When You’re Tired Despite Everything Being Normal… It Could Be Your Adrenals. Part 1


It’s becoming increasingly common to hear our patients say that they are tired, having a hard time losing weight, and suffering from insomnia. They go to their allopathic doctors and are told they are just stressed, their thyroid is normal, and they might be depressed. They leave the office frustrated because they know something just isn’t right. Well, there is an oft-forgotten organ that might be struggling to keep up with our lifestyles – the adrenal glands.

What are the adrenal glands?  They are small glands that sit on top of your kidneys that produce various hormones.

The medulla produces adrenaline (norepinephrine and epinephrine). Adrenaline is for short term stressors – it’s made to get yourself to a safe place as fast as possible. This is the hormone that allows family members to lift cars off loved ones, makes you shake and heart beat faster when you’re dodging accidents on the interstate, and the feeling that is chased by “adrenaline junkies”. The cortex produces 3 classes of hormones: aldosterone, pregnenolone and DHEA, and cortisol. Aldosterone regulates blood pressure and sodium balance. Pregnenolone and DHEA are precursors to our sex hormones like testosterone, estrogen, and progesterone. Cortisol is the main indicator of adrenal health. Cortisol is made to take over for adrenaline if a particular stressor continues. It tells the liver to release more sugar into the blood so the body can continue to cope with the stressor. It also suppresses the immune system, because as far as the body is concerned, when you’re running from the bear and trying to find food, the immune system takes a back seat. Cortisol is so powerful at suppressing the immune system, that even watching a violent TV show has been shown to lower white blood cell count, which is an indicator of immune status.

Cortisol is secreted throughout the day in different levels. Below is an example of a cortisol curve, the blue background is the normal curve.

Cortisol is high in the morning to help you wake up and lowers throughout the day, until it is as it’s lowest at night, so you can fall asleep. This curve is malleable and changes throughout your life. One to three adverse events as a child can permanently change your cortisol curve! This curve can go up during times of stress and if that stress continues over a long period of time, the adrenals become “fatigued”. The brain continues to tell the adrenals that the body is stressed, but the adrenals aren’t as responsive to this message and begin to react less to those stress messages. This causes that curve to slowly lower and ultimately become flat. Sometimes the stress message gets jumbled and the curve starts low in the morning and high at night. The size and behavior of your curve changes throughout your life.

So what does adrenal dysfunction feel like in your day to day life? Common symptoms are fatigue, mood changes (especially irritability, depression, and anxiety), waking unrefreshed, among others. Insomnia is common when the curve is inverted and cortisol raises at night. It is often accompanied by “monkey mind”, where your mind just can’t stop before bed.  Cravings for carbs and sugar are common that can result in weight gain around the middle. When your adrenals aren’t functioning optimally, other symptoms include excess urination, dizziness, brain fog, low libido, being easily startled, and decreased immunity.

These symptoms are pretty nonspecific, so how do we test for adrenal dysfunction? There are several methods, but they aren’t created equal. Below is a small table that compares the methods. Saliva is best because it tests bioavailable cortisol, it shows you a cortisol curve, and has over 3000 studies supporting this testing method.

Method Collection Circadian Rhythm? Bioavailable? Notables
Blood/Serum Blood draw No No
Urine Urine Collection- depends on your comfort handling your own urine. Yes Yes* *Tests metabolites, which can vary significantly between people
Saliva Easy! Saliva collection Yes Yes Over 3000 studies supporting this method


Our next blog will tell you about how to treat your adrenals and help keep them functioning optimally!