April is Adrenal Awareness Month and with adrenal fatigue becoming increasingly common in today’s fast-paced, overly stressed-out society, Western medicine still does not recognize this issue that so many of us are facing today. 

Our adrenal glands have the job of controlling how we respond to stressors in our lives, whether they be physical or emotional. This is not an enviable task because for so many people stress is a huge part of life. When our adrenal glands can no longer respond to stress appropriately, we experience insufficiency of our adrenal glands, leading to a host of health issues which include fatigue, insomnia, mood issues, weight gain and a compromised immune system. 

In honor of this month and with the need to spread more awareness on this health issue, we spoke all about adrenal health with one of our favorite functional medicine doctors Dr. Will Cole. Here, Will talks to us in depth about adrenal health, why Western medicine seems to still turn a blind eye on this issue and gives us practical advice on how to fix our adrenals through diet, supplementation and lifestyle support from a modern, functional medicine lens perspective. 

What role do our adrenals play in our health?

The main role of your adrenal glands is to control the release of cortisol - your body's stress hormone - when you are faced with a stressful situation. Your adrenal glands regulate the production of other hormones as well.

What is the difference between Addison's disease and other adrenal issues you see in your practice?

Most adrenal problems I see in my practice have to do with cortisol imbalance - either your body is making too much cortisol or your cortisol rhythm is off, making it high when it should be low (in the evening) and low when it should be high (in the morning). Addison's disease occurs when the body doesn't produce enough cortisol ever. This condition is also referred to as adrenal insufficiency.

Why has the Western medical system not recognized adrenal insufficiency in the same way it is recognized in functional medicine?  

It is easy to dismiss the symptoms of adrenal problems as "just a part of getting older". We like to say because something is common it’s normal.  But in reality, it just means that the majority of people are dealing with the same, overlooked health problems. Also, symptoms like fatigue and cravings aren't given the same weight as other problems since they aren't as obviously debilitating... until they are.

What are some of the least and most obvious signs that we are having issues with our adrenals?

Some of the more obvious signs of adrenal problems are closely related to adrenal fatigue, including difficulty in waking up in the morning, afternoon fatigue, insomnia, and moodiness. But since problems with your adrenals can cascade into other areas of your health, symptoms like a low libido, blood sugar problems, cravings, weight loss resistance, weak nails and thinning hair can also be signs that something is off with your adrenals.

What role does the health of our nervous system play here?

When you are in a stressful situation, your sympathetic nervous system is what signals to your adrenal glands to release cortisol. This is your body's "fight-or-flight" response in action.

What are some of the worst things you can do when experiencing adrenal issues?

Constantly putting yourself in stressful situations (or relationships) is one of the worst things you can do. When your body is on high alert, you are never giving yourself a chance to calm down and help balance cortisol levels. While I understand that you can't avoid stress altogether, setting up healthy boundaries where needed, learning to say "no", and arming yourself with stress-reducing techniques such as meditation and breathwork, can help mitigate the stress you do experience on a daily basis.

What are your top 5 supplements that you would recommend to support our adrenals?

When it comes to supplements, I always turn to adaptogens. These are plant and herbal medicines that have a clinically-proven ability to help regulate hormone balance, and specifically cortisol. These are my favorite:

• Ashwagandha: linked to reduced cortisol and anxiety. My supplement, The Brain-Adrenal Balancer, harnesses the power of ashwagandha and other herbs to restore HPA-axis (hypothalamic-pituitary-adrenal axis) function, the communication line between your brain and your adrenal glands.
• Rhodiola: can increase energy and stamina while lowering cortisol 
• Holy Basil: the main ingredient in my supplement holi ( y o u t h ) with Agent Nateur, designed to restore balance to your hormones and to minimize inflammation
• Schisandra: can support HPA-axis function
• Methylated B-Vitamin Complex: B vitamins like the ones in my supplement The Methylator, play a role in healthy neurotransmitters and hormones for balanced mood and HPA-axis function.

What lifestyle advice you would give to those with adrenal issues?

Other than reducing stress in the ways we talked about above, leaning into superfoods that are going to help nourish your adrenals and lower inflammation is key. As a functional medicine practitioner, I believe food is foundational. Herbs and supplements are great, but it all goes back to what you are fueling your body with on a daily basis, whether it’s a slice of stress or a slice of pie.

What role do minerals play when it comes to our adrenals?

Your body is brilliantly connected, relying on specific ratios of macro and micronutrients to function.  Certain nutrients are more closely linked to healthy adrenal function than others. Magnesium, for example, has been shown to help support HPA-axis function.

How should we change our exercise routine if we think we may have adrenal issues?

Movement is an essential part of your overall health - physically and emotionally. However, there are studies which show that moderate- to high-intensity exercise can spike cortisol levels. That's not to say that you can never do a more intense workout ever again. But you may need to adjust your workout routine to incorporate more strength training exercises or the time of day that you work out. Everyone is different, so what works for you is ultimately going to come back to your level of fitness and your specific health case.

What role does diet have here? How can we adapt our diet to support us best?

In functional medicine, we believe that food is foundational to your health. You are either feeding dysfunction or fueling vibrant health with every bite of food you eat. Bear in mind that your specific diet is going to vary from someone else's, based on your own individual health case. However, we do know that certain nutrient deficiencies have been linked to pathways involved in HPA-axis function, cortisol production, and neurotransmitter function - including magnesium, Vitamin C, and B vitamins. Other factors like food intolerances can also perpetuate gut dysfunction and inflammation which can lead to hormone imbalances. 

In general, a well-rounded diet with a variety of clean, wholefood sources like animal protein, vegetables, fruit, nuts and seeds, and herbs and spices is going to be your best bet. Some of my favorite adrenal-supporting foods include wild-caught salmon, avocados, turmeric, oysters, and dark leafy greens.

What is the best way to test our adrenals if we do feel like we are having issues? 

Your functional medicine practitioner can recommend you run a 24-hour Adrenal Stress Index test. This is a salivary test that assesses your cortisol levels to determine if there is an imbalance in your cortisol rhythm which would indicate underlying adrenal dysfunction.

What role do our mitochondria play in this, and how can we best support our mitochondria? 

Your body's 37.2 trillion cells are responsible for every aspect of your health. They convert nutrients into energy and come together to form your organs and body as a whole. Basically, if your cells are unhealthy, chances are high that you are too.

Your cells have their own lifecycle, aging and dying out before being replaced by new, healthy cells that your body produces. However, damage to your cells from toxin exposure, poor diet, and other triggers can lead to health problems like adrenal dysfunction - especially if your body is doing a poor job of cleaning out these damaged cells in a process known as autophagy. One of the best ways to support cellular and mitochondria health is to enhance autophagy through tools like fasting.

How are mood and anxiety issues related to our adrenals?

Anxiety and adrenal fatigue go hand-in-hand. Whenever you feel anxious or stressed, your body is put in that "fight-or-flight" mode which triggers your adrenal glands to release high levels of cortisol. It's really a chicken and egg situation. Both perpetuate the other - adrenal fatigue can trigger anxiety and anxiety can lead to adrenal fatigue over time. Running labs to better understand your health in its entirety and knowing what is going on beneath the surface will help you identify what is triggering your anxiety and/or adrenal fatigue and help you decide exactly how to address it.

Dr Will Cole, IFMCP, DNM, DC is a leading functional medicine expert. You can find out more about him and his work by visiting his website.