Category Archives: Adrenal Fatigue


SUPERWOMANThe song I Am Woman says a lot about the strength of this gender. But what emotional and physical price do many women pay to do all the wonderful things that the song acknowledges and which very often men depend?

Client X has symptoms of fatigue, insomnia, weight gain , headaches and a series of minor illnesses. She denies being under stress and requests an antidepressant. A traditional allopathic physician would probably prescribe one. After all, she exhibits the classic symptoms of depression.

An holistic physician would not take, “No I’m not under stress,” at face value. We can better evaluate the cause of her symptoms when we take the time to listen to a client and learn something about how they live, and the challenges they face. Does she have all the above symptoms because of years of taking care of children, a husband, a job, and not getting much recognition? Is this an all-too-common “Superwoman” putting in 25-hour days and trying to lighten the load for everyone else? We may find she is dealing with the threat of unemployment, or a recalcitrant teenage child on drugs, or a parent with Alzheimer’ disease. The patient may have been living with all or some of these for some time and may not consider them particularly stressful – “It is my job.” But whether or not they are “normal,” these kinds of stresses do have an effect on the body’s system. The body reacts with the Acute Stress Response (ASR) but now it has become the Continuous Stress Response (CSR). Both put out the same adrenal hormones and cancel the non-essential functions for flight or fight. (see book: Emotional Vampires and Your Hormones……) The CSR causes many diseases due to the hormonal imbalance.

The most frequently prescribed anti-depressants are the SSRI’s, (Selective Serotonin Re-uptake Inhibitors), which have the effect of increasing the blood levels of Serotonin, a hormone that creates a feeling of well-being. This latest generation of anti-depressants (for example Prozac, Zoloft, Celexa, Lexapro, to name only a few) at first appeared to be wonder drugs, without the nasty side effects of the previous generation of anti-depressants, the MAO inhibitors and tricyclics. But after many years of their use we are seeing that these drugs too can have side effects, such as weight gain, insomnia, sexual dysfunction and with some younger people suicide and/or aggressiveness. So patient X, after a few months on conventional anti-depressant treatment, may not feel much better, or may even feel worse due to the drug’s side effects which cause more anxieties. Realize also, that taking drugs only may alleviate the symptoms and signs and negate the cause: Putting a band-aid on a large laceration

All of our endocrine (hormone) system is interconnected. If one of our hormones, for example serotonin, is “out of whack,” then probably other hormones- in trying to compensate so that the body will be in homeostasis – have also reached compensatory dysfunction. For example, Patient X may do well on restoring her serotonin levels (preferably naturally), but because of the long-term stress and lack of sleep she may also have Adrenal Fatigue Syndrome. The adrenals put out many of our hormones, especially in stressful situations. Cortisol, for example, is produced in higher levels during periods of stress to help the situation (reacting as if in fight or fight) but eventually can be depleted (Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it. Then, because more glucose is needed to provide more energy to the cells to support the increased metabolic rate during continuous stressful situations, we get the involvement that an holistic physician would consider and discuss with the patient.

If a diagnosis of depression is made there are many options. It may be appropriate to refer this client to counseling. If she is the caregiver and problem solver and general fix-everything person in the family, she may benefit from having someone simply listen to her and give her their full attention. Perhaps she has a problem saying “no” and could benefit from some assertiveness training: or perhaps she has never considered that self nurture, can be nurturing everybody; it is not selfish but necessary. Counseling has been shown to be as effective as the SSRIs for mild to moderate depression and anxiety. So has exercise, which also has many other obvious benefits. Part of the benefit is that taking the time to exercise means taking the time for self-care. It also provides an outlet to be in a different social environment and interfacing with other people.

An holistic physician would consider hypothyroidism, alone or in conjunction with perimenopause or menopause. If there is some hormonal imbalance there is a range of clinically-proven botanicals to be considered that can have the same affect as expensive patented drugs without the side effects. Also appropriate human bio-identical hormone replacement often is the answer. But also consider stress interferes with estrogen, progesterone, testosterone, cortisol, aldosterone, digestion and thyroid. (Emotional Vampires and Your Hormones….)

Patient X can learn to take care of herself by learning how to better cope with stress, or by working through emotional challenges, and by taking the time for self nurture. In so doing, she has a good chance of not having to take medicines, whether they are prescription or botanicals. Either of the latter are reality only alleviating the depression and not curing the source. Until a person comes to a conclusion of how to deal with stress and also that they deserve to have self-nurture they will not be able to create the vibrant health that they deserve. When a client says to me that they do not have time for self-nurture I make them listen to what they just told me and explaining that they are sending a subconscious message that the kids, husband, boss,etc are worth her time but she is not worth at least 30 minutes per day.

Take time to nurture all aspects of your being: physical, Emotional, mental and spiritual. A joy-filled life is Your birthright : CLAIM IT!!!

Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.”

Author: Alan J. Sault MD, ABHM

Adrenal Fatigue: symptoms and signs


-Adrenal-Fatigue S&SThis is a well organized short synopsis for the layperson to understand and be able to ask questions of those they seek for their healing. There are certain signs and symptoms that one should look for to see if low cortisol levels are developing. Keep in mind that at first the continuous, high cortisol levels are also dangerous to our well-being as I wrote about in my blog: What is Adrenal Fatigue.The physician also should have the following in their diagnostic differentiation because there are many illnesses with similar signs and symptoms so that diagnostic conclusions must be done carefully and by experienced healers. A person does not need to have all the listed symptoms and signs, only some to begin to think about stress and adrenal fatigue.

But first let us see what are the functions of  cortisol.

At healthy levels cortisol influences, regulates and moderates:

  • Blood sugar levels
  • Fat, protein and carbohydrate metabolism
  • Anti-inflammatory mechanisms (our immune system)
  • blood pressure
  • The central nervous system
  • Thyroid functioning

Elevated cortisol levels cause:

  •  Impaired cognitive functioning
  •  low thyroid and eventual hypothyroidism
  • Decreased bone density
  • Insomnia
  • Decreased muscle mass
  • Elevated blood pressure
  • Slower wound healing
  • Increased fat deposition which can lead to cardiovascular problems

Low cortisol levels cause

  • Foggy brain
  • Depression
  • Low blood sugar or hypoglycemia
  • Fatigue
  • Insomnia
  • Low blood pressure
  • Decreased immune function
  • Increased inflammation

The following are clues Adrenal Fatigue

1-morning fatigue where the person does not awaken easily and stays groggy until about 10AM.

2-from 10-12 feels awake especially after lunch,

3-starts getting a low about 2-4PM and then picks up again around 6PM,

4-with this burst they are tired again by 9-10 but if they remain up they get another energy burst until abut 1-2AM

5-best sleep is between 7-9AM,

6-during the day they need a lot of caffeine to keep going and

they  often crave salt and hyperventilate [frequent sighing and breaths]

7-liver spots [chloasma],

8-frequent colds and allergies

9-feelings of helplessness which causes more stress.

Clinical tests for adrenal fatigue:

  • Blood pressure drops >10mm/hg when going from supine to upright position.
  • The pupils cannot hold contraction when light is shone in the eyes.
  • Sergant’s sign=a line drawn on the abdomen remains white instead of turning red after a few minutes.
  • Rogoff’s sign= pain or tenderness over the adrenals when pressed. The adrenals are found below the posterior 12th rib. Just put the thumbs over them and let the patient breathe in and out.

Changes occur in carbohydrate, protein and fat metabolism, fluid and electrolyte balance, heart and cardiovascular system and sex drive. So this can lead to the below symptoms and signs. Listed also are some of the illnesses. Notice that so many of them are related to the depletion of hormones because without the proper carbohydrates, fats and protein (amino acids) the hormones cannot be made. Low cortisol also causes the intestine to promote leaky gut syndrome which does not allow normal nutrient absorption. This metabolic interference because of the adrenal influence of changing the carbohydrate, protein, fat metabolism and absorption can lead to other signs and symptoms that give clues to adrenal fatigue. But some of these can also go along with other pathologies, for example low thyroid (hypothyroidism). Low thyroid and adrenal fatigue very often comorbidities (they come on together). Hypothyroidism since the stomach cannot break down protein to amino acids so that the amino acid tyrosine cannot be made. Tyrosine hooks up with iodine to make T4. Also cortisone sensitizes the cell receptors to take in T3.

Additional Potential Problems of Adrenal Fatigue

Feeling tired despite sufficient hours of sleep, always fatigued
Weight gain
Hair loss
Reliance on stimulants like caffeine
Cravings for carbohydrates or sugars, hypoglycemia
Cravings for salt
Poor immune function
Intolerance to cold
Chronic fatigue Immune Disease Syndrome (CFIDS)


young brunette sleeping at working time.

In the mists of time the acute stress response protected our survival. For example, it readied us for fight or flight from a saber tooth tiger. Our blood pressure went up, our heart and respirations were quickened; and our non-essential functions (hormones,digestive system) were stopped since one does not need them to fight or flight. All the previous adrenal-cortisol stress reactions are to get more blood, sugar and oxygen to the needed leg and arm muscles and brain for the flight or fight response. All this took minutes and then all went back to normal. One either escaped or not. If it was the latter then there was never stress again. The exact same cortisol stress-response occurs today but now it is a continuous stress response,7days a week, 24 hours/day. The stress response depends on the adrenal glands putting out cortisol for the flight -fight response to occur.  Though we have evolved in many ways there is no stress distinction between an acute or chronic stress response. The adrenal-cortisol reaction is the same for both!

When we have the adrenal glands working overtime due to chronic stress situations at first the cortisol output is high. When high the cortisol depresses the output of many of the  hormones and the digestive system since these are not necessary for flight or fight. The adrenal glands eventually wear out like any machine that is continuously abused. Therefore, the hormones of the adrenal glands, cortisol, adrenaline, and DHEA cannot be produced. This is similar to when the pancreas is forced to put out insulin all the time due to an high output of blood sugar for fuel for the flight-fight response. Cortisol stimulates the liver to utilize the liver’s glucose stores by putting the sugar into the blood for fuel.

Cortisol is a hormone that normally is secreted from the adrenal glands between 6-10 AM. The secretion time span depends on the person’s genetics and habits of time of rising. Theoretically it is put out to help the person awaken by stimulating an energy burst of glucose (sugar). Cortisol has many functions but here we are concerned with stress.

If he/she remains in stress and the adrenal glands persistently secrete cortisol we get into a potentially pathological state. At first the cortisol stays high all the time in order to stimulate the liver to put out sugar for fuel so the person can “fight or flight.” The high sugar levels stimulate the pancreas to put out insulin constantly to push the sugar into the cells via the cells receptors, which let the sugar enter the cells. There are a few sequels to this scenario. First the cells cannot use all the sugar that the cortisol-liver (sugar)-insulin axis delivers continuously, so it pushes it into storage as fat [triglycerides]. This gets deposited in women in the thighs and buttocks and then the abdomen. In men it is usually first deposited in the abdomen and then the other areas. Another thing that can happen to some people is the insulin surge may drop the blood sugar too much so they get what is called a reactive hypoglycemia ( This is not a true hypoglycemia). This makes the person hungry, lethargic, angry-aggressive and sleepy. This hypoglycemia is an added stress to the already ongoing stress. More stress! If stress continues to stimulate the adrenal glands and therefore high cortisol levels the adrenal gland fatigues out and produces low levels of cortisol or none. Now we have true adrenal fatigue. Also the receptors on the cells for insulin get tired of being consistently hit with insulin and develop a resistance to the insulin. The sugar stays in the blood causing high blood sugar. So the pancreas puts out more insulin to push the perceived needed sugar into the cells. This vicious cycle continues causing more cell receptor resistance evolving which we call Insulin Resistance. This is the first step to diabetes melitus (Diabetes II) and the Metabolic Syndrome [once called Syndrome X]. This fact is so important that I wrote a chapter in my book dedicated to diabetes and the metabolic syndrome.

This constant outpouring of cortisol can lead to numerous other problems that are not being addressed in the conventional medical world. One is the problem of osteopenia and osteoporosis. It is known that high night cortisol levels lead to bone absorption. For example, there is a warning that is posted on corticosteroid medications [ex. Prednisone]. It states that people on cortisol-like medications producing high cortisol levels can develop osteopenia, osteoporosis and stomach-intestinal ulcers.  Instead of investigating a stress causation and therefore high cortisol levels for why the person has osteopenia or osteoporosis the physician puts them on calcium, vitamin D and sometimes synthetic hormones.

If he/she does nothing to alleviate the stress situation eventually more breakdowns in the body occur. First the pancreas cannot keep putting out insulin constantly so it just runs dry and one has full-blown diabetes II. Similarly, the adrenal gland cannot keep putting out cortisol and it runs dry, so no more cortisol. And not mentioned yet is that while the adrenal gland is putting out cortisol it cannot at the same time put out DHEA (dihydroepiandrosterone) which cells need as an anabolic [building] hormone. Cortisol is a catabolic [breaking down] hormone. DHEA hormone is also a backup for making testosterone and estrogen when a person cannot produce it due to other problems such as aging. This lack of production of DHEA is very important as another body builder and energy stimulant. It is also an adjunct in the production of testosterone and estrogen especially in peri-menopausal and menopausal females.

In summary: cortisol when being abnormally secreted from the adrenal gland constantly due to stress is known as the death hormone. This is because it was created for the periodic fleeting flight or fight encounter. To enhance this response a lot of the other hormones are diminished by the cortisol since they are not needed to run or fight. These hormones include, estrogen, testosterone, progesterone, aldosterone (BP control) and thyroid hormone. Cortisol also shuts down the non-essential digestive system, raises blood pressure and heart rate. Prescription corticosteroids are used for allergies since they block the immune  response. Well so does high cortisol levels do to stress leaving the person without a good immune system and therefore illnesses to microbe infections. Just think of the illnesses that can occur without well functioning hormones,  digestive system and immune system. Another blog coming will soon give more functions and the symptoms and signs of Adrenal Fatigue Syndrome.

No wonder a person feels terrible and starts getting different illnesses when under stress. All these hormones are necessary for ones well being and anti-aging and they need to be in a state of homeostasis (balanced). In fact, sometimes the person believes that the prescribed hormone by the physician is not working; in reality it is, but it is the person that is still not doing anything about their stress. Therefore, they are counteracting a lot of the good affects of the prescribed hormone solution whether it is one of the sex hormones or thyroid or insulin by resisting seeing a counselor for stress. (See the blog on “Stress and your well-being”).

I believe in testing ones cortisol levels by a saliva test. Testing this way is for several reasons. Cortisol by nature changes its day-night production output (diurnal production). It is high in the AM and then by noon it is dropping and by evening it is down and even lower at midnight. It starts to go up again about 5-6 AM so that it can wake one up with a sugar spurt. A blood test would tell you the cortisol level at one particular time and not give the healer the knowledge of this diurnal trend which is needed in the diagnosis of one of the two stages of adrenal fatigue- too high or too low. Having blood drawn for some people is a stress and theoretically can cause an elevation of the cortisol level. Also with the right saliva test you get a calculation of the DHEA levels which is important in the adrenal fatigue diagnosis. It is important to know the DHEA level and compare this to the cortisol in order to really help the client.