Adrenal Fatigue: Is this a real thing?

I heard this the other day: “I am so tired and stressed out. I just can’t get enough sleep and I feel terrible. I exercise regularly and I am taking all the vitamins and supplements, and nothing is helping. Yet my doctor says nothing is wrong. Am I going crazy?”

No, you are not going crazy. We just need to better understand what is happening.

First, let’s take an inventory of your life. What were your life situations starting from when you can remember? And when did these symptoms start?

This client faced numerous stressful situations over the course of 20 years.  She was divorced, moved, and become a single parent about 20 years ago. Around the same time, she acquired a new job that was needed to support her and her children.

Over the years she’s climbed the career ladder well. Currently, she is a senior director of sales with very demanding workload. She says she has no time for exercise or relaxation. She always puts herself last to take care of her family and her staff.

Do you think it’s odd that she is feeling tired and stressed, and not feeling like herself? I don’t.

It’s unfortunate that so many women have come to this point in life. Perhaps we are more nurturing, or perhaps we believe we should be nurturing because we were told so. Whatever the case, we often feel obliged to overlook ourselves to take care of others.

I looked at the lab results she brought in and it would appear that indeed the values tested were normal and within range. But her blood sugar is bordering on pre-diabetes, and her CRP is somewhat elevated, indicative of inflammation. One piece of information I did not have is her cortisol level.

A salivary cortisol test was ordered. The result was interesting. Her cortisol was low and flat. She had no cortisol-awakening-response (CAR). 

Cortisol Curve

Usually, there is a rise in the morning, peaks around 10-11AM to prepare you for the day. This is known as CAR. Cortisol will then gradually decline over the day and becomes low in the evening in preparation for sleep.

Most people think of cortisol as a bad thing since it is known as the “stress hormone”.

Cortisol is a necessary hormone for us to survive. Without cortisol, we would not have the fight or flight response, and we cannot respond and run away from danger.  It only becomes a problem when we are faced with chronic stress, and cortisol elevation becomes the norm.

In a fight or flight mode, all the blood is diverted to the extremities to get us ready to move and our parasympathetic autonomic nervous system shuts down. When this happens, you do not digest food, you are not sleeping. Your breathing is rapid and shallow, and your heart beats faster. Your body is going to hold on to every ounce of energy and store fat because you may not be eating for a while. Is this mode sustainable? Absolutely not. But chronic stress puts us into this mode every day.

Your body is smart. It knows if it continues to produce adrenaline and cortisol, you will die sooner rather than later. To protect itself, the brain shuts down the biochemical pathway to produce cortisol, in effort to force you to rest.

This is what is known as Adrenal Fatigue, as the adrenal glands now produces very little cortisol.  Adrenal Fatigue is an unfortunate misnomer. It’s not that the adrenals that are so tired and cannot produce cortisol. It’s actually the brain signaling the adrenal glands not to produce so much cortisol via the HPA axis (Hypothalamus-Pituitary-Adrenals axis). Your brain is trying to help you to survive. So, a more appropriate term to use is perhaps HPA Axis Dysfunction. 

At this stage, the person will feel very tired, has no energy, and probably lacks drive to accomplish things in life. They feel completely spent and they are just going through the motions of doing what is required of them. Many women are diagnosed with depression at this point because the symptoms are similar…no vitality, lacking joy of life, always tired. It is important that you know this could happen and provide your doctor as much information as you can.

What do we do now?

20 years of stress cannot be undone in one day. From personal experience, it will take years of restoration before cortisol level returns to normal again. But it can be done!

Lifestyle – The importance of lifestyle choices can’t be overstated. There is nothing new here. Unfortunately, society’s apathy toward these important habits is wreaking havoc with our health. So here we go again!

Sleep: Sadly, this is the first thing people give up when busy or stressed. Sleep is your best friend! It’s during sleep that our entire body is restored. “Sleep is the single most effective way to reset our brain and body health each day.” (1)  So really try to get 8 hours of good sleep daily and have a regular sleep schedule. Make this a non-negotiable in your life. I know there is so much to be done, and you need to put on your own oxygen mask on first or you will be no good to anyone. And yes, I am a pharmacist, but I would not recommend using a sleeping pill of any sort. Using these drugs would be counterproductive. Sleeping pills take away the quality of sleep, which is the part of sleep that allows for the body’s restoration process.

I can go on forever about the need for 8 hours of good quality sleep. Rather than taking up more space here, I will be giving a presentation on June 22 on sleep (see link below). More to come on this subject!

Movement: I use this term over exercise because most people think about running a marathon or CrossFit when I say exercise. That’s not what I mean! Don’t overdo it right now. This is not a good point in life to try to run a marathon, as your body will perceive stress once again (running from the white tiger!).  Walking briskly is a great way to get movement and help your body and mind to unwind. Walk for 30 minutes to an hour each day will significantly improve your condition.

Meditate: Allow your brain to take a break with meditation. Meditation does not mean having no thoughts. Don’t worry if you notice you have many thoughts. It’s good just to know you have thoughts. But also know that you don’t need to engage with your thoughts during meditation. Allow the thoughts to come and go and know these are just thoughts. Nothing more, nothing less. Meditation trains you to better handle stress. After all, stress in modern days is often created by our perception of what is going on, in our thoughts. A great book on meditation is Mindfulness by Jon Kabat-Zinn. There is also an audio version with guided meditation that I often reach for.

Eat: What you eat, how you eat, and when you eat, will all impact your body’s response. Stress reduces your body’s ability to digest and absorb nutrients. If you are feeling run down, likely you are. Eat quality, nutrient dense food, avoid packaged food if you can. I always advocate for eating fresh food whenever possible. There are more nutrients to nourish your body, and nutrient dense foods will help you to feel full longer, so you are not as likely to reach for snacks all the time. And take your time when you eat. Chew your food 40 times before you swallow will allow your body to engage the digestive system and help you to better breakdown the food and absorb nutrients. And eat with your circadian rhythm. Eating at 8:30pm in the evening when you want to go to bed at 10pm won’t work well. Ideally, you want to finish eating 3 hours before you go to sleep so food has a chance to digest. When you are fast asleep, your body may not be in the mood for food digestion. If you must eat late for reasons beyond your control, consider going for a 20-minute stroll after dinner to help with digestion. Otherwise try to work backwards from your sleep schedule. And remember your sleep schedule is sacred!

If you are not sure about what to eat, speak with a dietician or nutritionist who can guide you to better eating habits.

You can also book an appointment with me here.

What can you take to support your body?

There is a class of herbs that are known as adaptogens. These adaptogens helps to regulate the body and may help to normalize the cortisol curve. My favourite is Ashwagandha. It is calming and not too stimulating. Others include Rhodiola and Ginseng. However, these may be somewhat stimulating, so not suitable for someone who is already stressed and feeling wired.

Self-care is extremely important during the restorative phase. By self-care, I don’t mean booking a spa day for facial/mani/pedi, although that is good too. But you won’t be doing that every day. Self-care means really appreciating yourself and put yourself first. If you are truly too tired, decline some events and delegate what you can to others. You don’t need to give anyone a reason for saying no to something. Society has trained us to feel guilty when we say no, and with each no you must have a good reason. In reality, no one would blame you if you told them that you are committed to taking care of your health right now and you don’t want to break that commitment.

Delegating duties to others may seem “bossy”. But think about it from the other person’s perspective. You are enabling that person to help you, and you are also giving that person a chance to show his/her talents. Having been an employee, I know how much I appreciated my boss giving me the responsibilities and showing me that I am trusted. This is also true for family members. You don’t have to do everything for them, and they would be more than willing to contribute if you are in need of their help!  Take 20 minutes each morning for yourself:10 minutes meditation or journaling, then 10 minutes of stretching. Do not jump on social media right away…this is a sure way to get you off your track.  Take the 20 minutes every day for you and only you.

I understand what you are going through. I’ve been there. My personal experience was 2 years of restorative healing before I noticed significant changes. And that came with drastic measures of quitting my job and finding every bio-hack that I could try. I probably had enough supplements and gadgets to open up a biohacking clinic!

Not everyone is in the position to leave one’s job or have access to information and tools. In retrospect, I probably didn’t need to leave my job had I known what I know now.  But it may have taken longer for me to get back on track and feeling like myself again.

Remember this is a long-term process and you may not notice any changes right away. But over time, you will start noticing how things become just a little easier and less stressful.

With knowledge, you can turn this around and regain your optimal health!

1. Matthew Walker, “Why We Sleep – Unlocking the power of sleep and dreams”, Scribner, 2017

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