Saul Marcus, ND - Naturopathic Doctor

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Adrenal Fatigue

Cortisol, the energy hormone

Cortisol has so many different jobs it's hard to simply sum it all up in a single word. But if cortisol had to be described using any word that would be energy. Cortisol controls how the body makes and uses energy.

In the morning cortisol rises and gives us energy to get our day started. By night cortisol falls 90% from morning levels and we fall asleep. During moments of stress cortisol surges up, allowing up to better survive emergency situations. During moments of calm such as prayer or meditation cortisol goes down.


High stress raises cortisol. Picture of a man under high stress Low stress lowers cortisol. Picture of a woman relaxing

Is cortisol good or bad?

No hormone is all good, or all bad. What is good or bad, is if we have the right amount at the right time

What causes cortisol to go up or down?

Some major factors that affect cortisol are:

What is stress?

In medicine stress simply means the body’s non-specific response to any extra demand. This includes any extra psychological, physical or bio-chemical demands on the body.

Some examples of stress are:

Adrenal Resistance

Since failure to fight or flee away from danger means death, the body will do everything it can to survive. This includes breaking down tissue to quickly produce sugar and energy, elevated blood pressure and heart rate. Systems not essential for immidiate survial will be supressed.

. caveman running away from a dinosaur. Cortisol gives his body the energy it needs to do this

But what happens when the stressors do not go away?

If the "fight or flight" response continues indefintly it can lead to:

  • High blood sugar (may lead to diabetes)
  • High blood pressure
  • Protein catabolism (the body breaks down its own muscle and converts it into sugar for quick energy)
  • Insomnia (some people who can't fall asleep)
  • Poor digestion and immunity as the body will prioritize other system that are more concerned with immidiate survival when under stress.

The adrenal glands will attempt to resit chronic stress by chronically elevating cortisol. This is called adrenal resistance.

The causes and symptoms of stress and high cortisol

Adrenal Exhaustion

Eventually the adrenals may become so worn from prolonged stress they loose the ability to make even normal amounts of cortisol. This is known as adrenal exhaustion, commonly called adrenal fatigue.

Low cortisol and adrenal fatigue symptoms

Adrenal fatigue myths:

Myth #1: Only workaholics putting in 60+ hours a week at the office and living off candy bars get adrenal fatigue.

In reality due to long hours of work, emotional stress, poor diet and toxic foods, environmental toxins, lack of sleep, nutritional deficiencies, allergies and other stressors, people with all sort of various lifestyles may develop adrenal fatigue.

Myth #2: Adrenal fatigue does not exist.

Patients with adrenal fatigue who go to medical doctors are commonly given lines such as:

Adrenal fatigue is based upon scientific research going back 100 years, sound medical theory and repeatedly validated by physical exam and hormone tests.

Myth 3#: Taking B-vitamins and some "adaptogenic herbs," are the best supplements for adrenal fatigue.

This is a half truth. B vitamins and herbs such as ginseng, withania, rhodiola and eleutherococccus can help. However, by the time someone get to the point of adrenal fatigue they will usually need a more comprehensive wellness plan to recover than just taking these supplements.

Adrenal Exhaustion Treatment

The vicous cycle of adrenal fatigue

Normal levels of cortisol are essential in protecting us from everyday stress.

Without the enough cortisol minor stressors can become major burdens. A missed meal can turn into a hypoglycemic episode without cortisol to raise blood sugar. Or a minor allergy turns into asthma. Not everyone is going to react the same way to having low cortisol, but what can be said is that they will have less ability to resist stress.

When the adrenals can't respond to stress the body deteriorates. The more this happens, the more stress we experience. More stress means more stimulation to the adrenals to make cortisol that's it's unable to produce.

In health we call a situation like this (where A causes B and B causes A) a viscous cycle.

Stress and adrenal fatigue the vicious cycle


If you don't do anything to stop this cycle, your body will force you to

You can't will yourself through adrenal exhaustion. Eventually if you don't make the necessary changes in your life and de stress, you're body will force you to.

Adrenal exhaustion robs energy so people can't do all the activities they used to enjoy. Personal relationships and work suffer as well. Sometimes salary and career advances give way to just trying to figure what job can you function at. The real financial burden of adrenal exhaustion is often not medical expenses but lost income due to fatigue.

Since adrenal exhaustion is driven by two factors, stress and the actual adrenal exhaustion, treatment must be directed at both of these factors.

Treatment for adrenal fatigue


1. Eliminate or significantly reduce the stressors causing chronic fatigue

Since adrenal exhaustion is driven by stress, and stress the is the body's response to any extra demand, adrenal exhaustion is driven by any extra demand (psychological, physical or biochemical) on the individual.

Therefore I find a comprehensive review of each client's health history is essential in order to find out what specific demands have been causing fatigue in each individual.

Sometimes chronic fatigue develops comes after a major life event that pushed the adrenal's past their limit. In these cases most of the focus can be on the adrenals. However working on health and wellness in other areas should at least a small part of recovering from adrenal exhaustion.

Depending on individual circumstances some people may need to focus more on relieving stressor, and other more on nourishing the adrenal glands. Sometimes people need to work equally on both. The key point is that we have to think in terms of holistic medicine and treating the whole body.

2. Nourish the adrenal glands

By the time things get to this point it's important to support the adrenal glands with supplements. In an ideal worlds people would stay healthy by just eating a good food, breathing clean air, drinking pure water and forming positive relationships with friends and family. But we are not living in an ideal world. People live incredibly stressful lives. Even if supplements are just supplements to a healthy lifestyle they are still needed.

There are many different adrenal supplements such as vitamins, herbals, hormonal precursors, homeopathics and adrenal glandulars. Which supplements work the best, and in what dose greatly depends on how functional the adrenals are.

If necessary, adrenal function can be measured by a saliva cortisol test. Typically this means taking 4 cortisol collections during the day to see not just if it is high or low, but if there any abberations in cortisol curve

© Naturopathic Wellness, 2018