Fatigue and overwhelm–I know them well! From the depths of full blown adrenal melt-down (any other type A’s out there?) to the tired and overwhelm of an extra busy week. We’ve all been there. It’s not at all unusual to feel run down from our busy lives, the crazy world we live in, and the high energy atmosphere of springtime!

The adrenals–these are the seat of our life force energy–and producers of the stress hormones that support the energy we need to thrive and survive through all of life’s challenges. That can become depleted in the face of the stress of life. That need our support and care.

Who needs adrenal support? We all do–all of the time.

Here are common signs that your adrenals need help:

  1. You are persistently tired in spite of sleep and rest.
  2. You feel tired and wired and have trouble falling to sleep or staying asleep.
  3. Your usual emotional calm has turned to overwhelm, irritability, sadness, or loss of enthusiasm.
  4. In addition to fatigue, you become light headed easily.
  5. You are more tired and achy.
  6. You’ve been under a great deal of stress lately and just don’t have the usual mojo.
  7. You’re depending on stimulants like caffeine, exercise, or drama to keep you going.
  8. You feel well but recognize you’re burning the candle at both ends these days.
  9. You are a parent to young children (need I say more?).

A Closer Look at the Adrenal Glands and Adrenal Hormones

The adrenals sit on top of both kidneys and are often referred to as our “stress” glands. The inner parts of the adrenal glands, called the adrenal medulla, make the hormones, adrenaline and noradrenaline (also known as epinephrine and norepinephrine), in response to electrical signaling of the autonomic nervous system (ANS) during acute stress. These hormones get us ready for quick action.

In both acute and chronic stress, the outer parts of the adrenals, the cortex, make the hormones cortisol, DHEA, and aldosterone, to manage the more long-term energy needs of the body under stress.

The job of cortisol is to focus our biological energy on survival and managing the tasks in front of us right now. It does this by making sure there are enough carbon atoms available (from glucose, fatty acids, and protein) for conversion into chemical energy. Carbon atoms are required for energy production in its various forms, including electron transport, where oxygen is consumed to make chemical energy, ATP. Cortisol also helps suppress non-vital biological functions during stress, such as reproduction, digestion, and growth.

DHEA’s primary action is on the brain, priming it for growth and learning, creating strength and resilience for subsequent stresses. The ratio of cortisol to DHEA is important in chronic stress and how successfully we manage it. Higher levels of cortisol over time can lead to immune suppression, delayed wound healing, and depression, while higher levels of DHEA ameliorate these effects, reducing many of the negative effects of chronic stress, lowering our risk for depression, anxiety, inflammation, and neurodegeneration.

Aldosterone maintains blood volume and blood pressure through its effect on the reabsorption of water and electrolytes from the kidneys. This action maintains the circulation and transport of the carbon atoms to the vital organs during times of stress where they will be converted into energy.

Adrenal Rescue 911

In the face of high stress, fatigue, and overwhelm, here are simple and fast ways to nourish your adrenals to improve energy and wellbeing:

  1. Get to bed on time and sleep 8-9 hours.
  2. Breathe–even a single breath with the intention of letting it go will provide solace and put some distance between you and the stress.
  3. Tell your story–talk to someone you trust, who will listen, and tell them what’s going on and how you are feeling about it.
  4. Write it down–writing about your feelings will help unload your overwhelm and lead you toward creative solutions.
  5. Eat well–ditch the sugar, grains, and processed foods, and include healthy protein, fat, and veggies at each meal.
  6. Move your body–this improved energy production and releases excesses of stress. Walking improves decision making and creative solutions.
  7. Take nutritional supplements: see below.
  8. Take herbs to support healthy adrenal function: see below.

The Consequences of Persistent Stress and Fatigue

We often refer to loss of adrenal resistance to stress as “adrenal fatigue,” or “adrenal exhaustion.” In essence, the adrenals lose reserve—the resources they require to sustain the hormone levels and energy requirements that support us. As the stress response becomes prolonged, the energy needs and demands of the body become greater, resources are utilized and become diminished, and the system cannot sustain itself without the right support. The adrenals require nourishment just like all other parts of the body. A stressed body in a prolonged state of challenge or vigilance will become depleted of the nutrients and resources needed to sustain it.

Prolonged stress can lead to loss of energy reserve and fatigue, and can make us less prepared for future stressors. Initially prolonged periods of stress result in sustained elevations of adrenal hormones levels. This leads to persistent utilization of internal resources to provide the energy we need to sustain us while stressed. When the stress and stress systems (including the adrenals) maintain a persistently high state of vigilance, we can lose reserve and fail to adapt to the stressors at hand. Eventually the adrenals may no longer be able to sustain the high hormone levels that are called for unless resources are adequate to sustain them. Adrenal hormone levels will decline, and there will be a systemic loss of resilience to stress and energy demand. This can become the crash and burn of adrenal fatigue.

What Adrenal Fatigue Feels Like

People experience adrenal fatigue in a multitude of ways, but some of the common denominators are: loss of energy, loss of sense of resilience, loss of tolerance to exertion and exercise, low blood pressure, light headedness, body aches, cognitive dysfunction, poor sleep, gut dysfunction, and loss of sense of wellbeing.

Chronic Fatigue Syndrome

This term represents the medicalization of persistent fatigue that does not seem to have a cause or a cure by conventional medical standards. Chronic fatigue syndrome is a descriptive diagnosis only and does not represent a true singular illness. The typical symptoms of chronic fatigue syndrome are persistent fatigue, poor exercise tolerance, diffuse myofascial pain, insomnia, brain fog, and gut disturbance—all manifestations of energy deficit throughout the body. The fatigue and related symptoms are quite real and the impact is often catastrophic for the people who experience it, but there is always a cause or causes. There is always a reason why energy production becomes impaired.

There are as many causes for persistent fatigue as there are people who experience it. I’ve yet to work with a client suffering from chronic fatigue who does not have identifiable points of dysfunction that can be corrected. The systems biology approach of Functional Medicine and body-mind principles allow us to dig deeply into the roots of energy production and the many potential causes of chronic fatigue.

Self-Care Fundamentals for Adrenal Recovery

First, Work With the Body:

By breathing deeply. In the face of challenge and stress we must breathe.

When we’re stressed, many of us fold forward, making our breathing shallow. When we open up our bodies to receive deep conscious breathing, we shift our physiologies in profound ways. Deep breathing stimulates the Parasympathetic nervous system, which serves as a counterbalance to our stress hormones. It calms us and brings us more into the present moment, a place from which we can act upon our challenges with greater wisdom and awareness. When we cultivate a practice of deep breathing, such as with meditation, those deep conscious breaths become more second nature for us. Further, when we adopt an open-body, open-hearted posture, we increase the power of our presence through hormonal shifts (increased testosterone, decreased cortisol) and mind shifts (increased confidence, personal strength, and resilience.) Deep breathing optimizes the in-flow of life and energy-sustaining oxygen.

By eating a diet that is nutrient-rich and low in irritants and pro-inflammatory foods. Follow the Liftoff Foundational Nutrient-Dense Food Plan, or the more intensive, Gut-Immune Restoration Intensive Nutrition (GRIN) food plan. These food plans will provide the nutrients needed to power energy production, heal the adrenals, support detoxification and restore healthy gut function, including support for a robust microbiome.

By hydrating well. Drink clean, pure water. Most of us need two quarts per day, more for coffee or tea drinkers and for those who sweat a lot through high activity.

By sleeping well. Don’t skimp here. There is nothing more profoundly stressful as chronic sleep deprivation and, conversely, nothing as healing to the adrenals as sleeping well and long enough. Sleep is the ultimate re-set and repair at the deepest level. Good sleep is a non-negotiable part of all healing. How much is enough? You probably can get a sense this based on the number of hours you sleep when left uninterrupted. The average optimal sleep duration for adults is 9.5 hours.

By moving your body wisely. Movement calms the nervous system and regulates stress hormones. Cross-crawling activities such as walking, running, and swimming help with problem solving. Yoga is a great way to combine movement with breath work and positive affirmations.

Work with the Mind and Emotions: Unload the mental and emotional stressors that challenge the adrenals.

By changing your relationship with stress. Understand stress as the wise teacher rather than the enemy. To decipher the wisdom of the body when feeling stressed, remember that the body’s response to a challenge is neutral and non-judging. What your body is telling you about the situation in front of you is true. First, listen closely. Don’t kill the messenger. Trust the wisdom of your body and that it’s only purpose is to support you. What is the message? What is the intuitive guidance of your body trying to tell you?

By softening your expectations for yourself and others, allowing room for improvisation and the unexpected. It’s good to soften when we feel stressed: soften our thoughts, soften our expectations, soften our stories. Just soften. Even as we brace our minds and bodies for the impending catastrophe lurking just ahead, soften. When we breathe and soften we begin to remove the prickly edges from our experiences. This puts us more in the flow of our lives.

By mobilizing your support team of friends, family members, or healthcare professionals. We can communicate to others about how we feel and mobilize our support team. Soak in and feel nourished by having someone listen and support us. Remember, we are wired for human connection. Part of the stress response (via the hormone, oxytocin) is to move us closer to others. We can’t always do this alone. We need the support of friends, family, or trusted consultants who understand us and want to support what is best for us. We need to surround ourselves with people who celebrate who we are and where we are headed and don’t feel jealous or threatened by our positive change.

By creating an action plan to address your life challenges: We all need a plan to specifically address the stressful situation, if that is necessary. Writing the plan down gives us the opportunity to contemplate our action steps.

By simplifying your life: There are many times when we can slow things down and reduce distraction. Put cell phones away, stop trying to multitask (studies confirm that our brains can’t do it well anyway.) Disconnect from news and email. The world can wait while we become better versions of ourselves. And declutter: a cluttered personal environment adds to a cluttered mind. Get rid of those piles of stuff, organize, and minimize.

By avoiding negative stories about your life. This is hard but necessary. The more time we spend on our negative interpretations of the events of our lives, the stronger those neural networks become that support that way of thinking, and the more stressed we remain. We want to dismantle our old, negative way of thinking and open space for new understanding, for what is possible.

By releasing strong emotions in health ways. When we have strong emotions about stressful events, we must relieve them in productive ways. Before acting out about the stress-producing situation, it can be helpful to take time out and use our resilience tools: go for a walk, have a cry, state positive affirmations about courage and support. Taking an active time out allows our inner wisdom to fully declare itself, and mobilize our resources toward a solution.

By naming the stress: Name it and claim it. When we feel stressed about something, it is important to acknowledge it and name it out loud. “I am feeling stressed, I am anxious about giving that talk, I feel overwhelmed by this project.” Naming it grounds it instantly. It gives us an anchor and a purpose. It allows us to start strategizing our way toward resolution, to call in our reinforcements. Writing about what stresses us is a way to expand our awareness about how we truly feel, and open the door to greater clarity about what needs to be done.

By creating an action plan. We all need a plan to specifically address the stressful situation, if that is necessary. Writing the plan down gives us the opportunity to contemplate our action steps.

By affirming your resilience (even if you don’t believe it). In other words, practice resilience. We can use positive affirmations about stress to further change how we think about it. Practicing affirmations helps us to expand the neural networks that support our desired state of being. I like to have my favorite affirmations written down and ready to pull out in a pinch: I am undaunted. I am fully supported by the Universe. I am courageous. I am courageous. I possess all of the resources to handle my life’s challenges successfully. I am Divinely guided and protected.

By practicing courage: Research shows that people who open themselves up to others by sharing their true feelings, even when it feels uncomfortable, are happier and more resilient than those who hold it all in. It can feel very risky to expose our inner selves in this way, but the rewards are huge. Avoiding connection is risky—our levels of stress skyrocket and we tend to experience stress as negative.

By laughing: Cultivate humor in the face of stress. It allows us to instantly diffuse the negative impact of stress on our bodies and minds. I love how author Anne Lamott describes laughter as “carbonated holiness.” Laughter is a sure indication that we don’t take ourselves too seriously and allows us to punch through negative aspects of stress, getting us closer to the transformation we need to move through difficult times.

By forgiving: Yes, we can work to forgive everyone and everything. Nothing burns out the adrenals as profoundly as holding onto past hurts. Remember, forgiveness is not about pretending nothing happened. All kinds of things have happened to all of us. Unfortunate things, tragic things. But our attachment to those events and the ways we believe they define us and our current lives, strangles us, stresses us, and puts a strong foothold on the possibilities for our lives. We must free ourselves from the past, whatever it takes.

Nourish Healthy Adrenal Function with Nutritional Supplement

Supplements support the foundational aspects of adrenal recovery as we discussed above, but are not a substitute. Sustainable healing at the root-cause level requires vigilance to the fundamentals of self-care. No supplement in the world will help you recover your energy and vitality to its full potential (or at all) if you continue to sleep poorly or if your food plan doesn’t support your basic needs for energy recovery and adrenal function.

  • High quality multivitamin-mineral supplement. I like DFH Complete Multi by Designs for Health–with iron for premenopausal women and without iron for postmenopausal women and men.Take 3 twice daily with food.
  • B-complex. Make sure it contains biologically active forms of Bs: look for methylfolate, methyl B12, and pyridoxal-5-phosphate (p5p). Take 50-100 mg daily.
  • Magnesium. Take a chelated form, preferably glycinate or mixture: 250-1000 mg daily in two divided doses, one at bedtime. Magnesium is a natural stool softener–if you develop excessively loose stools just decrease your dose a bit.
  • Vitamin C. Take in a buffered form, 1000 mg twice daily.
  • Omega-3-fatty acids. Take 1000 mg of combined EPA and DHA twice daily with food.
  • N-acetyl cysteine: Take 600-1000 mg twice daily.
  • Curcumin (turmeric extract): 400 mg of a 95% curcuminoids product, taken twice daily.
  • Vitamin D: Vitamin D is very hard to get in sufficient quantities in the diet and most of us need to supplement to optimize blood levels. I dose based on blood levels of 25-hydroxy vitamin D (goal: 50-70 pg/dl for most individuals). This translates to about 5000-10,000 IU of vitamin D3 for most people.

Herbs to Support Adrenal Recovery 

For chronic stress associated with feeling tired, sluggish, unmotivated, and in pain:

  • Asian or Panax Ginseng root: standardized to 8% ginsenosides, 400 mg 1-2 times daily.
  • Rhodiola root extract: standardized to 1% salidroside and 3% rosavins, 100 mg 1-2 times daily.
  • Curcumin: 400 mg with 95% curcuminoids; take 2-3 three times daily.

For chronic stress associated with feeling tired, wired, anxious, and poor sleep:

  • Phosphatidyl Serine: 150-300 mg taken at bedtime.
  • GABA: 500 mg taken at bedtime or 2-3 times daily.
  • L-theanine: 200-400 mg taken at bedtime.
  • Melatonin: 1-3 mg taken in the evening.
  • Rehmannia root: 1-2 tablets or capsules taken daily.
  • Holy basil leaf 8:1 extract: 1-2 tablets or capsules taken daily.

For Adrenal Dysfunction with Low Cortisol Levels: when you feel tired, sluggish, and light-headed.

  • Ashwaganda root: 15:1 extract containing withanolides: 50 mg 1-2 times daily.
  • Asian or Panax Ginseng root: standardized to 8% ginsenosides, 400 mg 1-2 times daily.
  • Licorice root extract: standardized to 25% glycyrrhizic acid, 300 mg 1-2 times daily. Caution should be taken for those known to have high blood pressure and blood pressure should be routinely monitored throughout therapy.

For adrenal dysfunction in conditions of persistent stress to support resilience:

  1. Adrenal Glandulars: Whole adrenal and adrenal cortex glandular from organic pasture raised beef sources: 200-300 mg daily.
  2. Asian or Panax Ginseng root: standardized to 8% ginsenosides, 400 mg 1-2 times daily.

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Resources:

Karyn Shanks, MD. Vital Energy: Rock it With Five Simple Steps. 2017.

Karyn Shanks, MD. Create Vital Energy: From Mitochondria to Sex. 2016.

KARYN SHANKS MD

Karyn Shanks, MD, is a physician who lives and practices in Iowa City. Her work is inspired by the revolutionary science of Functional Medicine, body-mind wisdom, and the transformational journeys of thousands of clients over her twenty-five-year career. She believes that the bones of healing are in what we do for ourselves.

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