted the traditional medical system, I became my own health advocate, and began ordering and reading my own tests.
The Stop the Thyroid Madness website is a wealth of information, and has a great article summarizing how to order, interpret, and treat adrenal dysfunction based on the saliva cortisol test. Link here.
Low cortisol can be treated with adrenal glandular supplements, like Adrenal Cortex Extract, for extreme lows. Adaptogen herbs such as rhodiola, eleuthero, and cordyceps can be used for moderate lows. Other herbs including ashwagandha and holy basil are usually used to help bring down or balance high cortisol.
Another of my favorite tests is the HTMA, or hair tissue mineral analysis. It provides mineral ratios to determine the vitality of various body systems and glands, such as the thyroid and adrenals. More here.
A note on time.
Healing the adrenals can take up to several years. Do not be discouraged if healing is taking longer than you would like. The path to healing is measured in a series of baby steps, complete with many potholes along the way. It is common to see progress via the "two steps forward, one step back" pattern. It is important to not stress over small detours during this time. And always remember, we cannot force our healing journey into a specified period of time. Be patient. The body will determine its own timeline for healing.
Resources and Additional Reading: