July 23


“Adrenal Fatigue”

By Sunny Brigham, MS, CNS, LDN

July 23, 2018

minutes read time


“Adrenal fatigue”…I bet you’re wondering why I have this is quotes.  Well…because it doesn’t exist!  GASP!  I know….but let me explain.

I am a big fan of peer-reviewed studies.  So, this review came out in 2016 claiming that adrenal fatigue (AF) isn’t a thing.  And I agree with it.   Now you’re super confused because isn’t this blog about AF.  Yes…yes it is.  But AF is not the correct name for what’s going on in the body.  It’s actually, and more aptly, called HPA Axis Dysregulation.  HPA stands for hypothalamus, pituitary, and adrenal.  For the purpose of this blog, we will continue to call it AF. 

In this blog, we’ll take a look at exactly what AF is, how one develops it, signs and symptoms of AF, and what you can do to help the body heal.

Role of the HPA Axis

The HPA axis has a role in the cardiovascular system, metabolic system, immune system, reproductive system, and the central nervous system.  It controls our circadian rhythm (the sleep/wake cycle in the body).  It controls the stress response as well allowing us to adapt to our environments. 

Here’s a great picture of the HPA axis and what it does:

Adrenal Hormones
HPA Axis and Stress

When we encounter a stressor, let’s say a lion.  Our body releases three hormones …epinephrine, norepinephrine, and cortisol.  Epinephrine, also known as adrenaline, gets the heart pumping. This is the feeling in the chest we get when we are scared.  The next one released is norepinephrine.  This also acts on the heart rate and helps oxygenate muscles so we don’t get fatigued running from this lion. The last is cortisol.  Most have heard of this hormone.  While the other two hormones start the signal to release stored energy, cortisol really gives the green light to the body.

Upon the release of cortisol, the body’s stored form of energy, glycogen, is quickly reconverted to energy and floods the body so we can sustain physical activity for a long period of time (i.e. running from the lion).  When the stressor is over, we find that we are really hungry.  This is because we need to rebuild our energy stores in the body.

But…most of us aren’t running from lions.

Unfortunately, this same process happens when we get an unexpected bill, get into a tiff with someone at work, or another driver on their phone floats into your lane during rush hour traffic. The same hormones are released in the same manner as out running a lion.  We flood the body with stored energy.  But…we aren’t using the energy that’s been released. 

We can’t restore glycogen again, so the body converts it to fat and we store it mostly around the belly.  This is why stress can cause weight gain and weight loss resistance.  Now, the stores are empty and we need to refuel….HELLO CRAVINGS!!  Sugary foods are quickly broken down to build the stores again…this is partly why we crave them after stress. 

If this process happens once in a blue moon…not to worry.  But if you’re like most people today, it’s happening at least once a day but more likely several times a day.  You can stress yourself into illness.

How “Adrenal Fatigue” Develops

AF is something that is fairly common today but can be missed by physicians.  I see this in about 50% of my clients.  It’s usually women, but it can absolutely happen in men. 

There are other conditions that can be linked to HPA Axis dysregulation that typically aren’t.  These include chronic fatigue syndrome (CFS), fibromyalgia, T2D, anxiety, major depression, fatty liver disease, and more.  Fun, right?

Like insulin sensitivity in diabetics, we can develop cortisol sensitivity.  This means either the body is producing cortisol but the body just doesn’t recognize its there or we are no longer producing the amounts that we need to function normally.  If the body is producing it but doesn’t recognize it, this means the body can no longer control or regulate the hormone letting it continue to wreak havoc on the various systems in the body. 

Signs and Symptoms of “Adrenal Fatigue”

The symptom list for this guy is lengthy.  Why?  Because AF affects so many aspects of the body. Remember above we discussed how the HPA axis plays a role in the cardiovascular system, metabolic system, central nervous system, and immune system?  When you think about what each of those systems control in the body, the list of symptoms will make more sense.  Here are the common symptoms:

  • Anxiety
  • Dizziness, unexplained
  • Dry skin and/or hives
  • Fatigue after fitness
  • Never sick or always sick
  • Excessive food cravings leading to binge eating or uncontrolled eating
  • A boost of energy in the evening around 7-9 pm
  • High stress lifestyle or being a high stress person
  • Loss of muscle tone or inability to gain muscle mass
  • Weight gain

Usually the tell-tale signs I see in my office is excessive stress in the life, lack of quality sleep, unexplained weight gain or inability to lose weight, energy in the evening, and excessive exercise. 

Now, let’s take a look at a few things you can do to help the body recover. 

Interventions for “Adrenal Fatigue”

Taking care of the body comes first when dealing with AF.  It’s a hard thing to do and it takes time to recover, but with the right strategies, it can be done.  Many want the quick fix because they have felt like crud for so long.  I get it…but AF doesn’t heal in a matter of weeks.  When we talk healing time for AF, we’re talking months to years.  I know…it sucks. 

Food first!  Diet will play a huge role in recovery from AF.  When suffering with AF, adding stimulants is really common such as sugar and caffeine.  But these can be damaging to the repair process.  I definitely recommend removing sugar, but coffee is really person dependent.  Adding in healthy fats, whole grains, and good sources of protein is important as well.  Basically, consume a healthy balanced diet free from packaged and processed foods with little to no added sugar and you’ll be rocking your way to wellness.

I’ve talked about pregnenolone steel in this blog.  This will give you a good idea of how stress acts on hormone function in the body.  Because of this, DHEA is a common supplement I use for individuals with AF.  I, first, like to have testing done on cortisol levels and hormone levels.  However, I find this to be very effective at stabilizing hormone levels, reducing exercise fatigue, and reducing overall fatigue associated to AF. 

Adaptogenic herbs are another thing I will employ.  Adaptogens help the body react appropriately to a stressor and take the edge off when it comes to the cortisol response.  I find that individuals react differently to different adaptogens so I really like a product called HPA Adapt by Integrative Therapeutics.  This one contains a variety of adaptogens that most people do well with.  The thing about adaptogens is you won’t necessarily feel a difference…I think many look for that.  It’s a subtly effect that shows results over prolonged use.

If you’d like to learn more about adaptogens, here’s a good blog I was featured in. 

Meditation is another great intervention.  I recommend starting the day with 5-10 minutes of meditation and ending it the same way.  Meditation can be sitting quietly, utilizing a guided video, using an app, taking a walk, reading, etc.  As long as you’re not brooding and only focusing on the activity, you’re meditating.  Belly breathing is another great resource to employ. 

The list goes on and honestly, the interventions I prescribe vary from person to person.  AF is actually more common than you think.  If you suspect you have it, getting your 24-hour saliva or urine cortisol levels checked is a great first step is seeking diagnosis. 


Tell me…do you or someone you know suffer from AF?  If so, what’s a good first step you plan on taking?


Bose, M., Oliván, B., & Laferrère, B. (2009). Stress and obesity: the role of the hypothalamic–pituitary–adrenal axis in metabolic disease. Current Opinion in Endocrinology, Diabetes, and Obesity, 16(5), 340–346. http://doi.org/10.1097/MED.0b013e32832fa137

Cadegiani, F. A., & Kater, C. E. (2016). Adrenal fatigue does not exist: a systematic review. BMC Endocrine Disorders, 16(1), 48. http://doi.org/10.1186/s12902-016-0128-4

Crowley, S. K., & Girdler, S. S. (2014). Neurosteroid, GABAergic and Hypothalamic Pituitary Adrenal (HPA) Axis Regulation: What is the Current State of Knowledge in Humans? Psychopharmacology, 231(17), 3619–3634. http://doi.org/10.1007/s00213-014-3572-8

Lee, R., & Sawa, A. (2014). Environmental stressors and epigenetic control of the hypothalamic-pituitary-adrenal-axis (HPA-axis). Neuroendocrinology, 100(4), 278–287. http://doi.org/10.1159/000369585

Marino, L., & Jornayvaz, F. R. (2015). Endocrine causes of nonalcoholic fatty liver disease. World Journal of Gastroenterology : WJG, 21(39), 11053–11076. http://doi.org/10.3748/wjg.v21.i39.11053

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