We all deal with stress. Stressors such as losses, job interviews, presentations, medical diagnoses, lack of sleep, job and home life balance, or challenging relationships can make us feel overwhelmed. Our bodies should be able to deal with these stressors, for a short period of time. And that’s the key: for a short period of time. The problem is, most of us are chronically stressed!
How Heavy Is The Burden You Carry?
You’ve probably heard of the analogy of holding a glass of water. Hold it for a minute, and it feels light. Hold it for an hour, and your arm will start to ache. Hold it for a day, and your arm will be numb and the glass will feel unbearably heavy. We often don’t remember to put the glass down until it’s too late. Until we have seen the repercussions on our body, mediated primarily by our adrenal glands, these little soldiers that sit on top of our kidneys, trying to fight for us.
Fight Or Flight
Your adrenal glands perceive any form of stress, whether it is a physical, emotional, environmental, biochemical, or spiritual stress, and respond the same way: by trying to produce either adrenaline (short-term) or cortisol (long-term). They are responsible for our fight or flight response: when our body assesses its environment and deems it unsafe, it prepares us for battle, getting our blood pumping, shifting our resources away from digestion and into our muscles and brain so that we can run from danger or fight it head on. But if this goes on for a long period of time, we will get exhausted, as it’s just not sustainable.
How Chronic Stress Affected Me
When I graduated from naturopathic medicine, and shortly after writing my licensing exams, my adrenal glands were in rough shape. I had pushed myself through medical school, but once the stressor was over, it was difficult for me to peel myself off the couch or do any exercise at all. I had survived on insufficient sleep, caffeine, deadlines, and willpower, but in the process, my digestion was a mess, and I was constantly battling fatigue throughout the day. Any new stressor made me feel overwhelmed. Luckily, as a new naturopathic doctor, I knew that my adrenal glands were in need of some tender loving care. I was probably near burnout. It took me a good year before I felt a lot better, and a few years more before I felt better than I had years before, during my undergraduate and naturopathic medical school studies.
You don’t need to be near breaking point before realizing that your adrenal glands need some help, and that stress is affecting your body in various ways. It’s best to catch it in the early stages, when it’s easier to shift back to balance.
Adrenal Fatigue Stages
You may have heard of the term “adrenal fatigue” (or adrenal insufficiency, hypoadrenia) from naturopathic doctors and integrative medical doctors. This term really refers to an older concept founded on Dr. Hans Selye’s research (a Canadian endocrinologist), called “General Adaptation Syndrome”. If we are under stress for long enough, we move through the different stages of adaptation to chronic stress, from the alarm stage, to the exhaustion stage. At the end of the exhaustion stage is burnout. You don’t want to get to the exhaustion stage if you can prevent it!
Stage 1 – Alarm
In this initial alarm stage, the body panics a little and tries to mobilize its resources. You might have a temporary decreased resistance to stress as your body starts to produce more cortisol to deal with the chronic stress, and you mobilize your energy sources from fat and muscle. Some people will lose weight in this stage.
Stage 2 – Resistance
In this stage, the adrenal glands actually grow in size as they try and keep producing more cortisol. But the high cortisol will wreak havoc on the body. Symptoms of high cortisol include:
-feeling tired but wired
-anxiety and nervousness; heart palpitations
-depressed mood; irritability; mood swings
-brain fog, confusion; memory problems; decreased concentration
-decreased sex drive
-hot flashes; night sweats
-weight gain around the middle
-more frequent colds and flus
Stage 3 – Exhaustion
In this stage, the adrenal glands can’t keep up with the production of cortisol and eventually cortisol production goes down. Any added stressor will be more difficult to deal with, as your resilience goes down. While cortisol levels fluctuate throughout the day, your highest levels of cortisol should be in the morning. Morning cortisol levels are also the last ones to drop in hypo-functioning adrenals. Cortisol helps keep us alert. So if you are having trouble peeling yourself out of bed, and you have late afternoon energy crashes, you may be in this stage.
At this stage, you may have symptoms of both low and high cortisol all at once. Symptoms of low cortisol include:
-burned out feeling
-cold body temperature; cold extremities
-cravings for sweets and/or salt
-joint pains; muscle pains
-low blood pressure
At the end of naturopathic school, I was definitely into Stage 3. Luckily, there are things we can do to help you deal with the stress and rebuild the health of your adrenal glands.
Do you need to put your glass down?
Do you think you might suffer from adrenal fatigue? In my next blog, I will discuss testing methods for assessing the health of your adrenal glands, so that you can know which stage you’re in and we can treat more specifically based on your needs.
But if you’ve read this and think you’re in the later stages based on your symptoms, don’t wait! Come on in for a visit, and I’d be happy to help you start to feel better. And don’t forget to put your glass down!
Image from 123RF.com, Copyright: https://www.123rf.com/profile_bialasiewicz'>bialasiewicz / 123RF Stock Photo</a>
Selye, H. (1998). A Syndrome Produced By Diverse Nocuous Agents. Journal of Neuropsychiatry, Spring 1998; 10(2): 230-231.
Scott, TD, Speidel, K. (2017). Essential Elements of Prescription Hormone Compounding. LP3 Network. Conference 2017 Apr 29-30.
Guest post by Dr. Justin Gallant, ND. See original post here. I have had many patients recently come in with sleep maintenance insomnia, and Dr. Gallant explains very nicely why this may happen.
Almost 80% of the patients who walk through my door wake up around 1-3am. The most common reason for this is hypoglycemia. Once I get them eating a small snack with protein before bed their sleep-maintenance insomnia usually subsides.
There are several other reasons for waking up around this time but clinically I have seen low blood sugar as being the most common. If having a snack before bed doesn’t cut it and you’re still waking up in the middle of the night you should definitely talk to your Naturopath or Medical Doctor about it, especially if you're having other symptoms. Many people say eating before bed will cause you to gain weight but a small snack may actually help you lose weight as I discuss further down.
Protein helps glucose get into your cells more efficiently via insulin and is converted to glucose much slower than if you were to just eat sugar. Fiber slows your absorption rate of glucose so both protein and fiber will help keep your blood sugar stay stabilized while you’re sleeping. Protein also provides amino acids that are necessary for neurotransmitters like serotonin, dopamine and GABA (which I mention below) to be made. Every action has a reaction so if you eat that donut your blood sugar will sky-rocket and then plummet soon after. Your goal should be to keep your blood sugar as close to the midline in the picture above as you can and aim to have blood sugar regulated until cortisol is naturally elevated when it's time to wake up.
A piece of bread with peanut butter
Legumes like chick peas, beans, nuts, seeds
Soup or stew
Protein shake or protein bar
Veggies, crackers or pita dipped in hummus.
Stay away from simple carbs and sugary snacks like fruit before bed as they’ll just temporarily elevate your blood sugar and it will come crashing down soon after, increasing the likelihood of hypoglycemia while you’re sleeping.
Explanation of why you wake up:
During the night your liver is working hard at metabolizing glucose and your brain is actively organizing your thoughts and dreaming. If you eat dinner at 5 or 6pm and then try to go until 8 or 9am without any food you’re going to get hypoglycemic just like you would if you tried to go 14 hours without food during the day. Once our sugar gets too low we pump out cortisol from our adrenal glands. Cortisol is one of our stress hormones. We pump it out naturally to increase our blood sugar but since it’s a stress hormone it wakes us up. Cortisol also inhibits GABA, which is an inhibitory neurotransmitter which helps keep us calm and relaxes our muscles. So now you’re stressed and can’t relax…thanks a lot brain, I thought you were smart? Once our blood sugar gets too low we must secrete cortisol for survival. Our brains use ~30% of the glucose we take in and even though we’re sleeping, each cell in our body needs glucose for fuel.
Eating a snack before bed will actually help you lose weight! Bold statement right? Well think about it. If you’re going 10-14 hours without food your body is going to go into famine-mode. It thinks once it gets breakfast that you could go another 12 hours without food so it’s going to store whatever you put into it as fat to be used for energy later. This is the equivalent of your Uncle Bob carrying a bunch of Jerry cans full of gas in his ol’ pick up so he doesn’t have to keep going to the gas station when he’s running on fumes.
There are plenty of other reasons why we wake up in the middle of the night which can be exacerbated by hypoglycemia as well. For instance, if you have Benign Prostatic Hyperplasia (BPH), you may be waking up around 3am because you have to pee. Most men attribute this to the BPH but once I get these guys eating properly and having a snack before bed the urge to urinate doesn’t wake them up anymore. It’s more of a combo of something is going on in your body that would wake a light sleeper but if you can get into the deep sleep, you won’t be so sensitive to it. This effect can happen with almost any symptom that’s preventing you from sleeping (i.e. bloating, pain, flatulence, snoring, etc…). Our bodies are programmed to turn our senses off while we’re sleeping, but if we pump out cortisol we’re going to wake up and those senses will re-engage. Once our senses re-engage we will be able to perceive those internal and external stimuli that we wouldn't have noticed while in a deep sleep.
Besides feeling terrible, insomnia comes with its complications as well which are too plentiful to discuss in this article but can involve weakening your immune system, emotional strife, poor work performance, side effects from caffeine and poor-decision making to name a few.
Other causes of sleep-maintenance insomnia:
A restless partner
Restless Leg Syndrome (RLS) - I'll be blogging about this soon!
Congestive Heart Failure
Sleep paralysis, hypnopomp, astral catalepsy, whatever you want to call it.
Nutrient deficiency (Iron most commonly)
Respiratory conditions like COPD, Lung cancer, etc…
High or low blood pressure
Segmented sleep, bimodal sleep pattern, biphasic or polyphasic sleep
Pelvic floor weakness
Medication side effect
According to Traditional Chinese Medicine, waking up between 1-3am could indicate your liver needs attention. This could be due to anger issues, dietary, excess alcohol, etc… Sometimes just doing acupuncture, taking Chinese herbs or dealing with diet or anger can completely resolve sleep-maintenance insomnia.
Thanks for reading!
Please read the disclaimer in the footer of my website (www.drjustingallantnd.com).
If you have any questions, comments or contributions feel free to comment below.
If you would like to book an appointment with me please call 905-547-5393 or contact me.
Dr Justin Gallant ND
Dr. Tamar Ferreira is a Naturopathic Doctor in Brampton, Ontario. Her areas of focus include digestive health, hormone balance, and skin conditions.