Adrenal fatigue syndrome is a collection of signs and symptoms, that results when the adrenal glands function below the optimal level. As the name suggests, its paramount symptom is fatigue that is not relieved by sleep but it is not a readily identifiable entity like acne or a wart. You may look and act relatively normal with adrenal fatigue and may not have any obvious signs of physical illness, yet you live with a general sense of not feeling well, tiredness, lethargy or "gray" feelings. People experiencing adrenal fatigue often have to use coffee, colas, sugars of various forms and other stimulants to get going in the morning and to push themselves through the day.

Adrenal insufficiency is a condition in which the adrenal glands, located above the kidneys, do not produce adequate amounts of steroid hormones (chemicals produced by the body that regulate organ function), primarily cortisol, but may also include impaired aldosterone production (a mineralocorticoid) which regulates sodium, potassium and water retention. Craving for salt or salty foods due to the urinary losses of sodium is common.

Adrenal insufficiency can also occur when the hypothalamus or the pituitary gland, both located at the base of the skull, does not make adequate amounts of the hormones that assist in regulating adrenal function. This is called secondary adrenal insufficiency and is caused by lack of production of ACTH in the pituitary or lack of CRH in the hypothalamus. 

Addison's disease and congenital adrenal hyperplasia can manifest as adrenal insufficiency. If not treated, adrenal insufficiency may result in severe abdominal pains, vomiting, profound muscle weakness and fatigue, depression, extremely low blood pressure (hypotension), weight loss, kidney failure, changes in mood and personality, and shock (adrenal crisis).  An adrenal crisis often occurs if the body is subjected to stress, such as an accident, injury, surgery, or severe infection; death may quickly follow.
See also “Chronic Fatigue Syndrome”, “Depression”, and “Hypothyroidism”.

Causes

Addison's disease is rare, affecting about 1-4:100,000. It affects men and women equally. The glands must be at least 90% destroyed before symptoms are evident. In approximately 70% of cases it is due to an autoimmune adrenalitis. Other causes include sarcoidosis, fulminating infection (meningococcal septicemia), tuberculosis, neoplasm, or iatrogenic influences. Usually the disease becomes clinically evident when the patient undergoes metabolic stress or trauma.

• Primary adrenal insufficiency is due to impairment of the adrenal glands. 
• One subtype is called idiopathic or unknown cause of adrenal insufficiency.
• 80% are due to an autoimmune disease called Addison's disease or autoimmune adrenalitis.
• Other cases are due to congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland.
• Secondary adrenal insufficiency is caused by impairment of the pituitary gland or hypothalamus.[8] The most common cause in the United States is exogenous steroid use. Other causes are a pituitary adenoma or microadenoma, hypothalamic tumor (surgical removal of a pituitary tumor can also suppress production of ACTH and lead to adrenal deficiency); Sheehan's syndrome, which is associated with impairment of only the pituitary gland.
• Tertiary adrenal insufficiency is due to hypothalamic disease and decrease in corticotropin releasing factor (CRF).

•"Roots of Many Fatigue Syndrome Cases May Lie in Adolescence", Family Practice News, April 1-15, 1991;21(7):4

•"Adrenal Suppression Often Overlooked in Topical Steroid Tx," Kubetin SK, Family Practice News, January 1, 2004:69

Diet and Nutrition

Vitamin B5 Deficiency

•"Lupus Erythematosus: Treatment by Combined Use of Massive Amounts of Pantothenic Acid and Vitamin E," Welsh AL, Arch Dermatol Syphilol, 1954;70:181-198



Vitamin C Deficiency

•"Sodium Ascorbate in the Treatment of Allergic Disturbances: The Role of the Adrenal Cortical Hormone-Sodium-Vitamin C," Ruskin SL, Am J Dig Dis, September 1947;302-306

•"The Regulation of Steroid Hormone Metabolism Requires L- Ascorbic Acid", Moser, Goralczyk R., et al, Beyond Deficiency: New 

•“Vitamin C Increases Stress Tolerance," Ungar E, Medical Tribune, September 23, 1999;40(16):4



Vitamin E Deficiency

•"Vitamin E: Metabolism and Role in Atherosclerosis," Paul, J. -L., et al, Omega-3 Lipoproteins and Atherosclerosis, 1996;Chapter 16:137-149



Magnesium Deficiency

•"Benefits of Magnesium Use in the Emergency Department: An Underestimated Therapy Wins Recognition", Dansky, David, M.D., Journal of the American Academy of Physician Assistants, January 1993;6(1):9-5

•"On the Significance of Magnesium in Extreme Physical Stress," Golf SW, et al, Cardiovasc Drugs Ther, 1998;12:197-202

•"Adverse Stress Reactions and Magnesium Deficiency: Preventive and Therapeutic Implications", Seelig, M.S., Journal of The American College of Nutrition, October 1992;11(5);609/Abstract 40

•"Epidemiologic Studies on the Frequency of Hypomagnesemia and Hypocalcemia in Children With Functional Disorders and Neurasthenia", Schimatschek, H.F. and Classen, H.G., Magnesium-Bulletin, 1993;15(3):85-104



Zinc Deficiency

•"Zinc Acutely and Temporarily Inhibits Adrenal Cortisol Secretion in Humans", Brandao-Neto, J., et al, Biological Trace Element Research, 1990;24:83-89



Coffee Excess

•"The Effect of Coffee on the Function of the Sympathoadrenomedullary System in Man," Levi L, Acta Med Scand, 1967;181(4):431-438

Sugar Excess

•"Hypoglycemia and Personality", Budd, M.L., Complimentary Therapies in Medicine, 1994;2:142-146.

Associated Conditions

Thyroid Dysfunction

•"Evaluation of Thyroid Function on Patients With Isolated Adrenocorticotropin Deficiency", Shigemasa, Chiaki, M.D., et al, The American Journal of Medical Sciences, November 1992;304(5):279-284

Weight Gain

•"Pantothenic Acid as a Weight-Reduction Agent: Fasting Without Hunger, Weakness and Ketosis," Leung, L., Medical Hypothesis, 1995;44(5):403-405

Chronic Fatigue Syndrome

•"Chronic Fatigue Syndrome: A Stress Disorder?" Cleare, Anthony, J. and Wessely, Simon, C., British Journal of Hospital Medicine, 1996;55(9):571-574

•"Evidence For Impaired Activation of the Hypothalamic Pituitary-Adrenal Axis in Patients With Chronic Fatigue Syndrome", Demitrack, M.A., et al, Journal of Clinical Endocrinology and Metabolism, 1991;73:1224-1234

Immune Weakness

•"Vitamin C and the Common Cold: A Double-Blind Trial," Anderson TW, Reid DBW, Beaton GH, CMAJ, September 23, 1972;107:503-506

Blood Sugar Imbalance

•"Hypoglycemia and Personality", Budd, M.L., Complimentary Therapies in Medicine, 1994;2:142-146

Comment:  Chromium helps with hypoglycemia by normalizing blood sugar, sensitizing cells for insulin and reduces sugar cravings.



Depression

•"Adrenal Gland Volume in Major Depression: Relationship to Basal and Stimulated Pituitary-Adrenal Cortical Axis Function," Rubin, Robert T., et al, Biological Psychiatry, 1996;40:89-97

•"Plasma Cobalt and Manganese in Depression", Narang, R.L., et al, Trace Elements in Medicine, 1992;9(1):43-44

Plant Foods High in Vitamin B12

DHEA Deficiency

•"Oral Dehydroepiandrosterone (DHEA) Replacement Therapy in Women With Addison's Disease," Gebre-Medhin G, Husebye ES, et al, Cain Endocrinol, 2000;52:775-780

•"Dehydroepiandrosterone Replacement for Patients With Adrenal Insufficiency," Achermann JC, Silverman BL, Lancet, May 5, 2001;357:1381-1382

Herbs

•"Chronic Fatigue Syndrome and Licorice", Baschetti, Riccardo, New Zealand Medical Journal, April 26, 1995;157

•"Licorice Ingestion and Blood Pressure Regulating Hormones", Schambelan, Morris, Steroids, February 1994;59:127-130

•"The Influence of Glycyrrhetinic Acid on Plasma Cortisol and Cortisone in Healthy Young Volunteers," MacKenzie MA, Hoefnagels WH, et al, J Clin Endocrinol Metab, June, 1990;70(6):1637-1643

•"Curcumin reverses the effects of chronic stress on behavior, the HPA axis, BDNF expression and phosphorylation of CREB," Xu Y, Ku B, et al, Brain Res, 2006; 1122(1): 56-64. (Address: Department of Pharmacology, School of Basic Medical Science, Peking University, 38 Xueyuan Road, Beijing, 100083, PR China).

•“Grapefruit juice and licorice increase cortisol availability in patients with Addison's disease.” Methlie P, Husebye EE, Hustad S, Lien EA, Løvås K. Eur J Endocrinol. 2011 Nov;165(5):761-9

•"Panax Ginseng," Kiefer D, Pantuso T, Am Fam Physician, October 15, 2003;68(8):1539-1542

•"A randomized, double-blind and placebo-controlled study of a Ganoderma lucidum polysaccharide extract in neurasthenia," Tang W, Gao Y, et al, J Med Food, 2005 Spring; 8(1): 53-58

Other Herbs

• Borago officinalis (Borage)
• Eleutherococcus senticosus (Siberian ginseng)
• Glycyrrhiza glabra (Licorice): for adrenals with Taraxacum officinale leaves (Dandelion leaves) 
• Centella asiatica (Gotu kola): strengthens adrenal glands

•"Physical Stress-Induced Secretion of Adrenal and Pituitary Hormones in Patients With Atopic Eczema Compared With Normal Controls," Rupprecht, M., et al, Experimental and Clinical Endocrinology & Diabetes, 1997;105:39-45

•"The Link Between Stress and Illness: Do Our Coping Methods Influence Our Health?", Sutherland, John E., M.D., Postgraduate Medicine, January 1991;89(1):159-164

Summary and Suggestions

Dietary Suggestions

• Eat 4 regular meals a day (3 meals and a snack) including a complex carbohydrate and/or protein at each meal 
• Emphasize complex carbs include roots vegetables (potatoes, sweet potatoes, squash, melons), whole grains (brown rice, basmati rice, millet, quinoa)
• Emphasize lean or vegetarian proteins including avocado, sprouted beans and peas, or add organic chicken to diet
• More organic sodium (eg. Himalayan salt), 
• More raw than cooked
• If you are cooking add curry spice into soups and stews
• Avoid concentrated starches, sugars, fructose, honey, maple syrup, molasses, artificial sweeteners, 
• Avoid stimulants like coffee, black tea, and other caffeinated beverages

• Plant foods high in Vitamin B5 including shiitake mushrooms, crimini mushrooms, avocado, corn, sweet potato
• Plant foods high in Vitamin C including red bell peppers, kale, green kiwifruit, green bell peppers, broccoli, Brussel sprouts, papaya and strawberries
• Plant foods rich in Vitamin E including sunflower seeds, turnip greens, spinach
• Plant foods high in Chromium including corn, sweet potato, Romaine lettuce, broccoli and onions
• Plant foods high in Magnesium including pumpkin seeds, cocoa powder (unsweetened), sesame seeds, sunflower seeds, Swiss chard, spinach
• Plant foods rich in Sodium including celery, beets, spinach, swiss chard, pomegranates, strawberries, tomatoes
• Plant foods rich in Zinc including pumpkin seeds, sesame seeds, and oats

• 1 cup filtered water                                                               
• 1 heaping tbsp Purefood A-Z (10 g)                                                 
• 1 scoop Purefood B (1.5 g)                                                         
• 1 scoop Acerola C (2.5 g)                                                          
• 1 scoop Annatto E (0.6 g)                                                          
• 2 tsp organic raw sesame seeds (11.2 g)                                            
• 1 medium organic apple (125 g)                                                     
• 1 heaping tsp raw cacao (5.8 g)

• 1 small organic beet (82g)
• 1 cup organic turnip greens (55g)
• 2 leaves organic romaine lettuce (65g), 
• 1/2 cup organic strawberries (72g)

Substitute

• Spinach/ swiss chard for turnip greens
• Carrot for beet
• Papaya  or red pepper for strawberries

• 2 medium leaves romaine lettuce (65g),  
• 1/2 medium red pepper (240g), 
• 1/2 avocado (110g), 
• 1/2c spinach 15g 
• 1/4c  sunflower seeds, (35g)
• 1/4c pumpkin seeds  (52g)

Substitute

• Green Pepper or Strawberries, Apple for red pepper
• Swiss Chard for Spinach
• Almonds for Sunflower Seeds
• Sesame Seeds for Pumpkin seeds

Substitutions

• Hemp or Walnut Oil for flax oil
• Apple Cider Vinegar for lemon juice

• 1 small head broccoli (250g)
• 1/2 shiitake mushrooms (45g)
• 2 stalks celery (170g)
• 1 small red pepper (240g)
• 1 small sweet potato (136g)
• 1 tbsp coconut oil (13.5g)
• Chicken/ 1/2 c sprouted mung beans (52g)
• 1 tbsp gf tamari
• 1 tbsp lemon
• 1tbsp sesame oil
• 1 clove garlic (3g)
• Brown Rice 1 c (195g)

• Licorice and Panax ginseng tea.  Place 1 flat tsp of each of the herbal roots (sliced) and place in a pan along with 4 cups of water. Boil for 5 minutes, then simmer at low heat for 15 minutes.  Then turn the heat off and let steep for another 15 minutes.  Drink 2 to 3 cups per day.

• Maintain regular sleep/wake cycles; this will coincide with a healthy glandular rhythm (your internal clock)
• Get adequate sleep every night; lack of sleep with lower your stress tolerance and induce stress hormones
• Exercise only during the day;  exercise in the evening can disrupt your sleep cycle and cause insomnia
• Praying, meditating, reading and taking a bath in the evening helps to slow down your mind and body before bed
• Watching TV, emailing, playing video games, and socializing are not considered relaxation and may disturb sleep
• Staying positive, being grateful and compassionate, and enjoying a good laugh each day also helps

Naturopathic Medicine

• Saliva or blood collected at several times in the day to determine cortisol levels
• Rule out autoimmune disease by testing for Anti-nuclear antibody
• Rule out allergies by doing RAST test for food allergens
• Follow elimination diet and avoid all allergenic foods if necessary
• Herbs including Licorice, Ginseng and Reishi mushroom
• DHEA for Addison’s Disease or Adrenal insufficiency

•www.whfoods.org 
•www.nutritiondata.self.com 
•www.ndb.nal.usda.gov/ndb/foods/list  
•www.wikipedia.com 
•www.vitasearch.com  

This article is for educational purposes only. This information has not been evaluated by Health Canada nor the Food and Drug Administration.  This information is not intended to diagnose, treat, cure, or prevent any disease.