What are the two little organs that sit on top of your kidneys and control your stress response? That’s right – your adrenal glands.
Even though they’re tiny, your adrenals are super important as they influence your weight, blood sugar, blood pressure, immune system and, most notably, control your stress response. Specifically, they manage the fight or flight mechanism and the secretion of the hormone cortisol.
Historically as humans, stressors were typically of the immediate danger variety and almost always short-lived. The classic example is being chased by a saber-toothed tiger. In this scenario, your fight or flight mechanism gets activated, you pump out tons of cortisol to make your brain sharp and muscles fueled with blood sugar so you can outrun the danger. Once out of harm’s way, your nervous system would go back to normal.
In our modern world, we are faced with constant stressors. No longer are they the life-threating kind (usually), but your nervous system doesn’t differentiate between getting chased by a tiger and rush-hour traffic or work deadlines. With our fight or flight mechanism consistently activated, our health pays a price. Specifically, it’s our adrenals which take a big hit, leading to issues related to adrenal overdrive or burnout.
With adrenal dysfunction, you can have too little cortisol, too much cortisol, or too little and too much at the wrong times of day. For example, your cortisol is too high at night and too low in the morning. This is that classic picture of “tired and wired” whereby you get a second wind at night, can’t get to sleep, can’t wake up in the morning and drag yourself through the day. In addition to difficulty falling asleep, staying asleep and waking up feeling exhausted, there are many other common symptoms that can occur.
Common Symptoms of Adrenal Dysfunction
- Feeling stressed or overwhelmed by day-to-day activities
- Getting irritable and angry more often than you want to
- Low libido
- Menstrual irregularities or fertility problems
- Feeling lightheaded when you go from lying down or seated to a standing position
- Experiencing a 3pm slump most afternoons
- High fasting serum glucose…even if you eat well
- Cravings for sugar, carbs, fat and/or salt
- Weight gain, particularly around your midsection
- Exercise intolerance or difficulty recovering from workouts
If any of those are sounding familiar, your adrenals may need some support.
While there are tests that a functional or integrative doctor can run for HPA dysfunction, if you’re experiencing a few of those symptoms I just mentioned, you can actually start to treat yourself without special testing. If you do want to get tested, there are various tests you can get, looking at serum levels, saliva, urine and hair.
- Blood/Serum. You can get a blood test to measure the level of cortisol in the blood, which may indicate problems with the adrenal glands or pituitary gland. Ideally, perform the test around 8am – the optimal range for adults of 10-15 mcg/dL. The advantage of blood testing is that it’s the universal language of conventional health professionals; the disadvantage is that it’s a 10-15 second snapshot of your stress level while the needle is in your vein. This one is only somewhat helpful, in my opinion.
- Saliva. There’s a diurnal (read: 24 hour) pattern to your cortisol levels. Cortisol rises after getting up in the morning (called the “Cortisol Awakening Response”) and should be at its lowest point around 9-10pm. A Four-Point Cortisol saliva test can measure your cortisol at four points during the day (usually before breakfast, lunch, dinner, and bedtime) to assess your cortisol slope. The advantage to saliva is convenience (you can do it at home), but the disadvantage is that salivary cortisol levels can be variable. Another disadvantage is that you’re measuring free cortisol, which is only ~1% of the total cortisol load in the body. Still, you can spot trends over time so I think it’s a helpful test. A good one is the Adrenal Stress Index which does four-point cortisol plus it includes DHEA, progesterone, insulin, and fecal sIgA, which look at the effects of adrenal stress on other hormones, blood sugar regulation, and whether your gut is stressed.
- Urine. Relatively fresh on the scene is diurnal urinary cortisol testing via the DUTCH test from Precision Analytical. Dried urine hormone testing combines the advantages of saliva testing (ability to measure diurnal production of cortisol) and 24-hour urine testing (ability to measure hormone metabolites in addition to the hormones themselves). It’s super easy – you simply pee on filter paper four times in 24-hours. The report you get back is extremely comprehensive!
- Hair. Hair is an interesting choice because it’s quite stable as it measures the last 90 days of cortisol load. It’s a reliable measure of your allostatic load which is the wear and tear on your body that happens when you’re chronically exposed to an activated stress response.
Treating Adrenal Dysfunction
From my experience, the only way to really heal your adrenals is to remove the factors that cause imbalance and provide the factors that create balance.
The primary nutritional recommendation for treating cortisol dysfunction is supporting proper blood sugar management and consuming foods that nourish the adrenals.
For blood sugar regulation, I recommend starting your day with a breakfast rich in protein and healthy fats, such as eggs + avocado or a protein smoothie. Throughout the day, it’s important to eat regular meals (roughly every 4-6 hours) which consist of protein, good quality fats, and vegetables. Also, do not allow yourself to go really long periods without eating. Low blood sugar is hard on the adrenals. When your blood sugar drops, it tells your body you are starving – and this is perceived as danger by your adrenal system which will activate the survival hormones, cortisol and adrenaline.
There’s some research to show that, particularly in women, a very low carb diet can actually increase your cortisol. I recommend a small amount of complex carbs in the afternoon or evening to create a healthier cortisol pattern.
Foods to Avoid:
- Caffeine. Caffeine allows us to push past our natural energy limits and triggers some of the same adrenal chemicals (like adrenaline) that get fired up when we’re under stress, leading to increased cortisol production and adrenal overdrive. I recommend doing a caffeine detox for three weeks while you reset your adrenals. I know it’s hard to cut back on caffeine when you’re exhausted and hitting that 3pm slump, but cutting back (or ideally completely cutting it out) is the only way to break that vicious cycle. I can promise you that after you get through caffeine withdrawal, you will actually have more natural energy, not less! Try this energy boosting adrenal elixir as an alternative.
- Sugar and artificial sweeteners. Eating sugar causes a sharp rise in blood sugar, followed by a crash, which is really tough on your adrenals.
Supplements and Herbs
Because adrenal issues are often brain-based, most of the natural remedies I use focus on supporting optimal brain health and the brain’s response to stress.
- Methylated B Complex – to support healthy methylation pathways, which help balance the melatonin-cortisol rhythm.
- Magnesium – Magnesium is an essential mineral that up to 70% of the population is deficient in. It helps support the adrenal glands, relaxes stressed muscles and nerves and promotes quality sleep. There are various forms of magnesium. I generally recommend either Citrate or Glycinate. For someone with leaky gut, I’ll use magnesium oil which bypasses the gut and absorbs into the skin. Epsom salt baths work great too!
- Adaptogens: Adaptogens are a special category of herbs that specifically support, nourish and replenish the adrenals, whether you have adrenal overdrive or adrenal fatigue. Ashwagandha, Rhodiola, Holy Basil, and Eleuthero are my favorites for their regulating effect on cortisol rhythm.
- Theanine – An amino acid naturally found in green tea that acts on the calming, inhibitory neurotransmitter, GABA, in the brain.
- CBD – CBD is getting a ton of attention recently. For good reason! Check out my post about its benefits here.
Lifestyle, routine and consistency play a large role in adrenal health and are paramount to recovery.
Believe it or not, the best treatment for adrenal stress is not supplements, herbs or fancy diet strategies…it is simply learning to practice relaxation. Relaxation techniques let your adrenals know that you are safe, and this allows your system to recalibrate to a lower stress state, no longer needing to pump out as many stress hormones. If you have already progressed from adrenal overdrive into adrenal fatigue, relaxation techniques can help your adrenals to heal and restore themselves.
I recommend a commitment to doing one stress-relieving practice every day. Like diet, there is no ‘one size fits all’ approach here either. Everyone has to find their own practice that makes them feel calm and grounded. Some ideas are:
- Breathing exercises, such as 4-7-8, left nostril, alternate nostril
- HeartMath – Cool technology that measures heart-rhythm patterns. With more balanced and smooth heart rhythms, stress levels recede, energy levels increase and clarity, perception and cognitive performance improve.
- Gratitude journaling
- Yin or restorative yoga
- Baths – especially with Epsom salts
Exercise, but not too much! Strength training, gentle cardio and stretching are best for adrenal health. Over-doing it, especially with hard core cardio, can often make adrenal dysregulation worse.
It’s virtually impossible to heal your adrenals if you’re not sleeping! Sleep is the ultimate pause we need at the end of every day. Most people need at least seven hours of good quality sleep every night for optimal daytime functioning.
When you’re not getting adequate sleep (quantity and quality!), symptoms become exacerbated: we are more irritable, our carb cravings are out of control, we can’t concentrate, we have no energy to exercise, we can’t lose weight, our digestion and hormones are a mess, we get sick more often…the list goes on! On the other hand, good sleep makes us happier, healthier and more relaxed in every way. If your sleep could use some work, check out some of my sleep tips here.27