The common assumption is that stress causes adrenal fatigue.
Stress does cause adrenal fatigue. But the source of stress is not what you think.
When you think of stress, what comes to mind?
- Work?
- Relationships?
- Responsibilities?
- Commitments?
- Finances?
- Deadlines?
All of the above cause stress. And therefore, they all can contribute to adrenal fatigue. But the real causes of adrenal fatigue are not normal life stresses. Instead, there are 3 hidden causes that you need to know about in order to overcome adrenal fatigue.
Before we jump into the 3 hidden causes of adrenal fatigue, let’s make sure you the basics of how your body responds to stress.
The two factors that determine whether or not you’ll develop adrenal fatigue
If you haven’t already, make sure you know why adrenal fatigue isn’t a real medical condition.
I would like to introduce you to the terms metabolic reserve and allostatic load. These terms serve as the foundational principles that adrenal fatigue (HPA axis dysfunction) is built upon.
Metabolic reserve and allostatic load will determine whether your body is resilient in the face of stress. Or, if you’ll be overcome by the stress and go on to develop adrenal fatigue.
Metabolic Reserve
Metabolic reserve is the buffer that allows your stress-response system to maintain resilience in the face of stress. Think of metabolic reserve as a bank account.
When you practice meditation, you make a deposit to your bank account and your balance grows. When you undergo stress, you make a withdrawal from your bank account and your account balance decreases.
So long as your account balance remains above zero, your metabolic reserve remains intact. Of course, having more money in your account is advantageous as it better equips you to deal with unexpected stress. Should your balance go into the negative, your body no longer has the metabolic reserve to handle incoming stressors.
You have a finite amount of resources within your body to deal with all of life’s stress. These resources are your metabolic reserve. When your metabolic reserve is empty, you’re going to develop adrenal fatigue
Allostatic Load
Allostatic load measures the total amount of stressors upon your system and the cost this places on your body. If you have a minor argument with a loved one, the allostatic load is likely quite small.
But if you be battling a serious bacterial infection, the allostatic load is very high. The higher the allostatic load, the greater the stress placed on our body.
If the allostatic load is too high, you will go on to develop adrenal fatigue. There are three situations that illustrate how allostatic load leads to your body developing adrenal fatigue:
- Frequent stressful events that reduce your ability to adapt.
- Example: Traveling to multiple time zones for work on a regular basis.
- A stress response that does not end.
- Example: An undiagnosed bacterial infection in your digestive tract.
- Inadequate response or a failure to respond to a stress.
- Example: High blood sugar that is not being addressed through dietary changes.
From an evolutionary perspective, your body’s stress response system is best designed to deal with immediate stressors. Think, an encounter with a Grizzly bear. During this instance, cortisol is excreted in order to transfer glucose to your muscle cells. This transfer of energy ensures your muscles are ready to either attack the bear (fight) or run from the bear (flight).
In this example, the stress is short-lived. After running away from the bear, your body can return to a state of relaxation (homeostasis) because the stress is now gone. This type of stress is what our body is ideally adapted for.
It doesn’t place too much of a burden on either your allostatic load or metabolic reserve. These are the types of stresses you can recover from.
But into today’s world, these short-lived stresses are rare. Stress today is chronic, long-lasting, and often occurs with little to no reprieve. This will deplete your metabolic reserve and allostatic load. The resulting effect is adrenal fatigue.
The most important hormone involved in adrenal fatigue
In the context of adrenal fatigue, cortisol is the celebrity hormone. You probably know cortisol as a stress hormone. But cortisol has many other functions! Some of the primary functions cortisol exerts on your body include:
- Helps with controlling blood sugar levels
- Regulates metabolism
- Helps reduce inflammation
- Assists with memory formulation
- Helps with salt and water balance
- Helps control blood pressure
In a healthy body, cortisol levels rise just before waking. They then rise even higher (to their highest point of the day), thirty minutes after waking. This is what is known as the cortisol awakening response. As the day progresses, there’s a gradual decline of cortisol. Before bed, your cortisol should be at its lowest point of the day.
While you sleep, your cortisol levels gradually begin to rise and the cycle starts again the next day. This fluctuation of cortisol levels is known as a diurnal rhythm. (9)
Stress’s effect on your adrenal glands
To better explain stress’s effect on your body, a three-stage model is used to explain the way adrenal fatigue progresses:
- Stage 1 – Acute HPA axis activation
- Stage 2 – Stress maladaptation
- Stage 3 – HPA axis down-regulation
Below, I’ll give you an example of these three stages in action.
Stage 1 – Acute HPA axis activation:
You’re involved in a minor car accident. You suffer from whiplash but no broken bones. This is the acute stage of HPA axis activation.
In order to deal with the inflammation brought on by the whiplash injury and the psychological stress of being in a motor vehicle accident, your cortisol levels increase.
Stage 2 – Stress maladaptation:
Continuing with the motor vehicle example, you’ve been undergoing physiotherapy and chiropractic care now for three months. Your neck is still in a great deal of pain. For the first time in your life, you suffer from migraines. This stage occurs after the stressors have been present for a long period of time.
In stage 2, your body reacts to having ongoing high levels of cortisol by a process called down-regulation. When down-regulating, your brain instructs the adrenal gland to lower cortisol levels. This is an inappropriate reaction. You’re undergoing an injury that requires cortisol to help reduce inflammation. Yet your body is telling itself no need to respond. This should occur only after your neck pain is alleviated, not before.
Stage 3 – HPA axis down-regulation:
It’s been just shy of a year. Your neck pain and headaches have not changed. Your doctor has given you the diagnosis of fibromyalgia and referred you to the chronic pain clinic. In addition to pain, you feel exhausted and experience brain fog throughout the day. Aside from an antidepressant, nothing else seems to help with the pain levels.
In response to chronic stress, your body creates a state of low cortisol in order to preserve its metabolic reserve. Remember, cortisol is a stress hormone. Long-term states of high cortisol are incredibly exhausting to your system.
At this stage, most treatment therapies will seem ineffective. Recovering from this stage requires a long-term commitment. On average, healing and recovery from stage three take in excess of a year.
The state of low cortisol prevents the body from removing inflammation. Raising cortisol levels are required in order to overcome the injury/illness. Treatment from stage three adrenal fatigue should be focused on raising cortisol levels.
Are there actually 3 stages to adrenal fatigue?
These stages are better thought of as descriptors than actual medical conditions. They’re a model. Like most models, the 3-stage theory of adrenal fatigue helps you to understand the way adrenal fatigue could progress. In reality, it is not so neat and tidy. You can fluctuate between stages and sometimes skip entire stages completely.
For a deeper dive into why the 3-stage model of adrenal fatigue is wrong, check out this post.
Now that you know the basics, let’s jump into the three hidden causes of adrenal fatigue.
The first hidden cause of adrenal fatigue:
Blood Sugar Imbalance
Imagine yourself to be a multi-millionaire, retired on a beach in Mexico in a perfect relationship with your spouse. In a word, it’s stress-free. Yet, you could still be moving towards a diagnosis of adrenal fatigue (at a rapid rate) if your body is unable to regulate its blood sugar.
Undiagnosed blood sugar imbalances are the number one cause of adrenal fatigue I see in the clinic.
When you eat foods like carbohydrates, your body breaks these down into their original components – sugars. This sugar enters your bloodstream causing a rise in what is called blood sugar. Having excess sugar in your blood is dangerous. So, your body comes equipped with a wonderful hormone called insulin. Insulin transports sugar from your blood (where it’s dangerous) to the inside of your cells (where it’s safe). (10)
In the world of blood sugar, there are two illnesses that you’re likely familiar with:
- High blood sugar (or insulin resistance) also known as diabetes
- Low blood sugar (medically known as hypoglycemia)
- you may know this feeling as being hangry
Both high and low blood sugar cause tremendous stress to your body. In fact, this stress can be so significant that it can cause adrenal fatigue.
Most alarmingly, blood sugar imbalances often occur with little-to-no symptoms until you’ve already developed adrenal fatigue. Even when your doctor tells you that your blood sugar levels are fine, you could still be heading towards adrenal fatigue!
I’ll explain why below!
How your blood sugar affects adrenal fatigue
One of cortisol’s main functions is in relation to regulating blood sugar levels. It can be used for day-to-day needs or in times of high-stress situations that require excess fuel for your muscles. If you run into a bear while hiking, cortisol is what will instruct your body to release glucose into your muscles so you have the energy to run away!
Unless you’re following a keto diet, your brain runs on glucose (sugar). To regulate sugar levels, your body comes equipped with a multitude of gauges that constantly measure levels. In particular, the hypothalamus is conditioned to be extremely sensitive to fluctuations in glucose levels.
If your blood sugar levels are too low, you’ll likely feel hungry. If your levels are too high, your hypothalamus will instruct you to stop eating. This proper functioning happens when your body is free from blood sugar imbalance.
Insulin helps to lower your blood sugar. Cortisol helps to raise your blood sugar. If your blood sugar is imbalanced – either too high, too low, or large fluctuations between high and low readings – your body excretes cortisol to help balance glucose levels.
If this imbalance in blood sugar occurs over a long period of time, you have a continual excretion of cortisol. Remember, cortisol is also a stress hormone. With high circulating levels of cortisol, your brain interprets this situation as stress.
Your body responds in a very similar way whether you see a bear while hiking or if you have a blood sugar imbalance – cortisol is released. Both situations are interpreted as high stress. Over time, the chronic stress of a blood sugar imbalance leads to a lowering of cortisol levels. And just like that, you have adrenal fatigue.
How does blood sugar become imbalanced?
In today’s world, you have infinite access to comfort foods. Comfort foods are defined as those foods high in fat, sugar, and/or salt. Think, a bag of your favorite potato chips or, a container of Ben and Jerry’s ice-cream.
In periods of high stress, comfort foods are… Comforting. And they actually do produce a positive response to stress. Comfort foods lower stress hormone levels within your brain. (11) That’s what makes them so comforting!
Imagine the following the scenario:
You work a high-stress job.
So, every day after work your body has elevated stress hormones. The easiest way to re-balance these hormones is through comfort foods. Therefore, each evening meal (and bedtime snack) consists of highly processed comfort foods.
Should this type of meal plan exist for any extended period of time, it is very likely that you will develop a blood sugar imbalance. Eventually, this blood sugar imbalance may result in adrenal fatigue.
In a sense, you create a perpetuating loop of stress. Initially, you trade a lowering of stress hormones for the extra calories found in comfort foods. In the short term, this is a stellar way to lower stress.
But the long-term consumption of excess calories results in weight gain. Excess weight often leads to blood sugar imbalances which then creates another stress to our system. Eventually, adrenal fatigue develops.
So far, I’ve illustrated only how blood sugar imbalances can cause adrenal fatigue. This mechanism is not a one-way street. Instead, it is bi-directional. Meaning that adrenal fatigue can also cause blood sugar imbalances.
If you have adrenal fatigue, your low levels of cortisol are often insufficient to regulate your blood sugar levels. This often results in low blood sugar symptoms. This is why you may feel you need to eat every couple of hours. Your low levels of cortisol cannot help raise your blood sugar into healthy ranges. Thus your only option to keep your blood sugar up is through eating at regular intervals.
For some, a ketogenic diet can help solve their adrenal fatigue. For others, keto diets make things worse. For a deeper dive into the keto diet and adrenal fatigue, check out this post.
Now, let’s find out if you have a hidden blood sugar imbalance!
How do you know if you have blood sugar imbalance?
It can be challenging to diagnose yourself with high or low blood sugar without having proper testing. Some of the more general symptoms associated with low blood sugar are (12):
- Sweating
- Nervousness
- Weakness
- Shaking
- Extreme hunger
- Nausea
- Dizziness
- Headache
- Anxiety
Some of the general symptoms associated with high blood sugar are (11):
- Increased thirst
- Headaches
- Trouble concentrating
- Frequent urination
- Blurred vision
- Fatigue
While the above symptoms can be challenging to recognize in ourselves, there are laboratory tests your doctor can run. These include (12):
- Hemoglobin A1C
- Oral glucose tolerance test
But perhaps the best way is to test your own blood sugar. You can purchase a glucometer from your local pharmacy and track your blood sugar. I’d recommend the following testing schedule:
- Fasting – take this reading first thing in the morning; before any food is ingested
- Right before eating lunch
- One hour after eating lunch
- One hour after the above reading (two hours after eating lunch)
Follow the above schedule for a period of three days. Afterward, the data you collect should give you a comfortable outline of what your blood sugar levels look like.
For your reference, the below ranges are where you would like your blood sugar readings to fall into (13),(14):
- Fasting: less than 5.6 mmol/L
- One hour after a meal: less than 7.8 mmol/L
- Two hours after a meal: less than 6.6 mmol/L
How do you treat adrenal fatigue caused by a blood sugar imbalance?
Treatment is not always as intuitive as you may think. For example, if you are overweight or obese, logic would assume that losing weight would be the optimal plan to help re-balance your HPA axis. While this can be a great strategy, the way in which it is done is of paramount importance.
Aggressive weight-loss plans are massive stressors to your system. In a body that is already suffering from adrenal fatigue, rapid weight-loss strategies will only add to the level of stress. This will further deplete the body’s metabolic reserve. Weight-loss needs to occur gently, at a moderate pace, without extreme calorie deprivation.
Below are some useful lifestyle strategies you can implement to better regulate blood sugar.
- The glycemic index of foods (GI index)
- This diet was popular during the Atkins and South Beach fads.
- The GI index indicates how easily a food is broken down into a simple sugar – more specifically, how much of an effect the food will have on your blood sugar.
- For those with both high and low blood sugar readings, limiting the number of high GI foods will better regulate blood sugar.
New research suggests that the glycemic index of foods is not as accurate as once thought. Foods with a low GI index may cause massive fluctuations in your blood sugar. Foods with a high GI index may have little to no effect on your blood sugar. The key takeaway here is that you are unique. So-called healthy foods may not be so in your body.
- Consume soluble fiber
- Researchers at Lund University in Sweden found that those eating soluble or fermentable fibers for breakfast decreased the glycemic impact of all other meals that day. (15)
- Try to include one serving of soluble fiber in every breakfast.
- Utilize the Mediterranean or low-carbohydrate/ketogenic diet
- A two-year long study done by the New England Journal of Medicine found that the Mediterranean-style and low-carbohydrate diet improved glycemic control. (17)
- I’ve written a lot more about the ketogenic diet and adrenal fatigue here.
- Remove refined carbohydrates from your diet
- Especially, soft drinks and sweetened beverages (including fruit juices).
- Identify exactly which foods cause a blood sugar imabalance in your body.
- I’ve developed a program to help you do just this.
- In just 60 days, you’ll know exactly which foods give you energy and which foods take it away!
- More info on how you can stop feeding your adrenal fatigue here!
Ok, now you know how to balance your blood sugar. It’s time to turn your attention to the second hidden cause of adrenal fatigue – your sleep!
The second hidden cause of adrenal fatigue:
Your sleep quality and quantity is so important that if either is altered for long enough, sleep issues can be the sole cause of your adrenal fatigue.
Our circadian rhythm (the sleep-wake cycle we all follow) is intertwined with our hypothalamic-pituitary-adrenal (HPA) axis. Meaning, if our sleep is suffering, we have a high probability of developing adrenal fatigue. (1)
All of us living on Earth abide under the influence of day-night cycles. Some activities, like sleep, are done at night. While others, like eating, are done in the day. When the light-dark cycle changes with a season, organisms sense these changes and synchronize their activities to be aligned with the new season’s rhythms.(2)
The body system in charge of regulating our sleep-wake cycle is known as the CLOCK system. The CLOCK and stress systems (adrenals or HPA axis) are both fundamental for survival. Therefore, they regularly communicate with each other.
The constant communication between the stress system and CLOCK system ensures our body’s energy expenditures are always in balance with its available resources. This is why we have low energy after staying up all night. The stress caused by a lack of sleep creates a state where we don’t have the resources to expend a lot of energy. (4)
The largest stressors to our body in regards to our circadian rhythm include:
- Working night shift
- Sleep deprivation
- Using electronic media before bed
- Air travel/jet lag
- Working indoors with minimal daytime light exposure
Sleep deprivation is likely the most significant issue for most of us. According to the World Sleep Society, the average Canadian sleeps only 6.4 hours each night. (4) Even though an overwhelming amount of evidence suggests that 7-8 hours of sleep each night is needed.
According to the Tulane Center for Aging and Circadianbiology:
Healthy aging is the ability to maintain the most consistent light/dark entrainable rhymicity and coordination at the molecular, cellular, and systemic levels throughout the lifespan, originating in the genetically programmed resistance to environmental cues and stress cabable of disrupting this balanced progression. (5)
Did you catch that?
They have found that the key to healthy aging is to maintain a consistent sleep schedule that is aligned with the natural light-dark cycle of where you live.
With the above in mind, there are two factors essential to addressing adrenal fatigue in the context of the sleep/wake cycle or circadian rhythm:
- Sleep quantity and quality
- Circadian disruption
Sleep
Sleep loss (both acute and chronic) triggers an immune system response to inflammatory processes; specifically, an increase in cortisol levels. If this occurs over a long period of time, our body will eventually down-regulate (or suppress) cortisol production.
If you remember from my previous post, cortisol is an incredibly powerful anti-inflammatory hormone. When our body down-regulates cortisol production, it is no longer able to sufficiently stop inflammation. This leads to greater levels of inflammation. It takes only two consecutive nights of shortened sleep to generate large changes in the circadian production of cortisol. (6)
To summarize, if you are suffering from adrenal fatigue, it is imperative that you allocate (at minimum) 7.5 hours for sleep each and every night. For those working night shifts or some other rotation that alters your sleep/wake cycle, it is recommended to change shifts (if possible) while healing from adrenal fatigue.
Circadian disruption
Circadian disruptors are factors that create shifts in our body’s circadian rhythm. Think jet lag and shift work. Shift work, in particular, has been linked to multiple chronic diseases including: (7)
- Cancer
- Autoimmune disease
- Metabolic disease (diabetes, obesity)
- Mood disorders
While it may take one night shift to initially alter cortisol levels, you likely won’t notice any immediate symptoms. These effects will often go unnoticed for years. Developing adrenal fatigue is not an overnight occurrence. It develops due to a consistent, unrelenting stress to the body. Often, it takes years to develop.
The more robust your immune system, the longer you’ll be able to endure disruption to your circadian rhythm. So, if shift work is unavoidable, it is imperative that your nutrition, stress reduction techniques, and exercise habits are all functioning at one hundred percent.
Use of prescription sleep aids and caffeine are not recommended. These contribute to further degradation of your body’s natural sleep-wake cycle.
How to treat adrenal fatigue caused by circadian disruption
There are three specific techniques we recommend for treating adrenal fatigue caused by circadian disruption:
- Sleep entrainment
- Access to morning sunlight
- Melatonin
- Avoid the use of electronics before bed
Sleep Entrainment
The most obvious (and often underutilized) is to regulate your sleep-wake cycle with that of your location’s natural sunrise and sunsets. You should aim to be asleep when it is dark out and awake during the daylight hours. This is the rhythm our bodies have adapted to over thousands of years.
In our culture of high performance, sleep is often regarded as an inconvenience. Therefore, in order to ensure you are getting 7-8 hours each night, this duration of time needs to be scheduled. It is unlikely that you will be able to alter the time in which you wake due to your work commitments. Therefore, the time that you have control over is the time in which you go to bed.
You need to consciously make the effort to put yourself in bed so that you have 7-8 hours before your alarm goes off.
Access to morning sunlight
One of the first things our body needs upon waking is a large dose of sunshine. Exposure to sunlight ensures a large release of cortisol. This is called the cortisol awakening response – for more information refer to my initial post in the series.
For those of us residing in the northern hemisphere, access to sunlight before work may not be plausible during the winter months. In this circumstances, I recommend purchasing a light-therapy device. After rising, spend 10-15 minutes in front of this device.
Exposure to light in the morning will entrain your body to a light-dark cycle that is aligned with your work schedule. During lunch, ensure that your body is again exposed to sunlight – a brief walk outdoors is all that is required.
Melatonin
Melatonin is a hormone our body produces at night to assist with falling asleep. A multitude of studies have shown melatonin to assist with bringing our body to rest. This is especially true in older patients who typically have decreased melatonin production. Always begin melatonin supplementation at the lowest possible dose that helps maintain proper sleep pattern.
Typical doses are 1-3mg and should be taken as close to bedtime as possible.
Avoid the use of electronics before bed
The brightness from your device’s screen is from the blue color spectrum. The retinal ganglion cells in your eyes are very sensitive to the blue and green light. So sensitive, in fact, that our bodies confuse the light from our screen with that of the sun. (2)
When your body should be sensing darkness and increasing melatonin production in order to prepare for sleep, the light from your device is suppressing melatonin by telling your body that it is still daytime.
Apps like F.Lux can be used to block blue light from being emitted from your device. Whether you have adrenal fatigue or not, I would recommend installing f.lux. The use of this app can reduce the stress on your body caused by a decrease in melatonin production.
