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What is Adrenal Fatigue and can you recover from it?


Adrenal Fatigue is an umbrella term for a group of symptoms caused by poorly working adrenal glands. Our adrenal glands are walnut-sized glands on top of our kidneys and they deal with stress by producing the stress hormones adrenaline and cortisol. But after long periods of stress (or shorter periods of intense stress) the adrenals “fatigue” and are then no longer able to produce sufficient stress hormones like cortisol. This leads to a chronic imbalance in the adrenal hormones causing fatigue, issues with concentrating, sleep disturbances and difficulty to deal with stress.



How Do You Get Adrenal Fatigue?


In a healthy person the adrenals instantly respond to a stressful situation by increasing production of adrenaline, cortisol and other hormones that give the body a burst of energy and strength.


But this important defence system, that’s also known as the fight-or-flight response, is 40.000 years old. It was meant to be triggered occasionally and only for short-term use so that our early ancestors could deal with physical threats in which the emergency resolved very quickly in a few seconds or minutes. Think about our ancestors running into a sabre-toothed tiger or warrior from another tribe.

Modern life

Unfortunately the modern day stressful events such as health worries, financial problems, work stress, noisy neighbours, relationship troubles can not be resolved by fighting or running away. (When your boss stresses you out, you can’t really punch your boss in the face and you also can’t run from the office)


Still, these psychological stressors do trigger your fight-or-flight response. When you feel you are under constant stress as can be the case with the above psychological stressors the adrenal glands are not able to keep up with the body’s demand. They will produce less and less cortisol, the body’s dominant stress hormone. When this happens symptoms of Adrenal Fatigue appear.




Adrenal Fatigue Has Multiple Stages


Adrenal Fatigue is a multi stage process. First, there is a rise to unusually high levels of stress hormones. After a while, the body reacts by reducing sex hormone levels to compensate for the elevated stress hormone levels. Later the stress hormones start to drop, unable to sustain the pressure. The lower levels of cortisol and adrenaline, together with the disruption in the daily cortisol cycle, are what generally cause many of the Adrenal Fatigue symptoms. The constant tiredness, inability to focus, disrupted sleep cycles and more are all results of the stress hormones not being at their optimal level.


Adrenal Fatigue is actually a misnomer


Adrenal Fatigue is nothing new, it was first diagnosed over 100 years ago and has been successfully treated for several decades. It has been known by other names like non-Addison’s hypoadrenia, sub-clinical hypoadrenia, adrenal neurasthenia, neurasthenia, adrenal apathy, adrenal burnout and adrenal exhaustion.


But today, most medical doctors are not aware of this condition. For several reasons that mainly have to do with the close relation between medicine and the pharmaceutical industry, the medical community has ignored the existence of Adrenal Fatigue over the past 40 years. Due to this lack of knowledge, individuals continue to suffer because of improper diagnosis and treatment.


Actually, the term Adrenal Fatigue is a misnomer. A better label would be “HPA axis dysfunction” as the adrenal glands work in concert with the hypothalamus (part of your forebrain), the pituitary gland (just below the hypothalamus) to regulate the stress response, digestion, immune system, libido, mood, energy levels and metabolism. Because the term Adrenal Fatigue has drawn much popular attention over the last few years we will stay with this term on our website to prevent further confusion.


Impact On Life


As the name already tells you, the most telling symptom of Adrenal Fatigue is — you guessed it — fatigue. But the kind of fatigue experienced here is when the tiredness and sense of being sleepy continues the whole day and does not go away after a good night’s sleep. Energy levels are only boosted up usually late in the evening as caused by a disrupted cortisol cycle. As a result, people experiencing Adrenal Fatigue often feel the need for stimulants like coffee and sugary foods and drinks to get going in the morning and through the day.


Unfortunately Adrenal Fatigue is not as easily to identify as measles or influenza. So you may look and behave relatively normal without showing obvious signs of physical illness when suffering from it. But those with Adrenal Fatigue feel far from normal and often report feeling “grey” throughout day, tiredness and a general sense of unwellness. Often also reported are a general lack of enthusiasm or difficulty in keeping up with everything that goes on around.

The problems

Aside from the physical symptoms, Adrenal Fatigue can have a profound impact on emotional and psychological health and with respect to relationships, social life and work. In the more serious cases, the activity of the adrenal glands is so diminished that an individual may have difficulty getting out of bed for more than a few hours per day, limiting the ability to work, to take part in daily activities, relationships, exercising, social events and community activities.

A Brief History Of Adrenal Fatigue


Strangely enough, you would have been more likely diagnosed with Adrenal Fatigue 100 years ago than you are today (although things are starting to change!).

Italian anatomist Bartolomeo Eustachi already described the adrenal glands in 1564, but Hypoadrenia (the term for adrenal insufficiency back then) was only first described in medical texts in the 1800s when doctors further started to study the role of adrenal glands and began to understand adrenal function and their impact on energy levels, sex drive, immune system and metabolism.


Dr. Thomas Addison first identified Addison’s disease in the mid 1800s while working at a hospital in London. He published a short article in the London Medical Gazette in 1849: “Disease: Chronic Suprarenal Insufficiency, usually due to Tuberculosis of Suprarenal Capsule” 2. Later in 1855 Addison further published one of the most recognized works on adrenal glands in his monograph: “On the Constitutional and Local Effects of Disease of the Suprarenal Capsule” 3. It was Armand Trouseau however who later gave it the eponym Addison’s disease.

In 1896, William Osler was the first to find that the most severe form of Hypoadrenia (Addison’s disease) could be treated by using extracts of adrenal glands from animals to help the body rebuild the adrenal glands. In the 1918s these adrenal cell extracts became commercially available and ever since they have been used by thousands of doctors as a powerful and valuable supplement in the treatment of non-Addison’s Hypoadrenia.

20th century

Where in the first half of the 20th century thousands of patients were diagnosed and treated for Hypoadrenia, in the second half of the century diagnosis of Hypoadrenia began to diminish. Why? Mainly because there were no medical tests available to accurately detect Hypoadrenia; the “normal” ranges for adrenal function on standard tests include all but the most severe cases of adrenal dysfunction (Addison’s disease and Cushing’s syndrome; up to this day if your lab results and symptoms do not qualify you for one of these two conditions, then your adrenal glands are considered “normal”).


The lack of accurate tests had two consequences: a) since Hypoadrenia is a slow insidious condition, symptoms were easily attributed to a number of other causes b) there was a growing division between 2 groups of people; proponents and opponents of Hypoadrenia. The former claiming it was a real health condition and the latter who said it’s not (similar to the modern day debate).


For these reasons Hypoadrenia fell probably off the medical radar until in 1998, after decades of working with stressed patients, a chiropractor by the name of Dr. James Wilson gave the condition the name Adrenal Fatigue to refer to “below optimal adrenal function resulting from stress and distinguish it from Addison’s disease” 4.

Adrenal Fatigue was called many names




Fast forward to the 21st century to have a look at the present situation.


Why Adrenal Fatigue Is Misdiagnosed (Or Not Diagnosed)


Although thousands of people experience a fatigue that is not relieved by a good night’s sleep, there is no scientific evidence yet to support the notion that long-term mental, emotional, physical or infectious stress overwork and deplete the adrenal glands and contribute to developing Adrenal Fatigue. As such most doctors and healthcare professionals do not verify it as a real condition and are not able to test and recognize it.


Where in the past doctors’ most essential diagnostic tools were skills of observation, physical examination and deductive reasoning, now in modern times doctors rely on narrowly interpreted lab tests in combination with a list of numerical diagnoses allowable by insurance companies. As a result drugs and surgery are usually the only therapies offered by modern medicine. If there is no known surgical or drug treatment for the problem, then the condition does not exist.


There are no clear-cut reasons why Adrenal Fatigue is ignored by mainstream medicine, but one prevailing thought is that it has something to do with money.

  1. No money in it for pharmaceutical companies

The rise of the pharmaceutical industry over the last 50 years has had a profound impact and completely altered the practice of medicine and as a result the emphasis in education in medical school. Medical institutions are highly subsidized /sponsored by the pharmaceutical companies, which obviously influences curriculum toward treatment methods that are lucrative to themselves and as such, only drug-related treatments are likely to be pursued 5. In addition, pharmaceutical companies are the leading medical researchers these days and they reserve their research for diseases that can be cured with drugs. Also, most post-med school education is given by drug representatives  6.


These pharmaceutical companies make money by developing and patenting drugs (bio-identical hormones cannot be patented). Even if Adrenal Fatigue were to become more commonly diagnosed, the treatment primarily involves dietary and lifestyle changes and natural therapies, not drugs. Therefore, there is no money in it for pharmaceutical companies.

  1. No ICD code


Another big problem in today’s medical system is the use of ICD’s.  These are International Classifications of Disease.  In order for doctors to claim payment from insurance companies all patients must be given an ICD code. Without an ICD code insurance companies will not process claims. Adrenal Fatigue is not classed as a disease and therefore does not have an ICD code  7. Every patient needs an ICD code for their medical condition, but if a doctor cannot label you with a code that describes your disease then they will not be paid for seeing you as your insurance will not cover your visit. There is no ICD code for Adrenal Fatigue and the code for Hypoadrenia is usually reserved for Addison’s disease, because this extreme form of adrenal insufficiency is the only form that is acknowledged.


  1. Adrenal Fatigue has many common symptoms

The most common symptom of Adrenal Fatigue is unrelenting fatigue and since fatigue is such a common symptom, Adrenal Fatigue can easily be missed or misdiagnosed by doctors and healthcare professionals.


Not all conventional medical practitioners, healthcare professionals or integrative doctors for that matter are on the same page and have a unified view on the topic of Adrenal Fatigue, amongst them are proponents and opponents of Adrenal Fatigue.


The former claiming it is a valid health condition while the latter accuses the opposing group of having invented a fake disease.


Some arguments of the opponents


Some arguments of the proponents



The conventional medical community


Fortunately alternative medicine and increasingly more health websites acknowledge the existence of Adrenal Fatigue as a real health condition and thanks to the continuing efforts from doctors and naturopaths such as Dr. James Wilson, Dr. Michael Lam, Dr. Christiane Northrup, Dr. Joseph Mercola, Dr. Mehmet Oz and many others there is also increasingly more awareness about this condition in the conventional medical community.


To get a clearer understanding of Adrenal Fatigue, let’s take a closer look at the myths and facts surrounding the Adrenal Fatigue Syndrome.


Facts About Adrenal Fatigue


Over the last 100 years a list of several “known facts” have been noted to be associated with the Adrenal Fatigue:


  1. It affects the speed of recovery from illness


In Adrenal Fatigue, the hormonal imbalances are causing suppression of the immune system. Simply said, there are fewer antibodies to fight against infection making the body susceptible to infection and thereby increasing recovery period.


  1. It could hit anyone


Any male or female from birth to old age can suffer from Adrenal Fatigue. However certain factors such as poor diet, substance abuse, lack of sleep, chronic illness, physical or emotional pressures, a mother with Adrenal Fatigue during pregnancy and/or birth as well as the presence of personality characteristics that exacerbate the experience of stress all increase susceptibility to Adrenal Fatigue.


  1. Stress is highly associated with Adrenal Fatigue


Every time the body is faced with stress (whether it’s physical, emotional, mental or infectious) the adrenal glands mobilize the body’s stress response through the secretion of stress hormones that enable the body to cope with that stress.


Adrenal Fatigue occurs when the adrenal glands have been over stimulated without proper time for recovery and rest. Overstimulation of the adrenal glands can be caused by a very intense single stress, by chronic, persistent low-level stress or repeated stresses that have a cumulative effect.



  1. It is Highly-Treatable if and when discovered and patient is willing to be treated


Adrenal Fatigue is very treatable, but it takes time to heal and the patient has to be willing to make some major changes in lifestyle. Treatment involves reducing stress, eliminating toxins, sufficient rest and relaxation and replenishing the body with healthy food and positive thoughts. In more severe instances prescription medication can be required.


  1. Hypoglycemia is found to be connected


Hypoglycemia (or low blood glucose) commonly occurs in Adrenal Fatigue due to the combination of a lack of adrenal hormone production (in the setting of advanced Adrenal Fatigue) and increased insulin production (insulin lowers blood glucose). The increased demand and decreased availability of blood glucose creates a state of hypoglycemia, whereby the body cells do not get the blood glucose and other nutrients they require. Symptoms of low blood glucose are: blurry vision, rapid heartbeat, sudden mood changes, sudden nervousness, unexplained fatigue, pale skin, headache, hunger, trouble thinking clearly, shaking and sweating.


  1. Sex life is impacted as well by this condition


Cortisol and the sex hormones are made from the same precursor hormone, pregnenolone. When we are stressed the body diverts pregnenolone toward producing more stress hormones away from the production of sex hormones (the body prioritizes survival over reproduction for practical reasons).


Since libido is largely controlled through hormones and these are greatly affected by stress it’s very common to experience a decrease in libido due to excessive cortisol production stealing pregnenolone from sex hormone production.


  1. Adrenal Fatigue cannot be diagnosed through any kind of test


According to Endocrine Society there is no test for Adrenal Fatigue  8. But there are alternative physical and saliva tests capable of detecting non-optimal adrenal conditions. However there is no scientific evidence that these tests provide meaningful information or are correlated with Adrenal Fatigue.

Myths  About Adrenal Fatigue


If there are “know facts” about Adrenal Fatigue, there are also myths about it, let’s separate the wheat from the chaff:


  1. It is an existing disease


While adrenal insufficiency is recognized as a real disease by many, Adrenal Fatigue is not (yet) accepted as a real medical condition by most conventional endocrinologists, internists and major medical associations. Fortunately over the last few years medical doctors working in integrative medicine started to verify its existence as do an increasingly number of conventional medicine practitioners. So depending on the doctor that you are consulting with, they may have varying thoughts and opinions about Adrenal Fatigue.


As a side note; Adrenal Fatigue is often considered a SYNDROME, rather than a disease. The difference between the two is that a “disease” typically has a clearly defined cause behind it, a set of defined symptoms and a consistent change in the anatomy due to the condition. Whereas a “syndrome” (from the Greek word meaning “concurrence”) produces a group of symptoms without a clear identifiable cause and symptoms that are present are usually not consistent. Adrenal Fatigue indeed produces a host of non-specific symptoms and even when symptoms are present they are usually not consistent and certainly not traceable to a single cause.


However you will see that the words syndrome, disease and disorder often end up being used interchangeably and so do we throughout this book.

  1. Tests could detect Adrenal Fatigue


There is no specific test that can detect Adrenal Fatigue, since it is not a medically accepted health condition, no clinical test is designed to test for the presence of it. However, there are tests available that are capable of detecting non-optimal adrenal conditions.


  1. Strenuous exercise is good for Adrenal Health


Getting adequate exercise is good for your energy levels and general health, but excessive exercise wreaks havoc on already exhausted adrenal glands by spiking cortisol.


  1. Hormone replacement therapy is required to restore adrenal health


Adrenal Fatigue can be corrected in most cases by a treatment that provides adrenal support through a variety of lifestyle changes, diet, adequate rest, nutrients, gentle exercise, nutritional supplements and tools for managing stress. Only in more severe cases bio-identical adrenal hormone supplementation may be required.



  1. I have a mental problem if I have Adrenal Fatigue


Mental stress coming for example from worry and negative thinking could be a component contributing to Adrenal Fatigue. But there is also a physical component involved which includes food allergies/intolerances, heavy metals, pathogens (parasites, viruses, bacterial infections, candida), biochemical imbalances to name a few. Therefore a recovery plan needs to incorporate both the mind and the body.


  1. All herbal supplements are good for the body, especially for those with Adrenal Fatigue


Just like in the case of prescription medication, herbal supplements, even the 100% plant-based organic kind can have side effects (or even adverse effects), ranging from nausea and vomiting to life-threatening conditions like liver or kidney dysfunction. To avoid such complications, always consult your doctor before you decide to try a herbal supplement (and make sure to disclose any supplements you’re taking even if you’re not asked).


  1. All doctors are familiar with the topic of Adrenal Fatigue


In this day and age there is a specific type of doctor for almost every major system located in the human body, there are doctors for heart and cardiovascular diseases, ENT problems, hormone problems or any problem with the endocrine system just to name a few. The medical profession is extremely broad with more than 60 disciplines, so not all doctors are aware and educated about Adrenal Fatigue or verify it as a real medical condition.


Confusion Between Addison’s Disease And Adrenal Fatigue


Adrenal Fatigue and severe adrenal insufficiency (or Addison’s disease) seem to be highly related and this is usually cause for a lot of confusion.  But Addison’s disease is more of a total shutdown of the adrenal glands, whereas Adrenal Fatigue occurs when the adrenal glands are unable to secrete adequate hormones. It is a milder (temporary) version of Addison’s disease if you will.


Additionally, Addison’s disease has a clearly defined symptomatology and there are lab tests for diagnosis that include blood levels of cortisol and urinary levels of cortisol and aldosterone. Adrenal Fatigue on the other hand cannot be tested (outside alternative testing) and is manifested through vague symptoms that could also signify other disorders.


The 3 other distinct differences


  1. Addison’s disease is a lifelong condition that requires continuous treatment with steroid replacement therapy. Adrenal Fatigue can often be naturally corrected (sometimes bio-identical hormone therapy is used).


  1. Addison’s disease occurs when the adrenal glands are damaged, while Adrenal Fatigue usually develops as a result of overworking and depleting the adrenal glands. If the causes are removed, the adrenal glands will recover.


  1. Unlike Addison’s disease, for which the estimated prevalence is 1 in 20,000 persons in the United States and Western Europe, Adrenal Fatigue is very very common today. Dr. James Wilson estimates that it now affects millions of people around the world 9,10.


The Positive Side Of Adrenal Fatigue


In this little section we would like to share with you that while Adrenal Fatigue can be very debilitating, there is actually a positive side to it. So what could possibly be positive about Adrenal Fatigue? Well, Adrenal Fatigue can be a wakeup call for you, a critical turning point in your life. If you listen to it, it can be a signal that your life is out of balance. It can provide a stimulus to re-examine where and how you live. Maybe your beliefs need adjustment, or you have set unrealistic goals, you might need to learn how to say “no” or you eat an unhealthy diet.  You might not have loved your body enough and have in fact ignored or mistreated it. As such Adrenal Fatigue can be an opportunity for you to re-evaluate priorities in order to bring your life into greater harmony and happiness.


Change your life

A critical turning point is one of the many events in your life that can result in you drastically changing your life. If you suffer from Adrenal Fatigue and as you are reading this workbook right now, you are at a critical turning point in your life and it is good to be aware of this fact! The situation you are in can have a positive physical, mental or spiritual impact on your life, or you can neglect this opportunity and keep doing what you always did and you’ll keep getting what you always got.

Health issues solved

A critical turning point can take the form of a car accident, major business challenges, death of a loved one, break-ups, or (as is the case with Adrenal Fatigue) illness. You can view these circumstances as the worst thing that has ever happened to you and spend your time wallowing in self pity, self-denial, and moaning about your situation. Alternatively, you can take the chance to see the positive aspects of this situation and see it as a chance for change. Adrenal Fatigue is a health issue that you can turn around by tending to your adrenal glands through lifestyle adjustments, stress reduction, diet and supplementation.

Our workbook

There have been many people who were in the same situation as yourself and they were able to beat Adrenal Fatigue and afterwards excel in different areas of their lives according to their own wishes, just as you will be able to do if you follow the general recommendations in this workbook as well as your doctor’s or healthcare professional’s advice.

You have probably had many different critical turning points in your life and in the past you were able to overcome problems in both your professional and personal life. So acknowledge your previous successes and now take on the problem of Adrenal Fatigue!

A Closer Look At How Your Adrenal Glands Work And How You Can Keep Them Healthy

The Fight-or-Flight Response


Before we will discuss diagnosis and treatment options for Adrenal Fatigue let’s have a look at some of the key organs and structures involved to get a feel for what exactly happens inside the body when it goes through a stressful situation. Let’s start at the beginning with the fight-or-flight response.


The fight-or-flight response (or the acute stress response) was first described in the 1920s by American physiologist Walter Cannon and refers to a psychological reaction that occurs in the presence of a stressful event  11. This archaic response was developed during evolution to help us survive encounters with a saber-toothed tiger, a warrior from another tribe or anything that physically threatened us.


We now know that it’s not the situation itself that is dangerous, but our perception of it, it’s how we think of it, as the amygdala, the part of our brain that triggers the automatic part of the stress response can’t distinguish between a real and a perceived threat (like missing a deadline, public speaking and an argument with our boss). Nonetheless these “modern day threats” do trigger the activation of our fight-or-flight response as if our physical survival was threatened by a saber-toothed tiger.


The fight-or-flight response was designed to make us fight or flee, so that once the fighting was over our body and mind would return to a state of calm. This fight-or- flight response is invaluable and can be life saving in the case of an actual and imminent physical threat. But in most cases today, once our fight-or-flight response is activated, we cannot flee and we cannot fight. We cannot run away shortly before or during our presentation and we have to sit through traffic jam and cope with it. It’s probably also not a good idea if we punch our boss while we are in an argument.


When the perceived threat or stressful situation is gone, the body is designed to return after approximately 20 to 60 minutes to its pre-arousal levels, but in our modern times of chronic stress, this often doesn’t happen enough, causing damage to the body that can lead to all sorts of disorders of the autonomic nervous system, endocrine and immune systems.


How Does The Fight-or-Flight Response Work?


When a person judges a situation and decides (based on sensory input, sensory processing and stored memories) whether or not it is threatening, a number of physiological changes take place in the body. If the situation is interpreted as being threatening and thus stressful, the hypothalamus is activated. In response to a stressful experience the master stress hormone Corticotropin Releasing Hormone (CRH) is released by the hypothalamus. CRH acts as both a neurotransmitter and a hormone.

As a neurotransmitter CRH stimulates the brain and spinal cord to activate the sympathetic nervous system (SNS), responsible for the fight-or-flight response. This stimulation of the SNS causes the adrenal medulla to release adrenaline and noradrenaline into the bloodstream increasing heart rate, blood pressure, expanding the air passages of the lungs, enlarging the pupils, redistributing blood to the muscles and altering the body’s metabolism in order to maximize blood glucose levels.


As the initial surge of adrenaline rushes off, the hypothalamus activates the second part of the stress response system, known as the HPA axis. The HPA axis consists of the hypothalamus, the pituitary gland and the adrenal glands as the diagram below illustrates.


CRH’s role as a hormone is to stimulate the anterior pituitary gland to release Adrenocorticotropin Hormone (ACTH). This hormone then reaches the adrenal glands causing them to release cortisol as well as several other hormones. When the stressful situation passes, cortisol levels fall, dampening the stress response. This normal and natural response that the body does automatically was coined the “Relaxation Response” by Dr. Herbert Benson in 1974  12.

HPA Axis And The Main Organs Involved In The Stress Response


As we have just explained in the previous section, the adrenal glands, together with the hypothalamus and the pituitary gland make up the HPA axis. The HPA axis comprises a complex set of direct influences and feedback interactions which controls reaction to stress and regulates many internal processes that include digestion, the immune system, mood, emotions, sexuality, energy storage and expenditure. It is important to realize that the HPA axis operates through feedback loops. Feedback loops occur when the output of a system in your body loops back to that system and serves as input to influence its functioning. A positive feedback loop would stimulate that system’s output, and a negative feedback loop would inhibit it. In the HPA axis the following negative feedback loop occurs with regards to cortisol. When cortisol activates the stress response it simultaneously sends back a signal to your hypothalamus to inhibit CRH production and your pituitary gland to inhibit ACTH. As part of this feedback loop, cortisol is also able to lessen noradrenaline activity, gradually calming you down and creating a well-functioning checks-and-balances system.


In healthy individuals this negative feedback loop works harmoniously, but when stress hormones are chronically overproduced, the HPA axis eventually becomes desensitized to this negative feedback loop putting chronic stress on the hypothalamus, pituitary gland and adrenal glands.




The hypothalamus (represents the “H” in HPA Axis) is approximately the size of an almond and is located in the middle of the base of the brain. The hypothalamus plays a crucial role in controlling many bodily functions including the release of hormones from the pituitary gland. One of the primary functions of the hypothalamus is homeostasis, which is to keep the body in a constant and stable condition


The hypothalamus responds to multiple signals from the internal and external environment such as body temperature, feelings of being full after eating, hunger,  blood pressure and levels of hormones that are in circulation. In addition, the hypothalamus responds to stress and controls daily physiological rhythms such as the night-time secretion of melatonin from the pineal gland and the changes in cortisol and body temperature over a 24-hour period. The hypothalamus monitors these variables and puts changes in place to correct any imbalances.


Pituitary Gland


The pituitary gland (represents the “P” in HPA Axis) is a pea-sized gland located beneath the brain, behind the bridge of the nose and is attached to the hypothalamus. Although it may look like a single gland, it really consists of two distinct parts, the anterior pituitary gland and the posterior pituitary gland. The pituitary gland constantly monitors the body’s needs and sends signals to various glands and organs around the body to regulate their function and keep an appropriate environment. It releases a range of hormones into the bloodstream which act as messengers to transmit information from the pituitary gland to remote cells, regulating their activity. For example, the pituitary gland releases hormones that act on the adrenal glands, ovaries and testes and thyroid gland, which in turn create other hormones. Through production of its hormones, the pituitary gland controls metabolism, sexual maturation, growth, reproduction, blood pressure as well as several other vital bodily functions and processes.


Adrenal Glands


The adrenal glands (represent the “A” in HPA Axis) are two small organs that look like triangles above the kidneys that secrete vital hormones to our body. They are more or less 1.5 inches tall and 3 inches wide. The name directly defines their location in the body, the etymology of adrenal is from two Latin words “ad” and “renes” meaning “near” for ad and “the kidneys” for “renes”. They are responsible for a number of things but when you think of adrenal glands probably stress might be the first word that comes to your mind, and you are right, the adrenal glands are commonly known for releasing adrenaline, which prepares the body to fight-or-flight in stressful situations. But the adrenal glands not only produce adrenaline, they also produce many other hormones that are necessary for your overall health.


If you take a look at the illustration on the next page you can see that the adrenal glands consist of two parts: the adrenal cortex and adrenal medulla. The hormones released by the adrenal cortex are necessary for life and those secreted by the adrenal medulla are not.


Adrenal Cortex is the external part of the gland that produces 3 hormones.



Cortisol is involved in the stress response, helps regulate blood pressure and body metabolism. Aldosterone helps to maintain the right balance of salt and water and regulate blood pressure. Small amounts of male and female sex hormones are also released by the adrenal cortex.


Adrenal Medulla is the internal part of the gland that produces catecholamines including adrenaline, noradrenaline and small amounts of dopamine. These hormones control your body’s stress response (fight-or-flight response).

The adrenal glands recover quickly from the production of stress hormones in short bursts, but if the stress continues for a longer period, they become overworked, tired and depleted, contributing to imbalances in hormones or premature declining of hormones. There may be coping mechanisms (such as the “Pregonenolone Steal”) to help the adrenal glands manage for a time but these will eventually wear off, taking a heavy toll on the body. Since the adrenal glands are part of broader structures, a weakening of the adrenal glands will affect other organs and structures too.


One known organ that is often affected by Adrenal Fatigue is the thyroid. The thyroid gland controls the body’s metabolism and when the adrenal glands are depleted, they force the body to slow down in order to save energy as the body needs to rest. To do this the thyroid gland slows down resulting in a condition known as Hypothyroidism, or underactive thyroid disease. This condition is associated with symptoms of a slow metabolism such as feeling cold, constipation, dry skin, tired, forgetful and depressed. Symptoms indeed similar to Adrenal Fatigue and the two conditions are often confused. Since Adrenal Fatigue is usually not recognized by conventional medicine, 70% of people taking thyroid replacement medications continue to complain of symptoms because treatment does not include the adrenal glands  13.





Adrenal Fatigue is a multi stage process. Under times of stress initially there is a rise to unusually high levels of cortisol, but after a while the adrenal glands can’t keep up with the body’s need for cortisol and a state of fatigue (with low cortisol levels) kicks in. In order to deal with the body’s high needs for cortisol, pregnenolone (mother hormone to all other steroid hormones) is converted into cortisol, at the expense of converting into sex hormones as can be seen in the Steroidal Hormone Principle Pathways diagram. This process is called the “Pregnenolone Steal” and is one of the body’s coping mechanisms. The body prioritizes survival at all costs, so cortisol production takes priority over the production of sex hormones. Ultimately the Pregnenolone Steal has more damaging effects resulting from the loss of balance amongst the steroidal hormones impairing all of the metabolic processes that depend on their availability  14.

As you can see in the diagram, cholesterol (on top) is the raw material for all steroid hormones, which is converted to pregnenolone. Under normal circumstances pregnenolone is converted into progesterone and DHEA (Dehydroepiandrosterone) where the body uses DHEA to make both testosterone and the estrogen hormones (estrone, estriol, and estradiol).When under stress, the body is hyper stimulated to produce cortisol, the body’s primary stress hormone, and pregnenolone is diverted (stolen) from other pathways. So, instead of pregnenolone taking the normal route of progesterone or DHEA, testosterone and the estrogen hormones, it is “stolen” or diverted away to convert into cortisol (via progesterone). This phenomenon is called the Pregnenolone Steal and happens under stress.

Not the initially high levels of cortisol, but the lower levels of cortisol together with the disruption in the daily cortisol cycle, are what generally cause many of the Adrenal Fatigue symptoms. The constant tiredness, inability to focus, disrupted sleep cycles and more are all results of the stress hormones not being at their optimal level and in harmony.

Low sex drive and other symptoms are all related to the disruptions of our hormonal balances due to HPA axis dysfunction. Seemingly unrelated symptoms like frequent urination and salt cravings can be traced back to low levels of aldosterone, another adrenal gland hormone. Taking all these symptoms in consideration and collating them requires experience and thorough knowledge of how the endocrine system works. Luckily, modern lab tests and in particular the cortisol saliva test are very effective diagnostic tools. There should be careful analysis and interpretation of the test results though as the lab reference ranges tend to be quite wide. Therefore ideally your healthcare professional should have enough experience to recognize and correctly diagnose cases of Adrenal Fatigue.


In Short


The last part was a little bit more technical and if you did not fully comprehend it don’t worry as long as you understand on a high level that in a stress filled situation, the hypothalamus sends a chemical message to the pituitary gland which in turn sends a chemical message to the adrenal glands. This then prompts the adrenal glands to release hormones like cortisol and adrenaline thereby increasing blood glucose, heart rate and blood pressure. In a matter of seconds the body is prepared and ready to face whatever is causing the stress.


This is commonly known as our fight-or-flight response. This stress response evolved from the time when our ancient ancestors had to protect themselves from incidental and immediate physical threats that came from saber-toothed tigers or warriors.  However, this reaction is not appropriate when deluged with the constant low level stressors and pressures of modern life that come in the form of lost keys, traffic jams, financial concerns and unrelenting pressure at work. Under normal circumstances the adrenal glands recover quickly from a stressful situation, but if the stress continues for a longer period, they become overworked, tired and depleted leading to hormonal imbalances and Adrenal Fatigue.


Cortisol Is Not A Bad Hormone


In the lay public cortisol, or Hydrocortisone, has gotten the reputation of being a bad hormone that is released by stress and you might get that impression as well. In normal release however, cortisol has several beneficial functions that include raising our blood glucose levels when they are low and helping reduce inflammation and indeed mediate stress levels. Cortisol is actually a life sustaining hormone dedicated to maintaining balance in our body. It’s called “the stress hormone” because it influences and regulates many of the changes that occur in the body in response to stress. But it also helps balance blood glucose, metabolism, immune response, inflammatory responses and blood pressure.

Cortisol is always present in the body in varying amounts, while levels are generally highest in the morning and lowest a few hours after going to sleep. This is called a “diurnal variation” and these levels repeat on a 24-hour cycle (see diagram). The timing of cortisol levels may be different for people who work irregular shifts or sleep at unusual times of the day. Cortisol secretion differs among individuals, one person may secrete higher levels of cortisol than another person in the same situation. If you’re a person that is more sensitive to stress, it’s even more important for you to learn stress management techniques and maintain a low-stress lifestyle.

How Knowledge Of The Fight-or-Flight System Can Help You With Adrenal Fatigue


Activation of the fight-or-flight system usually is accompanied by several signals. You may experience the signals from the fight-or-flight response as physical symptoms like tension in your muscles, headache, upset stomach, racing heartbeat, deep sighing or shallow breathing. You may also experience them as emotional or psychological symptoms such as anxiety, poor concentration, depression, hopelessness, frustration, anger, sadness or fear. The most telling signals are when:

You might be wondering how understanding the physical symptoms of the fight-or-flight response is going to help you with Adrenal Fatigue, so let’s get right to it.


As explained, modern day threats are mostly psychological rather than physical. So by recognizing the symptoms and signs of being in fight-or-flight, you can begin to take steps to handle your stress response. You can indeed learn to avoid reacting excessively to situations and threats that are not life threatening.


The first step to breaking the cycle is to recognize the symptoms of stress for what they are and to remind yourself that they are not life threatening (unless of course they are). The next step is to deal with the symptoms of stress as symptoms which can be “treated”. Learning to calm down your rapid breathing with deep abdominal breathing can counteract the fight-or-flight response and induce calmness.

Other things you can do to further relax immediately after a fight-or-flight response include meditation, visualization, exercise or going for a walk.


Other Adrenal Gland Dysfunctions


Adrenal Fatigue is a mild form of adrenal insufficiency, but there are two other, more extreme conditions associated with adrenal dysfunction which require immediate medical attention. We have referred to these conditions several times and for your understanding here is some basic information about these two conditions.


Cushing’s Syndrome


Also known as Hypercortisolism – this is a very rare (prevalence is close to 40 cases per million persons) endocrine disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. Typical symptoms include upper body obesity, increased fat around the neck, thinning arms and legs, rounded face, fatigue, weakness, high blood pressure and mood disorders. The most common causes of Cushing’s syndrome are pituitary adenomas or taking too much glucocorticosteroid medication.


Addison’s Disease


Addison’s disease on the other hand (also known as primary adrenal Insufficiency, Hypoadrenalism, Chronic Adrenal Insufficiency or Hypocortisolism) is a rare chronic endocrine system disorder in which the adrenal glands do not produce sufficient cortisol and often insufficient levels of aldosterone as well.


(In the United States and Western Europe, the estimated prevalence of Addison’s disease is 1 in 20,000 persons).


Early stages of Addison’s disease are characterized by a number of relatively nonspecific symptoms, such as fatigue, muscle weakness, weight loss, and aches in the joints, muscles and abdomen. Over time these symptoms may become more severe such as dizziness, fainting, cramps, exhaustion and under certain circumstances, these may progress to an adrenal crisis, a severe condition which if not treated as an emergency can eventually lead to death


5 Ways To Keep Your Fight-Or-Flight System In Check


Since modern life tends to expose us frequently to persistent low level stresses, your understanding of how these stresses relate to your overall health is essential to healing from Adrenal Fatigue and achieving your health goals. Despite the amazing ability of the fight-or-flight system to protect your body from stressful situations, this system is by no means bulletproof. Therefore managing stress is key to keeping your adrenal glands healthy.


And to give you an idea, here are some ways to do it:


Manage Your Stress By Eating Regularly


Low blood glucose levels are by itself stressful to your body. You can think of cortisol as sort of a moderator, it helps to keep your blood glucose levels between meals (and during the night) adequate. But when you deprive yourself of food for a long period of time, say, you are on a strict diet trying to lose weight, your adrenal glands are stimulated to work harder in order to release more cortisol just to balance your blood glucose levels. As an Adrenal Fatigue sufferer you don’t want to squander your cortisol by eating irregularly.


So eating the right kind of food AND doing so at the right time is contributory to the optimal health of your adrenal glands. Eating three healthy meals combined with two to three snacks throughout the day is a great way keep your blood glucose balanced and lessen the stress on your adrenal glands and body.


Have An Exercise Routine


Exercise is one of the best ways to reduce stress and increase energy, but it can also be a stressor, particularly if you push yourself harder than what feels good during long winded workouts. Instead start with lighter more gentle forms of exercise, such as walking, swimming, yoga, pilates, stretching, meditation and work your way up to more moderate physical activity. Make sure you listen to your body and you build in adequate recovery time.


Give Yourself Sufficient Time To Sleep


Sleep is very important in recovering from Adrenal Fatigue. Sleep at least 8 hours per night and aim to be in bed by 10.30 p.m. before the “second wind” of energy hits and you end up staying awake for hours.


Note that a lack of sleep results in an elevation of cortisol levels the next evening and since cortisol is directly contributing to your wakefulness (the more cortisol the more awake you are) you can end up in a vicious cycle, meaning that you are tired through the day and then you can’t sleep at night.


Watch Your Sugar Intake


Whenever you eat sugar (also white flower products and other refined products for that matter) it’s metabolized quickly by your body into blood glucose causing your blood glucose levels to rise rapidly reaching excessively high levels. Cells in your pancreas are then signaled to release an excessive amount of insulin into your bloodstream to cope with the excessively high levels of blood glucose. Now the body will signal the adrenal glands to secrete cortisol to bring the blood glucose levels back up. Every time you eat sugar (white flower products, or other refined foods) the pancreas and the adrenal glands go through this cycle putting a burden on your adrenal glands.

Implement Healthier Stress Management Techniques


If your current methods of coping with stress aren’t contributing to a better physical health, it’s time to implement healthier ones that will ease the workload of your adrenal glands and stave off the negative effects of stress. Since everyone has a different response to stress, there is no single method that works for everyone, so experiment with the various techniques and strategies. Here are a few:


Inducing The Relaxation Response


Of course ideally you should make lifestyle changes in order to keep your body from reacting to stress in the first place. But you can’t avoid all stress and luckily our body has a natural “relaxation response” to stress that’s effective and powerful. The relaxation response brings back balance in the body by deepening breathing, reducing stress hormones, slowing down heart rate and blood pressure and relaxing muscles. This is a normal and natural response that the body does automatically after a threat is gone. The good news is that the relaxation response can also be induced by relaxation techniques.



The following is a relaxation technique from Herbert Benson’s book “The Relaxation Response”. You can use this technique to bring back your body and mind back into a state of equilibrium when you are in a heightened state of readiness:

  1. Pick a focus word, short phrase, or prayer that is firmly rooted in your belief system, such as “one,” “peace,” “Hail Mary, full of grace,” “Shalom,” or “Om.”
  2. Sit quietly in a comfortable position.
  3. Close your eyes.
  4. Relax your muscles, progressing from your feet to your calves, thighs, abdomen, shoulders, head, and neck.
  5. Breathe slowly and naturally, and as you do, say your focus word, sound, phrase, or prayer silently to yourself as you exhale.
  6. Assume a passive attitude. Don’t worry about how well you’re doing. When other thoughts come to mind, simply notice them and gently return to your repetition.
  7. Continue for 10 to 20 minutes.
  8. Do not stand immediately. Continue sitting quietly for a minute or so, allowing other thoughts to return. Then open your eyes and sit for another minute before rising.
  9. Practice the technique once or twice daily. Good times to do so are before breakfast and before dinner.

Regularly inducing the relaxation response has been scientifically proven to be an effective treatment for a wide range of stress-related disorders.

Conclusion: Adrenal Fatigue?

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The good news is that most people can heal from Adrenal Fatigue with the right approach. This includes reducing stress, eliminating toxins, moderate exercise, avoiding negative thinking, and replenishing the body with healthy food and positive thoughts.



Are You Suffering From Adrenal Fatigue?

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