Weight gain, low energy, overwhelm, moodiness, poor sleep, anxiety, brain fog - any of these sound familiar? If so, hormone imbalance is likely a big part of the problem. Today I am discussing “adrenal fatigue”, a common term used to address a cluster of symptoms most often found in women between the ages of 35 and 50. Five years ago, I had adrenal insufficiency, and I learned all that I could to heal from this debilitating state of health. I'd like to share some of this wisdom now with you.
The adrenal glands are critical parts of the endocrine system, which is a group of glands that produce the body’s hormones. Nearly every facet of good health is a product of the delicate balance of these hormones. In today’s fast-paced world, there are many things that disrupt this equalibrium, namely poor diets, environmental pollutants, and stress. Today I’m sharing how to better understand and care for your adrenal glands by resetting your internal rhythm with nourishing foods and implementing a powerful lifestyle approach.
Adrenal Fatigue = HPA Dysregulation
Before we talk about “adrenal fatigue”, let's clear up some confusion about the term itself. If you google "tired all the time," you'll probably get adrenal fatigue as a top hit. Some articles say adrenal fatigue is not real; it's a made-up condition. Adrenal fatigue is not a diagnosis in conventional medical terms, but HPA axis dysregulation (HPA) is. HPA stands for the hypothalamic-pituitary-adrenal axis. When we talk about “adrenal fatigue” we're talking about HPA axis dysregulation. Because the adrenals don’t actually fatigue, it's important to realize that HPA axis dysregulation is the correct term and gives you the bigger picture of what’s going on.
Your Body On Stress
When we perceive a situation to be challenging or threatening, the brain initiates a cascade of events involving the hypothalamic-pituitary-adrenal (HPA) axis, which is the primary driver of the stress response. This results in an increase of cortisol, which is referred to as the "stress hormone." Making cortisol is entirely biologically appropriate; it's something your body was designed to do. Running away from a bear? Prepping for an interview? You need that cortisol. But modern-day, everyday stress is where the problem comes in. Constant stress has a significant impact on your HPA axis. Add in yo-yo dieting, over-eating, under-eating, poor sleep, traffic, loss of a loved one, PTSD, and/or money problems, and now you have a stress-cocktail in your body. In fact, your HPA axis reacts the EXACT SAME if your stress is actual, anticipated, or imagined. At some point, your HPA axis gets activated to the point where it starts to stop responding to the activation signal. You and your cellular receptors become less sensitive to the effects of cortisol and become cortisol resistant. The final stage ends up becoming what's called HPA axis dysfunction or “burnt-out adrenals”. Phew! So that's a brief behind the scenes biology lesson on how the body reacts when we get stressed out and a basic overview of what adrenal fatigue is.
Test Don't Guess
Testing your adrenal function is beneficial because you can see precisely where your cortisol levels are, morning, afternoon, and evening. You can test your cortisol levels with a salivary test from a lab. Two lab tests that I like are Labrix and DUTCH Plus. A healthcare practitioner can help guide you with their interpretation. Cortisol is ideally highest in the morning when you wake, and lowest in the evening. If your cortisol is wonky, you may have low levels in the morning or get that "tired but wired" feeling at night.
Food Rehab for Adrenal Support
Cortisol plays a big role in digestion, cravings, circadian rhythm, blood sugar, and blood pressure. When cortisol is out of balance, you are more susceptible to overeat, drink coffee and wine, have disrupted sleep, and gain weight. Chronically high cortisol slows metabolism. It does this by affecting thyroid hormone levels, creating inflammation, and inducing cravings (mostly for sugar), thus creating a big metabolic mess.
So what are nutritional tips for supporting adrenal health?
Find your sweet spot with food intake. Over-eating, under-eating, eating too many refined carbs, or not enough carbs are all hard on your adrenals!
Dial-in your unique carb tolerance. Experiment with how many and of what type of carbs you can eat while keeping your hormones in balance. The goal is to discover how much and what kind of food is best for your biochemistry. Generally speaking, carbs should make up 35-45 percent of calories, most of which should come from veggies, beans, low glycemic fruit and intact whole grains. That translates to around 75-90 grams of carbs per day for adults who exercise under an hour per day. The best carbs to eat are ones that are fiber-rich and burn the most slowly, like leafy greens, broccoli, black beans, quinoa, sweet potatoes, and berries. Here are a few other key things to consider:
Balancing and Timing Your Macronutrients: People with adrenal fatigue tend to have low levels of the hormones that help stabilize blood sugar especially during fasting or in between meals. Balancing each meal or snack with fiber-rich carbs, quality protein, and healthy fat is essential. Shoot for 3-4 meals/eating periods a day to provide slow and steady fuel. Start the day with a protein-rich meal with non-starchy carbs like an egg and spinach omelet or a berry protein smoothie. Save then the starchier carbs (like sweet potatoes or quinoa) for later in the day as it often helps with cravings, mental function, focus, and sleep.
Eat Fiber: Fiber is the part of carbohydrates we cannot digest and has major health benefits. It helps us lose weight, removes toxins from our bodies, strengthens our immune system, reduces our risk of developing some cancers, and feeds the healthy bacteria in our intestinal tract. But aside from all that goodness, in terms of adrenal fatigue, its greatest role is helping to keep blood sugar balanced. A common problem with underactive adrenal glands is hypoglycemia, or low blood sugars, especially between meals or while sleeping. Eating carbohydrate foods high in fiber, along with healthy fat and protein together at each meal is key to achieving blood sugar balance.
Limit Disrupting Beverages: Too much caffeine and alcohol can wreak havoc with cortisol. I know that eliminating coffee is not realistic for everyone, but if you are suffering from insomnia or daily agitation then you might want to consider replacing it with tea or limiting your consumption to before 9 AM. I highly recommend green tea which has less caffeine and more antioxidants. Teeccino, a healthy coffee alternative, is another good choice.
Salt: If you are adrenal fatigued, you will likely need to honor your craving for salt. Say what? Yes, salt can increase blood pressure but only in the rare few (around 6% of the population), and low blood pressure (hypotension) is a very common sign of adrenal fatigue—at all stages. In addition to salt cravings and low blood pressure, people with adrenal fatigue often experience light-headedness (when first getting out of bed or out of a hot bath), irregular heartbeat, lethargy, muscle weakness, and increased thirst. These are all a result of an imbalance in sodium and other minerals, including potassium and magnesium. Increasing your intake of high-quality sea salt or other natural salts (not iodized table salt) is one way to help restore these imbalances.
Supplements for Adrenal Health
Please don't read a LiveStrong article about adrenal fatigue, and then go buy a bunch of adrenal supplements. I can't stress that enough. People take the wrong supplements for their particular stage of adrenal fatigue all the time. Confirming if you have high or low cortisol can change the way you deal with your symptoms. Testing will ensure the right supplements for your cortisol patterns. If you have very high cortisol, you don't want to be taking an adrenal supplement that's actually is meant to raise cortisol (like adrenal glandulars) and vice versa.
Vitamin C: Required for adrenal hormone production. I suggest getting a sufficient amount from both food and supplementation. Foods high in vitamin C include papaya, bell peppers, broccoli, Brussels Sprouts, strawberries, pineapple, oranges, and kiwifruit. I often supplement with 1,000-2,000mg a day. Note that too much will cause loose bowels.
Omega 3s: In clinical studies, taking fish oil a day for six weeks, lowered morning cortisol levels to healthier levels. Supplement dosing is between 1,000- 3,000 mg/ day. Foods rich in omega 3s include wild salmon, sardines, anchovies, mackerel, herring, and flaxseed.
Vitamins B3, B5, and B6: Each of these B vitamins is essential in varying quantities throughout the adrenal cascade, as well as in many other processes from mood regulation to DNA synthesis to energy production. A good B- complex vitamin will support these nutrients.
Magnesium: Depleted during stress, magnesium is involved in over 300 enzymatic reactions in the body and 60% of Americans don't get enough. A good dose is between 250 and 400mg daily, taken with food. I recommend magnesium glycinate or magnesium citrate if constipated.
Probiotics and Prebiotics: Gut health is very connected to adrenal health. If you don't have good gut health, or if you have altered gut bacteria, that can lead to HPA axis dysfunction. Mind your microbiome (if you want more info on this, I go into great detail in my book, Nourish Your Tribe).
Adaptogenic Herbs: Or "adaptogens" have been used for centuries to help the body "adapt" to stress. Ashwagandha and Rhodiola have a long history of use in traditional Chinese and Ayurvedic medicine. These can be wonderfully supportive in reducing anxiety and balancing cortisol.
Licorice: One of the most useful herbs in the case of underactive adrenal glands. It has been shown to help with increasing circulating cortisol levels until the adrenal glands restore function. Licorice contains glycyrrhizic acid, a compound that stops the body from breaking down cortisol, which in turn enhances stress resistance. It’s best taken in the morning.
Lifestyle
While food and supportive supplements are critical to healing adrenal fatigue, they will only get you halfway there. You must find strategies to help manage your stress or else you will not heal fully. Stress is associated with just about every modern disease that you can think of, from depression to cardiovascular disease to type 2 diabetes to autoimmune conditions such as Crohn’s disease and multiple sclerosis and even the common cold. I highly recommend that you start prioritizing sleep and find ways to calm your inner spirit. For me, shutting down electronics at night and sticking to a nighttime routine greatly helps. I also get great benefits from daily guided meditation. There are great apps like Insight Timer, Calm, and Headspace that can offer many different options to fit your schedule. In terms of exercise, endurance cardio can increase cortisol, so try adaptive workouts, such as yoga or pilates, which can help lower cortisol. If you're going through a very stressful time, then minimizing high-intensity activity while you're dealing with other stressors can be helpful. This doesn't mean you can never do high-intensity exercise again; it just means you might take a break from it. Listening and honoring your body is where it's at. Eating nutrient-dense, anti-inflammatory foods will help you feel better and less stressed. That's you managing your cortisol levels and being kind to your adrenals.
Wishing you thriving health,
Nicole
Psssst: These general recommendations are meant to jump-start you in your adrenal healing. I always remind everyone that any significant lab testing and supplement changes should be made under the care and guidance of your healthcare provider and integrative nutritionist.