RHR: The Myth of Adrenal Fatigue
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RHR: The Myth of Adrenal Fatigue

by Chris Kresser

Last updated on

Revolution Health Radio podcast, Chris Kresser

Does adrenal fatigue really exist? Is it an accurate representation of stress-related pathology? Do the adrenal glands really become drained and unable to produce cortisol? Today I’ll discuss the current scientific evidence behind what happens to us when we experience chronic stress and propose that a much more accurate term for this would be HPA axis dysfunction.

In this episode, we discuss:

  • How our stress-response system works
  • The concepts of resilience and metabolic reserve
  • The origins of “adrenal fatigue”
  • The problems with the adrenal fatigue model
  • Why an accurate understanding matters
  • The causes of HPA axis dysfunction
  • How to treat HPA-D

Show notes:

Chris Kresser: Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. Today, we have a question from Mary. Let’s give it a listen.

Mary: Hi, Chris. I’m Mary from Oregon, and I heard that you recently did a presentation at a symposium in California with more information about evidence-based research addressing adrenal fatigue. And I think you’re going to focus of course on using diet to remedy those things. So I’m especially interested in that, and I know you’ve done some recent podcasts about over-exercising and adrenal fatigue. But I would appreciate it if you would do an updated podcast on adrenal burnout, or HPA axis dysfunction, or whatever you want to call it. So I appreciate it. Thank you.

Chris: Thanks for that question, Mary. It’s really an interesting topic. Adrenal fatigue has become a popular diagnosis amongst both patients and practitioners, at least within the functional and integrated medicine worlds. It’s really used to describe a wide range of symptoms from fatigue, insomnia, and brain fog to things like joint pain, allergies, and weight gain. If you search for adrenal fatigue online, you’ll see usually a bullet point list of pretty much every symptom that you could possibly ever experience, so very nonspecific and associated with a lot of problems.

Proponents of the adrenal fatigue concept will suggest that it affects hundreds of millions of people around the world and may be at the root of most modern disease. But the question is, does adrenal fatigue really exist? Is it an accurate representation of stress-related pathology? What happens to us when we experience chronic stress, and is it in alignment with current scientific evidence? These are questions I’ve been exploring for a very long time.

Can your adrenals really become fatigued?

When I started studying functional medicine and getting involved in this world, I heard the term “adrenal fatigue” thrown around a lot, and it’s one of those things that I think a lot of us as health care practitioners just accept, at least those of us in the functional and integrated medicine world. It’s certainly true that we see a lot of patients with stress-related issues and that chronic stress is associated with numerous health problems, so I didn’t doubt that because I had seen that both in my own experience and also with many patients. There is tons of research correlating stress with many different symptoms and diseases, but I did wonder if this idea that the mechanism that explains all of that is because our adrenals become drained and unable to produce cortisol anymore, which is kind of the fundamental idea behind the adrenal fatigue hypothesis.

I did a really deep dive into this issue in preparation for my clinician training program, and what I learned might surprise you. It definitely surprised a lot of the practitioners that I trained who have been like I was: just kind of accepting the adrenal fatigue idea without a lot of critical thinking and just assuming that it was true because it does make sense on the surface in many ways. I’ve been doing presentations for practitioners to dispel this what I call the “adrenal fatigue myth” and replace it with a more accurate conception of what’s really happening. I realized, Mary, when you asked me that question, that I haven’t actually shared this information with the general public and people that aren’t healthcare practitioners. So I wanted to take the opportunity to do that here, and thanks for giving me that excuse, Mary.

How Our Stress-Response System Works

In order to really understand this, we have to get a little bit geeky and take a closer look at some of the basic physiology and concepts here, otherwise it won’t really be possible for me to explain why the adrenal fatigue idea isn’t consistent with our current understanding of the body and how it responds to stress.

Our stress-response system consists of two primary components. There’s the sympathoadrenal medullary system (SAS) that primarily governs our immediate or short-term response to stress, and then there’s the hypothalamic–pituitary–adrenal axis (HPA axis), which governs our intermediate- to long-term stress response. These are both really complex systems, so I’m not going to bore you with all the details, but the key concept to understand here is that mechanisms that protect us in the short term from acute stress can actually become harmful or damaging over the long term. For example, let’s say you’re a hunter–gatherer and you’re out walking on the savanna and you’re confronted by a lion. Well, in that case, it’s a really good thing that your heart rate, blood pressure, blood sugar all go up, your muscles tense and your digestive and reproductive systems shut down because those immediate changes that happen help you to survive that threat.

But what happens if that system that helps us survive the short-term threats is continually activated, as it often is in the modern world? We’re stuck in traffic. We’re working two jobs, eating an inflammatory diet or using electronic media late at night. All of these things activate that same stress-response system, but those changes that all happen like, when you’re confronted by a lion, for example, that are adaptive in the short term can become maladaptive, or harmful, over the long term. The constant activation of that stress-response system erodes resilience and it depletes metabolic reserve. These are really, really important concepts to understand when it comes to understanding the effects of stress on our physiology.

The Concepts of Resilience and Metabolic Reserve

Resilience is defined as the immediate capacity of our body to respond to changes in physiological need—or to stress, to put it more simply. Metabolic reserve is basically the long-term capacity of our body to withstand stress. What happens is if we’re under a lot of stress, initially that resilience will drop. But if we have sufficient metabolic reserve, if you can think of it like a battery that’s charged, if our battery has a lot of charge, we should be able to withstand those changes fairly well or at least bounce back from those changes.

Another analogy that could be helpful is like a bank account. If you have a good balance between making withdrawals and making deposits and you’ve got a lot of deposits in a big bank account, you can withstand a period where you’re making more withdrawals because you’ve got that reserve there to back you up. But if you’re constantly making withdrawals over a long period of time and you’re not replenishing with deposits, then over time that account is going to be overdrawn.

That’s really a similar thing that happens with stress. There are a lot of things that we can do that build our resilience and metabolic reserve. Eat a healthy diet, get plenty of sleep, get adequate amounts of exercise (not too little, not too much), manage our stress, spend time in nature. All of the things that we talk about, those are metaphorical deposits into our metabolic reserve account and our resilience account. But if we’re constantly drawing that down with an inflammatory diet, not getting enough sleep, not getting enough exercise or getting too much exercise, the converse of everything that I just said, then that’s going to deplete our resilience and our metabolic reserve.

What we know when we look at the research is that there are a huge number of conditions that are associated with the loss of resilience and the depletion of metabolic reserve, and it is true that I think this is a key driver of the epidemic of modern disease. I’m just going to tell you a few of them. This is only a partial list, but:

  • depression
  • obsessive–compulsive disorder
  • alcoholism
  • diabetes
  • obesity
  • PTSD
  • hyperthyroidism
  • hypothyroidism
  • chronic fatigue syndrome
  • fibromyalgia
  • premenstrual tension syndrome
  • rheumatoid arthritis
  • asthma
  • eczema

These have all been associated with an activation of the HPA axis and that stress response and then the progressive loss of resilience and depletion of metabolic reserve.

The Origins of “Adrenal Fatigue”

Now let’s get back to this adrenal fatigue idea. It really comes from something called the general adaptation syndrome, which is a theory advanced by a pioneering doctor and researcher, Hans Selye. He was trying to describe the effects of stress on physiology, particularly in the animals that he was studying. This general adaptation syndrome that he suggested predicts what happens to the body when it’s exposed to stress. He basically argued that first you see rising cortisol, DHEA and pregnenolone hormones, stress hormones that are produced by the adrenal glands. When you’re first exposed to stress, you see all those things go up, and then over time they begin to decline as the stress is chronic or lasting. You have high cortisol at first, and then cortisol drops. It might even fall into the normal range in stage 2, and then in stage 3, cortisol and DHEA are falling below the normal range, until finally you reach adrenal exhaustion or failure, where cortisol, DHEA, and pregnenolone are all very low. That’s the typical idea.

This isn’t what Hans Selye argued, but people who saw Selye’s model and kind of took it and ran with it advanced the idea that what happened in that situation was that the adrenal glands, which normally produce cortisol, lost the ability to continue producing cortisol. The adrenal glands become fatigued, hence the name “adrenal fatigue,” and they were just over time, because of the exposure to chronic stress, they become less and less able to produce cortisol.

That’s the basic idea behind adrenal fatigue, and certainly we hear many people now saying, “Oh, my adrenals are shot.” “I’ve got adrenal fatigue. I can’t make cortisol.” People are taking supplements to increase cortisol levels because of this, including some medications like hydrocortisone to actually increase cortisol levels in the body.

The Problems with the Adrenal Fatigue Model

But there are really three primary problems with the adrenal fatigue hypothesis, and I’m just covering these very briefly because it gets pretty technical pretty quickly. I think for most people listening to this podcast, you’re mostly concerned with how this affects you and what you can do about it, maybe not so much about the terminology and why that’s important, but bear with me because I think it is meaningful and it does make a difference in terms of how we approach this, so I want to just quickly go over these three reasons that I think the adrenal fatigue concept is not accurate.

Number one, many, if not most, people with adrenal fatigue don’t really have low cortisol levels. Mary, I’ll talk about each of these in a little more detail. Number two, even when cortisol is low, it’s rarely because the adrenals are fatigued and unable to produce it. Number three, adrenal fatigue as a concept isn’t really supported by our current scientific understanding of the stress response.

1. Most people don’t really have low cortisol

Let’s go back to number one, which is that most people don’t actually have low cortisol. People with so-called adrenal fatigue don’t actually have low cortisol. Adrenal fatigue is often diagnosed by using a saliva cortisol test, and the cortisol that’s measured in saliva is in the unbound or free form. It means it’s not bound to a protein carrier. If you’ve heard of “free testosterone” or “free T3” or “free T4,” we’re talking about the same thing. It’s the free unbound form of the hormone. That is the most potent form of cortisol, but it only represents about 3 to 5 percent of the total cortisol in the body at any given time, and the rest of the cortisol is cleared by several different metabolic pathways before it’s excreted in the urine.

Again, this can get complex, but the key thing to understand here is that when we measure saliva cortisol, it’s not necessarily representative of the total cortisol levels in the body. When studies have looked at total cortisol levels in addition to free cortisol levels, they found that when people have low free cortisol, they don’t necessarily have low total cortisol. In fact, it’s more common when people have low free cortisol for them to have either normal total cortisol or even high total cortisol.

One of the reasons for this is that this constellation with low free cortisol and high total cortisol is common in obesity. Now we know that one-third of Americans are obese, two-thirds are overweight, so that’s not an uncommon thing to see. Again, the first thing is we need to be clear about what we’re actually measuring, and when we are clear about that, we see that free cortisol is not as common as is typically assumed.

Another issue is that some of the functional labs that are testing saliva cortisol in saliva have ranges that I believe are actually too narrow. I’ve often argued that the lab ranges are too broad, but in some cases, I think they’ve been revised in a way that isn’t totally supported by the evidence. That can lead to false diagnosis of low cortisol.

Another problem is how saliva is collected. When the saliva test is done in the morning, it’s really important in terms of determining the cortisol levels. Before we even wake up, cortisol levels are beginning to rise, and then right when we wake up and open our eyes and light hits our eyeballs, that leads to a dramatic rise in cortisol within the first 15 to 30 minutes after we wake up, and that’s called the cortisol awakening response. That accounts for over 50 percent of the total cortisol production during the day. It’s a major event in terms of cortisol production. What happened was that a lot of the labs that were doing this testing didn’t instruct people to take the first sample within that first half-hour period. If someone wakes up and then they wait for an hour or even two hours to do that first sample, they missed that entire cortisol awakening response—that surge of cortisol that happens early, first thing in the morning. The level that they get back will miss that surge of cortisol and it will lead to a falsely low morning level of cortisol, and they’ll be falsely diagnosed with low cortisol.

As you can see, there are a lot of problems with how we’ve been doing this. When you do the testing correctly, far fewer people actually do have low total cortisol and even low free cortisol than the testing initially led us to believe.

2. Even when cortisol is low, it’s rarely because the adrenals are fatigued

The second thing is that I mentioned was that even when cortisol is low, it’s rarely because the adrenals are fatigued and unable to produce it. Now this gets very technical very quickly too. But the first thing, I think, to say is that there certainly is a condition that does lead to the adrenal glands being unable to produce cortisol, and that’s called Addison’s disease. Addison’s is pretty rare. There are fewer than 200,000 cases a year. Even though stress is probably a factor, it’s an autoimmune disease, so it’s not a stress condition that’s wholly caused by stress.

It’s also important to note that the low levels of cortisol that are observed in Addison’s are way, way lower than what are observed in so-called adrenal fatigue. If you don’t have Addison’s, but you do have low cortisol, it’s not because the adrenals are not able to produce it. There are actually several other mechanisms that determine cortisol levels in the body and can lead to low cortisol levels, and they have nothing to do with the adrenals’ ability to actually produce cortisol.

I’m not going to go into detail on all these, but I’m just going to mention a few of them. One is downregulation of the HPA axis. When we’re exposed to stress over a long period of time, the body has some mechanisms that it uses to try to protect us from the effects of that high cortisol that would result from that stress. It essentially decreases the sensitivity of some receptors that are involved in this pathway, and that again is a protective mechanism. The body’s trying to prevent any harm coming from this exposure to high cortisol from stress, but unfortunately, that ends up leading to a decreased ability to produce cortisol in the face of future stress. That has to do with the brain. It doesn’t have to do with the adrenals not being unable to or not being able to produce it.

The second thing that can happen is cortisol resistance. If you’re familiar with the concept of insulin resistance, this is very similar. Chronically high cortisol levels can lead to cortisol resistance, and that’s caused by a decrease in cortisol receptor sensitivity. The receptors become insensitive to cortisol, and it can also be caused by a decrease in the number of receptors for cortisol. Again, that’s a protective response. The body’s trying to protect against the effects of high cortisol, but it ends up leading to low cortisol over time.

The third reason would be decreased bioavailability of cortisol at the tissue level. That can be caused by increased levels of the binding protein that carries cortisol throughout the body, and that can be also caused by an increase in the conversion of cortisol, which is the active form of the hormone into cortisone, which is a less active form of the hormone.

Those are just three of many other mechanisms that lead to low cortisol that have nothing to do with the adrenals being unable to produce it.

3. The adrenal fatigue concept isn’t really supported by our current scientific understanding of the stress response

The third reason is that adrenal fatigue is just really not supported by scientific understanding and the stress response. If you go on to PubMed, which is the clearinghouse of scientific studies database where you can search for various topics, and you type in “adrenal fatigue” in quotation marks, which means it will just search for that phrase, you’ll find about 10 results, and they’re not really impressive results either. But if you then search for “hypothalamic pituitary adrenal axis,” you’ll find about 18,000 results. The difference there is, as I said in the beginning of this podcast, there is tons of research connecting stress and disease showing that the effects of stress-related physiology are profound and can cause numerous symptoms and numerous health problems. But again, it’s because of brain or central nervous system or tissue-specific regulatory mechanisms that govern the availability of cortisol, not because the adrenals can’t produce enough of it.

Why an Accurate Understanding Matters

Okay, so let’s talk about why this matters a little bit. The first reason is that if we want to really, truly understand how to address the signs and symptoms that were previously known as “adrenal fatigue,” if you will, then we need to understand what it actually is and then what causes it, which I’ll get to in a second. In functional medicine, of course, we’re always trying to address the underlying cause of disease. If we don’t know what the cause is, we can’t be as effective in our treatment.

Second is it brings us into alignment with the current scientific evidence, and that means we can leverage the vast amount of research that’s been done on stress and the HPA axis and disease outcomes to figure out better treatments and better ways of approaching things.

Third, it leads to better treatment outcomes for the two reasons that I just mentioned and can prevent harm. For example, let’s say we falsely diagnose a patient with adrenal fatigue because we’re not using saliva hormone testing properly, and we don’t collect the sample well, and it comes back with low cortisol, and we prescribe hydrocortisone or some some herbal treatment that raises the cortisol levels. Well, if they actually have high cortisol levels instead of low, then that might not be a good idea and may make them worse and potentially cause harm. There are real reasons why this is important, and it’s not just a question of terminology and splitting hairs.

The Causes of HPA Axis Dysfunction

Let’s talk a little bit about the causes of HPA axis dysfunction. That’s really what we’re talking about here. We’re talking about a dysregulation of the hypothalamic–pituitary–adrenal axis and possibly the SAS, sympathoadrenal medullary system. It’s not as sexy as adrenal fatigue. It’s not as easy to say. We could call it “HPA axis maladaptation.” That actually is probably even more accurate because most of the changes that occur, as I mentioned, are the body’s attempt to adapt to a chronically high cortisol, but in doing so, it overshoots the target and we end up with low cortisol. We can call it “HPA axis dysregulation,” which I have argued for. HPA-D is a way we could say it in shorthand, but we can also name a specific abnormality. If the patient actually has high cortisol rather than low, we could call it “hypercortisolism,” or just “high cortisol.” Or if the patient has normal cortisol but they’re producing not enough in the morning and too much at night, we could call it “disrupted diurnal cortisol rhythm.” Again, these terms are not as user friendly, not easy to say, but they’re important in terms of improving our understanding of what’s going on.

Okay, so what causes HPA axis dysfunction? Well there are four primary causes, and if anyone is interested in reading more about this and diving into this in much more detail, especially if you’re a health care provider, Dr. Tom Guilliams wrote a fantastic book. He’s with the Point Institute, and the book is called The Role of Stress and the HPA Axis in Chronic Disease Management. It’s oriented towards clinicians and practitioners, but if you’re interested, that’s what I would suggest.

Okay, so let’s talk about the four triggers of HPA axis dysfunction as Tom describes in his book.

  1. Perceived stress

The first is perceived stress, and that is what we all think about when it comes to stress. It’s financial stress, job stress, relationship stress, and there’s a lot more to say about that, and maybe we’ll do a separate thing on that. Perceived stress is an important term because it highlights the fact that people perceive stress in different ways. Something that’s stressful for one person may not be stressful for another. There are actually positive forms of stress called “eustress” and negative forms of stress called “distress,” but we can group this together in this category called perceived stress. Then inflammation is number two, blood sugar dysregulation is number three, and circadian disruption is number four.

Most people, I think, when they think of adrenal fatigue, think of stress as being the major cause, and it’s true that it is a major cause. But part of the problem there is we tend to neglect these other three causes that can be just as significant when it comes to HPA axis disruption.

  1. Anything that causes inflammation

Anything that causes inflammation—if you have SIBO and gut issues, even if you have no perceived stress in your life, that can still cause HPA axis problems—obesity, inflammatory diet, any other issues that we know can cause inflammation or will trigger HPA axis dysfunction.

  1. High or low blood sugar

High blood sugar or low blood sugar will also trigger that, and it’ll cause problems with insulin and leptin signaling, and that can affect the HPA axis in a negative way, so that’s another issue.

  1. Circadian disruption

Circadian disruption, that refers to not getting enough exposure to light at the right time during the day and then the morning in particular, and getting too much exposure to light at the wrong times, like at night. I’m sure you’ve heard me talk about this a lot. It’s in my book. This is a growing problem in the modern world, and it contributes really significantly to HPA axis dysfunction.

We’re running out of time, and we won’t have time to go into a really detailed treatment of what to do about this, but I’ll come back to that in a future podcast. For the purposes of this show, I just really wanted to give you an idea of why the adrenal fatigue hypothesis is … it’s not really correct and what we should replace it with, and then I’m just going to briefly mention what we can do about it.

How to Treat HPA-D

Hopefully, that’s obvious now because you know what the four triggers are. We need to of course address those four triggers as the primary way of reversing HPA axis disruption.

  • This means reducing perceived stress. This is reducing our exposure to stress when that’s possible and then taking steps to manage stress when it’s not. I’ve written a ton about stress management, so we can provide some links in the show notes to help you get started with that, to keep going with that, because it’s so important. I can’t say enough about it. If a patient comes to me and they have significant HPA axis disruption, what I tell them is there is no way to supplement or eat yourself out of this alone. Those things are really important, but you really, really have to address the stress piece, the behavioral and lifestyle management part of it, or else you won’t get well.
  • Number two would be to address root causes of inflammation. Again, if you have gut dysbiosis, SIBO, parasites or fungal overgrowth, and that’s contributing to an inflammatory picture, then you have to address that before the HPA axis will improve.
  • Number three would be to regulate blood sugar. If your blood sugar is too high, taking steps to lower it like a Paleo-type of diet, possibly lower, low carb, and even keto, if necessary, would be helpful if you’ve got more of a hypoglycemic picture. Those steps still might be helpful, or you might need to eat smaller, more frequent meals, so whatever needs to be done to regulate blood sugar.
  • Then what we would call circadian entrainment, which means bringing yourself more into alignment with the natural rhythm of light and dark, making sure to get some light exposure first thing in the morning if you can, but certainly during the day, and then reducing your exposure to artificial light at night. All of those things are really important for reducing that circadian disruption that can cause HPA axis problems.

Okay, I know that probably ended up being pretty sciencey and geeky. I hope that wasn’t overwhelming or confusing, but I just really felt like it was important to give you the overview of why the adrenal fatigue hypothesis is not supported by current scientific understanding of stress and how stress affects our physiology. Hopefully this leads to a broader investigation into the causes of the symptoms known as adrenal fatigue, if you’re exploring that yourself on your own as a patient, and I’m certainly passionate about training practitioners through my ADAPT program to better understand this condition and be able to more clearly diagnose, more accurately diagnose it and then more effectively treat it.

That’s it for today, everybody. Thanks for listening. Please keep sending your questions in to chriskresser.com/podcastquestion, and I’ll talk to you soon.

31 Comments

Join the conversation

  1. Hi Chris .. great podcast on the HPA axis / adrenal fatigue. I was wondering if you will be doing a follow up podcast and dive a little deeper into the treating HPA-D, which you touched on at the end of this podcast? Many thanks Chelsea

  2. I figured out that I am adrenal resistant by my own research. 1. I have had PCOS since I was a teen. At that time I was very thin. But weight packed on after a knee injury lead to hydrocortisone treatments. That led to aditional hormonal resistance to insulin. Then my life became extremely stressful as we adopted a mentally ill child and I taught a very stressful special education program. I got caught in a stress/hormone resistance cycle that has led to lupus, celiac, chronic hives, and gout. I quit teaching. The child is now grown and out of the picture, I got the pain issues simi-resolved by having both knees replaced. I only eat a paleo/KETO diet with intermettent fasting. Working on lowering the acidity of my boxy and healing my gut by avoiding grains and sugars. But after 2.5+ years of effort, I still have a strange reaction to pain (as in little to no reaction to it). It is like my body is so overloaded by signals that it shut down l receptors. My cortisol and my females hormone levels are still high. I am borderline diabetic and need to lose 100 pounds. (I have lost 30 pounds but it has been very slow going). Another aspect to this was 10 hears of infertility treatments. Had huge breasts. They kept growing and growing. I finally had breast reduction surgery and was pregnant within 3 months. I am a hormonal mess.

  3. Regarding the awakening response, it’s pitch dark when I wake up, so I’m getting no light hitting my eyeballs. I just have a dim red light in my bedroom and my house is dark. Am I going to have low cortisol all day because I will have no surge when I wake up?

  4. Hi this is Mary from Oregon and it was my question that led to this amazing podcast! Chris thank you so much for responding to me and to so many others who are dealing with this issue. The information you provide is always clear, thoughtful, and despite what you may think, easily accessible. Even though I’m a career nurse and have a background in science and a fairly thorough understanding of human physiology, having taught nursing as well, I just want to say that I strongly support you explaining everything at the molecular and physiological level so thoroughly. You always talk about it being geeky or diving deep, but I think this is exactly the kind of information that empowers people to really understand what’s going on in our bodies. And when you have a health crisis and you have enough brain cells left to try to figure out what’s going on and how you can get real help, this kind of information is invaluable. So thank you again for responding to my question and for all the help that you’ve giving everyone in your work. You are much appreciated!

  5. Thanks for this article. Do you have a functional practioner you would recommend in London for Thyroid and SIBO? Without a recommendation from someone who has been, it is hard to figure out if a particular practictioner is good or not.

  6. I was diagnosed Secondary Adrenal Insufficiency by Endocrinologist and put on Cortef. A three month blood test of cortisol level was down to 1, at 9:00 am. Dr did not increase Cortef dosage. My early afternoon ACTH test was also low.
    I take 30 mg. Armour Thyroid generic daily.
    This was very interesting information you gave. Thank you!

    When I researched ACTH I did read somewhere about “HPA axis dysfunction as an important component in response to biological stress.”

  7. All so very interesting, informative & confusing at the same time. Maybe I’m having some type of ‘gut issue’? But my cortisol (blood test) came back low at 0.5L. (My TSH, free t4 & 3 are in range, but I have a goiter. No IR or type 2) I’m guessing I’m in the constant ‘Fight or Flight’, and have no idea why. Plus, hands/feet or cold but my body is extremely heat intolerant(?) at the same time. With a mix of so called “adrenal exhaustion” symptoms & the common Hypothyroid symptoms this is what’s puzzling to me. Again, maybe a gut issue is the root cause, maybe something else.. My Endo thinks it’s all in my head. Soooo where is that so called chill pill I’ve heard about my entire life? Apparently that’s all I need.

    Maybe another poster could shed some light on this for me? Maybe there’s a blood test or two I should have just to rule this or that out?

    • Netta,

      I can help you, but your issue is too complex to deal with on a blog.

      If you want my help, email me privately at david.pelly at hotmail.ca

      Make subject: From Netta

    • Hi Netta. Are you by chance in your late 30’s or 40’s? If so, you might be going thru peri-menopause. When your ovaries stop producing hormones, it can affect your sleep in particular among other things. The adrenals need to start taking over the production of these hormones. Some cycles you may be ovulating and others not. And if adrenals are not in tip-top shape, it can show many symptoms. You may find your sleep is more challenging before you start your cycle as progesterone plummets. Progesterone helps brings on our sleepy state. In any regard, you may want to get your hormone levels checked thru saliva testing. I personally used a supplement called Tranquility to sleep better until my adrenals strengthened a bit and I got my hormones under control thru a naturopath. Not sleeping is taxing your adrenals further and need to find a solution for yourself. Hope this gives you something to consider. Good luck.

  8. With Dawn Phenomena of disrupted circadian rhythm I realized too much cortisol was a symptom at my time of health failure.
    My Endocrinologist said ‘we don’t use the term adrenal fatigue anymore’, without offering further information, suggesting she did not understand HPAT axis disruption. That she relied on a singular, random T3/T4 blood test & did not interpret that correctly suggests that she didn’t.
    I alternately use the term adrenal fatigue or HPAT disruption depending on who I am talking with & barely consider what my glands are doing as I address root cause.

  9. Very interesting podcast – thank you!

    Is decreased bioavailability of cortisol at the tissue level included in the HPA-D and should be ‘treated’ the same way by addressing the four triggers?
    Or, is it caused by something else and therefore should be addressed in a different way?

    If you are ‘burned out’ and have very little or no energy is it then making things worse by taking supplements like adrenal cortex, even if you feel better when taking them?

    I also wonder if a low free T3 (but ok fT4 and TSH) and a total lack of energy could be a sign of downregulation of the HPA axis, cortisol resistance or decreased bioavailability?

    If you can’t answer these questions here, I would very much like you to bring them up in a future podcast if possible.

    Thank you for all the work you do!

  10. Chris, I literally can’t thank you enough for this information; especially now. I’ve become so much healthier since adopting a Paleo/ketogenic diet with Intermittent Fasting for weight loss, hypertension and pre-diabetes. My joints feel better, skin is clearer and healthier looking than it has been in years–if ever. In short, I’m thrilled with the results I keep getting and am forever grateful to all LCHF/Paleo/Keto/IF advocates.
    There is one major problem that I’ve been experiencing of late, however. It’s my sleep duration. I have very good sleep hygiene which I follow ‘religiously’, but when I lower my carb intake too much, I cannot sleep more than 3-4 hours, tops. I wouldn’t mind if that were all I needed to feel refreshed and rejuvenated, but it isn’t. A few hours after waking and getting up for the day, I feel cognitively impaired, nauseous and somewhat depressed and anxious. Basically miserable. I know there must be an answer to correct this, but I’ve reached out to those advocates I’ve come across and have received no reply. I feel like the solution is in a mere tweak or two to resolve this, but have only heard about the “honey hack” where the person takes a tsp or two of honey before bed. I tried it and it did make the “wired” feeling dissipate, but sleep wasn’t forthcoming. Then I tried it after the first awakening about 3 hours in when I need to get up to urinate. Again, it helped with the wide-awake, wired feeling, somewhat, but didn’t induce sleep.
    This podcast has given me so much hope I could just about cry, so thank you for that. I will be searching your website for any specific tips to address this lack of sleep, but if you or anyone else reading this has any advice, I would dearly appreciate it. Thanks again for the best explanation I’ve ever read for “adrenal fatigue” or HPA-D.

    • TEEDEE,

      Re: Sleep problem:

      Try having a baked potato an hour or two before you go to bed. To bake, I nuke them, approx, one minute per oz.

      I think the size of the potato depends on your size, or your weight.

      Do some experimentation.
      Start out with a 2- 3 oz and see how well you sleep.

      Help it go down with a bit of salt and kefir. (Best to make your own kefir, from freeze dried starter. Find it in good health food stores.)
      I found that the kefir found in big stores is poor quality.

      I expect that you will find some improvement in sleep by eating a baked potato and hr or 2 before bedtime.

      If you need improvement, size it up an oz. And so forth.

      Work to find your ideal point.

      Also do research on the potato diet.

      It is an interesting idea.

      • After trying the honey, I tried potato as another advised, but it didn’t work, unfortunately. If it does for some people, I’m truly happy for them. A Dr. I follow on Twitter told me yesterday that the “extra carbs” solution is not the way to go ( He reiterated the importance of excellent sleep hygiene and emphasised the importance of getting plenty of light in the morning and limiting light after 7pm (which is part of my sleep hygiene, anyway). I really appreciate your reply–thank you. 🙂

        • TEEDEEE,

          The potato worked well for me.

          I do not think you gave it a fair chance.

          I do not know your size or weight.

          As well as other health issues or factors.

          So I made a minimal suggestion.

          I am 200 lbs, and a 3-4 oz potato does the job.

          You have to keep on trying different things and ways until you find a way that works.

          Also maybe a lack of exercise could be a problem.

          Especially outdoor exercise.

          If you put in a good day of work or some kind of exercise, you should sleep well.

          Another problem that causes inability to sleep is some kind of stress issue, some sort of life problem, some sort of psychological issue or trauma.

          Worry, fear and guilt over something, for example.

          • Hi, David; for whatever mysterious reasons, I slept very well last night for the first time in a few weeks. I did nothing significant that would explain it; in fact, I only took my usual magnesium and small dose of melatonin and skipped the herbal ‘sleep remedy’ which I recently purchased and didn’t eat any of the 3 macros which have been recommended for sleep.
            That said, if the problem crops up again (which it might as I’ve been through similar weeks where I’ll get a good nights sleep, then 2 or 3 bad ones, then a decent one again..) I will give the potato hack another good try because it’s clear that you believe in it. I also couldn’t agree more about getting in some good work/exercise outdoors and fortunately, my property offers the opportunity to do so on a daily basis. I love activities outdoors and that’s one of the reasons I was so perplexed by the inability to sleep. Usually, all that fresh air and sunshine make me sleepy even earlier than my normal 10:30 bedtime. Even simply going on a picnic or spending the day at the beach makes me relaxed and sleepy without a lot of activity added in.
            I was so fed up yesterday, I told myself to forget all the rules and the sleep hygiene tips and just follow my gut as to when to go to bed, etc. I still strongly believe in excellent sleep hygiene and bedtimes, but maybe I needed to relieve some of the stress of having it not work these past weeks by rebelliously ignoring them for a day. Whether it did the trick or not, I’m not sure. I just know that I felt tired at my usual time and went to bed, but this time I woke up at 6am (I don’t use an alarm) instead of 1:30 or 2:30am. I was so happy I felt like dancing and singing as I made my morning coffee 😉 Thanks again for your concern and comments; it means a lot to me. You’re a good guy. Have a great day 🙂

            • You are welcome, TEEDEE.

              I have been through a lot myself.

              Mainstream medicine and psychology could not solve my problems.

              In fact, I learned that almost everything they know is wrong.

              They are pretty good at diagnosis and emergency care and keeping people alive. They can treat symptoms. But they cannot cure anything.

              The cause of a disease or disorder is not due to the lack of some drug.

              I had to take the unbeaten paths and seek the truth in all things.

              The truth is nothing more than the right answer to any problem.

              I have been reading books and taking courses to become my own doctor and psychologist in order to survive, since I was 15. Today I am better than I have been all my life. I was not able to do much else.

              I now know far more than most doctors and psychologists put together.

              The mainstream ones went to the wrong school.

              The truth is usually hidden and protected by many layers of lies, deception and traps to protect it from fools, swine and prostitutes. It is also often hidden in plain sight. Most people are blind to the truth.

              I did not begin to find the truth until I was told by an inaudible voice one day, back in 91 when things were really bad. The voice said that in order to find the truth, and before you begin to look for it, you have to ask that empty space in front of you, to open your mind and heart to learn what truth is, how to recognize it, and guide you to it, and teach you the truth in all things. That empty space is alive and well and all knowing. When you are ready, your teacher will appear. Ask and you shall receive. Ask non ceasingly.

              I found most of my answers in:

              The bible,
              the Oahspe,
              the Urantia,
              The Reams biological theory of ionization as applied to human health and agriculture (RBTI) ,
              German new medicine (GNM) by Dr. R.G. Hamer,
              “Dianetics, The modern science of mental health, by L. Ron Hubbard, Dr. Art Janov’s Primal therapy. Janov’s books and blog.

              Here are some links, to save you a lot of time and work and trial and error:

              RBTI: http://www.advancedideals.org
              (A.F. Beddoe: online courses on human body chemistry and chemistry balancing. Look for “human seminars”. )

              RBTI: Michael Olszta
              https://gem.godaddy.com/p/62654a?fe=1&pact=14224-140178520-8180027510-258725b4fceb50f6183a5f5028d09222f186c733
              [email protected]

              GNM: http://www.learninggnm.com (Read the entire website)

              Janov: http://www.primaltherapy.com/ Read the website and find the blog and read the blogs. Lots of invaluable information.

              Look in used bookstores to find a copy of Dianetics, the modern science of mental health. Or online.

              None are perfect. All have faults and shortcomings.

              But I was able to learn it and evaluate it and test it and find out what was true and what was not true, and what worked and what did not work, and find answers and pieces to the puzzle, by applying the prayer for seeking the truth.

              Today there is almost no problem that I cannot fix.

              There is no such thing as an incurable disease, there are only incurable people.

              • I believe it’s not only possible, but very likely that you’ve learned more than most mainstream doctors and psychologists, so bravo for that accomplishment. You’re able to help yourself and others and there are few things better than that. The books you mentioned contain ideas which are definitely faulty; with a lot of contradictions and outright misinformation, but they also contain some wise observations and can lead people to seeking their own answers from within. I don’t believe we ‘need’ outside resources to live a full, healthy human life, but they can certainly help us get there.
                I’m glad that you’ve gotten to a place in your life where you can now be both student and teacher. Best 🙂

              • Thanks for the link, Andrew; it was an interesting read. It was especially noteworthy to see sulphur mentioned as it’s the 2nd time in two days that someone has given me a link which discusses its importance to our health. I love eggs and other good sources of sulphur, but now I’ll pay even more attention to getting enough. Here’s a link to a short description of what sulphur does for us. Thanks again 🙂

                http://healthyeating.sfgate.com/major-sources-dietary-sulfur-4924.html

    • As you are LCHF try coconut oil. It is processed directly by the liver thereby reducing the need of adrenal induced cortisol to release glycogen thus avoiding fluctuating BG. The HPAT axis disruption however takes a lot longer to address.
      The increased inulin content of cold cooked potatoes may help those with gut disbiosis.

  11. I have similar thoughts, Valerie. If someone feels a lot better for taking low dose hydrocortisone, what does this mean?

  12. Mfrs of both synthetic and desiccated thyroid Rx warn of not using their drugs if you have adrenal issues – why? [Is it] because these drugs significantly stress HPA axis (e.g. hepatic over-clearance and/or desensitization of cortisol).

    To my knowledge, there are NO published, peer-reviewed, long-term (5-10-15 yr), longitudinal, placebo-controlled, double-blind studies with n > 100 non-placebo subjects indicating these drugs are safe (e.g. no HPA axis dysregulation) and effective for long-term use.

    For those taking thyroid Rx, the drug itself is the #1 stressor and thus cause of HPA-D, IMO and my data supports this.

    Chris, why do you continue to ignore thyroid Rx as a leading, if not most important, stressor and root cause of HPA-D? These drugs are iatrogenic and an atrocity to the health of the majority who take them. For those who are missing all/part of their thyroid (‘master’) gland, the only option is to regenerate the thyroid.

    If there are no long-term data showing thyroid Rx does not harm HPA functioning (i.e. looking not just at thyroid hormone levels, but HPA functioning) and many who take these drugs require significant adrenal support, including the use of hydrocortisone, then why are you and other providers not looking more deeply into thyroid Rx as a root cause instead of ‘accepting’ it as safe?

    • Linda T, I’ve been reading about thyroid issues (mostly Hashimoto’s) for a few years now, and hadn’t heard this before. Can you share more and/or link to your sources? It sounds like you’re a professional of some sort? Is there really no difference between synthetic and dessicated thyroid?

      I’m interested because I’m considering Nature-Throid, though it’s not strictly necessary, according to my labs. My doctor gave me the option. Because I didn’t want to be dependent on medication, for several years I’ve been trying to enable my thyroid to function better, but some say that a small dose allows the stressed thyroid to “rest” so I thought maybe I’d give it a try.

      I have some symptoms of cortisol being too high at certain times (early morning and evening), but I don’t have serious adrenal symptoms or fatigue. Most of my Hashimoto’s symptoms have been corrected by diet and supplements, but my metabolism is still too slow.

      • Diane:

        18yrs of research, 1st-hand knowledge of hypothyroidism. I’ve read over 1,000 complaints from other individuals and a long-time member of several different thyroid & adrenal advocacy groups w/tens of thousands of members. NO ONE returns to 100% normal; only a HANDFUL claim 85% of normal. MOST require adrenal support, which still does not return them to 100% – why?

        Thyroid Rx is iatrogenic, causing & exasperating adrenal/H-P-A axis/cortisol issues – daily over-stimulating of 1 side of the ‘axis triangle’ eventually leads to it’s dysfunction/collapse (e.g. hepatic over-clearance and/or desensitization of cortisol).

        This is why the mfrs include a warning against using their product if you have adrenal issues.

        The warning implies their product strains the adrenals/H-P-A axis functioning. Thyroid Rx is the BIG stressor that no diet, no supplements, no amount of rest or lifestyle change will correct.

        There are NO long-term (5-10-15 yr) longitudinal, dbl-blind, placebo-controlled clinical studies with n > 100 non-placebo subjects indicating these drugs are safe (e.g. no HPA axis dysregulation) and effective for long-term use; NONE showing Thyroid Rx long-term daily use safe for H-P-A functioning and that it does not harm cortisol regulation/function (e.g. hepatic over-clearance and/or desensitization of cortisol). NONE.

        Desiccated Warning from Armour Thyroid Web Site Important Safety Information http://www.armourthyroid.com/treatment.aspx :
        Thyroid hormone may increase symptoms of diabetes mellitus, diabetes insipidus, or cortical insufficiency. Appropriate adjustments of the various therapeutic measures directed at these concomitant endocrine diseases are required. [my note: the change from using cow to pig glands creates a much higher T3-T4 ratio than what humans are accustom to, increasing the likelihood for H-P-A axis and cortisol issues, IMO. also, the human body evolved over millions of years to a highly intricate system of dispersing small amts of T4/T3 throughout the day instead of a single mega-dose upon rising as prescribed by the mfrs].

        Synthetic Warning for Levothyroxine (Synthroid, Unithroid, etc.):
        USE OF THIS MEDICINE IS NOT RECOMMENDED if you have untreated adrenal gland problems, high thyroid hormone levels, or you have had a recent heart attack.

        Now some may be thinking, ‘how could this be? the drugs are FDA-approved? why aren’t sites like this one mentioning this?’. Well, look at Premarin/Hormone Replacement Therapy, an FDA-apporved drug prescribed for decades, only to finally be exposed to its harmful effects.

        Since thyroid hormone effects every single cell in the body, a 360 degree, long-term assessment, especially taking into account adrenal/cortisol/H-P-A axis functioning, is urgently needed and safe, effective alternatives provided asap. The unnecessary removal of all or parts of the thyroid gland is barbaric, needs to be stopped immediately and more accurate testing for thyroid cancer and dysfunction provided.

        Resources need to be redirected to healthy & effective thyroid tissue regeneration, the organic, natural alternative allowing one’s body to reclaim control of its own proper functioning/processing for the millions suffering … our bodies know best how to function. Finally, where are the ‘stats’ showing 80%+ are ‘back to their good old selves’ 10-15yrs after initiating daily thyroid Rx (regardless if synthetic or desiccated)? IMO, it’s just the opposite – 80%+ are NOT back to their normal selves and are dissatisfied w/their thyroid therapy.

  13. Here is the Traditional Chinese Medicine understanding of “adrenal fatigue”, written by Dr. Michael Tierra. Yes, it is worth plowing through. It does not ignore modern scientific findings.

    http://www.planetherbs.com/theory/integrating-the-traditional-chinese-understanding-of-the-kidneys-into-western-herbalism.html

    Now about your dietary recommendations. Not everyone wants to, or is capable of, following a highly restricted diet – namely, the paleo-type diet that you like. That is why, over the millennia, various peoples, virtually everywhere in the world, developed medicine and medical techniques (energy medicine, for example). People want and need to follow their traditional diets (minus the serious chemical-laced junk of today’s way of eating, of course) – but ultimately all people, everywhere, in any case will become sick one way or another, because that’s just the way things roll.

    You can tweak your diet like crazy (such as by trying to follow the paleo diets), but there are other things going on that require further treatment aside from daily diet. You yourself say this but didn’t go far enough into it, in my opinion.

    The paleo type diet is not suitable on a long-term basis for those of civilizational background, i.e., not aboriginal. It is a healing diet, for a limited time – if you can hack it – but that’s it. I recall a scientist saying this – that we need to eat according to our ethnicity.

    Your info on testing of cortisol is most informative. Many thanks.

    • Don’t understand how you can say that paleo diet is for healing only – then back to crap foods once you are healthy? What’s is restrictive about Paleo diet? you don’t eat grains. it’s not a whole food group. It’s two, three staple grains that 100s of thousands of products are made of. So if you say you don’t eat pasta, bread, baguettes, pancakes, crackers, tortellini, pizza – you don’t suddenly stop eating 7 food groups – you just eliminate ONE thing. All the other stuff that actually makes bread and pasta edible you can still eat – oil, cheese, vegetables, meats and so on.
      The other “food group” is sugars in any form ( yes, raw honey included ) unless it’s a treat – which sugars should be regardless of what diet you follow.
      The third food group are the rancid, pro-inflammatory seed oils.
      On a primal paleo diet, you can eat dairy, all kinds of meats, animal fats as well as olive oil, avocado etc. Probably any vegetable and fruit you wish, eggs.
      How is this restrictive? Because you need to make most of it from scratch?
      I’ve been paleo for perhaps 7-8 years and find nothing restrictive about it. Ok, so I need to ask for my steak to be served with salad instead of fries. Big Deal. there are places who will make fries fried in beef tallow ( yum )
      Any diet that is based on whole, unprocessed foods without the addition of grains and seed oils is probably “paleo”.

  14. What you say makes total sense, Chris. But why do I feel so much better talking adrenal Cortex & pregnenolone than not taking them? Why are they like “wonder drugs” for me?

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