Feeling Tired All the Time? Adrenal Fatigue: Symptoms and Treatment

By Susan E. Sklar, M.D.

This blog is about the adrenal glands that regulate many of our body’s functions. This is one area where the knowledge of alternative medicine doctors at the Sklar Center can help you feel better. There is no question that because of the Covid pandemic our stress levels are heightened. The response of our bodies to stress is primal. It is either flight, fight or freeze. This response is essential if you were walking in the savanna 50,000 years ago and you are attacked by a pride of lions. You either run like crazy, fight for your life or play dead. Either you survive or perish and it’s over. During this pandemic we have been in a constant state of arousal. This has had a negative effect on our adrenal glands and is one of the major causes of Adrenal Fatigue.

Feeling tired all the time may be a symptom of Adrenal Fatigue. As a physician in practice for the last 34 years I have cared for many patients with serious fatigue. However, it wasn’t until I began to work as a functional medicine doctor that I understood the causes of fatigue.

One of these causes is Adrenal Fatigue. It is a condition caused by stress and its effect on the adrenal glands. These two glands, the size of walnuts, sit on top of your kidneys. These glands are responsible for your ability to withstand all the stresses in your life. You may be one of many who is suffering with Adrenal Fatigue.

Heather finds the right doctor.

At 37, Heather, a hard driving director of public relations at a Fortune 500 company, began to not feel well. She was tired all the time. Other symptoms included hair loss, weight-gain, insomnia, depression, changes in skin and muscle tone. After seeing 5 or 6 doctors, she found me.

“Feeling Tired, weight gain, insomnia, depression, hair loss, changes in skin and muscle tone are all signs of Adrenal fatigue.”

Along with her demanding job, Heather’s marriage was in crisis. Her youngest child was starting college and her husband declared he was “taking a break” and moving out of their family home.

Given her feeling tired all the time and her other symptoms, I was almost positive of the diagnosis.  Blood tests revealed the source of her problems. Heather’s adrenal glands were not functioning. Her adrenal glands had burned. out

Three months into treatment, I noticed a complete turnaround. Her energy levels were up. She no longer felt tired all the time. Her hair and skin got better.  Also, her mood improved.  Moreover, she realized tiredness had affected her desire for intimacy. At my recommendation, she and her husband started couples therapy.  Heather was a much happier person. I was so glad that my knowledge as a holistic doctor helped her.

What is the Adrenal Brain Connection?

There is a connection between the adrenal glands and the brain. When this connection stops working, you may start your day feeling tired and feel your energy go downhill from there.  Some people start out the day with a lot of energy but hit the mid-afternoon crash. Others are barely able to function until they grab a coffee. So, what’s going on?

How does stress affect the adrenal glands?

Life is stressful. We all know this. How you understand and respond to stressful situations is what affects your health.  Cortisol is your life-saving stress hormone. Physical or mental stress makes the adrenal glands produce cortisol.

What is the cortisol connection?

This hormone controls your stress response. It also controls your metabolism, and immune responses. Constant stress causes the adrenal glands to put out too much cortisol over a long period of time. This causes the brain to disconnect from the adrenal glands. Feeling tired, insomnia, and a build-up of abdominal fat are common results.  After a long period of stress, there is a further brain-adrenal disconnect.  The adrenals fail to produce enough cortisol when this happens. Therefore, the cortisol production cannot keep up with the demands for healthy body function.  The result is profound fatigue or being extremely tired all the time.

How does stress affect DHEA the hormone of vitality?

Another important hormone is DHEA. DHEA is made by the adrenal gland. It is the hormone of energy, vitality, and immunity.  When too much stress occurs, more cortisol is needed. The body “steals” from the DHEA pathway. This has several bad effects on the body. Low levels of DHEA cause fatigue and can decrease immunity. This can lead to depression and feeling tired all the time.  In addition, you will be sick with colds and flus more of the time.

Here are the Symptoms of Adrenal Fatigue.

Do you recognize yourself in the list below?

  • Are you feeling tired most of the time?
  • Do you wake up feeling tired even after a good night’s sleep?
  • Are you having difficulty rejuvenating?
  • Do you feel like you have no energy by the middle of the afternoon?
  • Do you depend on coffee to make it through the day?
  • Do you have trouble sleeping even though you’re exhausted?
  • Is your sleep less regular or restful than it once was?

Did you answer yes to these questions?

If you answer yes to any of these questions, adrenal fatigue may be your problem. The “yes” answers are messages. They are telling you that your stress is overwhelming your ability to keep up. When you learn to respond to stress correctly, you will have control of your life again. When you treat your adrenal fatigue, you will enjoy a life in balance.  You will no longer feel tired all the time. You will feel restored, renewed, and revitalized!

How Stress Causes Adrenal Fatigue.

What causes stress?

You know the things and people that leave you at the end of your rope. Perhaps you have been feeling burned out and exhausted for years. Maybe you have never felt the same after a traumatic past event.  The event could be either physical or emotional. Are you are struggling to scrape up enough energy for the simple tasks of life? Do you have a demanding job with constant pressure? Or you may be trying to balance work and family responsibilities?  Are you being the sole caregiver of a loved one? These situations can often overcome your ability to cope.  You end up pushing your stress level to the limit.

The top  chronic stressors Are:

1) Mental and Emotional Stress

2) Chronic Inflammation

3) Poorly Controlled Blood Sugar

4) Perimenopause and Menopause

As you can see, the top four stressors are both physical and mental. By the time you finish reading, you will know about these stressors. Then you can begin addressing them. You will start to feel better right now and reduce your risk of long-term illness.

What are Mental and Emotional Stressors?

Research tells us what causes a stress response.[1] The stress response happens when people’s lives are disrupted. It does not matter if it is physical, like a car accident or emotional, like the death of a loved one.  Stress is stress no matter what the cause. Constant stress that is has bad health effects.  Your healthy stress responses become unregulated and exhausted. And, sometimes, they fail altogether.

What are the four stressful situations?

Scientists who study stress say that the things that cause the most mental and emotional stress usually have four similarities:

First, people are stressed by things which are new to them. First-time experiences cause you to worry about how you will feel during that event. This causes a stress response.

Second is unpredictability which heightens the stress response. The unknown causes anxiety and stress.

Third is a threat to you physically or emotionally. You may feel threatened by being judged by someone else.

Fourth is not having control over your situation. A perfect example of this is the person in middle management. They have the responsibility of performing new tasks. The results are often unpredictable. A bad result threatens their job approval. Most of the time, they don’t have control over the results. Not surprisingly, middle managers are often considered to have the highest stress in most corporations, leading to high turn-over, burnout, and poor job satisfaction.

How does chronic inflammation stress you out?

What is inflammation? You probably know the word “flammable” which means something can go up in flames. The word inflammation comes from the Latin, inflamare, meaning “to set on fire.” In the human body, the “fire” happens in your tissues and organs where you cannot see it. It is often silent which means you don’t feel it.

“In the short run, inflammation heals injury and prevents an infection. Conversely, long term inflammation is the cause of 90% of all chronic diseases.”

Inflammation is the body’s way of responding to harm. In the short run, inflammation is good. If you step on a dirty object, inflammation heals the injury and prevents an infection.  When it happens all the time, it is a threat to your health. Long term inflammation is involved in 90% of all chronic diseases.[2] These include heart disease, cancer, Alzheimer’s disease, arthritis, and many others. Inflammation is one of the causes of adrenal fatigue.

How do auto-immune diseases, food allergies, and poor digestion cause adrenal fatigue?

Auto-immune diseases are another type of long-term inflammation.  You may have been diagnosed with one of these diseases. They cause you body’s immune system to attack itself. This put stress on your adrenals and causes adrenal fatigue.

Other causes of long-term, silent inflammation are food allergies. The most common food allergens are wheat, dairy, corn, eggs, and soy.

There are other causes of adrenal fatigue are intestinal parasites, imbalance of digestive bacteria, and an overgrowth of yeast in the intestine.

Can poorly controlled blood sugar cause adrenal fatigue?

Yes, one common cause of adrenal fatigue is out of control blood sugar.  Low blood sugar makes the adrenal glands work hard to make cortisol which raises blood sugar levels. During severe adrenal fatigue, the adrenal glands cannot produce enough cortisol. The symptoms of low blood sugar are dizziness, shakiness, and irritability. These are also symptoms of adrenal fatigue.

How do menopause and perimenopause affect adrenal fatigue?

During mid-life, women’s hormones begin to change.  This time of life is called perimenopause. During perimenopause, estrogen levels may be higher than usual.  This can cause adrenal fatigue.  When women stop producing ova (eggs), estrogen decreases, and menstrual periods stop.  This is called menopause.  The symptoms of menopause are hot flashes, night sweats, insomnia, mood swings, and feeling tired.  These symptoms are stressful and can further strain your adrenal glands.

“Loss of estrogen during menopause makes it harder to handle stress. Estrogen replacement therapy with bioidentical hormones help women handle stress.”

Moreover, some of these symptoms are the same symptoms of Adrenal Fatigue. Scientific studies have been done on estrogen and stress.  Studies show that the loss of estrogen during menopause makes it harder for you to handle stress. They also show that estrogen replacement therapy with bioidentical hormones help women handle stress better.

Is recovery possible?

This is how to recover from Adrenal Fatigue.

Recovering from adrenal fatigue depends upon you. It means changing your lifestyle, changing your relationships with other people, and taking good care of yourself.  I tell my patients to treat yourself just like you would a newborn baby–with a lot of loving care and attention. When you are tired, go to sleep. When you are hungry be sure you have plenty of healthful, nourishing food.  When you are stressed by someone’s demands, learn to say no, at least temporarily. In this way, you will slowly learn to take the stress off your adrenal glands and allow them to heal.

First change your lifestyle.

The two most important steps to take are: 1) Change your hectic lifestyle and 2) learn stress reduction techniques.

The idea here is to lower the demands on your adrenal glands.  If you continue an exhausting and demanding way of living, your adrenal glands will be constantly struggling to catch up. Full recovery will be difficult if you don’t deal with stress.

“For stress reduction, yoga, tai chi, meditation, prayer and deep breathing are proven to be effective.”

For stress reduction, yoga, tai chi, meditation, prayer and deep breathing are proven to be effective.  They are simple, and available. Other ways of lowering stress are being out in nature or doing gentle exercises such as walking. There are also many phone apps for guided imagery and meditation. All these things get you out of the “high alert” mindset.

Work with  a functional medicine practitioner.

Finding the right practitioner is key.  A Functional medicine physician or naturopath can guide you through the healing process. Recovery may take anywhere from a year to two years. It begins with discovery the root cause of your Adrenal Fatigue.

Under go testing.

To test your adrenal glands saliva, blood, and urine samples are collected. These tests can show how your glands are working. Also, testing for food allergies, parasites, yeast, and bacteria in the GI track will help to find the cause of your adrenal fatigue. Blood sugar testing, insulin levels, and Hemoglobin A1C tests will show if your sugar regulation is the problem.

Restore your hormone balance.

Part of your solution is hormone balance. The hormone DHEA is almost always low in Adrenal Fatigue.  Small doses of this hormone can cause big improvements. For those who are beginning the menopause transition, using bioidentical hormones is often important.  These hormones relieve the menopause symptoms of hot flashes, moodiness and sleeplessness.  They also improve your ability to handle stress. Working with a doctor who can prescribe these hormones is the best choice.

Begin nutritional healing.

The Adrenal Recovery Diet is recommended. This diet is high fiber and protein.  A protein shake for breakfast can make a significant difference in energy levels. This allows the adrenal glands to begin healing. It is essential to stop eating foods made with sugar and white flour. This includes avoiding high amounts of processed and refined foods. These tips help to avoid very high and very low blood sugar levels. Since extremes in blood sugar stress your adrenal glands, it is important to make these dietary changes.

Avoid caffeine which pushes your body beyond its limits.

If you are feeling tired in the morning and If you use coffee or diet soda to feel good, you are likely to feel bad about two hours later.  This is when the caffeine crash happens. If you eat a high sugar or starch breakfast, you will also feel an energy crash about two hours later. This is because your blood sugar plummets.

Start herbal healing.

A variety of herbs are known as adaptogens. These herbs help your adrenal glands be more resilient or adaptive to stressful conditions. This means that they help to restore the important brain-adrenal gland connections.

Siberian Ginseng has been used by the Russians for improved athletic and mental performance. It helps to support and rejuvenate adrenal function. It increases resistance to stress and helps keep the blood sugar level.

Rhodiola Rosea is an adaptogenic herb. This means that it helps the body adapt to stress. It increases the body’s endurance without disturbing normal functions. It improves mental clarity, memory, and work productivity. Scientific studies have shown it has an anti-fatigue effect.

Licorice root is an adaptogen. It helps keep the adrenal hormones in their more active form by preventing their breakdown.  Caution: Don’t use if you have high blood pressure.

Ashwaganda has been used in ancient Indian (Ayurvedic) medicine. It has anti-stress, antioxidant, rejuvenating, and immune improving effects. Caution: Ask for advice if pregnant or nursing. It can be also be harmful in those with high blood pressure, liver, or kidney disease.


Vitamins are essential.

Vitamins are essential your body’s production of energy.  Furthermore, the body cannot produce hormones without the help of vitamins.

Vitamin C, Vitamin E, and the B Vitamins are important in the manufacture of adrenal hormones. During times of fatigue, the adrenal glands need help. It is difficult to get enough amounts of these vitamins from our diet alone.

Use Bovine Adrenal Concentrate.


Adrenal cell extracts have been used for over 100 years. The adrenal cell extracts help to nourish and rebuild your own adrenal cells.  They are in many adrenal supplements.

It is possible to recover from Adrenal Fatigue?

Yes, it is! Finding a functional medicine practitioner is the first step. As already stated, it can take one to two years to recover from adrenal fatigue. It may even take longer for some people. You must be gentle with yourself. You must be kind to yourself. Don’t be too hard on yourself. Don’t be excessively demanding on yourself. Give yourself a break.  If you give your body and your mind the opportunity to rest and recover, you will heal.


  1. Ravindra Ganesh, MBBS, MD, Saswati Mahapatra, MS, Debbie L Fuehrer, LPCC, Levi J Folkert, BA, Whitney A Jack, RN, Sarah M Jenkins, MS, Brent A Bauer, MD, Dietlind L Wahner-Roedler, MD, and Amit Sood, MD
    The Stressed Executive: Sources and Predictors of Stress Among Participants in an Executive Health Program
    Glob Adv Health Med.. 2018; 7: 2164956118806150.
    LINK: The Stressed Executive: Sources and Predictors of Stress Among Participants in an Executive Health Program
  2. Hänsel A1, Hong S, Cámara RJ, von Känel R.
    Inflammation as a psychophysiological biomarker in chronic psychosocial stress
    Neuroscience & Biobehavioral Reviews. 35(1):115-21 · December 2009.
    LINK:Inflammation as a psychophysiological biomarker in chronic psychosocial stress
  3. Nancy Fugate Woods, PhD, RN, FAAN, Ellen Sullivan Mitchell, PhD, and Kathleen Smith-DiJulio, PhD, RN
    Cortisol Levels during the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women’s Health Study
    Menopause. 2009 Jul–Aug; 16(4): 708–718.
    LINK: Cortisol Levels during the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women’s Health Study

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