(This post is a slightly edited version of a post on my previous website. It was a very popular one that seemed to help and encourage a lot of people so I wanted to move it over here, even though it is a little different in subject matter than most everything else on this site.)
There has been no one single topic that I have blogged or posted to social media about that has generated more questions and contact from readers than my experience with this issue and what I’m doing to heal. It has been interesting to notice that as I have learned more about this condition and how to heal from it, I see people with symptoms of dysregulated adrenal function and stress addiction every. Where. I. Look. And based on the volume of people reaching out to me asking for suggestions and feeling like they might be dealing with the same thing...I think this is a problem of epidemic proportion.
But first, I want to be 100% clear that I am in no way a medical doctor or healthcare provider and I am simply sharing MY experience and what has helped me so far. I do NOT want anyone self diagnosing ANYTHING or launching into aggressive treatments of any kind without medical supervision. Also, please know that the symptoms of this condition very much mimic (and sometimes go together with) other serious issues like thyroid dysfunction, clinical depression, and various autoimmune conditions. So...go to the doctor...kay?
As I have learned more about “Adrenal Fatigue” I have come to understand that this terminology is medically incorrect. Unless someone has Addison’s Disease (an autoimmune condition impacting the adrenal glands) your adrenal glands are not “tired”. They are not incapable of producing the necessary hormones. They may however be downregulated, upregulated, or even dysregulated to be producing the wrong amounts of adrenal hormones at the wrong times of day. The adrenals themselves don’t have their own “brain”. They don’t self regulate. They are controlled by the pituitary gland which is in turn is controlled by the hypothalamus. In a properly functioning system, the hypothalamus sends a signal to the pituitary gland, which sends a signal to the adrenals to make the hormones it is supposed to make: cortisol, epinephrine, norepinephrine, and aldosterone being the main players. Once a certain amount of hormone is produced, the adrenals signal back through the system to let the pituitary and hypothalamus know to stop requesting production. This is why the more medically correct term is Hypothalamic Pituitary Adrenal Axis Dysfunction (or dysregulation). For the rest of this piece I will shorten that mouthful to HPA-D. I point this out not to nit pick terminology, but because many medical practitioners will look at you like you’ve been reading too many internet blogs if you use the term “adrenal fatigue” but may be more likely to connect with the questions you are asking if you use the right term.
It is also not so simple as adrenals not producing enough hormone. HPA-D can also mean chronically elevated cortisol, or cortisol levels peaking at the wrong time of day. This is one of the reasons that self diagnosis is a bad idea. Even if you do have HPA-D, there is no real way to know for sure which KIND you have without testing.
If you think you might be dealing with these symptoms (constant fatigue, weight gain or loss with no other obvious cause, mood swings, difficulty focusing/brain fog, unexplained joint pain, disrupted circadian rhythms, cravings for salty and/or sugary foods, tendency to get sick more often, low sex drive, depression, anxiety and a few others) you may need to do some research to find a doctor who is knowledgeable enough about this issue to take it seriously and know how to test for it. While HPA-D is a legitimate medical diagnosis (A search of Pubmed for HPA-D turns up over 3500 medical studies which you can peruse HERE, a search for Adrenal Fatigue mostly turns up research on Addison's disease and Chronic Fatigue Syndrome) many general practitioners are not familiar with this condition and may not know quite how to look for it or treat it. You may also have better luck finding a Naturopath or Functional Medicine Doctor who is familiar with this illness, since it tends to be more of a specialty of the Functional Medicine realm. Here in Flagstaff I’ve been seeing Dr. Erin Victor at the Flagstaff Clinic of Naturopathic Medicine, in case anyone wants a referral.
Now that we have the technical details out of the way...update on my condition. In short, I’m doing much better, thanks for asking! Having had HPA-D, I will always be at risk for developing symptoms again, and I still have flares from time to time, but on the balance I’m a lot better. My sleep has improved, my anxiety and depression haven’t reared in a couple of months, the brain fog is mostly gone, and my moods are much more stable. The one lingering issue is fatigue that, while overall better, is still a problem sometimes. My Dr. thinks there may be some other causes contributing to that, but I’ll refrain from discussing it until I know more and see how it plays out. Anyone working to heal from HPA-D needs to understand that this is a long game treatment plan. It takes a minimum of three months, and up to a year for some people to fix depending on how bad the situation was. And this can be really tough for us go getter types..you know...the exact personality that tends to develop HPA-D.
What has worked for me:
Progesterone supplementation. When I first began seeking answers, I was suspicious of undiagnosed Postpartum Depression. My doctors tended to agree with me, and I will perhaps write more about that in another post. A first line of defense for PPD is to check for low progesterone and treat it if indicated. My progesterone was down the drain and taking the corrective dosage was a HUGE step in the right direction for me. It cleared enough of the anxiety and brain fog to even begin to do the other suggested treatments. I was literally incapable of self care when I was at my worst point. If you think clinical depression is a factor for you, it is wise to treat it appropriately before attempting anything else. Depression and anxiety are SERIOUS and despite what you read on the internet, exercise and vitamins alone are not a treatment for these conditions!
High dose oral B vitamins. This may take some tinkering to find what will work for you, but I have had good luck with THIS. It seems to be effective for me, and since it is a powder you mix with water, it minimizes the pills I have to swallow. It also contains some electrolytes which are helpful for HPA-D.
Targeted adrenal support supplements. I’m not going to list these as the precise supplementation you need will vary depending on the type of HPA-D you have. Taking the wrong kind can be dangerous.
Sleep. ALL the sleep. Initially when treating HPA-D you may need to prioritize 10-12 hours in bed per night to get enough hours of sleep. Especially if your sleep cycles have become disrupted and insomnia is a symptom for you. I learned a lot about the science of sleep and circadian entrenchment from Dr. Sarah Ballantyne’s e-book “Go To Bed”. You can purchase that HERE if you want to know more.
IV nutrient bolus called a “Myers Cocktail”. It gives you a big dose of vitamins and minerals to help with energy that bypasses digestion and gets the nutrients right into the bloodstream. These have to be done at a practitioner's office. They make you feel like a rock star for a couple of days afterwards. These were a godsend early on to help me feel energized enough for basic function.
No intense exercise. Sorry...I know. I was honestly so crashed I was incapable of intense exercise, but depending on what level of HPA-D you have you might be relying on it to get through the day. Intense exercise is a stressor to the body. For otherwise healthy people it is a stressor you adapt too and it mostly does more good than harm in the right amounts. If your body is already sensitive to stress though, the exercise has to go for now. Gentle walking and restorative yoga only.
No caffeine. For all my fellow coffee lovers, I know you feel my pain on this one. The good news though, is once you heal you may be able to tolerate a small amount down the road.
Worked with a therapist. In my case some of what I needed to work through was my tendency to be a perfectionist, workaholic, stress addict. I HEAVILY identify with my accomplishments in career and sports. Having to pull WAY back on goal driven achievement focus was really, really hard. I am still a work in progress on that. Whatever your issues are, I promise you have some. Do all the therapy. All of it.
Good Nutrition. Minimizing junk food and maximising veggies, quality meat and seafood, fruit, and some cooked whole grains is crucial for my long term health. This is a more subtle effect than the help of medications, but now that I’m in a better place I notice a change in my general well being very quickly if I indulge in too much junk. I also checked in with ensuring that I was getting adequate calories and carbs. While I have never personally experienced chronic undereating (I come from a LONG line of foodies. We eat ALL the food!) it is extremely common for women to undereat. We are regularly told that 1200 calories is enough food, even for active busy women. It is not. 1200 is the generally recognized base metabolic rate of an average sized woman. This means it takes that much food to keep basic functions of your body happening if you did nothing but lay in bed all day. Under eating, or being low carb for a long time creates a chemical stress response in your body that is unhelpful to healing HPA-D.
I cut out as many stressful things in my life as possible. This is a big part of why I’m not really teaching public drop-in yoga classes right now. Don’t know what could possibly be stressful about being a full time yoga teacher? Let’s talk. Maybe a different post sometime...hmmkay? I have had to practice saying no to a lot of things. Even things I might want to do or think would be fun or good for my career. Right now THE priority is fixing my health. My schedule has zero time for anything else. I need as much white space in my calendar as possible and I have had to learn how to truly accept “good enough” and “done is better than perfect”. (See #7 on therapy) We also hired a housekeeper twice a month to help with domestic chores which has been THE BEST investment ever. Think you can’t afford a housekeeper? We didn’t either. But somehow we are making it work and it is a game changer. Breathe deep, ask for help, clear your calendar. Of ALL the things I’ve done, this has been the hardest.
Integrated additional self-care practices. Abhyanga (ayurvedic self massage) has been a big one. Occasional visit to a massage therapist. Epsom salt baths (so easy and so effective). Regular Meditation and yoga nidra practice.
Acupuncture. We are fortunate to have an excellent acupuncturist here in town who runs a community acupuncture clinic that has a “pay what you can” sliding scale. If you are in Flagstaff, go see Stephanie at Stuck. If you are elsewhere, see if your city has a community acupuncture too.
I participated in an online program to learn more about HPA-D and get additional suggestions for healing. For me, this program was a good supplement as I was already working with a good practitioner. If you don’t have access to someone in your community who is knowledgeable about this condition or is willing to help you, I highly recommend this program! The two women who created it are Registered Dieticians with additional training in functional medicine. They even have an online resource for testing and a dispensary for acquiring supplements that are not available to the general public. They run this program a few time a year. To get their free e-book and be on the list to be notified the next time enrollment is happening go this this page HERE. You might also enjoy their podcast The Ancestral RDs Podcast where they talk about a variety of health, wellness and nutrition information in a nonreactive and sensible way. .
Namaste friends. And Be well.