Stress is rampant in today’s society. It is hands down the most common underlying cause of health issues seen in my practice. What many do not know is that chronic stress can and will alter your hormonal balance. Whether you are experiencing irregular or heavy periods, mood issues, sugar cravings, insomnia, weight gain: Stress may be your culprit.
This can stem from a variety of factors including both positive and negative situations. Whether you have experienced a traumatic event, work in a high pressure job, or are in the process of moving to your dream home, your body reacts to stress in the same way. There is no differentiation- your adrenals will pump out cortisol and prepare for a fight regardless of the trigger.
How does my body react to stress?
When you experience a stressor, your body reacts in a specific way designed for self-preservation. The adrenal glands are at the center of this process and produce the hormone cortisol as the primary stress response. It is intended to be useful in short term situations in which you will benefit from being alert, energized, and on top of your game. This is often described as the “fight or flight” response.
Cortisol has many functions including the release of adrenaline for alertness and glucose for fast energy. It has a role in the regulation of blood sugar, metabolism, blood pressure, inflammation, and sleep-wake cycles. Cortisol affects nearly every system of the body.
How does this affect me over time?
Cortisol production is well and good as intended: For short term stressors. The problems arise when stress is a long-term issue as is increasingly common. Under chronic stress, the adrenals continue to make cortisol, and the body is ramped up for battle over a long period of time. In this situation you feel wired but tired. You develop insulin resistance as your blood sugar remains elevated, and you therefore crave sugar, often intensely, as your body tries to fuel itself for this perceived threat. Your digestion is slowed while gastric secretions are increased. Bone and connective tissue formation is reduced, and your sleep is disrupted. Immune function is diminished, and certain amino acids, vitamins, and minerals are be depleted.
Under stress, your blood pressure is high and you feel anxious. Chronically high cortisol leads to increased inflammation over time which has a strongly negative effect on health. The aldosterone system is affected, altering fluid balance. This leads to swelling and salt cravings. The combination of these factors often contributes to weight gain.
What about my other hormones?
The adrenal glands use the same building blocks to produce cortisol as the ovaries and testes use to make sex hormones. As cortisol ramps up, there is less raw material for sex hormone production. This means that testosterone, estrogen, and progesterone levels are decreased when cortisol production is high. This phenomenon is known as the “pregnenolone steal”- indicating that the materials for sex hormone production are being stolen by the adrenals. In women, the body will start to deposit extra fat cells because these can sometimes pick up the slack in estrogen production.
Cortisol also inhibits the release of thyroid stimulating hormone by the pituitary gland, leading to lower circulating levels of thyroid hormones also known as hypothyroidism. Overall, you will feel unwell given the lack of sex and thyroid hormones as cortisol levels rise over time. Women will experience irregular or heavy menstrual cycles and sleep will be disrupted which perpetuates the stress cycle.
What are the long-term consequences of high cortisol levels?
Eventually, your adrenal glands will not be able to keep up with ongoing high level cortisol production. As their function declines, you will become lethargic and tired. Your blood pressure will lower and often cause dizziness. The hallmark of this phase is a severe afternoon and evening energy slump. Well documented effects of long-term stress include diabetes, cardiovascular disease, infections, autoimmune conditions, infertility, osteoporosis, chronic fatigue syndrome, psychiatric illnesses, digestive disease such as irritable bowel syndrome and ulcers, poor wound healing, and certain cancers among many others.
How do you test for this?
The best way to find out where your adrenal glands are in this continuum is through salivary hormone testing. Steroid hormones such as cortisol are sometimes bound to proteins in the bloodstream and this can obscure levels, making blood tests less reliable. Salivary hormone testing also allows for testing of your cortisol curve. Naturally cortisol levels should be highest in the morning and lowest in the evening, following a curving pattern. We are able to test this through taking 4 saliva samples at specific times during the day, providing a visualization of this curve. The best part is that salivary testing is noninvasive and can be done at home.
Once resulted, a functional medicine provider can look at the curve and see where your highs and lows are. These tests tell me if your adrenals are in the high-level cortisol production stage or in the fatigued stage and, if so, how far gone they are. Sex hormones can also be added onto this test which gives even more information into the effect that stress is having on your body.
What can be done?
The intervention is focused on the stage of adrenal fatigue that you have reached. This is very individualized! I have compiled a list of lifestyle interventions that can take some of the strain off your adrenals and help to calm down the stress response.
Here are some quick tips for adrenal health:
1. Never eat a carb alone! I recommend this across the board. If you are eating a carbohydrate, always pair it with protein or a healthy fat. This will stabilize your blood sugar and help to give your adrenal glands a break.
2. Reduce sugar in your diet. A low sugar diet stabilizes blood sugar, reduces inflammation, curbs insulin resistance, and promotes the release of extra weight.
3. Do not skip breakfast and eat at regular intervals. If you are stressed, this is not a good time to fast as the adrenals will take an extra hit while trying to keep your blood sugar up.
4. Include sea salt in your diet. This will help to ease the work of the adrenal glands in keeping the fluid balance correct and provides them with minerals that they need to be healthy. Try to use Celtic (best) or Himalayan (next best) sea salt. Table salt, which is stripped of its mineral content, is counterproductive and will make your symptoms worse.
5. Exercise daily for stress reduction, mitigation of cortisol release, improvement of blood sugar, insulin sensitivity, and hormonal health.
6. Avoid concept shifting as much as possible. Try to stay in the moment and address what is in front of you without worrying about the other items on your plate. This is easier said than done but will go a long way to alleviate your adrenal stress.
7. Remove stressors. This seems really basic, but I believe that we should all be taking a periodic look at our lives and assessing for any stressors that can be eliminated. This could be as simple as getting up 15 minutes early so that you are not rushing to get to work.
8. Get enough sleep! The most important hours to sleep are between 10 pm and 2 am. This is the time during which the adrenals are working their hardest to repair the body. Without good quality sleep, our bodies cannot regenerate themselves enough to handle the stressors of the next day. Some tips to improve sleep quality include elimination of caffeine, avoidance of screentime in the evening after about 8 pm, and eating a snack with carbs and protein at bedtime if needed to keep a stable blood sugar overnight.
9. Individualized nutritional, herbal, and hormonal supplementation rather than a one-sized-fits-all approach can help to treat deficiencies and rebalance the system. This can include the use of adaptogenic herbs such as ashwagandha or rhodiola in specific dosages and timings. If your adrenals need extra support, there are herbs such as licorice root and rehmannia that are used to nourish the cortex. Replacement of hormone precursors such as DHEA and pregnenolone can play a role, especially if your sex hormones are affected. Finally, bioidentical hormone replacement therapy can play a role in the alleviation of symptoms through hormone rebalancing.
10. Get a functional medicine evaluation! Every human being alive today can benefit from an assessment of their life stress and adrenal health. This is absolutely foundational to wellness and one of the first things that I address when working with functional medicine clients. There are many tools in the functional medicine toolbox for adrenal health and the individualized approach is what sets it apart. From nutritional counseling to herbal support and bioidentical hormone replacement therapy, functional medicine has an incredible track record in the restoration of wellness and adrenal health.