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Adrenal Fatigue

Adrenal Fatigue

Hypoadrenia more commonly manifests itself within a broad spectrum of less serious, yet often debilitating, disorders that are only too familiar to many people. This spectrum has been known by many names throughout the past century, such as non-Addison’s hypoadrenia, sub-clinical hypoadrenia, neurasthenia, adrenal apathy, and adrenal fatigue.

This syndrome is largely ignored by the general medical profession. As a result of this, it is unlikely that your physician will recognize adrenal fatigue, even after it is demonstrated as being the underlying problem.


Basically, do not waste your time trying to get sympathy or understanding from your doctor.
Every substance, medication, & supplement can be a nutrient or it can be a poison, depending upon the rate of administration, route of administration, and amount of administration.

Although fatigue is a universal symptom of low adrenal function, it is such a common complaint and occurs in so many other conditions, that today’s medical doctors rarely consider pursuing an adrenal-related diagnosis when someone complaints of fatigue. In fact, fifty years ago, physicians were far more likely than their modern counterparts to
correctly diagnose this ailment. Information about non-Addisons hypoadrenia had been documented in medical literature for over a hundred years but unfortunately, this milder form of hypoadrenia is missed or misdiagnosed in doctors’ offices every day, even though the patient clearly presents its classic symptoms. Adrenal fatigue is all too often the cause of patients’ run down felling and inability to keep up with life’s daily demands, and often remains undiagnosed.

Adrenal fatigue is a collection of signs and symptoms. Sometimes referred to as “Syndrome-X,” patients experience fatigue, and a general feeling of uneasiness and poor overall health. Often using coffee, sugar, colas and other stimulants, these persons have difficulty just getting out of bed. Often, patients report that they have not felt ‘well’ in years. They may have intervals of confusion, increased difficulties in concentrating. They are often intolerance to become easily frustrated. Insomnia is common.

As AF worsens, they experience frequent respiratory infections, allergies, rhinitis, asthma, and frequent sinus problems and colds. Adrenal fatigue is often misdiagnosed as fibromyalgia, chronic and fatigue syndrome. The development of AF often leads to adult-onset diabetes, auto-immune disorders, and drug-dependence.

Adrenal fatigue, not to be confused with adrenal failure, is an extremely common clinical entity. In all its mild and severe forms, adrenal fatigue (AF) is caused by some form of stress, whether that
stress is physical, emotional, psychological, environmental, infectious, or some combination.

Often the causes of adrenal fatigue are obvious. One of the more interesting misconceptions regarding adrenal fatigue is the notion that cortisol is the most important measure of adrenal damage. Cortisol is thought by many to be the principal ‘hormone of stress.’ In reality, however, it is only one of many measures, including DHEA, Pregnenolone, Testosterone, Progesterone the family of Estrogens. When the adrenals demonstrate fatigue, the problem most frequently involves more than one hormone ‘out of balance.’

Common sources of chronic stress resulting in adrenal fatigue is chronic or severe infection, chronic autoimmune disease states, and chronic gastrointestinal dysfunction. If there are other concurrent stresses, the development of adrenal fatigue is accelerated. Many people experience high levels of stress on a regular basis. This will put a chronic strain on the adrenal function.

The body normally secretes the highest amount of cortisol in the early morning hours. Inadequate cortisol levels will manifest first as low am cortisol levels. Blood assay should be performed between 0700 and 0800, and it is best to do this at the laboratory. If the blood assay is drawn in the doctor’s office, it may sit around for many hours before being processed. This leads to inaccurate readings.

Cortisol levels should taper off as the day goes on. Using serial saliva testing, abnormalities in normal diurnal cortisol values can result from subclinical adrenal dysfunction. Eventually, morning cortisols drop very significantly, demonstrating adrenal exhaustion. Adrenal fatigue can be caused by constant stress or poor nutrition, which can deplete and weaken the adrenal glands. In many patients with AF, thyroid problems are present and complicate the clinical picture. Adrenal Fatigue is a deficiency in the overall function of the adrenal glands.

Properly functioning adrenal glands secrete a balanced amount of steroid hormones. Physical stress, emotional stress, an environmental challenge can ‘stress’ the adrenals. Eventually, chronic stress puts such a load on the delicate glands that they are unable to produce sufficient hormone amounts. While levels cortisol drop, other hormone levels suffer, as well. The severity of dysfunction reflects the severity of stress, the duration of stress, genetic predisposition, and dietary habit.

Adrenal fatigue can range from minor to severe failure. Addison’s disease is the most severe form of adrenal fatigue. Named for the first physician to write and teach about it, Sir Thomas Addison described AF in 1855.

The most severe form is life-threatening if left untreated. As first described, adrenal failure was a result of chronic tubercular infection to the glands. The resulting structural damage to the adrenal glands led to prolonged illness and death. Other causes of profound adrenal failure include metastatic (and primary) neoplasm. This severe form of AF occurs in only about 4 persons per 100,000, general population.

Patients treated traditionally for Addison’s Disease are prescribed corticosteroids.  It is expected that treatment will be life-long.   The current belief is that  70% of cases of Addison’s disease are the result of auto-immune disease.

But stress can also take its toll in less obvious ways, like an abscessed tooth, a bout of the flu, intense physical exertion, a severe quarrel with a loved one, pressure at the workplace, an unhappy relationship, environmental toxins, poor diet, etc. If these smaller stresses occur simultaneously, accumulate or become chronic, and the adrenals have no opportunity to fully recover, adrenal fatigue may result. Often the causes of adrenal fatigue are so obvious because the face of combined stresses may present so differently. It is the summation or bundle of stresses, recognized or not, as
well as the intensity of each stress, the frequency plus the duration, all in the entirety that establishes stress load.

Causes of Adrenal Fatigue

Adrenal fatigue, in all its mild and severe forms, is usually caused by some form of stress. Stress can be physical, emotional, psychological, environmental, infectious, or a combination of these. It is important to know that your adrenals respond to every kind of stress the same, whatever the source.


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Treatment of Adrenal Fatigue: 

Adrenal Fatigue is more than a collection of clinical complaints. It is a real physiological phenomenon. In order to be properly treated, it should be properly diagnosed.

First and foremost, the diagnosis should be confirmed with hormone level testing. This can be accomplished with serum (blood) studies, saliva testing, or some combination, thereof. Only after obtaining baseline hormone levels, hormone replacement can be initiated.

Simply stated, if the person is suffering from adrenal fatigue, it is likely that cortisol levels will be depressed, and this can be demonstrated with am cortisol levels. Treating the cortisol shortage with cortisol is precisely what is necessary until the adrenal glands are capable of manufacturing the hormone itself. This healing process takes time, and it requires replacement of missing dietary requirements.

In addition, the use of ‘natural adrenal supplements’ will expedite the healing process. While ‘natural,’ there is nothing inherently safer about these products. While they may be available without prescription, they must be used with respect for the damage that can result from misuse. The assistance of a trained professional is essential for the safe use of prescription as well as with many non-prescription medicines.

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There are any number of ways to address the treatment of Adrenal Fatigue. First and foremost, hormonal imbalance is treated through the re-introduction of the missing hormones in a bio-identical manner. If the person is missing cortisol, cortisol is given. If the person is missing progesterone and DHEA, then progesterone and DHEA are given. Even with mild Addison’s disease, expert physician intervention and supervision is required. Bio-identical glucocorticoid and mineralocorticoid components drugs may be prescribed to treat Addison’s disease.

Once desirable cortisol levels are achieved, serum levels of DHEA, pregnenolone, and gonadal hormones should be re-evaluated to determine if DHEA/pregnenolone/testosterone/progesterone/estrogen replacement therapy is warranted.

  1. Blood and/or saliva testing is performed to determine initial levels, and follow-up studies are performed to fine-tune the hormone balance.

  2. Diet and dietary deficiency is treated as what may be the initial cause of the adrenal inadequacy. Mineral deficiency, in particular, can lead to hormonal difficulties. Essential minerals perform the function of enzyme co-factors, and in deficiency states, enzymatic processes are compromised.

  3. There may be a link between gluten sensitivity (celiac disease) and Addison’s disease. AF is thought to be largely auto-immune in nature, auto-immune disorders tend to occur with significant overlap with other auto-immune syndromes. Celiac disease is likely to have an auto-immune component, and many patients with Celiac’s disease suffer from autoimmune thyroid disease (Hashimoto’s) and AF.

  4. Chelated (organic) minerals are recommended that replace zinc, selenium, vanadium, and chromium. When given in a balanced formulation, synergism is realized and absorbance is maximized.

We prefer to use a mixture for us manufactured by Orthomolecular Products, Inc. called “Magic Minerals.” Taken 2 capsules, twice daily (preferably on an empty stomach). Calcium and Calcium-magnesium supplements should not be taken at the same time, due to
competition for absorbance in the gut. In fact, calcium and cal/mag supplements should be taken alone because they tend to bind up other nutrients, as well.

  • Essential oils are recommended. Omega-3 and Omega-9 fatty acids (EFA) are given in a balanced approach. Acting as anti-inflammatories and as hormonal precursors, the EFA’s are necessary for the adrenals to recover and eventually produce, once again.

Here, we prefer to use the Orthomolecular product “Orthomega” or the product produced by them, for us:  “Dr. Dave’s Heart and Sole.” Taken twice daily, this will provide the appropriate balance of EPA and DPA. It is distilled to ensure it to be mercury-free. We also use the Metagenics product, EPA/DPA, and the Xymogen line. These products are excellent, and the selection of the precise product is dictated by co-morbid factors & illnesses.

The omega-9 factors can be obtained with a good quality evening primrose oil, GLA, or CLA.

  • B-complex vitamin deficiencies can result in adrenal dysfunction. Care must be taken to avoid soy-containing products, in that the principal isoflavones present in soy and lecitithin behave as thyroid-antagonists, and worsen adrenal dysfunction.

In our practice, we use the Orthomolecular produced “Thyroid Friendly B.” For most persons, it is taken once, daily, with food. If the patient suffers from leaky gut or Celiac’s Disease, it is taken twice daily for a month, and then decreased to once, daily.

  • Adrenal supplementation frequently benefits from the addition of a ‘natural’ hormone complex that is a blend of desiccated glandular products.

There are many suitable products available. Some are very expensive, some are very reasonable.

Expense does not guarantee quality, by a long-shot. Before using these products, some of which can have inherent risks, research the manufacturer as well as the individual ingredients. We use the ‘OrthoAdrene’ product, but Zymogen and Metagenics do well with their offerings.

  • DHEA, pregnenolone, progesterone, estrogen(s), testosterone, cortisol should only be given after hormone levels are determined. It is a very poor idea, indeed, to go it alone when using these agents. They are ‘natural’ in that they are identical (or should be) to the hormones present in the human. DHEA has been shown to suppress inflammatory humoral chemicals, such as cytokines. In this manner, DHEA down – regulates autoimmune reactions in the

Some manufacturers will mention, in the small print, that they are ‘precursors. The body needs the finished product, not a ‘precursor.’

Never use a product that is not manufactured by a certified GMP manufacturer. This is one area where a little research is necessary. If the manufacturer does not adhere to GMP requirements, quality cannot be delivered. For me and my family, I want the hormone products (and others, for that matter) assayed.

If you do not think that you are worth getting the highest quality hormones, it is best that you do not get anything at all. It is that important.

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Production of DHEA is well-known to decrease as we age. Pregnenolone is converted into crucial many hormones including dehydroepiandrosterone (DHEA), estrogen, progesterone, and testosterone. DHEA supplementation may be of significant help in correction of the hormone imbalances caused by adrenal insufficiency.

DHEA and DHEA-sulfate (DHEA-S) levels can be restored to normal using 50 mg of DHEA, by mouth. Circulating levels of androgens (androstenedione, testosterone, and testosterone/SHBG ratio) can be moved towards normality with the use of DHEA.

DHEA may help to protect against the overproduction of cortisol from the adrenal glands. DHEA deficiency may actually compromise the immune status.

NOTE: DHEA and pregnenolone are important hormones in human physiology (and other mammalian systems). In order for these two hormones to be safely absorbed, they should be taken with oil.

Omega 3 or omega-9 products work well for this. My personal preference is to start with the omega-3’s, and I prefer the ortho product – Orthomega (we label it as ‘Dr. Dave’s Heart and Sole) or the Metagenics product EPA/DPA. dsk

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Licorice is helpful in many patients with AF in that it to reduce the amount of hydrocortisone broken down by the liver, thereby reducing the workload of the adrenal glands. Licorice is soothing to the digestive tract, and it is helpful to treat nausea and ‘queazy stomach.’

Deglycyrrhized licorice (DGL) is made by removing the active agent, glycyrrhizin. For the adrenal effects, only real licorice should be used, not DGL. Side-effects include increased blood pressure and water retention (edema)

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Pantothenic Acid:

Pantothenic acid (vitamin B5) deficiency can lead to adrenal failure. B5 is a precursor of acetyl CoA. Deficiency of B-5 is characterized by fatigue, headache, sleep disturbances, nausea, and abdominal discomfort.

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L-theanine is an amino acid found in green tea. L-Theanine works by increasing gamma-aminobutyric acid (GABA), one of the most prevalent of all neuro-transmitters. The net effect is a state of relaxation, a sense of well-being, and it works well to restore sleep.

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Vitamin C :

Studies show that vitamin C can modulate the influence of cortisol, inducing the anti-inflammatory response to prolonged exercise and stress. When combined with low-dose aspirin, Vitamin C may be extremely helpful in minimizing the inflammation that leads to coronary artery disease.

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Phosphatidylserine (PS) :

Phosphatidylserine is a phospholipid found in cellular membranes. Supplemental PS has been shown to improve mood and blunt the release of cortisol in response to physical stress.

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Melatonin :

Melatonin is secreted by the pineal gland, located in the very center of the brain. This hormone is co-secreted with ACTH (adrenocorticotropic hormone) and is integral to the regulation of circadian rhythm. That is, melatonin is important to the sleep cycle. Melatonin administration may induce an increase in the DHEA-S-cortisol ratio after 6 months of treatment.

Melatonin secretion is known to decrease with age. Further, the use of narcotics will decrease or eliminate melatonin secretion.

  • Vitamin C may be used, safely, in high doses. Some clinicians recommend up to 3000 mg a day, but in this practice, we use much more modest doses, that is, between 1000 mg and 1500 mg per day. DHEA dosage is different for men and women, and dosage requirements increase, with age. We start men with 50 mg per day, and women with doses of 5-10 mg per day. Our patients take it at bedtime, with one fish-oil capsule. Occasionally, it is a problem with sleep, and if this occurs, it is taken in the morning.

  • L-theanine, 100-400 mg a day.

  • Pantothenic acid (vitamin B5), 1500 mg a day

  • Melatonin doses are different for men and women. Women require higher doses, for some reason. Female dose begins with 3 mg and may be increased to 6 mg. Men start at 1 mg and increase to 2 or 3 mg at bedtime.

  • Phosphatidylserine capsules, 300 mg a day.

  • Licorice (Glycyrrhiza glabra), no more than 1000 mg of glycyrrhizin.

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