Getting to the Root Cause of Your Fatigue

Functional Medicine Registered Dietitian, Brigid Titgemeier is talking straight and sharing what so many of us need to hear in this stressful time. Explore her Functional Medicine approach to stress and fatigue below, then dive in deep with Brigid's virtual 10 week nutrition program that includes one-on-one calls and in-depth at-home lab testing... 

In this season of higher levels of chronic, low grade stress, it is normal to feel more tired, anxious and possibly even burned out. Other symptoms that can accompany fatigue may be feelings of overwhelm, bloating, constipation and weight gain. Your diet can absolutely trigger these symptoms but so often, stress plays an underestimated and overlooked role when addressing the root cause of your fatigue. Poorly managed, low grade stress can zap your energy, leaving you feeling tired and possibly even exhausted. This occurs when exposure to enough mini stressors leads to a disruption in your internal balance and autonomic nervous system, activating your fight or flight response and staying there. 

For context, there are two systems that are housed within your autonomic nervous system: your parasympathetic nervous system or “rest and digest state” and sympathetic nervous system or “fight or flight” system. You are either in fight or flight mode or rest and digest. Because stress is what initiates a cascade of events as your body shifts into a “fight or flight” mode, most people spend a lot of time in this state. The sympathetic nervous system is your body’s “on” switch. This physiological response prompts the body to confront or run away from a potential threat. 

The body’s stress response, when triggered by acute stressors can aid in survival and alertness. When giving a presentation or running an important meeting, your body undergoes the same biological processes that it would if you were running from a bear. A part of your brain called the amygdala sends a distress signal to another part called the hypothalamus. The hypothalamus responds by activating the sympathetic nervous system, which signals the adrenal glands to distribute a hormone called epinephrine or adrenaline into the bloodstream. If the brain continues to perceive something as dangerous, the hypothalamus releases corticotropin-releasing hormone (CRH), which travels to the pituitary gland and helps trigger the release of adrenocorticotropic hormone (ACTH). ACTH travels to and signals the adrenal glands to release a stress hormone called cortisol. 

If the sympathetic nervous system is the gas pedal or “on” switch, the parasympathetic is the brake or “off” switch, telling the adrenals to calm down and switch into rest and digest mode. As a result, your cortisol production goes down. But unfortunately, chronic exposure to stress can keep that feedback loop in overdrive, which can take its toll on, and eventually overtax, the adrenal glands.

It’s easy to write off the impact of stress or high cortisol levels. But because these stress induced shifts can alter your physiology, it is difficult to feel energized, focused and free of digestive symptoms without supporting your HPA Axis and achieving a state of homeostasis. HPA Axis dysregulation can lead to a whole host of unpleasant outcomes that prevent you from feeling your best.

Over time, low grade chronic stress can: 

-Deplete important nutrients such as vitamin C and magnesium 

-Suppress the immune system

-Suppress digestive enzyme production and disrupt your digestion

-Slow peristalsis and increase constipation 

-Create unhealthy blood sugar fluctuations

-Increase weight gain 

-Alter your hormone levels

These chronic stress reactions can manifest in a wide array of health conditions including osteoporosis, diabetes, hypertension, autoimmune disease and brain-related problems, in addition to fatigue and anxiousness.

Diving Deeper into Understanding your Body

Chronic stress can occur from a real or simulated event. If you have an overactive imagination of something you perceive as threatening, this can also keep the stress response going. Having a fear-based mindset and assigning fear-based thoughts to events will keep you in this overdrive response. In either case, real or imagined, chronic stress keeps those stress hormones elevated when they should ideally taper down. They should especially taper down as the day progresses, based on your normal cortisol curve. 

In an ideal situation, you would wake up in the morning and experience a rise in your cortisol levels within 30-60 minutes of waking. This is called your Cortisol Awakening Response (CAR) which is a distinct aspect of the circadian cortisol rhythm. If it increases at a normal rate within the first 60 minutes of being awake, then it will help you feel more alert and energized in the morning and can stave off fatigue. As the day goes on your cortisol rhythm gradually declines, reaching the lowest levels later in the evening, before bed, which can help improve your sleep quality. 

When it comes to stabilized adrenal health, I am an advocate for the mindset “don’t guess, test”! Testing your cortisol levels can be extremely helpful in knowing which part of your day requires adrenal support, whether your cortisol levels are high or low, and the most beneficial time to meditate or workout. But since your cortisol levels should change throughout the day, going from high to low, doing a one time cortisol lab test may not give you all of the information you are looking for. Collecting multiple cortisol samples throughout the whole day to observe your cortisol trends provides the most valuable insight. This is an easy lab that can be done through saliva collection.  

Some people may have normal cortisol levels in the morning but experience elevated levels mid-afternoon, right before their energy slump. For others, they may experience elevated levels in the evening, prior to going to bed. These elevated evening levels can interfere with the ability to sleep throughout the night. 

Without knowing your cortisol levels throughout the day, it is difficult to know the best time to incorporate adaptogens, targeted nutrients, breathing techniques, and other interventions into your routine. Adaptogens are herbs that have been used in traditional medicine for thousands of years. They are thought to be beneficial through their ability to bring a person’s bodily functions back to homeostasis and protect the body against the physical result of stress. Examples of adaptogens include Ashwagandha, Rhodiola, Ginseng, Holy Basil and Cordyceps. 

Based on cortisol lab results, an individual may find that drinking an adaptogen tea in the afternoon vs the morning may provide more impact in addressing your health. Alternatively, if you drink a cup of coffee, do a HIIT workout and practice time restricted eating (or intermittent fasting) until 11am, and based on your your lab results you learn your cortisol levels are already elevated, then you may want to consider staggering out these stress-inducing activities to help you feel your best.

This is the power of testing adrenal function! It can help you understand the root cause of your fatigue, the best intervention for your cortisol and DHEA needs, in conjunction with the best time of day for the intervention, which is the true game changer. 

If you are interested in testing your cortisol levels with a functional medicine practitioner and creating targeted nutrition and supplement recommendations from there, join the waitlist for My Food is Health, my signature program that launches again soon. My Food is Health is a 10 week virtual group nutrition program with at home lab testing to identify your personal nutrition needs. The labs include a cortisol test, nutrient deficiency test and an omega fatty acid profile test. The program is designed to help you improve how you feel, lower inflammation and feel confident in your food choices. 

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