For many years, I have worked with female clients who have been dedicated athletes, worked hard to quickly move up the career ladder, then dive right into parenthood. Usually, after the first or second child, something happens. At first, it is daily fatigue and issues losing weight. Then the hormones never quite balance and appear to bounce around, leading to anxiety and depression. Exercise at a level like before becomes a struggle, and the cycle is perpetuated with chronic stress that leads to even more health issues.
There is an epidemic growing that has left many women tired during the day, wired at night, struggling with weight loss and left without answers. It is an epidemic involving the thyroid gland, adrenal glands, cortisol levels and the sex hormones (estrogen, progesterone, and testosterone). Like fibromyalgia, IBS and chronic fatigue, adrenal fatigue/thyroid dysfunction are still not understood well by many doctors and treatment is often misguided or completely dismissed because the standard lab numbers look normal.
The term “adrenal fatigue” is a misnomer but has become the common term to describe poor adrenal function. Our adrenals glands are designed to last a lifetime, and it doesn’t seem possible for them to be completely out of juice by the mid-thirties. You could argue that chronic stress leads to their early departure, but there appears to be something else afoot.
In the brain, a chemical called CRH (cortico-releasing hormone) is responsible for driving the adrenals to release cortisol and adrenaline. What happens is that when your brain and body have finally become overloaded by the fight or flight response, your brain turns off the switch for CRH to give your adrenals glands a break to repair. Subsequently, this leads to low cortisol and low adrenaline, leaving you feeling like a sloth reaching for coffee every day just to get out of bed.
Spin Class as a Metaphor for Adrenal Fatigue
Spin class is a great example of what is happening in your body. A party atmosphere full of high-intensity, high-speed and high cortisol pushing yourself to complete exhaustion. Ironically, people who are already spun out are attracted to spin class. Unfortunately, the adrenal party ends with a long hangover.
There is a mentality in our society to push ourselves past limitations for both the mind and body. It starts early in life that the busier you are and harder you push yourself, the more successful you must be. The message with physical training is that more is better and to push past the pain. There is always a way to be stronger, look better and reach new heights. The body is resilient, and for a while, it will keep up with the demand. However, if you don’t find time to properly rest, your body will make you rest for much longer.
In the U.S., 75% of all Americans have moderate to severe stress and almost half suffer adverse stress-related health effects. In all stress-related statistics, women are at the top of every study. The internalization of stress is higher in women and therefore certain habits go up (more time watching TV, being on Facebook, more sugar, flour-based foods, caffeine, and alcohol) causing more physical symptoms to arise as a result of stress. Stress will deplete selenium and magnesium, two major minerals needed for proper thyroid function.
The top four sources of stress include money, work, family and health concerns in that order. Health concerns are last. As you can see, the problem here is that people neglect their health because of financial concerns, with 1 and 5 thinking of skipping seeing a practitioner due to the cost. I tell my Nutrition Genome clients that the cost of diet and lifestyle prevention will always save you thousands of dollars compared to the cost of treatment.
The Symptoms of Adrenal Shutdown and Thyroid Hormone Deficiency
If you are female and over 35, there is a culmination of events that can drop like a ton of bricks. Not to say this doesn’t happen to men too, but it is much more common in women. The exhaustion of over a decade at a stressful career (and further back from high school and college), relationships, hard physical training to stay in top shape, and one or more pregnancies in the mid to late 30’s typically tip the scales. The issues can remain well into the 50’s and up if not addressed.
Do you recognize these symptoms of adrenal and thyroid dysfunction?
- Tired and wired at night
- Low tolerance for stress
- Can’t make it through the day without coffee
- Trouble losing fat, especially in the mid-section
- Brain fog/inability to concentrate
- Thyroid blood work appears normal but have symptoms of hypothyroidism
- Thinning hair
- Low blood pressure
- Cold extremities
- Memory issues
- Hard to get out of bed
- Trouble producing milk
What is the HPA Axis?
The HPA axis stands for the “hypothalamic pituitary adrenal axis,” regulating the stress response and adrenal function. It is responsible for fight or flight; useful for survival and is overactivated in our modern way of life from numerous activation signals every day.
The axis is connected to the brain, nervous system, immune system, digestive system and circulatory system. So you can see how damaging the chronic stress response is to all of these systems via the HPA axis. What happens is that blood sugar and insulin stay elevated, you get easily irritated and overwhelmed, and the immune system stays activated leading to dysfunction.
Meanwhile, all other requirements in your body get put on hold and eventually also get depleted. A systemic shutdown. The reason pregnancy can be so hard on some women is because there are not enough reserves to give, causing higher deficiency post-pregnancy and potentially harder struggle to shed excess weight gain.
Environmental Toxicity and Thyroid Function
The environment is everything outside of yourself. We can no longer avoid the fact that what is in our water, air, and food is disrupting our body’s hormones dramatically. It is a topic many of us like to pretend isn’t as dire as it appears, but the facts emphasize reality. One of these realities is the environmental toxicity that causes suppression of the thyroid gland by hormone disruptors.
- Iodine deficiency increases the toxicity of halogens (fluoride, bromide, chloride), which becomes a double whammy for breast cancer risk and brain health because iodine is concentrated in both. One-third of the world’s population lives in areas of iodine deficiency.
- What else depletes iodine? SSRI anti-depressants such as Lexapro, Prozac, Zoloft, and Paxil. The rate of antidepressant use in this country among teens and adults (people ages 12 and older) increased by almost 400% between 1988–1994 and 2005–2008. Approximately 23% of women in their 40s and 50s take antidepressants, a higher percentage than any other group.
- Fluoride added to our drinking water, fluoride-based pesticides and medications disrupt thyroid function by blocking iodine and interfering with magnesium. Choose reverse osmosis water.
- Bromides sprayed on non-organic fruit like strawberries and fire retardants in our couches, beds, computers, phones and cars disrupt thyroid function by blocking iodine.
- BPA and BPS (in BPA free containers) in plastic interfere with thyroid function. Choose glass.
- Chlorine in swimming pools and our drinking water disrupts thyroid function by blocking iodine. Use salt water pools if available and a shower filter .
- Phthalates in personal care products.
- Organochlorines (pesticides and PCB’s) and glyphosate (GMO corn and soy) disrupt thyroid function. Sucralose (Splenda) is an organochlorine and had an adverse effect on thyroid function in male rats. Sucralose destroys gut flora like lactobacillus, which disturbs selenocysteine levels present in the catalytic center of enzymes that protect the thyroid from free radical damage. Free radical damage to the thyroid would lead to cell death and an autoimmune response.
- Gene polymorphisms that affect thyroid function and toxicity susceptibility.
My Blood Work Shows Normal Thyroid Function!?
Let’s say you exhibit all the symptoms of hypothyroidism but you are told by your doctor that everything is normal. Is it? The TSH set point is not the same for everyone and the range is controversially wide. Iodine, reverse T3, T3 (active) and T4 (inactive) need to be reviewed and are often omitted.
The liver is the major site of conversion of T4 to T3, making the thyroid and the liver a target for hypothyroidism. Elevated cortisol and toxins affect this conversion, which is also why caffeine in coffee makes things worse in the long run. Other factors that affect the conversion include iron deficiency, insulin resistance, elevated blood sugar and extreme diets.
- TSH > 2.5: Possible hypothyroidism
- Free T3 < 3.2: Possible hypothyroidism
- Free T4 <1.2: Possible hypothyroidism
- Reverse T3 <10 ng/dl: If elevated, the body is storing active thyroid hormone to conserve energy
- Iodine: 100-199 mcg/L and 150-249mcg/L for pregnancy. Deficiency affects thyroid, breast and brain health.
- TPO and AntiTg Antibody > 4 IU/mL: Possible Hashimoto’s disease. New moms are at a greater risk for Hashimoto’s and some women flip from hyperthyroidism to hypothyroidism after pregnancy, puzzling doctors.
The True Cortisol Test
The main telltale of cortisol dysregulation is the dreaded belly fat and weight gain, sugar cravings, premature wrinkles, elevated blood sugar, chronic fatigue, poor sex drive and increases in allergies, hives, eczema and autoimmune disorders arising from long-term activation of the immune system from stress.
- Have you tested your cortisol curve? The best one is a Diurnel Cortisol Test . Typically cortisol is only tested in the morning, and that really doesn’t give the whole picture. If it is low in the morning, you will struggle to get out of bed. But what you want to see is the cortisol curve throughout the day, especially when you wake up, at 3:00 pm and before bed. A poor curve will show low levels in the morning, low in the afternoon and elevated at night.
- Basal Reading for the thyroid: Buy a basal thermometer. Under the armpit for 8 minutes on the 1st, 2nd and 3rd day of your period. It should be 97.8 or above.
Adrenal Fatigue and SIBO?
While looking at a client’s Dutch test which gives a hormonal panel and cortisol curve, I started to think about the hormonal connection to SIBO (small intestinal bacterial overgrowth). It is considered very difficult to treat and is not responsive to diet. The protocol is usually multiple rounds of antibiotics, and the SIBO just comes back.
DHEA is produced in the adrenal glands and is one of the main circulating hormones in the body. It is a precursor to estrogen and testosterone and is considered to have anti-aging properties. DHEA also plays a role in improving the resistance to viral, bacterial and parasitic infections. My hypothesis is that stress is suppressing hormones that act as a barrier to infections and that DHEA may be another marker to look at with SIBO. More research is starting to consider how hormones affect the microbiome with the concept of “microgenderome,” exploring how the female digestive system is affected differently by dysregulated hormone function.
The Detoxification Plan to Reboot the Adrenals, Liver, and Thyroid
The following will help adrenal support, liver detoxification, and the “rest and reboot” of the thyroid gland.
1. Diet: Cut out coffee, alcohol, wheat, dairy, vegetable oils (canola, sunflower, safflower, corn, soy), non-organic plants and sugar for one month. Focus on the the PaleoEdge food list and add 1 Tbsp. of freshly ground flaxseed using a coffee grinder daily.
Beneficial Organic Foods for the Thyroid: Sea vegetables, radishes (contains a sulfur compound that regulates thyroxine and calcitonin), carrots, cucumber, lemon, cranberries, coconut oil, organic chicken, pastured eggs and wild salmon.
Beneficial Organic Foods for the Liver: Dandelion greens, beets, artichokes, garlic, onions, celery, parsley, cinnamon, turmeric, and cardamom.
*While I don’t think brassica vegetables (broccoli, Brussels sprouts, kale, etc.) are harmful to the thyroid in moderate amounts, avoid juicing kale and non-organic fruits and vegetables that could give you a potent amount of pesticides.
2. Sleep: You need 7-8 hours of deep sleep a night to detoxify chemical toxins that accumulate during the day, adrenal support, and to restore brain function, especially from information overload which is the highest ever in history. We have never needed more sleep than we do in the present day.
Turn off your phone and shut down the laptop before 9:00 pm. Fall asleep between 10:00pm and 11:00pm. Detox from Facebook and the news during this month to reduce the stress signals to your brain and your adrenals.
3. Exercise: Low-intensity exercise actually lowers cortisol level and calms the HPA axis, while high-intensity exercise causes high cortisol. When your body is in the adrenal fatigue mode, it can’t produce enough cortisol and therefore is even harder on your body. Trade CrossFit and Spin class for moderate hiking and restorative yoga.
Supplementation for Adrenal and Thyroid Restoration
*If you are at an extreme imbalance, you may need to start very slow and working your way up with supplements. Some people even react to little amounts of vitamin C due to a high toxic load.
The thyroid gland requires iodine, selenium, B2, magnesium, vitamin C, zinc, vitamin A and vitamin D. This is one of the few multivitamins that also provides magnesium. Magnesium is crucial for estrogen metabolism and detoxification by ensuring daily elimination.
You may require more iodine and this should be done under a practitioner’s care.
Cortisol blocks the production of T3, which is why the ashwagandha helps the conversion of T4 (inactive) to T3 (active) by lowering cortisol and the stress response.
If you are finding yourself needing more of a stimulant but is also an adaptogen, I would recommend Eleuthero Root by Herb Pharm.
3. Detox the liver with Liver Support by Herb Pharm.
The Liver Health product contains dandelion, milk thistle, Oregon grape root, artichoke leaf, schisandra, and fennel.
Milk thistle and dandelion have been well known for centuries to assist detoxification and protect against toxicity. Schisandra increases liver cells’ glutathione and superoxide dismutase and significantly improves fatty liver disease, protects against heavy metal intoxication and improves mental health and physical energy.
4. Assist the thyroid, liver and adrenal glands with C-Salts Vitamin C