Is Adrenal Fatigue Real?
The Top Strategies for Stress, Cortisol, and Adrenals: (Part 2 of 2)
“Adrenal fatigue”, medically referred to as “adrenal insufficiency”, occurs when the adrenal glands are hyporesponsive, or under-responsive to brain signaling for hormone secretion.
What happened is “adrenal fatigue”, which has become a buzzword to represent an array of symptoms due to insufficient adrenal gland activity.
While abnormal actions can occur at other points, we need to look beyond the adrenal glands.
The Hypothalamus, a brain region, in stress detection response, releases corticotropin secreting hormone, (CRH) which acts on the pituitary gland.
The pituitary releases adrenocorticotropic hormone (ACTH), which acts upon the adrenal glands, which are located on top of our kidneys.
The Hypothalamus-Pituitary-Adrenal axis, or the HPA Axis, is the result of the inner workings of these three organs.
Primary adrenal insufficiency or Addison’s disease is when the adrenal glands under-react to release ACTH or are damaged.
With adrenal insufficiency, the hypothalamus and pituitary gland are operating normally, but the adrenal glands are not producing sufficient cortisol and dehydroepiandrosterone.
An ACTH-stimulation test taken by an endocrinologist can diagnose this condition, with the primary pathology being less cortisol secretion and synthesis.
When either the hypothalamus releases less CRH, or the pituitary releases less ACTH, in stress response, we call this secondary adrenal insufficiency.
This is a signaling issue, as the adrenal glands work normally, yet are not receiving the signal to produce more hormones.
CRH is not easily detected, while ACTH is readily evaluated in a blood test.
Tertiary adrenal insufficiency is also the name we use for CRH deficiency.
This process is not a single action or event, and instead a catch-all term to represent lower hormone production due to dysregulation of the endocrine system.
So we can see “adrenal insufficiency’ is HPA axis dysregulation resulting in lower hormone release affecting energy and mood.
Function of the Adrenal Glands
The endocrine system, as one of our 13 bodily systems, is a network of hormone-producing glands.
As part of our endocrine system, we have two adrenal glands sitting on top of each of our kidneys.
- Blood pressure control
- Burning fat and protein
- Creating hormones
- Glucose regulation
- Stress management
Adrenal Insufficiency Symptoms
- Body hair shedding
- Fatigue and weakness
- Lightheadedness
- Low blood pressure
- Low or loss of appetite
- Weight loss
Adrenal Insufficiency Causes
- Anxiety
- Diet
- Diseases (Such as Addison’s disease and Cushing's disease)
- Drugs (Including Pharmaceuticals)
- Stress
Drugs Which can Cause Adrenal Insufficiency
- Aminoglutethimide
- Dexamethasone
- Hydrocortisone
- Ketoconazole
- Megestrol
- Metyrapone
- Mitotane
- Prednisone
Cortisol
Produced by the adrenal glands, cortisol is the body’s primary glucocorticoid, a steroid hormone.
When our body detects a threat, such as a loud horn, our brain releases a hormone called adrenocorticotropic hormone (ACTH).
Known as our fight-or-flight stress response, our adrenal glands are triggered to release adrenaline and cortisol.
Rising cortisol levels can stimulate new releases of energy and strength.
This is our natural and protective threat response process.
Suppressing unneeded and counterproductive functions, cortisol is the trigger maintaining control of our fight-or-flight response.
Adrenal Insufficiency: (Fight-or-Flight Response Symptoms)
- Body aches
- Chronic fatigue
- Depression
- Diarrhea
- Digestive issues
- Hair loss
- Hyperpigmentation
- Lightheadedness
- loss of appetite
- Low blood pressure
- Muscle weakness
- Nausea
- Nervousness
- Stomach pain
- Unexplained weight loss
When we experience a threat, our nervous system reacts by releasing stress hormones, adrenaline, and cortisol, springing our bodies into action.
Our heart races, muscles tighten, blood pressure spikes, breathing gets shallow, while our senses come into focus and sharpen.
Cortisol Release
- Digestive system suppression
- Growth process suppression
- Immune system response suppression
- Reproductive system suppression
Adrenal Gland Hormones
- Aldosterone
- Androgenic steroids
- Cortisol
- DHEA
- Epinephrine
- Norepinephrine
Actions of Adrenal Gland Hormones
- Blood pressure regulation
- Circadian rhythm
- Diurnal energy levels
- Immune system
- Inflammation
- Metabolism
The bulk of cortisol binds to corticosteroid-binding globulins, which prevents its binding to glucocorticoid receptors.
Cortisol must be freed, as in the case of testosterone, what counts is the amount of free cortisol.
As we connect an array of health conditions with inflammation, chronic suppression diminishes the immune response.
This could explain the connection between chronic stress and the increased risk of getting sick.
The Two Primary Stress Response Systems
Researchers believe there are two major body systems regulating our stress response.
Both of these systems arise from the hypothalamus, a forebrain region.
Playing a direct role in physical stress response, the autonomic nervous system is divided into the parasympathetic nervous system and the sympathetic nervous system.
As our bodies experience stress, the sympathetic nervous system promotes what we call the “fight or flight” response.
The parasympathetic nervous system, promoting “rest-and-digest” activity, can counterbalance the fight-or-flight actions of the sympathetic nervous system, as a part of our cholinergic system.
The other proposed stress pathway is the sympathomedullary system, where signals are sent to the adrenals to release adrenaline and norepinephrine
The HPA Axis
The hypothalamic-pituitary-adrenal axis, HPA axis, represents the interplay between our adrenal glands, hypothalamus, and pituitary gland.
While the adrenal glands are located on top of the kidneys, the hypothalamus and pituitary gland are found just on top of the brainstem.
We believe the HPA axis manages longer-term stressors, as the sympathomedullary system handles acute stressors.
Both of these can experience imbalance from stress, as other brain regions and pathways can likewise be affected by this.
These three glands comprising the HPA axis release these three hormones:
CRH (Hypothalamus)->ACTH(Pituitary)->Cortisol (Adrenal)
Blood cortisol is a standard stress response measurement, however, several other markers have also looked at how stress affects our body.
It’s important to realize our stress response involves an array of other potential drivers, such as our unique individual biochemistry, the physical environment, our overall health, and our genetic code.
Cortisol Tests and Treatment
Exceedingly high or low cortisol levels can indicate an adrenal gland disorder.
Disorders of the adrenal glands can cause bodily harm if left untreated.
While blood tests are the standard, saliva, or urine can also be used for cortisol testing.
Standard cortisol testing represents variable and transient effects.
Alternative cortisol tests such as hair cortisol tests can be more reliable of longer-term levels, when based on continuously monitored or multiple-day cortisol testing.
Labs use varying measuring ranges, with the deemed normal range varying from lab to lab.
The normal blood range at 8 a.m. will be in the range of 6 to 23 micrograms per deciliter (mcg/dL).
There is also a less active form of cortisol, called cortisone.
High Cortisol Levels can Indicate
- Excessive ACTH release because of a pituitary gland tumor or excessive growth
- Excess cortisol production because of an adrenal gland tumor
- Tumor elsewhere involved in cortisol release
Low Cortisol Levels can Indicate
- Addison’s disease, occurring when adrenal gland cortisol production is too low
- Hypopituitarism, occurring when adrenal gland cortisol production is too low because the pituitary gland is not correctly signaling for release.
24 Strategies to Lower Cortisol
- Acetylcholine Supplements (Theoretical)
- Butyrate/ SCFA’s (Dairy products or supplements. Dietary fiber: fruit and starch)
- Caffeine Elimination/ Reduction (Green tea and cocoa in moderation)
- Carbohydrate Elimination/ Reduction (Especially Simple Carbs)
- Cold Therapy (2–5 minute cold shower)
- Deep Breathing (Wim Hof breathing)
- Electronics (Reduction at nighttime)
- Exercise (Also HIIT. Not to excess in exertion or time)
- Fasting (Intermittent and prolonged)
- Fried and Processed Foods Elimination
- GABA Supplements (Theoretical)
- Gum Chewing (Lowers salivary cortisol)
- Hypnosis (Also self-hypnosis)
- Laughter
- Massage
- Meditation/ Yoga/ EFT
- Music
- Protein
- Socializing (Family and friends)
- Sugar Restriction
- Sufficient Sleep
- TMS/ tDCS/ PEMF (All promising yet unconfirmed)
- Vagus Nerve Therapy/ EFT
- Vegetables
Conditions which can Block Adrenal Glands
These conditions should be diagnosed and treated to promote healthy adrenal gland function.
- Anemia
- Autoimmune Diseases
- Anxiety and/ or depression
- Cardiovascular issues
- Diabetes
- High stress lifestyle/ environment
- Infections
- Irritable bowel syndrome (IBS)
- Kidney or liver disease
- Lung issues
- Sleep Apnea
Diet for Adrenal Fatigue
The best diet for adrenal fatigue involves proper hydration along with a whole food diet.
To follow a diet for adrenal fatigue, eating on a consistent schedule is a key target.
In maintaining the best diet for adrenal fatigue, limiting the intake of the following foods appears to deliver the best results.
- Alcohol
- Artificial sweeteners
- Caffeine
- Fast food
- Fried food
- Processed food
- Soda
- White flour
- White sugar
*The ketogenic diet has been found to raise cortisol from small to high amounts across three different research studies.
Conclusions on Cortisol and “Adrenal Fatigue”
So, even though the complementary approaches may reduce the symptoms, the biology is completely misunderstood.
One potential issue with this approach is that the patient’s immune system can be overactive, and most of the listed supplements are immune stimulants.
So not understanding our biology can have negative consequences in how we treat diseases.
Like many difficult conditions needing more than basic medical care, finding a naturopathic doctor or functional medicine specialist is an increasingly popular method for solving more difficult conditions such as adrenal fatigue.
What’s your favorite anti-stress supplement?
Your Friend in Health
Mark Stein
