In part 1, we covered basics on the hypothalamic-pituitary-adrenal axis and how the systems in the body can break to create the disease process of adrenal fatigue.  In this part 2, I’ll be talking about lifestyle modifications since our lifestyle has a huge part in the manifestation of symptoms and root cause of hypothalamic-pituitary-adrenal dysfunction. Part 3 will be all about my thoughts on diagnosis and management.

Let’s do a quick bit of review to get us started.

A Brief Review

The hypothalamic-pituitary-adrenal axis  is one major way your body normally responds to stresses in your life: to work, to finances, to marital problems…everything that you’re trying to do.

The process starts at the hypothalamus: your brain gets a signal that you need to do something and that it needs to happen right now. The signal then gets transmitted to your pituitary and the molecules that serve to provide that feedback go to your adrenals and let it know, “Hey, we need more cortisol.”

Your adrenals are relatively resilient, much like lots of organs in the body, and they can produce cortisol for quite a bit of time.  This allows you to stay up late, wake up early, and genearlly get pumped up enough to push you through the day. In my case, see more patients, respond to more emergencies and I feel fine doing that…at least I did for a while.

The problems results when you ask your body to do that for way too long.

In an ideal world, stressors would only stick around for short periods of time.  Let’s take a super basic example:  imagine that it’s back in the day and you’re being chased by a lion. Your hypothalamic-pituitary-adrenal axis and central nervous system would work together to fire and help you run away. Then–theoretically–you would survive, go back to wherever you are living, have some downtime, and do what you needed to do to relax and go back to your body’s homeostasis. (Homeostasis just refers to your push and pull of your body’s desire to come back to its baseline function.)

Unfortunately, with most of our lifestyles, that’s not the case.

Everyone has busy jobs. Everyone has families to take care of, relationships to manage, and finances to worry about. What happens then is that your hypothalamic-pituitary-adrenal system begin to dysfunction. This includes the development of cortisol resistance, breaking of normal feedback loops, and shunting of other substances to make more cortisol.  That last bit is what we’ll address next:

There are compensatory functions where you can actually steal precursors from other less vital pathways (such as the production of sex hormones) but this will only last so long. You’ve maxed out the cortisol production in the hyperfunctioning adrenal state and are now in the hypofunctioning state. While it can be confusing and misleading that both the hyperfunctioning and hypofunctioning states are termed “adrenal fatigue” (it would have been better probably to call it hypothalamic-pituitary-adrenal dysfunction…but that’s kind of a mouthful), that’s the term we’re all currently stuck with.

Management vs. Treatment of Adrenal Fatigue

In this post, it is my plan to discuss lifestyle modifications that will help you manage, and even possible “treat” (aka: resolve), adrenal fatigue.  This is important enough to get its own post because adrenal fatigue stems often from our lifestyle choices and trying to treat the medical symtpoms without addressing the instigating problems is like trying to use a bucket to get out water from a boat with a hole. (We’ve all seen cartoons, right?)

The reason I keep saying “manage my adrenal fatigue” is that it’s not always a condition that someone can just fix.  Some people will be able to reverse the process entirely while others will havea long-term management approach to the problem.

This is similar to other disease states; some folks can reverse the manifestations of type 2 diabetes while others will require a lifetime of management to control the symptoms and keep the damage to organs at bay.  Either way, the goal is to not have symptoms…so I’m not even really making the case that management of something is necessarily detrimental.  I’m simply stating that it’s an ongoing process. (I consider myself in the “managing my adrenal fatigue” category.)

Often, the extent to which someone can  officially “treat” their adrenal fatigue is directly related to how much control they have over the lifestyle changes they can make.  It’d be great if we could all live a relaxed, stress-free lifestyle…but I doubt that I‘m going to fool anyone into thinking that’s going to necessarily happen anytime soon.

Now, I’m sure someone out there is going to say that you have as much control over your life as you want and it’s totally possible to get to where you want to be.   And while I largely agree in a lot of ways, I think our desires are not always black and white like that.

For example, my work is totally crazy and hectic and leads me to have to manage my adrenal fatigue.  But in order for me to become the type of high quality doctor that I want to become, residency is just something I have to get through right now.  It’s imperative that I see so many patients now and get the adequate training so that, later in my career, I’m equipped to deal with the patients that are solely under my care. And thank goodness, right?

And the things is, as much as I want to control my adrenal fatigue and live as healthfully as possible, I really, really want to be a doctor.  And I want to be a good doctor at that!

.So as much as I may have suffered certain negative outcomes in health from going through the process, my choice of profession makes me really happy and gives me a purpose in life.

However, it is incredibly important that I manage this and make sure to minimize the any possible damage that I accrue over this stressful time in my life.

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So what follows is going to be a series of tips for what I do to help manage my adrenal fatigue, minimize negative outcomes, and control symptoms.  For the most part, even with my current job, I am symptom free the majority of the time.

1. Take Mini Breaks Throughout the Day

I always – no matter how crazy my day gets – take a little bit of time at regular intervals to shut down for just a few minutes and to sit somewhere quietly.

Now, I’m lucky enough to have a job that thas call rooms where you can get a little peace and quite but this can be done virtually anywhere, even at a desk.   I turn off absolutely any distractions I can turn off (obviously, I can’t turn off my pager and you may have something at your job that you absolutely must keep on) and work to minimize any disruptions that may come my way over this period of time.

A lot of times, this quiet time means that I sit in absolute silence, place my hands over my eyes, and give my body a break from any stimuli coming in.  I just breath, think about all the things I’m grateful for, and and breath some more.

Other times, this means I get out my phone and take a mental-shutdown-break.  I look at goofy pictures of cats on the internet (I’m not proud, ok? But it works) or I’ll call a loved one to chat about how things are going for them.  I give myself some time just for me, just to do something that makes me happy.

Always when I do this, I can feel my heart rate goes down and my breathing gets slower. I just feel better even with just a few minutes away from any obligations.

Sometimes I can sneak away 2 minutes and, when I’m lucky, I’ll get a whole 15.  I generally don’t put pressure on myself to get a certain amount.  I just grab a break when I can and appreciate the bit of respite it provides.

2. Natural Movement and Exercise

To effectively manage my adrenal fatigue, I always make it a priority to do some sort of activity with my body every day.

Now, the question of exercise and adrenal fatigue is a very complex one and there’ll be future articles talking about that.  But a common problem that happens for people, and one I have fallen victim to, is when someone is already very stressed (aka: they have high cortisol requirements with pre-existing dysfunction) and they try to do very strenuous physical on top of that (raising their cortisol output requirements even higher).  The amount of exercise and “strenuous-ness” of the exercise that someone can handle will vary from person to person, depending on their current and long-term adrenal state, but pushing too hard for too long will ultimately worsen the adrenal fatigue in anyone.

So instead of very intense exercise, what I’m talking about instead is simply moving my body in a way that increases blood flow, engages the joints and muscles, and maybe even gets me connected with nature a bit.  Activities that fall into this category include taking walks/hikes (especially out in a natural environment!), yoga/stretching, and bike riding…but you can fill in any activity you want!

Now, this doesn’t mean that I don’t do intense exercise at all!  I simply have to choose the appropriate times to do those strenuous bursts of movement.

In order to decide if I’m going to work out hard on any certain occasion, I’ll ask myself the following questions:

• How stressed have I been lately?
• How has my sleep been?
• How do I feel today? Do I have the reserve today to exercise safely?

In my mind, I look at it as “having the luxury of working out”.  When I know I’ve been pushing my hypothalamic-pituitary-adrenal axis around a bit (I’ve been really stressed, I’ve been sleep deprived, I‘ve haven’t been eating well), I know my body’s really in no place to have that cortisol spike that comes with intense exercise.

Sometimes it is difficult to pass it up, especially when you enjoy working out.  But like most things with exercise, pushing through an “injury” (yes, I’m counting adrenal fatigue as an injury to the body) will just mean that you’re out for longer later down the road.  I keep that in mind when I’m tempted to ignore how I’ve been feeling.

On occasional, I’ll be wrong about what kind of workout my body can handle.  I can always tell if I’ve overdone it by the fact that I’ll just feel exhausted the next day and or even later that night. I’m not only tired…I can’t keep my eyes open, I can’t think straight, and I get super grumpy.  And there’s no amount of chocolate in the world that makes me feel better!

So after a few rounds of that, I’ve learned what my body feels like when that happens.  It has allowed me to correlate what my body feels prior to doing the activity that to I chose to do and what pushed me over to the edge.

3. Get Sleep

This is a tricky subject, since most of us are sleep deprived but when it comes to adrenal fatigue, getting good sleep has to become a top priority.

Now, getting the alloted 8 hours of sleep isn’t always possible every day.  But I break sleep down into 2 important categories:

Option 1: Get extra sleep when you can.

This means making up sleep on the days I have off.  And grabbing a rejuvinating nap whenever the chance come up.

Again, these things aren’t always possible which is why there’s #2…

Option 2: Make the absolute best of the sleep you do get.

This one is actually easier, in my opinion.  (The body is actually quite willing to help out in this regard because the body will head into restorative sleep more readily when you’re short on sleep. This is not an invitation to abuse this ability…I’m saying this as a good thing though because it’s really easy to get stressed out about not getting to sleep enough.)

In preparation for sleep, I power down a lot of the lights and electonics in the house.  But since I usually still have to get some things done, I further decrease the stimulating effects of the lights by wearing amber tinted glasses.

I also keep a short bedtime ritual that involves a quick stretch and a cup of sleep-inducing tea (I like this Tranquilizer Tea Blend the best).  This is the time that I cool down our house to about 65-68 degrees by opening windows in the winter and turning on the AC in the summer.  I also close the black out shades in the bedroom to keep it extra cave like.  I’ll also turn on the humidifier because it helps me breathe at night and because it creates some really nice white noise to cover up the Chicago night-life din.  (A nice alternative is this free app you can download called White Noise on iTunes.)

This sounds like a lot to do but it all takes just a few moments.  However, having this ritual helps get my mind and body prepared for bed and I have noticed a significant difference in how quickly I fall alseep once laying down.

Once I lay down, I slather on some magnesium oil (I make it homemade but it’s widely available pre-made) or magnesium body butter. I actually even further block any stimuli by putting on an eyemask and ear plugs, but that’s because we live on a pretty noisy street.  Normally, I’m asleep within 5 minutes after all of this! But if I’m not, I do some deep breathing exercises to quite my mind and settle down.  If I’m up because I have an ongoing to-do list rumbling around in my head, I’ll get up and write myself a to-do list for the morning.

Reassuring myself that I won’t forget to take care of something and that I can take care of it in the morning is usually enough to let me relax for the night.

Sleep is a huge topic! And I discuss all this and more in great detail in this post.

4. Curb Your Caffeine

Intimately related to the topic of sleep is the consideration of caffeine intake.

Caffeine works in brain by blocking adenosine receptions. The blockade of these receptors increases the action of excitatory molecules in the brain and at the level of the adrenals.  Most relevant to our discussion is the increased release of cortisol from the adrenals…and this is why caffeine intake is such an important consideration when it comes to managing adrenal fatigue.

Caffeine is also often used a crutch by most peope, myself included.  I’ve used it to stay up late and to get myself energized to get more work done.  While these things can be ok in a more healthy individual on occasion, using caffeine like this can be a slippery slope for someone dealing with adrenal fatigue.

When I first was dealing with severe adrenal fatigue, I actually cut out coffee entirely and used this protocol to eventually only be drinking caffeine-free herbal teas.  As I began to improve, I slowly introduced caffeine into my life gradually and at appropriate times.

I now approach caffeine similarly to the question of exercise…when I’m already taxing my adrenals with my lifestyle, I don’t add caffeine to the mix at all or just in very small quantities.

Timing is Key

Regardless of the amount of caffeine you drink, timing is a really important aspect because of how much caffeine can impact sleep.  This is because caffeine in the body has a half-life, on average, of about 8 hours.  This means that if you drink 100 mg of caffeine at 2 pm, you’ll still have about 50 mg of caffeine in your system by 10 pm…that’s pretty surprising, right??  (And this is nothing considering your average drink from Starbucks has about 300 mg of caffeine.)

Because of this, I have a personal daily cut off caffeine time of about 12 pm since I aim to be in bed fairly early, if possible.  Since I love drinking teas throughout the day, I generally switch to caffeine free versions, like rooibos, for the afternoon.

But what if you really have to get stuff done??

I will, in very specific circumstances, use caffeine to help me get stuff done.  But I’m basically using caffeine as a supplement in this case and I believe it’s important to treat it as such.  For these instances, I’ll generally use a moderately caffeinated tea, like green tea, to give me a boost without as much of the sleep-altering after-effects.

Under normal circumstances, I’ve found that making the rest of the lifestyle choices I’ve outlined here is enough to keep me energized throughout the day…so it’s not necessary for me to use anything to pep me up at all.  It is absolutely more effort to do it like this, but the sustained energy, for me, is totally worth it.

5. Manage Blood Sugar Levels

A topic we didn’t delve into too deeply in part 1 was how all the other hormones in the body interact with the hypothalamic-pituitary-adrenal system…but this interaction is very intricate and important.

Negative and positive feedback loops exist for all the hormones in the body. Throw off any of them and the rest are effected.

A very commonly imbalanced hormone, besides cortisol, in our modern-day society is insulin.  This is because our main-stream cultures, with copious amounts of unhealthy, sugar-ladden foods and a decreased impetous for natural movement, aren’t super condusive to maintaining good insulin control.

While the rest of the lifestyle modifications outlined in this will help insulin control as well, I think it’s an important enough topic to mention on its own.  I personally have seen improvement in my adrenal fatigue and female hormone balance by discussing insulin sensitivity/resistance with my physician and taking appropriate action to monitor what my body was doing.

My personal actionable items with dealing with this are fairly straight-forward: decreased intake of sugar-y foods, maximizing nutrient density and diversity, and daily movement.

6. Eat Well

Good nutrition is pretty much good for everything, so I doubt I need to make the case for it too long here.  But I think it’s important to understand how eating nutrient-dense food plays a role in helping ot manage adrenal fatigue.

All of the micronutrients in food are used as co-factors to chemical reactions in the body.  Without them, the body has to either make do or use certain work-arounds to make the processes happen anyways…in either case, the efficiency drops.

When you ask your body to work harder in the setting of adrenal fatigue, the problems begin to compound. The depletion of nutrients acts as a stressor, and the stress contributes to nutrient depletion in the body.

As a result, I avoid certain nutrient-depleting foods and fuel instead with the more nutrient rich foods I can find (liver, bone broth, sardines, vegetables, healthy fats like ghee and coconut oil, and probiotic foods…just to name a few).  You can find all the specifics of what I focus on in this post.

This line of reasoning is part of why I started Nutrient Boot Camp.

Plus, eating good food is fun! Which brings me to my final point…

7. Have Fun and Connect

Now, this topic is another huge one!

I’m not sure everyone will relate to this but when I’m trying to deal with a health problem, most of the time my answer is buckle down and get more strict with myself.  I think stuff like, “I need to get more sleep. I need to narrow my food choices. I need to manage my stress, and I need to do all of these things right now.“  Certainly, this type of action-orientated approach has its place and can be incredibly helpful.

I have learned for myself is that one of the best things that I can do is sometimes just let go of the reigns a bit when it comes to being so laser-focused about the whole thing.  Sure, I can improve my sleep hygeine, make better food choices, and work on how I handle stress.  And those things definitely make me feel better.

But I also have to make time for having fun.  Whether this means taking time to goof around with my husband, watch a hilarious movie, or even zone out to Friends, the point is just to be happy.  It feels counter-intuitive to schedule time for a pedicure, massage, or brunch with friends when you have more pressing things to do, but the fulfillment and mental release from doing those things can improve your outlook and work flow on all the other parts of your life.

In the same vein, taking time to connect when you feel overwhelmed and stressed can be incredibly therapeutic…though most of us are resistant to doing it. But interpersonal relationships are incredibly powerful (think back to a day where you got in a fight with someone close to you…and how it impacted your day, your week, or your month).  Taking time out of my busy schedule to connect, vent, and relate to people close to me has been a huge help in managing my adrenal fatigue.

Moving On From Here

In the next post, I’ll be discussing my thoughts on diagnosis and management.