The Danger of Adrenal Fatigue or Adrenal Exhaustion

Many people suffer in silence low functioning adrenal gland due to chronic stress. Our body has two adrenal glands, located just above each of your kidneys. Adrenal gland produces more than 100 hormones and it is control partly from the hypothalamus in the brain.

Your hypothalamic–pituitary–adrenal (HPA) axis is the system responsible for one of the most important functions in your body — the management of stress. This includes stress from every conceivable source, be it injury or disease, work or relationship problems.

Exposure to chronic stress from overwork, chronic inflammation or long-term illness, for example, can result in HPA axis dysfunction, also referred to as “adrenal fatigue” or “adrenal exhaustion.” In reaction to mental stress, adrenal glands produce cortisol hormones. Chronic stressful life can taxed the adrenal gland and lose their ability to make cortisol due to overwork.

Besides Mental Stress Common Medications Can Dramatically Lower HPA Axis Function


Many people do not realize that certain common medications may in fact be suppressing their HPA output of cortisol. Drugs that fall into the “steroid” category, such as prednisone, can essentially shut down the pathway, which is why when taking this medication, the dose is often tapered so as to not cause a crash from lack of cortisol production.

Steroid asthma and allergy medications can also have this effect. Those who need inhalers or intranasal sprays such as those containing beclomethasone, triamcinolone, fluticasone, or budesonide are at risk, especially when taken over the long-term.

If you are taking Prednisone, most doctors will know that it suppresses adrenal production. Many of these other medications will do the same thing, but your health care provider may not be aware of their suppressive effects.

Another medication known to affect the hypothalamus and pituitary and thus the output of cortisol is isotretinoin, commonly used for the treatment of acne. In a 2015 Dermatology study,7 105 acne vulgaris patients were studied. The researchers found that many hormones, including Luteinizing hormone, testosterone, ACTH, cortisol, growth hormone and free T3 (thyroid) were decreased after three months of use.

Isotretinoin is often used in the teenage years and early 20s, but could have lasting health effects on energy, weight, the menstrual cycle and fertility. Another major one that likely affects a great number of people is opioid painkillers.

How to Identify HPA Dysfunction

Both primary and secondary adrenal insufficiency can be diagnosed with a lab test. More subtle abnormalities in the HPA axis, on the other hand, are more difficult to diagnose.

One of the biggest problems is that some hormones fluctuate throughout the day. Cortisol, for example, rises as soon as you get out of bed and then declines as the day wears on. If your diurnal pattern is dysfunctional, meaning you’re low in the morning and high at night. Therefore at least three times blood test for cortisol level, in the morning, noon, evening usually necessary to diagnose.

Hormones secrete by Adrenal Gland

Material for hormones production by adrenal gland is cholesterol. Too much suppression of cholesterol by drugs are bad for adrenal hormone production. They are called cholesterol derived hormones. Biochemists believe Adrenal Gland secrete more than 100 hormones.

Hormones by adrenal gland, for example:

  • These hormones, which include cortisol, help your body convert food into energy, normalize blood sugar, respond to stress and maintain your immune system’s inflammatory response.
  • These hormones, which include aldosterone, help keep your blood pressure and blood volume normal by maintaining a proper balance of sodium, potassium and water in your body.
  • This hormone increases your heart rate and controls blood flow to your muscles and brain, along with helping with the conversion of glycogen to glucose in your liver.

Together, these hormones and others produced by your adrenal glands control such body functions as:

  • Maintaining metabolic processes, such as managing blood sugar levelsand regulating inflammation
  • Regulating your body’s balance of salt and water
  • Controlling your fight-or-flight response to stress
  • Producing sex steroids such as estrogen and testosterone; initiating and controlling sexual maturation during childhood and puberty

Signs and Symptoms of HPA Dysfunction

A condition known as Addison’s disease or “primary adrenal insufficiency,” a condition where damage to your adrenal glands impairs their ability to produce cortisol is well known in conventional medical curriculum. Addison’s disease affects an estimated 110 to 144 out of every 1 million people, so it’s quite rare.

Adrenal fatigue is not part of the medical curriculum but in functional medicine and naturopathic medicine practice, this condition is frequent is common and more doctors start to understand HPA dysfunction.

This debilitating HPA axis dysfunction affects a great many people.  Though the symptoms are less severe than in Addison’s disease.

Symptoms of this potentially life threatening condition include:


  • Muscle weakness, weight loss, low blood pressure and low blood sugar. An estimated 80 percent of Addison’s cases are due to autoimmune disorders.
  • In more serious cases, the physical fatigue is so great that the person may have difficulty getting out of bed for more than a few hours a day. Going out of bed in the morning to go work is like dragging heavy load tied to the body.
  • Fatigue and weakness
  • Depression, fearfulness or anxiety
  • Hormonal imbalance and/or abnormal blood sugar levels
  • Low immune function
  • Muscle weakness and/or body aches and osteoporosis
  • Cravings for foods high in salt, sugar or fat
  • Increased allergies
  • Skin problems
  • Autoimmune disorders
  • Increased Premenstrual syndrome or menopausal symptoms
  • Lightheadedness when getting up from sitting or lying down position
  • Trouble waking up in the morning, despite a full night’s sleep
  • Low sex drive
  • Decreased ability to handle stress
  • Poor memory; mental fogginess

Rebuilding Your Metabolic Reserve

Exercise can exacerbate the situation, so while exercise is important, now’s not the time to push. If you have HPA axis dysfunction, your primary objective is to rebuild your metabolic reserve. To do this:

  • Improve blood sugar regulation by eating a healthy diet, low in net carbs (total carbohydrates minus fiber) and higher in healthy fats, along with a moderate amount of high quality protein
  • Get appropriate amounts of physical activity, but don’t overdo it
  • Reduce inflammation by improving your gut microbiome (avoid antibiotics and processed foods, eat real food, including fermented vegetables, and/or take a high quality probiotic supplement, reduce your net carbs and increase your fiber intake)

Address circadian disruption by making sure you get proper light exposure at the right times of the day. Get bright sun exposure during the morning and midday, and avoiding artificial lighting and light emissions from electronics in the evening. Sleep in total darkness is the best way of sleeping at night. Make sure to get enough sleep. Get around eight hours of sleep each night.

How to Exercise when you have Adrenal Fatigue

Exercise is good and useful but how to exercise when you’re exhausted all the time. Also, since exercise is a physical stressor, it can easily exacerbate HPA axis dysfunction.

Exercise is a physical stressor and as such, it can tax your adrenals. The key is to focus on gentle activities such as walking, yoga, gentle cycling or swimming, qigong or tai chi. Once you’re starting to feel better and have improved your exercise tolerance, gradually begin to add in some moderate exercise. In brief, graded exercise is advocated.

Recovery Is Possible

The good news is that natural treatments are quite effective and, with time, patience and the tips that follow, it is possible to recover. Just remember that treating “adrenal fatigue” or HPA dysfunction requires a whole-body approach — one that addresses the excess stress and unhealthy lifestyle habits that caused the impaired stress response in the first place.

Also please remember that chronobiology also has an important influence so it is vital you get regular outdoor sun exposure, especially before 10am as the blue light from the sun will trigger melatonin formation and help you sleep better that night. A good night’s sleep is crucial to improving your adrenal health.

Measures to address your HPA :

  1. Address past and current emotional traumas and stress. Spending more time outdoors. Reducing and managing your stress is a central key to restoring adrenal health
  2. Eat a healthy nutrient-dense diet like the one described in my nutrition plan. Be sure to eat healthy fats every day and stay well hydrated by drinking more water.
  3. Improve gut health and nutrient absorption by including homemade bone broth and fermented foods in your diet.
  4. You need to be relatively healthy and your adrenals have to be functioning normally in order to allow the hormonal shift to occur that will take you from sugar- to fat-burning mode
  5. Listen to your body and rest when you feel tired. This includes during the day by taking short naps or just lying down. Sleep in if you need to
  6. Avoid stimulants like coffee and sugar, as these can further exhaust your adrenal glands
  7. Opt for gentle exercises such as walking, cycling, swimming, yoga, qigong or tai chi, ideally outdoors. Once you’re starting to feel better, gradually include more moderate exercise. Avoid overtraining
  8. Certain nutritional supplements may be helpful, including magnesium, B vitamins, vitamin C, animal-based omega-3 fat and curcumin.

Your adrenals do need a lot of certain vitamins, such as vitamin C, so if you truly have “adrenal fatigue,” a lot of vitamin C might be helpful. However, if your problem is rooted in brain signaling (stressful life), vitamin C is not going to make much of a difference.

  1. Test your vitamin D level and if below 40 ng/mL, take steps to raise it, either by getting sensible sun exposure or taking a vitamin D3 supplement along with vitamin K2.
  2. Short-term (six to 12 months) hormone supplementation has been shown to restore and normalize adrenal function. This includes very low dosages of DHEAand pregnenolone. DHEA is a natural steroid and precursor hormone produced by the adrenals, and levels are often very low in people with adrenal fatigue.

Cortisol hormone replacement

Some people require cortisol in the form of hydrocortisone but the dose should be taken three or four times daily in day time and the time should be strictly observed. The total dose of 40mg per day shown beneficial and not suppress the adrenal gland further. Follow-up with your doctor, when measures to avoid suppression of HPA and when adrenal gland improves hydrocortisone may be able to be tapered down.