Utter exhaustion – could low adrenal reserve be to blame?

Are you always in a state of utter exhaustion? Are you fed up with everyone around you saying that if you went to bed earlier and did some exercise, then everything would be ok, and your energy would bounce back?

The reality is that many people find themselves in a constant state of fatigue and overwhelm, despite going to bed on time and trying to exercise. They still feel utterly shattered.

This state of burnout can boil down to several reasons for you, but one thing that many people overlook is that they may not be producing enough cortisol, a vital hormone that regulates metabolism, the immune system, blood pressure and the body’s response to stress.

The hypothalamus, pituitary gland and adrenal (HPA) axis is the control centre for the body’s stress response and cortisol management. It can get easily dysregulated by prolonged tension or a traumatic event leading to a state of low cortisol or adrenal reserves. This used to be called adrenal fatigue but is now called HPA axis dysregulation.

At the outset, when you are first dealing with ongoing stress, your cortisol levels may be slightly elevated. You may associate this with a heightened fight or flight state, You may feel ‘wired’ but not too tired to begin with, which can feel quite manageable, even if you’re not getting enough good-quality sleep.

And then, when the intensity of the stress is prolonged or a particularly stressful event occurs, you can experience an adrenal crash, where your cortisol levels plummet from being too high to now being too low – and this is why you feel so exhausted and burned out.

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What can HPA axis dysregulation feel like?

We are meant to have a natural surge of cortisol within 30-60 minutes of waking up in the morning which is called Cortisol Awakening Response (CAR) and gives us the energy to kick start our day. However, many people with low cortisol level or depleted adrenal reserves do not experience this and they wake up feeling exhausted and shattered, taking hours to feel fully awake.

Cortisol levels can also fluctuate significantly throughout the day from high to low and back to high again. It is why it can feel as if you are walking through treacle for a long period of the day and then as if a switch is flicked on you become super industrious and energised for the rest of the day.

Some people may experience a reversal of cortisol’s circadian rhythm, meaning low cortisol levels in the morning and high levels in the evening and during the night. This imbalance can result in exhaustion during the day, and then having quite good energy levels during the evening and then experiencing a surge of energy at night just as they should be going to bed. This can mean real difficulty getting to sleep, a pattern of light sleep or waking up wired around 4am, finding it almost impossible to go back to sleep…however tired you are.

Research shows that if your adrenal glands are not adept at dealing with chronic stress then this state can result in exhaustion, depression, anxiety, low self-esteem and even weight gain. Low adrenal reserves can mean you catch every virus and bacteria going and you feel run down all the time. It is also common for people suffering from chronic fatigue, functional neurological disorder (FND) or post-traumatic stress disorder (PTSD) to experience low cortisol levels or low CAR levels.

People tend to equate the term “stress” with life-changing events such as bereavement or divorce and somehow don’t feel the pressure they are under during day-to-day life is enough to warrant exploring low cortisol levels. It is helpful to understand that more minor daily stressors contribute to our tolerance “load”. In our fast-paced, constantly switched-on world, it’s all too easy for stress to quietly build up in the background, drip by drip, until we suddenly feel overwhelmed by it all.

The moment our alarm jolts us awake, a cascade of micro-stresses kick in – dashing about to get the kids ready for school, battling traffic jams on the school run or commute to work, or the build-up to a daunting meeting or performance review….and then there’s the endless doomscrolling on our phones. When we don’t give ourselves enough time to unwind. It all adds up.

Even physical issues such as aches and pains, recovering from illness or even overexertion at the gym, can add extra stress for our bodies to manage.

We are all unique, and the way we respond to life’s ups and downs can vary from person to person. Daily stressors which might lead to an HPA axis imbalance for one person could actually benefit another. That’s why it’s so important to gently tune in to your own needs, listen to your own body and make choices that support your health and resilience.

Think of the adrenal glands as the conductor of an orchestra. If the adrenals are out of sync, then this can influence the thyroid function, blood sugar balance, immune system and hormones. So, if your adrenal glands are constantly misfiring it can have a ripple effect on your metabolic health. This may be partly why you feel so tired, you get easily ‘hangry’, you get ill all time or struggle with managing your monthly cycle or mid-life hormones when you live with low cortisol or adrenal reserves.

What makes up the HPA axis?

There are three parts to the HPA axis which all need to be working efficiently for us to feel well.

Hypothalamus – the stress sensor

Nestled deep within the brain, the hypothalamus acts like a finely tuned stress sensor. When it detects that something’s not quite right, whether it’s emotional strain, physical illness or environmental assault, it sends out a signal in the form of corticotropin-releasing hormone (CRH). This is the first step to help the body adapt and cope with that stress.

Pituitary gland – the messenger hub

Just beneath the brain, the pituitary gland receives the CRH signal and responds by releasing adrenocorticotropic hormone (ACTH). Think of it as the body’s internal messenger, passing the baton to the adrenal glands to take action. It’s a vital part of the stress axis communication chain.

Adrenal glands – the resilience boosters

Perched like little hats on top of each kidney, the adrenal glands spring into action when they receive ACTH. They release cortisol, often called the “stress hormone,” which helps regulate energy, blood pressure and immune function. While short bursts of cortisol can be helpful for us all, too much overstimulation through hypervigilance or stress or traumatic events can lead to the unwanted symptoms.

This blog is mainly focused in on a state of low cortisol, low adrenal reserves and low CAR. However, you as mentioned above cortisol levels can vary quite a bit over a 24-hour period and this is where 1 to 1 guidance from a nutrition professional can help you to understand how to manage your cortisol highs and lows.

Symptoms of low cortisol

Symptoms of low cortisol levels are far reaching, and it sometimes may be difficult to join up the dots with all the symptoms. You may only have a handful, or all of them! Often with low morning cortisol your symptoms are much worse in the morning, and much improved by the afternoon and evening:

Anxiety
Craving salt
Depression
Difficulty getting to sleep
Digestive symptoms (nausea/loss of appetite)
Exercise intolerance (feeling worse after exercising)
Fatigue & low energy
Feeling weak
Fertility difficulties
Irritability
Low blood pressure
Menstrual irregularities (cortisol is often lower in the luteal phase leading up to your period)
Poor immunity (ill and run down all the time)
Poor memory (feeling scatty)
Reduced sex drive
Sensitivity to cold
Stress intolerance
Tired but wired
Unrefreshing sleep
Wake around 4am
Weight gain or loss

How can I tell it is low cortisol – are there any tests?

Cortisol levels can be checked by your GP. This is usually via blood drawn at about 9am in the morning, as 6am-10am is when cortisol levels should be at their highest over the day (the reference range for adults is 133 – 537nmol/L in the morning before 10am).

A cortisol level of less than 100nmol/L is suggestive of adrenal insufficiency and warrants further medical investigation and in severe cases, low cortisol can lead to an adrenal crisis where you see dehydration and very low blood pressure. Medication such as corticosteroid medications may well be prescribed at this point.

Addison’s disease is where the adrenal glands are damaged, leading to insufficient cortisol and aldosterone production which can lead to similar symptoms, and you will need lifelong medical treatment.

Cortisol levels lying at more than 450nmol/L indicates adequate adrenal reserves, whereas cortisol at less than 450 nmol/L indicates insufficient adrenal reserves. Much of the time people with the symptoms of low cortisol have inadequate adrenal reserve, but are not depleted enough to fall below the 100nmol/L. So, they have quite a few of the symptoms, but there are unlikely to be offered medical treatment to increase their adrenal reserves.

The blood test for low cortisol makes a good start to understanding if your adrenal reserves are low, however it is not always the whole story and does not look at the overall pattern of your adrenal function.

At NatureDoc we can run more in-depth saliva and urine testing to assess the balance of all your adrenal hormones and to understand the best ways of helping you feel better. These include:

Cortisol awakening response (CAR)
Daily free cortisol pattern tested four times over a day. This is the biologically active cortisol.
Daily free cortisone pattern tested four times over a day. This is the inactive form of cortisol.
Cortisol metabolites which measure the overall cortisol production and clearance from the body.
DHEA (dehydroepiandrosterone) which is an adrenal hormone which is the precursor to other hormones including testosterone and oestrogen.

During post-partum or the perimenopause/menopause years or living with female hormone challenges such as endometriosis, polycystic ovarian syndrome and fibroids, then we will often also test progesterone, oestrogen and testosterone levels at the same time.

If you are prone to sugar cravings and post prandial energy crashes after food we will do a deep dive into your blood glucose regulation.

And since often adrenal fatigue symptoms come hand in hand with thyroid issues, then we will likely also run a thyroid blood marker panel.

Looking at your overall hormonal and metabolic health you then have an individual roadmap of how to help you get back on track and rebuild your adrenal reserves. This will help you to feel more consistent and confident with your energy levels – and enable you to navigate life’s curveballs much more easily.

How can diet and nutrition help rebuild adrenal reserves?

Thankfully, several nutrients and herbal remedies can help support the body’s recovery from a state of low cortisol or burnout and can help to rebuild your adrenal reserves. Here are some of the key aspects of nutrition which normally can make a big difference to how you feel:

Enough protein is vital

Protein plays a crucial role in adrenal gland function and regulation and the amino acids in protein are the building blocks for hormones in the body. So, aim to eat around 1-1.5g protein per kg of body weight whilst you are reinvigorating your adrenal function.

Think meat, poultry, fish, shellfish, eggs, cheese, cottage cheese, Greek yoghurt, nuts, seeds and pulses.

Watch your blood glucose highs and lows

Opitmal cortisol production and blood glucose management highly influence each other and therefore a person in the state of adrenal fatigue may also experience a rollercoaster of high blood glucose and then blood glucose ‘hangry’ crashes.

See protein and healthy fats as your macronutrient heroes which can stabilise you more easily. If you feel that balancing your blood sugars are a key part of your symptoms, then start the day with a savoury high-protein breakfast such as a feta cheese omelette or cottage cheese with smoked salmon or avocado and scrambled egg.

One important habit to adopt while in a state of adrenal fatigue, is to avoid eating carbs on their own, since eating something sweet or starchy without the balance of protein and healthy fats can make you feel worse.

So, if you want to eat an apple as a snack, pair it with some almond butter or a chunk of cheddar cheese. Similarly slather rice cakes (if you must have them!) with cream cheese and crunchy carrot sticks with hummus. Try dark chocolate with pecan nuts in the morning to give you a boost! This little habit is an easy win and makes so much difference to how you feel.

Hydration, salt and electrolytes

When you are in a state of adrenal fatigue you may feel easily dehydrated, so it is vital to keep your liquid intake consistent over the day. Keeping well hydrated will help to reduce the physical stress on your body too.

You might crave salty foods, and this may well because your blood pressure is low. Lean into your cravings and eat foods naturally rich in sodium such as olives, capers and anchovies. You can even add a pinch of salt to your water first thing in the morning and sprinkle it liberally over your food.

Many people feel even better when they regularly take electrolytes which contain sodium, potassium and magnesium. This can perk you up first thing in the morning when you wake and are vital minerals for optimal adrenal function.

Think the gut-brain connection

Emerging research has found that a diversity of healthy bacteria in the gut may influence the HPA axis. Therefore, it is vital to support your gut microbiome whilst on your journey to better adrenal reserves.

Cultured and fermented foods such as live yoghurt, kefir, sauerkraut, kimchi and water kefir can help, as can eating a wide variety of different berries, salads, fruits, vegetables, nuts, seeds and pulses. And you may want to explore using a live bacteria supplement containing lactobacillus and bifidobacterium strains.

Try adaptogenic herbs

Herbal remedies can provide the scaffolding to rebuild your body’s reaction to the pressures of life. Adaptogens are herbs which work according to the body’s needs and will increase or calm down the adrenal metabolites when needed – usually meaning more energy during the day and a more refreshing night’s sleep.

These adaptogenic herbs include Siberian Ginseng, Gingko Biloba, Holy Basil (Tulsi), Rhodiola, Astragalus and Liquorice Root. Cordyceps mushrooms are also wonderful for exhausted adrenal glands.

Vitamins and minerals

Vitamin C is one of the most vital nutrients for feeding and reinvigorating the adrenal glands. Think oranges, lemons, limes, parsley, raw red peppers and for the first few months you may need to lean on a vitamin C supplement.

A blend of B vitamins including thiamine (B1) riboflavin (B2), pyridoxine (B6), folate (B9) and cobalamin (B12) are all essential for helping to improve the body’s response to tension and stress and optimising the HPA axis. B vitamins are found in meat, poultry, fish, shellfish, eggs, dairy, green veg and pulses.

Zinc is a key nutrient for regulating the HPA axis and is found in shellfish, meat, poultry, dairy products, pumpkin seeds and nuts.

Magnesium is often depleted after long periods of stress. Not only does it help you sleep better but it helps with muscle recovery, physical stamina. Again, think green vegetables, nuts, seeds and wholegrains. Dark chocolate is a particularly good source of magnesium. Also consider magnesium bisglycinate supplements and Epsom salt baths.

Round up

It is, um, exhausting being exhausted all the time, and this can put a strain on relationships, reduce your performance at work and you may feel that you are missing out on all the fun stuff. Your tiredness, foggy brain and poor immunity might well be due to low adrenal reserves which is easy to identify and to support. Luckily what you eat, how you eat, and a few targeted supplements can be the way to getting your energy levels back on track help you cope with stressful situations more easily.

To book 1 to 1 consultations and a full hormone overview, get in touch with our NatureDoc clinical team who are all very experienced in working with people of all ages experiencing burnout and exhaustion.

NB. This is a updated version of a post originally published on 30th Oct 2016.

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Utter exhaustion – could low adrenal reserve be to blame?

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