Cortisol and Adrenal Fatigue

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Weight gain, fatigue, exhaustion, low energy and the inability to sleep…These are just a few of the symptoms that may likely be associated with a hormone imbalance that is related to your adrenals. Even though adrenal fatigue is incredibly common, it is still a condition that is ignored by a majority of Doctors and physicians. However, when it comes to getting relief from these symptoms it is better to focus on the levels of the stress hormone cortisol instead of only on the term, “adrenal fatigue.” Once you have determined what is going on with your cortisol levels, then you can create a treatment plan to help you reduce symptoms and reclaim your energy.



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What is Cortisol?

Cortisol, also known as the stress hormone, is involved in several different functions in the body. Because of this, when cortisol levels are unbalanced it can cause many life-disrupting symptoms, including those associated with adrenal fatigue and the other hormones in your body. This is why it is important to not only understand what your cortisol levels are but to also how you can take action to treat them if necessary.

Problems with cortisol testing in modern medicine

Hormones are very complicated, and unfortunately, many doctors and physicians do not have a great understanding what exactly all of our hormones do, how they work together, how to test them or treat them. This includes thyroid, testosterone, estrogen, progesterone, etc., which can lead to a lot of confusion and frustration for both the patient and the physician. When it comes to cortisol, there are many different ways that you can test cortisol levels that could give varying results, and most physicians do not know which test to use for what, or how to interpret them. Because of this, many patients have started purchasing tests for hormones like cortisol on their own, and have begun to manage their own treatment as well.

Normal Cortisol vs High Cortisol vs Low Cortisol

cortisol levels

Most doctors are pretty familiar with the conditions related to cortisol known as Cushing’s disease and Addison’s disease. Both of these conditions have levels of cortisol that are outside of the reference range that is most often used by most doctors when they do look at cortisol levels. Addison’s disease is a life-threatening condition where you have almost zero cortisol, usually due to autoimmune or other damage, and requires steroid or cortisol replacement. Cushing’s disease is another condition that can be potentially life-threatening, where you have an extremely high amount of cortisol.

Typically, when your doctor is testing your cortisol levels it is to rule out one of these conditions, and anything within the “normal” range is considered to be fine. Unfortunately, this does not always make sense because there are conditions that also exist with cortisol levels that are in between zero cortisol and way too much. Just like with the other hormones in our bodies, cortisol can become unbalanced and small changes can create life-disrupting symptoms. These symptoms are often put into the category of “adrenal fatigue,” which is a broad term for what the difference between “normal” and “optimal” levels of cortisol are.


How do you know if you have Cortisol or Adrenal Issues?

Symptoms associated with Adrenal issues

Unfortunately, many hormone imbalances can share a lot of the same symptoms each other. This means that you can not go off symptoms alone, and should get proper testing before beginning any kind of treatment. That being said, it can still be helpful to assess your symptoms so you have somewhere to start.


Here are some of the common symptoms associated with cortisol dysregulation:
infographic signs and symptoms of adrenal fatigue syndrome
This isn’t a complete list of all the symptoms that can come from adrenal problems, but it includes the ones that most patients experience. Some of these are very specific, so you can probably relate if you have had them before. In most cases, these symptoms will start to get worse over time without treatment.

As you may have guessed, the culprit behind these symptoms is stress. When your body perceives that you are experiencing stress, it releases the stress hormone cortisol. The problem is that this response is often triggered all day and night due to stress in our daily lives.

What the body perceives as a stressor can include any or all of the following:

  • Frustration or other emotions related to your job/work/social life
  • Physical stress, including manual labor, too much exercise, etc.
  • Not enough sleep, especially over a prolonged period of time.
  • Pressure from school
  • Nutritional deficiencies, especially due to poor diet
  • Use of stimulants like coffee, energy drinks, soda, etc.
  • No exercise or sedentary lifestyle
  • Chronic medical conditions including high blood pressure, insulin resistance, etc.
  • Having a recent sickness or illness
  • Anything that causes you frequent frustration or “stress”

From this list, you can see how it’s easy for little things throughout our daily lives to stack up over time. Each time you experience one of these stressors, your body releases cortisol to help cope with the stress. Cortisol does this by releasing sugar stores and increasing adrenaline and epinephrine. This is not really a problem until it is happening frequently each day, which then can lead to things like weight gain, an increase in insulin resistance, and all the symptoms listed above.

Humans are not meant to experience constant levels of stress, so the toll that it takes on the body is measurable. It is not difficult to diagnose the result of this type of stress, however, it is often difficult to receive the proper treatment from conventional doctors. Children can also experience these symptoms, but they tend to respond differently than adults do with things like behavioral changes, poor grades and extreme fatigue. In order to determine if this is what’s going on you can check the reverse T3 levels in children, which are usually elevated when they are under extreme stress.


In order to fix low energy levels, we must first understand what their cause is. Feeling like you have low energy is a symptom resulting from low energy production in your body. Most of the energy that is produced in the body comes from mitochondria, which are special organelles that are inside of your cells. Mitochondria produce ATP, or adenosine triphosphate, which is what your body considers “energy currency”

energy and mitochondria

There are ways that you can both, directly and indirectly, impact ATP production in your body to increase the efficiency of energy production. ATP also influences heat production and your metabolism, which is why many people who have issues with low energy and their adrenals suffer from weight gain as the main symptom.

Vitamin B12 and energy production

It can be helpful to think of your body as a machine that is producing energy as long as you’re alive. But more than simply functioning, it is important to think about the efficiency of this machine. As long as you are alive your body will be producing energy, but you need to think in terms of efficiency. If 100% efficiency is considered “normal,” then with hormone imbalances, including high/low cortisol levels, your machine may actually be functioning at 70%. This means that you have a 30% deficiency in energy production, which leads to even more symptoms. When you treat adrenal fatigue, you are able to increase the efficiency of this machine, ideally back to 100%, so that you are able to restore normal energy levels, metabolism and feel more like yourself again.

Cortisol and metabolism

Below are symptoms that could mean you are experiencing adrenal problems, and that you should have your cortisol levels evaluated:

  • Fatigue throughout the day, especially with a “crash” around 2-3pm
  • Feeling like you’re “wired but tired,” especially at night
  • Getting a “second wind” later in the evening, usually around 9-10pm
  • Weight gain and/or the inability to lose weight
  • Other hormonal issues, especially hypothyroidism
  • Mood changes including anxiety, depression and/or irritability
  • Intense cravings for sugar or carbohydrates
  • Needing to rely on stimulants (like caffeine) throughout the day for energy
  • Feeling more energy after eating a meal high in carbohydrates or sugar
  • Cravings for salty foods

Cortisol Level Testing

There are several ways that you can determine if your cortisol levels are abnormal, however, some are better than others. Serum, or regular blood testing, is the cheapest and easiest way to go, but it may not tell you what you are looking to see, especially if you have cortisol receptor issues. Serum levels of cortisol can be especially helpful as a place to start if they are low normal or high normal, but not if they come back as simply “normal.”

So what is low normal and high normal?

  • Low normal cortisol range: Morning Serum cortisol levels that range from 4.0 to 10.0
  • Normal cortisol range: Morning Serum cortisol levels that range from 11-18
  • High normal cortisol range: Morning Serum cortisol levels that are greater than 20

Below is an example of a low normal patient:
adrenal fatigue cortisol serum test

In this example, the patient has an 8 am serum cortisol level of 6.5 within a range of 4.0-22.0.

These results are in the “normal” range, but they are still sub-optimal considering that cortisol levels should be at their highest for the day at 8 am. When cortisol is low at this time, it is often consistent with fatigue, since that is the highest they will be all day. As mentioned before, serum tests are not always the best, but in this way, they can be a good place to start.

Your Cortisol pattern

Checking your cortisol levels throughout the day allows you to see how your body responds to different situations. This gives you more information in regards to what would be the best treatment. Testing urine several times throughout the day is considered to be the more accurate form of cortisol testing, even more so than saliva.

In the example below, you can see how this is helpful because this patients 8 am serum cortisol levels were in the normal range, however, their levels spike very high at 10 am. This type of pattern is usually seen in people who rely on stimulants for energy in the morning.
cortisol weight loss
Still, not everyone needs to have their urinary cortisol levels tested, and you can also try a trial of treatment if you have symptoms with “normal” cortisol levels, because no test is 100% accurate. Adaptogens and adrenal glandulars give many patients benefits along with the improvement of symptoms.

Treatment based on your test results:

Adrenal related issues can be quite complex to treat, but treatment can be simplified. Whatever treatment you decide on should focus on a combination of what your symptoms are, as well as your lab results. For example, high normal and low cortisol levels can produce similar symptoms, however, they would require different treatment. Things like herbs and supplements that increase your cortisol levels are not helpful if you already have high cortisol levels. Nutrient treatments are a great place to start when treating cortisol issues, but lifestyle changes are ALWAYS required in order to see optimal results.

Low Cortisol Treatment

When you have low cortisol levels, you should focus on supplements and herbs designed to provide the precursors necessary for the production of cortisol in the body. Just like the other hormones, cortisol requires several different nutrients in order to function properly.

Here are several nutrients that can help with better and more efficient cortisol function:

  • Adrenal adaptogens: Adaptogens can help to lower cortisol levels, but they can still be helpful in treatment for already low levels. There are many types of adaptogens, but it is usually a blend of multiple adaptogens that tends to work best. Adaptogens can be combined with adrenal glandulars for even more benefit, nd should be used for at least 3+ months.
  • Adrenal glandulars: Glandulars are best for patients who have very low cortisol levels, and they usually provide an immediate boost in energy levels. Combining glandulars with other supplements is very effective for low cortisol levels, and they should be used for at least 6+ months.
  • DHEA: DHEA is the precursor to testosterone and other estrogen metabolites. When you have low cortisol and low adrenal hormone production, it is beneficial to supplement with hormone precursors. You should be careful with DHEA, because in high doses it can turn into androgens or estrogens. You should start with a low dose of DHEA every 2-3 days, increasing to daily as tolerated.
  • Pregnenolone: Pregnenolone is a hormone precursor that is helpful when it is used along with DHEA. Acne an be one of the side effects, and just like with DHEA, you should start with a low dose and increase slowly.
  • Alpha Lipoic acid: Alpha Lipoic acid (ALA) increases mitochondrial energy production, while also acting as a powerful antioxidant and an anti-inflammatory agent. ALA also has effects on insulin which can help with weight loss.
  • CoQ10: This co enzyme can help increase energy levels due to its role in proper mitochondrial energy production. Mitochondrial boosters can be particularly effective for adrenal related issues where energy levels are often low. It should be used for several months.
  • Vitamin B6: Vitamin B6 is a nutrient that many patients are deficient in that is used in several pathways in the creation of adrenal hormones. It may be necessary in the first stages of treatment to take higher doses of B6 for short periods of time.

It may be necessary to take at least 3 or more of the nutrients listed above for a minimum of 6 months in order to see results and an increase in cortisol levels, but many patients experience improvements in symptoms in as little as 4 weeks.

High Cortisol Treatment

  • Ashwagandha: Ashwagandha is an adaptogen that helps to lower cortisol levels. It also can boost libido and help with weight loss.
  • Phosphatidylserine: When taken in doses up to 600mg daily, phosphatidylserine has been shown to reduce cortisol levels. You should take 400-600mg at night for 2-3 months, and then recheck your cortisol.
  • Melatonin: Melatonin helps to reduce cortisol levels, and also improves your sleep at night. Even if you are not having any trouble sleeping Melatonin can help reduce cortisol levels, so you should still consider it for part of your treatment. 3mg is a good dosage to start at, and is usually tolerated unless you are very sensitive.

There are less supplements that lower cortisol, so it’s helpful to use several and then combine them with lifestyle changes.

Lifestyle Changes

The backbone of treating adrenal problems is healthy lifestyle changes. There are many areas that can be improved upon, and most people have problems in at least 2 of them. You should begin by focus on the areas that you are weak in first.

Diet: When you have adrenal related problems, it’s important to make sure you are eating a real, whole food diet with adequate amounts of healthy carbohydrates, like fruits and vegetables.

Sleep: 8 hours of quality sleep is necessary each night to avoid persistent fatigue and other symptoms including weight gain.

Stress: You should actively take steps to try to reduce sources of stress, as well as its impact on your life. If you can, you should aim to completely eliminate all stress, but this is not always possible. If you know that you are going to be under stress, you can take steps to reduce the impact that stress plays on your body through things like meditation, yoga, mindfulness or religion.

Exercise: Even though it can be difficult to exercise when you have the extreme fatigue that accompanies adrenal problems, it is still very important to try. You can start by simply trying to remain active throughout the day by doing things like taking regular breaks at work, walking for 1 hour daily and making time to do fun outdoor activities. If you have enough energy to do more exercise, you still should not overdo it and try to stick with 10-30 min sessions at a medium intensity level.


It is critical that you understand your cortisol levels if you’re suffering from adrenal related symptoms. Once you know the difference between “normal” and “optimal” cortisol levels, you then can determine how you should treat yours. You can start by testing your 8am serum cortisol levels, and if needed then do a diurnal (4x/day) test of urine or saliva. The best treatment for long-term success and a reduction in your symptoms is a combination of supplements and lifestyle changes. Remember that it takes time to treat your adrenals, and that it could take over 6 months of dedicated treatment to see a significant improvement.

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