Adrenal fatigue. It’s something modern medicine sticklers love to hate.

Do a quick Google search for “adrenal fatigue” and you’ll see dozens of articles about why it isn’t “real”.

If we’re being honest, though, it doesn’t matter whether or not adrenal fatigue is a “real” diagnosis. That’s just semantics.

What adrenal fatigue really is, is a term that describes a harmful cortisol pattern that occurs during prolonged physical and/or psychological stress, and the symptoms that go along with it. That’s what we’re going to focus on in this post.

To understand adrenal fatigue, we first have to understand how stress effects the body.

When the body perceives a threat, it sends a distress signal to the hypothalamus, which communicates to the organs of the body through the autonomic nervous system (ANS). The ANS is divided into two sections, the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS). The PNS is responsible for the “rest and digest” functions of the body when you are eating or at rest. The SNS triggers the “fight or flight” response in the body.

Immediately after receiving the signal from the hypothalamus, the SNS triggers the release of adrenaline and norepinephrine from the adrenal glands.

If the stressor is still perceived to be a threat after the “fight or flight” response, the hypothalamus triggers the hypothalamus-pituitary-adrenal (HPA) axis. First, the hypothalamus secretes the hormone CRH, which then causes the pituitary gland to release ACTH, which then signals for the adrenal glands to release cortisol, the most common glucocorticoid.

In normal, short-term stress responses, this process is self-limiting. Once the stressor is no longer perceived to be a threat, the hypothalamus and pituitary gland help prevent the secretion of CRH and ACTH so the release of cortisol is suppressed, returning cortisol levels to normal.

The HPA axis becomes a problem during times of chronic stress, whether physiological or psychological. Why?

A theory called the general adaptation syndrome (Seyle, 1950) explains.

In stage one (the alarm stage) of the general adaptation syndrome (GAS), the SNS triggers the “fight or flight” response and the HPA axis triggers the release of cortisol.

Stage two (the resistance stage) marks the increased activation of the HPA axis and ever increasing levels of cortisol when a stressor becomes long term.

Stage three (the exhaustion stage) occurs when the HPA axis depletes its resources and the organs of the body and immune system become compromised as a result.

(Bryant et al., 2019)

To summarize, adrenal fatigue is a harmful cortisol pattern directly resulting from the continual HPA axis activation that occurs during chronic stress. Not a “pseudoscientific” diagnosis.

Let’s learn how to heal from adrenal fatigue when it happens to you.

First, it is crucial to work on stress management – to target the stressors causing the ongoing activation of the HPA axis.

For psychological stressors, working with a mental health professional like the ones below is key.

– Licensed Professional Counselors,
– Clinical Licensed Psychologists, and
– Licensed Clinical Social Workers

You’ll also need to focus on infusing rest into your life as much as possible, as well as learning tools to incorporate every day, such as mindfulness, deep breathing, vagal maneuvers, biofeedback, CBT, and even somatic and EMDR techniques.

For physiological stressors, it’s essential to find and address the root health conditions.

These can be problems like:

– Unsafe environment
– Nutritional deficiencies
– Chronic/reactivating viral infections
– Gut dysbiosis
– Stealth bacterial infections
– Immune system imbalance
– Autoimmunity
– And more

The right health practitioner can run in-depth lab work and take a comprehensive health history to help you discover what’s going on with your health. To learn how to find the right health practitioner for you, read this post.

If you don’t have the means to work with a health practitioner or you enjoy taking charge of your own health and recovery, you can also explore my comprehensive list of functional lab work your can order yourself.

Second, it’s often necessary to reduce or increase cortisol levels through nutritional and herbal supplements to mitigate the symptoms of cortisol imbalance faster than lifestyle changes can improve it.

This is because it isn’t always possible to identify your stressors quickly, and they can take a long time to resolve even after they’re identified. The right supplements to try depend on the stage of adrenal fatigue a person is experiencing.

What are the stages of adrenal fatigue? Let’s explore.

Stage One Adrenal Fatigue

Stage one adrenal fatigue is marked by increased (too high) cortisol on a 4 point saliva cortisol test. Addressing any stressors through lifestyle changes is often enough treatment for stage one adrenal fatigue.

Stage one adrenal fatigue is equivalent to stage two of the general adaptation syndrome/GAS.

The most significant symptom people experience during stage one is feeling chronically stressed (burnt out, overworked).

Stage Two Adrenal Fatigue

Stage two adrenal fatigue is different from stage one in that the normal cortisol curve becomes disrupted. Usually, cortisol is higher in the morning and slowly drops throughout the day, until it reaches its lowest point at night.

During stage two, levels will be too high at the wrong times of the day (such as evening and night) and too low at other times (such as the morning). Or, go up and down all day instead of following the normal curve. This disrupted pattern can lead to severe fatigue and insomnia.

A common misconception from people who have not been through chronic illness is that experiencing fatigue or exhaustion is the same thing as being tired or sleepy.

Fatigue and exhaustion mean feeling like you don’t have the energy to get out of bed or move your body. They can include a sensation of lightheadedness and wooziness.

Feeling sleepy and tired means that you don’t feel fully awake and that you might doze off at any moment.

People with stage two adrenal fatigue feel exhausted due to their low morning cortisol and lack of sleep. Then, they can’t get sleepy or drift off at night because of elevated evening and night cortisol. You can read more about how cortisol impacts sleep here.

In stage two adrenal fatigue, addressing causative stressors alone may not be enough to mitigate adrenal fatigue symptoms anymore. Some people will need to take supplements to lower their evening and night cortisol so they can sleep and to increase their morning cortisol so they can get through their day.

Stage Three Adrenal Fatigue

Stage three adrenal fatigue occurs when the ongoing HPA axis has depleted the body’s resources and it can’t keep producing too much or even enough cortisol anymore. A 4 point saliva cortisol test will show (too) low cortisol at all times of the day, possibly flatlined, with no curve from morning to night.

People with stage three adrenal fatigue may continue to experience sleep disruption, and they often experience fatigue so severe they feel like they’re dying.

Stage two and three adrenal fatigue line up with stage three of the general adaptation syndrome/GAS.

In stage three adrenal fatigue, addressing the underlying stressors is still a crucial component of the healing process, but most definitely not enough on its own anymore.

People in stage three will need to take supplements and/or pharmaceuticals to raise their cortisol levels quickly.

So which supplements influence cortisol, and how?

Lowering High Cortisol

Studies have shown that several herbal adaptogens can lower high cortisol levels by acting on the HPA axis (source 1, source 2).

Adaptogens are a category of herbs that can favorably alter many of the chemical processes in the body, such as inflammatory cytokine cascades and the HPA axis.

These include ashwagandha, schisandra, rhodiola, astragalus, magnolia bark, passionflower, lemon balm, chamomile, ginseng, ginkgo biloba, reishi, milky oats, and jujube.

My favorite cortisol-lowering adaptogen is Holy Basil.

To lower high cortisol, it’s most effective to take your dose(s) of the adaptogen of your choice about one hour before your cortisol levels usually get too high. For me, that was 5:30 pm and 9:30 pm. After 90 days of treatment, it’s a good idea to re-test to see if your cortisol levels have returned to normal enough to stop supplementation.

Herbal adaptogens aren’t the only supplements that can help lower cortisol, however. Other compounds like l-theanine and phosphatidylserine make significant difference, too.

Phosphatidylserine is a phospholipid supplement that has been shown in several studies to reduce stress-induced high cortisol (source). It’s another excellent choice for reducing cortisol levels in adrenal fatigue.

I have taken both Seriphos and Life Extension PS Caps with success.

Like herbal adaptogens, it’s most effective to take Phosphatidylserine about one hour before your cortisol levels typically get too high.

I take it along with my Holy Basil at 5:30-6 pm and 9-9:30 pm. With these two supplements added to my sleep cocktail, I’ve been able to go from sleeping only 2 hours of light, unrefreshing sleep a night to a 6-8 hour night’s sleep many nights.

Raising Low Cortisol

Not as many herbal medicines raise cortisol as those that lower it, but there are a few effective options.

Studies have demonstrated that Licorice Root (whole licorice root/extract, not the DGL kind) raises cortisol by inhibiting the enzyme 11-beta-hydroxysteroid dehydrogenase (source 1, source 2). This can help people with stage 3 adrenal fatigue raise their cortisol levels. If you take licorice root long term, it’s important to stick to a low dose (no more than 30-45 drops, 3x daily) and to combine it with other herbal medicines rather than taking it alone, to avoid adverse effects.

Vitamin C is another supplement that has been shown to play a crucial role in adequate hormone production in the adrenals (source). People with stage 3 adrenal fatigue, or stage 2 adrenal fatigue with low cortisol at certain points during the day, can take a high dose (1000-3000 mg) of vitamin C to help their body produce the right amount of cortisol at the right times. I prefer liposomal vitamin C for better absorption. You can take it during the times of day your cortisol levels are lowest, for the best effect.

Animal-based adrenal glandular supplements are a popular choice for helping raise cortisol levels in stage 3 adrenal fatigue. It makes sense because the adrenal glands that make the supplements contain high concentrations of cortisol and catecholamines. For that reason, some people use adrenal glandular supplements as an alternative to taking a glucocorticoid. There have been some safety concerns over supplement contamination, though. So if you choose to take an adrenal glandular, be sure to purchase from a reputable source.

In the most severe cases, people with stage 3 adrenal fatigue may need to get a prescription for a glucocorticoid to raise their levels quickly. For those people, it’s also important to get tested for Addison’s disease to make sure the cause really is adrenal fatigue and not autoimmunity.

Potassium and Sodium

The later stage you are in adrenal fatigue (stages 2 & 3), the more your aldosterone hormone secretion drops. This can lead to a sodium imbalance in the body, causing symptoms of chronic low-level hyponatremia like fatigue and dizziness. Studies have shown that increasing potassium intake increases aldosterone secretion without any negative side effects. Increasing salt intake can also help offset diminished sodium concentration in the blood. Some people increase both at the same time by consuming adrenal cocktails throughout the day. Adrenal cocktails contain 4-8 oz of coconut water or orange juice, cream of tartar or vitamin C powder, and unrefined salt.

How can you tell if you might have adrenal fatigue?

The first step is to consider your symptoms.

Symptoms of adrenal fatigue include the following:

The most common symptom of adrenal fatigue is debilitating fatigue, unsurprisingly. That is by no means the only symptom, though. If you have a combination of the below adrenal fatigue symptoms, it might be time to talk to your health practitioner about getting functional lab work, to find the source of the problem.

• Debilitating fatigue/exhaustion
• Insomnia (any combination of sleep-onset, sleep-maintenance, and poor quality, up to and including severe insomnia)
• Lightheadedness
• Dizziness
• Brain fog
• An autonomic disorder (like POTS, orthostatic hypotension, or vasovagal syncope)
• Low blood sugar or insulin resistance
• Muscle pain/achyness
• Persistent headaches
• Unexplained weight loss or weight gain
• Hyper or hypothyroid, often Graves or Hashimoto’s

The second step is to get your cortisol levels tested.

The best adrenal fatigue tests include the following:

You can order the below labs yourself.

The most basic test is a ZRT 4 point cortisol test.

Elevated cortisol on all points indicates stage one adrenal fatigue.

A disrupted cortisol curve, with levels high and low at the wrong times of day, indicates stage two adrenal fatigue.

Low cortisol on all points, especially with no curve, indicates stage three adrenal fatigue.

For a more comprehensive look at your HPA axis and hormones try the
ZRT Male/Female Saliva Profile III instead.

If you’d like a more advanced look into your neurotransmitter activity, the ZRT Neuroadvanced Urine Profile.

Some naturopathic and functional medicine doctors will order a DUTCH hormone panel to test cortisol instead of the ZRT options above. This is also a reliable test for adrenal fatigue, but the downside is you can’t order it yourself.

Now that you’ve learned how to heal from adrenal fatigue, what are you going to try first? Let me know in the comments! I’d love to chat with you there.

This post contains affiliate links. If you choose to purchase a product through one of those links, I receive a small commission that helps me support my family, at no extra cost to you.

Works Cited

Bryant, C.X., Green, D.J., Matthews, J.A., & Skinner, J.S. (Eds.). (2019). The professional’s guide to health and wellness coaching. The American Council on Exercise.