In Adrenals, Thyroid, Tired

Brain fog is a part of Adrenal Fatigue

She was beyond exhausted. 

She wakes up almost every day after what feels like a good night’s sleep feeling ok, but by mid-day, she’s running on fumes.  She gets brain fog and feels like she needs a nap by 3 or 4 in the afternoon. After experiencing a long day of work, she then has to give the kids dinner and get them to bed.  She’s easily frustrated by their behavior – and when yelling at them doesn’t work, she gives up trying.  When the kids are finally asleep, she collapses on the couch, turns on the TV or pulls out her phone to check in Facebook, and feels like she could fall asleep anytime.

Around 10:30, she finally decides to go to bed – but then she sees the kids have left their toys all over the living room.  “Gotta clean that up!” she thinks, “it’ll just take a minute.”  An hour later, she’s still tidying up – and her energy has returned!  She’s wired!  No use wasting this second wind, right?  So she quickly logs on to her email, answers a few that she couldn’t get to during the day, and logs off.  It’s now midnight – she still has energy but realizes she has to wake up at 6:30 am, so she goes to bed.  Takes a little while to fall asleep, and after 6 hours of sleep, the cycle starts again.

Sound familiar?  I hear variations on this story a few times a day from patients, friends and even my wife.  This has become commonplace in our society.  We place a premium on productivity, financial gain, checking off that “to-do list” – and if we aren’t reaching these goals, we’re failing.  We sacrifice health, rest, and recovery, and even in many cases happiness, in order to be what we consider a “success”. It’s an impossible standard to which we hold ourselves – and it’s unsustainable.

Why can’t we keep doing this and expect to be healthy and happy?  The answer lies, as it so often does, in our hormones.  More specifically – our Stress Response, regulated for the most part by our Adrenal Glands.

stress adrenals adrenal fatigue metabolism

The adrenals are small endocrine (think “hormone-producing”) glands located on top of our kidneys.  The adrenal glands are responsible for producing and distributing several vital hormones, including some sex steroids (testosterone and DHEA), aldosterone (which regulates salt and water and ultimately our blood pressure), and the hormones we often associate with “fight or flight” – epinephrine (or adrenaline) and cortisol.  For the purposes of this article, I’m going to concentrate on cortisol – the most troublesome “Stress Hormone”.

What happens when we’re under stress?  It all goes back to our distant ancestors, early humans, and the fight for survival.  When confronted with a stressor – for example, an animal attacking us – the body needs to find a way to stay alive.  To put it simply, we have to either be able to run away or fight.  Adrenaline “pumps us up”, increasing our heart rate and blood pressure, helping to get oxygen to our muscles and brain, so we can move – fast.  Cortisol helps the body release stores of sugar and increase fatty acids.  Oxygen and sugar are two things vital for muscles to work, fatty acids are also important for the brain to function.  Once the threat is neutralized (we either kill the predator or run away to safety), this stress response calms down and we go back to our baseline metabolism.  The adrenal glands can recover, so they are ready to respond again when the next threat arises.

This is a good system!  And it’s served humans really well, until recent history.  The problem now is that our stressors have changed.  No longer can we simply run away or eliminate the threat.  One cannot simply stop being a parent, for a ridiculous example.  For another, most of us can’t quit our jobs and expect the bills to be paid.  These stressors are constant – and constant stress is NOT what our adrenal glands were designed to handle.

So what happens?  When the stress starts, our adrenals do exactly what they’re supposed to do.  Adrenaline and cortisol are released, and we handle the stress.  But there’s no recovery.  So the adrenals continue pumping out these hormones.  What started out as a beneficial effect turns dangerous.  Too much continuous adrenaline and our blood pressure stays elevated, leading to chronic hypertension.  Too much cortisol and our blood sugar continues to rise, leading to diabetes.

You may be asking, so if the stress response is meant to make me capable of fighting or running away, increasing energy to do so, why do I feel tired?  Great question!

There are books written on this topic, so we can’t go into all the details here.  Here’s a quick oversimplification.  Adrenaline and Cortisol are not made “out of thin air”.  It takes protein (for adrenaline), certain vitamins (B vitamins in particular), and cholesterol (for cortisol) – to name just a few.  During the stress response, remember the goal is immediate survival.  So the adrenals don’t care where they get these things to make the stress hormones – better to rob a less vital system in order to keep us alive.  These same building blocks are used in almost every system of the body – protein and cholesterol are part of every cell, B-vitamins are required for pretty much everything to work.  Cholesterol, which we all are taught to think of as “bad”, is where all of our sex steroid hormones come from (testosterone, estrogen, progesterone).  So the body diverts production of these hormones in order to supply more cortisol – essentially knocking out our production of sex hormones.  This is one-way chronic stress leads to fatigue.

Chronic cortisol production also leads to a suppressed thyroid.  The relationship here is remarkably more complex than that.  But, suffice it to say that chronic stress adversely affects the thyroid.

After a prolonged period of stress, eventually, the adrenals run out of ways to make more hormones.  When that happens, something known as “Adrenal Fatigue” sets in.  Now, the body can’t make the stress hormones, we’ve already depleted our testosterone, our thyroid is already suffering, and we feel all the symptoms we associate with being “stressed out” – extreme fatigue, unable to handle any new stress, irritability, brain fog, inability to concentrate, poor sleep (cortisol is needed for a restful sleep), and depression.


The good news is there are ways to combat this problem.  In an ideal world, we would eliminate the stress.  But as I’ve already pointed out, this just isn’t possible in most cases.  So, the first step is to take intentional steps to manage our stress.

The most important aspect of managing stress is balancing your schedule as much as possible – so that there are regular “decompression” periods.  Meditating for 10-15 minutes a day can have tremendous benefits.  Take a short walk when you are able (without the smartphone, if possible).  Find a hobby and spend a few minutes a day doing it (for me, it’s the piano).  Read a book for a few minutes before bed.  Anything you can do which requires minimal thought, and allows you to “unplug” from the world, will help.

Exercise is important too.  But it doesn’t have to be extensive or intense.   Just get moving!


We need to give our bodies what they need to function optimally.  Make sure there is enough protein, healthy fats, and fiber in your diet.  A good nutritionist, preferably one with an understanding of the relationship between food and stress, can help with this.  It’s also important to pay attention to what we shouldn’t be putting in our bodies – excessive sugar, large amounts of caffeine, junk food tastes great and we may even feel more energized afterward.  But these are wreaking havoc on our adrenal glands.

Even though we are better off getting our vitamins and minerals from food sources, sometimes it can be challenging to get all the nutrition we need from food alone.  Supplements can be helpful, particularly if you are on medications that can deplete nutrients, or are under significant stress.  In general, almost everyone can benefit from a good daily B-Complex supplement, for example.  Simple blood tests can reveal other deficiencies as well.


The adrenal glands can be encouraged to heal by the judicious use of herbal supplements.  Such herbs, known as “adaptogens”, help regulate adrenal healing, and will begin to balance the production of stress hormones.


When the adrenal glands go off kilter, so go the rest of our hormones.  As mentioned before, production of sex hormones like testosterone, estrogen, and progesterone are sacrificed in order to make more cortisol.  A deficiency of cortisol causes the body to find other ways to ramp up metabolism, so the thyroid becomes taxed and starts to malfunction.  (Thyroid dysfunction can also contribute to adrenal disorders – so a vicious cycle may be created.)  No hormonal system operates in a vacuum.  So, while working to fix the adrenal glands, you may require supplemental thyroid medication, or extra testosterone, in order to function optimally.  This will depend on the severity of your symptoms, as well as tests for hormone levels.  When adrenal fatigue is particularly severe, it may even be necessary to replace cortisol directly to support normal endocrine function.  This isn’t usually necessary, but it can be done using low doses and for a limited period of time so that dependence doesn’t become an issue.


In order to return ourselves to optimal health, it is important to first recognize the symptoms that there may be a problem.  We are available to help you determine if your exhaustion is due to Adrenal Fatigue.  And if so, we can help you treat it.  Get started today by calling your Functional Medicine provider, or contact Optimal Balance MD at (877) 496-0800.  You don’t need to suffer anymore!

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