Adrenals and Cortisol

By: Arturo Portales, DO


The adrenal glands are the stress glands that produce 2 hormones: cortisol and DHEA. The adrenal gland also produces epinephrine, also known as adrenalin.

When we are stressed, our bodies release cortisol and epinephrine. It's part of the fight/flight response and it is designed to keep us alive and safe. 

Epinephrine makes our heart rate go up and increases our blood pressure all in anticipation of fight or flight. Cortisol increases our blood sugar in anticipation of energy needs. Sugar is converted into energy. This was a big help when we were running away from an attacking animal. Once safe, all these responses would calm down.

However, today, we live in a 24/7/365 world, and our bodies do not distinguish the kind of stress we experience. To our adrenal glands, all stress is the same. Our adrenals are being pushed to produce more and more cortisol. In time, this response diminishes.

In the 1930s, Hans Selye described 3 stages of stress. First, there is the “alarm” phase. In this phase, cortisol levels are high and DHEA levels are normal. During the alarm phase, as the name implies, our bodies are ready for the flight or fight response. Blood pressure and heart rate go up, blood flow increases to our muscles, and several chemicals are released including cortisol and adrenalin. These return to normal once the stress has passed.

If stress continues, we move into the adaptive phase. Cortisol is responsible for most of the response in this phase. Cortisol increases blood sugar. . Cortisol also stimulates the retention of sodium which helps keep blood pressure elevated and cardiac output strong. These effects help you keep up your energy demands from the ongoing stress. Prolonged elevated cortisol is also inflammatory.

At normal levels, cortisol has a very powerful anti-inflammatory effect, but at prolonged elevated levels, cortisol will weaken the immune system. This puts us at increased risk of heart disease, diabetes, and cancer. Rather than stimulating repair and recovery, prolonged elevated cortisol will do just the opposite and slow down recovery and increase tissue breakdown. This leads to the exhaustive phase.

High cortisol causes the following:

  • A weakened immune system 
  • Decreases in bone and muscle mass
  • Hair loss thinning skin
  • The inability to grow nails 
  • Decreased concentration and memory
  • Disrupts thyroid function leads to type 2 diabetes, high cholesterol, high blood pressure, and osteoporosis.

During the exhaustive phase, cortisol levels are now low as are a related hormone, aldosterone. Aldosterone is made from cortisol and is responsible for sodium retention. When cortisol levels are low, so also is aldosterone. This leads to sodium loss and potassium retention. Blood sugar goes down as well because of decreased gluconeogenesis. Insulin levels are also high and this also lowers blood sugar levels. Blood sugar levels are now dependent solely on diet. This leaves you feeling weak and lacking energy. This leads to carb cravings or salt cravings.

How do you treat adrenal dysfunction? Start by removing the stressors from your life. That is not always practical, but if possible, that is where you start. Next, nutritional support. Eat a balanced diet, and stop eating sweets or salty snacks. Get off the coffee and sweets roller coaster!

Vitamin supplementation will also help the adrenals function better. This includes vitamin C, and B vitamins, and minerals such as zinc and magnesium. There are also adrenal-supportive herbs such as ashwagandha, and Rhodiola.

I have a few suggestions from Orthomolecular products to treat adrenal fatigue and support stress responses. Each stage of adrenal stress will have its own unique products. It is important to test adrenal function. This can be done using a 4-point cortisol saliva test. From this test, I can determine which stage of adrenal fatigue the patient is in and this will help determine treatment.

In stage 1, cortisol levels are elevated. Patients are stressed and wired. Supplement support is designed to decrease cortisol levels and to support calming neurotransmitters and DHEA 5 mg. The Orthomolecular products which support this stage are Cerenity, AdreneVive, and DHEA. Cerenity helps support calming neurotransmitters serotonin and GABA. Adrenevive is for the stressed and wired. It has adaptogenic herbs and calming nutrients. In addition, it has phosphatidyl serine which lowers cortisol levels. Cerenity is taken 3 capsules, 1-3 times per day. AdreneVive is 2 caps 1-2 times per day, and DHEA once a day at night.

For stage 2, I recommend CereVive and Adapten-All from Orthomolecular. Patients are stressed and tired. CereVive also supports calming neurotransmitters as well as dopamine which is important in having a positive outlook. Adapten-All contains adaptogenic herbs and supportive micronutrients. It also contains licorice root extract which helps raise cortisol levels. CereVive should be taken in 4 caps 1-2 caps per day. Adapten-All is taken 2 caps 1-2 times per day.

For stage 3 support, also stressed and tired, Adren-All and DHEA 25 mg. Adren-All is basically the same as Adapten-All but also contains bovine adrenal concentrate which will help to rebuild the adrenals. Adapten-All is taken 2 caps 1-2 times per day and DHEA is 1 cap at bedtime.

Finally, get a good night’s rest. Every night! The importance of sleep can not be overstated. You should have the same routine before bed every night. Limit electronics for an hour before bedtime. The light emitted from electronics actually wakes you up.

These are a few suggestions for treating adrenal dysfunction.

*All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.