A Note From A Reader
A big thank you to Lorraine for reaching out. She asked:
“Hi Dr. C, I’m exhausted and my morning cortisol levels are low. My doctor does not believe in adrenal fatigue and I’ve seen you say that it is a myth. If it is not real, why am I tired and what can I do?”
First, I want to extend a big thank you to Lorraine for reaching out. I love whenever people write to me and really appreciate the opportunity to go through this with you. Together, we can learn a lot about what it means to live healthy. From the moment you wake up!
Next, I want to address the first important concept you mentioned. Adrenal fatigue is a myth, but your symptoms are not.
I have gone at length to describe how I feel about adrenal fatigue. So I am going to include some super helpful articles to build on what we end up discussing today. (Read: The 7 causes of adrenal stress and how you can end them today)
Deconstructing Adrenal Fatigue
Folks that do not have a specific disease damaging their adrenals, but who have low cortisol, believe that “adrenal fatigue” is signifying that the adrenals are broken in some way, shape, or form. Some have even likened it to a weaker version of Addison’s disease.
Addison’s disease is sort of like the adrenal-version of Hashimoto’s disease. It is an autoimmune disease where the body eats up the adrenals. Leaving the adrenals with a deficiency of cells to perform its role in the body well enough.
Therefore, it has been suggested that if the body has low cortisol, it is because the body can no longer make cortisol. Adrenal fatigue comes from this idea that someone is tired. Specifically because their adrenals are tired. It has a bit of a double meaning in that way.
Bottom Line: Lorraine, your doctor is completely right. This is simply not true. Your cortisol is not low because your adrenals cannot make it. It is low because your body does not want your adrenals to make it. That in itself is a super important difference here.
The True Impact Of Low Morning Cortisol
All of this is to say that your low cortisol levels are definitely significant, even if they cannot be traced back to adrenal fatigue. Even though adrenal fatigue is not real, your low cortisol can still be a significant thing to dig deep into.
There has been a lot of literature on what we now know as the “cortisol awakening response” (CAR). Basically, it all boils down to the fact that you should be making a bunch of cortisol once you wake up. As it is a healthy thing for your body to do.
- Alzheimer’s disease
- Cardiac disease
- Many forms of cancer
- Autoimmune disease
Your cortisol slope can also be playing a big role in lots of different symptoms, such as:
Bottom Line: Even how long you live can be tied back to our cortisol slope. It is real, it is important, and it is a big deal for your health. That is why getting it in order can be one of the best things you can do for your health – both today, tomorrow, and years from now.
An Important Wrinkle
Some doctors have suggested that if low cortisol levels in the morning is what causes fatigue, then a boost of cortisol can go a long way in reversing fatigue.
I am here to tell you that you should really question that concept depending on your state of health.
If the body was unable to make cortisol, because it was truly broken, then yes – a boost of cortisol could go a long way, because the body would not be able to get it otherwise.
However, in cases of CAR or adrenal stress, it is not low because the body can longer make cortisol.
In these cases, it really does not help fatigue to give cortisol. The damaging aspect of this research is that it has led lots of doctors to believe that your morning cortisol does not relate to your fatigue in any way – and that is just not true.
How Do You Increase Morning Cortisol?The number one thing that we want to do here is to ensure that we are not dealing with Addison’s disease. Ideally, your doctor would take the time and take a look for that – ruling it out once you gain the full picture.
Key Insight: Whether it is a blood test or a salivary test, a doctor should see if your pituitary gland is “speaking properly” to your adrenals. This is just like the TSH to your thyroid (Read: Should you ignore your TSH).
In almost all cases of this, it comes down more to your CAR pattern. In those cases, and upon testing, a doctor would see a:
- Low cortisol level, and
- Low ACTH (because your body does not want more cortisol)
We would also see, once given ACTH, that your body would make more cortisol accordingly.
Doctors definitely need to distinguish a CAR problem from Addison’s, because if you did have Addison’s all of the treatments I am about to mention would not apply.
Bottom Line: Ensure that your diagnosis is determined before you start to treat what could be very different problems. If you know for sure that you do not have Addison’s disease, what I am now going to tell you is what you can do to feel better – and less fatigued!
The best thing that you can do is address the cause of your CAR. The following are some of the big root causes that you should consider, and what you might be able to do to alleviate them:
Big Trigger: Sleep Apnea Fatigue
One of the biggest triggers happens to be sleep apnea fatigue (Read: Sleep apnea, how to test and treat for sweet dreams). Many assume that apnea is strictly for older men with big bellies, but it can apply to women as well.
Key Insight: There are so many women, of any and all sizes, who have to deal with sleep apnea (and have to bear the consequences of not treating sleep apnea fatigue).
Workplace StressesAnother huge factor can be workplace stress levels. If someone has a good cortisol level on a weekend morning, this is typically a huge sign that workplace stress is playing some sort of role in your cortisol production. If you can leave a situation where you are under an undue amount of stress, that would be great. But that is not always the case. In those instances, we should consider re-framing your stresses and understanding your goals and priorities.
PTSD and Low CortisolThere is most definitely a relationship between PTSD and low cortisol levels. In fact, a low cortisol response can be driven by chronic anxiety, or what we might otherwise call post-traumatic stress disorder (PTSD). The solution here is to seek help in order to come to terms with your anxiety levels, and what is plaguing you deep down. Cognitive behavioral therapy is a proven way to help with chronic anxiety and PTSD. It can also help with cortisol levels. Mindfulness meditation is also extremely effective, easy to do, and can make a big difference in your life. Hopefully, after seeking help, it will be able to balance out your PTSD and low cortisol levels. I truly hope this helps!
Fuel OverloadThis is the kind of trigger that you really might not be paying attention toward. We call this metabolic syndrome, and it is a state where there is too much:
- High blood pressure
- Bad cholesterol
- Diabetes, and
- Heart disease
Key Insight: Your body might be creating a state of cortisol resistance to keep your blood sugar from rising even further. In this way, your body is actively trying to protect itself.
In these cases, we think more in terms of reversal. Enjoying healthy and effective weight loss can get your cortisol levels back to where they belong.
Start your morning strong…
Timing is everything! If you have an erratic schedule, you can really begin to negatively impact your cortisol slope. So, what is the most important part of your schedule? The top two most important are:
- Waking up at the same time every day
- Enjoying breakfast at the same time every day (within an hour of waking)
If you are able to get those things dialed in, everything else can begin to fall into place. Some other factors that help, though, are when you are:
- Going to bed
This is the last important factor that we definitely do not want to forget about. Your exposure to light is so important, and a lack thereof can really have a negative impact on your health. Lights, by way of our eyes, strongly influence our body’s internal rhythms.
Along with waking up at the same time every day, a half an hour of sunlight (within your first hour of being awake) can play a huge role in your cortisol rhythm. At the end of the day, get rid of artificial lights from:
- TV screens