Updated: July 30, 2020

Are you constantly feeling tired and run down? If so, you may be suffering from adrenal fatigue. Chronic (long-term) fatigue and stress may negatively impact your adrenal glands and hormone production. (50) Continue reading to learn about adrenal fatigue, as well as strategies you can implement to improve adrenal gland function and overall energy levels.

What are adrenal glands?

The adrenal glands are small, triangular-shaped organs found on top of the kidneys. They’re responsible for producing several important hormones, including cortisol, aldosterone, dehydroepiandrosterone (DHEA), androgenic steroids, norepinephrine, and epinephrine. These hormones help regulate your immune system, metabolism, blood pressure, response to stress, and other essential functions. (29)(36) If your adrenal glands are not functioning properly, they may over or underproduce these hormones, which can lead to several health issues. (52)

What is adrenal fatigue and how can you recognize it?

Adrenal fatigue is a term most commonly used by integrative healthcare providers and functional doctors to describe a collection of symptoms believed to be induced by chronic stress. (53) It’s important to note that adrenal fatigue is not an accepted medical diagnosis. Instead, you may also hear adrenal fatigue referred to as hypothalamic pituitary adrenal (HPA) axis dysfunction. The two terms are often used interchangeably. (5)(50)

The HPA axis represents the relationship between the adrenal glands, the hypothalamus, and the pituitary gland. When the body detects a stressor, such as emotional stress or immediate physical danger, the HPA axis is activated. Activation of the HPA axis triggers a response to release glucocorticoids, such as cortisol, from the adrenal cortex. (49)

Emotional, financial, and relationship stressors, as well as poor quality sleep, chronic health conditions, and excessive exercise, can all contribute to chronic stress. (28)(20) In individuals experiencing chronic stress, the HPA axis is constantly being activated, causing it to become less sensitive to activation signals. As a result, the HPA axis begins to down-regulate and the adrenal glands are unable to produce enough stress hormones, specifically cortisol and aldosterone. (49)

Identifying adrenal fatigue

Symptoms often associated with adrenal fatigue include:

• Cognitive deficits
• Decreased libido
• Depression
• Fatigue
• Hormone imbalances
• Hypoglycemia
• Hypertension
• Insulin resistance
• Irritability
• Poor stress coping skills
• Sleep issues
• Weight gain (49)(16)(3)(19)(17)

If you are suffering from any of these symptoms, it’s best to consult your integrative healthcare practitioner for guidance. There is not a formal test for diagnosing adrenal fatigue. However, blood, urine, or saliva tests can help your practitioner determine whether your adrenocorticotropic hormone (ACTH) and cortisol levels are in check. (54)

Visiting your practitioner and having your hormones tested may not reveal adrenal fatigue, but it could help determine if you might be suffering from other health problems that exhibit similar signs and symptoms, such as an autoimmune disorder, anemia, or depression. (30) Once you and your integrative healthcare practitioner have a better sense of what is causing your symptoms, they may create an individualized treatment plan for you.

What is adrenal insufficiency disorder?

Adrenal insufficiency, also known as Addison’s disease, is a recognized autoimmune disorder characterized by insufficient hormone production that occurs when adrenal glands don’t make enough of certain hormones. (32) Some integrative healthcare practitioners consider adrenal fatigue to be a mild form of adrenal insufficiency, however, the symptoms differ slightly.

Adrenal insufficiency symptoms include:

• Abdominal pain
• Chronic fatigue
• Darkening of the skin
• Diarrhea
• Hypoglycemia (low blood glucose)
• Irregular menstrual cycles
• Joint pain
• Low blood pressure
• Low libido
• Muscle weakness
• Nausea and vomiting
• Poor appetite
• Weight loss (33)

Five key strategies for supporting adrenal health

Incorporate these five simple strategies into your daily routine to help support your adrenal function.

Eat nutritious foods

Although there is no specific diet for treating or reducing the risk of adrenal fatigue, eating a healthy, well-balanced diet may help support adrenal health and promote general well-being. Research suggests that the Mediterranean diet, which focuses on the intake of vegetables, fruits, legumes, nuts, seeds, grains, fish, dairy, and moderate amounts of meat and poultry, may be the best diet for overall health and may reduce stress-induced inflammation. (6) Furthermore, individuals should limit their intake of coffee and other caffeinated foods and beverages, as high doses of caffeine can increase cortisol secretion and activate the HPA axis. (27)(40)

Aim for daily exercise

Research has found that regular exercise can combat stress and help you establish emotional resilience in response to acute stress. (9) The National Institutes of Health recommends that adults engage in at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity aerobic exercise per week. Strength training sessions twice per week is also encouraged. (51)

Get enough quality sleep

Did you know that poor quality sleep can negatively impact how your body responds to stress? (31) Research has demonstrated a possible link between inadequate sleep and increased cortisol levels. (2) According to the National Sleep Foundation, young adults should aim to get between seven to nine hours of sleep and older adults should get between seven to eight hours of sleep per night. (21) To support optimal sleep, maintain a regular sleep schedule, minimize external sources of light and sound around bedtime, and engage in regular physical activity. (22)(13)

Practice meditation

Meditation is a practice that can help reduce stress, improve overall well-being, and encourage a heightened state of awareness, focus, and relaxation. (47) One study investigated the effects of meditation on stress and found that meditation significantly reduced the change in cortisol levels in the first hour of waking, known as the cortisol awakening response (CAR), compared to the control group. (26)

Consider taking adrenal support supplements

When advised by a healthcare practitioner, taking certain supplements may help support the health of your adrenal glands. Individuals with adrenal gland issues may experience high levels of certain hormones, while others may experience low levels. (35) Depending on your condition, your practitioner may recommend a protocol of specific supplements.

8 best supplements that support adrenal health

The following supplements have been shown to ease mental stress and support adrenal health.

Ashwagandha (Withania somnifera)

Derived from a small shrub native to India and Southeast Asia, ashwagandha is a popular herb and adaptogen commonly used in Ayurvedic medicine. Adaptogens are a class of herbs that have been shown to increase the body’s resistance to stress and aid in stress relief. (48) Research suggests that supplementing with ashwagandha safely and effectively improves stress resistance. One study of 64 individuals with a history of chronic stress found that supplementing with ashwagandha for 60 days reduced perceived stress levels and lowered serum cortisol levels compared to the group receiving a placebo. (8)

Holy basil leaf (Ocimum sanctum)

Another adaptogen, holy basil leaf, sometimes referred to as tulsi, is a plant native to Southeast Asia. It has been found that supplementing with holy basil leaf may improve cognitive function and reduce salivary cortisol levels. (44) Tulsi may also combat psychological stress and normalize blood glucose, blood pressure, and blood lipid levels. (10)(23)

Magnesium

It is estimated magnesium deficiency affects up to 20% of the global population. (11) Insufficient magnesium levels in the body can lead to low stress tolerance and manifest in a number of ways, including fatigue and depression. (15)(46) Some evidence demonstrates that magnesium helps modulate the HPA axis by reducing ACTH secretion. Magnesium deficiency may induce anxiety and HPA axis dysregulation. (45)

Although human trials are limited, some studies have suggested that supplementing with adequate amounts of magnesium may have anti-anxiety and anti-stress effects. (41)(45)

Phosphatidylserine (PS)

Phosphatidylserine (PS), a phospholipid found in cell membranes, is primarily sourced from soy for its use in supplements. Research suggests that supplementing with PS may help normalize the HPA axis stress response and maintain normal levels of cortisol in the body. (18)

Rhodiola (Rhodiola rosea)

Rhodiola rosea is an adaptogenic herb that has been shown to decrease cortisol levels. In one double-blind, randomized controlled trial, subjects with stress-related fatigue were given two daily doses of Rhodiola rosea for a duration of 28 days. The subjects experienced increased mental performance, concentration, and decreased CAR. (37)

Asian ginseng (Panax ginseng)

Panax ginseng, also referred to as Asian or Korean ginseng, is a type of adaptogenic herb with demonstrated antioxidant and anti-inflammatory benefits. (25) Research has shown that supplemental Panax ginseng may improve chronic fatigue and reduce the HPA axis response to stress. (24)(12)

Vitamin C

The adrenal glands contain one of the highest concentrations of vitamin C in the body, and research indicates that stress can cause the adrenal glands to secrete vitamin C. (39)(38) A randomized, placebo-controlled trial of 120 participants showed that a high dose of sustained-release ascorbic acid lowered blood pressure, improved salivary cortisol recovery, and improved subjective psychological stress responses compared to the control group. (4)

Vitamin D

Vitamin D is responsible for supporting many important functions in the body, including supporting bone and immune health. Emerging research has demonstrated a possible link between supplemental vitamin D and improved CAR. (43)

Vitamin D is a fat-soluble vitamin, meaning it is stored in the body for long periods of time. (42) For this reason, it’s best to consult an integrative healthcare practitioner prior to supplementing with vitamin D.

The bottom line

The adrenal glands are small glands located on the kidneys that produce and control the secretion of several hormones. Chronic stress can negatively impact adrenal gland function, which can contribute to the development of certain health conditions. Managing your stress through lifestyle modifications, as well as supplementation when directed by your integrative healthcare practitioner, may help support overall adrenal health.