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Adrenal Fatigue & Hypofunction

The adrenal glands are two small glands, each weighing 3-5 grams that located above the kidneys. They  are responsible for secreting over 40 different hormones including epinephrine, cortisol, aldosterone, DHEA, male and female sex hormones, etc. Each gland is composed of two separate functional zones. Outer zone, or cortex, secretes steroid hormones made from cholesterol. The inner zone, or medulla, works as a peripheral ganglion of the central nervous system.  The adrenal is the stress gland. Its medulla responds  to immediate stress, making adrenaline. The outer gland makes cortisol in response to more chronic stress. Cortisol is one of few hormones essential to life. Too much is bad news (Cushings) and insufficiency causes a person to dwindle and even die (Addisons disease).

In its normal function, cortisol helps us to meet life challenges by converting food into energy and counteracting inflammation.  The adrenal cortex does not secrete  its hormones at a constant level throughout the day but actually releases them in a cycle with the highest value in the morning and the lowest at night. When the adrenal glands are functioning a sub-optimal level adrenal fatigue, or hypoadrenia, develops.  

Patients are usually very fatigued in the morning and will not feel fully awake until after a noon meal.  They generally begin to feel better after 4-6 PM; however, they are usually tired after 9 and in bed by 11 PM  These patients find that they work best late at night or early in the morning. Abnormal adrenal rhythm can influence energy production, immunity, bone and skin health, sleep quality, muscle and joint function, etc. 

Main symptoms of adrenal fatigue include decreased ability to handle stress, salt cravings, increased blood sugar under stress, increased PMS, menopausal symptoms, insomnia,  mild depression, muscle weakness, absent mindedness, decreased sex drive,   mucous membrane irritation (ex. vaginal or mouth burning), constipation alternating with diarrhea, as well as many others. The level of cortisol controls thyroid hormone production. Quite often, low thyroid symptoms such as fatigue and low body temperature are due to an adrenal maladaptation. Hypoadrenia causes chronic and prolonged infection and unwanted inflammation which lies at the root of cardiovascular diseases and arthritis. 


Although there no specific tests that will provide a true diagnosis of adrenal fatigue there are tests that may contribute to an assessment, such as a postural hypotension test, an AM cortisol and DHEA blood test, or saliva adrenal stress test. An elevated plasma ACTH level in association with a low plasma cortisol level may be diagnostic. We usually assess the adrenals together with thyroid tests to rule out insufficiency, which sometimes occurs in long-standing hypothyroidism.


In the case of adrenal fatigue, adrenal hormones may be within the "normal clinical" range and not low enough to warrant the diagnosis of adrenal insufficiency (Addison's).  Such "normal" level of  hormones does not mean that the patient is free from adrenal fatigue.   The main laboratory markers of adrenal function are cortisol and DHEA. These hormones balance shows the stage of adrenal exhaustion and help to determine the adrenal replacement protocol.  


You may need to allow 6 months to 2 years for the recovery process to take place. Individuals are often pleased to find that stretch marks, �love handles, and energy slumps can all disappear when cortisol rhythm is corrected. Infections and /or irritation of mucous membrane resolve often without use of antibiotics or other drugs upon following healthy lifestyle recommendations.   The most important step for recovery is removal of the stressors. Emotional stressors such as family, marital, relationship, or financial problems needs to be dealt with and normalized.


It is important to go to sleep by 10 p.m. every night and sleep about 8-9 hours. With this regime your adrenals are fully rested and the high gear is avoided. Without a good sleep, our bodies cannot regenerate itself to deal with stressors the next day. We should also rest in a completely dark room to maximize melatonin production. Switch off electronic devices, this will only increase stress on the adrenal glands.


If you wake up at 2 to 3 a.m. and find that you are unable to fall back to sleep, that is a sign of excessive stress. In this case, you may wish to consider a time-release melatonin or other sleep aids such as 5-HTP, magnesium, trace mineral tablets or herbs (valerian root, hops, and licorice).


Avoid all kinds of stimulants: coffee, caffeinated beverages, TV and computers. Some people may be photosensitive. Watching television or working at the computer may prevent the melatonin level from rising to induce sleep. If you are one of these people, you should turn off your television or computer at least 3 hours before going to sleep.


Exercising is a wonderful stress reducer and an excellent oxygenator, increasing blood flow and normalizing level of all hormones in your body.


The main task of aldosterone is maintenance the concentration of sodium and potassium in the cell and outside the cell. This in turn has a direct effect on the amount of fluid in the body. Aldosterone therefore plays a significant role in regulation of blood pressure.  As the concentration of aldosterone rises in the body, the concentration of sodium and water rises, more fluid is retained in the body, and blood pressure rises. Conversely, when the level of aldosterone lowers, the amount of sodium and water in the body is reduced and the blood pressure goes down. 


Unlike cortisol, aldosterone does not have its own negative feedback loop when there are excessive amounts. If the aldosterone level is too high, aldosterone receptor sites will be down regulated and its sensitivity to aldosterone is reduced. In the early phases of adrenal fatigue, the amount of cortisol and aldosterone increases in our body due to the ACTH stimulatory effect. As a result, the sodium and water is retained in the body with a feeling of bloated. The receptors that are sensitive to pressure of the blood vessels (baro-receptors) are triggered and vessels relax automatically and this is auto-regulated by the autonomic nervous system. 


With stress, the adrenal glands also secrete another hormone called epinephrine. This hormone constricts the blood vessels and increases blood pressure in order to ensure that our brain have adequate blood flow and oxygen to help us deal with impending danger. The sum reaction of aldosterone, epinephrine, and the autonomic relaxation response are some of the key factors that ultimately decide the final blood pressure at any point in time. During the early stages of adrenal fatigue, the resulting blood pressure is often normal if all bodily function is balanced. If the body is unable to overcome the hormonal  response, then the blood pressure is elevated. It is common to find many under stress experiences increase in blood pressure. 


At more advance stages of adrenal fatigue, the amount of hormone production reduces. Sodium and water retention is compromised. As the fluid volume is reduced, low blood pressure ensues. When cells get dehydrated and become sodium deficient, salt craving develops.  A low body fluid volume accompanied by absolute deficiency in sodium as well as a normal to high potassium level. When the fluid is replaced without adequate sodium, the amount of sodium in the body actually gets diluted, therefore resulting in an even lower sodium level. It is important to add salt liberally to fluids that are taken in by anybody suffering form adrenal fatigue. 


Adrenal fatigue suffers should take filtered drinking water with �-1 teaspoon of sea salt on a regular basis, especially in the morning. A good fluid cocktail for them is vegetable juice (cucumber, celery, cabbage, etc) diluted with water and sprinkled with sea salt and kelp powder. Kelp contains about 90 mg of potassium and over 200 mg of sodium per serving and is easily absorbed. The drink should be administered 2-4 times a day in intermittent dosages. Coffee, alcohol, and tea (with the exception of herbal tea) should be avoided. 


Most people who suffer from hypoadrenia often have multiple endocrine imbalances including sub-clinical hypothyroidism, insulin resistance, and estrogen dominance. These need to be optimized as well. Because the amount of hormonal balancing is intricate and is highly sensitive, the process of adrenal recovery takes  from 3 months to 1-3 years under the best of hands.


U-OK Treatment  plan is based on the patients test results and individual clinical signs.   


These may include: DHEA, low dose natural cortisol, adrenal glandular, adrenal extracts, cortisol enhancing agent such as licorice root extract or DGL, vitamin C with bioflavonoids, vitamins B5 and B6, beta-carotene, vitamin E, and other important minerals such as selenium, magnesium as well as important amino acids such as lysine, proline and glutamine   Each nutrient is like one silver bullet in the arsenal. Using the right one at the right time is critical because there are not many bullets available. Even if some nutrient appear to work well at first, it may subsequently fail as the body developed tolerance. 


Nutrients in the right dose should be administrated in a graded approach, with follow up by the physician.  If necessary, natural hydrocortisone is prescribed under the guidance of a physician.


Eating pattern is very important. A poor or unfitting diet is one of the key and leading causes of adrenal fatigue. Without a diet that is bio-chemically and metabolically compatible with the needs of a damaged adrenal gland, complete recovery is simply not possible.  If you have unbalanced protein and sugar-rich diet, metabolic acidosis develops with excessive renal excretion of hydrogen ion, that in turn, increases pituitary secretion of ACTH (adrenocorticotrophic hormone). This hormone stimulates production of cortisol and aldosterone. Since cortisol promotes development of obesity and insulin over production, it correlates with risk for metabolic syndrome and diabetes. Over time, insulin secretion becomes dysfunctional, resulting in a hypoglycemic state in the middle of the night. These symptoms are characterized by nightmares, anxiety, and night sweats. When this occurs, the body will have to activate the adrenals to put out more cortisol in order to raise the blood sugar back to its normal level. This will eventually put an excessive burden onto the already fatigued adrenal gland if carried on year after year.


A diet that maintains a constant sugar level in the blood is a critical consideration in adrenal fatigue recovery. Starchy carbohydrates that are converted quickly into glucose (such as pasta, bread, potato, white rice, banana) should be limited. Soda drinks should be totally avoided. 


Skipping breakfast is not a good idea. Eat your small breakfast by 7 a.m. even if you are not hungry. Eat small portion of low glycemic index meal every 3-4 hours. Even a small snack is better than nothing at all and will provide the needed energy even though there is no urge to eat. 


Fruits should only be taken in moderation. Fruit juices should be avoided. Whole fruits should be limited, especially melons, which are high in sugar and causes sugar spikes soon after food enters the body. Good quality protein from meat, fish, and eggs are recommended. These provide a steady source of energy to carry the body through between meals. 


Vegetarians with adrenal fatigue have a much higher challenge. Organic legumes (beans) must be eaten with whole grains, seeds, or nuts to get a complete protein. It is important for vegetarians to add eggs, miso, tofu. About 60% of the diet should consist of raw food. Seeds and nuts are critical elements and sources of fatty acids that the adrenal glands need in order to manufacture cholesterol, a precursor to all adrenal steroid hormones.


Fish oil and flaxseed oil are the good source of essential fatty acids. Peanuts should be avoided. Olive oil should be used for light cooking. The cooking heat should be low to moderate. Use coconut oil and butter for any high heat or deep-frying.


Many adrenal fatigue suffers also have a lower level of stomach juice and hydrochloric acid (HCl), which is necessary to break down the protein. Symptoms of this problem include gas, heartburn, bloating, and heaviness in the stomach after eating a protein meal. In such case, the use of digestive enzymes, probiotics, as well as HCl replacement is indicated


Maintain erect posture and avoid prolong periods of sitting. The flexion posture is an immediate invitation to the body to secrete stress hormones. It has been noted that excess steroids cause weak hip and shoulder girdle muscles. A straight spine helps to avoid the artificial boosts to adrenals. 

Simple exercises such as fast walking, stairs climbing, swimming, stretching, and treadmill are easy to do and can be done almost anywhere. in advance cases.    


  • Sleep by 10:30 p.m.  Sleep in until 7:00-8:00 a.m., if possible

  • Do the things that you like 

  • Avoid getting over-tired and/or over-exited 

  • Laugh several times a day Enjoy life, get a pet

  • Never skip breakfast, have it at 7:00-8:00 a.m.

  • Avoid coffee or other caffeine containing beverages

  • Avoid sugar and sweeteners  

  • Have a glass of water in the morning with � -1 teaspoon of sea salt (ask us about iodine supplementation)

  • Avoid grains such as bread, pasta, cereal. Try to follow gluten free diet.

  • Avoid starchy foods such as potato, banana

  • Avoid trans-fat such as French fries, margarines, pasteurized dairy products  

  • Take vitamins and minerals according to your blood test results and clinical symptoms

How We Can Help

As an immunologist, Dr. Koles is particularly qualified to evaluate, diagnose and treat the immune system - which plays a central role in stress responses. She keeps up with the latest research and news. This can mean a better natural and physiological treatment plan for you.

At the U-OK Optimal Health Center, we use a variety of tests and therapies to create your comprehensive and individualized testing and treatment plans:

Extensive testing:

  • Comprehensive environmental-oriented medical history and physical examination

  • Blood tests to determine the extent and severity of your adrenal dysfunction and hormonal imbalances

  • Saliva Adrenal Stress test to determine your adrenal rhythm, DHEA and insulin levels

  • Testing for various immunoglobulins -IgG, IgE, etc

  • Applied kinesiology testing (BioSet/NAET)

  • Functional medical testing with samples of blood, urine, stool and saliva


Comprehensive treatment:

  • Custom elimination/rotation diets based on test results

  • Adrenal gland support therapy (natural hormone replacement therapy, prescription medication in severe case, etc) 

  • Herbal treatment with individualized formulas

  • Gentle detoxification

  • Applied Kinesiology treatment (BioSet, NAET)

  • Customized nutritional counseling and orthomolecular support

  • Adrenal-Thyroid function balancing 

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