A Holistic View of Stress - Functional Medicine Approach to Adrenal Fatigue

A Holistic View of Stress: Functional Medicine Approach to Adrenal Fatigue

dr-carrie-lam md adrenal functional medicine Dr. Carrie Lam, MD
Functional Medicine Doctor
Adrenal Fatigue Expert

Everyday you wake up feeling exhausted, even after getting enough sleep. Getting out of bed is a struggle, you hit the snooze constantly. Your coffee is the only way you can get your day started. A few hours later, you’ve already had three cups and you can barely keep your eyes open. In fact, for the past few months, you’ve been feeling lethargic and fatigued. And as if that’s not enough, you have also started to experience brain fog, low libido, and depression.

Your blood work, however, is normal. Your doctor says there’s nothing wrong with you. Well, this doesn’t feel normal. In fact, it feels there’s something totally wrong with your body. What’s going on?

Despite how common it is, adrenal fatigue also called HPA axis dysfunction, is often overlooked in the conventional setting. This leaves many people on a constant health journey only to find themselves more confused, more discouraged, and not feeling any better.

In this interview, we spoke with Dr. Carrie Lam, M.D., a functional medicine doctor who specializes in adrenal fatigue. Dr. Lam shares the functional medicine approach to chronic stress, how stress affects your body, and some practical tips she recommends to her patients and uses in her personal life.

What is adrenal fatigue?

I often see patients that have been suffering from the devastating effects of stress for many years. Despite stress’s major role in chronic disease[1], it doesn’t always get the proper attention in conventional medicine as a potential underlying cause of illness.

Furthermore, chronic stress can cause a wide variety of symptoms all over the body that may seem random and unrelated, making connecting the dots challenging.

Understanding stress, and how your body responds to it is often the key to unlocking chronic symptoms and other health concerns. Unfortunately, the traditional model that is used to describe the body’s response to stress is incomplete, which can make it difficult to properly address stress related issues.

The conventional model of stress: the HPA axis

In conventional medicine, when doctors think about our stress response, they generally focus on the HPA axis – the hypothalamus, the pituitary gland, and the adrenal glands[2].

For those who aren’t familiar with the HPA axis, I’ll briefly summarize it, and how it is connected to stress.

The hypothalamus is a part of the brain that regulates and coordinates our basic biological functions. When you find yourself in a stressful situation, a part of the nervous system known as the sympathetic nervous system gets activated.

This is often referred to as our “fight or flight” stress response to life threatening and stressful events.

The hypothalamus responds within seconds by secreting CRH (corticotropin releasing hormone). Next, CRH tells the pituitary gland, which is located at the base of the brain, to secrete ACTH (adrenocorticotropic hormone). ACTH then activates the adrenal glands, which are located just on top of the kidneys. They produce stress hormones, like cortisol. These hormones activate several other body systems that together give us the energy we need to react to the threat.

So, while the HPA axis model can help understand our stress response, stress hormones have cascading effects on the whole body that affect all organ system, not just the HPA Axis. Furthermore, the exact pattern of changes caused by stress often differ for each person.

The differing responses to stress are what makes diagnosing a stress-related symptom challenging. A practitioner must account for these individual differences and effectively address all of the potential imbalances to find a proper treatment plan. Luckily, in functional medicine we specialize in looking at the underlying causes of health problems.

The functional medicine approach to stress

In functional medicine, we seek to understand the effect stress has on the entire person, rather than just on the HPA axis or the adrenals. It is a much broader perspective of stress that considers all the different organs and body systems involved in the stress response. This holistic view allows us to identify imbalances caused by chronic stress that we can then address with personalized treatment plans.

After decades of research as well as experience with thousands of patients, my team of functional medicine practitioners has developed the NeuroEndoMetabolic (NEM) model.

This model of the body’s reaction to stress can be described like an electrical circuit panel. There is one master circuit panel that controls the entire body, with individual circuits that control different body systems. Collectively they all work together, like the circuits in your house, to keep the lights of wellness turned on.

Here are the 6 main “circuits” or body systems that can be impacted by chronic stress:

  • Hormone circuit. People with disruption in this circuit may experience imbalances in hormones, including thyroid hormones and sex hormones such as testosterone, estrogen, and progesterone.
  • Bioenergetics circuit. Consists of the thyroid, pancreas, and liver, which play a key role in your ability to extract energy from food, regulate your metabolism and body weight.
  • Detoxification circuit. Issues with this circuit may cause toxins to accumulate leading to variety of symptoms of toxicity such as hypersensitivity, intolerance to supplements and medications, chemical sensitivities, and others.
  • Inflammation circuit. People with disruption in this circuit may experience signs of increased inflammation throughout the entire body.
  • Neuroaffect circuit. Involves a complex interconnection between the microbiome, brain, and the nervous system. A disruption of this circuit may cause neurological and psychological symptoms such as insomnia, anxiety, and panic attacks.
  • Cardionomic circuit. Involves the cardiovascular system as well as the autonomic nervous system and the adrenals. Issues with this circuit may cause high blood pressure, heart palpitations, cardiac arrhythmia, shortness of breath, and others.

The six colors of stress

Although more than one of these circuits can be affected at the same time, most people have one circuit that predominates in their body’s response to chronic stress. Based on the symptoms that you’re having, you will be able to get an idea which of your circuits is the most affected.

In our clinic, we refer to these six circuits as the six “colors” of stress. If you’d like to find out what color your stress is, you can take this quiz on our website.

A few tips for addressing stress

With all the different stressors modern life often brings, we can’t completely avoid stress. No one’s life is stress-free. However, there are plenty of techniques that can help us deal with the stress that we encounter and change our body’s response to these events. When we learn to manage stress, even stressful events have a less negative impact on our health. Here are a few tips that might help:

Try adrenal breathing

When a stressful situation arises, it can be helpful to have a tool available for dealing with the situation. And I don’t mean a drug or a supplement. Certain types of breathing techniques have been shown to help with stress[3]. Breathing offers a wonderful natural way that is available to us in every moment.

To help my patients enjoy the stress-relieving benefits of breathing, I’ve developed a specific adrenal breathing exercise. You can download this free app that will guide you through this practice.

Sit or lay down in a quiet place where you will not be interrupted:

  • Breath in slowly, filling your lower lungs with air. Fill your upper lungs.
  • Continue to breathe in a slow and relaxed manner. While breathing, imagine an elliptical shape that expands as you inhale and narrows as you exhale.
  • Let the air out slowly, focusing on relaxing the muscles in your shoulders, neck, and face as the air moves out of your body.
  • Repeat ten times.

This adrenal breathing exercise can be very helpful when you start to feel anxious. But you don’t have to wait until you feel stressed to use it. The more you practice it, the better it will work. You’re training your nervous system to shift into a parasympathetic (“rest and digest”) state. Some of my patients do the adrenal breathing exercise multiple times each day, to facilitate this process. I highly recommend it!

Is exercise helpful or harmful for adrenal fatigue?

You may have heard that exercise is good for relieving stress. But is exercise still helpful when you have adrenal fatigue?

Sometimes, it can be. But if you’re already feeling depleted and exhausted, then adding more physiological stress (in the form of exercise) may actually make things worse. You can get a good idea of whether exercise is helping you or hurting you by paying close attention to how you feel after you work out. If you go for a run, and then you feel energized and ready to tackle your day, then that’s probably the right type of exercise for you.

But if after your run, you feel even more exhausted than before, then that’s not what your body needs at this time. You might be better off with something more adrenal-friendly, like yoga. Once your body has healed from the effects of chronic stress, then you could try more intense workouts again.

With adrenal fatigue, it’s extremely important to listen to your body. Ignoring what it’s telling you because you think you “should” be feeling something different may work against you.

Adaptogens might NOT be the answer

I frequently get questions about using adaptogens and other supplements to help cope with stress. For those who may not be familiar with adaptogen supplements, these are natural substances that are capable of either stimulating you or relaxing you. If you’re wired or anxious, an adaptogen can help you relax; if you’re lethargic, it may help energize you. Some examples of adaptogens are ginseng, ashwagandha, tulsi (holy basil), and rhodiola.

While adaptogens are very popular, they are not for everyone. I’ve seen quite a few patients in my clinic who decided to try adaptogens hoping they would help with their adrenal fatigue, but ended up crashing even more. Using adaptogens without understanding the underlying causes of their health concerns made their symptoms much worse.

It’s not that adaptogens are not useful. Adaptogens have their place and may help in some cases. They do not, however, address the root cause of adrenal fatigue, or the different imbalances caused by the chronic stress. So, I wouldn’t reach for them without doing some baseline testing and getting other things in place first.

For example, you want to make sure you provide your body with all the nutrients your adrenal need to function properly. While there may be several nutrients we often use such as vitamin C, vitamin B5, and essential fats, we always test first to know exactly which nutrients you may be lacking.

You don’t have to accept your symptoms

Living with adrenal fatigue may be devastating, but the good news is that we have the knowledge and tools to help your body heal. And, you don’t have to take this journey alone. A qualified functional medicine practitioner can help guide you in the steps needed to bring your entire system back into balance. We see these results daily in our clinic. So, don’t lose hope!

  1. Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005;1:607-628. doi:10.1146/annurev.clinpsy.1.102803.144141
  2. Smith SM, Vale WW. The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dialogues Clin Neurosci. 2006;8(4):383-395. doi:10.31887/DCNS.2006.8.4/smith
  3. Hopper SI, Murray SL, Ferrara LR, Singleton JK. Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI Database System Rev Implement Rep. 2019 Sep;17(9):1855-1876. doi: 10.11124/JBISRIR-2017-003848. PMID: 31436595.
Dr. Carrie Lam, MD
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