Exercise and “Adrenal Fatigue”

In this episode we cover:

• The concept of metabolic reserve
• The price of being busy
• Halting withdrawals of metabolic reserve
• Building metabolic reserve
• The three stages of exercise

Chris Kresser:  Hey, everybody. Welcome to another episode of Revolution Health Radio. I’m Chris Kresser and today we’re going to answer a question from Jordan. So let’s give it a listen.

Jordan: Hi Chris. Thank you for all that you do in helping people like myself. As a result of my HPA axis dysfunction, my metabolism is pretty much shot. I would love to exercise, but every time I do, my fatigue becomes exacerbated. I would love to hear your thoughts on exercise while suffering from adrenal fatigue. Thank you.

Chris Kresser:  That’s a great question Jordan. It’s one that comes up a lot, particularly in my patient population, because I tend to see a lot of patients with HPA axis dysfunction. And for those of you that are not familiar with this term, this rather unwieldy term “HPA axis dysfunction,” or HPA-D, as we call it, the term you’re probably familiar with that most people use for this condition is “adrenal fatigue.” For a lot of reasons that I won’t be going into in this particular podcast, I think adrenal fatigue is not an accurate description of this condition and is a bit of a misnomer. And the system that governs our response to stress and our tolerance of stress is the HPA axis, or the hypothalamic–pituitary–adrenal axis. And this is a system that often becomes dysfunctional when we’ve been exposed to chronic stress and inflammation and chronic illness, and so we call it HPA-D.

The Concept of Metabolic Reserve

So before we jump into the specifics of my answer to Jordan’s question, I want to introduce another important concept to you, which is metabolic reserve. So metabolic reserve is defined as the long-term capacity of cells, tissues, and organ systems to withstand repeated changes to physiological needs. So that’s a mouthful, but we can use a couple of analogies to make it simpler to understand. So you can think of metabolic reserve like the charge level in a battery. So if the battery charge is full, your metabolic reserve is strong. You’ll be able to do a lot of work with whatever device that battery powers. But when that charge is depleted, the device stops functioning as well or obviously in some cases stops functioning entirely. If you have a cordless drill, for example, and the battery is run down, you won’t be able to drill a big hole in something because that requires more power than is available.

Another simple analogy is a bank account. So if you’ve got $100 in the bank and you withdraw $150, you have then overdrawn your account. And you might be able to do that a few times, but if you keep doing that, over time it’s going to present some problems. So with HPA-D, your battery is low or your bank account is depleted, however you want to think about it. So if you try to do a lot of exercise, you’ll not only not be able to do that exercise, you’ll actually exacerbate the HPA-D. So if you do have HPA-D and some of the symptoms of this in fact might be reduced exercise tolerance or decreased performance in whatever activity that you’re doing, fatigue, insomnia, not sleeping restfully through the night, not waking feeling refreshed even if you slept well, increased tendency to get colds and flus and other illnesses, brain fog, low libido, cold hands and feet. These are the kind of telltale symptoms of HPA-D. So if you have this condition and you try to do a lot of exercise, you’ll not only not be able to do it, you’ll exacerbate the HPA-D. You’ll make it worse and you’ll dig a deeper hole for yourself that will be harder and harder to get out of. And I see this happening a lot in patients and readers, people I’m exposed to, and it can create a real problem over time. Because the further you get into that hole, the more difficult it is to get out of it and the more patience it requires to get out of it, which we’ll talk a little bit more about in a moment.

Should you exercise when recovering from “adrenal fatigue”?

So if you have HPA-D, you’ll need to focus on rebuilding your metabolic reserve. So in other words, recharging the battery or refilling your bank account. But how do you do that? It’s pretty simple, actually. If we’re going to stick with the bank account analogy, you need to do two things. You need to first reduce the number of withdrawals that you’re making on that bank account. And second, you need to increase the number of deposits that you’re making into that bank account.

The Price of Being Busy

So I said it is simple, but that doesn’t mean it’s easy. Many of us end up with HPA axis dysfunction because we’ve done just the opposite. We’ve made too many withdrawals and not enough deposits. And unfortunately that’s a bit of a cultural paradigm, in the industrialized world at least. And it’s somewhat built into the modern lifestyle. And you have to really kind of swim against the tide to reverse it. We have the sayings like “I’ll sleep when I’m dead,” and now it’s somewhat of a badge of honor to say how busy you are if people ask you how you’re doing.

We have this cultural attitude that being as busy as possible all the time is something to be proud of and a sign of our worth. And that’s really unfortunate because I think we’ve essentially created a cultural paradigm that celebrates HPA axis dysfunction and virtually guarantees it if you go along with the way things are currently set up. That would mean that in almost any moment of solitude you’re interacting with your digital device, your iPad or iPhone, or technology. Either you’re working almost constantly that you’re not taking any time for vacation you don’t have, and when you are on vacation, you’re checking your email and your social media accounts. You rarely if ever have time where you’re just truly resting without being engaged in some way in work or social media activities. And I think that this is having a profound adverse effect on humanity overall, and certainly on the industrialized world, and people who have these devices and are plugged into a certain kind of lifestyle. And I think it’s really actually causing serious harm to our nervous systems, not to mention just our sense of what it is to be human and our capacity for empathy and our ability to be present with ourselves and with each other. But that’s another podcast.

I just wanted to mention that because it’s not easy for many of us to make these kinds of changes. It’s not just simply a question of not having the right information. We have to actually shift the way that we interact with other people, the way we structure and manage our time, and the way we relate to ourselves. And that’s a big task and it’s why HPA-D is so common and why it’s not as simple as just taking a supplement or even changing your diet to recover from.

Halting Withdrawals of Metabolic Reserve

So let’s first look at the first strategy, which is reducing the number of withdrawals. And there are four big categories of triggers that lead to HPA axis dysfunction in the first place. So these would be, you could look at this as the four big categories of withdrawals that are made against the bank account, against our metabolic reserve.

1. So the first is perceived stress. And this is what most people think of when they think of stress. So these are emotional and psychological stressors. It could be financial stress, relationship stress, job stress, anything that provokes that kind of fight-or-flight response and that we experience as a stressor. And I say “perceived” stress because we know that what one person considers to be stressful, another person may not. And not all stress is harmful. It’s the stress that we perceive to be stressful that’s problematic. And the things that define whether we perceive something as stressful include how novel it is as an event, whether it’s new and unfamiliar. If it’s unpredictable, it’s going to be more stressful for us, and if we have a sense of loss of control, it’s going to be more stressful for us. So we want to do what we can to reduce our exposure to perceived stress. That’s not always … there are certain stressors that we can’t always eliminate, but we want to do what we can to eliminate the ones that aren’t necessary.
2. Dysglycemia, or blood sugar dysregulation, is another major trigger of HPA axis dysfunction. So eating a crappy diet with a lot of processed and refined carbohydrates, which wreaks havoc on blood sugar, can play a big role in inducing HPA axis dysfunction and withdrawing that bank account.
3. Inflammation, inflammatory signaling, is another major trigger, and that’s a very broad category, of course. It can be anything from an injury to a gut issue like SIBO or intestinal permeability or leaky gut or an autoimmune disease or arthritis. Most modern chronic illness is inflammatory in nature. So this is an important concept to understand because a lot of people think that stress is only psychological or emotional. The truth is, with both the blood sugar dysregulation and inflammation, we understand that anything that taxes the body over a long period of time like a chronic illness or chronically disrupted blood sugar is also a stressor on the body. So I like to tell my patients you could have no perceived stress at all, meaning maybe you’re independently wealthy, you’re living on the beach in Thailand and you have great relationships, and you have no stress in the conventional sense the way that people understand it at all. But if you have an autoimmune disease and your blood sugar is all over the map, then you can be under a significant amount of stress according to this way of understanding it.
4. So the fourth category of withdrawal is circadian disruption. So this essentially means too much exposure to light at the wrong times, meaning at night, and not enough exposure to light during the right times, which means during the day. So this can be caused by shift work or travel across time zones, or more simply and for more people just sitting in bed with an iPad before you go to sleep in the bright light that those devices emit. And then working inside of an office all day where you’re not exposed to light. So I’ve written about this a lot in my book The Paleo Cure and elsewhere in my blog. So I’m not going to go into detail here. But just know that circadian disruption is one of the main categories of withdrawals. So you want to reduce your exposure to all of those four categories as much as you can so you’re not taking as much out of the bank account.

Building Metabolic Reserve

What about deposits? These deposits that we make into the account, the things that actually rebuild our metabolic reserve.

1. The first would be a nutrient-dense diet. Nutrients are things that are required to rebuild that metabolic reserve. A Paleo template-type of diet is what I recommend, as I’m sure many of you know, as a starting place there.
2. Getting enough sleep. So seven to eight hours is what most people need to function properly.
3. Stress management, so this is reducing your exposure to stress as much as you can but also taking steps to mitigate your exposure to the stress that you can’t avoid that. I have an article about that with some tips on how to do that. If you just Google “Chris Kresser stress,” it should come right up at the top there.
4. Mindfulness practice or meditation—both of these can be really crucial in terms of rebuilding metabolic reserve.
5. Having fun and play are also very important, really as much a part of our human DNA and as necessary to our function and well-being as sleep and stress management and physical activity.
6. I think appropriate physical activity, which I’ll talk about a little more in a moment.
7. Touch and pleasure, so things like massage or sex, things that actually increase endorphin release in the body and help us feel connected to other people.
8. Along those same lines, social connection in general, so friends, family members, people in your local community, having meaningful social connections have been shown in many studies to have a dramatic impact on lifespan and life expectancy.
9. Spending time in nature, I think, is a crucial and often overlooked way of rebuilding metabolic reserve. We evolved in a natural environment and it’s only been very recently and as far as the evolutionary timescale goes that we’ve been, many of us at least, almost entirely separated from the natural environment in which we evolved. And there is something very soothing and restorative about being in nature, as I’m sure almost everyone listening to this podcast knows.
10. Creative expression, I think, is an important part of rebuilding metabolic reserve. There’ve actually been studies done on this. Listening to music, making music, even just observing art, certainly making art; those are all important.
11. And then having a purpose and volunteering are also important ways of rebuilding metabolic reserve.

So that’s a rather long list and a lot of things to choose from and things to bring your awareness to. So the more that you can incorporate those aspects into your life and the more you can reduce your exposure to the four categories of withdrawals—perceived stress, dysglycemia, inflammation, and circadian disruption—the more you will be able to rebuild your metabolic reserve.

The Three Stages of Exercise

So let’s talk a little bit more specifically about exercise now, since that was the focus of Jordan’s question. So remember that exercise is a stressor, and as I said earlier on in the podcast, not all stressors are negative. In fact some stressors can be hormetic, which means that they trigger a positive adaptation. So think about lifting weights. If you lift weights, you lift, let’s say ten pounds, and you lift it until you can’t lift it anymore, your body interprets that as a challenge essentially to its survival. And so you break down the muscle in that failure and then when the body rebuilds that muscle, it rebuilds it a little bit stronger so that it can hopefully meet that challenge in the future. And as I said, that’s a survival mechanism because that would’ve been an adaptive change that would help us survive in a natural environment.

So exercise, that’s how it benefits us through that kind of hormetic positive adaptation. But when you have HPA axis dysfunction and you do an amount of exercise that overshoots your metabolic reserve, it can actually become a stressor and it can trigger inflammation and be a withdrawal on the account rather than a deposit. And I think that’s what’s happening to you, Jordan. When you exercise and your fatigue becomes exacerbated, what your body is essentially telling you is that you have overshot your metabolic reserve with the amount or intensity of exercise that you did in that particular instance. So the strategy for physical activity involves the following stages when you’re recovering from HPA-D.

Stage one is where you really focus on minimizing withdrawals and maximizing deposits, as we just discussed. So during that phase, I would ask my patients to really limit exercise to very gentle activities: walking, restorative yoga, maybe mild cycling or mild swimming, and particularly qigong and tai chi, I have found to be helpful at this stage. Qigong is especially beneficial because it cultivates and builds energy rather than depletes it. And you can find a qigong teacher in your local area or you can you buy some videos on Amazon. Or Netflix probably has some streaming qigong videos if you subscribe to Netflix. It can be really, really valuable. But the point here is that you really want to be on balance rebuilding your metabolic reserve and you want your physical activity to contribute to that. Some people say, well, why not just completely avoid exercise during this first stage? Wouldn’t that be better in terms of rebuilding metabolic reserve? I don’t actually think it is. Being completely sedentary, I think, is stressful for the mind and the body. And doing at least some gentle activity, particularly outdoor activity, I think, is very helpful at this phase.

So if you do qigong, if you could go out and do it under a tree at least outside your house or in the woods or on the beach, even better. Because you’re accomplishing a few things at once. We mentioned time in nature is one of the things that rebuilds metabolic reserve. And then appropriate physical activities; so you’ve got two things there that rebuild metabolic reserve, and if you do it in a group, especially a group of people you’re connected to, you can get three things going all at once there. And then really kind of four things because qigong is arguably a mindfulness practice as well. So there are some activities where you really kind of can go a long way toward rebuilding the metabolic reserve. So that’s what you’re focused on in this first phase.

The second phase is when you feel your metabolic reserves start to improve, then you would gradually add some more moderate exercise in. But you have to watch out in the second phase, especially. It’s the most dangerous phase as far, as I’ve seen with my work with patients. Many of my patients tend to go too quickly here and they end up depleting their metabolic reserve again. And sometimes they end up even more depleted than when they started, and that’s a real risk. So it needs to be taken seriously. What will happen is, let’s say that if we use the battery analogy, they were at 10 percent battery. Then they went up to 20 percent or 30 percent battery and they really started to feel better and they get excited, and this is completely understandable. I’ve been through this myself, so this is part of the reason I can speak to it.

We start to feel like we have more energy again and we’re, like, “Fantastic, I can go back to doing exactly the kind of exercise I was doing before this started.” And we go out and we take a six-mile run or we go surfing for three hours or we do whatever it is that we do that we used to be able to do, and we might even feel okay while we’re doing it. But then the next day we wake up and we know that something is really wrong. And we don’t just go back to 10 percent in that circumstance, we often will go below that back to 5 percent. So it’s a stage that really demands a lot of patience. I think we all have a tendency in this phase to project how we’re currently feeling far into the future. And we can have thoughts like “I’ll never be able to do what I want to do again and I’m going to feel like this forever.” And that kind of thinking really doesn’t serve us because it makes it harder to just take one step at a time and be really gradual about how we reincorporate exercise and physical activity into our life. So at this stage I tell my patients you really need to err on the side of caution and not try to do too much too quickly. Because if you do, you could actually really set yourself back even further than you were when you started the recovery process.

So if you do manage stage two well, then eventually you end up at stage three, where your metabolic reserve is rebuilt and you can resume your full exercise activities. But you have to remember—even if this does happen, that you need to continue focusing on making deposits and not making too many withdrawals into the account. Unfortunately, as I said before, most people in the industrialized world have a tendency to do this. Meaning not enough deposits and too many withdrawals.

And I’ve also found that once people have experience with HPA-D, they do need to be more careful in the future because they just have a tendency to relapse. And you may even need to adjust to a new normal where you change the type and intensity of exercise that you do, especially for people who’ve been suffering for HPA-D for many years. It may not be possible to go back to exactly the kind of physical activity and routine that you were doing before you started suffering from HPA-D. I wish that weren’t the case, but I’ve just seen in my practice with patients that it’s not always possible to recover 100 percent of that function. And if it’s been many years, it’s also sometimes hard to know even what you would be in a different place anyways ten years down the line, even if you hadn’t had that HPA-D.

So it requires some flexibility, open-mindedness, a willingness to be present to what’s actually happening in the moment now; how your body is responding now and to give your body what it needs now rather than to stay attached to an idea of what kind of exercise you should be able to do.

So really there’s a lot more to this question than might meet the eye initially. And it’s a really rich question and it allows us to explore a lot of really important topics and approaches within this whole context of HPA axis dysfunction.

Okay, I hope this was helpful, everyone. And please do keep sending your questions. ChrisKresser.com/podcastquestion. See you next time.