Adrenal Fatigue: Part 2

In my last blog post I introduced a condition called Adrenal Fatigue and included some ways to manage it naturally, before seeking treatment.  If you haven’t read Part 1 yet, I suggest starting there! Here I’ll give you some treatments to consider, once you’ve reduced the stress, which may be triggering your adrenal fatigue.

I wish it were as simple as scheduling a regular doctor’s appointment.  Unfortunately the conventional medical community does not recognize adrenal fatigue as a medical condition.  And, actually, adrenal fatigue is a coined term to describe a condition whereby the adrenal glands are not working properly.

The only time a condition of the adrenal glands is recognized as a medical diagnosis by my conventional medical peers is when it’s one of the extremes (Addison’s or Cushing’s Syndrome) in which the organs are either over-producing hormones or not producing any at all!  These both are pretty serious medical conditions but rare.

So when you go to your regular doctor with symptoms of adrenal fatigue, understand they may not take you seriously. They may laugh at you and tell you to stop reading things on the internet (I like to think that you’re just educating yourself)! Also, they rarely test for it and if they do, they don’t do the correct testing to diagnose it. 

That’s why I find it so vital to educate others on how to advocate for themselves when slipping through the holes in modern medicine.  I’ll share with you how I helped the patients in my functional medicine practice, from testing to treatment plans!


As a functional medicine doctor, my preferred form of testing for adrenal dysfunction is a four-point salivary cortisol test, which checks for the free form of the hormone (hormone that is NOT bound to other proteins.).  There is a diurnal pattern to the secretion of cortisol. Your cortisol should be high in the morning to help you get out of bed and get going for the day. And throughout the day, it should decline slowly until bedtime. The four-point salivary test is done four times throughout the day to check for those variances. The first is about an hour after waking, the second late morning/early afternoon, the third around dinner and the last at bedtime.  

If we were to do just one check, (which is common in regular medical practices and often checked in blood), it wouldn’t give us enough information to understand what’s happening throughout the day.  Is it only high in the morning? Is it high all day? Depending on the results of the four-point salivary cortisol test, we can tell if it’s adrenal fatigue, and if so, which stage.

The four-point saliva test is done at home.  It’s a kit with four vials, one for each saliva sampling, and includes the instructions to effectively collect the data.  Activity is limited in the hour before each saliva test. It is recommended that there is no exercise, smoking, eating, or anything that could generally raise the cortisol and trigger false results.  

Another way of testing for adrenal fatigue is a blood test, but I find it problematic because it doesn’t test for the free-form of the hormone, making the test inaccurate.  Also, just the experience of being in a lab to get blood drawn, being late for work since the lab might be packed or actually seeing someone you don’t like at the lab can raise cortisol levels in the blood and lead to falsely high levels.  I have heard of all of the scenarios which is why I give them as examples as to why this is not the best test for adrenal dysfunction!



Stage one is when all the four points on the test come back with high cortisol.  This is basically someone who is running on adrenaline. This is typically early on in adrenal dysfunction, but nonetheless, still very dysfunctional!! Oftentimes, I would also rule out Cushing’s Syndrome in these patients since a very high cortisol can be a serious medical condition long term. 

Stage two is what we call wired/tired. This is the stage that I saw most commonly in my medical practice.  These people usually have lower cortisol in the morning and higher at bedtime. They generally struggle to get out of bed in the morning and have a hard time falling to sleep at night so I often could make the diagnosis just by taking a good medical history!  (This is the stage of adrenal fatigue I suffered from.)

Stage 3 are the real adrenal fatigue sufferers.  They generally have pretty low cortisol levels throughout the day.  In this stage, it’s important to then test for Addison’s Disease, which is an extreme adrenal condition that can be very serious. 



It’s important to note here that you can’t fix the abonormal hormone secretion issue without addressing the stress first.  I talked in my last blog post about different ways to alleviate stress on the body, and following these steps should be your first focus.  Just like you can’t out-exercise a bad diet, you can’t out-supplement adrenal fatigue.

A good B-complex and magnesium supplement are the most recommended for most anyone.  It’s largely due to lack of micronutrients in our food supply, but generally provides relief for so many ailments, including adrenal fatigue. In addition, I usually would supplement with extra Vitamin B12since there is usually not an adequate amount in the B-complex. B12 helps not only with adrenal support but it is also helps bring down certain inflammatory markers, like homocysteine. Homocysteine is an amino acid that, at high levels, can cause inflammation in the body and is a known cause of heart disease. 

Another supplement that is helpful for the treatment of adrenal fatigue is L-Theanine. It is an amino acid from green tea that calms you naturally and helps you focus without making you feel groggy or drugged! It’s an amazing supplement that I used to recommend for everyone (because who doesn’t need to be more calm and focused) and one which many of my family members take each night.  This is ideal for Stage 1 sufferers to calm the high levels of stress throughout the day and also good for those with Stage 2 to help bring down their evening cortisol levels, especially when trying to go to sleep! 

Next is something called an adrenal gland adaptagen. These are helpful for all stages. Bascially, an adaptogen helps lower cortisol if it’s high and raise it if it’s low. I typically would recommend Ashwagandha, Relora, and Rhodiola.  This is one of the reasons why I love and drink Shakeologydaily since it contains adaptogens to help me with my energy and stress throughout the day!

Another useful supplement for the treatment of adrenal fatigue is an adrenal grandular. It is basically an adrenal gland from an animal (usually bovine.).  I know, it sounds unpleasant, but I would find when taken in the morning and at lunch, it would help my patient’s feel more energetic without feeling wired or jittery!  Raw Adrenal is the brand that I would most commonly recommend FOUND HERE.

Phosphatidylserine is a supplement that is good for those with Stage 2 adrenal fatigue who have higher nighttime cortisol levels. If taken in the evening, it will help to lower nighttime cortisol in an attempt to prevent sleep disturbances and anxiety.

DHEA (dehydroepiandrosterone) is hormonal support for the adrenals. It is a hormone that is produced in the adrenals but may be lower in those with adrenal fatigue and is naturally produced less as we age. It is a good supplement to support the adrenals in  men since it can also help slightly with testosterone production! I would usually only use it in menopausal women (not women who are still having a regular menstrual cycle) since it may also raise estrogen levels, which can be beneficial in a woman who is only producing a small amount of estrogen naturally. I would recommend having your DHEA level checked by your doctor prior to starting supplementation. 

In women who are still cycling, I would recommend 7 Keto DHEA. Women who have not gone through menopause (but are getting close), tend to be estrogen dominant (relative to progesterone). The last thing that I ever wanted to do was make her even more out of balance by giving her a supplement (like regular DHEA), potentially increasing her estrogen levels even more! For this reason, I would give 7-Keto DHEA since it is not thought to raise estrogen (and testosterone) levels like DHEA.  And, again, I recommend having your DHEA level checked prior to supplementation. 

Pregnenolone is an adrenal hormone that is known as the “grandmother of all hormones”! Basically, pregnenolone is made from cholesterol but then is the source for the production of all other hormones, including estrogen, progesterone, testosterone, cortisol, DHEA and other hormones! I would often see it very low in those with adrenal fatigue because of a phenomenon called the “pregnenolone steal.” Essentially, those who are super stressed and needing cortisol to keep functioning “steal” pregnenolone to make cortisol and compromise the production of the other above mentioned hormones! So a woman could have even lower estrogen and progesterone and a man with lower testosterone levels if they also have adrenal fatigue. So supplementation with pregnenolone would not only help support the adrenals but the production of the other hormones! I would, again, recommend having your pregnenolone level checked prior to starting supplementation. 

Vitamin D should basically be taken by everyone. I have never tested a Vitamin D level on someone in the Northeast and found it to be “normal,” unless they were already on supplementation.  It’s crucial for all hormonal support. I do recommend that you get your Vitamin D level checked since it has so many other important roles in the body! Most docs will check this for you!

I would rarely put someone on LOW DOSE steroids (like hydrocortisone) but this is a treatment. In my opinion, it is a band-aid and I would only use it in those who were completely debilitated by their symptoms. I found the biggest problem with using steroids is that I could never get my patients off of them once they started! They would feel instantaneous energy (and who doesn’t love that) but then would be less motivated to get to the underlying cause of their problems and fix them! For this reason, low dose steroids were not usually part of my treatment plan! I want to help people feel better, not keep them on drugs, masking their symptoms!


While I have so much knowledge and experience with holistic medicine, I don’t have experience with YOU and your specific body situation.  Any information here is not meant to replace the expertise your doctor brings to the table.  Instead, it’s to inform you so you know how to talk to your doctor, and ask for recommendations specific to your needs.


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