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Low Aldosterone Levels: Little-Known Source of Dehydration and Fatigue

Two of the most important hormones produced by your adrenal glands, cortisol, and aldosterone, regulate a number of important functions in your body. And when you experience low cortisol or low aldosterone levels, significant problems can result.

Aldosterone Problems: Fluid Balance and Adrenal Fatigue

An image of a man drinking water from a water bottleAldosterone's job is maintaining the best balance of fluids in your body. This balance results from a self-regulating mechanism in which blood volume and electrolyte levels remain stable. However, problems emerge when the hormones controlling these fluids become dysregulated.

This balance is even more critical if you suffer from Adrenal Fatigue Syndrome (AFS). AFS results from chronic stress overwhelming your adrenal glands with demands for cortisol, the stress hormone. Once the adrenals become overwhelmed, they can not produce sufficient cortisol or aldosterone. Fluid dysregulation is a significant problem in AFS. These low aldosterone levels resulting from adrenal dysfunction lead to fluid dysregulation and more serious symptoms of AFS.

This fluid dysregulation becomes a more significant issue for people in the advanced stages of AFS. They begin showing symptoms of fluid imbalances and dehydration earlier than those in good health, typically a long time before laboratory testing shows any abnormality.

How Aldosterone Works

Aldosterone comes from the adrenal cortex. It is stimulated and guided by another hormone called adrenocorticotrophic hormone (ACTH). This guiding hormone is produced by the anterior pituitary gland. It serves to stimulate the adrenal glands to secrete a large number of hormones including aldosterone. Similar to cortisol, aldosterone typically undergoes a diurnal pattern of secretion, usually reaching a peak at 8 a.m. and reaching its lowest point between 12 and 4 p.m.

The steroid hormone aldosterone makes up part of a group of linked hormones called the renin-angiotensin-aldosterone system. When the blood flow to the kidneys decreased due to decreased blood pressure or loss of blood volume, this system becomes activated.

As a result, the enzyme renin sets in motion a chemical process resulting in the production of angiotensin II, which then stimulates the production of more aldosterone. Low aldosterone levels then become replenished, resulting in increased salt and water reabsorption into the bloodstream by the kidneys. Consequently, blood volume increases along with salt levels and blood pressure.

Aldosterone, the main mineralocorticoid in your body, works to regulate your fluid and salt balance. These salts made up of electrolytes such as sodium and potassium, affect your body’s fluid balance.

When aldosterone levels remain sufficient, they work on your kidneys and colon to increase the amount of sodium reabsorbed into your bloodstream and increase the amount of potassium excreted through your urine. In addition to increased sodium, the amount of water in your body also increases, resulting in increased blood pressure and volume.

What Happens with Low Aldosterone Levels?

Issues resulting from low aldosterone levels typically lack the attention paid to low cortisol levels. However, some significant symptoms experienced by those who suffer from AFS can occur with low aldosterone. Those symptoms include:

  • Salt cravings
  • Dizziness or lightheadedness on standing
  • Low blood pressure and high pulse on standing
  • Palpitations
  • Fatigue
  • Brain fog

The mechanism behind the connection between low aldosterone and fatigue works like this: When low aldosterone levels develop, your kidneys lose salt, resulting in decreased blood volume. Your leg veins don’t constrict in the way they should, leading to even lower blood volume and decreased blood supply to your brain. Fatigue results. Low aldosterone levels can become even more of a problem if you restrict your salt intake.

Research on Aldosterone and Renin

Recent research into the renin-aldosterone relationship has revealed some significant patterns. Approximately half of the subjects in the research who experienced fatigue also experienced low aldosterone and low renin levels. This finding may result from dysfunction of the autonomic nervous system’s communication with the kidneys. The autonomic nervous system can become dysfunctional with AFS.

Another third of the subjects in this research showed low aldosterone levels and high renin levels. This apparently indicated lowered production of aldosterone from the adrenals, along with a rise in renin from the kidneys as compensation. This also follows the pattern seen in those people suffering from AFS.

Aldosterone and Blood Pressure

An image of a woman pressing her templesAs aldosterone stimulates the kidneys to retain sodium, the level of water in your body also increases. The more aldosterone produced by the adrenals, the more water stays in your body. Since the cardiovascular system is a closed system, this higher level of water in your body increases blood volume. A greater blood volume results in higher blood pressure.

Normally, your body regulates blood pressure in this way automatically. When it senses blood pressure getting low, it stimulates your adrenals to produce more aldosterone to ultimately raise your blood pressure. Problems occur when this normal process becomes dysfunctional, as happens in AFS.

Low Aldosterone and AFS

When stress hits your body, regardless of its source, the same mechanism becomes activated. Your adrenal glands come under pressure to release increasing amounts of cortisol and aldosterone. Therefore, in the initial stages of AFS, you tend to experience high blood pressure due to the increased levels of aldosterone.

However, as stress becomes chronic, the pressure placed on your adrenals to produce more of these necessary hormones increases. Your adrenal glands become overburdened and unable to meet the demands. At this point, the levels of both cortisol and aldosterone diminish.

The more advanced the stages of AFS, the lower your aldosterone levels. Consequently, your body experiences difficulty in retaining fluids. This can lead to you craving salty foods such as chips and to you salting your food more than usual.

Chronic low blood pressure can result if your aldosterone levels continue to drop. You may feel fatigued, dizzy, lightheaded, and experience decreased urine output. A chronic subclinical dehydration state may also result.

Early symptoms of subclinical dehydration due to low aldosterone include:

  • Increased thirstiness
  • Dry mouth
  • Brain fog
  • Heartburn
  • Wrinkles
  • Dry skin
  • Urinary tract infections
  • Decreased elasticity of the skin
  • Constipation
  • Darkly colored urine

Most of the time, these relatively subtle signals of trouble escape detection in the early stages of AFS. However, as AFS reaches the more severe stages, other symptoms appear. These include:

  • Postural hypotension
  • Postural tachycardia
  • Chronic low blood pressure
  • Cardiac arrhythmia
  • Dizziness on rising
  • Adrenal crashes
  • Heat intolerance
  • Lethargy

With drops in blood pressure, the flow of blood to your brain decreases, resulting in some of the symptoms listed. As a result, when this occurs your autonomic nervous system becomes activated to deal with the issue.

This compensatory mechanism results in more palpitations increased strength of heartbeats, increased heart rate, skin pallor, increased respirations, and fainting.


An image of a man holding his head and a glass of waterThe subclinical dehydration mentioned above becomes more problematic as AFS reaches more advanced stages. The electrolyte balance that drives dehydration can become fragile as AFS worsens.

This is the point at which your brain activates the autonomic nervous system (ANS) to deal with lowering blood pressure. Low blood pressure means too little blood going to your brain and results in many of the symptoms already mentioned.

Activation of the ANS leads to a release of epinephrine and norepinephrine, two powerful hormones/neurotransmitters in an effort to increase blood pressure and the amount of blood your brain receives. Epinephrine is stronger than norepinephrine and typically comes into use as no other stimulation works to increase blood pressure. It brings significant stimulation to your cardiovascular system. As a result, your brain gets a sufficient supply of blood, and your blood pressure increases. But collateral damage occurs. Some of the side effects of this release of epinephrine and norepinephrine include:

  • Nightmares
  • Shortness of breath
  • Tachycardia
  • Cardiac arrhythmias
  • Pounding heart rate
  • Tightness in the chest at rest

These symptoms often seem like those felt with a heart attack and can become very scary.

Anxiety and a feeling of impending doom may occur along with these symptoms as your brain becomes stimulated more by these chemicals and your body goes on high alert. This may result in trips to the emergency department for a cardiac workup. Seldom do conventionally trained medical professionals consider low aldosterone as a factor.

Low Aldosterone and the NEM Stress Response

The NeuroEndoMetabolic (NEM) stress response makes up another of the automatic systems in your body that becomes important when stress becomes chronic. Consisting of six inter-related circuits of three organs or systems each, the NEM works to keep your body balanced and working properly.

When stress becomes chronic and AFS results from your adrenals losing the ability to produce sufficient hormones to fight the effects of that stress, the NEM becomes activated. The Hormonal circuit goes into action early in this process.

Made up of the adrenals, thyroid, and reproductive system, this circuit becomes affected quickly by low aldosterone and other hormones. When your adrenals become weak due to the pressure place on them by chronic stress, their production of the stress hormones decreases. Due to the inter-relatedness of the systems in this circuit, low adrenal function affects your thyroid and reproductive organs.

Low adrenal function leads to low thyroid function. Your thyroid gland helps regulate your body temperature, speed of total stress response, and a great number of other functions in your body. Low thyroid function results in fatigue.

As a result of the fatigue caused by low thyroid function, your body slows down and libido drops causing reproductive interest to decrease. The ovarian-adrenal-thyroid (OAT) axis becomes disrupted, leading to disruption in other areas, as well.

For example, when your adrenal function becomes weak due to AFS, you experience low thyroid function and irregular menstruation. A weaker thyroid increases adrenal fatigue. Likewise, with an imbalance in ovarian hormones and resulting estrogen dominance, any hypothyroidism that already existed becomes worse.

A dysfunctional hormonal circuit may bring on the following symptoms:

  • Fatigue
  • PMS
  • Exercise intolerance
  • Infertility
  • Irregular menses
  • Low libido

Feeling cold when others feel warm


Low aldosterone levels do not receive the amount of attention paid to low cortisol levels. These two hormones assume leading roles in multiple functions of your body, so when their levels become low, problems can develop.

Many symptoms of AFS can be traced back to low aldosterone levels. This mineralocorticoid regulates the fluid levels in your body, resulting in significant effects on blood pressure. As AFS progresses, it becomes more difficult to regulate fluid levels, often resulting in low blood pressure and subclinical dehydration.

Both of these conditions bring on symptoms. For example, postural hypotension, dizziness, lightheadedness, and even fainting.

The loss of water and electrolytes in your body also can lead to your body activating your ANS to release strong hormones to raise your blood pressure. Side effects of this process include several symptoms that can cause you to think you’re having a heart attack.

When your adrenal function is low, it also affects your thyroid and reproductive system. Low thyroid function leads to fatigue. As your body slows down due to these thyroid problems, libido suffers, and reproduction no longer is important. In addition, ovarian hormone imbalance can increase the severity of any pre-existing hypothyroidism.

What Can You Do?

If you are suffering from low aldosterone levels, here are a few things you can do to alleviate the situation:

    An image of a woman leaning on a railing holding her head

  • Increase your salt intake, preferably with sea salt.
  • Be sure to drink sufficient amounts of water daily, including salty water.
  • Avoid foods and drinks that work to decrease the amount of water in your body.
  • If you suffer from AFS, do all you can to decrease the overall stress you experience.

Whatever course of action you decide to take, however, please do so with the guidance of your healthcare professional who can help you determine the best options for you.

If you would like to know more about or need additional assistance with low aldosterone, the team at Dr. Lam Coaching can help. We offer a free** no-obligation phone consultation at +1-626-571-1234 where we will privately discuss your symptoms and various options. You may also send us a question through our Ask The Doctor system by clicking here.

© Copyright 2021 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

Low aldosterone can lead to a significant imbalance in sodium and potassium. These two electrolytes play major roles in keeping your blood pressure stable. Low blood pressure leads to fatigue and other symptoms. Aldosterone levels become even lower as AFS advances to more serious stages.

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