Are you constantly tired no matter how much you sleep?
Do you get overwhelmed by stressful situations that you could handle in the past?
Is it hard to get out of bed in the morning even after a long sleep?
Do you depend on caffeine or sugary drinks just to get through the day?
If you answered yes to any or all of these questions, there is a strong chance that you are dealing with adrenal issues, particularly adrenal fatigue.
In this article I will discuss the symptoms of adrenal fatigue and how to diagnose it.
I will then walk you through the best natural treatments for adrenal fatigue and lifestyle changes that will help you regain your energy and your life.
Here we go...
What is Adrenal Fatigue?
So what is adrenal fatigue?
When the body is under stress, the adrenal glands will release hormones such as cortisol, DHEA, and epinephrine.
These hormones regulate heart rate, the immune system, energy storage, and more.
Cortisol is our "stress hormone." When its levels are elevated, that signals the mitochondria in our cells to increase energy production to help us get through whatever stress is occurring.
When the body is functioning correctly, the cortisol will only be elevated for a short period of time then drop back to the normal pre-stress levels.
However, under high stress situations such as chronic illness, relationship issues, death in the family, a job you hate, and others, the cortisol level remains high for an extended period of time.
Eventually, the adrenal glands will be unable to keep up with the cortisol demands and the levels will drop.
Energy production in the cells decreases, which causes symptoms of fatigue.
These people often resort to consuming large amounts of caffeine, sugar, or other stimulants just to get through the day.
This is what we call adrenal fatigue.
If something causes the adrenals to essentially stop all cortisol production (such as autoimmune disease or other damage), it can be life-threatening. This is called adrenal insufficiency or Addison's Disease.
These patients require oral steroid replacement in order to live.
On the other hand, Cushing's Disease is a syndrome that causes an incredibly high amount of cortisol in the body which leads to many serious and potentially life threatening conditions.
As a general rule, conventional medicine does not recognize any adrenal issues until it reaches one of these extreme levels.
If your cortisol levels are in the normal reference range of the labwork, you will be told you are "normal" and sent on your way.
Like other hormones in the body, small changes to concentrations of these hormones can lead to big symptoms that are felt throughout the body.
People with suboptimal levels of cortisol can have significant symptoms that affect their quality of life, so it deserves our attention.
There are 4 basic stages of Adrenal Function/Dysfunction:
- "Surviving" - In this scenario, the normal cortisol slope is absent because of increased cortisol production. (This is actually MY cortisol curve during a very stressful time of my life)
- "Thriving" - Cortisol production is normal.
- "Wired and Tired" - The cortisol levels are high during the day then drop during the evenings. That makes you feel anxious in the morning then exhausted by evening.
- "Crashed Stage" - The adrenal gland is no longer able to keep up with the cortisol demands so the levels drop very low. Extreme fatigue is the predominant symptom.
Cortisol has been shown to increase insulin resistance. It also worsens leptin resistance.
Elevated cortisol also promotes hypothyroidism.
All of this leads to weight gain and lack of energy.
Adrenal Fatigue Symptoms
Symptoms that suggest you have adrenal problems and that you may need to get your cortisol level evaluated include:
These symptoms indicate a problem with energy production and adrenal issues.
Remember, cortisol is a "stress hormone" and is typically secreted in to response to a perceived stress.
These stressors can include:
- Frustration or emotions related to your job, work or social life
- Anything that is physically stressful on the body (exercise, manual labor, etc)
- Lack of sleep (especially if prolonged over months or years)
- Pressure of school work/work load
- Poor diet or food choices (especially diets lacking in fruits and vegetables)
- Constant use of stimulants such as caffeine
- Complete lack of exercise or sedentary lifestyle
- Chronic medical conditions (high blood pressure, insulin resistance, chronic pain, etc)
- Recent illness
- Anything else that causes your annoyance, frustration or stress
Please note that many of these symptoms are non-specific and can also indicate that something else is going on in the body.
That is why it is important to get a thorough evaluation by a qualified medical professional.
How to Diagnose Adrenal Fatigue
So how do you diagnose adrenal fatigue, especially if your labs fall in the "normal range?"
There are several ways to test for cortisol available. Some are better than others.
I'm going to discuss the ones that I think are best.
It is easiest to start with a serum cortisol level.
This test can be very frustrating because is has a very large "normal" reference range.
However, it's cheap and usually easy to get.
Levels that fall in the middle of the reference range will not be particularly helpful, but it can show us a lot if it falls in the low normal or high normal of the range.
So what is low normal or high normal?
- Low normal cortisol range - 8am serum cortisol levels ranging from 4 to 10
- Normal cortisol range - 8am serum cortisol levels ranging from 11-18
- High normal cortisol range - 8am serum cortisol levels greater than 20
It is important to check your serum cortisol level at 8am because that is when it is at its "peak" level.
This represents the highest level your cortisol will be throughout the day. If it's already low normal at 8am, it will only get worse from there.
In order to get a full evaluation of your cortisol levels it may be necessary to evaluate the "rhythm" of your cortisol throughout the day.
By checking your cortisol several times per day you can accurately see how your body is responding to various situations.
This allows for more detailed information which can then be used for treatment.
The most accurate form of testing is through urinary measurements taken several times throughout the day (compared to a 24 hour urine test).
This is even more accurate than salivary levels.
My favorite is the DUTCH test.
With the DUTCH test, you check your urinary cortisol levels 4 times throughout the day. This gives a much better representation of how your cortisol level is trending.
Although this test is the best, it is expensive and more difficult to perform.
So should every patient that we suspect has adrenal fatigue have their urinary cortisol level tested? No.
I would recommend starting with an 8am serum cortisol level. Depending on what it shows, then moving to a DUTCH test may be necessary.
It is also worth doing a trial of treatment if your levels are "normal" but you are still symptomatic with several of the symptoms I discussed earlier.
Natural Treatments for Adrenal Fatigue
So based on your symptoms and perhaps a low normal serum cortisol test or even an abnormal DUTCH test, you have been diagnosed with adrenal fatigue.
What can you do about it?
Actually, there are a lot of things that you can do.
Many of them are common sense. Others are more targeted treatments that will depend on which stage of adrenal dysfunction you are in.
For now, let's divide into 2 main groups - those that have low cortisol levels and those that have elevated cortisol levels.
Treatment for Low Cortisol ("Wired and Tired" and "Crashed")
Click on each supplement to see my recommended brand.
- Adrenal glandulars: These work best for patients with very low cortisol levels. They also tend to provide an immediate boost to energy levels. Using glandulars in combination with other supplements listed below may be necessary. Should be used for 6+ months.
- Adrenal Adaptogens: Adaptogens can actually help to lower cortisol levels when they are high and some can even raise cortisol levels when they are low. There are many types of adaptogens but I find that blends of multiple adaptogens tends to work best. These can be combined with glandulars as well for more benefit. Should be used for at least 3 months.
- CoQ10: This coenzyme is involved in proper mitochondrial energy production and can help increase energy levels, which can be very helpful in adrenal-related issues. Use 2 capsules (240mg) per day for several months.
- Alpha Lipoic Acid: ALA helps increase mitochondrial energy production, acts as a powerful antioxidant, reduces peripheral neuropathy, and lowers inflammation. ALA can also help with weight loss due to its effects on insulin. Start at 600mg daily and increase up to 1800mg daily as tolerated.
- Vitamin B6: Vitamin B6 is used in several pathways in the creation of adrenal hormones and many patients are deficient in it. Taking higher doses of B6 during the acute phase of treatment may be necessary for a short period of time.
- DHEA: DHEA is the precursor to testosterone and other estrogen metabolites. With low cortisol and low adrenal hormone production, supplementing with hormone precursors may be of benefit. Start with a low dose every 2-3 days and increase to daily as tolerated. Be careful because DHEA can turn into androgens or estrogens in high doses.
- Pregnenolone: Pregnenolone is another hormone precursor and can be helpful if used along with DHEA. Watch out for acne as a side effect and like DHEA, start low and go slow. The use of these hormones may be necessary for 3+ months.
Treatment for High Cortisol ("Crashed" stage)
- Phosphatidylserine: Phosphatidylserine has been shown to reduce cortisol levels if taken in doses up to 600mg per day. Use 4-6 capsules at night (each capsule is 100mg) and recheck cortisol levels in 2-3 months.
- Ashwagandha: Ashwagandha is an adaptogen that can actually help to lower cortisol levels when they are high and raise them when they are low. It also can boost libido and may help with weight loss. It can also reduce anxiety symptoms caused by chronic stress. Doses vary from 500-2000mg per day depending on tolerance and severity of symptoms.
- Melatonin: Melatonin has been show to reduce cortisol levels and may actually help improve your sleep at night. Even if you are sleeping well, melatonin can still help reduce cortisol levels and should be considered. It can also help with depression symptoms. Doses vary from 1-3mg, but most people tolerate 3mg well.
Using supplements alone will not be enough to adequately treat your adrenal fatigue and increase your energy level.
It will be critical for you to make the necessary lifestyle changes as well.
Why? Because your lifestyle is what got you here to begin with!
If you don't learn how to reduce stress, get better sleep, and eat better, your adrenal fatigue symptoms will eventually return.
On the flip side, if you make the necessary changes in these areas, it will result in long term improvement for you.
Boy, this one is easy to say but hard to do!
However, there is nothing you can do that will be more important to your success than learning how to better manage your stress.
If there are stressors in your life that you can remove, then that should be a priority.
That may mean changing jobs, avoiding certain unhealthy people, or selling your kids (just kidding).
Unfortunately, there may be several stressors that can't be removed, such as a sick family member, issues raising children, or others.
If that is the case, then you need to learn tactics that will help you manage stress and reduce its impact on your quality of life (and your cortisol!).
These stress reduction strategies can include:
- Relaxation exercises such as yoga
- Spend 20 minutes per day in prayer or meditation
- Start doing something you enjoy (hobby, sports, etc)
- Go outside! Walking or hiking in nature can do wonders for our stress
- Count your blessings and write them down. It's easy to get caught up in the negative cycle of only focusing on the things that are wrong in our lives.
- Do something good for someone else without expecting anything in return, especially for someone less fortunate than you.
- Donate your time or money to a worthy cause.
- Make yourself smile everyday (even when you don't feel like it)
I cannot stress enough how important it is to get a good night's sleep every single night.
Your quality of sleep directly impacts your melatonin production when then impacts your cortisol level.
Lack of sleep also increases inflammation in the body and causes weight gain.
If you deal with sleep issues or insomnia, then this needs to be a priority for you.
You should be getting a minimum of 8 hours of sleep per night.
When you wake up, you should feel refreshed and energetic.
If this doesn't describe you, then you need to make some changes.
These changes include:
- Go to bed at the same time every night and get up at the same time every morning
- No electronics (TV, phone or computer) for a least 2 hours before bedtime
- Keep your bedroom cool and dark
- Avoid stimulants (especially in the evenings)
- Use supplements if necessary. I discuss them in more detail in my article The Leptin Resistance Treatment Guide.
Diet is the most basic and one of the first things you should do to improve your energy and normalize your cortisol.
Something as simple as cutting out sugar and refined carbohydrates can do wonders for you.
Basically, you should focus on eating whole, natural foods and avoid processed food.
A simple question to ask yourself is, "Is this food natural or processed?" Obviously, choose natural food.
In some cases, more stringent dietary instruction may be needed, but for now just realize that you HAVE to eat a healthy diet to increase your energy levels.
I would recommend starting with a good, whole food diet such as the Whole 30 diet or the Paleo Diet.
There are definitely things that you can do to help you feel better and give you more energy if you have adrenal fatigue.
Start by checking your serum cortisol level along with other hormones such as insulin, leptin, and a complete thyroid panel. You may want to consider urinary cortisol levels after the initial blood tests.
Once you have a clear picture about which stage of adrenal dysfunction you are in, supplements can be used to target your specific cortisol issues as well as other hormonal imbalances.
Appropriate lifestyle interventions will also be crucial for your success. These include diet, stress management, and improving your sleep.
It is important to remember that correcting adrenal issues is not a quick fix - It may take 6 months or even longer.
Be consistent and patient. You can do it!
Now it's your turn...
Do you have adrenal fatigue?
What supplements have you used?
Has your treatment been successful?
Leave your comments below.