Feeling Tired? Stressed? Adrenal imbalance may be the cause – Part1

April 28, 2016 Dr. Martin Gleixner, MSc, ND

Feeling Tired? Stressed? Adrenal imbalance may be the cause - Part1

By Dr. Martin Gleixner, MSc, ND


You may have asked yourself one of the following questions…

  • How does stress affect my health?
  • Are my adrenal hormones out of balance and if so, how are they affecting my health?
  • Feeling tired but unable to find out why? Need a nap after lunch? Exhausted during the day but feeling ‘wired’ in the evening before bed?
  • You may be finding it difficult to lose weight despite exercising and calorie counting?
  • Wishing you could exercise, but not finding the energy to do so? Or noticing that exercising is no longer provides a boost, but rather depletes your reserves
  • Frequently catching common colds and other infections or unable to heal quickly after an injury?
  • Diagnosed with IBS or experience on-going digestive system symptoms and not realizing how stress hormones are affecting you?
  • Experiencing hotflashes or other menopausal symptoms?
  • Wondering if a medical explanation still exists to explain your symptoms even when your medical doctor (MD) says “laboratory blood tests are all within normal range”?
  • Perhaps you are experiencing a ‘burn-out’ and have been recommended an antidepressant medication by your MD?
  • Feeling irritable? Dealing with insomnia? Having trouble concentrating?

If you’ve answered yes to any of these questions, adrenal dysfunction can be the cause.

The term "adrenal fatigue" is often used to describe a functional change in adrenal health. However, this is somewhat misleading as in most cases, the adrenal glands are not fatigued.  It is not that the body is incapable of producing adrenal hormones such as cortisol, but rather the body is intentionally producing less cortisol in an attempt to heal. This act of self-preservation is best defined by changes in the hypothalamic-pituitary-adrenal axis (HPA axis) such that the brain downregulates its stimulation of the adrenals in order to protect energy levels and overall health. Therefore, a more appropriate term to characterize this health problem is "adrenal dysfunction".

In more rare cases, the adrenals are truly fatigued and unable to make cortisol. This occurs in Addison's disease, a serious autoimmune disease. Because the immune system attacks the adrenal glands, the problem is within the gland itself (thereby causing adrenal insufficiency) and not a problem with stimulation of the gland from higher up in the axis (i.e. the brain). Addison's disease is diagnosed via blood tests as conducted by MDs/endocrinologist. Cushing disease (in which case the adrenals produce too much cortisol) is also diagnosed and recognized by conventional health care.

The diagnosis of other adrenal imbalances, however, is typically not performed in a standard conventional medical visit. In fact, adrenal dysfunction may be a condition that many physicians simply don’t know about, or commonly write off as an unimportant condition. For these reasons, a diagnosis may be missed that would otherwise explain your symptoms.

Throughout our lives, the adrenal glands are responsible for the production of cortisol, aldosterone, adrenaline, among other hormones. The adrenals allow humans to respond to changing life situations and daily demands by regulating sugar levels and heart rate, adjusting our metabolism, moving blood to where it’s needed in the body, controlling electrolytes concentrations and regulating blood volume, etc… In doing so, they affect our energy levels, our sleep/wake cycle (circadian rhythm), our blood pressure, and our ability to do things we need to do day-to-day (i.e. work, exercise, sleep, take care of the kids, etc…).

The adrenals are able to secrete androgen hormones such as DHEA (known as the anti-aging hormone) and androstenedione. For females, once secreted in the blood stream, such androgens become precursors (i.e. a template) to other female hormones if there is a demand by the body. As discussed in a previous column entitled “Understand the link between adrenal health, menopause”, the adrenal’s role in maintaining baseline levels of female sex hormones can be important during menopause to ward off hotflashes, and other related symptoms.

The human body was made to adapt to the demands of daily living. However, as we continually increase the demands we place on ourselves, our adrenal glands are constantly stimulated to produce hormones as our bodies’ way of coping. As the stressors continue however, eventually HPA axis dysregulation occurs leading to adrenal dysfunction.

To address adrenal dysfunction, I recommend a 3-step approach:

Step 1 – Obtain a diagnosis even when you are told “labs are all normal”

When an irritation in the body (e.g. uncontrolled inflammation) occurs for long enough it starts to injure cells. In turn, tissues (groupings of unique cell types found in organs or body parts) can become damaged or severely changed. At this stage, a pathological disease state occurs in the body that can be diagnosed using conventional laboratory blood tests and imaging studies (e.g. x-rays or ultrasounds). Such tests help to diagnose and monitor progress for conditions such as diabetes, hypothyroidism, hepatitis, colitis, cancerous tumors (cancer), etc...

In the case of the adrenal gland, a disease can occur such as Cushing’s syndrome or Addison disease. Such serious adrenal diseases reflect extreme highs or lows of cortisol, respectively for each of those conditions, and are best diagnosed via blood serum levels as conducted by your MD. Such pathological conditions are quite rare however, compared to the problems related to adrenal function.

Adrenal dysfunction may still be present even though such laboratory values may be within the ‘normal’ range.  To assess for functional (versus pathological changes) in our adrenal glands, cortisol levels are more appropriately checked via our saliva.

Hormone saliva testing conducted by Naturopathic Doctors (NDs) at the Moncton Naturopathic Medical Clinic is a useful tool for diagnosing abnormal cortisol patterns that may be missed by conventional blood tests. Imbalanced cortisol levels can contribute to a host of different symptoms. Under normal health conditions, cortisol is highest in the morning giving the pick-up and go that is needed and should be lowest in the evening when it is time to relax before bed. When its 24-hour rhythm is offset, symptoms include feeling tired (among many other symptoms already mentioned at the start of the column).

To accurately assess adrenal function, it is necessary to measure cortisol levels at appropriate times throughout the day: depending on a patient’s symptoms, saliva cortisol measurements can be made at 4 different points during the day: on waking, before lunch, before supper, and before bed.

At the Moncton Naturopathic Medical Clinic, we provide sufficient time during our patient visits to perform a complete overview, including: 1) a review of standard laboratory blood test results (especially to rule out other conditions that could also explain certain symptoms possibly related to the adrenals); 2) cortisol and other hormone saliva tests if required; 3) complaint-oriented physical examinations; and 4) a complete review of all symptoms (not just a patient’s chief concern, but of all systems and organs in the body).  I personally believe that it is only when we look at the whole that we can gain a complete perspective of one’s state of health – including the status of one’s adrenal health.

Please make sure to avoid self-diagnosing adrenal dysfunction on symptoms alone. Too often patients tell me that they have tried the latest health supplement aimed for supporting the adrenals (or other health concerns) and have been disappointment with the results. Be sure to discuss your health concerns with your MD or ND prior to rushing to start treatments – proper diagnosis is crucial for treatment success.



Step 2 – Find out the cause of your adrenal imbalance(s)

Once your ND confirms the diagnosis of adrenal dysfunction, the next step is to figure out why your body became out of balance in the first place. Determining and addressing the cause of one’s health condition should always take first priority.

If adrenal imbalances are observed, it is crucial to determine which of the following causes are most involved in each individual person:

  1. Inadequate sleep and rest.
  2. Higher than usual life demands: excess work hours, extra commitments raising children, caring for a sick loved one, relationship difficulties, etc…
  3. Blood sugar imbalances and related poor eating habits such irregular eating, missing meals (especially breakfast), and not eating three balanced meals per day. Skipping snacks is particularly harmful for the adrenal glands (snacking on fruits in between meals is extremely important to recuperate the adrenals).
  4. Excess exercising and for some, sedentary lifestyles.
  5. Perceived or subconscious emotional stresses: such as worry, anxiety, loneliness, depression and a feeling that life is out of control.
  6. Emotional traumas.
  7. Modern life stresses such as information overload, technology over-usage, deadlines, job insecurities, multiple task complexities, incessant noise.
  8. Chronic inflammation, infections and/or tissue damage.
  9. Chronic illnesses.
  10. Obesity or non-optimal weight.
  11. On-going immune reactivity resulting from autoimmune diseases or from daily exposures to environmental allergies or IgG food sensitivities.
  12. Nutrient deficiencies as caused by chronic digestive tract issues such as malabsorption or inadequate elimination.
  13. Excess intake of inflammatory foods such as sugar, refined carbohydrates, saturated fats, caffeine, alcohol, etc…
  14. Chronic exposure to toxins.
  15. Liver dysfunction (the liver metabolism many hormones).
  16. Polypharmacy or inappropriate use of prescription medications.

Some of these topics have been discussed in previous articles. Although it is beyond the scope of today’s article, stay tuned for my next column that will describe the causes of adrenal dysfunction in much greater depth.



Step 3 – Consider a unique treatment approach

A multifaceted approach should be used to treat adrenal gland imbalances. It should aim to: a) determine and address underlying causes (examples are described in Step 2); b) support other organs that that are interconnected to the adrenal problem (e.g. liver, thyroid, etc…); and c) support the adrenal gland itself by using nutraceuticals (combination or specific nutrients), herbal medicines as well as other naturopathic formulations prescribed by the ND in medicinal doses. The aim is to replenish nutrients that the gland requires to make and secrete hormones and supporting/strengthening the gland to prevent further deterioration. It is important to help patients provide relief from on-going symptoms while addressing the causes associated with the adrenal dysfunction.

Treatments may start by improving liver and digestive function thereby improving hormone metabolism and increasing the absorption of key nutrients to manufacture hormones in the body. Balancing blood sugar levels will result in more appropriate insulin levels and lessen the need for higher cortisol secretions. Improving sleep will reduce the need for stress hormone outputs and improve the body’s ability to repair at night. Addressing the root cause of stress and adopting strategies to decrease stress is paramount. The idea is to adopt a personalized treatment protocol that is specific to each person’s health situation.

As I’ve often mentioned before, chronic health conditions and related hormonal imbalances are complicated and should be evaluated based on the greater context of your care. Work with your MD and ND to determine how hormone imbalances are affecting your health.

Such an approach discussed herein can provide better therapeutic outcomes in treating your symptoms. Improved treatment outcomes allow you to live with more energy and lead more fulfilling lives.


Published by Dr. Gleixner on Friday, June 13th 2014 in Times & Transcript. Modified December 23rd 2019.


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