BLOGS Ask the Pharmacist Ask the Pharmacist: July 2017

Q:What is Adrenal Fatigue?

The adrenal glands are located on your kidneys and produce several hormones that are vital for life.

Normally, you would start out your day energized. After having slept well, you would be full of vitality and ready to face whatever comes your way. If you are beginning your morning feeling fatigued and are depending on jolts of caffeine to get you started; or if you are reaching for sugary foods midway through your morning to try to fuel your brain, you may have “adrenal fatigue”. If you have been telling your primary care provider about how hard it is to trudge through your day feeling a lack of focus, and about how you crash after eating a good lunch or dinner….you might have burned out adrenals. If you are told it’s all in your head when all your labs come back “normal” and you are getting no support, maybe your adrenals are shot!

Honestly, the term adrenal fatigue has been upgraded to HPA axis dysregulation (HPA=hypothalamic pituitary adrenal). It is used to describe not only the effects of chronic stress, but also a group of symptoms which include exhaustion, sleep problems, sexual dysfunction, poor exercise recovery, muscle weakness, joint pain, and a weakened immune system. It is becoming a common phenomenon due to our unrelenting stressful lifestyle, but it truly can be remedied by paying attention to how the symptoms express and making a plan to take action to repair the dysfunction. Knowing that stress can be physical, mental or from toxins, and understanding that it is more a disruption in the brain and not necessarily low cortisol production, will lead to better outcomes when the stress source is identified.

Clinically, there are four stages that lead to HPA-D. In stage one, the alarm stage, you have been exposed to an immediate stressor like an imminent event. It’s the appropriate response to danger. The short term increased production of cortisol and adrenaline increases your heart rate and blood flow, you react to the situation and then you relax. If the stress continues and it becomes chronic, the feedback balance of cortisol and DHEA can be disrupted and symptoms of anxiety, insomnia, insulin resistance and weight gain become apparent. Wired but tired is an apt description. If the proper lab testing is ordered, Stage 3 may show erratic patterns of cortisol production throughout the day, depleted estrogen, progesterone and testosterone and insulin resistance. The exhaustion Stage 4 phase brings multiple issues of chronic fatigue, severe depression, hormonal imbalances, pain, inflammation and autoimmune disorders.

With the symptoms identified, what to do becomes dependent on reducing the stressors while supporting the systems that have been affected. From a functional medicine perspective, in addition to improving social connection, the five actions to restore the HPA axis revolve around sleeping, thinking, eating, moving and supplementing when appropriate.

Improve sleep quality by building your sleep sanctuary, turning off screens at nine p.m. and incorporating a bedtime routine. Reduce reactions to stress by learning mindfulness techniques. Eat a diet rich in real, unprocessed organic food, mostly plants and cut out empty calories like soda and sweets. Move every day in moderation, preferable outside, by stretching, walking, aerobic exercising and strength training. Supplements can be important to keep you functioning while your hormones become balanced.

Adaptogens are supplements that act as metabolic regulators to reduce your body’s response to stressors and act on tissues to normalize levels of hormones. It may be beneficial to combine herbs such as Rhodiola, Holy Basil, Panax ginseng, licorice root and Ashwagandha. Maca is an herb that helps restore libido and phosphatidylserine helps normalize cortisol and improve brain fog. Building blocks to restore adrenal hormone production include liposomal Vitamin C 500mg to 3000mg daily, pantethine 250mg-450mg twice daily, B-complex and magnesium 400-800mg daily. Designs for Health makes a combination product for those who suffer with anxiety from HPA axis dysfunction (CatecholaCalm) and (Adrenatone) for those who have more extreme fatigue as the major symptom. DHEA and pregnenolone are available over the counter, but they, along with a prescription for oral hydrocortisone should only be recommended or prescribed by your health care provider.

While fatigue and depression may show up as the first symptoms, they may be dismissed early on, allowing chronic, unrelenting stress to create more severe HPA-D. Be vigilant in asking for a diagnosis from your physician, as early lifestyle support and attention to nutrient depletions will allow for a speedy recovery. The return to your energetic self is your reward.

Deidre (Dee) Kohley, Rph, works at Watkins Pharmacy, is a graduate of Ferris University and has lived all her life in Muskegon. She continues to find ways to reach women who genuinely want to get well or live an optimal life. Dee loves digging into research to find new ways to help people. She is married and has seven children and nine grandchildren who keep her busy. She loves the beach and spending time outside enjoying the seasons. You can contact her by going to her website or

Print pagePDF pageEmail page