Adrenal Fatigue Part 3: Managing Stress and Sleep

by Kirsten Chesney | Sep 7, 2021 | Chronic Health Conditions

This is the third and last installment of our three-part series on adrenal fatigue. Part one discussed our stress response and how it can go awry. It highlighted the four stages of adrenal fatigue and showed how chronic stress can cause chronic disease. Part two launched into the recovery solutions by sharing an eating plan that supports and restores adrenal health. It also covered several different supplements that can improve our stress response and adrenal function. Be sure to read parts one and two to get a broader picture of adrenal fatigue and recovery!

In part three of our blog, we’re adding on the next element of adrenal recovery: self-care. Specifically, we’re discussing ways to lower and avoid chronic stress as well as the importance of maximizing our sleep routine.

Manage Your Stress

Adrenal fatigue is caused by chronic stress so it naturally follows that addressing your stress is a critical element of adrenal recovery. Keep in mind though that stress should not (and cannot) be eliminated. Rather, it needs to be transformed into a positive and effective response. To that end, we need to reframe our thoughts on how we perceive stress, lower our stress before it gets out of control, and adopt life strategies that save you from unnecessary stress. Let’s take a deep breath and cover these topics.

Schedule time for relaxation: This could be anything from journaling, reading, listening to music, meditating, getting outside, talking to a supportive friend, or taking up a relaxing hobby. Schedule these into your day and let others know that you are not available during those times.

Prioritize your responsibilities: First, write out your to-do list in advance, making sure they are all truly necessary. Be realistic with how long your tasks will take so you don’t overfill your day. For larger tasks that take more time, plan out the individual steps and schedule out which steps you’ll do on which days. Oftentimes, seeing a long list of to-do’s in one day can be stressful even if none of them are very big. If this is you, try tackling the quick tasks first in order to make that list shorter. Then you can focus on the larger tasks without the looming fear that the small stuff will go unfinished.

Focus on your daily needs: We all feel less than our best when we are too busy to address our basic needs. Working through lunch, skipping that shower for the third day in a row, or going to bed way too late, all contribute to rising stress. Make a point to fulfill your daily needs even if you have to schedule it in.

Balance your day: It’s easy to get hyper focused in one area of your life to the exclusion of attending to other areas. When our attention is balanced between several areas we find support and fulfillment from multiple sources. This makes it less likely to get overwhelmed when any one area becomes threatened. Examples of areas to focus on are family, friendships, career, personal time, exercising, and hobbies.

Keep things in perspective: Have you ever looked back on an old journal entry or childhood diary and chuckled to yourself about the problems you thought were a big deal? Think back to those problems for a moment. Did any of them turn out as horrible as you had imagined? Humans have a knack for being fatalistic. We tend to underestimate our abilities in the face of overestimated problems. Most problems are only huge because we tell ourselves that they are. In reality, the majority are not worth the extra worry and fear we assign to them. When faced with a problem, take a step back and evaluate it from its broader context. Will it matter in a week? In a year? What is the best way to solve it? Of course, problems are still important. But important things don’t get solved through stress and unimportant things are none of our concern.

Know your limits: Don’t take on more than you know you can handle. And don’t suffer through stressful situations that you have the ability to change. Practice saying no when asked to take on another responsibility or when invited to do something “fun” when you know it will zap your energy. Identify the situations that give you the most stress and approach it from a different angle. For example, limit contact with high-strung or demanding people, order groceries online to save time, or take a longer but less-traveled route to avoid morning traffic.

Accept the things you can’t change: Some things in life are out of our control, such as the behavior and choices of others. This can be a source of stress but recognize that stress won’t solve other people’s problems. Rather, accept the circumstances as they are and choose healthier ways to respond to them. For example, view these situations as an opportunity for personal growth, or channel your anxieties into helping others. Let go of any anger or resentment you might be harboring towards others, as well as any guilt or regret you are burdening yourself with. Talking this out with a trusted friend or therapist can help loosen your grip on uncontrollable circumstances.

Develop Healthy Sleep Habits

As discussed in part one, cortisol is produced at varying levels throughout the day, following your circadian rhythm. This daily cycle is referred to as the cortisol curve. A normal cortisol curve begins rising in the morning, around 6am, peaking about an hour after you wake up (usually by 9am or so). This high level of cortisol provides the alertness you need to start the day. Levels gradually lower from there, tapering off throughout the afternoon. It is not uncommon to have several small pulses of cortisol during this time, depending on need and activity level. Cortisol is significantly lowered around 6pm and is at its lowest point around midnight, allowing you to sleep.

In this way, cortisol regulates our sleep cycles and helps with energy production. When a person has adrenal fatigue or is under constant high stress, their cortisol levels deviate from this natural curve. Depending on which stage of adrenal fatigue a person is in, cortisol can be significantly high (or low) at the wrong times of day. One can imagine how this negatively affects sleep, energy, and focus. Not only does adrenal dysfunction cause poor sleep patterns, but the reverse is also true: poor sleep quality and quantity is directly related to adrenal dysfunction.

The Ideal Sleep Schedule

It’s important to maintain a predictable sleep schedule in order to train your body back into a normal cortisol curve. The healthiest schedule is to go to bed around 10pm and rise around 6-7am. This provides 8-9 hours of sleep per night. Make this a habit and you’ll notice that your body will begin feeling tired, naturally, around 10pm and arise without much persuasion in the morning. Stay alert to how you’re feeling in the morning because grogginess can be a sign that you have low morning cortisol.

Sleeping at the right times, however, is only part of the solution. You also need to have good quality sleep.

Prior To Bedtime

• Avoid stimulating or exciting activities close to bedtime; anything that hypes you up or spins your thoughts. Examples would be a workout, a book, a TV show, an important conversation, checking your finances, etc.
• Use the nighttime setting of your phone or tablet starting 2-3 hours before sleep. All screens should be avoided an hour before bed.
• Begin bedtime prep 30 minutes before your desired bedtime
• Avoid late-hour sleep (going to bed after 11pm)
• Avoid late afternoon or evening naps. Other napping should be less than 45 minutes long unless you are ill or very sleep deprived
• Avoid large meals or spicy foods before bed
• Finish all eating and snacks 3 hours before bedtime
• Avoid drinking more than 8 ounces of fluid before bed
• Try a hot bath or shower before sleep as a higher body temperature helps induce sleepiness and eases tension. Epsom salt in the bath can help

Falling or Staying Asleep

• Don’t stay in bed more than 20-30 minutes trying to fall asleep. It’s better to go into a different (comfortable) room and do a relaxing activity like reading a light, neutral book
• If reading in an attempt to fall asleep, don’t turn on a large light or table lamp. Opt for a small reading light that only illuminates the book. If available, set the light to a warm tungsten rather than bright white
• If it’s difficult to fall asleep, eat a small amount of carbohydrate before bed, such as whole grain bread
• If you wake up in the night with stirring thoughts, keep a notebook next to your bed and write them down to release them from your mind.
• For those prone to nighttime awakenings, eat a small amount of protein and fat before bed, such as cheese or nuts.

Control Your Sleeping Environment

• 15 minutes before bed, switch to small lamps or dimmable lights in your bedroom rather than using the main large light
• Wear blue light blocking glasses 30 minutes before bed
• If you are light sensitive in the early morning, sleep with an eye mask or use room-darkening window coverings
• Use white noise, and air filter, or earplugs to decrease irritating noises
• Avoid being too hot or too cold while sleeping. Adjust blankets or temperature as needed
• Sleep at least 8 feet away from electromagnetic fields produced by clock radios, cell phones, laptops, etc.
• If using an electric blanket, turn it on while prepping for bed then turn it off once you get into bed

Bedding and Pillows

• If allergies are a concern, replace pillows, pillow cases, and mattress covers with hypoallergenic material
• Consider a contour pillow to support your neck and keep you aligned as you sleep. Placing a pillow between your knees will also keep you aligned

Supplements for Sleep

Supplements may be considered to help you sleep. The following list are good options and do not hinder adrenal recovery. Start with one supplement at a time to find the one that works.

• Melatonin (1-5mg) can help you fall asleep, while timed release melatonin (5-20mg) can help you stay asleep
• 5-HTP (100-200mg) an hour before bed
• Taurine (500-2000mg) an hour before bed
• Magnesium glycinate (200-400mg) 30 minutes before bed

As you have seen through our three part series on adrenal fatigue, supporting our adrenal glands and lowering chronic stress is primarily accomplished through diet and lifestyle changes. Our eating pattern and daily routine should always support ongoing health and vitality. It is often necessary to make minor adjustments during times of recovery, focusing on certain nutrients or supplements while avoiding others, for example. Once balance is restored, always return to your health-supportive routine. In this way, you will avoid most (if not all) chronic health conditions and be well equipped to address health issues quickly and effectively.

As with a healthy diet, stress management and quality sleep are key elements in the recovery of adrenal fatigue. These changes need to become habits that you carry throughout life. Not only do they support the recovery of adrenal dysfunction but they also help prevent it. Making these a part of your daily routine will stave off future adrenal crashes and downstream health concerns.

Adrenal Fatigue Part 2: Nutrition Support

by Kirsten Chesney | Aug 28, 2021 | Chronic Health Conditions

It is imperative for long-term health to maintain healthy support of our adrenal glands. Our adrenals are where our stress response originates from and where cortisol is produced. Adrenal glands are what allow us to focus under pressure, boost our performance, keep us awake, endure hardship, and process and respond quickly to danger. These are healthy responses and our adrenal glands are up for the task, however, they only work as well as we allow them to. In other words, we get to choose how healthy our stress response is by how well we nourish and support our adrenal glands. As with anything else in our body (and our life in general), if we don’t care for it things will start malfunctioning and affect other areas of our life. When our adrenal glands don’t have the resources to meet our constant, high-stress demands (figuratively and literally), adrenal insufficiency, also called adrenal fatigue, creeps in.

What is adrenal fatigue and how does it develop? When does stress become unhealthy? How does chronic stress affect other areas of our body and health? These questions, and more, are addressed in part one of this blog. Part one provides a great foundation of knowledge to help you identify negative stress and the red flags of adrenal fatigue. You can read part one here!

This is part two of our blog on adrenal fatigue. After covering the causes and stages of adrenal fatigue, as well as the downstream effects of chronic stress, we’re going to move forward and discuss what to do about it. In this blog, we’ll cover what nutritional supports can reverse adrenal fatigue. Specifically, we’ll discuss an eating plan for adrenal recovery as well as specific supplements to restore adrenal health and cortisol levels. But wait, there’s a part three to this blog series! Part three is where we’ll cover healthy habits for managing stress and improving sleep. Check it out here!

Don’t Make Your Adrenal Fatigue Worse

Oftentimes the simplest way to learn how to make things right is to first see what went wrong. As discussed in part one, we know that adrenal fatigue is caused by ongoing stress. But there are other factors that perpetuate adrenal fatigue after it has already taken hold. Developing adrenal fatigue is hard enough on our body, but here’s some elements that make the process decidedly worse and more difficult to overcome:

• Eating an unhealthy diet
• Poor glucose control
• Ongoing exposure to environmental and household toxins
• Overconsumption of sugar, caffeine, or alcohol
• Sleep deprivation or staying up late
• Repeated use of antibiotics
• Having co-occurring chronic disease(s)
• Fighting off recurring infections (whether bacterial or viral)

All of these things are stressors in and of themselves and are capable of launching the stages of adrenal fatigue. However, if we cut out all other chronic stress from our lives but still retain one or more of the above items, we will have a harder recovery.

Start With Your Diet

The key to correcting underlying causes of most chronic conditions, whether or not we have digestive symptoms, is to first make sure we’re feeding ourselves properly. The nutrients in our food each play very specific roles in the biochemistry of our body. Any lack in these nutrients and our biochemical processes slow down, affecting everything from our detox pathways, thyroid health, inflammation, fertility, mental health, and (you guessed it) adrenal health.

For those in any stage of adrenal fatigue it is critical to first support your adrenal glands through a healthy diet. Eating in this way provides all the nutrients you need for your body to heal from any stress-induced damage while rebooting the health and function of your adrenal glands.

Foods To Eat

Eat the following foods to support and restore the health of your adrenal glands:

Vegetables: 30-40% of your diet will come from vegetables, particularly those that grow above ground. Vegetables should be eaten either raw or lightly cooked to retain the most nutrients. The most helpful vegetables for adrenal recovery are sea vegetables (seaweed) and leafy greens (spinach, kale, Swiss chard, etc). Avoid white and red potatoes as they are high-glycemic (discussed later on). Always rotate your vegetables so you consume a good variety. Include vegetables of every color and purchase organic vegetables where possible). Aim for 6-8 servings of vegetables per day.

Proteins: This includes lean meats, poultry, fish, eggs, dairy, and legumes. Collectively, these protein sources should account for 20-35% of your diet. Ensure organic meat and dairy products as well as pasture-raised eggs.

Healthy Fats: These include monounsaturated fats as well as select saturated fats. Foods in these categories are nuts, seeds, nut butters, olives, olive oil, avocados, coconut oil, canned coconut milk, and all of the protein sources listed previously. Healthy fats should compose 20-35% of your diet.

Whole Grains: Whole grains are unprocessed and thus retain their outer layer (bran) and inner core (germ). These are rich in fiber, protein, vitamins, and minerals. Refined grains, on the other hand, are processed to remove the bran and germ. Not only does this remove important nutrients but it also creates a grain that is high-glycemic, meaning that it produces large spikes in blood sugar. About 20-25% of your diet should come from whole grains. Examples of whole grains include oats, quinoa, buckwheat, brown rice, corn, barley, and whole wheat. Avoid gluten grains if you are gluten intolerant.

Whole Fruits: To get the most nutrients and fiber out of your fruit, be sure to eat them with the pulp, seeds, and peel (edible parts only). Some fruits help lower increased cortisol. These are blueberries, strawberries, apricots, papaya, pineapple, and mango. Other fruits should be avoided during adrenal recovery such as those containing potassium or have a high glycemic load (reasons for this are discussed further on). Fruits in these avoided categories are fruit juices, bananas, oranges, grapefruit, all melons, dried figs, raisins, and dates. 5-10% of your diet should be whole fruits.

Fermented Foods: These contain probiotics which are great for gut health, immune health, blood sugar balance, and cholesterol levels. Fermented foods are found in sauerkraut, kimchi, kefir, plain yogurt, tempeh, and miso soup.

Salt: Those with adrenal fatigue often have an increased potassium to sodium ratio. Specifically, their bodies contain too little sodium and too much relative potassium due to low aldosterone levels. This imbalance leads to low body fluid and low blood pressure. To remedy this, it’s important to hydrate throughout the day with the addition of salt in your water. Add one half to one teaspoon of salt into a full glass of water. Repeat throughout the day, starting in the morning. Increase salt on your food too, by sprinkling liberally to taste. Only choose between sea salt or Himalayan salt. Common table salt, including kosher salt, is heavily processed, contains additives, and lacks minerals.

Foods To Avoid

An adrenal recovery diet avoids foods that we commonly associate as being unhealthy. These include added sugars, artificial sweeteners, soda, alcohol, refined carbs, baked goods/desserts, snack foods, excess salt, vegetable or seed oils, and fried or greasy foods. Avoiding these foods will improve adrenal health (and overall health).

Unlike many other healthy diets, however, the diet for adrenal recovery further avoids all caffeine (including chocolate), alcohol, foods high in potassium, and any high-glycemic foods.

What’s so bad about caffeine? Caffeine in coffee, teas, soda, and chocolate, stimulate your already depleted adrenal glands and perpetuate the cycle of energy crashes every few hours. Even without the blood sugar spike from added sugars, caffeine creates a forced energy expenditure that is unsustainable (and quite harmful) for those with adrenal fatigue.

No alcohol?? While our brain might think that alcohol helps calm our nerves and help us relax, it’s really just the alcohol convincing us of that. Alcohol only serves to mask our symptoms, as evidenced by how our stress returns as soon as the alcohol wears off. More than that, alcohol places more stress on our body, physically. It not only taxes our liver but also our adrenal glands, increasing cortisol production. Even after alcohol consumption is stopped, high levels of cortisol remain in the brain; the area of the brain where the stress response begins. Lastly, alcohol causes sleep disturbances, specifically cutting out REM sleep which is the most restorative stage of sleep. Breaking up this sleep pattern disrupts our normal cortisol curve and sleep/wake cycle. Overall, alcohol consumption can worsen and perpetuate adrenal fatigue.

Why avoid potassium? As discussed above, adrenal fatigue can cause an increased potassium to sodium ratio. These minerals are balanced out by increasing sodium while decreasing potassium in the diet. Foods high in potassium are bananas, oranges, grapefruit, dried figs, raisins, and dates.

High-glycemic foods, and the importance of avoiding them, are discussed in the section below.

Lastly, as with any new diet, it is always a good idea to continue avoiding any foods you are sensitive to such as gluten, dairy, or others.

Balance Your Glucose

A diet that supports the adrenal glands must maintain a constant blood sugar level throughout the day. In a healthy state, cortisol (produced by our adrenal glands) works alongside insulin to keep glucose within a tightly controlled range throughout the day. This provides a steady supply of blood sugar to maintain our energy. When our adrenal glands are in distress, cortisol production drops below normal causing our blood sugar to drop below the healthy range. Low blood sugar puts further stress on our adrenals and prevents us from regaining a healthy cortisol rhythm (cortisol curve). It also causes symptoms of hypoglycemia such as dizziness, light-headedness, and weakness. Therefore, it is up to us to regulate our glucose levels through proper meal timing and eating low-glycemic foods. The following guidelines speak to this:

• Aim for three small meals and 1-2 snacks per day, separating all eating by 2-3 hours (do not graze). This helps maintain balanced blood sugar and ensures a steady supply of nutrients through the day. Eating 2-3 hours apart prevents an overloaded digestive system while ensuring that food is moving through (and out of) the body.

• Eat at the same time each day to prevent glucose crashes and inappropriate cortisol spikes. Breakfast should be within an hour of waking and no later than 10am. Lunch should be between 11am and noon, and dinner around 5-6pm. A great time for a snack would be between 2-3pm.

• Eat breakfast and keep dinner small. In the morning, our body needs to replenish its low reserves of nutrients and glycogen after not eating (ie sleeping) for several hours. Come evening time, our digestion slows down so we want to avoid eating heavy foods before bed that take longer to digest.

• Breakfast should be high in protein and fat. Avoid glucose-spiking breakfast foods such as fruit, fruit juice, yogurt, bagels, or refined cereal. Choose eggs, quality meat, nuts/seeds, leafy greens, avocado, and small amounts of whole grains, like oats.

• Avoid high-glycemic fruits and grains. These are ones that contain “fast” sugar, supplying you with a quick surge of glucose (and energy) and then dropping off quickly a couple hours later. If you have compromised adrenal glands, you want to regain a steady rhythm of energy and wakefulness throughout the day. Eating high-glycemic foods interrupts the normal cortisol cycle and can cause an adrenal crash. Focus on low to moderate glycemic foods instead. See here for a list of high and low glycemic foods.

Support With Supplements

In addition to the above eating plan for adrenal fatigue, it may be helpful to further support recovery through specific supplements. The following supplements act to restore adrenal function and alleviate stress:

Adaptogenic Herbs: This collection of herbs has been used for thousands of years in Chinese medicine as balance-restoring substances. Adaptogens are so called because they help a person “adapt” to stress. They contain particular substances that improve our resistance to stress, balance cortisol, improve mental work capacity, and protect us from stress’ negative effects. They also have a balancing effect on several body systems including the immune system, nervous system, and cardiovascular system. There are several herbs that are classified as adaptogens. Some of the more common ones include, ashwagandha, panax ginseng, rhodiola, magnolia, and holy basil. Supplement companies often package adaptogens together into one blended product. This provides support from several angles without purchasing multiple supplements.

Glandulars: Some people benefit from taking small amounts of the actual adrenal tissue of animals, specifically either bovine or porcine (pig). These animal organ products are meant to stimulate the activity of that organ in humans. Not everyone with adrenal fatigue needs stimulation however. Those who have reduced adrenal activity and a low to no cortisol curve (normal diurnal pattern is not present) can be helped by taking glandulars. But those with high cortisol are over-stimulated as it is and upregulating adrenal activity with glandulars would make their situation worse. For this reason glandulars should not be taken for extended periods but rather used for short-term purposes under the guidance of a knowledgeable physician.

Licorice Root: This is one of the best known herbs to help treat adrenal fatigue. It also helps with immune disorders, digestive issues, and mood support. Licorice root helps our adrenals by preventing the breakdown of cortisol to help maintain energy levels. This provides the extra reserve we need to respond better to stress. Smaller does are best so that healthy cortisol levels are maintained and don’t get too high. Because it raises cortisol, licorice root should be reserved for those with low cortisol. Lastly, this supplement should not be taken by people with hypertension.

Phosphatidylserine (PS): This is a type of fatty acid found in our cell membrane. Supplement versions of PS are derived from soy. PS supplements help normalize the stress response by regulating the hormone that stimulates cortisol production. This action helps maintain normal cortisol levels throughout the day.

Vitamin C: This vitamin is not produced by our body and so can only come through our diet. It is most highly concentrated in our adrenal glands where it helps synthesize steroid hormones including cortisol. Our adrenal glands require more vitamin C during states of high stress than they otherwise would. Vitamin C acts to slow down any increased rate of cortisol production, making it helpful for those with high cortisol. It also helps improve psychological stress responses. High doses are often required to achieve these effects.

B Vitamins: Several B vitamins are needed for the production and secretion of stress hormones. Stress itself requires more B vitamins than our body usually needs and so must be replenished. Niacin, pantothenic acid, folate, thiamin, biotin, and B12 all support a healthy stress response. Niacin and B12 further support a healthy circadian rhythm, which is diurnal critical release.

Magnesium: An estimated 75% of the US population do not consume adequate amounts of magnesium. A deficiency in this mineral can lead to a low tolerance for stress, manifesting as anxiety, lethargy, depression, and irritability. Furthermore, stress increases the need for magnesium, further raising the likelihood for deficiency. Supplementing with magnesium can have a positive impact against stress and anxiety.

Supporting our adrenal glands and maintaining a normal cortisol pattern is critical for everyday functioning. As the moderators of our stress response, our adrenal glands carry the responsibility for getting us through the day as awake, focused, calm, and resilient humans. Chronic stress threatens this stability and burdens our adrenals, making it all the more imperative to support them with the nutrients they need. An eating plan designed for adrenal recovery is the first place to start. Adding specific supplements may also be necessary depending on the stage of adrenal fatigue. In addition to diet changes, lowering and avoiding high stress is paramount to adrenal recovery, as is building a healthy sleep pattern. Both of these are discussed in our third (and last) installment of this adrenal fatigue blog. Check out part three here!

Adrenal Fatigue Part 1: When Stress Becomes Chronic

by Kirsten Chesney | Aug 20, 2021 | Chronic Health Conditions

Stress is a protective feature of our normal human condition. It is our body’s way of protecting us from things that could harm us. When the body is under stress, it diverts its attention away from all unnecessary functions and refocuses them on life-saving measures. Our adrenal glands are the control center of our stress response, providing essential hormones that prepare us for the fight as well as protect us from damage.

Oftentimes, we think of stress as psychological or emotional (like job stress or relational stress). However, our body defines stress much more broadly. From our body’s perspective, learning a new skill is stress. Calorie restriction is stress. Infections or diseases are stress. Heck, even exercising or throwing a party is stress! These stressors may seem benign but our body responds to them the exact same way as it responds to job stress or relational stress. Regardless of the cause of stress, our body always reacts as if we’re running from a tiger. But it doesn’t know that we’re not. It treats everything as an emergency.

This normally isn’t a problem as long as the stressful event(s) eventually stops and our body can calm down. Too often in our lives, however, multiple stressors compound on top of each other and/or our body and mind never seem to rest at the end of the day. This is when we have a problem and our stress response deviates from normal, causing damage to our bodies and adrenal glands.

This blog is the first of three parts in our series on adrenal fatigue. In part one we’ll discuss the healthy response to stress, types of stress, and the stages and symptoms of adrenal fatigue. We’ll also cover how stress can cause chronic disease. We believe it’s important to be aware of what adrenal fatigue is and how it progresses so you can recognize when you need help and take steps towards healing.

Parts two and three of this blog series discuss the dietary and lifestyle changes that are necessary for healing and reversing adrenal fatigue. Part two discusses an eating plan that supports adrenal recovery. It emphasizes the importance of glycemic balance as well as shares some supplements that may be helpful in various stages of adrenal fatigue. In part three, we wrap up our discussion by addressing ways to manage and prevent stress, as well as tips for how to improve the quality and quantity of our sleep. Managing stress and sleep are essential for reestablishing healthy adrenal function.

The Healthy Response to Stress

The stress response is also called the “fight or flight” response, which is controlled by our sympathetic nervous system. The first stage is when our adrenal glands secrete two hormones called epinephrine and norepinephrine. You might be more familiar with the other name for epinephrine, called adrenaline. These hormones are released immediately after a stress trigger and have an explosive and aggressive impact. Together, these hormones quicken your heart rate, providing more blood flow to your muscles, lungs, and heart. Consequently, blood flow is decreased in the digestive system, slowing our gut motility and other digestive processes. Epinephrine and norepinephrine also sharpen your sight, hearing, and overall alertness, along with increasing endurance and physical strength. These two hormones act as the immediate, short-term response to stress, enough to get us out of harm’s way within a matter of minutes (around 15 minutes to be exact). Examples include jogging stairs, swerving to avoid a car accident, or public speaking.

This short-term response may be all that your body needs to escape danger. If, however, your body continues to perceive stress for longer than 15 minutes (like planning a wedding, giving birth, or anticipating a first date), the second part of the stress response occurs. This is when the adrenal glands release the hormone, cortisol. Cortisol is the prolonged response toward stress and prepares the body to weather the storm while protecting it from excessive damage.

In many ways, cortisol counter-balances some of the aggressive actions of epinephrine and norepinephrine. Cortisol is a powerful anti-inflammatory hormone and decreases the inflammation that was brought about by epinephrine and norepinephrine. Cortisol also suppresses our immune system, which was put on high alert during the first stage of the stress response. It increases blood sugar levels by freeing up stored glucose from the liver, and increases metabolism and appetite so we eat more food for energy. Lastly, cortisol suppresses our reproductive system. Afterall, procreation is not a main focus during prolonged stress.

After the stress event is over, whether short-term or prolonged, our adrenal glands clear away these hormones and homeostasis (balance) returns. We are now in the “rest and digest” mode, which is controlled by our parasympathetic nervous system.

Cortisol At Its Best

It’s important to note that cortisol is released throughout the day, whether or not a person feels stressed. Cortisol serves several functions such as regulating sleep cycles, helping with energy production and immune activity, repairing body cells, and regulating glucose and inflammation. It also plays a role in building muscle and bone as well as maintaining mental focus and stamina.

Healthy cortisol levels follow a diurnal schedule, peaking in the morning so you are alert to start the day. Levels drop down around mid-day and then gradually taper off as the day continues. Cortisol is at its lowest point around midnight, allowing you to sleep. A healthy stress response will disrupt this natural “cortisol curve” to help you get through the stress event.

DHEA During Health And Stress

Cortisol isn’t the only stress hormone that’s also necessary in daily life. DHEA is another hormone released by the adrenal glands each day, as well as during a stress response. When the body is in “rest and digest” mode, DHEA doesn’t really fluctuate throughout the day, unlike cortisol. DHEA is responsible for improving energy levels, lipid levels, bone mineral density, and overall well being. It also helps lower cholesterol, decrease body fat, and block inflammation-causing proteins. The brain also produces DHEA and it’s thought to help with memory and cognition. Lastly, DHEA creates testosterone and estrogen. The production of DHEA does decline with age, and deficiency levels are associated with age-related diseases.

During times of stress, DHEA prevents systemic inflammation from getting out of control. It also protects part of the brain, called the hippocampus, from damage. DHEA begins rising evenly with cortisol in the beginning stages of stress. However, if stress becomes chronic and unhealthy, DHEA levels drop significantly, independent of cortisol. It eventually flatlines at the end stage of adrenal fatigue. The greater the spread, or ratio, between cortisol and DHEA, the greater the damage from stress and the more health issues arise.

Positive Stress Vs. Negative Stress

We’ve talked about two types of stress so far. The first was stress that is short-term, such as public speaking or avoiding a car accident. Stress events that are short-lived allow the body to recover afterwards without any damaging effects. The second type of stress discussed was “positive stress”, also called eustress, such as planning a wedding, exercising, or prepping for a first date. Positive stress is when we face a challenge that we believe is within our ability to handle. This kind of stress evokes feelings of excitement and anticipation. It motivates us to keep focused and improves our performance. These types of stress (short-lived stress and positive stress) are what our stress response, or “fight or flight” response, is designed to handle. Our body follows a set manual of instructions and acts in predictable ways. We are then saved from “danger” and return to rest and balance.

Conversely, there is another type of stress that acts against our body’s instruction manual. It opposes “rest and digest” and resists homeostasis, or balance. This type of stress is “negative stress,” also known as distress. Unlike eustress, distress is a stress event that we believe is outside our ability to handle. It causes feelings of anxiety, decreases our performance, and can lead to mental and physical health problems. Negative stress can be short-lived or long-term. Examples include filing for divorce, losing a loved one, enduring abuse or toxic relationships, being unemployed, having trouble sleeping, or fighting an illness. With negative stress, the stress event either lasts for years, or the body remains on alert long after the stress event is over. Either way, our body doesn’t return to baseline afterwards; it is in perpetual “fight or flight” mode. This is when things start going haywire and begin progressing towards adrenal fatigue.

Stages and Symptoms of Adrenal Fatigue

Adrenal fatigue is a slow fade, often progressing over decades. People usually enter this progression without ever noticing because it takes so little effort. The path towards adrenal fatigue involves four stages: Alarm, Resistance, Adrenal Exhaustion, and Adrenal Fatigue. Starting on this path is normal (and healthy), but progressing on this path causes increasing damage to our adrenals as well as our entire body.

The good news is that there are several off-ramps along the way and the vast majority of people find support and healing and take the nearest exit. The progression towards adrenal fatigue can be stopped and is reversible.

Each person responds to stress differently, depending on the actual stress event and how much stress is endured. People have varying levels of stress tolerance as well as varying abilities to cope with each stress event.

Most people cycle in and out of some of these stages throughout their life. Because, let’s face it, we aren’t immune to pain, fear, or worry. And life can dish out severe circumstances that are tough to cope with. Raising awareness of adrenal fatigue is key to identifying it in your own life and sparking the change you may need to turn it around.

Stage 1: Alarm

Stage 1 describes our normal stress response. As discussed earlier, when our stress response is triggered, our adrenal glands produce more cortisol to counterbalance the “threat.” We learned that cortisol works tirelessly to bolster some of our body processes (like increasing glucose for energy), while keeping the negative effects at bay (like lowering inflammation and calming our immune system). In essence, cortisol protects our body while also supplying it with what it needs to combat stress. The adrenals also pump out more DHEA, roughly equal to the amount of cortisol. The adrenals at this stage are able to produce enough of these hormones to carry you through the stress event, and hormone levels are still within the normal range and able to return to rest.

This stage does not cause any physical or psychological dysfunction. Fatigue, caffeine, and sugar cravings may occur but they would be mild. Those in stage 1 are classified as being “stressed and tired.”

Stage 2: Resistance

If the stress response continues, cortisol levels get ever higher; much higher than what is healthy. Usually there is a reversal response (called a negative feedback loop) that is designed to shut down cortisol production once it hits a certain height so that the body can return to rest. However, the body interprets the very high cortisol levels as a sign of even more danger to come. This tells cortisol to dampen this reversal response. Without the negative feedback loop to protect us, cortisol levels continue to rise to excessive and dangerous levels. As cortisol climbs higher, DHEA levels now begin to drop. This stage of constant high cortisol and low DHEA may last years. Many medical practitioners often treat each symptom of stage 2 as separate entities rather than recognizing (or testing for) poor adrenal function.

This high disparity between cortisol and DHEA levels causes a host of health issues during stage 2. As you might imagine, some of the protective actions of cortisol can get out of hand when they don’t turn off. For example, cortisol increases blood sugar but chronically high blood sugar can result in reduced insulin sensitivity. Furthermore, cortisol suppresses the immune system, but if this never turns off then it raises the risk of severe infection and subsequent inflammation. Cortisol also raises metabolism so we eat more food for energy, however, as cortisol rises, it’s common to crave sweet and fatty foods resulting in weight gain. Other symptoms in this stage include imbalances in sex hormones, hypothyroid issues, irritability, anxiety, insomnia, and ever increasing fatigue. Stage 2 is also known as the “wired but tired” stage, where people get jittery and develop an unhealthy relationship with coffee and other stimulants.

Stage 3: Adrenal Exhaustion

However, our adrenal glands can’t maintain high cortisol production forever. They were not designed to meet these constant high demands and before long they become overworked. The adrenal glands are unable to keep up with demand and they begin slowing their production of cortisol down to low-normal levels. DHEA levels are now well below normal. At this stage, both cortisol and DHEA fall below the minimum required levels for normal functioning. In response, our body tightly controls what’s left, conserving it only for the most essential body processes. This stage of near-failure is very serious and is the beginning of a catabolic phase where muscles are broken down for energy and nonessential functions are shut down. People should seek medical attention if they haven’t already, but recovery at this stage will be slower and many may never fully regain their original energy levels or body homeostasis.

Stage 3 is where any prior symptoms from earlier stages begin getting worse and even become chronic. Infections will be more constant, anxiety and depression will be more severe, and getting out of bed becomes a daunting task. Digestion and metabolism slows down causing constipation and risk of digestive disorders. A person may have only small bursts of energy but overall will be mentally, emotionally, and physically exhausted. Caffeine and other stimulants no longer help and quality of life lowers. Other symptoms in this stage include lack of enthusiasm, low libido, inability to handle stress, low exercise tolerance, and brain fog. This stage describes the adrenal crash and can last for several months to years.

Stage 4: Adrenal Fatigue

This stage is also called adrenal insufficiency and marks the point where cortisol levels are flatlined throughout the day and DHEA levels are in the tank. The body furthers its catabolic processes and is breaking down. Regaining homeostasis in the body is essentially impossible.

Even the smallest stressor at this stage can trigger cardiovascular collapse and can even be fatal if left untreated. Luckily, stage 4 is very rare and most people never reach this phase, having found successful treatment in earlier stages. Recovery from stage 4 is possible but takes the right kind of support and lots of time.

Symptoms of stage 4, adrenal fatigue include little to no interest in surroundings, severe weight loss and muscle weakness, diarrhea and vomiting, low blood pressure, low blood sugar, dizziness, depression, and intense pain in the legs and abdomen.

Chronic Stress Can Cause Chronic Disease

There is a large body of evidence linking chronic stress and psychological trauma to chronic diseases such as CVD, gastrointestinal diseases, fibromyalgia, diabetes, chronic fatigue syndrome, and musculoskeletal disorders like rheumatoid arthritis (RA). Some of these are autoimmune disorders, like fibromyalgia, RA, and some gastrointestinal diseases like Crohn’s and ulcerative colitis.

How do chronic diseases occur under high amounts of stress? Stress itself does not directly cause disease. Rather, it’s the subsequent effects of high stress that are the drivers behind chronic disease. These drivers are the immune system, digestive system, and systemic  inflammation.

Immune System Diseases

Immune system dysfunction is unique in that it can cause disease from being too alert and from being too suppressed. Depending on where a person is in the stress response stages, their immune system may be either overactive or under-active. With an overactive immune response, the immune system can mistakenly launch an attack on our body’s own tissues. This is the underlying progression of autoimmune disease. If the immune system is under-active, it opens us up to higher risk of infection and longer recovery periods. A common bacterial infection is H. pylori which can cause digestive issues.

Digestive System Diseases

Ongoing high stress also impacts our digestive system, which slows down so that other body systems can have more energy. A slowed digestive system slows down gut motility and can cause constipation, bloating, and gas. If gut motility does not improve, a person can develop gastrointestinal disorders like inflammatory bowel disease (autoimmune disease), irritable bowel syndrome, SIBO, or GERD. The sugar and carb cravings associated with high cortisol levels would further exacerbate these conditions, as well as cause an imbalance of bad gut bacteria. When there is too much bad gut bacteria and not enough good bacteria, a whole host of issues can occur ranging from mental health issues, impaired glucose metabolism, and a dysregulated immune system.

Inflammatory Diseases (which are all diseases)

Inflammation is a normal process that easily gets out of hand when there are no controls over it. Cortisol is one way that inflammation is kept in check. Once the adrenal glands become exhausted and cortisol levels drop, inflammation can now spread freely throughout the body. Systemic inflammation is the one common thread that links all chronic diseases together. Left untreated, it can precede and perpetuate all disease development. If a person already has a chronic disease (like those described above), uncontrolled inflammation will worsen their condition.

A healthy stress response keeps us alive. Not only does it allow us to run from the proverbial tiger, but it also gives us energy and focus to tackle the tough stuff of life. We can thank our stress response and adrenal glands for acing a test, nailing a speech, running a race, or planning an event. This is the positive stress we were designed to handle. Of course, most of us are worried by negative stress events. Life puts us in the fast lane and we feel like we have to keep up. When negative stress never seems to end, our adrenal glands start a slow decline and begin to malfunction. We feel the results of this and begin to malfunction too. The four stages of adrenal fatigue (or adrenal insufficiency) carry us further down the road towards progressively worse symptoms and a higher risk of chronic disease.

Stress doesn’t have to progress this far! It can be stopped and reversed at any stage with the right support, lifestyle changes, and diet. This is what we discuss in parts two and three of our adrenal fatigue series. Check them out!