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Adrenal Fatigue and Hashimoto’s: Can they make each other worse?

by | Apr 25, 2023 | Symptoms

Classic Hashimoto’s symptoms include fatigue, weight gain, and brain fog. You may have heard about “adrenal fatigue” as a possible cause of these symptoms. While adrenal fatigue or health issues from chronic stress are real, recent science says that it’s not exactly the adrenals that are the problem. In this article, I’ll explain what adrenal fatigue or adrenal insufficiency truly is, along with its connections to Hashimoto’s. Lastly, we’ll discuss safe and effective ways to support your adrenal health for women with Hashimoto’s.

What is Adrenal Fatigue, and Is It Real?

Adrenal fatigue is a term coined by Dr. James Wilson, ND, DC, PhD in 1998. He created and recommended a questionnaire with a list of symptoms to diagnose and treat “adrenal fatigue.” Dr. Wilson believed that chronic exposure to stressors exhausts the adrenals. 

The adrenals are triangle-shaped glands that sit on top of your kidneys. They produce stress hormones, including adrenaline, noradrenaline, and cortisol. Adrenaline and noradrenaline are fight or flight hormones, as you may experience during stressful situations. Cortisol is an essential steroid hormone that regulates your body clock, stress responses, blood sugar, inflammation, and many more. Cortisol gets a bad rap, but think of it as your motivation hormone. Cortisol helps get you out of bed in the morning and gets you motivated to start your day.

At first or at Stage 1, you’ll have elevated cortisol. But eventually, once the adrenals tire out, they’ll become unable to produce enough hormones to catch up with the stress during stages 2-3. The fatigued adrenals cause the symptoms in the questionnaire. Stage 4 adrenal fatigue is absolute burnout. 

Examples of adrenal fatigue symptoms:

  • Fatigue
  • Body aches
  • Nervousness
  • Mood swings
  • Digestive issues
  • Salt and sugar cravings
  • Needing caffeine to keep going
  • Reduced sex drive

Key insight #1: Dr. Wilson’s adrenal fatigue refers to obscure and bothersome symptoms arising from chronic stress responses.

The concept took off in the alternative health world. For many, it was the first time someone could explain why they have mysterious and stubborn symptoms. In many cases, doctors consider such symptoms normal or part of aging, and provide no solutions. For practitioners, it’s easy to explain to patients and prescribe supplements to treat. It’s also easy for supplement companies to market adrenal supplements.

Why Does Conventional Medicine Not Believe in Adrenal Fatigue?

The medical community does not recognize Dr. Wilson’s adrenal fatigue theory as a valid diagnosis for the following reasons:

  1. Confusion with Addison’s disease In conventional medicine, the term “adrenal fatigue” or “adrenal insufficiency” refers to Addison’s disease. It is an autoimmune disease that attacks the adrenal glands. This indeed causes the adrenals to produce insufficient cortisol. It’s a very severe illness. When Addison’s goes untreated, it can eventually cause death. 

Whereas, Dr. Wilson’s adrenal fatigue only refers to obscure symptoms due to chronic stress. It’s not Addison’s. These alone are nowhere nearly as serious as Addison’s and won’t kill you. 

   2. The adrenal fatigue diagnosis can lead patients to miss the true diagnosis and the         right treatments, sometimes for years. Doctors rightfully consider this dangerous. For        example, so many symptoms of adrenal fatigue overlap with hypothyroidism that it’s          possible to miss a Hashimoto’s diagnosis and believe the adrenals are the problem. It is,    therefore, a good idea to get a full workup and rule out more serious conditions before        concluding that adrenal fatigue is the problem. Then, see a naturopathic or functional        medicine doctor to run functional lab tests and properly diagnose your stress-related        symptoms.

Key insight #2: Adrenal fatigue in alternative medicine is not Addison’s disease, an autoimmune disease that attacks the adrenals. It’s important to see your doctor to rule out any serious conditions if you have some adrenal fatigue symptoms.

   3. There is no scientific basis behind the idea that chronic stress tires out the adrenals   and your cortisol levels will crash.

  4. Adrenal fatigue does not show up as abnormal on cortisol blood tests, and the               symptoms associated with it are not specific to adrenal dysfunction.

Key insight #3: There is no scientific basis behind Dr. Wilson’s adrenal fatigue theory. Also, most people with adrenal fatigue have normal blood cortisol levels.

So, if you’ve ever brought up adrenal fatigue to your conventional doctor, chances are you’ll get brushed off. 

Is Adrenal Fatigue Real?

Are your exhaustion, brain fog, hormonal symptoms, and mood issues real? Absolutely!

Does chronic stress contribute to them? Absolutely!

Can chronic stress set off Hashimoto’s or make Hashimoto’s worse? This is often the case.

So, in short, adrenal fatigue is real, but it’s not the adrenals that become fatigued; it’s your stress response that goes haywire. The closest thing to Dr. Wilson’s adrenal fatigue is called hypothalamus-pituitary-adrenal (HPA) axis dysfunction. It’s the dysfunction of your stress response system due to chronic stress. Even conventional medicine recognizes HPA axis dysfunction because there is science behind it.

Key insight #4: The correct name for adrenal fatigue is “HPA axis dysfunction.” It’s a dysfunction of your stress response that starts in the brain. It explains many symptoms of adrenal fatigue. Unfortunately, most people nowadays have some HPA axis dysfunction.

Your stress response system consists of three glands

  • The hypothalamus
  • The pituitary
  • The adrenals

Your stress response (HPA axis) starts in your brain, not your adrenals. In the medical literature, HPA axis dysfunction is mostly described as a contributor to depression [1]. However, you can have HPA axis dysfunction without having depression. In fact, almost everyone has some degree of HPA axis dysfunction nowadays.

The Link between HPA Axis Dysfunction (Adrenal Fatigue) and Hashimoto’s

Your stress response system works closely with your thyroid, sex hormones, and immune system [2]. So, too much stress for too long can:

  1. Reduce thyroid hormone levels by reducing your thyroid stimulating hormone (TSH)
  2. Reduce the thyroid hormones that get converted into active forms (T4 to T3)
  3. Impair immune function, making you more likely to catch sniffles
  4. Increase chronic inflammation, making autoimmune issues like Hashimoto’s worse
  5. Destroy brain cells, contributing to mood issues, brain fog, and forgetfulness
  6. Accelerate age-related bone and muscle loss
  7. Cause weight gain, especially in the midsection
  8. Throw off your sex hormones, making issues like hot flashes, premenstrual syndrome, and fertility problems worse

Compound with most symptoms of Hashimoto’s like fatigue, brain fog, joint pain, and even skin problems and digestive issues

Key Insight #5: HPA axis dysfunction and Hashimoto’s are a double whammy. They can make each other much worse. So, you want to support your HPA axis and manage stress if you have Hashimoto’s.

How to Know if It’s HPA Axis or Hashimoto’s

Many of HPA axis dysfunctions and Hashimoto’s have the same symptoms. The best way to know if you have either or both is to:

  1. Have your doctor evaluate your history, symptoms, and presentation. This may include a physical exam such as a palpation in your neck.
  2. Get tested with the full thyroid panel (blood) and a stress response panel such as DUTCH (urine) or salivary cortisol. You’ll need your naturopathic or functional medicine doctor to interpret these for you. 

How to Safely Support Your Adrenals with HPA Axis Dysfunction

Nearly everyone with Hashimoto’s also has HPA axis dysfunction. So, it’s a good idea to support your stress response. 

If you have Hashimoto’s, it’s essential to approach adrenal support with caution since some herbs and supplements can overstimulate your immune system. These can cause flares or make autoimmune symptoms worse.

Key insight #6: Addressing the basics such as sleep, food, exercise, and stress management should be your #1 focus when healing HPA axis dysfunction. Then, consider adding nutritional and herbal supplements as appropriate.

First, let’s start with the basics on supporting your adrenal health:

  1. Practice stress management techniques: For instance, restorative yoga, meditation, visualization, or deep breathing.
  2. Optimize your sleep: Lack of sleep can exacerbate symptoms of both HPA axis dysfunction and Hashimoto’s. Prioritize getting enough high-quality sleep and create a healthy sleep environment to support your adrenal health.
  3. Eat a nutrient-dense anti-inflammatory diet: Consuming a diet rich in fruits, vegetables, healthy fats, organ meats, and lean protein can give your body the nutrients it needs to support optimal adrenal function.
  4. Consider nutritional supplements to provide nutrients that support your stress response. Nutrients like magnesium, vitamin C, and zinc can help support a healthy stress response. However, it’s best to work with a qualified healthcare practitioner before taking any supplements. They can help you identify the best supplements for your needs and ensure that they are safe and effective for you.
  5. Heal from your traumas. Traumas are one of the leading causes of a chronic stress response, even though your life currently appears to have no stress. 

Safe Adrenal Support Herbs if You Have Hashimoto’s

These herbs are generally considered safe for those with Hashimoto’s, but check with your practitioner if it’s a good idea to use these [3].

  • Ashwagandha: Ashwagandha is an adaptogenic herb that can help counteract the chronic health effects of stress and support healthy cortisol levels. Research has shown that ashwagandha can improve mood in healthy people going through chronic stress [4]. 
  • Licorice root: Licorice root can help support healthy cortisol levels by inhibiting the enzyme that breaks down cortisol in the liver. However, it’s important to use licorice root under the guidance of a healthcare practitioner since it can increase blood pressure in some people. Many Hashimoto’s patients also have high blood pressure, which can worsen with licorice.
  • Rhodiola: Rhodiola is another adaptogenic herb that can help support healthy stress responses. Rhodiola can improve energy and cognitive function, which can be helpful for those with HPA axis dysfunction. 

Holy basil: Holy basil is an adaptogenic herb that can help support healthy stress response and cortisol levels. It can also support mood and mental health.

Key insight #7: Adaptogenic herbs can support your HPA axis, but some can stimulate your immune system and make Hashimoto’s worse. Ask your practitioner if ashwagandha, licorice, rhodiola, or holy basil is safe and right for you.

In conclusion: Adrenal fatigue is a misnomer. It actually is HPA axis dysfunction, which happens due to chronic stress. HPA axis dysfunction can set off Hashimoto’s or make Hashimoto’s worse. Addressing HPA axis dysfunction with Hashimoto’s requires well-rounded approaches including: 

  • Practicing stress management techniques
  • Exercising the right way and without overdoing it
  • Healing traumas
  • Getting enough high-quality sleep every night 
  • Consuming a nutrient-dense diet
  • Considering nutritional and adaptogenic supplements

However, it’s important to work with a qualified healthcare practitioner to get the correct diagnosis, identify the best approach for you, and to ensure that any supplements are safe and effective.

How to Exercise with HPA Axis Dysfunction and Hashimoto’s

Exercising right is indispensable for stress management and recovering from adrenal fatigue or HPA axis dysfunction. Aside from helping you let off steam and improving your energy, it improves your body’s ability to cope with stress [5]. However, the worst thing you can do is go for another long cardio workout. Long cardio sessions or overdoing exercise can increase cortisol and can worsen HPA axis dysfunction [6]. 

Exercise, especially resistance training, also counteracts many negative effects of stress on your health. It protects your bones, muscles, and brain, and helps you sleep better, for example [7].

With Hashimoto’s, less is more, so you get results without burning out. This is why in Thyroid Strong, I teach my methodology to get stronger safely. In my experience, women with Hashimoto’s and adrenal fatigue feel better taking long rest breaks, training at lower reps, and doing short workouts, around 20 minutes 3 times a week. This gives you just enough stimuli to improve HPA axis function and get stronger without exhaustion or burnout.

Aside from the exercise programs, you’ll also get over 20 hours of content from functional medicine experts covering everything you need to know to put Hashimoto’s and HPA axis dysfunction into remission. 

Join the Thyroid Strong waitlist today for early details and exclusive bonuses and discounts for the next round of Thyroid Strong.


Article's References

1 Varghese, F. P. and Brown, E. S. (2001) The Hypothalamic-Pituitary-Adrenal Axis in Major Depressive Disorder: A Brief Primer for Primary Care Physicians. Prim. Care Companion J. Clin. Psychiatry 3, 151–155.

2 Johnson, E. O., Calogero, A. E., Konstandi, M., Kamilaris, T. C., La Vignera, S. and Chrousos, G. P. (2012) Effects of short- and long-duration hypothyroidism on hypothalamic-pituitary-adrenal axis function in rats: in vitro and in situ studies. Endocrine 42, 684–693.

3 Panossian, A. G., Efferth, T., Shikov, A. N., Pozharitskaya, O. N., Kuchta, K., Mukherjee, P. K., Banerjee, S., Heinrich, M., Wu, W., Guo, D.-A., et al. (2021) Evolution of the adaptogenic concept from traditional use to medical systems: Pharmacology of stress- and aging-related diseases. Med. Res. Rev. 41, 630–703.

4 Chandrasekhar, K., Kapoor, J. and Anishetty, S. (2012) A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J. Psychol. Med. 34, 255–262.

5 Caplin, A., Chen, F. S., Beauchamp, M. R. and Puterman, E. (2021) The effects of exercise intensity on the cortisol response to a subsequent acute psychosocial stressor. Psychoneuroendocrinology 131, 105336.

6 Torres, R., Koutakis, P. and Forsse, J. (2021) The Effects of Different Exercise Intensities and Modalities on Cortisol Production in Healthy Individuals: A Review. J. Emerg. Nurs. 4.

7 Di Liegro, C. M., Schiera, G., Proia, P. and Di Liegro, I. (2019) Physical Activity and Brain Health. Genes 10.

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