Adrenal fatigue

Caffeine and your adrenals — could they be paying dearly?

by Marcelle Pick, OB/GYN NP

• Caffeine prompts the stress response
• How adrenal function supports hormonal balance and energy
• Caffeine, adrenals, and insulin
• Finding a healthy balance between caffeine and adrenal health

“I’m useless ‘til I’ve had my morning coffee.” How often have you heard this statement from a coworker, a friend, or even yourself? It’s almost a cliché in our culture that to get ourselves going in the morning, we need a caffeine jolt first thing — many of my patients reach for coffee, tea, or cola before they’ve even gotten dressed or had breakfast.

And you know, there’s nothing wrong with that — in moderation. But for many women, caffeine masks an adrenal imbalance that may be preventing them from restful sleep, so that they have a tough time waking up. When I suspect adrenal issues in a patient, one thing I ask about is her caffeine use. If she tells me she simply can’t function in the morning without caffeine — or that she needs several cups of coffee to get going plus “booster cups” later on in the day — it raises red flags about what might be going on with her adrenals.

I’d like to make the point that although caffeine itself isn’t the sole cause of adrenal fatigue, many of the changes our bodies undergo when we use a lot of caffeine can stress our adrenals to a point where they can no longer take the load. When we’re not getting enough rest, when we’re often anxious and “revved-up,” and especially if we’re substituting a cup of coffee for a nutritious meal (or for sleep!), these factors can all undermine our adrenal health. So let’s take a closer look at how caffeine affects our bodies — our adrenal glands, in particular.

Caffeine cries “wolf” to the stress response

It’s not news to anyone that using caffeine brings you “up,” making you feel more awake, alert, and energetic, but to catch the connection between caffeine and adrenal imbalance it’s important to look at what happens in the brain. As a psychoactive stimulant, caffeine increases the rate at which neurons in the brain fire and stimulates both the central and sympathetic nervous systems.

This “stimulation” that caffeine produces in the body has a lot to do with our natural reaction to stress. They both originate along the HPA axis: with just 100–200 mg of caffeine (less than one short cup of Starbucks drip coffee), your Hypothalamus, Pituitary, and Adrenals are suddenly engaged in the “fight or flight” response, pumping out stress hormones — epinephrine (aka adrenaline), norepinephrine, and cortisol.

These stress hormones are needed for our bodies’ innate response to a real or perceived threat, sending the message: Think fast! Act fast! That’s why, after that cup of coffee your pupils dilate, your heart beats faster, your blood vessels dilate, your breathing intensifies, your muscles contract, and your liver releases sugar and free fatty acids into the blood for instant energy. You may also feel more anxious and worried, with no more cause for these feelings than the shot of caffeine you just drank. You are literally poised and ready to outrace and outwit any danger — but most of the time you’re sitting at your desk or behind the wheel of your car.

That’s great for productivity and alert driving. What I like to tell women is that their adrenals’ “mission critical” is to ensure survival. But the secondary function of our adrenal glands is to provide for hormonal balance across the life span — and this function is particularly important as we get older.

The indirect effects of caffeine on adrenals, hormonal balance, and fatigue

The adrenal glands don’t just produce stress hormones — they also help to maintain levels of sex hormones as a woman transitions into menopause and her ovarian function tapers off. They just can’t do that when they’re constantly under siege — whether the “stress” you’re under is real or perceived, caused by a woolly mastodon or just the trials of everyday life in contemporary society — OR a turbo-charged caffeine hit every few hours, day after day, year after year! So indirectly, caffeine may be affecting your hormonal balance.

It’s a similar story with your energy levels. Caffeine used every so often, a cup or two a day at most, isn’t likely to do most women much harm, unless they’re highly sensitive to it. But when used more frequently or when the body should be naturally winding down for rest, caffeine disrupts the regular rhythm of cortisol. In effect, it distances you from your natural energy cycles, tricking your body into a state of emergency — which, in depleting your adrenal reserves, ultimately makes you more tired. Much more tired. If you use caffeine to offset fatigue, you can’t ignore the fact that your solution may be part of the problem — especially if you become too wired to rest when the time comes, and so weary the next day that you must reach for it again and again.

Caffeine, adrenals, and insulin

Another element of caffeine’s spell on a woman’s body is insulin resistance. The actions of cortisol and insulin are closely entwined, as the dominant hormones ensuring our survival. For those whose glucose tolerance and insulin sensitivity are completely normal, caffeine appears to have little harmful effect — but in a case where insulin resistance or diabetes is already underway, caffeine can make the problem worse.

Normally when you’re under stress, an increase in cortisol levels will prompt more glucose to be released into your bloodstream. Then your pancreas increases its insulin output, to usher all that extra glucose into your cells, where they can fuel your “superhuman” response to the “threat.” But in women whose cells are already insulin resistant, studies show that caffeine exaggerates their glucose and insulin responses.

It may be that caffeine directly inhibits glucose uptake in fat cells and skeletal muscle by occupying adenosine receptors. (Normally, adenosine causes drowsiness by slowing down the nervous system). Alternatively, caffeine could be acting indirectly by way of an increase in the release of epinephrine, which itself deranges glucose metabolism.

It’s confusing because caffeine’s effect on insulin sensitivity varies significantly between men and women; what condition the body’s in; whether caffeine is taken when fasting or with meals; and whether it’s paired with carbohydrates — particularly when taken with sugar. What’s more, tea does not appear to have the same insulin-deregulating effects of coffee. In fact, research suggests that tea does the opposite — helps reduce blood glucose — because of its polyphenol content, rather than any action of caffeine.

We’re still connecting the dots on all this, but the data clearly cast caffeine as a highly active metabolic agent that impacts both insulin resistance and adrenal imbalance. The two issues compound one another, and it’s very common for women to have both. Which comes first is like the chicken-or-egg dilemma, so for optimal healing you may need to address them both at the same time.

Finding healthy balance between caffeine and adrenal health

My message here is not that you must live the rest of your life without caffeine — rather, if you think caffeine could be having you instead of you having it, you may want to consider a caffeine holiday to help your adrenals heal. Just quitting caffeine won’t do it — you’ll need to look at your eating habits and stress patterns, too — but eliminating the “noise” that caffeine creates between you and your body’s natural rhythms will surely carry you a long way toward healing. Once the adrenals recover, you’ll be in a much better place to create a healthier relationship with caffeine.

But be prepared — caffeine is not an easy drug to quit for some women. I see patients in my office willing to make every other lifestyle change I suggest but this one. I’ve even seen women break down in tears when I suggest they forego caffeine for a day or two, to take the 24-hour tests I use to evaluate adrenal function. Caffeine is an addictive substance, both physiologically and psychologically, so stopping “cold-turkey” may cause you so much stress and discomfort that its absence does you more harm than good. (After all, when healing the adrenals the goal is to minimize stressors!)

When you’re ready to make a change for the better, there are a number of measures that can help ease your way — it’s not something that needs to happen all at once (for more guidance, see our article on caffeine detox). So if it takes you a while to cut back, that’s okay — with a deeper understanding of caffeine’s detrimental effects on your hormone balance, plus a little planning ahead, it’s easier to do what’s most beneficial for your adrenal health. Adrenal healing doesn’t happen overnight, and we wouldn’t want you to expect it to!

Do your adrenals need help? Here’s how to tell

If you’re uncertain as to whether your caffeine use could be masking or possibly incubating an adrenal issue, it might be helpful to keep a diary, so you know when and how much caffeine you’re using in the course of a day. Compare this diary to our diagram of natural daily dips and peaks in cortisol — do you see any patterns relative to cortisol? You may also want to ask yourself the following and jot down your thoughts.

• Are you using caffeine to bring you “up” during times when your adrenals would normally be expected to generate an upswing in cortisol?
• Or, are you using it during periods when you should naturally be experiencing a downward cortisol dip?
• Do you feel tired and wired a lot?
• Get a nightly “second wind” toward bedtime?
• Spring to life at 2:00 or 3:00 AM?

A “yes” response to any of the above could point to adrenals that are still providing cortisol, but not necessarily when it’s supposed to be peaking — upon arising, and at intervals through the day. Adrenal imbalance occurs across a spectrum, so it could mean that your adrenal function is progressing toward exhaustion, where they’re just not pulsing out much of anything.

Not surprisingly, this state is often accompanied by depressed mood. And if your adrenals are busy producing survival-mode cortisol for you — or they’ve gone beyond cortisol dominance to adrenal exhaustion — they’re not in a position to provide the level of sex hormones you need for hormonal balance, either. Learning where your caffeine use is having an impact, either by shoring up your flagging cortisol production or by throwing off your natural rhythms, is a first step toward restoring balance.

Where’s the caffeine? Tips for protecting your adrenals

One simple way to reduce the impact your caffeine habit has on your adrenals is to learn the caffeine content of your favorite caffeinated beverage and moderate your use accordingly. With coffee the general rule of thumb is that the darker the roast, the lower the caffeine content. Espresso actually has less caffeine than drip coffee, typically. Arabica beans are lower in caffeine than Robusta. Black teas are lower in caffeine than coffee, and green teas contain less than black varieties. Check out the Center for Science in the Public Interest for a list of caffeine-containing products and their caffeine quotients.

It’s also helpful to take a cumulative look at your daily caffeine consumption. You might find it helpful to record your eating patterns — what you eat and when — during the same period, and use the information to help make a transition away from caffeine. Supporting your body to stay in synch with its natural cortisol rhythms can make it easier to lessen or eliminate your caffeine dependency — especially if you pay attention to the timing and nutritional balance of your meals. (For more on this, see my article about eating to support adrenal health).

By addressing the caffeine habit, you can begin to restore the regular rhythms of cortisol and ease the strain on your adrenals, so they can fulfill that secondary but critical function we at Women to Women are always talking about: providing you with all the hormones you need for a lifetime! When you do, you’re honoring the body’s ability to create its own renewable energy sources from healthy adrenal glands and a balanced metabolism, supported by good nutrition — not the coffee machine! From there, the choice to use caffeine is up to a healthier, more energetic, more empowered you.

Related to this article:

References & further reading on caffeine and the adrenals

 

Original Publication Date: 08/24/2009
Last Modified: 02/16/2010
Principal Author: Marcelle Pick, OB/GYN NP