You may have heard people blame their crushing exhaustion, brain fog, and moodiness on burnout or adrenal fatigue. But experts say those usually aren’t accurate diagnoses. Here, a new term for what ails us, along with new thinking on exactly how chronic stress is affecting our health—and why yoga can help.
Story by Leslie Goldman
In Our Fast Paced, Always on Culture where phrases like “burned out,” “stressed,” and “exhausted” are regularly bandied about— humblebragged, even—it’s no wonder the term “adrenal fatigue” has become a health buzzword. What is it? In fact, it’s been dubbed “the stress syndrome of the 21st century” and is described as being sick and tired of feeling sick and tired.
What is it? A nebulous, controversial ailment that blames overtaxed adrenal glands for a cluster of nonspecific symptoms, including chronic fatigue, sleep and digestive disturbances, cognitive difficulties, and odd food cravings. (Your adrenals are the two triangular glands on top of your kidneys and are responsible for secreting the energizing hormones cortisol and adrenaline in times of stress.)
To be sure, people are reporting higher and higher levels of stress, says Jeffery Dusek, PhD, chief research officer at Kripalu Center for Yoga & Health, in Stockbridge, Massachusetts, and a research psychologist who has studied the body’s stress response with mind-body medicine pioneer Herbert Benson. Yet even though adrenal fatigue is sometimes diagnosed—and frequently self-diagnosed— the medical community largely denies that it is a real thing.
Both the Endocrine Society and the Mayo Clinic say the condition lacks proper scientific support, and a 2016 review of 58 studies, published in the journal BMC Endocrine Disorders, concluded “there is no substantiation that ‘adrenal fatigue’ is an actual medical condition.” Detractors think symptoms are more likely due to well-recognized medical conditions like depression or hypothyroidism, and they fear that ascribing them to adrenal fatigue could delay critical treatment. (To be clear, true adrenal insufficiency, an autoimmune disorder called Addison’s disease, is rare.)
Dusek posts that Western practitioners might also feel hesitant to accept adrenal fatigue because it’s what he calls a “squishier” diagnosis, akin to irritable bowel syndrome, chronic fatigue syndrome, or gluten sensitivity. Other practitioners say the name “adrenal fatigue” is largely to blame for the confusion.
“Adrenal fatigue sounds like you have these tired, sad little adrenal glands that can no longer make cortisol and adrenaline for you, so you feel sluggish,” says naturopathic and functionalmedicine doctor, Brooke Kalanick, ND, MS, LAc. “That’s not quite it. It’s more like chronic, unmitigated stress is making it so that your brain and adrenal glands can’t communicate as nature intended.
Your Body on non-stop Stress
One thing most experts agree on is that the adrenals play a pivotal role in maintaining everyday energy levels. To understand this, a quick neurochemistry primer is helpful: Cortisol is your main stress hormone. In healthy individuals, cortisol runs on a 24-hour rhythm, normally peaking around 5 a.m. and then slowly tapering throughout the day so it’s lowest at bedtime, says Kalanick. When you’re well rested and your stress is in check, a green juice and a few Sun Salutations should be enough to get you going in the morning. And falling asleep at night feels easy, thanks to the natural fall of cortisol, which coincides with the rise of melatonin—the body’s sleep hormone.
Shorter, more intense cortisol bursts— along with your other stress hormone, adrenaline—occur when the brain senses imminent danger. When that happens, a lightning-fast chemical cascade occurs along something called the hypothalamic-pituitaryadrenal axis, says Kalanick. The hypothalamus (the part of the brain that communicates with the nervous system) shoots a signal to the pituitary gland (the orchestra leader of the body’s various hormones), triggering a fight-orflight response in an effort to spur the body into action, says Cynthia Ackrill, MD, an American Institute of Stress Fellow and life coach based in Washington, D.C. The galvanizing force comes from the adrenals, which pump out adrenaline so you can react— fast. As that initial hormone surge diminishes, the hypothalamus kicks off a second chain reaction, this time directing the adrenals to release cortisol to keep you vigilant. Once the danger has passed, the adrenals send a message back to the hypothalamus to calm down, and you return to the opposite of the fight-or-flight state—commonly referred to as “rest-and-digest”—which is the body’s preferred, restorative state.
But we live in a world saturated with stress, thanks to work, relationships, caregiving, over exercising, and all the shoulds we’re bombarded with. A post-election American Psychological Association study found that nearly half of Americans said they lie awake at night due to stress. Our brains are on perpetual high alert, with all of these stressors being interpreted as dangers and triggering the continued release of cortisol. Millions of years ago, these cortisol bursts helped when we needed Red Bull–level energy to outrun a saber-toothed tiger. Yet as smart as the modern brain may be, “it doesn’t think, ‘This stupid computer is giving me trouble.’ It thinks, ‘This tiger is going to attack me,’” says Wendie Trubow, MD, MBA, a functional-medicine gynecologist in Newton, Massachusetts.
When stress gets serious
How do you know when habitual stress has turned into something more serious with potentially long-term health consequences? Jeffery Dusek, PhD, chief research officer at Kripalu Center for Yoga & Health, encourages anyone who feels chronically stressed and notices trouble with sleep, cognition, digestion, or interpersonal relationships to see their health care provider for a physical. A functional or integrative medical practitioner, in particular, can help determine whether you have hypothalamic-pituitary-adrenal axis dysregulation (HPA-D)—see the definition on page 44—as well as rule out look-alike conditions like hypothyroidism, anemia, and depression. HPA-D can be assessed by testing salivary cortisol levels at four times during the day, which “allows us to see the timing and rhythm of cortisol output, as well as your total cortisol levels,” says functional-medicine doctor Brooke Kalanick. Your health care practitioner should test other key adrenal hormones—such as pregnenolone and DHEA—as well as your thyroid hormone levels and progesterone and estrogen (in women). At the appointment, discuss your energy and stress levels, nutrition, appetite, caffeine use, food cravings, and sleep habits. If you have been calling your symptoms “burnout,” it’s worth noting that burnout is technically a work-related condition. It results in a trio of symptoms: cynicism; feelings of ineffectiveness; and exhaustion.
That’s what Donna Brooks, 58, a yoga therapist and somatic movement educator likely had as she constantly pushed to achieve the perfect poses in asana and foster a magical ambiance in class. “Yoga is supposed to ultimately be relaxing, but creating a space for what people think yoga is supposed to be can be stressful,” she says. “A lot of yoga teachers feel pressure to be at the top of their games, which creates a lot of stress and strain—physiologically and emotionally.” A functional-medicine practitioner eventually tested Brooks’s cortisol levels—they were high—but high cortisol is not synonymous with adrenal malfunction. Still, her healing plan was very similar to that of someone diagnosed with HPA-D: plenty of self-care by way of adaptogens (stress-reducing herbs), somatic yoga (slow, easy movements designed to soothe the nervous system), and a wholehearted effort to step away from her perfectionistic tendencies.
The Cost of Chronic Stress
Like the villagers in Aesop’s fables who eventually start ignoring the little boy who cried wolf, the hypothalamus becomes less sensitive to adrenal feedback when stress is constant, and cortisol levels essentially go rogue. When this happens, it becomes harder to keep cortisol output on its normal circadian timing, says Kalanick, “which can result in periods of inappropriately high or low cortisol.” In some people, cortisol surges at night (when it should be low) so you lie there, worn out but wide awake. In others, it plummets in the morning (when it should be high), making it feel impossible to get out of bed.
The effects of this relentless cortisol dump usually first manifest as troubled sleep and fractured energy levels, but other red flags include headaches, irritability, and cognitive difficulties—a combo sometimes called “brain fog”—all due to a lack of restorative sleep. Many women also experience menstrual irregularities, adds Trubow, who was trained as a Western obstetriciangynecologist before turning to functional medicine. Excess cortisol inhibits ovarian function, because a habitually stressed brain thinks danger lurks around every corner. “Survival trumps procreation,” says Trubow, “and your body focuses on providing energy to your legs to run—not to your ovaries.”
Digestive issues are also common, as excess cortisol decreases stomach-acid production. “You can’t properly break down food,” Trubow says, leaving you gassy, bloated, or with diarrhea. After prolonged periods of high cortisol levels, you may also experience nutrient deficiencies. There’s also a good chance you’ll experience food cravings. Yearnings for salt are common, mainly because the adrenal glands produce a hormone called aldosterone, which maintains the body’s sodium balance (and, consequently, blood pressure). The sodium imbalance that can result from excess adrenal hormones leads to salt cravings, and can also cause low blood pressure, according to Mayo Clinic. Unmitigated cortisol also leads to fat accumulation around the midsection, says Trubow. Increased cortisol can cause spikes in blood sugar, which is ultimately stored in the abdomen as fat.
This constellation of symptoms is commonly attributed to adrenal fatigue, but experts say the more accurate term is hypothalamic-pituitary-adrenal axis dysregulation (HPA-D). “The HPA axis, this pathway linking the brain and the adrenals, is well known and has been studied extensively,” says Ackrill, adding that decades of research verify that an onslaught of stress hormones—the ones controlled by the HPA pathway—can upset every process in the body, from energy production and sleep to sex hormone production and immune system repair.
Whether you call it HPA-D, adrenal fatigue, burnout, or chronic stress, one thing is for sure: There’s a good chance your nervous system is, well, way too nervous. Self-care is critical, says Ackrill. In fact, she calls it non-negotiable for physical and emotional resilience. “Somehow, our culture has made us feel like better care is selfish, so we ignore our body’s check-engine lights and end up taking care of our yoga gear better than we do ourselves,” she says. Any of the following practices can be used to jumpstart the healing process and help you regain your energy. Just be careful not to try to adopt them all at once. “You don’t want the process of destressing to feel stressful,” says Kalanick.
Prop your Practice
Now is not the time to practice intense vinyasas or push yourself through fast, hot yoga classes, which are too strenuous for someone with HPA-D. But you do need your yoga practice more than ever if you are diagnosed with the condition. Roger Cole, PhD, a sleep research scientist and certified Iyengar Yoga teacher in Del Mar, California, recommends starting with more passive, prop-supported restorative yoga, “which allows you to approach classic restful poses, yet completely let go because you have additional support,” he says. Try folded blankets beneath your pelvis in Viparita Karani (Legs-up the-Wall) or blankets and bolsters under your head, back, and knees in Salamba Supta Baddha Konasana (Supported Reclining Bound Angle Pose).
How Ayurveda Helps
From an Ayurvedic perspective, hypothalamic-pituitary-adrenal axis dysregulation (HPA-D) is the manifestation of an imbalance of vata, one of the three different energies, or doshas, in Ayurvedic medicine. (The others are pitta and kapha.)
“There are two types of vata,” says certified Ayurvedic practitioner John Douillard, DC, founder of LifeSpa.com: There’s prana vata, which moves up into the head and supports nervous system function, and apana vata, which moves down into the pelvis, supporting adrenal, reproductive, and eliminative functions. “If the mind is stressing the body, the downward-moving vata will be redirected upward to handle that stress,” leaving the adrenal glands depleted. (This also explains why many people experience stomach woes when they’re stressed, and why women can develop menstrual irregularities.)
Douillard says most HPA-D patients feel significantly better within two weeks of starting a combination of the following Ayurvedic healing approaches:
1) Load up on seasonal produce. Fruits and veggies carry ever-changing microbes from the soil into your gut to boost immunity, which drops during times of stress.
2) Practice forward-bending yoga postures. These push apana vata back down.
3) Meditate. A regular meditation practice creates a sattvic, or peaceful, state of mind.
4) Give yourself abhyanga, or oil massage. Not only does this foster a connection with your body, but it also helps to restore hormonal balance and improve immunity, according to Ayurveda. “We have at least 1,000 sensory neurons per square centimeter of our skin,” says Douillard. “When you massage just one arm with oil, you’re calming more than a million neurons.” Massage also boosts oxytocin, and oiling the skin keeps the skin microbiome healthy, which in turn supports immunity.
5) Take adaptogenic herbs. “The beauty of adaptogens is that you can utilize them whether your cortisol is high, low, or all over the place,” says functional-medicine doctor Brooke Kalanick, who recommends rhodiola for preventing stress-induced adrenaline activity and combating the immune-lowering effects of long-term stress. You can also try holy basil (tulsi) to normalize blood sugar, increase endurance, and improve your overall sense of well-being.
Try Yoga Nidra
If you love the way you feel when you emerge from Savasana (Corpse Pose) feeling recharged yet peaceful, yoga nidra may be a great choice for you. This simple, guided meditation ushers you into deep-sleep brainwave territory, but with a trace of awareness. “You wake up after 45 minutes feeling like you’ve slept three hours,” says Karen Brody, author of Daring to Rest: Reclaim Your Power with Yoga Nidra Rest Meditation, “so you get all the science-backed benefits of meditation, plus the benefits of sleep. It’s a 21stcentury power nap.”
Because yoga nidra involves deep breathing, it triggers the relaxation response. “Your brain shifts from an awakened state, with lots of brain activity, to a more relaxed state, where the calming, mood-regulating hormone serotonin is released,” says Brody. From there, you eventually proceed toward an ultra-restorative brainwave state, where thoughts slow and excess cortisol gets scoured from your system. “In our go-go-go culture, very few people are entering this state on a regular basis,” says Brody, “and as a result, our bodies are not powering down and getting the opportunity to restore themselves.”
Be Choosy about what you consume
Headlines scream of alarming news and violence; your social media feeds are likely filled with divisive political views. “Taking in too much bad news sends an overdose of danger signals to the brain,” says Ackrill. Limit your intake of soul-crushing headlines and up your daily dose of positive news via websites like dailygood.org or goodnewsnetwork.org.
Connect with Others
The feel-good hormone oxytocin is secreted during times of joy—like when you have an orgasm, if you’re breastfeeding, and even when you’re hanging out with your crew. When we’re in the presence of friends whom we feel supported by, women in particular get a rewarding jolt of oxytocin—because those are the people who helped us survive and raise kids back in prehistoric times, explains Denver-based psychotherapist Sheryl Ziegler, PsyD. Find friends with whom you can talk, vent, and laugh—especially if you’re female. “Women experience oxytocin’s effects more strongly than men, as estrogen is an oxytocin amplifier,” she says. The good news is that most patients end up working their way back to health with a combination of mind-body stress-relief techniques, dietary adjustments, herbs, and healing movement.
Leslie Goldman is a writer in Chicago, Illinois. Learn more at lesliegoldmanwrites.com.
This article was first published in the print edition of Yoga Journal Singapore, which is now Yogahood Online.
