This article originally appeared on The Trek, which you can read here.
Is your stamina and endurance suffering? Have you been getting more colds? Do you often hit a mid-afternoon slump? Do you feel anxious, down, and lack the motivation you used to have?
If you had asked me these questions a couple of years ago, the answer would have been a resounding “yes to all of the above.” I didn’t realize it at the time, but through long-distance running and hiking, plus ignoring my body’s feedback, I was gradually developing Adrenal Fatigue.
While there’s a lot of debate within the medical community about the existence and etiology of Adrenal Fatigue, the term is still widely used in popular media and within the general public. Increasingly, “Adrenal Fatigue” is replaced with more accurate descriptors like “HPA (hypothalamic-adrenal-pituitary) axis dysregulation” and “General Adaptation Syndrome.” But regardless of what you call it, the condition describes a set of symptoms resulting from the many effects of chronic stress on the body.
More on that in a moment.
What are the adrenals and how do they become “fatigued?”
The adrenals are two pea-sized glands that sit atop the kidneys and are part of the HPA axis, which controls our stress response (aka the fight or flight response). When we encounter stress, whether real or perceived, a series of hormones trigger the adrenals to release cortisol into the bloodstream to make us focused and alert. Heart rate increases and glucose is released to fuel muscles. Once danger has passed, cortisol levels return to normal, insulin takes care of the extra blood sugar that was released, and all is well.
Historically, dangers were short-lived. Imagine the lion chasing the gazelle. The gazelle goes into the flight response, outruns the lion, and then goes back to grazing. The problem occurs when the danger or perceived danger never stops. This is common in our world where stress comes in many forms from physical stress, such as over-training, to emotional and psychological stress, such as concerns over finances and relationships.
Constant stress is not common in nature. The gazelle doesn’t keep stressing about the lion after the danger has passed. When we’re constantly stressed, in addition to having extra cortisol in our bodies, we also pump out extra insulin. This leads to insulin resistance, weight gain and cravings for sugar, salt, and fat.
This results in the HPA axis becoming dysregulated. The HPA axis affects systems throughout the body including thyroid and metabolism, immune function, and hormone production.
Does any of this sound familiar?
Because the HPA axis governs several functions in the body, the symptoms are wide ranging. As anyone who has hiked a long trail will attest to, it is a demanding endeavor, and physical, emotional, and psychological stress is a constant companion. If you find yourself nodding yes to most of these, read on to discover steps you can take to mitigate adrenal stress.
Some of the more common symptoms include:
- Waking up not fully rested and having difficulty falling asleep.
- Craving sugar, fat, and salt.
- Hitting an afternoon slump and craving sugar, caffeine, or both.
- Gaining weight without changes in diet or exercise.
- Feeling anxious, down, or lacking motivation.
- Getting sick more often.
- Experiencing low libido and hormonal issues, such as infertility,
- Experiencing brain fog, such as issues with memory and focus.
Why are hikers particularly at risk?
Adrenal Fatigue exists on a spectrum ranging from adrenal overdrive to burnout and exhaustion.
As mentioned, stress is the driver of HPA dysfunction and that stress can come in many forms. It can be long-term emotional stress, like worrying that you’re not going to successfully finish the trail, that you’ll run out of money, or that you won’t find a job when you get home. It can also be physical stress, like walking 20+ miles daily and maintaining a poor diet. A disrupted circadian rhythm caused by poor sleep, disrupted blood sugar from eating processed foods and refined carbs, and inflammation from substance abuse, gut issues, chronic illness, bacterial infections, and wounds, among many other factors, can all contribute to the overall stress load of the body.
When you are chronically under-eating and over-exercising, the body goes into survival mode. Your body reduces thyroid production (which plays a large role in metabolism), reduces sex hormones, and increases cortisol while you try to meet the demands of these stressors. Eventually this leads to HPA dysfunction.
The physical stress of a long hike, coupled with the nutrient-poor diet and often low-quality sleep of hikers, sets them up as prime candidates for developing HPA axis dysfunction. Those who set out on thru-hikes also tend to be driven, Type-A personalities who ignore their bodies’ red flags and push through the discomfort.
I know that was the case for me on the PCT in 2014. I actually felt great for the majority of the trail. I didn’t experience any injuries or illnesses on trail. I ate a fairly healthy whole foods diet. It wasn’t until I returned home and tried to start training for my next ultra marathon that I discovered my stamina and endurance were completely gone. Many other symptoms, such as lethargy, muscle fatigue, and hair loss were surfacing as well. After a long process of searching for answers, I discovered I had adrenal dysfunction and Hashimoto’s thyroiditis. Some of the symptoms were there all along and I’d been ignoring them. My salt cravings, for instance, which gave me my trail name (Salty), are one that come to mind. Frequently experiencing cold hands is another symptom I’d been ignoring. Most of it didn’t hit me until I’d returned home though.
Before you end up with complete adrenal exhaustion, look for these early indicators:
- You experience a loss in appetite. If you’re normally hungry, then suddenly you’re not, this may indicate that you’re over-stressed.
- You have an inability to fall asleep and stay asleep, even when you’re exhausted.
- Your mood is off and you’re unmotivated, even though you’re living your dream and hiking through some of the most beautiful parts of the country.
- You’re really cold all the time (disrupted thyroid function).
- You’re sore more frequently, long after you have your “trail legs.”
How do I know if I have Adrenal Fatigue?
There are a couple tests which can be done by an integrative or functional medicine doctor to assess adrenal health. The most common is to check salivary or serum cortisol levels over a 24-hour period to see where there are dips and spikes in cortisol. Additionally, doctors can test other hormones such as DHEA, progesterone, and insulin, as well as immune markers to evaluate the effects of stress on your body.
If you’re experiencing some of these symptoms, you don’t need to wait for a test to begin treating yourself. Hikers may be able to improve symptoms with the following approaches:
- Reduce your stress as much as possible. Uncertainty is a big driver of stress. Set yourself up for less stress by having good health and solid finances before your hike as well as a plan for when you finish. Also, find support on your hike through fellow hikers and staying in touch with loved ones at home. Enjoy your adventure and don’t pressure yourself to hike at a pace that doesn’t suit you.
- Improve your sleep habits. Sleep is your prime recovery time, and how you sleep is how you hike. Make sure your sleeping pad is comfortable, your bag is warm enough, and avoid stimulants before bed.
- Regulate your blood sugar levels. Adjust your resupply strategy to include less sugar and more nutrient-dense foods. Include a healthy fat and protein with each meal. Fuel consistently to avoid bonking.
- Cut back on caffeine consumption. Caffeine can be a major adrenal stressor and it’s easy to overdo it on trail. Many drink mixes contain a lot of caffeine. For more consistent energy, opt for low-sugar electrolyte blends instead to flavor your water.
- Exercise, but not too much. This is next to impossible for thru-hikers, of course, but you can still listen to your body. If you’re constantly fatigued, give yourself an extra zero day in town. It’s your hike. Take care of your body, so you can finish the trail healthy.
- Add in adaptogenic herbs, such as Ashwagandha, Eleuthero, or Rhodiola. These can be sent in resupply boxes as teas, capsules, or tinctures. These herbs have a long history of traditional use in various cultures as well as scientific research showing their stress-protective properties. If you’re prone to stress, consider them an insurance policy.
- Take a daily multivitamin with B-complex and Magnesium. Even when you’re eating healthy on trail, you can run low on key micronutrients and stress depletes them even faster. Again, consider it a nutrition insurance policy. Throw a Ziploc with a few multi-vitamins in each resupply box. They’re not that heavy.
It’s important to note that I’m not a medical doctor and this is not medical advice. I don’t diagnose, treat, or prescribe. HPA axis dysfunction is a complex topic and it’s beyond the scope of this article to discuss it in full detail. This article is intended to raise awareness of an issue that hikers may be prone to experiencing, and which frequently goes undiagnosed since symptoms are wide-ranging and often confused with the ‘normal’ discomfort of thru-hiking.
If you want to know more, speak to a licensed medical professional.
If you’re seeking support with other health-related goals, such as increasing energy and stamina, eating well on trail, and preparing for or recovering from your hike, check out my other blog posts or schedule a free discovery session.