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NW Functional Thyroid Clinic


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Portland, OR 97206

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Adrenal Fatigue Syndrome

Chronic stress and inflammation can cause cortisol dysfunction


Adrenal Fatigue Syndrome (AFS) occurs when prolonged stress causes abnormal cortisol production. Cortisol often called the “stress hormone”, helps protect the body from inflammation. Chronic stress results in long term cortisol elevation which can cause even more problems.

Historically, stress has been short term resulting in a fight or flight response. Cortisol helped our ancestors survive in emergency situations. But in our modern era, we experience ongoing stress from physical, emotional, and environmental sources. Our bodies aren’t designed for this, we can experience an abnormal prolonged shift in cortisol production

Over time, the elevation in cortisol can switch from being anti-inflammatory to becoming a source of problems itself. High cortisol can lead to weight gain, hormonal problems, and mood swings. If this early stage of AFS continues, cortisol production decreases well below normal as the body loses its ability to properly regulate the cortisol stress response. 


The symptoms of adrenal fatigue syndrome and hypothyroidism are similar. Shared symptoms include fatigue, poor endurance, weight gain, depression, brain fog, PMS, low libido, and sore musclesThose with adrenal fatigue syndrome are often easily startled and cannot tolerate any form of stress. Low blood pressure and blood sugar are also common, resulting in sugar and salt cravings. It is possible to have both hypothyroidism and adrenal fatigue syndrome at the same time. This can be especially unpleasant as many cannot tolerate thyroid medication.

Learn more about Dr. Soszka’s diagnostic and treatment approach by clicking on the sections below. Using the correct adrenal testing methods reveal what’s happening with your adrenal gland function. Using individualized treatment, you can improve your adrenal health rapidly.

The Four Stages of Adrenal Fatigue

Functional medicine recognizes four stages of adrenal fatigue syndrome. Each of these stages has different but progressively worsening symptoms.


The first stage, called the alarm reaction, results in elevated cortisol due to high stress. High-stress situations that trigger stage once include moving, a new job, or an important deadline. Symptoms are usually minimal with some fatigue in the morning and afternoon. Many in stage 1 begin to rely on caffeine to get through the day. Once the stress source diminishes, most recover normally with rest.


When stress continues, prolonged cortisol triggers a worsening of symptoms. Fatigue worsens, with many feeling tired in the afternoon. Caffeine use commonly increases to keep going. Elevated cortisol increased appetite, especially strong cravings for sugar. Overeating is common, especially carbohydrate-rich foods. Weight gain around the abdomen resulting in an “apple shape” body often occurs during stage 2. Menstrual irregularities and PMS can also begin during the resistance stage.


The name for stage 3 is technically incorrect as the adrenal gland is able to produce cortisol. Instead, the part of the brain regulating hormones, tells the adrenal glands to reduce cortisol production. Chronically high cortisol causes more damage than the inflammation it was trying to control. The hormone system becomes maladapted and symptoms change as cortisol is now lower than normal.
Fatigue worsens significantly with many people lacking endurance. Weight gain in stage 2 is lost as body fat and muscle mass withers away. Along with fatigue comes paradoxical insomnia. Often called “wired and tired” because trouble falling and staying asleep becomes commonplace.


This final stage is severe and often requires the intervention of an endocrinologist. Fatigue is debilitating, most are unable to get out bed. Stage 4 is rare and not commonly encountered by the functional medicine provider.

Testing Adrenal Function

Best Methods of Adrenal Testing

Measuring cortisol fluctuations over 12 hours is key for identifying your adrenal fatigue stage. Unfortunately, the conventional medicine approach of testing blood levels of cortisol isn’t helpful for uncovering adrenal fatigue syndrome. For this reason, most practitioners miss cases of adrenal fatigue and attribute these symptoms as something else. To accurately measure functional adrenal status the savvy functional medicine practitioner will use either saliva or urine testing.

Adrenal Stress Index

Known as the Adrenal Stress Index this saliva test is considered to be the gold standard for assessing cortisol production by researchers. It has been used for the past few decades to uncover adrenal fatigue syndrome. Salvia is collected over a 12 hour period during specific times identifying the cortisol circadian rhythm. Normally, cortisol is highest in the morning and slowly decreased during the day. It is lowest at night as melatonin begins to rise. Abnormal patterns of cortisol can indicate adrenal fatigue syndrome as it advances through the four stages. This saliva test is far more sensitive than blood tests.

There are a few downsides to this test. The first is that it only collects a small percentage of cortisol that isn’t attached to a carrier protein (free cortisol). As such, it doesn’t provide a complete picture of cortisol production. The second detractor being that only 12 hours is collected, so you aren’t getting a full 24-hour cortisol circadian rhythm. Some practitioners will collect 5 or more saliva samples, especially in cases of insomnia.

24-Hour Urine Testing

Another testing method that is commonly used is the 24-hour urine collection. This test provides a complete picture of cortisol production. However, it doesn’t provide any information on the cortisol pattern over time and it is of little value other than indicating total cortisol production. Many patients find it inconvenient to carry around a large conspicuous container for a day.

Dried Urinary Testing

A newcomer to the adrenal testing scene, dried urinary testing represents a significant advanced in adrenal testing. Like the saliva test, urine is collected during specific times during the cortisol circadian cycle providing information needed to determine adrenal status. This dried urine test also provides both free and bound cortisol levels and thus a complete picture of cortisol production. This test does more, it also shows how quickly cortisol is excreted out of the body through the urine. It is superior to both of the above-listed tests and has quickly become the test of choice for practitioners in the know. Dr. Soszka uses the D.U.T.C.H. test by Precision Analytics.

Getting Answers

Using this functional approach to adrenal testing along with a comprehensive health history we get answers to several important questions about current adrenal function:

  • What stage of adrenal fatigue are you in, and how much is this impacting your health?
  • What are the sources of your stress? Are they strictly emotional? A stress inventory coupled with comprehensive labs can help determine sources of stress.
  • If you have a thyroid condition, evaluating your adrenal status can help guide treatment. Adrenal fatigue syndrome makes you more likely to react poorly to thyroid medication no matter how badly you need it.


Conventional practitioners don’t recognize adrenal fatigue syndrome. Instead, they test for signs of adrenal gland damage but fail to identify the stages of AFS. Dr. Soszka has completed advanced training in diagnosing and treating adrenal fatigue syndrome with known experts such as Dr. Dan Kalish. He keeps up to date with the latest research and treatment methods. He is an active member of the Endocrinology Association of Naturopathic Physicians.

Treating Adrenal Fatigue Syndrome

There are several key steps for recovering from adrenal fatigue. First, you must remove yourself from as many sources of stress as possible. Second, getting enough sleep is essential for recovering from adrenal fatigue syndrome. Third, use herbs to modify how your body responds to stress. As a result, you won’t be as negatively affected by stress. Fourth, address all the sources of inflammation in the body. This is often a long process depending on the cause. Fifth, make dietary changes that support adrenal function, balances blood sugar, and is anti-inflammatory. Finally, replenish all of the missing vitamins and minerals to speed recovery. These steps are not sequential but can be worked on at the same time. The speed of recovery is dependent on how ill you are and how well you are able to implement these steps.

Reduce Your Stress

Because the many forms of chronic stress are the cause of adrenal fatigue, it is vital to remove these stressors as much as possible. As previously mentioned there are three primary sources of stress; emotional, physical, and environmental. Emotional stress is most commonly associated with adrenal fatigue. Taking steps to reduce emotional stress is important and is a key component to healing from adrenal fatigue syndrome. Mind-body exercises such as yoga, tai chi, or meditation can help reduce your stress. Acupuncture is commonly used in our practice to help with this process. Likewise, completing a “stress inventory” - listing all your current stressors can help shed light on your sources and help you identify which of these sources you can change or remove.

The Importance of Sleep

Getting adequate amounts of restorative sleep is key to recovering from adrenal fatigue. Sadly in our modern age, many don’t get enough sleep at night and we’re paying for it. There are many reasons why we don’t get enough sleep, but if you can make changes to improve your sleep quality, you owe to yourself make those changes. Poor sleep can be a trigger for adrenal fatigue. More advanced cases of adrenal fatigue syndrome often result in insomnia, because of cortisol rhythm imbalances. In these instances, supplements can help address this issue.  

Improving Stress Response

Poor stress tolerance is common in adrenal fatigue syndrome and often causes a vicious cycle of progressively worsening stress. Thankfully, there are herbs, called adaptogens that help rebalance how your body responds to stress. As a result, you are less impacted by stress and you feel more capable of facing your day. These adaptogenic herbs can also help improve energy. Deciding which combination of herbs are best suited to your needs depends on which stage of adrenal fatigue you are experiencing.

Hidden Sources of Stress/inflammation

While emotional stress could be the sole cause of adrenal fatigue, it is usually accompanied by another trigger. So it’s important to remember that inflammation triggers overproduction of cortisol, not just emotional stress. So, it’s also important to uncover and address these sources of inflammation, if present. This can be as varied as digestive imbalance, toxic exposures or stealth viral infections. This step can involve a bit of detective work, but a carefully documented health history along with a thorough exam and comprehensive testing can uncover your root cause(s). Additionally, since the endocrine system is so connected, the root causes of a thyroid disorder can also cause adrenal fatigue syndrome. 

Adrenal-Friendly Diet

Dietary changes are key for recovering from adrenal fatigue. Cortisol not only responds to stress and inflammation but also to how much sugar in the blood. Many with AFS experience blood sugar crashes between meals. This causes symptoms of fatigue, irritability, and sugar cravings. Sugar-rich snacks are often sought out as a “quick-pick-me-up”. But ultimately, this makes things worse, resulting in a “blood sugar rollercoaster”. Likewise, most have increased inflammation in their bodies as an initial trigger for AFS. Therefore, it only makes sense that switching to an anti-inflammatory diet is important for recovery. 

Replenish Nutrient Deficiencies

Vitamin and mineral deficiencies are common in AFS. The deficiencies vary from person to person, but most commonly both B and C vitamins are needed. Magnesium is also often low in the AFS population. In most cases, therapeutic doses of these vitamins and minerals are needed to get the desired results. Ultimately comprehensive testing is needed to identify the individual deficiencies.  

How Dr. Soszka Can Help You

Dr. Soszka has completed advanced training in diagnosing and treating Adrenal Fatigue Syndrome with the University of Functional Medicine and Dr. Dan Kalish. He also recognizes and uses the approaches of Dr. Michael Lam and Dr. Alan Christianson. Dr. Soszka has been helping people successfully recover from AFS for nearly 20 years.

Are you ready to find real answers to your health problems?