Inflammation - could stress be a big culprit?
What do low mood, anxiety, low sex drive, digestive problems and thyroid issues all have in common? Apart from being felt by many of us at some point in our lives, these symptoms are often the sign of prolonged stress and hormone dysregulation - say hello to adrenal fatigue syndrome. Never heard of it? I’m not surprised. Adrenal fatigue syndrome is not widely recognised in the medical community; due to the wide array of seemingly unrelated symptoms, doctors often treat each symptom in silo, rather than taking a more holistic approach to the hormones systems of the body.
This is a topic close to my heart as it’s something I have experienced myself, and something that comes up in my clinic all the time. I have seen too many people with adrenal dysfunction being overlooked by doctors due to solo diagnosis of it’s individual symptoms - leading to being unnecessarily prescribed antidepressants, put on long-term thyroid medication, repeated courses of antibiotics, told to live with IBS, battling with anxiety or self conscious about their lack of libido. I want to help empower you to recognise the signs of adrenal fatigue so that you can take control of your health. In this two-part series, I’ll be exploring adrenal fatigue syndrome and its causes, why it is so common among busy professionals and new mums alike, and most importantly, what changes you can make to your lifestyle to get these symptoms under control.
Let’s start from the beginning…
Our adrenal glands are walnut-sized organs located at the top of the kidneys and are a part of the endocrine system, which organises the release of hormones within the body, and they are vital to cortisol regulation, metabolism, keeping inflammation at bay, and controlling our energy levels . There are three important hormones that the adrenal glands secrete: cortisol, adrenaline, and dehydroepiandrosterone (DHEA). When released at optimal levels, these hormones are incredibly useful; they help you to buffer stress and adapt to everyday life demands by determining the stress response (1).
No doubt you’ll have heard of the ‘fight or flight’ response - this is our body’s stress response, which helps to put our body in a state of preparedness ready to tackle, or flee, from the stressor we are facing. Under stress, healthy adrenals increase their output of cortisol and DHEA to enable you to preserve health. They also secrete adrenaline, giving you a boost of energy. The system response sends glucose to our muscles, increases our heart rate, scales back on non-essential bodily functions (such as digestion) and sight, hearing and other senses becomes sharper (2). Now, when this happened when we came face-to-face with a bear (as we would have many years ago), we were ready to fight or flee. Once the bear was out of sight, our hormones would drop back to normal levels and we would carry on with our day.
What happens when this system goes wrong?
In our modern society, it is very unlikely that we are going to be faced with choosing to fight or flee from a bear (!). However, we now have a different set of stressors to deal with: looming work deadlines, traffic jams, balancing a busy home life with a career, constant stimulation from computers, phones and social media and worries about the state of the world. We are in a chronic state of stress 24/7. Our bodies are not adapted to being in this high stress state all the time - and this is where adrenal dysfunction (often referred to as adrenal fatigue) can strike. Adrenal dysfunction is a state where the adrenal glands do not make the correct amount or type of adrenal hormones at the correct time of day, resulting in a hormone imbalance across all biological systems and processes (3). One of the big problems is elevated levels of cortisol, which has a whole host of unwanted effects - suppressed immune system, digestive issues and increased blood sugar levels, which all increase levels of inflammation within the body.
Cortisol also plays a vital role in our circadian rhythms, which are important as they influence our sleep-wake cycles, hormone release, eating habits, digestion and body temperature, among other important bodily functions. Cortisol should naturally peak in the morning, and dip at night (helping us to feel sleepy) (4), but in the first stage of adrenal dysfunction this system is disrupted, with cortisol being higher at night and lower in the morning - which is why many people experience poor sleep, feel ‘tired and wired’ at night, or need a caffeine fix to get them going in the morning. The second stage of adrenal dysfunction shows more severe cortisol disruption; people in this stage may have higher cortisol in the morning (hello pounding heart and anxiety) but it tends to fall quickly after lunch, leading to afternoon fog and tiredness. They may get a second wind at night, but most often wake in the middle of the night and are unable to fall back asleep. The final stage resembles how a person feels in early pregnancy or with a new baby at home - exhausted all the time, no matter how much he/she has slept and completely burned out. Cortisol patterns in stage 3 are completely disrupted or even completely flat and this is especially risky because this stage is associated with higher risk of thyroid and autoimmune disease, as well as gut problems.
Adrenal dysfunction is classed as a syndrome because it is a set of symptoms that all correlate with each other and indicate a problem. This varies from a disease, which has a specific cause and related symptoms and treatments, which could explain why adrenal dysfunction so often goes undiagnosed…
How will I know if I’m experiencing adrenal dysfunction?
As you can see, practically anyone living in the modern world can suffer from adrenal dysfunction. Particular groups thought to be at increased risk include those in high pressure or emotionally taxing jobs, individual’s working two jobs or shifts, single mum’s and the self-employed. However, if you are experiencing symptoms of elevated cortisol, it is likely you are experiencing adrenal fatigue to some extent. Here are some of the most common signs of elevated cortisol and adrenal fatigue:
Rapid weight gain (mainly in the face, chest and abdomen) contrasted with slender arms and legs
A flushed and round face
High blood pressure
Tiredness when you wake up, no matter how much sleep you got the night before
Difficulty falling asleep or waking up
Mood swings, shown as anxiety, depression or irritability
Reduced ability to handle stress or feeling stressed more often
Thyroid problems or low thyroid hormone production
Food cravings - especially salt and sugar
Reduced memory or inability to concentrate
Skin changes (bruises and purple stretch marks)
Low sex drive
Irregular periods or menstrual cycle disruption
Muscle weakness or body aches (5)
Can I be tested for adrenal dysfunction (adrenal fatigue)?
As adrenal dysfunction is a syndrome and not well recognised by doctors, getting a diagnosis can be somewhat difficult; as such, it is often diagnosed on symptoms alone. Elevated cortisol levels may also be tested, either via saliva, blood or urine. The most common method is a salivary cortisol test that measures cortisol at different times of the day, to check if cortisol patterns are correct. This test has to be done privately so speak to a registered nutritionist, nutritional therapist or functional medicine practitioner about this. Luckily, many of the lifestyle treatments for adrenal fatigue can offer some benefit to most people, so even without an official diagnosis, you can follow the advice in my next article and will see some improvements in your symptoms.
In my next article, I’ll be taking a closer look at some of the lifestyle steps you can take to soothe those adrenals and lower your cortisol levels, to get you feeling calmer, more balanced and in control. Have you or are you experiencing adrenal fatigue? Let me know about your experience in the comments.
NHS (2017) Cortisol deficiency. Available at: https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/cortisol-deficiency (Accessed: 16 September 2020)
Harvard Health Publishing (2011) Understanding the stress response. Available at: https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response (Accessed: 24th September 2020)
Wilson JL Adv Integr Med 2014; 2(1): 93-96. https://doi.org/10.1016/j.aimed.2014.05.002
Society for Endocrinology (2020) Cortisol. Available at: (https://www.yourhormones.info/hormones/cortisol/) (Accessed: 24th September 2020)