Adrenal burnout. It means fatigue, irritability, anxiety, and maybe even weight gain, caused by low cortisol, poor mitochondrial function, and unbalanced hormones. If you told your doctor you suspected adrenal fatigue, you’d likely be sent to an endocrinologist who may test you for Addison’s or Cushing’s diseases, relatively rare endocrine disorders that indicate very low or high cortisol (your main stress hormone) levels. The treatment is surgery and medication. That’s not what we’re talking about here.

Is Adrenal Fatigue Real?

I’ve had clients say their doctors have told them adrenal fatigue is an outright hoax. Adrenal fatigue isn’t acknowledged in the conventional medical model because it is not a disease for which drugs can be prescribed, and that’s how our medical system works. More importantly, adrenal fatigue really doesn’t mean your adrenals are tired. It’s not a condition of the adrenals but rather a breakdown in communication between the brain and the endocrine system and a faltering of your mitochondria to produce energy on a cellular level. 

Adrenal fatigue should really be called hypothalamic-pituitary-adrenal (HPA) axis dysfunction, which is a fancy way of saying that the feedback loop between the brain and the adrenals is fried, so there is miscommunication and resistance about when and how to release stress hormones. (read more about the HPA axis here). Adrenal fatigue isn’t the fault of the adrenals per se; it’s a dysfunction between the brain and adrenal glands. When you experience chronic stress, your brain thinks your body is in grave danger, so it’s sending constant fight or flight commands to the adrenals, telling them to release cortisol. When this response becomes chronic, problems arise.

Your adrenals are 2 small glands that sit atop your kidneys and produce cortisol and sex hormones. In many ways the HP axis and the adrenals are the command and control center for your body, and they help you manage your stress levels, hormone levels, thyroid function, sleep, sex drive, and metabolism. When everything is functioning normally, you have good and stable energy throughout the day, you sleep well, you have a good sex drive, and you maintain your weight.

When you encounter stress, the body reacts with a chain of hormonal events to get you ready for battle. Corticotropin-releasing hormone (CRH) is released from the hypothalamus. CRH stimulates the production of adrenocorticotropic hormone (ACTH). ACTH stimulates the release of cortisol, the body’s main stress hormone. Cortisol keeps blood sugar and blood pressure elevated so you’re able to fight or flee and stay alive during the stressful event. This is a normal and healthy stress response.

But when you are chronically stressed and this chain of events is continuously triggered, your cortisol stays elevated, you become eventually depleted of the hormones you need to battle the stressor. At this point you are facing burnout and may also notice anxiety and depression, as serotonin is depleted when cortisol is chronically elevated, and now there is neuroendocrine dysfunction.

This dysfunction goes beyond the HPA axis. Stress eventually makes you fatigued because your mitochondria, the cells’ powerhouse that generate energy, are faltering. The mitochondria use nutrients from the food you eat, break them down, and create energy for the cell. When the body is chronically stressed, its survival mechanism response is to down-regulate to conserve energy and keep you alive. This means your adrenals and thyroid slow down. Your mitochondria detect stress, inflammation, the resulting nutrient deficiencies, and danger, and begin to shut down to conserve cellular energy. You’re not going to be firing all cylinders when energy and nutrients are scarce. It’s a brilliant design, but the result is layers of dysfunction throughout the body, not solely in the endocrine system.

Adrenal fatigue is a constellation of symptoms, such as insomnia, anxiety, fatigue, or brain fog, that disrupts your day-to-day life. These nagging issues wouldn’t send you to the hospital, maybe not even the doctor, but they are your body’s way of signaling to you that there is an imbalance. People may ignore these signs, thinking it’s part of stress or “getting old,” or they may go to a doctor who will prescribe them meds based on their symptoms: Ambien for insomnia, for example, or antidepressants and anti-anxiety meds. But here again, the underlying imbalance isn’t addressed, and the problem continues until it triggers a full blown illness or disease.

When your adrenals begin to falter, you may notice

• fatigue
• weight gain
• digestive issues such as bloating, constipation, diarrhea
• sugar and/or salt cravings
• the “3pm crash”
• brain fog
• irritability
• increased susceptibility to illness
• decreased ability to handle stress, feeling frazzled
• insomnia or waking around 3-4am, unable to get to sleep
• anxiety
• depression
• PMS/hot flashes associated with menopause
• inability to focus
• low sex drive

Causes of Adrenal Fatigue

• emotional stress. Interestingly, 95% of adrenal fatigue cases are precipitated by extreme emotional stress. I see this regular pattern in my practice all the time. That could be a death, divorce, injury, job loss, OR even positive stress like getting married or having a baby. Chronic stress trips the body into slowing down to conserve energy and resources to keep you alive. Stress really is the main cause of imbalance in the body.
• diet and deficiencies. Too many processed foods, too much coffee/caffeine, irregular mealtimes, refined sugars, nutrient poor meals, not eating enough, or eating foods that lack nutrients because they are processed or refined. Your body isn’t getting the nutrients it needs to heal, repair, and replenish.
• pain, chronic inflammation
• microbiome imbalance & digestive infections such as h pylori, dysbiosis, SIBO, candida, parasites (more common than you might think!)
• lack of sleep
• autoimmune conditions

What starts out as chronic stress is usually burning the candle at both ends: staying up all night studying (or partying), chugging coffee or sodas, working 2 jobs, working 80 hours a week, skipping meals, sleeping only 4 hours a night– or not at all. People typically feel pretty good in this stage because your body is churning out more cortisol in response to the stress to make you more alert and get you through whatever you’re doing (the fight or flight response). A little stress is normal and good, and we all have it. BUT it’s your body’s ability to recover that matters, and if you’re not sleeping or eating well and continue in stress mode for years, you’re headed for burnout because your body doesn’t have the chance to recuperate.

Once your body can’t keep up with your stress levels, you start to burn out. Your brain is signaling that there is a stress, but your adrenals can’t produce the required amount of cortisol to keep you going, and you start to crash. Now you’re in adrenal burnout and experiencing low cortisol. Your resources to fight the stressor have been depleted. If you’re a woman, you may start to have irregular cycles or a worsening in PMS symptoms because your body is starting to borrow molecules of other hormones, like progesterone (one of your main female hormones), to make cortisol. Your body perceives that survival is more important than reproduction, so women notice infertility or cycle irregularities. Your body knows a stressed environment is not ideal for creating a baby! This lack of progesterone can leave you estrogen dominant. (Read more on that here).

You may also experience symptoms of hypothyroid, such as constipation and thinning hair, because your adrenals affect your thyroid as well as your female hormones. You’re probably tired or having trouble sleeping, and you may be gaining weight (especially around the midsection) and are unable to lose it no matter what, because your metabolism has slowed due to your body being in a state of stress. A stressed body is not in fat burning mode– it’s working to conserve resources.

If you continue down this path, chugging caffeine to keep yourself going, skimping on sleep to get your work (or your partying) done, or skipping meals to prevent gaining even more weight, you’re headed for serious burnout. The kind you can no longer ignore. At this point, your adrenals, thyroid and female hormones are imbalanced, and even though your doctor may look at you, perplexed, because your blood work came back ok, you know there’s something wrong because you’re not feeling right, you’ve gained weight, maybe have anxiety, and your hormones have gone haywire.

How to Reverse Adrenal Burn Out

• saliva testing to determine cortisol levels
• support mitochondrial health
• restore circadian rhythm
• SLEEP, at least 8 hours nightly. In bed by 10pm. THE MOST IMPORTANT FACTOR!
• eat in regular intervals to maintain stable blood sugar
• eat enough calories for healing
• eat hormone-building, nutrient dense foods and good fats
• stop chugging coffee (green tea is ok)
• support digestion with probiotic foods
• minerals and vitamin C
• adaptogenic herbs
• B vitamins
• address stress in job, relationships
• self care: naps, massage, detox bath, gardening, yoga, meditation

The first step is saliva testing to determine what your cortisol levels look like. Some doctors may offer blood testing for cortisol, but they’re not nearly as accurate and only offer one snapshot of what your cortisol levels are doing during the day. The saliva test requires 4 samples so you get an idea of your cortisol rhythm. They should be highest in the AM to wake you up and get you through the day, lowest at night so you drift off to sleep. If cortisol is too low, say, in the morning, you’ll be tired. If it’s too high at night, you can’t sleep. Your body is in sync with the natural rhythm of light and dark, and the closer you can re-establish that circadian rhythm, the quicker you’ll heal. The saliva testing measures your cortisol rhythm, then you’ll have the information you need to repair. High cortisol is treated much differently than low cortisol, so it’s important to test and see what your rhythm looks like.

It’s important to note that focusing on cortisol alone won’t help. Think about it: if your cortisol levels are low and you just pump in more cortisol or supplements to solely boost cortisol, you’re forcing an already exhausted system to ramp back up. This approach can make people feel worse. Healing happens on a cellular level, and flooding the body with nutrients to nourish, support, and rebuild the mitochondria while addressing hormone balance is a more comprehensive solution.

circadian cortisol rhythm

The second step is to combine a healing protocol with a nutrient dense diet. Make vegetables of all types the base of every meal. High quality, organic, and fatty acid rich protein such as wild fish, grass fed beef, lamb, and eggs at every meal in amounts appropriate for you. Tons of mineral-rich veggies and sea veggies, because the adrenals require minerals to function. Lots of sea salt (which is probably welcome, because you might be craving salt!); good fats like coconut oil, butter, olive oil; superfoods like bone broth, organ meats, raw kraut/probiotic foods, anti-inflammatory foods. B vitamins and amino acids are critical to nourish the mitochondria.

Some of the supplements needed to heal adrenal fatigue are

• vitamin C
• adaptogenic herbs. I recommend GAIA, maca root, adrenatone, and/or licorice root (for low cortisol only!)
• Adrenal glandular support supplement (ONLY buy from trusted companies!)
• minerals
• B vitamins
• PQQ for the mitochondria. Read more on PQQ here.
• Branched chain amino acids
• blood sugar support, if needed (How do you know? You have energy spikes and crashes and sugar cravings). I like this one.
• I love Adrecore to heal adrenal fatigue and the neuroendocrine axis, especially if mood imbalances are present
• certain nutrients, like phosphatidylserine, can encourage sleep at night if cortisol is high when it should be low.
• nettles and tulsi tea

To restore your natural circadian rhythms, put your body on a schedule. Wake up at the same time. Eat every 4 hours. Go to bed by 10pm. No later. Sleep is the key factor for healing. Be sure to manage your blood sugar, because blood sugar highs or lows stress the adrenals. This means cut the refined foods, gluten, white sugar, sodas, coffee and nightly wine (sorry), and stop skipping meals. Support digestion with probiotic foods like raw kraut or this coconut water kefir, my favorite source because you also get the benefits of coconut water along with a hefty dose of probiotics. If your digestive tract is inflamed from too much bread and sugar and wine, you won’t absorb nutrients from all the great food you’re now eating. And, remember: your body perceives inflammation as a stressor, so an inflamed GI tract can worsen adrenal fatigue! You may want to take a probiotic supplement to support digestion.

refined flour and white sugar jack your blood sugar levels, which stresses your adrenals

Adaptogenic herbs like maca, rhodiola, schizandra, ashwaganda, licorice root and holy basil can really help. I have to stress that you should work with a practitioner to help you determine exactly what you need– don’t go it alone! Some of these herbs, especially if taken at the wrong times, can make you feel worse or further aggravate insomnia, for example.

The lifestyle factors are the most important. You won’t get better if you don’t change your habits– sleep, stress, and diet.  I cannot stress this enough; so much so, in fact, that I wrote an entire post about it. Keeping stable blood sugar balance is crucial. I’ve had clients take time off work to heal because they understand their health is so important– and that they will prevent medical bills in the future (as well as the inability to work because they’re on disability with chronic fatigue syndrome). Fix your stressful relationships, and have I mentioned? SLEEP. Take a day per week and unplug to help calm down an overstimulated and exhausted mind and body. Click here for my sleep tips. Certain nutrients like magnesium and Seriphos (a phosphatidylserine supplement) can help bring down high cortisol at night and help you sleep if you’re having trouble. Healing your adrenals will reverse sleep issues long term, but it may take some time. Also, stop over-exercising and find an activity that rejuvenates you, whether it’s gardening, yoga or meditation.

Testing for and correcting adrenal fatigue is an example of preventive health care. If you can reverse adrenal fatigue, it’s possible to prevent the illnesses that can be caused as a result of long-term hormone imbalance and stress. Not to mention you’ll feel better, look better, sleep better and be healthier.

Mary Vance, NC

Mary Vance is a Certified Nutrition Consultant and author specializing in digestive health. She combines a science-based approach with natural therapies to rebalance the body. In addition to her 1:1 coaching, she offers courses to help you heal your gut and improve your health. Mary lives in San Francisco and Lake Tahoe in Northern California. Read more about her coaching practice here and her background here.