Adrenal Fatigue and Leaky Gut – Heal the Adrenals and Help Heal the Gut

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By Dr. Justin Marchegiani

Adrenal fatigue is a collection of signs and symptoms, known as a syndrome, that results when the adrenal glands function below the necessary level. Most commonly associated with intense or prolonged stress. Discover how these type of conditions are healed.

Today's video is going to be on leaky gut and adrenal fatigue, and this is a topic really near and dear my heart.

I see dozens of patients every week with chronic gut issues, whether it's ulcerative colitis, Crohn's, autoimmune diseases, or the thyroid or other tissues of the body, bloating, gas, constipation. And there is one unifying principle with all those different conditions — that is inflammation.


Inflammation is this chronic breakdown of the body.  So we have homeostasis where we have this constant building up and breaking down.  That's normal. It is life.  That’s homeostasis.  And with extra stress in our lives, conventional medicine calls it allostatic load.  I just call it stress from physical, chemical, and emotional sources that will start causing our body to break down faster than you build up.  So now we’re in this breaking down accelerated aging type of pattern.  Again, anyone that has gone to their physician and they have been told, “Well, it's all in your head,” or “You’re just getting older.”  That's what I'm talking about.  It’s this inflammatory breakdown.

Dangers of Medications

In conventional medicine, the only option really is dangerous medications. Ibuprofen, Vioxx, Celebrex.  Ibuprofen kills 20,000 people taken properly a year.  Vioxx killed 60,000 in the early 2000's according to all the released documents.  We have Vicodin, Percocets.  We have all of these Morphine-like compounds that are highly addictive, and then we have things like ibuprofen, Aleve, like I already mentioned. They actually drop down glutathione levels, too.  So they're going to decrease your liver's ability to deal with stress and environmental toxins. Lots of options in the conventional community that don't sound too pleasant and none of them really address the underlying cause.

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Functional Imbalance

When we talk about adrenal fatigue, it's really important.  We're talking about functional imbalances.  So I always tell patients, “Imagine health on a spectrum of 1 through 10.”  10 being optimal health, 1 being disease pathology.  This is where you go into your doctor's office and they’re like, “Whoa!  You got this disease or that disease, or that-it is whatever.”

Imagine the functional imbalance is somewhere between 5 and 2.  You're not sick enough to be picked up by conventional lab work or conventional doctor’s visit. But again, you're not feeling great enough where you’re motivated to be doing or you're feeling worse enough so you're motivated to be doing this lab work.  People that are 7, 8, 9, they’re feeling pretty good.  They’re probably not going to be motivated enough to dig in.  So somewhere on that spectrum of 6 through 2 where my functional imbalances kind of live.

Most patients that think we talk about adrenal fatigue, we're not talking about Addison's disease which is a extreme low version of cortisol, but we’re talking about functional imbalances and one of the key functional imbalances here is HPA.  Hypothalamus, pituitary–your brain–hypothalamus, pituitary, adrenal axis and this is what happens when we have chronic stress.

adrenal fatigue


We have cortisol which is a stress hormone.  Cortisol’s really, really important. It is glucocorticosteroid.  Let's break it down.  Anytime you don't understand a word.  You just draw it out and you break it up because it makes so much more sense.  Gluco–gluco meaning pertaining to blood glucose and energy.

Cortisol  for  Energy Production

So we have the energy side of the cortisol spectrum.  We need energy for healthy energy.  We’ll run cortisol rhythms on all my patients and typically cortisol is higher in the morning and it slopes down like a rollercoaster throughout the day.  So cortisol’s there, it responds to sunlight. Right around 6 to 7 AM–6 to 7 AM in the morning, cortisol is really high and what we'll see is if cortisol is low on that cortisol rhythm.  Imagine here is the natural slope. If someone's coming in here and they’re flatter, typically what we're going to see are energy problems. We’re going to see massive energy issues in the morning if our cortisol’s lower.  So we need cortisol for energy.

Mobilizing Blood Glucose

Cortisol mobilizes blood glucose.


Glucose then goes into the Kreb cycle and it spits out ATP.  ATP is the currency for our body.  Our mitochondrias need it.

Healthy Hormone Production

We need cortisol for healthy hormone production as well.  If we’re too stressed and our body is burning up cortisol, one the biggest imbalances we see is lower progesterone in relationship to estrogen.

Typically we have about 23 to 25 times more progesterone than estrogen.  But one of the starting points of PMS or any mood disorder is progesterone starts to drop and why does it drop?  Because it's actually going downhill to cortisol.  So we need healthy cortisol balance.  So it’s like Goldilocks.  You don’t want the porridge too hot, you don't want it too cold; holding that bar of soap, you grip it too, it squirts out; too loose, it falls out.

So if we’re too stressed, our progesterone goes downstream.  Any woman that has PMS, this is one of the underlying driving factors.  That's why the cortisol being a glucocorticosteroid. And that’s why watching your blood sugar and eating healthy glycemic foods are important. Also, not eating extra refined sugar, maybe even avoiding fruits and starches that are too sweet as well, can be really important to helping to balance PMS. This is because progesterone will go downhill to cortisol.  So you can see cortisol is really helpful for hormones.  Not too much stress or we go estrogen-dominant.

Cortisol for Inflammation


So corticosteroid– a lot of people hear corticosteroids may be in their inhaler or corticosteroids for a cream to rub on an achy joint. Maybe even heard of a cortisone injection.  These are really important.  They are anti-inflammatory components.  The problem when we expose joints or tissues to extra cortisol in medication form too long, it’s going to start breaking down ligaments, tendons, cartilage, soft tissue.  That’s why if you go to an internist or an orthopedic person, they're going to tell you, “I can only give you a couple of injections of this cortisone  before it starts breaking down their tissue.”  So they only can give you one or two shots.

Again, seeing lots of athletes–I see many of them say, “Well, I’m just going to get this injection,” and I tell them and I say, “You're going to make the problem worse in the long run.”  They come back in 3 to 6 months almost always and they're feeling worse than they did in the first place.  And that's not the best situation to be in if we're ignoring the underlying cause of a problem.  So this is really important.

We always have to ask, Where does inflammation come from?  The underlying cause. Well, what's driving that?  That is chronic pain.  Do you have chronic back pain, neck pain, old surgeries, old injuries.  This pain is going to drive extra cortisol.  So it’s kind of like having a leak in the boat. Water is going to come in slowly.  In other words, cortisol’s going to be leaking out slowly because of all this extra pain.


A lot of people ignore food allergens.  Now this is really important when we're dealing with leaky gut. This is because anytime you have extra intestinal symptoms (bloating, gas, fatigue, migraines), and you’re just not feeling good, almost always there’s going to be leaky gut in there.  And if you're eating gluten, you can almost always make the assumption there’s leaky gut.

Leaky Gut

Just for any new listeners here, leaky gut is nothing more than the gastrointestinal tight junctions.  So really simple, take your fingers.  Put them right together like this, hold them tight.  This is your tight junctions here. This is the inside of your tummy where the food is.  The outside here is where the blood is. Open your fingers up just a little bit and you can pop your fingers through, that’s like the undigested food particles going through into the bloodstream. And our immune system is not used to seeing all these undigested food particles and even bacteria like LPS, etc. So when these are in there, it’s stressing out our immune system.  Anything that you eat frequently enough, you’re going to develop food allergens, too.

There’s the old expression, if you love it, rotate it.  And part of healing from a healing gut is obviously cutting out all of the junky food and going on an autoimmune type of diet.  No nuts, no seeds, no nightshades, tomatoes, potatoes, eggplants, peppers. Potentially even low FODMAPs and eggs. Say that 10 times fast, that’s quite a-leave your head spin in there.

But again, foods are so important and again it's different for every person.  Sometimes we have to cut off FODMAPs.  Or maybe we have to be really strict on eggs. Sometimes we need more of a bone broth type of GAPs approach.  At times we need to cut out salicylates or phenols.  Again, it’s different for every person.  So having a kind of a baseline template wherein you can customize is the best way to go.


Infections, a lot of people that have these chronic leaky gut, chronic stress in their tummies, well, their hydrochloric acid levels tend to drop. And that's partly because they’re autonomic nervous system is favoring the sympathetic side.

So the sympathetic is the fight-or-flight mechanism and if you open up your Guyton’s physiology textbook, what you're going to see there is the fight-or-flight mechanism. This is actually antagonistic for enzyme and hydrochloric acid production. Big fancy words, all it means is that you're stressed, digestion goes down. That's why the parasympathetic, that's the opposite side of the sympathetic nervous system branch, is nicknamed the rest and digest.

Parasympathetic stimulates hydrochloric acid secretion.  Hydrochloric acid’s the first domino that then activates the enzymes, the protein-digesting enzymes in our stomach such as pepsin and these help break down protein.  The acidic chyme in our stomach then hits–it flows out into the small intestine and it hits the duodenum. This is where the bicarbonate is now secreted.  The gallbladder then produces bile salts. The pancreas produces more protease and lipase, more digestion occurs, and then reabsorption in the colon.


What we need is a healthy domino reaction that has to form.  We are in a sympathetic state because of inflammation, pain, allergens, chronic infections, emotions of feeling sick and tired. I almost always see that.  That in and of itself is a major stress.

Again, pain, food, infections, managing emotions. There are good things you can do with meditation, just communicating about emotions.  Also, there are different tapping techniques that you can do in such, very helpful to reducing that sympathetic amygdala type of brainstem sympathetic stress response.


A lot of people are exercising too much.  I can't tell you how many CrossFit patients I have.  They're just doing too much CrossFit.  CrossFit’s a great modality especially when it's ramped up for people in the right way at the right dosage in time.  It’s going to be a modality.  But some people are going at it too hard and they’re doing it too frequent. It's causing their body to break down. And we're making too much of this cortisol, too much of the corticosteroid side. Thus, we are becoming significantly inflamed.

adrenal stressors


So all of these things, if we have inflammation on one side, if we have energy issues on the other side. These are creating major, major problems and it’s setting us up for leaky gut. It’s setting us up.  Now, the longer our gut’s leaky, the more we start losing tolerance to self, meaning our immune system’s getting exposed to all kinds of food, even bugs.

Lipopolysaccharide from the bacteria in our tummy is going into our bloodstream.  It’s creating lots and lots of stress. And the longer we have our gut leaky, the greater chance we have of creating an autoimmune condition. There’s even a lot of research out there by Fasano, et al saying that it's almost impossible to have an autoimmune condition without having a leaky gut.  It’s like a prerequisite.

Treatment for Leaky Gut with the 5R Approach

So really simple, 5R approach is essential to healing the guts.

  1. Removing all of the bad foods is essential.
  2. Replacing enzymes and hydrochloric acid.
  3. When we repair, it’s adding extra nutrients to help soothe and heal the gut but we also need to be on an adrenal support. This is because the healthy cortisol from our adrenal glands helps put out the fire in our gut.
  4. Remove the infections.  This tends to get mixed up.  It tends to go first in a lot of doctor’s programs and people tend to have a healing crisis or a Herxheimer’s or die-off reaction.
  5. We put all of the good bacteria at the end. We don’t drop down seeds until we pull out the weeds. We remove the infections.  It's pulling out the weeds then reinoculating or dropping down the seeds.  So, it's weeds before seeds.

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Again, this is Dr. Justin here, lots of great information.  You may have to watch this video twice.  If you have a chronic tummy issue, chronic fatigue, even a thyroid issue, 90% of thyroids are autoimmune in nature, this information has to be applied to your health plan for you to get better.

If you have any questions or you want to reach out and start taking the right step to heal, click onscreen or click below.  I look forward to helping you out.

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