Fatigue is one of the most common symptoms we hear about. And when we ask these women to tell us about what's going on in their lives, all too often the answers reveal they have more responsibility in their lives than seems humanly possible to manage.
They're waking up still tired and unable to think straight in the morning without caffeine; needing high-carb snacks, additional caffeine, or naps to get through the afternoon, then burning the midnight oil because they're too wired at this point to sleep. Alcohol or sleep aids are sometimes used to unwind, which can disrupt normal sleep patterns, setting them up for non-refreshing sleep. Pretty soon they're caught in a seemingly unending cycle of exhaustion and poor nutrition, desperate for the energy they once had.
How chronic stress affects the adrenal glands
Science tells us that if you experience stress on a chronic basis, the tiny adrenal glands that moderate your stress response and keep many other hormones balanced will suffer. The stress response — when the adrenals produce the hormone cortisol — is normal. We need cortisol to handle emergencies. However, the stress response is designed to be short-term, with a fairly quick return to a relaxed baseline.
Unfortunately, our adrenals don't know the difference between a true emergency and the stress from merely sitting in a traffic jam. Many of us stay revved up all day in a ‘fight-or-flight' state. But when cortisol stays elevated like that, our bodies gradually become less sensitive to the mechanism that helps bring it back to normal.
The consequences of high cortisol
Chronically high cortisol interferes with digestion, immune function, sleep, and the body's ability to produce other essential hormones, such as DHEA, testosterone, estrogen, progesterone, and thyroid hormone. Over time, unrelenting cortisol production can contribute to excess abdominal fat, high blood pressure, high blood sugar, and aches and pains from too much inflammation. It demands too much from the adrenal glands and affects DHEA production, which in turn compromises bone health, immunity, mood, and sex drive.
As the adrenal glands become increasingly compromised, it's harder for them to make cortisol. Instead, extra adrenalin is produced to compensate, which can make us irritable and shaky. Adrenal fatigue can cause low blood sugar, anxiety, inability to concentrate, lightheadedness on standing, allergies, and low blood pressure. Now we are on our way to pure exhaustion.
On the upside, adrenal dysfunction can be healed. Although stress management (both decreasing your stress load and adjusting your emotional response to stressors) is the most important step in reversing adrenal fatigue, changing what you eat, when you eat, and how you eat can make a dramatic difference. Let's look at some easy dietary approaches for supporting your adrenals — so you can enjoy good energy all through the day, and get a great night's sleep.
First and foremost: timing your meals and snacks
One thing we often tell women is to never allow themselves to get too hungry. Low blood sugar alone produces a stress reaction in the body and can tax the adrenals. You may not realize that your body is in constant need of energy — even as you sleep. And because cortisol is the primary adrenal hormone, it serves as a kind of moderator in making sure your blood sugar between meals, especially during the night, stays adequate.
Long periods without food make the adrenals work harder by requiring them to release more cortisol and adrenalin to keep your body functioning normally. Eating three nutritious meals and two to three snacks throughout the day is one way to balance blood sugar and lessen the adrenal burden.
When you eat your meals and snacks can make a big difference. As you can see in the graph, cortisol follows a natural cycle that works with your circadian rhythm. Normally, it begins to rise around 6:00 AM and reaches its highest peak around 8:00 AM. Throughout the day, cortisol gradually and naturally declines — with small upward bumps at meal times — to prepare your body for nighttime rest. That's why cortisol is normally at its lowest level during the night.
Ideally, you want to work with this natural cycle to keep the tapering-off of levels as smooth as possible as the day progresses, and to avoid dramatic ups and downs. Eating the majority of your food earlier in the day can help accomplish this, so can eating an early dinner (by 5:00 or 6:00 PM). If it's difficult for you to eat early, you can at least try to make your evening meal the lightest one of the day. Many women tell us they overeat at dinner and before bed to soothe themselves in the evening. But if our cortisol levels are still high at this time, we'll be attracted to foods that are high in sugar and fat. Unfortunately, this “night-eating” habit usually can further upset our hormone balance.
Keep in mind that cortisol will also rise a bit with exercise. Lighter activities, such as a walk after dinner or some gentle stretching, will not interrupt this natural tapering-off process. But to work in concert with your body's natural cortisol cycle, more intense exercise is best planned for the morning or early afternoon.
But I’m not hungry in the morning...
As your mother probably told you, breakfast is important. But maybe you don’t feel hungry in the morning, and if so, it could be for the following reasons:
- Corticotrophin-releasing hormone (CRH), which has appetite-dulling effects, begins to enter the bloodstream at a fast rate first thing in the morning.
- Decreased liver function, which can accompany adrenal dysfunction or a heavy toxic burden, can also dampen morning hunger.
Even if you don’t feel hungry, having a nutritious breakfast within an hour of rising — preferably with protein — will provide energetic benefits to your metabolism and cortisol levels that last throughout the day.
Here are some simple tips for the timing of meals and snacks, which can help support your body's natural cortisol cycle:
- If possible, eat breakfast by 8:00 AM or within an hour of getting up (earlier is better), to restore blood sugar levels after your body has been relying on glycogen stores for energy during the night.
- Eat a nutritious snack around 9:00AM, to soften the natural dip in cortisol in late morning.
- Try to eat lunch between 11:00 AM and 12:00 noon because your morning meal can be used up quickly.
- Eat a nutritious snack between 2:00 and 3:00 PM to get you through the natural dip in cortisol around 3:00 or 4:00 in the afternoon.
- Make an effort to eat dinner around 5:00 or 6:00 PM, and make this your lightest meal of the day.
- Finally, eat a light and nutritious snack about an hour before bed. This should ideally include some carbohydrate to help with sleep, perhaps some cheese or nut butter with fresh fruit — avoid refined sugar carbs.
Supporting your body's natural rhythms by properly timing meals to prevent dramatic dips in blood sugar has lots of benefits: it minimizes cortisol output and frees up your adrenals to perform their secondary functions, and also gives you more sustained energy throughout the day. Life becomes much more enjoyable when you have the energy you need!
Eat, drink, and support adrenal gland function
As our awareness increases about when we eat, it's also helpful to think more about what we eat. Stress often brings out the worst in our food choices. Women with adrenal fatigue tell us they reach for foods and drinks that give them instant energy — cookies, cakes, doughnuts, white bread, coffee, or soda. Craving sweets makes sense — it's the body's normal response to low blood sugar.
Unfortunately, the surge of energy you get from consuming these foods is followed by an even greater dip in energy, causing you to feel worse. Sugar and simple carbohydrates stimulate a spike in blood sugar and a subsequent spike in insulin that clears sugar from our bloodstream so fast that we “crash.” Complex carbohydrates don't cause this same spike and crash, though too many carbs in general can still imbalance blood sugar.
We often suggest a gluten-free diet and limited caffeine for women with symptoms of adrenal imbalance. Many women don't realize that caffeine can over-stimulate the adrenals and affect sleep patterns.
Choosing adrenal-healthy beverages
Just as with food, your choices about drinks can either support or strain your adrenal glands. Here are some not-so-good choices and some healthy alternatives.
- Drinks that contain caffeine
- Ginseng [Panax sp.]
- Eleuthero/Siberian ginseng [Eleutherococcus senticosus] (in the morning)
- Herbal teas like chamomile, passionflower, valerian
- Vegetable juice (with salt), like V-8
If you find yourself craving caffeine or refined carbohydrates, it may be that your cortisol or blood sugar is low or that your serotonin is imbalanced. In any case, you may not have much energy and your body probably needs a rest. I encourage you to honor your body's request and take a break, instead of cranking it up another notch. Treat yourself to some deep breathing or a ten–minute walk. And if drinking a cup of coffee is a relaxing part of your routine, drink it in the morning along with something nutritious to eat, and add cream to help dull the negative effects of caffeine.
Try, in general, to eat meals and snacks made of fresh whole foods, preferably organic or locally grown, without colors, dyes, chemicals, preservatives or added hormones. Including some protein in all of your meals and snacks (especially in the morning) will have a stabilizing effect on your blood sugar, which, in turn, can help you overcome cravings for caffeine and sugars. No longer will it be an issue of will power. (For more information on eating balanced meals, see our Nutritional Guidelines.)
To lessen the stress that's often associated with making dietary changes, consider preparing additional servings of nutritious foods on the weekends so you have them ready and available on busy weeknights, or stop at a health food store to pick up some hot prepared food. Don't feel guilty if you veer off the nutritious path occasionally.
Bingeing, especially on sugar, can often lead to feelings of guilt or self-disappointment, making you want to throw your hands up and surrender. But don't worry. Eat your best 90% of the time and the other 10% is up to you because guilt is the last thing your adrenals need!
Salt and adrenal imbalance
Women with adrenal fatigue often crave salt — and many women should give in to this craving. Yes, salt can increase blood pressure, but low blood pressure (hypotension) is a very common sign of adrenal insufficiency. If you feel lightheaded when you get out of bed in the morning, stand up quickly, or get up out of a bath or hot tub, you may very well have low adrenal function, so including more salt in your diet could be helpful. But try to make it good-quality sea salt.
Salt cravings in people with adrenal insufficiency are mostly due to low levels of aldosterone, a steroid hormone that, like cortisol, is produced by the adrenal cortex. Aldosterone is part of the complex mechanism that regulates blood pressure in the body, partly by helping the body to hang on to salt and water. Levels of aldosterone go up and down in a similar diurnal (daily) pattern as cortisol, and also are influenced by stress. Generally speaking, when cortisol goes up, aldosterone goes down, lowering blood pressure. If cortisol levels stay high, or if your adrenal glands run out of steam, chronically low aldosterone can disturb both electrolyte balance and cell hydration. Increasing your salt intake is one way to help restore these imbalances.
If you need additional support for adrenal health
Our Essential Nutrients provide an optimal nutritional foundation for your adrenal health. Some women will still need extra nutritional and/or herbal support for healing adrenal imbalance. Several key herbs that support adrenal function are called ‘adaptogens' because they can adapt to the needs of your body, nourishing and strengthening the adrenals, whether they're over- or underactive. Here are our top recommendations for adaptogenic herbs and key nutrients:
- Ashwagandha (Withania somnifera)
- Eleuthero / Siberian ginseng (Eleutherococcus senticosus)
- Astragalus root (Astragalus membranaceus)
- Schisandra (Schisandra chinensis)
- Rhodiola rosea
- Licorice root (Glycyrrhiza glabra)
- Extra B vitamins (B-complex)
You can begin on your own with B vitamins and the first two herbs listed above. If you do not notice improvement within a few weeks, consult a functional medicine or naturopathic practitioner to create a program that best fits your personal needs — dosage, timing, blood pressure, and cortisol levels are some of the factors that should be taken in to consideration.
A nutrient-rich foundation — essential for healing adrenal imbalance
If you decide to do nothing else for your adrenals, provide your body with a strong nutrient base. The vitamins, minerals and other micronutrients available in a pharmaceutical-grade supplement like the one in our Adrenal Health Program are absolutely essential for healing and reversing adrenal fatigue — as well as for the everyday workings of your adrenal glands.
Vitamins like C, E and all the B vitamins (especially pantothenic acid and B6) have crucial roles in the production and actions of stress hormones. And a mineral like magnesium provides necessary energy for your adrenals — and every cell in your body — to function properly. Calcium and several trace minerals, like zinc, manganese, selenium, and iodine, provide calming effects in the body. These minerals can help relieve the stress associated with adrenal fatigue and imbalance, which will ultimately restore normal cortisol output.
A strong nutrient foundation also supports the endocrine system overall. There is great synergy between the different organs of the endocrine system, including the adrenal glands. And when hormonal levels become deficient or excessive, our cells count on extra nutritional support to compensate.
Small changes, dramatic adrenal differences
Your adrenal glands are tiny in comparison to many other organs — each is roughly the size of a walnut — yet they have enormous responsibilities in your body. When they are functioning properly, these small glands help you feel energized when you need to be and relaxed when it is time for rest. They produce cortisol and DHEA, and contribute to the production of estrogen, testosterone, progesterone, and so much more. But life's demands can slowly drain the balancing power of the adrenal glands. Even the healthiest person's adrenals become impaired under chronic, unrelenting stress.
You have the power to lessen the burden on your adrenals — and your whole body. It doesn't take much. The small choices you make in regards to your nutrition and eating patterns will make a big difference. Here's our advice to you: in addition to exploring stress management, support your body with a high quality nutritional supplement and eat good food in harmony with your own natural daily rhythms. Soon you'll find the energy you thought was lost — and it will be here to stay!
1 Wilson, J. 2007. “Assessment of adrenal function: Integrating laboratory and symptoms.” IFM 14th International Symposium, 05.27.2007, Tucson, AZ.
2 Wilson, J. 2001. Adrenal Fatigue: The 21st Century Syndrome. Petaluma, CA: Smart Publications.
3 Takeda, E., et al. 2004. Stress control and human nutrition. J. Med. Invest., 51 (3–4), 139–145. URL (full text): http://www.jstage.jst.go.jp/article/jmi/51/3,4/51_139/_article (accessed 04.29.2008).
4 Mitchell, P. 1992. Effects of caffeine, time of day and user history on study-related performance. Psychopharmacology (Berl), 109 (1–2), 121–126.
5 Burchfield, G. 1997. What’s your poison? Caffeine. URL: http://www.abc.net.au/quantum/poison/caffeine/caffeine.htm (accessed 06.08.2006).
6 Stansbury, J. 2007. “Helping the stressed adrenals: Dietary, nutritional, and botanical supplementation.” IFM 14th International Symposium, 05.25.2007, Tucson, AZ.
Further reading on the connections between nutrition and adrenal fatigue
Adrenal Fatigue, the 21st Century Stress Syndrome, by James Wilson. An excellent and up-to-date introduction to the pathways of chronic stress, adrenal fatigue, adrenal exhaustion, and how nutrition can support adrenal function and healthy cortisol levels.
The Relaxation & Stress Reduction Workbook, by Martha Davis.
The Cortisol Connection: Why Stress Makes You Fat and Ruins Your Health, by Shawn Talbott & William Kraemer.
The Relaxation Response, by Herbert Benson, MD. An updated version of the classic text.
The Schwarzbein Principle II, Dr. Schwarzbein’s second book, explores more deeply the relationship between adrenal stress and insulin resistance.
Dalvi, S. 2003. Adrenal Fatigue: A Desk Reference. Sandy Beds, UK: Authors Online.