Stress has an impact on the adrenal glands – this could explain why you feel so tired

If trauma and chronic stress have made an imprint on your life – it is likely you experience feeling tired and drained most of the time. Adrenal fatigue has become an increasingly common term that describes the depletion of the adrenal glands and their inability to produce new cortisol. This is a result of chronic activation of the stress response.

The adrenals are the first responders to stress and they become overworked if stress becomes chronic. Eventually, they deteriorate, burn out, and stop producing cortisol that is needed for optimal daily body function.

The term ‘Adrenal Fatigue’ was popularized by Dr. James Wilson in 2001. It describes a unique set of fatigue patterns and symptoms.

Difficulty waking up and feeling tired in the mornings.
Experiencing fatigue throughout the day especially from 2-5 pm
Improved energy after 6 pm
Getting a second wind from 11 pm to about 1 or 2 am
Sugar and salt cravings, lethargy, decreased productivity, lightheadedness when standing quickly, depression, irritability, poor memory, brain fog.

There is often controversy over the term ‘adrenal fatigue - but we do know there are certain biological processes that have to do with the adrenal glands, and they are significantly impacted by trauma and chronic stress. While there may or may not be a better way to label this phenomenon – it’s the impact it has on our overall well-being that is of most importance. The adrenal glands have a profound effect on our whole body – and when they are not functioning properly many issues can arise. Nutritional strategies have a lot to offer when it comes to supporting the health of the adrenals.

Understanding the stages of adrenal overwhelm

Stage one: The beginning of the “alarm” phase is the body’s immediate reaction to a stressor. Significant amounts of hormones epinephrine (adrenaline), norepinephrine, cortisol, DHEA, and insulin are produced. High cortisol levels lead to insomnia, weight gain, and insulin resistance. Increased alertness, feeling wired, and arousal are often experienced during this stage.

Stage two: Ongoing “alarm” phase is still characterized by an increased production of hormones – however production of DHEA and other sex hormones begins to drop as the body uses more energy to produce more cortisol. During this stage, the effects of over-exhausted adrenals begin to set in. Feeling “wired and tired” is often experienced at this point.

Stage three: The body is still focused on producing cortisol at the expense of important sex hormones. The hormone pregnenolone is a precursor for both sex hormones and cortisol – the focus becomes on making cortisol as a stress response. At this point, the quality of life begins to decline – symptoms might include regular tiredness, compromised immune system, low sex drive, and lack of enthusiasm. This stage can last for several months or years.

Stage four: The burnout phase is characterized by the body’s inability to keep up with the production of stress hormones – in this case, both cortisol and sex hormone levels are low. This occurs after coping with stress for a long time. Extreme exhaustion, anxiety, depression, irritability, low libido, weight gain or loss, and apathy occur during this phase. Insufficient hormone levels affect nearly every part of the body.

The science of HPA-axis dysfunction

The brain controls adrenal stimulation through the hypothalamic-anterior pituitary-adrenal pathway (HPA-axis). This system uses hormones rather than sympathetic neurons to send messages. Adrenal glands have multiple layers that produce hormones. They respond to stimuli from the brain by messenger hormones.

The adrenal glands are important organs that function in the resistance phase of the stress response. When the mind-body recognizes something as an ongoing threat – a signal is sent to the hypothalamus, which then releases CRH (corticotropin-releasing hormone) to the pituitary. CRH triggers ACTH (adrenocorticotropin hormone) to be released into circulation stimulating adrenal glands to release cortisol.

A normal healthy response would be for cortisol to down-regulate its production through negative feedback. The hypothalamus and pituitary can both receive cortisol’s negative feedback which will reduce or stop the release of CRH and ACTH. This process prevents uncontrolled and excessive cortisol production and the physiologic effects that come along with it.

Prolonged excess cortisol causes receptors to become insensitive – this is called cortisol resistance. The result is dysregulated cortisol output and HPA-axis dysfunction. HPA-axis dysfunction and cortisol resistance have an intricate relationship – each one exacerbating the other leading to relentless adverse effects.

Even if adrenal cortisol output is normal – low cortisol symptoms can be experienced because cortisol isn’t binding to receptors. This interferes with cortisol levels throughout the whole body – having a negative impact on many systems.

The significance of sleep

Ideally, cortisol is produced rhythmically throughout the day and night. It should be high in the morning and throughout the day and low at night. Melatonin is the sleep hormone and is the opposite of cortisol – high at night and low during the day. When the HPA-axis is dysregulated, normal cortisol patterns are disrupted. This can cause high cortisol at night – preventing melatonin release and interrupting proper sleep.

Sleep is essential to overall health and well-being. While we are asleep our bodies can repair and rejuvenate damaged cells. When we are deprived of sleep our bodies can’t properly heal and disease will arise. Stress makes it hard for us to get proper sleep and sleep deprivation will exacerbate a chronic stress response. This vicious cycle leads to further HPA-axis dysfunction, cortisol resistance, and consequently decreased emotional tolerance.

Common symptoms of HPA-axis dysfunction

Low mental and physical energy
Fatigue that is not relieved by sleep
Sugar and salt cravings
Memory loss
Weight gain
Brain fog
Depression
Decreased immune system function
Irritability
Increased heart rate
Hypoglycemia
Gastrointestinal issues.

The essence of healing

We can learn and grow from our experiences with trauma and stress. There are steps we can take to ease our pain and fatigue and support the healing of our adrenals. Deciding to create change in your life can be the source of your greatest strength.

Take your first step towards supporting the recovery of your exhausted adrenals and HPA-axis dysfunction. Here are a few tips to get started.

Food timing - Eat every 2-3 hours to help stabilize nutrients and blood sugar levels
Eat within 30 minutes to an hour of waking up. This will allow for consistent energy and help prevent further stress on the body
Stop eating at least 1 to 4 hours before going to bed. This will help your body prepare for rest and encourage the repairing and rebuilding of tissues during sleep.
Include complex carbohydrates in every meal to keep nutrients and blood sugar stable.
Avoid low-carb diets! These types of diets encourage cortisol to be released in order to raise blood sugar.
Eliminate caffeine. Caffeine is a stimulant that interferes with HPA axis function
Up your vitamin C intake. Adrenals have a high demand for vitamin C which is often depleted during stress
Take a B-complex supplement. All B vitamins can be depleted from chronic stress. They are essential for the heath of the nervous system.
Include sodium in your diet. Sodium is an important nutrient for a healthy HPA system.
Engage in gentle exercises and mind-body activities. This will help to reduce stress, improve sleep, and increase feelings of wellbeing.

Adaptogenic Herbs

Adaptogens are certain herbs that help manage the stress response. The use of adaptogens has been shown to prevent body dysfunction and disease that’s caused by HPAA dysregulation. They can increase the response when necessary as well as make it easier to cope with stress. They also decrease the stress response when cortisol levels are unnecessarily high. They target the HPA axis to influence output through the system as needed.

Siberian ginseng boosts the immune system, increases circulation, and decreases oxidative damage
Holy Basil boost the immune system and decreases depression and anxiety
Ashwagandha modulates the immune system, decreases oxidative damage, decreases stress response and cortisol secretion
Rhodiola reduces depression, decreases fatigue and inflammation
Cordyceps decreases oxidative damage, modulates inflammation, and improves stamina

Sources

1. JL Wilson, JV Wright, JV Wright Adrenal fatigue: The 21st century stress syndrome, 2001, Smart Publications Petaluma

2. Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review [published correction appears in BMC Endocr Disord. 2016 Nov 16;16(1):63]. BMC Endocr Disord. 2016;16(1):48. Published 2016 Aug 24. doi:10.1186/s12902-016-0128-4

3. Head KA, Kelly GS. Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep. Altern Med Rev. 2009;14(2):114-140

4. Packard AE, Egan AE, Ulrich-Lai YM. HPA Axis Interactions with Behavioral Systems. Compr Physiol. 2016;6(4):1897-1934. Published 2016 Sep 15. doi:10.1002/cphy.c150042

5. Kim JS, Han SY, Iremonger KJ. Stress experience and hormone feedback tune distinct components of hypothalamic CRH neuron activity. Nat Commun. 2019;10(1):5696. Published 2019 Dec 13. doi:10.1038/s41467-019-13639-8

6. Marino LO, Souza HP. Dysfunction of the hypothalamic-pituitary-adrenal axis in critical illness: a narrative review for emergency physicians. Eur J Emerg Med. 2020;27(6):406-413. doi:10.1097/MEJ.0000000000000693

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