Your adrenals are a pair of endocrine glands located on top of your kidneys and they produce cortisol and DHEA. The levels of cortisol throughout the day follow a specific rhythm which can become thrown off by insomnia, stress, chronic infection, inflammation and other hormonal imbalances. Proper levels of cortisol at key times of the day are essential for protein metabolism, sugar metabolism, blood sugar control, fat metabolism, maintenance of muscle tissues, heart function, and controlling inflammation. Irregular, low or elevated cortisol levels allow chronic infection to persist in the body, increase sugar cravings, weight gain, hair loss, and feelings of exhaustion and persistent fatigue.


Stress elevates cortisol levels and when prolonged can cause impaired cortisol receptor sensitivity, leading to blood sugar irregularities such as insulin sensitivity, syndrome X, and slow non-symptomatic brain damage (hippocampus). Elevated cortisol levels over time lead to adrenal glad exhaustion.

Chronic stress throws off the feedback function between the hypothalamus, pituitary and adrenal glands, elevating cortisol levels until the adrenal gland goes into fatigue and then exhaustion. Elevated cortisol levels especially in the morning and before bed at night contribute to depression. A study performed in 1992 found approximately 60% of Schizophrenics with abnormal cortisol rhythm. (Neuropsychobiol 1992:25:1-7)


Low cortisol function can result in feeling weak, tired especially after meals, or simply exhaustion. Exercise makes the person feel more tired. There may be low grade nausea and lack of appetite in the morning. Constipation, or slow bowels, abdominal pains,  diarrhea, or irritable bowel can be experienced. Cravings for salt are common as well as sugars especially during mid-afternoon when adrenal function first begins to become low. Postural dizziness may be accompanied by feelings of low blood sugar. Thinning of the hair, and hyper-pigmentation of the skin can result when cortisol levels stay chronically low. Insomnia, and excessive dreams or nightmares can result with prolonged REM stage sleep the result of low cortisol levels.


Elevated cortisol can make a person feel hungry all the time or only late at night. You can feel wired and tired, unable to rest. Headaches become more common as well as elevated blood pressure. Anxiety can increase as can cravings for alcohol or smoking to calm the nervous system. Weight gain around the stomach can be seen. Aggressive behavior, increased frustration, short temper, and irritability are common. Increased risk of heart attack, myocardial hypertrophy and atherosclerosis driven by increased inflammation. Thyroid function can become suppressed and insulin resistance and syndrome X can develop. Low progesterone and certain estrogens in menstruating women can also result from elevated cortisol’s effect upon accelerated consumption of progesterone. Elevated cortisol also is a key factor in causing osteoporosis! It contributes to calcium mal-absorption.


Over-secretion of cortisol in response to stress or infection will create symptoms of fatigue and exhaustion, depression, low blood pressure, weight loss, reactive hypoglycemia, and low buffer for stress. When chronic fatigue patients are tested, their salivary cortisol levels are often LOW, indicating mal-adaption phase, adrenal fatigue, or a stage of adrenal exhaustion. Persistent low cortisol levels significantly impairs immune system function such that many chronic fatigue patients show elevated immune titers to viral antigens such as Epstein Barr, cytomeg., echo virus, rocky mountain spotted fever, and coxsackie virus. 

Does adrenal exhaustion cause chronic fatigue? The clinical picture of many patients suffering persistent exhaustion lasting six months or longer is one of increased extra cellular toxicity, impaired detoxification pathways, impaired cell membrane repair, chronic viral titers and intestinal dysbiosis. Chronic toxicity and infection wear the body down and wear down the adrenals. By the time a chronic fatigue patient suffers symptoms of sugar sensitivity, fatigue especially after eating a meal with carbohydrates, their cortisol function is already low. A vicious cycle begins and low cortisol from exhausted adrenal function then results in lowered immune function. The patient continues to deteriorate in energy, sugar metabolism, immune system function, digestion and hormone metabolism.

Simply giving such a patient cortisol can make the patient feel better for a SHORT time only. Some patients given cortisol will feel worse almost immediately. This is due to their immune system’s response to cortisol. Whenever the immune system is hyper-vigilant, it will develop a recognition to something. The development of immune recognition to one’s own cortisol is very common. One can also develop an immune recognition to metabolites that are involved in the synthesis of cortisol. Therefore, if one is then given additional cortisol to increase low cortisol levels, this can trigger an immune system activation and increase inflammation in the body, triggering more fatigue, body pains, low grade fevers and digestive symptoms. The other down side to taking cortisol is that it makes the body dependent upon receiving cortisol rather than making its own. Lastly, taking cortisol supplementation at the wrong time of day can actually make your cortisol levels more imbalanced!

In order to help the adrenals to manufacture cortisol, the underlying cause of adrenal exhaustion must be addressed. This means that titers for viral infection musts be reduced. Western medicine uses drugs to suppress viral action in the body. This does not eliminate the virus from the body. However, serial dilution homeopathics from a trained medical practitioner are very effective in helping the body eliminate virus. It can take 3-6 months but it addresses the cause of the problem. Eliminating chronic low grade bacterial infection in the digestive track such as clostridium, staph and all forms of strep are also essential. Eliminating candida and fungal strains in the digestive tract are also necessary.

During the phase of pathogen elimination, one may need to take cortisol as a “crutch” per se to boost one’s immune system function but only if one’s inflammation markers are carefully monitored. As the digestion of the patient improves, the patient will be able to take herbs that help the adrenals synthesize cortisol and assist in re-setting the glucocorticoid receptors in the brain and body. The patient should have their salivary cortisol levels re-tested every 60 days to make sure the therapy is effective and to prevent low cortisol levels from becoming elevated!


The first step is to determine your cortisol rhythm. A salivary cortisol test is essential and preferred over a blood test for cortisol. Saliva tests the unbound free form bio-available cortisol and tests it to the biorhythm of the day. Knowing what your cortisol level is at specific times of day is crucial to understanding when your blood sugar regulation is more at risk, why you are likely to feel fatigue, or hunger, and WHEN TO TAKE adrenal supporting supplements! You can do this test in your own home and mail the results out. A graph showing your cortisol rhythm will be prepared in two weeks by Diagnos-Techs. available online at at their online store under Labs (Cortisol/Saliva Test – Diagnos-Techs,Inc. SKU: SKU16265). The cost of the lab includes a consultation with a medical health care practitioner from Immune Matrix.

The second step is to obtain information of the degree of dysbiosis from your digestive tract. This test will identify and quantify the good probiotics, the pathogenic bacteria, candida, yeast and fungi living in your digestive tract and test them for resistance to prescription and non-prescriptive agents to eliminate them. This test is available online at at their online store under Labs (Microbiology Stool (Doctor’s Data) SKU: SKU16263. Immune Matrix is making these tests available online because of the depth of information it tells the patient and because many patients do not know a practitioner that can make such tests available to their patients.

The third step is to meet with your medical health care provider to have blood tests run for immune titers for suspected viral infections. Future articles will discuss what patients can do on their own to support proper immune function specifically addressed to fighting chronic viral infections.

Armed with the knowledge of what your cortisol values are throughout the day, the fourth step is to begin a course of therapy to strengthen your adrenals. Working with an experienced medical practitioner in this regard is essential. However, there is much you can do in your lifestyle to support improved adrenal function.

If you have low cortisol:

a)      do not eat carbohydrates or high glycemic foods on an empty stomach

b)      add a sugar digestive enzyme to your meals to improve your sugar metabolism

c)      add BenaGene to each meal to improve insulin resistance

d)      eat protein with each meal, and snack

e)      do not skip breakfast, and include protein at breakfast

f)        Walking is the best exercise. If you are able to do more aerobic exercise, watch your fatigue level after your workout. If your fatigue does not resolve within 2 hours after a workout, then you have done too much and are at risk of weakening your adrenals from too strenuous exercise.

g)      Go to bed at a regular time, no later than midnight.

h)      Do not engage in mentally stimulating work an hour before bed. This means no internet surfing, video games, stressful tv shows, news etc before bed.

i)        Have a small protein snack 2 hrs before bed to help maintain your blood sugar while you sleep.

j)        Sleep in an entirely dark room, no night lights, no lights from alarm clock. This will help your body optimize melatonin, growth hormone and other essential hormone synthesis.

k)      Manage your stress and remove yourself from stress for brief periods when you can, to preserve your cortisol levels.

l)        When you feel yourself become fatigued, take a 15 minute timed break. Lay down on the floor with feet propped up on the chair. Close your eyes but do not let yourself rest longer than 15 minutes. This will help refresh your adrenals as if you had an extra hour of sleep in the day. Doing this when your cortisol function is the lowest in the day will help to regenerate them.

If you have elevated cortisol, you need to pay attention to what time of day the cortisol is elevated.

a)      avoid eating carbohydrates during the elevated cortisol times of day and watch the amount of carbohydrates you are consuming, keeping it to the size of the palm of your hand

b)      avoid stimulants like coffee, tea, chocolate, alcohol, during high cortisol times

c)      monitor your stressors during that time of day when your cortisol is elevated to become aware of what is driving your cortisol

d)      phosphotidylserine helps to detoxify excess cortisol, so taking it as a supplement at the time of day when your cortisol is elevated will help to bring it down, but only if you find the source of why your cortisol is elevated

e)      at least one hour before bedtime avoid overstimulation by TV, family stress or exercise

f)        2 hours before bedtime have a small protein snack

You can coach your adrenals back into balance. The more chronic your condition, the longer it can take but having a program guideline and getting your salivary cortisol levels checked every 60 days will keep you on target with your goal. Chronic infections complicate the regeneration of your cortisol rhythms, but to ignore your adrenal function during chronic infection is to risk lowered immune system function. The above information should give you adequate information to make well informed decisions about your adrenal function.

Please note:
Information on this site is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information on this site for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment.

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Anna Manayan

Anna Manayan