Your Scientific Source of Supplementation and Sports Nutrition

Adrenal Fatigue and Thyroid Dysfunction: The New Epidemic

adrenal fatigue


For many years, I have worked with female clients who have been dedicated athletes, worked hard to quickly move up the career ladder, then dive right into parenthood. Usually, after the first or second child, something happens. At first, it is daily fatigue and issues losing weight. Then the hormones never quite balance and appear to bounce around, leading to anxiety and depression. Exercise at a level like before becomes a struggle, and the cycle is perpetuated with chronic stress that leads to even more health issues.

There is an epidemic growing that has left many women tired during the day, wired at night, struggling with weight loss and left without answers. It is an epidemic involving the thyroid gland, adrenal glands, and the sex hormones (estrogen, progesterone, and testosterone). Like fibromyalgia, IBS and chronic fatigue, adrenal fatigue/thyroid dysfunction are still not understood well by many doctors and treatment is often misguided or completely dismissed because the standard lab numbers look normal.

The term “adrenal fatigue” is a misnomer but has become the common term. Our adrenals glands are designed to last a lifetime, and it doesn’t seem possible for them to be completely out of juice by the mid-thirties. You could argue that chronic stress leads to their early departure, but there appears to be something else afoot.

In the brain, a chemical called CRH (cortico-releasing hormone) is responsible for driving the adrenals to release cortisol and adrenaline. What happens is that when your brain and body have finally become overloaded by the fight or flight response, your brain turns off the switch for CRH to give your adrenals glands a break to repair. Subsequently, this leads to low cortisol and low adrenaline, leaving you feeling like a sloth reaching for coffee every day just to get out of bed.

Spin Class as a Metaphor for Adrenal Fatigue

Spin class is a great example of what is happening in your body. A party atmosphere full of high-intensity, high-speed and high cortisol pushing yourself to complete exhaustion. Ironically, people who are already spun out are attracted to spin class. Unfortunately, the adrenal party ends with a long hangover.

There is a mentality in our society to push ourselves past limitations for both the mind and body. It starts early in life that the busier you are and harder you push yourself, the more successful you must be. The message with physical training is that more is better and to push past the pain. There is always a way to be stronger, look better and reach new heights. The body is resilient, and for a while, it will keep up with the demand. However, if you don’t find time to properly rest, your body will make you rest for much longer.

In the U.S., 75% of all Americans have moderate to severe stress and almost half suffer adverse stress-related health effects. In all stress-related statistics, women are at the top of every study. The internalization of stress is higher in women and therefore certain habits go up (more time watching TV, being on Facebook, more sugar, flour-based foods, caffeine, and alcohol) causing more physical symptoms to arise as a result of stress. Stress will deplete selenium and magnesium, two major minerals needed for proper thyroid function.

The top four sources of stress include money, work, family and health concerns in that order. Health concerns are last. As you can see, the problem here is that people neglect their health because of financial concerns, with 1 and 5 thinking of skipping seeing a practitioner due to the cost. I tell my Nutrition Genome clients that the cost of diet and lifestyle prevention will always save you thousands of dollars compared to the cost of treatment.

The Symptoms of Adrenal Shutdown and Thyroid Deficiency

If you are female and over 35, there is a culmination of events that can drop like a ton of bricks. Not to say this doesn’t happen to men too, but it is much more common in women. The exhaustion of over a decade at a stressful career (and further back from high school and college), relationships, hard physical training to stay in top shape, and one or more pregnancies in the mid to late 30’s typically tip the scales. The issues can remain well into the 50’s and up if not addressed.

Up to 60 percent of those with a thyroid disorder are unaware of their condition. The cause is considered largely unknown and occurs 10 times more in women than in men.

Do you recognize these symptoms?

  • Anxiety
  • Tired and wired at night
  • Fear
  • Low tolerance for stress
  • Can’t make it through the day without coffee
  • Trouble losing fat, especially in the mid-section
  • Brain fog/inability to concentrate
  • Depression
  • Thyroid blood work appears normal but have symptoms of hypothyroidism
  • Thinning hair
  • Low blood pressure
  • Cold extremities
  • Memory issues
  • Hard to get out of bed
  • PCOS
  • Miscarriages
  • Infertility
  • Trouble producing milk

What is the HPA Axis?

The HPA axis stands for the “hypothalamic pituitary adrenal axis” and regulates the stress response. It is responsible for fight or flight; useful for survival and is overactivated in our modern way of life from numerous activation signals every day.

The axis is connected to the brain, nervous system, immune system, digestive system and circulatory system. So you can see how damaging the chronic stress response is to all of these systems via the HPA axis. What happens is that blood sugar and insulin stay elevated, you get easily irritated and overwhelmed, and the immune system stays activated leading to dysfunction.

Meanwhile, all other requirements in your body get put on hold and eventually also get depleted. A systemic shutdown. The reason pregnancy can be so hard on some women is because there are not enough reserves to give, causing higher deficiency post-pregnancy.

Environmental Toxicity and Thyroid Function 

The environment is everything outside of yourself. We can no longer avoid the fact that what is in our waterair, and food is disrupting our body’s hormones dramatically. It is a topic many of us like to pretend isn’t as dire as it appears, but the facts emphasize reality. One of these realities is the environmental toxicity that causes suppression of the thyroid gland by hormone disruptors.

Thyroid Health

  • Iodine deficiency increases the toxicity of halogens (fluoride, bromide, chloride), which becomes a double whammy for breast cancer risk and brain health because iodine is concentrated in both. One-third of the world’s population lives in areas of iodine deficiency.
  • What else depletes iodine? SSRI anti-depressants such as Lexapro, Prozac, Zoloft, and Paxil. The rate of antidepressant use in this country among teens and adults (people ages 12 and older) increased by almost 400% between 1988–1994 and 2005–2008. Approximately 23% of women in their 40s and 50s take antidepressants, a higher percentage than any other group.
  • Fluoride added to our drinking water, fluoride-based pesticides and medications disrupt thyroid function by blocking iodine and interfering with magnesium. Choose reverse osmosis water.
  • Bromides sprayed on non-organic fruit like strawberries and fire retardants in our couches, beds, computers, phones and cars disrupt thyroid function by blocking iodine.
  • BPA and BPS (in BPA free containers) in plastic interfere with thyroid function. Choose glass.
  • Chlorine in swimming pools and our drinking water disrupts thyroid function by blocking iodine. Use salt water pools if available and a shower filter.
  • Phthalates in personal care products.
  • Organochlorines (pesticides and PCB’s) and glyphosate (GMO corn and soy) disrupt thyroid function. Sucralose (Splenda) is an organochlorine and had an adverse effect on thyroid function in male rats. Sucralose destroys gut flora like lactobacillus, which disturbs selenocysteine levels present in the catalytic center of enzymes that protect the thyroid from free radical damage. Free radical damage to the thyroid would lead to cell death and an autoimmune response.
  • Gene polymorphisms that affect thyroid function and toxicity susceptibility.

My Blood Work Shows Normal Thyroid Function!?

Let’s say you exhibit all the symptoms of hypothyroidism but you are told by your doctor that everything is normal. Is it? The TSH set point is not the same for everyone and the range is controversially wide. Iodine, reverse T3, T3 (active) and T4 (inactive) need to be reviewed and are often omitted.

The liver is the major site of conversion of T4 to T3, making the thyroid and the liver a target for hypothyroidism. Elevated cortisol and toxins affect this conversion, which is also why caffeine in coffee makes things worse in the long run. Other factors that affect the conversion include iron deficiency, insulin resistance, elevated blood sugar and extreme diets.

  • TSH > 2.5: Possible hypothyroidism
  • Free T3 < 3.2: Possible hypothyroidism
  • Free T4 <1.2: Possible hypothyroidism
  • Reverse T3 <10 ng/dl: If elevated, the body is storing active thyroid hormone to conserve energy
  • Iodine: 100-199 mcg/L and 150-249mcg/L for pregnancy. Deficiency affects thyroid, breast and brain health.
  • TPO and AntiTg Antibody > 4 IU/mL: Possible Hashimoto’s disease. New moms are at a greater risk for Hashimoto’s and some women flip from hyperthyroidism to hypothyroidism after pregnancy, puzzling doctors.

The True Cortisol Test

The main telltale of cortisol dysregulation is the dreaded belly fat, sugar cravings, premature wrinkles, elevated blood sugar, poor sex drive and increases in allergies, hives, eczema and autoimmune disorders arising from long-term activation of the immune system from stress.

  1. Have you tested your cortisol curve? The best one is a 24-hour saliva test. Typically cortisol is only tested in the morning, and that really doesn’t give the whole picture. If it is low in the morning, you will struggle to get out of bed. But what you want to see is the cortisol curve throughout the day, especially when you wake up, at 3:00 pm and before bed. A poor curve will show low levels in the morning, low in the afternoon and elevated at night.
  2. Basal Reading for the thyroid: Buy a basal thermometer. Under the armpit for 8 minutes on the 1st, 2nd and 3rd day of your period. It should be 97.8 or above.

Adrenal Fatigue and SIBO?

While looking at a client’s Dutch test which gives a hormonal panel and cortisol curve, I started to think about the hormonal connection to SIBO (small intestinal bacterial overgrowth). It is considered very difficult to treat and is not responsive to diet. The protocol is usually multiple rounds of antibiotics, and the SIBO just comes back.

DHEA is produced in the adrenal glands and is one of the main circulating hormones in the body. It is a precursor to estrogen and testosterone and is considered to have anti-aging properties. DHEA also plays a role in improving the resistance to viral, bacterial and parasitic infections. My hypothesis is that stress is suppressing hormones that act as a barrier to infections and that DHEA may be another marker to look at with SIBO. More research is starting to consider how hormones affect the microbiome with the concept of “microgenderome,” exploring how the female digestive system is affected differently by dysregulated hormone function.

The Detoxification Plan to Reboot the Adrenals, Liver, and Thyroid

1. Diet: Cut out coffee, alcohol, wheat, dairy, vegetable oils (canola, sunflower, safflower, corn, soy), non-organic plants and sugar for one month. Focus on the PaleoEdge food list and add 1 Tbsp. of freshly ground flaxseed using a coffee grinder daily.

Beneficial Organic Foods for the Thyroid: Sea vegetables, radishes (contains a sulfur compound that regulates thyroxine and calcitonin), carrots, cucumber, lemon, cranberries, coconut oil, organic chicken, pastured eggs and wild salmon.

Beneficial Organic Foods for the Liver: Dandelion greens, beets, artichokes, garlic, onions, celery, parsley, cinnamon, turmeric, and cardamom.

*While I don’t think brassica vegetables (broccoli, Brussels sprouts, kale, etc.) are harmful to the thyroid in moderate amounts, avoid juicing kale and non-organic fruits and vegetables that could give you a potent amount of pesticides.

2. Sleep: You need 7-8 hours of deep sleep a night to detoxify chemical toxins that accumulate from the day and to restore brain function, especially from information overload which is the highest ever in history. We have never needed more sleep than we do in the present day.

Turn off your phone and shut down the laptop before 9:00 pm. Fall asleep between 10:00pm and 11:00pm. Detox from Facebook and the news during this month to reduce the stress signals to your brain and your adrenals.

3. ExerciseLow-intensity exercise actually lowers cortisol levels while high-intensity exercise raises cortisol. Trade CrossFit and Spin class for moderate hiking and restorative yoga.

4. Hydrate: Add Endure electrolytes to fluoride free water and aim for 32 oz. a day or drink 1 Gerolsteiner bottle of mineral water.

Supplementation for Adrenal and Thyroid Restoration 

*If you are at an extreme imbalance, you may need to start very slow and working your way up with supplements. Some people even react to little amounts of vitamin C due to a high toxic load.

1. Support the thyroid gland with the Naturelo Multivitamin Women

The thyroid gland requires iodine, selenium, B2, magnesium, vitamin C, zinc, vitamin A and vitamin D. This is one of the few multivitamins that also provides magnesium. Magnesium is crucial for estrogen metabolism and detoxification by ensuring daily elimination.

You may require more iodine and this should be done under a practitioners care.

2. Support the adrenal glands with Ashwagandha Tincture or Ashwagandha Capsules


Adaptogens like ashwagandha increase the body’s resistance to physical (heat, cold and exertion), chemical (toxins and heavy metals) and biological (bacteria and viruses) stressors. They are the perfect antidote to complete exhaustion. They help you resist and adapt to the stress, restore balance in the cardiovascular, immune and neuroendocrine system while causing minimal (if any) physiological disturbance, side effects or toxicity.

Cortisol blocks the production of T3, which is why the ashwagandha helps the conversion of T4 (inactive) to T3 (active) by lowering cortisol and the stress response.

If you are finding yourself needing more of a stimulant but is also an adaptogen, I would recomend Eleuthero root.

3. Detox the liver with Liver Health

The Liver Health product contains dandelion, milk thistle, Oregon grape root, artichoke leaf, schisandra, and fennel.

Milk thistle and dandelion have been well known for centuries to assist detoxification and protect against toxicity. Schisandra increases liver cells’ glutathione and superoxide dismutase and significantly improves fatty liver disease, protects against heavy metal intoxication and improves mental health and physical energy.

4. Assist the thyroid, liver and adrenal glands with C-Salts Buffered Vitamin C

Vitamin C is highly concentrated in the adrenal glands and it used up in large amounts during times of stress, illness and chemical exposure. In other words, it is required in high amounts to deal with modern life.

Other Sources:

If you interested in reading about this topic more in-depth, I highly recommend The Adrenal Thyroid Revolution by Dr. Romm.


27 Responses to Adrenal Fatigue and Thyroid Dysfunction: The New Epidemic

  • Great article! I have suspected for some time I’m suffering from adrenal fatigue. This article confirmed my suspicions. I’m going to try the paleoedge diet!

  • You always have the best articles. I too have suspected I’ve had adrenal fatigue for years. Now it’s time to make some changes. Thank you for sharing your knowledge!

  • Thanks Alex! Great article as usual.

  • Thanks for another great article, as an elite athlete struggling in this area how does one decide that it is more a thyroid problem over adrenals. My Tsh is over 4.5 and continuing to rise each year as it is not be treated. Also I have a ton of digestive problems, mainly severe bloating and can that be a problem from untreated thyroid issues? I am never tired and wired it is always tired. It has been going on for years and when I train hard I breakdown after a few months and have to stop. Shortly after the stomach issues get worse. I am about to do an organic acid test and wondering if it might show the overall picture better with my hormones as well as how my stomach bacteria is. Would love to here your thoughts.

    • Hi Nat,

      It is likely an HPA axis and thyroid issue because they go together. Yes, severe bloating can occur from thyroid dysfunction that hasn’t been addressed. Since you are at a point of constant fatigue without the wired feeling, you may be at a point where your thyroid needs treatment and your adrenals need time to recharge. I would recommend talking to your practitioner about getting T3, reverse T3, T4, iodine and the 24-hour cortisol test done as well.

  • Hi, I was diagnosed with hypothyroidism. I saw you recommend Naturelo Multivitamin Women but it contains broccoli and kale, which is not usually suggested for the condition. Can you clarify if that affects anything? Thank you

    • Hi Sara,

      Good question. I think the research has pointed towards low iodine levels as the main reason cruciferous vegetables can affect hypothyroidism. Cooked, cruciferous vegetables in low amounts will not likely drive down iodine levels. However, the trend of juicing kale and adding other raw cruciferous vegetables in smoothies could definitely pose a risk. Goitrogens are the main concern when looking at their connection to hypothyroidism and cooking destroys the enzyme responsible for activation of progoitrin to goitrin. Adequate iodine intake also helps offset their effect on the thyroid.

      The amount of kale and broccoli in Naturelo is very tiny (a pinch) and the formula contains iodine, so this isn’t something I would be concerned about. It also contains the other nutrients that support thyroid function (selenium, vitamin C, B2, magnesium, and zinc).

      • Hello Alex
        Can we take multivitamins plus the ashwagandha or we must pick one ? And how much iodine do you recommend per day?

        • Hi Zahra,

          Yes, you can take both. Approximately 150mcg is the base amount of iodine to get daily, however that amount goes up for people that are low in iodine. It is best to get tested through a practitioner when dosing higher amounts of iodine.

  • Hi Alex, with regards to the liver and adrenal support supplements, is there any other brands you recommend for both of these? I am having a hard time sourcing the herb pharm in Canada.

    • Hi Natalie,

      I’m not as familiar with what is available in Canada. If you send me links to products that you are considering, I would be happy to review them.

  • Thanks Alex, the Herb Pharm isn’t available here but I have lots of other top notch brands I could chose from, just wondering if you had some alternative brands/products that you have used or suggested before. Thorne, pure encapsulations, douglas labs, metagenics, st. francis are just to name a few I have a available.

    • Hi Natalie – St. Francis and Botanica both offer good tinctures in Canada very similar to the Herb Pharm products. As an example, I take the St. Francis Strest adaptogen blend which is strikingly similar to the Herb Pharm Stress Manager product.

    • Hi Natalie,

      I trust Marty’s recommendation. He is done some excellent research on products available in Canada. Pure Encapsulations and Thorne Research are also top companies. Thorne’s Basic Nutrients 2 a day is one of my top multivitamin picks on my best and worst multivitamin article.

      • Thanks Alex and Marty for the advice. Any specific products from these companies would help a ton. Your article is testing to be true for me. I went to my Naturopath yesterday with this article in mind. She tested the Naturelo vitamin with me and said it would be great. She uses pulse to see your response to products, and then she said my liver was congested. I have been an elite athlete my whole life but these last 5 or 6 years had a huge amount of fatigue and stomach issues. My TSH is over 5 and it really needs to be brought back down and I might have to start synthyriod at this point while doing the above protocol. Two questions, my NP said this product would really help my liver, how would you rate it to the Herb Pharm: And what are your thoughts of Rhodiola vs Ashwagandha?, she thinks I would have a better response to Rhodiola as she thought it fit me better. Thanks again.

        • Hi Natalie,

          That looks like a great liver product.

          Rhodiola, ashwagandha and eleuthero root are all adaptogens used with adrenal issues. It is really about finding the right fit. In my experience, rhodiola can be hit or miss with some women being sensitive to it. But that doesn’t mean it may not work for you. It is worth trying.

  • Hi Alex – since products with BPA linings may perpetuate thyroid problems, many people (including myself) are switching over to “BPA free” products, such as canned goods. But what I am now finding out after hounding companies is that vinyl organosol is becoming the “BPA free” lining of choice. This does not seem like an improvement to me. Your thoughts on the matter would be much appreciated.

    • Hi Marty,

      Good question. I’ve spoken with practitioners specializing in environmental medicine that believe that BPA alternatives in plastic are potentially causing just as many issues, it is just that the research has to catch up. This is true of vinyl organosol. You may have seen how BPS was a disaster in zebrafish studies. BPS has been used instead of BPA, and research has found similar estrogenic activity, cell interference, heart arrhythmia and thyroid suppression. My only solution, for now, is to choose glass until an innovative engineer sees a major opportunity to create a health and sustainable plastic alternative.

  • I’ve really enjoyed coming across your site (through a search for a solid prenatal)… I notice the vitamin C you referenced in your Adrenal Fatigue & Thyroid Dysfunction article. Recently I’ve been using vitamin C from acerola cherry (Terrasoul or Sarifoods). Do you find the vitamin C you reference in your article to be better than a vitamin C directly from a food source such as organic acerola cherry? Thanks!

    • Yes, I explain in more detail in this vitamin C article:

      The short version is that powdered vitamin C from whole foods depletes rapidly when exposed to oxygen and light. Vitamin C as L-ascorbate is a unique exception to the rule because our bodies have the machinery to produce our own vitamin C (like animals) except for the last step where a gene mutation occurred and turned it off. L-ascorbate is a bioidentical compound that our bodies recognize, has thousands of studies behind it, and this form is more stable. Due to our high-stress and polluted environment, our body uses vitamin C in large amounts.

  • Hi Alex,

    I have been taking Promix grass fed whey and even though it says it is cold processed, since it has to be pasteurized and heated to a minimum of 161 degrees Fahrenheit for 15 seconds, doesn’t that negatively affect the nutrients? And is it better to take their plant based protein?

    • Hi Adam,

      All whey protein in the United States is flash pasteurized. The amount of time and process is where retaining certain compounds changes. There is a study that looked at cold processing to standard heat treatment for whey, and lactoferrin, transforming growth factor (TGF-β2), BSA and immunoglobulins were all found in higher levels in the cold processed whey. So these compounds do remain even after flash pasteurization. Whether or not plant-based protein is better than whey depends on your individual needs, sensitivities, and goals.

  • This a a great site! I linked to Amazon to see the multi-vitamin listed here, but magnesium is not listed as an ingredient. Have they changed the formula or am I just not seeing it? Thank you, Diana

Leave a Reply

 characters available