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Executive Summary

  • There’s evidence against the adrenal fatigue concept.
  • The main symptoms of ‘adrenal fatigue‘ are caused by other scientifically valid concepts.
  • Inflammation and oxidative stress (OS) are the fundamental causes of what people call ‘adrenal fatigue‘.
  • The hypothalamus ‘senses’ inflammation and OS.  In their presence, the hypothalamus sends out ‘signals’ to the body to  behave in a way that makes us feel tired, sick, unmotivated, etc… (via orexin, neurotransmitters, and other hormones)
  • The active thyroid hormone (T3) is decreased by inflammation and OS, which independently causes problems of its own.
  • The tiredness you feel is mainly because of your hypothalamus (suppression of orexin) and secondarily because of low T3 and low pregnenolone.
  • In some cases, low cortisol can also contribute to tiredness, but cortisol levels are controlled by your hypothalamus.  Chronic inflammation generally increases cortisol levels.
  • Generally, there is no defect or problem with your adrenal glands themselves;  They are not ‘fatigued’.

To heal ‘adrenal fatigue‘ you need to get to the source of the problem.  You need to find out what factors are causing your inflammation and oxidative stress.  Read this post to discover the source of your ‘adrenal fatigue’.

What is Adrenal Fatigue?

The adrenals produce several hormones such as adrenaline, which is responsible for “fight or flight” response.

Adrenal Fatigue is the belief that the adrenal glands are exhausted and unable to produce adequate quantities of hormones, primarily cortisol.

What’s The History of Adrenal Fatigue?

James Wilson coined the term “adrenal fatigue” in his 1998 book of the same name. (R)

Wilson is a lone wolf in his adrenal fatigue concept.  He’s got degrees behind him, but I think he misunderstands the body.

Is There Any Scientific Support For Adrenal Fatigue?


A search of PubMed for “adrenal fatigue” brings up only eight results.

None of the results contain any substantive information or provide any markers or a sound biological basis for adrenal fatigue.  Basically, it’s as if nothing came up.

Contrast this with chronic fatigue syndrome, which has plenty of biological markers to speak of and scientific studies behind it.

The problem with the adrenal fatigue concept is that the underlying biology is false since our adrenals have a pretty good capacity to pump out enough cortisol.

When animals -and probably humans – undergo chronic stress, their adrenals get bigger. (R)  So we have a good ability to adapt and make more cortisol.

Adrenal fatigue shouldn’t be confused with Addison’s disease, which is an autoimmune disease that causes adrenal insufficiency. Also, adrenal insufficiency can be caused by a pituitary disorder that gives insufficient hormonal stimulation to the adrenals.

It could very well be the case that someone’s adrenals are not working well, but it would likely be an extremely rare condition (1 in a million maybe) and there’s no way to diagnose it.    Additionally, there’s not a shred of evidence for it.  This is opposed to Dr. Wilson’s view that most of the population has adrenal fatigue.

Nonspecific symptoms of fatigue aren’t evidence for adrenal fatigue because there are many scientifically validated causes of fatigue, and they don’t arise from adrenal dysfunction.

Low or high cortisol levels are found in many conditions, especially cognitive disorders.

Chronic stress response activation is a causal factor of a variety of health problems, including depression. See why stress is bad.

However, the adrenals themselves are not the problem.  Inflammation and other factors are.

What Endocrinologists Have to Say About Adrenal Fatigue

The public education arm of the Endocrine Society, representing 14,000 endocrinologists, recently issued the following advisory:

“Adrenal fatigue” is not a real medical condition. There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms. (R)

Now, you know I don’t take the words of any organization as true without my own research or understanding.  I look at the scientific literature and if none exists, I think about possible mechanisms based on sound biology.  But in this case, they are right.

What Are The Symptoms/Criteria of Adrenal Fatigue?

I’m bringing down the symptoms and criteria to show you that there’re much better scientific explanations as to what’s going on.

Take a look at the James’ own questionnaire, at, to see if you have it. Do you ever experience the following?

  1. Tired for no reason?
  2. Having trouble getting up in the morning?
  3. Need coffee, cola, salty or sweet snacks to keep going?
  4. Feeling run down and stressed?
  5. Crave salty or sweet snacks?
  6. Struggling to keep up with life’s daily demands?
  7. Can’t bounce back from stress or illness?
  8. Not having fun anymore?
  9. Decreased sex drive?

If you answered yes to any of these questions, you may have adrenal fatigue.

Elsewhere, Wilson mentions:

  • One or more severely stressful events that have affected my well-being,
  • Hopelessness and despair,
  • Trouble thinking clearly or finishing your tasks,
  • Unexplained fears/anxieties,
  • Low blood pressure,
  • Frequently cold,
  • Often become hungry, confused, shaky,
  • Hands and legs get restless,
  • Lost weight without reason while feeling very tired and listless.

He also lists a variety of inflammatory conditions that coexist with adrenal fatigue (CFS, Arthritis, Asthma, Fibromyalgia, Allergies, etc..)

See his whole quiz of questions.

If you read this list with a straight face then I commend you.  I got a good laugh.  If this is the criteria of adrenal fatigue, then over 90% of the world has it.

How is Adrenal Fatigue Diagnosed?

By checking your cortisol levels in the morning and throughout the day.  This is highly problematic as a diagnostic test because many factors can influence cortisol levels.

What’s The Real Cause of Fatigue? It’s The Hypothalamus, Silly.


All of the symptoms and diagnostic criteria above can be explained in a way that has much more evidence to it.  We don’t need to rely on the adrenal explanation.

First, the hypothalamus is mainly responsible for how fatigued we are and it works principally through orexin, but also histamine neurons.  See my post on why we get tired even after we have enough sleep and why you get tired after meals.

In short, the most common reason we are fatigued is because of inflammation (IL-1, TNF) and mitochondrial dysfunction, both of which lead to the suppression of orexin neurons.  

This inflammation can be localized in the hypothalamus.  Inflammation directly leads to the suppression of orexin.

Mitochondrial dysfunction indirectly leads to the suppression of orexin by causing an increased  sensitivity to orexin being suppressed by glucose. (R)

So if your mitochondria are working well, you wouldn’t get tired from a little glucose, whereas if they aren’t you will.

No disrespect to Dr. Wilson, but he created his fake disease 17 years ago.  Science only discovered that inflammation suppresses orexin in 2011 and the same for mitochondrial dysfunction.

Is Salivary Cortisol a Good Test?

I use salivary cortisol to see how bad the condition is and to get a deeper understanding of what’s going on.

Cortisol levels are also a good indicator of how someone’s circadian rhythm is doing.

When you suppress orexin neurons, that interferes with cortisol production, as Orexin A stimulates cortisol release. (R)

Since orexin is being suppressed (from mitochondrial dysfunction and inflammation), cortisol rhythms often shift and people have lower AM cortisol and higher relative PM cortisol.  (This is one possible/theoretical reason.)

When you have low cortisol, it’s not feeding back to inhibit CRH, which is causing more hypothalamic dysregulation as a result of excess CRH.

So low cortisol will tell me that somebody will likely do better with increasing cortisol in order to inhibit CRH.

On the other hand, if cortisol is high, then that means that CRH is chronically high, as it’s a good indicator of CRH (unless there’s an issue).

If cortisol is low, CRH can still be high, but other things are going on.

Hundreds or even thousands of studies speak about cortisol being too low or high in relation to various diseases, usually cognitive- based conditions.

For example, PTSD is associated with lower cortisol and higher DHEA. (R) The question is why?

Why Cortisol is Low and DHEA is High

It’s unlikely that cortisol is low from adrenal malfunction because DHEA is also produced by the adrenal gland and it’s relatively high usually.

One reason why this imbalance occurs is because of the hormone CRH (precursor to ACTH->Cortisol).

CRH directly stimulates DHEA‘s production in human adrenal cells. CRH increased the enzymes that shunt pregnenolone production to DHEA (17alpha-hydroxylase/17,20 lyase via PKC), which deprives cortisol production and causes low cortisol. (R)

The enzyme that causes cortisol to increase (3betaHSD via PKA) is stimulated by ACTH(R), but ACTH may be reduced in chronic stress as a result of glutathione depletion from oxidative stress caused by CRH (R) (just a theory). When this occurs, it usually means it’s been a problem for a while.

Low(ish) cortisol levels could also be due to HPA axis underactivity, increased negative feedback sensitivity (from cortisol) and/or changes in enzymes that metabolize it.

In PTSD, people are more sensitive to cortisol inhibiting the HPA axis because of higher glucocorticoid receptor density. (R)

There is also changes in the enzymes 11β-HSD1, 11β-HSD2, and 5α-reductase, which affect cortisol levels. (R)

Holocaust survivors show strikingly less liver 5α-reductase type 1, as well as a relative deficiency of 11β-HSD2 in the kidney, which increases cortisol levels in certain tissues, but reduces the HPA axis and lower cortisol more systemically.  These changes often happen early in life such as childhood or adolescence and the effects can be long term. (R)

What’s Really Going on in ‘Adrenal Fatigue’?

I can’t speak for everyone that has been diagnosed with adrenal fatigue because the purported symptoms can refer to any disease. Really.  It’s a brilliant marketing tactic.  List as many symptoms as possible so that everyone will think they have the disease.

But there’re some common themes.  Let’s deconstruct one symptom at a time.

1) Fatigue.  We spoke about this.  The lateral hypothalamus controls fatigue via orexin.   This has nothing to do with an inability to pump cortisol.

2) Stress.  If we are feeling stressed then that’s actually more from CRH (produced in the hypothalamus) than cortisol.  Our stress response can activate because of a number of reasons.

I’ve also spoken about how a variety of cytokines like IL-1, TNF and IL-6 can stimulate the hypothalamus to release CRH, which eventually leads to cortisol.

3) Cravings.  The ventromedial hypothalamus (VMH) is actually the part of the brain that is responsible for cravings and appetite.  It works via orexin, NPY, Leptin and other hormones.

4) Low mood and motivation.  Motivation is based on epinephrine and dopamine in the hypothalamus (R), as well as orexin and MCH (R).  Dopamine can activate orexin (R).  Read how orexin affects our mood and motivation and how to increase it.

5) Gut problems.  The hypothalamus controls two chemicals called VIP and CRH, both of which influence gut function.   CRH is known to cause IBS (R).  Various cytokines like IL-8, IL-6, IL-1b and TNF can also cause IBS and gut problems (directly and indirectly).  TNF and inflammation increase CRH (R).  Oxidative stress and inflammation are at the root of gut problems, not an inability to pump out cortisol.

6) Cold hands and feet.  The paraventricular nucleus and ventromedial hypothalamus (VMH) controls temperature regulation.(R) When you get inflammation like elevated TNF-alpha, this suppresses orexin and therefore appetite and causes you to get fatigued.  Orexin suppression also causes lower body temperature (R) and therefore you’ll feel cold.  This makes sense in order to keep the body in sync (eat less and therefore conserve energy). People who are cold are usually thin as well and have a decreased caloric intake.

7) Decreased/increased appetite.   The hypothalamus control appetite through orexin, ghrelin, NPY, T3,  leptin, norepinephrine, serotonin, MCH, FGF21+19 and GLP-1 all of which influence appetite and interact with each other (R, R2,  R3, R4). Orexin, T3, ghrelin, MCH, FGF21 and NPY increase appetite, while leptin, insulin, norepinephrine, serotonin, GLP-1, and FGF19 are appetite suppressants.  Orexin is activated by glutamate and suppressed by GABA. (R)  Low hypothalamic serotonin leads to increased carb cravings.  Low orexin leads to decreased appetite.

8) Decreased sex drive.  The ventromedial (R), arcuate and anterior nucleus are the portions of the hypothalamus that controls sex drive.   Dopamine in the hypothalamus is largely responsible for sex drive. (R) CRH, produced by the hypothalamus, also inhibits GnRH, which is largely responsible for sex drive.

9) Fear/Anxieties/Stress/OCD/Overly Emotional.   The picture below shows how the hypothalamus executes fear from the amygdala.  CRH is a very significant cause of these issues by causing glutamate to overexcite.

Specifically, the ventromedial hypothalamus (VMH) is involved in fear. (R)


10) Low blood pressure, Increased thirst, and urination  are all from too little ADH, which is released by….you guessed it! The hypothalamus.

11) Insomnia can be from hypothalamic activation and circadian disruption, which inflammation is known to cause.  CRH inhibits GHRH, which will cause sleep problems.  Again, it’s the hypothalamus, not your adrenals.

12) Hormonal issues.  The hypothalamus is the center for hormonal control…It controls the thyroid, pituitary, and adrenal glands, for example.

13) Blood sugar swings, shaking and hypoglycemia.  The hypothalamus (paraventricular nucleus) controls glucose sensing/balance and if it’s not functioning you can get hypoglycemic, which can cause shaking. (R)

14) Attention problems. The hypothalamus is involved in attention (R) – hence why motivational and attentional issues often go to together. (R)  Orexin, melanin-concentrating hormone (R), low levels of dopamine (R) and acetylcholine (R) are also involved with attention.  Inflammation can lower these neurotransmitters.  Orexin increases acetylcholine (R) and so inflammation will lead to lower levels of this neurotransmitter.  Acetylcholine also increases orexin (R).  CRH causes glutamate excess and you feel more anxious and less grounded.

15) Losing weight.  The hypothalamus is the most important factor in controlling our weight.  Inflammation from TNF causes us to lose weight as a result of decreasing hunger.  See the TNF post.

16) OCD and an inability to let go of thoughts. The hypothalamus is responsible for attachment behaviors.  CRH causes glutamate excess and you can’t let go.  Low serotonin is also a problem.

My point isn’t to demonstrate that everyone with adrenal fatigue has a hypothalamic problem.  The issue could by thyroidal, from sleep apnea, Addison’s disease, depression, etc…

Many of the listed symptoms above could also be as a result of having low levels of T3, which is the active thyroid hormone.   Doctors generally do not check T3 even if you ask and people don’t realize that they have low T3.  Low T3 can increase your risk for heart disease by 400%.

Many of the other symptoms can be categorized into Th1, Th2 or Th17 categories.  See if you’re Th1 or Th2 dominant.

You could have excess histamine or be histamine intolerant.

Sometimes people have chronic viral infections like Epstein Barr Virus, which causes some types of inflammation and oxidative stress.

Sometimes people have CFS, which has nothing to do with the capacity of the adrenals to pump out cortisol.  An autoimmune disease like multiple sclerosis or narcolepsy can be the problem (which directly has to do with the hypothalamus).

I could keep on going, but that’s not the point of this post.  The point is to show you that you can take the symptoms of adrenal fatigue and have  clear scientific evidence for an alternative explanation.

A fake diagnosis will only hold you back from really understanding what’s going on.

Why would you believe something with evidence against it when you have an alternative explanation that explains the situation much better?  And even without an alternative, “I don’t know ” is better than claiming we know when we don’t.

It’s the case that the hypothalamus is involved with all of the listed diseases (either directly or indirectly), but it’s not always (or even usually) the starting point.

The hypothalamus causes or is affected by all of the events in the picture below.  The adrenals aren’t damaged by these, but oxidative stress and inflammation usually do occur and the hypothalamus is affected.

Chronic Stress is Terrible, But Not Because Our Adrenals Are Fatigued

Most commonly, I see adrenal fatigue  being used in the context of having a variety of health problems after chronic stress.

I want to be clear that there are many reasons why chronic stress is unhealthy.   However, none of them have to do with the inability to pump out more cortisol.  

The most harmful aspect of stress is because of Corticotropin Releasing Hormone (CRH), which is released by the hypothalamus and leads to the eventual production of cortisol.  The more you activate your stress pathway, the more you release CRH.  So the damage is caused without regard to the capacity of your adrenals to pump out cortisol.

Stress is bad by causing:

  • Cortisol Resistance
  • Decreased immune function – and therefore inability to handle infections
  • Inflammation (CRH causes increased Th1 dominance, TLR-4, Nf-kB, IL-1b, IL-6, TNF, MHC-II (HLA-DR) and ICAM-1.
  • Obesity – raises blood sugar, insulin, makes you hungry
  • Cognitive dysfunction – by neurotransmitter resistance, inflammation, impairing memory and lowering dopamine, acetylcholine, LTP, BDNF, neurogenesis and dendritic branching.
  • Depression – as a result of CRH, chronic HPA activation, dynorphin, lower BDNF, lower neurogenesis, lower dopamine, and GABA, serotonin and glutamate resistance.
  • Gut dysfunction – by slowing intestinal flow and causing permeability.
  • Heart damage – by increased adrenaline, oxygen demand on the body, spasm of the heart blood vessels, and electrical instability in the heart.  It also lowers heart ratevariability and resting heart rate and increasing blood pressure
  • Infertility and lower libido – decreases GnRH, LH, FSH
  • Worse sleep – decreases slow wave sleep
  • Neurotransmitter resistance (Glutamate, Serotonin, GABA)
  • Lower dopamine and acetylcholine
  • Lower Pregnenolone, DHEA, Testosterone, Growth Hormone
  • Lower Thyroid Hormones (T3, T4, TSH)
  • Higher Prolactin and Estrogen
  • Oxidative stress – in your hippocampus or memory center via CRH

As you can see, stress is very harmful.  You do not want to chronically activate your stress pathway.  It also makes sense now why we start to develop all kinds of health problems after chronic stress.

All of these mechanisms that I list are based on science, whereas adrenal fatigue  has not a shred of evidence.

Read my post for references and more details on why stress is harmful.

How Did This Fake Disease Get So Popular?

There’re two reasons I believe this fake disease got popular.   I’d like to mention that most people who talk about adrenal fatigue are well meaning.

1) A lack of knowledge of biology.

2) As a way to make money.

People with chronic fatigue go to doctors only to be given a blank stare or be told it’s all in their head.

By giving a name to a disease, it’s a psychological tool to give you hope and certainty, which people crave.

From the patient’s vantage, it’s a natural human tendency to not want doubt as to what condition they have and so they seek out people who will give them a concrete diagnosis.

From the practitioner’s vantage, not sounding certain is bad for business.  Putting a name on something gives people hope and with hope comes $$money$$.

Think about it.  Do you think it’s easier to sell stuff if I told you “I don’t know what you have” or if I told you “you’ve got Adrenal Fatigue.”

Keep in mind that the best and sweetest people have used this term, not for profit, but because this is what they were taught or learned from other bloggers or teachers.

If you’re such a person, no worries!  I’ve made this mistake before, too, so I’m not putting myself on a pedestal.  I’m giving you the tools to have a better idea of what’s going on and sound really cool to your patients.

How is Adrenal Fatigue Treated?

While adrenal fatigue may not exist, the same can’t be said for the treatments.

AstragalusRhodiola, EleutheroGinsengLicoriceSchisandra, and Cordyceps are just a few examples of supplements given for adrenal fatigue.

If you click on the links, you’ll see that all of them interact with the hypothalamus.  Often, they are effective if used for the right condition, but for reasons that don’t have to do with the adrenal gland.

Traditional Chinese Medicine completely misunderstood biology, yet many of their herbs were/are effective for a set of symptoms that existed in the past.

So my point isn’t that the treatments don’t work for the symptoms, it’s just that the biology is completely misunderstood.

However, I do think that by not understanding the biology, the treatments aren’t as targeted as they could be.

Most of the time, people’s immune system’s are overactive.  All of the listed supplements are mainly immune stimulants (perhaps licorice being an exception).

So not understanding our biology can have negative consequences in how we treat disease.


Adrenal fatigue is a misconception that arose as a result of the misunderstanding of biology, making faulty associations and a good marketing opportunity.  Many well-meaning people have been misled by this load of horse shit, including myself.

How to Deal With ‘Adrenal Fatigue’

I’ve made a post of a regimen that I recommend for ‘Adrenal Fatigue’.

Health Tools I Wish I Had When I Was Sick

At SelfHacked, it’s our goal to offer our readers all the tools possible to get optimally healthy. When I was struggling with chronic health issues I felt stuck because I didn’t have any tools to help me get better. I had to spend literally thousands of hours trying to read through studies on pubmed to figure out how the body worked and how to fix it.

That’s why I decided to create tools that will help others cut down the guesswork:

  • Lab Test Analyzer – a software tool that will analyze your labs and tell you what the optimal values are for each marker — as well as provide you with actionable tips and personalized health and lifestyle recommendations to help you get there.
  • SelfDecode – a software tool that will help you analyze your genetic data from companies such as 23andme and ancestry. You will learn how your health is being impacted by your genes, and how to use this knowledge to your advantage.
  • SelfHacked Secrets – an ebook where we examine and explain the biggest overlooked environmental factors that cause disease. This ebook is a great place to start your journey if you want to learn the essential steps to optimizing your health.
  • SelfHacked Elimination Diet course – a video course that will help you figure out which diet works best for you
  • Selfhacked Inflammation course – a video course on inflammation and how to bring it down
  • Biohacking insomnia – an ebook on how to get great sleep
  • Lectin Avoidance Cookbook – an e-cookbook for people with food sensitivities
  • BrainGauge – a device that detects subtle brain changes and allows you to test what’s working for you
  • SelfHacked VIP – an area where you can ask me (Joe) questions about health topics

FDA Compliance

The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease. Information is shared for educational purposes only. You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication, or have a medical condition.


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  • Tarek

    Weil instead of Providing what could help you find Videos and some courses Where you have to pay Money for. Seems like there is someone Marketing his own Shit…

  • Philippe

    From my own perspective, it should be called “HPA-Axis Dysregulation” and as mentionned earlier in previous post, can be point out with the feedback loop that occure. Just keep in mind that as it implicate Neurology, Immunology, Psychiatry and endocrinology so I guess, what we could say a pretty mindblowing complex condition, you won’t find a consensus anytime soon among health professionals.

  • Kristin

    Um….wow. So I have A LOT to say about the hostility of this author towards this topic. And I must say, I have lived “adrenal fatigue” and he is dead wrong and clearly has an axe to grind. No idea why he is so angry at this concept. Its a blood test by the way. This is not some made up thing that is diagnosed with a diving rod. You go and get your cortisol levels checked. Its really that simple. You will either be normal or not and my adrenals just don’t produce enough. It is actually that simple. Im sure he, or anyone, would accept the concept of “percentage of function” of any other organ. The liver, the kidneys, the lungs…its the way the body works. NO organ is just on or off. NONE of them. ALL Organs function on a spectrum. My mother has kidney disease and we test her kidney function twice a year. Percentage of function of ANY organ in the body is nothing to be politically against, as this author is, and its actually HOW THE BODY WORKS. My husband has decreased lung function from smoking. My friend had heart issues and they could tell him what percentage of blood flow was restricted. This will all just be a number after testing. It will be normal, or not normal and its right there in black and white from the lab. And how do we know what that number is, simple basic lab work. This dude angrily gets on this soap box throwing around big words thinking it will support his pissed off opinion. Meanwhile there are people suffering who cant get out of bed or are just more tired than everyone else who may see this silly post and may not go to someone who actually does this for a living and just ask for the blood test. I happened to have had many tests. An endocrinologist did the ACTH challenge to see how my adrenals respond to stress. the answer is – they don’t – at all. nothing happens. I don’t put out enough cortisol under normal circumstances (normal is 25 mg a day – I make 10mg a day) and when a stressful event happens (in the lab they mimic this and retest your blood) and mine actually shut down. Sooooo, what the Hell this dude is going on about and why is beyond me. Once I got these test results I could then supplement with bio identical hydro cortisone and lead a basically normal life now. Adrenal fatigue is also called “adrenal insufficiency” – how is this revolutionary and how is this something to be so angry about??? EVERY ORGAN IN THE BODY CAN BE FUNCTIONING BELOW NORMAL. What the F does he think blood work and imaging tests show? It tests you liver, kidneys, heart, brain, spine, thyroid, ovaries, blood pressure… name it there is a test for it and it shows normal, below normal or above normal. WHY or what to do about the not normal results of ANY organ is an art. My causes are known. Sometimes they will not be discovered. That is also true of all “below normal” test results. I Spent 10 years trying every “natural” way (although HYDRO cortisone is bio identical) to repair my adrenals back to normal function and they did not work, for reasons beyond the purview of this post. The point is…one can not reject the entire concept that this one organ in the body is different from all the others and is only ever on, or off, functioning at 100% or at 0%. That is just so dumb. ONCE we accept anything – a knee, an ear, eye balls…can ALL diminish in function we can look for a cause if one can be found, we can address the cause, or we just go get new glasses so we can live a normal life again. This is nothing to Bang on and on about in a furious post against some unknown enemy and convince every one he can that adrenals cant diminish in function, its actually all something else. thats just so silly. I was reading this site and found it interesting and then I came across something I really really KNOW about and realized This dude is a bit of a goof ball. He’s too angry for one. he’s striking back at something. Thats fine but never a good place to make decisions from. If he can be this adamant that he is right and this angry about something i am 110% sure he is dead wrong about….I cant trust anything else he says either.

  • Gail

    Dear Joe, thank you for your very informative work! When taking saliva tests for cortisol, I have very low cortisol and very low to flat DHEA. I spike cortisol in the early a.m. and take Ennerphos to help with that. I am extremely careful about my diet and inflammation. I’m going to slowly introduce grapefruit in the morning to see if I can raise cortisol levels. You said it on the saliva test usually the DHEA is high, But that is not the case with me. All of my hormones are out of whack. I am going through your self hacked information which is kind of mind-boggling for me right now. Do you have any recommendations as to where I could start? My adrenals seemed to crash when I had a string of incidents: was given OxyContin for her back and only took it for 10 days but had to go into detox as my reaction was so bad, tried to correct reduced heterozygous for MTHFR, And took a natural organic/in organic product for Lyme disease and confections, mold and more. I had been trying to correct and help the adrenals for A number of years, but these three incidents including the loss of a molar and treatment for that caused “adrenal crash.” I’m wondering if you can guide me to what this may be since you say adrenal fatigue is a myth. Thank you so much, Gail

  • Mel

    Joe, your site is a wealth of information for me! I have a severe case of CFS ( I think since childhood actually ), having lived in fight or flight since birth. My condition escalated about 5 years ago with the onset of a shoulder injury (torn Labrum), which led to frozen shoulder for 18 months. I think it’s possible the added inflammation of the injury may have sent my system further into overload. At that time, I experienced a sudden onset of tinnitus and vertigo, both are still affecting me today. This injury occured during some pretty bad emotional stress and leaving my marriage, as well having hormonal imbalances due to menopause. After 18 months, the shoulder released and I have 90% range of motion. Currently, I have a good doctor that is experienced in treating CFS and considered an expert on hormonal issues. He has me taking the following based on labs: HRT ( E2 1.75/P60/D3/T 0.9mg RDT ). Thyroid 32.5mg. B-12. D3. Magnesium. Gaba. Omega 3. Cortisol 5mg.

    I don’t feel any better taking this stuff. My life is a train wreck and I can not work or function normal. Everyday is like trudging through quick sand mentally and physically. The anxiety this causes is tremendous on top of the rest of it. I take CBD oil and it does seem to help quite a bit with the anxiety.

    I haven’t slept well in years. My circadium rhythm is off. I get very sleepy at night and fall asleep pretty easily ( when my anxiety is low and I’m not having OCD thoughts ), but always wake up for a several hours in the middle of the night. I can fall into a deep sleep when the sun comes up. But, this is terribly inconvenient in life and I can’t usually sleep all day, so am up by 9 a.m.

    My doctor has told me I must be exercising which has been impossible for me for years now. He wants me lifting light weights 3x a week for 15 minutes to start. I know there are many reasons I need to be doing this.

    Not doctor prescribed, but I just started taking Shilajit this week. I’m praying it’s a miracle cure for CFS, or atleast a significant reduction in symptoms. What are your thoughts? I did read your article about it.

    Also, my doctor said at my last visit a few weeks ago that he can CURE my CFS with a Myers cocktail, 3x a week for 3 weeks. I’d like to know your thoughts on this!

    One last question, why are the meds and supplements I’m taking not helping me sleep? What is missing and what would you advise? I believe sleep is the key to healing!

  • Angie

    I’ve never wrote on a blog before in my life but I feel I must comment.

    I suffered from fatigue for over 20 years that got steadily worse, doctors in 3 states offered me no help and a few suggested it was all in my head. I got to the point where I was sleeping 20+ hours a day and something as simple as walking to the bathroom was a struggle because I could barely hold myself up because my muscles were so fatigued. My brain fog was so bad I couldn’t drive or function to do much of anything. I felt like I was walking through jello in a thick fog 24/7.
    Doctors would do blood work over and over and over…nothing stood out…thyroid must be the problem but thyroid was in the “normal” parameters.
    I had my silver filings removed.
    I detoxed. I took vitamins. I ingested things that were probably more harmful than good trying to cure myself.
    Finally I found an “Alternative” Health Clinic and had everything done that they offered. Saliva testing, hair analyses, stool checked for parasites and undigested food, and blood work again.
    The saliva testing showed my cortisol levels were messed up (It’s been a long time…but I think the opposite levels, a.m. and p.m. switched?) and they said I had adrenal fatigue.
    I went home with a bagful their professional line of supplements, including ACE….Adrenal Cortex Extract…and within ONE WEEK I was feeling better than I had felt in almost a quarter of a century! ONE WEEK! The fog lifted, my energy came back, I started sleeping just at night and woke up feeling normal.
    I am sure some of the other vitamins, powders and such helped me long term to recover but it was the ACE that gave me my life back IMO.
    I’ve been pretty healthy for the last 17 years, I continue to research to stay that way. I take food based vitamins, eat real food and limit the bad stuff like gluten, white foods, alcohol, sugar, etc. My biggest issue is sometimes I have insomnia but liquid magnesium and herbals help with that.
    I haven’t opened Dr. Wilson’s book for years, but I can say without looking of it I had marked many many pages and it was THE BOOK that gave me hope I wasn’t crazy.
    Everyone is different in how they respond to drugs, food, and supplements of any kind. Tests are guidelines for what is “normal” based on averages but that doesn’t mean if one is on the normal line that it’s right for them at that time.
    Thank you for this site 🙂

  • Rick herman

    Did you get see this meta analysis that supports Joe’s views?

  • josh

    joe, Do you think that trying Hypothalamus glandular could make a point here?

  • Ivan

    Dr. Wilson or Dr. Lam have not invented the “adrenal fatigue” (AF). This syndrome was described by Hans Selye in late 50s as General Adaptation Syndrome. Strange but nobody who works on AF refers to Selye’s work.

  • arnie

    Hello Shannon, I could not agree with you more. Joe certainly knows far more nutritional biochemistry than any MD, young or old because they lack the curiosity and are for the most part. brainwashed by the current medical paradigm. However, there is the issue of semantics, a proinflammatory state does not always precede the energy deficit issue/adrenal fatigue component. There is no denying the HPA involvement but when that negative feedback loop malfunctions, you will be stressing the 3gram adrenals and the symptoms can be endless. You must support the HPA and the neurotransmitter component of this daunting problem. When you have pregnenolone steal, low cortisol total and low DHEA, you will also have hypoglycemia, which further stresses the sysytem. Most cannot afford their own sauna or the vast amount of supplements. Low dose hydrocortisone is the last resort and it has its own risks. Sometimes, the adrenals do not fully reboot when you are weaned off of it. I am glad you are doing better.

  • pru whistler

    Hi Joe, I found this article fascinating – however I have a question. I am currently on Thyroid medication but my doctor has said for it to work I have to take an adrenal supplement – she did explain it to me medically but not sure I understand – especially since you said adrenal fatigue doesn’t exist – just curious your thoughts?

    1. Helen

      Hi Pru, we recommend that you follow your doctor’s orders. But if you’d like Joe’s opinion, you can ask him inside of VIP: or over at

  • Shannon

    I never reply to these things but I just had to. Just because western medicine doesn’t acknowledge Adrenal Fatigue does not mean it doesn’t exist. It may come from somewhere else in the body but it is a real condition that affects every aspect of life. I’ve been suffering for years and it only got worse and worse. My blood sugar was 50 all the time no matter what I ate, and I couldn’t deal with ANY stress. My brain would “blank out”. After testing my cortisol levels through a saliva test it showed I wasn’t really making any at all, maybe a little in the morning. I’ve been on just 10 mg cortisol and I already feel like I’ve got my life back. This article is dangerous in the sense that it will deter people from seeking treatment making them think it’s all in their heads. I spent 5 years being thrown around in western medicine, then eventually told its all in my head, spent YEARS in therapy to no avail, countless meds for anxiety and depression. Three days on cortisol and I feel incredible. No stress, thinking clearly, no stomach pain anymore while eating. Normal bowel movements, no shakiness. EVERYTHING I came to my doctor complaining about is improving. This post is not helping to progress modern medicine. Mainly because doctors should be looking at what’s right in front of them: their patients and their REAL concerns and what symptoms they’re ACTUALLY feeling.

  • Christtoff Schulz

    Well we’ve searched high and low to cure this condition, whatever name you name it and what finally actually works to bring back bountiful full nights of sweet sound sleep and more energy are nettle tops and nettle seeds cooked and eaten a a veggie, daily.

  • Steven Josephs

    The name of the condition is not really relevant, as those who have this condition, whether you call it Chronic Fatigue Syndrome or whatever know its debilitating effects. The fact that medical doctors don’t understand it and don’t know how to deal with it and therefore disregard those experiencing it as ‘all in their head,’ does not mean it doesn’t exist. It just means that doctors trained in prescribing drugs and not understanding the cause of illnesses are useless for those looking for solutions to their health problems.
    Those who have never experienced true chronic fatigue/adrenal fatigue should not be writing about it since they have no frame of reference and are only relying on others opinions who also have not experienced the condition.

    1. Nattha Wannissorn, PhD

      Joe has experienced years of fatigue that would fit into the adrenal fatigue definition, and has helped thousands of clients with it.

  • Adam

    Isn’t your argument here a semantic one as much as anything? Are you disputing the label Adrenal Fatigue because it points to the adrenals as the root of the problem? If they are not the root, rather it is chronic inflammation or a larger stress response, or other factors.. but people can still benefit from interventions that help the adrenals, isn’t that the main thing?

  • AC

    I never thought about “adrenal fatigue” as an actual “fatigue” of the adrenal gland, but as some sort of dysregulation in the system……

  • Tribl

    Like your website and your approach

    I hope you’ll reconsider your stance on adrenal fatigue however, and the information you are providing about it, or at least take a closer look the vast body of medical literature available

    “A search of pubmed for “adrenal fatigue” brings up only eight results”

    The medical literature on ‘Adernal Fatigue’ date back as far as the 18th century, however, the term ‘Adrenal Fatigue’ is a newly coined term by Dr. Wilson

    If you want to do a literature search on adrenal fatigue, search for non-Addison’s hypoadrenia

    Other terms used in the literature in the past century include:
    sub-clinical hypoadrenia, neurasthenia, adrenal neurasthenia and adrenal apathy

    Dr. Wilson’s book is intended for lay people and doesn’t reference heavily, however you could try starting with his reference list from p. 303 to p. 316 in his book. If you’re really interested in looking at the medical literature on adrenal fatigue I suggest you contact Dr. Wilson and ask him for a more comprehensive literature list

    Datis Kharrazian’s brain book also contains some good pieces of information, if you haven’t heard of him I think you’ll like his approch

    Best Regards

    1. mij

      ^^ This. ^^

  • Christtoff Schulz

    Yes, right on about the adrenals being made to secrete too much Cortisol too constantly, due to fear and stress! The root of the problem is NOT the pathway, be it adrenal pathway or hypothalamus pathway. The root of the problem is that most modern humans are constantly being stimulated, all day and night, by the “Lilly” waves that ride on our 60 Hz power grids right into our homes and also ride into our homes, via TV, cell phones, computers, iPhones. And Lilly waves bypass the conscious brain to directly stimulate the brain to be in state of fear. Such is the extent of fear producing technology! Check out “Lilly” waves on line. And protection from Lilly waves includes orgonite devices, the mineral Shungite, taped to all appliances, cell phones, iPhones and electrical outlets and of course turning off the TV and Wi-fi when not in use.

  • Geoff

    Great article, helped me a ton! I’m on my second day of NSI-189. It’s shown to stimulate neurogenesis. Will report more in time!

    I have a virus that I’m taking care with Monolaurin of as well.

  • Suzanne

    Apparently you have not read the book “Adrenal Fatigue: the 21st century stress disorder”! Adrenal fatigue is NOT a myth!
    Ive been diagnosed with Fibro and hinted at Chronic Fatigue but itt wasnt until I did lots of research and bought the above mentioned book that ALL of my symptoms matched as well as the causes. Ive also been told a few months ago I have a “mass” on my left adrenal gland.
    There is tons of biological and logical proof of Adrenal Fatigue! Your research is inadequate and biased!

  • Maureen

    Why such angry undertones Joe? Do you think Dr. Wilson is a flim-flam man just out to make a buck, or maybe he is a doctor who, after seeing so many patients presenting with these disabling symptoms that modern medicine thinks are all in our head, wanted to be different and actually offer solutions to help ease their sufferings? I admit I am less familiar with this situation than you are (being the first time ever hearing about this), but my feelers tell me this doctor was well meaning.
    I was diagnosed almost 15 years ago with AF, and am still feeling its affects. I am actually very sick, with a lifetime of anxiety, depression, then depersonalization the last 19 years. 6 years ago I developed unbalanced breathing…hyperventilation…and lost my job, my house, and my life! I am also a nutritionist, and the last 3 years I began really researching…and feel I actually have hope. Since coming across the traditional diet (high in critical animal fats…NO junk oils) and functional medicine, and of course the whole gut dysbiosis and permeability, and of course the gut brain axis, I know that I won’t be ‘celebrating’ my 20 yr anniversary come November 1. I can look back at my whole life and pinpoint both things that led me to all my health problems, and my body’s continued attempts to signal me to stop. But I didn’t listen. I completely blame it on our evil corrupt food system, comprised of greedy corporations and corrupt government. Same goes for our healthcare (managed sickness care, I mean) and insurance industies! The perfect (cumulative) DP storm was working at a Mexican restaurant, with all the free corn chips I wanted…and I love them! So we’re talking pesticide laden (GMO?) corn, deep fried in cottonseed oil (the worst!), full of acrilomides, and dipped in MSG packed salsa. Oh my aching toxic brain and blood sugar…and every cell in my body! I have also learned, through my colleague’s research, how large of roles ammonia, arginine, MSG and aspartame play in brain damage. Ammonia is a huge problem because pesticides inhibit the enzyme we need to excrete it! So we store it…you guessed it…in our brain, where it does alot of damage…similar to excitotoxins. It’s also stored in the gut (think constipation) and our muscles (think tension).
    Here is a small website on ammonia
    Arginine, which the SAD diet is high in, also has the same affect. Here is our website on this
    Which brings me to your website. I am thrilled to finally find it! I love all the brain fog and inflammation and oxidase (?) information. And I love your take on AF. I also LOVE your stress chart…very comprehensive. I believe you’re right, and I believe that gluten…and pesticides and chemicals (which includes most plant oils)…are at the root of my/our health pandemics we have today. The other huge factor is our tragic lack of critical good animal fats…organic, pastured, and unpasteurized dairy. I’m going to reread these articles for better understanding and try to figure out how to incorporate your info and recommendations into my plan. As you may have guessed I follow the Weston A Price diet, but it’s ever evolving as I am able to listen more to my body as it speaks to me. (Such a lost concept in this sick age we live in!) I really appreciate your article on sourdough bread as I struggle and wrestle with the whole To wheat or Not to wheat question. If you’re interested, I can give you more information on the protocol for removing ammonia. I hope you will give me some feedback on my colleague’s work, and any other comments you may have.
    So grateful I found you!

    1. Joseph M. Cohen

      Thanks 🙂

  • George

    Hi Joe

    so what would you suggest to a person with fibromyalgia?


  • Ashley

    I think most doctors who treat adrenal fatigue and call it such would actually agree that it is actually an HPA signaling problem that is the cause, not a fatigued adrenal gland. And I think that the reason the misnomer has stuck is because the removal of the stressors, such as chronic infections and stress, does lead to a correction of the problem.

    1. Kelly

      How do you heal this – 10) Low blood pressure, Increased thirst and urination are all from too little ADH, which is released by….you guessed it! The hypothalamus.

  • Dylan

    Hey Joseph,

    We spoke the other day. I wanted to mention that Adrenal Fatigue is used to describe high and low cortisol states. High cortisol can cause cellular resistance to all hormones, including cortisol itself, so having high cortisol is like having low cortisol.

    1. Joseph M. Cohen

      1) cellular resistance isn’t a term I see in the literature. I don’t get what you’re saying.

      2) I’m not aware of any disease that can be diagnosed if you have high or low levels of the same hormone. It would be two different diseases. Like Hashimotos and Graves.

      3) There could be many reasons why you have abnormal cortisol levels, most of which has nothing to do with your adrenal glands.

      Overall, the adrenal fatigue concept is terrible at explaing what’s happening in your body.

  • Marco

    Very good article, but it’s sad you didn’t write about possible treatments. I know the framework is wide, but… most people with CFS & co. really need solutions. I know you don’t have to give them, but it would have been nice for sure.

    What do you think about LSD, moving, light therapy, getting in peaceful environment? Or maybe methylene blue.


    1. N

      He does mention possible treatments (or factors that lead to such) – in relation to the real cause ~ the hypothalamus-inflammation-oxidative stress. Try to read his articles here: and then correlate it to his other articles.

  • Kelly Lynn

    So what is the correct treatment for the hypothalmus? I feel like this article is informative until it doesn’t give any suggestions – trreatment – or what the solution is – only the ‘real’ problem.

    1. Joseph M. Cohen

      It depends what the source of the problem is. I have written many posts about solutions. Click on the underlined links contained in the article.

      The treatment will be different if your sleep is messed up, if you’re lectin sensitive, have CFS, depression or another issue.

      Look around the site.

      1. Kelly Lynn

        Thank you so much!

      2. Joseph M. Cohen

        If I had to give advice for a majority of people I’d recommend these tips…


        The posts are about brain fog, but the tips will work if you have ‘adrenal fatigue’

    2. Michael

      Exactly. The owner of this blog missed the boat on the point of writing an article. Wouldn’t it be funny if later an article was published listing remedies for the hypothalamus disorder he discusses, and the remedies were the same things that the Adrenal Fatigue books recommend?

      Oh, I see some of this has already started to happen: his recommendation to use phosphatidylserine to lower cortisol.

      1. Joseph M. Cohen

        Isn’t adrenal fatigue from low cortisol levels?

        1. Dave

          Well you might try researching it a little more, the info is out there, and thousands upon thousands have been helped (including me, who like you, had to research and help and myself). AF has MANY causes, low Cortisol is NOT one of them

          1. Joseph M. Cohen

            Part 2 of the debunking is coming….

            reply icon
  • Ole

    So is caffeine and other stimulants used on ocassion from sources that dont inflamme you tolerated even if you have “adrenal fatigue”?

    People claim to stay away from it for years to heal, but i dont see how 100mg of caffeine once per week would be very harmful. Coffee makes me very calm and reduces my anxiety and stress anyway.

    1. Joseph M. Cohen


  • Jean

    Awesome, man. I want to share something interesting with you:
    200mg of Huperzine A before sleep (~3 days a week) has worked great for me in order to wake up completely refreshed each and every time, even before my alarm clock went off. Not sure if it’s the acetylcholine doing something for the orexin, decreased IL-1b or decreased Nf-Kb doing the magic. Its effect works about 10 hours, so it’s a great tool for sleep. I also dream very lucidly and can remember my dreams with it.

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