There are two little power packs perched at the top of the kidneys that ensure the human body can adapt to stress and maintain optimal energy levels. They are the adrenal glands and they produce powerful hormones such as norepinephrine, epinephrine, and cortisol to name a few. Cortisol, in particular, is a significant stress hormone that also helps control energy levels.
What is cortisol?
Cortisol production by the adrenal glands is a key component of the hypothalamic-pituitary-adrenal (HPA) axis function. Cortisol secretion helps regulate daily energy needs. It is also a factor in healthy blood glucose management, as well as inflammation control. When the HPA axis and the adrenals are functioning properly, cortisol production spikes in the morning and then gradually declines throughout the day. (1) Cortisol also surges during times of physical or psychological stress to provide the energy needed to cope with the perceived stressor.
Conversely, low levels of cortisol are associated with depression in patients with chronic fatigue syndrome and fibromyalgia. (3) According to the authors of a 2014 review published in the journal Physical Therapy, “…although a stress-induced increase in cortisol secretion is adaptive in the short-term, excessive or prolonged cortisol secretion may have crippling effects, both physically and psychologically.” (4)
What are adrenal glands?
You now know that the adrenal glands play a role in stress response and the related energy and/or fatigue that can occur. And yet, some medical experts question whether this condition even exists. In fact, the authors of a 2017 systematic review published in the journal BMC Endocrine Disorders concluded that “adrenal fatigue is still a myth.”
Whether it’s called adrenal fatigue, adrenal exhaustion, adrenal insufficiency, or even adrenal failure, most integrative healthcare professionals know firsthand that adrenal issues are very real.
“Perhaps the controversy surrounding the term ‘adrenal fatigue’ would dissipate if we could clarify its definition and view it as one of many manifestations of subclinical HPA axis dysfunction,” according to a review by integrative health medical writer Sarah Cook, ND, published in the October 2017 issue of the Natural Medicine Journal. (5) Cook and other integrative experts agree that there is significant research describing the myriad health issues associated with stress and HPA axis dysfunction. In clinical practice, adrenal fatigue is definitely a reality.
Helpful lifestyle factors
Fortunately, there are many key lifestyle strategies for adrenal insufficiency treatment that will also help with adrenal gland symptoms such as fatigue. The first tip is to look at diet, specifically sugar consumption.
As mentioned previously, cortisol is involved in blood sugar control and that’s one reason why the amount of sugar we consume is so important. For example, a study featuring 323 children that was published in 2013 in the journal Psychoneuroendocrinology found that the children who ate more sugar had elevated cortisol upon waking and continued to have elevated cortisol throughout the day. (6) A 2012 study featured in the journal Endocrine found that high cortisol levels were associated with individuals who ate “low quality” foods that included sugary foods like soda and simple carbohydrates, as well as “junk” foods and “fast” foods. (7) Flatline cortisol was also associated with the consumption of more saturated fats and fewer fruits and vegetables in a study that was published in 2012 in the journal Experimental Aging Research. (8)
It’s not surprising that the Mediterranean diet, which is one of the healthiest diets and perhaps the most widely studied diet in the scientific literature, has also been shown to counteract elevated cortisol levels. The authors of the 2018 HELENA study published in the journal Nutrients concluded that the Mediterranean diet “…may exert a protective effect on the association between stress and inflammation.” (9) For more diet tips on how to maintain optimal energy levels, click here.
Exercise has been shown to be an effective stress management tool, so it makes sense that it would also help with adrenal fatigue by optimizing the HPA axis response to stress. (10) One caution regarding exercise is that high-intensity exercise can have the opposite effect by elevating cortisol levels. According to Cook, “To coincide with the healthy circadian rhythm, it makes sense to engage in a high-intensity exercise in the morning and low-intensity later in the day.”
In addition to physical activity, a variety of stress reduction techniques have been shown to positively impact the adrenal glands and ease stress-related symptoms. These stress management tools can help stabilize cortisol production and support adrenal gland function:
A 2019 study featured in the journal Psychoneuroendocrinology demonstrated that a 6-week internet-based stress management program is effective in reducing the subjective stress levels. (11)
The bottom line
The adrenal glands are designed to support healthy sustainable energy. The cortisol these glands produce helps the human body cope with stress and maintain a natural circadian rhythm throughout the day and night. Supporting the adrenal glands with a comprehensive lifestyle approach that includes a healthy diet, exercise, and individualized and diverse stress management techniques will go a long way in combating adrenal fatigue. This integrative lifestyle approach can also be used to help reduce the risk of developing adrenal fatigue.
- Elder GJ, Wetherell MA, Barclay NL, Ellis JG. The cortisol awakening response–applications and implications for sleep medicine. Sleep Med Rev. 2014;18(3):215-224.
- Almadi T, Cathers I, Chow CM. Associations among work-related stress, cortisol, inflammation, and metabolic syndrome. Psychophysiology. 2013;50(9):821-830.
- Gur A, Cevik R, Nas K, et al. Cortisol and hypothalamic-pituitary-gonadal axis hormones in follicular-phase women with fibromyalgia and chronic fatigue syndrome and effect of depressive symptoms on these hormones. Arthritis Research & Therapy. 2004;6.
- Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical Therapy. 2014;94(12):1816-1825.
- Cook S. Current controversy: does adrenal fatigue exist? Natural Medicine Journal. 2017;9(10).
- Michels N, Sioen I, Braet C, et al. Relation between salivary cortisol as stress biomarker and dietary pattern in children. Psychoneuroendocrinology. 2013;38(9):1512-1520.
- Duong M, Cohen JI, Convit A. High cortisol levels are associated with low quality food choice in Type 2 diabetes. Endocrine. 2012;41(1):76-81.
- Heaney JL, Phillips AC, Carroll D. Aging, health behaviors, and the diurnal rhythm and awakening response of salivary cortisol. Experimental Aging Research. 2012;38(3):295-314.
- Carvalho K, Ronca DB, Michels N, et al. Does the Mediterranean diet protect against stress-induced inflammatory activation in European adolescents? The HELENA Study. Nutrients. 2018;10(11):1770.
- Silverman MN, Deuster PA. Biological mechanisms underlying the role of physical fitness in health and resilience. Interface Focus. 2014;4(5):20140040.
- Domes G, Stachele T, von Dawans B, Heinrichs M. Effects of internet-based stress management on acute cortisol stress reactivity: preliminary evidence using the Trier Social Stress Test for Groups (TSST-G). Psychoneuroendocrinology. 2019;105:117-122.