Adrenal Fatigue

You probably don’t have adrenal fatigue. 

Adrenal fatigue is a term that gets thrown around a lot, particularly by integrative practitioners.  But it’s inaccurate and doesn’t reflect what is actually going on in the body.  Though you may certainly be very fatigued, your adrenals aren’t.  It’s possible for adrenals to fail, but that typically only happens in the end stages of very serious illness — which is almost certainly not the case if you are reading this right now.

But if it’s not adrenal fatigue, what is it? What is actually going on?

If you are exhausted with poor sleep, reduced immune function, and, potentially, a host of many other symptoms and even disease processes – it is much more likely that your body is experiencing cortisol overload due to chronic stress.  The distinction is important, since the way we would treat adrenals that don’t function normally (possible but rare) is very different from how we treat fatigue resulting from chronic stress (probable and very common).

But now I’m getting ahead of myself. 

Since – what even is stress?  And what is chronic stress?  And how does chronic stress make us tired and affect our health in problematic and even dangerous ways?

So many of us have been so stressed for so long that we don’t even have a sense of what it would be like to move through the world with actual energy, vitality, and even joy.  What would that be like?  Do you remember a time when you were not stressed or depleted?  What was that like?  What would it be like to feel that vigor again?  What would it be like to thrive again?

Well the amazing truth is that you CAN get to a state of actual thriving, and there are ways to rebalance our systems when we have been exposed to stress for much longer than we were ever meant to handle these kinds of stressors.

To be clear, stress isn’t inherently a bad thing.  In fact, we need stress to adapt.  When we encounter a stressor, it “pings” our nervous system to activate the sympathetic nervous system (the fight or flight system).  

(Full disclosure: there is quite a bit of detailed medical info below, so hopefully this is up your alley.  I usually don’t go into this level of detail in my posts, but it’s truly helpful in being able to understand both why chronic stress is harmful and how to address it effectively).

The stressor (aka the thing that is causing stress) is perceived by the amygdala, which is the alarm system of the brain. The amygdala then immediately “rings the alarm” and tells the hypothalamus to activate the sympathetic nervous system. As in, “Activate the system, there is danger! We need to stand here and fight or run away!” (i.e., the fight or flight response). This means epinephrine and norepinephrine are released from both the adrenal medulla (the inner part of the adrenal gland) and from nerve endings.  Inflammatory cytokines (substances that play a role in inflammation) like IL-6 and IL-1beta are also released.  And if those cytokines sound familiar, it may be because they are two of the cytokines that are also released during Covid infection.    

At the same time that all this is going on, a negative feedback loop is activated by the hypothalamus to make sure the inflammatory process doesn’t get too big or go on for too long.  A negative feedback loop is when a process includes a signal to STOP the process that is going on.  In this case, the hypothalamus secretes CRH (corticotropin releasing hormone), which stimulates the pituitary to secrete ACTH, which causes the adrenal cortex (the outer part of the adrenal gland) to secrete cortisol.  Cortisol then signals the hypothalamus to turn the inflammatory system OFF. In other words, the stressor causes both the ON signal to the fight or flight response, but it also causes the release of cortisol, which gives a STOP signal to fight or flight response (via the hypothalamus), thus creating a negative feedback loop.  So, cortisol is actually an ANTI-inflammatory hormone in normal conditions.

But what happens when stress goes on for too long?  Like for years?  Or if the stress is too much and becomes DI-stress?  Or when you encounter health or life challenges that turn stress that was previously manageable into totally unmanageable DI-stress?  Like…I don’t know, a global pandemic, for example? 

Well, your body is still activating the fight or flight response – since it’s still stressed.  And your body is still secreting cortisol – a LOT of it.  But because the stress is constant (i.e., chronic), your body starts to become resistant to the cortisol it is constantly exposed to.  And since cortisol is the OFF switch for inflammation, this means your body loses its ability to turn OFF its inflammatory response to stress.

Additionally, your system is still releasing the fight or flight hormones, like epinephrine and norepinephrine, since you are still getting exposed to stress.  

AND, since the fight or flight system is still humming along at full speed, you are still secreting a lot of cortisol that isn’t dampening your body’s inflammatory response. But what does happen is your baseline cortisol levels rise.  And also, your cortisol release loses its circadian rhythm.

The normal circadian rhythm of cortisol is that its levels peak in the early morning and slowly decrease through the evening.  Then they rise again in the early morning.  But when the cortisol system has gone haywire, like in cortisol resistance, cortisol release can either become constant or even be released at exactly the opposite time of when it should be released.  Does being tired all day and then suddenly wide awake right when you should be falling asleep sound familiar to you?  If so, you might be experiencing cortisol resistance with cortisol circadian rhythm disruption..  

Worse still, ongoing exposure to cortisol means that not only do we have long-lasting inflammation, but also – elevated cortisol levels increase the severity of inflammation even further!  So not only have we lost our off switch, but our off switch now turns the volume UP on our inflammation.  And since inflammation underlies so many disease processes (autoimmune disease, cancer, cardiovascular disease, neurological disease, just to name a few), we can easily understand how chronic stress can cause disease.

Are we having fun yet?  

This may sound overwhelming or even scary, but the good news is that there are effective ways to treat cortisol resistance.  And, since we now understand that we don’t need to supplement the adrenal glands (as one would with adrenal fatigue), we can address what’s really happening: cortisol resistance. And there are many ways to bring balance back to our system.  

Lifestyle approaches are central to this rebalance.  There is also a specific class of botanicals called “adaptogens” that are literally named for their ability to bring the body back into balance.  Adaptogens do this by reinstating the aforementioned negative feedback loop, which, over time, reduces inflammation that has developed in the body as a result of chronic stress.

Exciting, right?

Getting exercise and sleep, and engaging in mind-body practices can all help rebalance our HPA axis (which stands for Hypothalamic-Pituitary-Adrenal axis: the key players in the activation and DEactivation of our fight or flight system).  

But what if your sleep is disturbed because your system is flooded with cortisol at the wrong times (meaning the circadian rhythm of your cortisol release has been disrupted)?  Exercise and mind-body practices like mindful meditation and diaphragmatic breathing can definitely help.  And so can adaptogens like Ashwagandha, Maca, Siberian ginseng, Tulsi (or “Holy Basil”), Schisandra chinensis, and even Asian ginseng (or “Panax ginseng”).  

Each adaptogen has its own unique properties, some being better suited for people who are depleted, and others for people who are overall in a stronger place but are still stressed and exhausted.  Adaptogens usually “play well” with other herbs, since they are, by definition, botanicals that balance the system.  Your practitioner can help you choose which adaptogen suits you best.   Though this class of botanicals is typically quite safe, some – like Ashwagandha, for example – are contraindicated in pregnancy and during breastfeeding.  So it is always important to consult with an experienced practitioner.  Typically, adaptogens are dosed when cortisol is the highest, to help combat cortisol resistance when your system is it with the largest amount of cortisol.  But other adaptogens can be dosed at night.  As always, the botanical and the way it is taken should be customized to your individual system and situation. 

So, although chronic stress can wreak absolute havoc on our systems, there ARE ways to get back to a place of thriving and truly enjoying our lives.  I hope this inspires you to take some time to care for yourself and to start rebalancing your own system.  You are truly worth it, and you absolutely deserve it.  To your health!

Photo by Ketut Subiyanto