Shep Saltzman, R.N., Vienna Complimentary Medicine
The Adrenal Glands
These hard working glands, the adrenals, have many important functions and
are often exhausted or over-stimulated. The gland produces the following
hormones: Cortisol, Corticosterone, DHEA , Aldosterone, Pregnenolone,
Estrogen, Progesterone, Testosterone, Androstenedione, Epinephrine and
The Following 14 Conditions Are Often Due To Adrenal Gland Dysfunction
1. Insomnia –
You cannot fall asleep due to high Cortisol or you cannot stay asleep due to low
Cortisol. High Cortisol at night is an indication of a dysregulated communication
between the Hypathalmus and the Adrenals.
Cortisol should be low at night, and it is very stimulating. This is part of why some
people are ”night owls”. Low Cortisol causes us to wake up in the middle of the night.
We use Cortisol while sleeping to convert stored sugar (glycogen) to usable sugar
(glucose). Our brains need Cortisol while we sleep, because the brain never sleeps.
If we run out of Cortisol, we can use alternative Adrenal hormones like Epinephrine
(Adrenaline). The problem is the alternative hormones are very stimulating, and
they wake us up, or cause light sleep that is not as restful as deep sleep states. This
is why some people wake up and feel like they did not get a good nights sleep.
2. Low Blood Sugar/Hypoglycemia ‐
Low cortisol can cause low blood sugar, because cortisol converts stored blood
sugar to usable blood sugar. Between meals, if your Cortisol is low, the conversion
does not take place, and low blood sugar symptoms occur: fatigue, feeling
lightheaded or aggravated, craving sweets, afternoon fatigue, getting dizzy when
you stand up.
After sleeping, which is a fast, it is a mistake to miss breakfast and restore blood
sugar. If you miss breakfast, and you have low Cortisol, you will experience
hypoglycemic symptoms. If you eat a high carbohydrate snack with coffee, you
will over‐stimulate the Adrenals and cause blood sugar to spike and then be quickly
reduced, which leads to hypoglycemic symptoms: fatigue, craving sweets, feeling
cranky, and functioning at a low level mentally. Some of our co‐workers or teachers
are hypoglycemic and their mood and effectiveness is determined by this
3. Inflammation ‐
Cortisol can reduce inflammation due to injury or infections, by reducing the
body’s production of inflammatory cytokines. We produce cortisol when we get
injuries and infections, for short term relief. Chronic infections and injury can
wear out the adrenals.
Chronic Arthritis can exhaust the Adrenals due to the constant pain. Arthritis is a treatable condition, and is often the result of allergies and toxic deposits made into
the joints. Sometimes Arthritis is undiagnosed Lyme disease. Low Cortisol cannot
deal with chronic inflammation, and chronic inflammation leads to low Cortisol.
4. High /Low Blood Pressure –
Aldosterone is a minera lcorticoid hormone which helps regulate Sodium/Potassium
levels. Aldosterone works with the Kidneys and lungs to regulate blood pressure.
Aldosterone increases sodium retention, increases potassium excretion, increases
water retention, increases extracellular volume, enhances the sodium/potassium
pump activity in the cells, and helps “bring on line” the sodium and potassium
channels in the luminal membrane in the kidneys. All these functions raise blood
volume and therefore increase blood pressure. Low blood pressure can be due to
Aldosterone deficiency, and high blood pressure can be due to excess Aldosterone.
Aldosterone also has an effect on constriction and dilation of small arteries, which
also affects blood pressure. Constricted arteries raise blood pressure and dilated
blood vessels lower blood pressure.
Today, it has been estimated that blood pressure disorders affect 30% of the
popluation, and is rising.
Edema can result from excess fluid, and Dehydration can result from deficient fluid.
Fluid levels are directly related to sodium/potassium levels and Aldosterone levels.
pressure is a growing hidden problem. Aldosterone prevents the loss of
sodium into the urine, and helps maintain blood volume and blood pressure. Low
blood pressure is experienced like: fatigue, low motivation, low resistance to illness,
poor stamina, slow to heal form injury. Low sodium can lead to low blood pressure.
Aldosterone is directly and indirectly related to low blood pressure.
Symptoms – (Hot flashes, night sweats, racing heart,
dry skin, fatigue, low libido)
The adrenals can make hormones like Pregnenolone and DHEA that get converted to
Estrogen, Progesterone and Testosterone if they are healthy. During Menopause,
Ovarian Sex hormone (Estrogen/Progesterone) decline.
The Adrenals can make sex hormones and you can avoid many symptoms of
Menopause due to sharp declines in sex hormones. Many woman have depleted their
Adrenals due to chronic stress and poor blood sugar management (high carb diet,
inadequate protein, lack of sleep, over work). When Menopuase starts, you might
have poor adrenal function and declining Ovarian function. That combination is
severe and can cause significant discomfort. Sharply lowered estrogen is also a
factor is cardiac risk for woman. Menopause symptoms are preventable and
6. Dehydration –
Is affected by sodium/potassium levels. As I stated in #4, Aldosterone increases
sodium levels and increases potassium excretion via the kidneys. If there is excess
sodium in the blood, fluids can be pulled from the cells, and that is cellular
dehydration. It can show up in skin turgor, and make you look older and less
vibrant. Dehydration can weaken cell function and interfere with the exchange
of important substances through the cell walls like minerals, sugar, hormones,
gases like Oxygen, toxins and Immune substances.
7. Insulin Resistance ‐
This is a condition that occurs when the cells are chronically subjected to high levels
of blood sugar. The cell walls become resistant to Insulin entering the cells. Insulin
escorts Glucose into the cell and the cells cannot get Glucose without Insulin.
Insulin is made by the beta cells of the pancreas, and is secreted in response to
glucose entering the blood (after eating and digesting food). If you eat a high
carbohydrate meal, a barrage of glucose will be produced and move into the blood
from the small intestines. This leads to high levels of Insulin being secreted. If this
occurs chronically it leads to Insulin resistance.
Glucose is needed for all cells to function. It is the source of all energy in the body.
Glucose is converted to ATP in the cells, in a very complex metabolic process called
the krebs cycle. If glucose does not get into the cells, they suffer from low sugar
–not low blood sugar, but low cell sugar. The problem is often that the
glucose/sugar is in the blood and is not getting into the cells. That is pre‐Diabetes.
The high blood sugar causes the pancreas to keep secreting Insulin, while the cells
are starving for glucose. This is a process that continues to get worse, once it starts.
Your labs will show high glucose readings and low insulin. The sugar in the blood
gets converted to fat and triglycerides. That is how weight gain occurs. Insulin is also
very inflammatory, and is often the cause of other health problems, like Hashimoto’s
disease, and other thyroid problems.
The Adrenals also play a part in Insulin Resistance. Elevated Cortisol
(often due to stress) generates high production of Insulin, because Cortisol converts
stored sugar into blood sugar, which again causes more Insulin to be produced. If
you already have Insulin resistance from inappropriate carbohydrate consumption,
the additional insulin that is produced due to elevated cortisol/elevated glucose
aggravates Insulin Resistance further.
Elevated Insulin also causes elevated Cortisol, because elevated Insulin is
inflammatory, and Cortisol will be produced to reduce inflammation. This is a
vicious cycle of elevated Cortislol causing elevated Insulin and elevated Insulin
causing elevated Cortisol. This patterns depletes the Adrenals and the Pancreas.
Usually the adrenals will get fatigued long before the Pancreas.
Insulin Resistance is pre‐Diabetes‐ and has many symptoms: weight gain, fatigue,
headaches, poor circulation, craving sweets, getting sleepy after meals, poor
circulation, vision problems, cardiac problems and brain dysfunction.
8. Weight Gain at the Abdomen ‐
This is one of the most embarrassing symptoms of excess Cortisol. Cortisol is a
“stress hormone”. It gives us the ability to respond to an emergency. However,
chronic stress is a common operating state and this drives the Adrenals to keep
producing Cortisol continuously. Our bodies to start to add adipose (fat) tissue for
emergency energy, in response to constantly using our reserves for stress responses.
Fat in the abdomen is highly correlated to cardiac problems. The abdominal fat also
stores toxins, hormones and metals which can leech back into the blood and cause
many hidden problems.
9 . Allergies –
Cortisol helps to mitigate allergic reactions. If our Cortisol is low, our ability to deal
with allergic reactions is compromised. Today, we are processing more allergic
substances than ever before. We are processing unprecedented levels of drugs,
chemicals, pesticides, food coloring, antibiotics, air borne allergens, and hormones.
We are seeing more allergic patterns at every age, even newborns, as
our Immune system and Adrenal glands get worn down.
10 . Thyroid Regulation ‐
Excess Cortisol suppresses TSH – thyroid stimulating hormone‐ a hormone
produced by the pituitary, which stimulates the thyroid to produce thyroxin.
Even if the hypothalamus senses Thyroxin is low and sends TRH to the Pituitary to
secrete TSH, so that thyroxin is produced, high cortisol will surpress the whole
system and cause hypothyroidism. This is a big subject, which I am going to devote
a whole article on. The are many symptoms of hypothyroidism including:
- cold hands/feet
- weight gain
- unstable pregnancy
- low mental function
- low metabolism
Low cortisol causes the Thyroid to work harder to compensate for low
blood sugar and low energy. This leads to a hyper‐functioning thyroid. Symptoms
- feeling heat in the head
- feeling aggravated
- weight loss
- increased metabolism
Chronic overcompensation by the thyroid to make up for low Cortisol and low
adrenal function will wear out the thyroid and cause it to become
under‐functioning and this leads to hypothyroidism.
11. Depression ‐
Norepinephrine and Epinephrine are Adrenal hormones. Cortisol and
norepinephrine are both correlated to the onset of depression.
Neurotransmitter physiology is complex and not well understood. However,
dysregulated blood sugar, and inappropriate levels of epinephrine and
norepinehrine can be part of the cause of depression. Part of the treatment for
depression can be the restoration of adrenal hormone levels and blood
12. Digestive and GI symptoms ‐
Elevated Cortisol (often due to chronic stress) can induce gastric ulcers, and
hypochlorhydria. Hypochlorhydria (low stomach acid) can be the beginning of a
great many problems. HCL (hydrochloric acid) is needed to break down protein. If
it is low, protein does not break down, and remains in the stomach, and becomes
more acidic, produces gas, and gets regurgitated (acid reflux).
Epinephrine causes the production of HCL to stop as part of the stress response.
Chronic stress leads to chronic low levels of HCL.
Another problem is the Chyme, the liquid that leaves the stomach and moves into
the small intestines, is far too acidic, if HCL is low and protein is undigested. The
small intestines are designed to be much more alkaline than the stomach, and if it
is flooded with highly acidic Chyme, the delicate digestive enzymes produced in the
pancreas are damaged or destroyed. Low levels of pancreatic enzymes do not allow
the food to be further digested and absorbed. The result of poor digestion is poor
absorption and poor nutrition.
The contents of the small intestines now moves into the large intestine, largely
undigested. This sets the stage for the growth of fungus, bacteria, and a general
dysbiosis (imbalanced friendly bacteria and unfriendly bacteria) H Pylori is a
common bacteria that grows in the stomach, and is commonly found in patients
that have chronic elevated cortisol. It Is thought that HCL issues begin to wear
out the lining of the stomach, allowing H Pylori to get a foothold. H Pylori
produces all kinds of discomfort and distress.
13 . Bone Density (Osteopenia and Osteoporosis) –
One of the functions of Cortisol that is not well known is the maintenance of bone
density via calcium absorption. Osteoporosis and fractures can result if Cortisol is
chronically low, due to low calcium absorption. Low Cortisol is often due to
chronic stress and chronic blood sugar dysfunction.
14 . PCOS (Poly Cystic Ovarian Syndrome) –
Chronic elevated blood sugar not only can cause diabetes, it is a primary cause of
the most common endocrine system disorder for woman – PCOS‐ a condition that
is marked by elevated Testosterone, proliferation of cysts and other growths, and
numerous other symptoms. Elevated testosterone and PCOS are major causes of
infertility, fibroids, cysts, and menstrual irregularities.
What can we do to improve our Adrenal function?
Well, quite a bit. Here are some simple actions anyone can take that support Adrenal
function that involve lifestyle changes and diet changes:
1) Eat breakfast – low glycemic foods and some protein – try to minimize coffee,
either none or reduce amount.
2) Eat protein with every meal‐ this keeps glucose spiking and sugar cravings to a
3) Eat protein snacks between meals‐ this helps maintain blood sugar levels.
4) Go to sleep before 11:00 pm and do not engage in stimulating activities
5) Treat infections aggressively – especially dental infections, fungal, viral ‐ that
means see your dentist regularly, and find a way to treat chronic conditions.
6) Get allergies identified and avoid allergic foods‐ especially subtle allergies that
cause digestive problems. If you have some of the following symptoms, you probably
have allergies: gas, bloating, diarrhea, constipation, acid reflux, stuffed up sinuses,
chronic headaches, unresolved skin problems, stomach pain, asthma. Autoimmune
disease are exacerbated by allergies, especially to gluten and casein.
7) Learn what “low glycemic” foods are –and eat more of them and avoid high
glycemic foods. This information is on the internet. Google “Glycemic Index”
and you will get a lot of good information. There are also many good books
on the subject.
8) Start exercising – moderately – it reduces the effects of stress and helps reduce
excess weight. Incorporate stress reducing activities like Yoga , Tai Chi , Pilates,
weight lifting and aerobic movement so all forms of exercise are utilized.
9) Do not eat late at night – eat dinner by 7:00 pm as often as possible. Eating late
interferes with good sleep and the stomach functions at a low level late at night. Lack
of sleep is a form of stress and so is indigestion.
10) Take digestive enzymes‐ they help digest food and minimize allergies. Enzymes
break down food into it’s constituent parts (amino acids, fatty acids, glucose).
Allergies are reduced because many allergic reactions are due to the larger more
complex food, and not to its components.
11) Take probiotics – they help restore friendly bacteria – which reduces internal
stress. Do not underestimate the far reaching effects of dysbiosis, a name for
depleted friendly bacteria. This is caused by antibiotic overuse. Antibiotics kill all
bacteria, friendly and unfriendly. There are antibiotics in our food. This is another
reason to buy food that is not tampered with
12) Take essential fatty acids – they improve blood sugar metabolism. Our cell
walls are made up of essential fatty acids, if they are available. We will use poor
quality fatty acids if we lack essential fatty acids and this creates problems at
the cell wall level. Avoid trans-fatty acids. they cause inflammation and
14) Avoid excess stimulants – (coffee, soda, red bull, alcohol)‐ they all
over‐stimulate the Adrenals, especially when the Adrenals are already depleted.
Of course, you may want stimulants the most because your Adrenals are already
depleted. Anyone who cannot get through the day without caffeine is suffering
from Adrenal depletion. All forms or caffeine are depleting to the Adrenals
15) Drink at least 1 quart and hopefully 2 quarts of quality water a day. Do
not drink tap water that is full of chlorine, fluorine, fluoride and other chemicals.
Supplements are available to help the adrenals recover and stay healthy. A
professional practitioner with good training can offer many quality products to
restore proper circadian rhythm to your Cortisol production, as well as nourish
the adrenal function. Taking hormones may be necessary until the Adrenals can
make them (DHEA, pregnenolone, progesterone, estrogen, testosterone).
I am going to list a few supplements that support the Adrenals that a
professional should provide, for optimal dosage and coordination with other
medication and supplements:
A) Adaptogenic Herbs for the adrenals:
- Panax Ginseng
- Siberian Ginseng
- Holybasil Leaf Extract
- Boerhaavie Diffusa
- Licorice Root
B) Insulin Resistance Botanicals and Minerals:
- Gymnema Sylvestre
- Alpha Lipoic Acid
- Mixed Tocopherols
C) Essential Fatty Acids:
- Omega 3 fatty acids (DHA and EPA)
D) Probiotics: (friendly bacteria):
E) Digestive Enzymes:
F) Elevated Cortisol:
- Phosphatidyl Serine
- B vitamins
- Lemon Balm
- Milk Thistle
G) Deficient Cortisol (Low):
- Licorice Root
- Siberian Ginseng
Stress reduction is paramount. All forms of
stress deplete the Adrenals.
Internal stress can be due to:
- Emotional causes: Worries, Fears
- Biochemically: Anemia, Vitamins
- Mineral, neurotransmitter, blood sugar, protein deficiencies
- Infections: Viral, Bacterial, Fungal, Parasitic
- Pain and Inflammation
- Lack of sleep
- Toxicity (metals, chemicals, neurotoxins)
External stress can be due to:
- Excess work
- Lack of exercise
- Financial problems
- Relationship issues with a variety of people,
- Time management issues
- Lack of joy
- Exposure to environmental hazards: cold/heat/humidity/pollen/pollution
- Loss of loved ones
If it is caused by internal conditions or external conditions, in the end,
stress is stress. Some forms of stress are easier to manage than others.
Overeating of high glycemic foods is relatively easy to change. Working
less hours and spending time enjoying your life can be a big change. If
you do not have a day “off”, this is an issue that must be addressed. Deal
with anything that interferes with good sleep. Go to therapy if you cannot
handle a relationship that is troubling and is draining your energy. Learn to
manage a relationship that is troubling and draining your energy. Learn manage your money so money is not a form of stress. Improve your job
skills and work skills if that will change your life for the better.
Get acupuncture, massages, Reiki, Chiropractic adjustments, Rolfing, learn to
meditate or hire a trainer. These are ALL excellent ways to reduce the impact
of Adrenal dysfunction.
Get lab tests (blood, saliva, stool) to get clear about your status and health. If you
have a major issue, you cannot handle it yourself. Major issues are: autoimmune
disease, pre-diabetes, diabetes, high blood pressure, an Epstein Barr Virus,
H Pylori bacteria, CMV virus, Celiac’s disease, anemia, elevated C Reactive Protein,
elevated Homocysteine, elevated liver enzymes, elevated Cholesterol, etc.
Get professional guidance regarding food and supplements. Most people do not
know what to do on their own. If the practitioner uses lab tests, even better.
As far as lab tests go – I like the Adrenal Stress Index Saliva test to determine
Adrenal fatigue. It costs about $100 and measures Cortisol and DHEA and Insulin.
For an extra $50 you can test: Ovarian hormone levels (estrogen, progesterone,
testosterone) , and Pituitary hormones (FSH & LH).
I like a comprehensive blood test that measures:
Blood Sugar, Kidney function, Liver Enzymes, Thyroid Function, Cholesterol,
Red Blood Cells, White blood Cells, C- reactive Protein Triglycerides, Basic
Minerals. This test costs approximately $115
If necessary, I get a GI panel to determine Parasites, Intestinal Infections and
Fungus. This test costs approximately $150. This is only done if there are good
reasons to suspect pathogens.
Lastly, nuture your spirit. When the spirit is well, the body follows. Do not despair.
If you are depressed, get supplements or medication that lifts your depression.
If you are discouraged, get support and reach out to people that can be helpful.
If you are stuck, find a way to get moving. If you are exhausted and confused,
improve your adrenal function.
I quote an old poem, “With all its sham, drudgery and broken dreams, it is
still a beautiful world”
About the Author
Shep Saltzman is a Licensed in Herbology and Acupuncture and NCCAOM Certified Registered Nurse. He has his own practice, Vienna Complimentary Medicine a Center for Holistic Health, in Vienna, Virginia. To make an appointment for a consultation, click here. Connect with him on Facebook and Youtube.