Due to the nature of life and work in modern society, we are all subject to immense amounts of daily stress. From paying bills on time, spousal relationships, children and the onslaught of negative social media portraying horrific acts of terror, and inciting partisan rhetoric we are constantly in a state of fight or flight. When we are under stress, cortisol, a stress hormone manufactured by a small gland that sits atop your kidneys becomes elevated.
This spike in cortisol temporarily suppresses the immune system as an evolutionary advantage to get away from bears. Your adrenal glands are also busy producing extra epinephrine, norepinephrine as an adrenaline response elevating your heart rate, breathing and pooling resources to your brain and other vital organs. Insulin levels are also elevated to aid in the cellular uptake of glucose for cellular energy production.
The adrenal glands are responsible for the manufacture of sex hormones like testosterone and estrogen, but with all the taxation from the constant stress response, we begin to experience symptoms of the early stages of adrenal burnout. The adrenals are a part of what is called the HPA (Hypothalamic, Pituitary, Adrenal) axis. A primitive, limbic structure in the brain called the hypothalamus, regulates the activity of the Pituitary gland through the release of Cortisol Releasing Hormone (CRH) which then stimulates the pituitary to release Adrenocorticotropic hormone (ACTH) ultimately signalling to the adrenals to make Cortisol.
Sustained psychological stress will eventually result in biochemical/physical stress in the body which can affect any, or all parts of this axis resulting in dysfunction of adrenal hormone metabolism. Primary causes of HPA pathology include either inherited or acquired autoimmune disease causing the immune system to attack the adrenal glands, infection, cancer, genetic mutation. Secondary causes of adrenal burnout are lowered ACTH from inflammation of the pituitary gland, Prednisone steroid injections, and the tertiary causes include lowered CRH from inflammation in the Hypothalamus.
In the first phase of adrenal fatigue, your adrenals are capable of producing massive amounts of hormones and neurotransmitters to supply fight or flight resources to the rest of your body. At first, you may experience an elevated level of alertness and arousal, but overtime this can lead to difficulty in sleep patterns and actually making it through all of the stages of sleep, leaving you feeling exhausted the next day.
If you were to be tested by your physician, it would show elevated levels of cortisol, norepinephrine, epinephrine, DHEA, sex hormones. Most people operate on this phase and rarely report quality of life issues and may come in and out of it several times in their life.
Chronic stress on the adrenals in this phase causes them to divert the majority of its resources to the production of stress hormones like cortisol causing the sex hormone levels to drop. Typical symptoms are the “wired, but tired” feeling, the 2 o’clock feeling, tired after eating, crashing hard in the evening. This is also when people begin depending on caffeine or other stimulants like Adderall to get them going in the morning keeping them in the fight or flight state.
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The adrenals continue pooling resources towards stress hormone production at the expense of sex hormones. The precursor molecule to both cortisol and sex hormones is called pregnenolone it is all getting used up for cortisol production. Reported symptoms of this phase are lack of enthusiasm, extreme tiredness, and lower sex drive.
Due to lowered testosterone and because of the suppression of your immune system, you’re more likely to get infections and get sick. Also note, visceral fat accumulation is a significant indicator of the state of your cardiovascular system, increases insulin production and lots of estrogen. This stage of chronic adrenal stress can last for months to years.
This is the final “burnout” stage. Up until this point, you are still capable of producing high amounts of cortisol and adrenaline, but due to the increased metabolic activity, oxidation begins to take its toll and your cortisol levels tank. This overall burnout of the adrenals affects all the hormones resulting in a feeling of extreme tiredness, continued decrease in sex drive, irritability, depression, anxiety, weight loss, obesity, chronic pain, glucose dysregulation, fibromyalgia, apathy, and a general loss of interest in life.
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What does this all mean then?
If any of this sounds familiar, the good news is you have options. If you are in late stages of adrenal burnout, you didn’t get there overnight, so regaining proper function of the adrenal glands will take time, patience, and a significant change in lifestyle to finally put a tourniquet on the sources of inflammation driving the pathology. These changes include reducing stress levels by doing things like yoga, meditation, massage and Vagus breathing exercises. Epsom salt baths are another great way to reduce stress and anxiety as magnesium is an important nutrient for the brain. Magnesium aids in the consistent perfusion of blood into the brain, irrigating all your neurons with lots of oxygen. It is also helpful with muscle aches and pains and improving proper gut motility.
Exercise is another great way to lower cortisol levels in the early stages of burnout. Although aerobic and anaerobic exercise help supply the blood with lots of oxygen and boost mitochondrial function, you may not be able to or feel like breaking yourself off so walking or bike riding is a great place to start without elevating cortisol.
Getting plenty of sun is also beneficial as it raises D3 levels which have a significant role in the brain and resets the pineal gland for proper melatonin production. Further, doing things like getting up at the same time every day, eating the same time every day, taking naps and going to bed the same time every day can reset your circadian rhythm and improve sleep and your body and minds resilience to stress.
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Proper diet and nutrition are paramount to reduce inflammation and regain normal function of the HPA axis. Making sure you are getting plenty of omega 3 fatty acids, colourful fruits and vegetables loaded with antioxidant polyphenolic compounds such as those found in blueberries, cruciferous vegetables, dark green leafy vegetables, reds, purples, orange sweet potatoes, nuts, and black sesame seeds. Anti-inflammatory herbs like, turmeric, ginger, rosemary, oregano, cinnamon, clove are another great way to combat oxidation.
Also be sure to avoid refined omega 6 oils such as corn, soy, safflower, and canola and processed carbohydrates. If you feel like you are more in the advanced stages of adrenal fatigue adaptogenic herbs such as Ashwagandha, Siberian Ginseng, Rhodiola, and cordyceps are great supplements to speed things up and will help the rest of your body too. Basically anything antioxidant is your best friend, high dose vitamin c with citrus bioflavonoids (2-5g’s daily), zinc, N-acetyl-cysteine, with B vitamins and phosphatidylserine for brain support.
Where does coffee come into play in all of this? Caffeine stimulates the same fight or flight response with some people obviously being more susceptible than others. Women using pharmaceutical contraceptives or hormone replacement therapy for the management of menopausal symptoms may metabolize caffeine much slower than normal as well. The bottom line is coffee has become a staple in almost everyone’s house It creates a feeling of perceived energy increase and is pleasing as it also raises levels of serotonin receptor sites in the body.
Coffee additionally contains lots of antioxidants so drinking it black can have some health benefits, but if you have become dependent on it to function, and your feeling anything like I have described you should probably cool it, or at least ween yourself off for a while. People who drink multiple cups of coffee per day develop tolerance and become physiologically dependent so trying to abruptly stop may result in withdrawal symptoms such as headaches and irritability.
Caffeine, as I said, allows for perceived energy increase but doesn’t actually boost the body’s ability to produce true cellular energy (ATP.) If you want to naturally increase energy levels without adding burden to your adrenal glands, consuming lots of antioxidants, improving oxygen utilization, supporting your body’s natural detoxification processes and staying hydrated and providing plenty of nutritive substrate for your cells to have all of the resources they need to meet the demands we place on them 24/7.
To be clear, I am not saying that everyone should stop drinking coffee, I’m saying listen to your body and realize that a dependent relationship with any psychoactive substance is an unhealthy one. If you feel like you need caffeine to stop being tired, get more sleep, do all the things I mentioned above to get your body firing on all cylinders and you can enjoy a nice cup of joe, not because you need to, but because you want to.