Adrenal fatigue
Caffeine and your adrenals — could they be paying dearly?
by Marcelle Pick, OB/GYN NP
“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 — it’s regarded as “fuel”
by many people, including some coffee purveyors (“America runs on Dunkin”!).
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 her about is her caffeine use — because
I can learn a lot about her adrenal health based on when and how often she needs
that caffeine boost. And when a patient tells me she simply cannot 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 — particularly if
we get caught up in the caffeine–fatigue cycle — 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, 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 see the connection between caffeine
and adrenal imbalance, it’s important to know what happens in the brain. As
a psychoactive stimulant, caffeine increases the rate at which neurons
in the brain fire and stimulates the central and sympathetic nervous systems.
This “stimulation” that caffeine produces in the body has an awful lot
in common 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 engage 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, you experience a surge in mental alertness
and increased muscle coordination and endurance. Your pupils dilate, your heart
beats faster, your blood vessels dilate, your breathing intensifies, your muscles
constrict, and your liver releases sugar and free fatty acids into the blood for
energy. You are literally poised and ready to outrace and outwit any danger —
but most of the time you’re sitting at your desk or in 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.
That’s because 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 declines.
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!
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
rhythms 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
One other piece of the puzzle many women don’t recognize while under caffeine’s
spell is insulin resistance. Cortisol
and insulin are closely intertwined, as the dominant hormones ensuring our survival.
For people whose glucose tolerance and insulin sensitivity are completely normal,
caffeine appears to have little effect — but when insulin resistance or diabetes
is already underway, caffeine can make the problem worse.
Normally when you’re under stress, an increase in cortisol levels prompts
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 via increased 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 a chicken-and-egg question, so when it comes
to healing, you may have to address them at the same time.
Finding a healthy balance between caffeine and adrenal health
My message is not that you must live the rest of your life without caffeine —
rather, if you think caffeine might 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 need to look at your eating
habits and stress patterns
— but eliminating the “noise” caffeine creates between you and
your body’s natural rhythms will bring you a long way toward healing. Once
the adrenals recover, you’ll be in a much better place to have 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 single lifestyle change I suggest but
this one. I’ve even had women break down in tears when I suggest they forego
for a day or two caffeine 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 benefit. (Remember, when healing the adrenals,
the goal is to minimize stressors!)
When you’re ready to make a change for the better, there are many measures
that can help ease the way, like weaning from caffeine incrementally and substituting
beverages with less caffeine. One adrenal-fatigued patient broke free of her heavy
caffeine dependency with an enzymatic probiotic drink called kombucha during
a “chillaxing” summer vacation. So if it takes you a while to cut back,
that’s okay — the idea is that with better 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 have to happen overnight, and we wouldn’t want you to expect
it to!
If you’re uncertain whether caffeine use is masking or possibly incubating
an adrenal issue for you, it might be helpful at first 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?
- Are you using caffeine to bring you “up” during times 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
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 a.m.?
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. It could also
mean your adrenal fatigue has progressed to 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 help make the sex hormones you need for hormonal
balance, either.
Learning where your caffeine use is having an impact, either by shoring up flagging
cortisol production or by throwing off natural rhythms, is a first step toward restoring
balance. Keep in mind as you do this that the caffeine content of caffeinated drinks
can vary widely from cup to cup. For coffee, a 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. Green
and black teas are lower in caffeine than coffee, but again, you want to take a
cumulative look at your daily consumption. Check out the Center for Science in the Public Interest
for a listing of various products and their caffeine quotient.
You might also 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 in synch with its natural cortisol
rhythms can make it a little 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 provide 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.
Our Personal Program is a great place to start
The Personal Program promotes natural adrenal balance with nutritional supplements,
our exclusive adrenal support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
We’re always happy to welcome new patients to our medical clinic in Yarmouth,
Maine, for those who can make the trip. Click
here for information about making an appointment.
Related to this article:
References & further reading
on caffeine and the adrenals
Original Publication Date: 08/24/2009
Last Modified:
08/26/2009
Principal Author: Marcelle Pick, OB/GYN NP