Tired All The Time?

By Elizabeth Boham MD, MS, RD

I remember a time when I always felt tired. I did not have the energy to do fun activities and often wanted to go to bed early. I was overwhelmed by simple tasks and wondered if I would ever have energy again. This was around 14 years ago. In the 3 years before then, I was very busy and full of stress. I was finishing up my training in medicine and at the age of 30 I was diagnosed with breast cancer. I went through surgery, chemotherapy, and radiation. I was so lucky when 5 months after finishing treatment, I became pregnant with my daughter. The next couple years were filled with pregnancy and breastfeeding, then pregnancy and breastfeeding again with my son.

After all of this, I crashed. I was exhausted. I struggled to stay awake at night while watching a tv show, and I had a difficult time getting going in the morning.  It was hard for me to handle even the smallest amounts of stress, and I got sick easily.  A few years later when I was starting to feel better, I learned more about stress and the body and realized that I was dealing with HPA axis dysregulation, more commonly known as adrenal fatigue.  

So What Is the HPA Axis?

The HPA (hypothalamic – pituitary – adrenal) axis is the structures in our body that help coordinate our stress response. Stress, whether emotional or physical, is defined as a real or perceived threat to our homeostasis. When we perceive that we are in danger, we have a fight or flight response that prepares us to either run away or stay and fight. In order to do this, our body releases hormones that cause our heart to beat faster, increase blood sugar to fuel your muscles, and increase rate of breathing, among many other responses. It’s an amazing system!

So What Goes Wrong?

Unfortunately, our modern stressful lives can keep this system activated a lot of the time, even if we are not in any immediate danger. With considerable stress or chronic stress this system is activated too often. When it does not have time to rest, HPA axis dysregulation occurs. When this occurs the HPA axis, including the adrenal gland, will not work properly and will burn out. That is what we call ‘adrenal fatigue’ which causes a host of symptoms.

It is not a critical medical disease that requires medication or surgery.  As a result, many conventionally trained physicians will tell patients with adrenal fatigue that they are fine or they may recommend an antidepressant.  

What are the Symptoms of HPA Dysfunction or Adrenal Fatigue?

  • Feeling irritable or depressed
  • Frequent colds and illnesses
  • Difficulty coping with stress and/or experiencing an exaggerated response to a stress
  • Feeling unrefreshed even after a decent night of sleep
  • Tasks that may have been easy before now seem difficult  
  • Feeling “tired and wired”
  • Mental fogginess or sluggishness
  • Cravings for sweets and salty foods
  • Dizziness when you stand up
  • Frequently feeling tired for no reason
  • Frequently feeling overwhelmed
  • Low blood pressure
  • Low blood sugar

Every day in my practice at The UltraWellness Center, I meet people who are frustrated by their fatigue. There are many things that you can do to help you regain your energy. And sometimes just understanding why you are tired is helpful.

What Can You Do?

Adrenal fatigue can be improved through a combination of dietary changes, stress reduction practices, and supplements. Use the following tips to rebalance your HPA axis and support healing.

1. Clean Up Your Diet

Focus on balancing your blood sugar. Key strategies include eating regularly, not skipping meals, and incorporating appropriate amounts of healthy protein, fat, and fiber with each meal. Also, avoid simple sugars and limit your consumption of alcohol to no more than an occasional drink.

2.  Avoid Caffeine

Caffeine mimics the stress response. By drinking coffee or other sources of caffeine, you add fuel to the fire and slow the healing process. It is best to gradually wean off caffeine entirely.

3. Engage in Stress Reduction

Incorporate stress reduction techniques for at least 15 minutes every day to calm your body and restore your adrenal glands and stress response system. Try a yoga class, download a meditation app, learn about biofeedback, and get a massage.

4. Incorporate Movement and Regular Exercise

Exercise is one of the most powerful ways to prevent stress, eliminate stress hormones from your body, and reduce secondary complications such as insulin resistance. Depending on your level of adrenal fatigue, you may not be able to handle intense exercise. If you get more tired the next day, you may have done too much. Even if this happens, don’t stop moving altogether. Movement and getting outside are critical for healing. Remember to take it slow and work up gradually.  

5. Get Regular Sun Exposure

Aim for about 20 minutes of direct, unblocked sun exposure every day. This is crucial not only for vitamin D synthesis, but also for improving mood through the release of endorphins, supporting optimal sleep-wake cycles, and preventing many diseases. If you are having a hard time getting to sleep at night, try to get outside when you wake up in the morning. Sunlight at this time will help your body understand the proper sleep-wake cycle.

6. Support Your Sleep!

Getting adequate, restorative sleep is key to rebalancing your stress response system and your body. Proper sleep hygiene is very important and should be a top priority. Work on getting 7-9 hours every night.  

7. Can Supplements Help?

Absolutely! I often recommend a good quality B complex and multivitamin. You can check out our favorites here. Look for a B complex with methylated B vitamins like methylfolate instead of folic acid. This is because some people can’t utilize folic acid easily. In addition, many botanical herbs act as adaptogens, which are natural substances that help the body adapt to stress. Some examples include: Asian ginseng, rhodiola, and ashwaganda. These herbs and supplements can support the body during a stressful time and help the body rebound.  

In this fast-paced life, we often just go, go, go. Remember to be kind to your body. Give it time to rest and incorporate self-care on a daily basis. HPA axis dysregularion / adrenal fatigue is just one reason that you may be tired. If these suggestions do not help, please consult with your own personal doctor and have a full examination.  

Read this guide to going gluten-free the healthy way and find out which healthy fats you should eat daily. Then see which vitamins you should be taking every day! 

The New Potato and its materials are not intended to treat, diagnose, cure or prevent any disease or ailment. All content on The New Potato (even when supplied by a medical professional) is intended for educational and conversational purposes only. Always seek the advice of your physician or healthcare provider before beginning any new diet, exercise regime, or wellness routine.