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The Exercise/Adrenal Connection: Why ‘pushing it hard’ isn’t necessarily good for your health

This article is also posted on This is a great website with a wealth of information  for women who are passionate about fitness, health, and wellness. 


Everyone knows that exercise is good for you. It is common knowledge that poor eating habits and lack of physical activity are two of the main causes of chronic disease in America. But today I want to talk to you about the other end of the spectrum.


There is a small, but growing, subset of the population that regularly participates in ‘high-intensity exercise’ routines on a daily to almost-daily basis. This type of exercise includes things like marathon running, bodybuilding, many competitive sports, and the expanding group of fitness programs like ‘Crossfit’ and ‘Amenzone’. These types of activities can be great for building physical fitness levels, preventing obesity-related diseases, building friendships, and even blowing off steam at the end of a hard day. And for many people out there, doing high-intensity exercise on a regular basis is a way of life. But along with its many rewards, this way of life can come with a few risks.


One of the main concerns with people who perform high-intensity exercise on a regular basis is its effects on the adrenal glands. The adrenals are two tiny organs that sit on top of your kidneys and secrete many important hormones like adrenaline, cortisol, and sex hormones. Cortisol and adrenaline are released when the body senses that it is under stress—and the important thing here is that it can be ANY kind of stress. It doesn’t matter if the stress is due to driving in heavy traffic, giving a presentation at work, performing an intense workout, or even worrying excessively. All of these things trigger the “fight or flight” response and cause the body to release adrenaline and cortisol.


Now this hormone release isn’t necessarily a bad thing. Both adrenaline and cortisol have many beneficial effects on the body. For example, they stimulate the breakdown and release of stored energy (protein, fats, and sugar) into the bloodstream for immediate use by the body. They also cause your body to divert energy from resting processes like digestion and immune function and direct it, instead, to your brain, muscles, and extremities. This increase in blood sugar and diverted energy is highly beneficial and essential when you are in the middle of a tough workout and your body needs calories to burn. It’s also helpful when you are doing strenuous mental work because your brain feeds almost exclusively on glucose.


So what’s so problematic about these hormones then? Well, just like everything else in life, problems only occur when moderation is lost. While our bodies actually thrive and function best on relatively short periods of stress that are interspaced with periods of rest and recovery (which is one of the reasons that exercise is so good for you), chronically high levels of cortisol and adrenaline can lead to all sorts of health problems. And the kicker is that your body reacts to ALL stressors the same way. So even if you are reading this and saying, “This doesn’t apply to me; I take the appropriate amount of rest time between my workouts,” keep in mind that rest doesn’t just mean ‘not exercising’. If the life you are living between your workouts is like many Americans’ — filled more with deadlines, to-do lists, financial pressures, and family responsibilities than with relaxation – then your body is likely being exposed to chronic stress.


Some of the most common conditions caused by chronically elevated stress hormones are insomnia, anxiety, and depression. There are many biochemical reasons for this. First of all, high cortisol actually inhibits the body’s ability to convert tryptophan to serotonin. On top of the significant mood changes that serotonin deficiency can cause, serotonin is a direct precursor to melatonin, a hormone that is vitally important to sleep. Due to their effects on blood sugar regulation, high cortosol and adrenaline can also lead to insulin resistance and Type 2 Diabetes. Excess cortisol also inhibits thyroid hormone production and can lead to hypothyroidism over time.


The next problem with chronically high cortisol is that it eventually leads to a cortisol deficiency. Your adrenal glands can only produce and release a certain amount of hormones before they simply run out of their precursor molecules or “hormonal building blocks”, and essentially “burn out”.  Low levels of cortisol can then lead to a whole different set of symptoms and disease processes. Some of the most common symptoms are fatigue (especially in the morning and the afternoon), unrefreshing sleep, sugar cravings, hypoglycemia, allergies, abdominal weight gain, and many different types of gastrointestinal and digestive problems.


Adrenal fatigue is also commonly associated with sex hormone imbalances, especially in women. Looking at the chart below may help this connection make more sense. As you can see, progesterone is a direct precursor to cortisol, so when your body is chronically pumping out stress hormones, your progesterone level can eventually become depleted. Additionally, when your body needs extra cortisol, it will preferentially choose to run the cholesterol/pregnenolone/progesterone pathway over the DHEA pathway that leads to formation of estrogen and testosterone. This is what is labeled below as the “pregnenalone steal”. In women, the primary producer of estrogen is the ovaries, so losing a small amount of estrogen is usually no big deal. But the adrenals are women’s only source of testosterone, so losing this pathway can lead estrogen-dominance, which is essentially a high or normal level of estrogen that is not being balanced by appropriate levels of progesterone and/or testosterone.


steroid hormone synthesis pathways


It’s important to note that whether you are a non-exerciser, light exerciser, or into extreme fitness, anyone exposed to chronic stress can experience these hormonal imbalances. But because intense exercise is a known trigger of these pathways, it is extra important for anyone who is an athlete to be educated and aware of what is going on inside their bodies at a biochemical level. That way, if symptoms arise, you have a better chance of figuring out why they are happening and most importantly, take appropriate action against them.


This is the point where naturopathic medicine comes into the conversation. First I want to say that, even though I am a naturopathic physician and am passionate about what I do and why I do it, I highly respect traditional ‘allopathic’ medicine. I personally encourage my patients to have both types of practitioners because each type has different training, specialties, and levels of expertise.  But when it comes to hormones, naturopaths almost always win in the expertise battle. The endocrine system is one of the most complex and intricate systems in the body, but also one of the most important and easiest to get out of balance. Because of this, naturopaths receive extra training in this area, both in analysis and in treatment.


The most accurate way to test steroid hormones is through the saliva. Salivary testing measures the biologically active component of these hormones, and, because it can be done at home, it allows for precise measurement of hormones at different times of the day and/or month. This gives the physician a complete picture of how much hormone the body is actually able to utilize and how that hormone level fluctuates based on bodily rhythms.


This is especially important with the adrenal glands because they do not secrete hormones at a constant level throughout the day. Cortisol is released in a cycle, with the highest value in the morning and the lowest value at night (when the adrenals are functioning properly). This 24-hour cycle is what is known as the circadian rhythm and is depicted below.


circadian release of cortisol


When a patient comes to my office with symptoms and/or a history suggesting an adrenal imbalance, running a salivary adrenal profile is one of the first things I do. This allows me to compare the patient’s cortisol rhythm throughout the day to a normal circadian rhythm. Depending on the severity and length of the stress, cortisol levels could be either high or low at one or many different times of the day. Because of their intimate correlation with cortisol levels, the profile also tests DHEA, progesterone, and fasting and non-fasting insulin. This information allows for very specific treatment based on exactly what is going on the patient.


While every treatment is individual, here are some treatments that naturopathic physicians use for adrenal imbalances:

  • Prescribing DHEA, cortisol, progesterone, and/or testosterone supplements to directly combat a deficiency.
  • Prescribing vitamins, minerals, and/or glandular products that provide cofactors and ‘fuel’ needed for proper adrenal functioning.
  • Prescribing herbal combinations that either tonify and strengthen adrenal function or “cool down” overactive glands.
  • Supplementing with the serotonin precursor molecule 5-HTP and/or melatonin.
  • Performing acupuncture, homeopathy, and/or constitutional hydrotherapy to re-regulate the body and stimulate proper adrenal function.
  • Providing dietary advice on foods that both “feed the adrenals” and combat blood sugar imbalances caused by stress.
  • Teaching mind/body techniques that modulate the stress response.


Just like anything else in life, exercise is about balance and moderation. While it is impossible to always live in complete equilibrium, learning what the symptoms of an imbalance look like and knowing that there are tools out there to help you is more than half the battle. If you are interested in learning more about naturopathic medicine or would like to find a naturopath near you, please visit your state’s naturopathic medical association website.

  • Posted by Dr Katie Nuckolls
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