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Fundamentals of Adrenal Fatigue

Hormone Circuit

By: Michael Lam, MD, MPH

Article at a Glance:

  • Adrenal Fatigue has not been recognized by mainstream medicine, but that doesn't mean it's not real.
  • Adrenal Fatigue symptoms are not a natural part of aging. There is a reason you might not be improving despite taking supplements or exercising regularly.
  • Learn the common causes and the variety of signs and symptoms that accompany adrenal fatigue.
  • Read about the 5 steps to healing adrenal fatigue.
  • Find an experienced clinician to look at the whole history and full picture of your current health to make an accurate assessment and then use lab tests as needed for support.

What You Need to Know About Adrenal Fatigue and How to Approach It

Many adults share common complaints that can often be connected to Adrenal FatigueAre you one of the millions of Americans that feel tired most of the time, can’t get a good night’s sleep, are generally lethargic, get mildly anxious and/or depressed from time to time, have some kind of brain fog, and can’t seem to lose weight? This could be a sign that you’re suffering from adrenal fatigue and either don’t know it or suspect it but can’t confirm it with your doctor.

The majority of adults suffer from this chronic condition at least once in their lives, and the challenge in tackling it is twofold: first of all, most people believe such symptoms are just part of leading a busy life with many responsibilities, or just part of getting older. Secondly, the mainstream medical community hasn’t yet caught onto the condition, and instead often writes these symptoms off as signs of some other issue, such as depression.

Learn More:

» Read our complete long-read foundational article on Adrenal Fatigue
» Adrenal Fatigue FAQs
» Take our 3-minute test to see if you may have Adrenal Fatigue

But these symptoms are not a natural part of aging or leading a busy life. There is a reason behind these symptoms, there is a reason you’re not getting better even if you’re taking your supplements and exercising regularly, and there’s a reason why you can’t find the help you need.

At this time, Adrenal Fatigue has not yet been recognized by mainstream medicine, and most conventional physicians have not been taught anything about it in medical school.

This pattern has happened in the past with many chronic conditions, and it sometimes takes decades for mainstream medicine to accept the legitimate concerns of patients with a yet-unrecognized condition. This is what happened with Chronic Fatigue Syndrome many years ago, for example, until health professionals began to take the experience of their patients more seriously and realized that such vast numbers of similar complaints must mean something.

But for the time being, most sufferers of adrenal fatigue or adrenal burnout will have trouble finding the validation and relief they need, and instead will be met with skepticism or, worse, be misdiagnosed. Most sufferers will go to their healthcare provider with different adrenal fatigue symptoms and get one or several tests done. The results are likely to rule out other conditions, but fail to point to a solution to their very real problem.

Debunking the Myths: What Adrenal Fatigue Is and Isn’t

Even though adrenal fatigue is not yet recognized by mainstream medicine, it doesn’t mean that it’s not real. From the decades of my own experience with sufferers, as well as the experiences of scores of other health professionals that deal with and recognize this condition, I believe it’s only a matter of time until it becomes accepted by the mainstream medical community.

Adrenal Fatigue Syndrome (AFS) is a chronic condition that manifests in many nonspecific symptoms that vary in severity and effect. It is referred to as a syndrome precisely because it is recognized by the different symptoms that sufferers have in common, symptoms that frequently come together, even if, at first, they don’t seem to come from any one specific cause.

And that’s the crucial difference between seeing a health professional with experience in AFS and one that has no experience in it. The one with experience will understand that the diagnosis of this condition has to be a holistic one, taking into account your whole-person, mind, body, and spirit. They are focused on understanding how the different symptoms tie together along with the different stressors that contributed to the development of the condition.

Your regular physician will run normal blood tests, such as the ACTH (adrenocorticotropic hormone) challenge test, which looks for extreme underproduction or overproduction of hormone levels - the top and bottom 2 percent of a bell curve. This won’t detect adrenal dysregulation that is less extreme than Addison’s Disease or Cushing’s Disease.

Addison’s Disease, also called adrenal insufficiency, is a serious endocrine condition where your adrenal glands don’t produce enough of the adrenal hormones, usually due to some type of autoimmunity. Cushing’s Disease, on the other hand, is when your adrenals produce extreme and excessive amounts of adrenal hormones.

Although cortisol levels do go outside of normal ranges in AFS, usually increasing at first then dropping when the condition is more advanced, symptoms can begin to show up after a 15 percent deviation from the mean on the bell curve and this won’t be detected by the ACTH test.

Other lab tests, such as those that measure cortisol levels in the blood or saliva, can also be misleading. That’s because cortisol levels naturally fluctuate throughout the day, and they also greatly vary from person to person and situation to situation.

That’s why you need the eyes of an experienced clinician who will look at your history and the full picture of your current health to make an accurate diagnosis, and then, if needed, use lab tests as support.

One of the reasons I have come to specialize in adrenal fatigue is because of how it has affected my own life. I have been dealing with it professionally for decades, and I also have personal experience with it.

Many years ago, at the height of my career, I was hit with extreme exhaustion while on vacation with my family. My wife and I were so frustrated with the lack of information and help available for my debilitated state, we had no other option but to research my condition and experiment with different recovery techniques ourselves. My background as a trained medical doctor who also uses natural medicine, along with my wife’s experience as a nutritionist, helped me make a full recovery. I was later able to turn the protocol we used during my illness into a pattern that has helped thousands of others suffering from the same condition.

— Dr. Michael Lam, MD, MPH

The Different Causes of Adrenal Fatigue

Many sufferers of Adrenal Fatigue experience anger as a response to stressAlthough AFS is caused by chronic stress, you can’t just simply use relaxation techniques to recover from this often-debilitating condition. And if your doctor sends you home with some antidepressants or anti-anxiety medications and tells you to manage your stress, you run the risk of eventually reaching adrenal exhaustion, and maybe even becoming bedridden, with no help in sight.

That’s why understanding exactly how chronic stress affects your adrenal glands, and your body in general, is the key to understanding AFS. It will also help you approach the recovery process more holistically and intelligently.

When I talk about chronic stress as the cause of AFS, I mean any stressor that your body is exposed to on a consistent basis. This includes stressors such as:

  • An unhealthy diet
  • Overconsumption of sugar, refined carbs, and processed foods
  • Food sensitivities, such as gluten or dairy
  • A sedentary lifestyle
  • Excessive exercise
  • Anger, fear, guilt, shame, depression, and any other extreme emotional states
  • Chronic psychological stress
  • Chronic pain
  • Exposure to toxins
  • Chronic infections
  • Injury
  • Surgery
  • Sleep disorders
  • Chronic fatigue
  • Chronic illness
  • Consumption of alcohol and/or recreational drugs
  • Certain medications
  • Chronic dental infections
  • Exposure to toxins
  • Poor blood sugar control
  • Malabsorption
  • Digestive issues
  • Excessive caffeine intake

But how do these stressors lead to adrenal fatigue?It has to do with your body’s built-in stress-coping mechanism: The NeuroEndoMetabolic (NEM) Stress Response. Your NEM is composed of the following six circuits of organs and systems that work together to fight stress:

  • The Hormone Circuit
  • The Bioenergetics Circuit
  • The Neuroaffect Circuit
  • The Cardionomic Circuit
  • The Inflammation Circuit
  • The Detoxification Circuit

Although all six are engaged when your body is facing any of the above-listed stressors, the adrenal glands, which are part of the Hormone circuit, are usually the first responders and also the ones that bear that biggest share of the workload.

In addition to the adrenals, the other two components of the Hormone circuit are the thyroid and the reproductive organs (male testes or female ovaries). All three components secrete hormones that help regulate different processes in the body, and all three are managed by the control centers in the brain: the hypothalamus and the pituitary gland.

The hypothalamic-pituitary-adrenal (HPA) axis is the hormone cascade that is responsible for the release of cortisol from the adrenal glands. When the hypothalamus receives information that stress is present in the body, it sends a signal to the pituitary gland to release ACTH, which then stimulates the adrenal glands to secrete cortisol. Once the stress is gone, any circulating cortisol is then taken as a signal by the hypothalamus that stimulating the adrenals is no longer necessary and sends the pituitary gland the order to stop releasing ACTH.

Check out this easy to understand infographic about the signs and symptoms of Adrenal Fatigue Syndrome

The Signs and Symptoms of Adrenal Fatigue

Other than a general feeling of fatigue, lack of energy and lethargy, which are the hallmarks of this condition, the following is a list of the different symptoms you can experience with AFS, and they will range in severity depending on how advanced your condition is:

  • Easily gaining weight and difficulty losing it
  • Weight gain tends to be around the waist
  • Lack of energy in the morning
  • Lack of energy in the afternoon, usually between 3 to 5 p.m.
  • Tired from 9 to 10 p.m. but resisting going to sleep
  • Difficulty falling asleep
  • Difficulty maintaining sleep, and difficulty going back to sleep if awakened at night
  • Lowered immunity, leading to more frequent colds, flu, and other respiratory diseases
  • Infections last longer than usual
  • Longer recovery time from injuries or illnesses
  • Hair loss
  • Dry, thin skin
  • Lightheadedness, especially when rising from a horizontal position
  • Loss of libido
  • PMS
  • Periods can be irregular, and sometimes show a pattern of being heavy until day 4, almost stopping, then restarting on day 5 or 6
  • Infertility
  • Cravings for sugar and salt, as well as fatty and high protein foods like meat and cheese
  • Hypoglycemia, which can sometimes occur in the middle of the night leading to disturbed sleep
  • Difficulty getting up in the morning and needing to rely on coffee and stimulants to keep going throughout the day
  • Anxiety
  • Mild depression
  • Brain fog
  • Memory issues
  • Nervousness
  • Needing more effort than usual to perform regular tasks
  • An inability to handle stress
  • Trembling when under pressure
  • Feeling better when there is less stress, such as when on vacation
  • Feeling better for a short while right after a meal
  • Low body temperature
  • Dyspepsia
  • Alternating between constipation and diarrhea
  • Pain in upper back and neck, with no definite cause
  • Food and drug sensitivities
  • Heart palpitations

Most people will not have all of these symptoms, but if you find yourself with many of them, you likely have AFS. And even though these symptoms do not automatically mean you have the condition as opposed to something else, an experienced health professional will use them, along with your medical history and current situation, to make a diagnosis and come up with a plan of care.

How Do You Heal Adrenal Fatigue?

Although how you manage AFS will vary depending on the condition and needs of each individual, there are some fundamentals that should be part of any AFS recovery protocol:

1) Reducing Stress

Obviously, unless you reduce or remove the stressors that have caused AFS in the first place, the stress will keep causing problems for you.

If the stressors are physical in nature, such as suffering from recurrent infections or chronic conditions, this will require the help of a clinician experienced in such issues who can help you recover from them without damaging your health in the process. If the stressors are situational in nature, such as marital or financial pressures, you will need to find ways to reduce the stress of those situations, such as utilizing the resources and support systems available in your community. If the stressors are psychological in nature, such as suffering from depression or anger issues, it may be time to get therapy or join a group support program.

Sometimes removing stressors is impossible right now, in which case,  the best thing you can do for your body is to work on developing techniques that improve your ability to cope with stress. Using relaxation techniques, such as deep breathing, meditation, journaling, visualization, and yoga, can also be added to the above to help you cope with and reduce the stress in your life.

2) Switching to the Adrenal Fatigue Diet

The cornerstone of AFS recovery is the diet, and it’s not just about what you eat; it’s also about what you eliminate from your diet and the timing of your meals.

The first step in lessening the burden on your adrenal glands is to lessen inflammation in the gut, and that will happen naturally as you get rid of inflammatory foods and drinks, such as gluten, dairy, sugar, deep-fried foods, refined carbohydrates, alcohol, sodas, and any food or drink with chemical additives like artificial flavors, artificial sweeteners, and artificial colors.

Next, you’ll want your diet to be composed of:

  • An image of a healthy bowl of quinoa, vegetables and grilled chicken with extra spinach and lemon wedges on the side30-40% vegetables (half raw, half cooked)
  • 20-30% animal protein
  • 20-30% healthy fats, like nuts and seeds
  • 10-20% legumes and beans
  • 10-20% whole grains
  • 10-15% whole fruits

It’s also important to eat throughout the day with AFS. Although intermittent fasting is very popular these days, with a condition like AFS, your energy and nutrition stores are depleted, so you need to make sure you replenish them consistently. You should also be eating something every three or four hours to maintain stable blood sugar levels.

Don’t skip breakfast. Try to have a healthy, protein-rich breakfast as soon after waking up as you can. Assuming you wake at about 9 a.m., eat breakfast no later than 10 a.m. If you eat a very early breakfast, like at 6 or 7 a.m., then you should have a snack around 10 a.m. Lunch is best between 11 and 11:30 a.m., then have another snack between 2 to 3 p.m. to keep your energy levels going during the afternoon slump. Dinner between 5 and 6 p.m. is ideal, and, like most other meals, should be low on the glycemic index. You can have a light snack of soaked nuts or seeds before bed to ensure your blood sugar levels don’t drop while you’re sleeping.

3) Getting Enough Good-Quality Sleep

Recovering from any chronic condition requires a lot of rest and sleep, and this is doubly so if you’re recovering from AFS because of the lack of energy involved. Some tips to get good quality sleep are:

  • Avoid caffeine as much as possible.
  • Try to be in bed by 10 p.m.
  • Try to sleep in until 9 a.m.
  • Keep the same sleep schedule every day.
  • Stop using digital devices at least two hours before bed.
  • Keep your room cool and dark.
  • Don’t turn on the light when going to the bathroom in the middle of the night; use a nightlight instead.
  • Read a soothing book or meditate before bed to relax your body and mind.
  • Stop drinking water two hours before bed to avoid waking to use the bathroom, but make sure you have plenty of water throughout the day otherwise.

You should also allow yourself to rest during the day if you feel the need to.

4) Doing the Right Kind of Exercise

Depending on how advanced your AFS is, it can be best to do either very mild exercises or none at all at first. If you’re bedridden, then it’s best to avoid exercise until you have more energy. If your adrenal fatigue is advanced but you’re not bedridden, very gentle adrenal breathing and adrenal yoga exercises may help you feel better. Once your adrenals are stronger, you can increase the length or intensity of your physical activity, perhaps taking walks in nature or doing more rigorous forms of yoga.

5) Taking the Right Supplements

Supplements can help fill in any nutritional gaps in your diet or give you a therapeutic boost when needed. In AFS recovery, different types of vitamins, minerals, nutrients, herbs, glandulars, hormones, and steroids can be given as supplements, depending on your condition and needs.

Some of the most commonly used supplements in AFS recovery include vitamin C, vitamin B5, glutathione, vitamin E, vitamin D, adrenal glandulars, and adaptogenic herbs such as ashwagandha and rhodiola. Other nutrients you can consider are collagen types I and III, DHEA, and CoQ.

Vitamins and minerals are the least risky supplements, but they can still lead to paradoxical reactions if your body is very fragile or if the combination taken is not right for you. That’s why even something like vitamin C should be taken under supervision.

Hormones and prohormones such as pregnenolone, estrogen, testosterone, and progesterone can also be considered, though they can pose a risk of masking the problem rather than actually allowing your body to balance its hormone production naturally, and so should only be used if the benefits outweigh the risks.

Less commonly used are steroids, such as hydrocortisone, which can give you a big push at first but can then leave you dependent. Your recovery would then stand on the crutches of these kinds of supplements and may not stand on its own if you stop taking them. In some cases, it may be a good idea, but only if under the guidance of an experienced professional who has a long-term plan in mind for you.

What Does Adrenal Fatigue Feel Like?

An image of a fatigued woman sitting on the couch holding her forheadMany AFS sufferers complain about a general feeling of weakness, a reduced ability to function well or to enjoy their lives, and the sensation that they just can’t reach true wellbeing no matter what they do. The symptoms can be many, some may be severe, and because they can be so varied, many sufferers are confused and feel hopelessly unable to control their own bodies.

This is why getting the right kind of support from someone who has had professional and even personal experience with the condition can make the difference between prolonged suffering and really thriving again. It will take time, but a natural and holistic approach can empower you to take your health back into your own hands and better equip you to handle the lows as you look forward to overall improvement.

The Most Common Causes of Adrenal Insufficiency

It is important to note, adrenal fatigue is not adrenal insufficiency. It’s good to understand some of the causes of primary and secondary adrenal insufficiency so you can distinguish between this and AFS.

Primary adrenal insufficiency occurs when the adrenal cortex is damaged, and that usually happens due to an autoimmune attack. Also, primary adrenal insufficiency can be caused by cancer of the adrenal glands, severe infection in the adrenal glands, tuberculosis, or bleeding into the adrenal glands.

Secondary adrenal insufficiency occurs when the pituitary gland doesn’t produce enough ACTH to stimulate the adrenals into producing enough adrenal hormones. This usually happens when something affects the pituitary gland itself, such as a tumor, surgery, or inflammation, rather than the adrenal glands. Taking corticosteroids to help with another condition can also lead to secondary adrenal insufficiency.

This, as noted above, is distinct from what happens chronic stress causes the body to produce too much or too little adrenal hormones due to overwork as in adrenal fatigue.


Adrenal Fatigue is a very common condition that can range from the early stages with nearly undetectable symptoms, to advanced stages with debilitating symptoms. Because it is not yet recognized by mainstream medicine, most mainstream medical professionals are not trained in diagnosing or treating it, which can leave you feeling hopeless and make your condition worse.

I experienced this condition first hand, and I was fortunate that as a trained medical doctor and a proponent of natural medicine, I had the tools available to me to come up with a holistic recovery protocol. This has helped me help many of my clients not only overcome adrenal fatigue but lead even healthier lives than before.

— Dr. Michael Lam, MD, MPH

It can be done, it just takes patience, empathy, and the right kind of support. So don’t hesitate to look for this support, even if you’ve been let down many times before.

Learn More:

» Read our complete long-read foundational article on Adrenal Fatigue
» Adrenal Fatigue FAQs
» Take our 3-minute test to see if you may have Adrenal Fatigue

Want more information about the symptoms of Adrenal Fatigue? Check out this great article on the symptoms of Adrenal Fatigue.
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