Adrenal Fatigue: Diagnosing the Burnout Epidemic

Adrenal fatigue is a metaphor for overwhelm, an epidemic that is largely treatable through awareness, diet and lifestyle choices

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Adrenal fatigue. Everyone’s talking about it. Alternative practitioners are diagnosing it. Yet the medical establishment dismisses it. The truth: While Adrenal Fatigue isn’t a recognized medical diagnosis, it is “code” for a much bigger, more widespread problem: pervasive, chronic, mental and physical overwhelm.

Metaphor for Overwhelm

So many of us are living our lives constantly teetering on the brink of imbalance, overwhelmed by trying to keep up with to-do lists and inboxes, struggling to stay afloat in a sea of competing financial and social demands. In our achievement-oriented culture, we may feel ashamed if we can’t “handle” the amounts of pressure we’re experiencing, since it seems like everyone else is handling it just fine, or so it appears on their Facebook pages. Living with the resulting chronic underlying sense of inadequacy drives anxiety and depression. At the end of the day, many of us cave into overriding cravings for sugar, alcohol, or distractions like TV or the Internet, because we’re so spent and it’s the easiest way we can think of to hit the pause button on the pressure that consumes us.

Chronic overwhelm is having an impact on our well-being. I see it daily in my medical practice. Medically, it’s a major cause of the chronic conditions rampant in our society — anxiety, depression, metabolic syndrome, obesity, autoimmune disease, and dementia, for example. Enter the adrenals.

The Heart of the Matter: Survival Overdrive Syndrome

You are brilliantly hardwired to cope with a formidable amount of stress, thanks to a powerful Survival Response System that originates in your brain. Here’s how this system works, in a nutshell:

1. We perceive a danger.
2. The amygdala, the area of your brain that catalogues self-preservation memories (memories that, evolutionarily, would have helped you, for example, to remember not to eat the plant that made you sick last time) gets triggered.
3. The amygdala activates the Hypothalamic-Pituitary-Adrenal (HPA) Axis by alerting the hypothalamus that there’s a problem.
4. The alarm message is relayed to the pituitary gland, which activates the adrenal glands to kick out adrenaline and cortisol.
5. A burst of adrenaline gets your heart rate up, constricts your blood vessels to boost your blood pressure, dilates your pupils and makes you hyper alert to your surrounding. You are primed to escape, subdue, and survive a mortal threat.
6. Cortisol simultaneously dumps sugar into your bloodstream for immediate fuel while insulin is secreted from your pancreas to clear the remaining sugar when the crisis is over; cortisol keeps your blood pressure elevated, so that if you bleed copiously from an injury while you fight or flee you won’t go into shock, and it mobilizes your immune system to withstand potential inflammation and infection.

The problem is that the amygdala is not highly discriminatory; it’s triggered by any signal your brain perceives or has ever cataloged as a threat to your survival. It’s also triggered by internal signals that result from chronic inflammation, which can be due to your diet, lack of sleep, and environmental toxins, to name a few factors. Most Americans are living with their Survival Response stuck in the on-position because we are so frequently triggered by stress, fear, and inflammation. What happens as a result is what I call Survival Overdrive Syndrome (SOS).

SOS: Too Much of a Good Thing

When you get stuck in survival overdrive, the cascade of events intended to protect you backfires. This phenomenon is called allostatic load. It’s a case of too much of a good thing and here’s what happens:

• The heightened awareness that is meant to protect you in a crisis, when prolonged, results in hypervigilance, anxiety and insomnia
• The effects of chronic cortisol on your brain’s executive function region derails willpower, focus, and memory
• Chronically increased blood sugar and insulin requirements can lead to insulin resistance (and even diabetes)
• Persistently elevated blood pressure becomes hypertension
• Cortisol causes us to crave excess sugar and carbs; in a twist of fate intended to protect us from famine and starvation, we store this excess energy in the form of fat for later use – predominantly as cholesterol and belly fat, a toxic form of fat that produces harmful inflammatory chemicals.
• Increased activation of our immune system ultimately leads to immune system dysregulation. We get sick more often (or never get sick until we crash on our first day of vacation) and increase our risk of autoimmune disease and “inflammaging” (signs of poor aging)
• Because survival mode keeps us on the lookout for danger, we become hyperaware of problems. You might find yourself irritable and overly sensitive, with a negative outlook on life, believing that nothing ever goes right for you, that you are bound for failure, or perhaps feeling overly judgmental of others. It’s not that you’re a negative person, it’s that you’re default mode is to find what’s wrong with the world – it’s called a negativity bias – and it’s part of survival mode.

Adrenal Fatigue – What We Really Mean

Adrenal fatigue expresses the emotional, physical, and mental consequences of burnout. Eventually, your brain blunts HPA signaling, dialing back adrenaline and cortisol production to protect you from the wear and tear of their impact. But adrenaline helps us to feel motivated, excited, focused; the drop leads to the opposite of these feelings and can cause depression. Cortisol keeps inflammation in check, amongst other important functions, and when our natural balance is off, we are at increased risk of immune system problems. Healthy cortisol rhythm is also responsible for morning energy and evening melatonin levels; dysregulation makes it harder to wake up refreshed in the morning and harder to get to sleep at night.

The medical response? A statin for cholesterol, a beta-blocker for blood pressure, metformin for blood sugar, and an antidepressant, antianxiety, or sleep medication for everything else. It you’re like so many Americans, you’ve already been prescribed several of these. So we all need to know about SOS because the solution is far more healthy and sustainable than what’s being handed out on prescription pads.

10 Signs that You’re in SOS

1. You’re having trouble falling asleep even when you’re tired (“tired and wired”) and even when you do sleep, you’re not rested when you wake.
2. You get irritable or angry really quickly or more often than you want to.
3. You’re craving sugar/carbs, fat, salt – or all of the above!
4. You get tired around 3-4 most afternoons, and that’s when you really want something sweet or some extra caffeine.
5. You’ve been gaining weight, perhaps noticing a spare tire growing around your middle.
6. You feel anxious or blue.
7. You’re getting sick more often than you used to.
8. Your hormones are all over the place, you’re having fertility problems, and perhaps your libido is nowhere to be found.
9. You’re memory and focus are not what you think they should be.
10. Your digestive system is a mess.

 Reclaim Your Life

To keep you out of SOS, your brain needs to receive safety, not danger messages, from your mind, body, and environment. The practices below are easy shifts you can make to reset your nervous system from alarm to calm. You don’t have to do them all; make sure you’re getting enough sleep, and pick one or two other practices to bring into your daily life.

Honor Natural Rhythms

Our schedules lay waste to the normal circadian rhythms that regulate cortisol. Especially important is a regular sleep cycle, with 7-8 hours of nightly, good quality rest. One of the biggest factors impacting most American’s sleep is the use of electronic devices close to bedtime. A “digital detox” (no electronics) in the hour before bed, can reset your natural cortisol and melatonin cycles. It’s a great place to start resetting your rhythm.

Clarify Your Priorities

Getting your priorities straight can help you to get out of the chronic self-perpetuated overwhelm that comes with taking on too much. Ask yourself with ruthless honesty:

• What’s most important to me in my life right now?
• What can I let go of that I really don’t have to do, don’t want to do, and that’s stressing me out?
• What do I really want to take on right now?
• What can I realistically get done without undue pressure?

When you’re clear on your priorities, say “No” to everything else. If you’re not good at saying this, say, “I’d like to think about that. I’ll get back to you in a week.” Don’t worry about missing out in favor of more balance.

Embrace Stopping as a Spiritual Practice

When you’ve hit the wall of overwhelm, stop everything. Unplug completely for 10 minutes to an hour. Take some time to be a human being — not a human doing. It takes downtime to get out of SOS.

Practice Presence

When you’re in the present you aren’t regretting the past or worrying about the future. Here are simple practices to get you present-minded:

• Sit quietly, and for 1 minute, notice all the sounds around you.
• When you shower, focus only on the sound and feel of the water on your body.
• Savor the aroma and taste of your food for 1 minute of your next meal.

If your attention wanders, bring it back. It’s that easy.

Create a Daily Ritual

It can be a cup of tea sipped in quiet place, a regular walk alone or with a friend, a five-minute meditation, or a bath night. Rhythm and peace reset your HPA Axis.

Nature Rx

Science proves what our ancestors knew — nature heals. Get outside for 30 minutes a couple times a week; the caveat is that you unplug at the same time.

Root Out Inflammation

If you also have physical health symptoms, getting to the root causes of chronic inflammation is an important part of getting out of SOS and preventing/reversing longer term health consequences. The most common root causes are food intolerances, processed foods, poor quality fats, a high sugar diet, environmental toxin exposure and overburdened endogenous detoxification systems, gut disturbances including leaky gut and microbiome disruption, certain medications, including commonly used ones like ibuprofen and Tylenol, and even hidden infections. In my book, The Adrenal Thyroid Revolution, I walk readers through a comprehensive self-assessment to root you’re your root causes and reverse SOS.

Connect More

Stanford researcher Shelly Taylor has identified what she calls the “tend and befriend” stress response. Along with adrenaline and cortisol, the body also produces a small amount of oxytocin during the stress response, which is an “antidote” to fear and anxiety. When we connect with others, whether to give or receive love and support, we increase the amount of oxytocin we produce, which not only helps us feel safe and supported, but also increases our confidence and courage. Make time to connect.

Restore Yourself After Work

Studies have shown relaxing and rebooting mentally and emotionally after a hard workday leads to healthier cortisol levels and better sleep. Make it a weekday end-of-work habit to decompress for 15 minutes with a favorite activity when you get home from work. My personal favorite is a solo dance party!

Welcome Pleasure

Pleasure is the biggest indicator to your Survival System that everything is right in your world. Laughing, dancing, exercise, sex, savoring good food, playing, getting outdoors have all been shown to reset cortisol rhythms, reduce inflammation, and bring you out of SOS and back to balance. Make pleasure an everyday practice rather than an afterthought.

Overcoming what so many are calling adrenal fatigue is a radical act of rebellion – it requires us to step outside the “status quo” that demands we sacrifice our lives at the alter of high pressure living, the never ending quest for more achievement and acquisition, and instead, look within to creating sustainable energy. Sustainability has to come not just in how we care for our world, but how we care for ourselves in our world.

In any moment, no matter how lost we feel…we need only pause, breathe, and open to the experience of aliveness within us.

Tara Brach

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