Low energy. Brain fog. Depression. Sugar cravings. Insomnia. Irritability. Lightheadedness. Fertility problems. Body aches. Digestive issues.

These are some of the most common symptoms of what is commonly known as “adrenal fatigue.” But the biggest problem is that many patients go to their doctor, explain these symptoms, and share their concern that they are struggling with adrenal fatigue, only to be told by their doctor that adrenal fatigue isn’t real.

So, is it real?

Yes. The symptoms are absolutely real–and they are absolutely related to the adrenal system. However, no, the idea that the adrenal glands become “fatigued,” so causing the above symptoms, isn’t quite how things work. Instead, we use the phrase hypothalamic-pituitary-adrenal axis dysfunction. Let’s dig in…

Stress, adrenal glands, cortisol, oh my!

Let’s first talk about what the word “stress” means. The way I typically think about stress is any condition under which the brain or body needs to be operating at a higher-than-normal level. This could be psychological (i.e. demands at work or school), emotional (i.e. relationship problems), physical (i.e. induced by exercise or sickness), or nutritional (poor diet in terms of quantity and/or quality). Whenever we are in a stressful situation, our bodies release stress hormones into our blood stream, which help our minds and bodies to respond to the stressful situation. The most notable of these stress hormones is cortisol.

Cortisol is produced in the body through a feedback loop called the hypothalamic-pituitary-adrenal axis. Basically this means that the hypothalamus and pituitary gland (two parts of the brain) work together with the nervous system to communicate with the adrenal glands (located in the abdomen) to produce cortisol. This cortisol is released into the blood stream and acts on every organ of the body to get it ready to encounter the stressful situation. Some of these stress responses include:

• increased blood sugar (for quick energy)
• increased heart rate and blood pressure (to get the body moving)
• decreased digestion (who has time to run to the bathroom when they’re being chased by a bear?)

This loop is important for two reasons. First and foremost, the hypothalamus and pituitary axis are responsible for managing more than just the stress response in the body. These two parts of the brain utilize hormonal signals to regulate almost every other system in the body — everything from digestion, to fertility, to the thyroid…you name it! When stress levels are high (or stressful situations are frequent), the hypothalamus and pituitary gland are forced to focus their efforts on managing the stressful situation. That means the other bodily systems fall to the wayside, which is why many people struggle with fertility and digestive issues, for example, due to stress. Although this is frustrating, it makes a lot of sense, because fertility and digestion don’t matter so much if you get eaten by a bear. The most important thing is to get away from the bear so that you can survive long enough to worry about fertility and digestion! The issue, of course, is that we are rarely chased by bears in the modern age. Instead, we’re chased by thoughts of monstrous work assignments, relationship issues, and other worries. Or, we’re doing a whole lot of running even though there are no bears around (too much exercise). For us in our modern age, the chronic stress response isn’t about survival…it’s a health problem.

The second important consideration of this HPA-axis feedback look is the concept of cortisol resistance. This is the term we use to describe the syndrome of “adrenal fatigue.” In this situation, the cortisol rise and rise and rise, until they can’t rise any more without causing huge problems. The result is elevated cortisol that isn’t having the intended effect. (There’s a need for more of a stress response in the body, but the adrenals are working at capacity.) We call this cortisol resistance. It’s almost as if the brain is saying “we need more cortisol” and the adrenals respond by saying “I don’t think that’s a good idea!”

Out of a protective effort, the high levels of cortisol signal to the hypothalamus to stop signaling so much. In some regards, operating the adrenals at max capacity still isn’t enough, and so the body recognizes that it had might as well pull back on the amount of cortisol it produces. Just like an overworked pancreas eventually stops producing insulin in late stages of type 2 diabetes, the adrenal glands can stop producing enough cortisol to maintain healthy responses. Some circles refer to this as “fatigue,” but the adrenals don’t really get fatigued. It’s more that the body has reached its maximum stress threshold and protectively responds by shutting itself down. But it feels a lot like fatigue.

Supporting the HPA axis

The best way to avoid “adrenal fatigue” or cortisol resistance is to avoid reaching “max capacity” of the body’s stress response. While some stressors are unavoidable, others are much more manageable. Emotional and psychological stressors are much more difficult to control than physical and nutritional ones, however, so it’s always a good idea to start with a balanced diet, keeping up with regular, moderate exercise, and sleeping enough. (Here are some more tips for stress management.)

For everything in between, which we have less control over, we can support our adrenal responses with herbs and supplements that help us respond to stress on a biochemical level. The mechanism of action of some of these nutraceuticals vary, but the main idea is that they help reduce inflammation, moderates the severity of the stress response to any given trigger, and helps the body recover from stress faster. Some of these evidence-based supplements include:

• Panax ginseng (Korean ginseng): improves sensitivity to cortisol, so the body doesn’t have to produce as much
• Eleutherococcus senticosus (Siberian ginseng): reduces systemic effects of stress by moderating blood pressure and heart rate, reducing symptoms of anxiety, and enhancing recovery from physical stress
• Ashwagandha (Indian ginseng): counteracts biological effects of extreme stress like changes in blood sugar, helps reduce cortisol levels, reduces anxiety behaviors
• Rhodiola rosea: protects the cardiovascular system against long-term effects of stress
• Phosphatidylserine: counteracts stress-induced activation of the HPA axis
• Cod Liver Oil: reduces cortisol spike following a stress trigger

To sum things up…

Stress in life is unavoidable, but there’s a lot we can do to improve our health by managing our exposure to stress…especially long-term. From eating well, to managing exercise and sleep, to keeping work-life-balance in check, we can support our bodies’ natural ability to respond to stress. Coming down off a “stress high” (or low, really) can be really challenging to do, but working with a functional medicine provider to use herbs, supplements, and lifestyle techniques for managing the HPA axis can make a world of difference.