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Comprehensive Adrenal Fatigue Article

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Carrie Lam, MD

Introduction to Adrenal Fatigue

Many adults share common complaints that can often be connected to Adrenal FatigueOne of the most common health complaints today is the experience of fatigue and lethargy. If you have fatigue along with other symptoms such as difficulty concentrating, insomnia, inability to lose weight, feeling anxious, allergies, or brain fog, Adrenal Fatigue Syndrome (AFS) may be at the root of the problem.

Adrenal Fatigue consists of many nonspecific but debilitating symptoms. The onset of this condition is often slow and insidious. Sufferers are told that they are stressed and need to learn to relax more. Yes, we all know that "stress kills" to a large extent. But, the question is how?

The real truth is that stress and Adrenal Fatigue are not a mysterious entity at all. Our body has a built-in mechanism to deal with it. Being able to handle stress is key to survival, and the control center in our bodies is the adrenal glands.

Adrenal Fatigue Syndrome is one of the most prevalent conditions. Most people experience it at one point or another. However, most conventional physicians are not taught about Adrenal Fatigue in medical school. As such, they are not prepared to take Adrenal Fatigue as a serious threat to health.

This condition was seldom considered as a dysfunctional sickness. Instead, people think of Adrenal Fatigue Syndrome as a condition related to stress. Thus, the solution was to tell the person to "relax" and take anti-depressants. This does not solve the underlying issue and over time, the condition worsens. Adrenal Fatigue Syndrome is not a medical condition recognized by mainstream institutions. Invariably, the adrenal glands are structurally normal. Low cortisol, the most common associated finding, may be caused by factors outside the adrenal glands.

Do not confuse Adrenal Fatigue Syndrome with another medical condition called Addison's disease. Addison's disease has adrenal glands that are not functioning according to conventional endocrinologists' standards. Addison's disease is often caused by an auto-immune dysfunction. Adrenal Fatigue Syndrome is caused by stress or other factors. These can include dysregulation of the HPA axis, nervous system problems, immune system problems, and metabolic-nutritional problems. It is a complex condition with complex clinical presentation, depending on the stage of dysfunction. Those in neuroscience may prefer to label this condition Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation. This is due to the strong association with dysfunction of the HPA axis. A forward-looking endocrinologist may be more comfortable with calling this condition Non-Adrenal Illness Affecting Adrenal Function because of the associated low cortisol output which does not meet the diagnostic criteria for Adrenal Insufficiency.

Conventional medicine only recognizes Addison's disease as hypoadrenia. As such, it is not surprising if your doctor is unfamiliar with this condition. Adrenal Fatigue Syndrome is a sub-clinical non-Addison's form of adrenal dysfunction. Because there are many causes, Adrenal Fatigue Syndrome is a more accurate name. The addition of "syndrome" implies no definitive cause. It would be up to the physician to determine the list of symptoms and signs appropriate to the syndrome.

We will be using the terms Adrenal Fatigue Syndrome and Adrenal Fatigue interchangeably because Adrenal Fatigue is the most commonly used terminology recognized and used by the public.

Signs and Symptoms of Adrenal Fatigue

A major issue many have with Adrenal Fatigue is weight gain usually centered around the waist

  • Tendency to gain weight and unable to lose it, especially around the waist.
  • High frequency of getting the flu and other respiratory diseases.
  • Infections that tend to last longer than usual.
  • Tendency to tremble when under pressure.
  • Reduced sex drive.
  • lightheaded when rising from a horizontal position.
  • Unable to remember things.
  • Lack of energy in the mornings and in the afternoon between 3 to 5 pm.
  • Feel better suddenly for a brief period after a meal.
  • Often feel tired from 9 - 10 pm, but resist going to bed.
  • Need coffee or stimulants to get going in the morning.
  • Cravings for salty, fatty, and high protein food such as meat and cheese.
  • Increased symptoms of PMS for women. Periods are heavy and then stop, or are almost stopped on the 4th day, only to start flow again on the 5th or 6th day.
  • Pain in the upper back or neck with no clear reason.
  • Feels better when there is less stress, such as on a vacation.
  • Difficulties in getting up in the morning.
  • Lightheaded.
  • Mild depression.
  • Food and or inhalant allergies.
  • Lethargy and lack of energy.
  • Increased effort to perform daily tasks.
  • Decreased ability to handle stress.
  • Dry and thin skin.
  • Hypoglycemia.
  • Low body temperature.
  • Nervousness.
  • Palpitation.
  • Unexplained hair loss.
  • Alternating constipation and diarrhea.
  • Dyspepsia.

If you have many of these signs and symptoms, it is time to consider Adrenal Fatigue as a possible cause. None of the signs or symptoms by themselves can definitively pinpoint Adrenal Fatigue. However, when looked at collectively, these signs and symptoms form a specific picture of a person under stress. These signs and symptoms are often the end result of acute, severe, chronic, or excessive stress. The body is unable to reduce such stress.

The ability to handle stress, physical or emotional, is a cornerstone to human survival. Our body has a stress modulation system in place, known as the neuroendometabolic (NEM) stress response. The adrenal glands are part of this response system. When these glands become dysfunctional, our body's ability to handle stress is reduced.

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

Adrenal Gland Basics

The adrenal glands are the main organ affected by Adrenal FatigueThe adrenal glands are two small glands, each about the size of a large grape. They are on top of the kidneys. Their purpose is to help the body cope with stress and help it to survive. Each adrenal gland has two compartments. The inner compartment is the adrenal medulla. The adrenal medulla modulates the sympathetic nervous system through secretion and regulation of two hormones called epinephrine and norepinephrine. Epinephrine and norepinephrine are responsible for the fight or flight response.

The outer compartment is the adrenal cortex. The adrenal cortex comprises 80 percent of the adrenal gland and produces over 50 different hormones. These hormones make up three major classes - glucocorticoids, mineralocorticoids and androgens.

The most important glucocorticoid is cortisol. When cortisol is lowered, the body will be unable to deal with stress. This happens in Adrenal Fatigue.

Mineralocorticoids modulate the delicate balance of minerals in the cell, especially sodium and potassium. An example is aldosterone. It thus regulates our blood pressure and the fluid in the body. Stress increases the release of aldosterone, causing sodium retention. This results in water retention and high blood pressure. Potassium and magnesium are lost in the early stages of Adrenal Fatigue. Magnesium is involved in over 300 enzymatic reactions in the body. When the body lacks magnesium, cardiac arrhythmias and other symptoms may arise.

The adrenal cortex is also responsible for producing all the sex hormones, although in small amounts. One exception is DHEA, a weak androgenic hormone that is made in large amounts in both sexes. DHEA, together with testosterone and estrogen, are made from pregnenolone.

Pregnenolone also leads to the production of progesterone. It is one of the intermediary steps in the making of cortisol. Pregnenolone is thus one of the most important intermediate hormones in the hormonal cascade. A prolonged deficiency in pregnenolone will lead to reduced glucocorticosteroids and mineralocorticoids. This can occur in Adrenal Fatigue

Adrenal Fatigue and the Steroid Hormone Synthesis Pathway flow-chart

Cortisol (The Hormone of Death)

Often times cortisol is dysregulated during the stages of Adrenal FatigueThe most important anti-stress hormone in the body is cortisol. Cortisol protects the body from excessive Adrenal Fatigue through:

Normalizing blood sugar levels

Cortisol increases blood sugar levels in the body. Cortisol works in tandem with insulin from the pancreas to provide adequate glucose to the cells for energy. More energy is needed when the body is under stress, from any source, and cortisol is the hormone that makes this happen. In Adrenal Fatigue, more cortisol is secreted during the early stages. In the later stages of Adrenal Fatigue (when the adrenal glands become exhausted), cortisol output is reduced.

Reducing inflammation

Cortisol is a powerful anti-inflammatory agent. When we have a minor injury or a muscle strain, our body's inflammatory cascade is initiated. Cortisol is secreted as part of the anti-inflammatory response. Its goal is to remove and prevent swelling and redness of tissues. These anti-inflammatory responses prevent mosquito bites from enlarging, bronchial stress, and eyes from swelling shut from allergies.

Suppressing the immune system

People with high cortisol levels are much weaker from the immunological point of view. Cortisol influences most cells that take part in the immune reaction, especially white blood cells. Cortisol suppresses white blood cells, natural killer cells, monocytes, macrophages, and mast cells. It also suppresses Adrenal Fatigue.

Regulating blood pressure

Cortisol contracts mid-size arteries. People with low cortisol have low blood pressure. They do not respond to other body agents that constrict blood vessels. Cortisol tends to increase blood pressure.

Dealing with stress

People with Adrenal Fatigue cannot tolerate stress and succumb to severe stress. Higher stress levels require higher levels of cortisol. When the cortisol level cannot rise in response to stress, it is impossible to maintain the body in optimum stress response.

Cortisol sustains life via two opposite, but related, kinds of regulatory actions. It releases and activates the existing defense mechanisms of the body. At the same time, it shuts down and modifies the same mechanisms to prevent them.

Cortisol Regulation

Adrenal Fatigue can impact the stress response system of the bodyThe hypothalamus-pituitary-adrenal (HPA) axis controls the adrenal glands. There is an existing negative feedback loop that governs the amount of adrenal hormones secreted under normal circumstances. For example, the HPA axis adjusts cortisol levels according to the body's need via a hormone called Adrenal Corticotropic Hormone (ACTH). The pituitary gland secretes ACTH in response to signals from the hypothalamus. When the ACTH binds to the walls of the adrenal cells, a chain reaction occurs within the cell. The adrenal cells release cholesterol. Cholesterol is then converted into to pregnenolone, the first hormone in the adrenal cascade. After this, cortisol is released into the blood stream. It travels in the circulatory system to all parts of the body and back to the hypothalamus.

Cortisol and ACTH are not secreted uniformly throughout the day. They follow a diurnal pattern. The highest level secreted at around 8:00 a.m. in the morning. Cortisol then start to decline throughout the day. Episodic spikes during the day can also occur when the body is stressed. Certain foods can elevate cortisol as well. The cortisol level is at its lowest between midnight and 4:00 a.m.

Common Causes of Adrenal Fatigue

Chronic stress is common in western society. The most common causes of stress are work pressure, changing jobs, death of a loved one, moving homes, illness, and marital disruption. Adrenal Fatigue occurs when the amount of stress exceeds the capacity of the body to compensate and recover.

Many sufferers of Adrenal Fatigue experience anger as a response to stressStressors that can lead to Adrenal Fatigue include:

  • Anger
  • Chronic fatigue
  • Depression
  • Chronic illness
  • Excessive exercise
  • Chronic infection
  • Fear and guilt
  • Chronic pain
  • Gluten intolerance
  • Low blood sugar
  • Mal-absorption
  • Mal-digestion
  • Toxic exposure
  • Severe or chronic stress
  • Surgery
  • Late hours
  • Sleep deprivation
  • Excessive sugar in diet
  • Excessive caffeine intake from coffee and tea
  • Chronic infected root canal

One of the most overlooked causes of Adrenal Fatigue is chronic or severe infection. This gives rise to an inflammatory response. Such infection can occur sub-clinically with no obvious signs at all. Parasitic and bacterial infections including Giardia and H. pylori are often the main causes.

How Stressors Affect the Body

When stressed, the body reacts by mounting a stress response. The bodies stress response is also known as the neuroendometbolic stress response system. It contains 6 circuits that help to regulate stress: hormone, bioenergetic, detoxification, inflammatory, neuroaffective, and cardionomic. Each of the circuits is regulated by a different set of organs of systems in the body. These 6 different circuits help to regulate the stress in the body, however, if stress is chronic, then symptoms may start to arise as different circuits and their respective organs become dysregulated. It stimulates the sympathetic nervous system. This is also called the "fight or flight" response as the body arms itself to face what it perceives as a danger. The adrenal medulla secretes epinephrine. The HPA axis also releases ACTH, which causes the adrenal cortex to increase production cortisol.

Hormone Circuit

Stress and the body are often responsible for Adrenal Fatigue symptomsThe hormonal circuit is made up of the ovaries, adrenals, and thyroid organs. When stressed continuously, cortisol levels may rise to such a high level that the adrenal becomes exhausted. At the same time, DHEA, a hormone produced in the adrenal glands, will start to decrease from stress. With chronic stress, there is decompensation of DHEA with a concurrent rise of cortisol. As a result, the ratio of cortisol to DHEA increases.

As with most hormonal systems, there is a negative feedback system in the body to limit the production of each hormone. The same occurs in the case of cortisol, with one exception. During prolonged or acute stress, the body perceives that its survival is at stake. Excessive cortisol output actually blunts the negative feedback response. Instead, cortisol production increases. This is the body's way of coping with ongoing stress.

When stressed, our cortisol level rises in an environment where the negative feedback system is dampened. While this is happening, our DHEA level continues to drop. The result is a high cortisol to DHEA ratio and:

  • Reduced insulin sensitivity, reduced glucose utilization, and increased blood sugar, which leads to diabetes.
  • Reduced secretory IgA (the main cellular defense factor), natural killer (NK) cell and T-lymphocyte activity which lead to increased chances of getting infections such as Herpes, yeast overgrowth, and viral infections.
  • A block in calcium absorption results in an increased loss in bone mass. The demineralization of bone occurs, leading to osteoporosis.
  • Increased fat accumulation around the waist and protein breakdown. This leads to muscle wasting, an inability to reduce weight.
  • An increased in water and salt retention, leading to high blood pressure at first, with low blood pressure as the condition worsens.
  • Estrogen dominance, leading to PMS, uterine fibroids, and breast cancer.

Stress Response from a Hormonal Perspective

How the body manufactures and responds to hormones is affected by Adrenal FatigueAt work, what happens if your boss screams at you? Let us now examine some of the effects within our body from a hormonal perspective:

  • Your hypothalamus signals your pituitary gland to release ACTH.
  • ACTH will stimulate the adrenal medulla to secrete epinephrine and the adrenal cortex to secrete cortisol.
  • Your cortisol level will increase and convert more stored glycogen into blood sugar for energy. Energy is also increased from the release of epinephrine from the adrenals.
  • Your heart rate will increase (from the epinephrine).
  • You will tend to sweat more (from the cortisol).
  • Your muscle tension will increase (from the cortisol and epinephrine).
  • Diverting blood away from your gut, results in slowed digestion.
  • Your bladder and rectum muscle may relax.

When the above physiological response occurs over a long duration, then Adrenal Fatigue is the result. This can also occur under traumatic acute stress.

Adrenal Fatigue Progression

Adrenal weakness progresses through stages as the body de-compensates. It is the body's strategy to return to a state of simplicity from a life that is too complex for the body to handle.

Progression Chart for Adrenal Fatigue

Stage 1: Alarm Reaction

In this stage, the body is alarmed by the stressors and mounts an aggressive anti-stress response to reduce stress levels. Some doctors call this the Early Fatigue stage.

ACTH increases from the pituitary gland. The adrenals are stimulated to mount a retaliation response. epinephrine and cortisol are released. There is usually, but not always, a corresponding reduction in the DHEA production. No symptoms are reported at this stage. There may be a sense of being tired. Daily activities continue unaffected.

Stage 2: Resistance Response

With under chronic or severe stress, the adrenals eventually are unable to keep up with the body's demand for cortisol. Cortisol output will start to decline from a high level back to a normal level, while ACTH remains high. The adrenals start to become exhausted. Morning, noon, or afternoon cortisol levels are often low. Nighttime cortisol level is usually normal. Anxiety starts to set in, and the person becomes irritable. Insomnia becomes more common, as it takes longer to fall asleep. There are also frequent awakenings as well. Infections can become recurrent. PMS and menstrual irregularities surface. Symptoms suggestive of hypothyroidism (such as a sensation of feeling cold along with a sluggish metabolism) become prevalent.

Often the body is unable to keep up with the demands on the adrenal glands during Adrenal FatigueA phenomenon called pregnenolone steal (also called cortisol shunt) sets in. The body starts to favor cortisol production over other hormones. Other hormones such as pregnenolone, DHEA, testosterone, and estrogen are less favored and start to decline. As a result, total pregnenolone output is reduced but the total cortisol output continues at a normal level. The daily diurnal cycle of cortisol shows a dysfunctional pattern. Cortisol is low in the morning, when it is needed the most. Nighttime cortisol is usually still normal.

There is occasional mild fatigue. A nap or some time off work usually can help the recovery process greatly.

Stage 3: Adrenal Exhaustion

Despite rising ACTH, the adrenals cannot keep up with the body's demand for cortisol. This may happen over a few years. Total cortisol output is reduced, and DHEA falls far below average. The nighttime cortisol level is usually reduced as the HPA axis "crash". The body is unable to maintain homeostasis. Early in this stage, mild symptoms characteristic of the first and second stages of Adrenal Fatigue become persistent or chronic (Phase A). As the condition gets worse, multiple endocrine axis imbalances tend to occur (Phase B). This manifests in the form of ovarian-adrenal-thyroid (OAT) axis imbalance in females and adrenal-thyroid axis imbalance in males. The body is in a constant state of mild to moderate fatigue in phase A and B.

As the body continues its downward path of impaired function, it gathers steam. The body becomes compromised in trying to maintain the fine controls of homeostasis. Normal equilibrium is lost. The body enters a state of reactive disequilibrium (Phase C). Severe fatigue is the norm for those with Phase C.

Adrenal Fatigue forces the body into maintenance mode where it struggles to maintain balanceYour body will try to maintain equilibrium with the activation of the autonomic nervous system (ANS). However, the body is too fatigued. Other pathways of the NEM stress response are damaged as well. impaired metabolic, clearance, and detoxification pathways give rise to paradoxical, unpredictable, and exaggerated outcomes. Reactive sugar imbalances, fragile blood pressure, postural hypotension, heart palpitations, POTS, dizziness, anxiety reactions, being "wired and tired," periodic adrenaline rushes, fragile fluid state; such as hypersensitive dilutional hyponatremia, sudden onset of anxiety, and a sensation of impending doom are common.

There is a strong mind-body connection. Every thought process invokes a physiological response. Many of these symptoms represent what a "reactive sympathoadrenal response." This response is the result of an over-activation of two components of the ANS - the sympathetic nervous system (SNS) and the adrenomedullary hormonal system (AHS). These two components constitute the sympathoadrenal system (SAS). the body bathes in a sea of epinephrine and norepinephrine, when the SAS is over-activated due to stress. These two hormones are responsible for many of the above-mentioned symptoms.

As the body's key hormones fall below the minimum required reserve for normal function and output fails, the body may down-regulate the amount needed to preserve what is on hand for only the most essential body functions. This near-failure state (Phase D) is quite serious and requires professional attention. This is a state of extreme low energy as the body tries to conserve to survive. Normally helpful nutrients may backfire with paradoxical responses being the hallmark. Those in Phase D are usually bedridden most of the time. Normal daily chores need ambulatory help. Traditional macro-nutritional approaches may be helpful. But, the body may continue to decompensate. In these cases, a carefully titrated micro-nutritional program may be necessary to help the restore the body.

Stage 4: Failure

Eventually, the adrenals are totally exhausted. In this stage, the line between Adrenal Fatigue and clinical Addison's disease can be blurry.

Typical symptoms of Addison's disease may start to emerge. Fatigue becomes extreme. Other symptoms include weight loss, muscle weakness, loss of appetite, nausea, vomiting, hypoglycemia, headache, sweating, irregular menstrual cycles, depression, orthostatic hypotension, dehydration, and electrolyte imbalances. The body appears to have lost its normal homeostasis and is breaking down. If not attended to, the natural progression of this condition may be fatal.

The following diagram shows how Adrenal Fatigue progresses with time through the stages. This is not for diagnosis purposes. Adrenal Fatigue is not a recognized medical condition by mainstream institutions. This diagram helps to paint a broad picture of what is seen clinically. Each person's progression varies tremendously and is dependent on a wide variety of factors.

Adrenal Fatigue Data Progression Chart
[Click to expand]

Why Conventional Medicine Missed Adrenal Fatigue

Adrenal Fatigue has been recognized as a distinct clinical syndrome since the turn of the 20th century. But, most doctors are unfamiliar with this condition. That is because it is difficult to diagnose by traditional blood tests. Normal blood tests detect severe, changes in adrenal hormones, such as Addison's Disease. However, Addison's disease afflicts only 4 out of 100,000 and is often the result of an autoimmune disease or infectious origin. Blood tests are also useful to detect extreme, excessive levels of adrenal hormones, a condition known as Cushing's disease.

Let's examine this in more detail. The ACTH (adrenocorticotropic hormone) challenge test is the conventional test used. This test recognizes extreme underproduction or overproduction of hormone levels. It measures the top and bottom 2 percent of a bell curve. In other words, make a diagnosis requires adrenal function to be very low (the bottom 2 percent).

Usually test results fall into a normal range for someone with Adrenal Fatigue, causing this condition to be labeled a syndrome instead of a diseaseSymptoms of non-Addison adrenal malfunction, meanwhile, can start to present itself after a 15 percent deviation from the mean on the bell curve. Therefore, the adrenal glands could be functioning anywhere from 15 to 48 percent below the norm and not be detected by the ACTH test.

To sum it up, adrenal hormones are low in the case of Adrenal Fatigue. But they are still within the "normal" range and not low enough to warrant the diagnosis of Addison's disease. Such "normal" levels of adrenal hormones do not mean that the patient is free from adrenal malfunction. Conventional doctors are not taught the significance of sub-clinical Addison's disease, or Non-Addison's Hypoadrenia (commonly referred to as Adrenal Fatigue). Blood tests misguide them. As a result, patients tested for adrenal functions are told they are "normal". But in reality, their adrenal glands are performing sub-optimally, with clear signs and symptoms as the body cries out for help and attention.

Laboratory Tests

There are many routine laboratory tests for fatigue. Unfortunately, they are not diagnostic. Normal values do not mean that the body is free of illness. Abnormal values are not necessarily diagnostic either. There are many advanced functional tests additionally available. They also pose similar problems with regards to accuracy. They can also often be misleading if not correlated with the overall clinical picture.

Adrenal Fatigue can be screened and demonstrated in laboratory studies of surrogate markers for adrenal function. Two such markers are cortisol and DHEA by serum. These two markers by blood give a general picture of the body as to whether it is in anabolic (build up) or catabolic state (breakdown). It is not diagnostic. Another way to test your adrenal health is to measure your level of free key adrenal hormones such as cortisol and DHEA through saliva. Again, this is not diagnostic. Relying on a single snapshot to draw clinical conclusions can be misleading. For best correlation, use serial studies.

The symptoms of Adrenal Fatigue are usually subclinical, meaning they do not constitute a disease state defined my conventional medicineYou can measure DHEA can anytime during the day. Cortisol, on the other hand, is highest in the morning and lowest in the evening before bedtime. Taking 4 samples of cortisol (at 8 am, noon, 5 pm, and before bedtime) is desirable if a saliva test is undertaken. With multiple samples taken throughout the day, we are able to map the daily diurnal curve of free cortisol in the body relative to DHEA level. This will give us a much clearer picture of adrenal function.

It is important to interpret saliva cortisol levels properly. Morning free cortisol level is indicative of peak cortisol output. Lunch cortisol level points more towards cortisol adaptability. Mid-afternoon cortisol is associated with metabolic issues such as blood sugar imbalances. Evening cortisol level refers to baseline adrenal cortisol function. You must match the different cortisol values with the body's symptoms throughout the day. Otherwise, a saliva test is of limited value and can in fact be misleading.

If you are taking oral or applying topical supplemental hormones such as DHEA or pregnenolone, saliva test results may be elevated. Blood test results will also increase, but this will take about 3 months to show.

Stress can also affect the levels of adrenal hormones. Your cortisol level tested after a quiet and relaxing morning will be different from when you are under tremendous stress.

A normal culture for bacteria and parasites will often be negative. To rule out sub-clinical infection as a cause of Adrenal Fatigue, specialized test measuring the immunoglobulin response may be necessary.

WARNING: Due to tremendous individual variance and the body's constant changing state, laboratory tests should be undertaken judiciously under the right setting and only when needed in order to be cost-effective and relevant. It is not uncommon to have Adrenal Fatigue symptoms with "normal" laboratory results, and vice versa. Furthermore, in Advanced Adrenal Fatigue, the 24-hour saliva cortisol curve becomes flattened most of the time. It can stay that way for an extended period of time, even during recovery. Sometimes there is a delayed response, resulting in testing results that may be confusing. Over-reliance on tests is a common Adrenal Fatigue recovery mistake.

A good history by an astute and experienced clinician is by far the best and most accurate way to ascertain Adrenal Fatigue status. It is far better than any laboratory testing.

Laboratory tests are best used as supporting tools under the guidance of the right health professional. They should not be relied on as a sole gauge of adrenal function and therapeutic options. Saliva testing is best used as a serial studies performed regularly overtime and compared. Relying on a single snapshot of the hormonal picture at one time to determine your Adrenal Fatigue recovery strategy is a common mistake. Consumers often make the mistake of embarking on a self-guided nutritional recovery program that relies on laboratory test without understanding their limitations. Over time, this approach often leads to improper use of nutrients which makes the condition worse.

Paradoxical Reactions

One of the many issues people have with Adrenal Fatigue is the onset of heart palpitationsIn Adrenal Fatigue, the body can often exhibit many paradoxical reactions that one does not normally expect. These include:

  • A sense of fatigue or malaise instead of a sense of calm when taking steroids.
  • A sudden onset of anxiety attacks and impending doom at rest.
  • Sudden onset of heart palpitations despite normal cardiac function.
  • Rapid onset of dizziness and lightheadedness at rest, or after stressful situation, or after taking certain types of food, especially carbohydrates.
  • Sudden onset of fluctuating blood pressure.
  • Staying in bed for an extended period of time with no energy to get up even after a full night's rest.
  • A sense of being "beaten up" that lasts for days after vigorous exercise.
  • Inability to think clearly and difficulty recalling even a recent problem.
  • Waking up in the middle of the night for no reason and the inability to go back to sleep.
  • Constipation instead of loose bowels when taking high doses of vitamin C or magnesium.
  • A sense of getting wired up and anxious after taking Vitamin C, adrenal glandular, or herbs.
  • Getting more toxic instead of feeling better when going through a detoxification program like juice fasting.
  • Sudden onset of fragile emotional states such as crying for no apparent reason.
  • Taking multiple trips to the Emergency Room because one feels impending doom even though one is told that nothing is wrong after a complete work-up.
  • A sense of well-being after taking selected nutrients, only to be followed by a "crash".
  • Fluid retention/depletion in a setting that is highly sensitive to sodium load that is hard to maintain.

One can have any combination of the above. The exact pathophysiology of each of these symptoms is not fully known. The more advanced the Adrenal Fatigue, the more prevalent these are. Collectively, they point to an adrenal that has lost its ability to maintain fine control. The NEM stress response is not in homeostasis. Toxins and inflammation run rampant in the body. Self-directed Adrenal Fatigue recovery programs normally fail in such cases because normal healing tools do not apply. It is best to consult a professional for help if you have a significant number of these paradoxical reactions.

Paradoxical reactions can be the result of various concurrent conditions that mimic Adrenal Fatigue. It can also be a result of an exacerbated disruption of internal body function with collateral damage to the adrenal glands. They include:

  • MTHFR disorder
  • Pyroluria
  • Receptor site disorders
  • Mitochondria diseases
  • Neurotransmitter imbalances
  • Biological rhythm imbalance
  • Extracellular matrix pollution
  • Sub-clinical liver congestion
  • Retoxification reaction
  • Excessive histamine release
  • Fluid and metabolic imbalances
  • Copper and mineral overload
  • Stealth infection
  • Electromagnetic field overload
  • A body that is in a state of catabolism

Women and Adrenals

There are strong interlinked relationships between the ovarian, adrenal, and thyroid systems in women. These three organs are intimately co-dependent on each other for optimal function. This is called the Ovarian Adrenal and Thyroid axis (OAT) axis. Balancing the OAT axis is important if a woman wants to feel good. When medication alters one of the organ's functions, it may lead to an often unrecognized change in the other two organs. For example, if thyroid medication is administered, it is not uncommon to see concurrent menstrual irregularities, a function of ovarian hormones, reduced ability to deal with stress may also occur, a function of the adrenals.

Let us look more closely at the reason. In Adrenal Fatigue, internal cortisol often creates a condition of multiple organ resistance. This can include the thyroid and ovaries. First, let us look at the Thyroid.

Thyroid tissues fail to respond as efficiently to the hormonal signal. Adrenal Fatigue is often accompanied by clinical or sub-clinical hypothyroidism. Laboratory values can be normal but classical signs of hypothyroidism may be present. Physicians and patients alike are often confused. Anti-depressants are often prescribed as a solution. However, this seldom works and instead often makes the condition worse.

A cortisol induced organ resistance applies to nearly all other hormone-regulated organs. Few hormones work at optimal levels in the presence of Adrenal Fatigue. A multitude of hormones including insulin, progesterone, estrogen, and testosterone become affected. The normal negative feedback loop in place can be disrupted. The ability of each hormone to regulate and fine-tune its target organ is often compromised. Blood pressure can become erratic, blood sugar levels may experience wide swings, bipolar and anxiety states come at will, and menstrual flow can become irregular. Even the brain may become less sensitive to estrogen.

Let us now look at how the ovarian system is affected in particular. Many women often exhaust their adrenal glands by the time they reach their mid-thirties or early forties. This is due to a stressful lifestyle. The adrenal glands help to regulate stress. In early stages of Adrenal Fatigue, cortisol output is high as the body attempts to neutralize the stress. But, when too much cortisol is produced, it will have many undesirable effects. For example, cortisol blocks progesterone receptors, making them less responsive to progesterone. Progesterone normally produced by the adrenals comes to a halt in favor of cortisol.

One symptom that is often hard to cope is the hair loss associated with Adrenal FatigueInsufficient progesterone production leads to an imbalance of estrogen to progesterone. With reduced progesterone to offset estrogen, the body may experience a host of undesirable side effects. This leads to a condition known as estrogen dominance, a state of excess estrogen in the body. It is no coincidence that we see a proliferation of conditions associated with excessive estrogens such as PMS, fibroids, and pre-menopausal syndrome when women reach their mid-thirties and early forties.

It is interesting to note that most post-menopausal women who are experiencing hair loss have an adrenal problem. Hair loss is a sign of excessive androgens. Some women produce too much androstenedione, which then gets converted into estrone and testosterone. Testosterone, in turn, is converted into DHT. DHT is the more potent form of testosterone responsible for excessive hair loss. Estriol can be given to offset the testosterone effects as estrogen balances testosterone in the body.

Cortisol can be considered when closely supervised and used for a short period of time. It keeps the adrenal glands from getting stuck in the androgen part of the stress cycle if indeed it is in that state. Cortisol also complements the use of progesterone as well. The effective cocktail, therefore, consists of estriol, cortisol and progesterone. Each of these hormones, especially cortisol, has their own side-effects. Knowing what to use and when to use is critical, or hair loss could worsen.

Any serious attempt to normalize this axis should consider Adrenal Fatigue recovery as the first step. Adrenal normalization should precede hormone modulation. The adrenal glands deal with the daily stresses of life. A woman must normalize her adrenal glands to have a total body hormonal balance. Replacing deficient hormones alone without addressing the health of the adrenal gland is a band-aid approach. It is often ineffective in the long run. The normalization process can begin with investigating and eliminating stressors. Stressors are often chronic in nature. They can be related to lifestyle, dietary, mental, and inflammatory causes. Women with heavy menstrual bleeding and adrenal exhaustion can normalize their adrenal function with natural compounds. Only consider Exogenous cortisol replacement as a last resort because of its long term negative effects.

Antidepressants, thyroid replacements, and ovarian hormones can often make women with OAT axis imbalance worse. Estrogen replacement often becomes ineffective, and symptoms of estrogen dominance like hot flashes, weight gain at the hips, water retention, and moodiness are observed despite normal estrogen levels. Patients become frustrated as it seems that nothing can help and a downward spiral of symptoms surface.

Failing conventional therapy, many turn to natural compounds. It is not unusual to see many people take a full battery of these nutrients. For example, Vitamin C, DHEA, pregnenolone, natural progesterone, and natural thyroid replacement. In the beginning, this might be helpful. Unfortunately, a shotgun approach by taking many nutrients seldom works and often backfires with time. The higher the dose the worse the patient can become. That is why chronic stress and Adrenal Fatigue can make one feel so rotten, like a slow-motion train wreck in progress. In severe cases, client often feels like the "walking dead". They are caught in a vicious downward cycle of deteriorating physical and emotional functions.

Adrenal Fatigue Recovery

Adrenal Fatigue can be reversed. You may need to allow 6 months to 2 years for the recovery process to take place. These are some of the important steps.

Removal of stressors

This is the most important step in Adrenal Fatigue recovery. It is important to deal with stressors such as marital, family, relationship or financial problems.


It is important to go to sleep by 10 p.m. every night. Why? This is because our adrenal glands kick in for a "second wind" to keep us going from 11 pm to 1 am. This puts tremendous stress on the adrenals. When we rest early, our adrenals are rested. Between 10 p.m. and 1 a.m., our adrenals work the hardest to repair the body. We should also try to sleep in until 8:30 a.m. or 9: 00 a.m. if possible. This is because our cortisol level rises to its peak from 6:00 a.m. to 8:00 a.m. to wake us up and get us going for the day.

In later stage Adrenal Fatigue, the level of cortisol falls and we feel tired. It will be more difficult to wake up. If we wake up too early, this will only increase stress on the adrenal glands, which will have to produce more cortisol.

A good night sleep is thus mandatory for effective Adrenal Fatigue recovery. Without good sleep, our bodies cannot regenerate itself to deal with stressors the next day. We should also rest in a completely dark room to maximize melatonin production.

If you are unable to fall asleep, take oral melatonin (0.5 mg to 3mg) 30 minutes before bedtime. You may begin with a low dose (0.5 mg) and gradually work upwards. If you start with 3 mg, the common over-the-counter dose and find it not helpful, go to a lower dose instead. The right dosage varies from person to person.

If you have a tendency to wake up at 2 to 3 a.m. and find that you are unable to fall back to sleep, that is a sign of excessive stress. In this case, you may wish to consider time-release melatonin. Try other sleep aids such as 5-hydroxytryptophan (5-HTP) 50-100 mg, adrenal extracts, and trace mineral tablets. Another wonderful relaxant and sleep aid is magnesium.

Avoid Coffee or Caffeinated Beverages

Coffee and tea can act as stimulants and interrupt sleep pattern. Herbal tea is okay because it does not contain caffeine

Avoid TV and Computers

Some people may be photosensitive. Watching television or working at the computer may prevent melatonin levels from rising to induce sleep. Turn off your television or computer by 8 p.m.


An easy method to reduce stress and Adrenal Fatigue symptoms is proper exercise that your body can handleThis is a wonderful stress reducer and a tremendous oxygenator in Adrenal Fatigue recovery. Exercise reduces depression, increases blood flow, normalizes level of cortisol, insulin, blood glucose, growth hormones, thyroid, and makes you feel generally much better.

Exercise is a key component to Adrenal Fatigue recovery if done right. The key is to adjust the level of exercise in accordance to your capacity and do the proper amount at the right time. Over-exercise is a trigger for adrenal crash. More is not necessary better when it comes to exercise and Adrenal Fatigue.

The more advanced your Adrenal Fatigue, the less you should exercise vigorously. Vigorous exercise can lead to a catabolic state and worsen Adrenal Fatigue. Those with severe adrenal weakness should start with gentle adrenal breathing exercises. Progress to adrenal restorative exercises, then to special adrenal yoga exercise series. Exercises specially designed for adrenal recovery scale based on exercise capacity, adrenal function, and autonomic nervous system function. You should feel fresh after each exercise session. Allow adequate recovery time for the body to recuperate. Strength should return gradually with the right program. A catabolic state will slowly reverse. Do not proceed with exercise unless under professional supervision. Especially if you have Advanced Adrenal Fatigue.

One of the dangers of self-guided Adrenal Fatigue recovery programs is the tendency to over-exercise once there is more energy. The proper amount of prescribed exercise varies from person to person in different stages of Adrenal Fatigue recovery. Those in Advanced Adrenal Fatigue may only be able to tolerate a 5 minute slow walk every other day. This may be all the body can tolerate. Too much exercise exceeding the body's reserve capacity can worsen Adrenal Fatigue. As Adrenal Fatigue improves, regular exercise can be incorporated. Regular exercise should cover the following three categories:

  • Aerobics - such as fast walking, stairs climbing, Nordic track, swimming, and treadmill.
  • Anaerobics - such as weight lifting, push-ups, sit-ups, chin-ups.
  • Flexibility - such as stretching, yoga, and tai chi.

From our Readers:

I am 102 lbs and have been healthy and active until I turned 40 this last March. I have four children and lead a very busy life. A few months before my 40th birthday, I began to shake and feel like I was going to pass out during highly stressful times. My periods, which are usually 28-day cycles, started coming every 21 days. I went to my family Doctor and my OBGYN to see if it was my thyroid or if I was hypoglycemic. They did blood tests and an EKG and said I was the picture of health.

My family doctor thought that I might be suffering from anxiety. My OB doctor was worried about my sugar levels dropping and advised me to always have a little snack with me so I won't pass out. However, I began to feel worse and consequently, my period came 3 times a month. I heard about Dr. Lam through a nurse I did yoga with. She had received help from him and felt great with his help. Dr. Lam is an angel! He understood my problem as soon as he understood my medical history, which mostly just consisted of the knowledge that I had my tubes tied after my fourth baby. My doctor said that I would not suffer any consequences from this surgery. However, Dr. Lam informed me that this type of surgery would cause your progesterone to drop, thus explaining my 14 to 21 day periods. He also helped me to understand adrenal gland fatigue, which explained the shaking.


I followed Dr. Lam's advice, using the all-natural personalized program, and thus began my steady ride to recovery. I contacted Dr. Lam the first week in May and he told me that I would begin to feel better in 3 to 4 weeks, good in 6 to 8 weeks, and great in 10 to 12 weeks. He was right on the money. He brought my adrenal glands back to health slowly and steadily and I did not even suffer a crash.

Following his instructions, he brought my period from 21 to 27 days and my energy level rose. Now, I can do power yoga 2 to 3 times a week in a 90 to 95 degree room with no problems. Dr. Lam now has me working on improving my bones and skin as part an anti-aging protocol to keep me in optimum shape. I feel like I did when I was in my 20's. My children, husband, family and I thank Dr. Lam for my great recovery.

Dr. Lam explained to me that even though my body was out of balance and not working in harmony, blood tests show that they are in the normal range. If I had followed the advice of my local medical doctors, I would have been taking prescription anti-depression drugs like the majority of my peers. Dr. Lam has given me a better and more effective way through my problems with his natural approach.

Thank you Dr. Lam, for getting me back on track and feeling better than ever! You are a pioneer for women. Keep doing research to help women stay balanced naturally.

Nutritional Supplementation

In an Adrenal Fatigue recovery program, it is prudent to consider optimizing the adrenal gland functions.

An optimal balance of vitamins and minerals for optimum adrenal function can include:

Vitamin C

Ginseng is among popular herbs that can be useful for short term treatment of Adrenal Fatigue500 mg to 3,000 mg of vitamin C with bioflavonoid and synergistic co-factors is beneficial. Vitamin C is one of the gentlest of all adrenal supporting nutrients. It is best to get take Vitamin C in ascorbic acid and sodium ascorbate form. Those who have a sensitive gastric system should consider mineral ascorbates. A personalized combination of different forms of oral vitamin C often works better than a single form. The proper delivery system also plays a critical and significant role. Nutrients are good only to the degree they can be delivered to the cell. The right combination of delivery systems is critical. These include liposomal, powdered, and capsulated. One of the most common Adrenal Fatigue recovery program mistakes is the lack of properly administered vitamin C dosed for the body's specific need.


Glutathione by intravenous or by liposomal oral delivery to enhance the effectiveness and cellular bio-availability of vitamin C, E, alpha lipoic acid, and carnitine. Specifically, glutathione acts as a liver detoxifier. It helps recycle inactive oxidized vitamin C back to its reduced active form in the body after vitamin C has served its function.

Vitamin B5

Most hormones in the adrenal gland need co-enzyme A for production. Co-enzyme A is a product of vitamin B5

Vitamin E

400-800 I.U. of Vitamin E is another important nutrient. It is involved in at least six different enzymatic reactions in the adrenal cascade.

Vitamin D

1000 to 5000 I.U of Vitamin D is a good nutrient to support hormonal synthesis.

Adrenal glandulars, extracts and herbs

Adrenal glandular, adrenal extract and herbals such as ashwagandha root, licorice root, Korean Ginseng, Siberian Ginseng, ginger root, and ginkgo leaf can be helpful for short term. They are widely promoted. Their effectiveness and adaptogenic properties may be better for those with mild Adrenal Fatigue. Those with moderate to advanced adrenal weakness should exercise extreme caution before using compounds. Adaptogenic compounds typically behave as stimulants when Adrenal Fatigue becomes more advanced. Stimulating the adrenals at a time when they need rest can be devastating.

They may give a short term sense of well-being but may lead to withdrawal and dependency issues long term. Some of these compounds can trigger and adrenal crisis. Stimulating the adrenals is thus not the best long term solution. Providing the adrenals the gentle nutrients they need to recover on their own is by far the most effective approach over time. There are many tools available and these compounds are often not needed.


Supplementing with steroids such as natural hydrocortisone or cortisone acetate in doses of 2.5 to 5 mg two to four times a day can be a safe and effective way to replenish depleted adrenals for a short time in severe cases when properly supervised. The problem with this approach is that most people will find it hard to get off once their body is used to it. An ever-increasing dose is often needed with time as the body develops tolerance. It is best to undertake this only when supervised by a knowledgeable physician along with a defined goal. Otherwise it is best to wean off this drug as soon as possible. Younger people should avoid this approach unless it is absolutely necessary. Fortunately, there are many gentler and non-addictive natural compounds that help adrenal function. Under the hands of an experienced clinician, this approach is seldom necessary.

Note that while many practitioners use synthetic or bio-identical hormones (estrogen, progesterone, and testosterone) to modulate symptoms of fatigue and hormonal imbalance, this approach should be taken with care as it may mask the underlying root cause and worsen the overall condition over time.

Other Nutrients

Extra nutrients that may to consider include 10,000 to 25,000 I.U of beta-carotene, selenium (100-200 mcg), magnesium (200-800 mg), lysine (1-2 gm), proline (500mg - 1gm), glutamine (1-5 gm), DHEA 15-50 mg, and pregnenolone 25-50 mg, Ribose and co-factors 2,000-10,000 mg, CoQ 300-1,000 mg, Type 1 and Type 3 collagen.


It is important to understand that a shotgun approach by taking many nutrients at the same time seldom works and often backfires over time. The use of nutritional supplementation in overcoming Adrenal Fatigue needs to be individualized, based on each person's history, background, and body metabolic and clearance system. One person's nutrient may be another person's toxin. Each nutrient is like one bullet in the arsenal. Using the right bullet at the right time is critical.

Improper selection, dosage and timing of nutritional supplementation is the number one cause of Adrenal Fatigue recovery failure. Unless Adrenal Fatigue is in its mildest form, selecting the right compound, dosage, delivery system to match the stage of Adrenal Fatigue is best left to the experienced clinician.

Misguided by marketing and often misinformed, many sufferers take a whole battery of nutrients without careful consideration. This approach seldom works long term in the case of Adrenal Fatigue. In fact, the more advanced the condition, the more dangerous this approach. Even if some nutrients appear to work well at first, they may subsequently fail as the body developed tolerance and resistance. More is not necessarily better and may actually worsen the condition because improper administration may mask the underlying condition, creating a sense of temporary which eventually fails. Most only need a few natural compounds to get better. The key is selecting the right ones.

In Adrenal Fatigue, the body's ability to process and assimilate nutrient is compromised. Proper clearance of metabolites is a major concern. The more advanced the fatigue, the less the body is able to breakdown metabolites out of the body after nutrients have served their function. This is called the low clearance state. Without proper clearance, the best nutrient can accumulate in the body and become toxic. There is no laboratory test available to measure this. Experienced clinicians use various qualitative challenges to determine the amount of reserve capacity and clearance the adrenal has. This is vital information before initiating any comprehensive nutritional program. Failure to do so is a common mistake and a major reason why many self-guided programs fail. Administer nutrients in the right dose in a graded and step-wise approach, with follow up evaluation by a qualified health care professional. Here are some other helpful tips

Adrenal Fatigue Diet

When our cortisol levels are at its peak from 6 a.m. to 8 a.m. we may have no appetite. Many people skip breakfast because "they are not hungry". This is because our bodies need sugar to run on. Furthermore, our body's energy requirement does not change during this period. Even a small snack is better than nothing at all and will provide the needed energy even though there is no urge to eat.

Eating Pattern

Skipping breakfast is not a good idea. If you are low on sugar, the adrenals are instructed to secrete cortisol. cortisol activates gluconeogenesis to increase blood sugar level and allow the body to function. It is therefore important to have a healthy breakfast soon after waking and no later than 10 a.m. This will prevent the body being put in a position to play "catch-up" for the rest of the day.

The best time for lunch is from 11:00 a.m. to 11:30 a.m. Cortisol levels dip between 3:00 to 4:00 p.m. Sometimes, a nutritious snack between 2:00 to 3:00 p.m. is needed to sustain our bodies.

Evening meals should be around 5:00 to 6:00 p.m. Supper, if needed, should be in small quantities and low in glycemic. This will avoid the steep rise in blood sugar seen in high-glycemic index snacks such as cakes. These snacks will cause the blood sugar to rise and a corresponding increase in insulin output.

Over time, insulin secretion becomes dysfunctional, resulting in a hypoglycemic state in the middle of the night. These symptoms include nightmares, anxiety, and night sweats. When this occurs, the body will have to activate the adrenals to put out more cortisol to raise the blood sugar back to its normal level. This will eventually put an excessive burden onto the already fatigued adrenal gland if carried on year after year.


Glucose is a simple sugar found in food. It is an essential nutrient that provides energy for the proper functioning of the body's cells. After meals, food is digested in the stomach and is broken down into glucose and other nutrients. The glucose is absorbed by the intestinal cells and carried by the bloodstream to cells throughout the body. However, glucose cannot enter the cells alone. It needs help from insulin in order to penetrate the cell walls. Insulin therefore acts as a regulator of glucose transport and metabolism in the body.

Insulin is called the "hunger hormone." As the blood sugar level increases after a meal, the corresponding insulin level rises. As glucose is transported from the blood into the cell for energy, blood sugar levels drop. As energy continues to be generated, the blood sugar level continues to drop. When it drops below a certain level, hunger is felt. This often occurs a few hours after a meal. This drop in blood sugar triggers the adrenals to make more cortisol. Cortisol increases the blood sugar by converting protein and fat into its component parts. With this, the blood sugar rises to provide a continuous supply of energy for our use between meals. Cortisol works hand in hand with insulin to provide a steady blood sugar level twenty-four hours a day. It helps keep blood glucose levels in a tightly controlled range.

When the adrenal glands are weak, cortisol production drops below the normal level. Less sugar is available to the cells. With less sugar, less energy is available to the body, and fatigue sets in. As the sugar level drops below a critical point, dizziness and lightheadedness can occur. These are common symptoms of low blood sugar (also called hypoglycemia). Low blood sugar is most likely experienced between meals at 10 12 p.m., as well as 3 p.m. to 4 p.m.

To make matters worse, the body's automatic response when more sugar is needed during a stress response is to make more insulin. The insulin is intended to move the sugar into the cell from the blood stream to create more energy. Insulin opens up the cell membrane to push the glucose in, resulting in a further reduction in blood glucose. This worsens the already existing hypoglycemic state.

Those with Adrenal Fatigue often report symptoms such as dizziness and weakness. These symptoms arise as the blood sugar level drops below a comfortable level for the body to function normally. The quick fix solution is to take food that is high in refined sugar such as a donut or sweets, or drinks such as coffee or cola's that are stimulatory. This causes the adrenal to put out more cortisol and gives the person a boost of energy. However, this hypoglycemic symptom relief only lasts for about one to two hours.

Inevitably, it is followed by a crash to an even lower blood level. Those suffering from Adrenal Fatigue are constantly on a roller coaster ride in terms of their blood sugar level throughout the day. The sugar level tends to increase after each quick fix, but drops after a few hours. By the end of the day, the body is totally exhausted.

A diet that maintains a constant sugar level in the blood is a critical consideration in Adrenal Fatigue recovery. This can be done by taking a variety of low-glycemic index food that releases sugar slowly to sustain the body during and between meals. Starchy carbohydrates that are converted quickly into glucose (such as pasta and bread) should be limited. Soda drinks should be avoided.


Aldosterone, the sodium regulating hormone, can be drastically impacted from Adrenal Fatigue The amount of salt in the body is highly dependent and regulated by a chemical called aldosterone. Aldosterone is manufactured in the adrenal cortex under the direction of another hormone called ACTH (adrenocorticotrophic hormone). ACTH is produced by the anterior pituitary gland. ACTH stimulates the adrenal cortex to secrete a wide variety of hormones including aldosterone as well as cortisol. Like cortisol, aldosterone follows a diurnal pattern of secretion, peaking at 8 a.m., and it's at its lowest between 12 a.m. to 4 a.m. Aldosterone is a very specific compound that is responsible for maintaining the concentration of sodium and potassium inside and outside the cell. This in turn has a direct effect on the amount of fluid in the body. Aldosterone thus plays a significant role in regulation of blood pressure.

It is important to note that in our body, sodium and water goes hand in hand. Where sodium goes, water follows. As the concentration of aldosterone rises in the body, the concentration of sodium and water rises. More fluid is retained in the body, and blood pressure rises. Conversely, when the level of aldosterone lowers, the amount of sodium and water in the body is reduced. The blood pressure goes down.

Unlike cortisol, aldosterone does not have its own negative feedback loop during excessive levels. If the aldosterone level is too high, aldosterone receptor sites will be down regulated. Sensitivity to aldosterone is then reduced. In the early phases of Adrenal Fatigue, the amount of cortisol and aldosterone increases in our body due to increase ACTH from stress. Your body retains sodium and water resulting in a bloated feeling and increased blood pressure.

The baroreceptors (receptors that are sensitive to pressure) are triggered and blood vessels dilate. This is regulated by the autonomic nervous system. This auto-regulation helps to maintain a stable blood pressure at a time when the total fluid volume increases due to high levels of aldosterone triggered by stress. With stress, the adrenal glands also secrete another hormone called epinephrine. This hormone constricts the blood vessels and increases blood pressure in order to ensure that our brains have adequate blood flow and oxygen.

The sum reaction of aldosterone, epinephrine, and the autonomic relaxation response are some of the key factors that decide the final blood pressure at any point. During the early stages of Adrenal Fatigue, the resulting blood pressure is often normal if all bodily functions are well balanced. If the body is unable to overcome the aldosterone and epinephrine response, then the blood pressure is elevated. It is common to find people under stress experience an increase in blood pressure.

As Adrenal Fatigue progresses to more advanced stages, the amount of aldosterone production reduces. Sodium and water retention is compromised. As the fluid volume is reduced, low blood pressure ensues. Cells become dehydrated and sodium deficient. Hydration of a person in Adrenal Fatigue should take about twenty-four to forty-eight hours or more. Fluid with adequate electrolytes should be administered two to four times a day in intermittent dosages. Coffee, alcohol, and tea (except for herbal tea) should be avoided.

Most with Advanced Adrenal Fatigue report low blood pressure as well as a salt craving. The low blood pressure is due to the reduced fluid in the body. Salt craving is due to an absolute deficiency of sodium in the body. Both are due to the lack of aldosterone. To compensate for this, potassium leaks out of the cells so that the sodium to potassium ratio remains constant. The loss of potassium is less than that of sodium, and as a result, the potassium to sodium ratio is increased. This imbalance causes another set of problems.

While lost fluids should be replaced, it has to be done carefully and slowly. When replacing fluid too quickly without adequate sodium, the amount of sodium in the body may be diluted. This results in an even lower sodium level. This is called dilutional hyponatremia. Symptoms of low sodium include non-specific symptoms of confusion, lethargy, nausea, headache, seizure, weakness, and restlessness. Adrenal Fatigue along with low sodium leads to a clinical picture that is challenging to all but the most experienced clinician.

Those in this state may find themselves visiting the Emergency Room for many of these disturbing symptoms. They are often told that all is normal after extensive workup. In fact, those in Advanced Adrenal Fatigue may have electrolytes within normal range. Some may need diuretics to reduce fluid load while sodium load is being replaced. Symptoms may take some time to resolve.

Sufferers of Advanced Adrenal Fatigue usually have a low cortisol and sodium level. They should take filtered drinking water with half to one teaspoon of salt on a regular basis. If blood pressure increases, or signs of edema occur and nausea develop, stop the salt and report to a qualified health practitioner.

Only a small number of people with Adrenal Fatigue have concurrent high blood pressure. Those that fall into this category should check their blood pressure carefully during fluid replacement.

Sea salt is better than table salt in that it contains additional trace minerals as well. A good fluid cocktail for Adrenal Fatigue suffers is vegetable juice diluted with water and sprinkled with sea salt and kelp powder. Kelp contains about 90 mg of potassium and over 200 mg of sodium per serving and is easily absorbed.

Carbohydrate, Protein and Fats

It is important for Adrenal Fatigue sufferers to balance the amount of protein and fat, as well as carbohydrates. As compared to a normal person, the Adrenal Fatigue person has an immediate need for sugar when hunger strikes. At the same time, they also need good protein as well as good fat to have sustained energy until the next meal comes.

The primary diet should be high in raw food that is low in glycemic index. Avoid Fruit juices. Whole fruits should be limited, especially melons, which are high in sugar and cause sugar spikes soon after food enters the body. Good quality protein from meat, fish, and eggs are recommended. These provide a steady source of energy to carry the body through between meals.

Vegetarians who have Adrenal Fatigue have a much bigger challenge. Legumes (beans) must be eaten with whole grains, seeds, or nuts to make a complete protein. It is important for vegetarians to add eggs and miso, as well as combining beans, seeds, and nuts with a small amount of whole grains. About fifty to sixty percent of the diet should consist of raw food. While six to eight servings of a wide variety of vegetables should be included.

Seeds and nuts are critical elements and sources of fatty acids that the adrenal glands need to manufacture cholesterol. Cholesterol is a precursor to all adrenal steroid hormones. The key is to take nuts and seeds that are raw and free of rancid oils. Rancid oils make symptoms of Adrenal Fatigue worse and should be avoided at all cost. Take raw nuts should on a liberal basis and soak them overnight in water. Nuts such as cashews, almonds, Brazils, pecans, walnuts, and chestnuts are excellent. Avoid peanuts. Use olive oil for light cooking. The cooking heat should be low to moderate. Use coconut oil for any high heat or deep-frying.

Vegetables high in sodium include kelp, black olives, red hot peppers, spinach, zucchini, celery, and Swiss chard. Only take fruits should only in moderation. If you feel worse after food consumption, that is the body's way of telling you that you are on the wrong track. Organic fruits such as papayas, mangoes, apples, grapes, and cherries are recommended. Limit high potassium foods such as bananas, dates, figs, raisins, and grapefruits.

Excellent choices for Adrenal Fatigue sufferers are nuts and seedsMany people with Adrenal Fatigue also have a lower level of hydrochloric acid (HCl). HCl is necessary to break down the protein. Symptoms of this problem include gas, bloating, and heaviness in the stomach after eating a high protein meal. In such case, the use of digestive enzymes, probiotics, as well as HCl replacement is indicated.

It is especially important to avoid wheat. Wheat has been selectively bred to increase larger quantities of protein, a lectin called "wheat germ agglutinin" and glycoprotein. This lectin protein is what is largely responsible for many illnesses and allergies. This wheat germ agglutinin glycoprotein can do direct damage to the majority of tissues in your body. It can promote inflammation, pass through the blood-brain barrier, interfere with digestive/absorptive activities, shift the balance in bacteria flora, and may disrupt endocrine function. Lectins are extremely small and resistant to a breakdown. Even sprouting does not negate some of the harmful anti-nutrient effects. Adrenal Fatigue sufferers usually have a dysfunctional food assimilation pattern and slowed absorption. Adding wheat to the diet may lead to extra stress for the already weak body to process. This can slow down Adrenal Fatigue recovery or in advanced cases, trigger adrenal crashes.

Sample Dietary Plan of 2000 calories a day:

  • Whole grains 20% (on a rotational basis) = 400 calories = 2 slices of Ezekiel Sprouted Wheat bread, 1 cup of brown rice, and 1/2 cup of oatmeal.
  • Vegetables 30% = 600 calories = 3 cups salad, 2 cups green leafy vegetables, 2 cups mixed vegetables.
  • Nuts and beans 15% = 300 calories = 1/2 cup legumes, 3 tablespoons of nuts and seeds.
  • Fat 15% = 300 calories = 2 tablespoons of olive oil.
  • Animal proteins 10% = 200 calories = 2.5 oz. meat, chicken, or fish.
  • Whole fruits 10% = 200 calories = 2.5 medium whole fruits such as apple.

Tips for a Healthy Adrenal Gland

If you suffer from Adrenal Fatigue, coffee should be avoided

  • Sleep by 10 p.m.
  • Sleep in until 9:00 a.m., if possible
  • Do the things you like
  • Avoid coffee or other caffeinated beverages
  • Eat early
  • Have a glass of water in the morning with 1/2 to 1 teaspoon of salt
  • Avoid grains such as bread
  • Stay clear of starchy foods such as potato
  • Avoid trans-fats such as French fries
  • Laugh several times a day
  • Take vitamin C, pantothenic acid, magnesium, and vitamin E
  • Avoid becoming over-tired
  • Take pregnenolone and DHEA, as needed
  • Avoid sugary fruits such as melons
  • Never skip breakfast

Adrenal Fatigue Recovery Progression

Most Adrenal Fatigue is mild, lasting a few days or weeks, with full recovery. A minority of people will find recovery a challenge. Their conditions last longer than usual. They improve, but never fully recover. Still, a smaller number slowly decompensate and the condition worsens with time.

Normal Adrenal Fatigue recovery usually takes only a few weeks or months. The normal recovery curve when plotted should resemble a series of stair-steps going up, with a pause between each step. Those failing to recover usually have their recovery curve looking like a series of stair-steps going down, with a lower low after each crash.

Frequent onset of Adrenal Fatigue symptoms with ever increasing severity and duration is often a hallmark of Adrenal Fatigue recovery failure. While the body has a built-in system of self-repair, this mechanism is often not properly taken advantage of fully in the recovery process. There are many reasons for this failure. Here are a few common reasons why:

  • Improper use of nutritional supplements: Long-term use of stimulatory nutrients can lead to addiction and withdrawals. Applying the same dose of nutrients throughout the recovery process without careful consideration of this cyclical recovery process can lead to devastating results. The lack of attention to blending various forms of one nutrient leads to less than optimal levels required for recovery. Failure to employ the right delivery system of selected nutrients leads to waste and inadequate cellular concentration. One could be overdosing and putting excessive load on the adrenal at a time when it does not need as much. Or the adrenals could be under-dosed, thus depriving the adrenal of nutrients when it needs it the most if the dosage and delivery system is not titrated with the body's need each step along the way. Sometimes, fewer nutrients are needed in an up cycle, while more are needed in the down cycle. Other times, it is just the reverse. Applying a static approach to nutritional therapy often fails and in fact worsens the condition. It is important to match the dosage to the state of recovery for maximum effectiveness.
  • Inexperienced health care provider and operator malfunction for those who are attempting to self-navigate: Most conventional physicians are not well informed or trained on Adrenal Fatigue because it is not a recognized condition in the mainstream medical community. The lack of medical education and research results in tremendous misinformation and confusion among medical professionals and lay communities alike. Those with beginning and mild Adrenal Fatigue may do well with rest, removal of stressors, and gentle nutrients on a self-guided basis. If recovery fails within a short time, it is imperative to seek professional help because the natural progression of this condition is decompensation as the body ages. Advanced stage Adrenal Fatigue is a complex condition best left to those highly specialized in this field. Inappropriate therapy often backfires and worsens the condition over time. Most on a self-guided recovery program (along with many treated by conventional doctors) tend to waste too much time (often years) on their own only to make matters worse.
  • Excessive use of prescription drugs and medications: Excessive use of prescription drugs often makes Adrenal Fatigue worse, especially when anti-depressants, thyroid replacements, and hormone replacements are dispensed without careful attention to the state of adrenal condition. Those who are on thyroid medication should especially be on the alert if ever-larger doses of thyroid medication are needed to keep the condition stable.


Adrenal Fatigue is a decrease in the adrenal glands ability to carry out its normal function. The chief symptoms are fatigue, excitability, or depression.

Adrenal Fatigue is caused by chronic stress from any source (including emotional, physical, mental, or environmental) that exceeds the body's capacity to adjust to the demands placed on it by stress. It is a condition that afflicts children as well as adults. It can be diagnosed by laboratory tests only if the physician pays greater attention.

Adrenal glands can be restored to optimum health by adhering to healthy living principals. Proper rest, specific nutrition, proper diet and stress reduction are key components to Adrenal Fatigue recovery.

Most people who suffer from Adrenal Fatigue also have multiple endocrine imbalances. Some examples include sub-clinical hypothyroidism, insulin resistance, and estrogen dominance. These need to be optimized as well. Adrenal Fatigue recovery is a process akin to running a marathon. The process is long, but it can be done one step at a time. Most will find some improvement in a matter of weeks, depending on the degree of preexisting damage and the clinical skills of the health professional. Because the amount of hormonal balancing is intricate and is highly sensitive, the process can take anywhere from three months to three years under the best of hands. It is a long marathon, and recovery should not be expected in a matter of weeks. Frustration and disappointment are common and normal. Patience is key. During the recovery process, most people will go through a roller coaster type ride with advances and setbacks.

Using the correct amount of nutritional supplement can speed up the recovery process. While there are many nutrients that can help Adrenal Fatigue recovery, only a few are needed at any moment. Nutrients, if not dosed properly, can become toxic and make the Adrenal Fatigue worse. A shotgun approach seldom works and can in fact backfire if the adrenal is not able to take in the nutrients at the right rate, time, and dose.

It is best to take it one step at a time under professional guidance to ensure the right step is taken at the proper time. This is especially true for advanced cases. Laboratory tests can be helpful, but are not critical in most cases. The key is a knowledgeable clinician who takes the time to understand your body with its signals and cries for help. A complete nutritional and lifestyle approach that helps the adrenal gland to normalize itself, along with ongoing adjustments in terms of nutritional supplementation to assist the adrenal during this recovery is the key.

Dr. Lam's Key Questions

Adrenal fatigue is a weakening of your adrenal glands that can lead to a wide variety of symptoms such as weight gain, anxiety, reduced sex drive, low blood sugar, and blood pressure fluctuations (POTS).

Adrenal Fatigue Syndrome is caused by stress or other factors. These can include but are not limited to dysregulation of the HPA axis, nervous system problems, immune system problems, and metabolic-nutritional problems. It is a complex condition with complex clinical presentation, depending on the stage of dysfunction. Those in neuroscience may prefer to label this condition Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation.

  • Tendency to gain weight and unable to lose it, especially around the waist.
  • High frequency of getting the flu and other respiratory diseases.
  • Infections that tend to last longer than usual.
  • Tendency to tremble when under pressure.
  • Reduced sex drive.
  • lightheaded when rising from a horizontal position.
  • Unable to remember things.
  • Lack of energy in the mornings and in the afternoon between 3 to 5 pm.
  • Feel better suddenly for a brief period after a meal.
  • Often feel tired from 9 - 10 pm, but resist going to bed.
  • Need coffee or stimulants to get going in the morning.
  • Cravings for salty, fatty, and high protein food such as meat and cheese.
  • Increased symptoms of PMS for women. Periods are heavy and then stop, or are almost stopped on the 4th day, only to start flow again on the 5th or 6th day.
  • Pain in the upper back or neck with no clear reason.
  • Feels better when there is less stress, such as on a vacation.
  • Difficulties in getting up in the morning.
  • Lightheaded.
  • Mild depression.
  • Food and or inhalant allergies.
  • Lethargy and lack of energy.
  • Increased effort to perform daily tasks.
  • Decreased ability to handle stress.
  • Dry and thin skin.
  • Hypoglycemia.
  • Low body temperature.
  • Nervousness.
  • Palpitation.
  • Unexplained hair loss.
  • Alternating constipation and diarrhea.
  • Dyspepsia.

Most Adrenal Fatigue is mild, lasting a few days or weeks, with full recovery. A minority of people will find recovery a challenge. Their conditions last longer than usual. They improve, but never fully recover. Still, a smaller number slowly decompensate and the condition worsens with time.

Normal Adrenal Fatigue recovery usually takes only a few weeks or months. The normal recovery curve when plotted should resemble a series of stair-steps going up, with a pause between each step. Those failing to recover usually have their recovery curve looking like a series of stair-steps going down, with a lower low after each crash.

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


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