15 - Recognizing Adrenal Fatigue in Patients and the Role it Plays in Emotional Health

Updated: Jan 25, 2019

I wanted to talk to my friend and nutritionist, Erin Thole, on recognizing Adrenal Fatigue symptoms in ourselves and our patients so we can understand the role that Adrenal Fatigue plays in emotional health. A lot of people don’t know the symptoms associated with Adrenal Fatigue, but here a few of them: Being prone to road rage Having the urge to cry Feeling constantly on edge Feeling irritable or depressed Feeling stressed or upset over little things Feeling listless, depressed, emotionally numb Having low libido, frequent nightmares, anxiety Startling easily Having trouble concentrating, feeling foggy

In our discussion, I wanted to analyze the intersection of physical and mental health in this situation. You can’t really heal one without working on the other as well. As therapists, we should definitely seek functional medicine so we are familiar with the pathways available for physical wellness.

I hope you enjoy the interview with Erin (You can also stream or download the audio on iTunes- this is episode 15.) Below is the full interview and an edited transcript of our conversation.

Here is an edited transcript of my interview with Erin Thole on recognizing adrenal fatigue in patients and the role it plays in emotional health:

Leanne Peterson: Today, I’m really excited to be talking to my nutritionist and friend, Erin Thole. Erin has worked with me on figuring out my diet and how to eat so that I have the most energy. Recently, I realized and self-diagnosed myself with adrenal fatigue. I thought I had adrenal fatigue because I was having some random symptoms, and felt all over the place. I Googled a combination of things, and the first thing that popped up was adrenal fatigue. I started reading about adrenal fatigue, and everything it listed - this kind of tired but wired state- was so accurate to my experience and what I had been dealing with. I wanted to share with the Inspired Therapist community, because as therapists, we kind of push ourselves and are on this go-go-go schedule. We find ourselves burning our adrenals out without even realizing it.

As therapists, when we’re kind of “on” for other people, really listening, really outwardly focused, it can be easy to go too far, to push ourselves too hard, and end up with this more literal, physical burnout than just this mental, “Oh, I’m burnt out.” It’s like, “No, really. I’ve burnt my body out, and because of that I’m having difficulty feeling awake, and difficulty being able to really feel energized at the right times.”

So Erin, I was hoping you could give us a little bit more information. I have a Google search definition of adrenal fatigue, and I’ve been doing my own research, but I’d love for you to talk to our audience about how you would know someone has adrenal fatigue, and what you see when people are experiencing adrenal fatigue, so if anyone is resonating with any of the symptoms they know that maybe this is something they should look into.

Erin Thole: Adrenal fatigue, adrenal issues and general hormonal issues is something I deal with a lot in my practice because we live in a society where, everyone’s just go-go-go all the time, and they’re like, “I’m not stressed. I’m not stressed. I’ve got plenty of energy or brain power or capabilities, or whatever, to power through everything that’s going on.” No one wants to admit that they need help, or that they’re tired, or that they can’t do something. We kind of live in this society where everyone is just burning the candle at both ends.

I see adrenal fatigue in many different forms in my practice a lot. It looks different to different people, depending on their situation and what else is going on with their health. A lot of times people will be super fatigued, have mood swings, hit that afternoon slump, or they have one period of the day for a couple of hours where they’re like, “Yeah! Go-go-go!” And it’s like they’re unstoppable, and then all of a sudden they slam into a wall. They’ll have problems sleeping at night, they have thyroid issues, mental fog, you know, that brain fog kind of feeling. They’re forgetful. I have a lot of clients who are like, “I just forget stupid things. I just make dumb mistakes. Things that I should know, things that are just kind of every day or whatever, and I just you know, forget to take the clothes out of the washer and put them into the dryer for 2 days, and then I have to re-wash that load of laundry.”

All of those things play into a big part of it. They also have food cravings. A lot of times people with adrenal fatigue will really crave sugar, especially in the afternoons or in the evening, because they’re looking to drive themselves out of that afternoon slump, or at the end of the day when they’re just crashing and they need to relieve stress and relax for a while. So they’re reaching for the ice cream, or the cookies, or the brownies, or something like that. If people have had chronic adrenal issues for a really long time, they’ll switch back and forth between the sugar and salt. Real salt, like Himalayan or Celtic salt, not table salt- which is just poison- has all of your trace minerals in it which is actually really nourishing for the adrenal glands. So a lot of times, we’ll start to crave salt after a while because the adrenals are so shot, and they’re like, “I just need minerals,” to boost them back up. So the body will start to crave salt. They might ping-pong back and forth between salt and sugar, salt and sugar. Need a pick me up, but then also need to nourish the adrenal glands. Unfortunately, people don’t tend to pick quality things to be eating when it comes to those salty foods. They’ll reach for the chips and the popcorn and things like that instead of making a bunch of vegetables, or having a smoothie, and having some salt in those things to replenish their minerals. They’ll be reaching for those salty snacks instead.

The tortilla chips, and the salsa, and the queso, and the guac, and you know, all the things. Bring me all the things. I know a lot of times, people will do their salt, and then they’ll do their sugar afterwards, or vice versa.

Those food cravings are really trying to give us signals. What I really work on teaching all of my clients no matter what they’re dealing with is that these symptoms that you’re having are not just random things that are happening within the body. They’re the body’s way of communicating with us to tell us, “Hey, this is off over here. Pay attention to me.” But sometimes it’s really hard to decipher what the heck your body is trying to tell you, which is why I’m here, I guess.

You’re the translator!

I’m the translator, exactly. Trying to figure out, get to the root of the issue.

Exactly, and I think that’s so important to know. For me, what tipped me off to the possibility of adrenal fatigue is that I was wired at night, so I was able to stay up really late. I did a lot of work at night. I could stay up till midnight, till 1 o’clock working, and my brain was working, and everything was like, “Let’s do this!”. But then in the morning, I could not get out of bed. It wasn’t even depression. It was physically, just so much fatigue I was having so much trouble pulling myself out of bed. That’s what I was reading, too, though. When your adrenals are messed up, your whole system is messed up, so you’re not firing at the right time, so that morning boost you’re supposed to naturally get, you don’t get anymore. Then it’s coming in later at night when you should be sleeping, so it throws the whole system off that way.

Exactly. When I do an adrenal panel on somebody, and I do those through urine and not through blood. The reason for that is if we look at blood first, the adrenal cortex won’t show up as fatigued in a blood test until the adrenals are about 90% dead. So by that time, you’re in a pretty dire straits situation.

Your blood is the last thing to change. So we test so many things in blood because that’s how our labs are set up, our medical system for the most part is set up to test blood. However, there are multiple ways to test for things that are, in a lot of cases, much more accurate, and much more proactive. So I test urine because in blood, we can only see the total hormone. I can only see your total number of cortisol at that exact point in time in the day. Or your cortisone or whatever other adrenal hormone that we’re looking at. So that gives people a big disservice when we do that. So when we test in urine, you do it at home, which is much easier to do.

You’re peeing on these filter papers 5 times a day at distinguished times in the day so we can see the rhythm or the pattern of what those adrenal hormones are doing throughout the course of the day. From nighttime, to early morning, and then throughout the day as well. When we get the results back, we can see that. You know, “When I wake up, this is where my cortisol is, this is where my cortisone is.” Then at noon, in the late afternoon, in the evening, at night. We have that so we can see, are you really, really low in the morning when you’re supposed to be having that get-up-and-go energy to get you moving through your day. A lot of times people are doing exactly what you’re talking about, where they’re actually flipped, and their cortisol level is so in the basement all day long until they get to evening, and then it spikes up and they can’t sleep at night. Their mind is racing. They’re thinking about a million things. Or they’re worrying, or they’re fidgety, and they’re agitated, and you know, things like that. Then the sugar and the salt feeds into that and makes you stay up even later.

With a urine panel, we’re able to see that. We’re also able to see the total, 24-hour cortisol, how much hormone is your body making in the day, within a 24-hour period. Is it high? Is it

low? And that shows us total hormone function and then we’re able to see cortisol to cortisone, which is your body favoring? If you’re favoring cortisone over cortisol, there’s way too much inflammation going on in the body, and there’s something else going on as well that we need to look into. Inflammation in the gut, the liver is not detoxing properly, the thyroid’s acting crazy, there’s something else going on there. Then we’re also able to see in urine, which we can’t see in blood, is how your body is utilizing that hormone. How is it detoxing those hormones out? We can only see that in urine.

A lot of times we’ll see people where their cortisol level looks like it’s in balance, if you look at the 24-hour period of time, but if you look at their detoxification of cortisol, it’s completely nonexistent. So in that case, what’s happening is the person is actually doing something called tooling, where their body’s really, technically not making that much cortisol, which is why they feel like crap, but their body’s also not detoxing cortisol. So it’s filling this cup, the little bit that you’re making just keeps on filling the cup, filling the cup, filling the cup. Because the body’s not draining it out.

It’s necessary to know the different ways these things are being processed in our body. It’s not just like, “Oh hey, you have a problem with adrenal fatigue, done.” No, no, no, these hormones can be a different combination of messed up.

Exactly. Which is why I like to do the panel that I do, to look at those adrenals. On that panel I also look at sex hormones, and I look at methylation, which is basically, methylation is in the simplest terms possible, how well does your DNA turn over, how well do your cells regenerate? A lot of people, methylation is just happening in general, and that’s part of the reason, or the majority of the reason why their body’s not detoxing the cortisol and the cortisone and things like that. And that adds to the crappiness that you feel. Also, a lot of times it will add to other issues within the body.

As a functional medicine practitioner, though, it’s important to remember that I’m not looking to cover up symptoms, or just to deal with symptoms, I’m looking to get to the why. Why do you have adrenal fatigue in the first place? Why does your panel look this way? A lot of times, that adrenal health will go back to liver health, liver toxicity, and also digestive health. Most of your hormones are made into their active form in the liver and the gut, so if those adrenals are off, the gut is more than likely off, and there’s this very, very strong connection between the adrenals and the thyroid. Especially for women, we see a lot of women who have been diagnosed with hypothyroidism, or maybe they haven’t been diagnosed, but they feel like they have a thyroid issue even though their doctor keeps on telling them that their thyroid is normal.

I’ll have clients where they’ve been on Synthroid, or something like that, for a long time, and they still don’t feel better. It’s because we have this missing component of adrenal fatigue going on. 9 times out of 10, if someone does have a thyroid issue, the thyroid is not the driver of that issue. It’s the gut, or the adrenals, or both.

We have to look at the why. Whenever someone comes to me and it’s like, “Okay, these are all the things you’re dealing with. Why? Why is that?” There has to be a reason. The body just doesn’t do something for no reason. Like, “Eh, I don’t think I want to deal with making adrenal hormones anymore, so I’m just not.”

Your body is always striving for optimal health, so we just have to help it get there.

Exactly. If you are someone who suspects you have Adrenal Fatigue, then you should definitely talk to someone about it. We’ll link Erin’s information in the notes. She works remotely, so anyone listening can sync up with her. But, you also need to find someone and start digging into “Why? This is what my body is going through. How can I support my body?”

And, like you said, Erin, the protocol to help with adrenal fatigue is a very holistic model of cutting out the foods that cause inflammation, cutting out the things that would irritate your gut, doing a lot more mindfulness to bring your body back to balance. It’s really interesting how it’s not just, “Adrenal fatigue. What’s the medicine I take for that?” It’s, “Oh, adrenal fatigue, ooh. I need to really learn how to support my body differently, because the way I’ve been running my body, and often running my body down, is no longer going to work. I have to really figure out what my body’s needing and meet those needs, versus continuing to force my body into how I want my body to be.”

Exactly. You know, in our current medical society, they don’t really test for adrenal issues unless it’s blatantly obvious that someone has some kind of adrenal autoimmune issue. Because unless you have an adrenal autoimmune issue, there’s really not a prescription drug that they can give you because everything is so intertwined, and it’s really based on your lifestyle. Because we have this medical field right now where it’s a very, “Here’s your diagnosis, here’s your medication”, which sometimes is good and a lot of times is really not so great, there’s really nothing they’re going to do if they do diagnose you.

Here’s the usual conversation, “You have adrenal fatigue.”

“Okay, well what do I do for that?”

“I don’t know, manage your stress.”

You know, there’s not a prescription really for that.

Right. I find that’s really hard working with clients who I see that have a thyroid issue or adrenal fatigue. I’ll really encourage them, like, “You should really look into other methods than just the medication.” Of course I’m not a doctor, but I’ll say, “Have you talked to a functional medicine practitioner?” And usually, people respond with, “No. I’m so frustrated with my doctor. I’m so frustrated that I don’t feel good. You want me to do this other thing? No, I don’t want to do that thing.”

As a therapist, that’s really hard because we’re here to help support people, and I think we’re really not supporting people to the best of our ability if we’re not aware of this stuff.

I just want to share with all the therapists out there, the psychological symptoms of adrenal fatigue, which are:

Clients who are irritable and quick to lose their temper,

They’re prone to road rage or become extremely angry over little things,

They feel constantly on edge, ready to lose it on the little things, feeling listless, depressed, or emotionally numb,

Their sex drive is low,

They have frequent nightmares, the overpowering urge to cry, trouble concentrating and feeling mentally foggy,

They suffer from free-floating anxiety, easily startled, feel stressed all the time, and everything feels like a chore.

This is where it’s so hard, because there’s such an intersection between, a.) our own selves. We probably can see, at least for me, I saw some of those symptoms showing up. But b.) working with clients seeing those. And then that frustrating piece of, “You’re coming to me for your mental health, but your physical health right now is so much determining your mental state that it’s hard to work with one without working with the other.”

Exactly. I don’t think you can really separate the two. You have to work on both. You have to work on the mental and the physical at the same time if you truly want to be well. I work with my clients on their stress management, and their outlook on life, and I refer them to other practitioners such as therapists. I just think that’s so important. You can’t really focus on one and not the other and expect to get stellar results.

But, people have to be ready to take action. They have to chew on it for a while, and sometimes that takes a year or two before they realize they’re ready. By then, they’re so exhausted and tired of feeling bad, they’re more open to change.

That’s a good point. Just like therapy, people have to be ready. But, as therapists, we have to be aware and provide a gentle nudge like, “Hey, I hear you, and we’re going to work on that, but, this could also be about your adrenals, so you might want to look into that.”

I also think we all should have that functional medicine provider that we can refer to. And again, not saying that you have to go to a certain person, but someone that you know and trust that you’re willing to send your clients to. At the Inspired Therapist, we’re all about us as therapists taking the best care of ourselves so that we can take the best care of others. It’s good to have a practice of seeking that functional medicine piece, so that you can be in full alignment and you're sharing from a place of, “Hey, I’m working on all these pieces, too.”

I think a lot of times people think their practitioners have everything all figured out, and they’re just like these perfect human beings. I like to share stories about myself with my clients so they’re like, “Oh, she gets it. She understands what it’s like to have X, Y, and Z”. Because we’re all human. We all have stuff. There’s always something. That’s really important. It’s not just like, “Here’s this name of this person.” It’s more like, “I went to this person. It was helpful to me. Maybe it’ll be helpful to you.” You know, that kind of thing. Then I think they’re a little bit more open to take you up on those offers Maybe not right away, but eventually.

Like I said for me, when I found that it had to with my adrenals, it just felt like, “Ahhhh. I’m not crazy. This all makes sense.”

So thank you so much for sharing. Do you have any other tips for people that either are experiencing adrenal fatigue, that think they might be experiencing adrenal fatigue, have clients who they can see these symptoms and think they might be present in their clients? Is there any other parting wisdom you have for us on this?

Diet is the most important thing, and a lot of times people think they’re eating clean, and they’re really not. Or they feel like they can’t eat clean because they don’t have willpower. 9 times out of 10, that is not the case. It’s hormonal imbalances that are causing the lack of willpower. So if we get those hormones in balance, and they just need support through that, and figuring out what foods are best for them. One of the biggest things is if you’re tired after you eat, you know, your food should be energizing to you. It shouldn’t be making you tired. If you’re tired after you eat, you’re more than likely eating too much starch, which is another sign of adrenal fatigue, and you’re probably not digesting starches very well. That’s something definitely to look for.

I recommend that you work with someone that knows what they’re doing with the adrenals. Whether that’s me, or another practitioner, to get to the root of the issue, because once you know exactly what your body is doing in terms of adrenal issues, it’s not really that hard to fix. You just have to know the underlying issue of what exactly is going on and what your hormones are doing, and then we unwind it from there. People need to know that it’s not a lost cause, it can be a pretty easy fix if you’re working with someone who knows what they’re doing.

Just remember that the diet is the most important thing and that everything in the body is connected. If you’re seeing someone that has a thyroid issue, or you are someone that has a thyroid issue, and you’re noticing that you have some or all of these symptoms, 9 times out of 10, it’s the adrenals that are actually driving the thyroid issue and that’s why you don’t feel better. Especially when your doctor is telling you that your thyroid panel is amazing.

Right. You feel crazy, because they tested everything.

There’s a book written by a doctor that specializes in thyroid issues, and the name of the book is, Why Do I Still Have Thyroid Symptoms When My Labs Are Normal? It’s obviously a very common thing if there’s this whole huge, thick book that’s dedicated to that topic.

He talks a lot about adrenal fatigue in that book. A lot of times the thyroid is not the root of the issue, the adrenals are part of the root of the issue, and typically the gut and the liver are the other parts. So we’re always trying to look for the why, not just, “Oh. I have this. Now I have this label. Okay.” That’s not the end of it.

Why do you have that diagnosis? It can be helpful in some instances when someone says they have hypothyroidism or Crohn’s. Then I know basically what’s going on with somebody, but a lot of times when people begin to just identify with the diagnosis, and then they just kind of succumb to it. But, you’re not your diagnosis.

Let your diagnosis be information on where you are now, not where you’re always going to be.

It’s more like a call to action, not a reason to get stuck.

I love that. That’s awesome, a call to action, not a reason to get stuck. That’s great.

Thank you for all of this information. I love to hear you speak and learn even more about adrenal fatigue, not only for me, but to share with others. Keep in mind that it can look different for everyone and if you’re feeling burnt out, maybe it’s simply you’re overworked, or maybe you’ve overworked yourself to the point that now your adrenals are suffering. So, the solution might be a little different than just taking a bubble bath.

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The Inspired Therapist is where mental health professionals turn to focus on their own wellness and reignite their passion for helping others.We help therapists create thriving practices through mentorship and personalized coaching. Our mission is to help you discover BALANCE, REFINE your SKILLS, and REIGNITE your PASSION!

Helpful links for today’s Episode:

Is It Me or My Adrenals?: Your Proven 30-Day Program for Overcoming Adrenal Fatigue and Feeling Fantastic https://www.amazon.com/dp/1401942873/ref=cm_sw_r_cp_api_dJB4Bb97BYH96

Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal: a Revolutionary Breakthrough in Understanding Hashimoto's Disease and Hypothyroidism https://www.amazon.com/dp/0985690402/ref=cm_sw_r_cp_api_hKB4BbPTMF357


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