A nutritional approach to adrenal fatigue

By Kellie Blake, RDN, LD, IFNCP

Adrenal fatigue is not accepted as a valid diagnosis by the conventional medical community but is nevertheless affecting many of our clients. In my practice, complaints of fatigue, insomnia, depression, digestive distress, mood changes, and weight gain are common. There may be many root causes to address, including adrenal dysfunction.

The hypothalamus-pituitary-adrenal axis (HPA) keeps us healthy during times of stress. The adrenal glands, located on top of the kidneys, function as part of this system by secreting cortisol, adrenaline, and dehydroepinandrosterol (DHEA). When the body is under stress, adrenaline is quickly released to provide a boost of energy to fight the perceived threat and cortisol mobilizes energy stores, alters immune system function, reduces certain physiological processes, and heightens brain function.

DHEA is important for balancing the sex hormones. Once the immediate threat has been removed, cortisol signals the hypothalamus and pituitary to return to normal function. When perceived stress is chronic, the adrenal glands become vulnerable to exhaustion leading to a variety of symptoms that reduce quality of life.

Nutrition-related changes work synergistically with other lifestyle modalities to restore adrenal function and rebuild the adrenal reserve. Nutrition recommendations should be tailored to the individual, but all clients will benefit from blood sugar stabilization, removing symptom triggers, and replacing nutrients that are missing or in higher demand.  

Small, frequent, protein and fiber-containing meals, along with the elimination of processed foods, refined sugars, and artificial sweeteners, can stabilize blood sugar levels. Caffeine and alcohol consumption should be discouraged as both can affect sleep quality and can stimulate the adrenal glands, exacerbating symptoms. If symptom relief is not realized quickly, a full elimination diet may be considered to determine other food triggers that could be contributing to symptoms.

Nutrient deficiencies are common in adrenal fatigue related to poor dietary intake and the increased demand for the B vitamins, vitamin C, and magnesium. Encourage clients to consume at least nine servings of vegetables daily, with several of those being leafy greens to maximize nutrient intake. Nutritional supplementation will likely be necessary.

B vitamins serve as co-factors in the production of hormones and neurotransmitters and are important in helping clients manage stress appropriately. Encouraging the consumption of a variety of leafy green vegetables, nuts and seeds, gluten-free whole grains, legumes, organic poultry, eggs, and grass-fed meat, if not on an elimination diet, will improve B vitamin status. A vitamin B complex, taken in the morning, is almost always necessary to meet the increased demand in adrenal fatigue. Larger doses of individual B vitamins may also be required depending on the phase of adrenal fatigue and some clients may need methylated B vitamins.

Vitamin C is vital to maintaining a healthy immune system and is required in larger amounts by clients experiencing chronic physical or psychological stress. According to a review in the journal Nutrients, vitamin C is the fourth leading nutrient deficiency in the United States related to poor dietary intake, toxin exposure, alcohol and drug abuse, and increased stress levels. Vitamin C intake will naturally increase as vegetable intake increases, but supplementing with 500 milligrams to two grams of vitamin C per day can further boost the immune system and improve stress resiliency.

Magnesium is a cofactor for over 300 reactions in the human body and magnesium-deficient diets have been linked to depression and anxiety. The Nutrients article also found 68 percent of Americans consume less than the recommended amount of magnesium. Adequate magnesium levels are needed for optimal HPA axis function, but stress reduces both serum and tissue levels of magnesium. To increase dietary magnesium intake, encourage clients to increase consumption of leafy greens, nuts, seeds, beans, figs, and avocados. Supplementing with 400 milligrams of magnesium, Epsom salt baths, or topical magnesium applied to the legs before bed can also be helpful to meet the increased demand and improve sleep quality.

Other nutritional supplements to consider for clients experiencing adrenal fatigue include a multivitamin- mineral to fill the gaps, omega-3 fatty acids to decrease inflammation, vitamin D3 to boost the immune system, and a probiotic to target gut health. Adaptogenic herbs are also very helpful but must be matched to the phase of adrenal fatigue.

Case Study

Dene is a 30-year-old female referred for digestive distress, stubborn weight gain, and sleep disturbance.  She complained of abdominal bloating after meals and the inability to lose weight despite very intense workouts. She had stopped weighing herself five months prior to our meeting due to previous weight obsession and feeling depressed after stepping on the scale.

She described her job as very stressful, she was exercising excessively, and complained of terrible self-esteem. She had recently begun seeing a therapist due to mood changes and feeling more depressed. She followed a gluten- and dairy-free diet and allowed herself a less-restrictive meal once per week. Her initial My Symptom Questionnaire Score (MySQ) was 69, indicating severe symptoms, and she documented mood swings, anxiety, anger, and depression. 

Adrenal fatigue was suspected as a root cause of her symptoms and salivary cortisol testing revealed phase three adrenal fatigue with low levels of both cortisol and DHEA. The initial plan for reversal included:

1. Fifteen minutes of meditation twice per day
2. Continue the gluten- and dairy-free diet, consume nine servings of vegetables per day, and consider a full elimination diet
3. Proper sleep hygiene
4. Supplements, including a multivitamin-mineral, probiotic, vitamin C 750 milligrams, B complex, magnesium 400 milligrams, adrenal formula, DHEA 5 milligrams
5. Decrease exercise to only four days per week and reduce the intensity of training

After four months, Dene said, though she didn’t notice change within the first month, in the second month she was sleeping better and was less moody. She said her clothes were looser and she felt she had lost weight and inflammation decreased.

After five months, her MySQ decreased from 69 to 36 and her emotional health score improved from 16 to three. Dene said she had improvement in energy, sleep, digestive symptoms, sinus congestion, weight and fluid retention, as well as excessive sweating. “You have no idea how much happier I am and how much this means to me,” she said. “To continuously diet and work out and get nowhere is so depressing and for my body to finally do what it’s supposed to do, I just feel like a brand-new person.” 

Dene has continued the whole-foods, plant-based diet. She does not like taking supplements, so she has discontinued the probiotic and added fermented foods daily. She will discontinue the adrenal formula, DHEA, and magnesium, but plans to continue the multivitamin-mineral, B complex, and vitamin C supplements. Dene has restored her adrenal reserve with nutrition-related strategies, healthy stress management techniques, and by allowing her body the opportunity to rest and recover.

Adrenal fatigue is a very real experience for many clients and requires a comprehensive lifestyle plan for reversal. Nutritional supplements are often required in addition to nutrition-related changes, but nutritional intervention should be tailored to the client and to the phase of adrenal fatigue to prevent symptom exacerbation. 

References

Benetiz-Lopez, Y., Redolar-Ripoll, D., Ruvalcaba-Delgadillo, Y., and Jauregui-Huerta, F. (2019) Inhibitory control failures and blunted cortisol response to psychological stress in amphetamine consumers after 6 months of abstinence.  Journal of Research in Medical Sciences. Mar; 24(20) 10.4103/jrms.JRMS_1148_17

Boyle, N., Lawton, C., and Dye, L.  (2017) The Effects of Magnesium Supplementation on Subjective Anxiety and Stress – A Systematic Review.  Nutrients.  Apr; 9(5), 429; https://doi.org/10.3390/nu9050429

Carr, A., & Maggini, S., (2017) Vitamin C and Immune Function.  Nutrients.  Nov; 9(11), 12ll; https://doi.org/10.3390/nu9111211

Fitzgerald, K. (2012). Health Regimen for a 29-Year-Old Female Diagnosed With Adrenal Fatigue.  Integrative Medicine. Dec/Jan: 10(6) 

Procyk, A. (2018) Nutritional Treatments to Improve Mental Health Disorders:  Non-Pharmaceutical Interventions for Depression, Anxiety, Bipolar, & ADHD.  Eau Claire, WI: PESI Publishing & Media.