Adrenal Fatigue


NB! The adrenals and the thyroid are strongly connected to each other and their management cannot be separated. When you have completed reading this section, please read the article about the thyroid. You MUST make sure you have assessed and treated your adrenals first before working on your thyroid! Treating your thyroid first will boost your metabolism and further fatique your adrenals.


This section discusses adrenal and thyroid issues, especially within the context of, but not exclusive to, oral chelation for mercury toxicity. Oral chelation should follow ALL mercury amalgam removal programs and needs to be based on Andy Cutler’s careful protocol of safe and rational mercury detoxification. For detailed information, order his book Amalgam Illness – Diagnosis and Treatment.

Previously unexpressed adrenal and thyroid problems can often become apparent during the stress of dental clean-ups and chelation. Thus ideally, treatment should be initiated before, so that some hormonal support is in place during these stressful processes. Mercury preferentially targets these endocrine glands, as well as the hypothalamus and pituitary that govern them, and thus mercury can be the source of many unexplained endocrine problems. During mercury amalgam removal it is unavoidable that a lot of mercury will be released into the system (though this can be minimised through careful mercury removal protocols) , and this induces further damage as it moves through the body, due to its highly oxidative effect. It is thus of vital importance that the endocrine glands are supported before and during chelation to assist the body in effective detoxification and make the healing process that much easier for you. Dental work by itself is very stressful to the body and, if the adrenals cannot effectively manage that stress, they may crash inducing an adrenal and thyroid crisis of varying degrees. For more comprehensive information on this subject please follow the included weblinks.

~ NOTE: You cannot depend on what most medical practitioners tell you regarding adrenal and thyroid function as they are most under-trained in this area. Diagnosis should be made by:


  1. Proper saliva testing. We strongly suggest DiagnosTechs for all saliva tests of hormones. The thyroid and the adrenals control your metabolic temperatures. Read the body temperature page for an explanation of exactly what to do. 
  2. Tracking your daily temperatures.
  3. Hair tests.

Signs and symptoms. Adrenal symptoms of low cortisol can be a more accurate indicator than all lab testing. Diagnosis should be based on these findings. Common signs and sypmtoms of adrenal weakness (hypoadrenal) include low BP and dizziness on standing (orthostatic/postural hypotenstion), unexplained and chronic fatigue, aches and pain, hypoglycaemia, sugar and/or salt cravings, frequent infections and difficulty shaking infections, poor response to stress, crashing with stress, shaking with stressful events and carbohydrate intolerance. can give a very early indication of adrenal issues, showing up adrenal and thyroid problems years before they become visible on blood or saliva tests. More importantly, they can indicate a hidden source of toxicity, most often mercury, which could be causing the endocrine problems in the first place.
REMEMBER: Lab tests are not always conclusive for mercury toxic people, but for the sake of being thorough should be done if at all possible. However, don’t let inability to test, due to cost etc., keep you from proceeding to find suitable treatments by trial.

Trial supplementation and/or medication should be used routinely if signs and symptoms suggest it, and the treatment continued based on response to these medications.


ALWAYS treat your adrenals first!

If the adrenals are weak, replacing thyroid hormone first would most likely make a person feel much worse and may stir up ‘hyperthyroid’ symptoms bu increasing the metabolism and initiate an adrenal crisis. The adrenals must be strong enough to cope with the increase in metabolism. This is the most common mistake made in the medical management of these conditions.
Simply put: The adrenals interact with the thyroid and mitigate the affects of thyroid hormone. So always address your adrenals first, and once they have stabilised wait another two weeks at least, and often longer, before you address the thyroid. Some people need several months of adrenal support before thyroid support is added.
Oral chelation and mercury amalgam removal should proceed with caution in those who have compromised adrenals and/or thyroids. The hormonal systems should be to be stabilised first and then oral chelation and adrenal/thyroid medication and/or supplementation can continue simultaneously. Good adrenal and thyroid function supports successful detoxification during chelation.

Where to start: Adrenal vs. Thyroid? From www.drrind.com
If both the thyroid and the adrenals are weak, adrenal repair must precede thyroid repair (see Metabolic Scorecard™ to determine whether problem is adrenal, thyroid, or both). If the adrenals are weak, then even normal thyroid activity places an excessive burden on them. One may begin to feel ‘hypoadrenal‘ (coldness, weight loss, dryness, fatigue, insomnia, and/or anxiety) and then the body innately turns down its own thyroid energy production by increasing production of RT3. Conversely, if the adrenals are strong and the thyroid is weak or unable to keep up with the adrenals, one begins to feel ‘hypothyroid‘ (heat intolerance, weight gain and fluid retention, tiredness, excessive need to sleep and/or depression). A very common error is to focus entirely on the thyroid and ignore the adrenals. In a weakened adrenal state, prescribing thyroid medication that contains T4 and/or T3 may produce limited or transient improvement. Subsequent increases of the dose offer little or no benefit as the medication pushes the energy machinery into overdrive. Unfortunately, this higher energy level is unsustainable due to the stress on the adrenals. Eventually the adrenals become fatigued and the symptoms of low energy return. If, however, the adrenals are functioning well, the thyroid hormones can do their job and the result is good metabolic energy.


Adrenals and Lab Tests - for an overview of specific adrenal hormones go here… Most adrenal testing is not useful for mercury toxic people. The only reliable test is the cortisol saliva test. For this reason, most mercury toxic people use adrenal support based on symptoms and ignore the tests. If you are in a position to order lab tests, consider them, but base treatment options on signs and symptoms. The bare minimum tests for adrenal fatigue/stress are in RED type.


    • USA: The best lab to have the saliva tests performed by is Diagnos Techs in the USA. Their tests are very comprehensive and they will offer your doctor excellent support as well as a suggested treatment program. You can also have a full male or female endocrine profile and a thyroid panel done with them. Here is a good list of options for finding a doctor or way to test yourself.
    • South Africa: There are only one lab that can do the cortisol saliva test – Synexa Labs. Contact Synexa labs for local doctor options. Make certain you ask for the 4 times a day cortisol saliva test – named the ASI (Adrenal Stress Index)
    • There is no substitute for the cortisol saliva test and temperature taking to understand your adrenal function. However, If you decide NOT to follow these recommendations, then the 24-hour Urine Cortisol test can be considered and/or used to gain extra information. It is by far a distant second-best option and is inferior to the cortisol saliva test, as it does not measure fluctuations in cortisol that occur naturally as part of the circadian rhythm. This test yields little valuable information and is not advised, rather get a cortisol saliva test performed.
  • DHEA-S and DHEA Most Labs will only offer you DHEA-S option. It is good to test both of these if you can to assess how DHEA is sulfated in the liver thus giving you an idea of how well your phase-2 sulfation pathways in the liver are working. It is best to test these in the morning. However, DHEA is included in the ASI panel at DiagnosTechs.
  • 17-OH Progesterone: The precursor to cortisol, gives you an idea of your adrenal reserves. This is also included in the ASI panel from DiagnosTechs.
  • Females: Progesterone, Estrogens (Estrone – E1, Estradiol – E2 & Estriol – E3) & Testosterone
  • Males: Progesterone, Androstenedione, Estrone - E1 & Testosterone
  • Pituitary hormones: LH, FSH
  • Aldosterone/Renin Test - Aldosterone is a mineralocorticoid, which means it regulates salt balance, specifically by retaining it. It is seldom considered in routine tests,  but it is well worth checking.
Once-off blood serum tests for cortisol or ACTH stimulation tests usually won’t show stages of adrenal fatigue and many doctors will use this to suggest that your adrenals are fine, when in fact they are not. They can only show end state adrenal failure which is known as Addison’s Disease. Thus these tests are a poor indicator of general adrenal function and will only pick up extreme cases. ACTH stimulation tests are of limited value, but should be added if possible to ensure there is not a problem cortisol production from ACTH stimulation pathway.

Testing ACTH and cortisol in response to stress: Draw blood at rest, then exercise vigorously for 15 minutes and draw blood again. If ACTH and cortisol drop there is a problem. The ACTH stimulation test is designed to pick up primary Addison’s disease. Addison’s disease is extreme adrenal failure – some estimates are 80-90% loss of adrenal function. The test is not designed to pick up on the adrenals that ‘haven’t quite’ reached the high failure point yet, but almost. It also isn’t designed to pick up on pituitary or hypothalamus problems. The ACTH stimulation test is not accurate if the person has been on Hydrocortisone (or most other cortisol replacements) for a period of time.

Other tests can  be ordered based on signs and symptoms of deficiencies (or excesses of particular hormones – see Diagnos Tech labs for more options on lab tests)

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4) What can I do to support my adrenals?

Dessicated Adrenal cortex/glandular - Adrenal insufficiency can be treated with a adrenal cortex. This supplement is absolutely wonderful and if you are able to choose/try only one adrenal supplement try this one. It is very safe, and should be tried by everyone chelating or undergoing dental work to check if adrenal support is needed (though testing with a cortisol saliva test first is ideal). They are a fantastic base-line adrenal support and are generally safe accross the board, including for children. They usually work immediately, but need to be taken for many months, even years, for optimal effect. The ‘adrenal cortex’ is where the steroid hormones are made, so some manufacturers only use the cortex, and this is considered preferable, while others use the whole adrenal gland. It does not seem to make a big clinical difference whichever one you use.  These products have the hormones ‘processed out’, thus only providing the building blocks of the gland (peptide chains), so that the gland can rebuild and repair itself. Their often exceptional, and instant affect, on adrenally insuffient people, suggests that some hormones do remain. Theoretically, when restoring the adrenals, hormones to allow the gland to rest e.g. cotisol/DHEA/progesterone, and adrenal cortex/glandular allows the gland to repair. Many/most do need both i.e. cortisol and adrenal cortex. Tired glands cannot repair without hormone support, however glandulars may be all you need to use and have proved very helpful in treatment.

  • Andy Cutler has in the past recommended Adrenal Cortex by Nutricology (adrenal cortex tissue (bovine) organic glandular”), Thorne Research ( “pure dried bovine adrenal cortex”) or Standard Process in the Frequent Dose Chelation Yahoo group. Andy Cutler also noted also that “Adrenal Cortex Extract or ACE” used to be available as an injection and was used before hydrocortisone was available. When ACE is mentioned, he refers to Adrenal Cortex/Glandular, with a preference for the cortex, but not a big one. In other words either product is suitable.
  • In South Africa: The only option is Adrenal Cytotrophin by Enzyme Process. Usual dosage: Take 2 tablets in the morning and one at lunch. If your sleep is interfered with, reduce dosage, and or take earlier in the day. You can remain on this for years if need be.
  • General supplementation and advice:
    • Diet & Salt: You will feel a lot better if you eat frequent small meals with protein included with each meal. Protein is essential for adrenal support, and vegetarians may battle to include enough protein in their diet. Salt is also very important to include, with adrenally fatigued people having trouble retaining salt (sodium in particular). Current mainstream advice discourages the use of salt in food, causing further problems for your adrenals. The lack of salt is one of the reasons people with adrenal fatigue have low blood pressure (along with the fact that the other adrenal and salt-retaining hormone, aldosterone, is often reduced). You need to include a lot of salt in your diet to feel better. Choose a good quality sea-salt, and if you still need help, make some electrolyte drinks.
    • Omega 3 Oils: Ensure that your adrenals are fed high quality oils rich in Omega 3 (Pharmaceutical grade fish oils 1-2 tablespoons) daily in order to supply the ‘good’ cholesterol that is the precursor to the adrenal steroid hormones – see pathway here (courtesy of Dr Lam’s website). Intake of the right balance of essential fatty acids will help to promote adrenal recovery. Providing enough essential fatty acids is vital. Pharmaceutical-grade fish oils (e.g. cod liver oil), flax oil, borage oil and/or evening primrose oils are needed for this. This is the most commonly overlooked and most easily rectified solution/support for adrenal problems (and menopausal symptoms) and your adrenals cannot make hormones if they are not fed good quality oils.
    • Other supplements: that are beneficial for the adrenal glands are:
      • Vitamin C (2000mg/day)
      • Vitamin E (800-1000IU/day
      • B-vitamins 50-100mg/day of each in divided doses, especially pantothenic acid – B5 500mg twice a day, B6, and Biotin 2000mcg twice a day)
      • Magnesium aspartate/chloride/citrate (500mg/day in divided doses)
      • Zinc 50-100mg/day
    • Herbs:
      • Ginseng and ashwagandha support the adrenals by stimulating them to produce all of the hormones.
      • Licorice works in a different manner, by inducing a cortisol-retaining effect which slows clearance of cortisol and increases its effects. It also helps to activate aldosterone receptors (see more info on how to measure licorice here…). Because ginseng boosts the adrenals it is not always the best thing for fatigued adrenals. You do not want to push already tired glands. For this reason licorice is often the ’softer’ option.
      • Licorice and ginseng should only be used about 2 weeks of the month to maintain their effect long-term. Licorice can be helpful in boosting adrenal function, because it helps the body retain more of its cortisol. These would give you adrenal support taken long-term if you were not going to do anything else. You DO NOT usually need licorice and ginseng if you are going to take Isocort (desiccated adrenal gland) or Hydrocortisone (synthetic cortisol).
      • Ashwagandha is particularly good for combined hypothyroid and adrenal problems and it helps both simultaneously. Take 1000mg the first week, 2000mg the second week and 3000mg the third week and stay at this dose if it works for you.

    • Bio-idential natural hormones: Other safe ways to support the adrenals is with supplements like pregnenolone (1mg/kg twice per day), DHEA (50-150mg/men & 25-50mg/females) and progesterone (creams), especially if lab tests indicate deficiencies in production. These are commonly available over the counter at health shops. They will not give you the full adrenal support needed, but rather supply the hormone/s that you can’t produce and should supplement if you are low in them. Get your levels tested if possible. These should never be given to children.


Isocort:Standardized Adrenal Extract

This is available over the counter in the USA (OTC) and is the first choice of adrenal support for many. Isocort contains a small amount of freeze-dried adrenal cortex of New Zealand sheep (extracted through soluble fractionation). This amount is much less than the usual Adrenal Cortex supplements. However Isocort is standardized to contain 2.5 mgs. of cortisol per pellet (which we suspect is the legal amount of cortisol allowed to be sold over the counter). It also has some echinacea (a herb for immune support, which can pose a problem for some, especially if taken long-term), and also some other adrenal hormones made in the adrenal cortex like aldosterone (an adrenal steroid that regulates salts, especially sodium and potassium). It thus supplies a wider range of the corticosteroids manufactured by the adrenals including, and especially, cortisol. Isocort can be purchased over the counter or on-line as a nutritional supplement in the USA. UK residents can order from Wellnessworks in the USA and South African residents should get it sent to a friend in the UK and brought over by hand as customs may stop it and request a Section 21 permit (South Africa is limiting health freedoms by insisting all supplements and medications obtain a Section 21 permit from the Medical Control Council). International orders from Wellnessworks require you to e-mail the order through and phone through your credit card details rather than order directly on-line.  They declare the full value on the customs declaration & so expect to pay 17.5 VAT on the parcel in the UK, together with a fee from whoever delivers it for them collecting the VAT – between £1.50 & £13.50.

  • Taking 2 pellets of Isocort (each containing 2.5 mgs natural cortisol) would equate to a 5 mg tablet of Hydrocortisone (HC – synthetic cortisol). Some people find that even 8-10 Isocort a day doesn’t make a big enough difference, and they need to make the switch to using the stronger Hydrocortisone anyway, or another synthetic form of cortisol such as Prednisolone. But, although Prednisolone can work very well for some people, it should be noted that it is also hard on the liver. Andy Cutler notes that Methylprednisolone is much easier on the liver, and it does cost significantly more. Some people will use Adrenal Cortex as a general supplement and Isocort when needed e.g. when you feel your cortisol levels are low.
Cortisol or Hydrocortisone
When it comes to the most common adrenal problem – low cortisol release – there is often only one option that usually works well enough and fast enough – supplementation with low-dose bioidential cortisol known as Hydrocortisone. This provides a much stronger adrenal support. Cortisol is the name given to what the body actually makes and the synthetic version is known as Cortisone,and the bioidentical version is Hydrocortisone. Low-dose Hydrocortisone (20mg or less/day) is used to support the adrenals in adrenal Insufficiency, when the adrenals make insufficient hormones to cope with daily life, and cortisol is often necessary simply to tolerate normal thyroid hormone levels.

According to W. Mc K. Jefferies, in his book Safe Uses of Cortisol, 20mg of cortisol is a sub-replacement physiological dose and will not suppress endogenous adrenal function if kept at this dose or lower. Most doctors are unlikely to prescribe it due to its abuse at high pharmacological dosages as explained in these reasons, so print out the page in this link and take it to him/her. Cortisol can support the adrenals and allow them an opportunity to heal by taking the strain off of them and replacing the cortisol reserves. If your adrenals cannot make enough cortisol to meet your demands, your body simply cannot heal. It is the missing link for many people. Most people find that they feel well taking about 20mg of Hydrocortisone, or less, per day divided up as follows:

Always take your cortisol doses at close to these times to mimic the natural circadian rhythms at 8am, noon and 4pm
The general suggestion is 2 to 4 doses of 5mg. (or 2.5mg) spaced throughout the day in a routine, taken at the times mentioned above in order to mimic natural rhythms. If you have proper saliva testing you will know when you are low and at what times you need more cortisol, but if you don’t have the luxury of testing to determine this, start with:

  • 2.5mg at 8am - 2.5mg at noon and 2.5mg at 4pm. If this is not enough, then slowly adjust the dosage up until you find the one that works for you. Try:
  • 5mg at 8am - 5mg at noon and 2.5mg at 4pm. Figure out when your energy dips to discover when your cortisol is low and supplement then. For example if you have ample energy in the morning and none at noon and 4pm, then miss the morning dose.
  • Some other commom dosing schedules are:
    • 10mg at 8am and 5 mg at lunch, or
    • 15mg at 8am, 5mg. at noon and, if needed, a further 5mg. at 4pm.

Teitelbaum, in the book “From Fatigued to Fantastic”, says to use the lowest dose of cortisol that feels the best and not to go above 20 mg. The highest dose of cortisol, 20 mg. is commonly quoted, however, on occasion, some may need closer to 30 mg. with stress dosing during time of serious emotional upset e.g. funerals, and then returning to the maintenance dose. Taking physiological doses (about 20mg.) of supplementary cortisone can partially suppress the body’s own adrenal function after about a month. However, healing of the adrenals frequently takes quite some time – as much as 2 years or more in some instances. When on steroids for a long period of time like this, a weaning off process is required at the end to allow the body to readjust back to normal production. Sometimes it’s vital to allow the adrenals to heal by using Hydrocortisone, while chelation removes the mercury preventing normal production and utilization of cortisol. Chelation and stress management will cure the problem over time. The best advice is to find the lowest dose possible of cortisol and maintain that level.
You will usually need the support of a doctor as Hydrocortisone is prescription only in South Africa (unless in the US – see International Pharmacy to order online). UK residents can also order from International Pharmacy (don’t forget to tick the box stating that you are taking them under the control of a doctor, and expect to pay VAT at customs and shipping charges). Chronically mercury-poisoned people may need long-term cortisol replacement while chelating (nine months to two years). If the damage to the hypothalamic-pituitary-adrenal axis (HPA axis) is resolved through chelation and subsequent healing of the tissues takes place, you will eventually be able to stop Hydrocortisone and should wean off it by taking smaller doses each week. Cortisol, as with all supplementary hormones should never be stopped abruptly, as you need to allow your own adrenal function to come back while you taper down slowly.

Tapers
Others can consider 5-8 day tapers every 2-3 months with Prednisolone (Intermediate-acting) and this is often enough to get the adrenals working again while chelation ultimately provides the cure. Andy Cutler notes in Amalgam Illness pg. 75 that: “Allergies and fatigue can be controlled with 5-8 day Prednisolone tapers (at fairly high doses) every 2 months during therapy [oral chelation] if needed”.
Hydrocortisone tapers may also be possible. You need 4 times the amount of Hydrocortisone (20mg.) to equal one dose of Prednisolone (5 mg.). So update the dosages accordingly. Hydrocortisone is a short-acting corticosteroid, while Prednisolone is an intermediate-acting corticosteroid making it much more suitable for tapers. Most people are able to convert Prednisolone into cortisol, but on rarer occasions not. Bear that in mind.

In South Africa Hydrocortisone is available in tablet form (10mg known as Covocort in South Africa and Cortef in the USA) and can be considered for long-term, low dose use while chelating. The average time needed to heal the adrenals can be 9-16 months. Those considering occasional corticosteroid tapers every 2 – 3 months are usually advised to use Prednisolone 5mg tablets (Previously traded as: Capsoid, Lenisolone, Meticortelone, Predeltilone), which is now discontinued in South Africa. Most doctors will offer you Prednisone - note the different spelling – (traded as: Meticorten, Panafcort, Predeltin, Prednisone) and on rare occassion some mercury toxic livers may not be able to convert Prednisone into Prednisolone. Other synthetics (Prednisone, Dexamethasone etc) are not as good because the body has to do more conversions, and mercury poisoned people might have trouble with this and cause increased side-effects. When used sensibly cortisol supplemention can have miraculous benefits while you chelate.

If you are desperate for cortisol and cannot get a doctor to support you, Hydrocortisone Cream can easily be purchased. The dosage is 1/2 ml of the 1% Hydrocortisone cream or 1/4ml of 2% cream. It is put into capsules and swollowed in the morning. Others prefer to use about 1 tablespoon topically and rotate the application site daily to protect the skin from its long-term effects.


Cortisol or Licorice?

Another option is to use instead of cortisol is Whole Licorice Extract (Glycyrrhizic acid content 15%) intead of cortisol and see how you do.

150mg of Whole Licorice Extract is roughly equivalent to 5mg of cortisol. It can be taken at 8am, noon and 4pm. Licorice MUST only be continued for 6 weeks to maintain its effect, then you need a two week break from it. It must not be used in conjunction with cortisol, but rather separately. Once your adrenals are healthy again, and if you need further support, then use Licorice 1-2 weeks per month. Licorice and
Hydrocortisone work by different mechanisms to increase cortisol in your body. Licorice works to retain endogenous cortisol (cortisol made by the body) and increase its effectiveness while circulating, while Hydrocortisone supplies exogenous cortisol (cortisol supplied from an external source). Some people will only feel better by using Hydrocortisone, since their body is simply not making enough cortisol for the licorice to retain – this is a very important point. See how to mix/measure licorice here….

Adrenal insufficiency is linked to insomnia in two ways.

  1. If your cortisol drops too low during the night your blood sugar drops too. Your body compensate by releasing adrenaline as an emergency measure to mobilize more sugar. This has the effect of waking you in an instant. This can be reduced by eating high protein snack before retiring e.g. sardines, nuts of high quality protein shake.
  2. In early stages of adrenal fatigue cortisol levels tend to rise and if they are high at midnight they can energise you and keep you awake. Phosphorylated serine can be used to lower cortisol at these times due to its ACTH dampening effect.

Aldosterone is another hormone released from the adrenal cortex. It is a mineralocorticoid, meaning it regulates salt balance, specifically by retaining sodium and secreting potassium.
~ High Aldosterone causes high blood pressure and low potassium.
~ Low Aldosterone levels provide symptoms like low blood pressure, high pulse (especially on standing), salt cravings, dizziness and/or light headedness on standing and palpitations. In severe cases high potassium and low sodium is found in the blood. Low aldosterone induces more renin to be made from the kidney which is why renin is measured with aldosterone. It’s more typical for people with adrenal insufficiency to be low on cortisol but sufficient in aldosterone, but some people will have both. So, the usual recommendation is to start on Hydrocortisone and monitor to see if aldosterone would also be needed, if so Fludrocortisone (synthetic equivalent of aldosterone) commonly traded as Florinef, can be added.

SAFE USES OF CORTISOL By William McK. Jefferies