Adrenal fatigue and hypothyroidism


How with Thyroid Diet I Reversed My Recent Adrenal Fatigue, Heavy Metal Toxicity, Hair Loss, and Estrogen Dominance

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A path to reversing hypothyroidism

I’ve come to accept the fact that the management of my health will always be a journey and not a destination. If you are familiar with the Buddhist way of life, you are probably smiling. And, if you not – in short, it just means embracing life as it unfolds, treating it with appreciation, kindness and forgiveness rather than be solely focused on a specific goal. Because the reality is: we lose ourselves in the pursuits of a goal, never live in the present, never appreciate what we have and once we reach the destination/goal, we are still not happy and we want more.

This is a very personal blog post that details the challenges and steps I have taken in the past year on my continuous journey of healing. It might be specific to me but I have a feeling that many of you will find yourselves in my tales, too.

It all started with a hair loss in 2010.

By 2010, after two years of dietary and lifestyle changes which I talk about here, my thyroid started doing much better. By “better” I mean: my TPO antibodies dropped, I was no longer fatigued, had no more heart palpitation and these terrifying anxiety attacks. My mood improved, I felt like being social and kind to people again. I say “again”, as this was not the case when I lived in Shanghai, China when my health was at its worse.

But, now my hair started falling out – a symptom I did not experience earlier. So it felt like managing my thyroid was a moving goal and a rather mysterious one as all lab work proved to be OK. An integrated doctor in Seattle (where I lived in 2010) told me that I was the “healthiest person he had seen in a long time”. That was not helpful, to say the least.

I then moved to NYC and one of the first things I tasked myself with was to find a good physician who was willing to run the tests I request and who understood the peripheral body systems that can impact the thyroid and my hair loss.

Hair loss is a sign that there is some imbalance going on in the body.

The easiest thing to look at first were vitamin and mineral deficiencies so I went down that path – zinc, calcium, more meat proteins, biotin, iron and silica. Yup, did them all and still had no results. Out of desperation, I even went on Cytomel (synthetic T3) for three months. It temporarily helped but it stopped working after two months and the hair loss came back.

Finally, I found a doctor who ran a battery of tests; including DHT (di-hydro testosterone), cortisol, heavy metal panels and my estrogen levels.

Verdict: heavy metal toxicity, estrogen dominance and overactive adrenals.

I had high levels of mercury and lead both in my urine (indicator for past exposure) and blood (indicator for current exposure). This was hardly surprising as I had a mouth full of old amalgam fillings, lived in China for over four years where I fearlessly ate seafood and fish – partly in denial and partly in ignorance.

It’s the second diagnosis, estrogen dominance, is what threw me off. Me? Estrogen dominance? I’ve not been on birth control pills for years, I eat clean food, I don’t use plastics at home, I select clean skin care products and I exercise regularly. How can it be?

I still remember watching one of the great health/self-healing/alternative medicine documentaries on Netflix that featured a woman diagnosed with breast cancer who said “I was the annoyingly healthy person. I never ate crap. I never fell sick. I never had a weight problem. Breast cancer was the worse thing God could ever punish me with.” I heard and felt every word she uttered.

In case you do not know this, estrogen dominance is the leading cause of breast cancers and osteoporosis in women. It can also contribute to autoimmune diseases and both Graves’ and Hashimoto’s fall into this group.

My estrogen dominance was diagnosed based on a simple blood test called the 2:16 Hydroxyestrone Ratio (more details below).

What does it mean to have estrogen dominance?

I am going to borrow the explanation from Dr.Dan Lukaczer, N.D., who is director of clinical research at the Functional Medicine Research Center. He explains it so eloquently:

“In premenopausal women, the ovaries produce the estrogen estradiol (E2), which converts into estrone (E1), both of which must eventually be broken down and excreted from the body. This breakdown occurs primarily in the liver, and the excreted metabolites flow out in the bile or urine. Estradiol and estrone undergo this breakdown through a process called hydroxylation. (…)

What makes an estrogen good or bad? That has to do with the biological activity, or potency, of that estrogen. Estrogens are important in a host of cellular activities that affect growth and differentiation in various target cells. This is normal and beneficial, but too much estrogenic stimulation can have a negative effect.

Therefore, properly metabolizing and excreting estrogens is crucial. If these estrogens are metabolized into the 2-hydroxylated estrone and estradiol, they lose much of their cell proliferative and estrogenic activity and are termed “good” estrogen metabolites. Studies show that when 2-hydroxylation increases, the body resists cancer, and that when 2-hydroxylation decreases, cancer risk increases.”


This was a humbling experience. After all, I teach people how to live clean, yet, I’m a perfect candidate for breast cancer now? Losing hair was just the onset of the bigger storm that was to come.

Can you see yourself in this? You eat well, you exercise, you don’t drink Diet Coke…

So many of you write to me and say “I’m eating so well, I exercise, I try not to be stressed and I’m still not 100%. What is going on?”

And this is what I mean by my own health and healing being a journey. It’s not about the thyroid anymore, at least not for me. My thyroid numbers are and were perfect (apart from the TPO antibodies). It often can be about the peripheral body systems that are impacting you, too.

You know what I love about it? Every crisis makes me dive deep into understanding what is going on and WHY is it happening.

Of course, the next step for anybody with a Type A personality is to dive into action. Yup, that’s me. Embrace it and battle it. Head on.

So I did.

How do I reverse adrenal imbalance, estrogen dominance and heavy metal toxicity?

First stop: the internet.

A bad idea. A very bad idea.

Do you remember when you first got diagnosed and googled “hashimoto’s”, “hyperthyroid” or “hypothyroidism” and got millions (literally) of pages coming up? You suddenly found yourself in a jungle of information; overwhelmed and confused with all the contradictory information. Not to mention the supplements and magic pills each website promises to heal you with.

This was my path too. Google “heavy metal detoxification” or “estrogen dominance” and see what you get. I wanted to cry and my heart started pounding as I didn’t know where to start and who to trust. And believe me, I’ve learned over the years what are my credible go-to sources.

My action plan to healing.

So I took a deep breath and slowly, over the next few weeks, I came up up with an action plan. Which read:

  • Get rid of the heavy metals
    • Remove all my amalgam fillings.
    • Support my liver.
  • Have a solid liver detox in place supporting the Phase 1 and Phase 2 detoxification process
  • Re-balance my estrogen levels
    • Internally: again, support my liver and especially the methylation and sulphication pathways of the liver as they excrete mutated estrogens.
    • Externally: diligently get rid of any xenoestrogens (sythetic version of estrogens) found in my house cleaning products, skin care, cosmetics and perfumes.
  • Address my elevated cortisol level

So I got to work.

Step #1. Removed the biggest source of mercury: my amalgam fillings.

First stop: in January 2013, I had all my 6 amalgam fillings removed by a holistic dentist who specializes in mercury removal. It was expensive ($4,000 for 6 fillings) and in spite of all the precautions she took, I felt terrible for 3 days and slept 14 hours each day. But, I recovered from this fatigue soon after that.

Step #2. Started juicing daily.

I dusted off my juicer (well, not really, but actually started using it every day) and started juicing vegetables that are known to cleanse the liver. No raw cruciferous veggies here, though.

Step #3. Upped the cruciferous vegetables.

Here is a great opportunity for me to finally address why I’m one of these crazy thyroid experts who recommends cruciferous vegetables. In case you don’t know what they are; it’s the brassica (or cabbage) family of goodness like kale, broccoli, chards, spinach, cauliflower, etc. In their raw form, they are known to slow down the thyroid and this is why, as thyroid patients, we should consume them in a cooked form. Many websites and writers have an obsessive tendency to view nutrition in black and white and recommend for people with thyroid conditions to cut them out completely. I don’t agree with this approach – most of my clients eat cooked cruciferous veggies in moderation and heal well.

Why I like cruciferous vegetables? They are the superstars of the vegetables; there are no other veggies that are as rich in Vitamin A carotenoids, Vitamin C, folic acid, Vitamin K (which regulate our inflammatory responses – very common in people with autoimmune conditions) and fiber. As it is, most people are nutritionally depleted and rely heavily on supplements which they don’t even absorb properly – so why deprive your body of this wonderful nutrients?

In my own journey since January 2013 till today, I’ve added at least 1-2 servings of cooked cruciferous vegetables per day. In fact, if you see my result below, my TSH dropped from 1.02 to 0.82 which is most certainly not a sign of going hypo.

In the liver detoxification protocol, I used the cruciferous vegetables because they are key in the Phase 2 process and specifically the glutathione pathway which gets rid of heavy metals, PCBs (endocrine disruptors) and pathogenic bacteria in the liver.

Step #4. Did a major liver detox.

Knowing that the liver is largely responsible for the neutralization and elimination of mutated and excess hormones like thyroid and estrogen, I embarked on a highly tailor-made liver detoxification protocol. Even though I’ve lived a very clean life for the past 7 years, it appeared that there are still residual burdens that inhibit the liver from detoxing our body properly.

If you wonder what are the symptoms of a sluggish liver, read this post. It’s key to your healing to understand the Phase 1 and Phase 2 part as well as the different detoxification pathways that will help you get back on your feet.

Step #5. Added an amino-acid protocol.

I got on a strict protocol of a combination of amino acids that help the liver pathways in detoxifying the mutated hormones, including thyroid and estrogen.

Step #6. Minimal supplements.

If you know me well, you know I’m not a fan of these, for many reasons. So I limited them to only two things: passionflower extract and an estro blocker.

Step #7. De-stressing to reduce my cortisol levels.

I was pretty aware that a romantic relationship I was in was going south and it had a big impact on my stress levels. I also took on too many work projects which we were depleting me.

Solution? I walked away from the relationship (very hard at first but it felt so much lighter later) and went back to doing a 20-minute meditation every morning to start the day on the right foot. I also frequently carve some time out and sit in silence and just breathe whenever I find myself overwhelmed, annoyed or just having a racing mind.

I also cut out my habitual morning espresso and switched to matcha green tea. Adrenals hate coffee and sugar.

I did not go for any adaptogens many practiotioners prescribe to patients with adrenal fatigue or overactive adrenals.


So I just got back from the doctor’s office who is totally on board with the madness of tests I wanted him to run (I love this kind of doctor – works with you in partnership and does not get intimidated by you knowing a bit about your own body) and he said to me: “How did you do it?”

“What did I do?” – me, confused.

“Your numbers look really good” – him, smiling.

We all like to see a person smile and this smile was different.

I kind of knew that something has shifted in my own body over the past few months.

  • My hair loss stopped and I started having lots of baby hair growing back. Like a little orang utan.
  • My PMS is totally gone – even in my good days I always had a bit of a mood dip not noticeable to others but me. Now I feel n.o.t.h.i.n.g.
  • My periods are painless and I do not get bloated at all. And yes, this is yet another symptoms of estrogen dominance even though we’ve grown to accept it as a “norm” of every woman’s menstrual reality.
  • These darn 7 strands of hair under my chin and rather dark hair above my lips stopped growing. Facial growth (under your chin and above your lips) are also a sign of estrogen dominance.

All of it is not surprising, as my lab work has significantly improved, namely:

  • My TPO antibodies dropped from 138 to 66 (more on that below).
  • The marker for estrogen dominance (ED), 2:16 a-Hydroxyestrogen improved from 0.35 to 0.54 which means I no longer have ED.
  • My mercury and lead levels dropped to “normal” levels.
  • My cortisol levels are mostly in “normal” range, too with a slight elevation at 12.30pm – something to work on.
  • My reverse T3 (rT3) dropped significantly – this is another great marker to observe as it’s often elevated due to estrogen dominance and adrenal issues. rT3 acts like T3 but instead of powering you up, it parks itself in the T3 receptors, does nothing and worse still, it blocks the real T3 from coming in and doing its job. T3 is what gives you healthy hair, good skin, energy, clarity of mind, etc.

I scanned my results and highlighted the changes – before and after.

Estrogen Dominance Reduction

Cortisol (Stress Hormone) Reduction

Heavy Metal (Mercury and Lead) Reduction

Reverse T3 Reduction

But, there is more work to be done.

Is it perfect yet? No.

It’s the journey, remember?

Btw, if you are frustrated with your doctor not wanting to order the right tests for you (thyroid, vitamins, minerals, lipids etc), you can do it yourself on

I still have to work, what I suspect, is my gut absorbability.

In spite of eating meat 3-4 times per week and taking vit B complex, my B12 is only 348 and I would like it to be in the 800 range as that’s what is recommended by functional medicine for people with autoimmune conditions.

The same thing goes with my Vitmain D levels – in spite of taking perhaps not a high enough dose of fermented cod liver oil, I would like it to go up higher. I suspect it’s the same reason – my gut’s ability to absorb vitamins and minerals.

Furthermore, my TPO antibodies, even though lowest ever now at 66, I want to get them down to below 30. This will classify me for being free of Hashimoto’s. Even though I have no symptoms of hypothyroiditis (remember that the hair loss was due to either ED and/or heavy metals not the thyroid), I still want to get them below 30. Because this is my work.

Here is what my next action plan is: test for gluten cross-reactivity. There are foods that may not contain gluten but our body’s immune system labels them as antigens if you have a gluten sensitivity (which I obviously do). The list is a little scary: chocolate, quinoa, rice and hemp seeds are on this list, too. Auch. And, they all happen to be a part of my regular diet. It does not mean that I (or you) have a sensitive to all of them but even eating one of them can be causing digestive disbiosis and hence the absorbability issue.

The challenge is that the state of NY did not license Cyrex Labs, the lab provider to run these tests. What a shame. So I’m currently searching for a practitioner in NJ, CT or MA who can do them. Easier said than done.

If you want a more scientific explanation on gluten cross-reactivity, go to this good source.

What can you do?

  • Partner up with a good Doctor – Find a practitioner who you can trust and who can be your partner. Preferably someone who has done this work before and who (preferably) has lived through it herself. We posted a list of good doctor directories here.
  • Take action, like Thyroid Detox – All of the plans I talked about above have been incorporated to my step-by-step Thyroid Detox program which is now available as a DIY program and twice a year we run it as a Live program. This year, based on my own journey, we added a very complete and comprehensive program that addresses extensively the process of repairing your gut, cleansing your liver and getting you in a better emotional path. You can check it out here.

I captured some of the comments posted by the participants, you can read them here if you are not sure if the detox is for you.

Be well, have hope and take action to heal.

Weight Loss and Hypothyroidism

​Sometimes we can be doing everything we know should lead to weight loss, including watching our diet and exercising, but still the weight will not come off – and can even continue to pile on. Many people discover that in this case there is an underlying issue preventing them from reaching their weight loss goals, and in a lot of these instances hypothyroidism can be the culprit. The good news is that if you have hypothyroidism it does not mean that it will be impossible for you to lose weight, it just means that you will have to go about it differently than someone with normal thyroid function.

​Common Mistakes when Trying to Lose Weight with Hypothyroidism

So you’ve been trying to lose weight and restricting your calories, but every time you just end up more fatigued than normal. So far you have been able to lose 5-10 pounds by dieting this way, this but the minute you begin eating normally again your weight goes RIGHT back to what it was before dieting.

Does any of this sound familiar to you? If you have hypothyroidism, it probably does.

This is because calorie restricted diets are actually harmful to patients with Hypothyroidism, and can make your thyroid function even worse. ​When you limit the calories you consume you are telling your body that you are lacking the calories that you need to survive, so it tries to protect itself by lowering your metabolism. The way that it does this is by reducing the active amount of Thyroid hormone, or reducing Free T3 levels, as well as by increasing your Reverse T3 levels. Unfortunately, the majority of doctors do not even look into either of these.

Balancing your Hormones for Weight Loss

Losing weight isn’t just about burning more calories than you consume. If it were that easy for everyone to lose weight then the rate of Obesity would not look like it does in the chart below.

There is a reason that there’s about a 1% chance that going on a calorie restricted diet will lead to long-term weight loss. Calories do play a role, but it is what your body does with those calories that is far more important, and your hormones are what decide how your body is going to use them. Therefore the focus of your weight loss should not begin with cutting calories, but instead with balancing your hormones.


Hypothyroidism is incredibly common in the U.S., with it affecting approximately 1 in 20 adults.

​Insulin resistance (AKA Diabetes) is also common with it occurring in almost 1 out of every 10 people.

​Not only are both of these common, the majority of Hypothyroid patients ALSO suffer from insulin resistance which leads to inflammation, an inability to lose weight and worsening hypothyroid symptoms. Along with insulin resistance, there are many other issues that can accompany hypothyroidism and complicate matters including Thyroid resistance, Leptin Resistance, Estrogen Dominance, Low Testosterone and High Cortisol/Adrenal Fatigue.

Optimal Thyroid Function

Before looking into your other hormones, you should first start with your thyroid. ​​Once your thyroid function has been optimized then you move on to testing for other hormonal imbalances.

If you thyroid looks like the results below, then your other hormone systems do not factor in. In this case, this is what is considered “normal” for thyroid results, however this patient was experiencing all the symptoms of hypothyroidism. Treatment with the correct medication and dosage resolved her symptoms, but many patients with results like this are simply left untreated, are under-dosed or given the incorrect medications.

1. ​Insulin Resistance with Hypothyroidism –

Is Insulin Resistance Sabotaging your Weight Loss Efforts?

Hypothyroidism is common, but so is insulin resistance, which many people suffer from and don’t even know it. According to statistics, as an adult in the U.S. you have about a 50% chance of having pre-diabetes or diabetes and insulin resistance is what actually leads to diabetes and high blood sugar.

Insulin resistance happens before you get high levels of blood sugar, but to understand why you must reverse insulin resistance in order to lose weight, you need to look at the physiology.

In the presence of insulin your body stores all of the calories that you eat as fat, and also when your insulin levels are high your body is not able to use fat cells for fuel. This means you are primarily using glucose as an energy source, and your glucose levels drop you will feel sluggish, have to rely sugar for energy and have strong food cravings every 2 hours.

So in order to burn fat, and in turn lose weight, you MUST first reduce your insulin levels.

This is depicted in the graph below:

What is Insulin Resistance?

Insulin is a hormone that increases when you eat a large amount of sugar. When everything is working correctly, this hormone takes sugar and puts it inside your cells to protect your body from having high levels of sugar in the blood. When your insulin levels stay chronically elevated, from things like having a lot of sugar in your diet, your body becomes resistant to insulin. These high levels of Insulin also cause you to store your calories as fat in your belly. This means that if you have high levels of insulin, you will still gain weight even if you are eating less calories.

Here are some symptoms typically seen in patients that have insulin resistance:

  • Inability to lose weight
  • Cravings for sugary foods
  • Belly fat (or visceral abdominal fat)
  • Dizziness and lightheadedness when fasting
  • Irritability when going long periods of time without food

How do you know for sure if you have Insulin Resistance?

The first step in identifying and diagnosing insulin resistance is by looking at Insulin levels in the blood. You will want to check fasting insulin levels (which should be less than 5), HgbA1c (which should be less than 5.3), fasting glucose levels (which should be less than 85).
In the example below the patient has pre-diabetes, which you can see with her fasting insulin levels that are greater than 5, and elevated HgbA1c. If your fasting insulin level is greater than 5, it will be impossible for you to lose weight.

​How to Reverse Insulin Resistance and Heal your Thyroid

Insulin resistance is treatable, despite what conventional medicine would have you think. The problem with the common treatment targeted at blood sugar is that it only resolves a symptom of insulin resistance. As insulin resistance increases, your blood sugar rises, and when it gets too high is when you are diagnosed with Diabetes – which is really just advanced insulin resistance.

Some medications can be helpful in treating and even reversing insulin resistance, but the majority treatment should focus on the following things:​

– Diet to reduce Insulin levels

Diet i​s an important factor for reversing insulin resistance, but it is usually not enough on its own – especially for advanced cases. What you eat can definitely lead to increased insulin levels, and then cause insulin resistance, however, once your levels are high enough they can start a vicious cycle and cause insulin resistance on their own. This is why changing your diet is a good and necessary first step, but not enough to reverse insulin resistance on its own.

You should strive to eat a nutrient-dense, whole-food diet that is low in refined carbohydrates and sugar.

High intensity interval training exercise (HIIT)

Exercise is important, but what most people don’t realize is that the type of exercise matters a lot – especially if you want to lose weight and/or reverse insulin resistance. High Intensity Interval Training (HIIT) gives you more bang for your buck in a shorter amount of time than other types of exercise, and is very helpful for sensitizing your body to insulin.

​HIIT consists of small bursts of activity with maximum effort for about 30 seconds, followed by 60-90 seconds of moderate activity. You should repeat this process 5-8 times in a single session, at least one time per week. This is more beneficial than doing cardio on something like an elliptical for 30 min for much less time.

Warning for Hypothyroid patients:

Do not start HIIT unless your thyroid and adrenals have been optimized and can handle the stress. Exercise of any kind puts stress and strain on the body. The benefits of exercise come from the healing process, release of endorphins and cellular changes associated with it. Exercise is important, but it’s better to take it easy at first or you can risk worsening your thyroid and adrenal function. ​If you are fatigued for several days after exercising, then that means you should to look at your thyroid and/or adrenal function. It is normal to feel tired or sore after exercise, but for no longer than 3 days.

Intermittent fasting

Fasting can be one of the most effective treatments, because every hour you go without eating carbs or protein, your fasting insulin levels continue to drop. Once it gets below 5, your body will then be able to unlock fat stores and burn fat for energy. ​If you decide to try a fasting protocol, check your fasting insulin level at the end to ensure that your level is less than 5.

​Here’s a slightly oversimplified explanation of how it works:

The longer you go without eating, the lower your insulin levels will become. Once you use up the most of the stored glucose in your liver, your body MUST start to use triglycerides found in your fat cells for energy. In this way, as your insulin levels fall, your fat cells become “unlocked,” and you are now able to burn fat for fuel, while also sensitizing your body to insulin in the process.

Do NOT attempt fasting if you are on insulin, because hypoglycemia could cause it could be harmful. You also should not begin intermittent fasting until your adrenals and thyroid function have been optimized.

If you begin fasting and experience any of the following, you may need to stop and optimize your thyroid and adrenals first:

  • Dizziness/lighteadedness
  • Tremors or “shakes”
  • Headache
  • Intense thirst
  • Extreme cravings
  • Increased urination

Here is how you can get started with a gentle intermittent fasting program:

Start with fasting for 12-14 hours.

  • Eat an early dinner at around 7pm.
  • The next day have a late breakfast/early lunch at 11:00am.

Repeat this twice per week. ​

​2. Thyroid Resistance and Leptin Resistance

Years of recurrent yo-yo dieting, combined with very low calorie diets or ones like the HCG diet can lead to chronic damage of the thyroid. While these diets do work to help you lose weight, it is usually only temporary. When you deprive your body of the calories it needs, it lowers your metabolism, decreases your thyroid function and increases your appetite to try to make up for it. This is what causes you to not only gain back any weight that you have lost, but you also lose muscle mass in the process.

When you repeat this process several times throughout your life, you can cause Thyroid Resistance, combined with Leptin Resistance.

Here is an example of what someone who has Thyroid and Lepin Resistance’s labs look like:

What can be frustrating about this is that your labs may appear to be completely “normal,” or in rage, like in the example above. However, it is not that they are normal, it is just that many doctors are not looking for the correct things.

When you have thyroid resistance, your body takes Free T4 (thyroxine) and converts it to inactive Reverse T3, while at the same time increasing leptin. This majorly slows down your metabolism and tells your body that you are always starving, when actually you are gaining weight and always hungry.

​The patient in the example above had these symptoms, and also had previously done 3 rounds of using the HCG Diet. With each attempt at this diet she was able to lose weight, but each time she lost less. The last time she did the diet she did not lose any weight. Before starting treatment, her Reverse T3 levels were very high, and her Leptin was 19 when anything above 12 is considered Leptin Resistance.

This study below shows the effectiveness of GLP-1 Agonists in reversing Leptin resistance, and also helping with weight loss (in non-diabetic women)

If you think you have Thyroid Resistance or Leptin Resistance, here’s what you need to do:

  • Have your serum Leptin levels tested. Anything below 12 is considered normal, and anything above 12 is considered Leptin resistance. Also have your Free T3/Reverse T3 ratio checked so that you can see if you have too much thyroid-blocking hormone in relation to free and active Free T3. The ratio should be greater than 0.2, with anything less being considered thyroid resistance.
  • The best treatment for Thyroid Resistance is NDT and/or Liothyronine, or sustained release T3. While you are on T3 you should monitor your Reverse T3 levels regularly so that you know when you “wash” out the reverse T3 levels. Once those levels have reaches less than 5, you can start to take less Free T3. Approximately 2/3 of people respond to NDT, with the other 1/3 needing Pure T3.

3. Estrogen Dominance and Hypothyroidism

When you have too much estrogen in relation to your progesterone levels, it is called estrogen dominance. ​Estrogen dominance is something else that is very common for many women, but especially in women who also have Hypothyroidism.

There are in 3 different ways that you can have estrogen dominance:

1. Having too much estrogen and “normal” progesterone levels

2. Having too little progesterone and “normal” estrogen levels

3. Being exposed to too many xenoestrogens from your environment while having “normal” estrogen and progesterone levels

Along with many other symptoms, estrogen dominance causes you to gain weight in the hips, buttocks and thighs. Too little estrogen can also cause weight gain, like with menopause, so you should not just to looking for estrogen dominance unless you have a history of issues like PMS, PMDD, Fibrocystic breast disease, uterine fibroid and/or endometriosis.

The women in the example above has elevated levels of Estradiol, Estriol and Estrone in her blood, and also is not metabolizing and eliminating Estrogens very well through her liver – which has led to a build up of excess estrogen and metabolites. Her symptoms include weight gain and and inability to lose weight – especially in the buttocks and thighs. ​

The best approach to treatment is to optimize her liver function with herbs to help eliminate estrogen down the protective 2 hydroxy pathway, and then improve her ability to methylate with activate B vitamins. This leads to weight loss and the reduction and elimination or other Estrogen Dominance symptoms.

​If think Estrogen Dominance is playing a role in your inability to lose weight you should do the following:

  • Have your urinary Estrone, Estradiol and Estriol, as well as metabolites (16-hydroxy Estrone, 4-hydroxy Estrone and 2-hydroxy Estrone) tested on day 19-22 (mid-luteal phase) of your menstrual cycle.
  • If your labs indicate you do have Estrogen Dominance, you will need to improve your liver function, increase the amount cruciferous vegetables in your diet and consider supplementing with DIM or Indole-3-Carbinol to help metabolize excess estrogen through the liver. You can also consider using a FAR infra red sauna, and depending on your progesterone levels you could also incorporate a Bio-identical Progesterone cream to reduce symptoms

4. Low Testosterone, Insulin Resistance AND Hypothyroidism​

Many people thing that testosterone is only important for ​men, but it is also a very important hormone for Women as well. Testosterone helps to burn fat, build lean muscle and improves your overall mood. When women have low testosterone levels, they may feel flabby and have trouble losing weight and gaining muscle, as well as experience irritability, anxiety and/or depression. Another common symptom of low progesterone for both men and women is low libido, or a decreased sex drive.

The example below is of a patient who was complaining of low testosterone symptoms:

As you can see, her testosterone levels are in rage, but on the lower end, or what we call Low “normal.” ​If you look at the rest of her results, you can also see that she is suffering from insulin resistance. It is common for low testosterone and insulin resistance to come together, and it is important that you treat both issues if you want to see results in regards to weight loss.

In this case, using bioidentical low dose testosterone will allow the patient to lose weight, build muscle and improve her mood, while making dietary changes can reverse her insulin resistance.

If you think that you may have low testosterone and/or insulin resistance this is what you should do:

  • Have your Free and Total Testosterone levels checked. Your individual situation, including symptoms, will help determine what the optimal level should be for you. In general most women should be in the mid-range, unless you have a history of autoimmune disease or Hashimoto’s – in this case DHEA and Testosterone can help reduce autoimmunity. Also check for insulin resistance.
  • If your Testosterone levels are low, you can start with a low dose of a bio-identical testosterone cream, and then check your testosterone levels after 4-8 weeks. If you discover you also have insulin resistance and treat aggressively, it may cause a natural increase in Testosterone levels.

5. Adrenal Fatigue, Elevated Cortisol and Hypothyroidism

Another extremely common hormonal imbalance in patients with hypothyroidism is adrenal fatigue. This is partly due to the fact that when your thyroid hormone is low your body turns to cortisol to create energy, which leas to “adrenal fatigue” over time.

Cortisol is the hormone that our bodies create in response to stress. It is supposed to reduce inflammation in the body and help it to cope with the stressor. It also increases insulin’s effectiveness in the body, which is good in the short-term, but not in the long-term as it leads to weight gain – especially in the belly. Adrenal fatigue begins with having elevated levels of cortisol for extended periods of time.

​Symptoms of elevated cortisol and adrenal fatigue include:

  • Feeling “wired but tired”
  • Extreme fatigue
  • Weight gain especially in the belly
  • Weight loss resistance
  • Food cravings for sugar and salt
  • Anxious or jittery feeling

The patient in the example below was dealing with stress from her job, only getting 5 hours of sleep per night, and was unable to rest or relax due to a highly stressful event that happened a year earlier in her life. As a result, she was consistently gaining weight and having other symptoms of high cortisol and adrenal fatigue.

If you think that you may have elevated cortisol levels and/or adrenal fatigue contributing to your inability to lose weight here is what you should do:

  • Check your Cortisol x4 throughout the day with a saliva or dried urine test. Serum/blood testing of cortisol levels are not reliable.
  • If your Cortisol levels are elevated, you can try a combination of the following: remove caffeine and stimulants from your diet, add higher amounts of salt to your diet, eat smaller portions more frequently, reduce stress, and supplement with adaptogens or adrenal glandulars.

Did you know that almost everyone struggling with thyroid disease also has some form of adrenal fatigue? When the adrenals become taxed, they tell the pituitary to slow down the thyroid. If you struggle with thyroid disease, it’s important you take steps to heal the adrenals so the rest of your endocrine system can return to homeostasis.

Here are some common symptoms of adrenal fatigue:

A tendency to be a night person
Having difficulty falling asleep
Waking up in the middle of the night with difficulty falling back asleep
You’re a slow starter in the morning
Feeling keyed up and having trouble calming down
Low blood pressure
Headaches after exercising
Clenching or grinding your teeth
Chronic low- or middle-back pain
Difficulty maintaining chiropractic adjustments
Craving salty foods
Perspiring easily
Chronic fatigue or getting drowsy often
Afternoon yawning
Afternoon headache
Panic attacks
Seasonal or chronic allergies
Pain on the medial (inner) side of the knee or knees
Needing to wear sunglasses
Dizziness when you stand up
Difficulty losing weight
Gaining weight around the waistline
Getting upset or angry easily

Doesn’t that sound like “modern life?” No wonder people are having so many endocrine issues!

What do the adrenals do?

The adrenal glands are the body’s emergency system. When the body is under chronic stress, the adrenals will send out cortisol into the bloodstream. Over time, chronic cortisol output will weaken the endocrine system, liver, digestive system, and brain; it will also “slow down” your thyroid. So, if you are wanting to reduce your thyroid symptoms, start with healthy adrenal glands.

What do you eat?

While a lower carb diet is fabulous to reduce inflammation and many symptoms of thyroid disease, eating this way for too long can put stress on the adrenals and cause hormonal imbalance. So it’s important to get good, healthy carbs into your diet each day such as: potatoes (make sure to eat with plenty of butter), root vegetables, peas, properly prepared legumes or gluten-free grains (if you can tolerate them), apples, pears, berries, and beets.

I like Dr. Christianson’s idea of eating one golfball-size portion of carbs at breakfast, two golfball-size portions of carbs at lunch, and three golfball-size portions of carbs at dinner. Using this method, dinner should be the largest meal of the day. And most importantly, don’t stress about your food. Do the best you can, and let the rest go.

As you read the list below, remember: this is a marathon, not a sprint. Fully healing the adrenals may take up to 12 months. The good news is that even making just a few changes can help you feel better within weeks or even days.

Here are 20 Steps to Heal Adrenal Fatigue:

1. As soon as you wake up, drink a glass of water along with 1/4 teaspoon of Celtic sea salt. Then, throughout the day, have a pinch of sea salt with each glass of water and also use it to season your food. Daily total consumption of about 2 teaspoons of Celtic sea salt is a good place to start. The 80+ minerals in the salt will help nourish the adrenals and endocrine system.

2. Eat breakfast within one hour of waking. If you wait any longer than this, it can cause your blood sugar levels to decrease too much and your adrenals will start kicking out the cortisol.

3. Eat a small snack between breakfast and lunch: a boiled egg, 1 ounce raw cheese, a spoonful of nut butter, etc.

4. Have lunch about 4 hours after eating breakfast and include some protein, carbs and fat in your meal. I know this is a simple step, but skipping meals will put strain on your adrenals.

5. Only do low-impact exercise like walking, pilates, gentle yoga or stretching. High impact exercise puts strain on the adrenals, especially when the adrenals are already fatigued. If you’re having trouble losing weight, I know this can seem counter-productive, but I’ve seen clients lose weight by resting and following the steps I’m listing here.

6. Sit down to eat each meal and eat slowly. Don’t eat on-the-go, when you’re stressed, driving, etc. Here’s an entire article to help you understand the importance of eating in a slow and relaxed state.

7. Diffuse essential oils throughout the day to help you feel more relaxed. If you can’t diffuse the oils, put a drop or two on the bottoms of your feet twice a day to help lower stress levels. In fact, this study found that inhaling lavender essential oil can decrease cortisol levels. That’s good news for the adrenals! Do make sure you only use a completely pure essential oil so you aren’t adding any synthetic chemicals to your body — that could stress your system further. I personally use doTERRA essential oils for me and my family and have found them incredibly helpful. Some of my personal favorites are Lavender, Balance, Serenity, Ylang Ylang and Lemon.

8. Eat a snack in-between lunch and dinner: again, a boiled egg, 1 ounce raw cheese, a spoonful of nut butter, etc.
and make sure to sit down while you eat.

9. Eat dinner no later than 6 or 7pm and make sure to sit down while you eat. Dinner should be your largest meal of the day. This will help keep cortisol levels down at the end of the day.

10. Don’t eat any food after dinner except if you have trouble sleeping. If you’re having trouble going to sleep, eat a small snack (an ounce of raw cheese, a spoonful of nut butter, etc.) right before you go to bed. This will help bring cortisol levels down. If you wake up in the middle of the night, eat a small snack again and then get right back into bed.

11. Take an epsom salt bath a few times a week (or each evening, if you can). When you’re stressed, the first mineral your body burns through is magnesium (this is why so many people are magnesium deficient!). Soaking in a bath with 1 cup of epsom salts and a few drops of your favorite essential oil will help you relax and replenish your magnesium stores.

12. Go to bed by 9pm each night. Honestly, the best way to heal your adrenals is with sleep.

13. Take the right kind of B Vitamins – I recommend Cataplex B from Standard Process.

14. Try an Adrenal Tonic that contains adaptogenic herbs – Our office carries an adrenal tonic we mix in-house. It contains ashwaganda, licorice root and rhodiola. It’s immensely helpful for calming the body.

15. Drink plenty of filtered water each day. Drink 1/2 your weight in ounces is a good goal — a 160-pound person should drink about 80 ounces of water per day. Hydration is really important for the endocrine system. Without the right amount of water, the body can’t transport the necessary nutrients and hormones to the cells properly. So, please make sure you’re getting enough water.

16. Eat as many fresh organic vegetables as possible at all three meals with some healthy fats. There is no limit on vegetable intake.

17. Include protein at each meal – get these proteins from meat, poultry, wild seafood, eggs, etc.

18. If you have trouble with sweet cravings, then eat a butter mint every 30-60 minutes for the first two weeks to normalize your blood sugar. Here’s an easy recipe for butter mints.

19. Eliminate all caffeine. I know this is a hard one, but your adrenals will thank you! Here’s a post about how I kicked the coffee habit — with step-by-step instructions for you.

20. Take one day of rest each week. While it’s popular to “hustle”, that kind of daily mentality can lead to all sorts of health issues and will strain the adrenals. Take a day each week to rest. Turn off your phone, get outside, or just sleep all day if that’s what your body needs. It’s ok. God set the example by taking a day to rest, so I order my week that way, too!

If you’re curious to know exactly what your adrenals are up to, you can call our office at Biodynamic Wellness and order an adrenal test kit. It’s $120 and will give you insight into which stage of adrenal burnout you’re in. You can also schedule a consult with me and I’ll write up a personalized protocol to help you bounce back from adrenal fatigue. I’ve used many of these steps with my clients and have seen fantastic results!

Cortisol and Thyroid Hormones

Have you had saliva cortisol testing done? I have and it was one of the most important pieces to my thyroid puzzle. Turned out my cortisol was low throughout the day.

Written by Cammi Balleck, CTN, ANCB Board Certified Naturopath

Where is your cortisol level?

Do you know that excess cortisol can be the CAUSE of:

  • decreased metabolism
  • depression
  • high blood pressure
  • chronic fatigue
  • insomnia
  • migraines
  • tunnel vision
  • acid reflux
  • hostility
  • hunger
  • arthritis
  • low immune system

CORTISOL is an important hormone in the body, secreted by the adrenal glands and involved in the following functions and more:

  • Proper glucose
  • Regulation of blood pressure
  • Insulin release for blood sugar maintanence
  • Immune function
  • Inflammatory response

Did you know cortisol lowers your thyroid hormones?

Here is the simple truth:

Stress triggers the adrenal hormone cortisol.
Cortisol triggers the flight or fight response.
Over time cortisol lowers thyroid hormones.

Ok so here is the dirty truth, this is why weight loss is so hard with hypothyroidism, not only is your thyroid function low, but your cortisol being high slows down weight loss and on top of that cortisol causes your thyroid to work even slower. In addition to negative effects of cortisol like increased blood sugar, high blood pressure, poor digestion, poor immune function, it also lowers thyroid hormones. When the body is pushed too hard, thyroid hormone and the metabolic rate goes down. This is the body’s way of protecting itself, like pushing on the brakes in a car that’s speeding down a hill. It’s a fact cortisol messes with your thyroid hormones.

1. Cortisol decreases TSH, lowering thyroid hormone production.
2. Cortisol inhibits the conversion of T4 to active T3, and increases the conversion of T4 to reverse T3.

The other most significant indirect effect the adrenals have on thyroid function is via their influence on blood sugar. High or low cortisol can cause hypoglycemica, hyperglycemia or both. Blood sugar imbalances cause hypothyroid symptoms in a variety of ways.

Always remember adrenal stress also has a more direct impact on thyroid function. In order for thyroid hormone circulating in blood to have a physiological effect, it must first activate receptors on cells. Inflammatory cytokines have been shown to cause hypothyroidism.

If you’re familiar with insulin resistance, where the cells gradually lose their sensitivity to insulin, this is a similar pattern. It’s as if the thyroid hormone is knocking on the cell’s door, but the cells don’t answer. A perfect example of this in practice is the Hashimoto’s patient who is taking replacement hormones but still suffers from hypothyroid symptoms – often in spite of repeated changes in the dose and type of medication. In these patients, inflammation is depressing thyroid receptor site sensitivity and producing hypothyroid symptoms, even though lab markers like TSH, T4 and T3 may be normal.

Who isn’t stressed these days?

On top of not feeling good, you have kids to take care of, dinner to make, parents to help, deadlines to meet, traffic, bills, illness, anger, phone calls, and family. We either exercise not enough or too much. Most people can admit to eating foods that are not ideal and when we are tired and stressed we stop for a fancy coffee and sweet bite to feed our flesh because it’s been a long day. This stress is not just one day – it is long term, day after day after day.

What happens if long term stress continues?

If the adrenals are put under stress long enough, they eventually become exhausted. At this point, the adrenals won’t even be able to make a normal amount of cortisol.

The two conditions of hypothyroid and hypoadrenal are hand in hand friends and often come together. I believe in order to feel better instead of thinking in terms of just hypothyroidism, it is wise to think in terms of a hypo-endocrine system.

Cortisol is one of the hormones released by the adrenals during the stress response. Prolonged cortisol elevations, caused by chronic stress, decrease the liver’s ability to clear excess estrogens from the blood. Excess estrogen increases levels of thyroid TBG, the proteins that thyroid hormone is attached to as it’s transported through the body.

When thyroid hormone is bound to TBG, it is inactive. It must be cleaved from TBG to become “free-fraction” before it can activate cellular receptors. (These free-fraction thyroid hormones are represented on lab tests as “free T4 ” and “free T3 ”.)

When TBG levels are high, the percentage of free thyroid hormones drops. This shows up on labs as low free T4/T3.

If you are hypothyroid I highly recommend you look at your body as a whole and you know where your cortisol is as well as your thryoid hormones.

Normally, cortisol is present in the body at higher levels in the morning and at its lowest at night.

Although stress isn’t the only reason that cortisol is secreted into the bloodstream, it has been termed “the stress hormone” because it’s also secreted in higher levels during the body’s fight or flight response to stress, and is responsible for several stress-related changes in the body. Small increases of cortisol have some positive effects:

  • A quick burst of energy for survival reasons
  • Heightened memory function
  • A burst of increased immunity
  • Lower sensitivity to pain
  • Maintenance of homeostasis in the body

While cortisol is an important and helpful part of the body’s response to stress, it’s important that the body relaxes so the body’s functions can return to normal following a stressful event. If you are not sleeping it could be your cortisol. Unfortunately, in our current high-stress culture, the body’s stress response is activated so often that the body doesn’t always have a chance to return to normal, resulting in a state of excessive stress.

Higher and more prolonged levels of cortisol in the bloodstream like those associated with chronic stress have been shown to have negative effects, such as:

  • Impaired cognitive performance
  • Suppressed thyroid function
  • Blood sugar imbalances such as hyperglycemia
  • Decreased bone density
  • Decreased muscle tissue
  • Higher blood pressure
  • Lowered inflammatory responses in the body and other health consequences
  • Increased abdominal fat, which is associated with a greater amount of health problems than fat deposited in other areas of the body

To keep cortisol healthy and under control, the body’s relaxation response should be activated after the fight or flight response occurs.

Cortisol is normally 10 times higher in the morning than at night. However, in adrenal dysfuntion (either too low or too high cortisol) there is also a change in this basic pattern of cortisol release. As covered in the charts below, there is simply no way to accurately guess cortisol levels at 8PM based on a single 8AM sample.

Therefore, multiple cortisol samples are needed throughout the day. If testing blood, this would require multiple blood draws during the same day, which is just simply not practical.

Waking up extra early in the morning to run to a lab and get stuck with a needle is a big stress in itself and may alter the level of the body’s main stress hormone cortisol. Therefore, this is testing cortisol levels when a patient is under unusual levels of stress in the morning, not during a typical day.

Saliva tests require people to merely spit in a tube. This is a much less stressful test than getting a blood draw, and so getting the test itself will not change cortisol levels.

The saliva cortisol test

Saliva cortisol is usually measured 4 times during the day: upon waking up, noon, the late afternoon and before bed. Saliva is collected by spitting into a small collection tube, therefore it can be collected just about any time or any place. This is often referred to as an ASI or Adrenal Stress Index test.

Adrenal Stress Panel is used when individuals are complaining of:

  • fatigue
  • weakness
  • insomnia
  • headaches
  • irritability
  • nervousness
  • sugar cravings
  • dizzy spells
  • decreased stamina

All individuals with chronic disease will have changes/compromises in their adrenal function.

Cortisol Patterns

It is never good sense to “guess” whether you have high or low cortisol, even if you “think” you do! Symptoms of high cortisol can be similar to symptoms of low cortisol. Plus there are different variations of an adrenal problem which require different supplements.

The following examples show why cortisol needs to be measured throughout the day and the usefulness of this information.

Reference range is highlighted in green. Either too high, or too low cortisol is not a good thing.

Low cortisol, adrenal fatigue results

In this case cortisol is low through the entire day. Simply taking some herbs like adrenal adaptogenic herbs and B vitamins (common advice for adrenal fatigue) would not nearly be enough support for someone in this situation.

In addition comprehensive health history would need to be reviewed, as this sort of adrenal fatigue doesn’t just happen for no reason. Major stresses (psychological or from other illnesses) need to be dealt with in order to relieve some of the stress on the adrenal glands.

High and low cortisol, cortisol deregulation

Morning cortisol was so high it was literally off the chart. For the rest of the day it followed at the very bottom of reference range.

Such high AM cortisol indicates how the stress response may be causing insomnia, such as waking up 3AM or 4AM every night.

This person may respond better to supplements that help the brain better regulate cortisol production (which is controlled by the hypothalamus and pituitary glands) than taking boat loads of adrenal supplements for daytime fatigue. This person would also be helped with minerals.

Phosphatidylserine is a well-known cortisol suppressor used in the evening. Some other OTC nutritional supplements to lower cortisol levels in the body include gingko biloba, Zinc, and acetyl l-carnitine.

More patterns of cortisol deregulation

In these two cases rising cortisol during the end of the day (when cortisol should be decreasing) shows cortisol contributing to inability to fall asleep.

In the first case morning fatigue related to low cortisol can be seen. The increase in cortsol was related to blood sugar imbalance (besides energy production, cortisol works very closely with insulin to regulate blood sugar), so nutritional support for both the adrenals and blood sugar was needed.

I recommend a low-glycemic diet balanced in protein, healthy fats, and complex carbohydrates like vegetables, eaten as smaller meals more frequently (5-6 small meals/day), has a positive influence on hormones. Protein is important for the adrenals and requires adequate stomach acid (HCL) for digestion.

The second case has a large drop between 8AM and Noon, which indicates stress coming from the gastrointestinal system which must also be treated. This person would need probiotics and GI support.

About Cammi Balleck, CTN, ANCB Board Certified Naturopath

Cammi Balleck is an ANCB Board Certified Traditional Naturopath. She has been called the leading Happy Hormone Doctor. She has over 11 years experience specializing in biochemical balance and she is author of the book Happy the NEW Sexy. Cammi is the women’s health expert for Women’s Day, O, Prevention, Shape, and First Magazines as well as a featured expert for TBN, and FOX NEWS NATIONALLY. In addition she has made guest appearances on CW stations in Denver.

Why it’s helpful to get a cortisol level test

Cortisol is a stress hormone produced by your adrenal glands (1). Cortisol affects many parts of your body—including your muscles and bones, heart and blood vessels, lungs, hormone-producing glands, and your brain (2).

Cortisol has lots of functions—controlling how you respond to stress, how your body fights infections, adjusting blood sugar levels, and regulating blood pressure (2, 3).

Cortisol and your thyroid

An underactive thyroid causes an increase in cortisol levels in your blood (4). Two of the most common conditions caused by cortisol are Cushing’s syndrome (too much cortisol) and Addison’s disease (too little cortisol).

When should you have a cortisol test?

Ask your doctor for a cortisol test if you have the following symptoms:

  • Obesity (especially around your abdomen)

  • Very high or very low blood pressure

  • High blood sugar

  • Skin that bruises easily and purple streaks on your stomach

  • Weak muscles

  • Irregular periods

  • Hirsutism (in females)

  • Fatigue

  • Abdominal pain

  • Nausea, vomiting, and diarrhea

  • Hair loss

What can affect cortisol test results?

Bacterial or viral infections, stress, and pregnancy can influence a cortisol test read-out (5-7).

Cortisol should be measured in the morning—around 8am—when levels are highest (1).

Cortisol lab values

A cortisol test can be done through blood samples, urine, or saliva. Cortisol has a circadian rhythm—levels are very low to undetectable at midnight, increase to a peak in the morning, and then slowly decline throughout the day (8-10).

Average cortisol levels at 8 A.M. are between 100–250 mg/mL (11).

Reducing cortisol levels

There are several physical and mental ways you can reduce your cortisol levels.

Activities including yoga (especially if you have depression-like symptoms) creating art, and spending time in green and natural environments are all proven to lower cortisol levels (12-14).

Mental training including perspective-taking (looking at a situation from a different point of view), as well as techniques that optimize expectations and/or provide beneficial distraction (noting ways to healthily manage stressful situations or writing to distract yourself from unnecessary stress) can also help keep cortisol levels low (15, 16).

Track your stress levels, cortisol blood values, and more in BOOST Thyroid.

Often, at Naturmend, we see people who have symptoms of low thyroid function. Things like weight gain, fatigue, brain fog, hair loss etc. Yet, when they’ve been tested their thyroid hormones continually come back in the normal range.

OR we see people who have been diagnosed with hypothyroidism (low thyroid function). And after initiation of thyroid medication and the normalization of all their thyroid tests, they continue to feel the same symptoms of fatigue, hair loss, weight gain, brain fog etc.

What is happening in these two scenarios?

We need to look closely at the hormones involved and secreted by the adrenals and the thyroid. These two essential organ systems are responsible for much of the important hormonal happenings in our bodies.

The thyroid is found in the neck and is responsible for producing thyroid hormones which help in the regulation of metabolism. The adrenals are small glands situated on top of the kidneys, that function in producing several hormones. These include: stress hormones (epinephrine, norepinephrine, and cortisol), some sex hormones, and mineralocorticoids which regulate fluid balance and blood pressure.

To help explain what’s happening above we are going to focus in on the interaction between cortisol and the thyroid hormones.

What we know is that excess cortisol suppresses TSH secretion (1). TSH is a hormone produced by the brain that tells the thyroid to make more thyroid hormone. In essence then, excess cortisol inhibits the thyroid from making more thyroid hormones.

Conversely when cortisol is low, TSH levels are shown to increase (2,3) which is a sign of a poorly functioning thyroid. Additionally, low levels of cortisol also decrease T3’s (active thyroid hormone) affinity to its receptors in the tissues where it is active (4). So we see that low cortisol is linked with lower thyroid function.

From this we see that both low and high cortisol can create symptoms of low thyroid function.

Let’s focus a bit more on the low cortisol situation as that is what we see most commonly. When researchers look at patients with adrenal insufficiency (inability to make much or any cortisol from the adrenals) they present with high TSH and hypothyroid symptoms (4,5) and over time a decrease in T4. These people will not respond favourably to thyroid medication unless the cortisol levels are treated as well (4). This makes sense when we know that cortisol is needed to allow thyroid hormone to work properly in the tissues. This highlights the importance of adequate cortisol levels to have a well functioning thyroid system. Not too much and not too little.

For these reasons, for any patient suffering from thyroid symptoms or already diagnosed with a thyroid disorder, I like to investigate what is happening with their cortisol levels throughout the day. After testing many patient’s cortisol levels, I find it very common in my practice to see low cortisol levels. Now we know that with low cortisol we can see elevations in TSH (sometimes mild, but still there) and in some cases low thyroid symptoms may show up.

Often if we can restore adequate cortisol levels, the TSH will normalize. Sometimes patients can lower their dose of thyroid medication if they are on it (under the supervision of their prescribing doctor always) or they just feel a lot better and we see a reduction or elimination of the low thyroid symptoms they’ve been suffering from.

Take home points:

  • Your low thyroid symptoms might not be purely a thyroid problem. If cortisol levels are too high or too low, this will compromise thyroid function.
  • If you have cortisol imbalance, it is hard to correct thyroid symptoms with purely thyroid treatment. It’s important to also support cortisol levels.
  • If you are one of those suffering from low thyroid symptoms, despite normal thyroid numbers – either on medications or not, then consider getting your cortisol levels evaluated by an ND or functional medicine practitioner.

Dr. Meaghan McCollum, ND

I am a strong advocate of integrated healthcare. To me this means bringing together all forms of healthcare from your healthcare team and communicating to help you reach your health goals. I work along side all types of practitioners and treatments.

1. Samuels, MH. Effects of variations in physiological cortisol levels on thyrotropin secretion in subjects with adrenal insufficiency: a clinical research center study. J Clin Endocrinol Metab. 2000;85(4):1388-1393.

2. Hangaard J, et al. Pulsatile thyrotropin secretion in patients with Addison’s disease during variable glucocorticoid therapy. J Clin Endocrinol Metab. 1996;81:2502–2507.

3. Hangaard J, et al. The effects of endogenous opioids and cortisol on thyrotropin and prolactin secretion in patients with Addison’s disease. J Clin Endocrinol Metab. 1999;84:1595–1601.

4. De Nayer, P et al. Altered interaction between triiodothyronine and its nuclear receptors in absence of cortisol: a proposed mechanism for increased thyrotropin secretion in corticosteroid deficiency states. 1987;17(2):106-10.

Chronic fatigue is a medical condition that affects more than 1 million people in the United States, and those are just the extreme cases. (1) We are a society that works hard, doesn’t sleep enough, and often seems to run on fumes and caffeine. Many of us constantly crave sugary foods and suffer from debilitating exhaustion. That exhaustion can be caused by different things, and chronic fatigue is multifaceted, but in many cases, one common aspect of the condition is something called adrenal fatigue.

The Adrenal Glands

The adrenal glands, which sit on top of your kidneys like little kidney baseball caps, release several important hormones, one of which is cortisol. Cortisol is one of your primary adrenal hormones and regulates your energy. Normally, it rises in the morning to help you wake up, then slowly goes down throughout the day, sinking at night so you can sleep well. Cortisol also helps regulate your blood sugar and pressure as part of the body’s stress response—fight-or-flight.

What Causes Adrenal Fatigue?

The problem starts when cortisol levels stay high when they shouldn’t, often due to chronic stress. The result can be adrenal fatigue, which is not actually an adrenal problem but rather a brain problem. Typically, adrenal fatigue is when the brain-adrenal (HPA) axis isn’t working, so that the brain is not communicating appropriately with the adrenal glands to regulate cortisol.

Additionally, if the adrenals fail to produce enough aldosterone—a steroid hormone important to potassium, sodium, and blood pressure regulation—adrenal fatigue can be a result. (2)

Adrenal Fatigue Symptoms

Adrenal fatigue is characterized by a set of non-specific symptoms including:

  • Trouble getting started in the morning
  • Sugar or salt cravings
  • Low libido
  • Low blood pressure
  • Afternoon tiredness
  • Brain fog
  • Getting a “second wind” in the evening
  • Trouble staying asleep
  • Dizziness when standing up quickly
  • Afternoon headaches
  • Blood sugar issues
  • Chronic inflammation
  • Thinner, weaker nails
  • Moodiness
  • Weight gain or weight loss difficulty

If adrenal fatigue is not dealt with, it can escalate to an adrenal crisis, a life-threatening condition where the sufferer experiences sudden and severe pain in the lower back, legs, or abdomen, dehydration, diarrhea, and even loss of consciousness.

As a functional medicine practitioner, I’m normally the one guiding people out of their health problems, so when I saw the symptoms of adrenal fatigue creeping into my own life, I knew I had to start practicing what I teach. Here are the steps I took to rehab my own adrenals and what I recommend for many of my patients.

15 Ways to Support Adrenal Health

1. Run labs to assess adrenal function and more.

Because adrenal fatigue symptoms are so non-specific and could be indicative of other diseases such as depression, sleep apnea, fibromyalgia, and certain autoimmune diseases, it can be hard to make a medical diagnosis. Seeing a medical professional or endocrinologist to establish a baseline of what’s going on in the body is the first step to overcoming adrenal fatigue. In addition to conventional blood labs, I recommend:

  • Adrenal fatigue labs: This is saliva test involves spitting into several vials throughout the day. It’s a lot of spit, but it gives you and your doctor a lot of information about your brain-adrenal function. When I did these labs, I learned I did indeed have adrenal (HPA) dysfunction, as I suspected.
  • Microbiome labs: The microbiome refers to the community of trillions of bacteria and fungi in your gut. Because gut health is the foundation of total health, especially brain and hormonal health, it is important to discover what is going on and deal with any underlying gut problems such as leaky gut syndrome, candida overgrowth, and small intestinal bacterial overgrowth in order to recover from adrenal fatigue.
  • Methylation labs: Methylation is a collection of biochemical actions in the body that happen 1 billion times every second. Healthy methylation helps to maintain a healthy brain, gut, hormones, and detox pathways, and also protects your DNA. However, some of us have genetic mutations that impair the methylation process. I have multiple methylation gene mutations, one of which is the MTHFR gene mutation, making me less able to absorb certain essential vitamins. This was useful information because I was then better able to supplement to make up for my nutritional deficiencies.

2. Jumpstart your hormone rehab with a 90-day diet reset.

Food is medicine. I always ate healthy, other than my favorite “healthy junk foods” of gluten-free pizza and stevia soda. However, I knew that if I was going to rehab my adrenal fatigue, I had to take my food medicine plan to the next level by making sure my diet was on point for hormone health. Here’s the 90-day food plan I used to improve my sleep and energy.

3. Eat nutrient-dense proteins.


Oysters are packed with zinc, and having a balanced trace mineral ratio between copper and zinc can help with healthy neurotransmitter function and adaptogen to stress. Increased copper and decreased zinc have been shown to contribute to brain stress and anxiety. (3) Oysters—the superfood of the sea—are a great way to achieve this balance to help ease your stress levels.

Organic turkey

There is some truth to the notion that a post-Thanksgiving meal heavy on the turkey will put you into a “food coma.” The reason is the calming amino acid tryptophan in the turkey. Tryptophan is a precursor to the neurotransmitter serotonin, which helps you feel calm and better able to deal with anxiety. (4)

Grass-fed organ meats

Organ meats like liver are some of the best sources of nutrients needed to beat fatigue, like zinc and vitamin D. They also contain copious amounts of choline and other B vitamins needed for methylation. (5)

4. Eat more green superfoods.

Leafy greens

Plant foods like Swiss chard and spinach are rich in magnesium, the original nutritional “chill pill,” which helps to regulate and optimize communication in the brain-adrenal axis. (6)


This sulfur-rich vegetable also contains the beneficial B vitamin folate. Low levels of folate are linked to neurotransmitter impairment, which can lead to brain-hormonal problems. (7)

5. Eat healthy fats every day.


Avocados contain beneficial B vitamins and monounsaturated fats that boost neurotransmitter production and brain health. This fatty superfruit also contains potassium, which naturally helps to lower blood pressure.

Full-fat kefir

Bacterial imbalances in your gut can contribute to brain problems because the gut and brain “talk” to each other through the vagus nerve. (8) Kefir is rich in beneficial bacteria for your microbiome and also has fat-soluble vitamins A, D, and K2, which are important for brain health, so it helps out from both ends of this critical connection.

Coconut oil

Coconut oil is super versatile – you can cook with it, put it in smoothies, or just eat it off a spoon as I do. It offers good fats like medium-chain triglycerides (MCTs) that can help with brain function. (9)

Wild-caught fish

Omega-rich foods like Alaskan salmon can help decrease inflammation, which is crucial for brain and hormonal health.

6. Sip on herbal tea.

Chamomile tea

This soothing, mild herbal tea isn’t actually from the tea plant. It’s made from an herb, Matricaria recutita, that has been shown to help decrease anxiety, depression, and stress symptoms in just a few weeks. (10)

Rooibos tea

Another non-tea “tea,” this one comes from the African red bush, typically known as Rooibos, and can have a balancing effect on cortisol. (11)

7. Try natural medicines.

Because so much of adrenal fatigue is really brain-based, most of the natural, alternative medicines I use focus on supporting optimal brain health and the brain’s response to stress. Explore blends of adaptogenic herbs like ashwagandha, eleuthero ginseng, holy basil, and Rhodiola Rosea to give your adrenal axis some TLC. I also incorporated phosphatidylserine supplements into my routine. (Of course, consult your doctor before implementing any herbs or supplements.)

8. Increase magnesium intake.

In addition to eating magnesium-rich foods, supplementing with magnesium can take its benefits to the next level. Magnesium helps support the adrenal glands, relaxes stressed muscles and nerves, and promotes quality sleep. I am a fan of magnesium threonate, which studies suggest can be beneficial to the brain. I also put magnesium oil on my skin. (12)

9. Bring down inflammation.

Curcumin, a compound in the turmeric root, has potent antioxidant properties, as well as a neuroprotective quality. Bonus: It’s a mood-enhancer, too. In a randomized controlled trial, turmeric appeared to act as an effective option for depression, which can occur concurrently with adrenal fatigue. (13)

10. Improve sleep habits.

When I was working to rehab my adrenals, I needed to recommit to getting a good night’s sleep, and that meant breaking the bad habit of staying up too late. I know it’s difficult when you work all day, get home late, and just want time to unwind, but your brain and adrenals recuperate overnight while you sleep, and they need time, too.

I now try to avoid caffeine in the afternoon. This is difficult, as I am a self-admitted tea addict, but I opt for the caffeine-free chamomile or rooibos instead if it’s after lunch. Other ways to promote quality sleep include turning off the TV, computer, and smartphone a few hours before bed (those screens and artificial light can overstimulate the brain, block melatonin production, and negatively impact sleep quality), and eating an ounce or two of clean protein like organic turkey, along with 2 tablespoons of coconut oil right before bed. This has a balancing effect on blood sugar throughout the night.

11. Learn stress management techniques.

Stress, especially long-term stress, can have devastating effects on health. Even if you do everything else right health-wise, if you don’t manage your stress, none of it will mean much. During my healing journey, I practiced mindfulness meditation and other stress-busting strategies to bring mindfulness into my day, like taking time-outs for slow, deep breathing. This is a simple way to defuse stress levels and calm the brain-adrenal axis. I’m also a big fan of listening to Eckhart Tolle audiobooks when I’m in the car.

12. Start practicing yoga regularly.

Another great way to manage cortisol while also getting in better shape is yoga, which can bring both more alertness and more stillness into your life. I recommend the awesome video courses from my mindbodygreen siblings Lauren Imparato, Tara Stiles, and Michael Taylor, for easy access to yoga at home.

13. Spend more time outdoors.

Because I have a job that’s indoors, I need to make it a point to get outside more often. I believe there is something coded in our DNA that gives each of us an affinity with the sun and fresh air so that we seek out these health-boosting influences. I also like to practice earthing, or walking barefoot outside, as much as I can to help de-stress. Something about that skin-on-earth connection feels literally grounding and refreshing.

14. Get vitamin D levels into a healthy range.

Spending more time outside in the sun also helps boost levels of vitamin D, because your body manufactures this important vitamin/hormone when it senses the sun on your skin. Vitamin D is responsible for regulating over 200 genetic pathways, so make sure your levels are high enough. I recommend an optimal range of around 60 to 80 ng/ml. Ask your doctor about a simple blood test to help you keep track.

15. Learn to say “no.”

This one is still hard for me. I don’t want to disappoint anybody and there is always more work to be done. But managing stress means creating space in your life to refuel, spend time with the people you love, and doing what you need to do for you and you alone. Don’t just pencil it in. It’s as important as anything else you do for your health, and maybe more so.

With these diet and lifestyle changes, you can get your stress in check and support better adrenal health. If you want to learn more about your own health case please check out our free health evaluation. We offer in-person as well as phone and webcam consultations for people across the country and around the world.

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Adrenal Fatigue Treatment: Your Thyroid Part IV

Adrenal Fatigue Treatment includes lifestyle and food shifts as well as removing emotional stressors, starchy foods, caffeine, tap water and staying up past 10 pm.

The Adrenal Fatigue Treatment information in this article is a combination of what I learned throughout the last decade of healing Hypothyroidism in my body as well as information from the following Functional/Integrative doctors and their books: Amy Meyer’s M.D.and Aviva Rohm M.D., who I truly admire, believe in and agree with. Click on their name for additional Adrenal Fatigue Treatment information.

Before you read this article, please read Part I and Part II and Part III so that this all makes sense to you. There is a wealth of information there that will be necessary to understand before you dive into Adrenal Fatigue Treatment.

Click the PLAY button below to LISTEN to my tips and strategies for Adrenal Fatigue and Thyroid Health.

Adrenals. Ahhhhhhh, how I wish I knew about these guys a decade ago before my doctor put me on steroids in my 20’s, which took away my pain but also destroyed my adrenals!!! It’s taken me over 10 years to build back my adrenals. So much fun. Let me tell you. This has become part of my life so I love learning new ways to heal myself and my adrenals have been anything but easy to heal. They’re tricky and they’re exhausting and you end up feeling depleted, tired and fed up most of the time. When I learned about adrenal fatigue treatment from my Functional/Integrative M.D.’s I was amazed at all the knowledge I found on how I could start to heal these babies, which were KEY for my thyroid health. You’ll never have an optimal thyroid if your adrenals are out of whack. So, let’s talk about what adrenals are and how you can make sure they’re in tip-top shape. As Susan Blum, M.D. (she was my 1st Functional MD) mentions in this article for Well&Good, 8 Signs You Have Adrenal Fatigue, “When there’s severe, chronic stress, the adrenal glands can stay in the ‘on’ position, making extra amounts of these stress hormones.”

So, what are your adrenals and why should you care about them?

Let me count the ways…

Your adrenals produce your stress hormones, which are super important for your metabolism and they totally effect your thyroid so it’s key to look at these glands when you’re dealing with any sort of thyroid issue. If you’re in that amped-up mode that causes you to feel stressed all the time (and you feel like you can’t turn it off), you’re headed for some degree of Adrenal Fatigue. In this state, your cortisol is chronically elevated or it’s high when it should be low (at night). Adrenal Fatigue is when your cortisol is chronically low when it should actually be elevated. Your production of stress hormones declines and leaves you with low adrenaline and low cortisol–feeling depleted.

The thyroid and adrenals are interconnected; they influence numerous functions together and they impact each other. Therefore, you can’t just treat one without treating the other

Does Stress Cause Adrenal Fatigue?

You’ve heard about your stress hormones before and we know that we do not want our stress hormones running the show because then our body is in fight/flight mode and everything starts to get out of balance, leaving us with terrible symptoms, aches, pains and frustration, not to mention exhaustion.

These stress hormones regulate everything from your mood to your digestion to your blood sugar to your stress response (acute short term and chronic long term stress), your immune response, blood pressure and so much more. Your adrenals are regulated by the hypothalamus and the pituitary glad along the HPA axis (the hypothalamus, pituitary and adrenal axis). Now, let’s break this down.

When you experience some sort of stress (physical, mental or emotional), your hypothalamus lets go of a chemical that sends a signal to your pituitary gland and then your pituitary releases an alert to your adrenals, which then let a whole bunch of stress hormones out into your body. Your body makes adrenaline and noradrenaline, cortisol and dopamine and they’re there to help you when you’re experiencing stress. Stress can be a good thing or a bad thing. And also a very bad thing! Stress can also be emotional, mental and physical. I went under HUGE amounts of emotional stress as a child. I was highly sensitive and remember being yelled at and crying all the time because some of the people around me were very intense and angry and so I took all that on myself and it suppressed my immune system and my adrenals. Now that I look back, it all makes sense. I could feel myself being suppressed. I’m highly sensitive to what’s going on in my body, as well and so when I’m being suppressed, I notice it right away. Anything that your body must do to exert effort on these levels such as an exam, carrying heavy luggage or crying because you got in a fight with your father, is a form of stress. For example, planning a wedding can be stressful but fun. Planning a party can be stressful but fun. So, you see, stress can be fun but also have negative effects. Not all stress is bad stress. But dealing with a mean woman at work, like my days in fashion, can be a huge stress on your body. Getting let go from a job can be a huge amount of stress. Fighting with your in-laws or a customer service person can be forms of stress for your body, as well. So, what does all of this have to do with your health?

Well, any form of stress involves your nervous system. Specifically your sympathetic nervous system, a part of your autonomic nervous system. This system takes care of your blood pressure, digestion, breathing, heartbeat and sexual response. When these things need to increase because of a threat, your sympathetic nervous system is in charge and when they need to be relaxed, your parasympathetic nervous system cools them off.

Stress is not a bad thing. We all have stress in many forms but the key is to be able to handle it and to balance your life in a way so that you do not stay in the fight/flight mode all the time. When that happens, you’ll have insomnia, belly issues/digestion issues, exhaustion, hormonal imbalances, weight gain, thyroid issues and many other symptoms. Your immune system will also be very suppressed so you’re susceptible to getting infections and viruses/colds or even catching something like Lyme disease. Sound familiar? I’m pretty much telling you what happened to me. My nervous system was knocked out of balance so much that my body couldn’t perform it’s regular duties and everything started to shut down because of emotional, physical and mental stressors that I was put under when I was younger, which is why I was a prime case for Adrenal Fatigue Treatment.

Your Nervous System

When a threat happens, your sympathetic nervous system stops digesting your food, it stops worrying about producing babies so your reproduction stops and it takes away the priority from worrying about your immune system and your thyroid (because your body thinks it’s in survival fight/flight mode getting chased by a tiger) and your blood rushes out of those areas and into your legs and arms so that you can flee from the tiger your body thinks is chasing you. Your sympathetic nervous system was deigned to deal with physical challenges, so that’s why this reaction occurs. So, what is really happening is that your body doesn’t care about the long-term focus of your health right now. It’s focused on how to keep you alive right now in this moment through the fight/flight mode. THIS is called the stress response (fight/flight mode). Your blood pressure increases, your palms sweat and you feel pumped up and ready to fight or flee from danger. Sound familiar?

Now, here’s the kicker.

If you’re healthy, your body will fall back into the relaxed state it was in before the threat and your body calms down. Everything shifts back to helping you digest, etc and your thyroid and reproductive organs go back to work. This relaxation response is spear headed by your parasympathetic nervous system, the other part of your autonomic nervous system. If you’re like many people, your stress will be high at work and your sympathetic nervous system will be in full gear helping you tackle everything that comes your way, then you shift into the parasympathetic nervous system at night when you’re with your lover or family or children and you can relax, watch TV, read, eat a nice dinner, cuddle, get ready for bed and perhaps have sex. All of which are quite relaxing to your nervous system. This is ideal.

Fight/Flight and Adrenal Fatigue

When you live in the fight/flight mode all the time and you’re constantly stressed out, you’re setting yourself up for adrenal fatigue because they’ve been in overdrive for a long period of time and they’re been flooding your body with cortisol until they can’t keep up with the constant demand for more stress hormones. Now, your adrenals cannot produce enough stress hormones and/or they’re producing the wrong types of hormones at the incorrect times.

In a healthy person, your cortisol is high in the morning, which wakes you up and then the cortisol levels start to decrease throughout the day and into the night until they’re so low that you fall asleep. Now, when you’ve got adrenal fatigue, like I had for probably about 30 years (yes the majority of my life)–I’m only 34, you could wake up feeling like you got hit by a car and you have to drag yourself through your day. Then bedtime comes and you’re wired and can’t fall asleep and you have insomnia. Sound like you? There are millions of people dealing with this and Western M.D.’s do not address Adrenal Fatigue Treatment so it’s really sad to know that so many people are not getting the help they need. When I had adrenal fatigue, I felt depleted and wired and on edge and by body was so out of whack. It was awful.


I first learned about cytokines years ago when I was dealing with Lyme. What many of us do not realize is that the stress response triggers inflammatory immune cells called Cytokines. These cytokines perform many jobs and one of them is to make your thyroid receptors less sensitive to thyroid hormones- meaning that you’ll need more thyroid hormone that usual to have the same impact! This is where things get tricky because your thyroid blood work (see Part I for the blood work labs to get), can come out perfect but you’ll still be seeing thyroid symptoms because if you’ve got thyroid resistance, you can have the correct levels of thyroid hormone in your blood but your cells are being deprived. Yikes, right? Your hormone in your blood is not getting into your cells where you need it so you’re not seeing an improvement in your symptoms and your blood work can look perfect.

That’s why your thyroid can be so complicated and why it’s key to work with a Functional/Integrative M.D. to address your Adrenal Fatigue Treatment so that they can see all of these avenues to dive deep into what’s really going on here.

The Adrenal Thyroid Connection

Now, when your cortisol gets too high, your pituitary and hypothalamus slow down and so they don’t let go of any stress hormones and your thyroid begins to slow down. Now your thyroid stops producing as much thyroid hormone, which causes your metabolism to slow down and you all of a sudden start gaining weight, even though you haven’t changed anything about what you eat or workout. You start to feel fatigued, foggy and unmotivated. Also, when your stress is high, you convert more T3 into Part III (read Part III to learn more about Reverse T3), which slows things down and halts your metabolism even more.

The key message to understand here is that when your body is stressed out and the stress does not go away and it’s not taken over by your relaxation response, then your body is in fight/flight mode and you’ll start to see all of your organs slowly shut down and you’ll experience awful symptoms. I’m talking about your digestion, your immune system and your reproductive organs (I had lots my period for years because of this and the Lyme). Everything is connected folks. That’s key to understanding your body!

Letting go of stress and supporting your adrenals is huge if you want your thyroid to function optimally. This is a big part of the Adrenal Fatigue Treatment. You cannot expect to keep going on with your stressed out life and expect to heal or feel better. It’s simply not possible. Your body is telling you it needs rest. listen to it.

There are many ways that you can start to release your stress, which I’ll be talking about soon. For now, focus on your breathing, cutting out things that you don’t need from your life, saying NO more often and giving yourself quiet time away from your phone and your computer. Your body needs this down time to heal and to stay healthy.

Adrenal Fatigue Test

Answer the below questions and see how many you answer yes to. If you answer yes to more than 2, I recommend you see a Functional MD to address your Adrenal Fatigue Treatment.

  • Do you have morning fatigue? Is it hard to wake up before 10AM?
  • Do you feel sleepy and tired from 2-4PM?
  • Do you have burst of energy around 6PM?
  • Do you get tired around 9-10PM and resist it and then go to sleep around 1AM?
  • Do you crave salty foods?
  • Do you have PMS?
  • Do you have anxiety?
  • Do you have a decreased libido?
  • Do you get lightheaded when you get up from laying down or sitting?
  • Do you have a lot of allergies?
  • Do you easily feel overwhelmed?

Adrenal Fatigue Treatment

There are many ways to address adrenal fatigue but here are a few. I never wanted to hear these and ignored this advice for years but I have slowly come to understand that these are at the core of what we need to do as we embark on our Adrenal Fatigue Treatment journey.

  • Avoid becoming overtired.
  • Talk to your Functional MD about supplements to support your adrenals.
  • Avoid negative people.
  • Bring happiness and joy back into your life.
  • Get into bed by 10PM.
  • Get as much rest as you can between 7-9AM because these are the optimal hours to restore adrenal function.
  • Do something everyday that you enjoy such as going for a walk outdoors.
  • Do gentle exercise. Do not do cardio, do not do spinning and do not go running. Easy exercises like yoga and pilates work well.

Adrenal Fatigue Diet

You know the drill by now and if you’ve read my book, Eating Clean, you know this is what it’s all about. Below are a few points for you to consider during your Adrenal Fatigue Treatment.

  • Drink high quality purified water.
  • Drink a large glass of water immediately when you wake up with 1 tsp. of high quality sea salt such as Redmond sea salt.
  • Eat within one hour of waking up. Always eat breakfast before 10AM because your body needs glycogen after going through the night fasting.
  • Eat lunch before 12PM.
  • Eat dinner before 6PM.
  • Eat 5-7 servings of organic vegetables everyday.
  • Eat organic.
  • Remove processed foods such as cookies, cakes, breads and rice cakes and crackers.
  • Avoid sugar and high sugar fruits.
  • Eat small amounts of protein and fat before bed if you have a tendency to wake up between 2 and 3 AM.
  • Avoid starchy foods such as white potatoes and white rice.
  • Eat adrenal supportive food such as dark leafy greens, walnuts, sunflower seeds, flaxseeds and organic grass-fed animal protein.
  • Always combine protein and fat at EVERY meal and snack.
  • Avoid caffeine and coffee, which are stimulants and interrupt your sleep pattern. Drink herbal tea and try dandelion root tea if you’re having a hard time cutting out coffee.

Adrenal Fatigue Supplements

There are numerous supplements you can use for adrenal fatigue but remember, you have to get to the root cause of WHY you have adrenal fatigue before you start your adrenal fatigue treatment. If you don’t, the supplements will just be a waste of money! Talk to your Functional MD about the following supplements to support your adrenals. But please know that anything that supports your adrenals will increase your estrogen so this may lead to worse PMS, acne, weight gain or mood swings- something NO ONE told me about until recently. Probably because no doctor understood this!

  • Ashwagandha
  • Rhodiola
  • Eleuthera
  • Holy Basil
  • Shatavari
  • Licorice
  • Ginseng

I hope you enjoyed this Thyroid series. I’d love to hear from you and any thyroid symptoms you are experiencing. If you missed the previous articles, please read Part I and Part II and Part III.

Those of us with Hashimoto’s often blame our thyroid for the many signs and symptoms we experience. Hair loss? Thyroid! Weight gain? THYROID! Fatigue? It’s gotta be the thyroid!

Treating hypothyroidism without treating the adrenals is one of the biggest reasons people continue to feel exhausted despite receiving treatment with thyroid hormones. Patients may initially report feeling more energetic after starting thyroid hormones, but this is usually followed by feeling worse and worse until they are right back to where they were before they started the thyroid medications. At this point, they will likely go back to their physicians to check blood work and will be told that everything is normal.

The patient begins to feel crazy… but that’s when another layer of what is broken in Hashimoto’s becomes unraveled. Many symptoms of hypothyroidism overlap with symptoms of underactive adrenals. However, physicians don’t routinely check adrenal function in those with Hashimoto’s.

Symptoms of poor adrenal function may include the following:

  • Feeling overwhelmed
  • Feeling tired despite adequate sleep
  • Difficulty getting up in the morning
  • Craving for salty foods (a.k.a. the “I just ate a whole bag of chips syndrome”)
  • Increased effort required for everyday activities
  • Low blood pressure
  • Feeling faint when getting up quickly
  • Mental fog
  • Alternating diarrhea/constipation
  • Low blood sugar
  • Decreased sex drive
  • Decreased ability to handle stress
  • Longer healing time
  • Mild depression
  • Less enjoyment in life
  • Feeling worse after skipping meals
  • Increased PMS
  • Poor concentration
  • Reduced ability to make decisions
  • Reduced productivity
  • Poor memory

Do any of these sound familiar?

The Adrenals at a Glance

The adrenal glands release hormones such as cortisol and adrenaline. These “stress hormones” impact many important functions throughout the body. They help establish your stress tolerance, tame inflammation, regulate blood sugar and body fat, control potassium and sodium levels (impacting blood sugar), and influence sex drive and anti-aging… among other things.

You may have heard that the stress hormone cortisol is “bad”. This is misleading — while high levels of cortisol are problematic, what could be equally or more problematic is having low levels of cortisol, especially when it comes to having an autoimmune disease and fatigue.

Cortisol is a hormone that is required for life — we could not live without it, and it is an important anti-inflammatory hormone. In fact, it gets released whenever we have inflammation to cool things down.

I have found that the majority of people with Hashimoto’s have low levels of cortisol.

Testing for Adrenal Issues

In addition to looking at your symptoms (above), you can determine if you have adrenal dysfunction by utilizing the assessments below.

The Irritability Test

Irritability and overwhelm are two cardinal signs of adrenal dysfunction. My best test for determining adrenal issues is being snappy or short-tempered, feeling overwhelmed, or finding other people annoying. For example, I can always tell that my adrenals are overwhelmed when my mom calls to say hello, and I feel like this is too much of a demand!

Blood Pressure Test

People with adrenal fatigue often have low blood pressure and/or a drop in blood pressure after standing up from a lying down or sitting position (orthostatic hypotension). If your blood pressure is below 120/80 mmHg, this may mean that your adrenals are underactive, or that you are dehydrated. Symptoms may include dizziness or lightheadedness when standing up from a sitting/lying down position.

Pupil Contraction

People with low adrenal function may often have difficulty with contracting their pupils. Usually our pupils dilate (enlarge) in the dark, and contract (get smaller) in the light. Symptoms of adrenal dysfunction may include light sensitivity, difficulty seeing in bright lights, having to wear sunglasses on most days, or as I like to call it, feeling like a vampire in daylight!

Unstable Temperatures

If you are keeping track of your first morning temperatures, low and unstable morning temperatures may be suggestive of adrenal insufficiency. In contrast, pure hypothyroidism usually results in temperatures that are low, but rather stable, on a daily basis.

The “Whole Bag of Chips” Test

Have you ever eaten (or wanted to eat) an entire bag of chips in one sitting? You’re not alone! Salt cravings are a cardinal sign of adrenal issues. With adrenal issues, we may find ourselves with intense cravings for salty foods like crackers, chips, pretzels and olives.

Hormone Testing

Adrenal saliva tests provide a way to test our current adrenal function. These tests are generally only available from functional medicine and integrative health care professionals.

Normally functioning adrenals are supposed to put out the most cortisol in the morning, and the levels of cortisol should decline during the day until very little cortisol is secreted at bedtime. A cortisol kick in the morning helps us to get out of bed bright-eyed and bushy-tailed, ready to face the day. Low cortisol secretion at bedtime helps us relax and sleep.

Some people with adrenal dysfunction have the opposite pattern — they can’t get up in the morning and drag their feet until the early afternoon, feel slightly human for a few hours between 2pm and 8pm, then get a second wind at bedtime. These people often have a flipped cortisol rhythm, where their adrenals put out very little cortisol in the morning and too much in the evening, causing them to be alert and sleepy at the wrong times.

Other people may have abnormally low cortisol readings all day, everyday. These poor souls wake up tired and the fatigue lasts all day — I have been there, and it’s not fun. This low cortisol causes inflammation to go unchecked in the body, prevents healing, and causes the person to be sluggish for most of the day.

I recommend the HPA Stress Profile test from BioHealth Lab. I have found it to be the most accurate for adrenal testing. However, the lab recently redefined their reference ranges, resulting in labs I would have previously classified as dysfunctional to be misread as normal by the untrained eye. If you’re going to go down the road of adrenal saliva testing, I recommend working with a practitioner trained in interpreting these labs, preferably one who has been interpreting them for at least 4-5 years.

What Causes Adrenal Fatigue?

In most cases of adrenal fatigue, the problems generally originate in a communication breakdown that occurs within the hypothalamic-pituitary-adrenal axis, otherwise known as the HPA axis. The HPA axis describes the interactive feedback loop that takes place between these three endocrine glands.

The hypothalamus is like the CEO of our body’s production of hormones. It scans messages from our environment and other endocrine glands, as well as checks the body’s overall hormonal status before passing on the order for more hormones to the pituitary gland. The pituitary gland then acts as a project manager and will pull together individual workers (like the thyroid gland, the adrenal gland, and the gonads) to do their jobs. The pituitary will also make sure the workers have adequate resources to do their jobs by managing growth (and repair), and electrolyte/water balance.

The HPA axis works in response to two types of stress: immediate stress and chronic stress. Let’s see how the responses to each type differ.

In cases of immediate stress, the hypothalamus senses stress and sets off a hormone cascade that leads to the activation of our fight or flight response. As part of this response, the adrenals pump out extra hormones and our bodies go from the state of relaxing, digesting and healing, to a survival state.

Your body’s energy is shifted from activities not essential to survival like growing beautiful hair, metabolizing nutrients into energy, making hormones, and digesting and repairing itself to instead focusing its resources to meet the great, stress-induced demand for cortisol and adrenaline.

Then, once you’ve escaped from the threatening bear or gotten out of the way of the oncoming car, the demand for emergency levels of hormones settles down and the focus once again turns to parasympathetic response, focused on body maintenance and upkeep.

In cases of chronic stress, the never-ending presence of stressful, yet non-life-threatening situations, can lead to the constant activation of the stress response.

To help meet the demand for cortisol, your body will decrease the production of other hormones normally produced by the adrenals such as progesterone, DHEA, and testosterone.

Eventually, with enough chronic stress, the HPA axis becomes overwhelmed and desensitized to the usual feedback loop and stops sending messages to the adrenals to produce more hormones or less hormones, no matter what’s happening. Additionally, a person may run out of nutrients that are required for proper adrenal function.

One of the most common causes of adrenal fatigue is stress, which creates an intense demand for stress hormones such as cortisol and adrenaline. There are four main types of stress to consider:

  1. Sleep disorders
  2. Mental/emotional stress
  3. Metabolic/glycemic dysregulation
  4. Chronic inflammation

Sleep Disorders: One of the fastest ways to induce adrenal dysfunction is through sleep deprivation. In fact, sleep deprivation is used in lab animals to suppress the hypothalamic-pituitary and adrenal axis (HPA) axis. Sleep deprivation can be caused by insomnia, sleep apnea and shift work.

Mental Stress: Feelings such as grief, guilt, fear, anxiety, excitement and embarrassment can be classified as stress. This stress is based on our perception, not on the nature of the individual stress. For example, public speaking may cause plenty of mental stress for someone with social anxiety, but another person who enjoys speaking in front of others may perceive the experience as pleasurable. Situations that are new, unpredictable, and threaten the ego, or that involve feeling a loss of control, are perceived as stressful.

Glycemic Dysregulation: Researchers in Poland have found that up to 50 percent of patients with Hashimoto’s have an impaired tolerance to carbohydrates. This means that after consuming carbohydrate-rich foods, their blood sugar levels would spike up very high, causing a great amount of insulin release. The role of insulin is to clear blood sugar out of our bloodstream and store it in our cells, so a large insulin release is followed by a rapid drop of blood sugar (hypoglycemia). Symptoms of hypoglycemia are very unpleasant and may include irritability, fainting, lightheadedness or tremors. Hypoglycemia necessitates the release of cortisol to help maintain the glucose supply to the brain and counteracts insulin, causing insulin resistance. (This is also linked to the Type 2 Diabetes epidemic).

Inflammation: Chronic inflammation may occur from joint pain, obesity, toxic burden, inflammation in the GI tract from irritable bowel disorders, pathogens, or food sensitivities. These conditions will signal cortisol for its anti-inflammatory effect.

The Conventional Approach to Adrenal Fatigue

The adrenals are a source of disagreement between conventional medical doctors and natural practitioners. Conventional medical doctors only recognize Addison’s disease as an adrenal insufficiency disorder, but do not recognize “adrenal fatigue” as a medical diagnosis.

When my integrative doctor first suggested that I get tested for adrenal fatigue, I “Googled” the term and found a “reputable source” that adrenal fatigue was a made up disorder and did not exist.

Being a skeptical pharmacist, I put-off testing my adrenals — I had just ventured into the world of alternative medicine, and was always afraid of people trying to take advantage of me and take my money, not realizing that they were simply trying to help.

But then I got to a point where I was just so exhausted and irritable, despite taking thyroid medications and following a gluten free diet.

I started talking to Carter Black, RPh, my compounding pharmacist, about the symptoms I was experiencing; and he suggested that I have my adrenals tested. Mr. Black had specialized in hormones for many years and told me that the interventions for adrenal fatigue did indeed work well for many of his patients.

Finally, it stuck: maybe it was hearing it from a fellow pharmacist, or maybe because he didn’t have any adrenal test kits to sell to me, that I decided to try it out.

Sure enough, I had an advanced stage of adrenal fatigue, and the recommended treatments for the adrenal fatigue helped me feel tremendously better!

I now recommend the adrenal saliva test to all of my clients with Hashimoto’s, and have found that 90 percent of my clients (who do the test) have some degree of adrenal fatigue. So trust me, adrenal fatigue does exist!

Recovering From Adrenal Fatigue

There are six main pillars of my Adrenal Recovery Protocol:

  • Rest
  • Balance blood sugar
  • De-stress
  • Reduce inflammation
  • Replenish nutrients
  • Build resilience with adaptogens


Sleep is the reset button for the adrenals. When we sleep, our body releases human growth hormone and repairs itself. Make sure to get at least 7 hours of sleep each night and go to sleep before 10pm. If you can pull it off, I actually recommend getting 10-12 hours of sleep per night for 1 month in my adrenal-focused recovery protocols. Be sure to read my article on the Sleep Apnea and Hashimoto’s connection if you have unrefreshed sleep, snoring and/or a scalloped tongue.

Balancing Blood Sugar

Stabilizing your blood sugar through diet is a crucial step in overcoming adrenal fatigue and thyroid conditions. Balancing your blood sugar can create noticeable improvements in how you feel each day.

Aim first and foremost to eat more fats and proteins, and less sugary and starchy carbs. When consuming carbohydrate-rich foods, your blood sugar goes up too high, too quickly, causing symptoms such as nervousness, lightheadedness, anxiety, and fatigue. These swings in blood sugar can weaken your adrenals and cause a spike in your thyroid antibodies.

Check out my article on stabilizing your blood sugar with diet for more information.

Stress Reduction

The most important strategy for combating adrenal fatigue does not involve dieting, supplements, medications, or testing. This strategy, however, is often the hardest to implement.

That strategy is… stress reduction.

Reducing my stress was probably the hardest lifestyle change for me to implement. I only had two settings, “GO” and “SLEEP.” I did not know how to relax, smell the roses, turn-off, or unwind.

So, I came up with this list of strategies to make myself more relaxed and shift my body into a state of relaxing, digesting, and healing. I hope some of my strategies will resonate with you. But, many of you will want to come up with your own list. Many of these items may be really difficult to implement, especially for those of us with responsibilities like jobs, children, or elderly relatives who need our care. However, somehow, you HAVE to schedule time for yourself.

We often expect our doctors to heal us, but the healing comes from within just the same. No one else will do it for you. Put it in your planner if you must.

Some strategies to reduce stress include:

  • Do your best to eliminate, simplify, delegate, automate.
  • Be more resilient by being more flexible. Bruce Lee once said, “Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind.”
  • Do the things that you like.
  • Avoid burning the candle at both ends.
  • Massage, acupuncture, meditation or tai chi may help get you relaxed.
  • Avoid multitasking. Do one thing at a time and keep your full attention on it before you move on to the next task. Take a small break in between tasks.
  • Start a journal, make your list, be mindful of what makes you feel better and what makes you feel worse.

Reduce Inflammation

Food sensitivities are a common source of inflammation. Gluten, dairy and soy are the most common reactive foods in Hashimoto’s, and eliminating them will eliminate inflammation in your body. Elimination diets and food sensitivity testing may help you determine additional foods that may need to be removed from your diet. I have an article on Food Sensitivities you can read for more information.

Chronic infections are also a common source of inflammation in the body. Common infections include H. pylori, Blastocystis hominis and Candida, but there are numerous potential infections that can be root causes as well.

Replenish Nutrients

The salt cravings and feelings of dehydration that occur with adrenal fatigue are our body’s way of letting us know that we need more salt. Rather than reaching for processed foods or thyroid toxic iodized salt, including a good-quality sea salt in your diet may help if you feel a bit dizzy getting up in the morning or after a hot bath, or have other symptoms of adrenal fatigue. I like to recommend buying a pink or grey sea salt and making yourself a salty drink each morning and sipping it throughout the day. Homemade bone broths with plenty of sea salt are also a great and tasty way to rehydrate.


While supplements often need to be individualized for people depending on their level of adrenal dysfunction (which needs to be determined via testing), I have found that most people with Hashimoto’s feel better when they utilize the ABC’s of adrenal supplements.

The ABC’s are: Adrenal Adaptogens, B Vitamins, and Vitamin C.


Adaptogenic herbs are any natural herb products that supplement the body’s ability to deal with stressors. In order to be considered an adaptogen, an herb must possess several qualities. First, the herb must be nontoxic to the patient at normal doses. Secondly, the herb should help the entire body to cope with stress. Finally, the herb should help the body to return to “normal” regardless of how stress is currently affecting the person’s functioning. In other words, an adaptogenic herb needs to be able to both tone down overactive systems and boost underactive systems in the body. Adaptogens are thought to normalize the hypothalamic-pituitary-adrenal (HPA) axis.

Adaptogenic herbs include: Ashwagandha, astragalus reishi mushroom, dang shen, eleuthero, ginseng, jiaogulan, licorice, maca, schizandra, spikenard, and suma. These are examples of herbs that may increase the body’s ability to resist stress, and have been helpful in relieving adrenal dysfunction when used in combination with vitamins and minerals.

I personally love using adaptogens. I always joke that adaptogens make other people in my life much easier to tolerate. 🙂 I have taken adrenal adaptogens on and off since 2012. I like to use more of them around holidays and periods of stress, and they really help me stay balanced. I did stop them during pregnancy, and getting back on them is one of the things I looked forward to the most, with the exception of my little one’s arrival of course. 🙂

B’s and C’s

Vitamin C and B Vitamins become depleted during high cortisol production. Pantothenic acid and biotin deficiency in particular have been linked to decreased adrenal function in animals and humans.

While some may wish to obtain these supplements from natural whole food sources, due to gut issues, people with Hashimoto’s usually have an impaired ability to extract vitamins and minerals from food.

Rootcology Adrenal Support

I created the supplement Rootcology Adrenal Support to use a combination of the ABC’s I recommend for balancing adrenals: Adaptogens, B Vitamins and Vitamin C.

I included ashwagandha in the blend, as ashwagandha has research-supported benefits for thyroid health. Please note, ashwagandha is a nightshade, so if you have nightshade sensitivity, you may be sensitive to ashwagandha. (However, some people may only be sensitive to certain nightshades and may tolerate it).

I also added licorice to this blend. Licorice was one of the herbs that helped me the most in overcoming fatigue. Licorice root extract prevents the breakdown of cortisol into inactive cortisone. Thus, it keeps our cortisol around longer, giving us more energy. It may be helpful for those with low cortisol and low blood pressure. Please note, it should not be used by those with water retention or high blood pressure.

I generally recommend using the ABC’s long-term, as life is inevitably full of stress. For added convenience, you can subscribe to get Adrenal Support delivered straight to your door on a monthly or bimonthly basis. As a bonus, the Subscribe & Save option will give you a 10% off discount!

If you are unable to get the Rootcology brand of supplements in your country, or have high blood pressure, the following formula is comparable to the Rootcology Adrenal Support, but contains different ingredients.

Alternative ABC Blend

Daily Stress Formula –This blend of adaptogenic herbs, vitamins, minerals, and amino acids is designed to support the adrenals and provide a powerful defense from the mental and physical factors associated with occasional stress. The formula synergistically supports mental relaxation while counteracting the metabolic effects of occasional stress as well.

In some cases, you may benefit from additional B vitamins and Vitamin C to support your adrenals.

Standalone B Vitamins

B Complex Plus – B vitamins play an important role in cell metabolism, thyroid function, and adrenal function. They become depleted in stressful situations that often precede the development of autoimmunity. Four especially important B vitamins are pantothenic acid (B5), thiamine or benfotiamine (B1), biotin (B7), and cobalamin (B12). This exceptional combination of B vitamins, including Vitamins B1, B2, B3, B5, B6, B12, biotin, and folate (as Metafolin L-5-MTHF) should be helpful for most people with low energy levels. B vitamins are water-soluble vitamins and do not build up in the body, so the risk for toxicity is almost nonexistent.

BenfoMax – Thiamine is one of the B vitamins, known as B1. It supports blood sugar function, the adrenals, and can boost our energy levels. It also has the important roles of converting carbohydrates into energy and aiding with the digestion of proteins and fats. Thiamine is required for proper release of hydrochloric acid in our stomachs, which is needed for proper protein digestion. (Most people with Hashimoto’s have little or no stomach acid.) The latest research suggests that a mild deficiency may exist in people with autoimmune disease and related malabsorption issues. If you’ve been struggling with fatigue, low stomach acid, carbohydrate intolerance, low blood pressure, and your adrenals, you may benefit from up to 600 mg of Thiamine a day.

Other Supportive Nutrients

Magnesium Citrate – As magnesium is depleted by stress and is often difficult to obtain from foods, most people will benefit from long-term supplementation. It is also excellent for promoting relaxation.

Vitamin C – Vitamin C is an essential vitamin for supporting adrenal function. I recommend doses of 500 mg to 3,000 mg per day, as tolerated.

Advanced Strategies

While many cases of adrenal dysfunction are caused by current stress and modifying those stressors can help with overcoming adrenal dysfunction, in some cases, additional interventions may be needed to address past traumatic stress, as well as chronically altered release of adrenal hormones.

Traumatic Stress

Traumatic stress may lead to a chronic pattern of adrenal hormone dysfunction. Various types of traumas and abuse have been tied to autoimmune conditions and thyroid hormone abnormalities. Many of my clients have experienced significant traumas such as the loss of a loved one and/or being in an abusive relationship before the onset of Hashimoto’s. Some of us have also experienced childhood trauma, which can set the tone for altered hormone patterns in adulthood.

Resolving traumatic stress usually requires a targeted therapy (I prefer neurofeedback and EMDR), and is a bit beyond the scope of this article, so until I have a chance to write an article on this topic, I have dedicated an entire chapter to it in my recent book, Hashimoto’s Protocol.

Supplemental Hormones

A variety of hormones and adrenal-supporting substances may be used based on your cortisol saliva test results and adrenal insufficiency stage.

Although most of these hormones are available over the counter at health food stores, they are certainly not benign and should be used under the supervision of a trained professional with extreme caution. Not everyone will need all of these supplements.

Your practitioner may utilize pregnenolone, DHEA, 7-Keto, adrenal glandulars and in some cases, the medication hydrocortisone to rebalance your adrenals.

Looking for more info about the adrenal glands? I cover adrenal protocols in my book Hashimoto’s Protocol.

I wish you the best of luck on your healing journey!

P.S. You can also download a free Thyroid Diet Guide, 10 Thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter of my Root Cause book for free by signing up for my weekly newsletter. You will also receive occasional updates about new research, resources, giveaways, and helpful information.

Note: Originally published in September 2013, this article has been revised and updated for accuracy and thoroughness.

The Adrenal-Thyroid Connection

August 21st, 2019

• Free eBook: 35 Gut Recovery Recipes

I’m going to be honest here: Stress is a given in our lives. I know I can’t avoid it and, while I’m not much of a gambler, I’d be willing to bet you can’t either. Yet, whether you have Hashimoto’s or hypothyroidism, Graves or hyperthyroidism, or you haven’t been diagnosed yet, stress and your adrenals play a huge role in your thyroid health.

Fortunately, that doesn’t mean there’s nothing we can do about it. The key is to understand the adrenal-thyroid connection, how stress affects thyroid function, and how to relieve it!

How Chronic Stress Impacts Thyroid Function

You probably know your adrenal glands for producing adrenaline and managing your fight or flight response. However, did you know that, as part of your endocrine system, they also produce hormones which impact major metabolic processes, just like your thyroid does? The hormones produced by your adrenal glands help to regulate blood pressure, electrolyte balance, blood sugar, immune response, digestion, and more.

When you experience stress, be it emotional, mental, or physical, your hypothalamus sends a signal to your pituitary gland. Your pituitary gland signals your adrenal glands to produce and release a series of stress hormones, including cortisol.

Once a stressor triggers this cascade of hormones, cortisol and your other stress hormones redirect your body’s normal functions to essentially ignore anything that is not necessary for overcoming the stressor in front of you. This means that functions such as digestion, immune response, and yes, thyroid hormone production and distribution, are temporarily put on hold or slowed down until the stress has passed. Ideally, the stress passes quickly, your body returns to normal, and everything runs smoothly once more.

Unfortunately, due to our hectic lifestyles, many of us experience chronic stress, either because our stress does not end quickly or it is quickly followed by another stressor. This state of chronic stress puts your adrenals on overdrive for extended periods of time, continuously flooding your body with cortisol until your adrenals can no longer keep up with the constant demand for more and more stress hormones, leaving you in a state of adrenal fatigue. This flooding and eventual plummeting of stress hormones have many negative impacts on the thyroid.

Slowed Thyroid Hormone Production

Cortisol functions in a negative feedback loop with the hypothalamus and pituitary gland. Once it enters your bloodstream, its presence signals to your hypothalamus and pituitary gland to slow down so that they don’t trigger any additional stress hormones. These organs also regulate thyroid hormone production, so that slows down as well.

Reduced T4 to T3 Conversion

Stress hormones affect the enzymes that convert T4 to T3. Remember that Free T3 (FT3) is the active form of the hormone that I like to think of as the ‘gas.’ Reverse T3 (RT3) is the inactive form of the hormone that I like to think of as the ‘brakes.’ When stress is high we convert more of our T3 into RT3 rather than FT3. This imbalance essentially puts the brakes on all of your metabolic processes, slowing them down and causing hypothyroid symptoms.

Thyroid Hormone Resistance

Also released in the stress response are inflammatory immune cells called cytokines, which make thyroid receptors less sensitive to thyroid hormones. This means that even if you’re taking thyroid medication and your thyroid hormone levels are normal, you can still be suffering from underactive thyroid symptoms.

Shortage of Unbound Thyroid Hormone

Prolonged cortisol elevation can cause excess estrogen to accumulate. This extra estrogen increases levels of thyroid-binding globulin (TBG), which is the protein that allows your thyroid hormones to travel through your bloodstream. When thyroid hormones are attached to TBG they remain inactive, so T4 can’t be stored in your tissues or converted to Free T3.

Suppressed Immune System

While your body is in stress mode your immune system is suppressed. Partially so that your body can focus fully on overcoming the stressor, and partially because stress causes inflammation. Your immune system slows down to prevent a state of chronic inflammation. As I explain in my book, The Thyroid Connection, a suppressed immune system can trigger latent viral infections, some of which can trigger autoimmune thyroid disease.

Furthermore, if you experience multiple episodes of chronic stress, causing your immune system to rev up and slow down repeatedly, you are at greater risk of your immune system overreacting and triggering an autoimmune response.

Weakened Gut Barrier

As part of suppressing your immune system, cortisol weakens your immune system’s primary barriers—the blood-brain barrier, lungs, and gut barrier.1 As we know from Part II of this series, a weakened gut barrier leads to leaky gut, which sets you on the path toward autoimmune disease by releasing gluten and dairy, among other things into your bloodstream. These can trigger attacks on your thyroid via molecular mimicry.

How to Best Test for Adrenal Fatigue

As you can see, your adrenal function plays a huge role in the effectiveness of your thyroid hormones. It is very important to determine if adrenal stress is an underlying cause of your thyroid dysfunction. That way you can treat them side by side.

In fact, many patients with adrenal-related thyroid problems who are put on thyroid medication without adrenal support initially get worse. They can experience a racing heart or shaking hands as their body is forced into overdrive from the sudden rush of thyroid hormones.

Conventional doctors typically rely on a blood test to measure cortisol levels, but your stress hormone levels fluctuate significantly throughout the day. That means the one-time test does not provide nuanced results. I prefer an at-home saliva test. You can order your own adrenal profile from My Labs for Life to measure stress hormone levels.

The Myers Way® Adrenal Fatigue Test

If you are unable to use a saliva test or do not feel that formal testing is necessary, I have a basic symptoms checklist test in both of my books, The Thyroid Solution and The Autoimmune Solution, that will give you an idea of your degree of adrenal fatigue. You can also download a PDF version in the link below.

How to Reduce Stress and Support Your Adrenals

The best way to support your adrenals and accompanying thyroid problems long-term is to learn to manage your stress. Realistically speaking, there will always be stress in your life, but learning the tools and routines to leave a stressful situation behind after it’s over, instead of carrying it around with you, will reduce the physical effects of chronic stress.

Stress-Relieving Tools to Support Your Adrenals

Here are two of my favorite ways to reduce stress:

  • Infrared Sauna Therapy – Spending time in an infrared sauna has many health benefits, including stress relief and detoxification. I have one in my home, and you can also receive treatments from natural spas that house their own.
  • A relaxing hot bath – I love winding down with a relaxing hot bath in the evening. For a little extra pampering and relaxation, check out this recipe for a DIY Calming Lavender Body Oil Scrub

Helpful Supplements for Adrenal-Thyroid Health

  1. Adaptogenic herbs help the body adapt and cope with stress. My go-to supplement to support the adrenal gland contains Rhodiola rosea, Panax ginseng, and a number of other herbal extracts. I carry The Myers Way® Adrenal Support, in my store to promote a healthy stress response.
  2. All B vitamins are critical for the chemical processes within the adrenal glands, which makes my multivitamin ideal for adrenal support. It contains all 8 B vitamins in their pre-methylated forms.
  3. For added adrenal support, you can also take Omega-3 fatty acids, vitamin C, and magnesium.

If you are curious about your own adrenal health, or would like further assistance in combatting your adrenal fatigue, I highly recommend seeking a Functional Medicine practitioner in your area.

Article Sources


Hypothyroidism and Adrenal Fatigue: What You Need to Know

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Your adrenal glands sit atop your kidneys, where they have a very important job. According to the Society for Endocrinology, the adrenal glands secrete hormones, or chemical messengers, into your bloodstream, where they travel to various parts of your body to do their work.

But sometimes the adrenal glands go haywire, overproducing the stress hormone cortisol (Cushing’s disease) or not producing enough hormones (Addison’s disease or adrenal insufficiency), says Frederick Singer, MD, director of the endocrinology and bone disease program at the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California.

Some nontraditional physicians recognize another adrenal condition: adrenal fatigue. They say adrenal fatigue is when you’re under a great deal of stress and, as a result, your adrenal glands just can’t keep up with your body’s demands for hormones.

According to David Borenstein, MD, an integrative medicine physician in New York City, when you have adrenal fatigue, you feel run down. You have low energy, yet you can’t sleep. You must rely on stimulants like caffeine to get you through the day, and you may also have headaches and find yourself craving salt and sugar.

“Many doctors that practice alternative or integrative medicine believe you can have mild or moderate cases of adrenal problems,” Dr. Borenstein says. “It doesn’t have to be extreme to affect you.”

Hypothyroidism and Adrenal Gland Troubles

The thyroid is another gland responsible for producing hormones that keep your body running optimally. When the thyroid gland, which is in the lower front of your neck, isn’t functioning well, you can become tired, forgetful, and depressed — similar to adrenal symptoms. Other signs of hypothyroidism include feeling cold, dry skin, and constipation.

Because some of the symptoms of hypothyroidism are similar to adrenal fatigue, the two conditions can be confused, Borenstein says. In addition, people with hypothyroidism often have weak adrenal glands, he adds. The two glands work together to supply essential hormones and deliver them where they need to be throughout the body. When your adrenal glands aren’t producing enough cortisol and you have a thyroid problem, it can make the situation much worse, Borenstein says.

Controversy Around Adrenal Fatigue

Adrenal fatigue is somewhat of a controversial topic. According to the Endocrine Society, adrenal fatigue is a myth promoted by health books and alternative medicine websites. “There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms,” the society says on the Hormone Health Network website.

“Adrenal fatigue isn’t an accepted diagnosis,” Dr. Singer says. “It’s not something doctors are taught about in medical school.”

However, if you take synthetic hormones for hypothyroidism and still experience fatigue and other symptoms, it’s important to determine the cause, Singer says. Extreme fatigue can be a symptom of many health other conditions, such as depression, that are identifiable and treatable, he says.

There’s no test for adrenal fatigue, according to the Endocrine Society. However, if your traditional doctor believes your synthetic thyroid hormone should be making you feel better and it’s not, you can schedule an appointment with a doctor that practices alternative or integrative medicine if you’re interested in learning more about adrenal fatigue.

If Borenstein suspects adrenal fatigue, his first recommendation is to practice relaxation techniques like meditation and deep breathing. He also recommends cutting back on high-fructose corn syrup, gluten, and stimulants (such as caffeine) and to get good sleep.

Treating Adrenal Fatigue

If making these types of lifestyle changes don’t help improve your symptoms, you can take supplements to build your adrenal glands back up, Borenstein says.

However, many endocrinologists warn that taking adrenal hormone supplements when you don’t need them is dangerous. “These hormone supplements could cause your adrenal glands to stop working,” Singer says. The glands could become unable to make the hormones you need when you’re under physical stress, he says, and you could be in danger of going into adrenal crisis, a life-threatening condition.

Before taking any supplements, be sure to talk to your doctor and undergo any testing to rule out other possible causes of your symptoms.

Adrenal Fatigue and Hypothyroidism: What Most Doctors Miss Might Hurt You (Rebelle Nutrition)

Everyone knows someone with a slow thyroid, am I right? (Or maybe that person is you…)

Symptoms like a slowed metabolism, brain fog, digestive issues, crippling fatigue, hair loss, and cold hands and feet are increasingly more and more common.

But did you know that hypothyroidism is often the easily diagnosable-disguise that hides an underlying illness – missed by even most functional medicine doctors?

This is because the symptoms of hypothyroidism are nearly identical to those of…

Adrenal fatigue.

Adrenal fatigue is the syndrome that describes a number of unwanted symptoms that occur to improper hormonal output from the adrenal glands.

These are things like trouble waking up in the morning, slowed metabolism, feeling cold often, decreased immunity, brain-fog, depression/anxiety, infertility, PMS, lack of a period and more.

Adrenal fatigue sufferers are most commonly women who have been chronic dieters, over-exercisers, stress-addicts, perfectionists, workaholics, people who have hard time saying ‘no’ and those who have a history of disordered eating or body obsession.

Adrenal fatigue occurs in varying stages, starting as mild fatigue and evolving into full blown hormonal problems like infertility, insomnia, chronic acid reflux, weight gain/loss and more.

Why does adrenal fatigue occur?

Stressors of any kind – physical, mental, emotional, and financial stressors can all lead to adrenal fatigue. Plus, the near-constant exposure to these stressors, year after year, never allows for the proper downtime the adrenals need to heal and repair.

Here are some examples:

Physical stress from working out too much, consuming foods you are sensitive to, working 40+ hours a week, sugar/caffeine addiction, or chronic digestive problems. Mental/emotional stress from a sick relative, financial problems, or a job you hate.

Adrenal fatigue is very dependent on YOUR BODY’S threshold for stress; meaning that someone who works 40 hours a week, exercises for 2 hours a day, and eats a mediocre diet may not experience any symptoms, whereas you could only be working a part time job and doing yoga daily, but still experience intense cravings, dizziness upon standing, and fatigue.

I call this delicate-flower syndrome 😉 . Some of us are just delicate flowers (me!) and easily effected by any type of stress – whether physical, mental or emotional.

How does Adrenal Fatigue get confused with Hypothyroidism?

Adrenal Fatigue is often the cause of under-active thyroid, or hypothyroidism. This is because stress causes the pituitary gland (the hormone signaler in the brain) to down-regulate production of TSH (thyroid stimulating hormone). This leads to less energy production, meaning fatigue and weight gain, among other things.

Stress also causes the liver to have a difficult time converting T4 to T3 (the active form of thyroid hormone that we want), which can drastically reduce energy levels and lead to a cascade of other hormonal effects. If you have tested positive for low thyroid, there is a good chance that it’s your adrenals that need healing first and foremost.

Where doctors get it wrong

Taking these symptoms to your family doctor (and even most naturopaths) will result in the ordering of a blood test for TSH (Thyroid stimulating hormone). If your results fall outside of the “normal” range, the Doctor will likely prescribe Levothyroxin/ Synthroid (pharmaceutical route) or Naturethroid/ Armour (holistic/ natural route). If you fall within the normal range, you will likely be prescribed an antidepressant and told to eat less and exercise more. (<<< this will usually make things WORSE if your problem is stemming from adrenal fatigue)

It is no surprise that the symptoms adrenal fatigue often result in a misdiagnosis of hypothyroidism; especially since they look SO similar – plus we (unfortunately) live in a culture where overwork, over-stressing, and “clean eating” is still widely praised.

So, if you are someone who is experiencing the symptoms of hypothyroidism, but you know that you have a history of perfectionistic, do-it-all mentality, over-exercise, chronic dieting or reliance on sugar and stimulants, here are a few things you can do to determine whether your problem is truly hypothyroid in nature, or if you simply need to change your diet, relax, and rest:

Make sure to be eating enough (real) food

If you’ve ever been a fitness magazine junkie (like myself) you’ll know how commonplace it is to be recommended a diet of 1200-1500 calories if you are a woman wanting to lose weight.

Get ready for something that is about to blow your mind:

According to the National Institute of Health:

Adrenal fatigue is real when you have Hashimoto’s low thyroid

By Josh Redd, DC on August 31, 2018

If you struggle with Hashimoto’s low thyroid, chronic exhaustion, insomnia, poor immunity, and low blood sugar symptoms, you may have poor function of the adrenal glands, or adrenal fatigue. These glands sit atop the kidneys and secrete stress hormones. However, your doctor likely told you there is no such thing as adrenal fatigue, thanks to guidance from The Hormone Foundation. However, there is a continuum of adrenal function and the brain plays a role in adrenal fatigue.

The debate around adrenal fatigue and primary adrenal insufficiency

The term “adrenal fatigue” is commonly known in the Hashimoto’s low thyroid world. Many people are nutritionally depleted and and chronically stressed, causing these hard-working little glands to become exhausted, along with the areas of the brain that govern them. A recent statement by The Hormone Foundation claimed adrenal fatigue does not exist and is not supported by any scientific facts, and that primary adrenal insufficiency is the only real version of adrenal dysfunction. However, according to Richard Shames, MD, adrenal fatigue and primary adrenal insufficiency exist along the same continuum. They are separated by severity of symptoms and treatment. In a nutshell, adrenal fatigue can also be referred to as mild adrenal sufficiency. Primary adrenal insufficiency is caused by damage to the adrenal glands, such as an autoimmune condition such as Addison’s disease, which attacks and destroys adrenal tissue. It is diagnosed through blood tests and can be treated with adrenal hormone replacement medication. Symptoms of primary adrenal insufficiency include:

  • Weakness
  • Fatigue
  • Muscle aches
  • Loss of appetite with weight loss
  • Craving salty foods
  • Dizziness, low blood pressure
  • Feeling lightheaded when standing up
  • Gastrointestinal symptoms such as nausea, vomiting, and abdominal discomfort

Adrenal fatigue describes when lab tests don’t support a diagnosis of primary adrenal insufficiency but a person still experiences symptoms of adrenal fatigue such as:

  • Excessive fatigue and exhaustion
  • Non-refreshing sleep
  • Feeling overwhelmed by or unable to cope with stress
  • Craving salty foods
  • Difficulty concentrating
  • Brain fog
  • Poor digestion

Adrenal fatigue is diagnosed by considering symptoms and running a 24-hour saliva cortisol test.

The role of the brain in adrenal fatigue

The brain plays an important role in adrenal fatigue. This is why nutrients to support your adrenal glands may not be helpful when the real problem is happening in the brain. Adrenal fatigue stems from poor function in the hypothalamus-pituitary-adrenal (HPA) axis. The HPA axis is the feedback loop between your body and parts of the brain that governs adrenal function. Chronic stress fatigues this entire system, including the brain.

How the adrenals become fatigued

When our bodies experience stress, no matter how small or large, our adrenals pump out hormones such as adrenaline and cortisol to help us fight or take flight. Our bodies are designed to return to baseline after a stressor so the nervous system can return to a “rest and digest” state necessary for daily function. However, in our chronically stressed modern lifestyles, our bodies are constantly reacting to stressors, many we are not even aware of, such as dietary triggers, toxins, even electromagnetic frequencies, and undiagnosed autoimmune diseases such as Hashimoto’s hypothyroidism. This constant state of high stress hormones damages tissues in the body and brain and is linked to:

  • Suppressed immunity
  • Low energy
  • Depression
  • Insomnia
  • Insulin resistance and diabetes
  • High blood pressure
  • Heart problems
  • Increased belly fat

Removing all stressors in life is impossible, but there is much we can do to support adrenal function and buffer the damage of stress. Adrenal adaptogens and phosphatidylerine are two natural routes that especially support the HPA axis and the brain’s ability to handle stress. Contact my office for more support in taking care of your Hashimoto’s hypothyroidism, adrenals, HPA axis, and your ability to become more resilient to stress.

How to learn if you have Hashimoto’s low thyroid

Many patients are not diagnosed with hypothyroidism or Hashimoto’s until after several years and going through several doctors. It is a demoralizing journey richly illustrated in my book The Truth About Low Thyroid: Stories of Hope and Healing for Those Suffering With Hashimoto’s Low Thyroid Disease, through real-life stories from patients in my practice. Managing Hashimoto’s goes far beyond using thyroid medication as you must work to stop the immune system from attacking the thyroid. For more information on identifying and managing Hashimoto’s low thyroid, contact my office.

About Dr. Josh Redd, Chiropractic Physician — Utah, Nevada, Arizona, Idaho, and New Mexico functional medicine

Dr. Joshua J. Redd, DC, MS, DABFM, DAAIM, author of The Truth About Low Thyroid: Stories of Hope and Healing for Those Suffering With Hashimoto’s Low Thyroid Disease, is a chiropractic physician and the founder of RedRiver Health and Wellness Center with practices in Utah, Arizona, and New Mexico. He sees patients from around the world who suffer from challenging thyroid disorders, Hashimoto’s disease, and other autoimmune conditions. In addition to his chiropractic degree, Dr. Redd has a BS in Health and Wellness, a BS in Anatomy, and a MS in Human Nutrition and Functional Medicine. He speaks across the nation, teaching physicians about functional blood chemistry, low thyroid, Hashimoto’s, and autoimmunity. You can join his Facebook page here.

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