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7 Adrenal Fatigue Recovery Mistakes
By: Michael Lam, MD, MPH

Table of Contents

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1. Improper use of nutritional supplements

Natural compounds are very different from prescription drugs. Clinical behaviors of prescription drugs usually follow a well defined efficacy curve that is highly predictable. The desired response is usually generated at a therapeutic dose range. Because the body does not have a natural built-in system of metabolizing non-natural compounds such as synthetic drugs, toxicity ensues in high dosages.

Compare this with natural compounds:

First, many natural compounds have different dose dependent behaviors. In other words, how they behave at one dose can be very different from how they behave at another dose.

Second, the exact standardization of what is considered a normal dose is not well known or established. The RDA (Recommended Dietary Allowance) was set up for common natural compounds as a general guide for a healthy population that wishes to avoid recognized vitamin deficiency diseases such as scurvy or rickets. The prevailing view among nutritional experts is that this is hardly sufficient to maintain optimum health, not to mention therapeutic uses.

Third, most compounds have little or no recognizable side effects at doses many times higher than RDA dose because the body has the built-in mechanism and is able to metabolize them effectively. Nutritional experts therefore tend to use higher doses but practitioners of conventional medicine find this hard to understand.

Fourth, few studies have been conducted in the toxic consequence of many of the natural compounds due to funding constraints. As a result, there is lack of standardization.

Fifth, the same natural compound (such as herbs and glandulars) can behave differently in the same person depending on that person's state of dysfunction. They can act as adaptogens and become beneficial when the Adrenal Fatigue condition is mild, but turn stimulatory when the fatigue is severe.

Sixth, the optimum therapeutic dosage required for recovery is body-specific. The right dosage for one person is very different for another person, even if the degree of Adrenal Fatigue is similar.

Seventh, there is a drastic difference in the bio-availability of nutrients made available to the cells depending on the delivery system. For example, absorption of ascorbic acid in capsule form that is taken orally normally takes place in the stomach and the absorption rate seldom exceeds 15%. The absorption rate of liposomalized vitamin C taken orally is far superior as it is delivered through the small intestines. A 100 mg dose of liposomalized oral vitamin C can therefore be many times more effective than when the vitamin is taken in capsule or tablet form, even though both are taken orally.

Eighth, different manufacturers of natural compounds use different grades and purity which are not disclosed to the consumer on the bottle labels. Low quality nutritional supplements are usually less effective than higher quality supplements.

Due to the lack of this knowledge among the general public, inappropriate use of nutritional supplements is rampant in all areas of natural health, including Adrenal Fatigue. Consumers are often confused, not knowing what to take, when to take, how much to take and the right delivery system and form to use. It is no surprise that therapeutic failure is common.

The danger of inappropriate use of nutritional compounds is that not only is the recovery impeded but invariably they lead to the worsening of the condition over time. Harm is done to the body more than the benefit received. The net result is a worsening state. This is one of the greatest misgivings of most self-guided and non-professionally guided programs, especially if the Adrenal Fatigue is advanced. Let us examine this more closely. Adrenal Fatigue support nutrients commonly include Vitamin C; Vitamin B12; Vitamin B5 and its derivative pantethine, Vitamin E, adrenal glandulars from various sources, herbs such as licorice, ashwagandha, ginseng, maca (Peruvian ginseng); pro-hormones such as DHEA and pregnenolone; and steroids. These nutrients vary greatly in their intrinsic properties as well as having different dose-dependent properties. Selecting the right form of the nutrients at the right time with the right dose and delivery system is the key to providing the body with the necessary nutrients to start the healing process in a systematic and comprehensive fashion. This sound principal is unfortunately not being followed often enough.

Let us look at the three most common errors in compounds selection;

  • Long term use of stimulatory nutrients can lead to withdrawal problems and addiction. Though they might have other concurrent adaptogenic properties, many adrenal supportive nutrients commonly used are intrinsically stimulatory in nature in a setting of advanced adrenal weakness, These include ginseng, licorice, ashwagandha, maca, vitamin B5, and vitamin B12, just to name a few. In principle, they help the body generate energy and overcome fatigue by stimulating the adrenal glands to work harder. Hormones related to adrenal function include cortisol and epinephrine. These are important "fight or flight" and "survival" hormones designed to help the body overcome its perceived stress, whether it be physical or emotional. When these nutrients are administered, the body has to absorb and metabolize them to be effective and therapeutic. If the body can accept and process these nutrients, a surge of energy may be experienced. This is considered a desired response. However, many are misled to believe that this rush of energy is a sign of successful recovery. Some may even attempt to take more, thinking that more is better. However, there is a significant risk that is seldom recognized. As the body gets used to these nutrients, tolerance may develop. A higher dosage is required over time to maintain the same energy level or for the avoidance of fatigue. This is a classic sign of addiction. In addition to caffeine from coffee and black tea to kick start the system, the body now has an added addiction - stimulatory nutrients. Without these, the body may experience symptoms of withdrawal resulting in a sudden onset of severe fatigue or "adrenal crash". The crash can last for hours at first and then expand into days and in severe cases, months. With each crash, the overall adrenal function gets worse.

  • Natural compounds can behave differently at different dosages. Vitamin C, for example, is a common antioxidant and an adrenal enhancer. At high doses and in certain people, there may be transient clinical deterioration due to possible "re-toxification" effect. Melatonin, for example can be more effective at low doses like 0.3 mg than higher doses like 3 to 30 mg. Natural compounds such as herbs and glandulars that are traditionally gentle can become stimulatory at times and generate overreactions as well as paradoxical reactions. Some people feel calmer with vitamin C, while others may feel more anxious at various doses. Some of these behaviors can be traced to the particular compound or the environment within which the compound functions. For example, while most people develop diarrhea with excessive vitamin C, some will develop constipation instead. That a particular nutrient can have different properties depending on different dosages taken must be recognized to effectively formulate a nutritional supplementation program.

  • The body's metabolic state changes during the recovery process affecting the dosage requirement. The adrenal recovery cycle typically consists of multiple peaks and valleys, resembling a roller coaster ride. While the general recovery trend should be upward resembling a staircase, in the overall scheme of things, it is normal to have minor down cycles in the recovery process. An experienced clinician will anticipate these dips and take quick action to help avoid downturn as much as possible by adjusting the dosage of nutrients. Avoidance of crashes is a sign of clinical excellence. Inexperienced clinicians and people in self-guided programs often find themselves in a catch-up mode after the crash has occurred and not knowing why.

Applying the same dose of nutrients throughout the recovery process without careful consideration of the cyclical recovery process can lead to devastating results. You can be overdosing and putting excessive loads on the adrenals at a time when they do not need as much, or under-dosing and thus depriving the adrenals of nutrients when they are needed the most. Sometimes, less nutrients are needed in an up cycle, while more is needed in the down cycle. Other times, it is just the reverse. It is important to match the dosage and the most appropriate form and delivery system to the metabolic curve throughout the entire recovery journey for maximum effectiveness.

2. Inexperienced health care providers

Most conventional physicians are not well informed on Adrenal Fatigue because it is not a recognized condition in the main stream medical community. The lack of medical education and research in the condition results in tremendous misinformation and confusion among the medical professionals and lay communities alike.

On top of this, modern medicine has a tendency to lean towards laboratory-based rather than body-based to be the best scientific approach to healing. In many clinical settings, modern diagnostic testing is absolutely necessary. It is in fact life saving. However, in the case of Adrenal Fatigue, accurate and dependable testing has yet to achieve the level of correlation with the body's symptoms to be fully recognized by the medical community at large, despite significant development in recent decades. The more advanced the adrenal weakness, the lower the clinical correlation with laboratory results.

A large number of presenting symptoms of Adrenal Fatigue are vague and unusual because the adrenal glands affect almost every major system of the body. Dysfunctions of the adrenals therefore have wide influences with symptoms that often defy conventional medical logic. Imagine a patient presenting himself with symptoms of fatigue, insomnia, hypoglycemia, heart palpitations, salt cravings, sugar cravings, joint pain, sore muscles, exercise intolerance, low libido, and dizziness concurrently. To the untrained physician, sorting out this maze of complaints is challenging to say the least. These symptoms, however, can often be explained under the unified umbrella of Adrenal Fatigue. For example, a weak adrenal is often associated with clinical or sub-clinical dysfunction of the autonomic nervous system (ANS) and its various sub-components. Symptoms such as postural hypotension, fragile blood pressure, cardiac arrhythmias , POTS and temperature intolerance can be caused by sympathetic nervous system (SNS) dysfunction which is part of the ANS. Fainting, low body temperature, hypoglycemia and anxiety can be caused by over stimulation of the adrenomedullary hormonal system (AHS) and its chemical messenger, adrenaline. The AHS is part of the ANS. Irregular sweating can be due to dysregulation of the sympathetic cholinergic system (SCS), part of the ANS as well. Finally, gastric discomfort, leaky gut, IBS, bowl movement irregularities and urination dysfunction can be tied to over stimulation of the parasympathetic nervous system (PNS), a branch of the ANS.

Similarly, hypoglycemia, fluid retention, metabolic imbalance, low blood pressure, muscle ache, joint pain, sugar imbalance, frequent infection, IBS and CFS are regulated to a large degree by cortisol. A weak adrenal with accompanying low cortisol level can present itself with these symptoms.

Because dysfunctional adrenals affect virtually every system of the body including the central nervous system, a thorough understanding of the following areas of medicine is needed: neurology, cardiology, endocrinology and psychiatry. Most medical specialists are trained in their respective narrow scientific fields and few are experienced enough in all of the disciplines to fully comprehend the Adrenal Fatigue condition.

Unable to understand or solve the problem at the root level, most well-intentioned physicians tend to prescribe anti-depressants and anti-anxiety agents in their best attempt to help their patients. These medications are usually prescribed after basic stress reduction techniques are recommended and laboratory tests have turned out to be unremarkable. Referrals are made to endocrinologists and other specialists if the symptoms fail to resolve. Unfortunately, this is often futile. Nutritional supplementation may be recommended, but due to the lack of systematic approach, most nutrients are dispensed in a shot-gun attempt to control the symptoms rather than focused on allowing the body to use the nutrients to help heal the adrenals. As a result, the symptoms usually get worse with time.

After extensive workups that generally turn out to be negative, steroids are often prescribed quickly to control the symptoms. While steroids can be used short term in severe cases under experienced medical hands, addiction often becomes a major issue in the long term, regardless of the clinician's best intention. Chronic use of steroids is often the end result. This can lead to a catabolic state with systemic organ resistance and breakdown.

Our current understanding of adrenal function is still at its infancy at best. It is therefore very difficult for any health professional to have a good grasp of the Adrenal Fatigue condition from a purely pathological and physiological perspective. The number of physicians with true expertise in advanced Adrenal Fatigue is very small. Those who are good in this gain their expertise not from textbooks, but from years of clinical experience. There is no short cut, because text-book cases are few and far between. Because the full recovery cycle can take years to complete in severe cases, practitioners with little experience will find it hard to handle cases other than the most mild and straight forward ones.

3. Excessive use of prescription drugs and medications

Excessive use of prescription drugs often makes the Adrenal Fatigue condition worse. We live in a world where symptoms are often classified as diseases and the control of symptoms is considered to be the cure in many chronic conditions. For example, over 90% of all hypertension today is classified as "essential hypertension". In other words, we don't know the root cause of the disease. All physicians can do is treat the symptoms because they cannot treat the root cause if they don't know what the root cause is.

In the case of Adrenal Fatigue, one should respect the body's signs and symptoms as they are valuable sensitive indicators to help guide us in the recovery process. Just as pain is a warning signal from our body that says something is wrong, suppressing pain is not the same as a cure for the condition that causes the pain. Pain suppression is therefore a masking mechanism at best. In the case of Adrenal Fatigue, this will not work long term, as the body will continue to be punished by the worsening symptoms. The logical approach is to give the body the tools to heal itself, while monitoring the symptoms and using them as a barometer of the body's healing efficacy. This approach is all but abandoned by many health care providers. Modern medicine has a tendency to suppress symptoms under the mistaken belief that the absence of symptoms is the same as being cured. This may work in the short term, but fails over the long term as the body decompensates in one form or another with worsening symptoms requiring an ever increasing dose of medications to control.

The following are common prescription drugs used to relieve symptoms of Adrenal Fatigue: thyroid replacements, anti-depressants, anti-anxiety drugs, sleep medication, blood pressure medications, hormones (bio-identical or synthetic), steroids and antibiotics.

Thyroid medications are widely prescribed by physicians to symptomatically control sluggish metabolism associated with hypothyroidism. Their use is justified by conventional medicine based on laboratory tests that show reduced thyroid function evidenced by high levels of TSH and low levels of Free T3 and Free T4. Dysfunctional adrenal glands are often totally ignored. Those suffering from Adrenal Fatigue and hypothyroidism are treated for hypothyroidism alone. Over time this approach backfires and causes the Adrenal Fatigue condition to worsen for several reasons. First, thyroid replacement medications increase the overall basal metabolic rate. The body is put into a state of over-drive. No organ system is spared. Pushing the adrenals to work harder when they are already fatigued can unmask adrenal exhaustion or even trigger an adrenal crisis. At the same time, weak adrenals can lead to a state of blunted response by the body to thyroid hormones. Weak adrenals are often associated with reduced availability of free thyroid hormone to the cells as well. As a result, symptoms of hypothyroidism often fail to improve over time and may in fact get worse with this single organ approach to healing. The patient remains symptomatic even when placed on thyroid replacement therapy. Physicians focusing on the thyroid without considering the adrenals frequently find themselves administering ever higher doses of thyroid replacement medication or switching from one medication to another without success. It is important to remember that those who are placed on thyroid medication should not abruptly stop the medication without professional help due to possible unpleasant withdrawal effects.

Anti-depressants are often prescribed when physicians are at a loss of what to do. Many patients do not respond well and develop paradoxical reactions. Physician often find themselves changing from one medication to another in their best effort to help. Over time, addiction issues may also arise.

Anti-anxiety agents are prescribed to help calm the patient. This works only temporarily at best, with ever increasing doses needed for long term.

Sleeping medication is frequently prescribed to help insomnia. Inability to fall asleep and frequent awakening are hallmark signs of Adrenal Fatigue and the long term use of the medication can also lead to addiction.

Blood pressure medication is often prescribed by physicians. Early on , the patient can be presented with reactive hypertension at first, to be followed by hypotension as Adrenal Fatigue progresses. This is often due to aldosterone and electrolyte imbalance as well as reactive adrenergic responses secondary to dysregulation of the autonomic nervous system. Physicians may find themselves constantly having to adjust the dosage of medications and changing the medications to normalize the blood pressure, only to find the blood pressure becoming more fragile as the Adrenal Fatigue condition worsens.

Hormone replacement, whether it be synthetic or natural, is often prescribed. These include estrogen, progesterone and testosterone. They are frequently prescribed to manage irregular menstrual cycles, hot flashes and increase in energy. Physicians are often misled to prescribe these medications based on laboratory test results. They may be helpful at first, but the body's response is often blunted after a while. Hormone replacement has its place, but timing is important. The best time to consider such replacement is when the adrenals are well on their way to recovery. Thyroid hormones are also commonly prescribed. Using hormone replacement to suppress Adrenal Fatigue symptoms seldom generates desirable long term result, though there may be transient and short term periods of improvement. It is no surprise that the majority of patients taking thyroid replacement still are symptomatic. The symptoms of Adrenal Fatigue and hypothyroidism are very similar. As mentioned earlier, focusing on the thyroid without concurrent attention to the adrenals is a failed recovery strategy if Adrenal Fatigue is in fact the problem. The reason is simple - thyroid medications can mask adrenal weakness by artificially propping up the metabolic rate. Those who require an ever larger dose of thyroid medication to maintain their energy level over time should be especially on the alert. If hormones are deemed to be necessary, it is better to give the adrenals the gentle nutrients they need to generate their own desired level of hormones rather than using external hormones. This approach is far more effective and will lead to ultimate healing instead of risking dependency on drugs. In fact, it is interesting to note that it is not unusual for many sufferers to find their need for thyroid medication reduced, as their adrenal function strengthens.

Antibiotics are prescribed to help overcome the frequent infection. However, they can worsen the irritable bowel condition that often accompanies Adrenal Fatigue, leading to gastrointestinal upset and internal dysbiosis. Irritable bowel symptoms are prevalent and systematic infection such as candidiasis can be exacerbated.

Steroids are commonly prescribed to suppress symptoms of chronic fatigue, irritable bowel, auto-immune conditions, skin rashes, severe fatigue and frequent allergies. These symptoms are commonly associated with Adrenal Fatigue. While short term use of steroids has its place in Adrenal Fatigue if carefully monitored, chronic intake of steroids leads to a catabolic state of function where proteins and systemic organs are broken down, further weakening of the body and ever increasing dose of steroids being taken to achieve the same degree of relief of symptoms.

Prescription medications often have multiple side-effects. Common side-effects of anti-depressants include dry mouth, urinary retention, blurred vision, constipation, sedation, sleep disruption, weight gain, headache, nausea, abdominal pain, loss of libido, agitation and anxiety. The more medicine that is given, the more side effects are to be expected. It is not unusual for the average sufferer to be on three to four medications at one time or another. Just to process the medications alone poses severe stress on the adrenals and the liver. Instead of giving the body the tools to heal itself and using the symptoms as a guide on how well the body is recovering, the body is not given a proper chance to heal as symptoms are being suppressed. It comes as no surprise that most people with Adrenal Fatigue never fully recover.

4. Failure to recognize paradoxical and unusual reactions

A paradoxical reaction is when medical treatment, usually a drug, has the opposite effect to that which normally will be expected. An example of a paradoxical reaction is when a pain relief medication causes an increase in pain. Some sedatives prescribed for adults actually cause hyper-activeness in children. Experienced clinicians know this and are on high alert for these abnormalities.

Paradoxical reactions are generally more prevalent in natural compounds. The reason for this is not known. The more decompensated the body is, as in the case of advanced Adrenal Fatigue, the more frequent such paradoxical reactions will occur.

Nutrients that are suitable for one body are therefore not necessary good for another one. In fact, it can be toxic for another body. Nutrients can become toxic and paradoxical reactions can surface after a period of time of indigestion. This can range from weeks to months. The body may also reject these nutrients immediately from the onset. Instead of feeling better with energy boost, one may feel worse in what is known as a paradoxical reaction. Severe fatigue may be precipitated, setting off an adrenal crash.

Common paradoxical reactions and abnormal reactions include:

  • A sense of fatigue or malaise or a state of anxiety instead of a sense of calm when taking steroids.
  • Sudden onset of anxiety attacks and impending doom at rest.
  • Sudden onset of heart palpitations despite normal cardiac function.
  • Sudden onset of dizziness and lightheadedness at rest.
  • Sudden onset of fluctuating blood pressure.
  • A sense of being "beaten up" that lasts for days after vigorous exercise.
  • Inability to think clearly and difficulty recalling recent events.
  • Waking up in the middle of the night for no reason and the inability to go back to sleep.
  • Being constipated instead of having loose bowel when taking high doses of vitamin C or magnesium.
  • A sense of feeling wired up and anxious after taking certain vitamins, adrenal glandulars or herbs.
  • Feeling more toxic instead of feeling better when going through a detoxification program like juice fasting, acupuncture or massages.
  • Sudden onset of fragile emotional states such as crying for no apparent reason.
  • Taking multiple trips to the Emergency Room because one feels impending doom even though nothing is wrong after repeated work-up.
  • A sense of well-being after taking selected nutrients, only to be followed by a "crash".

One can have any combination of the above. Collectively, they point to an adrenal that has lost its ability to maintain the fine control characteristics of a stable internal homeostasis environment. It is like taking a shower with either very hot or very cold water but not the comfortable warm water. The exact etiology of many of these paradoxical and unusual reactions is not known. Scientists suspect a variety of factors may be in play, including defective receptor sites, dysfunctional transport messenger system, improper clearance of metabolites and reactive adrenaline responses of a dysfunctional autonomic nervous system. Self-directed recovery programs following the standard textbook approach normally fail in such cases because normal healing tools and rules do not apply and in fact may make the body worse off.

As stated earlier, the more advanced the Adrenal Fatigue, the more paradoxical and unusual reactions tend to surface. In addition, there can be concurrent paradoxical as well as overreaction that occur close to each other in time. One may feel worse for a few days or weeks, followed by a short burst of well-being, only to relapse back into a fatigue state without doing anything significantly different. The body goes into a phase of homeostatic instability characterized by wild swings in emotional and physical states. This is the worst of both worlds, as the body is caught in a vicious cycle of cascading downward state of functions with its own violent attempt to rebalance itself. Eventually, this leads to severe incapacitation of daily functions Symptoms can include severe fatigue, bed bound most of the time, fragile blood pressure, reactive hypoglycemia, unexplained palpitation, severe anxiety attack, profound dizziness, extreme brain fog, frequent infection and severe insomnia, just to mention a few. This experience is akin to a state of the "living dead". The clinical picture becomes extremely convoluted and confusing to all but the most astute and experienced clinician.

5. Failure to recognize multi-organ involvement

Failure to recognize the multi-organ involvement associated with Adrenal Fatigue often leads to a narrow focus that makes the condition worse off over time. The adrenal glands are regulated through the hypothalamus-pituitary-adrenal (HPA) axis. The adrenals themselves are then intricately connected to many other organs in a variety of axes. One such intricate relationship ties in with the thyroid and the ovaries. This axis is called the Ovarian Adrenal and Thyroid (OAT) axis. These three organs are intimately co-dependent on each other for optimal function. They must be balanced if a woman wants to feel good. In men, the balance between the adrenals and thyroid is critical.

In the case of the ovarian-adrenal-thyroid or OAT axis, when a medication alters one of the organs' functions, it will invariably lead to an often unrecognized change in the other two organs. For example, if thyroid medication is administered, it is not uncommon to see concurrent menstrual irregularities, a function of the ovarian hormones and reduced ability to deal with stress and worsening fatigue, a function of the adrenals.

Let us consider this OAT axis more closely. The adrenal glands contribute about 35 percent of the female hormones pre-menopausal and almost 50 percent post-menopausal. Today, women often have exhausted adrenal glands by the time they reach their mid-thirties or early forties due to their stressful lifestyle. In Adrenal Fatigue, cortisol output becomes imbalanced. Excessive cortisol output can lead to multiple undesirable effects. A cortisol induced organ resistance can occur and this applies to nearly all other organs regulated by hormones including the ovaries and the pancreas. Few hormones are allowed to work at their optimal levels in the presence of Adrenal Fatigue. For example, cortisol blocks progesterone receptors, making them less responsive to progesterone. Insufficient progesterone production leads to an imbalance of estrogen as compared to progesterone. With reduced progesterone to offset estrogen, the body may experience estrogen dominance and a host of undesirable side effects associated with excessive estrogen, including PMS, irregular periods and fibroids. Over time, Adrenal Fatigue is often associated with sub-clinical hypothyroidism as well, as the thyroid tissues fail to respond as efficiently to hormonal signals. That is why chronic stress can make one feel so rotten, like a slow-motion train wreck in progress. Few hormones are allowed to work at their optimal levels. Sugar levels can become imbalanced, blood pressure regulation is affected and menstrual flow can become irregular.

Often times, the use of anti-depressants, thyroid replacements and ovarian hormones such as estrogen and progestin (or even natural hormones) make women with OAT axis imbalance worse off. Estrogen replacement often becomes ineffective. Symptoms of estrogen dominance like hot flashes, weight gain at the hips, water retention and moodiness are commonly observed despite normal estrogen levels. Patients become frustrated as it appears that nothing can help when a downward spiral of multiple symptoms commonly surface, including depression, insomnia, fatigue, metabolic and thyroid imbalances.

When multiple organs are involved and decompensate concurrently because of Adrenal Fatigue, the body's ability to recover is made much harder. Processing and assimilating nutrients are often compromised. Absorption of nutrients in the GI track is reduced, as leaky gut, irritable bowl, food sensitivity, and internal dysbiosis overwhelm the normal flora. Liver function is reduced, despite normal liver function laboratory test results. Good nutrients, if not processed and metabolized properly, become toxic. Toxic metabolites circulate in the body and if not properly cleared, can lead to brain fog, joint pain, skin rashes, allergies, muscle discomfort, and multiple chemical sensitivities among many other symptoms. No organ system is spared of dysfunction when the adrenals are not in optimal condition. As a result, an adrenal recovery program that does not factor in other organ involvement invariably will fail as the condition worsens.

In addition to the OAT axis imbalance, the HPA axis can also be involved. In addition, dysfunction of the autonomic nervous system (ANS), often times sub-clinically, can exaggerate the imbalances of these axes. A thorough knowledge of how to normalize and rebalance these axes is of paramount importance in trying to achieve Adrenal Fatigue recovery.

6. Over-reliance on laboratory testing

The best way to test your adrenal health is to measure your level of free key adrenal hormones such as cortisol and DHEA. Additional hormones such as progesterone, testosterone and estradiol are commonly measured and can be helpful as well. There are, however, several common pitfalls.

First, saliva testing is preferred but seldom performed in the conventional medicine setting. Saliva testing measures the amount of free and circulating hormones instead of binded hormones commonly measured in blood tests. Most conventional physicians, however, still rely on blood serum testing for Adrenal Fatigue and can therefore miss the true picture of adrenal function. Patients are often told that their adrenal function is normal when in reality it is not. Under diagnosis is common.

Second, there is tremendous individual variance of test results correlated to symptoms. It is not uncommon to have significant Adrenal Fatigue symptoms presented with "normal" laboratory results. In advanced Adrenal Fatigue, the 24 hour cortisol curve as measured by the saliva test often becomes blunted or flattened. It can and often will stay this way for an extended period of time, even during recovery as symptoms subside. Overdosing or under dosing is frequently seen if one relies primarily on laboratory test results without factoring in individual specificity.

Third, laboratory results vary depending on the stage of Adrenal Fatigue. Hormonal levels vary in different stages of Adrenal Fatigue. In early stages, the cortisol, DHEA and pregnenolone levels tend to be high as the adrenal glands work hard. In late stages, pregnenolone level tends to be low and morning cortisol level is blunted. These are just some very general rules. There are many exceptions to the rule and this makes laboratory interpretation most challenging even to the experienced clinicians. Laboratory testing is frequently confusing and misleading as a result.

Those with concurrent thyroid dysfunction may find similar pictures. They may have classic symptoms of thyroid irregularity clinically and yet their laboratory test results are shown to be normal. Conventional physicians often find themselves chasing a moving target and misled by laboratory test results. In that process, the body is subject to numerous trial and error protocols resulting in further weakening the body's already low adrenal function.

The body's signs and symptoms are far superior in gauging adrenal weakness as compared to laboratory test results based on the current technology. A good and comprehensive history of the patient taken by an experienced clinician is the gold standard and is the key.

7. Lack of a comprehensive recovery program

The body is a perfectly designed ecosystem with built-in self repairing properties. It normally can recover on its own if given a chance with the proper nutrients, lifestyle and dietary changes and time. Recovery strategies focusing on this comprehensive approach often produce excellent results, even in severe cases. Results can be seen in a matter of days and weeks. On the contrary, strategies focusing on controlling the symptoms and getting quick results often fail. The root cause, such as removal of stressors, improper dietary habits and improper use of nutrients, needs to be addressed in a comprehensive program for maximum recovery speed.

If the adrenals do not recover, they tend to get worse off with time. Maintaining the status quo is therefore not the best therapeutic strategy but is in fact a strategy that will almost guarantee failure.

The most effective recovery program must incorporate the following:

  • Customized nutritional support based on the person's internal body needs and sensitivity level to nutrients. Vitamin C doses, for example, can vary from 100 mg to 10,000 mg or more. Some people do well on regular ascorbic acid, while others do much better on buffered vitamin C or fat soluble vitamin C. Some cannot take vitamin C at all. The delivery system can drastically affect the bio-availability of nutrients when it comes to the transportation of nutrients into the body cells. This needs to be considered along with the quality and form of the nutrient. A thorough knowledge of the particular natural compound and its many properties is a perquisite to a successful adrenal recovery program.

  • Customized lifestyle program based on the person's constitution and generic makeup. While general lifestyle tips such as avoiding sugar and caffeine are helpful, there is tremendous variation in routine that needs to be factored in based on each person's own makeup. Exercise programs, for example, need to be particularly adjusted to allow the body to enhance blood circulation but not to trigger a catabolic state. Sleeping early is good for the majority of people but may not be good for some people. Any attempt to cleanse and detoxify the body must proceed with extreme caution to avoid a sudden toxic reaction.

  • A customized dietary program based on the sufferer's blood and metabolic type is necessary. Some body types do better with proteins and fats, while others do better with more vegetables. Some bodies welcome nuts as a good source of fat, while others do not. Alkalizing the body may be good for some but bad for others. What is the right food for one person may be toxic to another.

The above three prong approach can produce dramatic and quick results if carried out under the supervision of an experienced clinician.


Adrenal Fatigue is a condition that has puzzled the medical community for the past 100 years. Physicians scorn to come near it because of the lack of a standardized approach and understanding of its progression and the various therapeutic options. Patients are abandoned and left on their own to self-navigate. The fact that the majority of self guided programs has failed is a warning sign that something is very wrong. This paper outlines the 7 common mistakes committed by lay people and professionals alike. They include inappropriate use of nutrients, failure to factor in paradoxical behavior and multi-system involvement, lack of comprehensive approach, over reliance on laboratory testing, overuse of prescription drugs and inexperienced health care providers.

Imagine living a life where one is bed bound most of the time, exhausted from doing the simple chores of daily living, startled by simple events like the ringing of the telephone or the door bell, unexplained onset of feeling impending doom, depression, sudden anxiety attacks, heart palpitations, hypoglycemia, hypotension and insomnia. These are symptoms of severe Adrenal Fatigue which can result in total incapacitation and a debilitated state of function called the "living dead". These symptoms are also the characteristics of the end stages of Adrenal Fatigue if left to its natural progression.

Adrenal Fatigue as a condition is much more complicated and debilitating than we think. Fortunately most will recover. The body's stress response mechanism has sustained and ensured our survival for thousands of years. Our understanding and knowledge of this condition is at best only in its infancy. Those who are suffering or fail to recover on a timely basis should scrutinize their current recovery program to see if there is any room for improvements. Qualified professional help from those who are highly experienced should be sought out as early as possible to avoid and reverse the natural progression of this condition.

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