You may recognize the term adrenal fatigue. This term has been used to indicate weakened or burned-out adrenal glands that cause fatigue and other symptoms. The conventional medical establishment is not supportive of this term. Conventional medicine recognizes rare medical conditions where there is a major deficiency of adrenal hormones, known as primary adrenal insufficiency or Addison’s disease. In addition, they recognize excessive cortisol production, known as Cushing’s syndrome. The reality is most people experience adrenal hormone imbalance somewhere between low-normal to high-normal. A term that integrative doctors have been using recently, and one I support, is adrenal dysfunction. However, as I mentioned earlier, the adrenal glands do not work in isolation. So, the term adrenal dysfunction really means imbalanced adrenal hormones as a result of a communication imbalance from the hypothalamus and pituitary glands, also known as the hypothalamic-pituitary-adrenal axis (HPA axis). The term HPA axis dysfunction is found in the medical literature. Therefore, the term adrenal dysfunction (easier to refer to) is the same as HPA Axis Dysfunction.
One of the best ways to test for adrenal dysfunction is salivary stress hormone testing. This testing involves collecting multiple saliva samples over the course of a day. Saliva testing makes it practical to measure your stress hormone levels multiple times in a day or over several days to see if the hormone levels match a typical pattern. This type of testing is routine in stress studies conducted at major research institutions. Saliva testing is also more convenient and accurate since some people experience stress during a blood draw, which can affect blood cortisol levels. Saliva testing can identify people with irregular cortisol patterns that may be too low, too high, or a mixture. It should be noted that in recent years dried urine testing is being used as well in testing cortisol and other hormone levels. Many tests measure morning DHEA levels in addition to cortisol, which is another adrenal hormone that the body uses to combat the effects of stress and works in tandem with cortisol.
For many people, adrenal dysfunction can be identified by its signs and symptoms. Classic symptoms include fatigue, inability to cope with mental or physical stress, and poor exercise recovery. Moreover, adrenal dysfunction can be associated with other signs and symptoms, including digestive problems.
Holistic approaches to balancing your HPA axis are by far the best way to optimize adrenal hormones. You will find many people with adrenal dysfunction taking antidepressants, anti-anxiety medications, and recreational drugs to try to cope with their brain and body’s poor resistance to stress. In this situation these types of approaches are temporary cover-ups that do not get at the root of the poor stress response.
To address the underlying triggers of HPA axis dysfunction, it is imperative to improve your nutritional status. A diet such as the Modified Mediterranean Diet extremely helpful. The benefits of the traditional Mediterranean diet are supported by a plethora of studies showing it reduces the risks of major diseases. The traditional diet revolves around vegetables, fruits, seafood, poultry, beans, herbs and spices, olive oil, nuts, moderate dairy, and limited red meat. There are plenty of free Mediterranean diet cookbooks available. I modify the Mediterranean diet to reduce wheat products, as they spike blood glucose and insulin and are a common food sensitivity. You should consume a limited amount of caffeine (one to two cups of coffee a day, or preferably green tea) as well as restrict simple sugar intake (less than 25 grams daily).
Stress reduction techniques, such as prayer, meditation, neurofeedback, and counseling, are also helpful. These approaches are often needed to address the deepest level of poor stress adaptation. Individual preferences to stress reduction techniques vary greatly, so focus on those you will be consistent with.
Regular exercise is important but needs to be light enough for you to recover adequately. The length and intensity vary depending on the individual. However, consistency is very important for HPA axis balancing.
Adequate quality sleep is essential. For most people, this means seven to eight hours. Sleep disorders like insomnia or apnea, if present, must be treated. Take HPA Axis–Balancing Supplements
I often have patients take an adrenal formula (Adrenal Wellness) that contains a combination of adaptogenic herbs that work to balance the HPA axis and improve adrenal hormone balance. My favorite adaptogenic herbs include rhodiola rosea, ashwagandha, and eleuthero-coccus (Siberian ginseng). These herbs, along with nutrients such as B vitamins and vitamin C, are effective in helping people reestablish adrenal balance. And remember, the better your adrenal health, the better your gut health will be.
The European Medicines Agency (EMA) defines herbal adaptogens as follows: “Adaptogenic substances are stated to have the capacity to normalize body functions and strengthen systems compromised by stress. They are reported to have a protective effect on health against a wide variety of environmental assaults and emotional conditions.” The EMA also notes that adaptogens are virtually nontoxic to the user.
The two top herbal adaptogens I use are ashwagandha and rhodiola rosea. Ashwagandha has a long history of use in Ayurvedic medicine. There are several human studies published concerning its beneficial effects as an adaptogen. Ashwagandha extract has been studied in people with a history of chronic stress to improve their resistance to stress and quality of life scores based on a variety of questionnaires. Perceived stress by the participants was reduced by 44 percent. In addition, after 60 days, serum cortisol levels were reduced by 27.9 percent from baseline compared to 7.9 percent of those in the placebo group. One other study worth mentioning is a double-blind, placebo-controlled trial, which found that 125 to 250 mg of ashwagandha extract taken twice daily led to a 79 percent reduction in fatigue as well as improvements in ratings of stress, anxiety, irritability, inability to concentrate, and forgetfulness. These factors did not improve in the placebo group. Serum cortisol levels also decreased by 24.2 percent and DHEA levels improved by 32.2 percent for those taking ashwagandha extract. It should be noted that DHEA works to balance cortisol.
Ashwagandha is well tolerated. The recommended dose is 250 to 500 mg daily of a standardized extract.
Rhodiola is a medicinal plant that has had almost 200 studies published on its chemistry and clinical use. It has a long history of use in Siberian and Russian medicine as an adaptogen. It is also an effective antioxidant that protects the brain and nervous system from free radical damage. Rhodiola has been shown to increase physical work capacity and shorten recovery time between bouts of high-intensity exercise.
Recent research shows that rhodiola rosea has “anti-aging, anti-inflammation, immunostimulating, DNA repair, and anti-cancer effects in different model systems.” Moreover, the International Journal of Psychiatry in Clinical Practice revealed that Rhodiola rosea extract has the beneficial actions of “providing both physical and psychological symptom relief, normalizing stress hormone levels and increasing energy.”
Rhodiola has multiple effects in the body, including effects on neurotransmitter production in the brain and balancing effects on the HPA axis.
Side effects are uncommon. The recommended dose is 200 to 300 mg of a standardized product containing 3 percent rosavins.
Many nutrients support adrenal gland function. A good strategy is to include a high-potency multivitamin and mineral formulation and then additional nutrients with human/animal studies supporting adrenal function.
Additional recommendations include vitamin C (1000 to 2000 mg), B complex vitamins (follow directions on the label), pantothenic acid (100 to 250 mg), and magnesium (250 to 500 mg).
For patients who have more severe symptoms and lab testing that shows a deficiency of adrenal hormones, supplementing hormones such as DHEA, pregnenolone, and in limited cases, cortisol can be beneficial. DHEA and pregnenolone are available over the counter. Keep in mind that although they have direct effects on tissues, they also function as precursor hormones. For example, pregnenolone is a precursor to progesterone and DHEA, while DHEA is a precursor to testosterone and estrogen. These hormones should be used only under the guidance of a doctor.
Adapted with permission from Dr. Stengler’s bestselling book The Holistic Guide To Gut Health (Hay House Publishing)
