Updated: Nov. 12th, 2023

When was the last time you felt exhausted, anxious, and overwhelmed? If you’re like many women I know, you won’t have to think too hard to come up with this – and it wasn’t that long ago!

Do you have a time in mind? When you do, ask yourself what you assumed caused this feeling. Maybe it was the stress of an upcoming event or deadline, the needs of your family, or just a very long day. Maybe you didn’t sleep well, or drank a little bit more wine than you normally would over the weekend. You might suspect, or even know, that you have a hormonal imbalance, adrenal fatigue, or another underlying issue that is contributing to your symptoms and feelings.

But what about your gut? Did you know that a digestive system imbalance could be contributing to fatigue, anxiety, and any number of other symptoms of adrenal dysfunction?

Over the last few years, research has exploded linking the gut to the brain and many other health concerns. More and more people are now at least somewhat aware of these connections. Still, when we feel exhausted and moody, we don’t tend to think of the gut. And we don’t always make the connection between these symptoms and adrenal fatigue.

One of the most important components of functional medicine is making the connections that conventional medicine might miss. Gut health and adrenal health are linked in myriad ways, and often need to be addressed together in order to heal and achieve optimal wellness. Let’s take a look at the profound connections between the two, and what we can do to restore balance and healthy function to both the stress response and the gut.

The connection between adrenal fatigue and gut health

When Sarah came to see me, she had already done some research. She knew her symptoms aligned with symptoms of adrenal fatigue, and had been trying some natural solutions, but nothing seemed to be helping. I took a detailed history (as I always do) and, as is often the case, I learned that she was experiencing a fair amount of digestive dysfunction in addition to her other symptoms.

Some women have already been diagnosed with a gastrointestinal condition like IBS, when they come to see me. Others, like Sarah, are experiencing undiagnosed symptoms like bloating, abdominal pain or discomfort, gas, constipation, or food sensitivities.

Depending on how severe the digestive symptoms are (especially compared to any other symptoms you’re experiencing), they may not seem like a high priority issue. That was Sarah’s situation. She almost didn’t mention those symptoms at all, because her other symptoms were so intense. But gut health has a huge impact on adrenal health and vice versa, whether or not gastrointestinal symptoms are problematic enough to raise the red flag.

As with many connections between different body systems, the relationship between gut health and adrenal health is like a circle. They’ve worked together forever, and we can’t always pinpoint where or when the relationship became dysfunctional. Imbalances in the gut contribute to adrenal fatigue or dysfunction, and adrenal fatigue contributes to issues in the gut.

And of course, the vicious cycle of stress impacting gut health and vice versa leads to more dysfunction related to hormonal and neurotransmitter balance, immune system function, thyroid function, and more.

What stresses out the gut?

If we take a look at what we know about adrenal fatigue, it all makes sense. The adrenal glands and the rest of the HPA axis are responsible for producing hormones in response to stress, and thereby regulating our stress response. Adrenal fatigue, which can lead to all kinds of symptoms that interfere with our quality of life, occurs when stress is high and/or chronic, preventing the adrenal glands from functioning properly.

Although major traumatic events and extremely high-stress situations can certainly lead to adrenal fatigue, I often find that the biggest problem is chronic, “low-level” stress. This is the kind of stress that just lingers around all the time, putting our bodies in a near-constant state of fight-or-flight, instead of returning to normal after a danger has passed. And it’s important to understand that when we talk about stress for our bodies, we’re not just talking about emotional and mental stress (worries related to family, relationships, work, money, etc). Stressors also include things like chronic exposure to toxins, inflammatory foods, or hidden imbalances within the body.

The body responds to stressors like inflammatory foods in the same way it responds to stressors like getting into an argument with a loved one. And here’s the thing: anything that is stressful for the gut is stressful for the entire body and mind.

Common stressors related to gut health can include things like food sensitivities (especially the hidden ones), foods that are inflammatory or difficult to digest, the presence of parasites, an overgrowth of bacteria in the small intestine (SIBO), a yeast overgrowth or candida, dysbiosis (an imbalance between “good” and “bad” gut bacteria), nutritional deficiencies, the use of certain kinds of medications, and more. That’s a lot of stress – and often more than one is at play.

The underlying, low-level, chronic stress caused by these triggers and imbalances can lead to or exacerbate adrenal dysfunction, and perpetuate the vicious cycle. It can be so frustrating to feel like you’re doing everything right when it comes to healing from adrenal fatigue, but you’re still suffering. The thing is, many gut stressors are hard to find. Even if you’re eating a healthy diet, if you have a moderate food sensitivity that you’re unaware of, or if you have a leaky gut or another functional digestive issue that is keeping you from processing nutrients properly, you might end up hitting a wall. That’s what happened to Sarah. She was trying so hard to follow all my natural healing solutions, but hadn’t stopped to consider that her digestive symptoms might be connected.

That’s why it’s so important for women (and their physicians!) to really investigate and search for where some of our less obvious stressors might be– including in the gut– so that we know which areas we need to target.

This is especially true if, like Sarah, you’ve already spent some time working on healing from adrenal fatigue, but you’re still not where you want to be. If it feels like something is missing, an imbalance in the gut just might be the key.

How stress affects digestion

Our stress response is designed to help us in very challenging or truly dangerous situations. In order to keep us sharp and focused on dealing with the stressful situation (both internally and externally), our stress response slows down or shuts off functions that seem to be less pressing. This includes immune system function, reproductive function, and digestion.

This is actually very helpful in the face of a truly stressful event! But when stress is constant, including from exposure to toxins, gut imbalances, and overly stressful day-to-day lives, essential systems and processes like digestion are never really given the chance to function at their normal levels and do their jobs.

Chronically high levels of cortisol (the infamous “stress hormone”) can inhibit digestive function, leading to digestive issues as well as a reduction of healthy bacteria in the gut. Stress is actually a common cause of dysbiosis (an imbalance between friendly and unfriendly bacteria in the gut microbiome), which can contribute to health problems of all kinds, including (you guessed it) adrenal fatigue.

Adrenal fatigue and leaky gut

One of the most common issues I see associated with adrenal fatigue is leaky gut. What does leaky gut mean? Basically, our intestinal walls are protective barriers, designed to allow only certain things (like nutrients) out from the gut and into the bloodstream. Leaky gut occurs when this barrier becomes problematically permeable, and allows substances like undigested food particles and bacteria to slip through into the bloodstream.

When these foreign substances manage to leak out into the bloodstream, our immune system sounds the alarm, which can contribute to all kinds of issues including autoimmunity, increased food sensitivities, and chronic inflammation.

Elevated cortisol levels can actually increase gut permeability. Dysbiosis also contributes to leaky gut, and we just learned that chronic stress and high cortisol can contribute to dysbiosis, too. Of course, leaky gut and the resulting immune system issues all create more stress within the body.

How to Restore Gut Health and Heal from Adrenal Fatigue

There is so much you can do to help restore gut health and adrenal function naturally. Here are some of my top tips:

  • Try Probiotics: Probiotics are friendly bacteria that can be taken as supplements or found in certain kinds of food. The use of probiotic supplements in the treatment of a multitude of different conditions has been studied with positive results, as they help to repopulate the gut microbiome with the healthy bacteria we need to restore balance. Research has shown that cortisol levels can be lowered by taking a probiotic. Probiotics have also been found to reduce gastrointestinal symptoms associated with stress. Probiotic foods (fermented superfoods like kefir and kombucha) can also be added to the diet.
  • Eat a Clean Diet: Inflammatory foods including sugar, gluten, dairy, and processed foods are stressors for the gut and the rest of the body. Caffeine and alcohol are stressors, too. The more you avoid these things and build your meals around fresh, whole foods, especially clean protein, superfoods like dark, leafy greens, and healthy fats like avocados, the less stress you will be putting on the gut and the adrenals.
  • Look Into Specialized Testing: One of the best tools we have in functional medicine is specialized testing that allows us to explore factors that are unique to each individual. If you have made healthy lifestyle changes and are still struggling and confused, it’s worth looking into specific functional medicine tests that might help to fill in the pieces of the puzzle. Testing for IgG food sensitivities (different from food allergies) is huge, because many of us don’t even realize that our bodies are sensitive to certain healthy foods. Gut microbiome testing can also help to identify where there may be gut issues that are hindering the healing process.
  • Check Your Magnesium Intake: Magnesium is one of the most important nutrients for helping to normalize the stress response, heal from adrenal fatigue, and achieve optimal health, but many of us are deficient in it, especially if we have a leaky gut or another digestive issue that is keeping us from absorbing enough of it from our diet. Eat plenty of magnesium-rich dark, leafy greens like spinach and swiss chard, and consider supplementation if you are deficient.
  • Work on Stress Management and Relaxation: Healing from adrenal fatigue and restoring gut health requires that stress of all kinds is addressed. It’s important to take time for yourself to relax, practice yoga or meditation, spend time in nature or unwinding with loved ones, and learn to say no when you need to! It’s the only way you’ll be able to really recover. Getting enough good quality sleep is another absolute must!
  • Eat Mindfully and When Relaxed: Eating when stressed, nervous, in a rush, or distracted makes it harder for us to digest food properly. Even if you’re eating a healthy diet, if you’re forcing a meal down while standing up at the kitchen sink about to rush out the door, your gut and the rest of your body will be stressed. Work on creating an environment that allows you to relax while you eat, and focus on eating. It can even help to get into the habit of taking a few deep, cleansing breaths before every meal.

Sarah was surprised to find out how much her (seemingly minor) digestive symptoms could be telling her. We did some testing and she discovered she had a dairy sensitivity – and cheese had been a mainstay in her diet! She was also low in magnesium, and often ate on the run. She began taking a probiotic, a magnesium supplement, cut cheese out of her diet, and made a point to sit for her meals. After just a few weeks, she said she felt so much better!

Restoring gut health and adrenal function naturally is possible, and it all starts with understanding how connected these two areas really are. Keep these connections in mind as you go along your healing journey. I believe you can get to the bottom of your adrenal fatigue and any gut imbalances, and feel like the best version of yourself – just like Sarah!


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