Adrenal Fatigue and Blood Pressure Symptoms – Part 1

By: Michael Lam, MD, MPH

Introduction to Adrenal Fatigue and Blood Pressure Symptoms

Although Adrenal Fatigue may be difficult to detect clinically, careful attention to blood pressure symptoms can be a clear sign the body is in distressBlood pressure is an important indicator of adrenal health and function. Mild adrenal weakness is usually accompanied by normal to high blood pressure symptoms. As Adrenal Fatigue advances, low blood pressure, at rest or related to posture becomes more prevalent. This paper will attempt to examine how a weak adrenal can drastically alter the blood pressure landscape in the body. In particular, we will examine the physiology behind low blood pressure within a setting of advanced Adrenal Fatigue and the wide variety of low blood pressure symptoms such as dizziness, lightheadedness, orthostatic hypotension and heart palpitations that accompany this state.

Blood Pressure Basics

Blood pressure is the force exerted by circulating blood on the walls of blood vessels. It constitutes one of the key vital signs of life, along with heartbeat, rate of breathing, and temperature. Blood pressure is generated by the heart pumping blood into the arteries and is regulated by the response of the arteries to the flow of blood.

A person’s blood pressure is expressed as systolic/diastolic blood pressure, for example, 120/80. The systolic blood pressure (the top number) represents the pressure in the arteries as the muscle of the heart contracts and pumps blood into them. The diastolic blood pressure (the bottom number) represents the pressure in the arteries as the muscle of the heart relaxes after it contracts. Blood pressure is always higher when the heart is pumping (squeezing) than when it is relaxing.

Systolic blood pressure for most healthy adults falls between 90 and 120 millimeters of mercury (mm Hg). Diastolic blood pressure falls between 60 and 80 mm Hg. The commonly accepted guidelines define normal blood pressure as lower than 120/80. Blood pressures over 130/80 are considered high.

Unlike high blood pressure, low blood pressure is defined primarily by particular low blood pressure symptoms and not by a specific blood pressure number. Low blood pressure is not defined by blood pressure readings below a certain threshold. Vegetarians, for example, generally have low blood pressure and at the same time are quite healthy and asymptomatic. Some individuals may have a blood pressure of 90/50 with no low blood pressure symptoms and therefore do not have low blood pressure clinically. However, others who normally have high blood pressure may develop low blood pressure symptoms if their blood pressure drops to 100/60.

When the blood pressure is not high enough to deliver adequate blood flow to the organs of the body, the organs may be damaged. Low blood pressure symptoms or signs of insufficient blood flow to the brain/brain cells include lightheadedness, dizziness, or fainting.

If the blood pressure is already low, standing can make the low blood pressure symptoms worse, to the point of causing severe dizziness and even fainting episodes. This is called orthostatic hypotension. Under normal conditions, the body compensates rapidly for the low pressure created by standing using various automatic responses mediated by the autonomic nervous system (ANS). If there is dysfunction in the ANS (as frequently seen in advanced Adrenal Fatigue) orthostatic hypotension may be exhibited.

Adrenal Fatigue and Blood Pressure Symptoms

Dizziness and lightheadedness can be attributed to low blood pressure symptoms in adrenal fatigueAdrenal Fatigue should not be confused with another medical condition called Addison’s disease, where the adrenal glands are not functioning. While Addison’s disease is often caused by autoimmune dysfunction, Adrenal Fatigue is largely caused by stress. Adrenal Fatigue is the non-Addison’s form of adrenal dysfunction in a sub-clinical form. If you have symptoms such as tiredness, fearfulness, allergies, frequent influenza, arthritis, anxiety, depression, reduced memory and difficulties in concentrating, insomnia, feelings of being worn-out, and the inability to lose weight after extensive efforts, you may be suffering from Adrenal Fatigue (technically known as hypoadrenia).

Typical blood pressure of a person in Adrenal Fatigue ranges from normal to high in early stages and then progresses to low in later stages.

When the body is under stress, blood pressure usually goes up first as the body releases chemicals that raise blood pressure. This, in turn, sets off a series of compensatory responses resulting in normalization of blood pressure if the body functions are intact and no symptoms surface. Dysfunction of such compensatory mechanisms leads to persistent high blood pressure. This picture changes drastically, however, if because of stress, the adrenals become exhausted and are unable to mount a compensatory response. In this case, blood pressure usually drops below normal as the compensatory mechanism fails. This is especially prominent during postural changes.

Blood pressure in a normal person usually drops as a person stands after lying down due to gravitational forces. This drop immediately triggers the ANS, which causes the blood pressure to return to normal accounting for some overshoot. The rise in pressure on standing usually ranges from 10-20 mm Hg. This overshoot normalizes in a short time and the overall blood pressure returns to normal. A healthy person will not feel this behind the scenes automatic compensatory response under normal circumstances. If the blood pressure drops instead of rises when rising, it is called postural hypotension. There are many causes of postural hypotension, from dehydration to heart disease. It is important to have a thorough conventional medical investigation if the symptoms are clinically significant.

Blood pressure can be low at rest and not considered abnormal. Many have low resting blood pressure under 90/60 and function very well.

The key determinant of whether low blood pressure is clinically significant is whether it is accompanied by symptoms, and whether or not it is postural related.

Low blood pressure symptoms include dizziness and lightheadedness. In Adrenal Fatigue, low blood pressure usually occurs at rest. However, it can be more prominent when there is postural change. In severe cases, sufferers cannot maintain a standing posture for an extended time without sitting down. Multiple trips to the emergency room and extensive workups are not uncommon. Conventional investigative studies are often unremarkable and futile while blood pressure symptoms become more pronounced over time as Adrenal Fatigue progresses.

The key hormones responsible for blood pressure regulation in the Adrenal Fatigue setting are aldosterone and cortisol. Both are low in advanced stages of Adrenal Fatigue such as adrenal exhaustion. Aldosterone is a hormone secreted by the adrenal cortex, which is part of the rennin-angiotensin-aldosterone system (RAS), which regulates blood pressure. Low cortisol leads to low blood pressure symptomsCortisol is a hormone that is secreted by the adrenal cortex under the direction of the Hypothalamus-Pituitary-Adrenal (HPA) axis and is a main anti-stress hormone. Low aldosterone and cortisol levels both lead to low blood pressure symptoms. When the blood pressure drops, blood flow to the brain reduces. A person becomes dizzy and lightheaded. The body then automatically activates its emergency repair system. The ANS is activated as a compensatory mechanism, with associated blood pressure symptoms such as heart palpitations, increased heart rate, skin pallor, increased strength of each heartbeat, increased respiratory rate, and fainting in severe cases.

Common Causes of Low Blood Pressure

The following are important causes of low blood pressure that need to be investigated prior to considering Adrenal Fatigue as the culprit.

Dehydration. Dehydration reduces the volume of blood and reduces cardiac output (the amount of blood pumped by the heart). It is common among patients who have prolonged vomiting, diarrhea, nausea, and Adrenal Fatigue. Paradoxically, dehydration is also a common cause of high blood pressure as the body may overcompensate by constricting blood vessels in order to prevent reduced low pressure in early Adrenal Fatigue and normal people alike. In fact, taking more fluid can be quite helpful in the majority of essential hypertension cases in its early stages.

Heart disease. Heart disease such as weakened heart muscle, pericarditis, bradycardia, arrhythmias, heart block, and tachycardia can also lead to low blood pressure as the heart is unable to maintain the stroke volume to supply adequate blood flow to the body. Arrhythmia is more prevalent in those with ANS dysfunction. Persistent overtones of the SNS increase the release of norepinephrine. Chronic increases of norepinephrine can lower the heart’s threshold for cardiac arrhythmia, which is commonly seen in Adrenal Fatigue.

Medications. Medications such as calcium channel blockers, beta-blockers, and digoxin (Lanoxin) can slow the rate at which the heart contracts. Elderly people are especially susceptible. Medications used in treating high blood pressure can excessively lower blood pressure and result in symptomatic low blood pressure as well. Water pills (diuretics) such as furosemide (Lasix) can decrease blood volume by causing excessive urination. Medications for adrenal fatigue treatment of Parkinson’s disease, such as levodopa-carbidopa (Sinemet), and medications used for treating depression, such as amitriptyline (Elavil), erectile dysfunction (impotence), such as sidenafil (Viagra), vardenafil (Levitra), and tadafil (Cialis) when used in combination with nitroglycerine, can cause low blood pressure.

Less common causes include septicemia, alcoholism, diabetes, shock, kidney disease, vasovagal reaction, micturition syncope, anaphylaxis, and certain rare neurological syndromes such as Shy-Drager syndrome that damage the ANS, and Addison’s disease.

In the absence of any of the above-mentioned causes after a full conventional medicine investigation, Adrenal Fatigue should be considered.

We shall now examine each of these three major contributors to blood pressure dysregulation in Adrenal Fatigue aldosterone, cortisol, and the autonomic nervous system (ANS) in detail. These three form an intricate web of interdependency and interactions that ultimately determine blood pressure.


Anxiety can cause many blood pressure symptomsAldosterone is a chemical that regulates the amount of salt in the body. It is a very specific compound responsible for maintaining the concentration of sodium and potassium inside and outside the cell. This in turn has a direct effect on the amount of fluid in the body and thus blood pressure.

It is manufactured in the adrenal cortex under the direction of another hormone called ACTH (adrenocorticotrophic hormone). ACTH is produced by the anterior pituitary gland. ACTH stimulates the adrenal cortex to secrete a wide variety of hormones including aldosterone as well as cortisol. Like cortisol, aldosterone follows a diurnal pattern of secretion, peaking at 8 a.m., and at it’s lowest from 12-4 a.m.

It is important to note that in our body, sodium and water go hand in hand. Where sodium goes, water follows. As the concentration of aldosterone rises in the body, the concentration of sodium and water rises; thus more fluid is retained in the body and blood pressure rises. Conversely, when the level of aldosterone lowers, the amount of sodium and water in the body is reduced. Therefore, the blood pressure goes down.

As mentioned earlier, aldosterone is part of the rennin-angiotensin-aldosterone system (RAAS) that is responsible for regulating and maintaining sodium balance in the body. Dietary sodium restriction stimulates RAAS activity, while sodium loading reduces the RAAS activity.

Along with the SNS, the brain, therefore, has two primary regulatory systems that it relies on to maintain appropriate levels of blood pressure, cardiac filling volume, blood volume, and potassium/sodium balance in the body.

Unlike cortisol, aldosterone does not have its own negative feedback loop when there are excessive amounts. If the aldosterone level is too high, aldosterone receptor sites are down regulated and its sensitivity to aldosterone is reduced. In the early phases of Adrenal Fatigue, the amount of cortisol and aldosterone increases in our body due to the ACTH stimulatory effect from stress. As a result, the sodium and water are retained in the body with a feeling of being bloated. The baro-receptors (receptors that are sensitive to pressure) of the blood vessels are triggered and blood vessels go into a relaxation mode automatically, which is regulated by the ANS. This auto-regulation helps to maintain a stable blood pressure at a time when the total fluid volume increases due to high levels of aldosterone triggered by stress. With stress, the adrenal glands also secrete another hormone called epinephrine. This hormone constricts the blood vessels and increases blood pressure in order to ensure that our brain has adequate blood flow and oxygen to help us deal with impending danger. The sum reaction of aldosterone and other chemical messengers including cortisol, norepinephrine, acetylcholine, and epinephrine ultimately decides the final blood pressure at any point in time.

During the early stages of Adrenal Fatigue, the resulting blood pressure is often normal if all bodily functions are well balanced. If the body is unable to overcome the aldosterone and epinephrine response, then the blood pressure is elevated. It is common to find many under stress experiencing increases in blood pressure.

Strong black tea's stimulatory nature can trigger dysregulated blood pressure symptoms in Adrenal Fatigue sufferers

As Adrenal Fatigue progresses to more advanced stages such as adrenal exhaustion (the third stage of Adrenal Fatigue), the amount of aldosterone production reduces. Sodium and water retention is compromised. As the fluid volume is reduced, low blood pressure ensues. Cells become dehydrated and turn sodium deficient. Hydration is needed to return the body to proper function. Coffee, alcohol, and tea (with the exception of herbal tea) should be avoided.

Many with adrenal exhaustion report a state of low blood pressure as well as salt cravings. The low blood pressure is due to the reduced fluid in the body. Salt cravings are caused by the body’s absolute deficiency of sodium state. Both are due to the lack of aldosterone. In order to compensate for this, potassium is leaked out of the cells so that the sodium to potassium ratio remains constant. The loss of potassium is less than that of sodium, and as a result, the potassium to sodium ratio is increased. This imbalance causes another set of metabolic problems, which further complicates the picture.

Those with adrenal exhaustion often have a low body fluid volume accompanied by salt cravings due to an absolute deficiency of sodium as well as a normal to high potassium level. While lost fluids should be replaced, it has to be done carefully and slowly. When the fluid is replaced too quickly without adequate sodium, the amount of sodium in the body may become diluted, resulting in an even lower sodium concentration. Sometimes the replacement is gradual but the body over-reacts, leading to sub-clinical dilutional hyponatremia. Laboratory measurement of common electrolytes may be normal but patients may be presented with full-blown signs of hyponatremia, including confusion, lethargy, nausea, headache, seizure, weakness, and restlessness. Those in this state may find themselves visiting the Emergency Room for the many of these disturbing symptoms only to be told that all is normal after extensive workups.

The body is in turmoil and confused. Using its crude compensatory mechanism to maintain homeostasis to ensure survival of the key organ systems such as the heart and brain first, the rest of the body is thrown into disarray. Secondary function such as electrolyte replenishment takes a back seat and its modulation is compromised. Without a fine modulation mechanism in place, the body goes thru wild swings. The body gets easily dehydrated. If its overall fluid load is not maintained, sub-clinical dehydration occurs and symptoms of adrenal exhaustion worsen.

A relatively easy tactic of increasing blood pressure is simply to take in more salt and water. Salting food liberally as well as taking salt-water drinks can be very helpful. Sea salt is better than table salt because it contains trace minerals. Drinking more water will increase blood volume. This helps those who have chronic hypotension, chronic orthostatic intolerance, neurocardiogenic syncope, and POTS.

Many Adrenal Fatigue strategies may help blood pressure symptomsAlthough there are small percentages of people who are sensitive to sodium and develop high blood pressure, the vast majority does not experience an increase in blood pressure, even with moderate salt intake. Those with low blood pressure may see a temporary increase in blood pressure when sodium is added to their diet. Their energy also increases. If heart function is normal, there is no fluid retention, and no signs of edema or other symptoms suggestive of salt sensitivity, then a salt increase in the healthy person will not elevate blood pressure to more than 140/90 (normal being 120/80 mm HG). If the adrenals are weak, increasing salt intake will often enhance adrenal recovery. As the adrenals become stronger, the desire for salt reduces, and excessive salt may make one feel nauseated, especially if the salt is taken with water rather than from salting food. In fact, this is one indication that the adrenal functions are improving.

For some, this replacement is not without complications. The body can sometimes over-react to fluid replacement and trigger a state of sub-clinical dilutional hyponatremia (with confusion, headache etc.) while laboratory electrolyte level is normal. Maintaining the proper balance of solute and fluid requires extensive clinical experience in such cases.

Herbs such as licorice root (Glycyrrhiza glabra) have small blood pressure raising properties but can also be stimulatory; therefore, only small doses should be considered. Harmful herbs to be mindful of include Ephedra (Ma Huang), cola nut or strong black tea as these are very stimulatory in nature and may trigger long-term addiction and withdrawal issues in addition to being known for triggering adrenal crisis. In severe cases, drugs that promote retention of sodium by the kidneys, such as Florinef, may be required.
Read Part 2 Now!

© Copyright 2013 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

Yes. Potassium also regulates sodium. Which in turn, regulates your blood pressure.

Although Adrenal Fatigue may be difficult to detect clinically, careful attention to blood pressure symptoms can be a clear sign the body is in distress
5 -
I was interested to read your observations on how acupuncture, massage and various herbal supplements can be too much for someone suffering from adrenal fatigue to cope with. I share this view, since they all caused additional crashes when I tried them, before I knew I had AFS.


  • Tom says:

    I’ve gotten a lot better over the last 5 years by doing a lot of things. One thing I’ve done is take one teaspoon of salt with 3 oz of water and 6 oz of apple juice with 100% vitamin c. When I take the salt with apple juice my mind automatically becomes more clear and I have more energy. I take the salt with apple juice ever 2 or 3 hours 3 times a day. Thanks for the information.

  • Lyn says:

    How can you tell if low bp is normal or is the result of something else happening beneath the surface?

    • Dr.Lam says:

      A detailed history by someone who knows physiology well is the best place to start.

      Dr. Lam

  • Myra says:

    Is there a connection with aldosterone and potassium? For example, will increasing the intake of potassium help with balancing the salt levels?

    • Dr.Lam says:

      Taking potassium supplementation needs to be done carefully under supervision because it can quickly make you worse.

      Dr. Lam

  • Jess says:

    I am underweight, dealing with a chronic infection in my intestines and multiple deficiencies. For the past month by body has felt like it’s in a constant state of panic, regardless of external stressors. i have always had normal BP, but recently at two dr’s appointment they said my BP was high, and my standing BP showed signed of adrenal dysfunction. I do recall a fairly recent test that said I had high aldosterone. What is going on? I am not in a good state of health, and would appreciate any insight you might have

  • Shelly says:

    How does salt help with adrenal recovery?

  • Sophia says:


    What can you recommend for someone on florinef due to low BP and resulting tachycardia trying to wean off of florinef and find more natural ways to increase blood pressure and thus decrease chances of fast heart rate?

    • Dr.Lam says:

      Trying to adjust medication can only be done with your doctor at the right time if needed. Florinef is a strong medication not to be taken lightly, and there can be many complications during any wean off of it if not carefully done.


  • Samara says:

    Does a cleansing sauna make adrenal fatigue related blood pressure problems get worse?

  • Bendy_Clutz says:

    Very interesting article..
    I’m a nurse and don’t think I will ever get a good handle on the RAAS system lol =)
    Ive had POTS for 3 1/2 years nearly- (I suspect I might have Hyper POTS as I have several of the symptoms but my doc isn’t interested in doing much). I’m on florinef and propranolol.

    So I’ve had pretty significant weight gain since going on Florinef- 20lb in the first year (0.1mg/day) and 10 more lb in the 4 months since he increased the dose to 0.2mg. While I’ve had a good response to my HR (WAY less variability and rarely even over 100 now) but in addition to the weight gain, I’ve had a decent increase in my BP both supine and standing… Supine pre-florinef was 90’s/50’s and now its 110/70 or so.. but sitting and standing it’ll go up to 140’s/100. I often still FEEL Potsy even when my HR isn’t bad too which is annoying. I also wear 30-40mmgh compression hose waist high and drink 3L of fluid/day. And Pre and Post florinef salt helped both my BP and my HR pretty decently. (Caffeine also drops my HR but increases my BP for what that’s worth).
    I get that I’m retaining more salt and fluid hence the higher supine BP and wt gain, but I don’t get why my HR is better but my orthostatically high BP is worse if I should be making less adrenaline d/t the overall better fluid volume (and yet I’m still symptomatic though not as bad as I was).

    My doc doesn’t seem to understand POTs nor does he care too much about the ins and outs.. when I asked about clonidine and labetolol he was hesitant to try me on either one.. choosing to just up my florinef (which HAS helped the HR side of things…)

    I’m not sure what I should ask about or what to ask to test… My body is stupid. lol I’ve been doing acupuncture for a different condition with fairly decent results (tho did NOT respond well to too many needles- she had to cut way back or I’d get these bad dizzy spells and feel awful). …
    I don’t get what my adrenals are trying to do…

    • Dr.Lam says:

      Your adrenals may be telling you to reduce putting it on an excitation mode, and that can include acupuncture. We coach many people like you, and the key to recovery is really knowing what the body wants to start.


  • Tera says:

    Is it better to address BP with meds or try natural supplements?

    • Dr.Lam says:

      It depends. In an acute situation, meds are fast acting. If you have a choice, and natural is an option, that should be considered.


  • Lori says:

    I’ve always been told by my doctors that my BP is low but that is okay so I always assumed it was more of a good thing.. maybe not though?

  • Tony says:

    Can salt interfere with BP medications?

    • Dr.Lam says:

      Yes, salt can interfere with BP medications. You need to check with your doctor first if you have BP issues.

      Dr Lam

  • Priscilla Edwards-King says:

    are you in private practice, available for consultation? What state are you located in? I am very interested in your medical approach. Most sincerely,

    • Dr.Lam says:

      We are in Southern California and we have a telephone based nutritional coaching program. See my website for more detail under our services.

      Dr Lam

  • Bret says:

    If my BP is unstable and I take BP meds should I still try and take salt?

  • Kenzii says:

    I had adrenal fatigue for a few years I put lots of weight on tummy and couldnt tolerate bright lights and had hollow cheeks.. Then I seemed to recover and it would happen again.. Anyway one period in my life I had extreme stress and I lost weight I couldnt eat much and slept lots. Eventually I went to A&E and blood pressure was slightly raised I had sickness pain in lower back etc.. I was diagnosed with Primary Addisons disease. Now I am on medication I take 12.5mg Hydrocortisone a day, 10mg and Fludrocortisone in the morning and 2.5mg Hydro at 6pm. When I check my BP in the morning this is before I take my medication my blood pressure is normal 121/74 and goes up by 3 or 6 on standing ?? then I take my medication and re do my BP after an hour or 2 then my BP is 140/94 I have asked my doctors about it but they say thats ok just keep an eye on it..Really confused as I thought I would naturally have low BP until I take my medication.

    • Dr.Lam says:

      BP variability is like a moving target in these cases. There are many issues involved with Addidson’s and a much more detailed history is needed to sort things out.

      Dr Lam

  • Paige says:

    Thank YOU!!! As I am reading your posts, I feel that you are reading my mind. I CRAVE salt. I have hypothyroidism and have been telling my doctor that all is not well. She won’t listen to me. My feet and hands are always freezing! I get out of breath easily when walking upstairs, and no, I am not out of shape. I do drink sea salt water, but maybe I should be drinking it every night.
    I don’t want to try ‘other medicines’…..kind of over that…..I do take synthryoid ..I believe it needs to be upped, as it has been the same for 5 years.
    Anyway, back to the salt craving……have you seen success with just drinking the sea salt water? I actually LIKE it.

    • Dr.Lam says:

      We do not recommend seawater due to possible impurities. Salt is salt as far as the body is concerned.

      Dr Lam

  • B Knotts says:

    I have had mild Adrenal Fatigue (for approx 40 years) and now very high blood pressure. With my family history of heart disease, I thought I was having a heart attack one evening and ended up in the ER, but turned out to be a panic attack. They prescribed a beta blocker which is not lowering my BP at all. Am taking tons of adaptogens (NO maca or licorice), phosphatidylserine, lemon balm, magnesium, etc. with no improvement in BP. All electrolytes checked out fine, but adding potassium seems to make me feel less dizzy. Now what?

  • Walter says:

    How do blood pressure medication changes affect adrenal fatigue?

    • Dr.Lam says:

      medications that lower blood pressure can cause excessively low reading in setting of advnace AFS. In early stages, they normalize the high BP that can occur.

      Dr Lam

  • Sheridan says:

    I know salt can affect blood pressure, but can potassium as well?

  • Sofia says:

    I didn’t realize that aldosterone plays a role with blood pressure…thank you for the info!

  • Polly says:

    For those who have a high sodium level, would it makes sense to increase potassium intake with bananas or avocados?

  • Stacey Ewell says:

    Dear Dr. Lam, I have been diagnosed with a high aldosterone/low renin situation and our in spironolactone. From the side effects listed, it looks dangerous. If there anything else I can do?

    • Dr.Lam says:

      A lot more data and clinical correlation is need to form a complete clinical picture. sorry cannot be more helpful.

      Dr Lam

  • Samantha says:

    Hi Dr Lam

    Firstly – thanks for this great website!

    I would really like to know if it is possible to have high aldosterone with low cortisol? And if so, is this possibly part of adrenal fatigue?

    Thanks again.

  • denise chapman says:

    Have another question I just thought of. When treating your cortisol and your aldosterone levels should you treat them together or should be one be treated before the other?

    • Dr.Lam says:

      The body is best approached with a holistic manager. The key is a doctor who knows how as modern medicine tend to be quite compartmentized.

      Dr Lam

  • denise chapman says:

    If the potassium leaves the cell and sodium enters the cell, don’t we want to add more potassium? Especially if we’ve shown low sodium and potassium on blood and hair test?

    • Dr.Lam says:

      The more potassium you put in, the less sodium is available. In AFS, you tend to want more sodium as a rule, but there are exceptions. YOu really need professional help when you are dealing with electrolytes because the margin of error is low.

      Dr Lam

  • Paola says:

    I have heard that potassium is good for the body. How come it’s not the case for some people?

    • Dr.Lam says:

      potassium has to be in perfect balance with sodium for the body to feel good. when the sodium is off balance , as often with AFS, then potassium is affected.

      Dr Lam

  • Larry says:

    Here’s one for ya (and I do have an appointment next month with my indo guy).

    After some 15 years with High Blood Pressure, we figured out that I had “hyperaldosteroneism”. I had my left adrenal out and it had a very definite “malformation” that was producing too much aldosterone. That was about 1 year and half ago.

    Since then I had been in this weird state where I want to get up and do stuff, but very shortly after exerting myself, I get light headed and a bit nauseous. I also get muscle fatigue. For instance, merely holding up my arms over my head feels like I’ve been lifting weights for 30 minutes.

    I have been pulling VERY low numbers when I take my pressure right when I wake up…98/65 was the lowest. I get light headed most anytime I bend over.

    So I’ll post what I learn from my Indo.

  • gary says:

    Hey Dr. Lam. My doc has me on nitrates for my heart, but I’ve also been getting light headed lately. I know it’s a side effect from them, but I have a lot of other AF symptoms too. Can you point me to more information on this? Thanks !

  • Elaine says:

    Thank you for this article. I had vestibular neuritis for 10 months. Not dizzy now but no energy at all. Feel anxious, exhausted, bloated, cannot stand for more than about 10 minutes. Now the neurologist says I have peripheral neuropathy and it is not connected to the first condition. Not sleeping well and feeling like my body is really struggling. Not sure conventional docs are right. Does it sound like adrenal fatigue. Am female aged 64.

  • Michelle says:

    Thank you for your article. I am a 46 year old women who has been in good health until April of this year. I’m an elementary school teacher and came down with a virus which resulted in a fever, fatigue and nausea. 3 days after the fever, I had near syncope which then resulted in vomiting and a trip to the er. All test results came back fine but er doc wanted me to follow up with a cardiologist. I had an echocardiogram and stress test which was normal. A month later another trip to er for near syncope and high blood pressure and heart racing. Tests in er all normal. Followed up with cardiologist who said maybe I was having episodes of extra adrenaline and wanted to put me on a beta blocker. (Never took). I went to my gynecologist to check hormone levels thinking maybe caused by peri menopause. Estrogen perfectly normal. I went for a second opinion and this cardiologist wanted me to have a tilt table test. Tested positive 25 min with a near syncope episode with blood pressure immediately dropping to 50/40, diagnosed with POTS. Was told to stay hydrated, increase salt levels and that I probably always had this but brought out my being sick with virus and its lasting fatigue on my body. Ever since virus in April, additional symptom has been chronic loose bowels. Referred to gastroenterologist, stool samples fine, no parasites or infections. 4 months later, still not back to myself, fatigue, still drops in blood pressure which causes near syncope and instant shock to my body which causes me to lose my bowels about 8 times the rest of the day. Tested for Lymes disease, negative. Blood work comes back normal. Doctor started me on Zoloft in case this is all caused by stress. I had another fever last week too and was in bed all week. I’ve only been on the Zoloft for 4 days, was feeling better and then another episode today. Could all of this be related to Adrenal Fatigue? I’m used to running around with 7 year olds and now I can’t do much. Looking for answers!! Thank you!

    • Dr.Lam says:

      What you have gone thru is quite standard. None of the docs are on alert for the association between AFS and POTS like symptoms you are having, and as a result, you have gone thru major work up ,and given conventional dx and treatment. The docs are doing what they are taught. If you are NOT getting better or results, you have to start looking outside the box. Click Postural Orthostatic Tachycardia Syndrome (POTS) & Adrenal Fatigue Syndrome for more information. People like you call me all the time asking what to do. My best answer to you is to have an open mind, and do not rely only on conventional medicine once work up is complete and you are left essentially abandoned. Your body is always on the right, and do not doubt your body’s ability to heal when given the right tools and right approach. I dont want you to miss anything, but I can tell you from my experience that conventional medicine often makes things worse because the approach is towards patching symptoms that ultimately mask the underlying problem, which may be AFS or some trigger that sets this series of events, and only made worse with medicine. If you have any questions, call my office and I will explain to you.

      Dr Lam

  • Isabella says:

    If potassium is being leaked out of the cells, would it be good to try to increase my intake of potassium?

  • Paula says:

    I am still waiting to see my endo To review my labs but I know my 8am cortisol is 3 and my aldosterone is 1dg/nl(?). My HR resting is bw 95-122 and my sitting BP is bw 117/77 – 132-90. Supine (I took it at work) was 95/70. Other symptoms are the strong rapid and very heartbeats, Shaky hand, dizzy upon standing occasionally salt/sugar cravings and hands that feel like they have “gone to sleep and are waking up”. Can you give me any idea what I may be told at my follow up??

  • JD says:

    Wow. To this article and the comments below with your sincere responses. Just wow. May I take this time to thank you for your help. I have suffered from an invisible disease for years with people telling me that I was “overreacting” and “it can’t be that bad”. Now with your in depth explanations on all aspects of the human body, how could any one in their right mind argue that this is not real? Thanks again for sharing!~JD

    • Dr.Lam says:

      Thanks for your kind words. Humans have a tendency to deny the obvious until change is inevitable. I am sadden to note that no amount of science can convince a skeptical mind. But we will continue to try.

      Dr Lam

  • Rachel Hanna says:

    Hello, your article on Adrenal Fatigue and Blood Pressure seems to fit my symptoms well and I’ve suspected Adrenal Fatigue for years but I’ve been repeatedly told that my numbers are low but still considered normal.
    I’m a 43 year old female and I’ve had severe unrelenting pain for 17 years. About 12 years ago I began experiencing fatigue and insomnia in addition to the pain and over the years they have steadily progressed until my life seems to revolve around these three debilitating symptoms.
    I’ve been diagnosed with Fibromyalgia but the last few years I’ve developed additional symptoms, some of which have baffled my doctors.
    After too much activity – the amount varies and is quite unpredictable and is very little when compared to a ‘normal’ person, it can be too much walking, climbing stairs, or scrubbing the bathroom floor on my hands and knees – my legs become extremely weak and I’m unable to walk for up to a month at a time. Sometimes the weakness lasts for a few days but often it takes weeks to recover. They’ve tested my muscles and nerves and the results always come back normal, but they’ve never tested me during an episode. After the normal results they didn’t seem too interested.
    In addition, during these episodes my fatigue gets so much worse and if I try to push through it I often collapse, bringing me to my next set of symptoms.
    Two years ago I developed heart palpitations that come and go. I can go a month and have a hundred palpitations a day then I can go six months with a couple a week. My heart has tested healthy. During the time the palpitations started I began having syncope episodes, but the palpitations and syncopes don’t always go together.
    The syncope episodes are all pretty similar. Again too much exertion brings them on, but again, it’s unpredictable and not nearly the amount of exertion a healthy person has in a normal day. The syncope episodes begin with me freezing in place, even my eyes become fixed and can’t move. If I do try to move I fall immediately. But if my family doesn’t catch that I’ve become statue-like very quickly I fall anyway. I rarely lose consciousness, if I do it’s for no more than a few seconds to a minute or two. Usually I don’t lose consciousness at all, I can hear people talking to me I just can’t react or reply.
    Afterwards, if it was a more severe episode I often stutter or lose the ability to move my body at all for hours at a time. Even if it wasn’t that serious of an episode I have to be half-carried to bed to rest the remainder of the day. If I try to get up again I’ll just have more episodes.
    I’ve been told it’s Cardiovascular Syncope and to up my intake of water and salt. And while they might help me recover faster they certainly don’t stop the syncope episodes from happening.
    As an end note I also gained weight while taking Lyrica and no matter what I do I can’t seem to lose it. Even when I do the exact same healthy eating plans as my daughter and my best friend, they lost weight and I don’t.
    Do you think that Adrenal Fatigue might fit my symptoms even though my adrenals tested a low normal? If so, how do I go about getting the correct tests that will tell me if I have Adrenal Fatigue?
    Thank you, Rachel

    • Dr.Lam says:

      There is no definitive adrenal fatigue test and that is why it is not accepted by conventional medicine. Saliva test can be indicative but it takes a detailed history to put the big picture together. Click Laboratory Testing for more information.
      Some of your symptoms are consistent with AFS but not all. I suggest you look for an AFS literate practitioner. The is the key. If you cannot find someone, you can call my office.

      Dr Lam

  • Sylvie Lee says:

    My dad suffers from mobility problem and as a result has very prolonged stay in bed (3 months now). He usually has high BP but now he suffers from low BP as soon as he stands up. Wearing compression socks is not helping. Should he continue his usual BP pills he has been taking for years? Any advice on how we can stabilise his situation because as matter stands he cannot even do his rehab exercises because of the low BP. Thanks

    • Dr.Lam says:

      Low blood pressure as it relates to AFS is a very specific entity. Your situation is more about cardiovascular system instablity due to prolong immobility and needs conventional medical medicine’s help. That is where you should begin your focus. His doctor will know what to do as this is a relatively common problem.

      Dr Lam

  • April says:

    I have been experiencing severe edema. I have been taking VitB Complex, P5P, Licorice root, Zinc, Evening primrose, and Cortisol manager (hs). My water intake has been approximately 2000mL daily. I do not know what to do and how to reduce the edema. I have gained several pounds in just a few days.
    As a point of reference, I was diagnosed with AFS and Pyroluria. And, I have celiac disease and have been managing the celiac’s disease for over 10 years now. I was going to start and take L-glutamine with theracurmin for leaky gut. I don’t know if I should stop all of the supplements cold turkey to stop the edema or if I am simply doing something wrong with my diet. Thank you for your help.

    • Dr.Lam says:

      there are many many reasons for edema. From cardiac to electrolyte to hormonal to kidney issues, these all have be considered. Adrenal issues are not commonly associated with edema unless there are concurrent issues going on. I suggest you really take a closer look into this by talking to someone who knows well the mechanics and put the puzzle together. Not everyone knows, but the clues are there, if you look closely.

      Dr Lam

  • Bobby says:

    I do the salt in my water and I salt my food and nothing seems to help I dont know what to do anymore

    • Dr.Lam says:

      There may be other causes that is responsible, and a detailed history to the root problem is needed. Our telephone coaching services cam provide some insight if you do not have anyone to help you

      Dr Lam

  • Sal says:

    I’ve been reading a lot about adrenal fatigue and feel like I have many of the symptoms BESIDES the low blood pressure. Basically I always feel keyed up and feel like my adrenals respond TOO strongly as opposed to not enough, so for example if I am in a stressful situation I feel like my stress response is too strong, with too much adrenaline/cortisol, as opposed to the opposite, and then it takes me longer to calm down than it used to.

    This has been happening over the period of a few months where stress/anxiety levels have been high, before anxiety started my blood pressure was never an issue.

    Is this just the like “pre” pre afs (meaning if it goes on it will LEAD to afs), or is this not really adrenal related and just plain old anxiety (blood tests and other standard examinations come back fine). I’m trying to figure out if treating this as “AFS” makes sense or if I’m just going to further excite the already excited adrenals.

  • Andrea says:

    Through saliva testing my Doctor said I have early stage adrenal fatigue, elevated cortisol and low DHEA, along with symptoms of extreme afternoon fatigue, low body temperature and weight gain. I also have other tested issues such as elevated estrogen and low thyroid function but my Dr. wants to address the AFS first. She recommended a specific diet, meditation, breathing and L-theanine (800 mg). After taking the L-theanine, I noticed that my heart rate was low (low 50s) and I was doing a lot of deep sighing. I told her and she told me to scale back the L-theanine. I have gradually done so until in the hopes of getting my heart rate back up. I have no dizziness, fainting etc. just fatigue. I am now completely off the L-theanine but my heart rate is still low (mid to upper 50s.) Is this normal with AFS? Is there another supplement that helps AFS but doesn’t affect the heart rate?

    • Dr.Lam says:

      you need to be very careful with any supplements . your body’s exaggerated response points to deeper underlying issues that needs to be resolved for long term recover.

      Dr Lam

  • Paula says:

    If I have high blood pressure because of adrenal fatigue, will blood pressure medication help or make it worse?

    • Dr.Lam says:

      High blood pressure needs to be dealt with by conventional medicine. BP is a symptom of underlying problem. Even if you normalize your BP with meds, you would be wish to continue to search for answers as symptoms can be masked by meds while the underlying root issue remains unattended to and that is not good long term.

      Dr Lam

  • Chen Pei Li says:

    Hi Dr Lam,
    I’m have high blood problem since year 2014, about 140/90, and sometime its goes higher or a bit lower. My doctor try to convince me to start medication, but I refuse cause there are some symptoms that the Dr never know and consider. Some of the symptoms that I facing are when I fell hungry I can fell my adrenaline grand start to produce hormone, I start sweating a lot and my body start shacking, feeling nauseous and dizzy too, sometimes I can feel me heart beating very strong for a while and it back to normal after that. It reduce when I take glucose or plenty of sweet things. My weight is 47kg and height is 153cm. I have no diabetics problem. I’m 42 years old and I diet are mostly vegetable compare to meat, I took non preg injection to control pregnancy. I sleep less during weekdays around 4-5 hours but longer time during weekend. Dr Lam, do you think I need to start medication? Or do u have other suggestions?

  • Marsha Mayes says:

    I am charting my BPs in an effort to get my adrenals optimal. If I have a Marsha Mayes

    Question regarding the Blood Pressure Test, it states to take your first reading sitting or lying down and your second reading immediately after standing. With healthy adrenals, the blood pressure will rise 10 to 20 points…. My question is: is this based on Systolic or Diastolic? Here are examples:
    Sitting Standing
    139/78 131/91 I thought the Sitting one was higher, but my Home Health Nurse said, “No, it’s based on your diastolic, so you Standing one is higher. Most of my BPs are like this.

    Another example is:
    Sitting Standing
    124/72 130/82 In this case, I’m guessing the Standing is higher because both the Systolic and Diastolic are higher when Standing.

    Another example is:
    Sitting Standing
    126/91 108/79 In this case, I’m guessing the Sitting is higher because both the Systolic and Diastolic are higher when Sitting.

    The first example is the one that throws me a bit. The other two appear to be fairly simple, but since most of my BPs are like the first example, is it true that you go by the Diastolic and not the Systolic? Thank you

    • Dr.Lam says:

      In the setting of advance AFS, charting is seldom needed nor accurate because the BP tend to stay low all the time, both diastolic and systolic. Generally the systolic is not over 100 and diastolic is stable. The exception is if you are in the early stages of AFS of have other issues going on such as sympathetic overtone. If you are going to chart the BP, you also have to chart the heart rate and talk to your doctor. The key therefore is to know where you stand in terms of AFS, then you have the proper parameters and framework to understand and interpret BP readings. You can read my book for more info on this.

      Dr Lam

  • KK says:

    Thank you for this information. It is much appreciated. I have had symptoms for years, but now have access to health care after 10 years without access. During my first Dr. visit, I feel like my doctor did not understand or was seeing my symptoms as very minor and not part of a bigger picture. Overall, I take very good care of my health and do/teach yoga and meditation. However, I have been under high stress finishing grad school without adequate financial or social support for a long time. During this first Dr. visit, they established that I have orthostatic hypotension. My blood pressure had been fairly low (confirmed at two points at the eye doctor and dentist at 6 month intervals) around 103/60. At the last interval, I was having difficulty arising from seated position or doing a yoga flow sequence without having to return to to floor without moderate dizziness. It has not been uncommon for me to experience dizziness most of my adult life upon arising, but it is usually minor. My ECG was normal, but I have a slight heart murmer (confirmed several times in my life by a doctor). I have noticed that my heart rate often decreases under stress on exercise equipment rather than increasing, but the doctor felt that the ECG was enough to confirm that my heart was working normally. Upon finding the orthostatic hypotension, she simply told me to eat more salt (I had been consuming about 32 ounces of vegetable broth or about 2000 mg of salt a day and plenty of water prior to the doctor visit because I had read that dehydration could be causing the symptoms. I have had a little improvement with this treatment. However, it seems odd that I would need to consume so much salt and fluid for my body to function normally and I wonder how to convey to her that I want to understand any underlying causes that can be addressed so I don’t have to consume so much water and salt. She has ordered a thyroid test, but how do I talk to her about other possibilities. I mentioned adrenal fatigue, but she seems to only recognize Addison’s level adrenal problems and says that Addison’s is pretty rare. Overall, my physiology seems like it over-reacts to little stressors and takes an overly long time to settle down. I also have morning heart palpitations. I’m eager to work with nutrition, yoga, and meditation if I can pin-point what is happening, but I need to figure out how to communicate with my doctor so I can address the issues more than her just telling me to eat more salt. Any suggestions? Thank you!

  • TJ McCrum says:

    Hello, Really appreciate this article. I have been dealing with AFS over the last few years. I have a great doctor who I am working with. Last spring I had a high stress event which triggered all sorts of new symptoms. I started having digestive issues, which I had never had before. These symptoms have improved, but one still puzzles me. I get dizzy, very tired and lightheaded after eating. I am recovering and improving slowly in other areas, but these symptoms are obviously troublesome since I have to eat. I eat a very good; clean diet. I have theorized that perhaps my already low blood pressure state causes wilder swings in blood pressure after I eat? I am also working on bringing my thyroid into a healthier range (hypothyroidism) as well. I am also wondering if supplementing with aldosterone would help. Thank you.

    • Dr.Lam says:

      There are multiple reasons for dizziness after eating, including metabolic issues such as sugar imbalance, wrong supplementation that usually include herbs and glandulars, or sympathetic overtone that is organic or triggered by metabolic dyregulation. Bear in mind that in advance stages of AFS, its not only about fatigue as the neurological, endocrine and metabolic systems are all involved. Residual symptoms such as what you describe can point to incomplete healing process. find the root cause and not simply patch it with meds as you can mask the underlying issues that is still unresolved. Go back to talk to your doctor. A detailed history is needed and the answer is there if you look hard enough. Labs are not helpful in such cases.

      Dr Lam

  • mike says:

    After my most recent crash. I now have periods throughout the day of what I think is low aldosterone. Frequent urination, dry nose, mouth hands and eyes. Panicky and anxious. It gets better in the morning around 7-10am and worse at night 8pm-2am I feel. Will this get better as adrenals get better from the crash I had?

  • Bernard walters says:

    Hey Doc. I was wondering if this sounds like adrenal fatigue:
    Dizzy when getting up from a chair or bed, lowered bp, inability to sleep adequately, symptoms of chronic fatigue and feel like fainting if I miss a meal or going too long without eating. After a workout I get extremely fatigued as well, where I feel the need to lie down. (But recently I don’t exercise too often)
    Background leading up to this was a horrible stressful experience a year ago at work, ptsd, leading to reduced sleep and ability to relax enough to sleep. Also lots of anxiety and fearful thinking.
    I feel like I need a month off from life to recover at a quiet hotel somewhere..

    • Dr.Lam says:

      Your many symptoms are consistent with AFS. There are not many other conditions that fit the bill, but you should always check with your doctor to make sure. Taking time off may be helpful, but ultimately, at your level of dysfunction, you need a lot more than that to reverse the situation.
      Read Adrenal Exhaustion for more information.

      Dr Lam

  • Anonymous says:

    Should add, not sure of sons blood pressure but mine has always been low except for in the last 4 years when it is what they consider normal, interestingly I’ve stopped drinking black tea (herbal or redbush only).

  • Anonymous says:

    My 17 year old son has been having problems in the morning for some years now, usually a while after waking up he feels nauseas and vomits, this does not happen interestingly when he has a lie in and is not rushed into getting up. I would think maybe it was a teen age thing, but I have the same problem and have done so all my life only difference is I rarely actually vomit, I also have Fibro. IBS, and CFS and also have 2 other children (now adult) who also have some degree of these sypmtoms.
    I have been reluctant to give labels to one so young, but after reading this maybe thinking it’s time I woke up.
    So first of what do I tell our regular doctor and what can they help with, and how do I help my son.

  • Verna Hebert says:

    Some days about an hour or so after I am up in the mornings i get this feeling of nausea and lightheadedness. I feel like I need to sit down, then I feel clammy. I can feel my heartbeat increasing. If I am home the best thing I can do is lay down. After about an hour or so I begin to feel better . Passing a cool cloth on my face and neck feels so good !!!!! Then once I am back on my feet I am feeling OK. I am a 67 yr. old female. I had a few episodes as a child , but 40 + yrs. ago I would occasionally suffer this on school mornings with my children. I always fear I will completely pass out or start vomiting !!!!!! This happened to me recently when my sister went to the local farmer’s market . I had to sit down until I felt better !!!! Then I was fine for the rest of the day !!!!!

    • Dr.Lam says:

      In addition to blood pressure issues, you should check with your doctor on metabolic imbalances such as sugar problems. The low blood pressure experienced with AFS usually does not present so acutely as what you described.

      Dr Lam.