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Chronic Stress: A Root Cause Approach

Updated: Nov 22, 2018



So let me tell you a little story. Someone in my family (guess who) thought it would be a really good idea for my fiancé and me to host Thanksgiving at our house this year. It’s our first holiday season in our new place, and the guilty party thought it would be great to have everyone over and give back to our family members who usually do most of the work every year. Well, that was all well and good in theory. Our house, while cozy and welcoming, is NOT big. In fact, it is impressively small once you factor in the two of us, the kids and the cat (not to mention the mice the cat is finding), and when we sat down to start planning for Thanksgiving, we had no idea where to put everyone. We then realized that our well-meaning decision might have been a mistake. It was at that point that my partner, who is not historically the stressed out one in the house, got stressed out. Ah, the joys of the holidays. The first of what I am sure will be many other occasions of anxiety over the next month or so, with trips planned, weddings, presents to buy, kids to entertain and endless amounts of cooking. While my fiancé eventually came up with the perfect plan for our Thanksgiving dilemma, the whole affair did give me the perfect subject for this month’s post as we head straight on into the chaos: stress, how it works, and what to do about it.


Here’s what you absolutely have to know:


Stress starts in the brain, which means it starts in the nervous system as a nerve impulse. Once it reaches the hypothalamus (the brain’s “switchboard” between the nervous system and the endocrine system), it becomes governed by hormones and the glands that secrete them. The hypothalamus sends out a hormone called CRH to the pituitary gland, which in turn sends out the hormone ACTH to the adrenal glands that sit on top of your kidneys.


The adrenal glands have two parts: the medulla houses the catecholamines epinephrine and norepinephrine, also known as adrenalin. These are not actually hormones but “neurotransmitters”, which means they use nerve pathways to transport messages instead of the bloodstream . Which means they work FAST. The catecholamines do things during stress like:


*raise your blood pressure

*increase your heart rate

*make you sweat

*make your hands cold

*make you hyperventilate

*make you hyper alert and super strong

*dilate the pupils of your eyes


The whole point of adrenalin is to get you ready for “fight or flight”, and to do it fast. It increases the amount of oxygen getting to the big muscles in your legs, makes it easier to see what’s in front of you and sharpens your mind towards the stressor. All of this is great if you’re being chased by a puma, but we’ll explore how some of this works against us in modern society.


The other part of the adrenal glands is the cortex, and this is where cortisol lives. Such a famous hormone now, cortisol gets blamed for just about everything that goes wrong these days. And while low or high level s of this hormone are problematic, it has an important role to play in the stress response. Unlike the catecholamines, cortisol works a little more slowly and is in charge of “rerouting” the rest of the body in times of stress. What does that mean? Here’s what that means:


*Cortisol weakens your immune response, because during stress your body doesn’t care about healing


*Cortisol slows your gastrointestinal tract, because during stress your body doesn’t care about digesting


*Cortisol decreases your libido, because during stress your body doesn’t care about reproducing


*And perhaps one of its biggest jobs: Cortisol increases your blood sugar so that your muscles get enough energy to either fight the puma or run away from it


So all of that is well and good. But! With the exception of the time I was camping as a kid and I thought there was a bear outside my tent but it turned out to be my brother, I haven’t really spent much time in my life being chased by predators. Modern society has created a pretty cushy existence for us humans, one in which we are protected from the kinds of life-threatening stressors that evolution has built the stress response for. This can be a huge problem.


See, your body only knows how to do all the stuff I listed above when you’re stressed out. That’s all it knows how to do. So even though for most of us stress comes in the form of a missed deadline, the kids screaming, traffic jams and the grocery store being packed the day before Thanksgiving, our body still reacts to that mental anguish as if we are being chased by a puma.


This is a problem.


It’s a problem because our modern world produces a lot of mental anguish. Our lives just seem to get faster and more complicated as human existence goes on, which means we get stuck in fight or flight and can’t get out. Our bodies just aren’t wired to be in stress mode all the time. Adrenalin and cortisol are designed to be in charge for a short period of time, then recede and let our “rest and digest” hormones take over. But this just doesn’t happen for a lot of 21st century humans.


This is not without consequence. We see more and more people with both mental and physical symptoms of chronic stress, where the body is living in a heightened state without any breaks. Sometimes folks get GI upset and constipation and they don’t know why. Sometimes its high blood pressure. It is not unheard of for chronic stress to push someone on the edge of diabetes all the way into it. If you throw lack of sleep and our modern diet into the mix, it’s just bad news all around.


So what do we do? This is the part I really want to talk about, because I think there are a lot of misconceptions out there about “adrenal fatigue” or “adrenal burnout”, and even more about how to treat this condition. It is now accepted among most functional and non-functional practitioners that “adrenal burnout” is a misnomer. For the folks that haven’t heard of it, adrenal fatigue is the idea that when pushed to release cortisol again and again and again because of chronic stress, your little adrenal glands get tired, and they just can’t do it anymore. It’s not that this idea isn’t plausible; it’s just that the wording just doesn’t accurately reflect reality.


What’s actually happening with cortisol levels and chronic stress comes from the brain, not the adrenals. When the adrenal glands pump out cortisol, it sends a message back to the brain that the job got done, which should stop the brain from asking for more cortisol to be released. But if the brain is continually battling stressor after stressor, that message gets lost. The adrenals keep being stimulated again and again and again. This mess eventually ends in a loss of proper conversation between the brain and the adrenal glands, and as a result, cortisol levels drop. This is more properly referred to as “adrenal insufficiency” or “HPA Axis dysfunction”.


Folks get tired. They get depressed. They can’t keep their energy levels up and they lose their ability to cope with stress at all. They don’t sleep well because cortisol also helps govern out sleep patterns. Appetite changes. Blood sugars go down. Things are not great.

It is usually at this point that people end up in their doctor’s office with chronic fatigue. Many times, holistic-minded people turn to a class of herbs called adaptogens (because they help you “adapt” to stress) to help them feel better when they get to this point. Some of these herbs include ginseng, rhodiola, licorice root and cordyceps mushroom. While these herbs work really well, I am going to get on my soapbox for a minute and share a word of caution.

Repeat after me: Folks with adrenal insufficiency need rest. Say it again. Now a few more times.


Adaptogenic herbs help people with an impaired stress response stay in stressful situations. By giving them an energy boost and blocking the effects of stress hormones, they help people adapt to stress instead of take a break from it. Perhaps the most damaging aspect of this is that the “empty energy tank” at the heart of chronic stress just gets worse and worse, because these herbs do not help fill it, they actually enable someone to push the empty tank further.


So now I make a bold statement: unless it is an incredibly exceptional situation, people who have adrenal insufficiency causing chronic fatigue should not take adaptogenic herbs. Don’t pick up that bottle of panax ginseng and pop a few to get you through your day. Just don’t do it. That’s not what they are there for, and while adaptogenic herbs certainly have a role in recovering from chronic stress, they are not there to help you push yourself past your limits.


You have to fill the tank.


How do we do that? Folks with adrenal insufficiency need rest. They need to sleep, probably a lot. Sleep allows your body to repair inflammatory damage, normalize cortisol levels, blood sugar levels and generally gives your body a chance to reset. Here’s the other stuff that plays an important role:


1. Stress reduction techniques. This could be therapy, it could be meditation or it could be watching a funny movie


2. Eating right, and the right amount. Some people stress eat and others completely lose their appetite. Try to eat three meals a day, even if they are small. Remember your body needs proper nutrition in order to heal. Choose a nutrient dense, whole food based approach that minimizes caffeine and potentially inflammatory foods such as trans fats, processed foods and added sugars. The Mediterranean diet is a nice place to start and information on that is widely available. Try not to eat before bed, especially sweets.


3. If you or your medical provider thinks you might need medication, that might be the right choice for you. Stress for some people truly is a chemical deficiency. There’s nothing wrong with getting the kind of help you need, and don’t let anyone tell you otherwise.


4. Do use herbs that help with sleep and relaxation. Some great ones are California poppy, passionflower, blue vervain, kava kava and valerian root. Talk to someone who knows how to use herbs properly before starting herbal therapies.


5. What have you done for your flora lately? A huge amount of serotonin is produced in the gut, and a healthy microbiome is necessary for that to happen. Try adding some probiotics to your life: in food form is best, like plain yogurt, kimchee, sauerkraut, but if thats really not an option for you, you can take a capsule. Make sure the capsules you buy have at least 3 strains, and are coated to survive stomach acid. Make you're eating a large array of fibrous, colorful vegetables to feed your microbes, and stay away from inflammatory foods.


6. Lastly, and maybe most importantly, take a look at the stressors in your life. Can you change any of them? This might be reevaluating a relationship, asking for help with the kids more often or finding a different job. Sometimes it’s impossible to change these things. But the ones you can change, do it. Self care goes a long way in the road to recovery from stress.


After a person suffering from chronic stress and adrenal insufficiency starts putting energy back in their reserve, then adaptogenic herbs are appropriate to assist them in preventing the same thing from occurring again by protecting their hormonal pathways. And in some cases, they may be appropriate earlier on if someone is in crisis and just needs a little leg up. But remember, root cause medicine means you treat the underlying problem, not just the symptoms. While symptom management is important to get folks in crisis to a place where they can look at the bigger picture, it should never stop there. The road to wellness is a long one, especially with chronic stress. Always remember to ask for help when you need it, take deep breaths and never stop loving yourself.


Happy Holidays everyone! Be safe, be healthy and enjoy it!