From Adrenal Fatigue to Adrenal Balance
Written by Dr. Suzanne Tang
March 28th, 2023
Dear Patient,
Every spring, as flowers are blossoming, the weather is warming up, and the sun is shining a bit brighter and setting later, I feel the shift from winter to spring, darkness to light, and lethargy to energy. Spring symbolizes new beginnings and transformations, an opportunity to release the old and start anew, and harness newfound energy to birth new projects.
Despite this positive seasonal shift, many of us may still feel exhausted, unmotivated and foggy brained. There are many causes of fatigue, such as depression, stress, lack of exercise, hypothyroidism, iron deficiency anemia, insomnia, sleep apnea, poor diet, nutrient deficiencies, infections, and other diseases. These possible causes need to be ruled out and addressed, however one cause that is often overlooked by most doctors is adrenal fatigue.
While some may dismiss adrenal fatigue as a non-issue, naturopathic doctors and integrative physicians understand that it can lead to a range of health problems. Adrenal fatigue occurs when chronic stress takes a toll on the adrenal glands, impacting the body's ability to regulate stress hormones.
It's important to rule out other possible causes of fatigue and address them accordingly, but exploring the possibility of adrenal fatigue can be a valuable step in optimizing your health and well-being.
Physical, emotional, mental or environmental stress causes the hypothalamus and the pituitary gland to release corticotrophin releasing hormone and adrenocorticotropic hormone, respectively, which stimulate the adrenal glands to release stress hormones, cortisol, adrenaline and noradrenaline. This axis is referred to as the hypothalamic - pituitary - adrenal axis or HPA axis. The adrenal glands are small but mighty endocrine organs that reside above the kidneys and release over 50 hormones. Prolonged and excessive stress overstimulates and overtaxes the adrenal glands, oftentimes leading to adrenal fatigue or a decline in adrenal gland function. Adrenal fatigue signs and symptoms can include:
Fatigue
Anxiety and/or depression
Joint pain
Weight gain
Dizziness
Insomnia
Nausea and/or diarrhea
Frequent infections and allergies
Hormone imbalances
Salt and/or sweet cravings
Insulin resistance
Mood swings and irritability
The stress theory behind adrenal fatigue has long been studied, beginning with endocrinologist, Dr. Hans Selye and his work on General Theory of Adaptation. Based on the General Theory of Adaptation, there are three stages of adrenal fatigue - alarm, resistance and exhaustion.
Alarm- This is the body’s immediate response to stress when the sympathetic nervous system is in overdrive causing a “flight, fight or freeze” response. The adrenal glands are pumping out stress hormones, cortisol, adrenaline, and noradrenaline as well as dehydroepiandrosterone (DHEA). Elevated cortisol increases glucose and insulin to fuel the body to react to the stress or perceived threat. This phase is also marked by increased alertness, hypervigilance and arousal with anxiety, palpitations, sleep disruption, digestive issues, high blood sugar and intermittent fatigue. Feeling “wired but tired” is common.
Resistance - The body continues to cope with ongoing or frequent stress by producing stress hormones, cortisol at the expense of sex hormones, DHEA and testosterone. Elevated cortisol decreases active thyroid hormone, triidothyronine or T3 by increasing conversion of free T3 to inactive or reverse T3, which can lead to hypothyroidism. Common signs and symptoms are consistent fatigue, low libido, interrupted sleep, lack of drive and enthusiasm, weight gain, and frequent infections.
Exhaustion or burnout - The final stage of adrenal fatigue in which the body is unable to cope with stress or manufacture optimal levels of cortisol, neurotransmitters and sex hormones, DHEA, testosterone, and progesterone. The decline in these hormones lead to chronic exhaustion, depression, irritability, weight loss, apathy or disinterest, salt, sugar and caffeine cravings, dizziness, low blood pressure, increased inflammation and allergies, and frequent infections. For women, adrenal fatigue may be correlated with infertility, polycystic ovarian syndrome, premenstrual syndrome and more severe perimenopausal and menopausal symptoms.
Salivary adrenal tests along with neurotransmitters and hormone levels can be ordered to assess adrenal function and the phase of adrenal fatigue and guide the treatment plan. Rebalancing and restoring the adrenal glands with nutrients, herbs and glandular therapy is a customized approach based on each patient’s level of adrenal fatigue and phase of life that the person is in at the time. For the alarm phase, phosphatidylserine and amino acid, L-theanine may be recommended to regulate elevated cortisol levels. In addition, adaptogenic herbs, such as ashwagandha, holy basil and schisandra can help lower cortisol and mediate the stress response. Vitamins B-5 and C as well as magnesium and adrenal cortex are beneficial for the production of cortisol in the resistance or exhaustion phase of adrenal fatigue. It may be tempting to purchase and take adrenal supplements widely available on the market before seeing a naturopathic doctor or functional medicine practitioner but I highly recommend an approach of “assess first than treat” when it comes to adrenal fatigue to comprehensively support adrenal function.
While waiting for results to arrive, implementing stress management tools, improving sleep hygiene, and eating an adrenal supportive diet is great start. Please revisit my blog, Dr. Tang’s Inspire Daily Self-Care Challenge and follow my Instagram posts on self-care for inspiration to support your daily stress reduction practice.
To nourish your adrenals and reduce stimulants that further tax the adrenal glands:
Eat a whole foods diet abundant in vegetables, with moderate amounts of whole grains, nuts, seeds, oils, beans and lean animal protein (if you eat meat), and small amounts of fruit.
Avoid caffeine. Replace coffee or black tea with green tea or herbal tea. Eliminate soda or energy drinks. Moderate chocolate intake.
Reduce sugar and alcohol intake.
To regulate your blood sugar:
Eat protein and healthy fats within 1 hour of waking and 1 hour before bed.
Refrain from eating just fruit in the morning.
Avoid sugar, high fructose corn syrup and white flour products.
Keep fruit servings to 2 per day.
Eat a balance of protein sources from legumes or wild fish, organic turkey or chicken, complex carbohydrates like whole or gluten free grains such as quinoa, millet or buckwheat or root vegetables, such as carrots, squash, and sweet potato and fats from hemp, chia seeds, olive oil and avocados at each meal.
Eat every 3-4 hours.
If you experience low blood pressure and dizziness:
Salt your food to pleasant taste
Add 1/4 tsp of salt to morning glass of water
Restorative yoga, meditation, breath work, acupuncture and craniosacral therapy are truly beneficial therapies to regulate the nervous system, reduce stress, balance hormones and neurotransmitters and nourish the adrenal glands.
Yours in Wellness,
Dr. Suzanne Tang, ND, LAc, RYT
