Worn out. Unmotivated. Achy. Exhausted. Depressed. These are just some of the common words people use to describe adrenal fatigue. Some other symptoms may include feeling wired, anxious, or overstimulated.
While many people experience these types of symptoms in certain seasons of life, if they’re happening as a result of adrenal fatigue, then individuals likely have endured them for so long that they’ve become intractable and disruptive to their quality of life, often leaving them feeling hopeless.
This condition can impact anyone, however, it does tend to affect women more often than men.
Even though the process to address adrenal fatigue can be frustrating, with time, patience, and diligence, there is hope on the other side.
Is Adrenal Fatigue Even a Real Thing?
Adrenal fatigue is not a recognized medical condition, and some conventional doctors might raise their eyebrows if you suggest to them that you might have it. It’s more likely to be diagnosed with depression than to have adrenal fatigue considered (the symptoms are similar for both).
The adrenal glands, sometimes called the suprarenal glands, are two walnut-sized glands that sit on top of the kidneys. They secrete our main stress hormone, cortisol, as well as DHEA, a precursor to sex hormones.
The adrenal glands work in tandem with the hypothalamus in the brain and the pituitary gland. The interaction between the three (often referred to as the HPA axis) is intimately involved with our stress response, digestive and immune systems, and overall metabolism. When all is well, a cascade of hormones pings back and forth in the HPA axis, using a biochemical Morse code to create a system of checks and balances to stimulate cortisol when needed and suppress it when not.
Western medicine typically only recognizes the most extreme imbalances in cortisol levels: Cushing syndrome (associated with clinically high cortisol) and Addison’s disease (associated with clinically low cortisol). In the absence of one of these diagnoses, cortisol is often not of great concern in the conventional approach.
The concept of “adrenal fatigue” really comes down to semantics.
From a fat loss, energy, vitality, and metabolism standpoint, cortisol imbalances are an issue and a potential barrier to success — even in the absence of Cushing syndrome and Addison’s disease. While it is unlikely that the adrenal glands themselves are actually “tired” and in need a nap or a vacation, HPA axis dysfunction and cortisol insufficiency are a real thing that ought to be addressed.
Using the term “adrenal fatigue,” while physiologically inaccurate, often can help explain and simplify some of the complex physiology that can occur when cortisol levels are low.
At the end of the day, the goal is to look, feel, and function as optimally as possible and to be the best version of you that you can be.
Cortisol Rhythm, Stress, and Recovery
It’s helpful to better understand the connection between stress, cortisol, and adrenal fatigue.
Cortisol is not all bad — we need some, at the right times, and in the right amounts.
Ideally, cortisol levels rise in the morning, giving us energy to awake from our slumber and joyfully greet the day. (It’s possible!) Levels should drop from morning to noon, then gradually taper down and stay low throughout the night. The low levels of cortisol and the rise in melatonin should allow for a peaceful night’s rest.
Stress causes cortisol to rise outside of its normal daily rhythm. In times of acute, immediate stress, cortisol shoots up, arming us with the quick energy needed to either meet face-to-face with the threat or flee from it, assisted by an increase in heart rate, blood flow, energy, acuity, and an enhancement of reflexes.
After this “fight or flight” response, cortisol should return back to baseline to achieve balance and stability. Elevated cortisol is only detrimental when your diet, lifestyle, and exercise habits don’t allow you to recover from one release of cortisol to the next.
Cortisol also helps stimulate the recovery process, so you adapt and grow stronger following the stressful event.
This is where adrenal fatigue fits in. It’s not necessarily the stress itself that causes problems. It’s the lack of recovery following the stress that leads to adrenal fatigue. When you don’t recover properly, your daily cortisol rhythm changes.
How Recovery is Supposed to Work
Stress is part of life and is necessary for growth, learning, and physical and mental adaptation.
The stress of intimate relationships makes you adapt and develop empathy, the stress of your business or career helps you think differently and communicate more effectively, and the stress of weight training is needed to strengthen muscles and improve bone health.
Take a deadlift for example. Let’s say that the most weight you’ve lifted off the ground in the past year has been a 40-pound bag of mulch. You then begin a more formal exercise routine, and you incorporate a deadlift using 45 to 50 pounds and do a few sets of eight repetitions.
Four days later, you use 55 pounds, and every three to seven days, when you do deadlifts, you lift a little more weight or do more repetitions.
The deadlift is the stress.
The time between deadlift sessions is your recovery period.
Although your stress (the weight of the deadlift) increases each training session, your capacity for handling the stress (your resilience) also increases, provided you have the proper lifestyle, attitude, rest, and nutrition habits in place to do so. Over time, you should be able to handle heavier and heavier weight.
So, basically, if you recover properly, then your body adapts to be able to handle higher amounts of stress over time. Lifestyle stressors — and your recovery from them — act in the same way. We gradually build our ability to handle more stressors, provided we recover well in-between.
When Things Go Wrong
When we’re unable to recover from our stressors, our resilience decreases and adrenal fatigue can set in. It generally manifests in one of these three common patterns:
- Amped up and anxious: When cortisol is high all day long, you can feel anxious, irritable, tense, and overstimulated throughout the day.
- Tired and wired: When cortisol levels fall in the morning and rise at night, you have trouble falling asleep at night and can’t get out of bed in the morning. You turn into a night owl with cravings for junk food.
- Fatigued all the time: Chronically high cortisol is bad for you. Research shows it can even shrink your brain. If cortisol levels remain unchecked, your adrenals stop producing cortisol as a way to protect your body and brain. With constantly low cortisol, you feel totally wiped out all the time. Most people experience a period of high cortisol and sustained stress before cortisol levels start to tank, so the process of developing adrenal fatigue can take some time and can elicit different stages of unwanted symptoms.
Adrenal Fatigue Symptoms
The table below outlines some of the most common symptoms of adrenal fatigue, or more accurately, HPA axis dysfunction.
ADRENAL FATIGUE SYMPTOMS
Difficulty getting out of bed in the morning
Difficulty going to sleep at night
Increased cravings for salt, fat, and sugar
Inability to “deal” with stress
Weight gain and fluid retention
Skin discoloration (hyperpigmentation)
Changes in blood pressure and feeling dizzy when going from sitting to standing
Note that the most common adrenal fatigue symptoms overlap with other conditions, such as:
- Low thyroid or hypothyroidism
- Low testosterone
- Under eating
- Sleep deprivation
When trying to get to the bottom of what’s causing your symptoms, the most foolproof strategy is to do an annual, comprehensive lab workup that evaluates several aspects of internal health all at once. Your digestion, nutrient status, inflammatory patterns, cortisol rhythm, and hormone balance all closely interplay with your functioning, so obtaining this internal snapshot is invaluable for determining the right steps for you to take to feel better.
Reasons Why Resilience to Stress Diminishes
It’s rarely the stressor itself that causes adrenal fatigue, it’s more so our inability to adapt and recover. The true “why” behind this decrease in resilience generally falls into one of three categories:
1. Low-to-Moderate Stress That’s Persistent
The first way we lead ourselves toward adrenal fatigue is that we take on more than we can handle — we say yes to too many things. Each “yes” alone may seem like a small commitment, but as they add up they create more total stress than we can handle.
Let’s go back to the deadlift as an example. Because you’re getting such outstanding results from deadlifting twice a week, you decide to do deadlifts every day. Though a day of deadlifts by itself is not a big deal, the frequency with which you take on that stress is too often for you to be able to recover from it. Within a few weeks, you become weaker, more worn down, and might even get injured.
That’s how chronic stress breaks you down over time, physically, mentally, or emotionally.
2. Acute, Extreme Stress
Let’s use another example with the deadlift. You’ve worked your way up to a 135-pound deadlift. You arrive at the gym super motivated and energetic. You think, “I did 135 pounds easily last time. I wonder if I could do 225 pounds.” So you load up the bar, grip it, and pull with everything you’ve got. Amazingly, you lift it. You set the bar down feeling ecstatic.
The next morning, you wake up and cannot move — everything hurts. You spend the next week in bed, potentially taking extra supplements, anti-inflammatories, or painkillers.
This form of stress could also be called trauma. When you’re exposed to something way beyond the level of stress you’ve experienced before, that single situation can cause severe, long-term damage. You can work your way back from it, but you first have to understand the impact it had on you.
3. Chronically Compromising Your Capacity to Recover
Let’s continue with the deadlift example.
Say that you followed the perfect strength training program correctly. It was designed to help you consistently build strength while allowing plenty of time to recover between training sessions.
However, between training sessions, you mainly ate processed food, low in protein and high in sugar and ingredients that cause inflammation. You only got six hours of sleep each night. You followed another trainer’s marathon training program on your off days. And your personal life is full of emotional challenges.
You would have seen some initial progress from your program, but then you’d start to regress. You could expect to get weaker, feel sore for longer, and eventually get sick or injured.
Your training program is rarely the problem. Most often, your diet, lifestyle, and any additional exercise you add to the program compromises your capacity to recover.
This is how most people end up in adrenal fatigue. It’s not that the stress in their lives is the problem. It’s that their diet, lifestyle, and exercise choices compromise their capacity to recover from stress.
Steps to Reclaim Your Resilience
There is no quick-fix to rebuilding resilience — it requires a daily commitment, persistence, and patience. The following strategies involve your lifestyle, exercise, attitude, and nutrition.
1. Address Key Lifestyle Factors
Modern technology has blurred boundaries we once had in our lives: laptops allow us to work late into the evening from our homes, on-demand television enables us to binge-watch shows when we should be sleeping, and social media keeps our news feeds and minds scrolling at all hours of the day and night.
It takes some purposeful effort to lock in these much-needed lifestyle habits to support recovery.
Sleep Seven+ Hours
When you produce sufficient melatonin, which requires you to avoid excessive blue light and to go to sleep at a consistent time, you secrete growth hormone to help your body physically repair itself, and brain-derived neurotrophic factor (BDNF) which helps your brain repair itself.
Remember, adrenal fatigue is caused by an inability to physically and mentally recover from stress. Sleep is your number one tool for recovery.
Read more: “Sleep: Your Guide to a Better Brain and Body”
Take More “Me Time” Breaks
Remember the example of what happens if you did deadlifts every day? You don’t allow enough time between sessions to recover from one to the next.
You do the same thing when you bounce from one event, meeting, conversation, or task to the next without taking a break.
Plan your day and calendar to allow you to reset and stay focused and on-task — without feeling rushed. Look ahead to find and block off regular times of the day to take mental breaks from your professional or personal responsibilities.
You can’t jump from one mental stress to the next and expect your mind to relax when it’s time for bed. You need short mental breaks throughout the day.
Finding time throughout the day to physically step away from your desk, cubicle, or busy household for a moment can be a game-changer.
Interestingly, research has shown that smokers have lower stress levels — the evidence indicated that their smoke breaks forced them to get away from work more often than non-smokers. While it’s not prudent to start smoking, there is an important lesson to be learned there: Take a break and go for a walk, do a few yoga poses, complete some pushups, or jump on a trampoline.
2. Adjust Your Exercise Routine
Here’s where so many people who’d like to overcome adrenal fatigue dig the hole deeper.
They often gain weight when dealing with adrenal fatigue. They also get it stuck in their head that they have to do hours of cardio to keep from gaining more weight. Yet that very activity may compromise their resilience even more.
In the case of adrenal fatigue, excessive cardio does little, if anything, to control body fat — and does much to mess with your stress response.
The foundation for rebuilding your resilience with exercise is weight training, daily walking, and optionally adding in a gentle or restorative yoga.
The right type of weight training for those with adrenal fatigue is progressive and methodical. It isn’t high-intensity, it doesn’t include reps for time (or high repetitions in general), and should not push you to your limits.
Instead, during your journey to overcoming adrenal fatigue, focus only on basic, compound movements done in three to four training sessions per week. You need plenty of rest between sets, should not go to momentary muscle failure, and want to keep the reps around the 6 to 8 range to avoid significant muscle soreness the next day.
The goal is to provide moderate physical stress and then allow for sufficient time and proper nutrition to recover from one session to the next. Weight training slowly helps retrain your body’s and mind’s stress and recovery process.
This approach also should not include extra interval training, running, or other intense exercise. You’ll only hold yourself back from recovering. Those activities are earned over time and should be incorporated only after your resilience and recovery are fully optimized again.
Walking isn’t about calorie-burning, it’s about movement. Walking increases your oxygen uptake, which can improve mental clarity.
Evidence also indicates that the repetition of walking helps lower stress levels and calms the mind.
If you can walk outdoors, even better, as the fresh air can further help calm the mind, and if you want to take it another step further, walk in nature. Research shows that exposure to the greenery of nature or a forest can help lower stress and cortisol levels.
3. Reframe Your Attitude
Your attitude about, or perspective of, your situation determines the amount of stress it creates.
The more you talk about having adrenal fatigue, the more power you give it over you. The more you use your adrenal fatigue as a reason to not participate in life, the more you believe that it hinders everything about your life.
And the more you talk about your adrenal fatigue, the more emotional you’ll feel about it. Those feelings won’t serve you well as you try to reclaim your mental and physical health. Instead of talking about your situation, try to start talking about and acting on your solutions.
Surround yourself with people who challenge you and encourage you to keep moving forward — and stay away from toxic people who make you feel worse.
Note: This is one of the many benefits Life Time members experience. They’re surrounded by hundreds of other people pursuing a healthier, happier life.
4. Optimize Your Nutrition
If the core of adrenal fatigue is a reduced resilience to stress, and good nutrition provides the vitamins, minerals, and macronutrients necessary for our bodies to recover from stress, then it’s no surprise that nutrition is an uber-important factor.
Eat Plenty of Protein
Low protein intake can cause higher levels of stress. Conversely, imbalanced cortisol levels from stress are catabolic, meaning they literally break down muscle tissue. To mitigate the breakdown, you need to incorporate plenty of amino acids, or protein building blocks, to preserve and regain the lean tissue that’s at risk.
If you read “High Protein Diets: Health Benefits and Controversies,” then you know how essential protein is and why so many people don’t get enough of it.
If you consistently fall short of optimal protein intake, you deprive your body of the most important macronutrient for growth and repair. Amino acids also play an important role in cognitive health and your body’s stress response.
Take Foundational Supplements
Before you delve into supplements to support your adrenal health, start with The Foundational Five, which we consider to be the best supplements to support your health. They include:
Stress increases your use of vitamins and minerals and can deplete your nutrient status, so don’t let a micronutrient deficit contribute to unnecessary fatigue.
Stop Depriving and Start Fueling
Adrenal fatigue often leads to weight gain. To avoid further weight gain, or in hopes of losing some of the extra weight, you might be tempted to cut calories or incorporate the latest nutrition trend. However, that may make the root issue worse, not better.
With HPA axis dysfunction, your body is already hypersensitive to stress, and adding another form of stress by restricting calories or doing something like eliminating carbs can make things worse.
Your priority is to rebuild your health and resilience, and this is a prerequisite in getting your body composition to respond in the way that you’d like it to. While it sounds simple, here’s one of the most effective, go-to nutrition frameworks to follow if you have adrenal fatigue:
- Prioritize protein at each meal and snack
- Avoid gluten, dairy, and any other foods you may be sensitive to
- Eat most of your carbs with your evening meal, making sure they are minimally processed, and finish eating a few hours before going to sleep
- Limit caffeine to one serving per day, and try to consume it before midday
While doing the above might not be easy, it is simple and effective when you make it a priority.
Consider Short-Term Specialized Supplementation:
If you’ve already implemented the nutrition priorities and foundational supplements mentioned above, some additional supplements have been shown to help support a healthy stress response and enhance recovery and resilience.
Tailoring specialized supplements is best done after using objective lab testing to confirm if your cortisol levels are above optimal, below optimal, or erratic throughout the day. Based on your test results, here are a few popular options to consider in partnership with your healthcare practitioner:
- Adrenal extract: Like thyroid extract, adrenal extract is often used to support adrenal health and normal stress levels.* Unfortunately, it’s difficult to find research on the use of extracts, but there are plenty of people who’ve used it and found positive effects.
- Ashwagandha, ginseng, and adaptogen blends: Adaptogens are a category of supplements thought to restore balance and support the body’s overall stress response.* Adaptogens typically take more time to affect the body, so don’t expect to feel an immediate effect. They may also supports muscle strength and recovery, and helps maintain healthy body composition in adults under chronic stress.*
- 5-Hydroxytrptophan (5-HTP): This is a precursor to serotonin and melatonin and an important part of the body’s stress response. It can support more restful sleep and help mitigate sugar cravings.* It’s generally not to be used by those taking prescription SSRIs (selective serotonin reuptake inhibitors)
- Blend of additional B-vitamins: Stress can increase our demand for B-vitamins, which (except for vitamin B12) are not stored in the body. Using a targeted blend with extra vitamin B5 and vitamin B6 can be supportive of metabolism and energy levels.*
- DHEA: The adrenals also produce DHEA, and in the various stages of adrenal dysfunction, this crucial hormone commonly declines as well. It’s a precursor to testosterone, especially in women. DHEA is a hormone and should be used with the guidance of a healthcare practitioner. Men should only use it when having their sex hormones tested regularly, as it may increase estrogen.*
- GABA: Often referred to as a “brake” for the nervous system, GABA is an inhibitory neurotransmitter, or brain chemical, involved in restful sleep and a calm mind*
- Lemon balm: Also known as “Melissa officinalis,” lemon balm is often recommended in the traditional health world. It’s been used for a long time, so there is plenty of anecdotal evidence for its benefits with stress. Lemon balm has been shown to mitigate the effects of mental stress, as well as lower acute feelings of anxiety.* Use caution with lemon balm if you’re on thyroid medications.
- L-theanine: Has been shown to stimulate alpha brain waves, which allow you to remain awake and alert, while feeling a sense of calm.*
- Relora™: A proprietary combination of Magnolia and Phellodendron extracts which has been shown to help cause feelings of relaxation and modulate the body’s stress response.* It may also support normal DHEA levels, especially in women.* It may help maintain normal testosterone in seasons of high stress that normally cause testosterone levels to fall.* Read more about Relora here.
One other note about supplements: Remember, no two people are the same, and you cannot supplement your way out of adrenal fatigue. Using these specialized options under the guidance of a qualified practitioner, based on regular lab data, your health history, and current symptoms, can be a helpful piece of a more comprehensive overall plan.
Take it Day by Day
Overcoming adrenal fatigue takes consistency and time. While some people see differences in as little as four weeks, it’s not uncommon for the process to take six months or more. I always share this quote with clients as they start out on their journey of addressing adrenal fatigue:
Whether you do it or don’t do it, the time will pass anyway.
Try to keep your chin up and maintain resolve to optimize your health. Aim to stay diligent with your strategic lifestyle, exercise, outlook, nutrition, and supplement plan, and trust that with the right approach, your body and your symptoms will respond in time.