What exactly is adrenal fatigue?

Adrenal fatigue is commonly known as burnout.

adrenal fatigue

When your adrenal glands are overtaxed, a condition known as adrenal fatigue or adrenal exhaustion sets in. This, in turn, can set a cascade of disease processes into motion.

One tell-tale sign of adrenal burnout is feeling chronically fatigued. Burned out? Is that how you’d describe yourself right now? Then, you LIKELY have adrenal fatigue.

Your adrenal glands are each 3/4 of the size of a golfball but are responsible for one of the most important functions in your body: managing your stress and the physical manifestations of stress-meaning the physical ailments caused by too much cortisol and adrenaline (epinephrine).

It’s estimated up to 80 percent of adults experience adrenal fatigue during their lifetimes, yet it remains one of the most under-diagnosed illnesses in the United States. Why? In short, traditional doctors (and I am one as I am still a board certified Internist) are not taught how to recognize this.

So most primary care doctors will end up offering anti-depressants to adrenal fatigue patients. You have no idea how much of this I’ve seen!

The basis of adrenal fatigue or burnout is physical or psychological stress

Over time this can tax your adrenal glands to the point of causing all sorts of heath issues such as: Sleep disorders/unexplained weight gain/severe fatigue/depression and more. As it progresses, it can have a far greater health impact.

Adrenal fatigue is a depletion of the normal cortisol levels in your body due to prolonged stress that eventually over-rides the body’s ability to respond. The resulting low cortisol creates symptoms including severe morning fatigue and difficulty getting out of bed in the morning.  It also includes short term memory loss and trouble concentrating, difficulty making decisions, anxiety, depression, and feeling overwhelmed. Ugh, right? Again, I cannot tell you how many adrenal fatigue patients I have seen who are simply placed on anti-depressants. Another ugh from me here!

Why do we get adrenal fatigue?

The five most common reasons for adrenal fatigue and dysfunction are intense emotional stress, intense physical stress including illness or intake of stimulants such as energy drinks, poor diet, chronic inflammation, and having an underactive thyroid.

Let me expound on this, but first a special shout-out to bodybuilders who all have high cortisol levels and often have adrenal fatigue. Why? Because they take bodybuilding supplements along with testosterone, human growth hormone, and anabolics to make their bodies super-human with great amounts of lean body mass and are very susceptible to adrenal fatigue.

Emotional stress:

This is typically related to grief or loss. These days divorce is a big one.


Many suffering from adrenal fatigue describe a long history of stressful events that they were previously able to “handle.”

They often note the slow creep-up of both fatigue and difficulty “handling” stress.

According to some studies, up to approximately 90%+ of patients experience major emotional stress around the time they start feeling fatigue.

Poor meaning an unhealthy diet: 

contain nitric oxide benefits expecially the beetsEating too many carbs can disrupt cortisol rhythms as well as a certain group of corticosteroids (a blood pressure-stabilizing hormone). The average “American Diet” is a perfect recipe for destroying your adrenal glands. This diet includes the over-consumption of coffee and (worse) energy drinks.

I’ll also say a negative shout out here to drugs like Cymbalta or ADHD drugs or even drugs for nasal congestion. They all will tax your adrenal glands.

One of the most important things cortisol does is regulating secretory IgA in your gut. What does this mean exactly? It means cortisol controls the immune response in your gut.

Therefore, if you’re stressed, your cortisol level goes up. Then, the immune response in your gut suffers. The GI-tract tissue becomes damaged, and good bacteria give way to bad bacteria. As a result, this causes immune dysregulation that is centered in and around your GI-tract. This is why high cortisol levels impair your immune response, and you’ll be more susceptible to colds, flu, and more.

Two important components to address this problem are to take pre and probiotics as they will dramatically increase the beneficial bacteria in your body (which automatically will help decrease pathogenic bacteria) and to eat a diet low in sugars and carbs, as that will also promote a healthy gut flora.

Chronic inflammation in your body:

Inflammation is the hallmark of virtually every disease you can think of, from diabetes to cancer. When chronic, it stresses your entire body which includes your adrenals.
I have talked endlessly about how to combat inflammation. Weight normalization and the appropriate anti-inflammatory supplements are key.

Hypothyroidism or underactive thyroid:

Thyroid function is diagnosed by blood tests, but there’s some controversy over what is normal and what’s not in the “regular medical world.” Most anti-aging doctors feel that you need a “free T3 which is 2/3 of the upper range value.” If your tests are normal, we all say “treat the patient, not the labs” so please search this blog. Or just ask me!

The Four Stages of Adrenal Fatigue:

Stage one:

In stage one, your cortisol levels are very high, and you’re under a lot of stress. Your DHEA levels are generally normal. DHEA is the hormone put out by the adrenal glands that is less important than the cortisol until the later stages.

Let’s get back to stress. It might be an enjoyable type of stress. Maybe you have a new, exciting job. It’s stressful, yet you’re enjoying yourself. You even feel charged up and really “alive. You love the excitement. Your body requires it. It’s somewhat like exercise.

On the other hand, you might be having a negative stress experience. Perhaps, it is an illness, or you are going through a divorce, or you are having financial problems. These scenarios are certainly not enjoyable but will also put you into a high-cortisol stage of adrenal fatigue.

Either way, if you don’t sufficiently rest and recharge, your adrenals will get overtaxed, causing your cortisol levels to drop. This is where most people notice there’s a problem. When I evaluate people (I evaluate patients and AWS members or those who request a consult), I suspect of having adrenal fatigue I want to know, on a scale of 1-10 where your energy levels are all day. I want to know how you feel when you get up, mid-morning, lunchtime, midafternoon, dinner-time, after dinner and at bedtime.

A level of 1 means you can’t drag yourself out of bed and a 10 means you feel that you can run a marathon. In stage one, people feel pretty good energy-wise, with no dips.(8-10 all day.)

Stage two:

Stage two means the cortisol levels are peaking and the adrenals are now “cranking out” excess DHEA (which is not a health issue). You may be cranking out more aldosterone which will make you hold onto salt and fluids, causing some noticeable water retention.

Somewhere during this stage, the high cortisol levels start to cause sleep interruption. Then people tend to add more caffeine to their routine which further stresses their adrenals.

The high cortisol causes weight gain and especially gain of belly fat. This is also when your sex drive starts to go away.

This is when people just know that there’s some health problem. Energy levels drop to a 6-7 out of 10 with mid-afternoon being typically the worst time of day, while others just are “tired all day.”

Stage three:

At this stage we see DHEA levels falling and cortisol levels starting to fall as well. Sleep is interrupted, and when you wake up, you don’t feel refreshed. Even when you get “enough sleep” you never have energy levels which feel close to adequate.

Eventually sleep deprivtion and feeling lousy all the time drive people to see a doctor. A non Anti-aging doctor will not know that you’re in adrenal fatigue and only hear that you aren’t sleeping, you’re gaining weight and maybe a little depressed.

A non Anti-aging doctor will not know that you’re in adrenal fatigue and only hear that you aren’t sleeping, you’re gaining weight and maybe a little depressed. The doctor thinks, “AHA! I have figured it out! You’re depressed.” So, you leave your visit with a prescription for an anti-depressant. Two weeks later you are still fatigued and not sleeping. Now you’re also feeling numb from the anti-depressant. Note: You paid for that advice.

Stage four: Low cortisol, low DHEA, inability to function.

At this stage, you are truly burned out, and your adrenal glands need to be rescued. Some people require bioidentical hydrocortisone, but most are fine with everything I recommend for treatment below.

It is a must that both of the adrenal supplements plus DHEA is taken and the behavioral treatment is followed to a T. At this stage you are feeling just awful with energy levels of a 1-3 with no real night-time “bounce.”

You just feel awful. I totally get it. I have treated many many people, and I have dipped down into stage 2-3 and personally stay on “adrenal support” due to the demands of my life.

How do we test for Adrenal Fatigue?

In the conventional medical world, when they think about the adrenal glands, they really only think about extreme medical conditions that are rare. They do conventional medical tests to determine whether you have a rare endocrine disorder or not.

The choice method of testing for adrenal fatigue is through saliva. Saliva offers a great, non-invasive way to look at the adrenal hormones, namely cortisol, at various points over the course of the day. It is much easier to see how the cortisol levels vary and if they are following the normal pattern throughout the day. This happens to be the method NASA uses for their testing.

However, as you are reading this article and perhaps “seeing yourself” I will tell you that I don’t need salivary cortisols the majority of the time to make this diagnosis. As long as there is no other ‘medical reason’ to explain these symptoms, this is what’s wrong. A fasting serum cortisol that is either way too high or way to low is “very suggestive” and that, combined with a good medical history can make the diagnosis.

If you have had medical illness and thyroid disease “ruled out’ by your doctor, I have no problem with you just following these next steps.

How do we treat adrenal fatigue?


losing shot term memory can be correct with b vitamins

Of course for health reasons, you want to eat an anti-inflammatory diet, but this will also help heal your adrenal fatigue. We want to make sure to eliminate stimulants as well which should be obvious. We even have a special adrenal fatigue diet for you.

Some of the rules are to eat whole foods, avoid fast foods, avoid processed foods, avoid sugar and do not “fast” to lose weight if that is a goal, as that will worsen your symptoms.


Since high-stress levels likely brought you in, lowering them will help get you out. There are many stress-busting techniques and behavioral changes.

This is a topic in and of itself. Here’s a quickie video on trained breath control that will help.


Keep it gentle and don’t get that heart rate pounding until you have your energy and sleep patterns back. Cardio and gentle stretching is the way to go for a while.

Massage and baths and one more thing:

Massage is a great stress-reliever.  Baths which are soothing, relaxing and containing mineral salts such as magnesium are beneficial as well.

An “adrenal fatigue cocktail” of water, a pinch/tiny pinch of baking soda, stevia, and a hint of lemon or orange juice daily for a month will adjust the usually-acidic condition of most people with AF. This sounds hokey, I know and there is no evidence in any other condition that “adjusting pH” is needed. The reason people with adrenal fatigue are acidic makes sense. The majority of AF patients have been overdrinking coffee and tea to stay alert and indeed are acidic and indeed that delays healing.


do I have insomnia asks all sufferrers

 Since a hallmark of stage 2-4 adrenal fatigue is difficulty falling and staying asleep as well as waking up unrefreshed, this must be addressed for the adrenals to heal.

The supplements to heal the adrenals I’ll talk about in a minute are necessary to get the sleep issues straightened out. It will take more, though.

At the beginning of the fatigue phase, for falling asleep and wake-ups chewable PharmaGABA is great. This is one of the best supplements for anxiety and all types of stress. To help you stay asleep the amount of 5-HTP your GI-tract can tolerate will be quite helpful.

Melatonin is not the best sleeping aid during the high-fatigue phase as it stresses the adrenals slightly.

Supplements necessary to heal from adrenal fatigue:

Everyone with adrenal fatigue wants energy which means you must take the correct adrenal fatigue supplementsHonestly, it didn’t happen overnight, and you won’t get better overnight. However, if you do all of the above and take what I suggest below, you’ll get better.

Instead of leaving this site to go purchase nonpharmaceutical grade lousy-won’t-work supplements on Amazon or worse-at a GNC or something, note you will only get better if you get GMP sticker, non-GMO sticker products for starters.

You need what you need, and you cannot get it other than through a Physician. So, if you are going to shop around, please find another M.D. and not some “supplement store” O.K.?

You will need two adrenal-specific supplements to heal your adrenal glands. One is called an adaptogen. This is an herbally based product and can contain a variety of herbals in differing ratios. Adaptogens are quite useful in the early stages of adrenal fatigue (alarm phase, resistance phase) when cortisol levels are high and the adrenal glands have not yet started to fail. However, when fatigue is present, you need to add the second, glandular product. That’s why I’m saying from the get-go that most people need both.

Our very effective adaptogen contains American and Siberian Ginseng for starters. 

Siberian ginseng

This an herb with a long history of use across Russia and China. Known to provide adaptogenic effects on the adrenal glands, a wealth of studies also support it’s use in enhancing immunity, and even sustaining athletic endurance. The effects appear to be mediated by the active component, the eleutherosides.


appetite suppressant naturalThis great adaptogen is sometimes referred to as Indian ginseng. This herb provides a range of effects that are largely comparable to Siberian ginseng, although the plants are not in any way related.

Ashwaganda contains withanolides, phytosterols, and alkaloids which Ayurvedic practioners have used for centuries to help patients combat resist stress- symptoms. The herb is popular for its ability to balance out adrenal and thyroid problems. In fact, it has been used to address hypofunction of both of these energy-producing glands.

Rhodiola Rosea


Licorice Root 

This herb increases cortisol levels which are plunging and mitigates problems with low blood pressure. It improves the body’s ability to retain sodium and magnesium, which is dimished in later stage adrenal fatigue. It is a glucocorticoid (cortisol) potentiator that functions by inhibiting the key enzyme that inactivates steroid hormones in the liver and kidneys.

muscle soreness relief

Further, it has “mineralocorticoid-like activity,” thereby potentiating aldosterone. Aldosterone is a salt-saving hormone made in the adrenals which, again, starts going down in later stage AF.

It’s a useful adrenal tonic that helps with adrenal insufficiency (exhaustion), including even Addison’s disease.

It’s an anti-inflammatory, mild laxative, pancreatic “tonic,” immune stimulant with anti-viral properties. It soothes and tones the GI-tract.

Other adaptogens do indeed work, but clinical studies with the combo we have and my clinical experience as well as that of other Anti-aging M.D.’s show this works. Big time. I will confess that my hectic schedule is a “burden” on my own adrenals so I am always on this particular product to save my sleep and energy and immune system!

The other product necessary to heal adrenal fatigue

 When fatigue sets in you need a product that will basically heal the adrenal glands and allow them to “do their thing.” This means to get you OUT of adrenal fatigue.

Adrenal Fusion™ is a glandular-based product scientifically formulated to support overall adrenal and hypothalamic-pituitary-adrenal axis function. This product was formulated with the mission to rejuvenate tired adrenal glands naturally. It is ideal for patients with extreme adrenal burnout.

Other supporting players for supplements for adrenal fatigue:

Although the two products discussed above are the only ones you really need (in addition to DHEA replacement), some people report more energy as they heal with the addition of acetyl l carnitine as well as the addition of DHEA. The most helpful form of DHEA is Keto-DHEA since most adrenal fatigue patients needs to lose weight. This is a non-stimulant metabolism-booster which is also needed for immune healing and adrenal healing. Many patients experience mitochondrial dysfunction and therefore benefit from mitochondrial boosting supplements as well.


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