Tired, pot-bellied, dark circles, wrinkled, pigmented, emotionally labile, irritable, and prone to infection.

You don’t want that. Right? If you’re even close, I’ve got news for you. It’s not you; it’s your adrenals.

Any stress, physical or emotional, taxes the adrenals. Whether it’s endurance training, chronic infection, excitement, or anxiety, stress is physically experienced by the body in the same way. Hence, enlightened ancient masters advising non-attachment and a middle path.

With each stress, we release epinephrine (adrenaline), norepinephrine, and cortisol. You may actually feel like you thrive on stress and that thrill seeking has become a way of life, but it will catch up with you. Our society positively reinforces being a star multi-tasker, pushing oneself past the limit, and commends achievement no matter the cost.

While these adrenal hormone levels are high, we truly feel amazing. Nothing can touch us, that is, till the levels plummet. And then, with falling cortisol (which is anti-inflammatory and energizing), comes inflammation, infection, and fatigue.

Have you wondered why you tend to get sick on vacation? Usually, before vacation, stress goes up with meeting deadlines and preparing for time off. Cortisol levels increase, decreasing immunity and early immune/inflammatory responses to infection. When cortisol levels return to normal, the infection is unmasked, and it’s raging because of the lack of early defense.

Our body chemistry hasn’t evolved as fast as our society. Adrenal hormones were intended to be secreted in response to fighting or fleeing from a wild animal, not in response to a cell-phone ringing or road-rage. Increased heart rate and mobilizing glucose and blow flow to skeletal muscles does not serve us in a chair! Getting stressed is just not worth the infection, belly fat, aging, and depletion of sex hormones.

Adrenal insults are often cumulative and build over time; however, severe shock or trauma will get you there on the fast train. Normally, cortisol peaks in the morning and slowly tapers throughout the day, petering down so that we are tired for bed at night. In early adrenal fatigue, cortisol levels are actually elevated as the gland is being pushed to respond to repeated stressors. However, periods of chronic stress deplete the glands’ hormonal reserves and whittle away at the glands’ ability to maintain circadian cortisol levels.

An early sign of decreased morning cortisol levels is that we just don’t awaken with as much pep in our step. We may become dependent on caffeine. Often adrenal fatigue is masked by coffee, tea, and caffeinated soda consumption, which further tax the adrenals by squeezing out the very last bits of adrenal hormone from them.

Along the progression, we may get an afternoon dip in energy, which we recover from. Then, we may not recover from this dip. Finally, we just have low baseline adrenal output all day with no rises or falls and difficulty falling asleep because the daily rhythm is lost — we are flat-lined. This pattern of decline is the common scenario, however, there are many variations within this pattern, and insomnia can present sooner.

Along the road to adrenal burn-out, comes a quick startle response, mood disturbance, central weight gain, aging, low libido, and an early/more symptomatic menopause. A cortisol steal syndrome occurs, where adrenal raw material is shunted towards making cortisol instead of sex hormones – the body’s innate intelligence to choose survival over procreation.

I want to emphasize that emotionally fragility and inability to cope with new stressors has an actual physiologic root in adrenal dysfunction. Psychology is not distinct from physiology. It doesn’t have to be you; it may just be your adrenals!

Vata Connection

So what you may be wondering is the Ayurvedic connection? Adrenals = vata. So vata management is adrenal management! The adrenals and kidneys in Ayurveda are essentially the same entity, referred to as vrukka. Vrukka is the emotional seat of anxiety and fear (vata emotions). Vrukka is also one of the openings of ambu vaha srotas (the body’s water channel) and thereby in charge of salt and water metabolism. Anxiety causes a loss of body water — commonly sweating and frequent urination.

As we know vata (air and space) is the driest of the doshas and the cause of dryness and decay of the body as we move into the vata stage of life. When it comes to aging, juicy is good and dry is bad. To be clear, I’m not just speaking of diminished reproductive fluids, although it is a terrific marker. I’m talking about dessicated cell membranes, cell damage and loss, fragile blood vessels, loss of muscle mass, a loss of elasticity in the skin and plasticity in the brain, cracking joints, and brittle osteopenic bones – rasa dhatu feeds all other dhatus. The less adrenal fatigue, the less vata, the more sex hormones we make, the less dryness, the less we age.

Another correlate is that vata aggravation manifests as darkening of the skin and tongue. So does elevated ACTH! (adrenocorticotrophic hormone), which is released in response to adrenal fatigue. ACTH increases melanocyte production of melanin in the skin and leads to hyperpigmentation.

One more. People with adrenal fatigue tend to crave sugar and salt due to low adrenal production of cortisol and aldosterone. It’s no coincidence that two out of the three vata-balancing tastes are sweet and salty!

5 steps to adrenal rescue

So now it should be no surprise, that the way we manage adrenal fatigue is the way we manage high vata. (Refer to the home section of Home and Away for a refresher.)

Join me starting this Sunday, on a 7 day adrenal rescue program, as below:

1) Establish/maintain a routine. Eat and sleep at the same time everyday. This is actually really difficult to do if you are already vata-aggravated. Like the wind, you enjoy flexibility and tell yourself you thrive on going with the flow. However, nothing anchors and brings down vata faster like routine and reestablishing a circadian rhythm.

2) Don’t multi-tasking or rush. Allow yourself plenty of time for each chosen activity and do everything super-slowly. If you have too much to do, prioritize, do less, and give your adrenals a rest.

I like to remember a day from this summer, where I spent several hours looking up at the sky threatening a storm. My body fit comfortably on the shelf of a roof-top jacuzzi, and I periodically hummed and chanted, as I watched the sky and warm water drizzled through my hair onto the ground. After, while getting dressed, it felt so wrong to do anything that wasn’t with the utmost attention and care. I invite you to slow down with me and savor it.

3) Eliminate caffeine, alcohol, and sugar. These are actually considered to be adrenal toxins. When adrenally fatigued, you may feel that you need them more so than ever. Remember, when we are out of balance our cravings cannot be trusted. Fulfilling them only serves to propagate the imbalance.

4) Do abhyanga every night for 7 nights straight, aka oil it up! There’s a method to deciding which oil, and yes, the type of strokes matter. However, to simplify for general use, use sunflower oil and apply it like lotion before a hot bath/shower. Oil and dry balance eachother more so than wet and dry.

5) 2 minutes of nadi shodhana before bed. At first so that you can better relax into to it, set a timer on your cell phone. This is the number one balancing pranayama for high vata and stress. Refer to the “how to” video in the red box.

A note on exercise:

Exercise is an important stress relief – however, depending on the degree of adrenal fatigue, restorative movement may be more appropriate. Exercise to the intensity that you are not exhausted either directly after or the day after your workout.

Supplements

You can get at least ¾ of the way there with the above five steps! They are also great prevention. However, depending on the degree of adrenal fatigue, you may need supplements which alleviate symptoms, while resting the adrenal glands – giving them a chance to replenish their stores.

1) Ashwagandha is a terrific adrenal modulator and is one of Dr. Lad’s two vata specific herbs (dosha pratayanikas.) It’s nervine properties make it an excellent choice before bed. It is also a reproductive rejuvenator and rasayana – literally “extends how juicy you are,” which is anti-aging.

2) Yastimadhu (licorice) is part of many adrenal formulations. The deglycyrrhized form is safer in cardiac patients, hypertension, and electrolyte disturbances. It can be added to a morning tea or taken as part of an adrenal complex. It potentiates cortisol and does not have modulatory activity; therefore, it is best used in severe adrenal fatigue and dosed early in the day.

3) Adrenal glandulars (dessicated animal adrenal gland) work incredibly well. They are best dosed early, as they are usually too stimulating after noon. Although Ayurveda comes from India and the largest population of vegetarians live in India, Ayurveda is not a vegetarian discipline. It actually favors the use of the jivaniya or life-promoting property of animals, especially in those that are severely depleted. It is the science of life and longevity, so that one has the health to venture beyond the body.

Many modern formulations contain a combination of adrenal modulating herbs, stimulating herbs, B vitamins (especially important is pantothenic acid (B5), and glandulars. As part of your adrenal rescue program, try one of the above supplements that you feel is best suited to you.

Also, salivary cortisol testing is available. It lends an adrenal graph of a person’s daily cortisol secretion, allowing therapy to be better tailored, and may yield surprising results. I know mine were a surprise.

These are all great ways to balance out existing adrenal fatigue, but you’ll always being playing catch up, unless you implement life-changing measures to prevent adrenal stress in the first place. So, try not worry, stay present and steady, take care of your gut, eat for nourishment, and check in with yourself periodically about your goals and what’s the motivation behind achieving them.

— Nisha Khanna, M.D.

It’s Not You; It’s Your Adrenals