046 The Case of Always Feeling Tired w/ Dr. Deborah Matthew

The Case: 

• Sydney is 41 and struggles with fatigue and fluctuating energy levels.
• She wakes up tired after a full night’s sleep and can barely make it through her day. 
• She saw an endocrinologist and the 3 GPs who had no explanation for her condition.
• She tried several different supplements, but nothing helped.

Feeling tired seems like such a common problem that so many people don’t even complain about it anymore - it’s just the accepted human condition. But, Sydney knew that how she was feeling wasn’t normal and she certainly couldn’t accept it. She had her thyroid tested so when her numbers came back in the normal range, she knew she had to dig even deeper. 

 

The Investigation

When I first met Sydney, I noticed that she had a lot on her plate. By exploring vitamin deficiencies and thyroid issues, she’d already eliminated some of the usual suspects of fatigue issues. I took a look at her diet and saw that she was already eating pretty clean so that wasn’t the culprit either. 

My sense was that we need to have an indepth look at how her adrenal glands were functioning in order to solve this health mystery. Joining me on the show today to talk more about it is Dr. Deborah Matthew. 

Dr. Matthew is the Founder and Medical Director of Signature Wellness in Charlotte. She’s a Diplomat of the American Board of Integrative and Holistic Medicine, the President of The North Carolina Integrative Medicine Society, a member of the Institute of Functional Medicine, and is Board Certified by the American Academy of Pediatrics.

What are the Adrenal Glands

We each have two adrenal glands and they are responsible for making stress hormones like adrenaline and cortisol. They're about the size of a walnut and they sit right on top of our kidneys.

When the body perceives a threat, adrenaline gets released instantly and only lasts for a few minutes. If the perceived threat continues, then the adrenal glands begin to produce cortisol, which the body can convert into energy over a longer period of time.

The adrenal glands also make a hormone called DHEA, which is an anti-aging hormone that protects our cells, bones, and brain.

Symptoms of Adrenal Gland Imbalance

When the adrenal glands are overstimulated and over producing hormones, we call this an imbalance. The most common symptom is fatigue. Oftentimes there's a pattern to the fatigue, which is that it is hard to wake up in the morning and your brain feels groggy. Often, caffeine is needed to boost the cortisol and bring you up to a functioning level. The pattern continues with a slump late in the afternoon (usually  when you reach for more caffeine or some sugar) and then the energy may return briefly around dinner but after dinner, the fatigue sets back in and you feel like you’re ready for bed. If you do stay up though, you may experience a second wind around 10 pm (just when you should be getting to bed) making it hard to get to sleep. 

What Causes Adrenal Gland Issues

The job of adrenal glands is to respond to stress. This includes emotional stress (like our job, relationships, or general busyness) as well as physiological stresses that may come from chronic pain, injury, infections, exposure to toxins, or allergies.  (including physiological and emotional stresses). 

The adrenal glands pump out cortisol to deal with each of these stresses. Over time, and as stresses start to add up, your cortisol levels can become chronically elevated. Chronically elevated cortisol can affect your blood sugar (and push you toward diabetes), it can push your blood pressure up, it can prematurely age your body by thinning the skin and hair, and by increasing the rate of bone depletion. It can even shrink your brain and bring on dementia. 

If chronically elevated cortisol levels continue for too long, the system can actually burn out and suddenly your body can’t make cortisol leaving you feeling burnt out, overwhelmed, and exhausted. 

Why Conventional Doctors Don’t Diagnose Adrenal Issues

It can be very frustrating to work with conventional doctors who dismiss the possibility that an adrenal imbalance could be the cause of ongoing symptoms. However, doctors are trained in medical school to look for either tumors (which would be the cause of too much cortisol production) or other life threatening diseases. If they do not find evidence of these very rare health conditions, they have no more tools to help them since adrenal imbalance is not a disease and it is not taught in medical school. 

Testing for Adrenal Issues

There are several lab tests that you can do to identify issues with your adrenal glands including a saliva test and a urine test. It’s important that these tests are done throughout the day to identify fluctuating levels. A single blood test will not paint a complete picture of what’s going on. Testing urine or saliva throughout the day however provides the best information about cortisol levels as well as DHEA levels and their relationship to each other. 

 

Treatment for Adrenal Issues

Stress is the biggest cause of adrenal issues so the first step in treating adrenal issues is to find ways to minimize stress. This can be very difficult for people, but it’s essential. Start with mindset work by shifting to a more optimistic outlook. Incorporate stress management techniques like meditation, light exercise, prayer, or getting out into nature.  

Diet is also important for getting the adrenal glands back in order. Eat whole foods (including lots of veggies and fruits), avoid sugar and processed foods. And, limit caffeine as well as alcohol. 

 

Dr. Deb also suggests that adaptogenic herbs can be helpful including holy basil, ashwagandha ginseng, and rhodiola. Vitamin C plays a role in supporting healthy adrenal gland function, so supplementing with vitamin C is also often recommended. Some find that glandular supplements (either bovine or porcine desiccated adrenal) can be helpful. 

Treating adrenal issues can be complex. It’s important to test your levels before settling on a treatment plan because you could potentially be exacerbating the problem. For example, if the cortisol levels are high, supplementing with phosphatidylserine might help but it would not be the right choice if cortisol levels are actually low. The same can be said about supplementing with DHEA without having tested the levels. 

The Thyroid-Adrenal Connection

Symptoms of an adrenal issue can be very similar to an underactive thyroid gland - thin skin, thinning hair, weight gain, and low lobido. Poor functioning adrenal glands can challenge the thyroid or increase symptoms of hypothyroidism. This is because cortisol, produced by the adrenal glands, is required to convert T4 (produced by the thyroid gland) into T3 to make it useful to our cells. If the adrenal gland is not producing enough cortisol, then T4 does not get converted and we can feel like the thyroid is not functioning properly. If the thyroid is already underperforming, then the situation is worse. Those who are taking thyroid medication like Synthroid, may feel like it’s not working because their symptoms persists. However, the low cortisol levels from the adrenals may actually be to blame. 

 

What to Do if You Think You Have an Adrenal Issue

Dr. Deb offered up three pieces of advice for people dealing with adrenal issues. 

1. Get Stress in Check. 

Think about the sources of stress in your life and identify what you can avoid, alter or balance out.

2. See a Functional Medicine Practitioner. 

A conventional doctor is unlikely to identify the problem and a...