What is Adrenal Fatigue?
When the body is exposed to stress, the hypothalamic-pituitary-adrenal axis (or HPA axis for short) is activated, and a cascade of hormonal changes occur to eventually cause the release of cortisol (our stress hormone) from the adrenal gland. Normally, when a stressor goes away, negative feedback cycles serve to turn off the HPA axis and reduce the release of cortisol. In the modern world, however, many of us are constantly activating our HPA axis.
When we’re exposed to chronic stressors over a long period of time, our adrenals pump out more and more cortisol as we become more and more resistant to its effects. The negative feedback cycles that normally keep things in check get turned off, and our health suffers as a result. Eventually, the HPA axis can’t keep up with the demand for cortisol, and cortisol levels become low. (1) This dysregulation of the HPA axis is what we refer to as “adrenal fatigue syndrome”. “Adrenal Fatigue” is a syndrome, not a disease, which means it is a collection of symptoms. Symptoms of adrenal fatigue syndrome are numerous and include:
- Waking up un rested
- Decrease ability to handle stress
- Brain fog or decreased cognitive ability
- Dizziness when standing from sitting or lying down
- Low sex drive
- Increased severity of allergic responses
- Low blood pressure
- Low blood sugar
- Weakness, and more…
“With stress all around us, are we doomed to develop adrenal fatigue syndrome?”
A Day in the Life
Let’s break down the most common stressors leading to adrenal fatigue by jumping into the shoes of a modern worker:
You startle in bed when you hear the distinct buzz of the alarm clock blaring in your ears. You’re startled, already activating the HPA axis and increasing your cortisol. You haven’t slept until you’re ready to wake up, and it’s not as if you were a few minutes off from the eight hour mark. Sadly, you fall into the third of Americans who get less than 6 hours of sleep a night. (2) This lack of sleep has serious consequences for you, including mood and cognitive issues as well as an increased risk of metabolic problems. (3, 4) Sleep deprivation activates the stress response and causes an increase in cortisol levels (5), priming you for adrenal fatigue.
You rush through getting ready for work, stuffing breakfast in your mouth as you gather up everything you need to go. Sit down for breakfast? Who’s got time for that? Perhaps you’ve chosen a standard American high carbohydrate, high glycemic load breakfast like cereal with skim milk, which shoots your blood sugar up high, only to drop it low in the coming hours. Seriously low blood sugar can be life-threatening, so it’s no wonder your body views it as a stressor. When blood sugar drops, the adrenals release cortisol and epinephrine, sending a signal to the body that it needs to get glucose into the bloodstream as soon as possible. When this happens, the body responds by breaking down glycogen (the stored form of glucose) as well as working to create new glucose from protein and fat through a process called gluconeogenesis. In short, every time blood sugar drops, it’s an emergency signal to the body and the HPA axis is activated.
But let’s say you’re health-conscious – perhaps you’re into the Paleo diet and have chosen to eat low-carb. You rush through breakfast to make it to the gym before work so you can fit in a high intensity exercise routine. This might sound like a healthy lifestyle, but don’t think you’re off the hook quite yet. A consistent low carbohydrate diet coupled with intense, anaerobic exercise forces the body to rely on the same stress-fueled process of creating glucose that occurs with the low blood sugar scenario I discussed above. Whether you’re eating a processed, high-carb diet or a low-carb diet in combination with intense exercise, your adrenals are taking a hit.
You get in your car, only to get stuck in traffic. Getting cut off left and right, you curse the other drivers you share the road with, activating the HPA axis with each encounter. Finally, you arrive at work. Your boss passive aggressively signals that he’s unhappy with your tardiness, putting you in a sour mood, and you finally sit at your desk. Work is stressful – everyone seems to have a problem and you’re supposed to have the solution. It makes you wonder if you’re paid enough to do your job, which gets you thinking about how life would be so much easier if you just made more. You’re certainly not alone here: money and work are the two most common things causing significant emotional stress for Americans. (6) This is the kind of stress that truly separates us from our ancestors. Whereas their stressors were acute (i.e. being chased by an animal), ours are chronic emotional issues that never truly leave us. It’s hard to imagine our ancestors worrying about the economy, isn’t it? It’s these stressors that take the biggest toll on our adrenal health by consistently activating the HPA axis.
By the time you get home from a long day at work, all you want to do is relax. You make dinner and sit down to eat while you watch some TV. For the rest of the night, you’re glued to the TV, your phone, or the computer until it’s time to sleep. Even if you’re in bed on time, you’re likely in bed surfing the internet on your phone or watching more TV – with so many options of things to do, it’s hard to convince yourself to actually sleep. The blue lights emanating from your screens reduce the production of melatonin (the sleep hormone). (7) This can lead to insomnia or disrupted sleep, causing you to get less sleep than you need. Perhaps you find yourself turning off all the devices and trying to fall asleep, only to find yourself worrying about upcoming deadlines. All of these issues lead you to get less sleep than you need and you wake up unrested the next morning to start the cycle all over again.
Preventing and Healing from Adrenal Fatigue in the Modern World
The modern lifestyle stacks the odds against us and can lead to adrenal fatigue, but that doesn’t mean we’re doomed. In fact, there’s a lot we can do to keep ourselves healthy. Here are my top tips for keeping your adrenals in good shape, even in the modern world.
- Leave yourself time to sleep for 8 hours per night – that means you’re in bed, ready to go to sleep by 10 if you need to be awake at 6. If possible, use an alarm clock that wakes you up gently by monitoring your sleep cycles (I like activity bracelets that wakes you up by vibrating on your wrist like the Jawbone Up24 or the app Sleep Cycle for this purpose).
- Limit your exposure to blue light by using orange glasses or installing apps like F.lux on your computer. Chris has an excellent article about this topic if you want to learn more about blue light.
- Eat on a regular basis and don’t go too long without meals – if you’re worried about your stress level or think you might already have adrenal fatigue, I’d highly caution you against skipping breakfast (or any meal, for that matter) regularly. Getting a high protein breakfast in the morning stabilizes your blood sugar throughout the day, which in turn helps to keep your HPA axis functioning appropriately.
- Don’t skimp on healthy carbohydrates like fruit and starchy tubers if you’re worried about your adrenal health, especially if you’re also engaging in high intensity exercise. A moderate carbohydrate diet is best for those with high stress levels or recovering from adrenal fatigue.
- When you do eat carbohydrates, combine them with protein and fat to slow absorption and stabilize your blood sugar.
- Start a mind-body activity practice like meditation or yoga to reduce mental and emotional stress. The benefits of implementing a stress management practice grow over time, so the sooner you start, the better!
By Kelsey Marksteiner, RD