Adrenal Gland Health, supplements, vitamins, herbs for adrenal fatigue and disease by Ray Sahelian, M.D.
What are the benefits of adrenal cortex extract supplements, are they helpful?
April 22 2014

The adrenal glands are the triangle-shaped glands that rest over the kidneys. Two hormones made by this gland are available without a prescription, they include DHEA hormone and pregnenolone. Their main function is to regulate the stress response through the making of corticosteroids and catecholamines, including cortisol and adrenaline. They work with the hypothalamus and pituitary gland. The hypothalamus produces corticotropin-releasing hormones, which stimulate the pituitary gland. The pituitary gland, in turn, produces corticotropin hormones, which stimulate the adrenal glands to produce corticosteroid or steroid hormones. Both parts of the glands -- the adrenal cortex and the medulla -- perform separate functions.

Adrenal fatigue diagnosis
"I have adrenal fatigue" is a common self-diagnosis presented to me by patients who attribute their various health conditions to this malfunction of their adrenal glands. Patients assume the cause of their low mood and energy, tiredness, or other symptoms, is due to malfunction of their adrenal glands although the cause of their symptoms may be from quite a different source. See
fatigue for possible causes of low energy and steps you can take to improve your vitality. Unless a person has complete and reliable adrenal gland lab study evaluations that show clear problems with these glands, it would be premature to claim that their symptoms have to do with malfunction of these glands.

Definition, what is it?
Adrenal fatigue is a term used by laypeople and certain non- M.D. healers. Sometimes the term is used when there are actual blood studies that show a person has an adrenal insufficiency, but most often the term is used by people who are tired and believe their fatigue is due to inadequate production of hormones and substances by the adrenal glands. There are many other causes for fatigue and it is easy to blame the adrenal glands which is commonly done by laypeople and certain nutritionists and non M.D. doctors and healers.
   I prefer to use the term adrenal fatigue only when actual blood studies show an adrenal hormone deficiency. However, there may be cases of mild adrenal gland insufficiency which is not easily diagnosed by blood studies and in these cases one could loosely use the term adrenal fatigue. This may occur after periods of intense or prolonged physical or emotional stress, although in these cases other organ systems and tissues are likely to be affected too, not just the adrenal glands.

I have adrenal fatigue. My saliva tests indicates my afternoon to early evening cortisol is really low and my evening to early morning cortisol too high (insomnia and hot flashes). I have been taking phosphatidylserine in the morning for other condition prior to this test. I read somewhere that phosphatidylCHOLINE can raise cortisol level (which I sure could use to help me get thru the p.m. drags) What do you know of this and how much, and when, would you recommend I take? Also, do I keep taking the phosphatidylserine in the a.m.?
   The human body and hormonal system is very complicated and rather than focusing on one hormone (whose levels can fluctuate hour by hour and day by day, not even considering that different labs can give different results with the same blood sample), one needs to take a more comprehensive approach with diet, exercise, yoga, good sleep habits and a number of other factors that influence energy levels.

Vitamins
Adrenal gland and vitamin C
Human adrenal glands secrete vitamin C in response to adrenocorticotrophic hormone.
American Journal of Clinical Nutrition 2007. From the Molecular and Clinical Nutrition Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; the Diagnostic Radiology Department, Clinical Center, National Institutes of Health, Bethesda, MD; the National Heart, Lung, and Blood Institute, Bethesda, MD; and the Developmental Endocrinology Branch, National Institute of Child Health and Human Development, Bethesda, MD.
The purpose of this study was to determine whether paracrine secretion of vitamin C from the adrenal glands occurs.
During diagnostic evaluation of 26 patients with hyperaldosteronism, we administered adrenocorticotrophic hormone intravenously and measured vitamin C and cortisol in adrenal and peripheral veins. Conclusions: Adrenocorticotrophic hormone stimulation increases adrenal vein but not peripheral vein vitamin C concentrations. These data are the first in humans showing that hormone-regulated vitamin secretion occurs and that adrenal vitamin C paracrine secretion is part of the stress response. Tight control of peripheral vitamin C concentration is permissive of higher local concentrations that may have paracrine functions.

Herbs
Could maca herb be of benefit?
   Maca root can improve energy levels but one has to determine the cause of fatigue before starting any kind of treatment.

Hormones available over the counter
Q. Would DHEA hormone or pregnenolone be helpful supplement hormones in those with adrenal gland disease?
   A. If the adrenal gland disease is Addison's disease, then DHEA could be helpful. Perhaps pregnenolone could also be quite helpful although research is quite limited with this hormone in relation to adrenal gland disorders.

Adrenal insufficiency from Addison's Disease
Addison's disease (or adrenal insufficiency) usually results from an autoimmune response that destroys the adrenal glands. The symptoms of Addison's disease are loss of appetite, weight loss, fatigue, weakness, vomiting, nausea, and diarrhea. Other signs include a suntanned appearance, intolerance for stress, and a craving for salty food. The treatment of Addison's disease entails lifelong replacement of the steroid hormones produced by the adrenals, usually with hydrocortisone or cortisone.

Adrenal Insufficiency - exhaustion
Defective production of adrenal steroids due to either primary adrenal failure or hypothalamic-pituitary impairment of the corticotrophic axis causes adrenal insufficiency. Depending on the etiologies of adrenal insufficiency, clinical manifestations may be severe or mild, have gradual or sudden onset, begin in infancy or childhood/adolescence. Adrenal crisis represents an endocrine emergency, and thus the rapid recognition and prompt therapy for adrenal crisis are critical for survival even before the diagnosis is made. The recognition of various disorders that cause adrenal insufficiency, either at a clinical or molecular level, often has implications for the management of the patient.

Adrenal gland disorder - dysfunction
Cushing's Syndrome is an endocrine disorder caused by excess corticosteroid hormones produced by the adrenal glands.

Adrenal gland tumor - cancer
These types of tumors can be benign or malignant. They arise from either the adrenal medulla or the cortex. The three common adrenal tumors are Pheochromocytomas, Paragangliomas and Adrenocortical carcinoma. These cancers may produce excessive quantities of hormones such as cortisol or aldosterone.

Adrenal gland disorders
There are several conditions that are classified as such. These include:
Addison's disease
Congenital adrenal hyperplasia
Cancer
Adrenal insufficiency
Pheochromocytoma
Neuroblastoma

Adrenal adenoma
Adrenal surgery is necessary for the management of functioning tumors, such as aldosterone -producing adenoma, cortisol -producing adenoma, and pheochromocytoma.

Congenital adrenal hyperplasia
Congenital adrenal hyperplasia is an adrenal disease that affects adrenal gland function, resulting in abnormal steroidogenesis caused by a deficiency or complete lack of the enzyme 21-hydroxylase (accounting for 90% of CAH cases). Clinical manifestations include ambiguous genitalia in female newborns and life-threatening salt-wasting crisis in both male and female newborns.

Adrenal mass
The detection of adrenal lesions has increased with the wider use of cross-sectional imaging. Magnetic resonance (MR) imaging is often useful for characterizing adrenal masses. Adrenal masses can be classified into various groups on the basis of the presence of intracellular lipid, macroscopic fat, hemorrhage, and cystic changes and the vascularity and shape of the tumor. Some adrenal masses include adenoma, adrenal hyperplasia, simple and complicated cysts, lymphangioma, myelolipoma, pheochromocytoma, hemorrhage, cortical carcinoma, neuroblastoma, lymphoma, and metastases. Adenomas and metastases are common.
adrenal support.

Adrenal Disease and Intelligence
Women born with adrenal disease often show impairment of mental function. Adrenal "hyperplasia" encompasses a group of inherited disorders in which the adrenal glands produce inadequate levels of steroid hormones. Although adrenal disease can have serious, even fatal consequences, it can be effectively treated with hormone replacement. Researchers enrolled 35 women between 17 and 51 years old born with adrenal disease and the same number of healthy comparison subjects from the general population. They were tested using an abbreviated form of the Wechsler IQ test. Congenital adrenal disease patients had a significantly lower overall IQ score than did healthy subjects. This was also true of verbal IQ and performance IQ.

Emails
Q. I bought a product that claims it is an adrenal gland support formula. Do these adrenal gland products work?
   A. There are many herbal supplement products that claim to support the adrenal gland. I am not sure exactly what is meant by the term "adrenal gland support." I am not aware of any studies where an "adrenal support" product was given to a group of volunteers and then their adrenal gland hormones measured to see if the product boosted an adrenal gland hormone deficiency.

Q. I just signed up for your newsletter. I am researching the phrase ' elevated cortisol and adrenal burnout'. I have seen the phrase used frequently as well as 'adrenal fatigue.' What do people mean by adrenal fatigue?
   A. See the above full discussion on the term adrenal fatigue. Adrenal burnout is another term used by laypeople to mean the general understanding of adrenal insufficiency.

Q. I read your articles on Pregnenolone and DHEA. Just a word of caution from my experience. I took 25 mg of Pregnenolone along with my other vitamins and a dose of Raw Adrenal Cortex from Enzymatic Therapy. The combination of Adrenal Cortex (freeze dried beef adrenal glands) and Pregnenolone produced a dangerous asthma-like allergic reaction and it was hard to breathe. My face puffed up and I started wheezing and gasping for air. It was very frightening. I had to take anti-histamines (Diphenhydramine 25 mg) to quiet it down again. DHEA has not had that reaction, but now when I do Adrenals, I only add a multi-vit and nothing else at the same time. Alone, each of these two supplements give me substantial benefits. But they should never be taken together. I suspect they both act on the adrenal glands and produce too much stimulation which results in an allergy-like reaction. One interesting result I had with the Adrenal Gland supplements - they closed the chapter on chronic sinus problems I've had since childhood. No more sinus issues. A permanent recovery. I took one bottle as directed, from Enzymatic Therapy "Raw Adrenal II" or similar product. This was a significant benefit.

Q. Would it be possible to use pregnenolone supplementation to give overworked adrenals a break? If so what might be an intelligent way to do it?
   A. We are not sure what is meant by overworked adrenal glands, this is something that is determined by blood tests not necessarily general symptoms which can be due to a number of other organ failures or problems.

Q. If someone has adrenal fatigue (low saliva cortisol all day), but yet their serum levels of DHEA have always been in a moderately high normal range for several years does that mean that pregnenolone is not needed since the DHEA is in a sufficient range. Can one have adequate DHEA and still need pregnenolone? Which is the best way to test the pregnenolone levels-saliva or serum?
   A. I don't consider the term " adrenal fatigue " very helpful for diagnosis or treatment. I prefer treating and evaluating the whole person and the symptoms and signs a person has rather than overly focusing on levels of hormones or blood studies. If adequate DHEA levels are present, then it is likely that adequate levels of pregnenolone are also present. Blood levels of pregnenolone are more consistent and easier to interpret than saliva levels.

Q. Do you have any type of adrenal supplement or adrenal support medicines?
   A. The term adrenal support is quite vague.

Q. What is the recommended dosage of the adrenal cortex extract for adrenal support. I am 135lbs.
   A. There are a number of adrenal cortex extract supplements on the market, each one is different in what they contain. Plus, I am not sure what people mean by adrenal support. If a person has fatigue, click the link provided at the top of the page to learn more about the various causes of fatigue and natural treatment options.

Q. One more question...is there any rebound from stopping Adrenal Cortex Extract? When my daughter took prednisone for hives and stopped the hives came back. Has you seen good results with Adrenal Cortex extract?
   A. There are dozens of different adrenal cortex supplements on the market, each with a different composition and strength. Adrenal cortex extract supplements are not standardized as a specific mg dosage of prednisone. The effect of an adrenal cortex supplement from one company may be different than the effect from another company. Adrenal cortex extract does not have the same effect as prednisone.

Q. Iíve been tested for adrenal fatigue via saliva tests twice in the past 6 months and results are severe. However I have had the symptoms for 4 years now. My blood work DHEA is very low. My chiropractor is the only one helping me because I canít fine a M.D. who even knows what adrenal fatigue is to help me. My chiropractor has his limitations however and I am researching myself the best I can. Everything says to take pregnenolone and DHEA for adrenal support, but you warn extensively about this, yet I cannot find any information on your site what is recommended for adrenal insufficiency instead. Please, please offer me some guidance or direction of some kind.
   A. Fatigue is due to many causes, not just the adrenal glands. The diagnosis of adrenal fatigue is commonly given by some doctors as an easy way to comfort a patient who is seeking any answer for their fatigue.

Q. This is an inquiry regarding adrenal gland function. Iíve recently heard on the adrenal fatigue forum, from other posts, that excess vitamin C can reduce cortisol levels? I have very severe adrenal exhaustion, so bad, Iím seeing an M.D. who also uses alternative and specializes in adrenal fatigue. In the meantime, Iíve been taking pantothenic acid, adrenal glandular and vitamin C in doses of 1,000-2,5000 mg. a day. Can this in turn, put to much stress on my already weakened adrenals, since excess vitamin C lowers cortisol levels? Iím confused. The majority of sites Iíve seen recommend to take 1-2 grams of vitamin C a day For adrenal fatigue. But, then Iíve also heard that in very severe adrenal fatigue, to much vitamin C can put more stress on the glands. Is this true? I just finished a saliva cortisol adrenal stress index test today and will have it in the mail tomorrow ( ZRT lab). Oh, I would so much like to hear what you may have to say on this?
   A. It is unlikely that 1 or 2 grams of vitamin C a day would have a significant an influence of cortisol levels. There is little evidence that taking more than one gram or 2 of vitamin C a day provides benefits not achieved with lower amounts such as 500 mg.

Just thought you would like to know that I experienced a very itchy rash on my legs & arms from a product with inulin in it.  I have read about anaphylactic reactions. This thing had me scratching to bleeding. I had on this fine product before without problems---however, it was just reformulated with inulin. Not really necessary, since I can't take it now. it's something I still really need for my adrenal fatigue, but now it's worthless to me. It is Dr James Wilson's 'Adrenal Rebuilder, it has always been a great product. I''ve taken it before w/o a problem. But now they added inulin, which is just not needed---it worked great before. Now, I have no product to take. I'm not an 'allergic' type person either---I can take anything & eat everything, but this is a real problem---I stopped it & the itching stopped. I attempted one more time, & the rash/itching started again, so I know it's the inulin. I've done nothing else different. I sure hope they'll go back to the prior formulation. I'm sure I won't be the only one who reacts.
    It's possible that other changes were made to the product, I am not yet ready to blame it on the inulin based on one report.

Can you please find out what the BEST product for me to take to help cleanse the Adrenal Glands would be. I have searched endlessly. I would really, really appreciate his input, suggestion OR opinion.
    We have no idea what is meant by cleansing the adrenal glands.

I have been working with a homeopath for years. Unfortunately he relocated to another state. This week I went to see a chiropractor for nutritional counseling for adrenal fatigue. In the past I have always used Standard Process products. The new chiropractor sells standard process (which is why I chose her) but she told me that I should try Maxnfuse and and Cellgevity by Max Intl. I am hesitantto switch over because I have to join a loyalty program to get more affordable pricing. Do you have a preference or could you steer me in the direction ofwhere to look for sound advice for adrenal fatigue? Also, she used something called neurolink. What is your opinion on that as a diagnostic tool? She also suggested I get involved with Life Wave patches which is a multi level company.
   Frankly I do not keep up with products made by other companies so I don't know how effective they are or their quality control.