What all these symptoms have in common is the indication that a person may be suffering from a form of chronic stress commonly known as “adrenal fatigue.” While it’s important to keep in mind that the cause behind these symptoms is not always adrenal fatigue (many other health concerns can present with these symptoms,) adrenal fatigue is a common topic that comes up in the Functional Medicine conversation.

Because the goal of Functional Medicine is to restore the body to optimal function, understanding adrenal fatigue first requires some context about how the body’s stress organs and stress responses ordinarily function under optimal circumstances.

Understanding Your Body’s Stress Response

The human nervous system always occupies one of two stress-related states—parasympathetic and sympathetic—commonly referred to as the “rest-and-digest” state or the “fight-or-flight” state, respectively.

During moments of relaxation, the parasympathetic nervous system is activated, and we enjoy all of our bodies’ healthy, restorative, balancing physiological functions. These include digestion, low blood pressure and heart rate, fertility, and a feeling of peace and calm.

During periods of stress, the sympathetic nervous system or “fight-or-flight” system becomes dominant, increasing heart rate and blood pressure, and slowing down bodily functions that are not essential in overcoming the stressor.

While it is both normal and expected for us to face periods of stress throughout our lives (maybe even on a daily basis, to some extent), staying in the sympathetic state for too long or facing stress triggers too frequently can lead to health problems that often bring debilitating symptoms.

What is Adrenal Fatigue?

Life stress comes in many different forms, though we often think of it in terms of psycho-emotional factors such as work demands or relational strains. However, the stress response in the body may also be triggered by illness, exertion (including intense exercise), nutritional inadequacies (especially under-eating), and more.

When a healthy person faces stress in his or her life, the body’s natural stress system (the sympathetic division of the nervous system) is well equipped to handle it. In a healthy stress response, the brain sends signals to a pair of glands located in a person’s abdomen, triggering the release of stress hormones. These hormones, including adrenaline, cortisol, DHEA and more, then enter the blood stream and travel throughout the body to create changes such as slowed digestion, elevated blood pressure, dilated pupils, an increased heart rate and breathing rate, increased mental focus, and more.

Once the stress trigger is overcome, everything is then free to relax: the adrenal glands stop producing the high level of stress hormones, and we resume our status quo.

The Stages of Adrenal Fatigue

When a person is exposed to too much stress—that is too long, or too frequently—the body’s stress response falls into dysfunction. This dysfunction follows a predictable pattern, culminating in a set of symptoms commonly known as adrenal fatigue:

• Stage 1: In the first stage of chronic stress, the body’s stress response becomes overactive, in a sense. This means that the release of stress hormones in response to a trigger increases more quickly than usual and remains elevated even long after the stress trigger has resolved.
• Stage 2: In the second stage of chronic stress, after the body has been stuck in a heightened stress state for a period of time, the body begins to lose track of what is and is not an appropriate reason to elicit a response. This results in a functionally backwards pattern in which the body triggers stress hormones to be released during times when no stress trigger exists; likewise, in situations in which a person might expect to feel triggered, the body fails to produce the appropriate stress response.
• Stage 3: In the third stage of chronic stress, the body altogether fails to produce a normal stress response. Even when real triggers are present, the nervous system fails to communicate with the adrenal glands properly, which subsequently fail to produce sufficient levels of stress hormones. The symptoms that accompany this stage are often referred to “burnout” or “adrenal fatigue,” but the medical term for all three stages of the chronic stress syndrome is hypothalamic-pituitary-adrenal axis dysfunction, or HPA axis dysfunction.

The timeline for progression through the three stages of HPA axis dysfunction—and chronic stress—looks different for different people, and depends on factors like age, biological sex, co-existing diagnoses, and personal history. This means that some people facing chronic stress may progress quickly to stage 3, possibly within just a few months, but others may not reach that point for years.

What Are the Symptoms of Adrenal Fatigue?

The specific symptoms may likewise differ from person to person, but most people experience some of the following:

• Body aches and pains
• Hair loss
• Headaches or migraines
• Skin discoloration
• Weight gain or weight loss
• Loss of libido and/or motivation
• Anxiety or depression
• Frequent respiratory infections
• Low blood pressure
• Dizziness
• Fatigue
• Mental confusion (i.e. “brain fog”)
• Insomnia

What Causes Adrenal Fatigue?nbsp;

Chronic exposure to psycho-emotional stress is the most commonly known cause of HPA axis dysfunction, though it is not the only one. Excessive exercise, inadequate nutrition habits (especially undereating), use of stimulants such as caffeine or nicotine, poor sleep habits, use of certain medications, and other lifestyle habits may also contribute to the development of adrenal fatigue. For most patients, it is a combination of triggers over time that ultimately predisposes them to develop symptoms.

However, the symptoms of adrenal fatigue are not unique to HPA axis dysfunction. This means that other conditions may be the true root cause. Other conditions that may contribute to the development of these symptoms include:

• Thyroid dysfunction
• An imbalance in gut bacteria
• Nutritional deficiencies
• Clinical depression, anxiety, or other mood disorders
• Adrenal diseases such as Addison’s Disease
• Neurologic disease
• Autoimmune disease
• …and more!

Because the of the diversity of potential causes underlying a person’s symptoms, it’s essential to not assume that adrenal fatigue is the correct label. Functional Medicine Doctors at Aligned Modern Health are committed to an evidence-based approach, which means that we run diagnostic tests with our patients so that we can make accurate diagnoses and put together a safe, effective, and minimally invasive treatment plan for our patients.

How Does Functional Medicine Test for Adrenal Fatigue?

Testing for adrenal fatigue involves a combination of blood test and specialty diagnostic testing through saliva. Depending on a patient’s symptoms and history, his or her Functional Medicine Doctor may order some additional or alternative tests in order to rule out the possibility of other conditions. The most common test used in suspected cases of HPA axis dysfunction is a saliva test which a patient completes by collecting saliva samples in small tubes at different periods throughout the day. These tubes are then sent to a laboratory for analysis of hormone levels, and the results are then assessed by the doctor in making a diagnosis and putting together a treatment plan.

How Does Functional Medicine Treat Adrenal Fatigue?

Because everybody is different and the underlying factors contributing to HPA axis dysfunction vary so widely from person to person, treatment plans likewise look different for each patient. However, every treatment plan will involve a variety of lifestyle interventions (nutrition, exercise, sleep hygiene, stress management) and nutraceuticals (clinical-grade herbs and supplements) to help support the body in healing. Some patients may also be referred for co-management with other providers, such as an acupuncturist or nutritionist.

If you are struggling with symptoms that you suspect may be related to chronic stress or anything else make an appointment with a functional medicine doctor for a thorough workup. Personalized diagnosis and treatment is the only way to get to the bottom of your symptoms and truly get the care you deserve.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Resources abound for hypothyroidism online. After all, it is one of the leading hormonal imbalances affecting women, and rates are rising faster than ever. But for those dealing with a different condition—or really, quite the opposite condition—of hyperthyroidism caused by Graves’ Disease, it can feel lonely and isolating when nobody is talking about, or offering help for you.

Well, you’re in the right place.

Doctors use the term hyperthyroidism to refer to a condition in which the thyroid gland is producing too much thyroid hormone, increasing metabolic rate to debilitating and sometimes dangerous levels. There are classically two main autoimmune conditions that can cause this: Graves’ Disease and Hashimoto’s Disease. While both Graves’ Disease and Hashimoto’s Disease are autoimmune conditions affecting the thyroid, they are different from each other. They are diagnosed differently, treated differently, and have different long-term health implications.

Let’s start by explaining autoimmunity.

Autoimmunity refers to the abnormal immunological process of producing antibodies against a person’s own self. Antibodies are like little soldiers made by the immune system for the purpose of fighting off foreign invaders like germs. If the body starts mobilizing soldiers against itself, that leads to problems ranging from inflammation to organ damage and even death. Graves’ Disease and Hashimoto’s Disease both involve the abnormal production of antibodies targeting the thyroid gland, but they produce hyperthyroidism in different ways.

What Is Hashimoto’s Disease?

Hashimoto’s Disease is the most common autoimmune diseases affecting the thyroid. Classically, however, it is thought of as causing hypothyroidism, and that’s because most cases do eventually result in a hypothyroid state. However, in the early stages, it can cause hyperthyroidism, or an overactive thyroid, too.

In Hashimoto’s Disease, the body makes antibodies (anti-thyroglobulin and anti-thyroperoxidase antibodies) that destroy elements of the thyroid gland. This causes swelling and inflammation of the thyroid gland. The inflammation itself is what can cause periods of thyroid overactivity because the provocation from the antibodies and resultant inflammatory processes may trigger the thyroid gland to produce even more hormone.

However, over time, as enough damage is wrought on the thyroid resulting from this autoimmune-driven inflammation, the thyroid may stop functioning as well as it should, or perhaps even may stop functioning altogether. As a result, hypothyroidism develops and while it can sometimes be improved through functional medicine, Hashimoto’s Disease that is diagnosed too late may lead to permanent hypothyroidism.

What Is Graves’ Disease?

Graves’ Disease is very different. Whereas Hashimoto’s Thyroiditis is the most common cause of hypothyroidism (ultimately), Graves’ Disease is the autoimmune disorder that is the most prevalent cause of hyperthyroidism. It occurs when the immune system produces antibodies that bind to the thyroid-stimulating hormone receptor (TSHR), leading to excessive thyroid hormone production. Under normal circumstances, the brain makes TSH (thyroid-stimulating hormone) for the purpose of binding to these receptors and stimulating the thyroid to produce thyroid hormone. In Graves’ Disease, thyroid-stimulating immunoglobulins (antibodies) bind to these receptors. In other words, the immune system mimics the brain and triggers the thyroid to make antibodies.

How Does Graves’ Disease Cause Health Problems?

Overproduction of thyroid hormone in Graves’ Disease accelerates metabolism and can result in symptoms such as weight loss, rapid heartbeat, anxiety, tremors, and eye problems like bulging eyes (Graves’ orbitopathy). Additionally, Graves’ Disease poses risks for people who are trying to get pregnant (or stay pregnant,) who struggle with anxiety, or who have cardiac conditions. It also may be challenging to function with Graves’ Disease because it often also brings other symptoms that affect quality of life, like body aches, sleep problems, and panic attacks. The immune side of Graves’ Disease is also problematic, as it can bring on episodes of full-body hives. If you’ve ever experienced this, you know just how overwhelming it can be.

How Is Graves’ Disease Diagnosed?

Diagnosis typically involves:

• Blood Tests: Measuring levels of thyroid hormones (T3 and T4), thyroid-stimulating hormone (TSH), thyroid-stimulating immunoglobulin (TSI) and thyroid-stimulating hormone receptor antibodies (TRAb) is an essential piece of diagnosing Graves’ Disease.
• Ultrasound: Assessing the size and texture of the thyroid gland. Thyroid nodules can also produce thyroid hormone, so it’s important to understand the root cause of hyperthyroidism and not simply assume that the root cause is Graves’ Disease.
• Radioactive Iodine Uptake Test: Determining how much iodine the thyroid absorbs, which is often elevated in Graves’ disease.

The Role of Gut Health in Graves’ Disease

Emerging research indicates a significant connection between gut microbiota and Graves’ disease. Studies have shown that individuals with Graves’ disease exhibit reduced gut microbiota diversity compared to healthy controls. Specifically, there is a decrease in the abundance of Firmicutes and an increase in Bacteroidetes, suggesting an imbalance in gut bacteria that may influence autoimmune responses.

Furthermore, certain gut bacteria have been found to share structural similarities with thyroid proteins, potentially triggering immune responses that lead to autoimmune thyroid diseases like Graves’ disease. The functional medicine perspective recognizes that gut health, and balancing the gut microbiome, is essential for managing Graves disease.

Functional Medicine Strategies for Managing Graves’ Disease

Functional medicine emphasizes a holistic approach to managing Graves’ disease, focusing on diet, supplementation, and lifestyle modifications to support thyroid health and overall well-being.

1. Functional Medicine Testing

• Gut Health: Gut health plays a crucial role in regulating the immune system, as a large portion of immune activity occurs in the gastrointestinal tract. An imbalanced gut microbiome or increased intestinal permeability (“leaky gut”) triggers immune dysregulation, contributing to autoimmune reactions like Graves’ disease by allowing toxins or antigens to enter the bloodstream and provoke an inappropriate immune response. Functional medicine offers testing methods for identifying the status of the microbiome including specific strains of microbes that are or are not present, allowing tangible, specific tests for treatment and rebalancing.
• Food Sensitivities: Food sensitivities overstimulate the immune system by triggering chronic, low-grade inflammation each time reactive foods are consumed. In individuals with autoimmune conditions like Graves’ disease, this constant immune activation may exacerbate symptoms or contribute to flare-ups by increasing the overall inflammatory burden. Identifying and eliminating trigger foods can help reduce immune system stress and support more balanced immune function. Functional medicine offers testing methods for IgG and IgA-mediated food sensitivies as well as Ig-E mediated food allergies.
• Histamine:Histamine intolerance occurs when the body cannot properly break down histamine, leading to an overload that triggers inflammation and immune system activation. This heightened immune response worsens symptoms in autoimmune conditions like Graves’ disease by increasing systemic inflammation and aggravating thyroid dysfunction, especially symptoms like heart palpitations, hives and anxiety. Histamine is a routine part of functional medicine testing, as well as other pathways of the body involved in histamine production and detoxification.

2. Dietary Strategies

• Anti-inflammatory Diet: Incorporate whole foods rich in antioxidants, such as fruits, vegetables, and fatty fish, to reduce inflammation. Many patients also experience food sensitivities to eggs, gluten or dairy, so testing and elimination of these reactive foods is also important.
• Limit Iodine Intake: Excessive iodine can exacerbate hyperthyroidism; it’s important to limit high-iodine foods unless testing demonstrates that you’re deficient in iodine.
• Avoid Stimulants: Reduce or eliminate caffeine and high-sugar foods to prevent overstimulation of the thyroid.
• Regular Meals: Eating at consistent times helps stabilize blood sugar levels and support metabolic function. It also helps prevent exacerbation of Graves’ symptoms, like anxiety, racing heart, or feeling dizzy.

3. Herbal and Supplement Support

• 1. Bugleweed (Lycopus europaeus)
  Action: Inhibits thyroid hormone synthesis and reduces TSH receptor activity.
  Evidence: Shown to reduce thyroxine (T4) levels and may help manage mild hyperthyroidism.
  
  2. Lemon Balm (Melissa officinalis)
  Action: Competes with TSH for receptor binding and may help reduce symptoms like anxiety and palpitations.
  Evidence: Traditionally used to reduce hyperthyroid symptoms; more robust human trials are limited.
  
  3. L-Carnitine
  Action: Acts as a peripheral antagonist of thyroid hormone activity and may relieve symptoms like muscle weakness and fatigue.
  Evidence: Effective in reversing hyperthyroid symptoms in both overt and subclinical cases.
  
  4. Selenium
  Action: Antioxidant that protects thyroid tissue and modulates autoimmunity.
  Evidence: Supplementation improves quality of life and reduces thyroid autoantibody levels in Graves’ disease.
  
  5. Vitamin D
  Action: Modulates immune function and lowers autoimmunity risk.
  Evidence: Low vitamin D is associated with increased thyroid autoimmunity and more severe Graves’ disease.
  
  6. Omega-3 Fatty Acids
  Action: Anti-inflammatory effects and immune modulation.
  Evidence: Helps regulate immune response and may reduce autoimmune thyroid inflammation.
  
  7. Ahnjeonbaekho-tang (AJBHT)
  Action: Traditional Korean herbal remedy shown to reduce thyroid hormone levels.
  Evidence: Clinical trials demonstrate improvement in T3/T4 levels and TSH normalization.
  

4. Lifestyle Modifications

• Stress Management: Chronic stress can exacerbate autoimmune conditions; practices such as meditation, yoga, and adequate sleep can help manage stress levels.
• Regular Exercise: Engaging in regular physical activity can improve cardiovascular health and support metabolic function.
• Avoid Environmental Toxins: Limit exposure to environmental toxins that may trigger or worsen autoimmune responses. It’s also important to avoid using hormonal contraceptives, as in my experience, these are a common trigger for new onset of Graves disease.

Graves’ disease is a complex autoimmune disorder with significant implications for thyroid health. Understanding its pathophysiology, recognizing the role of gut health, and implementing functional medicine strategies can provide a comprehensive approach to managing the condition. Always consult with a healthcare provider before making significant changes to diet, supplementation, or lifestyle to ensure safety and efficacy.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

References

1. ZUFRY H, ZULFA PO, HARIYANTO TI. The gut microbiota and its role in Graves’ Disease: a systematic review and meta-analysis. Biosci Microbiota Food Health. 2024 Jun 7;43(4):300–308. doi: 10.12938/bmfh.2024-020. PMID: 39364132; PMCID: PMC11444861.
2. Kiseleva EV, Kiseleva EV, Kiseleva EV. Gut Microbiota May Play a Significant Role in the Pathogenesis of Graves’ Disease. Front Endocrinol (Lausanne). 2020 May 5;11:301. doi: 10.3389/fendo.2020.00301. PMID: 32416683; PMCID: PMC7210420.
3. Lee YJ, Lee YJ, Lee YJ. An alternative therapy for graves’ disease: clinical effects and mechanisms of an herbal remedy. J Ethnopharmacol. 2008 May 28;118(3):409-13. doi: 10.1016/j.jep.2008.04.014. PMID: 18479224.
4. Komosinska-Vassev K, Olczyk K, Kucharz EJ, Marcisz C, Winsz-Szczotka K, Kotulska A. Free radical activity and antioxidant defense mechanisms in patients with hyperthyroidism due to Graves’ disease during therapy. Clin Chim Acta. 2000 May;300(1-2):107-17. doi: 10.1016/S0009-8981(00)00306-5. PMID: 10727685.
5. Ross DS, Burch HB

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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. The only problem is that your symptoms are real, and you deserve health. In other words, you deserve to know how to recover from adrenal fatigue, or whatever it is you’re dealing with.

But let’s start by addressing the elephant in the room:

Is “adrenal fatigue” 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.

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
• 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.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Sign Me Up!

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The post How to Recover from Adrenal Fatigue Naturally appeared first on Dr. Alexandra MacKillop.

Can you relate?

For many, the symptoms of hunger are a little more than a mildly irritable mood, a grumbling stomach, and a little fatigue. In fact, many people don’t even feel hungry in their stomachs when they need to have a snack, which can make it difficult to identify that blood sugar levels are at risk of dropping. If going long stretches of time without eating, skipping post-workout snacks, eating sweets on an empty stomach, or having an especially busy day causes symptoms such as the above (fatigue, irritability, weakness, dizziness, feeling cold, breaking out in a sweat, fainting, headaches, stomach pain) then you may be struggling with reactive hypoglycemia.

Just like some individuals struggle to maintain blood sugar balance because their cells are less sensitive to insulin than normal or they don’t produce enough insulin (as with diabetes), individuals who struggle with hypoglycemia have difficulty maintaining blood sugar balance because their cells are more sensitive to insulin than normal or they produce too much insulin. The number one way to promote healthy blood sugar balance with reactive hypoglycemia is to eat balanced, regular meals. That means more food, more often.

The idea of “more food, more often” sometimes seems counter-intuitive, especially if you have a goal of weight loss. It may seem like eating more is the last thing you’d want to do. However, the case I’ll make in this post and what I want you to know is that for women, especially women with health concerns like PCOS, perimenopause, hypothalamic amenorrhea or hypothyroidism, eating more is exactly what you want to do.

As with everything on my blog, this post is not intended to diagnose, treat, or cure any illness. If you are experiencing symptoms of reactive hypoglycemia or any health condition, talk to your doctor.

What Is Reactive Hypoglycemia?

Reactive hypoglycemia is a condition where blood sugar levels drop too low (typically below 70 mg/dL) within a few hours after eating, particularly following a high-carbohydrate meal. It occurs when the body produces too much insulin in response to the rise in blood glucose, leading to a rapid and excessive decrease. Symptoms can include shakiness, sweating, fatigue, irritability, and dizziness. While not usually imminently dangerous, reactive hypoglycemia can be a sign of underlying metabolic dysfunction and may be managed through dietary changes or a targeted supplementation strategy.

What Causes Reactive Hypoglycemia?

As with any condition, the contributing factors to reactive hypoglycemia are complex and varied. More often than not, a person has a genetic predisposition to the development of the condition, which is ultimately triggered by environmental/lifestyle factors, namely stress. As I explain in this post about hormones, stress affects almost every system of our bodies, especially our metabolism. Stress interrupts the delicate web of signals between our brains and our organs, and over time this can lead to more long-standing patterns of dysfunction.

Stress comes in many forms, though we most classically think of it as being related to emotional or relationship triggers. But just like a hectic schedule, tight deadlines, or unhealthy relationships contribute to stress, too much exercise, not eating well, poor sleep habits, chronic illness or allergies, and other environmental exposures can contribute to our levels of stress. I like to describe our stress tolerance as a bucket, and each of those different types of stressors fills the bucket. When the bucket gets full, our bodies start to overflow into dysfunction and disease.

But just like stress contributes to the onset or exacerbation of our symptoms, stress management and self-care can help increase our body’s margin, making us better able to handle triggers. When we’re taking care of ourselves well, missing a snack is less likely to send me into a crisis.

Note: Stress is the most notable contributing factor to metabolic dysfunction like reactive hypoglycemia, but other factors can also contribute such as alcohol use, surgeries, liver or kidney disease, tumors, or other metabolic disorders. If you are concerned about any of your symptoms, always make an appointment with your doctor.

What Are the Symptoms of Reactive Hypoglycemia?

The symptoms of low blood sugar are varied, which is why it can be challenging for some people to recognize patterns between their eating habits and their health. Personally, I find that paying attention to my body’s signals and checking in with myself regularly has helped me to better understand how to care for myself. This helps me know when my body needs food even if it isn’t a “normal” meal time.

Some of the symptoms of low blood sugar include:

• Feeling shaky
• Being nervous or anxious
• Sweating, chills, and clamminess
• Irritability or impatience
• Confusion
• Fast heartbeat
• Feeling lightheaded or dizzy
• Hunger
• Nausea
• Color draining from the skin (pallor)
• Feeling sleepy
• Feeling weak or having no energy
• Blurred/impaired vision
• Tingling or numbness in lips, tongue or cheeks
• Headaches
• Coordination problems, clumsiness
• Nightmares
• Insomnia or waking during the night
• Seizures

Many of my patients liken the feeling of low blood sugar to feeling drunk. They describe feeling tired, disoriented, and like they have tunnel vision. They say their muscles also get weak, they might feel sweaty, or their moods becomes either anxious or irritable.

How Is Reactive Hypoglycemia (Low Blood Sugar) Diagnosed?

There are a number of different ways to evaluate a person’s blood sugar. In my practice, here are a few key flags that I look for on blood work:

• Low fasting insulin levels (less than 4 mUnits/L)
• Low fasting glucose at the time of the blood draw (<75 mg/dL)
• Low a1c (less than 4.8%)
• Low levels of LDH (less than 100 units/L)

Bear in mind that these are functional labs, which means that not all healthcare providers are willing to run them (however a fasting glucose level is usually included as part of a comprehensive metabolic panel on annual preventative wellness labs run by most primary care doctors. A1c is also often included.) You might need to ask for insulin and LDH to be run as well, to get a complete picture.

Testing for Reactive Hypoglycemia at Home

If you don’t want to make an appointment with your doctor, there are two ways that you can test your blood sugar at home. The first is with an old-fashioned fingerstick and the second is with a newer piece of technology: a continuous glucose monitor.

Finger Stick:

To test your blood sugar using a finger stick, you’ll need test strips, a lancet and a glucometer. Often, these tools can be purchased together as a package, such as the iHealth glucometer kit, which is FSA eligible. I recommend starting out by testing your blood sugar several times per day, including:

• Fasted levels, first thing in the morning
• 30 minutes after meals
• 60 minutes after meals
• 2 hours after meals

Continuous Glucose Monitor (CGM)

As an alternative to using a finger stick method, you could consider tracking your blood sugar using a continuous glucose monitor. This method tests glucose levels in the interstitial space (tissue just below the skin) which changes and updates the Bluetooth app in real time. To use, a subdermal needle connected to some adhesive and a Bluetooth device is applied to the arm, abdomen, hip or thigh and continuously monitors blood sugar levels. For many, this is less painful than recurrent finger sticks. Stelo by Dexcom is a continuous glucose monitor with both iOS and Android-compatible technology.

When tracking my blood sugar with a CGM, I log the following data:

• Meals and snacks I ate that day
• My quality of sleep
• My stress levels
• My exercise
• Blood sugar levels overnight, 30 minutes after meals, and 2 hours after meals

How Is Reactive Hypoglycemia Managed with Diet?

The number one way to manage reactive hypoglycemia is to eat frequently, and make sure to pair carbohydrate foods with protein, fiber and fat to stabilize the release of glucose into the blood stream. I often recommend that my patients consume a fiber supplement, like a teaspoon of chia seed of psyllium husk with water, about 15 minute sbefore meals. It’s also a good idea to eat a protein-rich snack with fiber before bed to keep blood sugar stable enough for a good night’s sleep.

A good recommendation is also to avoid alcohol, as this can be a big trigger for hypoglycemia. Of course, there are situations when moderate alcohol use is part of a normal, healthy lifestyle, and so my recommendation is usually to restrict drinking to no more than 1 drink at a time, no more than 3 nights per week, always taken with a meal or snack that contains protein.

It’s also really important to manage stress—all types of stress. That means addressing relationship conflicts, creating boundaries to support work/life balance, eating high-quality food, exercising in moderation, developing productive coping skills, and practicing sleep hygiene. These are the most effective ways to support a healthy stress response, but in a clinical setting, I also sometimes use adaptogenic herbs and other supplements to balance inflammation, manage cortisol, and support a healthy blood sugar response for my patients. If you are interested in using herbs or supplements to manage stress or blood sugar, always check with your doctor first. Even better, work with a functional medicine doctor to find the herbs that are right for you. (This is important because some adaptogens have a blood sugar lowering effect, which could worsen symptoms of hypoglycemia.)

While reactive hypoglycemia can be extremely debilitating, it’s not the end of the story for your health. It isn’t a sentence for weight gain and you definitely aren’t doomed to feel that way your whole life. With a little digging and some strategic hacking of your nutrition and supplements, you can feel like 100% again, no matter your season of life.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Reactive Hypoglycemia Diet: How to Manage Low Blood Sugar Naturally appeared first on Dr. Alexandra MacKillop.

In my office, I frequently see women dealing with period problems. Unfortunately, many providers have told these women that their experiences are “normal” even though they are far from optimal. So, they go along in life thinking that they need to deal with uncomfortable symptoms like unpredictable bleeding, irregular periods, cramping, PMS and more. In these instances, it make take years to get an accurate diagnosis. For other women, however, the change in period symptoms is what catches their attention. Their periods used to behave one way and then, all of a sudden, things changed. Even still, many providres write this off as normal, even when it’s not. “Bodies change,” they say. While this is true—bodies do change—we still have criteria that need to be met in order to classify something as normal.

With regards to a vague symptom like a period starting, then stopping, then starting again, many providers may write this off as normal because:

1. It isn’t going to kill you
2. It typically doesn’t affect quality of life enough to become debilitating
3. It’s really common

…and this is true. Unpredictable bleeding won’t cause end of life, and unlike severe cramps, it’s not painful, merely inconvenient. Plus, it’s a symptom many people deal with. However, providers in the traditional medical model aren’t equipped to deal with a symptom like this. They haven’t been trained in piecing out these symptoms of hormone imbalances and don’t have tools to address it apart from completely overriding your hormones altogether, like through hormonal contraception.

Abnormal bleeding might look like spotting mid-cycle, or having your period start as normal, stop for 24-36 hours, then resume again. Other times, it may stop for 3-4 days and then resume. These patterns indicate different root causes.

In this post, I’m going to outline a few reasons that a person may experience unpredictable bleeding of this nature. Whether you’ve been dealing with this problem for years or it’s a new symptom that suddenly changed, you deserve to have your health explored in detail.

Reasons for Unpredictable/Irregular Bleeding

1. Hormone Imbalances: At the start of your period, hormones drop quite low, comparatively to how things typically “flow” throughout the remainder of your cycle. Take a look at the graphic above: ovarian hormones drop quite low during the first phase, the menstrual phase of the cycle. Irregular hormone production, particularly of estrogen, can easily cause these levels to stop and start. Both high and low estrogen levels may cause irregular bleeding. High estrogen without enough progesterone to balance it out is problematic, growing the uterine lining too much and leading to this “extra” bleeding. Low estrogen dips can produce spotting.
2. Breastfeeding: Nursing, even after periods have returned postpartum, causes real-time hormone fluctuations. Paired with exercise, sleep deprivation, or stress, this can be a big tax on the body. Consider TLC and working on stress managment techniques to help support the demands on your body during this time.
3. Stagnation: This is a term from Traditional Chinese Medicine! In the TCM perspective, blood and energy, called qi, flow through the body in predictable channels. If there’s an interruption to this flow, blood may literally not flow how it should, getting “stuck” and causing irregular patterns of starting and stopping! Especially combined with clotting, dark colored blood, cramping, breast pain, irritability, bloating, and other symptoms associated with stagnation, you should see a TCM practitioner and/or acupuncturist!
4. Stress: Similar to the flow of energy in TCM, emotional stagnation can cause problems in the body. As with the effects of trauma and stress on the body’s neurological pathways (i.e. “The Body Keeps The Score” by Bessel van der Kolk, MD) emotions also affect physiological pathways. If emotions aren’t flowing freely, it can cause other areas of the body to get “stopped up” too. Think: constipation, difficulty crying, insomnia, headaches, muscle tension. Do you notice that you’re holding your breath or struggling to breathe deeply Do you have tightness and tension in your pelvis Are you feeling rushed, under pressure, or frustrated Find healthy outlets for emotional frustration. Focus on finding targeted means of relaxation. See a therapist, talk to a close friend, build TLC into your day. Even better, employ cycle syncing methods to help support emotional vitality and “let go,” especially during your period.
5. Fibroids/Polyps: If you have mid-cycle bleeding, particularly after physical exertion, sex, or bowel movements, you may have a structural abnormality of the uterus that may need surgical removal. Make an appointment for a pelvic ultrasound.
6. Ovulation Bleeding: Mid-cycle spotting (very light, pink or brown; not red) at the time of ovulation as identified by tracking basal body temperature is a different kind of bleeding, not related to your period. This one truly may be normal, associated with changes to the ovary at the time of ovulation. However, if you have new ovulation spotting when you never did previously, it may be time to see a healthcare provider for some hormone testing.

Overall, periods that start, stop and then start again after a few days are not normal, no matter how common they are. If you experience this, talk to your doctor about it. If they dismiss it, it may be time for a new approach through functional medicine. Pay special attention to the effects of emotions, stress and how energy flows through your body. After all, the body really does keep the score.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Why Does My Period Stop and Start Again? appeared first on Dr. Alexandra MacKillop.

“Okay, okay, hypothalamo-whatta-whatta?“

If that’s what you’re thinking, you’re in good company. The hypothalamic-pituitary-adrenal-thyroid-gonadal axis is quite the tongue twister. But don’t worry, it sounds more confusing and overwhelming than it is. In short, the HPATG-Axis is the system of hormone balance in our bodies. To understand how to balance hormones naturally, we need to first understand what hormone balance looks like through this great, big web of connections.

In a nutshell, the HPATG-Axis phrase refers to is the fact that a part of our brain called the hypothalamus communicates with our adrenal glands, thyroid, and ovaries (aka gonads) through a series of hormones produced by the pituitary gland (also located in our brain). In physiology, we often talk about those interactions separately, referring to them as the hypothalamic-pituitary-adrenal axis, or the hypothalamic-pituitary-thyroid axis. But in reality, they’re all connected, and this post will explain everything you ever wanted to know about how and why. (Okay, maybe not everything, but the basics…)

The HPATG Axis (AKA Endocrine Axis)

HPATG physiology can basically be summed up like this: the hypothalamus talks to our pituitary gland using hormonal signals, telling the pituitary gland when and how to stimulate our thyroid, our adrenal glands, and our ovaries. All of those glands send hormonal messages back to our brain with information about how much activity is going on, and whether or not there are any problems. In response, the brain tells the body to amp up activity in each of those sites, or tone it down. This is called a negative feedback loop.

When we face periods of stress (or rather, when we face too much stress for too long), our HPATG axis is completely intercepted. This is where we can run into imbalances in our thyroid hormones (such as hyperthyroidism or hypothyroidism), adrenal hormones (such as “adrenal fatigue”), or fertility problems, (such as hypothalamic amenorrhea). These problems can occur one at a time, or all at once, leading someone to feel really sick, and probably also really confused! Stress is a biggie when it comes to a properly functioning HPATG axis. In most cases, if you’re wondering how to balance hormones naturally, we need to start by addressing stress because stress is the single most powerful influence over the HPATG axis.

Stress and Stress Management

When we think about stress, we typically think about the psychological or emotional—deadlines at work, an overly packed schedule, a bad breakup, or a death in the family. But stress comes in many forms, and can even be triggered by good life events…

• Under eating (not enough calories or carbs)
• Nutritional deficiencies
• A significant/sudden change in diet/eating habits (especially yo-yo dieting)
• Over exercising (or a sudden change in the type of exercise)
• Lack of sleep or change in sleep schedule (i.e. night shift)
• Illness or injury (including surgery)
• Travel (even if it’s fun!)
• Moving
• Starting a new job or educational program
• Getting married
• Certain medications, or drug use
• Depression or anxiety
• Emotional distress (like the loss of a loved one)
• Psychological distress (like work deadlines or studying for exams)

Many of these things are normal parts of life, and when we are following a pattern of self care, our bodies are able to accommodate the stressors without falling into dysfunction. But when our self-care routine falls out of balance (or we begin struggling with disordered eating) we detract from the foundation of health. When that happens, everything else starts to crumble. One of my favorite ways to explain this relationship between stress and self-care is the bucket analogy:

Self-care fills our bucket, but stress drains our resources. When the bucket gets low, we start to notice symptoms of burnout. When the bucket gets empty, it leads to hormonal disaster, interrupting our whole HPATG axis at a biochemical level in our brains (big red stress arrow on the infographic at the top of this post). Ultimately, learning how to balance hormones naturally means learning how to identify and cope with the small, daily stressors in our lives.

Dysfunction, one axis at a time

The reason we often talk about the HPATG axis in terms of its separate components (HPA, HPT, HPG axes) is because unilateral dysfunction is common. For example, an autoimmune disease called Hashimoto’s Thyroiditis can lead to destruction of the tissue of the thyroid gland and subsequent hypothyroidism. When this happens, the thyroid loses its ability to produce thyroid hormone. When the pituitary gland realizes that thyroid hormone levels are so low, it amps up its secretion of thyroid-stimulating hormone in an attempt to tell the thyroid to do a better job. The problem is, the thyroid itself has been damaged—it can’t do its job until the autoimmune reaction is addressed. (Here’s where stress pops up again: if you’re wondering how to balance hormones naturally in terms of your thyroid hormones, you still need to pay attention to the stress piece because stress is one of the primary drivers of autoimmune disease.)

Low levels of thyroid hormone create a further stress response in the body, signaling back to the brain that something’s off. This consequently affects the signaling between the pituitary gland and the adrenals/ovaries as the body tries to balance things out. Low levels of thyroid hormone, for example, creates a dangerous environment for a growing baby, and so the reproductive system is one of the first to get shut down (via the HPATG axis). On the other hand, pregnancy causes the body to re-prioritize its hormonal resources. When a woman is pregnant, the body needs different levels of thyroid hormone, cortisol, and other hormones to carry the pregnancy to full-term. These body signals these changes through the same negative feedback loop. (All of this takes place without us ever having to think about it. You’ve got to admit, God’s design is pretty amazing!)

The HPATG Axis and Healthcare

When a patient complains of problems like fatigue, weight gain or weight loss, thinning hair, or irregular periods (just to name a few), the solution is never as simple as writing a prescription for birth control pills or Synthroid. There’s always more to the story, and that’s why its so important to identify the root cause of the problem when considering how to balance hormones naturally. In my practice, I do this primarily by talking with my patients in detail about their health history, and taking a closer look at the lab work. From a functional medicine perspective, it’s never safe to assume that the other components of the HPATG axis are functioning properly, even if we’ve already identified that one of them is out of sync. That’s why holistic healthcare means addressing the whole person, and not just using a symptom-by-symptom, band-aid approach.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post How to Balance Hormones Naturally (Understanding the HPATG Axis) appeared first on Dr. Alexandra MacKillop.