Our hypothalamic–pituitary–adrenal (HPA) axis is the system which is
responsible for one of the most important functions of our body — the
management of stress. This includes stress any type of stress, be it injury or
disease, work or relationship problems.
Extended exposure to chronic stress (chronic) for example from overwork,
chronic inflammation or long-term illness, is likely to result in HPA axis
dysfunction, also known as — although perhaps somewhat erroneously —
referred to as “adrenal fatigue” or “adrenal exhaustion.”
There’s plenty of controversy on this subject. According to conventional
medicine, there’s no such thing as “adrenal fatigue.” However, some
alternative medicine practitioners claim that your adrenal glands can become over-worked and as a result lose their ability to make the hormone cortisol.
There’s an emerging hypothesis that what we commonly refer to as adrenal fatigue is not really due to the adrenal glands reduced capacity to produce cortisol.
Although arguably this can sometimes happen, usually the cause is a dysfunction in the brain signalling portion of the HPA axis, meaning the primary problem is with the hypothalamus and pituitary rather than the adrenal portion of the axis.
Exercise is an important component of optimal health, but it can be a real challenge to exercise when you’re exhausted all the time. Also, since exercise is a physical stressor, it can easily exacerbate HPA axis dysfunction if you’re not careful.
Why is it important to maintain a healthy adrenal function?
Though the main cause for “adrenal fatigue” may in fact be due to a dysfunctional stress response in the brain, rather than fatigued or exhausted adrenal glands, adrenal health is still imperative.
Our body has two adrenal glands, located just above each of each kidney. They are a apart of the endocrine system, responsible for secreting more than 50 hormones, including:
Adrenaline. A hormone responsible for increasing the heart rate and controls blood flow to the muscles and brain, along with helping with the conversion of glycogen to glucose in the liver.
Glucocorticoids. These hormones, which include cortisol, help converting food into energy, normalising blood sugar and responding to stress. It also maintains the immune system’s inflammatory response.
Mineralocorticoids. These hormones, which include aldosterone, help keep blood pressure and blood volume normal by keeping a proper balance of sodium, potassium and water in the cells.
Collectively, these hormones and others which are produced by the adrenal glands control body functions such as:
Regulating the body’s balance of salt and water
Maintaining metabolic processes, such as managing blood sugar levels and regulating inflammation
Controlling your fight-freeze -flight response to stress
Producing sex steroids such as oestrogen and testosterone; initiating and controlling sexual maturation during childhood and puberty
Regulating the body’s balance of salt and water
Symptoms of “Adrenal Fatigue”
From the point of conventional medicine, there’s no such thing as “adrenal fatigue.” There is, however, a rare condition known as Addison’s disease or “primary adrenal insufficiency,” a condition where damage to the adrenal glands damages their ability for cortisol production.
Symptoms of this potentially life threatening illness include muscle weakness, weight loss, low blood pressure and low blood sugar. An estimated 80% is rooted in autoimmune disorders.
Many alternative medicine practitioners believe that there are grades of insufficiency. In other words, not everyone with insufficiency suffers from Addison’s. still, there are open questions regarding what is actually behind the reduced adrenal gland activity.
There is no doubt, however, that HPA axis dysfunction affects many people with quite devastating symptoms and sometimes it can be misdiagnosed as fibromyalgia. You can read more about it here.
In more serious cases, the physical fatigue is so great that the person may have difficulty getting out of bed for more than a few hours a day. Signs and symptoms typically associated with “adrenal fatigue” or HPA dysfunction include:
Fatigue and weakness
Depression, fearfulness or anxiety
Hormonal imbalance and/or abnormal blood sugar levels
Suppressed immune function
Muscle and bone loss, muscular weakness and/or body aches
Cravings for foods high in salt, sugar or fat
Increased PMS or menopausal symptoms
Light-headedness when getting up from sitting or lying down; poor blood circulation
Trouble waking up in the morning, despite a full night’s sleep
Low sex drive
Decreased ability to handle stress
Poor memory; mental fogginess
Rebuilding Your Metabolic Reserve
Physical exercise can aggravate the condition, so whilst exercise is important, you should be taking it easy. If you have HPA axis dysfunction, your primary objective is to rebuild your metabolic reserve. To do this:
Decrease and address emotional as well as psychological stressors — basically anything that triggers your fight-or-flight response. Strategies such as Hearthmath© can be very effective. I also recommend to set aside time for recreational activities with friends and family (especially in nature).
Get reasonable amounts of physical activity, but don’t over kill
Improve blood sugar regulation by maintaining a healthy diet, low in net carbs (total carbohydrates minus fibre) and higher in healthy fats, along with a moderate amount of high quality protein.
Reduce inflammation by improving your gut microbiome. This can be achieved by avoiding antibiotics and processed foods, eating real whole food ( including fermented vegetables), taking a high quality probiotic supplements and reducing your net carbs whilst increasing your fibre intake.
Getting adequate light exposure will ensure no circadian disruption. This means getting natural, bright sun exposure during the morning and midday, and avoiding artificial lighting and light emissions from electronics.
Be sure to get enough sleep. Most people require around eight hours of sleep each night.
Exercising While Recovering From Adrenal Fatigue
Physical activity is a stressor and as such, it can exert your adrenals. What is key to focus on moderate activities such as walking, yoga, moderate cycling or swimming, qigong or tai chi. Once you are beginning to feel better and more tolerant to exercise, you may gradually begin to add in some gentle exercise.
There’s danger of overdoing it during this phase, so listen carefully to your body and be patient with it. In due course, your metabolic reserve will be rejuvenated, which will allow you to resume your normal exercise regimen prior to the adrenal fatigue starting. Relapse is likely, so take notice of your energy reserves, and retreat if you start to feel like you’re regressing.
Diagnosing Adrenal Fatigue
Both primary and secondary adrenal insufficiency can be diagnosed with a lab test. Many doctors will use an ACTH (adrenocorticotropic hormone) test to check for adrenal glands problems. But this test only recognises extreme underproduction or overproduction of hormone levels, as shown by the top and bottom 2 percent of a bell curve. This means your adrenal cortisol production could be functioning 20 percent below the mean, and your body experiencing symptoms of HPA dysfunction, yet the test will still show as ‘normal’.
Therefore, to identify HPA dysfunction, a comprehensive hormone panel is recommended. One of the best available is the DUTCH test, which stands for Dried Urine test for Comprehensive Hormones. The DUTCH test is innovative in a number of respects, and offers several benefits over older limited hormone tests.
There are two additional tests that are slightly less comprehensive than the DUTCH test and they are based on salivary sampling (saliva) rather than urine. These test come from Genova Diagnostics and they too, can be carried out at the comfort of your home. The more basic test is Adrenal Stress Profile. This saliva test can detect imbalances in the daily circadian secretions of the stress hormones cortisol and DHEA. Imbalances in these hormones can indicate an inappropriate response that can negatively impact energy levels, emotions, and many other health complaints. These include anxiety, chronic inflammatory conditions, allergies, chronic fatigue syndrome, insomnia, depression, migraines, headaches, recurrent infections, menstrual difficulties and infertility. The second test is called Comprehensive Adrenal Stress Profile and it comprises of the standard Adrenal Stress Profile (which assesses cortisol and DHEA levels) and Secretory IgA (SIgA). Imbalances of cortisol, DHEA and SIgA can lead to the most common health complaints of the 21st century. Both excesses and deficiencies of DHEA and cortisol have been implicated in the aetiology of various illnesses and immune suppression.
Both tests can be purchased in my online shop here and I can help you ‘decipher’ the results once you’ve received them.
One of the biggest problems is that some hormones fluctuate throughout the day. Cortisol, for example, rises as soon as you get out of bed and then declines as the day gets on. If your diurnal pattern is dysfunctional, meaning you’re low in the morning and high at night, you have a serious condition. However, a 24-hour urine test cannot show it as your output is collected in the same container. The DUTCH test, on the other hand does because individual samples are collected throughout the day. It also shows you hormonal metabolites, which helps reveal the underlying pathology.
In my opinion, the DUTCH test is better than all of the other methods when it comes to finding out the state of your hormones, and this will allow you to figure out what areas you should be focusing on in terms of taking corrective action. I only recommend it because I believe it’s the best one out there. You can read more about hormonal imbalances here.
Other Reasons for Dramatically Lower HPA Axis Function
Certain common medications may in fact be responsible for suppressing HPA output of cortisol. Drugs that fall into the “steroid” category, such as prednisone, can literally shut down the pathway, which is why when taking this type of medication, the dose is often tapered in order not to cause a crash from lack of cortisol production.
Steroids used for asthma and allergy can also have this effect. People who use inhalers or intranasal sprays such as those containing beclomethasone, triamcinolone, fluticasone, or budesonide are at an increased risk, particularly when taken over an extended period of time.
Most doctors will know that Prednisone suppresses adrenal production. Many of these other medications will do the same thing, but your health care provider may not be aware of their suppressive effects.
Another medication known to affect the hypothalamus and pituitary and thus the output of cortisol is isotretinoin, commonly used for the treatment of acne. Isotretinoin is often used in the teenage years and early 20s, but could have lasting health effects on energy, weight, the menstrual cycle and fertility. Another culprit that is likely affects many users is opioid painkillers.
Testing is the best way to see if any regular medications being taken may be shutting off your hormone production. In order to determine whether your cortisol production is suppressed, you need to test both free cortisol AND metabolites. Lastly, studies have also shown that traumatic brain injury (TBI) or any serious head injury that affects the hypothalamus and/or pituitary (such as accidents, sporting events, slips and falls, bike crashes, boxing, military-related, or any other high impact motion resulting in trauma to the tissue in the brain) can have a direct impact on the adrenal gland’s ability to produce cortisol., TBI can also result in changes to both the male and female hormones and often leading to fatigue and depression.
But You Can Recover
The good news is that natural treatments are quite effective and, with time, patience, following the advice given above and adequate professional help it is possible to recover. Just remember that treating “adrenal fatigue” or HPA dysfunction requires a whole-systems approach — one that addresses the surplus stress as well as the bad lifestyle choices that are at the root of the condition.
If you suffer from any conditions in addition to your Adrenal Fatigue you should seriously consider consulting with a functional medicine practitioner. Combined conditions can be quite tricky to handle without professional help.
The treatment I recommend to ‘simple’ Adrenal Fatigue involves reducing stress on your body and mind, eliminating toxins, avoiding negative thoughts, and replenishing your body with healthy food and positive attitude.
1. Appropriate Diet
In every case of adrenal recovery, diet is a big component. Several foods are known to support adrenal function. They assist in replenishing energy so your system can recover. You should start by removing any hard-to-digest foods and any toxins or chemicals in your surroundings.
The idea is to remove anything that has a toll on your adrenals.
Foods to avoid include:
Caffeine- which can interfere with sleep cycles and make it hard for adrenal recovery. If you must drink coffee or a caffeinated drink, then have a limited amount in the morning (and then stop for the rest of the day).
Sugar and sweeteners- Includes avoiding high-fructose corn syrup and artificial sweeteners. Avoid sugary foods, cereals, candy, sweets, etc. Be aware that sugar is contained in many breads, condiments and dressings. Try to avoid sugar as much as possible. Choose natural sweeteners [ug1] as alternative.
Processed and microwaved foods- Remember that the microwave oven has its own dangers, additionally, most microwaveable foods have lots of preservatives and fillers that are difficult to digest and depletes you of energy and taxes your digestion system. Try to purchase healthier food choices and prepare your own food whenever possible.
Hydrogenated oils- Vegetable oils like soybean, canola and corn oil are highly inflammatory and can lead to adrenal inflammation. Choose oils such as olive oil, coconut oil and ghee. You can learn more about making good oil choices in this article.
The next step is adding nutrient-dense foods that are easy to digest and have healing characteristics. Some of the top superfoods for adrenal support include:
Cruciferous vegetables (cauliflower, broccoli, Brussels sprouts, etc.)
Fatty fish (e.g., wild-caught salmon)
Chicken and turkey
Nuts, such as walnuts and almonds
Seeds, such as pumpkin, chia and flax
Kelp and seaweed
Celtic or Himalayan sea salt
These foods help overcome adrenal insufficiency because they’re nutrient-dense, low in sugar, and have healthy fat and fibre.
See also my anti-inflammatory diet for more food suggestions and more.
2. Take The Right Supplements
Another big part of overcoming adrenal fatigue is taking suitable supplements. Eating the right foods to heal your body is not enough because of soil depletion (from over-farmed and unhealthy farming practices). Much of the fruits and vegetables which are available to us, don’t have the same amount of nutrition that they did in recent years.
Therefore, certain adrenal-boosting nutrients are required to get your adrenal function up and running. These include:
Fish oil (EPA/DHA)
Taking these supplements in their whole-food form could greatly improve your symptoms of adrenal insufficiency.
3. Reduce Stress
This is the BIG one!
Rest as much as you can, especially when you feel tired.
Sleep 8–10 hours per night.
Avoid staying up late and stay on a regular sleep cycle — ideally, in bed before 10 p.m. and leave the electronic devices (and especially your mobile phone) outside of the bedroom.
Get regular outdoor sun exposure, especially in the morning sun, as the blue light from the sun will trigger melatonin production which will help you sleep better that night.
Have fun and make sure you laugh every day.
Minimise stress from work and relationships.
Eat on a regular food cycle, and reduce your caffeine and sugar intake.
Exercise (even moderate exercise and walking can help).
Avoid negative people and self-talk. The words we use have a significant impact on our body and our ability to heal. Regardless of which diet and supplements you take, your environment is one of the most important components. So, be kind to yourself (and others). Try to avoid saying negative things about yourself and others. It’s important to choose being around positive people and staying positive.
Take time for yourself (do something relaxing).
Seek professional support for any traumatic experiences and emotional difficulties.
Read these tips to avoid emotional collapse