Symptoms that indicate you may have Adrenal Fatigue…
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- Morning fatigue — it’s hard to “wake up” until 10 a.m., even if you’ve been awake since 7 a.m.
- Afternoon feeling of sleepiness or brain fog from 2 to 4 p.m.
- You may have a burst of energy at 6 pm
- Sleepiness at 9 to 10 pm but often you resist going to sleep and get a “second wind” at 11 p.m. that lasts until about 1 a.m., when you finally go to sleep.
- Cravings for foods high in salt
- Increased PMS or menopausal symptoms
- Mild depression or anxiety
- Lack of energy, fatigue
- Decreased ability to handle stress,
- Feeling easily overwhelmed
- Increased allergies
- Lightheadedness when getting up from a sitting or laying down position
- Decreased libido
- Frequent sighing or air hunger
- Inability to handle foods high in potassium or carbohydrates unless they’re combined with fats and protein
Dr. Jill’s Top Treatment Strategies for Adrenal Fatigue
- Identify and remove stressors – this is the most important step. Emotional stressors such as relationships or financial problems needs to be dealt with and normalized. It might require a change in hours, who you spend time with, or even occupation. Make the necessary changes to restore your health.
- Go to sleep by by 10pm. You may need to set an alarm and begin getting ready for bed by 9pm.
- Whenever possible get rest in the morning from 7-9am, the optimal hours to restore adrenal function.
- Include something you enjoy every day, a leisurely walk, 30min of reading a great book, weekly massage, etc… Schedule these necessities into your calendar so that you are sure to carve out time for self-care.
- Incorporate humor into your day, laugh at comics, watch a funny video or just belly laugh about something funny with your spouse.
- Avoid becoming over-tired, by ensuring proper bedtime and avoiding activities that cut into your time for restful restorative sleep. Try red light at night and avoid computer screens, iPads or stimulating blue light after 7pm.
- Consider a melatonin supplement 3-6mg at bedtime to help regular cortisol before bed.
- Exercise gently at least 5 days per week, preferably morning and not late in the day. Try swimming, gentle bike rides, walking, yoga, stretching, or any restorative activity that incorporates breathing. Avoid high adrenaline activities, like kayaking, competitive sports, running, cross fit or high intensity training until you are well on your way to healing.
- Drink high quality, purified water with added minerals. Natural mineral waters, like San Pellegrino are also helpful to restore the missing minerals, like magnesium and have the added benefit of sulfur.
- Avoid negative people who drain your energy and instead make time for friends and family who lift you up, support you and encourage you. Life is too short to waste time on those who steal your joy.
- Consider taking specific adrenal-supportive nutrients with your doctor: Some of my favorites are Vitamin C, B complex, pantothenic acid, magnesium, and vitamin E.
- Consider adaptogenic herbs, like ashwaganda, rhodiola, ginseng, and licorice.
- You can order either of my favorite formulas Adrenal Manager or Adrenal Essence direct from Xymogen using code: DrJill and last name: Carnahan
- A poor unhealthy diet is a key causes of Adrenal Fatigue
- Always eat breakfast before 10am. The body’s glycogen supply needs to be replenished after going through the night. Try to eat your lunch before noon and evening meal before 6 p.m.
- Avoid coffee or other caffeinated beverages. Coffee and tea act as stimulants and interrupt sleep pattern. Herbal tea is acceptable because it does not contain caffeine.
- Eat within one hour of waking. Fasting is hard on the adrenal glands so minimize time overnight fasting. Never skip breakfast and be sure your first meal contains high quality protein and no refined carbohydrates or sugar. Eat your starches in the evening and never in the morning.
- Drink a large glass of water in the morning immediately upon waking with 1 teaspoon of Redmond real sea salt and 1/2 squeezed lemon. You can also use 1 scoop of my favorite adrenal supportive electrolytes in water: Thorne Catalyte (Order online using code: HCP1004064)
- Sprinkle sea salt liberally on food to taste provided blood pressure is normal. Foods high in potassium such as banana can make the adrenals worse and should be avoided.
- Adopt a whole food organic diet, devoid refined grains and all processed food, such as breads, pastas, and rice cakes and crackers.
- Eat 5-7 servings of organic veggies daily
- Avoid high starchy foods, such as white rice and white potatoes. Some people do better with a serving of complex starch, like brown rice, quinoa or sweet potato in the evening to lower cortisol and help them sleep.
- Avoid high sugar fruits and all juices, especially at breakfast.
- Eliminate trans fats (we all should do this anyway!)
- Eat wild-caught seafood at least 3X weekly or taking a high quality mercury-free fish oil supplement.
- Eat foods rich in adrenal-supportive nutrients, such as Organic 85% dark chocolate, leafy greens, nuts, sunflower or pumpkin seeds, flax and chia seeds, and organic grass-fed animal proteins.
- Combine protein and fat at every meal and snack. This will ensure sustained energy is available at and between meals. Avoid eating only fruit or carbohydrates alone as this may cause blood sugar instability. Upping your total fat intake with olive oil, coconut, and avocado may also help.
- Whole fruits may be eaten later in the day at lunch and dinner except banana, fig, melons, or dried fruits. Berries and apples are wonderful low-glycemic options.
- Take small amounts of protein and fat such as nuts, cheese or nut butter before bed if you have difficulty falling asleep or awaken frequently between 2-3am.
Follow these easy tips and before long your adrenals will be recovering and you’ll be on your way to feeling fabulous!
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DID YOU MISS PART I? Read it here: Could You Have Adrenal Fatigue?
* These statements have not been evaluated by the Food and Drug Administration. The product mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease. The information in this article is not intended to replace any recommendations or relationship with your physician. Please review references sited at end of article for scientific support of any claims made.
I have adrenal fatigue stage 3, I recently started a protocol to help my recovery, it seems to be helping. I wonder though, if I am slowing the process because I take a potassium supplement (99mg) for leg cramps caused, I believe, by seroquel. What should I do?
If you are low in potassium that is appropriate. You may need to increase sea salt.
May I ask what protocol you are taking?
Could you please share your protocol.
My 21 year old son has been diagnosed with”idiopathic hypersomulence” after a sleep study showing no apnea or narcolepsy. He lived in a house that had several feet of water in the basement and had black mold on the windowsills of his bedroom. He’s living with us now, but he is so tired all of the time! On weekends, he’ll sleep til 4 p.m.He will sometimes come in from work and lay on the floor from exhaustion. I desperately want to help him. He does have tonsil stones and we’ve scheduled a tonsillectomy. I don’t know if it will help or hurt, going through a surgery. If you can give ANY direction, I would be very grateful!
Yes, Ginner – find a doctor certified in Shoemaker protocol to help him get well… survivingmold.com
I’ve had my adrenals tested using a saliva test. I do have abnormal cortisol levels, low DHEA but what suprised me most was that I have much too high melatonin levels. I’ve not heard of this before. Why would this be? I thought most people with melatonin problems have too little melatonin.
Hi Claire, it is hard to give any interpretation without knowing the full history.
I’m 55 and was diagnosed with severe adrenal burnout about two years ago. I’ve slowly been getting better with my protocol, but my energy is still quite low. I’m wondering if maybe there’s some subclinical hypothyroidism going on (my blood work has been normal).
Anyway, I’ve been eating a vegan diet lately (McDougall/Esselstyn style) as there is heart disease and diabetes in my family, but seem to be be gaining weight on it, even though my calories aren’t that high. I am desperate to lose weight – I gained about 50 pounds with this adrenal thing!! I’ve tried everything and every diet out there. I found low carb dieting very difficult as my energy plummeted. I’m so confused as to what diet to follow. Any diet suggestions would be immensely appreciated!
Thanks so much.
Adrenals are the stress-response organ so if they are dysfunctional, I recommend looking for root cause – subclinical infection, toxic exposure (mold, chemicals, glyphosate), gut dysbiosis, etc. I recommend a nearly grain-free paleo diet with high healthy fats like avocado, coconut, olive oils and moderate protein (fish, chicken, eggs) and low carbohydrate with your carb intake being in the evening. For adrenals best to consume fat/protein in AM and minimal carbs. You may do ok on some cooked rice/quinoa but otherwise grain-free. It is clear that your current diet is not working if you are feeling poorly and gaining weight…
Are you a proponent of green smoothies for breakfast? Most smoothies call for fruit but it seems like you are not in favor of fruit until lunchtime or later? Would you suggest adding protein (whey or plant-based) to the smoothies, since one should have protein and fat at every meal and snack?
My favorite recipe includes fruit! https://www.jillcarnahan.com/recipe/spinach-berry-smoothie/
Hi Dr Carnahan, what may cause potassium spilling in urine? I am on over 2000 mg of potassium daily and it is causing me GI problems. No one can tell me why I waste it. It seems to cause blood sugar problems too. I have low cortisol via salivary and stim testing. I will follow your suggestions. Thank you. PT
Dr. Jill, I’m awaiting adrenalcortex testing (saliva) results, but I’m fairly certain already I have adrenal fatigue and that it’s multiply-determined or caused. I’m also compound homozygous MTHFR and recovering from leaky gut due to a moldy apartment.
Is there a toxic elements or mercury testing method you prefer? Because I have a mouth full of metal and suspicions that mercury is impacting my thyroid and other issues, but the info out there on testing for these metals is way confusing.
Thanks for any help! Always taking inspiration from your story and advice,
I use Quicksilver tai-test for mercury toxicity
Hi Dr. Jill,
I was found to have adrenal fatigue a year ago via salivary 4 point testing — showed low salivary cortisol in the morning and throughout the day – 4, 2, 2, 1. total 9nM). Also mildly elevated DHEA (11 ng/mL). I am doing all the lifestyle/dietary things you list and in the past tried both adaptogenic herbs (Thorne Phytisone) and adrenal glandulars for about 6 months with little improvement. My doctor wants me to try an adaptogen again and I am wondering if either of the formulas you recommended would be worth trying. Thank you for your time.
HI Dr. Jill,
I listened to your podcast on gluten free school about adrenal fatigue. you mentioned that some herbs raise cortisol and others lower cortisol. Can you share some of the herbs that are helpful to raise cortisol?
There are many and must be individualized to person. Best to discuss options with your functional medicine doctor. I do like Holy Basil Tea (Tulsi) for a bedtime treat to lower cortisol.
Thank you for your response Dr. Jill! Would there be any benefit to taking holy basil if my cortisol is already low at night? My morning cortisol is also low and thought if I could raise that maybe would have some more energy during the day. or is that not a good idea?
I would recommend holy basil to patients who are under stress with high cortisol.
Hi Dr. Jill,
I know adrenal fatigue can cause sunken cheeks but what can cause sunken cheeks that comes and goes? My cheeks were full on Thursday and then tonight they’re majorly sunk in. And then they’ll go back to being full. I would think sunken cheeks from adrenal fatigue would be constant.
I suppose it is possible but there may be something else going on…
Hi Dr. Jill,
What are the common causes of adrenal fatigue for someone who has Hashimoto’s? I don’t have a lot of stress. I’m exhausted and sleep practically all day so there’s no time for stress. Thank you!
There are many…. infections, toxic exposures, inflammation, stress, gut dysbiosis, hormone imbalance and many many more…..
Hi Dr. Jill,
I just had DUTCH test done that showed both high free cortisol and high metabolized cortisol, indicating overactive HPA axis. In the past had very low cortisol levels via salivary cortisol testing so I am a bit confused by this. I have been eating a fairly clean diet, reducing stress, getting enough sleep, gentle exercise, etc so I can’t imagine why my levels would be so high. What can cause overactive HPA axis? Can tapering an SSRI/SNRI medication cause this?
The DUTCH testing is the only one I use because with other salivary testing you will not see the true picture (more here https://dutchtest.com/2016/07/05/adrenal-fatigue-is-all-in-your-head-sort-of/) About 30% of people with low free cortisol overall, have elevated levels of metabolized cortisol. Think about the implications of that. When you see low overall free cortisol in saliva (or in urine) you THINK cortisol production is low. In almost one out of three patients, they are actually making more cortisol than 80% of their peers. They make lots of cortisol! You just can’t see it in the free cortisol.
Thank you Dr. Jill. So, maybe in the past my metabolized cortisol was high but I didn’t know it. I guess that explains why the adrenal glandulars weren’t helpful. So what can cause the cortisol levels to be so high? How does one investigate that further? Thank you!
Infection or inflammation or stress can elevated cortisol levels…
Thank you again Dr. Jill. I have H. Pylori and am thinking I may have SIBO. Are either of these infections enough to cause really high cortisol or is that not likely? Can toxic mold exposure or lyme cause this? My metabolized cortisol was almost 8800, free cortisol 330.
Hi Dr. Jill,
I was wondering if you are still accepting new patients?
We are accepting new patients by referral
Thank you for the wealth of knowledge you share in your blogs and follow-up comments. What stage of adrenal/HPA-axis dysregulation would you consider a patient with the following results? Symptoms are consistent with abnormal cortisol levels and hypothyroidism; current treatment protocol from primary includes Armour thyroid 30mg. Could Hashimoto’s (or autoimmunity) be a possible cause? Or are lifestyle factors (sleep, glucose regulation and diet, stress, etc.) more likely for the following patterns?
TSH 0.998 uIU/mL
total T4 4.9 ug/dL
free T4 0.69 ng/dL
free T3 2.3 pg/mL
cholesterol 223 mg/dL
glucose 85 mg/dL
Salivary adrenal stress index
morning cortisol: 19 nM (13-24)
noon: 5 nM (5-10)
afternoon: 3 nM (3-8)
midnight: 2 nM (1-4)
total load: 29 (22-46)
DHEA: 7 ng/mL (Normal 3-10)
cortisol:DHEA ratio 4:1
progesterone: 23 pg/mL (Normal 22-100 pg/mL)
borderline high secretory IgA: 20 (Normal 10-20 mg/dL)
positive gliadin antibodies: 30 (Positive >15)
The stages of adrenal fatigue terminology are a bit outdated… I prefer to use total metabolized cortisol, 24 hour urinary cortisone and 24 hour urine cortisol through Precision Analytics. By using only free salivary cortisol, you may miss the big picture. This patient seems to have a gluten intolerance that is likely stressing the HPA axis
I have much of the symptoms. I had testing done and This was high Chromogranin at 56. Stayed off ppi for 2 weeks and it came down to 22. No less 15. My cortisol level is low and they suggest a stress prednisone dose. I hate steroids as I went into adrenal crisis from last time. So now what. Just vitamins
Hi Dr. Jill,
I have Hashimoto’s and adrenal fatigue. I don’t know what’s causing my adrenal fatigue or how to find that out. Is it the autoimmune attack? Gut infections? Food sensitivities? The fact that I’ve been to like 50 doctors and nobody can help and they make me so stressed I want to yell at them? I also go to bed really late like 4am. And my blood sugar is chronically low despite eating protein and fat with each meal so I have these awful blood sugar swings which I’m sure is hard on the adrenals. I just don’t know how to figure out the cause and reverse it. Can you reverse it without figuring out the cause by taking a B complex and Vitamin C?
You may need to check for HPA axis dysfunction, hidden infections or toxic exposures causing your symptoms. The gut may also be the culprit. Find a good functional medicine doctor to help you!
Thank you for your article! I just received saliva test results showing that I have low cortisol throughout the day. I’m on a supplement plan, but I’m wondering about some of your other recommendations. What is the benefit of going to bed at 10 PM For the adrenals? If I am awake between 7 AM and 9 AM, what do you recommend for being restful for the adrenals? Thank you!!
Yes, getting to sleep by 10pm can be very helpful, Making sure you are eating small frequent meals to avoid hypoglycemia and higher fat/protein in AM and low-glycemic carbs at night
Prior to having my left Adrenal Gland surgically removed last month after the recommendation of an endocrinologists, I struggled from moderate adrenal fatigue, high blood pressure, low potassium, etc. The removal of the gland was to eliminate the need for blood pressure medicines all together. It didn’t seem to work. I have sever adrenal fatigue, sever high blood pressure, continued weight gain of my mid section, and now depression. Any advice?
Adrenalectomy is not the same as adrenal insufficiency. You will likely need to see your endocrinologist for hormone replacement in this case, hydrocortisone or similar.
Hi Dr. Jill. I’m in my 60s, and about 5 years ago I was diagnosed through testing with adrenal fatigue. I have high toxic metals, very low cortisol, but thyroid is normal. I understand that more sleep is restorative, but for the last 10 years I’ve been lucky to get 4 hours per night. I can go to sleep, but I can’t stay asleep. I’ve tried prescription meds, singly and in combinations (under a doc’s care), supplements of all kinds, and I just can’t stay asleep. My latest strategy is to go to sleep around 10 pm. Then when I wake up, I take Ambien to go back to sleep. Usually I can only sleep for another 2 hours, if that. I always feel sleep deprived and fall asleep at my computer or in meetings. My questions are:
Is it better to take sleeping pills to get a cumulative 6 hours of sleep at night, or just get by on the 4 hours that are pretty good quality?
Will the medication further affect my adrenals?
And will taking other corrective measures as you outlined eventually improve my sleep?
As you already know getting quality sleep is essential to health – I suggest taking sleep aids if needed in order to get restorative sleep so that you wake up refreshed and are not drowsy during the day
What is the difference between Candida and Adrenal Fatigue?
Candida is yeast infection. HPA axis dysfunction is related to the adrenal glands function.
Hi Dr. Jill,
I’m in my early 20’s and have severe adrenal fatigue. It’s so bad that it has caused weight gain in the belly area, fluid retention everywhere, and severe hypoglycemia. I don’t understand how I have adrenal fatigue this bad when I’m so young. I’ve been on a third shift sleep schedule for about 6 years (going to bed anywhere from 3am-6am) but despite doing that, I sleep in late so I still get plenty of sleep. But I know people who have worked third shift for decades. So I’m assuming it couldn’t have caused severe adrenal fatigue after just 6 years, especially considering I’m still getting plenty of sleep? I’m guessing there are other factors at play here?
Yes, there may be hidden infections or toxins or other things that are also contributing to your fatigue.
Hi Jill, thank you for this. I have been trying to uncover the cause of what ails me, just looking at food culprit vs the underlying cause. I have reason to believe Adrenal fatigue may be an issue. I get to a point at work when stress just feels like it is literally through the roof, like there is so much pressure in my head and throat and chest with no where to go and I just can’t function. Do you have any recommendations for where can I get tested for adrenal fatigue in California? I have Kaiser and don’t want to spend a ton of time and money figuring this out, so any recommendations are much appreciate.
You can search for functional medicine trained docs at http://www.functionalmedicine.org
Hi Jill. I havent had deep sleep since i took a supplement that increases dopemine, serotonin, noradreniline uptake as a pre workout stimulet. Ice been off it for a week and still cant sleep. I feel i might have a neurotransmitter inbalence/adrenal problem now. Cant sleep at all. Thanks
Hi David – these types of supplements can be too stimulating. If its affecting sleep I suggest stopping it.
Great article! Thank you for your help. Can you direct me to the type of Dr that deals with adrenal fatigue? I want to get tested to see if my adrenals are functioning correctly. I literally have every symptom you mentioned.
Try a doctor trained in functional medicine – you can search by zip code at http://www.ifm.org
Hi Dr. Jill,
I had an adrenal saliva test done with a functional medicine practitioner at the end of 2015 that showed my adrenals were not functioning highly. I took Adrenal Support supplement (with bovine adrenal cortex), made diet and lifestyle changes and over the course of a year or so my symptoms improved greatly. I am currently 28 weeks pregnant and have not been sleeping well since about 10 weeks into pregnancy due to itching all night. (I’ve had my bile acids/liver function panel run twice and it is not cholestasis). I am now feeling similar symptoms return from before because of the exhaustion/lack of sleep and wonder if you know whether the Adrenal Manager supplement by Xymogen is safe during pregnancy? Or if, there is another supplement with bovine adrenal that you would recommend for pregnancy? The supplement I took previously helped, but it also included some herbs considered unsafe during pregnancy. Thank you so much for any suggestions you can give.
Is there a difference in symptoms between adrenal fatigue and chronic fatigue syndrome. I have really bad fatigue at the moment and still trying to find out what it is with doctor.
Chronic Fatigue is a general term that describes a condition of persistent fatigue that may be caused my many different things including HPA axis dysfunction.
Ive been to the doctor about my depression but i feel as if the doctor doesnt listen to me why I tell her I am tired ALL the time. i feel like im running a marathon just to get through the day. ive been eating healthier and going to the gym 2 to 3 days a week. nothing is helping . Lost 1 pound 🙁 im a horriible napper (i wake up in a bad mood) so i try not to nap . What should my next step be ? im stuck in this rut for now.
Hi Jill! I feel like I have just found gold after reading your site about adrenal fatigue. I have been doing so much testing the last year and a half as endocrinologist has been concerned about my symptoms. After the onset on some very serious stress 4 years ago I started noticing light headedness throughout day esp upon rising, crawling sensation across back and what I would call back spasms at my rhomboids that would make it difficult to breath, itching in the location, of what I know now are the adrenals, hair loss, fatigue around 3 every morning, up late at night , hard to rise or even have a functioning brain til at least 10, test resulting in inflammation, increased blood pressure (being managed), irritable bowel, Random weight gain, then lost and now sudden weight gain again and on and on and on. Every single symptom you listed. Just saw derm (referred by endocrinologist) and she said I have paresthesia. I am so thankful you have posted this information in the easiest way to understand as Ive been so concerned with what has been going on in my body and just to know that I may have an answer is such a relief (I think). I have recently started upping my vitamins worries I was deficient including ashwaganda, and starting rhodiola. I am very concerned about damage that has been done over these few years and want to immediately try to fix this. How can this affect my organs and health? And has there been remarkable damage to my body? I just was ordered to take a calcium screening and heart was great, lungs great etc. just worried. I will start following you advice and hope to get back to normal. Thank you, thank you for your education and advice.
Take care of your stress levels, eat clean food and get sleep… you will recover!
Dear Dr Jill
I live in the UK and am having great difficulty getting a diagnosis. Having read your article and taken your “quiz” I realise that I have most of the symptoms covered. My problem is to get my doctor (a General Practitioner) to recognise Adrenal Fatigue Syndrome. Do you know of anyone in the UK that I could consult? In the meantime, I will try all your Lifestyle tips, I shall enjoy the chocolate!
you might try searching at http://www.functionalmedicine.org
I hope that you were successful in finding a Functional Medicine Doctor who was willing to treat your AF. I did find one and it has done wonders for me.
Hi Dr. Jill, I am confused about what you suggest for sleeping. Am I understanding correctly that you suggest to go to sleep by 10:00pm and sleep until 9:00am?
Hi Krystle – First this is to avoid a second wind and stay up very late into the wee hours. Second this is whenever possible, get sleep in the morning – average should be 8 hours per night
Hi Dr. Jill,
What is it about eating cheese or nuts before bed, that helps sleep? I tend to find that eating too soon before bed keeps me from sleeping, so this intrigues me!
it may increase serotonin or decrease cortisol
Interesting! Thank you!
Hi Dr. Jill,
I have a functional medicine doctor that has cured my AF. I am on a restricted diet high in vegetables and proteins, low in dairy (I eat cheese) and carbs. I do eat fruit, and it is mostly dried fruit as I find it difficult to keep fresh fruit around my retirement apartment. I am wondering why you discourage dried fruit?
dried fruit is high in sugar, fresh fruit is lower glycemic and more nutrient dense
Hello Dr. Carnahan,
There is so much conflicting information on how to treat thyroid and adrenal issues that seems nobody is correct…every person has different biochemistry, toxic load, vitamin/mineral status and/or deficiency….
The latest people getting all the headlines are Tom Brinmeyer medical researcher, who says eating fruit throughout the day is important, and Dr. Orrechio who recommends eating fruit with honey immediately upon waking, then having honey 1 hr before bed….even the Mayo Clinic and Cleveland Clinic cannot agree on the basics of low-carb paleo….what a mess!
Chocolate is a stimulate, yet you said to avoid stimulants such as caffeine, which of course, chocolate has in loads.
There is so much conflicting data because there is no one size fits all and diet must be individualized to you personally.
There is also the food combining which says NOT to eat fruit with protein or carbs, and not to eat protein with starches….there are a million studies all saying different things.