Adrenal Fatigue Related Health Conditions Beyond Excessive Tiredness

By: Michael Lam, MD, MPH

Adrenal Fatigue Symptoms and Excessive Tiredness

A man suffering from adrenal fatigue and excessive tirednessExcessive tiredness and lethargy are common complaints amongst adult patients. Symptoms such as excessive tiredness, fearfulness, allergies, frequent influenza, arthritis, anxiety, depression, reduced memory, difficulties in concentrating, insomnia, feeling worn-out, and the inability to lose weight after extensive efforts all point to Adrenal Fatigue. A weak adrenal system has profound systemic decompensatory actions, manifesting in a wide range of symptoms, including excessive tiredness. No organ is spared. The affected organs and their resulting conditions can be broadly classified into five major categories: metabolic system imbalance, musculoskeletal system breakdown, neurological system dysfunction, hormonal system imbalance/overload, and immune system dysfunction.

1. Metabolic System Imbalance

Hypoglycemia (low blood sugar) is common with Adrenal Fatigue. This is normally due to the combination of low cortisol and high insulin levels when the body is under stress. The normal stress response by the adrenals is to increase the blood glucose level. Glucose release is slowed as the output of cortisol reduces in adrenal exhaustion. This slowing, along with a high insulin level, leads to an increased demand for glucose. Ultimately, this leads to hypoglycemia with common symptoms of dizziness and fainting. As cellular energy demand is not being met by blood glucose, the body will turn to protein and fat as sources of energy. This pathway is not quite as efficient so the body is put in overdrive in order to provide the required energy. This increased demand is difficult or impossible to meet without adequate cortisol levels to elevate blood sugar levels by facilitating the conversion of glycogen, fats, and proteins to new glucose supplies. Clinically, one of the hallmarks of Adrenal Fatigue is irregular blood sugar patterns with hypoglycemia. In the presence of increased insulin and decreased cortisol, the blood sugar level drops rapidly, and frequent small meals are needed to replenish the body’s energy needs.

Hypoglycemia itself is a significant stress on the entire body, and especially on the adrenals. While this can be overcome with a sugar fix consisting of an instant load of sugary drinks such as juice or soda, this is only a quick-fix remedy. Usually the symptoms like excessive tiredness will disappear immediately, but then return after 1-2 hours. Reactivation and restoration of normal cell functions require extra amounts of energy beyond what is normally required for the maintenance of normal energy burn. With each hypoglycemic episode, more cells are damaged. Thus, the body reaches a new low with each incidence of hypoglycemia. If this happens at the same time as the demand for glucose increases, the stage is set for an adrenal crisis. With each plunge, the Adrenal Fatigue and excessive tiredness increases and hypoglycemia worsens. By the end of the day, the person may feel exhausted with excessive tiredness despite not having done anything. Low blood sugar levels are most likely to occur at around 10:00 AM, 2:00 PM, and from 3-4:00 PM.

Hypoglycemia is also related to autonomic nervous system dysfunction which is described in greater detail below.

2. Musculoskeletal System Breakdown.

Collagen and protein are broken down in a catabolic state of function during Adrenal Fatigue. This can lead to chronic pain syndromes, joint pain, chronic fatigue and excessive tiredness, and fibromyalgia.

Glucocorticoids, primarily cortisol, are steroidal hormones produced by the adrenal glands in response to stress. Cortisol output is usually high in stage 1 and 2 of Adrenal Fatigue. As Adrenal Fatigue progresses, cortisol output is often pushed to its limit. A chronically high cortisol output leads to a state of catabolism ( the breakdown of proteins in order to generate energy).

The cycle of catabolism is normally followed by a process of rebuilding or anabolism. In Adrenal Fatigue, the rebuilding process, normally carried out by androgens, is overwhelmed by the amount of catabolic hormones. Therefore the rebuilding process will be slow and sluggish. Broken down muscles are not adequately replaced. Collagen is broken down without significant replenishment. Outwardly, wrinkles start to develop as premature aging sets in. Internally, organ and muscle breakdown lead to chronic muscle and joint pains of unknown origin, especially after strenuous exercise or heavy lifting.

As the collagen structures of internal organs breakdown, their functions are compromised. Gastrointestinal track motility and contraction forces are reduced. Adrenal Fatigue is often associated with the poor ability to digest proteins and common symptoms include indigestion and irritable bowel syndrome. The amount of acid production in the body may not be sufficient to help break down the digested foods, resulting in further improper digestion.

It is therefore no surprise that secondary fibromyalgia and chronic fatigue syndrome are commonly associated with adrenal exhaustion. Many have postulated that Adrenal Fatigue often precedes fibromyalgia and chronic fatigue. These may indeed be part of the many symptoms of adrenal dysfunction.

3. Neurological System Dysfunction

Adrenal Fatigue can lead to insomnia, sleep disorders, brain fog, anxiety and depression if the central nervous system is involved. Peripheral nervous system dysfunction is often associated with orthostatic hypotension, dizziness, lightheadedness, temperature intolerance, fainting spells, tingling and a numbness sensation of extremities, and sweating dysregulation.

Central Nervous System Imbalances

If one suffers from adrenal exhaustion, one’s brain requires increased energy and is especially affected by a lack of glucose as well as toxic metabolite build up in the body. As far as the body is concerned, ensuring a well functioning brain is a top priority. Most mechanisms involved in regulating the body’s blood sugar are designed to ensure that the brain always has adequate glucose with which to function with. Insufficient glucose available to brain tissues contributes to the many central nervous system expressions of Adrenal Fatigue including sleep disorders, brain fog, anxiety and depression.

Sleep Disorders: Both too high and too low night time cortisol levels can cause sleep disturbances. The liver is often lacking the necessary glycogen reserve required by the adrenals to keep blood glucose stable during the night. When this happens, blood glucose levels may sometimes fall below the threshold and hypoglycemic (low blood sugar) symptoms occur. This can lead to sleep disruption during the night. Waking up between 1:00 and 3:00 AM is a characteristic of low blood sugar during this time. Sometimes it is accompanied by nightmares, sudden onset of heart palpitations, anxiety attacks, and cold sweats. Lack of sleep can be a significant burden in itself. The body’s ability to self repair is compromised when one is sleep deprived. This further contributes to Adrenal Fatigue and sets off a vicious downward spiral of cascading dysfunction.

Every time the wake/sleep cycle is altered, it takes some time for the body and cortisol levels to normalize. Chronic lack of sleep is strongly associated with decreased immunity, impaired glucose tolerance, and decreased alertness and concentration.

Cortisol, DHEA, testosterone and estrogen are key hormones produced in the adrenals. Decreased levels of each of these hormones and reduced adrenal function have been linked to depression. It comes as no surprise that adrenal exhaustion is strongly associated with increased fears, anxiety, depression, and difficulties concentrating.

Brain fog is a mental state where your memory becomes clouded and unclear. It is not a state of loss of memory, immediate or long-past. It is a state where your memory appears to be “so close and yet so far” in terms of your ability to recollect. Sometimes you cannot remember where you put your keys, or what you did yesterday. You are confused. It is often associated with Adrenal Fatigue, hormonal imbalance, PMS, estrogen dominance, heavy metal poisoning, and hypothyroidism. Brain fog is usually transient in its duration, lasting anywhere from hours to days, and in advanced cases can become chronic.

Brain fog and excessive tiredness can present itself in many ways such as the loss of mental acuity, forgetfulness, the inability to think clearly, short term disorientation which can last a few minutes, a decreased attention span, confusion, spaciness, difficulty in acquiring new skills, a reduction in creativity, short term memory problems, and a reduced ability to concentrate.

The exact pathophysiology is unclear. It has been postulated that excessive metabolite build up in the brain over time due to poor clearance is a major factor. Brain fog usually goes away as the body’s detoxification system kicks in. But if the system is not performing optimally, brain fog may remain for a long time. Some people try to do various types of detoxification, thinking that this will help. Sometimes it does, but most of the time, inexperienced detoxification methods can worsen brain fog and excessive tiredness. They may even trigger a re-toxification reaction, with symptoms such as fever, muscle and joint pain and general malaise.

Peripheral Nervous System Imbalances

The peripheral nervous system of the body is divided into two parts. The somatic nervous system regulates skeletal muscle functions that help us deal with the outside world, and the autonomic nervous system (ANS) regulates the functions of the smooth muscles and glands within the body for proper inner world workings. The ANS is further divided into the parasympathetic nervous system (PNS), the sympathetic nervous system (SNS), and the adrenomedullary hormonal system (AHS). The PNS regulates the vegetative processes such as urination and digestive function. Dysfunction of the PNS leads to a wide variety of illness including abnormal gastric acid secretion, reduced gut motion, erectile dysfunction, loss of urinary control, and bowl movement irregularities. The SNS regulates the unconscious “housekeeping” functions of the body, including blood pressure, body temperature, force of the heartbeat, and heart rate. SNS dysregulation is common in Adrenal Fatigue. The AHS (also called the sympathetic adrenergic system) regulates the emergency and distress functions such as those responsible for the body’s “fight or flight” response. When this response is activated fainting, shock, extreme fear, hypoglycemia, and low body temperature can occur. The combination of the AHS and the SNS constitutes the sympathoadrenal system (SAS).

The other parts of the ANS include the enteric nervous system (ENS) which regulates enteric functions and the sympathetic cholinergic system (SCS) which regulates sweating.

Maintaining a normal balance within the ANS, especially the SAS, is vital to optimal bodily function and homeostasis and the avoidance of excessive tiredness. Overstimulation of the SAS is commonly seen in advanced stage Adrenal Fatigue. It is usually a secondary compensatory response triggered by stress. The resulting influx of symptoms, like excessive tiredness, is known as the reactive sympathoadrenal response (RSR) (also called reactive sympathoadrenal overtone (RSO)). The body is flooded in a sea of adrenaline and norepinephrine. Symptoms include a faster than normal resting heart rate, anxiety and panic attacks, heart palpitations that come at will, strong heart beat, irritable bowel, being “wired and tired”, POTS, orthostatic intolerance, orthostatic hypotension, hypoglycemia, excessive tiredness, and temperature intolerance, just to mention a few. There would also be periodic burst adrenaline where all these symptoms can be amplified into a sense of impending doom. We shall examine the mechanism of this condition further below.

Neurotransmitter Dysfunction

Neurotransmitters are endogenous chemicals, which relay, amplify and modulate signals between a neuron and another cell. They are present in the synaptic junction of each nerve. Major neurotransmitters include glutamate, GABA, glycine, serine, dopamine, norepinephrine, epinephrine, histamine, serotonin, melatonin, acetylcholine, and nitric oxide. Some neurotransmitters are commonly described as “excitatory” or “inhibitory”. By far the most prevalent transmitter is glutamate, which is excitatory at well over 90% of the synapses in the human brain. It is also used at most synapses that are “modifiable”, i.e. capable of increasing or decreasing in strength. The next most prevalent is GABA, which is inhibitory at more than 90% of the synapses that do not use glutamate. Many sedative/tranquilizing drugs act by enhancing the effects of GABA. There are other neurotransmitters, such as acetylcholine, for which both excitatory and inhibitory receptors exist. GABA also operates in many regions of the brain, but uses different types of receptors. Serotonin is produced by and found in the intestine. It functions to regulate appetite, sleep, memory, learning, temperature, mood, behavior, muscle contraction, and function of the endocrine and cardiovascular system. If there is a dysregulation it could cause symptoms like excessive tiredness. It is also speculated to have a role in depression, as some depressed patients are seen to have lower concentrations of metabolites of serotonin in their cerebrospinal fluid and brain tissue.

In Adrenal Fatigue, many normal neurotransmitter functions are altered. In early stages of Adrenal Fatigue (Stage 1 and 2), serotonin levels tend to be weakened, epinephrine and norepinephrine are elevated, and GABA tends to increase to compensate.

As Adrenal Fatigue progresses, cortisol output will start to fall. Thyroid binding globulin tends to rise which leads to reduced T4 and T3 with a corresponding rise in TSH. DHEA increases and the body is put on overdrive to produce more cortisol. Serotonin falls as dopamine and norepinephrine continues to rise as the sympathetic nervous system is activated.

In advance Adrenal Fatigue (Stage 3 or higher), DHEA starts to fall along with cortisol and serotonin. Epinephrine, dopamine, norepinephrine, and GABA may remain high or erratic in their levels. The autonomic nervous system is dysregulated, leading to adrenaline rushes and reactive sympatho-adrenal responses classically responsible for the “wired and tired” sensation.

4. Hormonal System Imbalance / Overload

Key hormones associated with adrenal exhaustion and excessive tiredness include epinephrine (adrenaline), norepinephrine, estrogen, testosterone, melatonin, progesterone and thyroid. Their imbalances can lead to estrogen dominance, hypothyroidism, adrenaline rushes, fragile blood pressure, hirsutism, hair loss and acne.

Adrenaline / Norepinephrine Overload and Reactive Sympathoadrenal Response (RSR)

Norepinephrine is a neurotransmitter secreted under the control of the SNS. Adrenaline is a hormone secreted from the adrenal medulla under the control of the adrenomedullary hormone system (AHS) and deals with emergency functions of the body. While adrenaline is released during normal daily activities, its release is increased during extreme distress. Chronic or acute stress leading to Adrenal Fatigue increases AHS activation. A rise in the absolute level of adrenaline in the body leads to an increased heart rate, increased blood sugar, increased respiration, reduced serum potassium, relaxation of skeletal muscle blood vessels, an increase in energy, an increase in emotional sweating, constriction of skin blood vessels (pallor), relaxation of the gut and trembling. This adrenaline overload, along with norepinephrine, worsen the existing ANS imbalance already common in people with Adrenal Fatigue, and it triggers an additional host of dysfunctions above and beyond those already experienced.

In normal people, excess adrenaline released from the adrenal glands during stress is quickly sopped up by efficient adrenaline transporters which carry away these undesirable hormones before they can wreak havoc as they circulate in the body. For example, standing requires blood vessels to contract to keep gravity from allowing all your blood from pooling in your legs. This is accomplished through the release of small amounts of adrenaline, the body’s “fight or flight” hormone. The body releases just the right amount of this hormone throughout the day as we move around and change positions. Excess adrenaline is cleared out of the body. The body’s blood pressure is thus maintained in a normal state. Unfortunately in people suffering from adrenal exhaustion, the excessive activation of the SAS leads to a massive amount of adrenaline and norepinephrine being released which can remain in circulation for longer than the usual duration before they are inactivated. Blood pressures of people who are in adrenal exhausted states and suffer from excessive tiredness are usually below normal levels, but they can abruptly increase and stay high if a large amount of adrenaline is released quickly into the bloodstream. Alternatively, the heart rate may be elevated for no apparent reason. Consistent high levels of norepinephrine and epinephrine also lower the threshold of normal cardiac rhythm, triggering abnormal cardiac arrhythmias such as atrial fibrillation, whether they are vagally mediated or sympathetically mediated. Adrenaline release as part of the body’s emergency responses is usually self limiting in normal people. In people suffering from adrenal exhaustion and excessive tiredness, however, these symptoms not only persist but can become exaggerated. The mechanisms of these pathways physiologically are not fully known. Research studies are pointing to the loss of a negative feedback loop function, leading to a positive feedback loop response, as a possible etiology.

As mentioned earlier, adrenaline is a hormone that is stimulatory in nature. Symptoms of excessive adrenaline include heart palpitation, irritability, and anxiety. Less common are symptoms of dizziness, cold sweats, brain fog and orthostatic hypotension. In addition to possible adrenaline overload, those with weak adrenals may have a reduced capacity to clear the unwanted excess adrenaline and its metabolites from the body. This leads to excessive internal build up. In addition, a defective norepinephrine transporter system can worsen the condition and contributes to further excessive adrenaline level. This is because norepinephrine is the chemical father of epinephrine and its level is tied to epinephrine. As mentioned earlier, adrenaline and norepinephrine overload in the context of Adrenal Fatigue is usually a compensatory reaction of the ANS as the SAS is activated. This leads to a myriad of symptoms that are clinically confusing and hard to understand, such as unexplained orthostatic intolerance, fragile blood pressure, extreme lightheadedness, “spaciness”, tachycardia, irregular heart rate, temperature intolerance, body fluid imbalance, sweating, fainting, loss of bowel and urination control, sense of impending doom, and dizziness. Sometimes these symptoms may be associated with and triggered by a diet high in carbohydrates or by a stressful event. Other times, they can be triggered when at rest or from events that are not stressful at all, such as watching an action movie, taking a cold drink, being startled as the phone rings in a quiet room, etc. In layman’s terms, the body’s internal thermostat appears to be malfunctioning. The heating and cooling control systems are broken and the body activates the emergency mode (SAS) frequently. While the ultimate goal of ensuring survival has been met, the fine control is compromised. It’s like getting into a bath or shower with either very cold or very hot water running but not the pleasant warm water that is suitable for bathing. The body therefore goes through wild metabolic and hormonal internal gyrations like a roller-coaster ride with fluctuations in blood sugar, body temperature, blood pressure, heart rate and emotional state. Laboratory studies are usually found to be normal as these symptoms remain sub-clinical.

There may be a genetic component in this convoluted picture, but it is clear clinically that those with weak adrenals have a higher tendency to be more sensitive to excessive adrenaline / norepinephrine, and are more prone to suffer symptoms resembling sub-clinical dysautonomia. Unless a clinician is alert, this reactive state is often missed. Patients are often started on a failed approach of prescription drugs such as anti-depressants to control the symptoms rather than healing the adrenals.

Estrogen and progesterone imbalance leads to a continuum of Estrogen Dominance conditions including PMS, endometriosis, PCOS, cystic breast disease, breast cancer, and irregular menstrual periods, just to name a few. Here is how:

When the adrenals are stressed, the adrenal’s response is to increase cortisol output. This requires more of the precursor, progesterone. Cortisol output rises in Stage 1 and 2 of Adrenal Fatigue. As adrenal weakness advances, cortisol output starts to decline due to being overworked. The precursor progesterone becomes deficient as the increased need for cortisol depletes the progesterone levels used in making cortisol. As more progesterone ( and also pregnenolone) is shunted or sequestered to make cortisol, less is available to balance off the estrogen. As a result, there is a relative increase in estrogen in the body compared to progesterone. This progesterone deficiency is commonly called Estrogen Dominance (ED). What is so bad about estrogen dominance? It is the root cause of a myriad of illnesses. Conditions associated with this include fibrocystic breast disease, PMS, uterine fibroids, breast cancer, endometriosis, infertility problems, endometrial polyps, PCOS, autoimmune disorders, low blood sugar problems, and menstrual pain, among many others

Adrenal Fatigue and Estrogen Dominance are very similar in their symptom presentation and share a lot in common. Most women who have one tend to have the other to some degree. Because the symptoms are similar, Estrogen Dominance, when prominent, can mask underlying Adrenal Fatigue which then is overlooked. Clinicians can be misled into believing that the root problem is Estrogen Dominance when in fact it is Adrenal Fatigue in disguise. Administration of hormone replacement, natural or otherwise, may give temporary relief but normally fails over time if the adrenals are not healed. On the converse, if the recovery focus is placed on healing the adrenals first, symptoms of Estrogen Dominance often resolve on their own as adrenal health returns.

Another common reason for low progesterone levels is an anovulatory cycle (a menstrual cycle in which there is no ovulation). In Adrenal Fatigue, the body’s emergency repair system is activated. Priority is given to metabolic balance to keep the basic bodily function such as blood pressure and blood sugar stable. Reproductive functions are considered a low priority at this point. Ovulation can be temporarily shutdown. In fact, many women in high stress environments do have irregular menstrual cycles and amenorrhea for this reason. Without the ovulation, there is no corpus luteum to make additional progesterone for the cycle. The lowered progesterone level leaves us with an excessive estrogenic effect due to deficiency of progesterone.

Estrogen Dominance can also be caused by excessive estrogenic stimulation. As Adrenal Fatigue progresses, weight gain is usually the norm as the body tries to slow down metabolism to conserve energy. Excessive fatty tissue is accumulated. Fat cells make estrogen and estrogen causes fatty tissue growth. Both lead to excessive estrogen and relative progesterone deficiency.

Estrogen also increases thyroid-binding proteins in the bloodstream. Thyroid blood test results may therefore be normal although there may be an insufficient free thyroid hormone level in the tissues, resulting in a state of sub-clinical or secondary clinical hypothyroidism.

When estrogen levels are high, the adrenal cortex also fails to respond to signals from the brain. A woman with estrogen dominance may have adequate levels well within the normal range of total cortisol in her bloodstream. However, her free available cortisol level may be low. Since only free cortisol can pass through cell membranes and activate receptors inside the cell, the effectiveness of cortisol is blunted at the cellular level.

Just as estrogen dominance can contribute to adrenal insufficiency, adrenal insufficiency can contribute to estrogen dominance. Cortisol is made in the adrenal cortex from progesterone. When the adrenals are weak, there is a tendency towards a lowered progesterone output in favor of cortisol. A low progesterone level is often the result leading to a state of relative estrogen dominance with its many undesirable consequences mentioned above. This forms a vicious cycle. Excessive estrogen affects both thyroid and adrenal functions. In turn, dysfunctional thyroid glands and Adrenal Fatigue make estrogen dominance worse.

Thyroid hormone imbalances leading to clinical or sub-clinical hypothyroidism that is refractory to thyroid replacement therapy.

When the adrenals are weak, the ability of the adrenals to handle the stress associated with normal body functions and energy requirements is often compromised. To enhance survival, the adrenals force a down-regulation of energy production. In other words, the body is being forced to slow down in order to conserve energy. The body needs to rest in times of stress. Lower energy output reduces the workload of the body. This slowdown can result in hypothyroid symptoms despite sufficient circulating levels of T4 and T3.

Laboratory tests of T4 and T3 may look normal and TSH may increase. Classic symptoms of hypothyroidism are evident with persistent low body temperature. The physician reading the tests may be misled into prescribing thyroid replacement. In such cases, thyroid replacement without first considering adrenal fortification often fails. Thyroid replacement tends to increase metabolic functions. Raising the basal metabolic rate is akin to putting all systems of the body into overdrive at a time when the body is trying to rest with down-regulation.What the body wants (to slow down) and what the medications are designed to do (to speed up) are diametrically opposed to each other.

Thyroid medication administered under such circumstances may, in some cases, lead to a temporary relief of symptoms and a boost of energy at first. This is often short lived, and comes at a price. Those who are less fortunate with constitutionally weak adrenals may be intolerant to thyroid medications right from the start. Those that are able to accept thyroid replacement and remain stable may find themselves requiring it for life, often at increasing doses as time passes. The overall fatigue level continues to increase well beyond what the medications are trying to combat. Only by increasing medication dosage or switching to more powerful thyroid medication can the worsening excessive tiredness be avoided. The tendency is to switch from one medication to another. Starting with synthetic T4, to T4/T3 blends and ultimately, to potent the T3. The patient is subjected to an ongoing trial and error period as one drug after another fails. As this is going on, the body continues to decompensate as the medication usually prescribed becomes stronger and stronger. The patient’s condition often continues to get worse despite the physician’s best attempt to help. It comes as no surprise that as many as 70% of patients on thyroid replacement continues to complain of hypothyroid symptoms. Ultimately, excessive tiredness returns with a vengeance with time or stress, as thyroid medication further deteriorates pre-existing adrenal weakness and often precipitates an adrenal crisis.

Cortical Hormone Imbalance. The adrenal cortex comprises 80 percent of the adrenal gland and is responsible for producing over 50 different types of hormones in three major classes – mineralcorticoids, glucocorticoids, and androgens.

Aldosterone, a mineralcorticoid, modulates the delicate balance of minerals in the cell, especially sodium and potassium. It therefore regulates our blood pressure. Stress increases the release of aldosterone, causing sodium retention (leading to water retention and high blood pressure) and loss of potassium and magnesium. Higher than normal blood pressure is a sign of early Adrenal Fatigue. Magnesium is involved in over 300 enzymatic reactions in the body. When the body lacks magnesium, it will suffer from a variety of pathological conditions such as cardiac arrhythmias, uterine fibroid, and blood pressure imbalance.

The most important glucocorticoid is cortisol. In early Adrenal Fatigue, the cortisol level rises to help the body overcome stress. As Adrenal Fatigue advances, cortisol output generally drops and the body’s ability to handle stress is reduced. Cortisol contracts mid-size arteries. People with low cortisol (as in advanced stages of Adrenal Fatigue) tend to have low blood pressure and reduced reactivity to other body agents that constrict blood vessels. Lower than normal blood pressure is a sign of advanced Adrenal Fatigue.

As Adrenal Fatigue worsens, the body’s overall ability to maintain stable blood pressure is reduced, resulting ultimately in a condition known as labile blood pressure where the blood pressure varies and fluctuates widely.

Androgen imbalance. Both male and female hormones are secreted by the adrenal cortex, but their quantity is small and their effects are usually masked by the hormones from the testes and ovaries.

In adrenal exhaustion and excessive tiredness, the masculinization effect of androgen secretion may become evident after menopause or under stress – when estrogen levels from the ovaries decrease in absolute terms but increase in relative terms in a state of estrogen dominance. In women, the androgens ( testosterone and related hormones ) affect the secondary sex characteristics, leading to an increased conversion from testosterone to dihydrotestosterone or DHT and ultimately resulting in:

  • Seborrhea (a form of skin inflammation which has no known cause)
  • Acne
  • Hirsutism(excess hair)/Alopecia (hair loss). It comes as no surprise that most post-menopausal women who are experiencing hair loss have an adrenal function problem.
  • Velvety, light-brown-to-black, markings usually on the neck, under the arms or in the groin, associated with high insulin levels (acanthosis nigricans).

In men, a low libido is invariably an indicative sign of adrenal exhaustion and excessive tiredness. The body is in the process of preparing itself for survival. Production of hormones deemed less important by the body, such as reproductive hormones, is shunted to produce cortisol to ensure survival. Sex drive is reduced in both men and women, and period irregularity in women becomes common. Miscarriage prevalence is also increased. Long term androgen excess also increases the risk of infertility, cardiovascular disease, hypertension, osteoporosis, uterine cancer, and pituitary adenoma.

5. Immune System Dysfunction

This can result in exaggerated autoimmune responses such as rheumatoid arthritis and Hashimoto’s Thyroiditis, allergic rhinitis, skin sensitivities, psoriasis, hypoactive immune state of function, frequent infections, internal dysbiosis, candidiasis, recurrent herpes infection, HIV and Hepatitis C.


Allergic reactions usually have strong adrenal components. Most allergies involve the release of histamine and other pro-inflammatory substances. The body’s response is cortisol, a strong anti-inflammatory hormone. The level of circulating cortisol corresponds directly to the degree of inflammation in the body and the resulting symptoms of allergies. The weaker the adrenals, the stronger the effects of the allergies because the more histamine is released, the more cortisol it takes to control the inflammatory response and the harder the adrenals have to work to produce more cortisol. When the adrenals are exhausted, cortisol output is compromised, allowing unopposed histamine to inflame the tissues more. This vicious circle can lead to progressively deepening adrenal exhaustion and more severe allergic reactions. People with food and environmental allergies commonly have weak adrenal functionality. Common food allergens include wheat, corn, soy, milk, and eggs. One also can be gluten free and still have wheat allergies.

Autoimmune Disease

Autoimmune disease such as Hashimoto’s Disease or rheumatoid arthritis represent a spectrum of diseases in which the white blood cells of the immune system become overly active. Chemical messengers called cytokines form an integral part of the immune system. As messengers, cytokines inform and trigger other immune cells to activate, grow, or possibly die. Excessive chemical messengers known as cytokines are elevated in fibromyalgia and chronic fatigue, leading to excessive inflammation and flu-like symptoms. Chronic inflammation can reflect an improperly functioning immune system.The degree of hyperactivity of the immune response is also modulated by cortisol. If one has adrenal weakness, the cortisol output will drop below normal level, making one’s body more susceptible to autoimmune and inflammatory reactions. Toxins released from viruses become un-opposed. The inflammatory reaction will only surge upwards as the overall condition worsens. In other words, the cortisol levels are inadequate in response to the reactions taking place in particular tissues or locations in the body.

Steroid medications such as prednisone or hydrocortisone are commonly prescribed to suppress autoimmune responses. These drugs mimic the anti-inflammatory effects of cortisol. While there may be a temporary sense of well-being and lack of excessive tiredness, this is usually short lived due to the many side effects associated with these medications. Long term use is to be avoided unless under close medical supervision.

A body under stress needs the anti-inflammatory effects of cortisol to restrain various physiological mechanisms and to prevent them from causing havoc inside the body, as in the case of toxins secreted by the over-reactive white blood cells in an auto-immune disease setting. Cortisol thus protects the body from autoimmune processes and uncontrolled inflammation. Lack of a sufficient level of cortisol commonly seen in people with advanced Adrenal Fatigue as the body’s protective functions have been compromised leads to the unrestrained damage to the body by the overactive white blood cells.


One of the most frequently overlooked causes of Adrenal Fatigue are chronic infections. Respiratory illnesses and herpes are more common in people suffering from Adrenal Fatigue, and Adrenal Fatigue tends to predispose people towards developing respiratory problems. Respiratory infections such as colds, bronchitis, sinus infections, mycoplasma infections, pneumonia, and the flu are especially hard on the adrenal glands and fatigue them rapidly. Recurrent respiratory infections are one of the most significant problems that can hamper full recovery in people suffering from Adrenal Fatigue.

Adrenal Fatigue can occur after just one single episode of serious infection. Such infections can be a respiratory infection or a gastric infection. Poorly performed dental procedures such as a root canal can also be a trigger. The more severe the infection, the more frequently it occurs or the longer it lasts, and the more excessive tiredness one has, the more likely it is that the adrenals are involved. It is not unusual for an infection to trigger an adrenal crisis and excessive tiredness. At the same time, chronic infections (such as prolonged flu, periodontitis, or candidiasis) of known or unknown origins may also act as triggers as well. Adrenal Fatigue can also take place over time as the adrenals are gradually fatigued by prolonged or recurrent infections. Stealth viruses and other infectious agents such as parasites and fungus are commonly overlooked culprits. The direct effects of a smoldering pathogen in the body as well as the systematic stress the infection creates will overload the adrenals chronically and weaken the body’s immune system. This makes it harder to fight off the infection. Therefore, it is no surprise that adrenal exhaustion and excessive tiredness is commonly associated with frequent and repeated infections ranging from the common cold to sinus infections to gastrointestinal dysbiosis, with slower than normal healing times. The immune weakness that results from the weakened adrenals also sets the stage for pathogens responsible for fibromyalgia to be activated, resulting in greater debilitation. One must think of adrenal exhaustion and excessive tiredness as the cause if there is a longer than normal recovery period after an illness with decreased stamina and pronounced morning excessive tiredness.

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

Dr. Lam’s Key Questions

Feeling better after exercise is generally a function of adrenaline being released into the body during exercise. Do be careful. As adrenaline wears off, energy slumps can occur. Many people experience a crash after exercise and don’t know why.

If you don’t have advanced stages of AFS, any exercise is good for the body provided they are not extreme. Walking, biking, hiking, yoga, and flexibility exercise in moderation are all safe for everyone as long as there aren’t other medical issues. If you have advanced stages of AFS, make sure you follow professional guidance before embarking on exercise.

Some studies have shown that vaccination causes immune dysregulation. When anything is changed in your body the adrenals are affected because of the stress.

Cupping is a traditional Chinese Medicine method to increase circulation in the body so toxins can be removed from the skin. It can be considered for those who are in mild stages of AFS, but those with severe AFS should be careful as you can crash the body in the process.

Breastfeeding takes a lot of energy and nutrients from the mother’s body, plus it is a 24/7 job, at no set time your baby will need feedings. So a lack of sleep, post partum, caring for the infant can all be very stressful during the first couple months for a new mother. Any stress does affect the adrenal glands.

A man suffering from adrenal fatigue and excessive tiredness
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  • Toni says:

    I really liked the Hormonal System Imbalance / Overload part of this, makes a lot of sense to me! Great information here.

  • Melissa says:

    So, would you say that having many of these symptoms early in life and never having had high blood pressure, but actually having very low pressure since the time that my pressure was first ever taken (early 20’s), indicates congenital adrenal insufficiency?

  • DH says:

    Hello – do you feel there is a connection with multiple sclerosis and the adrenals? Is it possible to be misdiagnosed with ms and it really be an adrenal issue?

    • Dr.Lam says:

      They are two distinct conditions, though sometimes one can get confused as symptoms can cross. See your neurologist and run the test properly and your doctor will know if it is indeed MS. If not, then you can look into AFS.

      Dr. Lam

  • Jordan says:

    So much good information! I really liked that neurotransmitter dysfunction part!

  • Brandy says:

    Can sudden gut issues like IBS be a sign of one having adrenal fatigue?

  • Christine Clenney says:

    Dr Lam….. I’m I’m adrenal gland failure and secondary and all they do is keep me on hydrocortisone 10mg morning /5mg afternoon for a yr and a half now. 3 years ago a dr put me on 40 mg of prednisone daily for two years for a tanning bed rash which was gone in 24 hours they say that’s the cause of my adrenal gland failure and secondary and is why I was put on hydrocortisone. I hurt so bad my entire body can barely walk back neck spine knees feet swelling stomach fat elbows everywhere and I’m so tired and can’t rest I’m now depressed really bad. There has to be another answer please tell me what to do I feel I’m dying. I have severe stomach issues dental COPD I’m frail weak hot skin with no temperature bone loss can’t keep vitamins in my body, cyst on my thyroid liver and kidney and one says lung another says maybe not. Pre oral cancer puffy it is awful my knees wake me as I’m only dosing literally screaming pain please help me oh slight traces of cataract on both eyes becoming pre-diabetic spots dark and light all over my skin I have aged 20 years my hands are wrinkles and my face and neck

    • Dr.Lam says:

      Conventional medicine’s tool is steroids. Your situation is complex, and without more information, I am not able to give you any assessment. Calling my office is best.

      Dr. Lam

  • Alan says:

    I have Addisons disease and when i go swimming, i have no power or energy in my legs and get tried very easily and then i start to get muscle cramps after doing some lengths in the pool. What do you think is the problem DR Lam???

    • Dr.Lam says:

      There are multiple possibilities, depending on how severe your Addison’s’ Disease is and associated imbalances that can go with it, including electrolyte issues. A medical workup is needed and a much more detailed history.

      Dr. Lam

  • jeremy says:

    What does it mean if you’re so tired you can feel the physical anxiety but are not mentally alert enough to have the emotional aspects of the anxiety?

  • Matt says:

    Can health conditions and symptoms caused adrenal fatigue as much as adrenal fatigue can cause them?

  • Rupert says:

    Is it possible to be pushed to a “fight or flight” state even when you have severe exhaustion?

  • Rosemarie Marotta says:

    I’ve got it all…been tested for everything waiting for test results for saliva and urine. But I have AF, metabolic syndrome, anxiety, depression, estrogen dominance. you name it, I’ve got it. Came from years of severe stress, and BP meds that almost killed me. The brain fog comes and goes. the shakes and neck pain are the worst. Taking 20 supplements a day. (Temperature intolerance) lol would love to send you the results when they’re all back. Is that a possibility? Thank you…

  • Grace says:

    My husband and I have been trying to conceive for the last year and a half. I have had 2 miscarriages already… Could this be a sign of AFS even though my sex drive has not decreased?

  • JC says:

    I can’t thank you enough for writing this article.

    After losing a lot of weight and now realizing I was overexercising, I wound up with a myriad of health issues…

    Hormonal acne, recurrent throat infections, fever, mental fogginess, chronic fatigue, an oral herpes outbreak (never had one before), recurrent staph infections (MRSA and cellulitis), pre-diabetic in my blood work (though I eat no refined sugars and actually eat healthier than anyone I know), high EBV levels (never even had mono), and finally – Endometriosis.

    I swore it was all related as it all happened within 8 months – and I was utterly convinced I taxed my Adrenal Glands.

    It’s such a relief to read an article that directly correlates with my experience and backs it up with solid medical terms and explanations.

    My question what I do I do? I’m gaining weight despite exercising and eating healthy. All of my medical issues have gone away months ago with the exception of the chronic fatigue, fogginess, and Endometriosis.

    • Dr.Lam says:

      You may still have residual issues left. The body is not totally healed. You can call my office for a telephone appointment, and I will be able to tell you more as we need to focus on the root issues more.


  • Tonya says:

    Is it a good idea to monitor my sugars on a regular basis?

  • Dwayne says:

    Can long-term AFS damage the heart?

  • Sue says:

    I have been on .88 Levo thyroxin synthroid for about 20 years. I do not sleep well…ever. My blood pressure is always on the low side. I recently got the flu with intestinal illness and respiratory cough and phlegm. I am so weak I can barely stay up. I am lethargic and I have developed a rash on my chest and back that is bright red and periodically itchy. I have had this for a week now. it is fading…but still raised. I do not believe it is shingles…there is no seeping or clear head. it almost seems more of a blood rash? I purchased Adrenal Sense supplements to address the symptoms that I believe are Adrenal Fatigue (after hearing a health seminar). When I first came down with these flu symptoms, I had no rash. I got a fever and sweats…then the rash flourished. I have taken supplements all my life…magnesium, turmeric, K2 and D3, PS and PQQ for the brain fog I have, multivitamin, Omega 3, and a priobotic daily.

    When I got sick, I added GABA (to help me sleep…I was awake all night and it did help), and Biosil for my drying skin and nails, and also the Adrena Sense. I took those for 4 days and then the rash broke out. I stopped ALL supplements. Now I have barely got energy to function normally. What is wrong with me and how can I correct this. What are your recommendations?

    • Dr.Lam says:

      Your body is quite weak. I suggest you read my book for more info on the reasons. If you like a more detailed response, resubmit your question through the Ask The Doctor section of my website and we will answer you in confidence.

      Dr Lam

    • Lori says:

      Sue, all the symptoms you described I have also (my rash is on my stomach) & have seen a lot of people with what I call the ugly virus. It has gone around in central CA & has left me severely fatigued, even after getting well. I have however suffered from adrenal fatigue for years.

  • Mike says:

    Is Taking Cortisol a Safe Way to Treat Adrenal Fatigue?

  • shkoor says:

    Dr Lam,
    I have been suffering from underlying fatigue and stress for many years. However about 2 years ago, either related or unrelated, I developed other issues, namely gastro, racing pulse, cardio, all over body pain, and many other symptoms. Along with this I have slowly got to the point where my resistance to any kind of physical or mental stress has completely evaporated. The fatigue is very overcoming at times and no amount of rest will ease. I have visited many Dr.s and nothing is helping. Can you please advise what tests or course of action to take. Is there a way to evaluate what the root cause is?

  • Michelle Borsotti says:

    OMG….Dr. Lam after reading this article I am convinced my daughter is in an advanced stage of Adrenal Fatigue. She is currently seeing a Dr. that thinks her adrenal glands are suppressed due to being given heavy doses of steroids to counter a botched tattoo. I am extremely concerned as she is starting to develop many of the symptoms you’ve mentioned in this article. Namely the Seborrhea. Can you help? She lives in Washington State.

    • Dr.Lam says:

      She needs to call my office and set up a telephone appointment and we will take a more detailed history and decide whether or not AFS is in the picture. No charge.

      Dr Lam

  • Kathrine says:

    Is it possible to have extreme exhaustion from Adrenal fatigue and a Hormonal System Imbalance?

  • Jerry says:

    Hi Dr. Lam,
    I find your website very informative. I myself have adrenal fatigue and it is very tough to deal with at times. I find that slow and steady is the best way to go. As far as calming down the nerves and also not to trigger any crashes, which amino acid would you reccomend, glycin, gaba, or l-theanine, the gentler the better. Thank-you.

  • Pamela says:

    Are migraines associated with adrenal fatigue?

  • Gabriel says:

    Thank you for the excellent info! i never realized that some of my other concerns could actually be related to Adrenal Fatigue.

  • Katie Taylor says:

    Hi Dr. Lam,
    I am a medical student and I have been suffering from adrenal fatigue (AF) for about 3 years now due to recurrent exposure to foods that I am sensitive too (especially gluten). I am looking to learn the specifics of how to treat AF both for myself and my future patients. I am worried that my fatigue might hinder me when I begin my clerkships this summer. I would really like to be back to an almost normal level of functioning by then. Do you know of someone I could work with who would be willing to mentor me? I have worked with the local functional doctor in my community but have not yet seen the results I want. I’m desperate.

  • Caitlin says:

    Hi, I have had chronic fatigue syndrome for two years, diagnosed a few months ago w adrenal fatigue. I have been taking DHEA for about two months now, but if anything have been feeling a worsening overall of all symptoms, including those of both cfs and af (with much cross-over). Just wondering what the best approach is in this case in terms of treatment?
    Thanks, Caitlin

    • Dr.Lam says:

      Feeling worse with DHEA is a sign that your body is not happy with what you are doing. This occurs frequently and points to underlying issues that need a more detailed history to start and figure out what is really going on.

      Click Adrenal Fatigue & Hormone Therapy for more information.

      Dr Lam

  • Marcy says:

    I had my thyroid radiated about 6 years ago and did the adrenal saliva test which showed my cortisol to be almost non-exisistant along with the DHEA being very low. One of my symptoms is pouring sweat from my head only and it can last all day long, dripping from my head, to my chin, to my clothes, and/or the floor. This started back in 2011 and I can’t stand it. The perspiration has a musty oder to it. Another thing that I noticed at about the same time is that I used to take very hot baths and now I can’t even put my body into a hot tub. Is this a thyroid problem or an adrenal problem and what can I do to make it stop?

    • Dr.Lam says:

      Temperature dysregulation is common in those with advanced AFS. Low cortisol and DHEA are similarily assocaited when the body is weak. The clinical picture you painted point to a fragile body.
      Click Adrenal Exhaustion for more information.

      Dr Lam

  • Cadence says:

    What effect do neurotransmitters play in fatigue- if i have issues with them can that make me more tired?

  • Tiffany grigorian says:

    Do you think the eye test for adrenal fatigue accurate? I did it a few times only to have my iris constantly contract. I have a range of symtoms one of them being bad braid fog. My blood work has all came back normal and drs said I’m fine when I know I’m not I’ve never been like this in my life and I can’t find anyone who can give me a diagnosis.

  • Machelle says:

    Hi. Wow! Thankyou for the report it confirms alot for me. I had a saliva test done, my morning Cortisol was .70 (normal 6.0-45.0) evening level was .40 (normal 1.0-5.0). My naturalpath said in her 30yrs, she has never seen adrenal fatigue like this. But i need to ask, my heart races ALL the time, like im jogging. My resting HR use to be 56-60bpm, now is 88-90. I have GERD with “chest/bone” pain. I cant stay asleep due to heart. Is this a typical symptom ?

    • Machelle says:

      Ps.. Ive had All heart tests. I do have Pcv and pca (?) going on. But due to HR not been over 90, dr says its still normal. I also have a deseased thyroid due to Hashimotos.

  • Horace says:

    Hi Dr. Lam, I work in law enforcement and my job is very stressful, and recently I’ve just been beat when I get off my shift. Is it best to nap right after I get home, or should I spend time unwinding before napping, so my sleep isn’t stressful?

    • Dr.Lam says:

      Listen to your body and do what it wants. If you feel like sleeping, the body is telling you it needs rest right away.

      Dr Lam

  • J. says:

    Dear dr.lam,

    One of symptoms that my af is still cousing is a very high rate wen doing exercises in begin it used to be worse than now but its still not like it should be. How do you fix something like thiss? Or it gets beter after your body heals? I read alot info on your site about herbs & suppliments but cant find any info how to deal with thiss.

    God bless ya!

    • Dr.Lam says:

      A more detailed history is needed as there are multiple reasons fast heart rate can happen and one need to focus on the root cause.

      Dr Lam

      • J. says:

        Before i suffered from AF i used before evry worke out ‘pre workout booster ‘ it contains all kinds of stimulants. At the time i didint know anything about AF but i think thiss started it. It was over 3 years ago, i made alot progress but still have the issues with my haerate etc 🙁

        • Dr.Lam says:

          Your story is quite common. Using stimulants can have long term issues.

          Dr Lam

          • J. says:

            Yes but i stoped all kind of stimulants and following your advice. My question is how do you fix that? Or it ‘fix’ its self after your adrenals heal..

          • Dr.Lam says:

            My advise is for general educationally purposes and not intended to be person specific because everyone is different. Please see your doctor for specific recommendation to your unique situation. The body does have tremendous regenerative power to self heal, but the timing, velocity, and recovery process differs from person to person. Abrupt stopping any supplemnents, especially stimulants, is not recommended as it can trigger rebound.

            Dr Lam

  • Ryan says:

    I have been suffering from chronic musculoskeletal pain for over 4 years. Many of my symptoms match those listed for AFS. Do you have any dieting or exercise tips I can try to reduce my pain?

  • Christine Moir says:

    Dear Dr Lam,
    I have read lots of your site and have further questions. I have dizziness and unsteadyness which worsens with any stress.
    I also cannot tolerate any salt – it worsens the dizziness and causes bloat.
    I have many other symptoms but my pathology is subclinical and my doctor does not know but I have elevated renin (double upper normal rate).
    I eat a paleo diet.

    • Dr.Lam says:

      Not able to tolerate salt is not unusual and it points to deeper underlying issues in the setting of AFS.

      Dr Lam

  • Tina says:

    Why is it that insulin levels go up when cortisol levels are low? Is this a compensatory mechanism of the body?

  • Jennifer says:

    Hi Dr.Lam,
    Thank you for replying to my last question.
    I had told you my adrenals, cortisols, and progesterone were low through saliva testing. I’ve been dealing with high cortisol levels to now low for six years!!! Lots of auto immune issues, hypoglycemia, adrenal, gluten intolerant …..
    So I just found out through blood work my c peptide is elevated! I have mentioned several times to my doctors about Insulinoma. Is there any connection to adrenal fatigue, hypoglycemia, and elevated c peptide? Thank u!!!!! Jennifer ?

  • Jennifer says:

    Hi Dr.Lam
    As many questions as I have … Do beta blockers worsen adrenal fatigue???

    I’ve been on 4 or 5 feel awful every time. I am currently taking 2.5 milligrams of Bystolic. I’ve been on it for 5 months. My recent saliva test shows my adrenals are flat lined!
    Thank you! ? Jennifer

    • Dr.Lam says:

      Beta blocker does not worsen adrenal fatigue directly, but indirect effect is possible given its cardiac suppression and blood pressure remnifications.

      Dr Lam

  • Jenna says:

    The video explanation on this is very helpful, I am a visual learner and love that you guys do that along with the very informative article

  • Jared says:

    Judging from the symptoms I have I kno for a fact I have AF and I had it now for almost 2 yrs but I can’t find out how I can heal from it I’ve tried almost every supplement I just started on this supplement called adrenal restore doc i need your help how I can heal from adrenal fatigue for good bc it is really having a big affect on my life thanks looking forward to your reply .

  • Ella says:

    Dear Dr.Lam,
    Thank you for sharing so much imformation.
    I wanted to ask about sunken eyes? Is it a result of aldestreone imbalance and would it reverse when with healing?

    Looking forward to your reply,

    • Dr.Lam says:

      There are many reasons for sunken eyes. If it is an adrenal related issue, that usually resolves when the body heals.

      Dr Lam

      • Ella says:

        Thank you for your reply. I have AF. Could you explain what cause the sunken appearance? It literally happened over night.
        Will the skin also heal itself fully?

        • Dr.Lam says:

          We see it in severe cases. No one knows for sure. may have to do with aldosterone regulation issues.

          Dr Lam.

  • Megan Fordham says:

    I was diagnosed with Addisons Disease 10 years ago at the age of 38 , I was also put on thyroid medication around the same time. I was active and a healthy weight. In May 2015 I was diagnosed with hormonal breast cancer and underwent chemo & radiation. I am now wondering if this is all related ? I want to concentrate on clearing the unhealthy estrogen in my body to minimise a recurrence of cancer but I need to stay on throxine, Hydrocortisone & Fludrocortisone medication. Do you have any suggestions ? Megan

  • Liz says:

    I had problems last year with joint pain and it all starting in feet, and then in other joints, knee, rotary and neck, fingers, also. I finally got blood drawn with RA factor of over 300. I know the Range is 14. My question is could this be from adrenal fatigue? Thanks

    • Dr.Lam says:

      The adrenals can play a part because the hormone regulating inflammation , cortisol, is made in the adrenal glands. When cortisol level is off, auto immune problme can arise. You should not, however, jump to conclusion it is adrenal related until all conventional medical work up is exhausted.

      Dr Lam

  • Brian says:

    i have been diagnosed with IBS about 10 years ago and it has continually been getting worse, now im weak and fatigued all the time because of it. Would you consider IBS and similar digestive issues to be included in the adrenal fatigue related health conditions?

    • Dr.Lam says:

      Whe the body is in AFS, the auto-regulation of the GI track is often off, and IBS type symptoms are very common.

      Dr Lam

  • Amy Short says:

    I have been being treated for “chronic Lyme” for 2.5 years but am convinced that I have adrenal fatigue. I have had hypothyroidism since age 20. It was easily detected and I have been treated with Synthroid fairly easily since then. Last 2.5 years have horrible fatigue, body aches especially when stressed, low temp, GI issues, massively reduced exercise tolerance, sore eyes especially after exercise, mildly low IGG1. Antibiotics for Lyme have helped nominally but I am getting progressively worse and worse. Dizziness, severe anxiety. Saw endo 2 weeks ago who put me on T3 but I had to stop as it made me sick. My Anti TPO is 85. Had ACTH stimulation test as she suspected Addison’s. My cortisol is normal according to doc (19, 23 at 30 mins, 25 at 60) but my ACTH is slightly elevated at 55. I was on a course of Prednisone (taper) for two weeks approximately one month ago and initially felt good, but at higher doses was extremely anxious. By the time i got down to 20/10 mg I felt very good, better than I had in years, and for a week following felt very good, but then suffered the worst crash I’ve had since this started. My whole back is in pain from neck to tailbone, muscles are tight, joints in arms and hands hurt. I was treated in the spring with high-dose vitamin C infusions for possible EBV reactivation and/or Lyme and I would always feel awful the day or two after the infusion but it seemed to help for a good while while I was on it. It did take a slight hit on my kidneys which have since recovered. Also of note I’ve been under constant severe stress for several years with the most extreme bouts of relationship stress last November and over the last four weeks. I know this is not helping. I’m not sure where to go from here, endo says everything’s fine. Hem/Onc is the one dealing with Lyme (was originally referred to him for low Igg1 as we don’t have immunologists in my state & hematology handles immunology). He is good and has been persistent but I don’t know if it’s all Lyme or Lyme at all, and I don’t know what I should be doing to help myself. Thanks for reading.

    • Dr.Lam says:

      What you experienced is quite common. Despite heroic efforts, your body is telling you something is amiss. There may be deep laying issues yet to be resolved, and thus major crash when your body cannot rebound as you try to tapper off the steroid in the tail end. this is not usual at all. We deal with this issue all the time. there is little scientific literature to enlighten us the physiological pathway involved, but they likely involved the receptors, the liver, extra cellular matrix as we found support these can help, provided that it is done right, or it can also worsen the situation because the body is usually quite weak and fragile by the time this is experienced.

      Dr Lam

  • Kim Johnson says:

    I was dx with Addison’s disease 3.5 years ago, weeks after being dx with: type one adult onset diabetes, Hashimoto’s, degenerative disc disease, spondylarthritis, multiple endocrine neoplasia, Polyglandular autoimmune disorder, afib, from hypotension to hypertension and back again and placed on a whole slew of medications from my Endo, rheumatologist and cardiologist. I have since gone from periods of having some of these symptoms relieved for a while to them all coming back with a vengeance, then crisis and then the “cycle” starts again. I also found out I have the HLAB-27 gene and passed it onto my daughter who has Crohn’s disease. I have questioned the Addison’s dx as my Endo thought I had Cushing’s disease and gave me a 24 hour urine test and when the results came back he had me come in immediately stating that I had zero court is all that was detectable and had Addison’s disease . He put me on hydrocortisone and A short time after I was put on fludrocort. I didn’t know at the time about the ATCH stem test and when I found out about that I asked if we could take one and he said that I would need to be removed from all the steroids for several days and that it would be so dangerous. I would have to do so in the ICU to be closely monitored. I’m not sure if it really matters whether I have AI or addison’s but what I do know is my symptoms are so bad now I really feel like I’m facing the end of my life soon. So I guess I’m asking your opinion on whether I should be concerned with the differences? should I go into the hospital and get off all my meds to take the test and if it’s Addison’s then I’m assuming none of your protocol would help me? Also do you know how type one diabetes plays into all of this ? Your article was very insightful. And I greatly appreciate your vast knowledge in this area. Whether I have Addison’s disease or AI I feel like my Endo saved my life. All of these diagnoses were in a period of A few weeks and from what I’ve read a lot of people die before they’re even diagnosed. However, he will be the first to say I know more about it than he does and therefore is not helpful in determining what to do after diagnosis . Thank you for taking the time to read this and I look forward to your response!

    • Kim Johnson says:

      One last note, two weeks before I was in the ICU near dead and diagnosed with all this another doctor told me I needed to look into a mental healthcare provider and that nothing was wrong with me!

    • Dr.Lam says:

      AI and Addison’s Disease is the same thing. ACTH stim test is not necessary when the clinical picture is obvious because of the risk involved. Everyone is different so your endo will decide. Supporting the adrenals naturally can be very helpful but needs to be carefully done to avoid backfiring. Your situation is complex as swings like what you have experienced reflect underlying adrenals in a very fragile state. This only occur in a very small number of people. Dont try to self navigate. Follow your endo on meds. If you want a personalized natural support, it may or may not be able to be done, depending on your state. The proper timing is important. Call my office if you need more info.

      Dr Lam

  • Lila says:

    I had no idea that my low blood sugar and hair loss could be connected to adrenal fatigue!! There is so much that I don’t know about this! Thank you for educating us!

  • Michele Finizio says:

    What can i do to treat my adrenal fatigue and insomnia, problem with staying asleep. Wake up multiple times. Im on a supplement with ashwaganda ,bocopa, holy basil and cordyceps. Is this good. What can i do for sleep?

    • Dr.Lam says:

      AFS and sleep are related but seperate issues. I am concern about your supplementation because depending on your body, they can be a factor in your symptoms. Click Adrenal Fatigue & Sleep for more information.

      Dr Lam

  • Mandi Baker says:

    This is Me, to a T. I am 48, female, and in preparation to die.
    Previous Diagnoses;
    Haemachromatosis. Bi polar disorder. Fibromyalgia. Coeliac. Chronic GI problems. Chronic depression and drug dependency. Suicidal contemplations.
    I have ceased hankering for a cure, or relief, and have been studying Transcendental literature, with much enthusiasm and genuine passion, in preparation for the death of this physical form that I have been living within, for my next body, should I be unfortunate enough to have to return to this planet of death.

    This was a very informative description of the physiological processes underlying this state of Hell that I have found myself in. I will be sure to show it to my Dr, who has been kindly, removing my blood regularly, for years now, and trying to convince me try another one of the 40 antidepressants that zre avzilznle for humanity, because, that is all he can do to try and “help” me cope, with this Hellish predicament.

    I have tried 12 already.
    What is life like without drugs? I don’t know.

    All his “help” effectively does, is slow down the rate I am dying at, and make me feel even worse despite telling me that it is necessary….to keep living.
    From my perspective, it only continues my existence in Hell.

    Good health is just the slowest possible rate you can die at.

    Presently, my “quality” of life is wholly dependent on drug usage for attempting to manage the various chronic debilitating ailments associated with being bound in this present physical form, and maintaining God consciousness, remembering that He is the Ultimate controller.
    He knows when a blade of grass moves.
    He is determining my pathway back to him, and away from this jail of being.

    God laughs at death. This reality we exist in is but perverted reflection of the Absolute Truth.
    We never really die. These bodies, and our limited capacity to comprehend the larger world beyond our own pond, is the ultimate cause of all anxieties and frustrations.

    We will never find respite from pain and suffering while our spirit is bound to physical matter.
    We only ever gain respite from this human condition by realising that this body is not who we are.
    Who we are is eternal spirit, that can never die. We are part and parcel of God.

    He wants us to remeber Him, and get to know Him, so we can understand why we are here, suffering birth, death, old age and disease. He is the Ultimate Panacea for all of mankind’s ills. He has given us the knowledge we require for transcending the mundane level of conditioned consciousness that keeps us anchored to unecessary grief and suffering, due to ignorance.

    In getting to know Krsna, I have surrendered to my predicament, and have discovered a form of relief that cannot be compared to any thing that this material world can offer me for respite from thd pain and suffering.
    I completely understand why I am in this physical state of hell, where my body has been a cause for much uneccesary grief and misery. It is the pain and suffering that can bring us closer to the Absolute Truth of our phenomenal existence.
    We are not these bodies. We are eternal spirit soul, but we forget our constitutional position to God, our Father, and lose control of our senses in the materially mainfested energy, becoming slaves to our senses and suffering the consequences because of it.
    Our mind is our biggest sense. My mind has been dis -eased with “illness”, which can be wholly attributable to ignorance of sense control, due to lack of knowledge about my self; my soul, and why it is temporarilh bound to this physical matter which I have ignoramtly referred to as my self, until recently realising that this body is not who I am at all.

    Symptoms of disease are pandemic and represent mankind’s ignorance of the Absolute Truth, which is, that we are the cause of our own suffering and grief, and that the only intelligent thing for all of us to do is to realise this, and go about changing our level of consciousness from the mundane realm of mundane illusory concerns that cause us to lament unecessarily, to the Transcendental level of Krsna consciousness that brings peace within, through realising our own ignorance of what this reality and existence is ultimately for.

    We are here to serve God. That is the purpose of this existence. In serving God (Bhakti Yoga) one reavhes the ultimate state of human perfection, even if one is confined to a wheelchair, wearing nappies and sitting in their own faeces, dribbling, if the mind if fixed on God, and God’s purpose for this Hellish existence, one can accept and surrender to the price of the Knowledge attained, via pain and suffering.

    Do you have any better recourse for some body in this physical state of deterioration?

    • Dr.Lam says:

      There is a lot of truth in your writing. Life it what it is. We tend to reap what we sow, and smart people know that they need to take control of their health and thus their destiny.

      Dr Lam

  • Madison says:

    Can being a carrier of mononucleosis put you at higher risk of developing Adrenal Fatigue?

  • Annette says:

    I suffer from adrenal insufficiency and hypothyroidism. Three years ago the pharmacy gave me the wrong dose of Hydro-cortisone and now I have been diagnosed with Addison’s. I have managed pretty well over the years but recently I have had extreme panic attacks that will not go away. I have nothing to be fearful about, in fact it started on vacation at the beach. I shouldn’t have a care in the world but I am extremely shaky, forgetful and honestly freaking out over nothing. I went to the ER after 24 hours of panic. They gave me 100mg cortef and ativan. My heartrate was extremely low (42-50 before and on the meds), and my blood pressure was high for me (152/74) I am normally low bp 85/60. T3 and T4 were normal. TSH was low (.12). Called my doctor back home who told me to double my cortef for two days… is not helping. I can’t live with this panic. Recently my Levothyroxine was lowered from 75mg to 50mg. Could that be the trigger?

    • Dr.Lam says:

      There are multiple possible reasons for what has happened to you , from steroidal resistance to triggering of autonomic response. The matter is complicated by the fact you were on thyroid and withdrawal reaction is not uncommon. all in all, we have to piece the history together in more detail and the story will emerge. What you have shared is simply not detailed enough at this time due to so many moving parts. Find a clinic who really understand the connection with steroid, thyroid, and adrenal issues is your biggest challenge. We do deal with this type of issue so nothing very unusual to us.

      Dr Lam

  • Ash says:

    Very Informative Article Doc, highly appericate it.

    I have been dealing with symptoms of lightheadedness, racing thoughts,
    anxiety, panic, fearfulness, total loss of appetite (never had these In my life). I did the Saliva Testing (Diurnal)
    Apparently my cortisol is in the high ranges (all day/ all night long)
    Would this be considered Adrenal fatigue Stage one.
    Is there anything your Clinic/staff help me with,
    direct me towards the right path.
    I understand you are in Loma Linda,
    I am in los Angeles, I do not mind the drive to be examined by you or your clinicians.

    • Dr.Lam says:

      High cortisol throughout the day can be associated with the symptoms you mentioned. However, more often than not, its low cortisol that is more frequently associated with this. Remember that cortisol is just one piece of the puzzle that need to be put together with other clinical data to form the right picture. We do take care of situations like yours. For more information, call my office.

      Dr Lam

  • Kim says:

    Can you recommend a Doctor in the Minneapolis area that has experience treating people afflicted with severe Adrenal Fatigue? It would be much appreciated.

    • Dr.Lam says:

      Our approach is unique and we serve people worldwide from our office by telephone. General Practitioners tend to stimulate the body and we dont find that helpful long term.

      Dr Lam.

  • Nicole says:

    I have poly-cystic ovarian disease. Could Adrenal Fatigue treatment help to lessen my symptoms?

    • Dr.Lam says:

      PCOD involves hormonal imabalances which also involves the adrenal system. A healthy adrenal is conducive to optimizing the entire body and hormonal balancing.

      Dr Lam

  • Louise Leech says:

    How do i overcome extreme adrenal fatigue?

    • Dr.Lam says:

      The first step is educating yourself the physiology of what is going on . Most conventional doctors are not on alert . If you are in extreme weakness, then you should seek medical help from some someone who is literate of what to do. Most self navigation will fail because the body is quite fragile and sensitive at extreme states.

      Dr Lam

  • Robert says:

    For more than 2 years I suffer from excessive sweating all over body but mainly on the back part. The sweating is triggered even by little physical work. Plus when I walk in the shop my girlfriend is okay, but I must put off clothes, cause I feel hot and sweating. I have also noticed over fearfulness, anxiety, and when I am in stress I immediately sweat all over the body.
    I thought it might be hyperthyroid problem, but I was on blood tests and I have good levels of thyroid hormones. Could these sympthons indicate adrenal problems? What treatment would you recommend? On the web I found Thorne Research, Adrenal Cortex product. Can I try to take it? What do you think of it? Thank you for your reply.

  • Nicole says:

    This article was so informative, when reading over it I see that there are so many health conditions that can be caused by Adrenal Fatigue. Especially because I have hormone imbalances and PCOS and i did not know that it could be improved by treating the adrenal gland.

  • homme says:

    Hello DR. Lam I just want to ask a little question about , what happened when people who got Adrenal Fatigue watch Horror movie , will they react the same as a normal person or worst ?

  • Neil says:

    Hi Dr Lam

    Would you know of any solutions for frequent sinus infections? They generally cause great fatigue.


    • Dr.Lam says:

      When your immune system is low, bugs can take hold.The sinus area is hard to reach because it is quite embedded in the skull. Infections usually need antibiotic but even they may not be able to reach the bugs. Toxins secretion from the infections can be troublesome and cause inflammation, adrenal exhaustion, and fatigue. There are natural solutions but generally they are not very good as by the time chronic infection sets in, its quite advance. The program depends on each person.

      Dr Lam

      • Neil says:

        So could you say that the low immune system is caused by hormone deficiencies, and if those deficiencies are restored, the frequent infections would go away?

        Or would there be any short term solutions in the meantime to reduce the frequency or severity?

        Thanks so much

  • Andrea Gillette says:

    This information was very helpful. After having my baby, I went through a lot of stress going back to work. I know suffer from low energy, night wakings that have turned into severe insomnia even during the day, startle easily, lots of anxiety, and fatigue. I’ve been suffering for months now and feel like losing it. I can’t sleep at all. I take elavil and have tried some supplements. I know I have adrenal issues from my tests. What do you recommend?

    • Dr.Lam says:

      First you should see your doctor to make sure nothing is going that could account for your current low energy state. If everything is normal, then you should investigate more on AFS as the cause. Lab for adrenal function is usually normal, and most people are confused. The key comes down to a detailed history. We do see many post partum crashes and its really a sign of pre existing weakness that may be masked by the pregnancy. Try to avoid meds if you can and supplements unless you have a comprehensive plan of recovery as they can further mask the underlying issue while give you only temporary benefit, and the long term progression is downhill.

      Dr Lam

  • Stephanie Cohen says:

    Dear Dr Lam, I spoke with Doreen tues or thurs a week ago. I have written to you several times prior to that, about my having AF,,along with hx if 21 hydroxylase deficiency, treated with Cortef and dexamethasone, and difficulties waking around 2 am on for past 2 months. So,far,,dr has been unable to properly manage dosage/timing. I’m wondering if getting an adrenal saliva test for,day and night would offer some helpful info and guidance to improve my sleep,deprivation issues,,as,they are Jodi back my recovery. I am eating very healthily and often,,resting periodically, exercising modestly, in short, doing all I can to support my recovery. I had started some homeopathic sprays a week or so before speaking w Doreen. She suggested I check,back,with you in a month. Although they are mitigating some of,the harsher symptoms, calming my heart, sometimes,aiding sleep a bit, for whch I’m grateful, I,can see the extend if their help is limited due to the overpowering nature of steroidal effect on my compromised adrenals. So much time has already gone by without sufficient forward movement,,so I am contacting you now. I know saliva tests may take time to process as well, tho unsure how long, or of the costs involved. I am on a limited income,with disability,,and have been unable to supplement it due to my health in these months. Thank you for taking time here.

    • Dr.Lam says:

      A saliva test can give you more data points but whether or that it is helpful is in question especially in cases like you where you have already been on medicatoins by your doctor. Click Laboratory Testing for more information.

  • Marilee says:

    I have been to a few doctors and they just don’t get it. I have been depressed, suffering from indigestion, rashes, muscle aches and fatigue. They just want to put me on anti depressants, steroids for rash gerd meds and that is it. I want to find out what is really wrong with me without taking all those meds. Do you have any suggestions?

    • Dr.Lam says:

      This article will explain why conventional docs dont fully understand AFS. Click Why Conventional Medicine Rejects Adrenal Fatigue for more information. What you are doing is good -educating yourself. Get my book will be excellent so you have the proper reference material. if you have more questions, you can call me and I will help answer.

      Dr Lam

  • Danielle Goddard says:

    Hello I had postpartum with my last baby and he is 18 months now I started hormone Replacement last August 2015 was diagnosed with hypothalamus amnoreah and had extremely low estrogen and progesterone also MTHFR and Cadida…. I started hormone therapy and it worked really well I even was able to go off my antidepressant!… I was starting to feel a 100% and then just about 2 weeks ago I got my period and I started getting anxiety like crazy then this week I started getting depressing and I feel just totally exhausted every vitamins vitamin c, magnesium, pregnalone, Vitamin D, inositol, b vitamin, and 5-HTP I take I get agitated and racing heart feel paranoid about things and people… Even pregnelone which I never had a problem with before!… Is there anyway I could have adrenal fatigue?! The chores around my house feels so hard to get to also!… I have 4 children and I need to get my energy back!

    • Dr.Lam says:

      Your history is quite typical of a body that has never truly healed the root problem. Hormone therapy can be very helpful short term, but it can also mask the underlying problem until the body is faced with new round of stress, such as hormonal disruption, surgery, or accident, just to mentioned a few. When that happens, the body “crashes” and the root problem becomes more amplified. your threshold is lowered and you become very exhausted. Its not the supplement but a body that is drained. We deal with many like you in our daily telephone coaching, and we refrain from using stimulatory compounds exactly for this reason. Getting your energy back will be hard unless you focus on the root problem. Click Adrenal Fatigue & Hormone Therapy for more information. Laboratory test are not helpful when it comes to this point, and in fact can be confusing because it may mislead you.

      Dr Lam.

  • lucinda parmenter says:

    I have been dealing with adrenal issues for years, then Hashi’s (15 yrs), then diagnosed with a1298c (MTHFR) over a year ago, and now believe I have Sjogren’s Syndrome, although I tested negative 2 years ago but symptoms have gotten worse. I’m wondering if you work with patients over the phone. You clearly know so much and I’m at a loss where to start so I jump around, taking supplements for everything. I’m assuming I should start with one malady before I begin dealing with another. Any thoughts and comments will be greatly appreciated!

    • Dr.Lam says:

      When the adrenals are not well supported, a lot of other issues can arise and symptoms suppression usually is not a long term solution. The key is to look at the big picture and suppor the body and let it do its own work. this takes time and a comprehensive program. My book will be a good starting point for you to read further as reference material. We do have a telephone nutritional coaching program that may be helpful to someone like you. Read my book if not already done so, and you can call my office for more details. Click Book – Adrenal Fatigue Syndrome- Reclaim Your Energy and Vitality with Clinically Proven Natural Programs for more information.

      Dr Lam

  • Anne says:

    Hi Dr. Lam – I don’t know what to do with this information. I know this is me, I’m 41. I’ve had hypoglycemia since I was a child and hypothroid since I was in my early 20s. I’m on Levothyroxine. I’m on Celexa for depression. I’m on Valium for insomnia. I have fibromyalgia, chronic fatigue syndrome, hives from allergens regularly on my face and legs. I’m intolerant to chemicals, fragrances, pesticides, wheat, soy, dairy, eggs, corn – so I avoid those things. I don’t eat sugar. Just in the last few months I’ve been unable to regulate my body temperature. I’m either extremely cold for sweating profusely. The brain fog and physical exhaustion has been increasing over the years and is so great that I’ve been taking Adderall for three years just so I can work and get through the day. It’s not doing it anymore. There are days I’m nearly non-functioning. If I don’t have Adderall, I cannot leave the couch. I cannot think through the steps for how to do something as simple as writing out a check, putting it in an envelope with a stamp and putting it in the mailbox. Now even with Adderall I’m having difficulty making these connections.
    No doctor has ever said there is a problem with my adrenals, but what I’ve read above is so me, it’s terrifying. What steps do I take? What help is there for this?

    • Dr.Lam says:

      Unfortunately, adrenal health is not taught to doctors to the degree it should in medical school.Click Why Conventional Medicine Rejects Adrenal Fatigue for more information.

      Your history is quite classic for someone who is dependent on stronger and stronger compounds over time to “get going”. unfortunately there is no “free lunch”, and over time, your body can get resistance issues as well as tolerance issues. Do make sure with your regular doctor that nothing else is going on. Read my book of 500+ pages for tips on what to do. Allowing the body to heal itself is best, but it takes a comprehensive program to avoid relapses and crashes with a body as fragile as yours. Do therefore be very careful on what you do. Do not stop any meds abruptly. Click Book – Adrenal Fatigue Syndrome – Reclaim Your Energy and Vitality with Clinically Proven Natural Programs for more information. If you are at your wits end, you can call our office and we will help you figure out where you stand first of all so we know what we are dealing with. A detailed history and thorough knowledge of the physiology is key, as lab test are not very helpful and in fact can mislead you.

      Dr Lam

  • Lance says:

    Hi Dr. Lam. Can excessive sweating (enough that I feel dehydrated) during exercise connected to AFS?

    • Dr.Lam says:

      Excessive sweating can be due to many factors. It is regulated by a special branch of the autonomic nervous system. You can read more about it in my book. some people with AFS , especially in advance stages,also have dysregulated autonomic nervous system and thus can present with symptoms of sweating beyond normal. It is not common. Its a sign that points the body to underlying issues which can be sorted out with a detailed history.

      Dr Lam

  • John Brownlee says:

    Dear Dr. Lam, I stumbled upon your site, while searching for answers. Over a period of a year, I suffered 11 MI’s and on two occasions I flatlined ! Ultimately I became a patient of St Paul’s Hospital in Vancouver, B.C. Where I was diagnosed with what has been decribed as an extremely rare auto immune disease known as “KOUNIS SYNDROME” . Referred to as acute allergic heart attacks. I have an ID for backup and a cocktail of meds. Which I’m told will keep my vessels dilated and control the heart attacks. They seem to be working, as I have been attack free for almost 3 yrs. now ! They don’t know what the trigger is and tell me they might never know ? The common event each time I would have an MI is rash, then forming into hives all over my body. By this time I have back to front chest pains. On a couple occasions I passed out, before or after the paramedics arrived. I thought I would give you a little background first. Before asking you if this is something you might have ever come across. By the way they call me a medical miracle and have said I am 1 of 34 in the world. In reading your article I realized a lot of similarities such as chronic fatigue. Would you be kind enough to share your opinion ? Possibly suggestions or tests I might look into ? Sincerely, John

    • Dr.Lam says:

      At the root level, your situation is not much different from those who have inability to control inflammation and histamine reaction. Much of this is regulated by adrenal system. In your case, your reactions are quite extreme, requiring cocktail of meds to suppress the spasm once it comes on. From a natural medicine perspective, anytime you support the body at the root level, the outcome should be positive one,but to what extend, no one knows. there are no shortage of test to do, but I doubt they would lead to anything but academic discussions because at the end, you have to learn to listen to your body and take proactive action accordingly well before things get out of control. Medicine are good for emergency, but I suggest you find someone to really get to the root problem,and avoid any stimulants or hormones that can potentially aggravate your spams causing ischemia. The only way to look deeper is by way of detailed history will give us better clue,but that is a process takes multiple sessions over multiple weeks to fully appreciate your body’s unique response and triggers without trigger any paradoxical reactions and not a one time event. The signs are there, its just a matter of putting the pieces of puzzle together. Unfortunately, conventional therapy is about treating symptoms, which is good ,but does not focus on the root. We may never find the answer, but I think we know enough now to have a much better clue than decades ago, and if you have a window of opportunity and can afford the process, it will be invaluable to you, even if there are no solutions at this time, becuase as medical science advances, you will be in the position to take advantage of it rather than in the dark, and also you understand what may be coming ahead of you in the natural progression of histamine etc as you age. The key is to find some one who understand the physiology beyond what conventional medicine offers and look at the basic science to correlate to your body, and you can often be amazed at how much your body actually tells you if you listen closely. Talk to your doctor, and if you have no resource, you can call my office.

      Dr Lam.

  • Carol says:

    My glycine level is 535 and the highest range is 322. Also my Beta Amino Isobutyric Acid is 4 (should be <3), Phenylalanine is 90 (should be <74) and Ornithine is 110 (should be <83). I requested the amino acid testing and my GP doesn't know how to interpret it. Could this be indicative in any way of adrenal fatigue?

  • Sarah says:

    I am stage 3 adrenal as confirmed by my saliva testing. My cortisol is undetectable all day, and DHEA very very low. I give heroic effort to lose weight, but the scale doesn’t move, and I’m having tachycardia with palpitations and POTS symptoms regularly. I am seeing a doc who put me on hydrocortisone but I’m not improving. Please direct me to help. I’m in Portland, Or

    • Dr.Lam says:

      you have many of the classic signs of neuroendocrine stress response dysregulation. Low DHEA often corrects itself as the body rebalances. Not able to tolerate steroid is common for those who are in advance state and the body tend to reject it. My book goes into all this so you learn. Click Book – Adrenal Fatigue Syndrome – Reclaim Your Energy and Vitality with Clinically Proven Natural Programs for more information. When you get to this stage, you need to go back to your doctor, or find someone else who really understand advance AFS as you can easily make yourself worse easily. If you cannot find help locally, you can call us and I will explain to you more and your options.

      Dr Lam

  • kathy says:

    Dr. Lam,

    I am in the final stage of adrenal fatigue. My cortisol saliva test is 200x’s higher than normal, histamine is high, norepinephrine is high. I am losing my hair, aging rapidly, severe anxiety 24/7, depression, pots, hoshimotos and crps. I freeze all day and sweat all night.

    I have just recently realized this has been a problem for over 15 years. I had a family trauma 3 years ago and crashed hard. I have gone to psychiatrist, endocrinologist, nmd, Gi and considering a psychiatric hospital.

    I am hyper reactive to everything. I really want to save my life and just know that that psychiatry is not the answer.

    I need help getting my life back. Can you recommended anyone in Arizona or can you HELP ME?

    I wish there was an inpatient facility to help people recover.


    • Dr.Lam says:

      What you described is very typical when the body is weak. Nothing unusual. If your vitals are unstable or you are very worried, you should see your doctor right away. We do have a telephone coaching program , and you can call provided you are stable , and see if you qualify. There is no inpatient facility that specializes in AFS because the condition is not well appreciated by conventional doctors. Your doctor may arrange for you to be in hospital if your condition is serious.

      Dr Lam

  • Angela cole says:

    I would like more information about the Tele phone coaching program

    • Dr.Lam says:

      You need to call to my office and my staff will explain how it works and how to qualify for it. Here is a link for more details about our services.

  • Shelly Magno says:

    I am wondering if you might be able to recommend a naturopath or medical doctor who supports natural healing in the Boston, MA area.

    I’m a 41 year old mother of two. I’m in graduate school and working full time. A month ago, I fainted while standing in the kitchen. After that day, I’ve been unable to get through the day without getting lightheaded and faint usually around late morning. I can’t seem to think clearly and sometimes trip words. I have pins and needles in my arms and legs. I’ve seen my PCP several times but she says my blood labs and EKG are normal save for total bilirubin (1.3). She told me I have anxiety and gave me a script for tranquilizers, though I was not comfortable taking them.

    I was surprised at the match of many of my symptoms to AF though I can’t find a caregiver to help me. My PCP told me AF was snake oil and not a real condition. I feel helpless and discouraged.
    Your site is very educational. Thank you for so much information.

    • Dr.Lam says:

      Our approach to AF is unique in that we do not try to patch symptoms but go to the root cause through natural recovery approach and not use stimulants like glandular and hormones which is a problem long term. Read 7 Adrenal Fatigue Recovery Mistakes for more information. We do have a telephone coaching program to help those who want to pursue this total body approach. Read Total Body Approach for more information.

      Dr Lam.

  • Emma says:

    Thank you for such an informative article. I’ve read many articles on adrenal fatigue, but this one goes into so much depth.

    I am 32 and have suffered from ME/CFS for 16 years. After doing much nutritional work etc, I made what was a temporary recovery in my mid twenties, but with high insight, I ended up going back to old ways burning the candle at both ends. I crashed severely in 2010. Having a year in what I think was adrenal crisis (unable to function/extreme terror feelings/severe exhaustion etc)

    I’ve slowly rebuilt myself over the last 5 years with much work on my self (learning to relax/therapy/gentle yoga etc). This time last year I felt I was on the way to a slow but steady recovery. Once again able to function, drive my car again, have a gentle swim etc and many symptoms disappearing except the fatigue,

    However, earlier this year I lost my father to cancer and have had repeated viruses/infections.

    I am now 3 months into being housebound once again, with severe exhaustion, spaciness and a general feeling of awful malaise. My menstrual cycle has gone very irregular and I’m showing low progesterone on tests. I type this 4am after being awake for two hours which seems to have become a regular nighttime occurrence (I wake with what feels like a really weak heart beat and have to eat then can’t get back to sleep despite exhaustion)

    My question is this – is there any hope for me?

    I am a generally positive person who has educated myself so much in the world of health and wellbeing. Yet this seems so ongoing, that I wonder if I have done too much damage to my adrenals?

    I am doing an adrenal stress saliva test to see what stage I am at, and about to embark with a nutritionist at the Optimum Heath Clinic in London. But i fear this may not be enough. I feel a bit like I am fishing around in the dark.

    Thank you so much for your time and for such informative information on this site


    • Dr.Lam says:

      Saliva test at this point has no harm, but will not be helpful in what you need to do to reverse course. People with relapses like you with frequent crashes has a body that is very fragile. Lab test will not be able to give you the proper recommendation. It just tells you what we already know from detailed history. you biggest challenge is to find someone who really knows what they are doing. Unfortunately, there is none in your country at this time. I know because so many of your fellow countryperson call us for help in our telephone coaching program. Do be very careful not to embark on a stimulatory program. Read 7 Adrenal Fatigue Recovery Mistakes for more information.

      Nothing you tell me is unusual. Dont give up. There is hope. The body has amazing ways of rebounding if you do what is right. Do be very careful. Avoid crashes.

      Dr Lam.

  • Yvonne says:

    I had thyroid cancer 10yrs ago in 1995. Half was removed. I suffer from Hasimotos Disease. I lost my mom one year ago, then my job. I have never bounced back, if anything I can’t move forward? My husband has been diagnosed with stage iv prostate cancer metastasis to lymph & bone. I’ve been following “Eat Right For your Blood Type” which has mad me feel a little better, but I know it has to be something else? I watched the testimonials and that’s exactly what I’m going through for over a year? I have had chronic fatigue since I’ve had children starting in 1989. This sounds like to me, adrenal dysfunction? Looking forward to making this phone Asap!
    Thank you,

    • Dr.Lam says:

      you can move forward by continued to support not only thyroid gland but also your adrenals because the two work together. Try not to make the common mistakes many do. Read 7 Adrenal Fatigue Recovery Mistakes for more information.

      for your husband, consider very high dose of IV Vitmamin C and PolyMVA.

      Dr Lam

  • Dawn says:

    HI Dr. Lam,

    I have been diagnosed with AFS. I have chronic hives and angiodema being controled by Xolair. My goal is to get off the Xolair. However, lately my scalp is sore and I am getting sterile folliculitis. I even get swollen areas on my scalp. What I have noticed is that anything and everything is causing anxiety (it’s a quick trigger, but not debilatiting), and this triggers a histamine release. My face, scalp, ears turn red and I think this is what is irritating my scalp. I am not sure how to get the histamine releases under control.

    Other pertinent facts are that I have just realized my pattern of anxiety for most of my life. I am working hard on this and I have always had a sugar addiction. Last, I rarely if ever get sick which indicates to me an over active immune system. I have a lot of pain in my body, and my recent tests show that I am shedding a ton of calcium, and my vitamins, at the cellular level, are low. My heavy metal panel was not too bad. Any insight into this histamine/scalp issue is much appreciated.

    Thank you,

    • Dr.Lam says:

      Histamine overload is a very complex issue to resolve because histamine is released from multiple places through multiple mechanisms. Trying to suppress the symptoms can be helpful for short time but generally is not a long term solution as you already experieinced. the natural approach is by detailed history first to trace the issue to the root problem and then use natural principals to modulate the histamine release with various modalities from using the right food, diet and supplements.

      Here is an article that addresses this histamine issue. Read Histamine & Adrenal Fatigue Syndrome for more information.

      Dr Lam

  • Bennie DeLaRosa says:

    At what stage of Adrenal fatigue does the immune system start to fail ? Im usually a healthy person but Ive noticed that Ive been catching many more colds as i get older.

  • Sasha says:

    I have a lot of hypoglycemia symptoms. I am eating all the time but still have trouble getting my blood sugars under control. I am not diabetic or anything. What else can I do?

    • Newsletter says:

      There are different types of hypoglycemcia. Those with AFS have normal blood sugar by laboratory test but symptomatic. If your blood sugar is NOT within the normal range , then there are issues that is going on underneath. Are you focusing on food that is low glycemic? Your diet has a lot to do with it.

      Dr Lam

  • Anna says:

    Hi Dr Lam
    I’m treating myself for Adrenal Fatigue. This article showed me I am right regards to my symptoms… I have the imbalance of SAS and SCS. So that makes me feel less crazy! I am a health coach and know all about clean eating. I have a naturopath who is assisting me. I’m eating more of a Paleo diet … the less carbs have helped with fatigue and my sugar imbalances. I also take a tablet if I’m feeling fatigue coming on which is less often now…it’s got a herbal combination in it and it’s works nicely. I take Vit C in high dose, a little Maca root, and chinese herb combination.
    How long will it take to heal the Adrenals? Am I doing enough for them to heal at all? I’m so confused as to what the right protocol really is. I have your book but it’s not showing me a clear path. Everytime I have tried a combination of herbs I make it WORSE! My adrenaline gets worse and I have debilitating fatigue episodes. So it’s scary to try things and to know what my adrenals want. I tried Thyrocalm…(with Rhemmania). I loved this product, it made me so calm and relaxed but stimulated my thyroid gland which swelled and was sore…so I stopped. Do you know what that was? My Naturopath thought it was great that it stimulated the thyroid…but it didn’t feel right so she gave me chinese herbs instead. I feel nothing with these and don’t know what they are doing. Is there any direction you can give? I’m thinking maybe sleep, deep relaxation, try not to trigger the adrenals at all… and get adequate nutrition. I can’t have anything with potassium in it…I get an itchy nose…lots of inflammation and irritation on the outside and inside…not sure if it’s a histamine intolerance or my adrenals!!! Just want out of this condition I’ve had for more than 2 decades now.
    Thanks for all your knowledge. Glad to know I’m not alone.

    • Newsletter says:

      What you have experienced is actually quite common. One of the most common clinical mistakes people make in recovery is inability to gauge what the body really needs at every point in time. It is easy to prop up the body and generate more energy with herbs. Feeling good is not equal to true healing. Just as taking an aspirin to reduce fever is not the same as getting rid of the infection. In the case of AFS, the long term result of collateral damage and unattended root problem is a gradual increase in sensitivity to supplements and feeling worse. Some are in fact bedridden and this is not unusual. My 500+ page book is not designed to give a clear path for you because your situation is quite advance and requires personalization and no book in the world can do that. When the body is at this stage, it is highly sensitive. What works for one will indeed and easily backfires on on another person in ways that defy conventional medical wisdom. Yet if you trace the problem deep enough, it will start making sense to you. Start from there and learn what the body is really trying to tell you. Dont focus on symptoms as your gauge of success as that is what the body is telling you to do. I know it is a frustrating journey for most who are looking for answers without much assistance from the health experts. We deal with many . These are concepts that many may find foreign in a modern age of testings and pills. Deep relaxation etc are good , but may not be enough. Remember the more advance you are in AFS, the less your body can tolerate and over aggressive treatment is ac common clinical mistake. What the body needs is to be gently nurtured back to health. Focus on that and you will be able to see if indeed you are giving what the body wants. Dont rely only on your brain power and what your logic tells you for now as it has not worked, so you need a new path of thinking. Learn to listen to your body. Its not easy and much harder than you may think or know what to do.

      General recovery time for people at this stage is 1-2 years if everything is done properly. We deal with more people in this stage than anyone else in the world, and I can tell you that recovery is possible and do not give up hope. Continue your search for answers is excellent, and if you have more personalized questions that needs answer, call my office and I will explain to you. Until you really know the root problem, which in your case has now progress to deeper level than just adrenal fatigue, you cannot begin to fix it. You are not alone,and many have walk the same path and come out well.

      Dr Lam

  • Bruce says:

    Hi Dr. Lam. You mention that “many have postulated that Adrenal Fatigue often precedes fibromyalgia and chronic fatigue.” Could you elaborate more on this? Do you feel fibromyalgia is preventable if Adrenal Fatigue is caught in early stages?

    • Newsletter says:

      FM and CF both describe a set of symptoms with unknown causes. they are not the root problem or trigger. The root problem can be stealth infection, adrenal fatigue, heavy metal toxicity and many others. So it is important for you to trace your symptoms to the root level. People with AFS often have symptoms classic of FM and CF. FM symptoms can improve if you support adrenal function.

      Dr Lam