Heal Adrenal Fatigue
Article by Stefan Burns - Updated June 2022. Join the Wild Free Organic email newsletter!
Small adrenal glands are found above the kidneys which produce a variety of hormones as part of the endocrine system. A common health complaint often heard of is adrenal fatigue. Adrenal fatigue is characterized by the abnormal production of cortisol, an important stress hormone connected to the circadian rhythm and metabolism. The timing and release of cortisol is the last component of a complex pathway of hormones governed by the hypothalamic-pituitary-adrenal axis (HPA axis). Cortisol influences other body systems to alter their energy metabolism. Cortisol production is downstream of many hormones so many variables have the potential of affecting cortisol levels, with light being one of the main causal factors.
Because of the complicated pathway that leads to cortisol production, it has been argued that adrenal fatigue is a myth and that no evidence points to adrenal insufficiency in people who suffer from chronic fatigue syndrome (CFS). In this article we examine the evidence for adrenal fatigue, better known as chronic fatigue syndrome, and explore natural treatment options that may help restore balance to the HPA axis.
Note - This article does not constitute as medical advice, it is presented for informational purposes only. For medical conditions please consult a medical professional.
Is Adrenal Fatigue Real?
Before a discussion of treatment options to help heal adrenal fatigue, we must first determine if it actually exists or whether the symptoms of adrenal fatigue are due to an unidentified state of disease elsewhere in the body.
Common Symptoms of Adrenal Fatigue
Poor metabolism, weight gain
Low energy, generalized fatigue
Difficulty waking up, unrefreshing sleep
Impairment in short-term memory and concentration (brain fog)
Low stress tolerance
Overuse of stimulants
Lesser Symptoms of Adrenal Fatigue
Anxiety
Tender lymph nodes
Muscle and joint pain
Sore throat
Headache
Low libido
Examining the symptoms, we can see that they are quite broad in scope but generally deal with the metabolism, disrupted circadian rhythms, degraded cognitive function, and tender/painful body parts. The hypothalamic-pituitary-adrenal (HPA) axis is responsible for governing many of the systems that could exhibit the above symptoms, especially when immune dysfunction and neurochemical alterations are taken into effect.
Adrenal fatigue and chronic fatigue syndrome are different terms that describe the same issue, and the causal factors for these fatigue problems aren’t strictly defined yet because the system has proven complex to understand. That said, there are a few known factors that are well associated with adrenal fatigue which will be discussed below.
Main Factors of Adrenal Fatigue
Across the many studies that have been done on those with chronic fatigue syndrome and health controls, the most commonly observed changes are (1):
Mild hypocortisolism (low cortisol)
Attenuated diurnal variation of cortisol (less cortisol variation)
Blunted HPA axis responsiveness
Enhanced negative feedback by cortisol on the production of certain hormones by the hippocampus, hypothalamus, and pituitary glands.
Women are more likely to show hypocortisolism than men, and experiencing the abnormalities above is more probable for people who are inactive and/or depressed.
Examined biologically, adrenal fatigue is characterized by low cortisol levels and blunted cortisol plasma variation across the diurnal (24 hr) cycle (which governs in large part the wake/sleep cycle and energy levels throughout the day). In addition to hypocortisolism, HPA axis responsiveness is blunted by enhanced negative feedback.
Hypothalamic-Pituitary-Adrenal Axis (HPA Axis)
Cortisol hormone is one of the end products of the HPA axis, and cortisol also cyclically regulates the functions of the HPA axis through its actions on glucocorticoid and mineralocorticoid receptors. Glucocorticoid receptors are found in the hypothalamus and anterior pituitary gland. Mineralocorticoid receptors are found primarily in the hippocampus.
CC Sandi, C. Nat. Rev. Neurosci. 5, 917–930 (2004).
Hippocampus
The hippocampus is a major component of the brain consisting of two hippocampi, one of each side of the brain. As part of the limbic system, the hippocampus is important for the consolidation of information from short-term memory to long-term memory, as well as in spatial memory used for navigation. The hippocampus is one of the first regions of the brain to suffer damage with Alzheimer's disease and other forms of dementia.
Hypothalamus
The hypothalamus is part of the limbic system and regulates certain metabolic processes and activities of the autonomic nervous system. Hormones are synthesized in the hypothalamus that stimulate or inhibit the secretion of hormones from the pituitary gland. The hypothalamus controls circadian rhythms, body temperature, sleep, fatigue, thirst, hunger, and attachment behaviors.
Pituitary Gland
The pituitary gland regulates hormone activity in other endocrine glands and organs. The pituitary has an anterior and posterior lobe. Hormones produced by the anterior pituitary include growth hormone, thyroid-stimulating hormone, adrenocorticotropin hormones, luteinizing hormone, follicle-stimulating hormone, and prolactin. Hormones produced by the posterior pituitary lobe include oxytocin and vasopressin.
How Adrenal Fatigue Develops
Cortisol is one of the bodies main stress related hormones, and it is release in a diurnal cycle in response to stress and low blood-glucose levels. Cortisol increases blood sugar through gluconeogenesis and aids in the metabolism of fatty acids, proteins, and carbohydrates. Cortisol also suppresses the immune system and decreases bone formation.
When engaging in acutely stressful activities such as strength training or cardiovascular exercise, cortisol is released from the adrenal glands to increase metabolism, blunt pain, and improve performance. Social stressors at work or home can also increase cortisol production, and cognitive behavioral therapy is able to reverse some HPA axis changes associated with adrenal fatigue.
Many of the activities that benefit from the increased stimulation of cortisol by the adrenal glands are health promoting when done in moderation against the backdrop of a low-stress lifestyle. Adrenal fatigue develops when increased cortisol stimulation is abused by excessive exercise and activity, social stressors, a poor diet, abuse of psychedelics, and poor sleep. Adrenal fatigue can also result from inactivity, a factor which highlights the importance of exercising in moderation for optimal wellness. Cortisol is a feel good hormone which can ease the feeling of pain and promote feelings of euphoria. One of the ways adrenal fatigue can develop in the first place is because its overstimulation overtime can be slightly addicting, and that encourages repeat behavior.
Adrenal fatigue is commonly observed in a few subsets of people. One group has a high-stress job and also excessively works out while restricting their calories to lose weight. Adrenal fatigue is also observed in overweight individuals who are extremely inactive. Adrenal fatigue is a widespread problem that affects people from a variety of lifestyles because the HPA axis can become deregulated in a variety of ways. Women are more susceptible to developing chronic fatigue then men.
Abuse of the metabolic pathways governed by cortisol dampens the parasympathetic (rest and digest) nervous system and overstimulates the sympathetic (fight or flight) nervous system. Left unchecked, excessive cortisol stimulation overtime makes it harder to go parasympathetic, compromising the bodies recovery and healing mechanisms. Muscle and joint inflammation increases, bone strength decreases, the endocrine system is altered in function, libido lowers, and chronic stress and fatigue accumulate eventually resulting in even larger health problems if left untreated.
My Experience with Adrenal Fatigue
I first realized I was experiencing some level of adrenal fatigue after I recovered from SARS-CoV-2 early in 2020. My immune system was suppressed from an overindulgence in strength training while stress at work was increasing steadily. I was also dry-vaporizing cannabis regularly which had an effect on my metabolism and endocrine system.
While I was knocked out for 7-10 days because of the coronavirus, I realized that I had been placing too much stress on myself and on my adrenal glands, dysregulating my HPA axis. Afterwards I took a step back from lifting weights and shifted my exercise to calisthenics, walking, and yoga. A few months later I transitioned to a plant-based diet which further helped me recover from the mild chronic fatigue I had.
Now with a properly functioning HPA axis, my blood pressure is lower, my digestive system is healthy, I’m calmer and more emotionally stable, and I make better food choices. I’m more focused, no longer have any anxiety, and I enjoy restful sleep.
When plagued with chronic fatigue, it’s difficult to see how to get out of it because the energy to do anything is so low. Motivation feels ethereal, willpower is seemingly nonexistent, and depression may also be a factor. For these reasons it’s important to keep the treatment for chronic fatigue simple and to slowly build on the success first gained by various methods available.
Treatment for Adrenal Fatigue
When it come to treating adrenal fatigue, it’s suggested to start with the “low hanging fruits” that will provide quick and immediate improvements to one’s condition. Remember cortisol is a stress hormone connected to the circadian rhythm and metabolism, and by manipulating these variables fatigue can be reduced.
Diurnal cortisol variation averaged across 28 individuals. CC Whitaker, Martin et al Clinical endocrinology 2014;80554-61
Adrenal fatigue occurs when there is an accumulation of chronic stress that hasn’t been properly recovered from yet. Focusing first and foremost on restful activities will help to reduce and eliminate built-up chronic stress an inflammation while also resensitizing the HPA axis to normal function.
Prioritizing SLEEP is the first thing that should be done. Everyone receives the same 24 hours in a day, and setting aside a quality 8 hours a night for sleep is foundational to reducing and eliminating adrenal fatigue. There will be times where sleeping for the normal 7-9 hours isn’t possible, so when those variations are unavoidable, keep in mind the overall number of 56 weekly hours of sleep and catch up when possible. Catching up on sleep has the best success on the day following a shortened sleep cycle. Some simple advice is to listen to your body and to enjoy a nap if feeling tired.
Have time to REST and decompress every day. This doesn’t have to involve closing the eyes and can instead be performing some self-care, enjoying a peaceful walk through nature, or simply reading a book. When dealing with excessive muscle and joint inflammation and fatigue, Yin Yoga is great way to facilitate the recovery process while keeping energy expenditure low.
ESTABLISHING A ROUTINE and making a habit out of following a normal sleep cycle and resting when needed makes it easy to begin enabling positive incremental changes day by day without having to rely solely on motivation or willpower (which fluctuate). How each day is started determines in large part one’s physical, mental, and emotional status throughout the entire day. Simple movement, meditation, and BREATHING EXERCISES gently activate the metabolism and bring balance to the body and mind.
While making these lifestyle adjustments, the following herbs, supplements, and dietary changes can be made in tandem to facilitate the healing of chronic fatigue and the return to normal cortisol function.
Herbs for Adrenal Fatigue
There are many herbs that effect the energetic systems of the body and there are many ways the HPA axis can become dysregulated, therefore it is best to use adaptogenic herbs which help bring the systems of the body into balance irrespective of the starting conditions.
Ashwagandha for Adrenal Fatigue
Ashwagandha is a grounding and nourishing herb found in India. Popular in Aryuveda.
Helps to cope with stress and enhances sleep
Increases vital energy and balances hormones
Supports overall cognitive health
Ashwagandha - from Mountain Rose Herbs
Siberian Ginseng for Adrenal Fatigue
Siberian Ginseng is also known as eleuthero root and is native to Siberia (Asia). Eleuthero root is mildly stimulating.
Supports the adrenals, boosts the immune system, and fights fatigue
Reduces inflammation, improves sleep, and helps with depression
Improves vital energy, sexual energy, and enhances digestion
Siberian Ginseng - from Mountain Rose Herbs
Reishi Mushroom for Adrenal Fatigue
Known as the mushroom of immortality and found worldwide. Reishi is highly rejuvenating and a potent immune booster.
Has powerful immune strengthening, antiviral, and antitumor properties
Regulates blood sugar and lowers cholesterol by fighting free radicals
Reduces fatigue and fights depression through its strong neuroprotective effects
Reishi mushroom can be eaten raw, brewed into a tea, tinctured, or made into a herbal broth for soup.
Reishi Mushroom - from Mountain Rose Herbs
Chamomile Flower for Adrenal Fatigue
A gentle herb used worldwide to promote relaxation and calm.
Relaxant, relieves stress and tension, and improves sleep
Promotes the production of alpha brainwaves which increase sense of calm alertness
Supports digestive health, helps with stomach ulcers, and improves regularity
Chamomile Flowers - from Mountain Rose Herbs
Preparation: All of these herbs can be brewed into a tea individually or together in equal parts. Steep at 170 F (75 C) water for 5-15 minutes. These herbs can also be decocted into a tincture.
Supplements for Adrenal Fatigue
The herbs above can also be purchased as supplement pills for use in resolving adrenal fatigue. With a tea or tincture it’s more effective and costs less, but if the ease of use of pills is preferred that option exists.
Other supplements that are useful in healing chronic fatigue include key vitamins and minerals which are used by the endocrine and energy systems of the body.
Vitamins for Adrenal Fatigue
The main vitamins that are useful in the context of adrenal fatigue are the B vitamins, vitamin C, and vitamin D.
B vitamins help with energy metabolism, detoxification, and can have mood-elevating effects. For adrenal fatigue getting enough B vitamins through a food like nutritional yeast or by taking a B vitamin complex can help. I recommend the following vitamin B supplement.
The adrenal gland is one of the organs with the highest concentration of vitamin C in the body because it uses it in the production of all adrenal hormones including cortisol. Adrenal fatigue is marked by chronically reduced cortisol levels, and providing the body more vitamin C ensures that vitamin C is not a limiting factor in the production of normal levels of adrenal hormones. I don’t recommend vitamin C supplements because getting enough vitamin C is easy enough by eating fruits and vegetables, for example one orange contains 90% DV of vitamin C.
Vitamin D is important for the healthy functioning of the endocrine system, and most people are deficient in vitamin D. Vitamin D can be synthesized endogenously by the skin through sun exposure. Depending on skin color and the weather, bathe some or all parts of skin for 10-60 minutes to produce the vitamin D needed for 1-3 days. Limit sun exposure in order to not get sunburnt. If healthy sun exposure is not possible or problematic I recommend Nootropic Depots Vitamin D3 + K2 + C supplement.
Minerals for Adrenal Fatigue
Magnesium and boron are two important minerals which are used extensively throughout the body and supplementation with each is helpful in the context of adrenal fatigue.
Magnesium is the second most common micronutrient deficiency, and getting enough magnesium ensures the bodies hormonal systems, metabolism, and circadian rhythm function properly. Magnesium supplementation in the evening aids in relaxation and improves sleep quality. I recommend the following magnesium supplement.
Boron is a trace mineral which assists the actions of vitamin D and magnesium. Boron has also been shown to have anti-inflammatory and antioxidant effects, improving healing from tissues wounds and injuries. Boron improves the brain’s electrical activity, cognitive performance, and short-term memory for elders. Learn more about supplementing with boron.
Herbs for Adrenal Fatigue
There are two herbs that readily come to mind, chamomile and ashwagandha, that help mitigate the symptoms of adrenal fatigue and provide the body the support it requires to overcome and heal the issue.
Tea brewed from chamomile flowers has relaxing and sleep benefiting properties while also having the benefit of improving daytime functioning. Chamomile increases 8-12 Hz alpha brainwaves which provide a sense of stability and calm, and chamomile contains many flavonoids like apigenin which help the brain to repair itself and maintain proper function, important for HPA axis dysfunctions. Mountain Rose Herbs sells organic chamomile flowers which are easy to brew into a tea and can be used for a variety of other purposes.
Ashwagandha is one of the premiere herbs known for its ability to reduce the amount of stress experienced from a stressful event. For example ashwagandha taken before an endurance activity greatly lessens the depletion of cortisol from the adrenal glands in response to the stress experienced, thereby reducing the demand for nutrients like vitamin C for the production of new cortisol. Taking ashwagandha before a stressful event, whether physical, mental, or emotional will help reduce the stress burden that results from after the event which is super useful for those who already have chronic fatigue. Taking ashwagandha daily also is helpful. Mountain Rose Herbs sells organic ashwagandha root powder (recommended), ashwagandha root, ashwagandha root capsules, and ashwagandha extract.
Nootropics Depot also sells a variety of ashwagandha products that have been standardized to contain a certain minimum percentage of withanolides (the main active component of ashwagandha) and I recommend their Shoden Ashwagandha Capsules which has a minimum of 35% withanolides for those looking for a more potent ashwagandha supplement.
Diet for Adrenal Fatigue
There are two aspects of diet that are important in the context of healing adrenal fatigue, or really any health issue.
First is to eat foods that contain the micronutrients the body is currently deficient in. For the nutrients listed above, the following foods can be eaten:
B Vitamins - Nutritional yeast, leafy greens, sunflower seeds, fish, meat, dairy, and fortified grains
Vitamin C - Citrus fruits, parsley, rose hips, peppers, cruciferous vegetables (broccoli, kale, brussels sprouts)
Vitamin D - Fish, eggs, mushrooms (exposed to sunlight), fortified milk
Magnesium - Pumpkin seeds, nuts, avocado, dark chocolate, beans
Second is simply to eat a healthy well-rounded diet full of unprocessed foods which contain enough fiber and protein. This means eating fruits, vegetables, grains, nuts, seeds, and pulses if vegan. If vegetarian eggs and dairy can be added if easily digestible, and if a meat eater then pasture-raised meats and seafood can be further added to the diet. The main takeaway is to avoid sugary and ultra-processed foods is important to make sure cortisol secretion returns to normal because cortisol is released in response to blood glucose levels.
Adrenal Fatigue and Caffeine
Caffeine has an effect on cortisol levels. When caffeine isn’t used regularly, then caffeine will cause a robust increase in cortisol during morning, afternoon, or evening usage. When consuming caffeine on a daily basis, then morning caffeine usage doesn’t impact cortisol significantly but afternoon caffeine usage will elevate cortisol blood concentrations for up to six hours. Even if caffeine creates an afternoon cortisol increase, cortisol levels will drop to normal levels by nighttime.
Since it is the circadian rhythm and cortisol which plays a large part in the wake and sleep cycles of the body, it is important to be mindful of caffeine usage throughout the day and to limit usage of caffeine to time windows that won’t affect normal sleep, unless that is the desired goal. A good rule of thumb to follow is to not have any caffeine after 2 pm.
In the context of adrenal fatigue, it is best to not have any caffeine until the problem is well on its way to being resolved. An abuse of caffeine through heavily caffeinated drinks or excessive coffee usage often is a main factor that led to chronic fatigue syndrome in the first place. For help in quitting caffeine or in resetting a caffeine tolerance, read my caffeine guide:
Reset the Adrenal Glands
Incorporating wellness practices that promote balance into one’s lifestyle has a tremendous impact on health and wellness over the long term. Learning to evenly balance mind, body, and emotions takes time but the effort is well worth the reward. Healing occurs when the body is in a state of balance, so consider adding a morning routine that functions as a “balancing gyroscope”, bringing consistency and balance to day to day life. Establishing a grounding practice outside in nature is a great way to bioelectrically balance the various systems of the body
The human circadian rhythm is driven in large part by the cycles of light and temperature on our planet. Rising with the light and not going to sleep too long after the sun sets is the best way to stay aligned with these natural cycles. If experiencing insomnia and falling asleep is difficult, simply resting at the appropriate times when sleep normally should occur will create the habit of rest during that time window, and with consistency that habit will make falling asleep at regular hours easier.
Healing the adrenal glands and restoring normal function to the hypothalamic-pituitary-adrenal axis can take a long time, sometimes months to years. One step in front of the other will lead to eventual success.
As a holistic wellness practitioner I offer coaching services, contact me to learn more.
References:
Papadopoulos, A., Cleare, A. Hypothalamic–pituitary–adrenal axis dysfunction in chronic fatigue syndrome. Nat Rev Endocrinol 8, 22–32 (2012). https://doi.org/10.1038/nrendo.2011.153
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