One of the realities of being a pharmacist is that we’re easily accessible. There’s no appointment necessary for consultation and advice at the pharmacy counter. Questions range from “Does this look infected?” (Um, yes) to “What should I do about this chest pain?” to more routine questions about conditions that can easily be self-treated. Pharmacists have an important triage role — advising on conditions that can be safely self-managed, and knowing when medical referrals are necessary or appropriate. Among the most common questions I’ve received in my time working in a retail pharmacy are related to stress and fatigue. Energy levels are down, and patients want advice and solutions. Some want a “quick fix,” believing that the right mix of megadoses of vitamins are all that stand between them and unlimited energy. Others may ask if prescription drugs, herbal supplements, or even caffeine tablets could help. Evaluating vague symptoms is a challenge. Many of us have busy lifestyles, and don’t get the sleep and exercise we need. We may also compromise our diets in the interest of time and convenience. With some simple questions I might make a few basic lifestyle recommendations, talk about the evidence supporting supplements and vitamins, and suggest physician follow-up if symptoms persist. Fatigue and stress may be part of life, but they’re also symptoms of serious medical conditions. But they can be hard to treat because they’re non-specific and may not be easily distinguishable from the fatigue of, well, life.
While it’d be great if we could get all of our daily nutritional requirements from food alone, it’s rarely possible. The way in which food is grown, stored, processed and cooked destroys much of its nutritional value. Although most whole foods still harbor plenty of health benefits, they may not have enough of the vitamins and minerals you need to recover from adrenal fatigue.

Adrenal fatigue shouldn’t be confused with adrenal insufficiency, a legitimate medical condition that can be diagnosed with laboratory tests and has a defined symptomatology. Addison’s disease causes primary adrenal insufficiency and usually has an autoimmune cause, with symptoms appearing when most of the adrenal cortex has been destroyed. Secondary adrenal insufficiency is cause by pituitary disorder that gives insufficient hormonal stimulation to the adrenals. Some liken adrenal fatigue to a milder form of adrenal insufficiency — but there’s no underlying pathology that has been associated with adrenal fatigue.


It doesn’t have to be this way. Simply becoming more mindful of your caffeine and sugar consumption will often help to reduce it. Limit yourself to one or two coffees each day at first, then try to give it up entirely. Eat a nutritious, healthy diet, and try some of these low sugar recipes. Look for low glycemic fruits instead of sugary dried fruits or fruit juices. Learn how to improve your sleep hygiene so you won’t feel the need for those stimulants. And identify ways to work more efficiently during the day, so you take rests when needed.


I have been suffering since two years, due to I guess too much exercise and less carbs. I have the following symptoms, bad sleep, dehydrated and no thirst feeling, thinning hair, cold feet, dandruff, low libido, very bad digestive system almost always bloated, but the most important thing is, there is liquid coming out of my anus. In short, I feel extremely bad during the day.

Cortisol increases your appetite and energy level while toning down your immune system’s allergic and inflammatory responses. This hormone stimulates the storage and release of energy in the body, helps the body resist the stressful effects of infections, trauma, and temperature extremes, and helps you maintain stable emotions. Synthetic versions of cortisol — prednisone and cortisone, for example — are often prescribed to help people perk up and feel better so they will eat, drink, and move around more and therefore be better able to fight off illness or heal from an injury.
Methylation labs: Methylation is a collection of biochemical actions in the body that happen 1 billion times every second. Healthy methylation helps to maintain a healthy brain, gut, hormones, and detox pathways, and also protects your DNA. However, some of us have genetic mutations that impair the methylation process. I have multiple methylation gene mutations, one of which is the MTHFR gene mutation, making me less able to absorb certain essential vitamins. This was useful information because I was then better able to supplement to make up for my nutritional deficiencies.

These symptoms are mostly related to the changing hormone and neurotransmitter levels that come with Adrenal Fatigue. There are a number of other, less common, symptoms that can also appear. These might include vertical lines on the fingertips, frequent urination, and low blood pressure. Again, these are all related to the dysregulation of the HPA axis and the various hormone levels that depend on it.


The effects of adrenal dysfunction can be profound: fatigue and weakness, suppression of the immune system, muscle and bone loss, moodiness or depression, hormonal imbalance, skin problems, autoimmune disorders, and dozens of other symptoms. The good news is that adrenal fatigue can almost always be relieved. Let’s look at the relationships between stress, high cortisol levels and adrenal fatigue, and then we’ll look at how you can give your adrenals more support.
I’m VERY anxious to read the help we can do for ourselves for adrenal fatigue, as I am a mother of a 20 year old son who has multiple emotional, mental and behavioral disabilities. The last 20 years have been extremely stressful. I took the saliva test and my cortisol levels were off the chart. My doctor prescribed hydro-cortisone which I took for a period of time but I know I need to do more because the stress is ongoing. My physical health has suffered greatly. I’ve learned much on nutrition through webinars, some of which you, Heather have participated in,(thank you).
My 21 year old son has been diagnosed with”idiopathic hypersomulence” after a sleep study showing no apnea or narcolepsy. He lived in a house that had several feet of water in the basement and had black mold on the windowsills of his bedroom. He’s living with us now, but he is so tired all of the time! On weekends, he’ll sleep til 4 p.m.He will sometimes come in from work and lay on the floor from exhaustion. I desperately want to help him. He does have tonsil stones and we’ve scheduled a tonsillectomy. I don’t know if it will help or hurt, going through a surgery. If you can give ANY direction, I would be very grateful!
I had a doctor concerned about my adrenals and suggested a saliva test in 2009 because my cortisol was testing high- I didn’t do it. In April 2012 with another doctor I did a saliva test & my adrenals were off the charts. This Dr. handed me the adrenal support tablets with her face on the bottle bottle and did no subsequent testing. In October 2013 I wound up in the Endocornologist office. Her basic blood profile showed my cortisol high because of HCTH. After more subsequent testing and an MRI was discovered that I had Cushing’s disease- my set of symptom indicators were caused by a small benign tumor in my pituitary. I had a surgery in April 2014 and have been recovering my health steadily. I share this to say… If you are having testing done that shows your adrenals over functioning or underfunctioning you may need to see an Endocornologist to really have somebody who understands it working on the behalf of your health.

The ACTH has the effect of stimulating your adrenal hormone output, just like it would if you were placed in a stressful situation. This test allows you to see the response of your adrenals to stress. If your cortisol exhibits a healthy spike higher (at least double in a blood test), your adrenals are probably in reasonably good shape. If the spike in cortisol is not so large, this suggests adrenal insufficiency.


Exercise gently at least 5 days per week, preferably morning and not late in the day.  Try swimming, gentle bike rides, walking, yoga, stretching, or any restorative activity that incorporates breathing.  Avoid high adrenaline activities, like kayaking, competitive sports, running, cross fit or high intensity training until you are well on your way to healing.

Chronic stress is very common in western society. The most common causes of stress are work pressure, changing jobs, death of a loved one, moving homes, illness, and marital disruption. Adrenal fatigue occurs when the amount of stress overextends the capacity of the body to compensate and recover.   But there is hope…  stay tuned for my next article on how to treat adrenal fatigue
Hormones affect every function, organ and tissue in the body directly or indirectly. They react to each other as well as respond to conditions in the body in an intricate and highly sensitive balancing act. The adrenal glands work closely with the hypothalamus and the pituitary gland in a system known as the hypothalamus-pituitary-adrenal axis (HPA axis). (7)

Well that explains it Dr. Northrup! After a difficult winter I was on my way to rejuvination and ran into a road hazard without warning. I have been freaking out ever since. Very concerned someone else will hit it and not be so lucky. I have withdrawn from my usual uplifting activities and feel as if I will emerg reborn. Living by a motto of “Eat right, get plenty of rest and exercise” has worked for decades, menopause is a trip! I will be preparing delicious meals to savor and add Licorice and Ginseng to replace caffine. Practice having more fun while “Celebrating peace and love always”. I was shaken hard enough in the accident that my pinky and ring fingers are numb, it was spreding to my palm and wrist but numbness has receeded to fingers. I was restless and having nightmares too. My hump on the back of my neck flattened. I am doing PT to keep it away. Sleeping with arms straight and down seems to help too. Driving can be stressful as it requires we be more alert. I had taken a side road to get away from a driver who was swerving and driving at inconsistant speeds and a tailgater who had been behind me for sometime on a dangerous two lane road know for head ons and off road accidents. Hummm, getting back to focusing on love and having more fun. . .Now!!!

My doctor suggested I read this book as everyday I am exhausted & struggle to make it to the evening. I have chronic pain as well so it was good to get a scientific understanding of how the adrenals work & how my pain impacts on them & everything else. The book answered a lot of my questions & gave me the courage to say 'NO' to others just a little bit more (that's a journey!). Life is NOT about getting through the day, enjoyment & vitality is so important. The catchphrase 'Thriving NOT surviving" sums this book up! I LOVE it ...

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This extends to more than just lifestyle and dietary choices. Patients also need to identify and eliminate the sources of stress in their lives. This can often be difficult, but it is a necessary part of restoring their health. Unhealthy relationships, stressful jobs, family quarrels, money worries – these all need to be eliminated somehow. Often a patient will feel as though a huge weight has been lifted off their shoulders when these issues are fixed. As you would expect, that feeling also signifies a great deal of stress being taken off their adrenal glands and HPA axis too.
This can be extremely fast and effective at treating the symptoms of allergies, asthma, skin problems, arthritis, and other illnesses. However, since many of these type medications contain a hormone that is synthetic and is often 17 times more in strength than what is needed by the body, they may repress and in some cases shut down adrenal function – creating an even larger hormonal inequality than prior to treatment. Additionally, the side effects may be severe, ranging from kidney failure to dizziness and in some cases death. Some of the more common corticosteroids are prednisone (brand names of Cortan, Deltasone, Prednisone). These medications have lots of side effects.
I suffer with all of these I have fibro,bulging discs, degenerative discs, prolapse, annular tear, carp tunnel, tendonitis, cholesterol levels, folic acid deficiency, panic disorder, fobias, asthma, hypersensitivity to stimuli, ,I have raynauds symptoms, and rheumatoid arthritis getting tests for them they keep saying I don’t have autoimmune illnesses
We now know that HPA axis dysfunction is a more appropriate description of the fatigue that comes with adrenal dysfunction. Shift work has long been associated with increased health risks, including risk of insulin resistance, weight gain, cardiovascular disease and brain dysfunction. Many people do not have a choice but it is not a good idea to consistently lose sleep or upset your body’s circadian rhythm.

Food is medicine. I always ate healthy, other than my favorite “healthy junk foods” of gluten-free pizza and stevia soda. However, I knew that if I was going to rehab my adrenal fatigue, I had to take my food medicine plan to the next level by making sure my diet was on point for hormone health. Here’s the 90-day food plan I used to improve my sleep and energy.


Theories on adrenal impairment as the genesis for fatigue are tempting, as they allow for a treatable condition. Despite the widespread use of the term “adrenal fatigue” by the general media and certain health practitioner groups, in this systematic review, only ten citations were found with this exact expression, and they were all only descriptive and did not perform any test regarding the HPA axis and “adrenal fatigue”. Studies that tried to correlate the HPA axis and fatigue states used the term “burnout” instead of “adrenal fatigue” to denote adrenal depletion. Therefore, a distinction between the “general information” and the actual scientific literature regarding this condition is evident.
I had a bilateral adrenalectomy 30 years ago. I take Prednisone and Flourinef replacement steroids. But I’m tired and depressed all the time. I’ve never taken DHEA and wondering if would help me? I’m menopausal. I’m 57 years old. I don’t have osteoporosis. My adrenal glands were removed when I was 17 – I was diagnosed with Cushings Disease. Later on I had a pituitary adenoma removed. I still have my pituitary gland. It’s functioning properly. My fatigue interferes with my life.
Scientists in China have designed a cohort study to examine the interaction of genetics, biomarkers and environmental exposures with health metrics lead to chronic diseases. A validated questionnaire, along with a large battery of tests, has led them to develop a classification referred to as “suboptimal health.” This phase is essentially a step between optimal health and diagnosable illness or disease characterized by “the perception of health complaints, general weakness, chronic fatigue and low energy levels.”
Adrenal fatigue should not be confused with another medical condition called Addison’s disease where the adrenal glands are not functioning at all. While Addison’s disease is often caused by autoimmunity, Adrenal Fatigue is largely caused by stress along with a host of other factors, like accumulation of toxic exposures, hidden infections, hormone imbalance, or even nutritional deficiencies.
My sleeping and eating habits got worse over time, and suddenly I wasn’t able to handle life’s stresses anymore. Before, I couldn’t really see why this happened, but now it makes a lot of sense. I simply had a series of physical and emotional stressors that were more than my adrenals were capable of handling (mainly because they were not getting the support they needed through rest and a healthy diet).
Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs, by Dr. Michael Lam, is a reference guide that packs virtually every bit of information you ever wanted to know about adrenal fatigue into its massive 500-page frame. Dr. Lam has been a pioneer in the study of adrenal-related issues, and personally provides help for millions on his own website, drlam.com.

This syndrome develops due to the malfunction of the adrenal glands in producing hormone competently. The adrenal gland secretes cortisol which is a hormone essential to optimal health. Cortisol in the body in excessive amounts may lead to problems that are severe such as Cushing’s syndrome. But, if released in amounts that are common by the gland, cortisol is a hormone that is vital to helping the body fight infection and deal with stress – without cortisol the body is not able to sustain life. Balance is crucial as well. Cortisol has an effect on every tissue, gland and organ in the body. When these glands are tired, they don’t provide the body with adequate cortisol. The body does what is necessary to get by but it is not without penalties. As such, this syndrome normally precedes other chronic situations.


Here’s another important thing to know about cortisol testing. Taking a single measurement, or even a 24-hour average, is not enough. The best cortisol tests take 4 individual samples at various points of the day and then map your cortisol levels over the course of a 24 hour cycle. Our cortisol levels vary dramatically, starting high when we wake up and then tapering off until they reach their lowest point late at night. This usually represents something like an 80% drop, which is perfectly normal. Your health care professional needs to see not just your average cortisol level, but also the size of the morning spike and how sharply it drops off afterwards.

I got my saliva test results and my DHEA is extemely low. My cortisol is normal-ish at all four times of the day. Years ago I felt revved all the time and was a slight 105 lbs I have hardly changed my diet but in two years had more stress job change, less sleep, and now am up twenty plus lbs!! I am now depressed over it and have little to no umph like before. I am taking DHEA cream and licorice but only feel jittery then tired after. I eat a ketogenic Paleo diet as well. Iam 43 andfeeling worse than I have in over 20 years. I feel like there is no hope…
Written as one part case study and one part treatment guide, Heineken’s book covers such topics as the different aspects of Addison’s disease when compared to adrenal fatigue, basic details about the adrenals, symptoms that can help you recognize your ailment, and testing methodologies. There is also information detailing her experiences with a variety of recovery options presented as practical advice to aid in the development of your own treatment plan.
I was experiencing hair loss in huge amounts. My stress was through the roof last few years . My mom passed away of cancer seven months ago. Finally saw an endo Dr and found out my DHEA levels are soaring. My testosterone high. I have Pcos and Dr found a small benign mass on my left adrenal gland. I pretty much feel like crap all the time. Major panic attacks and anxiety, exhaustion, weight gain, stressed, depressed, headaches, body aches, left kidney pain. Now I have fast heart beat and high blood pressure. I’m on Aldactone and couple other meds. I just have severs fear if this small mass since cancer is in my family. The Dr thinks nothing of it as it seems to be build up hormone. I am afraid it will turn into something worse. And my anxiety makes me fear the worst. They are saying my thyroid is fine but I don’t believe that. Any suggestions? Thank you…….
Stimulant use, however, can also be a result of adrenal burnout. While stimulants can cause or contribute to adrenal weakness, some who use stimulants do so because they are in adrenal burnout already. Stimulants are attractive to one in burnout to provide temporary energy. This is an important appeal of the drug culture, both legal and recreational. It is also the appeal of loud music, sexual addiction, and even anger.
Diagnosing Adrenal Fatigue from a single test or symptom is very difficult. To make an accurate diagnosis, doctors and naturopaths need to look at a range of tests, sometimes conducted multiple times, and take note of every symptom. This requires experience and a thorough knowledge of the various systems in your body, as well as some patience too. It may require two or three visits to the doctor before you can be sure that you have Adrenal Fatigue.
Chronic infections play a critical role in some cases of adrenal exhaustion. Chronic infections may originate in infected teeth or gums, though they can be located anywhere in the body. They contribute greatly to the toxic load of the body. Infections also cause inflammation and stress that must be countered using the adrenal hormones such as cortisol and cortisone.

In The Adrenal Fatigue Solution, we have included everything you need to know about diet, stress management, exercise, supplementation, hormone replacement and much more. It gives you all the tools you need to get the right tests, identify what might be causing your fatigue, and begin restoring your energy levels one step at a time. You will also learn how to prevent your Adrenal Fatigue from reoccuring. Full recovery may take some time, but once you start on the right path you should begin to see your energy levels improving within weeks.
Dr. Will Cole, leading functional-medicine expert, consults people around the world via webcam at www.drwillcole.com and locally in Pittsburgh. He specializes in clinically investigating underlying factors of chronic disease and customizing health programs for thyroid issues, autoimmune conditions, hormonal dysfunctions, digestive disorders, and brain problems.Dr. Cole was named one of the top 50 functional-medicine and integrative doctors in the nation and is the author of Ketotarian in which he melds the powerful benefits of the ketogenic and plant-based diets.
Every challenge to the mind and body creates a demand on the adrenal glands. And the list of challenges is endless: lack of sleep, a demanding boss, the threat of losing your job, financial pressures, personality conflicts, yo-yo dieting, relationship turmoil, death or illness of a loved one, skipping meals, reliance on stimulants like caffeine and carbs, digestive problems, over-exercise, illness or infection, unresolved emotional issues from our past or present and more. The result is adrenal glands that are constantly on high alert.
Deficiencies in hormones like cortisol, DHEA, aldosterone, pregnenolone, estradiol, progesterone, testosterone and growth hormone are often missed or poorly treated because doctors have come to rely on standard blood tests that require an intact pituitary and hypothalamus for diagnosis and dosing of hormone levels. There is, however, severe hypothalamic and pituitary dysfunction with CFS, making the standard blood tests inadequate. Evaluating hormone function, not just hormone levels, can help diagnose CFS and adrenal fatigue; and when properly treated and balanced, tremendous results can be achieved.
The International Pediatric Adrenocortical Tumor Registry is a database for young patients afflicted with these rare tumors. The result has created more personalized and targeted care as well as benefited the patient’s families and their physicians. Last October, the Journal of Clinical Oncology published a paper that described the clinical features and outcomes in children with…
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