Chris Kresser addresses the question of “Is Adrenal Fatigue Real” in his fascinating interview with Dr. Christianson on the The Adrenal Reset Summit which runs from November 7-12. He shares that it’s virtually impossible to recover from any chronic illness without addressing the HPA axis and that he prefers the term HPA axis dysregulation to the term adrenal fatigue because it’s more accurate:
The endocrine society has a factsheet and downloadable PDF about adrenal fatigue and in that factsheet they say adrenal fatigue is not a real medical condition and they go on to say there are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands. Patients are out there searching for this information. They’re checking this stuff out and you’ve got a pretty well-known organization that is focused on hormone health saying that adrenal fatigue is not a real condition. Then you go and you search for hypothalamic-pituitary-adrenal axis in PubMed and just as you said, Alan, you get 18,320 results…
Here are some other snippets from his interview, where Chris covers root causes of low cortisol:
even when we do see true low cortisol where both total and free cortisol are low then the question becomes, in that situation, is it really an autoimmune issue like Addison’s where the adrenal glands are compromised and can’t produce cortisol or is it some other kind of regulatory mechanism in the body and it’s leading to this low cortisol output.
And then, more importantly, is that a maladaptive response, meaning something, perhaps, that happened a while ago – and that can even go all the way back to fetal development, when the patient was in the womb because we know that the HPA axis is programmed in the womb and, also, early life stressors can play a big role in programming the HPA axis – or is it something that’s another pathology like SIBO or a gut infection, or a chronic infection of some kind like Lyme disease or exposure to mold or heavy metals, or biotoxins that is affecting the body in such a way that it’s downregulating cortisol production as a result. In that case, the treatment is not to give cortisol or to give things that boost cortisol, it’s to address those things that are causing the body to downregulate cortisol production in the first place.
I really love Dr. Christianson’s advice for his patients, encouraging them to take better care of themselves, to sleep more, to do less and to stress-less:
imagine a scenario in which, heaven forbid, a loved one needs your care. They need your help in the hospital. They need you there for a few hours per day. So, let’s think about all the things you do that you would just drop from your schedule to be there for them because, of course, you’d be there for them. So, they’ll write some things out and I’ll say, okay, cool! So, now, that loved one is ‘you’.
I think it’s a message we could all apply in our busy lives!
Anxiety, feelings of constant overwhelm and fatigue, plus insomnia, sugar cravings, the inability to control blood sugar, lack of mental clarity… these symptoms can be due to adrenal issues and this condition is brutally disruptive. And yes, you can suffer from all of the above at once!
Here are a few of the many other excellent speakers and their topics:
- Steph Gadreau, CHNP – Perfectionism and Adrenals
- Aviva Romm, MD – Adrenal Adaptogens
- Ben Lynch, ND – Adrenals and Methylation
- Wendy Myers, FDN, CHHC – Heavy Metal Toxicity
- Dan Kalish, DC – Adrenal Neurotransmitter Connection
- JJ Virgin, CNS, CHFS – Preventing Adrenal Burnout
- Julia Ross, MA – Neurotransmitters and the Food Mood Connection
Hi Trudy. I loved your talk on the Adrenal Summit.
Can you tell me please, is it absolutely necessary to have your cortisol tested? I understand from Dr. Breus’ talk or Julia Ross’ I believe it was that it can be even low during the day and high at night. To be honest, I really can’t afford to spend any more money. I have been doing gluten, sugar, dairy, soy free, etc., as well as taking DPA, 5-HTP, Tyrosine, magnesium, Gaba Calm, and other supps. I also started with the Liposomal CBD. I am still not sleeping well, and my anxiety is high. If it is absolutely necessary, can you tell me please where you recommend getting the testing done through and if you know anyone really reasonable for what I think would be the saliva test?
Thank you.
Thanks Wendy – so glad you enjoyed it. Together with blood work, the adrenal saliva test is the most useful testing I do with clients and yes it can be low or high at various times of the day. It is especially important if you aren’t getting answers by trialing various nutrients. It’s also key to help know if you need something to lower high cortisol and to actually know if it is high so you can address why. Also with high cortisol I use tryptophan and not 5-HTP with clients. I test salivary cortisol thru Vitamin Diagnostechs (the Adrenal Stress Index) but there are many labs offering similar testing. Many are practitioner only, others are direct to consumer. I know there is much talk about the Dutch test being more effective but it’s more expensive and a $120 4 x saliva collection to measure has served my clients well for years.
I would also take a look at how the GABA is being used (sublingually and a GABA-only product), switch to Lidtke tryptophan (and increase until optimal amounts have been reached i.e no additional benefits are seen when more is taken) and consider stopping tyrosine which is stimulating. I also use melatonin, both sublingual and timed-release.
Thank you Trudy.
I was taking the Lidtke tryptophan but wasn’t seeing any results so switched to Lidtke 5-HTP. I was just using the tryptophan in afternoon and at bedtime. Should I go back to the tryptophan instead? I will stop taking the tyrosine. I was using sublingual Gaba but switched to Gaba Calm which has a few other ingredients as you know. I use it sublingually and let it dissolve under my tongue. I use melatonin 3mg time release. Anything I need to change? I also use DPA in the morning and no later than 3pm.
Trudy, One more thing please. If I could come up with the money to get the cortisol saliva test, do the results vary based upon how much stress you had the day before you took it or the day of, or what you ate, etc., or is it a pretty good indicator of what your levels may be day to day? Also, there are not any doctors I can go to here near where I live. If I get results, what do I do then? I am so disappointed that even with all the supplements I started taking I am still so anxious and depressed and still crave sweets so much, as well as not getting a good sleep. Thanks again.
Wendy
It’s best to do it on a typical day as added stress would affect results. I would work with a practitioner. My online virtual consulting will be opening up again in the very near future too (I’m training my new team as we speak) so that is always an option if you’re willing to work long distance.
Hello Trudy,
I had a saliva cortisol test done in July by Pharmasan Labs that showed my cortisol was very high from 4:30 am until 11:30 at night. I was taking Phosphatidylserine 6oomg and Cortisol Manager for 3 months. During that time I went to see an endocrinologist to rule out tumor and Cushing’s Syndrome. Both were ruled out by two, 24 hr urine collections for cortisol. The first 24hr showed an elevated cortisol, and the second a month later showed a high “normal” cortisol. My symptoms have not improved. I’m Still having terrible anxiety and insomnia. I am now taking Enerphos (not sure what dose to take). How high can I go with that? What are your thoughts about the 24hr urine test and do you think it is necessary to do the salivary cortisol again?
I have experimented a lot with the amino acids (GABA, Tryptophan, Theanine) with no real results. What do you think about using Taurine?
My hormone levels show an elevated FSH and low prolactin.
Also have you ever treated anxiety/insomnia with lithium orotate or ever heard of using Dilantin (Whitaker Wellness) for anxiety?
I am truly desperate and so sleep deprived (yet never tired) that I now have a prescription for Klonopin and Trazodone which is what I have been trying to avoid all along. I have been using Melatonin since July.
Any insight you may have is greatly appreciated.
Margaret
Sorry to hear this. I can’t give specific advice here but I would pick Trazadone over Klonopin (and other benzodiazepines). I have not had good results with Enerphos but just blogged about Relora which seems very promising https://www.everywomanover29.com/blog/magnolia-officinalis-phellodendron-amurense-relora-cortisol-stress-anxiety/
With ongoing high cortisol you have to find out why and address that – gluten? parasites? infection? and even external exposure from cosmetics?
Lithium orotate and lactium/De-stress are very helpful for many of my clients. I have not used Dilantin and wouldn’t recommend it.
Trudy, the best thing you could do for all of us suffering with high cortisol, jitters, interrupted or no sleep, feeling like we’re ready for a 10K marathon run anytime day or night …. is to provide a list of specialists by zip code so that we can find someone who can interpret lab tests and work individually with us as a whole person and not a body part. The functionalmedicine.org website is so sparse that the closest one to me is 40 miles away. None listed in Washington, DC?? Speakers, like yourself, who have come forward and show interest are busy and mostly on the west coast. We truly need a partner in the journey to get to the root cause of the issue and to treat it in a holistic/whole body way instead of taking drugs. We would be in your debt if you could do this for us.
I’ve had luck finding functional Med/holistic by asking regular internist if they know of anyone. Also there are good chiropractors out there, they will list nutrition as one of their specialties. I also was used to Pure Encaps supplements and emailed them for a List of doctors that carried their product. I did the same thing for ApexEnergetics products. Also health food store may have a list of docs.
Anu
I agree that you truly need a partner in this journey. Your suggestion is wonderful but I don’t feel comfortable recommending someone whose work I don’t know. There are so many amazing practitioners but I’ve had unpleasant surprises in the past. I am in the process of gathering people I know and once my Anxiety Nutrition Institute launches I’ll also have 100s of people trained by me in my methods that I can wholeheartedly recommend. My online virtual consulting will be opening up again in the very near future too (I’m training my new team as we speak) so that is always an option if you’re willing to work long distance.
Thank you Trudy:
We don’t have any practitioners within 150 miles of here, so I will check into your online virtual counseling when it’s up and running. Thank you.
Trudy, thank you for the response. I would be interested in your online virtual consulting when it comes on line.
I have read your wonderful book The Anxiety Food Solution. I am working with a practitioner whom I like a lot, but I am always interested in what others are sharing. I am a survivor of early childhood leukemia, cancer of the thyroid, and most recently, breast cancer. I have had anxiety and panic issues for as long as I can remember, and my doctor’s have had me on SSRI’S for years. I have tried tapering off these meds several times in hopes of swiching to more natural seratonin support with disastrous results. My practioner has been able to help me with thyroid and other hormone imbalance using saliva testing and bioidentical hormones, but the anxiety has been difficult to treat. Using my 23andMe data, she has helped me discover that I have many SNP mutations that may predispose me to anxiety issues (MTHFR, GAD, MAOA). I also have Stage 2 adrenal insufficiency, so my cortisol and DHEA are very low. I have constant hunger and trouble sleeping. I am taking Dr. Ben Lynch’s Optimal Adrenal and the GABA-T SAP that you recommend, but still have trouble waking in the night. Any thoughts you have time to share would be greatly appreciated.
Hello Trudy I recently took a cortisol saliva test and it showed really low in the morning, and low the rest of the day and night. What adaptogen might you recommend for this?
Thank you for your time!!!
Jesse
I can’t give you specifics but I have my clients use a good B complex, vitamin C, extra B5 and something like rhodiola. I suggest working with the practitioner who ordered the test and have them help you figure out the root cause of the low cortisol.