Lifestyle Recommendations for Adrenal Fatigue

Adrenal fatigue is characterized by fatigue, insomnia, poor stress tolerance, muscle aches, anxiety and increased susceptibility to colds and flus. Diet and behavioral/lifestyle changes are crucial for recovery from adrenal fatigue. Here are diet, lifestyle, and behavioral recommendations to support the HPA axis.

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Lifestyle Recommendations for Adrenal Fatigue

Adrenal fatigue is characterized by fatigue, insomnia, poor stress tolerance, muscle aches, anxiety and increased susceptibility to colds and flus. Diet and behavioral/lifestyle changes are crucial for recovery from adrenal fatigue. Here are diet, lifestyle, and behavioral recommendations to support the HPA axis.

By Blair Cuneo, PA-C

Definition and Screening

HPA axis dysfunction (HPA-D) is the more accurate term for the syndrome often referred to as “adrenal fatigue.” HPA-D is characterized by a diverse range of signs and symptoms, including but not limited to: fatigue, insomnia, poor stress tolerance, muscle aches, anxiety and increased susceptibility to colds and flus. It can be caused by high levels of perceived stress, blood sugar dysregulation, inflammation and/or circadian disruption (too much exposure to light at night, inadequate light exposure during the day, travel across time zones, etc).

 

To screen for HPA-D, patients conduct a saliva cortisol test or a urine cortisol test to assess adrenal hormones. This involves collecting four non-invasive samples over the course of one day to generate results with a diurnal cortisol curve. This four-point graph reveals cortisol levels throughout the day and allows health care providers and patients the opportunity to pinpoint issues with adrenal gland function.

Supplements like Vitamin C, B Complex, magnesium, adaptogenic herbs and potentially DHEA are an important part of the treatment of HPA-D, but diet and behavioral/lifestyle changes are crucial for recovery. Put simply, you cannot supplement yourself out of HPA-D.

 

Here is a list of diet, lifestyle, and behavioral changes that support the HPA axis.

Diet

  • Eat a moderate-carbohydrate diet: Most people with HPA-D have problems with blood sugar regulation, resulting in low blood sugar, or sometimes a combination of high and low blood sugar. You will want to focus on a moderate carbohydrate diet, which means about 15 to 30 percent of your calories coming from carbohydrates (100 grams of carbohydrate on a 2,000-calorie diet or 125 grams on a 2,500-calorie diet). 

 

  • Eat adequate protein, especially in the morning: Higher-protein diets reduce cravings and seem to have a regulating effect on blood sugar. You should eat at least 15 percent of total calories as protein (75 grams of protein on a 2,000-calorie diet or 95 grams on a 2,500-calorie diet). You should also eat a high-protein breakfast (40 to 50 grams). This has a stabilizing effect on blood sugar throughout the day.

 

  • Eat frequently throughout the day: To keep blood sugar levels stable, you should either eat five or six small meals per day or three regular meals with snacks in between. Choose whichever approach suits your preference and lifestyle best. Snacks and meals should always have some protein and fat, never just carbohydrate alone.

 

  • Ensure adequate salt intake: Extra salt in the diet can help increase blood pressure. If your HPA-D has caused you to have low blood pressure, you may want to start your day with a glass of water with one-half to one teaspoon of sea salt in it. You should also season your food to taste.

 

  • Avoid caffeine and alcohol: Caffeine is a stimulant, and it places additional stress on the body. Alcohol stresses the liver, which often functions suboptimally in HPA-D. It is best to avoid caffeine entirely and either limit alcohol consumption to two to three drinks per week or avoid it completely until your adrenals recover.

[Adrenal Fatigue] can be caused by high levels of perceived stress, blood sugar dysregulation, inflammation and/or circadian disruption (too much exposure to light at night, inadequate light exposure during the day, travel across time zones, etc).

Behavior and Lifestyle:

  • Get good sleep and plenty of rest: There is nothing more important for those with HPA-D than getting enough sleep and rest. If you feel you need to take naps during the day, do so as your schedule permits. Get as much rest as you can!

 

  • Be smart about exercise: Overtraining is another common cause of HPA-D. Signs of overtraining include difficulty recovering from workouts, a plateau or decrease in performance, fat gain despite regular exercise, insomnia, restlessness, anxiety, fatigue, muscle or joint pain, frequent illness, and depression. Favor low- intensity exercise such as walking, cycling, swimming, or yoga over high-intensity activities like CrossFit or endurance training. 

 

  • Be in contact with nature: Natural environments have rejuvenating and restorative effects, reduce stress, and alleviate mental and physical fatigue. Spending regular time outdoors in a natural environment is especially important for those with HPA-D.

 

  • Get pleasure, play, and connection: Many people with HPA-D are suffering from stress burnout. They are exhausted, dispirited, and often feel depressed or “flat.” Pleasure, play, and social connection are all deeply nourishing and restorative on both a physical and emotional level and can provide a powerful antidote to the symptoms of HPA-D.

Stress Management:

There are several clinically proven ways to manage stress, from yoga to deep breathing to biofeedback. Below are several points to consider, and a few options for specific techniques.

 

  • Start small. If you are new to meditation, start with just five minutes each day. Gradually increase that time as you become more accustomed to the practice.

 

  • Make it a priority. Consider putting it on your calendar, just as you would any other important task for the day.

 

  • Be gentle with yourself. It’s okay if you miss a day, and it’s okay if you don’t feel like you’re “good” at it.

 

  • Choose a mix of practices. Some days, sitting still on the cushion may feel near impossible, and yoga or another movement-based practice may be a better fit for the day.

 

 

  • Biofeedback is another option that some people prefer, since it provides a more tangible measure of how we modify our physiological response through relaxation. There are many options available that work with a tablet or smartphone, such as emWave2, BioZen, and Quantum Life.

 

If you have any questions or concerns, seek out the expertise of functional and integrative providers well versed in screening and supporting patients with HPA-D. 

Blair Cuneo, PA-C, is a Physician Assistant and Functional Medicine provider, certified through the NCCPA and the Institute of Functional Medicine. Before joining the Raleigh-based functional medicine practice, Carolina Total Wellness, she provided Family Practice and Urgent Care services in the Triangle for a decade. She has a B.S. in Radiologic Science from The University of North Carolina at Chapel Hill and a M.S. in Physician Assistant Studies from East Carolina University.


At Carolina Total Wellness she works with patients ages 3 years and older, especially enjoying when she is able to care for multiple members of a family. This partnership in the family dynamic emphasizes open communication, knowledge sharing and cultivation of individual and family strategies to create paths to wellness.

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