The adrenals are two small endocrine glands, about the size of peas, that sit on top of each kidney. They produce a wide range of hormones that impact the whole body, including the major stress hormones epinephrine and noradrenaline.
The term “adrenal fatigue” was coined in the 1990s to explain a set of unique symptoms centred around severe fatigue and malaise:
Symptoms of Adrenal Fatigue
– Physical fatigue
– Emotional fatigue
– Disinterest in others
– Moodiness and irritability
– Poor memory (short-term and long-term)
– Tiredness no matter how long you sleep for
– Trouble sleeping and waking up
– Craving salty foods and/or very sweet foods
– Unexplained weight loss or gain
– Reliance on coffee and other stimulants
– Loss of body hair
– Low libido
– Irregular menstrual cycle
– Feeling easily overwhelmed1
There are four steps to reverse adrenal fatigue…
And they’re easier than you’d think:
Step 1: Understand the Cause. What is Adrenal Fatigue… Really?
A clinical term for surviving and thriving amid stress is “allostasis” – the body is wired to employ a range of physiological adaptations to maintain health during different types of stress. Most commonly, the allostatic response involves the sympathetic nervous system (including the “fight or flight” response) and the HPA axis – this is a communication pathway between the brain (H for hypothalamus and P for pituitary gland) and the adrenals. During short bursts of moderate stress, the HPA axis is activated and the adrenal glands are stimulated. They release a wide range of hormones – not just epinephrine:
– Epinephrine & norepinephrine: Initiate the fight-or-flight response and help the body maintain allostasis during traumatic or stressful events.
– Aldosterone & other mineralocorticoids: Regulate blood pressure and electrolyte balance.
– Cortisol & other glucocorticoids: Control metabolism and the immune system, often in response to stress.
– DHEA and other androgen hormones: Create testosterone and estrogen balance.
The original model of adrenal fatigue from the 1990s went something like this:
Stage 1: Alarm Reaction. The adrenals respond to sudden stressors or traumatic events, and cortisol levels sky-rocket. This is like a fight-or-flight response, designed to maintain allostasis during stressful situations.
Stage 2: Adrenal Resistance. If the stressors remain in the environment for a long time, the adrenals continue to release cortisol and other stress hormones. Eventually, the adrenals become “fatigued” as they struggle to produce more hormones to deal with the continued stress. Cortisol levels are normal or high in this phase.
Stage 3: Adrenal Exhaustion aka “adrenal fatigue”. When the stress continues and the adrenals are “exhausted” of their hormones, the stress response continues to function but the glands are unable to raise stress hormones high enough to meet physiological demands. Cortisol levels bottom out and allostasis fails, resulting in immune dysfunction, sluggish metabolism and fatigue.
While this is a conveniently simple model, it does have some issues. Studies have shown that many people diagnosed with “stage 3” (i.e. adrenal fatigue) can unexpectedly have their cortisol levels shoot back up to stage 1 levels – which should be impossible if the adrenals are “fatigued”. Recent research has shown that improvement in other body systems can alleviate adrenal fatigue. Due to these inconsistencies, the Endocrine Society rejects the very concept of adrenal fatigue, and a 2016 systematic review concluded that there is no medical substantiation behind the condition23.
Does that mean that adrenal fatigue doesn’t exist? Or maybe the model is just slightly off…
New & Improved Model of Adrenal Fatigue is More Holistic
The new model of adrenal fatigue is far more holistic. A new branch of medicine called neuroendocrine immunology is centered around the connection between the endocrine system, the nervous system, and the immune system. If we look at the hormones that the adrenal glands produce, it’s clear that they are intimately connected to these three systems (and more)!
Under this model, the adrenals are viewed as “end of the line” glands – they are at the very end of a chain of reactions that begin in the brain (yep, the HPA axis we mentioned earlier). The hypothalamus in the brain acts as a connection point between the immune, nervous and endocrine systems. It responds to sensory input by sending stress signals to the rest of the body, including the adrenal glands.
In the new model, there is nothing actually wrong with the adrenal glands themselves. They aren’t fatigued. They are producing the hormones they’re told to produce, when they’re told to produce them. The fatigue and dysfunction occurs earlier in the chain of communication – in other parts of the neuroendocrine system and the immune system, which also connect to the rest of the body.
Oxidative Stress & Inflammation is The Main Cause
Under the new understanding of adrenal fatigue, its underlying causes all have something in common: oxidative stress and inflammation. When the hypothalamus detects oxidative stress, it sends signals to promote symptoms of fatigue – possibly in an effort to get you to rest and prevent creating more inflammation through more activity!
Stress itself is inflammatory, and adrenal fatigue often occurs after long-term pressure – the kind of stress where you believe everything is fine while trying to juggle an overwhelming To Do list each day. For other people, adrenal fatigue develops instantly after a traumatic event or series of events. Other causes can also involve:
– Diet low in fresh fruit and vegetables
– Pushing yourself or being pushed beyond physical or emotional exhaustion
– Sedentary lifestyle
– Lack of sleep
– Heavy use of caffeine or other stimulants
Health conditions that commonly cause inflammation and adrenal fatigue include:
– Undetected infections
– Low thyroid function
– Leaky gut
– Nutritional deficiencies
– Immune dysfunction
– Autoimmune conditions
– Undiagnosed chronic conditions
It’s important to address all of these possibilities to fully recover from adrenal fatigue.
Step 2: Take These 3 Adaptogenic Herbs
Adaptogens are substances that increase an organism’s ability to adapt to and avoid damage from environmental factors. They work on all of the body systems involved in adrenal fatigue – they can modulate the nervous system, support immune responses, and help to balance endocrine or hormonal signals. Herbal medicine is a great step to take to get yourself “out of the hole” – the right herbs can give you the boost you need take the next steps to fully heal from adrenal fatigue.
Ashwagandha is said to give you the power of ten horses – the perfect remedy to the flat feeling of adrenal fatigue, right? It’s known in Sanskrit for its horse-like smell (ashwa is “horse” in Sanskrit), and is called “Indian ginseng” for its ginseng-like energy enhancing powers. Meanwhile, its Latin binomial, Withania somnifera, refers to its relaxing qualities – somnifera means “sleep-inducing”. This should give you a hint about its multi-targeted approach to resolving adrenal fatigue.
Ashwagandha works on the three main systems involved in adrenal fatigue:
– Endocrine system: Ashwagandha can balance stress hormones like cortisol and epinephrine, sex hormones like testosterone and estrogen, and even insulin.
– Immune System: Ashwagandha has potent anti-bacterial and anti-fungal actions and it can balance the immune system by boosting white blood cell numbers.
– Nervous System: Ashwagandha regulates signaling between nervous system cells to combat over-stimulation, and promotes the release of soothing neurotransmitters.
And most importantly, ashwagandha reduces inflammation by selectively inhibiting COX-2 pathways (similarly to non-steroidal anti-inflammatory drugs, but without the side effects)4.
As an adaptogen and a neuro-protective herb, ashwagandha has been shown to exert an anxiety-reducing effect in humans and is a go-to herb as the basis of an adrenal restorative blend. It can give a gentle energy boost while helping the body adapt to stressful environments.
A systematic review of all human trials concluded that ashwagandha is an effective complementary therapy for anxiety and stress5. In particular, a study of 64 participants found that a daily dose of 300mg of high-concentration ashwagandha root powder resulted in a significant decrease in previously-high cortisol levels compared to a placebo group6. The study found that the participants who took ashwagandha were much more able to cope with anxiety and stress, and reported that they felt more “balanced”7– the perfect remedy for adrenal fatigue.
By reducing excess cortisol and boosting the synthesis of the neurotransmitter, GABA, ashwagandha promotes relaxation and improves stress tolerance at the same time. It also sharpens cognitive function and stimulating the regeneration of nerve connections, helping to keep the mind clear while it’s under pressure. This can help to remove brain-fog associated with adrenal fatigue, while giving an energy boost and addressing the underlying causes.
Panax ginseng is rich in ginsenosides – antioxidant compounds that have been shown to reduce inflammation and support signalling within the nervous system. It’s these ginsenosides that make Panax ginseng a powerful adaptogen. It can cool down a heightened stress response by regulating the secretion epinephrine and norepinephrine, and it has a mild stimulatory effect to boost resistance and endurance during stressful situations8. This stimulation also increases circulation to the brain to improve focus and memory. Panax ginseng also bolsters the immune system against any infections that may be underlying adrenal fatigue.
In Traditional Chinese Medicine, schisandra is often prescribed to increase general resistance to stress, particularly during times of burn-out or fatigue. Studies have found that schisandra extract can directly protect the adrenal glands against over-active HPA signals, and it can help the rest of the body remain alert but calm during times of stress9. Schisandra is particularly indicated in symptoms of low mood – it has been shown to exert an anti-depressant effect in people who experience burn-out10.
Step 3: Eat For Energy – Diet & Key Nutrients
To combat any type of fatigue, the body needs a steady supply of fuel to create more energy. Blood sugar regulation is particularly important during adrenal fatigue. Trauma and stress throw the body’s natural blood glucose regulation off balance and this contributes to feelings of tiredness, mood swings, lightheadedness, and malaise. Regular meals and intermittent fasting are quick fixes for disrupted blood sugar regulation, and can help to up-regulate cellular energy production.
While adding in fresh vegetables and plenty of plant-based protein, cut out the caffeine and stay away from sugar-rich, refined carbs which throw hormones of balance, increase inflammation, and promote oxidative stress11. Add apple cider vinegar to your meals to improve digestion and get maximum energy out of your food.
Focus on these three key fatigue-busting nutrients:
The adrenal glands hold 100x the concentration of vitamin C than any other tissue in the body. Vitamin C is required for the synthesis of epinephrine and cortisol hormones, so our stores get exhausted quickly when we are under stress12. This is unfortunate since vitamin C acts as a powerful antioxidant to fight the underlying inflammation behind adrenal fatigue. Good news – vitamin C is found in most fresh fruits and vegetables and is safe to supplement at high doses.
Key dietary sources: Broccoli, red capsicums, lemons and green leafy vegetables.
For an extra boost, try a food-based vitamin C supplement made from kakadu plum, acerola cherry or acai.
Vitamin B5 or Pantothenic Acid
Vitamin B5 is essential for the production of most adrenal hormones, maintaining the function of brain cells, and for the breakdown of fats, carbohydrates and proteins into energy. It’s also used in the production of hemoglobin, the protein that carries oxygen within red blood cells – without vitamin B5, oxygen delivery and energy production is completely impaired13 – hello fatigue, burn-out, mood swings and low motivation.
Key dietary sources: Shiitake mushrooms, avocados, sunflower seeds, sweet potatoes and lentils.
Not only is magnesium required for energy production in every cell in the body, it is also essential for muscle contraction and relaxation, nerve communication, cognition, digestion, and sleep. Remedying a magnesium deficiency can relieve many symptoms of adrenal fatigue.
Key dietary sources: Green leafy vegetables, whole grains (e.g. brown rice), pumpkin seeds, beans and other legumes, and almonds.
Step 4: Make Essential Lifestyle Changes – Relax, Exercise, and Sleep!
These are the most important interventions to reverse adrenal fatigue. We saved this step for last because it’ll be easy once you’re taking adaptogenic herbs, eating an anti-inflammatory diet and maintaining steady blood sugar.
Avoid & Adapt to Stressors
Improving your tolerance to stress is easier said than done. Daily challenges are generally unavoidable and a certain level is actually good for your health – but if you’re experiencing symptoms of severe fatigue, it’s time to pull back and prioritise what matters to you the most. Cut down your “to do list” and take time to connect to an inner sense of calm as much as possible before engaging in challenging tasks. Mindfulness meditation works for many people, while guided or visualisation meditations can be more effective for others. Surround yourself with supportive people and environments.
Restorative Environments & Moderate Exercise
Restorative environments are places that produce a feeling of pleasure while grabbing your attention – generally speaking, most people find natural or remote areas to feel restorative, while cityscapes and urban life is draining. Needless to say, time in the great outdoors can relax the nervous system and rejuvenate our sense of wellbeing.
A growing number of studies have backed up the idea that time in “green spaces” can reduce psychological stress and all forms of fatigue. A 2018 study found that green spaces with the highest level of “nature” have the greatest effects on reducing psychological and physiological markers of stress and fatigue – this means that time deep in a forest is more restorative than time in a city park14. But take what you can get, and get moving outside – exercising in any type of outdoor spaces has been shown to improve mood and relieve stress far more effectively than indoor exercise15.
A 2015 trial demonstrated that people with clinically diagnosed adrenal fatigue showed a significant improvement in their stress hormone levels immediately following physical activity16. Keep in mind that the type of exercise you engage in can have a major impact on your energy levels – over-training leads to major oxidative stress and inflammation, so trade in your HIIT classes for a yoga pass.
Sleep, Rest & Recover
When the body and mind are both tired, they’re telling you something – you need rest! Sleep is the cornerstone of adrenal fatigue recovery. This can be easier said than done. Unpredictable cortisol levels can have you feeling “wired but tired”, and give you an unexpected energy boost at night. Do all you can to encourage a good night’s sleep. Optimize your recovery with these sleep hygiene guidelines for adrenal fatigue17:
– Have “no screen” time for at least 1 hour before bed
– Ensure your bedroom is as dark and quiet as possible
– Go to bed between 9pm and 10pm
– Sleep until 9am if your schedule allows for it