In this post, I will explain how I recovered from severe adrenal fatigue due to chronic low thyroid function using natural methods, which made a huge difference to my ability to function.  Over ten years later, I still follow the advice in this blog to keep my body and mind functioning optimally.

This post is intended to empower you to resolve your own Adrenal Dysfunction, but if you would like support please go to the Wellness Coaching page for further information on how I can help.

The 21st Century Illness

Are you tired all the time? Do you struggle to get out of Bed? Do you automatically reach for a caffeine hit to get you through the day?

Contemporary living often means a busy lifestyle of work and social commitments which cause people to neglect nutrition and sleep in favour of quick-fix stimulants. As such many of us will have gut issues (covered in a separate post) and low levels of essential minerals and trace minerals which fuel our endocrine system, causing issues with our adrenal glands.

Our adrenals are small triangular-shaped glands located on the top of each kidney, which release cortisol and adrenaline hormones directly into the bloodstream during times of stress to give your body an energy boost or to start the fight or flight response.

Contrary to popular belief, drinking coffee, black tea, energy, and cola drinks doesn’t give you energy; it simply appears to energise you by overstimulating your adrenal glands causing a rush of cortisol and adrenaline.  After the rush has worn off, within a few hours we crash and feel exhausted again, causing the temptation to repeat the cycle.

Cortisol regulates our sleep/wake cycle so it is essential to take care of our adrenal glands by cutting out caffeine, alcohol, tobacco, and street drugs such as amphetamines and cocaine.

If we spike the adrenal hormones by regularly drinking caffeinated beverages we will eventually cause adrenal fatigue, where the adrenal glands stop functioning correctly, causing insomnia at night and tiredness during the day.

This is similar to Type Two Diabetes where an individual repetitively spikes insulin production which eventually causes the pancreas to shut down permanently so that insulin has to be regularly injected. Fortunately, it is possible to recover from adrenal dysfunction.

Signs of Adrenal Dysfunction

There are signs of adrenal dysfunction that are easy to spot:
– Low cortisol in the morning: waking up having had a full night’s sleep only to feel exhausted, causing us to reach for a caffeine hit to get us going;
– High cortisol at night: we feel tired but experience insomnia.

Other symptoms can be headaches, dizziness, general fatigue, and palpitations.

If you go to your GP with these symptoms it is likely that they will not test you for adrenal fatigue and simply put you on their standard cocktail of anti-depressants, sleeping tablets, painkillers, and for women, the contraceptive pill.  This is not medicine that heals the root cause of the illness, it is simply a method for relieving symptoms whilst allowing the illness to continue untreated.

Adrenal Cocktail

Instead of reaching for coffee when we feel tired, we should drink an adrenal cocktail to support the correct functioning of the adrenal glands. This can be taken on an empty stomach on waking, mid-morning, and mid-afternoon to balance our electrolytes.

• The juice of 1/2 freshly squeezed lemon for Vitamin C and alkalising the body;
• 1/4 tsp Cream of Tartar for Potassium;
• 1/2 tsp of Acerola Cherry Powder for additional Vitamin C (Now Acerola 4:1 Extract Powder);
• 1/2 tsp of Grey Celtic Sea Salt or Himalayan Pink Salt for Trace Minerals;
• Stir all of the ingredients together and top up with warm water.

A banana contains approximately 350mg of potassium but we need 4,700 to 6,000 mg per day, depending on lifestyle. You can get this from green vegetables and the adrenal cocktail by adding Cream of Tartar.

Natural Adrenal Support

You can support your adrenals naturally, in addition to the Adrenal Cocktail, with the following supplements, most of which can be ordered at low prices from https://www.dolphinfitness.co.uk.  It is assumed that you are already cooking your own meals using fresh fruit and vegetables and that you will be supplementing in the short term until you are well.  I do not advise taking supplements as a substitute for quality, home-cooked meals.

• Avoid all processed foods, alcohol, caffeine, cigarettes, strenuous exercise*, and street drugs.
• Small but frequent meals to help balance blood sugar levels.
• Ashwagandha, two capsules per night to normalise cortisol levels.  The Good Guru Organic Ashwagandha.
• Vitamin C: 600-800mg in divided doses at breakfast, lunch, and dinner. Whole food Vitamin C eg Acerola Cherry powder is better for the body than Ascorbic Acid. Nature’s Own Acerola Cherry Capsules or Now Acerola Cherry Powder.
• Vitamin E: 1 x 4ooiu capsule at breakfast and dinner. I use ZENement Natural Vitamin E Complex because it contains mixed tocopherols which is the best form. Avoid supplements containing only the d-alpha-tocopherol.
• Pantothenic Acid 1,500 mg per day in divided doses at breakfast and lunch (not dinner).
• Niacin 25 to 50 mg.
• Vitamin B6 as Pyridoxyl 5 Phosphate (P5P) 50 to 100 mg.  Terra Nova Vitamin B6.
• B-complex capsule after breakfast and lunch. Jarrow Formulas B-Right Optimized B-Complex.
• Trace Minerals, TM Sport, 40,000 Volts Electrolyte Concentrate. Three dashes in water before and after exercise or to replace your adrenal cocktail if you are travelling.
• Siberian Ginseng for calming and normalising adrenals. Taken at breakfast and lunch, not at night.
• James Wilson recommends lots of sleep: “On weekends, or any day possible, sleep in until 0900 or later. Take a nap in the afternoon and even in the morning if you feel draggy. In the evening time enjoy yourself: read entertaining books, watch funny movies”.
• Make a point of laughing as much as possible.

* Strenuous exercise would be classed as cardiovascular such as cycling or running.  Gentle exercise such as Tai-Chi, Chi-Gung, Yoga, or Pilates is recommended.

Cortisol Saliva Test

The best way to find out if you have adrenal fatigue is to test for Cortisol using a saliva test performed four times during 24 hours.

The Genova Adrenal Stress Profile 4-point test is recommended in England: https://www.gdx.net/uk/product/adrenal-stress-profile. When checking out use practitioner code A42AQ (Thyroid UK).  Do not use Medichecks or Regenerus to test adrenal function.

Go here to fill out a form and Thyroid UK will send you your results: http://thyroiduk.org.uk/tuk/testing/genova.html

The test is very sensitive so there is an extensive list of things to avoid before taking the test. Allow two weeks for some medications. Be sure to read the following list of medications and foods to avoid before taking the test, including chocolate and caffeine: https://stopthethyroidmadness.com/supplements-and-meds-which-affect-adrenals/

Interpreting 4-Point Cortisol Test Results

Post Awakening should be about 40 (the highest result)
+ 4-5 hours should be about 12.32
+ 4-5 hours should be about 4.75
Prior to Sleep should be EXACTLY 0.33

DHEA will adjust when cortisol is addressed.

Post Awakening should be at the literal top of the range (the highest result).
11:00 should be in the upper quarter or a quarter below the top.
16:00 – 17:00 should be mid-range.
23:00 to midnight should be at the very bottom

Patients with a Low, Low, Low result would take Thorne Adrenal Cortex Extract (ACE) three times per day to support the lows.

High cortisol at night would be brought down with up to three Holy Basil capsules before bed.

Thorne Adrenal Cortex Extract

Thorne Adrenal Cortex Extract is recommended because it doesn’t contain the whole adrenal gland, just the cortex. Any supplement that is described as an ‘adrenal glandular’ is likely to contain the whole gland which also contains adrenaline which you don’t want.

How I Dosed ACE

Dose 1: wake up time 06:00
Dose 2: 10:00
Dose 3: 14:00
Dose 4: no later than 19:00

• Start with 3, 2, 1, 1 at 4 hourly intervals if you have 4 lows, or if you have 3 lows, you would dose the last one before 19:00.
• On day 6 of a new dose start DATs for five days.
• Start on day 6 of a new menstrual cycle avoiding ovulation and menstruation.
• The average should be 0.2F apart or 0.16C.
• Increase the dose by 1 capsule if the fluctuation is more than 0.16C.
• If a raise causes worse unstable averages then the dose is too high. Reduce by 1 capsule and then hold for 5 days before testing.
• If stable averages are never found time to check Aldosterone and treat.
• For stress dosing add one capsule at any time during the day if you need it. Don’t do DATs during stress dosing.
• Stay on it for 6 to 12 months while you are sorting out your other vitamin and mineral deficiencies using Stop the Thyroid Madness.

How I Increased the Dose

My starting dose was: 3/2/1/1
DATs were unstable so I increased to: 4/3/2/1
DATs were unstable so I increased to: 5/4/2/1 – Once I started taking 5 pills I bought ProThera Adrenal Cortex which has 250mg in one pill.
DATs were unstable so I increased to: 5/4/3/1
DATs were unstable I increased to: 6/4/3/1. If you need more than this then you might need to try HC.

Weaning ACE

• Stay on ACE for 6 months to two years.
• If DATs are stable then maintain your dose.
• If DATs become unstable, you can reduce.
• 1st reduction comes from the afternoon dose. Reduce that by 1 pill per week.
• 2nd reduction comes from your morning dose.

Temperature Test

You can determine your thyroid and adrenal status by following Dr. Rind with a temperature graph–doing your Daily Average Temps. You simply take your temperature three times a day, starting three hours after you wake up, and every three hours after that, to equal three temperature readings.  If you have eaten or exercised right before it’s time to take your temp, wait 20 more minutes.  Then average them for that day.

Do this for AT LEAST 5 days. If your average temp is fluctuating from day to day more than .2 to .3 (with a lean towards .2), you need adrenal support. Again, your daily average temps should lean towards the .2 when on enough cortisol for your needs.

Summary from Dr. Rind: If your temps are fluctuating but overall low, you need more adrenal support and thyroid. If your temps are fluctuating but averaging 98.6, you just need adrenal support. If it is steady but low, you need more thyroid and adrenals are likely fine. (We note that mercury thermometers are the most accurate.)

For those already on cortisol, the above temperature test (comparing at LEAST 5 days of averages) is ideal to know if you are on enough cortisol for your needs. In other words, if any daily averaged temps are more than .2-.3 from another day’s, you are not on enough cortisol, patients have learned (most of those daily averages should be .2 from each other). Overshooting your cortisol supplementation can also cause this instability.

***Women: if you are still menstruating, it’s best to do your Daily Average Temps started at the end of your period i.e. away from your mid-cycle or ovulation.

Waking in the Night

Unfortunately, Medichecks had started not providing an accurate figure for the before bed reading so I didn’t know if my night cortisol was high or low. When I started taking ACE I started waking between 0300 to 0500 which I didn’t experience before. Early morning waking can be caused by high night cortisol causing an early morning low or by low night cortisol dropping even lower. I had to it work out via trial and error with different supplements, which I don’t recommend. I started with the low night cortisol supplements and after three weeks I realised that taking ACE at night wasn’t helping me. I then switched to Holy Basil and PS from the high-night cortisol supplements and started getting better results.

Low Night Cortisol

This can be helped by taking one ACE when you go to sleep. Try for three to five days and if that doesn’t work increase to two. You can also try having a small snack at bedtime such as oatcakes with butter and nut butter so you get some protein and fat which will stop your blood sugar levels falling in the night.

High Night Cortisol

To lower high cortisol we chose one of these sets of supplements, taken 1 hour before each of the highs increasing every three to five days until we have no symptoms. The goal is to sleep through the night and wake up refreshed.

For a night high try first: Holy Basil & PS100 (soy-free). Up to 3 Holy basil and 5 of PS100. I started with one Holy Basil and one PS100 which I took one hour before bed.

If I couldn’t sleep I raised by one of each, every 3-5 days until there were no symptoms of insomnia.

The key to lowering high cortisol is to increase the dosing until symptoms reduce. There is no max to the number of holy basil and ps we take. If you have very high results, you can expect to take multiple pills of EACH supplement at each high. We increase until we have no symptoms.

Night highs can be very stubborn so don’t be surprised at the number of supplements needed to lower a night high. We increase until we have no symptoms.

This page explains high cortisol. http://stopthethyroidmadness.com/ps/

Mix of Highs and Lows

Ashwagandha is an adaptogen, it ‘normalises’ cortisol levels when there is a mixture of highs and lows. Adaptogens are only helpful for a mixture of highs and lows or just highs. For adaptogens to be effective, the results need to be a combination of slight lows and slight highs.
https://stopthethyroidmadness.com/adrenal-wisdom/

Hypothyroidism (Underactive Thyroid)

Stop the Thyroid Madness says that 50% of thyroid patients have a cortisol problem because their hypothyroidism has been left untreated, causing the adrenal glands to take over which initially causes high cortisol. As they get overworked the cortisol starts to lower. Low cortisol causes fatigue and high Reverse T3 which means the brain doesn’t get the T3 it needs to feel better. Increasing doses of NDT becomes problematic until the adrenals are healthy.

Iodine & Mercury

Iodine and mercury also play a role in adrenal function. High levels of mercury accumulate in the body from amalgam fillings, vaccines, and eating certain fish causing damage to the adrenal, thyroid, and methylation functions, which causes adrenal insufficiency.
Mercury is known to be able to block cortisol synthesis by acting as an oxidant and therefore exerts stress on the antioxidant system, causing low cortisol levels. Because iodine opposes mercury at high levels it should support the antioxidant system. This means that by expelling mercury from the body adrenal function can be restored, thus improving cortisol levels through better cortisol synthesis.

Iodine only acts as an antioxidant at high doses when there is enough excess to produce an antioxidant lipid called delta-iodolactone, which is 300 times more powerful than Vitamin C. The body does not make it when there is insufficient iodine available so it is thought that a dose of over 100 mg would be required. At high doses, the antioxidant effect starts enabling iodine to support the adrenals and reduce cortisol levels by opposing the strong toxic effects of mercury.

T3

In his book ‘Recovering with T3’ Paul Robinson talks about the Carcadian Method he devised which uses T3 to heal the adrenals. You can do this instead of using ACE. This is helpful if you have high Reverse T3 and low cortisol because it allows you to sort both out at the same time. https://www.facebook.com/recoveringwitht3

Further Reading

https://stopthethyroidmadness.com/adrenal-info/
https://stopthethyroidmadness.com/adrenal-wisdom/
Low Cortisol: https://stopthethyroidmadness.com/adrenal-info/symptoms-low-cortisol/
High Cortisol: https://stopthethyroidmadness.com/ps/
List of supplements that affect test results: https://stopthethyroidmadness.com/supplements-and-meds-which-affect-adrenals/
Aldosterone: https://stopthethyroidmadness.com/aldosterone/
http://steppingstonesliving.com/adrenal-may-be-issues/
http://www.livingnetwork.co.za/lifestylefunctional-medicine/hormones/adrenal-fatigue/
‘Adrenal Fatigue: The 21st Century Stress Syndrome’ by James L Wilson.

Supplements to Avoid Before Cortisol Saliva Testing

These supplements will give a false reading about our adrenal profile:

• 5-HTP (serotonin precursor)
• Adrenal glandulars
• Adrenal Cortex 
• Ashwagandha
• Asthma supplements (over the counter)
• Astragalus
• Caffeine (from your coffee, tea or certain sodas, for example)
• Cold supplements (over-the-counter with ephedrine and pseudoephedrine)
• Cordyceps
• DHEA in higher amounts (it’s recommended to be off all DHEA for at least 3 days, says ZRT)
• Flonase
• GABA
• Holy Basil
• Insect bite sprays or creams that contain hydrocortisone
• Jujube
• Kava kava
• Licorice Root
• Maca 
• Magnolia root extract
• Melatonin
• P5P–the active form of B6 (could lower cortisol in some)
• Paba
• Pregnenolone
• Progesterone  (in high doses, can raise cortisol)
• Rhodiola
• Phosphatidyl serine (PS)
• Relora
• Schizandra Berry
• Siberian Ginseng (Eleuthero)
• Theanine
• Valerian
• Zinc

• HC (Hydrocortisone like Cortef and other brands)
• Prednisone or Prednisolone
• Medrol (aka Methylprednisone)
• Florinef
• Anti-depressants (whether Tricyclic or SSRI)
• Anti-anxiety meds, aka Benzodiazepines or Benzo (Xanax is an example)
• Antibiotics
• Blood Pressure medications like Spironolactone (Aldactone and CaroSpir)
• Clomid (Clomiphene)
• ADHD meds (Adderall for example)
• Beta Blockers (Lopressor or Toprol XL, Atenolol or Tenormin, Labetalol like Normodyne and Trandate)
  
• Asthma prescription meds or sprays
• Sleeping Pills (such as Lunesta, Ambien)
• Pain killers for arthritis
• Pain killers for Migraines (aka Imitrex)
• Compounded Progesterone 
• Lyrica/Gabapentin (See this)