Everything to Know About Adrenal Fatigue and the Adrenal Fatigue Diet
Ah, adrenal fatigue. The condition you've likely heard of…but have no idea what it means. Talk about #relatable.
Adrenal fatigue is the buzzword given to the slew of symptoms associated with prolonged, very high stress levels. If you're reading this, there's a chance your Google cal looks like a game of Tetris and/or you self-identify as a Stress Case. So how the heck do you know if you have adrenal fatigue or are just abyss-level deep in a bad week at work?
Here, holistic health experts bring you a guide to adrenal fatigue, including what adrenal fatigue is, what to do if you have it, and why the adrenal fatigue treatment plan could actually be beneficial to everyone.
What Is Adrenal Fatigue, Anyway?
As you might guess, adrenal fatigue is related to the adrenal glands. As a refresher: The adrenal glands are two little hat-shaped glands that sit on top of the kidneys. They're small, but they play an integral role in the functioning of the entire body; their main role is to produce important hormones such as cortisol, aldosterone, epinephrine, and norepinephrine, explains naturopathic doctor Heather Tynan. For example, these glands respond to stress by churning out cortisol (the "stress" hormone) or releasing norepinephrine (the "fight or flight" hormone).
Hormones affect literally everything in the body, and since these glands produce hormones, they have a hand in a steep number of bodily functions as well. For instance, because they produce cortisol, "the adrenals are indirectly involved in functions like regulating blood sugar levels, controlling metabolism, managing inflammation, respiration, muscle tension, and more," explains holistic health expert Josh Axe, D.N.M., C.N.S., D.C., founder of Ancient Nutrition, and author of the Keto Diet and Collagen Diet.
Generally, the adrenal glands are self-regulating (meaning they kick into action on their own, like other vital organs) and produce hormones in response to external stimuli (like a stressful work email, scary animals, or a HIIT workout) in the right doses. But it's possible for these glands to malfunction (or fatigue) and to stop producing the right hormones at the right times. This is called "adrenal insufficiency" or Addison's disease. "Adrenal insufficiency is a medically-recognized diagnosis in which levels of adrenal hormones (like cortisol) are so low that they can be measured by a diagnostic test," explains Tynan.
Here's where it get's tricky: "Sometimes, people have an 'in-between condition'," says functional and anti-aging medicine doctor Mikheil Berman M.D., with Hormone Correction. "Meaning, that their adrenal hormone levels aren't so low that they have Addison's disease, but that their adrenal glands aren't functioning well enough for them to feel or be healthy." This is called adrenal fatigue. Or, at least, this is what anti-aging doctors, functional medicine doctors, and naturopaths recognize as adrenal fatigue.
"Adrenal fatigue is not recognized officially recognized by the International Classification of Diseases, Tenth Revision (ICD-10) system, which is a system of diagnostic codes accepted by insurance and recognized by many Western medicine doctors," says Dr. Berman. (Related: How to Balance Your Hormones Naturally for Lasting Energy).
"No scientific proof exists to support adrenal fatigue as a true medical condition," agrees Salila Kurra, M .D., endocrinologist and assistant professor of medicine at Columbia University Medical Center. However, doctors and health professionals who are trained in different methodologies tend to feel otherwise.
What Causes Adrenal Fatigue?
Stress. Lots of it. "Adrenal fatigue is a condition caused by overstimulation of the adrenal glands due to long-term stress," says Axe.
When you're stressed (and that stress can be physical, mental, emotional, or a combination of all three) the adrenal glands are being told to release cortisol into your bloodstream. When you're overstressed, they're constantly churning out cortisol, which overworks them and wears them down, says Axe. "And in the long term, this chronic stress interferes with their ability to do their job and produce cortisol when they need to." This is when adrenal fatigue sets in.
"Adrenal fatigue hits when you can no longer produce enough cortisol, due to having been under chronic stress (and producing such high levels of cortisol) for a long period of time," explains Dr. Berman.
To be very clear: This doesn't mean one stressful day in the office or even a stressful week or month, but rather a p-r-o-l-o-n-g-e-d period of heightened stress. For example, months of doing high-intensity (read: cortisol-spiking) exercise like HIIT or CrossFit five or more times a week, working 60 hours per week, dealing with family/relationship/friend drama, and not getting sufficient sleep. (Related: The Link Between Cortisol and Exercise)
Common Adrenal Fatigue Symptoms
Frustratingly, the symptoms associated with adrenal fatigue are often described by medical professionals as "non-specific," "vague," and "ambiguous."
"Many of the symptoms associated with adrenal fatigue could be associated with a number of other syndromes and diseases such as thyroid dysfunction, an autoimmune condition, anxiety, depression, or infection," says Tynan.
These symptoms include:
Trouble sleeping or insomnia
Brain fog and lack of focus and motivation
Thinning hair and nail discoloration
Low exercise tolerance and recovery
Low sex drive
Cravings, poor appetite, and digestive issues
That list may be long, but it's far from complete. Because all your hormones are interconnected, if your cortisol levels are out of whack, your other hormone levels like progesterone, estrogen, and testosterone levels likely will be thrown off too. Meaning: Anyone with adrenal fatigue can begin to suffer from other hormonal conditions, which can compound the symptoms and confuse doctors. (See more: What Is Estrogen Dominance?)
How to Diagnosis Adrenal Fatigue
If any conglomeration of the above symptoms sounds familiar, your first step is to chat with a healthcare professional. "If you're experiencing [general] fatigue, it's incredibly important to get checked out and figure out the underlying reasons," says Dr. Kurra.
But because many Western medicine doctors don't recognize adrenal fatigue as a real diagnosis, the type of healthcare professional you seek out may affect the kind of diagnosis and treatment you get. Again, naturopathic doctors, integrative medicine practitioners, acupuncturists, functional medicine practitioners, and anti-aging doctors are more likely to diagnose and treat symptoms as adrenal fatigue than your general practitioner or internist. (Related: What Is Functional Medicine?)
If you think you're dealing with malfunctioning adrenals, Tynan recommends asking your healthcare provider to run something called a four-point cortisol test, which can measure your cortisol levels as well as the daily fluctuations in those levels.
But (!!) because adrenal fatigue can cause adrenal hormones to be low but not "low enough to qualify as Addison's disease" or to bring them out of the "normal" range on a test, confirming the condition is nearly impossible, says Tynan. If the test comes back negative (as it likely will), conventional medicine doctors will look for other underlying causes or treat the symptoms individually.
For example, in the absence of a positive test, "a functional medicine doctor may still recognize and treat as adrenal fatigue, whereas a conventional medicine doctor may recognize as anxiety and simply prescribe Xanax, which won't actually fix the problem," says Dr. Berman.
However, on the opposite side of the same coin, Dr. Kurra says, her "concern with an adrenal fatigue diagnosis is that someone's symptoms don't get resolved if there's another underlying issue that you missed. The exact testing and treatment protocols we'll go through with someone experiencing [general] fatigue will depend on things like their age, sex, and previous medical history." (Also see: What Is Chronic Fatigue Syndrome?)
Adrenal Fatigue Treatment
Sound complicated? It is. But even though adrenal fatigue may not be a condition recognized by Western medicine, the symptoms are very much real, says Tynan. "The effects of chronic stress can be debilitating."
The good news is that "it's generally accepted that any potential negative effects on the adrenals from one year of chronic stress can, with proper care, heal in about one month," she says. So, two years of chronic stress might take two months, and so on, Tynan explains.
Okay, okay, so how do you allow your adrenal glands to heal? It's pretty simple, but can seem daunting: "You have to manage your stress levels," says Len Lopez, D.C., C.S.C.S, chiropractor and certified clinical nutritionist. "That means you have to quit doing the things that make you feel more stressed. And start doing things that help you feel less stressed." (Related: 20 Simply Stress Relief Techniques).
That means less electronic use at night, fewer long days at the office when possible, and less (frequent) HIIT exercise. That also means seeking out a mental healthcare professional who can help you better manage social stress and anxiety, meditating, deep breathing, mindfulness work, and journaling.
What About the Adrenal Fatigue Diet?
Most folks with adrenal fatigue are also "prescribed" something called the adrenal fatigue diet. "It's a specific way of eating that aims to reduce the symptoms associated with adrenal fatigue, while also providing the body with the nutrients it needs to remedy the condition and help you return to a state of health," explains Tynan. "It's a way of healing your body from the inside."
The adrenal fatigue diet aims to stabilize blood sugar and balance cortisol levels by limiting sugar while increasing the intake of protein, healthy fats, veggies, and whole grains (aka a pretty healthy diet for most humans).
How is this supposed to help with adrenal fatigue? Refined carbohydrates quickly break down into sugar after you ingest them, which causes a spike in blood sugar followed by a steep decline, explains Tynan. This takes your energy levels on a rollercoaster—which, for someone experiencing symptoms of constant fatigue and exhaustion, is not good. Energy drinks and other caffeinated items can result in a similar effect, and for that reason, are also off-limits.
On the flip side, healthy fats and high-quality proteins slow the blood sugar rollercoaster and promote stable blood sugar levels throughout the day, says Lopez. Intake of these macros is especially important at the beginning of the day, he says. "Skipping breakfast is a major no-no on the diet. Folks with adrenal fatigue need to eat something in the morning to get their blood sugar up to a healthy level after a night of it dipping."
The diet discourages foods that are inflammatory or hard to digest and may contribute to gut health issues. "Irritation and inflammation in the gut trigger the adrenals to produce more cortisol to deal with the inflammation, which the system can't currently handle," says Lopez. (Related: Could Your Gut Bacteria Be Making You Tired?) That means cutting the following:
Sugar, sweeteners, and artificial sweeteners
Refined carbohydrates and sugary foods like cereals, white bread, pastries, and candy.
Processed meats, like cold cuts, salami
Lower quality red meat
Hydrogenated oils and vegetable oils like soybean, canola, and corn oil
While the diet may entail cutting back on certain foods, Axe makes an important point: The adrenal fatigue diet is more about eating more foods that make you feel good and nourish your body versus restricting. "This diet is not about cutting back on calories. In fact, just the opposite; because being too restrictive can stress the adrenals further," he says.
Foods to emphasize on the adrenal fatigue diet:
Coconut, olives, avocados, and other healthy fats
Cruciferous vegetables (cauliflower, broccoli, Brussels sprouts, etc.)
Fatty fishes (like wild-caught salmon)
Free-range chicken and turkey
Nuts, such as walnuts and almonds
Seeds, chia, and flax
Kelp and seaweed
Celtic or Himalayan sea salt
Fermented foods rich in probiotics
Chaga and cordyceps medicinal mushrooms
Oh, and drinking plenty of water is also essential, adds Tynan. That's because being dehydrated can further stress the adrenals and worsen symptoms. (ICYWW, here's what dehydration does to your brain).
Who Should Try the Adrenal Fatigue Diet?
Everyone! Seriously. Whether you have adrenal fatigue or not, the adrenal fatigue diet is a healthy eating plan, says registered dietitian Maggie Michalczyk, R.D.N., founder of Once Upon A Pumpkin.
She explains: Veggies and whole grains are a good source of fiber, vitamins, and minerals, of which most of us are not getting enough. "Adding more of these foods to your plate (and crowding out things that are high in sugar) will help boost your energy and improve digestion, whether you have adrenal fatigue or not," she says. (Related: What You Should Know About The Anti-Anxiety Diet).
Additionally, prioritizing high-quality protein can increase iron levels, which can combat symptoms of anemia and vitamin B12 deficiency, which can also make you tired, says Lisa Richards, C.N.C., nutritionist and founder of The Candida Diet. Plus, "healthy fats may reduce inflammation in the body, which is known to cause fatigue and many serious health conditions that aren't adrenal fatigue," she says. (See More: This Is What Chronic Inflammation Does To Your Body).
The Bottom Line
While the term "adrenal fatigue" is controversial because it's not generally recognized as an official diagnosis, it described a set of symptoms that are indeed associated with adrenal glands that have stopped working after a period of high stress. And regardless of whether you ~*believe*~ in the adrenal fatigue or not, if you're a Super Stress Case, and have been for a while, you may benefit from following the adrenal fatigue treatment plan, which, really, is just a let-your-body-rest-and-recover plan (which could benefit everyone). And that means doing your best to lower your stress levels while eating a healthy, veggie-rich meal plan.
Just remember: "These diet and lifestyle changes are only likely to be effective if there's not an underlying pathological cause to the symptoms you're experiencing," says Tynan. She emphasizes the importance of seeking out the opinion of a healthcare provider you trust instead of self-diagnosing and self-treating. "The diet and lifestyle changes recommended for people with adrenal fatigue and similar symptoms aren't going to hurt anyone," she says. "But still, an expert is step number one."