One uncompromising axiom of cheap medicine is less stress and more sleep, and the two are very much related.  The topic of sleep will require multiple blog posts to cover but we can begin by talking about adrenal health and how weak adrenals set the stage for poor sleep, chronic inflammation, fatigue, and pain.

Researcher Hans Selye coined the biological definition of the word “stress” in the 1950’s.  His early work mapping how adrenal hormones such as cortisol and epinephrine (previously known as adrenaline) are released in response to stress helped define three distinct stages of the stress response.  They are generally known as the alarm phase in response to acute stress, the resistance phase in response to chronic stress, and the exhaustion phase where the body is unable to cope with a chronic unremitting stress.  The latter of these is typified by a very low output of the hormone cortisol and is the hallmark of a patient diagnosed with chronic fatigue syndrome.  Selye’s work with the stages of stress, known collectively as general adaptation syndrome, is an excellent roadmap to discuss a person’s overall health, immune state, and prognosis going into a holistic healing program.  The adrenals are your deep reserves; if they are depleted, ANY medical condition will take longer to heal.

So what are these nefarious things that deplete your adrenals?  In two words – stress and sugar.  The stress part of the equation is fairly straightforward; you can only undergo so much chronic stress before it wears you down.  Even an acute stress, if severe enough, can severely deplete your reserves (think of going into shock).  To understand the influence of sugar, you need to know that the hormone cortisol is a glucocorticoid and manages your blood sugar.  Cortisol is one of the key hormones that helps keep your blood sugar regular in between meals.  With a relatively low-carb diet, cortisol works minimally and your hormonal reserves remain strong.  If you have a high-carb meal that puts you on a blood sugar roller coaster, vast amounts of cortisol is needed to pick you up from the crash that ensues from the high sugar/high insulin spike.  A breakfast of cereal with skim milk and orange juice will have your adrenals begging for mercy.

Cortisol will also raise blood sugar in response to a perceived stress in order to offer your body a quick burst of fuel to help you cope with the threat.  In an acute situation, this upshot of glucose goes to your muscles to help in the well known fight or flight response.  Even with the best nutrient-dense lower carb diet, you could still suffer from elevated blood sugars if you are subject to chronic stress.  Getting cut off on the road, having a bad review from your boss, and drinking a half a pot of caffeinated coffee (which coaxes cortisol from your adrenals) will all result in a day of blood sugar ups and downs as if you were eating a donut every few hours.  Now if you actually were eating a donut every few hours in addition to the metaphorical donut of stress, you have set the stage for some really overworked adrenals.

The last piece of the puzzle comes from understanding a healthy cortisol rhythm.  Cortisol is highest in the morning, waking you up and getting you ready for the day.  It is lowest at night when it’s time to wind down and let melatonin do its job.  It is possible to have this rhythm flip-flopped in what is called an inversion pattern.  If I were to do a lab on a patient in that scenario, what we would find is low morning cortisol and high evening cortisol, essentially the reverse of a healthy pattern.  These folks are the classic “wired and tired” types in that they are dragging in the morning (and hit the coffee hard) and wired at night and can’t get to sleep (often relying on sedatives).  That’s the cortisol rhythm of a type A person and it is very difficult to get to sleep if your cortisol is spiked in the evening.

Another abnormal cortisol rhythm is a flat-lined, or low all around cortisol as commonly seen in chronic fatigue patients.  This represents the last, exhaustive stage identified by Hans Selye and has gotten the modern moniker of adrenal fatigue or adrenal exhaustion.  These patients are tired all the time and can’t get enough sleep.  An interesting corollary to this is a patient with chronic pain and fatigue who feels like superman or superwoman if their doctor puts them on prednisone.  Steroid drugs such as prednisone and cortisone work by strongly supplementing your body’s natural production of cortisol.  High doses of these drugs, although necessary in certain instances, is the equivalent of supercharging your adrenals.  The point here is that in most cases you wouldn't need these stronger synthetic substances if your adrenals were doing their job in the first place.  In the absence of adequate adrenal health, reliance on these drugs will be a constant struggle.

Thankfully there are very safe and effective holistic strategies for treating any stage of your adrenals gone haywire.  An entire category of herbs (called adaptogens) and glandular substances do a remarkable job of helping your adrenals heal.  It takes months and must be done in the context of a patient taking responsibility for their part of the healing equation.  Patients with adrenal challenges must be prepared to eat a very healthy low-carb diet to keep their blood sugar in check.  They must also employ some strategy to cope with stress to avoid the physiological drain that comes from these situations.  With a healthy lifestyle and herbal adrenal support, most patients will see improvement in a few weeks but true healing of the glands will take months to years depending on the extent of depletion.

If you suspect your adrenals might need assistance, a holistic practitioner trained in evaluating cortisol through a salivary lab test can quickly and inexpensively diagnose the imbalance.  From there you can embark on a healing program to reclaim your energy reserves and live healthy and happily.


  • I certainly see myself as the “flip-flopped” type. ┬áSo for these types, eating less carbs (especially at night) and keeping the stress down is enough to reverse the confused cycle?

  • Got my test results back. Will share with you at my next visit. However, wondering if we should do the spit test…

  • Precisely right. It is the cortisol imbalance caused by elevated blood sugars and excess stress during the day which underlies the late evening spike. Over time this exhausts the adrenals to a degree resulting in low morning cortisol. Keeping your blood sugar stable, getting plenty of rest, and coping with stress will rebalance a maladapted cortisol rhythm.

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