The truth about adrenal fatigue – why adrenal supplements aren’t the solution

The truth about adrenal fatigue

Adrenal fatigue is a health buzzword that is commonly misunderstood, even among alternative practitioners. Adaptogenic herbs and adrenal glandulars are the most commonly prescribed solutions. However, the truth is that adrenal fatigue is a whole-body problem. While adrenal supplements like adaptogens are effective, it is not a long term solution if the root causes, like chronic stress, lack of sleep and inflammation are not addressed.

Embarrassing admission: I was once dependent on adaptogenic herbs for years and I am grateful that they were so helpful during those stressful years in graduate school. Even though it is natural medicine that is quite effective, it was still a pill that I used to cover up what I did wrong. Eventually… they lost the effectiveness and became a clutch. In this post, I explain why.

Adrenal fatigue is a misnomer, which actually means Hypothalamic-Pituitary-Adrenal Axis Dysfunction.

Dr. Wilson’s model with 3 stages of adrenal exhaustion is based on 50 year old science. While it is a good analogy to life, it is not scientifically accurate.

The adrenals do not simply fatigue. While adrenal fatigue is a real problem that is actually recognized in conventional medicine, the term “adrenal fatigue” is a misnomer. The adrenal fatigue that we refer to is called the hypothalamus-pituitary-adrenal (HPA) axis dysfunction. It is recognized in biomedical literature as a contributing factor to several mental illnesses, metabolic syndrome, infertility, sleep disorder, IBS, and even overgrowth of the wrong gut bacteria.

Hypothalamic-pituitary-adrenal axis

Our body’s stress response system is comprised of the hypothalamus, which is our body’s main sensor. The hypothalamus keeps tabs on everything in the body. It could be heat, energy availability, stress perception, hydration levels, mineral levels, etc. Your hypothalamus commands the pituitary with the hormone Corticotropin Releasing Hormone (CRH), which then tells the anterior pituitary to secrete ACTH, which tells the adrenals to secrete cortisol. In turn, cortisol can inhibit ACTH or CRH production at the pituitary or the hypothalamus.

“Adrenal fatigue” in conventional medicine refers to Addison’s disease, or when there is autoimmune attacking the adrenals, which can cause it to wither and die. When that happens, the treatment could be to replace the adrenal hormones as well as to stop the autoimmune attacks.

Adrenal Fatigue or HPA axis is actually a miscommunication between the brain, the pituitary and the adrenals.

Now, let’s step back to a little physiology. Hormones are a means in which different cells communicate with each other through the blood stream. Every hormone is produced and secreted into the bloodstream. When it reaches the target cell, the target cell will have the right receptor waiting for the hormone. The hormone has molecular sex (binds) with the receptor, so that it communicates the hormone’s messages into the cell.

Hormonal problems, including HPA axis dysfunction, could arise from 4 different issues with these processes, following the mnenonic PTSD – production, transport, sensitivity and detoxification (which I got from Dr. Sara Gottfried).

P stands for production, which is the how well the hormones are produced in the cells that produce these hormones. For example, cortisol is produced in the cells of the adrenal cortex.

T stands for transport. If somehow the hormones are produced, but are not transported correctly, then the target cell doesn’t receive the message that would be communicated by the hormones.

S stands for sensitivity. Sometimes the hormone receptor can be blocked, so the message doesn’t get to the target cell.

D stands for detoxification or destruction. When the hormones are used, they need to be destroyed so we don’t have trouble with excess hormones.

When someone has HPA axis dysfunction, they have a problem with production, transport, sensitivity and detoxification of one of the hormones in the stress response system.

Now that I have seen numerous 4-point salivary cortisol test results, this is how I look at it when I help my clients. It is critical to consider these lab results in the context of their stress and lifestyle factors.

What high cortisol, or “stage I adrenal fatigue” really means.

The so-call stage I “adrenal fatigue” is when someone has very high cortisol levels. The person could simply be experiencing acute stress, which results in high cortisol.

They could also be cortisol resistant. The receptors for cortisol in the hypothalamus and pituitary have become insensitive to cortisol, so the hypothalamus or pituitary keep harping on the adrenals to make more cortisol. They could have issues with destruction of cortisol, so they have a buildup of cortisol. And lastly (but unlikely), they could have an adrenal tumor or Cushing’s syndrome, which causes them to produce an excessive amount of cortisol.

Not only is high cortisol a problem, but an elevated levels of other hormones in the HPA axis may be unhealthy. The CRH receptors in the pituitary can also be resistant to CRH because of high cortisol levels. But CRH levels can be elevated due to stress and infections. Because CRH also has other roles than to stimulate ACTH production, elevated CRH is responsible for many stress-related diseases, like increased inflammatory symptoms and suppression of thyroid functions.

High cortisol could be a problem if it stays high. For many people, high cortisol results in hormonal imbalances and weight gain in the form of muffin tops. High cortisol relative to DHEA typically means that the body is in a catabolic state.

What low cortisol, or “stage II/III adrenal fatigue really means.

Now, when someone has reduced cortisol levels than is healthy, as it what looks like “stage II or stage III adrenal fatigue” there could be a few possible problems.

The adrenal cells are not producing enough cortisol. Often, this is because of mitochondrial dysfunction, because the process of generating steroid hormones starts in the mitochondria.

Also, factors such as inflammation can cause the ACTH receptors on the adrenal cortex to become less sensitive to ACTH, so the adrenals are not pumping out as much cortisol as it should. In short, inflammation may cause low cortisol.

Low cortisol could be a problem because cortisol has many important functions. For example, it keeps blood sugar at a healthy level, so someone with low cortisol may have symptoms of hypoglycemia, like waking up wired at 3 – 4 AM. In addition, cortisol helps to keep immune responses reasonable, so many people who have a flare-up of inflammatory symptoms typically have very low cortisol.

It is therefore very important to have healthy cortisol levels, as well as all the other hormones. While adaptogenic herbs can really help with HPA axis functions and mitigating many stress-related symptoms, it is also important to address the stress that throw off the person in the first place.

Because adaptagenic herbs usually normalize the entire HPA axis and may stimulate the immune system, most people will feel better, at least initially, on adaptogenic herbs. If problems like lifestyle factors, day-to-day stresses, poor sleep, sources of inflammation, metabolic malfunctions like mitochondrial dysfunctions are not addressed, then adaptogenic herbs will not be helpful in the long run. The adaptogens can eventually become a clutch that treats the symptoms and keep the symptoms at bay rather than the real solution to the root cause.

The Truth About Adrenal Fatigue (2)

What I do to help an “adrenal fatigue” client:

  1. Ensure that they are consistently getting quality sleep, meaning sleeping at the right time and getting the best quality sleep. Because it is rather inexpensive to do a take-home test to screen for obstructive sleep apnea, I may even recommend this even before any hormone test. Occasionally, I refer clients to get screened for sleep disorders with their doctors.
  2. Normalize blood sugar with dietary changes and (in some cases) supplements
  3. Cover the nutritional base by making sure they are on a mostly whole-foods and mostly plants diet, and a few good quality nutritional supplements
  4. Refer to their doctors to get screened for thyroid issues or other issues related to fatigue that can show on bloodwork, e.g. iron and B12 levels.
  5. Screen for potential causes of HPA axis dysfunctions that I just mentioned using the information regarding diet, lifestyle and symptoms from the intake forms, and correlate this with the test results. In addition to the hormone tests, I also run the Organic Acids Profile test to screen for non-apparent issues related to metabolism, mitochondrial dysfunctions, potential dysbiosis or yeast overgrowth, and nervous system depletion.
  6. If the symptoms, history, and lab testing indicates other issues that need additional testing, run additional labs and address the findings.

Interested in figuring out your HPA axis dysfunction? Click here to book an initial consultation with me.

Natcha got her sleep study

As a Functional Diagnostic Nutrition practitioner and Holistic Nutritionist, I help my clients by recommending changes in DRESS: Diet, Rest, Exercise, Stress reduction, and Supplementation. It seems like all the rage about health is diet these days. Personally, since I’ve figured out my weekly food prep routines and an identity of someone who loves being strong, sticking to a diet or exercise program has never been an issue. For most people, diet, exercise, and supplements are the easier part. Oddly enough, it is easier to do more than to do less… when what got us unhealthy in the first place was doing too much. Unfortunately, doing less and getting enough sleep is often the 20% of changes that gets us 80% of the results.

When I learned about obstructive sleep apnea from Dr. Joe Zelk through my mentor Ben Greenfield’s the Super Human Coach network, I was intrigued with Dr. Zelk’s statement that all adrenal fatigue clients should get screened for sleep apnea. This makes perfect sense! If people are not sleeping well or somehow missing in that department, it makes no sense even to add adrenal supplements. What good is all the other health troubleshooting if the client is simply not getting their blood well oxygenated at night? Missing the most powerful (and free) healing potential that we have means that everything else we do to fix the problem will be a clutch. Dr. Zelk recommends using an overnight oximeter kit, which can be done at home to screen for obstructive sleep apnea.

That’s when I started researching more about sleep while playing with sleep trackers and measurements like HRV. And the research that supports the importance of sleep is very strong. Even more struggling is that only 10% of sleep apnea cases are diagnosed, even though it is associated with numerous health problems like weight gain, cardiovascular risks, hormonal problems. So now I start referring my clients out to get screened for sleep apnea, especially ones that snore or seem to be mysteriously gaining weight.

At the same time, I was still dealing with lingering adrenal fatigue or HPA axis dysfunction despite getting 7 – 8 hours of sleep most nights. Therefore, my neuromuscular dentist wanted to send me to a sleep specialist. My dentist also said that my tongue is a little too big for my narrow palate, which could interfere with sleep.

I resisted this for a few weeks because I don’t like going to the doctor’s office, but in the end I decided to go. I took this as an opportunity to set an example for my clients and to really find out for myself if I had uncovered the root cause of my health problems. The good news was that it was covered by provincial health insurance, but I was told I wouldn’t be covered for a 2nd round if the first one came back normal.

To get this covered by insurance, I had to request that my family doctor sent a referral to the sleep specialist. When I went to see the sleep doctor, he asked me a few questions before his assistant gave me a really long questionnaire including the STOP-BANG and other kinds of surveys to fill out. (It took me hours to finish all the questionnaire, but I love it when a healthcare practitioner asks a lot of questions, because it means they do a better job when they are thorough. Some of these are for research purposes, and, being a researcher, I secretly enjoy seeing the research questions.) She then assigned me a date for the sleep study.

Natcha went for a sleep study

Sleep study selfie

The day finally came, I went in a little late and found myself with a nice soft and clean bed and pillow, which was nice for a hospital. The technician came in to get me wired up, which took about over an hour. There were probably hundreds of wires all over my body, from EEG probes to track my brain waves, bands round my rib cage to track my rib movements, probes on my arms and legs to track how I move, probe on my mouth and nose to track breathing, pulse oximeter on my fingers, and even the sound recording/filming to see if I was snoring. The wires were connected to me with some sticky, waxy goo (including in my hair).

She then monitored me all night to ensure that all the data was being collected. The worst part was that when anything fell off, she would come into the room, turn on the light and put it back in place. That means the nose probe would get yanked back into my nose multiple times during the wee hours of the night. That, I have to say, was the least fun part because it was impossible to get good sleep like that.

If I ever wanted to get up for any reason, I would have to call the technician to unhook everything so that I could get out of bed and re-hook everything back on as I got back into bed. That happened 3-4 times over the night and I totally appreciated her patience with me.

In the morning, the technician told me it would take 5 weeks before the results were analyzed and sent to the doctor. (I did think that’s a ridiculous amount of time for such data analysis given today’s computing powers, but I actually had no idea what went behind the scenes.)

The day finally came and I went to see the sleep doctor again. He said it came back normal, except for the fact that I probably was not sleeping well since I wasn’t home and the sleep was interrupted multiple times during the night.

My inner scientist says that I should never take the results as face value. Although the result was “normal”, there were minor changes in the oxygen saturation (OSat) that could indicate upper airway resistance. Possibly this could come from congestion or narrow palate.

sleep-study-graph

So, beyond this seemingly normal result, I am still nitpicking on my sleep issues to find out if this could contribute to hormone balance and fatigue. There is no diagnosis, but that’s not what I’m after. I’m after optimal sleep and 100% function. I’ll be trying more take-home sleep study over the period of days to see if my tongue and narrow palate prevent me from getting my best sleep.

I have to say getting a sleep study was not fun at all, especially the not getting sleep part. It’s perhaps my first introduction to real bio-hacking when I really was hooked up to a hundred different measurements. Now I know what to decide for my clients. Given the rather unpleasant experience, I’m more inclined to screen for obstructive sleep apnea with an overnight pulse oximeter for a few days first than to send them for a sleep study. I still do recommend many of my clients to ask their doctors about a sleep study in case any sleep disorder diagnosis can come up or if the pulse oximeter shows potential sleep disturbances. These clients are often ones who deal with “adrenal fatigue”, weight gain, depression, blood sugar issues, hormone imbalances or just persistent fatigue.

Are you ready to troubleshoot your adrenal fatigue and hormone imbalances? Click here to schedule a 30 min initial consultation with me.

Want to learn to troubleshoot your sleep yourself? Check out my sleep troubleshooting ebook.

When low thyroid function sneaks up on you

In this video, I explain how malfunctions that are present in the body like the digestive system, the liver, other hormone imbalances and nutrient deficiencies can contribute to symptoms of low thyroid function. The symptoms include fatigue, weight gain, depression, constipation and hair loss. Many women get low thyroid function as they age because of estrogen dominance.

While primary treatments of hypothyroidism usually involve adding thyroid hormones such as Levothyroxine or Armour thyroid, it may not address the root cause if the low thyroid function can be caused by other malfunctions in the body. This explains why I help people restore normal functions in all body systems rather than focusing on symptoms, diagnoses or even a few specific lab numbers. When everything functions correctly, there will be no symptoms. In the case that hypothyroidism was caused by autoimmune attacks on the thyroid, or Hashimoto’s, intestinal permeability or leaky gut plays a big role (check out this review paper for scientific evidences).

I also discuss the reasons why many lab tests come back “normal” even though you know something is wrong.

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Anxious, fatigued, cranky, hormonally imbalanced? Could it be dysglycemia?

Blood sugar is tied to many aspects of health. Because multiple hormones function together to manage blood sugar, you can have blood sugar readings well within the normal range, but still have symptoms of so-called blood sugar imbalances. That’s because your hormones and neurotransmitters could be trying to compensate in order to keep the blood sugar in normal range. Dysglycemia or blood sugar imbalances can throw off hormone balances and brain functions.

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There are many ways to test for how well your body works with blood sugar. One of the most common ways is fasting blood sugar where you go and get your blood drawn after 8-12 hours of not eating or drinking. The reference range is between 70 and 99 mg/dL. This test is 60% sensitive and 90% specific, which means that it is good at ruling out diseases, but not so much telling if there are hidden diseases. In fact, some studies found that people who are at the higher end of this spectrum, with blood sugar more than 90 mg/ml, fare worse than people who are in the middle in terms of diabetes risk: (study and study).

What really matters with blood sugar is how well your body is able to take up and use blood glucose for its normal functions. You know you have perfect blood sugar balance, i.e. no dysglycemia if your blood sugar returns to baseline fasting levels soon after you eat, regardless of what you eat. Also, if you have perfect hormone balance, brain function, and are free of blood sugar imbalance symptoms.

Blood sugar regulation is quite individual. It’s partly genetics, but lifestyle and nutrition has a lot to do with it. Many genetic variations are associated with increased risks of diabetes. However, because genetics load the gun and environment pulls the trigger, your diet, lifestyle and nutrition can override your genetics. Gut bacteria (which is considered as part of your environment) is also involved in regulation of blood sugar. Equally important would be how you eat, how you live, how well you sleep, and your hormones.

Conversely, it is very important to maintain blood sugar for health and hormone balance. This is especially the case if you want to lose weight or if you are approaching menopause.

Here are ten symptoms that show you may have problems with your blood sugar:

  1. Acne. Another name for acne is “diabetes of the skin.” Many people (me included) clear up their acne after taking on a diet that stabilizes their blood sugar. This is even more clearly demonstrated in Dr. Loren Cordain’s Dietary Cure for Acne. This has been clearly demonstrated both through biochemical mechanisms and in human trials (reference).
  2. Brain fog, or in general… poor brain functions. The brain likes a steady supply of fuel (glucose or ketones). And Alzheimer’s is called type III diabetes. Research shows that insulin resistance could be linked to risks of age-related dementia (reference).
  3. Mood swings or anxiety can be a result from low or unstable blood sugar.
  4. Waking up at 3 – 4 AM with heart racing and sometimes hunger could be caused by too low blood sugar.
  5. Carb cravings can also be caused by too low blood sugar or insulin resistance.
  6. Any symptoms relieved by eating.
  7. Fatigue 2 hours after eating, often around 2 hour post-meal. Another sign of this is needing coffee around 3 PM (this could also have something to do with imperfect digestive functions, so if a dose of digestive enzymes take this problem away, it’s not your blood sugar.)
  8. You are stressed out. This can cause misregulations of cortisol levels, which often result in misregulation of blood sugar.
  9. You wake up tired even though you got enough sleep.
  10. You are sleep deprived. Sleep deprivation immediately leads to insulin resistance.

High blood sugar can cause low blood sugar. That might sound counterintuitive, but someone with dysglycemia will have high blood sugar following a high glycemic impact meal. Then, their pancreas will release a lot of insulin to lower that blood sugar. This process could cause a dip in blood sugar soon after, as we commonly know as “sugar crash.” For some, this could manifest in the form of anxiety, hunger, sleepiness, craving for coffee or high carb foods. When the person reaches for high carb foods like donuts and bread every time they have low blood sugar, it becomes a vicious cycle that could lead to insulin resistance and diabetes.

Some people may have the genetics or lifestyle that allow them to tolerate high carbohydrate diets without developing insulin resistance. This may explain why some groups of people can stay very healthy with a high carb low fat diet, whereas others can’t. Therefore, eating a high carb diet may not necessarily be harmful to everyone. It is however important to get regular tests as well as to listen to your body to determine if that’s the case for you. If you have symptoms or if your lab tests came back suboptimal, then it will be critical for your health to adjust your diet and lifestyle to stabilize your blood sugar.