Why Do Some People React Differently to Herbs and Adrenal Extracts?

It can be truly disheartening when, having had a nutrient or herb recommended to you by a fellow sufferer, it only makes you feel worse. However, a key factor in understanding adrenal fatigue is acknowledging the very different, and sometimes paradoxical responses, that individuals may exhibit. These responses may vary according to the severity of adrenal fatigue, the general constitution of the individual; the same individual may also respond differently at separate points in their treatment.

This unpredictable reaction seems to occur most often when adaptogenic herbs are given to individuals with severe adrenal fatigue. Adaptogenic herbs – which include ginseng and ashwaganda – are prized for their ability to normalise hormonal secretions at the adrenal glands, boosting cortisol levels when they are low and attenuating them when they are high. However, this effect may only be reliable in cases of mild fatigue. When severe adrenal fatigue is present (to the level that normal 9-to-5 function has become impossible), it appears that these herbs can have an unwanted effect and bring about an ‘adrenal crash’. Exactly what component of the herbs is responsible for this is not yet unclear, although it is believed that a stimulatory factor is responsible.

While this does not preclude the use of adaptogenic herbs in severe adrenal fatigue, it does suggest that both practitioners and individuals should exercise caution before attempting to bolster flagging adrenal output with adaptogenic herbs. Other herbs like licorice root and echinacea, while showing more reliable responses, should also be considered with some caution as they too have been known to cause paradoxical responses, if to a lower extent. In any case, they do serve a purpose in cases of adrenal fatigue but any patient undergoing self-navigation may do best to avoid such compounds. This call should be made only by a suitably knowledgeable practitioner.

While these herbs tend to make up the majority of unwanted reactions, sufferers of severe adrenal fatigue are also known to react badly to adrenal extracts on occasions. Again, exactly why this occurs has not yet been established. It is thought that the adrenal extracts, which provide nucleic acids, fatty acids and enzymes unique to the organs, can provide nourishment to the adrenals which can stimulate activity in some parts of the adrenal tissue before the whole gland is ready to function. As with many other compounds, bad reactions can occur at some (higher) doses, when other doses were fine. In any case, a need to introduce functional foods and supplements in a timely manner is most definitely highlighted. Using a diary to record reactions is also a simple but important tool.

A practitioner familiar with the concerns can analyse the history of the patient and, in doing so, assess their general constitution. Those with a stronger constitution are generally expected to handle nutritional intervention better than others and may reach a state of ‘full recovery’ quicker, and with less crashes, than others. Another overlooked factor in the assessment of an individual’s constitution is the nutritional status of organs across the body. Due to eating habits and the mineral depletion of our soil, most people are coming in very short on their ideal intake of vitamins, minerals and phytonutrients. This is likely to have severe consequence in someone under severe internal stress. A full-spectrum multivitamin, plus sufficient levels of magnesium, zinc and iodine are always vital to nourish the other organs sufficiently.

When we consider the range of reactions that can occur between two individuals using the same supplement, it becomes clear that medical science cannot yet explain all the complex interactions that occur at the adrenal glands and elsewhere. It serves to underline the point that every sufferer of adrenal fatigue must be approached as an individual and, despite success with a herb elsewhere, no assumptions should be made in providing a well-considered and tailored treatment plan.

So Tired… So Why Can’t I Sleep?

The last thing you might expect with severe fatigue is difficulty sleeping. However, disturbed sleep is a feature of adrenal fatigue for the majority of sufferers, with most aware they are waking at similar times of the night. These disturbances in sleep often link in with a need to urinate or increased stress levels during the previous day. Understanding what can be done to manage these episodes is important, as good sleep is the foundation of healing.

Sleep occurs in five stages. Stage one represents the halfway house, a state of very light sleep where you are still semi-conscious and paralysis of the limbs has not occurred; as a result, people often kick out their arms or legs in reaction to mental images. Stage two is similar, only with increased paralysis of the limbs. It is stage three and four where the deep sleep occurs. This is where most of the repair and renewal take place, and where most of your daily growth hormone is released. Spending sufficient time in these two stages is crucial for providing your body with an effective platform for recovery. The fifth and final stage of sleep, REM or rapid eye movement, is associated with vivid dreams, although dreams do occur in all stages. A sleep cycle features all five stages and people normally complete a cycle in ninety minutes.

The simple act of falling asleep actually involves the interaction of multiple neurotransmitters and hormones. In adrenal fatigue, cortisol levels are markedly disturbed, which causes fluctuations in the release of both adrenaline and melatonin; poor sleep is the end result. Melatonin is a hormone released by the pineal gland in the brain, and it’s numerous effects include taking us into a state of deep sleep. Its release is inhibited by cortisol and by light. As a result, the flicker of a laptop screen before bed or raised cortisol levels in the evening reduces the release of melatonin. This pattern is often seen in stage two of adrenal fatigue, the resistance phase, where the release of cortisol remains excessively high to cope with perceived demands. Sleep is not good at this stage.

The ‘crash’ arrives, along with the all-encompassing fatigue, when cortisol levels drop. This marks stage three of adrenal fatigue, the exhaustion phase. Unfortunately, sleep gets no better; cortisol levels cannot maintain blood glucose effectively between meals or during the night, ensuing the release of adrenaline as compensation. While this reaction maintains life and avoids a hypoglycaemic coma, it also activates the sympathetic nervous system, the branch of the nervous system that makes us alert, anxious and wired. Waking at regular times during the night is a reliable sign of compensatory adrenaline spikes. Using herbs such as valerian root in stages of adrenal exhaustion can actually cause unexpected and paradoxical reactions; when the body has registered a definite requirement for adrenaline release, suppressing it with otherwise-gentle herbs like valerian can cause a counter-response and an even larger adrenaline release (this can also occur when the neural conditions are disturbed, although this is beyond the scope of this article). In any case, it is key to remember that the adrenaline is there for a reason – to compensate for a lack of cortisol.

Supporting cortisol levels is therefore paramount in maintaining a deep and restful sleep until the morning. Arguably the most important nutrient in this regard is vitamin C, and every individual with adrenal fatigue should have taken steps to find their ideal intake of the essential nutrient as cortisol production cannot occur without supply of ascorbic acid. As explained in a separate article on adrenal fatigue and vitamin C, most people with the condition will require between 3-4,000mg each day. Pantothenic acid, also known as B5, also plays a vital role in the production of adrenal hormones and should be addressed.

Although optimising intake of these two vitamins appears enough to restore good sleep in many, lots of individuals will need to provide further support. Although not everyone gets on with adrenal extracts and licorice root, they can both be excellent tools to boost output of steroid hormones from the adrenal cortex, providing more stable levels of cortisol in circulation. This then removes the requirement for the sympatheticoadrenal system to pour copious adrenaline into the bloodstream. Adrenal extracts or licorice root with an evening meal, or before bed, should be considered here – as always, taking an adrenal stress index and speaking to a knowledgeable practitioner is essential in these situations (self-navigation is not advised).

Beyond the management of cortisol levels, there are other steps you can take to increase the likelihood of a solid night’s sleep. As mentioned above, one of the most common reasons for waking during the night is the need to urinate. Seeing that you are well-supplied for sodium is very important in this regard. At my clinic, I recommend liberal use of unrefined sea salt for most individuals with adrenal fatigue. Magnesium supplements and a moderate amount of potassium should also help with hydration, and allow you to hold onto the water more effectively. Magnesium is also a muscle relaxant and a potent inducer of deeper sleep – it is no generalisation to say that almost everyone needs more magnesium, regardless of adrenal function or hydration.

Sleeping in the dark can make a big difference too. Thin curtains that let in street light inhibit the release of melatonin and result in increased tossing and turning. The creep of landing lights does the same. Black-out blinds and turning off any light-emitting electronics make a world of difference to the quality of sleep you experience. If you do not have a black-out blind, I suggest you invest in one.

Good sleep may be one of the most under-rated aspects of improving health and healing the adrenal glands. It may also be one of the most abused aspects in treatment protocols, but good healing does not occur without good sleep. Whilst good sleep is clearly a gift, understanding the causes of sleep disturbances and taking the appropriate steps makes it a gift you can give yourself, night after night.

Does Adrenal Fatigue Cause Yeast Infections?

In adrenal fatigue, a specific pattern of immune system dysregulation can often be found. Modern science is only starting to develop an understanding of the immune system, but we know that there are two branches that, together, provide a broad array of protection for the host. The first branch, the Th1 arm, is responsible for what is dubbed cellular immunity and must deal with viruses, intracellular bacteria, fungi and tumours. It’s Th2 takes responsibility for humoral immunity, which involves a more specific immunity mediated by the production of antibodies. Both sub-divisions of the immune system must regulate one another; should the function of one arm falter, the other becomes extra active.

A state of Th2-dominance stands out as the most common pattern in adrenal fatigue sufferers, the base cause of which lies in the under-activity of the Th1 branch. In this mode, the body’s infection-fighting ability (Th1) becomes compromised, while the Th2 branch begins to over-produce antibodies, often leading to allergic reactions. This explains why the typical sufferer of adrenal fatigue suffers from the paradox of a suppressed immune system that over-reacts to common foods.

Above and beyond the dietary issues caused by such reactions, one of the most relevant features of this immune imbalance is the susceptibility to yeast infections. Because the immune system is no longer able to deal with fungi effectively, any factors that support it’s growth can result in chronic and systemic fungal infections, often candida or trichosporan species. The sugar cravings, which often accompany the dips in blood sugar experienced by those with adrenal fatigue, and the sugar consumption that follows create a perfect setting for fungal organisms to take hold of their host.

It is worth understanding that many of the symptoms of adrenal fatigue and a systemic fungal infection can overlap. Fatigue, impaired thinking, increased inflammation, sugar cravings are just some of the more common symptoms that occur in both disorders. Recognising the similarities and differences between the two is important for effective treatment as, in many cases, a full anti-fungal program that reduces carbohydrates, makes good use of yeast-killing foods like garlic, coconut grapeseed extract and uses broad-spectrum probiotics will be required. Fortunately, none of these steps counter any of the traditional approaches in treating adrenal fatigue, although the die-off reaction experienced during a fungal cleanse may be too much of a strain for those with severe adrenal fatigue.

The causal link between adrenal fatigue and systemic fungal infections is only recently becoming recognised. However, what is very rarely acknowledged is how chronic yeast infections can actually be the cause of adrenal fatigue. Rather than a secondary consequence, evidence is mounting to suggest that infections of Candida and other fungi may cause chronic overactivation of the adrenal glands. The immune system gears it’s response to any infectious agent through a complex web of communication between various sub-types of immune cells. The most important method of cross-talk is in the form of cytokines. Cytokines are mini-hormones released by immune system cells such as macrophages and provide a signal to other immune system cells to tell them how best to respond to the threat. Some cytokines increase Th1 activity, some promote a Th2 response. Some increase local inflammation; IL-6 stands out as one such cytokine.

However, IL-6 has consistently shown effects beyond the orchestration of the body’s response to bacteria, viruses and fungi. Crucially, IL-6 also has a major impact on the adrenal glands. A research article by Bernstein and Chrousos (1995) covers this relationship in more depth, but the end result is that the ongoing immune response that accompanies a chronic fungal infection hammers the adrenals. If you hammer your adrenal glands for long enough, an exhaustion state becomes more certain. Some doctors have also offered evidence that fungal overgrowth can directly distort the normal function of the the hypothalamic-pituitary-adrenal axis by local infection of the paraventricular nuclei, an essential part of the hypothalamus. The message is clear: whilst the opposite remains true in the majority of cases, chronic fungal infections can cause adrenal fatigue.

The strong link between adrenal fatigue and fungal infections has been noted for a long time. Whilst correlation does not equal causation, the mechanisms through which one condition can trigger the other is proven and often seen in practice. To achieve a result in an individual suffering from both adrenal fatigue and fungal infection, a practitioner must consider employ systemic and complementary nutritional support for the body and make the appropriate interventions in the right order.

Adrenal Fatigue and Vitamin C

While the adrenal glands need numerous nutrients to function normally, perhaps the most important of them all is vitamin C. The highest concentrations of vitamin C reside in the eyes, brain and adrenal glands.

In the body, this water-soluble nutrient provides a strong anti-oxidant function, supports the immune system and increases the integrity of the artery walls and connective tissue. In the adrenals, vitamin C is required for healthy production of steroid hormones.

Whereas most animals can manufacture their own vitamin C, humans cannot. This means that we must obtain the nutrient from our diet on a regular basis. Under normal circumstances, optimum human requirements vary but the majority of people will require between 500-1,000mg per day. It is possible to get near to the lower figure with a diet rich in peppers, sprouts and other food rich in vitamin C, but it appears that most individuals will need to use supplements to ensure adequate vitamin C status. Autoreceptors for vitamin C in human cells show us that humans used to have the same capacity as animals to synthesize vitamin C from sugar but this ability has been lost at some point in the evolution of man.

Stress, infection and intense exercise all increase the cellular demand for vitamin C, with studies showing how blood levels of ascorbic acid fall at an increased rate during these times. A lack of adrenal output, as seen in adrenal fatigue, places all cells of the body under increased stress, with an almost automatic increase in nervous activity to compensate for diminished cortisol release and systemic inflammation that accompanies the low levels of this steroid hormone. The dysregulation of the immune system means that infection is also a common feature, driving up demand significantly. Vitamin C requirements during adrenal fatigue normally fall between 2,000-4,000mg per day, but Dr James Wilson, author of “Adrenal Fatigue: The 21st Century Stress Syndrome”, reports some patients requiring up to 20,000mg.

Sufferers of adrenal fatigue are hit particularly hard by vitamin C deficiency. The production of cortisol and other adrenal hormones, characteristically low in this disorder, is dependent on an ongoing supply of vitamin C. If this supply dwindles, so too does the secretion of adrenal hormones. This feeble response from the adrenal glands places the body under further stress, further increasing demand for the vitamin C. The importance of intervention with the appropriate amounts of this nutrient should not be overlooked.

There are several ways to establish the most appropriate dose of vitamin C. The most common is the bowel tolerance test, where individuals ingest increasing amounts of ascorbic acid over the course of a day until diarrhoea sets in. While this test does appear to have some use, the major criticism is that it reflects tolerance more than it does optimum requirements. Marek Doyle suggests starting a patient on 2,000mg per day, and slowly increase this when the person concerned feels the benefit. Although subjective, this approach allows the body to decide and often results in using a smaller dosage to achieve the desired outcome.

Finally, the form of vitamin C used makes a difference. Contrary to popular belief, ascorbic acid is not vitamin C. Vitamin C is a complex of naturally occurring hormones, phytonutrients and enzymes in which ascorbic acid is the active compound. Vitamin C can only be found in nature in the presence of bioflavonoids, normally in a 2:1 ratio. Supplementing synthetic ascorbic acid without the necessary co-factors challenges the body to rob these additional substances from it’s own stores just to metabolise the ascorbic acid; essentially, you solve one shortage but create another. Additionally, the low liver function that regularly presents with adrenal fatigue can sometimes result in sensitivity to supplements, including vitamin C. Using alternate sources of vitamin C, such as a mineral ascorbate or the fermented ‘food form’ product, should be considered here. Some individuals with very severe adrenal fatigue may only tolerate powdered amla berries or acerola cherries.

Recovery from adrenal fatigue can be a long and sometimes difficult experience. However, allowing the body’s needs for vitamin C to go unaddressed stands out as a sure-fire way of perpetuating the cycle of stress and adrenal dysfunction. All individuals should address their own specific requirement of this nutrient and this is especially true for anyone suffering with adrenal fatigue.

Adaptogenic Herbs in Adrenal Fatigue: A Lowdown

The stress that adrenal hypofunction places on the rest of the body makes adrenal fatigue self-purpetuating. The metabolic disruptions and immune system irregularities that come with a lack of cortisol result in more stress signals arriving at the adrenal glands, and once this game of catch-up has started it is difficult to break the cycle. While a full removal of all external stressors can be enough for some people, most individuals will need extra support in the short term to help normalise their adrenal function and restore balance to the body. Adaptogenic herbs have been touted as one method of achieving this.

Adaptogenic herbs are those that demonstrate an ability to normalise the secretion of various hormones, reducing them when they are in excess but boosting production when serum levels fall short. These adaptogens may be particularly useful for those with adrenal imbalance, where deviations of adrenaline and cortisol often combine to leave an individual feeling drained yet anxious, stimulated yet totally shattered. The theory makes sense; the only problem is use of such adaptogens often fails to deliver the goods in practice.

Adaptogens may be very useful in the early stages of adrenal fatigue (alarm phase, resistance phase), when cortisol levels are high and the adrenal glands have not yet faltered. However, when fatigue is present – confirmed by the adrenal stress index – then these affects cannot be relied upon. External solutions, even those with a wealth of science supporting their use, often results in paradoxical reactions. For example, taking herbs to reduce excessive release of adrenaline may cause a counter-response from the body and bring on the onset of more pronounced adrenaline-related symptoms such as increased anxiety, raised heart rate and sweaty palms. It appears that, once the production of cortisol falls, the body takes action to compensate; anything that interferes with these changes is not tolerated.

Some of the popular adaptogenic herbs include:

Siberian Ginseng – a herb with a long history of use across Russia and China. Known to provide adaptogenic effects on the adrenal glands, a wealth of studies also support it’s use in enhancing immunity, sustaining athletic endurance and improving social functioning. The effects appear to be mediated by the active component, the eleutherosides.

Ashwaganda – sometimes referred to as Indian ginseng, the herb provides a range of effects that are largely comparable to Siberian ginseng, although the plants are not in any way related. Ashwaganda contains withanolides, phytosterols and alkaloids which Ayurvedic practioners have used for centuries to help patients resist stress and related symptoms. The herb is noted for it’s ability to balance out adrenal and thyroid problems and has been used to address hypofunction at both of these energy-producing glands.

Rhodiola Rosea – typically identified as an ideal herb to enhance both physical and mental resistance to stress. As well as providing adaptogenic effects at the adrenal glands, rhodiola can block the depletion of norardrenaline and dopamine that typically occurs in stressful situations. Healthier levels of these two catecholamines are related to better mental performance, energy and mood.

Considering the complexity of these herbs interactions with the body gives us some scope to both appreciate their potential as a short-term intervention for a number of stress-related problems and understand why people may react so differently to their consumption. In my clinic, I rarely use adaptogens for stage three adrenal fatigue because they generally do nothing, or make the individual feel worse. A slower approach that involves offering gentle support to the body, rather than imposing external solutions, is often the only option available. However, a minority do respond well to these herbs. Some that suffered from the use of ginseng felt better taking rhodiola, and vice versa. Those in adrenal exhaustion that react well to adaptogens are firmly the minority, though.

Ruling out the use of these adaptogens in cases of adrenal exhaustion is ruling out a potentially useful treatment that may make a difference. Whilst we as a scientific community are unable to accurately predict a patient’s response to these herbs, the most sensible step appears to be to recognise the role that these agents may play but accepting that a significant proportion of individuals in adrenal exhaustion do not tolerate them. The watchword is caution, rather than exclusion.

Using Licorice Root

Licorice root stands out as one of the most useful herbs for adrenal fatigue. Although it is not necessary in many cases, it’s reliable effects on boosting cortisol levels make it a vital part of any practitioner’s line-up, although some confusion exists as to how best harness this effect.

In healthy individuals, cortisol levels rise in the morning and fall progressively during the day. A lot of practitioners fall into the trap of assuming that the use of licorice use must follow this pattern. This is not necessarily the case. Licorice root increases the circulating levels of cortisol in circulation by reducing it’s breakdown, not by creating extra cortisol. If cortisol levels are inappropriately low, then boosting them back into a more beneficial range is likely to alleviate symptoms, be that hypoglycaemia or poor sleep. Licorice root can be used to boost cortisol levels around the clock.

Licorice has been used for many centuries in Traditional Chinese Medicine and still features in a number of therapeutic interventions. Modern science shows us that the root of the plant contains a compound called glycerrhizinic acid, which inhibits the breakdown of circulating cortisol at the liver. As such, it can reliably enhances the potency of any cortisol produced by the adrenal glands. This makes it very useful in cases of adrenal fatigue.

Licorice is often used in the morning but can be equally useful in the evenings. For example, Tired Timmy feels totally washed out at 8pm each day, and this feeling does not dissipate for the rest of the evening. The adrenal stress index shows a very low reading for cortisol at 8pm. This low output of cortisol leaves his body over-compensating for the imbalance and, when he tries to settle down to sleep at 10pm, he finds himself wide awake and staring at the ceiling. He doesn’t want to do anything to boost his cortisol levels as he has been told that this will disturb sleep – after all, he has enough sleep problems as it is. However, if Tired Timmy used licorice root in the evening to boost his flagging cortisol levels, he could have avoided the over-compensation and maybe got a good night’s sleep.

Practitioners have tended to shy away from anything that boosts cortisol levels in the evenings. On one hand, this is understandable; high cortisol disturbs sleep and circadian rhythms. However, boosting cortisol from a problematic range into a desirable zone represents something different altogether. As discussed in articles on adrenal fatigue and sleep, low cortisol can damage sleep as much as high cortisol. In essence, the right intervention will vary from person to person; establishing exactly what this entails should be determined only by their requirements, not be predetermined ideas about what times licorice root should or should not be used.

In my clinic, I use the results of the Adrenal Stress Index, together with feedback from the individual concerned, to establish the most appropriate use of licorice root (if any). Typically, I may start off by introducing supplements earlier in the day and gauging response; however, if test results and our discussion both come to the conclusion that use in the evening is indicated, then this is what I suggest.

While many individuals will find their sleeping patterns settle back into a healthy pattern by supporting their adrenals with their own ideal blend of vitamin C and pantothenic acid, there are also many that will need more help. If your symptoms and test results suggest that such support involves licorice root in the evening, then the time of day should be no reason to avoid this.Licorice root stands out as one of the most useful herbs for adrenal fatigue. Although it is not necessary in many cases, it’s reliable effects on boosting cortisol levels make it a vital part of any practitioner’s line-up, although some confusion exists as to how best harness this effect.

In healthy individuals, cortisol levels rise in the morning and fall progressively during the day. A lot of practitioners fall into the trap of assuming that the use of licorice use must follow this pattern. This is not necessarily the case. Licorice root increases the circulating levels of cortisol in circulation by reducing it’s breakdown, not by creating extra cortisol. If cortisol levels are inappropriately low, then boosting them back into a more beneficial range is likely to alleviate symptoms, be that hypoglycaemia or poor sleep. Licorice root can be used to boost cortisol levels around the clock.

Licorice has been used for many centuries in Traditional Chinese Medicine and still features in a number of therapeutic interventions. Modern science shows us that the root of the plant contains a compound called glycerrhizinic acid, which inhibits the breakdown of circulating cortisol at the liver. As such, it can reliably enhances the potency of any cortisol produced by the adrenal glands. This makes it very useful in cases of adrenal fatigue.

Licorice is often used in the morning but can be equally useful in the evenings. For example, Tired Timmy feels totally washed out at 8pm each day, and this feeling does not dissipate for the rest of the evening. The adrenal stress index shows a very low reading for cortisol at 8pm. This low output of cortisol leaves his body over-compensating for the imbalance and, when he tries to settle down to sleep at 10pm, he finds himself wide awake and staring at the ceiling. He doesn’t want to do anything to boost his cortisol levels as he has been told that this will disturb sleep – after all, he has enough sleep problems as it is. However, if Tired Timmy used licorice root in the evening to boost his flagging cortisol levels, he could have avoided the over-compensation and maybe got a good night’s sleep.

Practitioners have tended to shy away from anything that boosts cortisol levels in the evenings. On one hand, this is understandable; high cortisol disturbs sleep and circadian rhythms. However, boosting cortisol from a problematic range into a desirable zone represents something different altogether. As discussed in articles on adrenal fatigue and sleep, low cortisol can damage sleep as much as high cortisol. In essence, the right intervention will vary from person to person; establishing exactly what this entails should be determined only by their requirements, not be predetermined ideas about what times licorice root should or should not be used.

In the clinic environment, the results of the Adrenal Stress Index, together with feedback from the individual concerned, are used to establish the most appropriate use of licorice root (if any). Supplements can be started by introducing them earlier in the day and gauging response; if test results and discussions with the individual suggest that evening use of licorice is indicated, then licorice should be used in the evening.

While many individuals will find their sleeping patterns settle back into a healthy pattern by supporting their adrenals with their own ideal blend of vitamin C and pantothenic acid, there are also many that will need more help. If your symptoms and test results suggest that such support involves licorice root in the evening, then the time of day should be no reason to avoid this.

The Number One Reason People Don’t Recover from Adrenal Fatigue

Adrenal fatigue is a surprisingly common affliction, with some experts stating that 80 percent of the Western world can expect to be affected at some point in their lives. Whether they recover from it’s effects is highly dependent on their general constitution, the amount of chronic stress that they inflict upon themselves and the level at which they nourish their body. Many people drift through life in a tired haze, unaware that it’s not normal or healthy to feel so abnormal and unhealthy.

Ignoring the symptoms is the number one reason people do not recover from adrenal fatigue. Accepting the low spells during the afternoon, the night after night of restless sleep and the diet-resistant accumulation of abdominal fat seems so illogical, yet why do so many of us do it? Is it because the doctor runs a brief thyroid test and tells us we’re OK? Or because we’re just too exhausted to do anything about it?

Whatever the reason and whatever your doctor thinks, adrenal fatigue is highly prevalent. It is also treatable. However, without any ‘standard of care’ attached to the adrenal fatigue label, a world of conflicting suggestions and unsuitable advice fills this void. Countless individuals fall into this trap and convince themselves that they are saddled with this state forever, when the opposite is true.

Your approach to supplementation makes a huge difference to the healing that occurs at the adrenals. The ‘shotgun’ approach, where a veritable cocktail of adaptogenic herbs. adrenal extracts, and high-dose vitamins and minerals are chucked down the throat is likely to end up causing unexpected reactions. Imposing a solution without considering what the body requires does not help the adrenals. Equally, relying on food alone in the hope that the body will heal itself represents an equally naïve strategy; expecting a weak body with impaired digestion to find sufficient nourishment from devitalised food grown thousands of miles away is overly hopeful, to say the least. In any case, the adrenal gland’s requirements for nutritional support are increased at this time. Thoughtful, but not random, supplementation of vitamin C, B5, licorice root, adrenal extracts and an array of minerals is a prerequisite to successful recovery.

Providing the right ingredients is not enough, though. Taking away the triggers is just as important. You may be able to convince yourself that your light nights in front of the laptop make the following day easier to manage, but your adrenal glands think otherwise. The alcohol that you tell yourself ‘helps you unwind’ is still ruining your sleep. If your relationship with a significant other consists mainly of gritting your teeth and fulfilling your duty, then you really don’t need someone else to point out that this relationship is doing you no good. If you have adrenal fatigue and you are training for a marathon, stop.

Most of these problems are factors that most of us are already aware of, but may still ignore. Those who choose their short-term wants over their long-term needs have plenty of time to consider the wisdom of their approach. However, a major obstacle in the way of recovery is rarely considered.

Chronic infection alters the function of the immune system. Not only does this directly tire the individual concerned, the secondary effects are that the adrenal glands get hit hard. Immune cells communicate with one another through the release of localised hormones called cytokines; the only problem is that these cytokines increase the pituitary gland’s signal to the adrenal glands, and directly challenge the glands themselves. This all adds up to a heavy workload for the adrenal glands, who were already struggling to keep pace with menial day-to-day demands. The irony is that adrenal fatigue makes fungal infections much more likely, as discussed here. The bottom line is that, regardless of how well you remove psychological stressors and nourish your body, if your adrenals are being hammered all day from the effects of a chronic infection you are unlikely to get anywhere.

Everyone’s requirements are different, as is the protocol required for efficient recovery from adrenal fatigue. Stressing the importance of appropriate supplementation and the changing of bad habits stands about amongst the best advice for adrenal fatigue sufferers. However, simply ignoring it and hoping for the best is still the worst choice possible.

Adrenal Fatigue vs Hypothyroidism

Not everyone experiencing fatigue, weight gain and general sluggishness is suffering from hypothyroidism. Although these symptoms are common among those dealing with an imbalance of thyroid hormones, they are also often found in individuals whose adrenal glands have reached the exhaustion stage. And then there is the group of people who are simultaneously suffering from both.

In regards to which affliction is more common, we have no real statistics. Dr Michael Lam, a US-based physician familiar with adrenal fatigue, haws stated that 80% of the population will suffer with adrenal fatigue at some point in their life. Dr David Brownstein, the author of “Iodine: Why You Need It”, estimates that 40% of the Western world is currently experiencing some sort of thyroid imbalance. In any case, it can be safely concluded that there are many individuals are needlessly suffering, searching for answers after being knocked back by their GP.

Although adrenal fatigue resembles hypothyroidism in some aspects, there are also significant differences between the two. Hypothyroidism normally presents with a number of key symptoms, although each individual often experiences a thyroid dysfunction in slightly different ways. In adrenal fatigue, the individual experience is even more varied, consistent with the wide array of metabolic activity that depends on the adrenal glands. The diurnal nature of adrenal function often means that particular times of the day/night will be more troublesome than others; this circadian pattern is not seen in thyroid problems. More common symptoms are listed below.

Adrenal Fatigue

Energy crashes at different points of the day
Anxiety
Sugar/salt cravings
Poor appetite in the mornings
Sensitivity to loud noises
Trembling
Disturbed sleep
Hypoglycaemic episodes
Frequent colds/infections
Palpitations/chest pains
Thin, brittle nails

Hypothyroidism

Hair loss
Dry skin
Eyebrow hair thinning
Persistant fatigue
Depression
Under-reactive to stimuli
Intolerant of heat

Both

Low energy
Cold hands
Low body temperature
Weight gain
Sluggish digestion

Patients currently navigating through their treatment and astute practitioners may notice that many symptoms listed for hypothyroidism were present in cases of confirmed adrenal fatigue, and vice versa. And herein lies the intrinsic link between the thyroid and adrenal glands, often referred to as the hypothalamic-pituitary-adrenal-thyroid axis. Both these glands are concerned with energy production and have evolved to balance each other out.

When the adrenals increase hormonal secretion, thyroid function is inhibited. This affect appears to be dominated by adrenaline, which increases the levels of reverse T3 in the bloodstream. Reverse T3 is inactive cousin of the primary thyroid hormone T3; because both competitively inhibit one another at binding sides, a high count of reverse T3 can cause the onset of thyroid symptoms. However, this will often be masked by excessive adrenal output of both adrenaline and cortisol but will be brutally unveiled if and when the adrenal function crashes, as is known to occur in adrenal fatigue. This is an example of how stress can induce hypothyroid symptoms. Not only does it demonstrate the need to always check for reverse T3 in all thyroid tests, it also shows why a shift from high adrenal output to low – typical in adrenal fatigue – can cause such a severe crash; the low thyroid function, which was previously masked, now becomes fully evident at the same time as the individual is gripped by adrenal fatigue.

Most of the individuals I see with adrenal fatigue have some sort of impaired thyroid function. In these situations, I focus the source of the problem (the adrenal function) whilst providing adequate levels of nutrition to the thyroid; this includes tyrosine and selenium, but especially iodine, for which 96% of the population test deficient for. Attempts to compensate for these organic imbalances by imposing synthetic thyroid hormones are clumsy and perpetuate the cycle. Removing the cause of thyroid dysfunction and nourishing it with essential nutrients represents a much wiser approach.

While adrenal fatigue and hypothyroidism have specific signatures, the symptoms seen will often overlap. An efficient return to optimum wellness requires knowledge of why the problems occurred in thyroid/adrenal glands in the first instance, but also how these energy glands interact and what knee-jerk interventions to avoid.

Adrenal Fatigue and Wholegrains

Sufferers of adrenal fatigue come to recognise the feelings of low blood sugar. Most will periodically experience the low energy, dizziness, furious carb cravings and shaking that often accompany hypoglycaemic episodes. This occurs when the adrenals, unable to maintain their normal function, cannot adequately maintain healthy glucose levels in the bloodstream between meals. The irony is that the emergency state that occurs hits these walnut-sized glands hard, purpetuating the adrenal fatigue.

Stabilizing blood sugar levels is a key to avoiding this ongoing cycle. Anyone with any experience of adrenal fatigue will advise that regular meals – each consisting proteins, fats and slow-release carbs – can help in this regard, and they are right. However, some carbohydrates sources may harm while others may help.

Wholegrain carbohydrates, like wholewheat, oats, rye and brown rice, stand out as regular recommendations for sufferers of adrenal fatigute. Unlike white flour products or sugary foods, they release their energy slowly into the bloodstream, reducing the ensuing insulin release and therefore the likelihood of any dips in blood sugar. However, the digestive problems some people suffer from eating grains means that their use should be carefully considered. While the exact set of symptoms in adrenal fatigue varies from one person to the next, poor digestion is a regular feature as the impaired regulation of both adrenaline and cortisol can cause a variety of changes in the digestive tract, from a loss of beneficial bacteria to constipation and a drop in protective sIgA antibodies. Some wholegrains may become problematic in this environment.

Gluten is a specific protein found in wheat, oats, rye and barley. It has been previously thought that these foods are easily digested in all persons except those with Coeliac disease, which involves the inability to tolerate gluten. However, newer evidence suggests that all individuals may be sensitive to gluten to some extent; the issue is more a case of how sensitive an individual is rather than if they are, with symptoms appearing above a particular threshold. This threshold is lowered in any person with poor digestive health. This covers most adrenal fatigue sufferers.

It is worthwhile pointing out that a major difference exists between the gluten found within wheat and the other gluten grains. The gluten in wheat is primarily a substance called gliadin, whereas this concentration of gliadin is not found in oats, rye and barley. The gliadin in wheat appears to be significantly more problematic that the other gluten proteins in the different grains. This explains why some Coeliacs cannot tolerate bread or pasta, but can eat porridge without problems.

The implications for individuals with adrenal fatigue appear to be that some can consume all wholegrains without problems; done within the confine of an appropriate diet plan, they are unlikely to experience any ill effects from a moderate amount of unrefined starch. However, just as many need to avoid gluten-containing foods, especially wheat; at my clinic, I generally stick to a blanket recommendation for all individuals to avoid wheat. For those with more sensitive digestion, vegetables are a beneficial source of the carbohydrates required. Fruits should be used with caution as the sugar content can cause reactive hypoglycaemic reactions.

Vegetables can be considered a safe bet for all individuals, including those with adrenal imbalance. They represent a reliable source of minerals and phytonutrients, but it should be pointed out that a high-plant diet is a high-potassium diet. Whilst this is generally a positive thing for most, adrenal fatigue often disrupts the salt:potassium ratio; as a result, a high potassium load can cause a ‘crash’. The answer is not to avoid vegetables, but to ensure that eat meal is seasoned with sea salt. This sea salt should be used liberally during adrenal fatigue.

As with many aspects of treatment, the use of wholegrain carbohydrates may need to be tailored to the individual concerned. Complex carbohydrates can be a welcome addition into the meal plans in adrenal fatigue sufferers, but understanding the likely issues with digestion and addressing this remains an important consideration for efficient recovery.

Adrenal Extracts vs Hydrocortisone

Unlike many medical conditions that have an insurance code attached to them. Many medical conditions have an insurance code attached to them. This means they also have a standard prescription etched next to their name in the Physician’s Desk Reference. Adrenal fatigue has neither.

This results in some inconsistency between many recommendations, especially those found online. Whilst this does not necessarily meant that conflicting opinions are wrong, only that some recommendations may be more suitable than others depending on individual circumstances. Understanding the basis for different approaches is important in evaluating what you read. A large gulf exists between one camp that recommends adrenal extracts, and those that maintain that hydrocortisone is the better option. Both have their uses in the treatment of adrenal fatigue.

Hydrocortisone is perhaps the most direct approach. Hydrocortisone is bioidentical to cortisol, so oral supplementation has a very reliable and measured effect on boosting low cortisol levels into a healthy range. It takes a daily dose of 5-20mg to achieve this, and many find that their symptoms recede quite rapidly upon the administration of the tablets. However, this comes at a cost; just as when athletes use anabolic steroid hormones, the internal balance of the body and the endocrine glands may be disturbed through the inhibition of negative feedback loops and pituitary production of ACTH. In essence, whereas the adrenal glands normally receive a regular signal from the brain requesting the production of hormones like cortisol, the introduction of exogenous hormones means that circulating levels of cortisol are high enough and the brain no longer sends such a signal. Adrenal atrophy (shrinkage) and dependency can occur.

It is these side effects that cause such damning indictment of the hydrocortisone approach. Those that criticise point to the benefits offered by adrenal extracts. Adrenal extracts have been used since the beginning of the 20th century and, whilst containing no significant traces of hormones, contain a rich array of nucleic acids, enzymes and fatty acids unique to the adrenal glands. They help nourish the adrenal glands and restore hormonal production without interrupting the complicated feedback systems of the hypothalamic-pituitary-adrenal axis. The value of extracts is not disputed, although the effect is not always instant and some individuals will not respond well to use of adrenal extracts. The individual’s response should be measured and treatment tailored accordingly.

For those that do not get on well with increased vitamin support, adrenal extracts or licorice root, the simple (if somewhat blunt) solution of providing steroid replacement with hydrocortisone tablets remains a solution to stabilise the function of other organ systems that rely upon a suitable output of cortisol. Used for short periods of time, atrophy need not occur.

The treatment for adrenal fatigue is often as varied as the symptoms suffered by an individual. When one considers the varied requirements for pantothenic acid and vitamin C, it becomes obvious that people would be likely to respond differently to interventions like adrenal extracts or hydrocortisone. A practitioner must let the body’s responses guide them in their decisions on how to use the extracts, and the pros and cons of steroid replacement should be carefully considered before use of hydrocortisone. Undoubtedly, both have a significant role to play in adrenal fatigue, but that exact role will vary from one person to the next.