High levels of stress seem to be significantly impairing everyone’s quality of life and health. At least that’s what I’ve observed in working with thousands of clients and maybe you can relate. When you live in a society of people addicted to being busy and disconnected, it can be extra hard to save more time for rest and relaxation and dive into your stressors. But it’s one of the best things that you can do because high levels of perceived stress that go unaddressed are one of the primary causes of adrenal dysfunction or HPA Axis Dysfunction.
Stress alone could be its own epidemic. This includes everything from early life trauma or stressful events to food intolerances, chronic illnesses, over-exercising, never shutting off, and filling your schedule 110%. Many people that I work with are high functioning individuals who find it harder to slow down and relax than to check every item off of their to-do list. They in fact do not need any additional discipline in their life and in some ways, may benefit from less.
It’s easy for me to identify this in people that I work with because they serve as a mirror of my own struggles with finding balance. I throw myself into everything 110%, overcommit to jobs and projects because I want to be involved in everything, work 10+ hours in a day regularly, and sometimes view downtime as being completely unproductive. And here’s the big cost that I always pay: not having the energy left to be present for myself and for the people that I value most, in addition to extreme episodes of crashing and burning. Thankfully, I have benefited from the inner wisdom and guidance of two amazing friends: Dr. Aunna Herbst and Diana Vitantonio who continue to bring me back to prioritizing balance.
So what in the heck does this have to do with your adrenals!? Well pretty much everything. Let’s dive into HPA axis dysfunction which is a more accurate way of saying ‘adrenal fatigue’.
What Are your Adrenal Glands & The HPA Axis
The adrenal glands are two small organs that are located above the kidneys. The adrenals are involved in hormonal balance, gastrointestinal function, brain health, blood sugar balance, the immune system, bone metabolism and more. They help regulate your response to stress and are able to protect you by activating the fight-or-flight response. When exposed to acute stressors like a bear chasing you, this system helps to keep you alive. It does this by increasing your blood sugar levels, elevating your heartbeat, and increasing your blood pressure by holding onto salt.
One of the primary ways that the adrenals do this is through their production of two hormones: DHEA and cortisol. DHEA is a hormone and a precursor to testosterone and estrogen. It’s also very important for development, thyroid health and the immune system. Cortisol is involved in regulating blood sugar and is the body’s stress hormone, as increased stress typically leads to more cortisol production. The adrenals also produce adrenaline (epinephrine) and other hormones. This process is ideal when you experience short periods of stress or adrenal stimulation, as it helps to keep you alive.
Stress & HPA Axis Dysfunction
Today, most people are exposed to acute stress topped with lots of chronic stress. But the body doesn’t know the difference so it responds in the same way, leading to a higher secretion of cortisol. The HPA axis is a complex interaction that occurs between the adrenal glands and the hypothalamus and pituitary and controls the innate way that you react to stressors. This is the entire system that communicates and secretes cortisol and other hormones. In the context of chronic stress, the hypothalamus secretes corticotropin releasing hormone which signals the production of Adrencorticotropic hormone (ACTH). ACTH travels through the body and acts on the adrenal glands to stimulate the release of cortisol. Other hormones and organs contribute to the stress response as well, activating the sympathetic nervous system and the body’s fight-or-flight response.
Constant exposure to stress can throw off the ‘cortisol curve’ which is the healthy pattern of cortisol production that each of our bodies are meant to follow throughout the day, as shown below. In this curve, cortisol levels are high in the morning and they decline as the day goes on. But when you are constantly stressed, running from task to task all day long, and never saving time for a break, your cortisol levels can become a rollercoaster. Different people will develop different cortisol patterns. Cortisol levels could be higher at certain parts of the day that it’s not supposed to be or constantly elevated or even in some cases completely exhausted. Some people refer to this as a stage of ‘adrenal fatigue’. The problem with the term adrenal fatigue is that it’s not a medically accepted term, condition or diagnosis. A more accurate way of describing the situation would be HPA axis dysfunction.
Common symptoms include difficulty falling or staying asleep, fatigue, brain fog/memory issues, anxiousness, irritability, weakened immune system, difficulty handling stress, headaches, muscle weakness, dizziness, weight gain and digestive issues. And while there are plenty of supplements and adaptogens that are useful for helping with your stress response, they are worthless if you don’t identify the root cause of your stress.
Stress can also alter the composition, function and metabolic activity of the gut microbiome. While the gut brain axis is thought to play a main role in this, research also indicates that there are other unknown correlations between stress and the gut. A 2014 study conducted in mice examined the effect of a short 2-hour stressor on the composition of the microbiome associated with the colon mucosa. They found composition was significantly changed and the abundance of L.reuteri and Lactobacillus was significantly reduced. This means that stress can actually alter the bacterial composition and diversity of strains, which may lead to the progression of disease.
Examples of Stress
Stress is the body’s way of reacting to a threat or challenge. Stress is a vague word as are recommendations such as ‘incorporate stress reduction techniques’ or ‘manage your stress better’. If it were that easy then everyone would be managing their stress levels and finding their zen place. Stress is also tricky for three reasons: 1) there are many different forms such as environmental, mental, emotional, & physiological 2) people normalize being stressed to the point that they don’t realize they are in fact stressed and 3) it’s not easy to measure. Here are some examples:
-Saying yes to everyone
-Not taking enough downtime
-Heavy metal exposure (mercury, lead, arsenic, cadmium, tin, etc.)
-Losing your job
-Infections (bacterial or parasitic)
-Death of a loved one
Top 10 Tips for Adrenal Dysfunction
Enhancing your adrenal dysfunction means getting to the root cause of what’s causing your stress in the first place. Once you are able to do that, you can set up a plan for how to manage it and consider the following recommendations to further support your adrenal health:
1. Redefine Productivity
The first step to improving your adrenal health is to view productivity as slowing down and investing in your health! Doing nothing can actually be very productive for your adrenal health. This will allow you to slow the heck down and stop saying yes to a million things! Schedule time for rest, meditation, down time, reflection, journaling, and slow activities that will allow you to have the space that you need to calm down and recharge.
2. Avoid Intermittent Fasting & Be Sure to Eat Every 3-4 Hours
While I am a huge advocate of intermittent fasting or time restricted eating, I do not recommend this for people with adrenal dysfunction. It can lead to dramatic fluctuations in blood sugar levels in addition to increased feelings of anxiety and jitteriness. The same can be true for a ketogenic diet. It’s fine to have a 12-hour window where you don’t eat overnight from 7pm to 7am but I don’t recommend anything longer than 12 hours if you have adrenal dysfunction.
Be sure to eat breakfast in the morning. And within the 12 hours that you eat, it’s best to have three meals and one or two snacks. That means eating every 3-4 hours. Try to incorporate a source of protein, fat, fiber-rich carbohydrates (veggies, beans, fruits, etc.) each time that you eat.
3. Avoid Added Sugars and Refined Carbohydrates
Blood sugar levels are directly tied to adrenal health so it is best to avoid added sugars and refined carbohydrates to help stabilize your blood sugar levels. There are two forms of sugar: natural (found in fruit, vegetables and dairy) and added (any added form of sugar). Examples of added sugars include coconut sugar, cane sugar, high fructose corn syrup, honey, maple syrup, brown sugar, sucrose, etc.). Pay attention to these added sugars in your ingredient list and try to avoid as much as possible.
You also want to avoid refined carbohydrates that are stripped of their outer layers (ex: white rice, white flour, white bread, and most white things) and lead to spikes in your blood sugar levels. Your best bet is to eat a low glycemic diet that does not include added sugars and refined carbohydrates. This is helpful given that adrenal dysfunction leads to higher blood sugar levels and the goal is to bring them down to a balanced level.
4. Avoid Caffeine & Alcohol
Caffeine is a stimulant and a stressor on the body. Caffeine consumption can lead to an increased production of adrenaline and cortisol, adding fuel to the fire. This can be tough if you experience a lot of fatigue throughout the day because without coffee, you may initially feel completely exhausted. But eventually that will balance out. Common sources of caffeine include: coffee, green/black/white tea, energy drinks, soda, chocolate, energy bars, etc. If removing caffeine from your routine feels completely unbearable then I would suggest weaning down on your intake, switching from coffee to green tea and also avoiding caffeine after noon. This is especially important for people that are slow caffeine metabolizers, which is indicated by your genetics.
Alcohol serves as an additional stimulant which is best to avoid or significantly reduce when trying to stabilize your adrenals. Not only does it affect cortisol levels but it also interferes with sleep. Do your best to cut out or reduce the number of alcoholic beverages to no more than 2-4 glasses each week.
5. Avoid Overexercising
There is an abundance of evidence demonstrating the protective effects that physical activity can have on stress. Exercise has been shown to help reduce levels of stress, stress-related conditions and lower cortisol levels. But the key to physical activity is finding the balance between moving your body enough that it’s beneficial and not moving it too much because overtraining can be a big contributor to HPA axis dysfunction. Individuals with adrenal imbalances typically do much better with lower intensity options such as walking and yoga.
What you definitely want to avoid is pushing your body past it’s limits. Harder is not always better. And you are not lazy for trying to take it easy and conserve your energy. Let me give you an example: a client of mine used to exercise to the point of feeling like she was going to pass out or become very light headed. She was in the mindset that the harder that she pushed, the better. Anything less than that felt lazy. That mindset led to pushing too hard, resulting in constant blood sugar fluctuations and feelings of fatigue. Despite what your workout instructor or coach is yelling in your face, going slower and taking breaks is not taking the easy way out—it can actually be a very hard thing to do! Be sure to avoid pushing too hard during your workouts, take plenty of breaks and lots of deep breaths!
6. Protect your Sleep Time
There’s nothing more important than sleep when it comes to adrenal health! Most research demonstrates that you need 7-8 hours to sleep each night to function optimally. Sleep is a powerful regulator of cortisol and melatonin secretion. A very helpful way to regulate the secretion of these hormones is to establish a regular sleep schedule. This helps regulate your circadian rhythm which helps the body secrete normal levels of cortisol in the morning and adequate melatonin in the evening. I also highly encourage napping during the day if it helps you feel more restored—even just a 20-minute nap can make a big difference! Read more here on how to improve the quality of your sleep.
7. Ditch your Screens At Night
In order to regulate your circadian rhythm, it’s helpful to get exposure to natural sunlight during the day and less exposure to light at night. This helps your body regulate cortisol production throughout the day, which is supposed to decline as the day goes on. But exposure to bright screens from televisions, ipads, computers, and iphones or too much light in your house can lead to higher levels of cortisol later at night and it also blocks melatonin. In the evening do your best to turn off screens at least 30 minutes before bed, consider not brining your phone into your bedroom and dim your lights to avoid stimulation to your nervous system.
8. Incorporate Mindfulness Based Stress Reduction (MBSR)
There are many, many studies indicating the benefits of MBSR not just for stress, but also a number of other illnesses such as sleep disorders. The practice helps modulate emotional and cognitive reactivity, mindfulness, rumination, and worry as identified by a 2015 meta-analysis. Dr. Jon Kabat-Zinn was one of the individuals responsible for popularizing MBSR, a program based on the Buddhist meditation called Vipassana. In fact, this type of meditation is common to a number of cultural traditions. The benefits of this practice have been shown in a range of populations as well from cancer patients to elderly individual across a number of countries. Check out this resource or book to get started. If you are more advanced in mindfulness then I would also recommend Jon Kabat-Zinn’s other book: Wherever you Go: There you Are: Mindfulness Meditation in Everyday Life.
9. Choose to Light Up From The Inside-Out
Find something that lights you up from the inside-out and do that at least once per day. In my experience of working with individuals, I’ve realized that many people do not experience enough joy in their lives. So make joy your priority. Be sure to incorporate it into your day by doing a favorite hobby like painting, scrapbooking, or reading; having sex; dancing around your house; reading a book; or whatever it takes to get you feeling more alive and more joyful.
10. Preserve your Energy
There’s nothing more powerful than your own energy that you give out to others and to the world. Start to pay attention to your energy at all times and recognize when you need a moment to recharge. The goal is to avoid extreme fluctuations in your energy and to evenly spread it out throughout the entire day. Think of your day and your week as a marathon rather than a bunch of tiny sprints. If you have a busy morning, schedule 20 minutes after lunch to meditate or nap to rebalance your energy for the afternoon instead of plugging away throughout the entire day to only crash when you get home.
Stay tuned for the next article on nutrients and adaptogens for adrenal health and please send me your questions!