Is it your adrenal glands or is it your brain and what is the solution?
It was 2004 when a doctor said that I may have adrenal fatigue. I had never heard of it back then but I went to the pharmacy and picked up a supplement he had recommended. I don't even remember what was in it, but most likely adaptogens.
I started taking the supplement, and doing research on adrenal fatigue and adrenal insufficiency, which led me down a rabbit hole like most other diagnoses that I researched. The internet told me that I needed to eliminate stress (still don't know how you do that!), that I needed to cut out gluten, dairy, sugar and soy (I was already on a Paleo diet), and that I needed to make sure I got 8 hours of quality sleep every night. Ironically, adrenal fatigue also tends to cause sleep problems.
At the time I really didn't feel all that sick (yet), but what I was reading had me a little concerned. I was working a full time, high-stress job and not sleeping well. I was also dealing with anxiety, depression and an eating disorder. I don't remember all the details, but I probably also took supplements for sleep and I had already been taking supplements for the depression.
As I got sicker and sicker, and accumulated one diagnosis after another, the adrenal fatigue also got worse. Doctors never fully explained adrenal fatigue to me. They just said that my adrenal glands were not producing cortisol like they should, which is the highest amount in the morning and then slowly declining throughout the day. This is your circadian rhythm. With adrenal fatigue you might have too much cortisol at night and not enough during the day. Some people experience an afternoon drop because their cortisol levels are just not high enough. I know cortisol gets a bad rap, and everybody talks about making sure your cortisol is not too high, but not having enough is not pleasant either.
By 2009 I had adrenal insufficiency. This is when your adrenal glands don't produce enough cortisol at all, and you just feel flat out fatigued. It also causes anxiety, it affects your thyroid, possibly weight gain, and other symptoms. My levels were so low throughout the day, my doctor at the time prescribed 20 mg of hydrocortisone taken in divided doses. If I remember correctly, I took 10 mg when getting up, 5 mg around mid-day, and another 5 mg around 5 PM. This was supposed to mimic the body's normal cortisol production. Of course no medication works as well as your body was designed to work, but it did help me feel better...for a little while.
The goal with hydrocortisone is to take it for a few months to let your adrenals "rest" and then slowly wean off. A typical wean is to cut your dose by 2.5 mg, stay there for one week, and if you feel well, reduce another 2.5 mg. You keep doing this until you are completely weaned off. It's sounds easy but it's not. Many people who have weaned completely off hydrocortisone had a really hard time doing so.
Five years later, I was still on hydrocortisone and up to 47.5 mg a day. This is also when I was at my worst and I thought I would never get better. If you haven't read my full healing testimony yet, you can find it here.
During all this time nobody had explained to me WHY my adrenal glands were suddenly not producing cortisol anymore. One doctor told me that I would never be able to stop taking hydrocortisone because of how long I had been on it. His exact words were, "After all this time your adrenal glands have shut down, and you will die if you stop taking it."
But God is bigger than any illness and disease, I stopped taking hydrocortisone November 2014, and obviously I didn't die!
So let's take a look at why the adrenal glands overproduce or underproduce cortisol. Your adrenal glands don't suddenly decide to go wonky. They are actually controlled by the brain, as is the rest of your body. Your thyroid also doesn't just decide to stop producing too much or too little thyroid hormone, but that's another blog post in itself.
Some practitioners started addressing the HPA (hypothalamic-pituitary-adrenal) axis versus just putting people on medication. That's great, but it goes even further upstream than that to the amygdala and the limbic system of the brain.
People with adrenal fatigue and other chronic illnesses typically have had traumatic childhoods and/or prolonged periods of more than usual stress. Often times there is also a traumatic event right before the onset of the illness. These people also tend to be high achievers, perfectionists, helpers, "goodists" and caretakers. There is nothing wrong with doing something well or helping others, but these people derive their sense of self from achievements and how others perceive them. That was definitely me!
Through MRIs we know there are profound changes in the brain in people with chronic illnesses such as adrenal fatigue (also chronic fatigue syndrome, chronic pain, fibromyalgia, and others). Patients have reduced volume in the prefrontal cortex, the insula, which takes in incoming information and creates an autonomic response, also shrinks and can’t handle all incoming data, and the brain goes into hibernation mode. The brain is simply exhausted and overstimulated.
Just like pain, fatigue is a danger signal and protective mechanism. If you get the flu, but you don't have fatigue, you would continue to do everything you would normally do, and you wouldn't rest. This would put your body at risk, because your body needs energy to fight the illness. In adrenal fatigue, the brain hasn't "bounced back" and it becomes a vicious cycle. The illness itself now causes stress, in addition to every day stress (job, children, marriage), and doctors start treating the symptoms, versus the root cause.
Most people have heard the term fight/flight/freeze. We all have a fight/flight/freeze response. It's normal and serves a purpose when there is real danger, like a bear chasing you. Your body produces increased levels of various hormones and chemicals to help you handle the dangerous event. Once the event is over, your hormone and chemical levels normalize, your nervous system calms down, and in roughly 72 hours you are ready to handle another dangerous event. In people with adrenal fatigue, the brain perceives every day stresses as dangerous. This could be a deadline at work, an argument with another person, fear of failure, or even public speaking.
So how do you overcome adrenal issues vs. just managing them with supplements and medications? The first step is knowledge and understanding that there is nothing wrong with your adrenal glands. Realizing that the symptoms, and wonky cortisol levels, were just from my brain, greatly reduced the fear I had about the diagnosis. It did take me a while to overcome doubt, but as I continued to learn more about how the brain works in people who have had trauma, it got easier. As I understood and believed that there is nothing wrong with my adrenal glands, I went back to doing everything I wanted to do, and was previously told not to do. This is step two. I started exercising, I stopped worrying about having an extra cup of coffee some days, I stopped avoiding stressful situations in my life. Basically, I started living my life as normally as possible. Step three is not letting symptoms scare you if they do come and reminding yourself that it's just your brain!
Those are the basics and while working on overcoming doubt, I used tools such as meditating on scripture, renewing my mind to who I am in Christ (I wish I had done this sooner and more consistently), and at times focusing on slowing down my breathing. Ultimately belief that healing is possible and available right now is the key. All the other modalities were just ways for me to calm my nervous system while I still had doubt and fear.
If you are dealing with adrenal fatigue or adrenal insufficiency and have questions, you can book a free 30 minute consultation with me here.
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