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The Critical Relationship Between Adrenal Fatigue and Cortisol

Evidence-based Reviewed Article

An image of a man being checked by a healthcare professionalAdrenal fatigue, also known as Adrenal Fatigue Syndrome or AFS, is a stress-related condition that affects many individuals. It is the non-Addison's form of adrenal dysfunction, where the body's stress response cannot keep up with life's chronic stressors. In general, it is caused by very intense or chronic stress that depletes the body's resources and causes widespread dysfunctions throughout the body. However, this condition is not officially recognized by many medical doctors, so it can be difficult for people dealing with it to identify the source of their symptoms and find relief. There are multiple aspects to adrenal fatigue, but here we will explore the relationship between adrenal fatigue and cortisol, one of the body's primary stress hormones.

How Stress Works

Before exploring the relationship between adrenal fatigue and cortisol, it's important to understand what stress is and what happens in the body. Stress as defined by the World Health Organization (WHO) is a state of worry, or mental tension caused by a difficult situation (1). It can be caused by a wide variety of situations, from a difficult boss to a broken-down car, and it can also be physical rather than psychological, such as the stress of a serious or extended illness.

Stress is a natural response to these situations. It helps your body to rise to the challenge or threat. Everyone will experience stress differently and experience stress in different situations. Some common symptoms of stress include anxiety, headaches, difficulties sleeping, and changes in eating habits.

When your body experiences stress, such as the need to run from a tiger, it activates what is often known as the "fight or flight" response. Certain organs are put into overdrive, like your heart, to give you the energy to fight or flee. Meanwhile, other organs are turned down or off, like your digestion and reproductive drive, which are not needed for immediate survival. Your body does this by releasing cortisol through the adrenal glands.

The Role of the Adrenal Glands

The adrenal glands are two glands that sit atop your kidneys. Your adrenal glands produce and release hormones that are crucial for your health. These include:

  • Adrenaline
  • Cortisol
  • DHEA
  • Progesterone
  • Testosterone
  • Estrogens

The most well-known role of the adrenal glands is in producing the "fight or flight" response, helping you to respond to danger. However there are some other roles of the adrenal glands, these roles include:

  • Activating energy production through converting carbohydrates to glucose
  • Maintaining fluid and electrolyte balance
  • Fat storage

Cortisol Release

When stress happens, you may be feeling some symptoms of stress such as anxiety or difficulty concentrating. Meanwhile, there are some key processes that happen in your body. The first is the production of two hormones, adrenaline and noradrenaline. This rush of hormones is also known as the 'fight or flight' response and helps you to act accordingly (2).

Another process that happens in your body is the release of cortisol. Cortisol is also a key hormone in stress. This hormone helps to regulate your body in times of stress and is your body's main anti-stress hormone.

Cortisol also has many other important roles within the body, including regulating:

  • Blood pressure
  • Blood sugar levels
  • Metabolism
  • Inflammation

NeuroEndoMetabolic (NEM) Stress Response System

An image of a woman holding her foreheadThe body's system for initiating the release of stress hormones such as adrenaline and cortisol, is known as the NeuroEndoMetabolic (NEM) Stress Response. There are six circuits within this collection of related organ systems that work together to help manage stress. These circuits are the Hormone, Bioenergetics, Detoxification, Inflammation, Neuroaffect, and Cardionomic circuits. Each circuit consists of three different organs and has its own role.

Because the circuits overlap somewhat, the NEM describes how what affects one circuit can affect others as well. It also helps to map symptoms of adrenal fatigue, based on which circuits are affected and which other symptoms are likely to occur.

The Relationship Between Adrenal Fatigue and Cortisol

Initially, the cortisol produced in response to stress helps your body cope. However, over the long term, it can be detrimental to your health. The body is designed to deal best with short-term stressors that end. But when stress continues, your body continues to produce cortisol. After a time, this can deplete your adrenal glands of the resources needed to produce adequate cortisol.

Eventually, this causes your cortisol levels to become low. Without the stress-regulating effects of cortisol, your body cannot regulate stress. Additionally, this leads to other hormone imbalances and imbalances within your NEM system. This results in adrenal fatigue.

The symptoms of adrenal fatigue depend on where the imbalance in the NEM system is occurring. Because adrenal fatigue is a syndrome, it means that there are generally a range of symptoms that individuals experience. These symptoms, also depend on the individual, so two individuals with adrenal fatigue may have very different symptoms.

Adrenal Fatigue and Cortisol Within The NEM System

One of the first circuits affected by cortisol problems is the Hormone circuit. This circuit consists of the adrenal glands along with the thyroid gland and reproductive organs. Like the name suggests, this circuit is responsible for producing key hormones that regulate the body.

This circuit is also one of the circuits that first responds to stress. Your brain stimulates the adrenal glands to produce cortisol. Then, as levels of cortisol rise, and then when the stress passes, cortisol levels lower. However, when the stress becomes long-term, your adrenal glands continue to produce cortisol. After a time, your adrenal glands are unable to keep up with the demand and are unable to produce sufficient cortisol levels.

With this increase in demand, your body converts pregnenolone (the precursor hormone used for other hormones such as progesterone, estrogen, and testosterone) into cortisol. This then results in an imbalance in these hormones. Eventually, cortisol levels will become low, which affects the functioning of the thyroid gland.

Imbalances in this circuit can cause a range of symptoms such as:

  • Fatigue
  • Changes in weight
  • Premenstrual syndrome (PMS)
  • Irregular periods
  • Low libido
  • Infertility

Rebalancing hormones alone may not work, as it is necessary to address the cortisol imbalance too.

What Can Cause Adrenal Fatigue?

Whilst you may be aware of common stressors such as work deadlines and family pressures, there are some other lesser-known factors that can aggravate the relationship between adrenal fatigue and cortisol. These factors include:

  • High consumption of sugar, alcohol, or processed food
  • Eating meat that contains hormones and/or antibiotics
  • Pesticides and herbicides in fruits and vegetables
  • Trans fats
  • Sedentary lifestyle
  • Smoking
  • Underlying illnesses
  • Reoccurring illnesses
  • Toxins in home and beauty products

Testing for Adrenal Fatigue

An image of four collection tube with samplesTesting for adrenal fatigue will depend on your healthcare practitioner, in some cases the cortisol levels in the urine and saliva will be measured. It's best to take a four-point cortisol throughout the day every 4 - 6 hours to get an accurate look at the whole cortisol curve. The saliva test is great at looking at the free cortisol levels, which are the more accurate working form of cortisol. It's difficult to get blood drawn four times in one day, that's why saliva testing is a good option. In addition to this, a comprehensive history should be taken including symptoms that the individual is currently experiencing. This helps the healthcare professional have a comprehensive view of the individual in order to determine whether or not they are experiencing adrenal fatigue.

Strategies for Improving Adrenal Fatigue and Cortisol Levels

There are many different strategies by which you can relieve adrenal fatigue.

Avoid Caffeine, Sugary Drinks, and Alcohol

Certain beverages such as alcohol, coffee, and caffeinated drinks such as energy drinks stimulate your stress response system and stimulate the release of cortisol. Reducing your intake of these beverages can help to limit the stress that is placed on your adrenal glands.

If your intake of these drinks is high, reducing slowly is important, as stopping abruptly can be stressful on your body and actually increase the release of cortisol. One study demonstrated that individuals with alcohol use disorder (AUD) had an increase in cortisol when alcohol was stopped, with the levels reducing over time (3). It's also important to discuss changes with your healthcare professional.

Avoid Sugary and Processed Foods

The research is currently conflicting on which foods increase cortisol. Some research shows that foods high in sugar and saturated fats increase the cortisol response. However, another study found that these foods reduce the body's reactivity to cortisol, potentially illustrating why individuals crave comfort foods during stress (4).

Still, it is important to focus on nutrient-dense foods that are not overly stimulating, like vegetables and lean protein. This will help support your body nutritionally during adrenal fatigue. Consider the adrenal fatigue diet as a guideline.

Stay Hydrated

Dehydration is another factor that affects your cortisol levels. It can increase cortisol, increasing the stress on your body. The requirements for water depend on multiple factors. However, some sources recommend up to 13 glasses of water per day for males and nine for females (5).

Gentle Exercise

Being physically active is an important component of a healthy lifestyle and directly affects cortisol levels. Intense exercise increases cortisol on a short-term basis, then it decreases and helps your body cope with the intense exercise. However, in adrenal fatigue and cortisol, your cortisol levels are already under strain, and intense exercise can put further strain on your body.

Rather than doing intense exercises, focus on gentle exercises that incorporate breathwork. Whilst some forms of yoga, such as hot yoga, can stimulate the release of cortisol, other types can help to lower cortisol, such as restorative yoga. Stretching can also help to relax your muscles and lower cortisol levels.

By doing gentle exercises, it will help you to meet the exercise recommendations of 150-200 minutes of exercise per week. Research suggests that regular exercising can help improve sleep and reduce stress which in turn can help lower cortisol levels.

It's also important to not overdo exercise during adrenal fatigue as this will also aggravate cortisol levels. Keeping to gentle exercises, like yoga, tai chi, qi gong, and walking can help, along with paying attention to your body and stopping before you get tired.

Get Enough Quality Sleep

An image of a sleeping womanSleep is another important aspect of your lifestyle that can affect your cortisol levels. Research shows that sleep loss of around four hours of sleep per night for one to six consecutive nights reduces cortisol levels in the morning, increases it in the afternoon, and reduces the reactivity and recovery of the cortisol response (6).

This makes it important to get adequate sleep. The recommendation for sleep at seven to nine hours per night (7). Sleep quality is also important.

To help improve the quality of your sleep you can:

  • Reduce your exposure to electronic devices before you sleep
  • Go to bed and wake up at the same time every day
  • Make sure the room is dark and that it is a safe and calm environment

Supplementation for adrenal fatigue

Vitamin C and Vitamin B5 are key nutrients in supporting adrenal health, especially for individuals experiencing Adrenal Fatigue Syndrome (AFS). These vitamins are crucial in maintaining normal adrenal function and managing the body's response to stress.

LipoNano C is a unique vitamin C supplement that utilizes Liposomal Encapsulation Technology. This method encapsulates vitamin C in essential fatty acids and phospholipids, aiming to enhance its delivery to cells. LipoNano C is formulated to be soy and alcohol-free, making it suitable for individuals with specific dietary needs. Its liquid form is designed for easy absorption and is gentle on the digestive system.

Pandrenal contains pantethine, the active form of Vitamin B5. This supplement is focused on supporting the adrenal's nutritional needs, particularly in relation to Vitamin B5. Pantethine is involved in various metabolic processes and is vital to the production of hormones in the adrenal.

Adrenal Daily Nutrient is a comprehensive supplement containing a wide array of vitamins, minerals, and antioxidants. The supplement is designed to support the adrenal, liver, gut, and detoxification pathways and is enriched with a blend of fruits and vegetables, aiming to contribute to daily nutritional intake.

Adrenal PS is a great supplement to help modulate cortisol levels if your levels come out elevated throughout the day. It's utilized throughout the day to help calm the system down and reduce stress.

It is important to consult with a healthcare professional before starting any new supplement regimen, as they can provide personalized advice based on individual health needs and conditions.

Closing Thoughts

There is an important relationship between adrenal fatigue and cortisol. Not only is cortisol one of the causes of adrenal fatigue, but it plays an important role in multiple circuits of the NEM system. Therefore, it is important to lower stress levels and allow your cortisol levels to drop after stress.

Nutrition and lifestyle choices significantly impact cortisol levels, underscoring the importance of holistic approaches in adrenal fatigue recovery. Whether you're experiencing adrenal fatigue symptoms or concerned about high cortisol levels, Dr. Lam's Nutritional Adrenal Fatigue Recovery Program offers a holistic approach to support your journey to optimal health. Our program integrates personalized nutrition plans, targeted supplementation, and lifestyle modifications tailored to address adrenal fatigue and cortisol imbalance.

Take the first step towards healing and reclaiming your vitality with a free, no-obligation phone consultation at +1 (626) 657-2269. During this confidential session, we'll explore your symptoms and discuss personalized options for your recovery journey. Alternatively, you can seek answers to your questions through our Ask The Doctor system here.

© Copyright 2024 Michael Lam, M.D. All Rights Reserved.

World Health Organization. "Stress." World Health Organization, Feb. 2021,

Chu, B., et al. "Physiology, Stress Reaction." StatPearls, Sept. 2022,

Price, J., and Nixon, S. J. "Retrospective Hair Cortisol Concentrations from Pretreatment to Early Recovery in Alcohol Use Disorder." Alcohol and Alcoholism, vol. 56, no. 2, Mar. 2021, pp. 181-184,

Di Polito, N., et al. "Real-World Intake of Dietary Sugars is Associated with Reduced Cortisol Reactivity Following an Acute Physiological Stressor." Nutrients, vol. 15, no. 1, Jan. 2023, p. 209,

Castro-Sepulveda, M., et al. "Basal Mild Dehydration Increases Salivary Cortisol After a Friendly Match in Young Elite Soccer Players." Frontiers in Physiology, vol. 9, 2018,

Nollet, M., et al. "Sleep Deprivation and Stress: a Reciprocal Relationship." Interface Focus, vol. 10, no. 3, Apr. 2020,

National Sleep Foundation. "How Much Sleep Do You Really Need?" National Sleep Foundation, Oct. 2020,

Dr. Lam’s Key Question

You can take steps to help manage the relationship between adrenal fatigue and cortisol by being mindful of this relationship and adopting practices to support your cortisol levels. These include practicing proper nutrition, gentle exercise, and adequate sleep. These will help to lower cortisol and help to prevent adrenal fatigue from occurring.

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