Adrenal Fatigue = Chronic Fatigue


The most common cause of chronic fatigue I see in people is due to chronic stress. When the body is stressed, the adrenal glands naturally kick in and send out cortisol for you to cope with the stressor. The stressor can really be anything - hunger, pain, mental-emotional stress/anxiety. Sure, a bit of stress is fine since it activates the body and causes better performance on certain tasks. However, when stress starts becomes longer than expected, it causes the adrenals to shunt resources and raw materials towards cortisol production so that you can cope with the constant stress. Eventually, your adrenals "tire out" and gradually reduces its cortisol output.


So, there are 3 stages to adrenal "fatigue" that I have seen:

First, you're very stressed out, and you have normal-functioning adrenals putting out cortisol. So, you're pretty much on the go, have little hunger, and feeling great. You don't think you have to consult a doctor yet.

Second, stress becomes longer than expected, and your adrenals start to shunt hormone production towards making cortisol. Why care about this? Your adrenals also make sex hormones. So, you may start seeing changes in libido and disturbances in menstrual regularity. And since your adrenals have been sending out cortisol for longer than needed, you could have lost some weight. You might think you have to see a doctor because of abnormal periods or lack of sex drive.

Third, stress is really becoming longer than needed, your adrenals to start spitting out cortisol and other adrenal hormones in a maladaptive pattern that is out of their normal circadian rhythm. When this happens, people start noticing insomnia, changes in energy, mental fog, and increased carb and/or salt cravings. The most common sleep pattern change that I see is waking from 3:00-4:00 am. This disturbed sleep pattern leads to difficulty getting up in the morning, with more snoozing than usual. This last stage really impacts a person's psychological and social wellbeing, with apathy, burnout, and depression leading to dysfunctional relationships and sometimes, suicidal ideation. And, this is when you realize that you gotta see a doc for your sleep and energy.


Usually, when people come to me for naturopathic adrenal support, they're usually in the last two stages. I like to run a panel of tests, with salivary cortisol testing being a priority test. What's salivary cortisol testing? It checks the rhythm at which your adrenals are sending out cortisol throughout the day. By a collection of at least 4 salivary samples, labs are able to determine your adrenal cortisol output and map out its rhythm. Once we get the lab results in, treatment plans are made dependent upon these results alongside any other factors that will help individualize treatment. I usually use at least two different herbal formulations to recalibrate and real circadian rhythm, personalized therapeutic dietary guidelines, and naturopathic lifestyle modifications. From there, I may add other naturopathic modalities that target specific health and wellness complaints beyond the adrenals if I see them to be connected and worthwhile to target concurrently. I always tell my clients that returning the adrenals back to its natural rhythm will not happen over night - it takes months, usually 3-4 months. This may seem like a lot of time, but the rewards of sticking to the plan are worth it. Once those 3-4 months are done, we will recheck your adrenal rhythm again, and then go from there.

Have you seen any naturopathic doctors or integrative health practitioners before for chronic fatigue due to stress? If so, how did it go for you? If you haven't and want to see a doc, come swing by. I'll be more than happy to help you out.

- Dr. B





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Hellhammer, Dirk H., et al. “Salivary Cortisol as a Biomarker in Stress Research.” Psychoneuroendocrinology, vol. 34, no. 2, 2009, pp. 163–171., doi:10.1016/j.psyneuen.2008.10.026. 

O'€™Connor, Daryl B., et al. “Cortisol Reactivity and Suicidal Behavior: Investigating the Role of Hypothalamic-Pituitary-Adrenal Axis Responses to Stress in Suicide Attempters and Ideators.” Psychoneuroendocrinology, vol. 75, 2017, pp. 183–191., doi:10.1016/j.psyneuen.2016.10.019.

Wichmann, Susann, et al. “Cortisol Stress Response in Post-Traumatic Stress Disorder, Panic Disorder, and Major Depressive Disorder Patients.” Psychoneuroendocrinology, vol. 83, 2017, pp. 135–141., doi:10.1016/j.psyneuen.2017.06.005.


DISCLAIMER: These statements have not been evaluated by the Food and Drug Administration. There are no financial ties to any supplement companies, pharmaceutical companies, or to any of the products mentioned in this post. This post is not meant to treat, cure, prevent, or diagnose conditions or diseases and is meant for educational purposes. As always, please consult your doctor before trying any new treatments or supplements.