The Thyroid-Adrenal-Pancreas Axis

In addition to gastrointestinal and blood sugar disorders, adrenal gland dysfunction is the most commonly seen imbalance in today’s society.  Adrenal gland imbalances are also one of the major factors that cause thyroid hormone imbalance.  Stress from work, relationships, electronics, poor diet choices such as consumption of refined carbohydrates and trans fats, infections, and environmental toxins all contribute to adrenal disorders.

The Adrenal Glands

The adrenal glands are about the size of a walnut and lie on top of the kidneys.  The outer adrenal cortex comprises eighty percent of the gland and produces many hormones including cortisol and DHEA from cholesterol.  Ninety percent of the cholesterol in the body is made by the liver and only ten percent comes from the diet.  Cholesterol converts into the hormone pregnenolone in the adrenal cortex which then converts to cortisol, the stress hormone, or DHEA, the sex hormone source, immune enhancer and anabolic.  Cortisol is our “fight or flight” stress hormone.  Cortisol slows down digestion, suppresses immune function and raises blood sugar as a survival mechanism when we are under stress.  The problem arises when this becomes chronic and over time, elevated cortisol will tear down your body.  Cortisol is secreted on a circadian rhythm with highest production in the morning that slowly tapers off as the day progresses.  Sleep is when our bodies repair and rejuvenate but high cortisol during sleep will prevent this from happening. 

Hormones Secreted by the Adrenal Glands

DHEA
DHEA (dehydroepiandrosterone) is a precursor to estrogens, progesterone and testosterone.  DHEA is extremely important for immune system function and anabolic (building up) processes in the body.  DHEA levels begin to decline after age thirty-five but cortisol can remain elevated during continuing periods of stress.  Low DHEA levels are also found in diseases such as multiple sclerosis, cancer, fibromyalgia, lupus, rheumatoid arthritis, Crohn’s, ulcerative colitis and of course, thyroid disorders.

Healthy adrenal glands are required for the conversion of inactive T4 into active T3. 
When the adrenals have reached a state of fatigue, they are no longer producing sufficient cortisol or DHEA.  This leaves individuals more susceptible to chronic diseases from an inability to compensate for the stresses they encounter on a daily basis.  It is very important to treat the adrenal glands before commencing treatment of the thyroid.  Increasing thyroid hormone production while the adrenals are in fatigue can overwhelm the adrenals and lead to further exhaustion.  I have found that once the adrenal glands are healthy and the other related system/factors associated with thyroid imbalance are optimized, there is no need to treat the thyroid directly.
 
The inner medulla produces adrenalin and noradrenalin also known as norepinephrine and epinephrine.  The cortex is under the control of hormones produced in the brain and the medulla is under the control of the nervous system. 

Healthy adrenal glands are vital for women who are peri- and post-menopausal.  The adrenal glands are responsible for producing the majority of sex hormones in a menopausal woman once the ovaries stop functioning.  If the adrenal glands are fatigued and not ready for menopause, there will be an exaggeration of menopausal symptoms such as hot flashes, weight gain, sleep problems, bone loss, mood swings, depression, anxiety, loss of sex drive and vaginal dryness.  Healthy adrenals ensure an easy transition into menopause and beyond.  A vast majority of the women I see in practice approach menopause with adrenal fatigue leading to severe menopausal symptoms and hormone dysfunction.

Aldosterone
Aldosterone is produced by the cortex and causes sodium absorption and potassium excretion.  Low salt diets and high water intake put a major stress on the adrenal glands to retain as much salt as possible as the blood becomes more diluted from the extra water intake.  One of the easiest ways to maintain healthy adrenals is to consume a half- teaspoon of unrefined celtic sea salt every morning with a few glasses of water.  It’s important to consume half of your bodyweight in ounces of water every day but it must be balanced with salt to remove stress from the adrenal glands.

Cortisol
Cortisol is also produced by the cortex which increases blood sugar when it is low or if the body is under stress.  Cortisol will cause glucose production in the liver or it will strip muscle tissue of protein to make glucose.  Excess cortisol over long periods of time can increase the risk of diabetes due to prolonged blood sugar elevations.

Adrenaline
Adrenaline produced by the adrenal medulla will also raise blood sugar if there is stress on the body.  Adrenaline will also increase fat circulation so that it can be burned as energy.  This is not a good scenario for someone who is sitting at a desk and under major stress.  Large amounts of fat and sugar floating in the bloodstream should be utilized to run from a saber-toothed tiger which is our built-in survival mechanism.  If there is no activity, the excess sugar will be converted into fat and stored mainly around the mid-section, hips and thighs.

The adrenal cortex communicates with the pituitary gland and hypothalamus in the brain.  The hypothalamus reads the amount of circulating hormones and tells the pituitary to make hormones that directly tell the cortex to make hormones.  This is called the HPA axis or hypothalamic-pituitary-adrenal axis.

All hormones are secreted on a circadian rhythm over a 24-hour period.  Cortisol is especially representative of this rhythm as cortisol production is the highest in the early morning and then slowly tapers off as the day progresses.  Cortisol levels are lowest at night so that the body can repair itself to the best of its ability.  You lose two-thirds of your stored sugar while sleeping and cortisol production ensures balanced blood sugar during the night.  If the adrenals are fatigued, you may have trouble staying asleep as the body will make adrenaline to raise blood sugar due to inadequate cortisol production which is enough to wake you up.  If your adrenals are in overdrive with too much cortisol production, then you probably have trouble falling asleep.  If you are a slow starter in the morning, your adrenals are probably fatigued and can’t make adequate cortisol to raise blood sugar and get you going in the morning.
 
The adrenals will go through phases of adaptation to stress beginning with elevated cortisol due to the initial stress.  In the second stage, the adrenals will begin to use sex hormone precursors to make cortisol and DHEA will drop.  The final stage is adrenal exhaustion/fatigue when the adrenals can no longer produce cortisol and DHEA.  If you have adrenal gland dysfunction you may have the following symptoms:

  • Can’t fall asleep
  • Can’t stay asleep
  • Fatigue
  • Salt or sugar cravings
  • Allergies
  • Slow to start in the morning
  • Headaches
  • Weakened immune system
  • Ulcers
  • Need to eat to relieve fatigue
  • Irritable before meals
  • Shaky or lightheaded if meals are missed
  • Blurred vision
  • Crave caffeine or cigarettes
  • Feeling full or bloated
  • Dizziness
  • Asthma
  • Varicose veins
  • Hemorrhoids

Remember that the hormone aldosterone made in the adrenal cortex regulates blood volume through sodium retention and potassium excretion.  If you have the following symptoms you have low aldosterone levels indicating adrenal gland dysfunction:

  • Craving salt
  • Fluid retention in the arms and legs
  • Pupils do not stay constricted when exposed to light
  • Rough or sandpaper tongue
  • Excessive urination – up to 15-20 times/day
  • Excessive sweating even without activity

Your natural physician will order a salivary hormone profile to measure cortisol production at four different times throughout the day.  This allows your physician to observe adrenal gland dysfunction during all parts of the day and will dictate the type of treatment you will receive.  Symptoms cannot adequately diagnose if the adrenals are in fatigue or if they are hyperfunctioning.  This is why testing is so vital to properly assess adrenal gland function.  In addition, it gives a baseline to compare to follow-up testing so treatment can be adjusted accordingly.

Blood sugar is intricately related to adrenal gland function and vice versa.  Chronically elevated cortisol levels from adrenal stress will cause insulin receptor insensitivity.  This basically means that when insulin binds to cell receptors to allow glucose (blood sugar) entry into the cell, the receptors may not respond which leaves sugar floating in the blood stream.  Remember that excess sugar will be converted into fat and stored mainly around the abdomen, hips and thighs.  This also puts extra stress on the pancreas to make more insulin to deal with the excess blood sugar which increases the risk of diabetes.  As discussed earlier, cortisol is very important for blood sugar stability. 

Hypoglycemia is a condition in which there is inadequate cortisol to raise blood sugar into the normal range.  We usually see adrenal fatigue and hypoglycemia together.  Hypoglycemics develop symptoms of low blood sugar and need to eat something to normalize blood sugar levels.  They may feel shaky, irritable, light-headed, fatigued or may crave sugar because their adrenal glands cannot raise blood sugar into the normal range.  Once hypoglycemics rejuvenate their adrenal glands, the symptoms will subside.  It’s important for hypoglycemics to eat frequently throughout the day and not skip meals.  Each meal should be a combination of protein, carbohydrates and fats as a low-carb meal or too many carbs will further throw off blood sugar levels.

You may ask which comes first – adrenal dysfunction or blood sugar dysfunction?  It doesn’t matter because when one starts to become imbalanced so goes the other.  This is also important to understand in treatment because both aspects should be addressed at the same time for optimal results.

So how does all this relate to optimal thyroid function?  In the chapter on thyroid hormone physiology, we discussed the enzyme that converts inactive T4 (thyroxine) into active T3 (triiodothyronine).  Remember that 93 percent of the hormone produced by the thyroid is inactive T4 until it is activated mainly in the liver by an enzyme.  Cortisol directly inhibits this enzyme (5’-deiodinase) which converts inactive T4 into active T3.  This in part can lead to low T3 levels.  In addition, elevated cortisol will cause thyroid hormone receptor insensitivity meaning that even if T3 levels are adequate, they may not be able to bind normally to receptor sites.  Cortisol will also increase the production of reverse T3 which is inactive.  Cortisol can also lower the levels of protein that binds to thyroid hormone so it can circulate in a stable structure.  Iodine, as you know from a previous chapter, is extremely vital to thyroid health but high levels of cortisol will increase the excretion of iodide from the kidney.  And finally, elevated cortisol will inhibit TSH (thyroid-stimulating hormone) production by disrupting hypothalamic-pituitary feedback leading to suboptimal TSH production in the range of 1.0-1.5.  Has your physician adequately assessed your adrenals before treatment?  It is very irresponsible for any physician to treat thyroid hormone dysfunction without thoroughly assessing adrenal gland physiology and of course, blood sugar.

Regarding cortisol’s effect on thyroid hormones, Werner and Ingbar’s The Thyroid:  A Fundamental and Clinical Text, (8th edition), states: “Serum TSH, TBG (thyroid-binding protein), T4 and T3 concentrations are slightly decreased, albeit usually within the respective ranges of normal; serum free T4 values are normal.”11 

As discussed in our chapter on the liver, impaired detoxification can lead to abnormal thyroid function.  Again, the adrenals come into play because elevated cortisol inhibits proper liver detoxification.  It is sometimes necessary to support liver detoxification pathways while treating the adrenal glands and thyroid to optimize results and metabolize toxins, excess hormones and thyroid-disrupting chemicals.  Signs of impaired liver detoxification include nausea, constipation, bloating, lack of response to treatment, acne, acne during menstrual cycle, medication sensitivity, and pale skin upon pressure.

I dedicated an entire chapter to the Gut-Thyroid connection.  There is also a powerful Adrenal-Gut connection as well.  Elevated cortisol levels slowly eat away at the immune system that lines the gastrointestinal (GI) tract.  Cortisol also increases inflammation in the GI tract and prevents the cells that line the GI tract from regenerating which increases the risk of ulcers.  This leads to increased infections from parasites, yeast, mold, fungi, viruses, and bacteria which further stresses the adrenal glands creating a vicious cycle.  Leaky gut is another consequence of chronically elevated cortisol levels which is a condition in which gaps open in the intestinal barrier allowing undigested proteins and toxins to enter the bloodstream uninhibited.  This puts a major stress on the body’s immune system and can lead to immune dysfunction, adrenal stress, chronic fatigue and thyroid hormone imbalance.

Adrenals that are functioning at a low level tend to exhibit various symptoms and patterns.  Adrenal-fatigued people usually have to run on caffeine and sugar throughout the day to keep going.  They are dragging out of bed and say, “I need my coffee before I can do anything.”  This is a sad state because it indicates an extremely unhealthy individual who requires a legal drug just to function.  These individuals crave sweets and crash many times throughout the day, especially in the afternoon, and need a “pick me up” such as another cup of coffee or something sweet.  This further drives blood sugar and hormone imbalances leading to weight gain, insomnia, fatigue and an underactive thyroid gland.  In addition, these people can usually fall asleep without problems but will wake up during the night.  This happens because there is inadequate cortisol production to stabilize blood sugar so the adrenals release adrenaline instead which raises blood sugar but is also too stimulatory resulting in waking up and insomnia.

People with adrenal hyperfunctioning usually cannot fall asleep because there is too much cortisol production which has an excitatory effect on the nervous system.  There are many possible causes of elevated cortisol that lead to too much cortisol production and eventually adrenal fatigue.  The following cause adrenal stress:

  • Anemia – red blood cells cannot deliver oxygen to body tissues
  • Blood sugar imbalances
  • Low cholesterol – statin medications such as Lipitor, Crestor, Zocor, etc.
  • Infections
  • Gums
  • Urinary tract
  • Gastrointestinal
  • Mold, yeast or fungus
  • Lyme Disease/Tick-Borne Infections
  • Chronic virus
  • Dehydration – especially in athletes or those who fly frequently (it is important to drink half of bodyweight in ounces of water every day)
  • Poor dietary habits (skipping meals, high intake of simple carbohydrates, etc.)
  • Eating foods you are sensitive/allergic to
  • Leaky gut
  • Liver detoxification issues
  • Essential fatty acid deficiencies
  • Not enough sleep
  • Overexercise
  • Emotional stressors (usually severe)
  • Heavy metals
  • Autoimmune adrenals
  • Chronic use of SSRIs (selective serotonin reuptake inhibitors, Prozac, etc.)
  • Chronic pain
  • Environmental toxin exposures – damages mitochondria
  • Surgical menopause
  • Chronic tissue injury or inflammation (autoimmune condition)

It takes a great deal of time and effort to do the proper detective work to find out why someone is ill.  The supplements covered at the end of this chapter are meant to complement diet and lifestyle changes.  In order for a treatment plan to be successful, it is very important that the following guidelines are adhered to without deviation.

Adrenal stimulants will disrupt your treatment plan and consist of the following:

  • Inadequate sleep
  • Eating sugar/simple carbohydrates
  • Caffeine and decaffeinated beverages
  • Nicotine
  • Alcohol
  • Food allergies
  • Trans fats (hydrogenated or partially-hydrogenated oils)
  • Artificial sweeteners
  • Excess exercise

As long as blood sugar levels are out of balance, it will be extremely difficult to restore proper adrenal function.  Practice the following guidelines to ensure stable blood sugar levels:

  • Always eat breakfast that includes more protein than carbohydrates
  • Eat every two to three hours
  • Snack on protein and fat such as nuts, eggs and seeds
  • Do not drink juice – this includes ALL juices which are nothing more than plant sugar
  • Consume protein at every meal

Blood sugar imbalances and a condition known as insulin resistance are major factors in optimizing thyroid and adrenal health.  Insulin resistance basically means that insulin receptors are no longer able to respond to insulin.  Insulin binds to receptors and allows blood sugar to enter cells.  With insulin resistance, insulin’s effects are negated leaving excess blood sugar.  The following symptoms can indicate insulin resistance:

  • Fatigue
  • Sugar cravings
  • Abdominal obesity
  • High blood pressure
  • Inability to lose weight
  • Always feeling hungry
  • Fatigue after meals
  • Aches and pains all over
  • High cholesterol, glucose, and triglycerides
  • Low HDL (“good” cholesterol)

Remember that impaired liver detoxification can significantly affect optimal thyroid hormone function.  Elevated insulin levels will reduce glutathione levels inhibiting the liver’s ability to detoxify.  This will affect the conversion of inactive T4 into active T3, increase thyroid-disrupting chemicals and may lead to excess estrogen levels which inhibit thyroid hormone function.

As discussed in the chapter on thyroid hormone basics, thyroid hormone’s main function is to regulate metabolism through the burning of sugar, fat and protein.  Insulin resistance prevents adequate sugar transport into the cell decreasing the available fuel for energy production.  This puts an increased strain on the thyroid to make more hormone and can eventually lead to hypothyroidism.

We have already discussed the importance of adrenal gland function and its relationship to optimal thyroid health.  The following supplements will help to correct adrenal gland dysfunction.  It’s very important to have the adrenal hormones cortisol and DHEA tested to ensure precise treatment.  Adaptogens are compounds that help to normalize the hypothalamic-pituitary-adrenal axis.  They will help adrenals that are in a state of fatigue, high stress or a combination of both.  The feedback loop of the HPA axis is key in balancing adrenal hormones, and adaptogens are vital in healing this process.

Supplements That Help Correct Adrenal Gland Dysfunction

Magnolia & Phellodendron
Magnolia is a tree native to the rain forests of China.  Its bark has been used for a variety of medicinal purposes including the regulation of stress and anxiety.  Phellodendron grows in northeastern China and Japan.  Together, these extracts restore cortisol and DHEA production in the adrenal gland.  They bind to stress hormone receptors promoting relaxation and feelings of well-being.

Perilla oil & MCTs
These essential oils have natural stress-reducing effects.  Perilla oil is rich in omega-3 fatty acids which stimulate repair and are anti-inflammatory.  MCTs reduce cell acids and help to produce energy in the cell’s mitochondria.  MCTs are easy to assimilate and metabolize which is extremely important for those with delicate stomachs and impaired absorption.

Ashwagandha

Ashwagandha is an adaptogen that is similar to panax ginseng.  It has the ability to normalize adrenal stress syndromes.  Stress responses can have many adverse affects on health and this herb will reduce these effects.

Eleutherococcus
Eleutherococcus senticosus is an adaptogen that supports the HPA axis under times of stress as well as enhance athletic performance.  Eleutherococcus will enhance physical work capacity as well as brain function when under stress.

Panax Ginseng
Panax ginseng is also known as Korean ginseng and is an adaptogen.  Panax ginseng optimizes the functioning of the HPA axis.  It has been shown to enhance physical performance, stamina and energy production.  Panax ginseng will shift metabolism into a fat-burning state as opposed to a sugar-burning state due to an increase in oxygen availability for muscles.

Rhodiola
Rhodiola is popular in traditional Eastern European and Asian medical systems.  Rhodiola is an adaptogen that has been shown to enhance immune function and brain function.  It also has antidepressant properties, protects the heart and protects against cancer.  Rhodiola will prevent adrenaline roller coasters due to high stress.

Holy Basil
Holy basil is an adaptogen that reduces cortisol production from stress, supports blood sugar, has antihistamine properties, optimizes the functioning of the HPA axis, improves the integrity of the gastrointestinal mucosal barrier, improves immune function, and enhances athletic performance.

Pantethine

Pantethine is required for adrenal hormone production.  However, it will not over-stimulate cortisol production under times of stress but has the opposite effect.

Licorice (Glycyrrhiza Glabara)
Licorice contains compounds that increase the half-life of cortisol which removes stress on the adrenal glands to produce more cortisol.  It also has been shown to boost the immune system, reduce inflammation and also reduce/minimize allergic responses.  Licorice is antibacterial and antiviral.  Due to estrogen’s negative effect on thyroid function, licorice is of great benefit because it helps normalize estrogen metabolism.

Pregnenolone
Pregnenolone is the “mother of all hormones” and is made from cholesterol in the adrenal gland.  Pregnenolone converts into cortisol, DHEA, testosterone, estrogen and progesterone.  Pregnenolone is a powerful antioxidant and has been shown to boost mood, improve memory and optimize brain function.

DHEA
DHEA is made by the adrenal glands and will convert into estrogen and testosterone.  In men, it will mainly convert into estrogen and in women, DHEA will mainly convert into testosterone.  DHEA has its own effects including resensitizing insulin receptors, boosting the immune system, preventing bone loss, enhancing memory and lowering cholesterol.  When under stress, the body will make cortisol at the expense of DHEA.

Phosphatidylserine
Phosphatidylserine’s greatest benefit is its ability to lower cortisol levels by optimizing the brain’s relationship with the adrenal glands.  After only ten days of high doses of PS, research has shown that excessive cortisol levels can be decreased in healthy men.  PS has also been shown to enhance brain function and memory, decrease anxiety and depression, improve mood, and enhance metabolism.  It is also an antioxidant.  It is very difficult for the body to make PS as it requires many nutrients for production.  Supplementation is vital for optimizing adrenal function so cortisol cannot have its negative effects on the body and the thyroid.

Supplements that Balance Blood Sugar

Blood sugar imbalances will greatly influence the ability of your thyroid to function optimally.  The following supplements are vital in balancing blood sugar.

Huckleberry/Bilberry (Vaccinium myrtillus)
The extract from the leaves of this plant has been shown to lower blood sugar levels and has been used traditionally to treat diabetes.

Galega Officinalis (French lilac)
This plant has been utilized since the Middle Ages in the treatment of diabetes.  French lilac lowers blood sugar by decreasing insulin resistance.  Prescription medications for blood sugar control such as Metformin are derived from the active ingredients in French lilac.

Gymnema Sylvestre
Gymnema sylvestre has been shown to regenerate the beta cells in the pancreas that produce insulin.  This herb will enhance the effects of insulin, reduce fasting blood sugar, decrease the need for insulin and help with insulin resistance.  It will not cause a state of hypoglycemia, however.

Chromium
Chromium stabilizes blood sugar and insulin levels after meals.  It will also ensure optimal delivery of blood sugar into your cells.  Deficiencies in this nutrient can lead to insulin resistance, high cholesterol and abnormalities in sugar’s ability to bind to red blood cells.

Zinc
Zinc’s role in blood sugar management includes optimizing insulin metabolism, protecting insulin-producing beta cells of the pancreas and improving insulin sensitivity which ensures optimal uptake of sugar into your cells.

Vanadium
Vanadium is very important for insulin resistance by improving transport of sugar into your cells due to its insulin-like effects on cell receptors.

Alpha lipoic acid (ALA)
ALA is another important nutrient for insulin resistance and is also a strong antioxidant.  ALA increases energy production by your cells, optimizes sugar metabolism and lowers lactic acid levels.

Vitamin E
Vitamin E should not be taken in its alpha tocopherol form.  Mixed tocopherols including gamma and delta tocopherol are the preferred form of delivery.  Vitamin E improves insulin sensitivity, lowers blood fats, is a powerful antioxidant and lowers the so-called “bad” LDL cholesterol.

Biotin
Biotin is important in supporting the liver’s utilization of sugar.  This nutrient will enhance insulin’s effects as well as lower blood sugar levels after meals.

Magnesium
Entire books have been written on the king of minerals.  Magnesium is involved in approximately 350 reactions in the body and deficiencies in our society are rampant.  Magnesium deficiency will lead to insulin resistance and abnormal sugar metabolism.  Magnesium appears to enhance insulin secretion by the pancreas.

L-carnitine
L-carnitine is a di-peptide compound that shuttles fatty acids in the cell to be burned as energy.  Carnitine has similar effects on blood sugar by supporting sugar transport into cells.

 

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54 Responses to The Thyroid-Adrenal-Pancreas Axis

  1. Lumduan October 2, 2011 at 8:40 am #

    Very clear explaination of the interelated among glands.

  2. Krishna Govindam October 20, 2011 at 12:53 am #

    Very helpful co-relation analysis and insight into working of various glands. Answers many questions related to symptoms I have been observing with self and how they connect to my hypothyroidsm.

  3. Nikolas Hedberg, D.C., D.A.B.C.I. October 20, 2011 at 10:00 am #

    Thanks for reading!

  4. Michelle September 4, 2012 at 8:10 am #

    Greetings Nikolas,
    please could you assist me with some information? My daughter (16) has Graves disease (diagnosed at 12, probably started much younger – stress from our divorce I believe). She is on neomercazole, and the Paed would like to use radiation as it does not want to stabilize and then she is on counter thyroid medication for life. I think she is not stabilizing because of her teenage hormones and possible exhaustion on other body systems. She is exhausted, and has allergies (on top of it all). I am actually at a loss here, any suggestions I would welcome? Thank you kindly, Michelle (KZN – South Africa)

  5. Jennifer Adams December 13, 2012 at 3:02 pm #

    Dr Hedberg-
    I wanted to let you know that I did a research report on adrenal fatigue for my anatomy and physiology class. My research brought me to a webinar taught at Hawthorne University, which led me to this website. Thank you for all of your insightful information. I made an A on the report and you were my most cited source. Thanks again!

  6. Nikolas Hedberg, D.C., D.A.B.C.I. December 13, 2012 at 10:11 pm #

    Great work Jennifer!

  7. Nancy Owens February 1, 2013 at 10:53 pm #

    Hello Nikolas,
    Thank you so much for your thorough details of the Thyroid-Adrenal-Pancreas Axis. It is helpful to find this information, although I would greatly like to find help in correcting the areas in which I recognize significant need in my own health care. How would you recommend an individual determine a corrective treatment plan? Thanks so much,
    Nancy

  8. beck February 18, 2013 at 8:42 pm #

    how many of these supplements can I take together

  9. Nikolas Hedberg, D.C., D.A.B.C.I. February 24, 2013 at 8:26 am #

    Thank you for the comment but I cannot give health advice on the internet.

  10. Tami February 24, 2013 at 10:47 am #

    Thank you so much for your thorough explanation. This is my first time commenting and I’ve been researching this topic for well over a year now. Not only have you explained the connections between many of my different symptoms/aliments but have also given in depth explanations for natural healing. You are a blessing!

  11. Tiffany March 16, 2013 at 3:37 pm #

    If your thyroid is hypo should you stop taking l-carnitine?

  12. Tiffany March 16, 2013 at 3:38 pm #

    you are amazing Dr. Hedberg outstanding website !

  13. Nikolas Hedberg, D.C., D.A.B.C.I. March 16, 2013 at 6:35 pm #

    Thank you!

  14. barbara March 17, 2013 at 10:34 pm #

    Thank you for your wonderful information. As an R.N. for over 25 years, I should know that we cannot diagnose ourselves. And, I know you can’t diagnose. I had a benign ‘hot’ nodule of my thyroid 20 years ago. My Endo told me if I did not take the radiative capsule, I may eventually get A-Fib. So I did that and did well many years. I found out at the age of 64 that my thyroid has an area that is “calcified”. I know that when tissue within the body dies this happens, i.e. stillborn baby does this.Then had a complete hysterectomy. shortly after.My question is this. At age 65 it is hard to get to sleep, and even harder to get out of bed. My Doctor won’t discuss use of Bovine thyroid and bovine adrenal supplementation. I have 3 wonderful sons and 5 grandchildren and don’t won’t to spend my days in bed. I want some energy. I can get these supplements but would like a generic opinion of side effects of using them. I took both for about a month, and felt 75% better but stopped. My endo won’t discuss these non RX uses either. Any thoughts….I want quality of life, not just quantity. Can you tell I am a Hospice nurse?? Thanks for your time.

  15. SuSun April 13, 2013 at 1:27 am #

    Thank you so much for making this extremely valuable information available. It is gold. It makes so many connections

  16. Liz P. April 13, 2013 at 6:49 pm #

    Firstly, THANK YOU Dr. Hedberg for this article! I just have ONE question…in the “aldosterone” paragraph, you recommend consuming a half- teaspoon of unrefined celtic sea salt every morning with a few glasses of water…do you mean a half teaspoon per EACH glass of water, or per several glasses?

  17. Nikolas Hedberg, D.C., D.A.B.C.I. April 14, 2013 at 9:50 am #

    1/2 teaspoon per glass.

  18. Jo May 16, 2013 at 8:33 am #

    Dr. Hedberg ,I was diagnosed with hashimotos in Oct . I was put on armour and felt wonderful for 3 weeks then bam almost worse them before . Doc did cortisol 24 hour saliva test and found very low morning ,low lunch ,low afternoon and high night . I have been on armour ,sellinium, vit C ,iodoral VtD3,K2, magnesium,and holy basil I also take 1/2 tsp sea salt in 1/2 cup water . I still feel bad . I am ready to stop all meds and just do the sea salt ,Vit C and Vit D3 (because I am low ) until my cortisol is correct . So I would like your opionion on what to continue to take and how much salt per 1 cup of water do. Need ? Thanks so much

  19. Nikolas Hedberg, D.C., D.A.B.C.I. May 16, 2013 at 9:09 am #

    Thank you for the comment but I can’t give medical advice on this blog.

  20. Jo May 16, 2013 at 9:39 am #

    How much sea salt per cup of water a day ?

  21. Nikolas Hedberg, D.C., D.A.B.C.I. May 16, 2013 at 9:54 am #

    1/4 to 1/2 teaspoon is the average.

  22. Janet July 26, 2013 at 2:33 pm #

    Interesting information. How can I find a medical practitioner in my area to help?

  23. Joan Fruson November 5, 2013 at 1:31 pm #

    I feel like this has been written about me. I had my right adrenal gland removed six years ago and am now considered subclinical hypothyroid. I tried synthroid but it actually made me feel like I was full on hypothyroid so I stopped taking it. I find that Macca helps me plus high potency vitamin B and a good multi vitamin. Unfortunately I have a serious problem staying asleep. Your article has given me some insight and I will investigate further to see if there is something else I can take to help me sleep.

  24. Barbara December 5, 2013 at 11:34 am #

    Dr., your article is really informative and I now understand the connections. Would you have private email conversation with me?
    I have questions that Ive gotten NO helpful answers for, from 4 endocrinologists and 3 primary Drs, and 2 GYNs. Not looking for diagnosis, just insight and I think you can help. Thanx.

  25. Bianca Brush January 6, 2014 at 10:09 am #

    Very interesting indeed. I have been hypo-thyroid for over 20 years following treatment with radio-active iodine and I was diagnosed with Addisons disease about 10 years ago. Even after all this time I have periodic episodes where my hormones seem totally out of sync and I cannot get my GP or my endocrine consultant interested enough to try and help. The beginnings of menopause added to the mix have made my life even more difficult for the last 12 months or so. People in this country seem happy to treat each individual condition (sort of) but nobody seems to understand (or care?) about the whole picture.

    One thing that confuses me a little: “drink half of bodyweight in ounces of water every day”. What does that mean to somebody weighing 11St 10lb?

  26. Nikolas Hedberg, D.C., D.A.B.C.I. January 6, 2014 at 10:54 am #

    Not sure how stones convert to pounds but the formula is based on total pounds. So someone who weighs 128 pounds would drink 64 ounces of water a day which is approximately 8 cups of water a day.

  27. Tom Hayward January 14, 2014 at 11:06 am #

    Above you mention
    “Do not drink juice – this includes ALL juices which are nothing more than plant sugar – ”
    Does this include the juicing of vegetables?
    I have just started juicing in hopes to get my pH up. It is hovering around 5.5.

    Thanks,
    Tom

  28. Nikolas Hedberg, D.C., D.A.B.C.I. January 14, 2014 at 1:29 pm #

    This includes vegetable juices. I recommend a VitaMix to blend up the entire plant so you get the fiber and everything else.

  29. Carol January 27, 2014 at 10:35 pm #

    I was wondering if you are familiar with the Apex supplements for thyroid and the book Datis wrote about thyroid.

  30. natalie bourke April 9, 2014 at 5:51 am #

    If pregnenalone is a precursor to both DHEA and cortisol, wouldn’t it be contraindicated in someone with adrenal fatigue as wouldn’t they just produce more cortisol from the pregnenalone as oppose to going down the DHEA pathway or is this not what happens?

  31. Nikolas Hedberg, D.C., D.A.B.C.I. April 9, 2014 at 8:51 am #

    Most of the pregnenelone goes to cortisol which is what you want in adrenal fatigue. We also supplement with some DHEA in adrenal fatigue to address both aspects. Check out my youtube video on adrenal restoration: https://www.youtube.com/watch?v=xdQ-xpHraqc

  32. Barb Zilla May 24, 2014 at 12:53 pm #

    Thank you for writing such a straight forward, easy to understand article on this connection – very informative. How does fasting influence this cycle? I fast to allow my digestive system to rest but typically drink herbal tea and raw honey to maintain blood sugar levels.

  33. Krisztina Szakacs May 25, 2014 at 6:42 pm #

    Dear dr Hedberg,

    I am diagnosed with adrenal fatigue ( inverse cortisol profile, low in the morning, elevated in the afternoon and at night) plus I have t3 resistence, my t3/rt3 ratio is 12,3. I treath my adrenals now with ashwaganda, magnesium, vitb12, vit c, Vit d, vit b5 in the morning, and I used phosphatidil serine in the afternoon to decrease the high cortisol. I try to use some t3 orally too, but it seems to be not working together. Do I need to treath my adrenals and my thyreoids together? Thank you, Krisztina

  34. Anh Nguyen July 4, 2014 at 10:02 pm #

    Thank you for the helpful, well educated and thorough health information on thyroid adrenal pancreas axis, it helps people to understand if any of these symptoms arise.

  35. John Condron July 17, 2014 at 5:10 pm #

    Does all the information apply to men as well?

  36. Nikolas Hedberg, D.C., D.A.B.C.I. July 17, 2014 at 7:43 pm #

    In general, this information applies to men and women.

  37. Mel August 19, 2014 at 10:28 am #

    Thank you for all this wonderful information.

    How much Biotin should my 24 year old daughter be taking? She weighs 130 pounds. She gets very tired after eating a meal.

    Thank you!
    Mel

  38. Nikolas Hedberg, D.C., D.A.B.C.I., D.A.C.B.N., B.C.N.P. August 19, 2014 at 3:08 pm #

    Thank you for the question but I cannot give medical advice on the internet. Please consult with your doctor.

  39. James September 30, 2014 at 9:05 pm #

    Doctor,

    I don’t quite understand the adrenal/hypoglycemia connection. I have hypoglycemia daily if I don’t eat within a certain timeframe, sometimes I feel it rapidly drop seemingly out of the blue. This has to mean bad adrenal function right? If so, want to take an adaptogen to help my adrenals, particularly, ashwagandha or rhodiola.

    My question is, adaptogens are said to support the adrenals, but how can they be supportive when most, if not all adaptogens lower cortisol, which is required to maintain blood sugar levels? Am I missing something? It seems like it would cause more of a problem by further plummeting my blood sugar.

    Could you shed some light on this for me? Thanks very much.

  40. Dr. Nikolas Hedberg October 1, 2014 at 8:52 am #

    Adrenal adaptogens don’t lower cortisol if it is normal or low, only if it is too high.

  41. qadeem khan October 10, 2014 at 3:53 am #

    very welldone.sir.i am a ph.d scholar and working on functional relation of adrenal and thyroid glands.i mean is there any relation between abnormal levels of cartisol and autoimmune thyroid diseases like hashimoto thyroiditis and graves disease.please send me the latest research articles and materials thanks

  42. Vaiva November 6, 2014 at 10:15 am #

    Dear Dr. Hedberg,
    Thank you for this article. It was very usefull, i’ve been researching these topics a lot these days, as I have some endocryne disorders myself. Unfortunately no doctors can help me in this case, because my symptoms are very unclear. I believe I might have adrenal fatigue, but the problem that concerns me the most is never ending severe cystic acne, mostly around my chin area and neck. I do not have PCOS, my periods are regular, and my over all testosterone level is in place. I was having this condition under control with high doses of zink. But it’s not helping anymore. It is definitely related to androgens or maybe low progesterone somehow. The thing is I was a very heavy coffe drinker all my life and I think it exausted my adrenal glands. I am 26 right now. So my question is: in this case should I address adrenals first? Or should I try some anti-androgen techiniques?
    I would be very grateful for your reply.

  43. Dr. Nikolas Hedberg November 7, 2014 at 1:13 pm #

    Thank you for the comment but these questions should be addressed by the doctor you are currently working with.

  44. dave November 11, 2014 at 1:20 pm #

    Great article, dr.Hedberg!

    Have a question regarding adaptogens if you know: if I have leaky gut or histamine intolerance would powder form of them be counter productive? I have sort of more immune activation after taking ashwaghanda powder or cordiceps. I suspect more a “immediate” reaction to powder rather than the real effect of adaptogens.
    What do you think?
    Thank you

  45. Dr. Nikolas Hedberg November 11, 2014 at 1:42 pm #

    I’ve never seen a difference in powder vs tincture regarding immune activation. The source of the herbs could be contaminated which could explain it. Ashwagandha is a nightshade so that could be an issue as well.

  46. MO December 11, 2014 at 11:59 am #

    Question for you. I had several major abdominal surgeries for a blocked artery in my abdomen that I was born with and didn’t know anything about it until after I had a child. After the first surgery I gained 50lbs in 5 months and realized it was my blood sugar. I also got an ultrasound on my thyroid because the blood work was completely normal. The thyroid showed 13 nodules. At my recent gyno appointment she recommended getting a hysterectomy to correct my blood sugar. I am very hypoglycemic through all of this. It is especially worse the week before I start my period. I get insulin resistance. I have been reading about adrenal fatigue for several months but your article is the best! I tried bio-identical hormones but just can’t afford that on a monthly basis. I would like to try some of the things you have listed, but I do not want to lower my blood sugar at all. I also get very bloated by the end of the day looks like I am very pregnant. What do you recommend to start out with? There are a lot of herbs listed here and I just want to make sure I am not taking something that will be dropping my sugar. Thank you so much for this article.

  47. B December 30, 2014 at 6:02 am #

    I stumbled across this site in the early morning, doing some research on some of the traits you point out here. Especially the sleep issues; the caffeine, salt and sugar cravings; and the daytime crashes. One particular trait I don’t see though is a skin condition on my lower extremities that seems to best be relieved by hydrocortisone. But here’s the rub, I’m male. A few years back I suffered a blood clot that killed off part of a kidney. Since my PCP also put me on testosterone therapy for a period. I am facing the stress of estate management and a house sale, but think I’m handling it pretty well. All that being said, and I hope this doesn’t sound nuts, I definitely have my mother’s physiology and she had pituitary issues. Are adrenal issues common in men as well?

  48. Dr. Nikolas Hedberg January 5, 2015 at 12:29 pm #

    Yes, they are common in men as well.

  49. matt g February 22, 2015 at 9:41 am #

    Good stuff doc hedberg. My wife has been going threw this stuff the last 3 years but most of the effects insulin resistance was the first clue everyone overlooked it has gotten way worse sense

  50. NIna Onsrud February 23, 2015 at 2:49 pm #

    Dr>herdberg. I loved your article and I now understand more so how important the adrenals are in order for the hormonal system to work correct. As a OMD i so often get patient who are worn out and unable to function even on thyroid medication. but most Doctors are unwilling to check the status of the adrenal glands as long as the test result of THS , T4 come back within range.

  51. Yas February 27, 2015 at 5:23 pm #

    Just a quick question…
    If a cushingoid patient presented with hypothyroidism, then latter became adrenaly insufficient and the the hypothyroidism persisted, once cortisol levels recovered to normal levels would the hypothyroidism resolve itself?
    You mentioned not treating thyroid issues until adrenals were treated. If thyroid issues were treated before adrenals recovered, would that just overtax the adrenals or could it affect the long term outcome of the thyroid distinction negatively?
    Guess that was 2 questions… And maybe not so quick after all!
    Thank you for the article. Well written and comprehensive.

  52. Dr Hooman March 16, 2015 at 2:10 pm #

    Hi there
    Thanks for the wonderful information, simple yet professional context. I everyday run across people of the low adrenal state in my job, however the medical establishment today fails to embrace the truth; which is the fact that Adrenal insufficiency is actually a “Gradient” not a clear cut diagnosis and these so called Medical experts, perhaps deliberately, go on ignoring. I do not know how long this challenge should go ahead. But we all know that Adrenal Exhaustion is the major cause of many disorders in the 21st Century

    I have a question, please, if you dont mind:

    DHEA, you said, within the above article, in women turns into testosterone and in men into estrogen. Is that true?

    Thank you

  53. Ashley June 2, 2015 at 8:53 pm #

    Great article! I have been diagnosed with subclinical thyroiditis, I also have elevated androgens(dheas) do you recommend any herbs/supplements that are safe to take with Paxil?

  54. Sanjay Singh June 16, 2015 at 8:41 am #

    Hi Nikolas,

    I am suffering from Hypothyroid. I am having pain in my upper right abdomen. Doctors say your liver is all right. I want to know can it be due to Pancreas or due to Adernal? I am suffering past more than 7 years. This pain comes and goes. Also some times pain persists on right shoulder blade. kindly advise.

    Regards,

    Sanjay

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