This is the third and last installment of our three-part series on adrenal fatigue. Part one discussed our stress response and how it can go awry. It highlighted the four stages of adrenal fatigue and showed how chronic stress can cause chronic disease. Part two launched into the recovery solutions by sharing an eating plan that supports and restores adrenal health. It also covered several different supplements that can improve our stress response and adrenal function. Be sure to read parts one and two to get a broader picture of adrenal fatigue and recovery!
In part three of our blog, we’re adding on the next element of adrenal recovery: self-care. Specifically, we’re discussing ways to lower and avoid chronic stress as well as the importance of maximizing our sleep routine.
Manage Your Stress
Adrenal fatigue is caused by chronic stress so it naturally follows that addressing your stress is a critical element of adrenal recovery. Keep in mind though that stress should not (and cannot) be eliminated. Rather, it needs to be transformed into a positive and effective response. To that end, we need to reframe our thoughts on how we perceive stress, lower our stress before it gets out of control, and adopt life strategies that save you from unnecessary stress. Let’s take a deep breath and cover these topics.
Schedule time for relaxation: This could be anything from journaling, reading, listening to music, meditating, getting outside, talking to a supportive friend, or taking up a relaxing hobby. Schedule these into your day and let others know that you are not available during those times.
Prioritize your responsibilities: First, write out your to-do list in advance, making sure they are all truly necessary. Be realistic with how long your tasks will take so you don’t overfill your day. For larger tasks that take more time, plan out the individual steps and schedule out which steps you’ll do on which days. Oftentimes, seeing a long list of to-do’s in one day can be stressful even if none of them are very big. If this is you, try tackling the quick tasks first in order to make that list shorter. Then you can focus on the larger tasks without the looming fear that the small stuff will go unfinished.
Focus on your daily needs: We all feel less than our best when we are too busy to address our basic needs. Working through lunch, skipping that shower for the third day in a row, or going to bed way too late, all contribute to rising stress. Make a point to fulfill your daily needs even if you have to schedule it in.
Balance your day: It’s easy to get hyper focused in one area of your life to the exclusion of attending to other areas. When our attention is balanced between several areas we find support and fulfillment from multiple sources. This makes it less likely to get overwhelmed when any one area becomes threatened. Examples of areas to focus on are family, friendships, career, personal time, exercising, and hobbies.
Keep things in perspective: Have you ever looked back on an old journal entry or childhood diary and chuckled to yourself about the problems you thought were a big deal? Think back to those problems for a moment. Did any of them turn out as horrible as you had imagined? Humans have a knack for being fatalistic. We tend to underestimate our abilities in the face of overestimated problems. Most problems are only huge because we tell ourselves that they are. In reality, the majority are not worth the extra worry and fear we assign to them. When faced with a problem, take a step back and evaluate it from its broader context. Will it matter in a week? In a year? What is the best way to solve it? Of course, problems are still important. But important things don’t get solved through stress and unimportant things are none of our concern.
Know your limits: Don’t take on more than you know you can handle. And don’t suffer through stressful situations that you have the ability to change. Practice saying no when asked to take on another responsibility or when invited to do something “fun” when you know it will zap your energy. Identify the situations that give you the most stress and approach it from a different angle. For example, limit contact with high-strung or demanding people, order groceries online to save time, or take a longer but less-traveled route to avoid morning traffic.
Accept the things you can’t change: Some things in life are out of our control, such as the behavior and choices of others. This can be a source of stress but recognize that stress won’t solve other people’s problems. Rather, accept the circumstances as they are and choose healthier ways to respond to them. For example, view these situations as an opportunity for personal growth, or channel your anxieties into helping others. Let go of any anger or resentment you might be harboring towards others, as well as any guilt or regret you are burdening yourself with. Talking this out with a trusted friend or therapist can help loosen your grip on uncontrollable circumstances.
Develop Healthy Sleep Habits
As discussed in part one, cortisol is produced at varying levels throughout the day, following your circadian rhythm. This daily cycle is referred to as the cortisol curve. A normal cortisol curve begins rising in the morning, around 6am, peaking about an hour after you wake up (usually by 9am or so). This high level of cortisol provides the alertness you need to start the day. Levels gradually lower from there, tapering off throughout the afternoon. It is not uncommon to have several small pulses of cortisol during this time, depending on need and activity level. Cortisol is significantly lowered around 6pm and is at its lowest point around midnight, allowing you to sleep.
In this way, cortisol regulates our sleep cycles and helps with energy production. When a person has adrenal fatigue or is under constant high stress, their cortisol levels deviate from this natural curve. Depending on which stage of adrenal fatigue a person is in, cortisol can be significantly high (or low) at the wrong times of day. One can imagine how this negatively affects sleep, energy, and focus. Not only does adrenal dysfunction cause poor sleep patterns, but the reverse is also true: poor sleep quality and quantity is directly related to adrenal dysfunction.
The Ideal Sleep Schedule
It’s important to maintain a predictable sleep schedule in order to train your body back into a normal cortisol curve. The healthiest schedule is to go to bed around 10pm and rise around 6-7am. This provides 8-9 hours of sleep per night. Make this a habit and you’ll notice that your body will begin feeling tired, naturally, around 10pm and arise without much persuasion in the morning. Stay alert to how you’re feeling in the morning because grogginess can be a sign that you have low morning cortisol.
Sleeping at the right times, however, is only part of the solution. You also need to have good quality sleep.
Prior To Bedtime
- Avoid stimulating or exciting activities close to bedtime; anything that hypes you up or spins your thoughts. Examples would be a workout, a book, a TV show, an important conversation, checking your finances, etc.
- Use the nighttime setting of your phone or tablet starting 2-3 hours before sleep. All screens should be avoided an hour before bed.
- Begin bedtime prep 30 minutes before your desired bedtime
- Avoid late-hour sleep (going to bed after 11pm)
- Avoid late afternoon or evening naps. Other napping should be less than 45 minutes long unless you are ill or very sleep deprived
- Avoid large meals or spicy foods before bed
- Finish all eating and snacks 3 hours before bedtime
- Avoid drinking more than 8 ounces of fluid before bed
- Try a hot bath or shower before sleep as a higher body temperature helps induce sleepiness and eases tension. Epsom salt in the bath can help
Falling or Staying Asleep
- Don’t stay in bed more than 20-30 minutes trying to fall asleep. It’s better to go into a different (comfortable) room and do a relaxing activity like reading a light, neutral book
- If reading in an attempt to fall asleep, don’t turn on a large light or table lamp. Opt for a small reading light that only illuminates the book. If available, set the light to a warm tungsten rather than bright white
- If it’s difficult to fall asleep, eat a small amount of carbohydrate before bed, such as whole grain bread
- If you wake up in the night with stirring thoughts, keep a notebook next to your bed and write them down to release them from your mind.
- For those prone to nighttime awakenings, eat a small amount of protein and fat before bed, such as cheese or nuts.
Control Your Sleeping Environment
- 15 minutes before bed, switch to small lamps or dimmable lights in your bedroom rather than using the main large light
- Wear blue light blocking glasses 30 minutes before bed
- If you are light sensitive in the early morning, sleep with an eye mask or use room-darkening window coverings
- Use white noise, and air filter, or earplugs to decrease irritating noises
- Avoid being too hot or too cold while sleeping. Adjust blankets or temperature as needed
- Sleep at least 8 feet away from electromagnetic fields produced by clock radios, cell phones, laptops, etc.
- If using an electric blanket, turn it on while prepping for bed then turn it off once you get into bed
Bedding and Pillows
- If allergies are a concern, replace pillows, pillow cases, and mattress covers with hypoallergenic material
- Consider a contour pillow to support your neck and keep you aligned as you sleep. Placing a pillow between your knees will also keep you aligned
Supplements for Sleep
Supplements may be considered to help you sleep. The following list are good options and do not hinder adrenal recovery. Start with one supplement at a time to find the one that works.
- Melatonin (1-5mg) can help you fall asleep, while timed release melatonin (5-20mg) can help you stay asleep
- 5-HTP (100-200mg) an hour before bed
- Taurine (500-2000mg) an hour before bed
- Magnesium glycinate (200-400mg) 30 minutes before bed
As you have seen through our three part series on adrenal fatigue, supporting our adrenal glands and lowering chronic stress is primarily accomplished through diet and lifestyle changes. Our eating pattern and daily routine should always support ongoing health and vitality. It is often necessary to make minor adjustments during times of recovery, focusing on certain nutrients or supplements while avoiding others, for example. Once balance is restored, always return to your health-supportive routine. In this way, you will avoid most (if not all) chronic health conditions and be well equipped to address health issues quickly and effectively.
As with a healthy diet, stress management and quality sleep are key elements in the recovery of adrenal fatigue. These changes need to become habits that you carry throughout life. Not only do they support the recovery of adrenal dysfunction but they also help prevent it. Making these a part of your daily routine will stave off future adrenal crashes and downstream health concerns.
It is imperative for long-term health to maintain healthy support of our adrenal glands. Our adrenals are where our stress response originates from and where cortisol is produced. Adrenal glands are what allow us to focus under pressure, boost our performance, keep us awake, endure hardship, and process and respond quickly to danger. These are healthy responses and our adrenal glands are up for the task, however, they only work as well as we allow them to. In other words, we get to choose how healthy our stress response is by how well we nourish and support our adrenal glands. As with anything else in our body (and our life in general), if we don’t care for it things will start malfunctioning and affect other areas of our life. When our adrenal glands don’t have the resources to meet our constant, high-stress demands (figuratively and literally), adrenal insufficiency, also called adrenal fatigue, creeps in.
What is adrenal fatigue and how does it develop? When does stress become unhealthy? How does chronic stress affect other areas of our body and health? These questions, and more, are addressed in part one of this blog. Part one provides a great foundation of knowledge to help you identify negative stress and the red flags of adrenal fatigue. You can read part one here!
This is part two of our blog on adrenal fatigue. After covering the causes and stages of adrenal fatigue, as well as the downstream effects of chronic stress, we’re going to move forward and discuss what to do about it. In this blog, we’ll cover what nutritional supports can reverse adrenal fatigue. Specifically, we’ll discuss an eating plan for adrenal recovery as well as specific supplements to restore adrenal health and cortisol levels. But wait, there’s a part three to this blog series! Part three is where we’ll cover healthy habits for managing stress and improving sleep. Check it out here!
Don’t Make Your Adrenal Fatigue Worse
Oftentimes the simplest way to learn how to make things right is to first see what went wrong. As discussed in part one, we know that adrenal fatigue is caused by ongoing stress. But there are other factors that perpetuate adrenal fatigue after it has already taken hold. Developing adrenal fatigue is hard enough on our body, but here’s some elements that make the process decidedly worse and more difficult to overcome:
- Eating an unhealthy diet
- Poor glucose control
- Ongoing exposure to environmental and household toxins
- Overconsumption of sugar, caffeine, or alcohol
- Sleep deprivation or staying up late
- Repeated use of antibiotics
- Having co-occurring chronic disease(s)
- Fighting off recurring infections (whether bacterial or viral)
All of these things are stressors in and of themselves and are capable of launching the stages of adrenal fatigue. However, if we cut out all other chronic stress from our lives but still retain one or more of the above items, we will have a harder recovery.
Start With Your Diet
The key to correcting underlying causes of most chronic conditions, whether or not we have digestive symptoms, is to first make sure we’re feeding ourselves properly. The nutrients in our food each play very specific roles in the biochemistry of our body. Any lack in these nutrients and our biochemical processes slow down, affecting everything from our detox pathways, thyroid health, inflammation, fertility, mental health, and (you guessed it) adrenal health.
For those in any stage of adrenal fatigue it is critical to first support your adrenal glands through a healthy diet. Eating in this way provides all the nutrients you need for your body to heal from any stress-induced damage while rebooting the health and function of your adrenal glands.
Foods To Eat
Eat the following foods to support and restore the health of your adrenal glands:
Vegetables: 30-40% of your diet will come from vegetables, particularly those that grow above ground. Vegetables should be eaten either raw or lightly cooked to retain the most nutrients. The most helpful vegetables for adrenal recovery are sea vegetables (seaweed) and leafy greens (spinach, kale, Swiss chard, etc). Avoid white and red potatoes as they are high-glycemic (discussed later on). Always rotate your vegetables so you consume a good variety. Include vegetables of every color and purchase organic vegetables where possible). Aim for 6-8 servings of vegetables per day.
Proteins: This includes lean meats, poultry, fish, eggs, dairy, and legumes. Collectively, these protein sources should account for 20-35% of your diet. Ensure organic meat and dairy products as well as pasture-raised eggs.
Healthy Fats: These include monounsaturated fats as well as select saturated fats. Foods in these categories are nuts, seeds, nut butters, olives, olive oil, avocados, coconut oil, canned coconut milk, and all of the protein sources listed previously. Healthy fats should compose 20-35% of your diet.
Whole Grains: Whole grains are unprocessed and thus retain their outer layer (bran) and inner core (germ). These are rich in fiber, protein, vitamins, and minerals. Refined grains, on the other hand, are processed to remove the bran and germ. Not only does this remove important nutrients but it also creates a grain that is high-glycemic, meaning that it produces large spikes in blood sugar. About 20-25% of your diet should come from whole grains. Examples of whole grains include oats, quinoa, buckwheat, brown rice, corn, barley, and whole wheat. Avoid gluten grains if you are gluten intolerant.
Whole Fruits: To get the most nutrients and fiber out of your fruit, be sure to eat them with the pulp, seeds, and peel (edible parts only). Some fruits help lower increased cortisol. These are blueberries, strawberries, apricots, papaya, pineapple, and mango. Other fruits should be avoided during adrenal recovery such as those containing potassium or have a high glycemic load (reasons for this are discussed further on). Fruits in these avoided categories are fruit juices, bananas, oranges, grapefruit, all melons, dried figs, raisins, and dates. 5-10% of your diet should be whole fruits.
Fermented Foods: These contain probiotics which are great for gut health, immune health, blood sugar balance, and cholesterol levels. Fermented foods are found in sauerkraut, kimchi, kefir, plain yogurt, tempeh, and miso soup.
Salt: Those with adrenal fatigue often have an increased potassium to sodium ratio. Specifically, their bodies contain too little sodium and too much relative potassium due to low aldosterone levels. This imbalance leads to low body fluid and low blood pressure. To remedy this, it’s important to hydrate throughout the day with the addition of salt in your water. Add one half to one teaspoon of salt into a full glass of water. Repeat throughout the day, starting in the morning. Increase salt on your food too, by sprinkling liberally to taste. Only choose between sea salt or Himalayan salt. Common table salt, including kosher salt, is heavily processed, contains additives, and lacks minerals.
Foods To Avoid
An adrenal recovery diet avoids foods that we commonly associate as being unhealthy. These include added sugars, artificial sweeteners, soda, alcohol, refined carbs, baked goods/desserts, snack foods, excess salt, vegetable or seed oils, and fried or greasy foods. Avoiding these foods will improve adrenal health (and overall health).
Unlike many other healthy diets, however, the diet for adrenal recovery further avoids all caffeine (including chocolate), alcohol, foods high in potassium, and any high-glycemic foods.
What’s so bad about caffeine? Caffeine in coffee, teas, soda, and chocolate, stimulate your already depleted adrenal glands and perpetuate the cycle of energy crashes every few hours. Even without the blood sugar spike from added sugars, caffeine creates a forced energy expenditure that is unsustainable (and quite harmful) for those with adrenal fatigue.
No alcohol?? While our brain might think that alcohol helps calm our nerves and help us relax, it’s really just the alcohol convincing us of that. Alcohol only serves to mask our symptoms, as evidenced by how our stress returns as soon as the alcohol wears off. More than that, alcohol places more stress on our body, physically. It not only taxes our liver but also our adrenal glands, increasing cortisol production. Even after alcohol consumption is stopped, high levels of cortisol remain in the brain; the area of the brain where the stress response begins. Lastly, alcohol causes sleep disturbances, specifically cutting out REM sleep which is the most restorative stage of sleep. Breaking up this sleep pattern disrupts our normal cortisol curve and sleep/wake cycle. Overall, alcohol consumption can worsen and perpetuate adrenal fatigue.
Why avoid potassium? As discussed above, adrenal fatigue can cause an increased potassium to sodium ratio. These minerals are balanced out by increasing sodium while decreasing potassium in the diet. Foods high in potassium are bananas, oranges, grapefruit, dried figs, raisins, and dates.
High-glycemic foods, and the importance of avoiding them, are discussed in the section below.
Lastly, as with any new diet, it is always a good idea to continue avoiding any foods you are sensitive to such as gluten, dairy, or others.
Balance Your Glucose
A diet that supports the adrenal glands must maintain a constant blood sugar level throughout the day. In a healthy state, cortisol (produced by our adrenal glands) works alongside insulin to keep glucose within a tightly controlled range throughout the day. This provides a steady supply of blood sugar to maintain our energy. When our adrenal glands are in distress, cortisol production drops below normal causing our blood sugar to drop below the healthy range. Low blood sugar puts further stress on our adrenals and prevents us from regaining a healthy cortisol rhythm (cortisol curve). It also causes symptoms of hypoglycemia such as dizziness, light-headedness, and weakness. Therefore, it is up to us to regulate our glucose levels through proper meal timing and eating low-glycemic foods. The following guidelines speak to this:
- Aim for three small meals and 1-2 snacks per day, separating all eating by 2-3 hours (do not graze). This helps maintain balanced blood sugar and ensures a steady supply of nutrients through the day. Eating 2-3 hours apart prevents an overloaded digestive system while ensuring that food is moving through (and out of) the body.
- Eat at the same time each day to prevent glucose crashes and inappropriate cortisol spikes. Breakfast should be within an hour of waking and no later than 10am. Lunch should be between 11am and noon, and dinner around 5-6pm. A great time for a snack would be between 2-3pm.
- Eat breakfast and keep dinner small. In the morning, our body needs to replenish its low reserves of nutrients and glycogen after not eating (ie sleeping) for several hours. Come evening time, our digestion slows down so we want to avoid eating heavy foods before bed that take longer to digest.
- Breakfast should be high in protein and fat. Avoid glucose-spiking breakfast foods such as fruit, fruit juice, yogurt, bagels, or refined cereal. Choose eggs, quality meat, nuts/seeds, leafy greens, avocado, and small amounts of whole grains, like oats.
- Avoid high-glycemic fruits and grains. These are ones that contain “fast” sugar, supplying you with a quick surge of glucose (and energy) and then dropping off quickly a couple hours later. If you have compromised adrenal glands, you want to regain a steady rhythm of energy and wakefulness throughout the day. Eating high-glycemic foods interrupts the normal cortisol cycle and can cause an adrenal crash. Focus on low to moderate glycemic foods instead. See here for a list of high and low glycemic foods.
Support With Supplements
In addition to the above eating plan for adrenal fatigue, it may be helpful to further support recovery through specific supplements. The following supplements act to restore adrenal function and alleviate stress:
Adaptogenic Herbs: This collection of herbs has been used for thousands of years in Chinese medicine as balance-restoring substances. Adaptogens are so called because they help a person “adapt” to stress. They contain particular substances that improve our resistance to stress, balance cortisol, improve mental work capacity, and protect us from stress’ negative effects. They also have a balancing effect on several body systems including the immune system, nervous system, and cardiovascular system. There are several herbs that are classified as adaptogens. Some of the more common ones include, ashwagandha, panax ginseng, rhodiola, magnolia, and holy basil. Supplement companies often package adaptogens together into one blended product. This provides support from several angles without purchasing multiple supplements.
Glandulars: Some people benefit from taking small amounts of the actual adrenal tissue of animals, specifically either bovine or porcine (pig). These animal organ products are meant to stimulate the activity of that organ in humans. Not everyone with adrenal fatigue needs stimulation however. Those who have reduced adrenal activity and a low to no cortisol curve (normal diurnal pattern is not present) can be helped by taking glandulars. But those with high cortisol are over-stimulated as it is and upregulating adrenal activity with glandulars would make their situation worse. For this reason glandulars should not be taken for extended periods but rather used for short-term purposes under the guidance of a knowledgeable physician.
Licorice Root: This is one of the best known herbs to help treat adrenal fatigue. It also helps with immune disorders, digestive issues, and mood support. Licorice root helps our adrenals by preventing the breakdown of cortisol to help maintain energy levels. This provides the extra reserve we need to respond better to stress. Smaller does are best so that healthy cortisol levels are maintained and don’t get too high. Because it raises cortisol, licorice root should be reserved for those with low cortisol. Lastly, this supplement should not be taken by people with hypertension.
Phosphatidylserine (PS): This is a type of fatty acid found in our cell membrane. Supplement versions of PS are derived from soy. PS supplements help normalize the stress response by regulating the hormone that stimulates cortisol production. This action helps maintain normal cortisol levels throughout the day.
Vitamin C: This vitamin is not produced by our body and so can only come through our diet. It is most highly concentrated in our adrenal glands where it helps synthesize steroid hormones including cortisol. Our adrenal glands require more vitamin C during states of high stress than they otherwise would. Vitamin C acts to slow down any increased rate of cortisol production, making it helpful for those with high cortisol. It also helps improve psychological stress responses. High doses are often required to achieve these effects.
B Vitamins: Several B vitamins are needed for the production and secretion of stress hormones. Stress itself requires more B vitamins than our body usually needs and so must be replenished. Niacin, pantothenic acid, folate, thiamin, biotin, and B12 all support a healthy stress response. Niacin and B12 further support a healthy circadian rhythm, which is diurnal critical release.
Magnesium: An estimated 75% of the US population do not consume adequate amounts of magnesium. A deficiency in this mineral can lead to a low tolerance for stress, manifesting as anxiety, lethargy, depression, and irritability. Furthermore, stress increases the need for magnesium, further raising the likelihood for deficiency. Supplementing with magnesium can have a positive impact against stress and anxiety.
Supporting our adrenal glands and maintaining a normal cortisol pattern is critical for everyday functioning. As the moderators of our stress response, our adrenal glands carry the responsibility for getting us through the day as awake, focused, calm, and resilient humans. Chronic stress threatens this stability and burdens our adrenals, making it all the more imperative to support them with the nutrients they need. An eating plan designed for adrenal recovery is the first place to start. Adding specific supplements may also be necessary depending on the stage of adrenal fatigue. In addition to diet changes, lowering and avoiding high stress is paramount to adrenal recovery, as is building a healthy sleep pattern. Both of these are discussed in our third (and last) installment of this adrenal fatigue blog. Check out part three here!
Stress is a protective feature of our normal human condition. It is our body’s way of protecting us from things that could harm us. When the body is under stress, it diverts its attention away from all unnecessary functions and refocuses them on life-saving measures. Our adrenal glands are the control center of our stress response, providing essential hormones that prepare us for the fight as well as protect us from damage.
Oftentimes, we think of stress as psychological or emotional (like job stress or relational stress). However, our body defines stress much more broadly. From our body’s perspective, learning a new skill is stress. Calorie restriction is stress. Infections or diseases are stress. Heck, even exercising or throwing a party is stress! These stressors may seem benign but our body responds to them the exact same way as it responds to job stress or relational stress. Regardless of the cause of stress, our body always reacts as if we’re running from a tiger. But it doesn’t know that we’re not. It treats everything as an emergency.
This normally isn’t a problem as long as the stressful event(s) eventually stops and our body can calm down. Too often in our lives, however, multiple stressors compound on top of each other and/or our body and mind never seem to rest at the end of the day. This is when we have a problem and our stress response deviates from normal, causing damage to our bodies and adrenal glands.
This blog is the first of three parts in our series on adrenal fatigue. In part one we’ll discuss the healthy response to stress, types of stress, and the stages and symptoms of adrenal fatigue. We’ll also cover how stress can cause chronic disease. We believe it’s important to be aware of what adrenal fatigue is and how it progresses so you can recognize when you need help and take steps towards healing.
Parts two and three of this blog series discuss the dietary and lifestyle changes that are necessary for healing and reversing adrenal fatigue. Part two discusses an eating plan that supports adrenal recovery. It emphasizes the importance of glycemic balance as well as shares some supplements that may be helpful in various stages of adrenal fatigue. In part three, we wrap up our discussion by addressing ways to manage and prevent stress, as well as tips for how to improve the quality and quantity of our sleep. Managing stress and sleep are essential for reestablishing healthy adrenal function.
The Healthy Response to Stress
The stress response is also called the “fight or flight” response, which is controlled by our sympathetic nervous system. The first stage is when our adrenal glands secrete two hormones called epinephrine and norepinephrine. You might be more familiar with the other name for epinephrine, called adrenaline. These hormones are released immediately after a stress trigger and have an explosive and aggressive impact. Together, these hormones quicken your heart rate, providing more blood flow to your muscles, lungs, and heart. Consequently, blood flow is decreased in the digestive system, slowing our gut motility and other digestive processes. Epinephrine and norepinephrine also sharpen your sight, hearing, and overall alertness, along with increasing endurance and physical strength. These two hormones act as the immediate, short-term response to stress, enough to get us out of harm’s way within a matter of minutes (around 15 minutes to be exact). Examples include jogging stairs, swerving to avoid a car accident, or public speaking.
This short-term response may be all that your body needs to escape danger. If, however, your body continues to perceive stress for longer than 15 minutes (like planning a wedding, giving birth, or anticipating a first date), the second part of the stress response occurs. This is when the adrenal glands release the hormone, cortisol. Cortisol is the prolonged response toward stress and prepares the body to weather the storm while protecting it from excessive damage.
In many ways, cortisol counter-balances some of the aggressive actions of epinephrine and norepinephrine. Cortisol is a powerful anti-inflammatory hormone and decreases the inflammation that was brought about by epinephrine and norepinephrine. Cortisol also suppresses our immune system, which was put on high alert during the first stage of the stress response. It increases blood sugar levels by freeing up stored glucose from the liver, and increases metabolism and appetite so we eat more food for energy. Lastly, cortisol suppresses our reproductive system. Afterall, procreation is not a main focus during prolonged stress.
After the stress event is over, whether short-term or prolonged, our adrenal glands clear away these hormones and homeostasis (balance) returns. We are now in the “rest and digest” mode, which is controlled by our parasympathetic nervous system.
Cortisol At Its Best
It’s important to note that cortisol is released throughout the day, whether or not a person feels stressed. Cortisol serves several functions such as regulating sleep cycles, helping with energy production and immune activity, repairing body cells, and regulating glucose and inflammation. It also plays a role in building muscle and bone as well as maintaining mental focus and stamina.
Healthy cortisol levels follow a diurnal schedule, peaking in the morning so you are alert to start the day. Levels drop down around mid-day and then gradually taper off as the day continues. Cortisol is at its lowest point around midnight, allowing you to sleep. A healthy stress response will disrupt this natural “cortisol curve” to help you get through the stress event.
DHEA During Health And Stress
Cortisol isn’t the only stress hormone that’s also necessary in daily life. DHEA is another hormone released by the adrenal glands each day, as well as during a stress response. When the body is in “rest and digest” mode, DHEA doesn’t really fluctuate throughout the day, unlike cortisol. DHEA is responsible for improving energy levels, lipid levels, bone mineral density, and overall well being. It also helps lower cholesterol, decrease body fat, and block inflammation-causing proteins. The brain also produces DHEA and it’s thought to help with memory and cognition. Lastly, DHEA creates testosterone and estrogen. The production of DHEA does decline with age, and deficiency levels are associated with age-related diseases.
During times of stress, DHEA prevents systemic inflammation from getting out of control. It also protects part of the brain, called the hippocampus, from damage. DHEA begins rising evenly with cortisol in the beginning stages of stress. However, if stress becomes chronic and unhealthy, DHEA levels drop significantly, independent of cortisol. It eventually flatlines at the end stage of adrenal fatigue. The greater the spread, or ratio, between cortisol and DHEA, the greater the damage from stress and the more health issues arise.
Positive Stress Vs. Negative Stress
We’ve talked about two types of stress so far. The first was stress that is short-term, such as public speaking or avoiding a car accident. Stress events that are short-lived allow the body to recover afterwards without any damaging effects. The second type of stress discussed was “positive stress”, also called eustress, such as planning a wedding, exercising, or prepping for a first date. Positive stress is when we face a challenge that we believe is within our ability to handle. This kind of stress evokes feelings of excitement and anticipation. It motivates us to keep focused and improves our performance. These types of stress (short-lived stress and positive stress) are what our stress response, or “fight or flight” response, is designed to handle. Our body follows a set manual of instructions and acts in predictable ways. We are then saved from “danger” and return to rest and balance.
Conversely, there is another type of stress that acts against our body’s instruction manual. It opposes “rest and digest” and resists homeostasis, or balance. This type of stress is “negative stress,” also known as distress. Unlike eustress, distress is a stress event that we believe is outside our ability to handle. It causes feelings of anxiety, decreases our performance, and can lead to mental and physical health problems. Negative stress can be short-lived or long-term. Examples include filing for divorce, losing a loved one, enduring abuse or toxic relationships, being unemployed, having trouble sleeping, or fighting an illness. With negative stress, the stress event either lasts for years, or the body remains on alert long after the stress event is over. Either way, our body doesn’t return to baseline afterwards; it is in perpetual “fight or flight” mode. This is when things start going haywire and begin progressing towards adrenal fatigue.
Stages and Symptoms of Adrenal Fatigue
Adrenal fatigue is a slow fade, often progressing over decades. People usually enter this progression without ever noticing because it takes so little effort. The path towards adrenal fatigue involves four stages: Alarm, Resistance, Adrenal Exhaustion, and Adrenal Fatigue. Starting on this path is normal (and healthy), but progressing on this path causes increasing damage to our adrenals as well as our entire body.
The good news is that there are several off-ramps along the way and the vast majority of people find support and healing and take the nearest exit. The progression towards adrenal fatigue can be stopped and is reversible.
Each person responds to stress differently, depending on the actual stress event and how much stress is endured. People have varying levels of stress tolerance as well as varying abilities to cope with each stress event.
Most people cycle in and out of some of these stages throughout their life. Because, let’s face it, we aren’t immune to pain, fear, or worry. And life can dish out severe circumstances that are tough to cope with. Raising awareness of adrenal fatigue is key to identifying it in your own life and sparking the change you may need to turn it around.
Stage 1: Alarm
Stage 1 describes our normal stress response. As discussed earlier, when our stress response is triggered, our adrenal glands produce more cortisol to counterbalance the “threat.” We learned that cortisol works tirelessly to bolster some of our body processes (like increasing glucose for energy), while keeping the negative effects at bay (like lowering inflammation and calming our immune system). In essence, cortisol protects our body while also supplying it with what it needs to combat stress. The adrenals also pump out more DHEA, roughly equal to the amount of cortisol. The adrenals at this stage are able to produce enough of these hormones to carry you through the stress event, and hormone levels are still within the normal range and able to return to rest.
This stage does not cause any physical or psychological dysfunction. Fatigue, caffeine, and sugar cravings may occur but they would be mild. Those in stage 1 are classified as being “stressed and tired.”
Stage 2: Resistance
If the stress response continues, cortisol levels get ever higher; much higher than what is healthy. Usually there is a reversal response (called a negative feedback loop) that is designed to shut down cortisol production once it hits a certain height so that the body can return to rest. However, the body interprets the very high cortisol levels as a sign of even more danger to come. This tells cortisol to dampen this reversal response. Without the negative feedback loop to protect us, cortisol levels continue to rise to excessive and dangerous levels. As cortisol climbs higher, DHEA levels now begin to drop. This stage of constant high cortisol and low DHEA may last years. Many medical practitioners often treat each symptom of stage 2 as separate entities rather than recognizing (or testing for) poor adrenal function.
This high disparity between cortisol and DHEA levels causes a host of health issues during stage 2. As you might imagine, some of the protective actions of cortisol can get out of hand when they don’t turn off. For example, cortisol increases blood sugar but chronically high blood sugar can result in reduced insulin sensitivity. Furthermore, cortisol suppresses the immune system, but if this never turns off then it raises the risk of severe infection and subsequent inflammation. Cortisol also raises metabolism so we eat more food for energy, however, as cortisol rises, it’s common to crave sweet and fatty foods resulting in weight gain. Other symptoms in this stage include imbalances in sex hormones, hypothyroid issues, irritability, anxiety, insomnia, and ever increasing fatigue. Stage 2 is also known as the “wired but tired” stage, where people get jittery and develop an unhealthy relationship with coffee and other stimulants.
Stage 3: Adrenal Exhaustion
However, our adrenal glands can’t maintain high cortisol production forever. They were not designed to meet these constant high demands and before long they become overworked. The adrenal glands are unable to keep up with demand and they begin slowing their production of cortisol down to low-normal levels. DHEA levels are now well below normal. At this stage, both cortisol and DHEA fall below the minimum required levels for normal functioning. In response, our body tightly controls what’s left, conserving it only for the most essential body processes. This stage of near-failure is very serious and is the beginning of a catabolic phase where muscles are broken down for energy and nonessential functions are shut down. People should seek medical attention if they haven’t already, but recovery at this stage will be slower and many may never fully regain their original energy levels or body homeostasis.
Stage 3 is where any prior symptoms from earlier stages begin getting worse and even become chronic. Infections will be more constant, anxiety and depression will be more severe, and getting out of bed becomes a daunting task. Digestion and metabolism slows down causing constipation and risk of digestive disorders. A person may have only small bursts of energy but overall will be mentally, emotionally, and physically exhausted. Caffeine and other stimulants no longer help and quality of life lowers. Other symptoms in this stage include lack of enthusiasm, low libido, inability to handle stress, low exercise tolerance, and brain fog. This stage describes the adrenal crash and can last for several months to years.
Stage 4: Adrenal Fatigue
This stage is also called adrenal insufficiency and marks the point where cortisol levels are flatlined throughout the day and DHEA levels are in the tank. The body furthers its catabolic processes and is breaking down. Regaining homeostasis in the body is essentially impossible.
Even the smallest stressor at this stage can trigger cardiovascular collapse and can even be fatal if left untreated. Luckily, stage 4 is very rare and most people never reach this phase, having found successful treatment in earlier stages. Recovery from stage 4 is possible but takes the right kind of support and lots of time.
Symptoms of stage 4, adrenal fatigue include little to no interest in surroundings, severe weight loss and muscle weakness, diarrhea and vomiting, low blood pressure, low blood sugar, dizziness, depression, and intense pain in the legs and abdomen.
Chronic Stress Can Cause Chronic Disease
There is a large body of evidence linking chronic stress and psychological trauma to chronic diseases such as CVD, gastrointestinal diseases, fibromyalgia, diabetes, chronic fatigue syndrome, and musculoskeletal disorders like rheumatoid arthritis (RA). Some of these are autoimmune disorders, like fibromyalgia, RA, and some gastrointestinal diseases like Crohn’s and ulcerative colitis.
How do chronic diseases occur under high amounts of stress? Stress itself does not directly cause disease. Rather, it’s the subsequent effects of high stress that are the drivers behind chronic disease. These drivers are the immune system, digestive system, and systemic inflammation.
Immune System Diseases
Immune system dysfunction is unique in that it can cause disease from being too alert and from being too suppressed. Depending on where a person is in the stress response stages, their immune system may be either overactive or under-active. With an overactive immune response, the immune system can mistakenly launch an attack on our body’s own tissues. This is the underlying progression of autoimmune disease. If the immune system is under-active, it opens us up to higher risk of infection and longer recovery periods. A common bacterial infection is H. pylori which can cause digestive issues.
Digestive System Diseases
Ongoing high stress also impacts our digestive system, which slows down so that other body systems can have more energy. A slowed digestive system slows down gut motility and can cause constipation, bloating, and gas. If gut motility does not improve, a person can develop gastrointestinal disorders like inflammatory bowel disease (autoimmune disease), irritable bowel syndrome, SIBO, or GERD. The sugar and carb cravings associated with high cortisol levels would further exacerbate these conditions, as well as cause an imbalance of bad gut bacteria. When there is too much bad gut bacteria and not enough good bacteria, a whole host of issues can occur ranging from mental health issues, impaired glucose metabolism, and a dysregulated immune system.
Inflammatory Diseases (which are all diseases)
Inflammation is a normal process that easily gets out of hand when there are no controls over it. Cortisol is one way that inflammation is kept in check. Once the adrenal glands become exhausted and cortisol levels drop, inflammation can now spread freely throughout the body. Systemic inflammation is the one common thread that links all chronic diseases together. Left untreated, it can precede and perpetuate all disease development. If a person already has a chronic disease (like those described above), uncontrolled inflammation will worsen their condition.
A healthy stress response keeps us alive. Not only does it allow us to run from the proverbial tiger, but it also gives us energy and focus to tackle the tough stuff of life. We can thank our stress response and adrenal glands for acing a test, nailing a speech, running a race, or planning an event. This is the positive stress we were designed to handle. Of course, most of us are worried by negative stress events. Life puts us in the fast lane and we feel like we have to keep up. When negative stress never seems to end, our adrenal glands start a slow decline and begin to malfunction. We feel the results of this and begin to malfunction too. The four stages of adrenal fatigue (or adrenal insufficiency) carry us further down the road towards progressively worse symptoms and a higher risk of chronic disease.
Stress doesn’t have to progress this far! It can be stopped and reversed at any stage with the right support, lifestyle changes, and diet. This is what we discuss in parts two and three of our adrenal fatigue series. Check them out!
The impact that our digestive system and gut bacteria have on the health of our entire body goes largely unnoticed until a disease or other dysfunction develops. And even then, the link between the gut and the disease often goes unrecognized. After all, who would think to look at the gut when someone has multiple sclerosis? The truth is, however, that our gut has powerful influence over how well our body operates and is the number one underlying cause behind all chronic disease, including autoimmune disease. It’s important to note that ongoing gut dysfunction can occur even in the absence of gut symptoms. This is why it’s wise to look at the health of our gut and microbiome whenever there is an autoimmune risk or diagnosis. Let’s dive deeper into this connection.
How Our Gut Affects Our Whole Body
Let’s take a quick look at some of the ways in which our gut communicates with and controls various functions within our body:
Gut and Immune System:
It is said that our gut contains between 70% and 80% of our entire immune system! And when you think about it, it’s not all that surprising. After all, every time we eat food we’re introducing a foreign substance into our body and our immune cells must identify it as “safe.” Once the food item is deemed to be safe, the immune system continues its patrol, no longer paying mind to our meal. The harm occurs when our immune system becomes hyper-focused and marks something as a threat when in reality it’s actually safe.
These immune cells interact with the bacteria in our gut and are sensitive to any changes in our microbial environment. Our gut can be prompted to “switch on” our immune system for short periods of time, such as when we’re fighting off an infection, or for long periods of time, which is unhealthy and leads to chronic inflammation and disease, including autoimmune disease. This chronic immune activation (always being switched on) lowers the ability of immune cells to distinguish between threats and non-threats. A hyper-focused immune system has many causes, with poor gut health being chief among them.
Gut and Inflammation:
The lining of our intestine is designed to transfer nutrients from the food we eat to our bloodstream, where they’re carried into our body tissues. This lining is composed of a single layer of intestinal cells that are lined up tightly side-by-side (called “tight junctions”). These tight junctions are so tight that they can only allow small particles (micronutrients) into the bloodstream.
However, if that tight cell lining gets loose (or “leaky”), larger particles escape our intestine and pass into our bloodstream. These larger particles include harmful bacteria, bacterial toxins, large proteins, and undigested food bits. Once these hit our bloodstream, our white blood cells (immune cells) recognize that they don’t belong there and launch an attack.
Anytime our immune system launches an attack (whether or not it’s justified), inflammation is always present. Acute inflammation is a healthy response and only lasts long enough for our body to fight off an illness. When the immune trigger (like a cold virus) is fought off, it leaves the body and our immune system calms down. However, when our immune system is constantly exposed to its trigger (such as food toxins, harmful bacteria, or our own body cells), then our inflammation becomes chronic, or ongoing, and can spread throughout the body. When the cause of the attack (such as a leaky gut) is ongoing (such as the unhealthy food we eat), then we get chronic inflammation. Chronic inflammation increases the possibility of autoimmune disease in those who are at risk. It can also tip the scales from having subclinical autoimmune issues to reaching clinical thresholds for diagnosis.
Gut and Mood/Cognition:
Furthermore, our gut bacteria impacts which neurotransmitters are made in our digestive tract (95% of our serotonin is made by our gut bacteria!). Neurotransmitters include GABA, serotonin, dopamine, norepinephrine, melatonin, and others. These chemical messengers collectively impact our mood, alertness, stress response, memory, learning, motor control, and digestive function. Similar to immune cells, the production of neurotransmitters are also sensitive to any alterations in gut bacteria.
Gut and Brain:
Our gut is often referred to as our “second brain.” As we learned in school, our central nervous system (CNS) comprises our brain and spinal cord where millions of electrical signals are sent back and forth between our body and brain every second. Similarly, we also have an enteric nervous system (ENS) located within our digestive system that controls our gastrointestinal secretions, motility (peristalsis), local blood flow, and overall digestion. It also modulates our immune system and endocrine (hormone) responses. Lastly, the ENS interacts with our gut microbiome and the nutrients from our food. The ENS of our gut communicates with the CNS of our brain through a long nerve called the vagus nerve. This connection is what describes the “gut-brain axis” where any imbalance or dysfunction of our gut health is immediately broadcast to our brain.
Gut and Thyroid:
The thyroid helps control the function of our muscles, heart, digestive system, bone integrity, and brain development. This important gland uses a hormone called TSH, which produces two other hormones, T3 and T4. T4 is an inactive hormone and must be converted into T3, the active form. Our gut bacteria are charged with converting about 20% of all T4 into T3. This conversion can only happen, however, with a certain enzyme that is produced by healthy gut bacteria. Harmful gut bacteria, on the other hand, contain a toxin called LPS that reduces levels of thyroid hormone and decreases TSH (thus lowering production of T3 and T4). Furthermore, the T3 hormone can be reduced by constantly high cortisol levels caused by stress and gut inflammation.
What Is Autoimmune Disease?
Autoimmune disease encompasses several diseases each sharing a common thread in their etiology (how a disease is caused). All autoimmune diseases are caused when the immune system mistakenly attacks the body. This is either because it can’t distinguish between normal body cells and foreign invaders, or because it can no longer control the intensity of immune response (ie it doesn’t know when to stop fighting).
During an autoimmune response, rather than producing antibodies against a harmful outside invader (such as the cold virus), the immune system produces autoantibodies, which are antibodies against “self”, thus marking our own body cells for attack. Where this attack takes place defines which type of autoimmune disease a person has. For example, an immune attack on the thyroid can lead to Hashimoto’s or Graves diseases, whereas an attack on the myelin sheath that protects nerve fibers can lead to multiple sclerosis.
In America, about 23.5 million people have an autoimmune disease of some type. These diseases are more common in women than in men. Examples of autoimmune diseases include type 1 diabetes, rheumatoid arthritis, lupus, Hashimoto’s, multiple sclerosis, celiac, psoriasis, and IBD (inflammatory bowel disease which includes ulcerative colitis and Crohn’s). Some scientists are considering Alzheimer’s disease to be an autoimmune disease as well.
Researchers don’t fully understand why the immune system targets body cells, so there are no surefire cures to autoimmune disease. The cause(s) of autoimmune disease is also not fully known, but we do know of several contributing factors. These factors include genetics, family history, viral and bacterial infections, exposures to toxins, obesity, and eating a Western diet. As the title of this blog suggests, autoimmune diseases are also strongly linked to the health of our gut microbiome.
Gut Dysbiosis and Autoimmune Disease
As mentioned earlier, chronic inflammation is detrimental to our health and an instigator of disease. Such inflammation is brought about by ongoing immune activation. This hyperactive immune response can tip the scales towards autoimmune disease. And since the majority of our immune system lies within our digestive tract, the health of our gut is imperative to the health of our immune system.
Part of keeping a healthy gut involves maintaining healthy bacteria that live in our gut (specifically in our large intestine). In fact, it is our gut bacteria that are responsible for regulating the majority of our immune system. Thus, it is important to keep our gut bacteria healthy and balanced. An imbalance of gut bacteria (dysbiosis) can lead to an overreaction of our immune system and the propensity for mistakenly attacking our own body tissues leading to the development of autoimmune disease.
Having too many harmful or pathogenic bacteria in our gut can overrun the number of healthy bacteria, leading to dysbiosis. These harmful bacteria are pro-inflammatory and contain toxins that jeopardize the integrity of our gut lining. These insults (increased inflammation and a leaky gut) cause an inappropriate immune response.
What Causes Dysbiosis?
Gut dysbiosis is caused by a number of factors. The overuse of antibiotic medication wreaks havoc on our gut bacteria and causes a significant reduction in the diversity of bacterial species. Chronic stress slows the motility, or movement, of our GI tract, thus altering the composition of our gut bacteria species. Diets high in sugar and processed carbs and low in fiber are associated with lower diversity of bacterial species as well as higher levels of harmful bacteria. Toxins found in food such as PCB’s, dioxins, pesticides, and food borne chemicals produced in high-heat cooking, can all cause inflammation in the gut as well as an imbalance of microbiome functions and activity.
Additionally, several of the contributing factors to autoimmune disease, discussed earlier, also threaten the balance and diversity of our gut microbiome. These include viral and bacterial infections, exposures to environmental toxins, and obesity.
Incidentally, all of the above causes of dysbiosis also cause inflammation, further perpetuating an improper immune response and a risk of autoimmunity. Note that these same insults can lead to other diseases that aren’t autoimmune in nature.
Improving Gut Health To Address Autoimmune Disease
We have seen how out gut and our immune system are intertwined, and how the bacteria in our gut play a huge role in how well our immune system functions. We also discussed the impact of chronic inflammation and the role it can play in autoimmune disease. So, what do we do about it?
Is Your Gut The Underlying Cause?
The health of our gut and the balance of our gut bacteria is a common underlying cause of autoimmune disease, oftentimes occurring alongside other underlying causes. If you have an autoimmune condition, it’s best to determine the cause(s) and whether or not it stems from gut health. Our functional medicine team can look at the biodiversity of your microbiome to see how many bacterial species there are in total, as well as which species are beneficial versus harmful. Knowing your bacterial makeup so-to-speak, alerts us to any overgrowth of bad bacteria or yeast, as well as to any undergrowth of good bacteria. Lastly, we assess level of gut inflammation to see whether you may have “leaky gut” or intestinal permeability. If the health of your gut or microbiome is compromised, we work with you to restore balance, healing, and function. In doing so, autoimmune flare-ups or disease progression can be mitigated or even prevented.
Follow An Anti-Inflammatory Diet:
As with any chronic disease, the key to addressing autoimmunity is by first limiting inflammatory foods. Foods that cause inflammation are the usual culprits such as gluten, dairy, processed foods (including processed meats), refined carbs, refined vegetable oils, and sugar. Limiting or avoiding these foods, not as part of a diet but rather part of a long term lifestyle eating pattern, will lower inflammation throughout the body. This occurs as your immune system calms down in the absence of the onslaught of toxins it’s used to dealing with. A calm immune system is now able to attend to actual threats (like the flu) rather than exhaust all resources fighting off the byproducts of the food we eat. An anti-inflammatory eating plan will also encourage healthy growth and diversity of beneficial gut bacteria, while outcompeting harmful bacterial species. Bringing balance to our gut bacteria helps restore appropriate function to our immune system.
Anti-inflammatory foods are the key to calming down an overactive immune response. These foods include fruits, vegetables, legumes, whole grains, healthy fats, clean proteins, and fermented foods. There are many versions of an anti-inflammatory diet, and for those with an active autoimmune disease, the autoimmune paleo diet (AIP) is commonly followed. The aim of this diet is to reduce flare-ups and calm symptoms. To do this, the AIP diet eliminates not only inflammatory foods, but also several categories of anti-inflammatory foods. These include all grains, legumes, dairy, eggs, and nightshade vegetables. Following the AIP diet can be tricky and overwhelming at times. Our team at CustomCare Nutrition can help you navigate it successfully!
Heal The Gut:
As mentioned earlier, the lining of our intestine is supposed to function as a strict gatekeeper against the passage of large, harmful compounds into the bloodstream. When a person has “leaky gut,” this gatekeeping ability starts to crumble, allowing all sorts of toxins and bacteria into circulation throughout the body. Lowering inflammation by eliminating inflammatory foods is much of the battle. The next step is to repair the damage already done and restore healthy functioning. In functional medicine, we do this by leading patients through the 5R protocol. Each “R” stands for one of the five phases of the protocol. In order, they are: Remove, Replace, Repopulate, Repair, and Rebalance. Our recent blog outlines further details about this 5R program, here.
Our gut plays a variety of roles that step beyond the usual role of digestion. It is integral to our immune system, our control of inflammation, our mood, our cognition, our stress, even our hormone balance. Any dysfunction in our gut or imbalance of our microbiota effects each of these areas, often causing chronic disease including autoimmune disease. With the help of functional medicine testing, an anti-inflammatory eating style focused on whole foods, and a protocol focused on gut healing, we can help prevent autoimmune flare-ups and improve inflammatory markers. Contact us today for a free phone consultation!
World Anti-Obesity Day is on November 26th every year. This year it just so happens to fall on our Thanksgiving Day. How fitting is that? Although it would be better fitting with elastic pants! Okay, sorry, bad pun. All joking aside though, obesity has become a global problem over the last few decades. And when we say global, we mean every part of the world except sub-Saharan Africa.
According to the WHO (World Health Organization), obesity worldwide has nearly tripled since 1975 and increased about five times in children and adolescents. In 2016, this equated to nearly 40% of adults being overweight, and 13% classified as obese. And in 2019, 38 million children under the age of 5 were either overweight or obese. This is the same as the metro area population of Tokyo! Yet, it gets even worse: when we group adolescents older than the age of 5, we see 340 million adolescents who are either overweight or obese. And this, my fellow Americans, is more than the entire population of the United States!!! Clearly, we have a global and complex public health crisis.
How Did This Happen?
Why has obesity been on the rise throughout the world? There are several factors that contribute to obesity, both internal and external. And you might even be surprised at a few of them.
The human body is designed to protect itself in all sorts of ways, including from starvation. This means that when there’s an opportunity, we have hardwired ways of holding onto excess body fat. Our body doesn’t know that we live in the land of plenty and errs on the side of caution that it might be several days before our next meal. How does our body increase fat storage? By telling us to eat.
There are two important hormones that come into play: leptin and ghrelin. Leptin is released by our fat cells and sends signals to the brain about on much fat is being stored. The higher our leptin levels, the more fat we are storing, and the more overweight we become. Leptin also tells us that we are full so that we (ideally) stop eating.
Once fat reserves fall and leptin levels are low, the brain starts believing that it’s starving and releases the hormone, ghrelin. This is often called the hunger hormone as it signals the feeling of hunger so that we begin eating again. In this way, our body can maintain a healthy weight.
A problem occurs when a person is overweight or obese. When a person stores fat in excess, their leptin levels remain constantly high. This should be telling our brain that we have maxed out our fat storage and to limit our calories, but that’s not the way it works. When leptin levels get too high for too long, our body develops leptin resistance. Leptin resistance is now considered one of the main contributors to obesity, biologically speaking. This is when our brain doesn’t get the message. It becomes resistant to all the leptin signals and thus resistant to feeling full. In essence, our brain doesn’t see that we’ve become fat. It signals us to eat more and reduce energy expenditure.
People with leptin resistance have a hard time keeping weight off as they are fighting against their leptin signals, essentially playing tug-of-war. The key to reversing leptin resistance is to overcome our biology with committed and long-term lifestyle and dietary changes.
It is said that our genes account for between 40% and 70% of our likelihood of developing obesity. Through decades of genetic research, scientists have identified which genes contribute to the risk of obesity (and there are hundreds of them). Taken individually, these genes each don’t contribute much, but when a person has all these genes turned on then the collective contribution significantly increases risk. This doesn’t give us the excuse to blame our body weight on our genes, however. Our genetics are only part of the picture.
The way we interact with our environment impacts our genes far more than previously thought. All external inputs are able to switch genes on and off. A healthy diet, plenty of exercise, low stress, low toxin burden, and positive relationships can all switch off genes that increase disease risk while switching on genes that protect against disease. Amazing, huh? We are not a product of our parent’s genes as much as we are a product of our own creation.
Some mental health disorders can have symptoms that lead to weight gain. Examples include decreased sleep (and excessive sleep), lethargy, and increased appetite. The reverse is also true, where weight gain can lead to mental health issues. Those who struggle with high blood sugar and insulin resistance (and thus likely to be overweight) have decreased growth of brain cells, incorrect wiring of brain cells, and increased stress hormones. These all lead to mental health disorders like depression and anxiety and cause a “chicken or egg” effect of perpetual cycling.
Furthermore, some medications meant to treat mental health disorders have actually been associated with moderate to severe weight gain.
On the genetic level, those with genes coded for high BMI are at a greater risk for having depression.
Of all environmental inputs, the food we eat has the most impact on whether a person becomes overweight or obese. This has become increasingly more true as processed foods are now being seen across the globe as they undermine traditional diets. Processed foods are stripped of nutrients and then altered with additives and preservatives to create a product that resembles food. They are cheap to make, designed to be addictive, widely available, affordable, and heavily promoted. It is far too easy to overeat when the food you’re eating is processed. They are manufactured to have desirable tastes and textures, leading to increased appetite and high reward value. Since they are cheap to make and cheap to buy, processed foods are able to enter all communities, all incomes, and all nationalities. Oftentimes, these foods are the only options available for those living in rural or remote areas with no nearby grocery store. This explains the explosion of diabetes and obesity in Indian reservations and other remote or rural areas.
Environmental inputs other than diet also influence our propensity towards weight gain. Even before birth, the nutrition and health of a fetus are affected by their mother’s diet. A person can therefore be more susceptible to weight gain and obesity throughout their life if their mother had an unhealthy diet while pregnant.
It goes without saying that weight gain can result after a pregnancy. On average, women gain two pounds after the birth of each child, which then adds up with multiple children. On the other side of the spectrum, women in menopause are also more likely to gain weight (and to have it redistributed into an “apple shape,” associated with diabetes risk).
Throughout life, people fall into a comfortable routine. Statistically, this routine embraces a sedentary lifestyle, poor sleep habits, and high levels of stress. Each of these habits can cause weight gain and obesity over the years.
Several chronic diseases are either brought on by obesity or weight gain (among other factors) or can cause obesity. Examples include diabetes, cardiovascular diseases, PCOS, thyroid imbalances, kidney problems, and more. Lowering your risk of chronic disease will further protect you from obesity.
Lastly, some medications can increase appetite and lead to weight gain. These include select antidepressants, mood stabilizers, diabetes drugs, steroids, beta-blockers, and allergy relief meds.
Poor quality sleep or not enough sleep both greatly contribute to weight gain and obesity as well as depression and cardiovascular disease risk. Sleep problems disrupt various hormones such as cortisol (stress hormone), ghrelin (hunger hormone), and leptin (satiety hormone). Imbalances of these hormones can lead to overeating and craving sugary, salty, or fatty foods. Developing healthy sleep habits and techniques to deal with stress can help increase energy, normalize appetite, cut cravings, and feel better overall.
Access to Healthcare:
Obesity is a complex and chronic disease often causing additional chronic diseases while robbing our quality of life. It is imperative to have affordable access to providers who can treat obesity using several tools at their disposal. Obesity requires individualized treatment to address the underlying causes and will always include diet modification and exercise habits. Other treatments would include behavior therapy, self-management tools, specific medications, supplements, and even surgical intervention. This comprehensive treatment approach to obesity is not readily available for many people. Factors such as clinician shortages in smaller communities, inadequate resources in low-income areas, transportation barriers, insufficient healthcare coverage, or inadequately trained clinicians, are all common issues facing those who aren’t under a doctor’s care.
When it comes to something as complex as obesity, medical schools must focus their curriculum on disease awareness, early diagnosis, underlying causes, health education during pregnancy, whole-food nutrition, appropriate exercise, and psychological support. Until such a multidisciplinary approach is offered in med schools, those with obesity must seek out the best level of care they can reach. This is often found in functional or integrative medicine physicians, holistic health coaches, or trained nutritionists.
Perhaps the largest factor behind obesity that most easily goes unnoticed is marketing. Marketing is seen everywhere we look. It’s the bright-colored packaging, smiling cartoons, feel-good health claims, fit and thin actors, catchy songs, flash sales, and even proper lighting. If there is money to be made, there is a marketing team at work behind the scenes.
There is significant evidence that marketing influences food consumption choices, and that those choices are part of a poor-quality diet. Why isn’t marketing associated with a healthy diet? Because there’s no money to be made there. This is why nobody can name a single song about carrots but everybody knows the Oscar-Meyer Weiner song. Songs tap into our emotions and motivate us to change. It is marketing at its best.
Another reason why processed foods seem to have the most marketing is that there are huge industries making sure their products get into our hands. The sugar industry, dairy industry, meat industry, and agricultural industry all invest in vast amounts of marketing research. They are dialed in and know how to speak to our emotions, habits, and motivations. The key is to recognize when you’re being marketed to and have the tools to distinguish between nutritious food and feel-good food. Our earlier blog on reading nutrition labels addresses exactly that. You can read it here.
Obesity has become a global problem and a public health crisis. It has reached the hard-to-reach corners, from young children to those living in rural areas. It is not bounded by social strata or education. Obesity has several underlying causes and is quite a complex disease. Some roots of obesity include biology, genetic factors, mental health, diet, life events, sleep habits, healthcare access, and clever marketing tactics. Many of these factors can be reversed and improved with lifestyle habits and increased awareness. Make it your goal to address the factors that most describe you and consciously choose to turn it around.
November is National Diabetes Month. This rampant chronic disease can be debilitating and even deadly if left uncontrolled or mismanaged. In fact, about half of those with diabetes do not even know they have it! This is a dangerous place to be, and highlights the need to pay attention to risk factors and check glucose and insulin with your doctor. With diabetes affecting nearly 11% of the American population, raising awareness of this disease is critical, specifically during the COVID pandemic. As we have discussed, it is known that those with pre-existing medical conditions are more vulnerable to becoming severely ill from COVID-19, and diabetes is no exception. The CDC states that roughly 4 out of 10 people with COVID also have diabetes. This statistic should wake us up and spur us into action. We must be taking steps to prevent and even reverse type 2 diabetes while also keeping it well-managed. With a virus like COVID-19, we cannot afford to be at increased risk, especially when it is within our power to reduce that risk.
How Diabetes Increases Risk and Severity of COVID
You might be wondering how a virus is even linked to diabetes in the first place. I mean, one affects our immune system and the other affects our blood sugar. They seem like completely separate systems working independently of the other…right? Well, no. These systems are very much interconnected. Let’s find out how.
Through Chronic Inflammation:
Chronic disease of any kind (arthritis, IBS, COPD, heart disease, dementia) all have inflammation at its core. Diabetes is no different. Chronic disease leads to chronic inflammation. Inflammation is not meant to be chronic, however. It’s meant to occur quickly when there is acute injury or sickness, and this activates our immune system to jump into action and fight the threat. When inflammation is chronically activated….our immune system is also chronically activated. This puts stress on our immune system, making it hyper-responsive. This might sound like a good thing, but our bodies cannot exist in a constant hyper-responsive state. There must be an ebb and flow where body systems are activated, the threat is removed, and then body systems calm down. In essence, our immune system cannot keep up with the demand (just like insulin cannot keep up with the demand from high blood sugar). When any body system cannot keep up, it slows down. When our immune system is overworked dealing with chronic inflammation, it is slow to respond to acute threats, such as a bleeding hand or the flu. Our immune system then becomes weakened, which affects how well we can fight off viruses, including COVID.
Through High Blood Sugar:
Our immune system is not only affected by chronic inflammation. It is also affected by high blood sugar. Low and chronic inflammation damages our pancreas. The pancreas is where insulin is made and a damaged pancreas leads to decreased insulin production. With less insulin to escort glucose into our body cells, glucose now hangs out in our blood stream causing high blood sugar. Sugar molecules in our bloodstream can weaken our immune cells, making it harder to control the spread of infection. The exact mechanism of how high blood sugar weakens our immune response is still being researched, but one thing is clear: those with diabetes are more susceptible to infections.
Through Poor Blood Circulation:
Chronic inflammation and high blood sugar are enough reasons to weaken our immune system, right? Well, we have one more: narrow blood vessels. High blood sugar can stiffen blood vessels by reducing how well our vessels can dilate (called vasodilation). Stiffened blood vessels restrict blood flow and lead to poor circulation. This leads to high blood pressure, lack of oxygen in blood cells, and even cell death in our extremities (causing necrosis and amputation). Our circulatory system carries oxygen and nutrients throughout the body. It also carries immune cells. When we have low blood flow from narrow vessels, our immune cells cannot travel quickly or in the right numbers to the site of infection. Essentially, constricted blood vessels cause our immune fighters to not only arrive late but also to show up understaffed.
I Have Diabetes. What Can I Do To Protect Against COVID?
As we have learned, those with diabetes are put at increased risk for getting COVID for a few reasons: having chronic inflammation, elevated glucose levels, and poor blood circulation. These factors all lead to a compromised immune system. There are steps you can take to lower your risk of getting COVID, which includes addressing inflammation and high blood sugar.
Follow CDC Guidelines:
The guidelines laid out by the CDC, which we have covered before in previous blogs, are recommended for all people but are doubly important for those with diabetes and other chronic conditions. A short summary of these well-known CDC guidelines are below:
- Wash hands frequently
- Avoid touching your face
- Wear a mask when in public areas and when meeting with people
- Maintain a 6-foot distance between people when in public places
- Disinfect high-touch surfaces in your home and workplace frequently
- Avoid sharing food, utensils, towels, etc.
- Cover your mouth and nose when sneezing or coughing
- Avoid contact with anyone having respiratory symptoms, including a cough
- Avoid unnecessary travel, public transport, and large gatherings
Manage Your Diabetes:
In addition to following the above guidelines, those with diabetes should also follow specific action steps to manage their condition.
- Pay close attention to glucose levels through regular monitoring throughout the day, both before and after meals as well as upon waking up
- Stay hydrated throughout the day. Drinking plenty of water helps your kidneys flush out excess blood sugar through the urine
- Ensure you have enough insulin to carry you for a few weeks should you need to self-quarantine
- Always be prepared to quickly address sudden blood sugar drops, including while away from home or in the car
- If you live alone, alert a neighbor or nearby friend that you have diabetes and have them able to assist you if you become ill
- Keep a manageable schedule and avoid overworking and late nights
- Prioritize getting good sleep
- If you develop respiratory or flu-like symptoms, alert your doctor immediately. He or she can guide you in what to do and if you should be seen. Coughing up mucus can point to an infection and warrants immediate treatment
Get The Right Nutrition:
Choosing the right foods is the number one way to stabilize blood sugar and is a key component in managing diabetes. Additionally, the right nutrition focuses on anti-inflammatory foods, thus lowering chronic inflammation. Incorporate the following eating habits into your daily routine.
Pay attention to the Glycemic Index (GI) and Glycemic Load (GL) of the carbohydrates you eat.
- Carbs that have a low GI or GL slowly release glucose into your body, resulting in a healthy, steady rise and gentle fall. High GI or GL carbs, on the other hand, release glucose quickly, giving you a quick spike and impairing glucose control.
- Eat foods on the low end of these measurements. Food with a low Glycemic Index is anything under 55, while a low Glycemic Load is any food under 10.
- Glycemic Load is a more accurate measurement to follow. Many foods have a high Glycemic Index but a low Glycemic Load. When there is disparity like this, opt for low Glycemic Load.
- Pay attention to serving sizes! Eating large servings will quickly raise a low food measurement to a high food measurement.
- See this chart for a list of foods and their associated Glycemic Index and Glycemic Loads
Prioritize green leafy vegetables! These are packed with nutrients, many of which are not found in other foods in the right amounts. Further, most people are deficient in several of these nutrients, so it’s impossible to eat too many greens!
Eat healthy fats, primarily from plant foods. Healthy fats are omega 3 fatty acids and monounsaturated fatty acids. These fats are found in fish, nuts, chia seeds, flaxseeds, avocados, olives, quinoa, and eggs. Coconut oil is also very healthy, despite its saturated fat content.
Eat lean protein. This includes fish, lean meats, eggs, and beans
Avoid eating fried foods, such as French fries, fried chicken, fried seafood, mozzarella sticks, etc. Fried foods are made using harmful seed oils that increase inflammation
Avoid high-sugar foods and anything with added sugars. Whole fruit is an exception, in moderation (2 servings per day). Be aware that some fruits have a high Glycemic Load.
Form an Exercise Routine:
Workout facilities such as gyms, sports centers, public pools, or YMCA’s may be closed or have limits on how many people can enter. This needn’t discourage you from exercising though. There are several ways to exercise without going to a gym. Those with diabetes should especially increase their physical activity, as it is an important part of diabetes management. Any physical activity that increases your breathing and heart rate will draw more glucose into your muscles (and out of your bloodstream) while also increasing insulin sensitivity. Here are several ways to get moderate-intensity exercise into your day:
- If you have a treadmill or elliptical machine at home, aim for one hour of brisk walking. This hour can be divided into three 20-minute sessions if needed. Increasing the slope on the treadmill will provide additional benefits. Brisk walking around your neighborhood or along a trail provides these same benefits
- If you have a stationary bike, aim for 30 minutes (or two 15-minute sessions) while slowly increasing the pedal resistance. Lower the resistance during the last 2 minutes as you cool down. Biking along a trail or street provides these same benefits
- Bodyweight exercises are done without any equipment. These include push-ups, crunches, sit-ups, squats, lunges, and planks
- Hand weights and bands elevate the intensity and resistance of bodyweight exercises. Lifting hand weights, using resistance bands for your legs, or securing a handled band in a doorframe are great ways to vary your exercise routine
- Stretching exercises are great for joint mobility and lower-back muscles. Common stretches work just fine, as well as following a yoga or Pilates routine
- If you have stairs in your home and are more accustomed to exercise, challenge yourself to do 5 trips up and down the stairs
The link between diabetes and the COVID-19 virus is undeniable, with about 40% of COVID cases also having diabetes. The very nature of diabetes, its causes and symptoms, cause a downward cascade of events that ends with a weakened immune system and a delayed immune response. This allows any pathogen (viral, bacterial, or fungal) to more easily overcome our defenses causing active infection and symptoms. Fortunately, there are steps we can take to help prevent the COVID virus–by following CDC guidelines, managing diabetes, and eating nutrient-rich whole foods. The link between diabetes and COVID does not mean we give up. Rather, it motivates us to develop new habits, develop healthier lifestyles, and stay one step ahead of this pandemic.