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.

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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 Recover from Adrenal Fatigue Naturally appeared first on Dr. Alexandra MacKillop.

Estrogen dominance is a buzz word in natural health circles. With it popping up in conversations everywhere, you might be wondering what it is, whether you need to worry about it, and how to fix estrogen dominance naturally through functional medicine. If that’s you, you’re in the right place.

Women’s health concerns tend to follow predictable patterns. In healthy women, cyclic changes in sex hormones throughout the month make it possible to track fertility—everything from ovulation, to an expected period, to optimal days for conceiving or avoiding pregnancy. In the same way, dysfunctional cycles tend to follow predictable patterns according to measurable imbalances in estrogen, progesterone, and testosterone. One of the most common hormonal imbalances is estrogen dominance, which can disrupt the natural rhythm of the menstrual cycle.

Whether or not the imbalance clinically correlates to a formal diagnosis—such as endometriosis or PCOS—there’s a lot that can be done to help balance female hormones. Estrogen dominance is one key reason that cycles can get out of sync, and it’s often associated with symptoms like heavy periods, breast tenderness, weight gain and mood swings. Addressing estrogen dominance through lifestyle changes, nutrition, and targeted supplementation can make a meaningful difference in restoring hormonal balance.

Estrogen Dominance and Progesterone

Throughout the female cycle, two hormones tend to be held responsible for triggering key events such as ovulation and the start of a period.

• In the first half of the cycle, which is classically defined by estrogen dominance, estrogen rises and falls, correlating with a hormonal signal from the brain that triggers the release of an egg.
• Following ovulation, the ovary produces progesterone, which is responsible for thickening the uterine lining in anticipation of pregnancy.
• After about seven days, progesterone levels peak and begin to steadily decline; once they drop low enough, the lining starts to shed, signaling the start of a period and another cycle.

However, that delicate balance between estrogen and progesterone can easily become disrupted by other hormonal imbalances such as thyroid hormones, or cortisol—the stress hormone. Often, this leads to a relative excess of estrogen in comparison to progesterone, creating symptoms like hot flashes, moodiness, fatigue, painful periods, and more. We call this estrogen dominance. Long-term elevation of estrogen can also increase risk for cardiovascular disease, breast and ovarian cancers, diabetes, and infertility. If monthly symptoms aren’t bad enough, the long-term risks mean that addressing estrogen dominance is really important for lifelong health and well-being.

What Causes Estrogen Dominance?

The production of estrogen from the ovaries is regulated by the hypothalamic-pituitary-gonadal axis, a delicate web of signals between the brain and reproductive organs. The estrogen excess form of estrogen dominance can result from interruptions along the entire axis, whether from a signaling problem at the brain level, or from dysfunction of the ovaries themselves. Many women also experience high estrogen because the pathways involved in the synthesis of estrogen can be interrupted by hormone-disrupting chemicals (such as BPA and plastics), because the precursor hormones are being diverted into the production of other hormones (like cortisol), or because of autoimmune diseases or medication use. Here are a few other reasons for high estrogen and estrogen dominance:

• Adrenal dysfunction
• Perimenopause
• Exogenous estrogen use (such as hormonal contraceptives)
• Exposure to xenoestrogens (BPA, phtlalates, DEHP, and other chemicals found in plastic; insecticides; food additives such as BHA and those found in red dye)
• Insulin resistance
• PCOS
• Liver dysfunction
• Hypothyroidism
• Smoking
• Use of the fertility drug, Clomid (Clomiphene citrate)
• Inflammation

Note: I explain the details of what is and isn’t normal and how to explore natural treatment options in my book, Go with Your Flow. Click here to learn more.

What to Do About Estrogen Dominance

As with any hormonal imbalance, effective treatment for estrogen dominance starts with identifying the root cause. This is why it’s so important to work with a naturally-minded healthcare provider to review diagnostic tests and lifestyle/history to get to the bottom of the estrogen dominance. If adrenal dysfunction is the driving force behind high estrogen and estrogen dominance, for example, no amount of estrogen-clearing supplements will effectively solve the problem. The adrenal dysfunction needs to be addressed, first!

Once an appropriate diagnosis is made and healing efforts are underway, there are a number of steps that can be taken to help the body clear out excess estrogen, balance out the production of progesterone, and get the hormone levels back to a functional status quo.

Lifestyle Modification for Estrogen Dominance

Gut Health: As with many other areas of health, the gut microbiome plays a huge role in hormonal balance. Not only do the naturally-occurring bacteria and yeast in our digestive tract aid in digestion of food and absorption of nutrients, they also produce a large proportion of the body’s hormones and neurotransmitters. They also are involved in the metabolism and excretion of hormone breakdown products. The group of bacteria responsible for metabolizing estrogen and estrogen breakdown products is called the estrobolome. A disruption in the gut microbiome can easily lead to estrogen dominance.

The more different types of bacteria we have in our gut, the greater the number of functions our microbiome has. (This is why microbial diversity is important.) When our gut diversity is limited, functions such as those carried out by the estrobolome are interrupted. Rather than restricting your diet, as many “estrogen dominance diets” encourage, focus on including as many different types of plant foods and fibers in your diet as you can. No, vitamin powders or fiber supplements aren’t going to do the trick.

Stress: In my clinical experience, the most common cause of hormonal imbalances among women, including estrogen dominance, are related to stress. Whether that source of stress is emotional, relational, physical, nutritional, or otherwise, stress management is key. In an estrogen dominance hormonal pattern, progesterone is also typically low. Progesterone and cortisol a both produced from the same hormonal precursor, called pregnenolone. When stress levels are high, the body allocates its resources towards producing cortisol, which means there aren’t many leftovers for producing progesterone. (This is called pregnenolone steal.) The end result is functionally low progesterone, either creating or amplifying an existing pattern of estrogen dominance.

For more information about lifestyle methods for balancing hormones, check out this post: 5 Ways to Balance Your Hormones, Naturally

Nutrition for Estrogen Dominance

Whenever I talk about diet minutiae with my patients, the emphasis is almost always on adding rather than restricting (except in the cases of allergies/intolerances, of course.) In terms of hormonal balance, research has shown that certain foods help drive or suppress certain dysfunctional hormonal pathways because of the biochemical compounds found in those foods. This is especially true of estrogen dominance.

Flax: When estrogen is metabolized, it converts into one of three breakdown products: 4-hydroxyestrone, 2-hydroxyestrone, and 16-alpha-hydroxyestrone. Each of these metabolites plays an important role in the body, but when levels of 16 and 4 hydroxyestrone get too high, it increases the risk of hormonal symptoms and even the risk of breast cancer. On the other hand, 2-hydroxyestrone has been shown to prevent these negative health effects. The lignans found in flax help drive the metabolism of estrogen down the 2-hydroxyestrone pathway. (In order to access the lignans found in flax, the flax must be freshly ground rather than whole or pre-ground.) Flax is a great solution for estrogen dominance when used appropriately, in the correct context.

Cruciferous Vegetables: Cabbage, broccoli, cauliflower and brussel sprouts sometimes have a bad reputation because of their smell. But those stinky, sulfur compounds (such as indole-3-carbinol and di-indolylmethane) also support the estrobolome in metabolizing and excreting estrogen breakdown products. They also help protect against estrogen-receptor-positive type breast and ovarian cancers, which is an important consideration in women presenting with an estrogen dominance pattern.

Avoid Excess Alcohol: A glass of wine (or beer, or whiskey, or whatever you enjoy) a few times a week won’t harm your health, but drinking above and beyond this inhibits the enzymes responsible for estrogen metabolism, furthering symptoms of estrogen dominance.

Supplements for Estrogen Dominance

Calcium-D-Glucarate (CDG): This supplement inhibits enzymes responsible for reabsorption of partially-metabolized estrogen, helping the body with excretion. Oral doses of CDG have been shown to lower serum estrogen levels and reducing risk of estrogen-receptor-positive breast cancer as well as associated symptoms of high estrogen. CDG also has a concurrent lipid-lowering effect, which is especially beneficial in women whose estrogen dominance is driven by insulin resistance. (In addition to managing blood sugar, insulin drives the production of cholesterol and blood lipids.) Calcium-D-Glucarate is typically used in the range of 1500-3000 mg daily.

DiindolylMethane: This is one of the main compounds found in cruciferous vegetables, responsible for estrogen-detoxifying effects. This supplement is often dosed in the range of 100-400 mg daily. (Fun fact: you can get the same level of DIM by eating cabbage. The equivalent would be 3 cups per day, or 1/2 cup if consuming it cooked, as the cooking process concentrates DIM six-fold.)

Indole-3-Carbinol: This is another compound found in cruciferous vegetables, contributing to the estrogen-detoxifying effect. Research shows that supplementing at levels of 300 mg/day has been helpful in reducing estrogen levels when they are problematically high in the case of estrogen dominance.

Cod Liver Oil: This is one of the best dietary sources of omega-3 fatty acids, especially DHA and EPA which are not found in plant sources. Since inflammation is one of the major drivers of estrogen-dominance patterns (and has a high association with elevated stress levels due to cortisol’s pro-inflammatory effect), supplementing with cod liver oil helps reduce estrogen dominance at the root cause. Supplementation should be in levels of at least 2,000 mg daily, though I often prescribe levels that are twice or three-times this amount in my practice, depending on the patient.

B Vitamins: The metabolic pathway responsible for estrogen breakdown and excretion uses a variety of enzymes which require B vitamins as cofactors in order to function, especially B12 (100 μg), B6 (50-100 mg) and folic acid (800 μg daily). These methylation reactions are also important in supporting the 2-hydroxyestrone pathway in estrogen dominance.

Closing thoughts…

As if the symptoms of estrogen dominance aren’t difficult enough, the journey towards a diagnosis to explain the symptoms, and finding a treatment strategy that works for you in the context of your own life can add enormous loads of stress to an already challenging life experience. There is a whirlwind of information out there, which only adds to the confusion and frustration of trying to manage your health. It can be a lonely and scary place, but I want you to know that you’re not alone. Consider making an appointment with a functional medicine doctor who can deliver personalized care and help you achieve your health goals and keep your estrogen balance in check.

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.

The post How to Fix Estrogen Dominance with Functional Medicine appeared first on Dr. Alexandra MacKillop.