Unraveling the Truth About Adrenal Fatigue: Supporting Optimal Health
In this episode, we delve into the controversial topic of adrenal fatigue and its profound impact on overall health. While the medical community may debate its existence, functional and integrative medicine recognize its effects. Adrenal hormone imbalances can give rise to various health issues, and factors like stress, trauma, and lifestyle habits can contribute to adrenal dysregulation. Join us as we explore practical tips for supporting adrenal health through diet, sleep, exercise, and mental well-being practices. Additionally, we discuss the importance of managing stress and trauma to achieve optimal adrenal health. Discover the testing options available to assess cortisol levels and gain insights into brain retraining programs that can aid in the healing process.
Key Points:
- Adrenal fatigue encompasses an imbalance in adrenal hormones that significantly impacts overall health.
- The intricate connection between the brain, adrenal, and thyroid hormones via the HPA axis makes adrenal imbalance prevalent among many individuals.
- High cortisol levels can lead to irregular blood sugar, weight gain, anxiety, and low energy.
- Cortisol testing and continuous glucose monitoring serve as crucial tools for assessing adrenal function.
- Women should exercise caution with low-carb, low-calorie diets and excessive fasting, as these practices can disrupt hormone levels.
- Incorporating adaptogenic foods and supplements, such as mushrooms and ashwagandha, can provide valuable support for adrenal health and help balance cortisol levels.
- Learn about available resources for optimizing adrenal health and explore potential insurance coverage options.
Hopefully this helps and feel free to reach out if you want help with assessing and optimizing your adrenal health!
Links from this episode:
- Gupta program: https://www.guptaprogram.com/
- Oura ring: https://ouraring.com/
- HeartMath: https://www.heartmath.com/
Ready to dive in? Listen here!
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SUBTITLES:
Well, hello Erin Skinner hair and welcome back to the Empowered Nutrition Podcast. The topic we’re gonna talk about today, I think is perfect for for this podcast because my real passion in life has become to marry the best of two worlds, the world of conventional medicine and the worlds of integrative and functional medicine and integrative nutrition. And so there is one question that divides these two worlds and that question is, is there such a thing as adrenal fatigue? Any conventional person will tell you no. Anybody that talks about adrenal fatigue is an absolute quack. But if you go to most functional medicine organizations, they’ll tell you it is a thing. So what is the truth about this? So let’s dig into it because this topic really touches most of the clients that come into our practice. And so people that struggle with their digestion, their metabolism or their hormonal health adrenals are often something important to think about.
So we’re gonna talk about it. The first thing to say that’s important is that in to side with a conventional crowd, it’s true that there is no true medical diagnosis for adrenal fatigue. So a medical diagnosis technically would have what’s called an ICD 10 code. So that’s like a code. It’s kind of like imagine that there’s this like master list of what can bea medical diagnosis and if it can be diagnosed, it has an ICD 10 code. There’s no ICD 10code for this. So it’s not technically an adrenal fatigue diagnosis that could go into your medical chart. If it’s a chart that uses ICD 10 codes, I guess if it’s a write in, you couldwrite anything, but it’s not a real medical diagnosis.
But let’s talk about like what this is alluding to. When somebody says this, they’re talking about an imbalance in terms of the levels of your adrenal hormones. So it could be either the absolute values of the hormones or it could be the pattern that they make across the day because they have a a daily rhythm to them. One important thing to understand about adrenal hormones is that they are driven to large part by signaling that comes from your brain and there’s also some gut mediated signaling that happens there as well. And the adrenals then feed into a feedback and messagingsystem that also touches your sex hormones and your thyroid hor hormones. So kind ofthink about it, it’s called the the HPA axis or the HPAT axis. There’s basically the hypothalamus pituitary refers to the brain, A refers to adrenal and T refers to the thyroid.
And then there that’s also involved. So now it’s starting to sound like we could be, this could apply to more people, right? Because everybody has this axis. Many people have imbalances in their gut. Many people have imbalances in their thyroid hormones, theirsex hormones, and so why not their adrenal hormones, right? So it’s kind of, if you think about it that way, sounds less crazy when we say adrenal hormones. What we’re talking about specifically are the family of hormones that are released by your adrenal glands which sit on top of your kidney. So it’s cortisol, aldosterone, adrenaline andnoradrenaline. These hormones are vilified, especially in integrative and functional medicine, but they do serve an important purpose. We have really two kind of modes that our nervous system can be in. We have the parasympathetic mode, which is whatwe should be in most of the time, which is like rest and digest your calm, calm you’re,you have low adrenal hormone release, you’re relaxed, you’re able to digest your food.
But then when some, there’s a stressor that comes into play, we need to have a stress response. And so like the classic example would be like humans across many millennial that could be chased by animals. If you’re getting chased down by a saber-toothedtiger, it’s not time to chill out, it’s time to like run for your life. So then you kick into what’s called the sympathetic tone of your nervous system where you do really see adrenal hormones and it’s gonna shunt blood flow away from your gut into the extremities, allowing you to to to have physical output to run away from the saber tooth. Tigerincreases your heart rate, your cardiac output and allows you to have that stressresponse. So we, we need both. The problem is just that the world for a number of reasons that we’re gonna talk about, can kind of shift the proportion of those two phases to where we’re spending too much time in the sympathetic response, which is meant to be more of an exception and not enough time in the parasympathetic to own, which is meant to be the what we spend the most of our time in.
Now, back to sort of like the thinking and conventional medicine, when if you talk start to talk about adrenals with say like your regular primary care provider, they’re gonna go, their mind’s gonna go straight to their training where they learn about things likeCushing’s disease where, which is a disease where you have very high cortisol. So thereare actual ICD 10 medical diagnoses that involve very high or low levels of adrenalhormones. So they’re gonna think about that and compare you to that and if they runlabs for you, those labs values are gonna have reference ranges that are set to look forthese like very overt extreme versions of adrenal imbalance that you probably don’thave. So it from that perspective,
They’re gonna tell you you don’t have an adrenal problem because they’re really thinking about these extreme cases where you have extremely higher low levels of adrenal hormones like cortisol. But what’s implied with this adrenal fatigue kind of language is not that you are at the levels that would meet the criteria for these like true medical conditions. It’s that you’re in this kind of gray zone where you’re not quitehealthy with your levels, but you’re not at the cutoff that maybe a LabCorp or Questwould give you for what your cortisol should be. So that’s really what the term adrenal fatigue is trying to refer to. So just to kind of think about this, if you suspect that you have some kind of adrenal imbalance or like if you’ve been told that you maybe have adrenal fatigue or HPA axis dysregulation and you ask your provider and they tell you there’s no issue, maybe they don’t just take that at face value, take that as like, okay, maybe they did some labs on you and they’ve rolled out like overt disease.
Now again, that’s a valuable thing. Of course you wanna be able to roll out things like Cushing’s disease. Here’s where we take it a little bit further, at empower nutrition. We kind of look at that gray zone to see if there’s an imbalance that can be impacting your health because it can, it’s very common that we’ll see adrenal hormones, imbalances and other hormone imbalances that do cause health challenges. And so like one, someof the specific things that we’ll see are with high cortisol, you get irregular blood sugar.Like a lot of times we’ll see blood sugar be high, especially at night or when you wakeup. So like not after meals, just high fasted blood sugar is something we’ll see quite a loteven in people who are lean and athletic, they’ll see this adrenal driven high bloodsugar people who struggle with their weight and are weight loss resistant.
So like dieting, weight loss attempts that would typically be effective like aren’t effective for them. And that, and often if it’s cortisol driven they’ll have more central weight storage. So they’ll have where like, yeah, not only diet gain weight, but it’s, it’s in my abdominal area mostly anxiety and depression. I’m definitely not saying the adrenal hormones are the only thing that can cause this, but certainly I’ve seen quite a lot where like higher cortisol will correlate with anxiety. Low below optimal cortisol will correlate with depression, low energy. So cortisol, you have this like natural cortisol response in the morning, like everybody has it. It’s called the CAR cortisol awakening response where you should wake up and within 30 minutes have this cortisol spike.That’s your body’s way of like ramping up and getting energy for the day. But when you don’t have enough cortisol production, you’ll have low energy, especially in the afternoon. But it can be even in the morning.
And, and actually I’ve seen where there’s like an energy burst at night that is like makes it hard to go to sleep and that can be adrenal driven as well. Low libido is a big onethat’s starting to touch on the way that, so like adrenal hormones come down from thesame tree trunk as sex hormones. So there’s definitely some cases, there’s a potential here, right? For like if you’re producing a lot of adrenal hormones, you’ve got this high cortisol that’s sort of using up the resources that flow in that would’ve potentially flow flowed into like the sex hormone pathway where you make androgens and then estrogens where you make progesterone. So low libido can be a sign of this. We’re using up all the resources to make cortisol, we have nothing left to make our sex hormones irregular menstrual cycle, same thing. The sex hormone imbalances can becoming not always, but it can be fully or partly rooted in an imbalance of adrenalhormones or if menstrual cycles are symptomatic.
So like PMs like I know this is crazy, but like I’m just gonna say it, it’s not normal to have severe PMs, severe cramping before your periods. That’s actually a sign of an imbalance and it can be that you’ve had it for decades so you can’t imagine that it’s not normal. But guess what? It’s, it’s not like many women just have like barely symptomatic menstrual cycles. And so that’s definitely something to look at. PMDD as well is something where I’ve seen adrenals play a role and then digestion. So your, your adrenals definitely play a role. So like when you’re in that, well we said it already. So ifyou’re in that rest and digest parasympathetic state where you’re relaxed, that’s whenyour body feels like it has the blood flow resources to go to send the blood to the gutand like work on breaking food down.
If it’s time to run from the tiger, that’s when it’s gonna use the blood for more importantthings like running. So in people who have this kind of chronic stress response of high cortisol, they’re gonna typically have less motility in their gut, slow digestion, more constipation. And then a lot of times I’ll see like IBS and other digestive symptoms flow from that because with slow motility you’re more likely to get bacterial overgrowth and small intestinal bacterial overgrowth or SIBO and dysbiosis. So it can kind of kick off this whole cascade of events that leads to gut imbalances that cause problems like bloating and flatulence and abdominal pain as well. Another thing, and this is starting to touch on the way that again, adrenals are on this axis with sex hormones, the gut and the thyroid. So like if your adrenals are like then impacting your thyroid hormones, you’ll have things like feeling cold often again, the weight gain, low circulation extremities.
I used to have this when my hormones weren’t healthy is like if I got even slightly cold, my hands would just like go white and I wouldn’t be able to get the blood back into them. And I’ve seen that with like a lot of my clients whereas like now, ever since I’ve like become healthy, I can get go outside in the cold and it’s like not, it’s not like my hands just like my body just decides to like give up on my fingers anymore. So that low circulation your extremities is a sign. And then fi last but not least the big one is sleep challenges. So we’ll see either like night waking, so like hey, I pop awake at 2:00 AM every morning or having a hard time getting to sleep or having early waking like wow I just pop up before my alarm every day.
Those are all times that you wanna kind of take a look at adrenals. So just to kind of rehash on that, remember there’s this intimate connection between adrenal hormones, sex hormones, thyroid hormones and the gut. So symptoms related to any of those, you wanna think about all the things in that axis. And a lot of times unfortunately the sex hormones and the thyroid hormones, even though they’re not like great at measuring these in conventional medicine, they’ll still tend to like act on that more than they’ll tend to act on the adrenal hormones when whereas like the adrenal hormones are actually usually like the initial root cause or the things, the thing that’s throwing off the adrenal hormones. So what I mean is like we’re gonna talk about some of the reasons, but let’s say you have something that’s throwing off your adrenal hormones to just get put on like hormonal birth control or like leave a thyroxine for like your thyroid might make you feel better but like you’re still not gonna have true health cuz you still have this underlying imbalance.
It’s gonna throw off other things as well. So like let’s kind of go into some of the scenarios where we’ll tend to see more adrenal. Let’s call adrenal dysregulation. We’re not gonna call it adrenal fatigue cuz that’s just first of all there’s different patterns of it. So adrenal fatigue refers to like you being very low cortisol, but that’s like kind of an end stage. It’s typically they’re gonna be high cortisol at first and then later on you start to go low. So that’s one reason why I don’t like that phrase. Aside from the fact that it’s not, it’s so controversial and it’s not a real thing but let’s talk about what things it can actually throw off your adrenal hormones, which is a thing. So the most common person we’ll see is like a busy, tired, burnt out mom. So like missing sleep due to kids overall high burden between like the kids and work and trying to like pack in some self-care trying to like look great on Instagram. It can just lead to burnout that that’s like the most common scenario where we’ll see adrenal challenges.
Along with that, we’ll see, we see it quite a bit where there’s like excess fasting. So like all the things you probably see on Instagram telling you that will give you like six pack abs are like horrible for your adrenal. So like too much fasting, too much high intensity exercise, especially if the exercise is fasted excess dieting. So like too much caloric restriction or just carb restriction, eating too low carb for too long, especially with high intensity exercise that’s fasted, that’s like the nightmare scenario for women in their adrenals and we see that all the time. Other just like miscellaneous stressors that we see a lot like career stress challenges with like a child that maybe is like special needs or like isn’t doing well otherwise a high stress job, a divorce, a chronic illness, all of those things can kind of tip this over and cause havoc and all the things that we talked about with the axis.
And another big one that I think is the least understood is like past trauma. So what we’ve seen from the research is that if there’s been like, and it this can be like either emotional trauma, sexual trauma, physical trauma and it can be away from the past even from childhood you it you could have like a completely normal and healthy life and lifestyle right now but you can still be in this chronic like sympathetic nervous tone.So like your flight or flight mode due to that past trauma, it’s almost like that trauma puts you into a different gear and you’re just kind of stuck in that gear unless you do something about it. So that would be like that scenario that we see is just kind of like wow, like it looks like you do great with self-care, you don’t have a lot of crazy stress, you sleep well, you take good care of yourself.
But you’ve got like a bunch of the things we already talked about with like maybe the central weight storage, the anxiety, the the fatigue, the feeling cold all the time. Gosh like it doesn’t seem like your adrenal should be off but then when we test, sure enough, a lot of times they will be and it’s related to this past trauma. So that’s something toreally think about as well. Now if you’re thinking that you might wanna check your adrenals, like you’re suspecting that you have an imbalance, there’s a few things that we do to get at that. So one, this is like kind of indirect but a lot of times we’ll have our client wear a continuous glucose monitor for bars go for 10 days and basically that will tell us a lot about the obviously the blood sugar cuz it tells you basically CGM tells you what your blood sugar is around the clock 24 7 for 10 days straight. So you see like okay, what’s the average blood sugar, what’s the, what are the spikes doing, what’s the overnight doing, what’s the standard deviation? All those things are meaningful but aside from
That there’s certain patterns on the CGM you’ll see that will match adrenal problem. So like the most common we’ll see is if overnight the the blood sugar is running high and then waking up it runs high so like it’s high fasted but then you have a normal insulin sensitivity like when you eat your blood sugar responds to your insulin. So you don’t have this like prolonged spike after eating. It’s more that like when you’re fasted you’re high. And then a more direct thing we do is we’ll measure an actual cortisol curve. Sounds like a traditional setting all they’ll just like take you in one day and like randomly measure your cortisol. That doesn’t really tell you much what, aside from like the reference ranges being like really extreme, it’s just one point in time. So what we’ll do isuse a test that looks at your cortisol across like multiple points across the day cuz youshould have this specific pattern across the day.
So we see like, okay when you wake up mid-morning, mid-day, afternoon, evening are you tracking along with the pattern? And then especially like looks at that car that we talked about that morning response because if that is not healthy, like if it’s too high or too low, that’s very telling. That’s an important critical like function that it needs to beable to perform. So that’s a good thing. And it’ll also look at D H E A, which is a precursorto cortisol. So it’ll kind of tell you like, okay, do you have gas in the tank or not? So we do that, that’s called the adrenal cortex by Genova, but there’s some other versions of that from labs like Z R T as well. And then the other thing we do a lot is something called Dutch testing, which is a dried urine slash saliva test that looks at even it is more advanced than the adrenal cortex.
So it’s gonna look at the two sides of the hormone tree that we talked about. It looks atall the adrenal hormones and it looks at all the sex hormones and it looks at the fullpathway. So it’s like the precursors, the actual active hormones and then the metabolize as it clears, like what does it turn into? And you look for blocks in those pathways so you not only see what’s due high or low or, but you see where the problem is starting and where it’s manifesting. And then it even looks at some markers around that. So like nutritional and inflammatory and gut related markers that can be like related to the root cause of why you have an imbalance. But part of that Dutch test is the actual cortisol curve that we talked about and then as the cortisone curve. So it looks at, that’s like the next step of cortisol is like, okay, how much, how well are you clearing it and what are you making basically?
So that is the most doubtful thing is like the Dutch testing that we do. And so like what we’ll do is like with clients, we’ll kind of talk about if any of these are appropriate and like what’s the best fit and kind of go from there and use that to make a targeted plan. So like last little topic on this is whether or not you test, if you’re just wanting adrenal health, I’ll share with you some steps that you can take just to support adrenal health. So those, these are things that are a good idea for everybody in our chaotic world, no mater what you know about your actual cortisol levels. So like, and each of these could be a podcast of their own. So I’m gonna be pretty brief on it and feel free to like reach out if you want more details on one of these and I could make an episode about it.
But there’s basically like four categories of things to think about. So one is your diet. I talked about some of the main points of like especially for women, women don’t tend to do well long term with like low carb, low calorie diets, intense exercise and fasting that will just totally wreck hormones. And then you’ll have metabolic consequences that cause weight loss resistance and weight gain from that. So try on like eating across the 12 hour period every day. So like eating breakfast, eat carbs, have them be whole food carbs like sweet potatoes if you eat grains and do whole grains, fruits, potatoes, so not like refined and processed carbs. And then when you have ’em, couple ’em with a protein or a fat or a meal, it should be both. So and then avoid a lot of caffeine. So maybe like if you tolerate it a little bit in the morning or better yet get like an adaptogenic like mushroom coffee, minimize alcohol.
Alcohol over time really increases your cortisol, it suppresses your cortisol in the short term and so your body kicks on this thing called diamorphine, which is like a rescue thing that causes you to pump out more cortisol like in response. So you think it’s chilling you out and it is for like half an hour until it does the opposite thing like chronically, so not a lot of alcohol. And then just avoiding severe energy restriction, energy deficits. And if you need help with your diet, obviously that’s what you do, we can, what we do, we can help you with that. But some things to think about, sleep is a huge deal our society under prioritizes this, but really work on your sleep hygiene. So like avoid blue lights for three hours before bed. Have a consistent routine of like how, what times you wake in sleep, dark room fan cold temp.
You can even go next level and get a tracker. Like I like how I have an Oura ring and that’s like my favorite. It’ll tell me the quality of my sleep, it’ll tell me how I’m doing with my sleep. So like how’s my heart rate variability? How’s my resting heart rate? How’s my temp so that I know like am I doing pretty well and like I can, you know, kind of give up some sleep or is it like I’m struggling with bus and I need to like prioritize sleep even more. So it kind of helps me how to calibrate that. But there’s other sleep trackers like the Apple watch and the Fitbit and stuff like that.
Exercise, I think I’ve talked about this a little, but like, yeah again, fasted exercise, high-intensity exercise, especially caffeinated. So like you take your caffeinated pre-workout, well you’re fasted and you go do some type of hiit workout that’s, that’s not gonna help with this. So think about things like traditional weightlifting, cardio that kind of shifts where it’s like usually a pretty steady state with occasional intervals in a fed state. So like you’ve had a meal but only at a level that like your body can tolerate. And then finally, last but not least, just like mental health. So like if you need therapy get, which is like most people I think can almost everybody really could benefit from a therapist. So like think about getting a therapist on top of that. Try to get a daily practice that gets you into that parasympathetic tone. So like for some people that’s meditation for me it’s not, I will sit there and like immediately I, this is probably, I need more meditation but I just, it’s hard for me to focus.
So I like things that have bio feedback. Like I use a heart math where it’s like I have something I can look at that tells me if I’m in a calm state and like it brings me back if I see it change colors, I know I’ve like lost focus and I need to kind of get back to calming with the, with my breath. So I like the heart math, but whatever it is that works for youthat can get you into calm state is important. And then especially if you do have past trauma, look into some brain retraining approaches help you to kind of shift out of that high gear back into the healthy gear. So like things that we use a lot are like the Gupta program, if you look that up, there’s a 30 day free trial or like DNRs is another program that we refer a lot of clients to that we found to be really helpful.
All right, well we’ll put some links to those things in the show notes and we don’t use affiliate links, so just like honestly the stuff we believe in. And so feel free to check thoseout. I hope it helps. If you have questions, definitely reach out. If you want help with optimizing your adrenal health, we take insurance, we, we can like chat with you. You can set up a free call on our website to talk about like what your goals are, if it sounds like something we can help with and talk to you about your insurance coverage as well. We offer telehealth but there’s only in certain states that where we can practice. So wecan talk to you about that. So feel free to reach out to us if you want some help withyour adrenal health or if you have any questions. I hope this benefited you and I hope you have a great rest of your day. Take care. Bye.
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