Fatigue – Adrenal Edition

Our world has changed in amazing and disruptive ways in the last 20 years. The advent of cell phones and blue screens in every room has led to information and sensory overload. We’re eating more food-like products that are leading to more and more inflammation. Our bodies haven’t evolved to manage how much we’re being asked to keep up.

The constant pings of our email, phone, Slack, social, it’s a lot and we’re suffering from it. Maybe you’re dealing with daily or frequent fatigue or brain fog. Or you’ve heard about adrenal fatigue and are curious if you have it, what on earth it is, and what to do about it. If this is you then keep reading, my love. This blog is just for you.

The rise of chronic stress and fatigue

This is absolutely on the rise in our modern world. Our work, our family demands, our commutes, the constant influx of information that demands our attention paired with not knowing how to manage our minds to deal with all of that stress can really lead to fatigue that doesn’t quit, no matter how much coffee you chug or how much sleep you get.

So that’s what we’re going to be talking about today. We’ll be taking a look at the condition commonly referred to as adrenal fatigue, as well as your adrenal glands and cortisol. Before I get all nerdy with it, I want to pause for a minute and acknowledge that the world, in this particular moment, can feel particularly exhausting.

For some folks, it’s the same, the same racism, xenophobia, sexism, transphobia, et cetera, that they’ve been experiencing for far too long. And for others, and maybe for that first set of folks too, there’s a heightened sense of urgency; what feels like a growing cosmic imbalance of increasing injustice and hatred on a global scale. And it’s hard not to feel it on some level.

Studies show clearly that this type of chronic stress and marginalization can literally make us sick.

This is especially true for women and people socialized as women and especially true for those women who are otherwise marginalized. Women of color, queer women, immigrant women, et cetera. Even with my own relative privilege in the world, as a white-presenting-cis-Latina-femme with a pretty much neutral American accent in English, I deal with micro-aggressions all the time.

I’ve been told I have, “Good English for an immigrant.” I’ve actually heard that one an awful lot. And I’ve also heard the good, “Well you don’t even really have that much of an accent in English.” And that one really makes me laugh, particularly when it’s, like, someone with a thick Boston accent saying it. My other favorite is, “You don’t look Latin.” Which is hard to do because how can you look like a dead language? This is often followed by, “I mean, I know you’re from Latin America, but you’re not Latin, you’re, like, white,” as though the two things were mutually exclusive.

Like negating someone’s identity was, like, at all an okay thing to do.

I could do a whole blog about micro-aggressions, but I’ll move on to my favorite warm-weather source of exhaustion; street harassment. When the weather gets warmer, I get excited to get some vitamin D on my skin, but I tense up at the thought of getting on the subway. Walking around New York City without my big winter coat of armor; the one that guards me against the whole range of street harassers who mistake the warmer air as their starting bell to run their mouths from then until the first frost in November.

And when it comes to dealing with the chronic stress of oppression, marginalization, macro, and micro-aggressions, I have got it easy. I mean, no one clutches their purse or children when I walk by them. No one ignores me in a store, follows me around in one. The police certainly don’t harass me. I have a roof over my head and security in my bank account. And there are days where I feel spiritually and emotionally exhausted by the world.

An embodied intersectional feminism, what I believe in, recognizes that there are a whole lot of power systems and dynamics designed to make some of us fail for the benefit and profit of others.

And fighting against those systems, whether we’re in the streets protesting or just literally trying to get through the day, can be tiring; emotionally, sure, but physically too. It grinds down our spirit and our immune system, digestion, and adrenals all suffer. And the western medical machine is part of these systems of oppression too. Studies clearly show that women aren’t believed at their doctor’s office. In my case, with all of my own privilege, I wasn’t believed time and time again when I tried to get help for my own health concerns.

It took me 20 years and having to study medicine on my own to get a proper diagnosis and treatment.

I hear this all the time in clinic, that exhausted women are written off by their healthcare providers or are told, it’s all in your head, sweetie, and that they just need to get more rest. Or they’re handed a prescription for an antidepressant when they’re not even depressed, they’re just bone-crushingly fatigued.

Selma Blair struggled to get her multiple sclerosis diagnosis comes to mind. She had symptoms for years, years and years, before she was finally given an MRI. In which 20-something MS brain legions were found. And I hear similar stories from my patients all the time, especially around things like fatigue. And while yeah, most of us do need more rest. Most of us do need to slow down, to learn to manage our minds.

The root causes of fatigue are often so much more than a nap and some therapy can even put a dent in.

I could go on for hours and days about the toll all of this takes on our bodies and spirits. But instead, what I want to focus on are positive affirming tools to help support your best wellness. So that wherever you’re starting from and whatever you’re experiencing, I hope I can make your life a little bit easier, a little more manageable, and a little bit more yours.

Let’s dive in. So, you may have heard the term adrenal fatigue. That name is super convenient and colloquial because people kind of get it, right? Something is wrong with your adrenals and you’re tired. But it isn’t quite right scientifically speaking and was created by the holistic medical community to describe what feels like your adrenals have given up the ghost, though that’s not what happens at all.

Glands can’t get fatigued, per se. And this is another area, like leaky gut, where folks are more likely to get an eye-roll from their PCP than an actually helpful answer. Remember that western medicine is fond of black and white thinking. Either you’re healthy or you’re not. They can diagnose you with a standard lab, or everything is normal, no grey zone. And while you might feel terrible, you’re told you’re fine and to go on home.

So much of what I treat and what women suffer from lives in that grey zone, as do many causes of fatigue.

For the record, the proper name of what’s called adrenal fatigue is hypothalamus pituitary adrenal dysregulation, or HPAD. Because the issue is often a problem in the communication between your hypothalamus and pituitary in your brain and your adrenal glands that live on your back.

Whatever you call it, I’ve had it, and I see it all day long in clinic and it’s a major cause of fatigue, achiness, and pain, loss of appetite (especially in the morning), weird weight changes, particularly stubborn belly fat that feels just, like, not right, low blood pressure (which often looks like getting dizzy if you hop up too fast from seated), depression and irritability, hypoglycemia or low-blood sugar moments, insomnia, and morning fatigue.

Folks with HPAD are often exhausted at 2pm to 3pm or have a spike of energy at 11pm, even if you’ve been exhausted all day. Digestive symptoms can worsen as can stress, ruminating, worrying, feeling anxious or on edge. You might crave salt, sugar, caffeine, chocolate.

All of these symptoms leave us feeling exhausted, even though our adrenals technically aren’t.

So, I’m going to take us on a quick tour of the science. I’ll circle back to what you all want to know most, my top tips for dealing with these imbalances. So, here we go, science time.

Your adrenal glands make adrenaline – you get it, adrenal glands, adrenaline – which works quickly and in the short term, and cortisol, which takes longer to ramp up and sticks around longer in your body. The adrenal glands provide the fuel for our fight, flight, freeze, sympathetic nervous system. Adrenaline, also called epinephrine,  reacts to stress by quickly increasing your heart rate. And by moving blood quickly to your muscles and brain, and spikes your blood sugar by acting on your liver to convert glycogen to glucose.

This whole process can happen in a flash to prepare your body to run, in case you’re about to be eaten by a lion, or to freeze and look dead if you’re being attacked by a bear. While these hormones are vital for saving our lives in the case of a wild animal attack, they’re the fuel for panic attacks, anxiety, blood sugar spikes, leading to lousy blood sugar crashes, heightened stress response, and nervousness.

When our bodies are responding to modern life like it’s about to eat your face.

So, a stressor happens; a traffic jam, an email from your ex, an actual lion attack, and your adrenals flood your body with adrenaline. Which can actually make you feel really good for a minute as your body alerts you that you need to snap to attention or die. Just as your adrenaline starts to come down, cortisol starts flowing through your veins. As cortisol comes up and adrenaline comes down, we start to feel the side effects of our stress hormones.

This is when you might feel anxious, spin in those negative thoughts, and eventually feel exhausted. We talk about this as an adrenaline rush, and its eventual adrenaline crash can feel terrible. Like feeling more energy from caffeine or sugar only to feel ourselves plummet back to earth. More worn out from having skyrocketed on internal or external fuel. Kind of like sprinting out of nowhere to catch the bus. You’re energized while you do it, and then you’re wiped out the second you sit down.

The four main drivers of HPAD are circadian disruption, perceived stress, inflammation, and blood sugar imbalance.

So, let’s start with circadian rhythm. Our modern circadian rhythms are a hot mess overall. We’re exposed to blue light from screens and indoor light until after the sun has signaled that it’s nighty-night time. So many of us go to sleep exposed to street lights or lights from alarm clocks and other appliances that confuse our brain into not really knowing when it’s day or night.

Most of us are also not getting any real sunshine during the day, and indoor lighting doesn’t compare to what our bodies are built to receive from the sun. All of this throws our circadian rhythm, that is our connection with the sun and the moon, and the movement of the earth, and our adrenal system way out of whack. Which can lead to fatigue paired with insomnia or lousy sleep, which is a particular bummer of a combo.

If your circadian rhythms are out of whack, your adrenals won’t be getting the signals they need to reduce the amount of cortisol in your body. So you can get sleepy when it’s dark out, or to increase the cortisol in your body so you can wake up with the sun, which is also when the lions wake up. Evolutionarily speaking, you better make sure that you’re up and ready for whatever beast may come for you when the sun wakes up in the morning.

The second main driver of the condition formally known as adrenal fatigue is perceived stress.

We are also dealing with so much more stress than we were ever designed to deal with. Are eating less real food, and more processed food-like stuff, are drinking more coffee and more alcohol, and are exposed to more chemicals, pesticides, and herbicides than ever before, which stresses our bodies out to the max.

We also don’t know how to manage our minds to deal with stress. I feel like I hear someone every two seconds talk about how overwhelmed or stressed they are. Like it’s a fact in their life or some kind of badge to wear, and not something that they can shift or change the story around. Both emotional and physical stressors take their toll on our adrenal health.

The third key driver of adrenal imbalance is inflammation.

And in another blog, I talked about how imbalances and infections in your gut can cause inflammation systemically. And your adrenals are super sensitive to this inflammation. If you’re exhausted, please get a proper digestive workup and start this work on your own with a 30-day nutrition reset or elimination plan, paired with the supplements, hints, and tips that I shared in the blog linked here.

Which brings me to the fourth most common cause of HPAD, blood sugar imbalance.

When we eat quick carbohydrates like sugar and white flour or drink alcohol, we spike our blood sugar. Which can confuse our bodies into thinking it’s cortisol time. What goes up must come down, and eventually, your blood sugar will plummet. Leaving your adrenals confused and your body exhausted.

It’s super important for adrenals that we lay off the sodas, the fruit juice, those little, like, packaged smoothie things at the convenience store or pharmacy. And that we pair our carbohydrates with fats and proteins to slow the sugar rush and allow a more even entry of sugars into our body so our adrenals don’t need to manage the quick up and down.

My go-to carbohydrates are vegetable carbs; butternut and winter squashes, pumpkin, sweet potatoes, broccoli, cauliflower, something from that family with every meal. One of my quick little tips that I’d love to share is that I don’t recommend you eat apples. You eat apples with almond butter. I don’t recommend that you eat gluten-free crackers, but if you’re going to eat them, have some avocado with them.

Don’t feed your body quick sugars that will become just another taxing thing that your adrenals will need to deal with.

So, if all of this is resonating for you, it’s time to find a licensed functional medicine provider to get a real root cause diagnosis. There’s a urine test for adrenals and sex hormones called the DUTCH test – no financial connection to that company – that I really love. That test is phenomenal.

You can also ask your healthcare provider for what’s called a four-point saliva test for cortisol. Where you spit on this weird little cotton thing four times a day and it helps measure and shows you the graph of what your cortisol levels are doing throughout a given day. Because cortisol is meant to go up and down during the day, a blood test for cortisol levels is not going to tell you what you want to know.

Remember, HPA dysregulation is only one possible root cause of fatigue, and don’t despair if your tests come back negative. There are other places to look and we’ll be talking about those in future blogs. Regardless of the cause of your fatigue, there are a couple of key things I’d recommend you start with to help you start feeling better now.

Number one: manage your screen time and help reset your circadian rhythm.

So, this first one is one that folks often don’t want to hear, because we’ve all been trained that there’s a pill for that. And while there are lots of supplements to support the adrenals, true adrenal health and healing requires a deep commitment to unplugging, to not being on your phone 24/7, to being mindful and meditating every day, to being your own watcher and being present throughout your life, to resting without a screen as a true habit, like brushing your teeth or putting socks on before you go out in the cold.

Rest and deep relaxation should not be things to check off a to-do list but should be actual no-brainer habits that you don’t even think about, you just do these things without question. I don’t even let myself open the computer or turn the internet router back on in the morning before I’ve taken care of myself; meditated, done my spiritual check-ins, done my future-self journaling, exercised, eaten well and enough.

I have an alarm on my phone at 9 pm that reminds me to turn all electronics off and to start ramping my body down for sleep. These habits are not optional in my life. I don’t want to go back to being sick, depressed, and exhausted, so I’ve worked to make these behaviors second nature, and my life is so much better for it.

Number two: manage your stress.

I also actively work to manage my stress on the daily. When little things happen that would previously have gotten me all worked up, I take a deep breath and tune into my watcher, which I talked all about in this blog, and do some nice deep breathing.

We all have that option regardless of what is happening, to get upset or stay calm, grounded, and centered. My work is deeply rooted in cognitive-behavioral theory; the belief that our thoughts create our feelings. And I’ll be talking so much about this in blogs to come, my loves. But for now, remember, you can always choose to freak out, and you can just as easily choose to stay calm. I mean, let’s be real, if I can do it, I know you can.

Number three: make food your medicine to heal your adrenals.

The other non-negotiable in my life is nutrition. We need to be eating whole real food every day, every meal, to properly feed our adrenals.  Food is the best source of nutrition. Food is medicine. To keep our adrenals healthy we need daily vitamin C, B vitamins, sodium, potassium, zinc, calcium, and magnesium.

So, let’s start with B vitamins. Researchers have found direct links between low B vitamin levels and chronic fatigue, particularly B6, pyridoxine, riboflavin, thiamin, and B12. And getting these vitamins in their correct amounts and forms can give you improved energy, mood, and can help with brain fog.

Garlic, grass-fed beef, turkey, wild tuna and salmon, bananas, sweet potato, hazelnut, and cooked spinach are great vitamin B6 sources. B12 can be found in organ meats, such as beef liver from grass-fed cows, lamb, organic eggs, raw milk and cheese, if your body can tolerate dairy, sardines, and wild tuna and salmon. And, of note, I’m not a big fan of farm fish or factory-farmed meats. If you want to geek out more about B12, there’s a whole article on my blog all about B12 and the magic that it is, so please, go check that out.

Sodium is also required for making our adrenal hormones.

It’s also super useful for symptom management if you have low blood pressure, which is common with adrenal issues. Check out my recipe for sole water. And it takes a solid one minute to make and it’s a really important thing to drink every morning for adrenal support.

Potassium and magnesium are also vital for adrenal health. There was a study published in the Lancet, which is this like super fancy-pants science journal, and it showed that folks with fatigue often had low magnesium levels,. With treated with magnesium, symptoms significantly improved and stayed better over time. Low magnesium can show itself as insomnia, muscle cramps, constipation, heightened stress response, and of course, fatigue.

Magnesium-rich foods include avocado, banana, spinach, figs, oysters, chard, pumpkin seeds, raw milk, yogurt, and kefir, black beans, crab, lobster, pork, nuts, and my beloved dark chocolate.

Before I go on, don’t start sending me hate mail about how I’m all, “Don’t eat sugar,” but I love dark chocolate. A, I can do whatever I want with my body, so can you, my love. And B, I walk my talk, don’t worry. I get soy-free fair-trade organic, super-duper dark, dark chocolate I have one maybe two squares most evenings and I eat it as a mediation. Like, I eat it really slowly and I luxuriate and I don’t chew it, I just let it melt and I like love my dark chocolate. And it feels really good in my body, so I’m going to keep doing it and I hope you do too, if it feels good.

Potassium – so, potassium keeps our electrolytes balanced and low potassium stresses the adrenals out, and low potassium can present as fatigue, muscle cramps, and irritability. Well, won’t you look at that? So, potassium-rich foods include avocado, spinach, sweet potatoes, coconut water, white beans, banana, acorn squash, dried apricots, and mushrooms.

Vitamin C is gobbled up by your adrenals. They need C for pretty much every function, and you also need it to support a healthy immune system. My go-to source of vitamin C is not orange juice. Please stop with the orange juice, my people. Orange juice, all the fruit juices, they just don’t even have that much C in them compared to some food sources, and it’s just so much sugar.

Just remember, when your blood sugar is out of balance, that messes with your adrenals.

They need to balance for it, so please, just steer clear of the fruit juice. Drink some water. And if you’re like, ooh I want a fun juice thing, put a little splash of lemon in your water or have a vegetable juice that’s really vegetables and not just a bunch of apple with a little kale.

So, for my vegetable-based real food vitamin C, I turn to broccoli, Brussels sprouts, cauliflower, green and red pepper, spinach, cabbage, turnip greens, and other leafy greens, sweet and white potatoes, tomatoes, and winter squash. And fine if you want fruit, kiwis and actual citrus fruits, berries, cantaloupe, and watermelon are the highest in C.

And finally, calcium and zinc are vital for adrenal regulation.

My favorite sources of calcium are sesame seeds, sardines with the bones, organic grass-fed raw milk yogurt, collard greens, spinach, turnip greens, sockeye salmon, again, with the bones, molasses, particular blackstrap molasses, and mustard greens. And zinc can be found in dark leafy greens, nuts and seeds, fish like mackerel, avocado, banana, figs, and once again, dark chocolate.

So, these are the nutrients to include. And what’s awesome about focusing on abundance and reveling in all of the amazing and delicious whole foods you could be eating is that there isn’t much room left on your plate for the things I recommend avoiding. Gluten, sugar, alcohol, caffeine, hydrogenated oils like canola, corn, and soy, processed foods like fast food and most things found at your local convenience store, or drive-in. All of those foods make your adrenals sad and I recommend that you steer clear of them. I recommend that you go on an elimination diet where you pause these foods for at least a month. Then slowly introducing them again to see how your body responds to them.

I know, I know, it can feel like a lot when you’re depending on these things to feel fake energy. But I’ve got to tell you, I have never felt more energy than I do since going off of sugar, gluten alcohol, caffeine, and the rest. It’s amazing what a body will do when you support it in coming back into balance.

Number four: is the restorative magic of sleep.

Set a sleep schedule to get your circadian rhythms back online. Be in bed by 11 pm at the absolute latest and get up at the same time every morning. Yes, that includes Saturday and Sunday. You’re sleep training, and if anyone out there has sleep trained a baby or a puppy, you know you need to be strict and to really develop a routine in order to train the body to do what you want it to. So, in bed by 11, up at 7 or 8, whatever time you need to be up on the weekdays is when I want you to be up on the weekends.

The myth of sleeping in is truly a myth. You’re not doing your body any good by sleeping until like 10, 11, or 12 on a Sunday. Wake yourself up. Start living your life. And if you need a nap later in the afternoon, go ahead and take it. Make sure to reset your body so that your circadian rhythm can count on you. Turn your electronics off at least one hour before bed. Make this habit a non-negotiable for at least one little month before you come and tell me it doesn’t work.

Your body is amazing.

Give it a chance to rebalance, why don’t you? Here are my top 10 lifestyle tips summarized for healing the beast that is commonly called adrenal fatigue:

  1.  Rest when you feel tired as much as possible. And, as always, you can’t pour from an empty cup.
  2. Prioritize getting those eight to 10 hours of sleep a night.
  3. Get that sleep rhythm in check.
  4. Play, have fun, laugh. It’s really important. Your body needs to know that you’re feeling alive, so find a way to laugh.
  5. Don’t let your blood sugar go too bonkers. Eat three meals a day with fat, protein, and complex carbs at each meal.
  6. Cut the adrenal-spiking sources of false energy, like caffeine and energy drinks for at least a month.
  7. Exercise daily, especially walking, yoga, tai chi. Take it easy on the big exhausting cardio if you have actual chronic fatigue syndrome. That can make things much worse. And if you don’t have actual chronic fatigue syndrome, try some cardio, see if it helps.
  8. Be kind and speak nicely to yourself. Your adrenals don’t want to live inside a bully. And when you’re mean to you, you spike your adrenaline and cortisol. And we know how lousy that can make you feel long-term.
  9. Take time for yourself. Do something relaxing for even two minutes a day if that’s all the time you can carve out.
  10. And last, but never least, manage your mind. Focusing on your stress begets more stress, truly, because science. And that brings us to what I know you’re all so excited for; adrenal support supplements.

There are three categories of supplements I love for adrenals.

The first is fish oil. So, it’s an absolute must for adrenal support because it reduces inflammation. It helps boost the immune system and reduces symptoms of depression and anxiety. I choose traditional cod liver oil for my adrenal support. And my favorite brand – again, no financial connection – is Rosita.

Food is the best medicine, but it’s important to also take a good multivitamin and replace what we may not be getting from our food because our soil is so sadly stripped of nutrients these days. And I always start my adrenal care with the adaptagenic herbs; herbs that can help to balance cortisol and stress responses.

They help your body adapt, which is why they’re called adaptogens.

My go-tos are ashwagandha, rhodeola rosea, schisandra, holy basil, and liquorish root. And that’s liquorish as in the herb, not the candy. So, I love these herbs as tea or preparations of an herb in alcohol or something called glycerin, that’s called a tincture. I rarely recommend that an herb be taken as power and a pill, that’s just not how nature intended it and you’re rarely going to get as much bang for your buck that way.

Note that liquorish can potentially increase blood pressure, which is great and why we use it for some folks with adrenal fatigue, but can also be dangerous for others, particularly for pregnant humans. So please, consult a skilled herbalist before playing with liquorish or any other herbal supports.

I love rhodeola tincture in the morning. Generally I start with one dropper-full and a little water as a pick-me-up. I put my rhodeola tincture right in my sole water first thing when I get up. I love to use the herb ashwagandha in the evening to help calm my adrenals and generally do about a dropper full again in a little bit of water around dinner time.

These herbs are adaptive.

They help you adapt and will affect each body in a different way. Rhodeola tends to pick people up, ashwagandha tends to calm folks down, and there are variations. That’s the beauty of plant medicine. It’s not like a pill that we can say, this will work this one way. Try these things. Play around with them. See what works for your body and how it makes you feel.

Schisandra and holy basil, which is also known as tulsi, are great as tea throughout the day, which is my favorite way to have those two herbs. And those are also adaptogenic, help the adrenals to balance out. And liquorish is also lovely for that 2 pm to 3 pm slump as an adrenal booster.

Folks like to use liquorish in a tincture, which is an alcohol preparation or a glycerin preparation. Or you can use liquorish as a tea, and that can also be really delicious and can be a really nice alternative if you’re trying to skip that afternoon coffee.

I hope this primer on the diagnosis formally known as adrenal fatigue was helpful.

If these symptoms sound like you, I really want to encourage you to start with stress reduction. Including being kind to your perfect self, adding some quality nutrition, and some basic supplement supports to help give your body the boost it needs.

Really focus your energy on reducing your experience of stress. Life can be really hard and it’s easy to feel overwhelmed when that’s the story you keep repeating in your mind and to those all around you. Keep an eye on your complaining. Ask yourself, is it helping me and supporting me to let this off my chest? Am I just working myself up into an even bigger tizzy?

See how your body responds when you tell the story of your stress, anxiety, your worry.

Be your own watcher. Watch to see if your shoulders and jaw tense, if your tummy aches, if your energy plummets. Attend to yourself. Give your body what it truly needs, which is your kindness and your love. You are made of stardust, my love. Honor that. Thank you for reading this week’s blog of Feminist Wellness!


Thank you for taking the time to read Feminist Wellness. I’m excited to be here and to help you take back your health!

I know not everyone is into podcasts, so I wanted to provide digestible blogs to go along with the episodes! If you’re curious about the podcast and haven’t checked them out yet, click here.  

Leave a Comment