Assessing the Adrenal Glands

Now that you’re starting to think that you might fit the picture of a person with chronic stress, let’s discuss how to properly assess it. First of all, it is most important to start with a thorough history of your symptoms and your lifestyle. We can get a lot of information from looking in detail at the symptoms you’re experiencing, the stress you’re under on a daily basis, as well as past life stressors. If your symptoms clearly point to a chronic stress picture and there are no red flags that come up in your history, we can often work on self-care and stress management (as I’ll discuss later in this post) and monitor improvements in your symptoms without jumping straight to invasive and expensive testing.

If testing is necessary, the most common way to assess the adrenal glands is to test your 24-hour salivary cortisol levels. Salivary cortisol testing is generally considered more effective than testing cortisol in the blood because it assesses the amount of cortisol inside the tissues, which is where it is actually used. The salivary cortisol test is conducted at home at four points throughout the day, upon waking, around noon, in the afternoon, and in the evening. Cortisol usually fluctuates throughout the day so this gives us an accurate picture of your cortisol curve. Urinary cortisol testing can also be used to assess how you’re metabolizing cortisol and other adrenal hormones.

Salivary cortisol testing can be used for assessing both minor adrenal dysfunction, such as adrenal fatigue, as well as serious adrenal dysfunction, such as Addison’s disease or Cushing’s disease. These and a variety of other diseases and disorders related to the HPA axis must be appropriately ruled out before you try to manage your symptoms naturally.

HPA Axis Dysfunction

Until we have more research around the concept of adrenal fatigue, HPA axis dysfunction is my preferred way of looking at the symptom picture related to chronic stress. HPA stands for hypothalamus-pituitary-adrenal (and some people also add O for ovaries in females, since many of the ovarian hormones are stimulated by the HPA axis as well). The hypothalamus produces corticotropin-releasing hormone (CRH), which stimulates the pituitary to produce adrenocorticotropin hormone (ACTH), which stimulates the adrenals to produce cortisol. Therefore, there is no doubt that the HPA axis plays a role in how our bodies react to stress.

The main question is how to appropriately support the HPA axis in times of chronic stress. As science advances and we learn more and more about our bodies, I’m sure we will learn more about this process. For now, this is where self-care comes into play as a very important factor in optimizing the HPA axis. We can also support it with certain nutrients and herbs. Read on to learn more!

Supporting the Adrenals and the HPA Axis

Healthy Eating

My top 3 healthy eating recommendations for nourishing the adrenals are:

1. Eat Real Food. Choose fruits and vegetables, lean proteins (chicken, fish, eggs), and healthy fats, while avoiding high amounts of dairy, wheat, red meat, processed foods, fried foods, and refined sugars to decrease inflammation (which is a physical stressor) and improve overall health. Limit chemical and toxin exposure in your food so that your body doesn’t have to expend extra energy on metabolizing and eliminating these toxins.
2. Eat Mindfully. Elevated cortisol levels lead to cravings for sugar, salt, and high fat foods. Eating mindfully helps manage these cravings and provides our bodies with the nutrition it really needs, instead of what it thinks it craves.
3. Eat Regularly. The goal is to nourish the body, not to starve it. Starvation is an alarm signal for the body and can lead to physical responses very similar to other stressors. Choosing fad diets that involve avoiding real food, skipping meals, or eating very low calories are likely not going to be effective to manage the symptoms of chronic stress, including the associated weight gain.

Nutrients

There are a variety of nutrients that are specifically important to increase in your diet or in supplement form during times of stress. The main ones to consider are B vitamins, vitamin C, magnesium, and zinc. B vitamins are depleted during periods of prolonged stress because they play important roles in energy production. Vitamin B5 is specifically important in the synthesis of cortisol and proper adrenal function. Vitamin B6 plays a role in the action of steroid hormones and supporting a healthy stress response. Vitamin C is a cofactor in the synthesis of many of the adrenal hormones and is a potent antioxidant to protect the adrenals from oxidative stress. Magnesium and zinc are both cofactors in many important energy production and hormone pathways throughout the body and deficiencies in these minerals can contribute to adrenal fatigue.

Herbal Options

The herbs that are most commonly used to support people throughout periods of prolonged stress are termed adaptogens. As the name sounds, it means that these herbs have actions that help the body adapt better to stress. Examples of herbal adaptogens are ashwagandha, holy basil, maca root, rhodiola, eleuthero root, and licorice root. Just writing these names makes me feel excited because I have seen these herbs work wonders in many of my patients! They can help you transition from feeling completely depleted and overwhelmed to having more focused thoughts, a calmer mind, and better stress management.

Because these herbs can be so effective, there are now many available adaptogen products on the market. I highly recommend discussing these herbs with a naturopathic doctor or herbalist before using them. They each have specific symptom pictures that they treat most effectively and therefore getting the wrong adaptogen can either leave you with negative side effects or feeling like they were a complete waste of money. Even though it is easy to buy natural health products over the counter without a prescription, it doesn’t mean they are all safe and effective for everyone.

Sleep

The HPA axis and sleep are intimately connected because CRH (from the hypothalamus) and ACTH (from the pituitary) fluctuate with the circadian rhythm under the influence of melatonin. Melatonin production is optimal when we are sticking to a natural and regular sleep and wake cycle. We also need to give our bodies enough time in a sleep state in order to heal properly. Sleep deprivation will lead to a host of negative symptoms and absolutely decrease stress resistance.

Getting to sleep can be an issue for a lot of people suffering from chronic stress because it is common for cortisol to peak at night (instead of in the morning) and it is also common to see more symptoms of anxiety. Both of these make it hard for the body to relax and get to sleep. This is when it can be beneficial to take a melatonin supplement or a supplement, such as L-theanine or lavender oil to calm the mind before sleep. Again, this should be discussed with a naturopathic doctor or herbalist. However, supplements should be your second line option. The first line treatment for sleep disturbances is proper sleep hygiene! Not sure what that means? You’ll have to wait for my September blog post to learn more.

Mindfulness

This is incredibly important when we are undergoing chronic stress. You might think that this seems crazy because I’m asking you to fit time for mindfulness into your already busy schedule! However, practicing mindfulness throughout the day can actually help you save time by being more focused and intentional with your activities. Being mindful of our bodies helps us notice when we are starting to experience symptoms of stress and take steps right away to combat it. Mindfulness can help us remember to drink water, eat properly, take bathroom breaks, exercise, and do the other self-care tasks that our bodies are screaming at us to do. I covered mindfulness extensively in the Mindfulness March blog post.