Podcast episode (hosted by McCall McPherson) explaining adrenal anatomy, physiology, common patterns of adrenal dysfunction—especially low cortisol—its overlap with thyroid disease, symptoms (fatigue, brain fog, salt cravings, insomnia, exercise intolerance, orthostatic/lightheadedness), recommended testing (four‑point salivary cortisol; DHEA‑S snapshots), lifestyle rehabilitation strategies (rest, sleep, meditation/NuCalm, avoid over‑exercising, salt, napping), and supplement/clinical approaches (ashwagandha at night, Orthomolecular “Adrenal” glandular dosing titration, niacin‑flush explanation). Emphasizes adrenal recovery is gradual (often ~9–18+ months) and that untreated thyroid issues can impede adrenal healing.
Questions this episode answers
A four‑point salivary cortisol test (samples collected at four times through the day).
About 9–18 months (sometimes longer), often concurrent with thyroid optimization.
Always at night (to aid sleep and delay inappropriate 3am cortisol spikes); not recommended in the morning except in very rare cases.
About 1/4 to 1/2 teaspoon of high‑quality pink salt (e.g., Redmond's) dissolved in water twice a day.
DHEA‑S (DHEA sulfate).
Chapters
Hello. This week we are digging into all things adrenal function and dysfunction. So this is such a major part of people's ability to get their lives back when they have a thyroid condition. I find almost ubiquitously our patients at Modern Thyroid Clinic also need their adrenals addressed. So I'm excited to share this topic with you all today. Let's dig in. Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness and thyroid unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. Let's start with the basics. What are your adrenal glands? Right, so your adrenal glands sit on top of your kidneys and they respond to stress. So when we are emotionally stressed, physically stressed, psychologically stressed, they secrete stress hormones like cortisol, epinephrine, norepinephrine, and then even on a day to day basis, they have a rhythm of cortisol and hormonal secretion that allows us to feel good, clear, alert, engaged, resilient to inflammation, et cetera. So we can measure adrenal function via cortisol, but if we simply go to the lab to get our cortisol checked, it doesn't really give us the full picture. So if we simply check our cortisol at one point during the day, it doesn't give us enough information. Our cortisol pattern should spike in the morning and pretty quickly drop off around lunchtime and then slowly taper as the day goes on until it reaches its lowest point at bedtime. And then when we wake up in the morning, bright eyed and bushy tailed, it's because in part, our cortisol is peaking. And that is what tells us, hey, it's morning, let's wake up, it's time to start our day. So think about that. With that entire pattern, if we randomly just go to the lab at a certain time at a random time, we're not going to be able to know truly what your picture of your cortisol pattern is. Even if you go in the morning, which is what's recommended with a blood lab, we still have no idea what's happening two hours later, four hours later, eight hours later. Right? So the best way to check adrenal function is through what's called a four point salivary cortisol test, which is available at most functional medicine practitioners offices. It will collect a salivary sample at 4 points throughout the day and it will measure your cortisol in each one so that we can actually paint the picture of what's happening on a daily basis with your cortisol. When I first started practicing functional medicine, I did this every day, all day. Now I don't really do it so much anymore. I think I can clinically interpret what is happening with someone's cortisol based on their symptoms. But if they seem or appear to have a complex cortisol pattern, then of course I'll check it. But that is honestly rare at this point. I do find, however, by the time people make it to modern thyroid clinic, most all of them have adrenal dysfunction, and most of the time it's with low cortisol. So let's continue on this conversation and let's talk about symptoms of low adrenal function. So symptoms of adrenal dysfunction, or what is referred to as adrenal fatigue, is or are fatigue, brain fog, craving of, like, salty snacks, especially, especially like in the late afternoon when people's cortisol tends to dip. Afternoon, late afternoon fatigue, late afternoon brain fog, even insomnia, waking up at 3am like your adrenals are spiking that cortisol response at the wrong time. Exercise intolerance, where you just get bombed, depleted after a workout, fatigue after stressors like exercise or emotional stress. Sometimes people can have almost like POTS symptoms where they stand up too fast and they get lightheaded or dizzy. So as you can probably infer, a lot of these symptoms overlap with thyroid issues. And so it can be a really confusing picture. And what I found with that truly, is if we fix someone's thyroid perfectly and just absolutely optimize it and make it beautiful, but we don't address their adrenals. Their adrenals almost keep them from feeling the improvement in their thyroid, and I believe the same as vice versa. If someone really works on a patient's adrenals and they don't address their thyroid and they have a glaring thyroid issue, it's the same. It's almost like this, give and take. They weigh each other down. Now, couple other really important things are most prominently when you have a chronic thyroid issue, your adrenals try to compensate. Meaning when you have hypothyroidism, your adrenals are picking up the pace to support you despite that thyroid problem. What's the issue with that? Well, when that goes on and on for years, five years, 10 years, decades, like anything that we're sort of overusing in life or our body, it gets worn down, right? So when our adrenals are Working overtime to solve this thyroid issue or compensate for it, they tend to get tired, worn out, and people develop adrenal fatigue. And at first, that usually manifests as symptoms like tired but wired. And then slowly, over time, they settle into just outright fatigue. Sometimes it'll also early manifest early as insomnia, waking up at 3am, those types of things. So you can see now why so many people at modern thyroid clinic also have an adrenal issue. They've had a thyroid issue for years before they ever found us. And by the time they do, their adrenals are shot. So it's very, very important to address it. Now. Part of addressing adrenal function is allowing them to heal. And the way that you heal adrenals is you rest more than you stress them. So it's kind of like these people that exercise and over exercise they're like, well, I'll just get over this hump and then I'll be really strong and then I'll be really resilient. But in fact, most people in those situations when they have adrenal dysfunction, they just deplete, deplete more and more and more. So. So you can't push your way out of adrenal fatigue. You have to rest your way out. So also fueling your adrenals is very, very important. So some lifestyle modifications that you can do to help facilitate adrenal repair are. Resting, Getting enough sleep at night is foundational, right? Letting your body heal and recover. Your cortisol come down at night. Meditation during the day is an extremely effective way to reduce cortisol. When I am really stressed, I honestly, I can't meditate. Like, I'm. I get too stressed to actually meditate. And when I do, there's a couple other things that I've been toying with. One that I can actually speak to the value of so far is called nucalm. N U C A L M. It's an app on an iPhone or I think on most mobile devices, and they have a free week trial. This is not like an ad or anything. It is simply. It's a. It's a very passive form of almost meditation. You put on headphones and it simply plays music. And behind that music are tones that take your brain waves from a really heightened stress state and they slowly transition them to a more relaxed state, again, allowing your cortisol to come down, allowing your adrenals to recover, allowing you to achieve that meditative state. And I'm actually able to do that even when I'm not able to Meditate so highly recommend do that free trial and see what you think. I think you'll notice pretty quickly that it's effective. Another thing to do is not over exercise again. We want to rest your way out of this. I almost tell people I don't want you to exercise really early on in these stages. If you do, I want it to be a very light walk or extremely, extremely slow weight training. Another is salt. Your adrenals need salt. In fact, once people move into what's called adrenal failure or Addison's disease, the first sign of that is they crave these massive amount of salt, this massive amount of salt, because that is fuel for your adrenals. So that's why people earlier on in those stages of simply adrenal dysfunction or fatigue tend to crave salty, like snacky foods, especially when they're really worn out. So I tell my patients to take like a quarter to a half of a teaspoon of pink, like high quality salt like Redmond's, and put it in water and drink it twice a day. Like just flood your adrenals with the salt that they need to thrive and flourish. So I also tell my patients, look, if you can nap, nap. Just because you can't exercise really intense right now, just because you need a lot of sleep right now, just because you need naps right now does not mean you're going to need that forever. Right? We are resting our way out of this issue. Okay, so those are some key key points. I did also want to chat about my favorite supplements for adrenal fatigue, because I do have them, one of which is possibly my favorite supplement of all time. But the foundational one is Ashwagandha. Ashwagandha is extremely effective at speeding up the time it takes for people's adrenals to heal. I estimate from my clinical experience, it reduces the amount of time from someone going from adrenal fatigue to good adrenal function by about 50%, which is incredible. I also find it helps people sleep a little bit more restfully throughout the night. That's not why I give it to them at all, but it's an added bonus. And it's probably the only thing that people notice when they take Ashwagandha. I only and always have my patients take it at nighttime. I would not ever recommend my patients take Ashwagandha in the morning unless it is 0.0001% of the time in very specific cases. But Ashwagandha taken before bed will help delay that cortisol spike in the morning keep you from waking up at 3am inappropriately thinking that it's morning and it's time to start your day. And also if you take it in the morning, it kind of feels like you drink a tall glass of red wine in the morning. And I don't know about you, but those are not the vibes that I want to bring into my work life or my mom life. I don't have that kind of time and ability to be red wine overly relaxed. So I don't really recommend Ashwagandha in the morning. And then I want to talk to you about adrenal. So the company is called Orthomolecular and they make a specific supplement called Adrenal. It has some micronutrients and minerals that help sort of nourish and repair your adrenals. But more important than that, it has some cow adrenal gland in it. In the same way that a lot of thyroid medications have pig thyroid gland in them, Adrenal has glandular basically to supply your body with what it needs. So it doesn't feel like it's missing adrenal function. And what that translates to from a patient's experience or a person's experience is better energy, clarity, motivation, engagement, resilience to stress, which is incredibly powerful. So almost all of my patients are put on this at some point in their treatment plan with me and often with most of the other clinicians at Modern Thyroid clinic. And the wonderful part about adrenal is it is incredibly, incredibly effective. You take it or people take it, it kicks in in about 30 minutes and it lasts for about three to five hours. So I have my patients take it in the morning and with lunch. The, the downside about it is that there is not like a one size fits all dose. It's kind of like thyroid. However much thyroid function you're missing is how much medication you need. It's similar with adrenals. So I have my patients slowly increase over a few weeks, up to three in the morning and three with lunch starting only at one in the morning and then four or five days later, one in the morning, one in the afternoon, then two in the morning, one in the afternoon, so on and so forth, until they feel clear, alert, engaged, motivated. If they end up getting too much, they're going to feel a little stimulated, a little stressed. I have them back off by one the next day and hold at that next lower dose. And that's the sweet spot. Generally, again, it kicks in in 30 minutes, lasts for three to five hours. So that is the window of time people should be looking for improvement in one other. One other interesting thing about adrenal, I literally had a patient conversation about this with a patient this morning during an appointment is it has a B vitamin in it called niacin. And niacin creates in higher doses a flush. And a flush sort of looks and feels a heck of a lot like hives. It's red, splotchy spots on your face, neck, chest, elbows, strangely. And it's tingly, scratchy feeling. It goes away in about 15 to 30 minutes. It's absolutely harmless. It is not an allergic reaction. It simply is a flush. And flush flushes can be really great. They can help detox, they can lower cholesterol. So it's harmless. It doesn't mean people don't need to change their dosing regimen because of it, but they, I just tell them so they don't start popping Benadryl, et cetera. Of course, none of this is medical advice. This is all something that you need to talk with your clinician, with your healthcare provider that can give you medical advice, right? This is education. But this is something that I talk with my patients about every darn day. I tell my patients often. I, I would say, on average, people are on adrenal supplements and working on their adrenals for about nine to 18 months, sometimes longer. Of course, that's when their thyroid problem is fixed, right? Because if you have this glaring, huge thyroid problem and you're working on your adrenals, this is, your thyroid is going to keep your adrenals from healing as quickly. So please, please keep that in mind. It is so foundational and important to address your thyroid function. One other thing I did want to mention is at modern thyroid clinic, we use a hormone called DHEA to just take snapshots of people's adrenal function over time. Technically, it's DHEA E E, a sulfate. And depending on your age, the normal range of this varies. But generally speaking, I would love for it to be 131, 40 to 180 in younger people. And I mean, someone that I saw today, it was at 25. So really this can be broken down and worn down significantly. And that's a great way to just check in on your progress over time to see if your adrenals are rehabilitating. And again, it is a slow process. Nine to 18 months, two years like this is something we're plugging away at for long term progress. However, these supplements can help people feel better and not experience even remotely the amount of adrenal symptoms while we are working on fixing their adrenals. So I hope this has been really valuable and useful information for you. Please check me out on social media. If you don't mind, I would love it if you would generously give us a podcast review and let the world know how you how valuable you think our content is. And don't forget to follow us on social we tune in there and check in a lot to ask what information you want to know, because that is the information I want to cultivate for you. Enjoy your day and be well.
