In today’s society, a common cause of illness is ongoing stress and the ensuing adrenal dysfunction that accompanies it. When a patient is exhibiting the signs of stress, it is important to support the health of the adrenal glands.

Adrenal glands (also known as suprarenal glands) are endocrine glands that sit at the top of the kidneys. Each adrenal gland has two distinct structures, the outer adrenal cortex and the inner medulla, both of which produce hormones.

The adrenal cortex is located on the outer edges of the adrenal glands. It produces cortisol, hydrocortisone and aldosterone as well as androgens, dehydroepiandrosterone (DHEA) and pregnenolone. It supports overall downstream creation of estrogen and progesterone levels that can serve to buffer gonadal production in times of need. Aldosterone and cortisol, along with the other sex hormones, are synthesized from cholesterol, which is transported into the adrenal glands.Most of the hormones produced in the adrenal cortex are also produced elsewhere in the body. However, aldosterone, cortisone, cortisol and hydrocortisone are produced exclusively in the adrenal glands.

The adrenal medulla is tucked away in the center of the adrenal gland, surrounded by the adrenal cortex. Adrenal medulla cells secrete the hormones dopamineepinephrine (adrenaline) and norepinephrine, which also act as neurotransmitters. The adrenal medulla needs sufficient quantities of the amino acids phenylalanine and tyrosine in order to produce all the catecholamines including epinephrine, which elevates heart rate, constricts blood vessels, dilates air passages and is a star player in the fight-or-flight response.

Norepinephrine plays a similar role to epinephrine. It is also involved in the fight-or-flight response, directly increases heart rate, encourages the release of glucose from energy stores and elevates blood flow to skeletal muscle as well as boosts the brain’s oxygen supply.

Beyond Cortisol

Often, when dealing with adrenal dysfunction, healthcare provides tend to primarily concentrate on cortisol and DHEA. However, it is crucial to make sure that epinephrine and norepinephrine are balanced as well. After all, epinephrine and norepinephrine are responsible for palpitations, and other stress-related symptoms.

Also, we should strive for balanced levels of aldosterone, which works with the renal (kidney) system to balance sodium and potassium in the body. This not only helps maintain fluid balance and blood pressure, it is also important to the ability to react to stress. When patients are suffering from adrenal fatigue, this aldosterone-controlled fluid-balancing system may be dysfunctional. The primary symptom of this is puffy hands and feet.

Thyroid - Another Important Gland

The thyroid hormones are synthesized form both iodine and tyrosine. Tyrosine is also used in the production of norepinephrine and epinephrine. Unfortunately, during periods of high stress there is an increased production of epinephrine and norepinephrine, which may deplete the body’s tyrosine stores. If high stress levels deplete tyrosine stores, there is not enough left for the thyroid. Furthermore, elevated cortisol levels can impair thyroid function by causing peripheral tissues to ignore the thyroid hormone signal. When my patients experience symptoms of adrenal burnout, besides strengthen their adrenals, I also examine their thyroid function and correct any imbalances in that area as well.

Conditions Associated With Adrenal Dysfunction

Both high cortisol levels and the depleted cortisol levels that occur after adrenal burnout can take a massive toll on the body. A number of health conditions are related to dysfunctional adrenal glands.


Studies have linked ongoing stress to alopecia or hair thinning in both children and adults.1-3The mechanism by which stresscauses hair loss is likely due to the enzyme 5-alpha reductase (gray arrow), which converts testosterone to dihydrotestosterone (DHT). DHT is the primary androgen in the prostate and in hair follicles and is the main cause of male pattern baldness4  and is alsoassociated with benign prostate hypertrophy (BPH). Therefore, in some predisposed individuals, stress may accelerate a genetic predisposition toward baldness and prostate disease.


In obese patients, cortisol metabolism is altered. This was shown in a May 1998 study that obesity alters cortisol clearance, and this may activate the hypothalamic-pituitary-adrenal axis. Additionally, obese subjects have higher concentrations of cortisol in key tissues including the liver and visceral fat, which may account for the negative metabolic consequences of obesity.5 Imbalanced cortisol levels have another adverse effect - an increased tendency toward insulin resistance, which also plays a role in weight gain.6  Also, glucocorticoids increase appetite and levels of the hunger-modulating hormone leptin.7 As cortisol rises with stress, it also triggers an increase in ghrelin,8 another hormone related to food intake and fat mass.

Cardiovascular Concerns

The medical literature is filled with reports documenting how stress is linked to atherosclerosis, hypertension, stroke and hyperlipidemia. In fact, stress-related inflammation is blamed for 40 % of the atherosclerosis that occurs in patients who have no other known risk factors.9  Additionally, epinephrine also increases coagulation, leading to an increased risk of thrombosis in patients with atherosclerosis.10  Furthermore, increased levels of norepinephrine that occur in intense aerobic exercise may increase platelet reactivity and hypercoagulability.11

One study published in 2012 demonstrated that elderly hypertensive patients had mean cortisol values greater than those of healthy people aged over 65 years. In fact, the higher the degree of hypertension, the higher the mean cortisol value.12 A connection between stress and cholesterol also may exist as researchers have linked job stress to dyslipidemia.13

Digestive Disorders

Another way in which adrenal dysfunction can affect the body is through disrupting the digestive system. Individuals with irritable bowel syndrome (IBS) have elevated cortisol and have an exaggerated cortisol and ACTH response to elevated CRH.14 There is also indication that women with IBS have a greater postprandial increase in plasma norepinephrine levels along with an increase in systolic blood pressure.15 In another study published in February/March 2012, female Irritable Bowel SyndromeBS patients with predominant diarrhea exhibited substantially heightened cortisol levels at awakening and a blunted cortisol awakening response.16

Immune System Dysfunction

Stress-related cortisol imbalances suppress the immune system. In a study published in August 2011, researchers observed the immune system response of grieving adults 65 years and older. The bereaved group had a significantly higher cortisol:DHEAS ratio compared to controls. Additionally, neutrophil superoxide production was significantly reduced among the bereaved, indicating reduced immune activity.17

In another earlier study published in March/April 2011, researchers studied volunteers performing a first-time bungee jump from an altitude of 60 meters. The study showed that the acute stress from bungee jumping suppresses human innate immunity.18

Diagnosing Adrenal Dysfunction

Here are some of the tests that can provide clues to the state of our patients’ adrenals and thyroids:

  • Salivary Adrenal Function Panel - This test offers morning, noon, evening and night cortisol levels and DHEA levels, for a comprehensive look at adrenal function. I use these test kits often in my practice.
  • Thyroid Testing - As noted above, I always tend to the health of the thyroid gland at the same time as the adrenals. I routinely have my patients tested for free T3, free T4 and reverse T3 along with TSH, and as needed Thyroid Peroxidase Antibodies, Antithyroglobulin and TSI (as indicated).
  • Morning Body Temperature - This test is useful to detect thyroid resistance, when thyroid hormone levels are normal, but tissues fail to respond effectively to the thyroid hormone signals. This causes symptoms of hypothyroidism such as low basal body temperature, and what is often referred to as subclinical hypothyroidism.
  • Epinephrine/Norepinephrine Levels - To capture a complete snapshot of a patient’s adrenal health, I test for epinephrine and norepinephrine. Epinephrine and norepinephrine may be measured in urine or via blood and serve as an important diagnostic aid. Patients should avoid physical activity and stressful situations before testing since these can affect the test’s accuracy. Certain foods and beverages - including coffee, tea, bananas, chocolate, cocoa, citrus fruits and vanilla—can increase catecholamine levels and alter test results.19

Lowering Cortisol

Once test results are in, we can determine the best approach for helping our patients restore adrenal and thyroid function. If cortisol levels are high, a good approach is to use adaptogens that help balance adrenal function. Here are some of the adaptogens that I use in synergistic combinations:

  • Eleuthero (Eleutherococcus senticosus) root is a powerful adaptogen shown to improve working capacity.20-21
  • Japanese aralia (Aralia mandshurica) root - Aralia mandshurica has historically been used to support mood and energy. A study published in 2008 is one example of studies showing its immune-modulating activity.22
  • Astragalus (Astragalus membranaceus) root - Astragalus is an adaptogen known for its immune-supporting activities.23-25
  • Ashwagandha (Withania somnifera) root - In animal models, ashwagandha has moderated the stress response to environmental stressors.26
  • Schisandra (Schisandra chinensis) fruit - Schisandra reduces mild fatigue, increases endurance and promotes liver health.27-28
  • Magnolia officinalis and Phellodendron amurense are ideal adaptogens for lowering cortisol levels. They were studied for their stress-reducing and weight management abilities. In one study published in 2006, these botanicals balanced levels of cortisol in the evening while the placebo group tended to have higherevening cortisol. Also, the placebo group gained weight while the group supplemented with Magnolia and Phellodendron maintained their current weight and reported lower perceived stress.29

Supporting Burned Out Adrenals

If cortisol levels are low, indicating adrenal burnout, certain botanicals and nutrients can recharge these important glands. Here are some of the nutrients I use to repair adrenal burnout:

  • Rhodiola rosea - Supplementation with Rhodiola enhances physical and cognitive function. It also modulates factors such as energy, motivation, daytime sleepiness, libido, sleep quality and cognition, including concentration, memory, susceptibility to stress and irritability. In one study published in 2007, treatment effectiveness was reported by 80 percent of patients as “good” or “very good” and physicians reported efficacy for 81% of patients.30
  • Bacopa monnieri - Bacopa helps balance blood sugar metabolism, supports insulin action, reduces markers of oxidative stress and supports mood balancing and cognitive function and memory in older adults.31-33
  • Glycyrrhizic acid - An adrenal tonic that helps maintain healthy cortisol levels.34-35
  • Vitamin B6 - An important cofactor for the production of norepinephrine.
  • Vitamin C - Decreased subjective stress response and allows for a faster cortisol recovery compared to placebo in subjects under psychological stress.36  In one study published in January 2002, supplementation with a B complex and vitamin C showed significant improvements in reported stress and occasionalfatigue, and enhanced cognitive performance.37
  • N-acetyl tyrosine - Individuals under psychosocial and physical stress supplemented with tyrosine showed enhanced memory and tracking.38

All the above substances work best when used together as they have a synergistic effect. If thyroid tests indicate patients are hypothyroid, it is best to also add some iodine into the regimen.



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