Are you experiencing fatigue, low energy, anxiety, depression, or brain fog? You may be dealing with adrenal dysfunction. Your adrenal hormones help to regulate your stress response, blood pressure, and metabolism. Your adrenals also work together with your mast cells. And mast cell problems, histamine intolerance, and adrenal dysfunction may go hand in hand.
In this article, I want to discuss adrenal health. Why is adrenal health so important and how can you support your adrenals? You will also understand the connection between your adrenals and mast cells. I will also recommend some dietary and lifestyle strategies and also the best supplements for adrenal health.
What Are Your Adrenals
Your adrenal glands, also known as your adrenals, are part of your endocrine system. They are two thumb-sized organs located just above your kidneys. They are responsible for making over 50 hormones to ensure optimal bodily functions. Some of the main hormones it produces include cortisol, adrenaline, and aldosterone (1).
Your adrenal hormones help to support and regulate a long list of bodily functions, including stress response, blood pressure, and metabolism. Your adrenal glands are also part of the hypothalamus-pituitary-adrenal axis (HPA axis), working together with your hypothalamus and pituitary gland.
Your adrenals and the HPA axis play an important role in the stress response. If there is an emotional, mental, or physical threat, your adrenals will release cortisol and adrenaline to help. Blood will be rushing to your brain, heart, and muscles. They will also release corticosteroids to reduce immune response, digestion, and other functions that your body doesn’t need for the immediate survival of a threat.
You may experience various adrenal issues, including adrenal insufficiency and adrenal fatigue. Adrenal insufficiency and adrenal fatigue are not the same, however.
Adrenal insufficiency refers to medical conditions where your adrenals are unable to produce enough of one or several of the hormones they are responsible for. Addison’s disease and Cushing’s syndrome or Cushing’s disease are two main forms of adrenal insufficiency.
You may develop primary adrenal insufficiency or Addison’s disease due to damage or trauma that causes problems with the production of cortisol or aldosterone. You may develop secondary adrenal insufficiency when your pituitary glands stop making adrenocorticotropin (ACTH) which stimulates cortisol production. Cushing’s disease is very rare and is characterized by the overproduction of cortisol. It may develop due to tumors, but often is due to an unknown cause (2, 3, 4). These types of adrenal disorders need to be managed by a medical specialist, specifically an Endocrinologist.
Adrenal fatigue, on the other hand, is a newer term. It suggests that stress can result in a mild form of adrenal insufficiency causing uncomfortable and chronic symptoms and health issues. The term was proposed by Dr. James L. Wilson in 1998. According to his theory, chronic, long-term stress can overstimulate your adrenals and lead to inconsistent levels of the stress hormone cortisol. Improper cortisol levels or too much cortisol may also be linked to low levels of DHEA, which is a hormone responsible for creating many other hormones.
Adrenal fatigue is a controversial condition. It is not a currently accepted medical diagnosis (5). However, it’s commonly accepted and used in functional medicine, naturopathic medicine, integrative medicine, and holistic health circles. The phenomena of adrenal fatigue may explain a group of long-term chronic symptoms, including fatigue, sleep issues, body aches, and digestive problems, especially in people under chronic emotional, mental, or physical stress (6).
Symptoms of Adrenal Fatigue
Symptoms of adrenal dysfunction or adrenal fatigue may include (6):
- Energy crashes
- Sleep problems
- Muscle aches and joint pain
- Brain fog
- Dark circles under the eyes
- Dry skin
- Pain in the upper back or neck
- Unexplained weight loss or weight gain
- Salt and/or carb cravings
- Low blood pressure
- Skin discoloration (hyperpigmentation)
- Hair loss and/or loss of body hair
Adrenals and Mast Cell Activation
Your mast cells interact with your mast cells in various ways. Stress and adrenal dysfunction may activate mast cell activation causing further issues. Let’s start with your mast cells.
What Are Mast Cells?
Your mast cells play a critical role in your immune system and overall health. They are a type of white blood cells in connective tissues, including your digestive tract, skin, respiratory tract, urinary tract, reproductive organs, surrounding your nerves, and near your blood vessels and lymph vessels. Your mast cells are in charge of storing histamine and other inflammatory mast cell mediators. When your body encounters an allergen or is exposed to a foreign pathogen or chemical, it can release these inflammatory mediators to fight invaders and protect your body.
Your mast cells are clearly critical for your overall health. However, overactive mast cells can cause issues. They may lead to mast cell activation syndrome (MCAS) or other mast cell disorders.
MCAS is a complex health condition that can cause chronic inflammation and widespread symptoms, including skin issues, headaches, migraines, fatigue, brain fog, weakness, dizziness, gastrointestinal troubles, anxiety, rhinitis, and more (7, 8, 9, 10).
Triggers of Mast Cell Activation
Mast cell activation may be triggered by a variety of stressors, including:
- Allergens, including insect bites, gluten, other foods, and preservatives
- Infections, including viruses and fungi
- Chemicals and other toxins, including conventional cleaning and personal hygiene products
- Heavy metals, including mercury from dental work
- Smells, including perfumes and other conventional beauty or body products
- Medications, including antibiotics, ibuprofen, and opiate pain relievers
- Physical or psychological stress from anxiety, exercise, lack of sleep, pain, rapid temperature changes, or other factors
- Hormonal changes, including hormonal fluctuations during the menstrual cycle
- Mast cell hyperplasia, a rare health condition related to certain chronic infections or cancers
Adrenals and Mast Cells
Mast cell activation can affect your HPA axis, and HPA axis function can affect your mast cells. When your mast cells trigger inflammation, they will generally turn on the HPA axis as well. However, when the HPA axis is turned up, it will further activate your mast cells. This can lead to a never-ending cycle of fight-or-flight response and inflammation.
Stress, including physical, psychological, and environmental stress, are among the major triggers of mast cell activation (12, 13, 14). When you are experiencing stress, your hypothalamus triggers the release of the corticotropin-releasing hormone (CRH). CRH prompts your pituitary gland to secrete adrenocorticotropic hormone (ACTH). Then ACTH will trigger your adrenals to make and release cortisol (15, 16, 17).
Under normal circumstances, increased cortisol production will send a message to your hypothalamus and pituitary gland to reduce the production and release of hormones, so the body can return to normal once the danger is over. However, if there is prolonged or chronic stress, it will lead to increased CRH production leading to increased or even constant cortisol production as well. If this becomes an ongoing issue due to chronic stress, it can lead to adrenal fatigue and related symptoms.
Moreover, CRH can also bind to mast cell receptors which can trigger histamine and other chemical releases (18). Increased histamine release will lead to increased inflammation. Since cortisol is anti-inflammatory, your body will send more cortisol to address histamine-related inflammation. This may force your adrenals to work overtime and lead to a vicious cycle of histamine and cortisol release (19, 20). If this cycle continues for a long time, it may further increase the risk and symptoms of adrenal dysfunction or adrenal fatigue.
If your body is experiencing chronic stress, it may cause your adrenals to limit the making of cortisol. This can lead not only to adrenal insufficiency but also to mast cell activation. Prednisone and other systemic steroids that are used to treat mast cell diseases may also confuse your body and cause your adrenals to suppress the production of cortisol (21). MCAS can also occur as a secondary condition to Addison’s disease.
Lifestyle and Stress Management Strategies for Adrenal Support
Adrenal health is clearly important for your overall well-being. It’s especially important if you are already dealing with mast cell problems or histamine intolerance. There are several lifestyle and stress management strategies you can try to support your adrenal health (+ I will share the best supplements for adrenal health in the next section):
- Follow an anti-inflammatory, nutrient-dense diet. Remove refined sugar, refined oils, artificial ingredients, additives, junk food, overly processed foods, and food intolerances. Eat plenty of greens, vegetables, herbs, spices, fruits, nuts, seeds, grass-fed meat, pasture-raised poultry and eggs, and wild-caught fish and seafood. If you have mast cell activation issues or histamine intolerance, you may want to avoid high-histamine foods and follow a low-histamine diet.
- Get 7 to 9 hours of restful sleep at night. If you have adrenal fatigue, you may need more sleep or naps during the day during your recovery.
- Move your body regularly. Exercise five times a week for 20 to 30 minutes, but don’t overexercise.
- Reduce stress as much as possible. Practice breathwork, meditation, yoga, and gratitude.
- Aim to do something joyful every day. Seek out laughter.
- Spend time with supportive friends and family and seek out a supportive community.
- Practice positive self-talk and positive affirmations
- Seek help from a therapist or counselor if you are dealing with trauma, anxiety, depression, other mental health issues, or simply need emotional support.
Supplements for Adrenal Support
In addition to these lifestyle strategies, I recommend several supplements for adrenal support.
DHEA, or dehydroepiandrosterone, is a precursor hormone that supports the production of stress hormones and sex hormones. Though your body naturally produces DHEA, production starts dropping as you age (22). Poor DHEA levels may be linked to adrenal fatigue. Poor DHEA levels may also contribute to depression, heart disease, sexual health issues, and mortality (23, 24, 25, 26, 27).
Taking DHEA may help to improve bone density, exercise performance, muscle strength, depression, and sexual function (28, 29, 30, 31, 32). DHEA may also be a great supplement for adrenal health. It may support the general health of those with adrenal dysfunction (33). According to a 2008 study published in the Journal of Endocrinology & Metabolism, DHEA may help to improve adrenal insufficiency (34). A 2007 study published in Annales d’Endocrinologie (Paris) has found that 25 to 50 mg of DHEA may be beneficial for adrenal insufficiency. However, further research is needed to fully understand its potential benefits (35).
Rhodiola rosea or rhodiola is a perennial plant grown in the mountain regions of Europe and Asia. It is commonly used in natural medicine as a remedy for all kinds of health issues. Rhodiola is an adaptogen, which means that it may help to improve your body’s resistance to stress (36). This means that rhodiola may be a great supplement for adrenal support. According to a 2015 study published in Phytotherapy Research, rhodiola may help to decrease stress, anxiety, and other mood symptoms (37). A 2018 review published in the International Journal of Psychiatry in Clinical Practice has found that rhodiola may be helpful for stress management (38).
By reducing stress, rhodiola may help to reduce cortisol and support healthy adrenal function. A 2009 study published in Planta Medica has found that rhodiola may help to lower the cortisol response and stress-related fatigue (39). Moreover, rhodiola may also inhibit histamine formation, reducing histamine-related cortisol production.
Ashwagandha is an evergreen shrub found in Asia and Africa. It’s another adaptogenic herb commonly used for its stress-relieving and other medicinal properties. Among many other benefits, it may be a great supplement for adrenal health. According to a 2012 study published in the Indian Journal of Psychological Medicine, ashwagandha may help to improve stress and anxiety in adults (40). According to a 2019 study published in Cureus, ashwagandha may be an effective adaptogen that may help to reduce stress (41). A 2012 case report published in BMJ Case Reports has found that ashwagandha may be beneficial for adrenal problems (42).
According to a 2020 study published in Antioxidants (Basel), ashwagandha may also help to reduce inflammation (43). Ashwagandha may also help to decrease histamine and improve sleep. A 2021 review published in PLoS One has found that ashwagandha may help to reduce mental alertness and anxiety and improve sleep (44). A 2022 study published in Preventative Nutrition and Food Science has found that by modulating the histamine receptor, ashwagandha may help to support sleep (45).
Magnesium is one of the most important minerals in your body. It may help muscle relaxation, support sleep, reduce anxiety, decrease migraines and headaches, reduce inflammation, support heart health, and more. Magnesium is also a great supplement for adrenal health. Unfortunately, magnesium deficiencies are common (46). Low magnesium levels may reduce the production of certain neurotransmitters and hormones, such as cortisol and epinephrine, which may increase stress, anxiety, mental health issues, and adrenal problems (47).
According to a 2020 review published in Nutrients, low magnesium levels may make you more susceptible to stress (48). A 2012 study published in Neuropharmacology has found that magnesium deficiency may cause adrenal dysregulation and anxiety (49). A 2017 systematic review published in Nutrients has found that magnesium supplementation may help to reduce stress and anxiety (50). According to a 1987 study published in Drug-Nutrient Interactions, magnesium deficiency may increase histamine levels (51). Magnesium may help to decrease histamine as well reducing histamine-related inflammation and cortisol release.
The last supplement for adrenal health I recommend is vitamin C. Vitamin C is a powerful antioxidant. It is well-known for its immune-supporting benefits and ability to support recovery from respiratory illness. However, vitamin C is also involved in cortisol production. According to a 2004 study published in the Journal of Inferno and Cytokine Research, vitamin C may reduce inflammation and cortisol production in runners (52). A 2001 study published in the International Journal of Sports Medicine has also found that vitamin C may help to modulate cortisol, adrenalin, and inflammatory cytokine production (53). Researchers found that vitamin C may help to support adrenal health and reduce inflammation. Furthermore, vitamin C may help to block histamine formation. A 2018 study published in the International Journal of Medical Research has found that vitamin C may help to reduce histamine and inflammation in allergy-related diseases (54). A 2014 study published in the Journal of Vestibular Research has also found that vitamin C may help to reduce histamine (55).
Are you experiencing symptoms of adrenal dysfunction, adrenal fatigue, mast cell activation syndrome, or histamine intolerance? If you want to improve your adrenal function, I recommend that you consider the lifestyle strategies and supplements for adrenal health outlined in this article. Working with a healthcare practitioner knowledgeable about histamine intolerance and MCAS is the best way to get to the root cause of your symptoms and create an individualized treatment. I welcome you to start a personalized functional medicine consultation with me for further guidance to improve your health. You may book your consultation here.
Check out my Histamine Intolerance Course here. Learn on your own time, from anywhere. Get an inside look at the most helpful functional medicine tests for pinpointing imbalances, ways to identify and manage the most common (and sometimes surprising) mast cell triggers, and learn what to eat, what to avoid, and why.