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The Best Adrenal Fatigue Supplements + How to use them

Fatigue, exhaustion and low energy...

These symptoms are incredibly common nowadays and they all may be pointing to a specific hormone imbalance commonly referred to as adrenal fatigue. 

But instead of focusing on the word adrenal fatigue it's better to focus on the hormone cortisol and how you can directly impact this very important stress hormone. 

Once you understand what is happening to your cortisol level you can target your therapies and supplements so you can finally reclaim your energy. 

In this guide I will walk you through how to treat your fatigue with the best adrenal fatigue supplements: 

More...

Do you have Cortisol or Adrenal Issues?

We need to talk about what causes low energy and then we can talk about how to fix it.

Low energy is really a subjective symptom that is a result of low energy production in your body.

The majority of energy produced in your body comes from special organelles inside your cells known as mitochondria.

These mitochondria are responsible for the production of a compound known as ATP (adenosine tri phosphate) and ATP is considered the "energy currency" for your body.

The amount of ATP that you produce and the efficiency of your mitochondria really help to define your subjective sense of energy. ​

energy levels and mitchondrial function

What's even more interesting is that you can directly (and indirectly) impact ATP production and increase the efficiency of energy production in your body. 

In addition to being involved in energy production, ATP production is also involved in heat production and metabolism.

This may explain why so many people suffering from adrenal problems and low energy also present with weight gain as one of their main symptoms.

Why?

Because if your energy production in your body is lower than normal you will have less heat production which will result in a lower than normal body temperature and a slower than normal metabolism.

Vitamin B12 and energy production

Make sense?

It's helpful to think of your body as a machine. 

As long as you are alive your body will be producing energy, but you need to think in terms of efficiency.

Let's say that "normal" is considered to be 100% efficiency.

If you have hormone imbalances, low/high cortisol levels this machine may be functioning at 70% of normal.

Cortisol and metabolism

This results in a ​30% deficiency in energy production that may be the result of nutrient deficiencies, hormone imbalances, etc. 

Treating adrenal fatigue is designed to increase the efficiency of this machine back up to 100%, so you have normal energy levels, a normal metabolism and you finally start to feel yourself. ​

​But this low energy production extends beyond just weight gain, in fact low energy production in your body may result in many different symptoms which manifest in various ways. 

Symptoms that suggest you have adrenal problems and that you may need to get your cortisol level evaluated:

  • Constant fatigue throughout the day (classically with a 2-3pm "crash")
  • Sensation of being "wired but tired" especially at night
  • Feeling of getting a "second wind" at night, especially around 9-10pm
  • Weight gain and/or weight loss resistance
  • Other hormonal problems in the body, especially hypothyroidism
  • Changes in mood including depression, anxiety and/or irritability
  • Intense carbohydrate or sugar cravings
  • Reliance upon stimulants (like caffeine) with frequent use throughout the day for "energy"
  • Sensation of more energy after eating a carbohydrate rich (or sugar rich) meal
  • Cravings for salty foods

​These symptoms all indicate an issue with "adrenal problems" or with energy production in your body. 

The good news is that if you suffer from these symptoms (or have a known diagnosis of adrenal fatigue) then you can use the following therapies to naturally increase your energy levels and improve energy production. ​

hormone mastery guide

The Most Effective Adrenal Fatigue Supplements

In order to treat your adrenal and low energy you really need to target your supplements to your body. 

That means looking at your cortisol level.

I won't go into significant detail here, because I've elaborated on the best cortisol test in this post, but it's worth a quick mention.

​First you need to understand that your cortisol level has a big impact on your subjective sense of energy in your body. 

Second you need to realize that certain supplements are better at lowering your cortisol and others are better at raising it.

Recall that high cortisol and low cortisol present with similar symptoms (those listed above), but you still need to know what is going on in your cortisol in order to target treatment.

There are a lot of different ways to measure cortisol in your body, but the best is definitely the urinary options with multiple tests throughout the day.

This doesn't mean your serum cortisol is not helpful though, quite the contrary.

One problem with urinary testing is that it can be expensive, whereas serum cortisol is cheap and is covered by insurance.

This makes serum cortisol a good place to start.

​If you check your serum cortisol level look for these ranges:

  • Low serum cortisol: Less than 8 mcg/dL
  • Normal serum cortisol: 14-16 mcg/dL
  • High serum cortisol: Greater than 18 mcg/dL
low serum cortisol levels

Using these ranges can give you an idea of where to start with your supplementation (though don't confuse this as the best or only way to test cortisol levels). 

Below you will find a list of all of the adrenal supplements I use targeted to cortisol levels.

These supplements have been shown to be efficacious through literary studies and I have personally used them. ​

After we go through the entire list I will go through several of them individually to help determine which ones might be the best for you. ​

Treatment for Low Cortisol: 

  • Adrenal glandulars: These tend to work best for patients with very low cortisol levels, they also tend to provide an immediate boost to energy levels. Using glandulars in combination with other supplements listed below is very effective for low cortisol levels. Should be used for 6 + months. 
  • Adrenal adaptogens: Adaptogens can actually help to lower cortisol levels as well, but should at least be considered in the treatment. There are many types of adaptogens but I find that blends of multiple adaptogens tend to work best. These adaptogens can be combined with glandulars as well for more benefit. Should be used for 3+ months at least. 
  • CoQ10: This co enzyme is involved in proper mitochondrial energy production and can help increase energy levels. Because energy levels are often low in adrenal related issues, mitochondrial boosters are particularly effective. Use 2 capsules (240mg) per day for several months. 
  • Alpha Lipoic acid: ALA helps increase mitochondrial energy production, acts as a powerful anti oxidant and an anti inflammatory agent. ALA can also help with weight loss due to its effects on insulin. 
  • Vitamin B6: Vitamin B6 is used in several pathways in the creation of adrenal hormones and a nutrient that many patients are deficient in. Taking higher doses of B6 during the acute phase of treatment may be necessary for short periods of time. 
  • DHEA: DHEA is the precursors to testosterone and other estrogen metabolites. With low cortisol and low adrenal hormone production, supplementing with hormone precursors may be of benefit. Start with a low dose every 2-3 days and increase to daily as tolerated. Be careful because DHEA can turn into androgens or estrogens in high doses. 
  • Pregnenolone: Pregnenolone is another hormone precursor and can be helpful if used along with DHEA. Watch out for acne as a side effect and like DHEA, start low and go slow. The use of these hormones may be necessary for 3+ months. 

Treatment for High Cortisol: 

  • Phosphatidylserine: Phosphatidylserine has been shown to reduce cortisol levels if taken in doses up to 600mg per day. Use 4-6 capsules at night (each capsule is 100mg) and recheck cortisol levels in 2-3 months. 
  • Ashwagandha: Ashwagandha is an adaptogen that can actually help to lower cortisol levels, boost libido and may help with weight loss. You can read more about ashwagandha in this comprehensive post
  • Melatonin: Melatonin has been shown to reduce cortisol levels and may actually help improve your sleep at night. Even if you are sleeping well, melatonin can still help reduce cortisol levels and should be considered. Dosages vary from 1-3mg, but starting with 3mg is generally tolerated unless you are very sensitive. 

#1. Adrenal Adaptogens (Ashwagandha)


Probably one of the best and most important supplements used to treat adrenal fatigue and cortisol problems are adrenal adaptogens. 

These are supplements that really can be defined by their ability to "normalize" or help "balance" cortisol levels.

Studies have shown that these adaptogens can actually help increase cortisol levels when they are low and conversely that they can help lower cortisol levels when they are high.

This makes adaptogens a critical component to anyone dealing with adrenal fatigue. 

I have found that of the adrenal adaptogens that Aswhagandha seems to stand above the rest both in terms of its clinical utility and the literary studies that support its use.

Ashwagandha ​has a number of beneficial side effects that extend beyond its ability to increase energy levels and balance cortisol levels including: 

Ashwagandha helps improve energy levels

The added benefits of helping patients lose weight and boost thyroid function make this supplement one of my top choices. 

Many patients have hypothyroidism whether they realize it or not (especially since thyroid function decreases as you gain weight), so this supplement can often treat many problems you didn't even know were present. ​

If you decide to use Ashwagandha make ​sure you use a high enough dose from a high quality brand:

thyroid lab testing

How to Supplement with Ashwagandha

Why I like it

May Improve Thyroid + Adrenal Function

Naturally occurring and generally safe

May also improve Mood + Depressive symptoms

Generally works within 4-8 weeks

How to tell if you Need it

I recommend checking the following lab tests prior to supplementation: 

  • Serum 8 am cortisol: For best results this level should be somewhere between 14-16. 
  • Note that ashwagandha can help increase cortisol if it's low and reduce cortisol if it's high making this a great treatment for anyone with low energy. 
How to Use

  • Dosage varies from 500-2,000 mg per day depending on tolerance and degree of symptoms
  • Length of treatment varies by condition, for adrenal fatigue supplementation as long as 6+ months may be required.
My Recommended Brand and Product:
A.R.C II (Adrenal Reset Complex) mini

#2. Adrenal Glandulars (Usually combined with Adaptogens)


​Next on the list is the use of adrenal glandulars. 

These ​extracts have been used for a long time and definitely work, but the exact mechanism behind why they work is less understood. 

Some studies have shown that these extracts provide ​cellular benefits such as a reduction in inflammation, while other people insist that they contain active hormones that provide cellular support. 

Regardless of how they work, we definitely know that they do work (for most people).

Glandulars, as long as they are sourced correctly, can be a very effective addition (or used as monotherapy) when treating adrenal and cortisol problems.

In my experience adrenal glandulars seem to provide ​the most benefit to patients who are suffering from EXTREME fatigue and those with very low cortisol levels. 

Glandulars can be used safely, but for best results should be used no more than 6 months at any given time. 

Adrenal glandulars seem to provide the quickest boost to energy levels with some patients noticing an increase in energy in as little as several days after starting supplementation. 

If you decide to use adrenal glandulars make sure you get a high quality product: 

How to Supplement with Adrenal Glandulars

Why I like it

May boost energy and well being

Almost ALL hypothyroid patients have adrenal problems

May help boost immune function

Most patients experience improvement in 1-2 months

How to tell if you Need it

Consider testing serum cortisol levels prior to treatment:

  • Serum Cortisol - AM cortisol should be between 14-16, anything less may be a problem (note: normal serum level doesn't rule out adrenal fatigue)
  • Urinary cortisol and cortisone x4 - I recommend using DUTCH testing (you can see an example of the report below)
Increased cortisol causes weight gain
How to Use

  • 1-2 Tablets per day if using Glandulars (preferably taken in the am and at noon)
  • If you get too jittery using these supplements then cut back to 1 or even 1/2 tablet each day as needed
  • Treatment may be required for up to 6 months
My Recommended Brand and Product:

For severe adrenal fatigue you should use a combination of adrenal glandulars + adrenal adaptogens (ARC II above): 

Thyroid Adrenal Reset Complex mini image

#3. Alpha Lipoic Acid


Remember that adrenal and hormone problems are a manifestation of other problems in the body.

Chronic stress, low grade inflammation and poor nutrition all contribute to reduced cellular energy production and hormone imbalances.

Because multiple conditions contribute to your symptoms you may need to use supplements designed to treat these other issues for the best results. 

​Alpha lipoic acid helps improve energy levels and treat adrenal problems through multiple mechanisms:

ALA helps increase mitochondrial energy production

ALA also has shown benefit in helping patients lose weight. 

If you are having issues with weight loss or weight loss resistance then adding ALA to your current adrenal regimen may help with this problem. 

Alpha lipoic acid can be safely added to existing adrenal supplements and should be used specifically in people who have issues with weight loss, chronic inflammation and insulin resistance in addition to low energy or fatigue. 

How to Supplement with Alpha Lipoic Acid

Why I like it

May increase energy levels through mitochondrial pathways

May help with weight loss by sensitizing the body to insulin

Helps multiple conditions including cognitive disorders

Generally well tolerated with few side effects

How to tell if you Need it

Patients with the following conditions should consider using ALA (alpha lipoic acid)

  • Patients with weight loss resistance or chronic weight gain
  • Patients with low energy or chronic fatigue
  • Patients with insulin resistance (as evidenced by an elevated fasting insulin greater than 5) 
  • Patients suffering from peripheral neuropathy
  • Patients with cognitive decline or a history of dementia
  • Patients with high levels of non specific inflammation (as evidenced by elevated ESR and/or CRP) 
  • Patients with non alcoholic fatty liver disease (as evidenced by AST/ALT values > 20) 
Elevated insulin and CRP
How to Use

  • Take up to 1,800mg per day (depending on tolerance)
  • Start titration at 600mg per day and increase as tolerated
  • Length of treatment may vary depending on condition, but should last at least 3 months
My Recommended Brand and Product:

#4. Phosphatidylserine


Phosphatidylserine is particularly effective for those suffering from high serum cortisol levels, or those with cortisol spikes throughout the day.

Unfortunately there are very few effective ​treatments for those suffering from high cortisol (compared to the therapies available for low cortisol). 

​Phosphatidylserine has been shown to attenuate (meaning decrease) cortisol levels

This is especially helpful for patients who exercise quite frequently. 

Exercise, whether you realize it or not, does cause stress to the body which can result in an increase in cortisol. 

Because so many people deal with weight issues, and because the conventional approach is to simply exercise more, many people consequently now have issues with cortisol because of over exercising. 

If you are exercising 4-5x per week (especially if this exercise is high intensity) you may be paradoxically causing more fatigue to your body. 

In these instances phosphatidylserine may be necessary (in addition to reducing the amount that you exercise). 

I have seen many cases of patients actually losing weight as they cut back exercise due to this effect. 

Phosphatidylserine should also be seriously considered in those who suffer from a racing mind, or issues with calming themselves down in the evening. 

How to Supplement with Phosphatidylserine

Why I like it

Helpful for reducing serum cortisol levels

May also improve sleeping patterns

Great for patients with anxiety and depression

May also improve work out recovery and reduce stress response to work outs

How to tell if you Need it

Patients with the following should consider using Phosphatidylserine:

  • Those with a serum cortisol (8 am) greater than 18 mcg/dL
  • Patients with extreme fatigue
  • Patients with anxiety like disorders including ADD/ADHD, OCD, etc. 
  • Those who get a second wind in the evening that prevents them from sleeping well
  • Those with a racing mind at night
  • Those who feel too stimulated with adrenal adaptogens or adrenal glandulars
How to Use

  • 1-2 Tablets per day if using Glandulars (preferably taken in the am and at noon)
  • If using supplements designed to lower cortisol like phosphatidylserine then use at night
My Recommended Brand and Product:

Phophatidylserine - Soy Free (for cases of ELEVATED cortisol):

#5. Melatonin


​You're probably aware that melatonin can help improve sleeping patterns, but you may not be aware that it can directly improve cortisol levels as well. 

Melatonin appears to have a direct action on adrenal tissue, meaning that melatonin helps regulate cortisol and other hormones. 

This relationship probably helps explain why cortisol levels spike around 8am considering that melatonin levels increase (or should increase) as you sleep. 

What we learn from this is that it is very important to have a normal circadian rhythm, and that various factors that interefere with this relationship can impact hormones and energy levels down stream. 

​Certain hormones (in fact most hormones) cycle normally throughout the day.

For instance cortisol levels peak at 8 am and then slowly decrease throughout the waking hours of the day.

thyroid metabolism reset poster for side bar

Compare that to melatonin, which peaks in the evening. ​

What we know is that if you interfere with this normal cycle there are serious consequences.

This may help explain why people who work night shifts have a higher risk of mortality (death) and lower growth hormone levels compared to people who work in the day time. ​

​Melatonin can be very benficial in the following instances: 

  • Post menopausal women (melatonin has been shown to increase cortisol in these women)
  • Those under heavy stress and difficulty sleeping at night (stress reduces melatonin secretion in the evening which lowers cortisol production in the morning)
  • Those who suffer from depression
  • Those with sleeping problems or circadian rythymn dysfunction
  • Those people working evening jobs or who have an abnormal wake/sleep cycle (those with "reversed" sleeping schedules)
  • Those who travel frequently (especially into different time zones)
  • Those who do not respond to adrenal glandulars or adrenal adaptogens

How to Supplement with Melatonin

Why I like it

May naturally increase cortisol levels

Many people have dysregulation melatonin due to stress

Great for patients with depression

Can be combined with other adrenal supplements

How to tell if you Need it

Patients with the following should consider using Melatonin: 

  • Patients with extreme fatigue & sleeping issues
  • Patients with depressive disorders
  • Women (especially post menopausal women) with low energy
  • Those who feel too stimulated with adrenal adaptogens or adrenal glandulars
How to Use

  • Start with 1-3 mg per day (depending on severity of symptoms)
  • Patients with extreme difficulty sleeping can start out at 3mg, sensitive patients should start out at 1mg 30 minutes prior to sleep
  • Take at night 30-60 minutes prior to planned bed time (can be combined with phosphatidylserine for more benefit)
My Recommended Brand and Product:

Start out with a low dose here (0.5mg): 

If you've tried and tolerated melatonin you can start out at 3mg: 

​Additional Treatments for Adrenal Fatigue

Using supplements should really only be part of your plan if you plan to increase your energy level.

While taking supplements can definitely provide an almost immediate boost to your energy levels, they should be accompanied with other lifestyle changes.

Why?

Because these lifestyle changes all contribute to your low energy in the first place!

That means if you don't improve your diet, change your sleeping patterns or reduce your stress that your symptoms will eventually come back.

Taking this approach, of combining supplements with lifestyle changes will result in long term benefits for you. ​

​#1. Stress Management & Stress reduction

​Number 1 on the list is to help reduce and/or manage stress in your life. 

This is listed as number one because it is THAT important.

What you need to understand is that in some cases you will not be able to ​reduce the cause of stress in your life (it may be related to your working environment, kids, spouse, etc.), but if it is something you can reverse or eliminate then you should make that your #1 priority. 

If you can't remove the stressor in your life then you need to use tactics to help manage your stress and reduce its impact on your quality of life (and on your cortisol).

You can do this by adopting the following strategies:

  • Spend time meditating each day for at least 20 minutes
  • Use relaxing exercises like yoga
  • Spend quality time by yourself with something you enjoy
  • Take time to enjoy nature and spend time outdoors (spend time hiking or walking)
  • Find something that brings purpose back into your life (something that you love doing and feels gratifying to do)
  • Donate your time or money to help those less fortunate than you
  • Make it a point to SMILE (even if it's forced!)
  • Spend time reflecting on the GOOD things in your life each and every day (come up with a list of 10 things at least)

#2. Quality Sleep​

​As you already know, your sleeping schedule directly impacts melatonin production and thus cortisol levels. 

Beyond this a general lack of sleep has been associated with weight gain and general inflammation in the body.

The importance of getting quality sleep each and every night can not be understated.

If you are someone who deals with sleep issues or insomnia, then managing your sleep should be a top priority for you.

And by quality sleep I mean you need to be getting at minimum 8 hours of sleep each and every night.

This sleep should leave you feeling rested and ready to tackle your day in the morning.

If your sleep is anything but this, then you need to fix it ASAP.

You can use tactics that we've discussed in this article like taking melatonin as well as improving general sleeping habits such as:

  • Setting a bed time and sticking to it
  • Avoiding caffeine or stimulants (that includes coffee, soda, etc.)
  • Improve your sleeping environment (sleep in a cool and pitch black room)
  • Taking supplements like melatonin 30-60 minutes prior to bed time if necessary

​#3. Dietary Changes

Lastly, but certainly not the least important, is your diet.

If you haven't changed your diet to exclude refined carbohydrates and sugars then you should start there first.

In a more basic sense you should focus on a whole foods type of diet.

This change in diet will help lower inflammation (if it exists) and increase the nutrient content and density of your diet.

Advanced dietary changes such as carbohydrate cycling may be necessary in some individuals, but for now just realize you HAVE to be eating a healthy diet if you want to increase your energy levels. ​

Adrenal Fatigue & Weight Gain

Does adrenal and cortisol problems lead to weight gain?

The answer is absolutely.

​Not only does cortisol increase insulin resistance and promote leptin resistance, but it also directly alters thyroid function. 

These hormones are all very important as it relates to your weight and how your body utilizes fat.

High cortisol has been shown to promote hypothyroidism (and lead to a higher than normal TSH).

Cortisol also promotes insulin resistance which may increase your risk of type II diabetes and lead to weight gain (especially belly and visceral fat).

It is through these mechanisms that adrenal related problems (specifically cortisol dysregulation) can lead to weight gain.

Changes to your cortisol, as we discussed above, also impacts cellular energy production which leads to a lower than normal metabolism.

The combination of hormone imbalances and a slow metabolism lead to the symptom of weight loss resistance and weight gain that many patients experience with cortisol issues.

In order to treat your weight problem you will first need to evaluate your cortisol function and treat any existing issues.

For best results you will also need to address any specific hormone imbalances that exist as a consequence of high/low cortisol. ​

​Back to you

​The bottom line is that you CAN feel better and can have more energy, but this requires a targeted approach with the right supplements. 

It all starts by getting your serum cortisol levels checked (you can use advanced tests like urinary testing after you get your serum cortisol checked) in addition to other hormones such as insulin and leptin. 

Once you know what is happening in your body you can then target your supplements directly to your cortisol level and to the other hormone imbalances that may be present as a result of cortisol dysregulation. 

Also, remember that treating your adrenals takes TIME - on the order of 6+ months in most cases. 

Take it slow, be consistent and make sure to also add in lifestyle changes. 

Now it's your turn:

Are you suffering from adrenal fatigue?

Have supplements helped you?

Why or why not?

Leave your comment below! 

Westin Childs
 

I'm Dr. Childs and I write these posts. I'm a physician that specializes helping patients lose weight, have more energy and FEEL better. My practice focuses on hormone imbalances, thyroid issues and weight loss resistance. My goal is to provide the BEST information out there on the internet that is both actionable and trustworthy. Get my free ebook: Hashimoto's Diet Guide here. You can also find more about my personal journey back to health here.

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