THYROID PHARMACIST

ABCs OF ADRENALS
Izabella Wentz, PharmD, FASCP
 ABCs OF ADRENALS
Based on my experience with clients and readers, I’ve found that most people with Hashi-
moto’s have some degree of adrenal dysfunction. The adrenals and thyroid gland work in a
delicate balance with one another, and treating hypothyroidism without treating the adrenals
is one of the biggest reasons people continue to feel exhausted despite receiving treatment
with thyroid hormones.

Patients may initially report feeling more energetic after starting thyroid hormones, but this is
usually followed by feeling worse and worse until they are right back to where they started.
At this point, they will likely go back to their physicians to check blood work and will be told
that everything is normal.

The patient begins to feel crazy… but that’s when another layer of what is broken in Hashi-
moto’s becomes unraveled. Many symptoms of hypothyroidism overlap with symptoms of
underactive adrenals. However, physicians don’t routinely check adrenal function in those
with Hashimoto’s.

Symptoms of adrenal dysfunction include:

• Feeling overwhelmed • Decreased sex drive

• Feeling tired despite adequate sleep • Decreased ability to handle stress
• Difficulty getting up in the morning • Longer healing time
• Craving for salty foods (a.k.a. the “I just • Mild depression
ate a whole bag of chips syndrome”)
• Less enjoyment in life
• Increased effort required for everyday
activities • Feeling worse after skipping meals

• Low blood pressure • Increased PMS

• Feeling faint when getting up quickly • Poor concentration

• Mental fog • Reduced ability to make decisions

• Alternating diarrhea/constipation • Reduced productivity

• Low blood sugar • Poor memory

Do any of these sound familiar?

ABCs of Adrenals | Izabella Wentz, PharmD 1

 THE ADRENALS AT A GLANCE
The adrenal glands release hormones such as cortisol and adrenaline. These “stress hor-
mones” impact many important functions throughout the body. They help establish your
stress tolerance, tame inflammation, regulate blood sugar and body fat, control potassium
and sodium levels (impacting blood sugar), and influence sex drive and anti-aging… among
other things.

You may have heard that the stress hormone cortisol is “bad”. This is misleading — while high
levels of cortisol are problematic, what could be equally or more problematic is having low
levels of cortisol, especially when it comes to having an autoimmune disease and fatigue.

Cortisol is a hormone that is required for life — we could not live without it, and it is an impor-
tant anti-inflammatory hormone. In fact, it gets released whenever we have inflammation to
cool things down.

I have found that the majority of people with Hashimoto’s have low levels of cortisol.

TESTING FOR ADRENAL ISSUES

In addition to looking at your symptoms (above), you can determine if you have adrenal dys-
function by utilizing the assessments below.

The Irritability Test

Irritability and overwhelm are two cardinal signs of adrenal dysfunction. My best test for de-
termining adrenal issues is being snappy or short-tempered, feeling overwhelmed, or find-
ing other people annoying. For example, I can always tell that my adrenals are overwhelmed
when my mom calls to say hello, and I feel like this is too much of a demand!

Blood Pressure Test

People with adrenal fatigue often have low blood pressure and/or a drop in blood pressure
after standing up from a lying down or sitting position (orthostatic hypotension). If your blood
pressure is below 120/80 mmHg, this may mean that your adrenals are underactive, or that
you are dehydrated. Symptoms may include dizziness or lightheadedness when standing up
from a sitting/lying down position.

Pupil Contraction
People with low adrenal function may often have difficulty with contracting their pupils. Our
pupils usually dilate (enlarge) in the dark, and contract (get smaller) in the light. Symptoms
of adrenal dysfunction may include light sensitivity, difficulty seeing in bright lights, having to
wear sunglasses on most days, or as I like to call it, feeling like a vampire in daylight!

ABCs of Adrenals | Izabella Wentz, PharmD 2

Unstable Temperatures
If you are keeping track of your first morning temperatures, low and unstable morning tem-
peratures may be suggestive of adrenal insufficiency. In contrast, pure hypothyroidism usu-
ally results in temperatures that are low, but rather stable, on a daily basis.

The “Whole Bag of Chips” Test

Have you ever eaten (or wanted to eat) an entire bag of chips in one sitting? You’re not alone!
Salt cravings are a cardinal sign of adrenal issues. With adrenal issues, we may find ourselves
with intense cravings for salty foods like crackers, chips, pretzels and olives.

Hormone Testing
Adrenal saliva tests provide a way to test our current adrenal function. These tests are gener-
ally only available from functional medicine and integrative health care professionals.

Normally functioning adrenals are supposed to put out the most cortisol in the morning, and
the levels of cortisol should decline during the day until very little cortisol is secreted at bed-
time. A cortisol kick in the morning helps us to get out of bed bright-eyed and bushy-tailed,
ready to face the day. Low cortisol secretion at bedtime helps us relax and sleep.

Some people with adrenal dysfunction have the opposite pattern — they can’t get up in the
morning and drag their feet until the early afternoon, feel slightly human for a few hours be-
tween 2pm and 8pm, then get a second wind at bedtime. These people often have a flipped
cortisol rhythm, where their adrenals put out very little cortisol in the morning and too much
in the evening, causing them to be alert and sleepy at the wrong times.

Other people may have abnormally low cortisol readings all day, everyday. These poor souls
wake up tired and the fatigue lasts all day — I have been there, and it’s not fun. This low
cortisol causes inflammation to go unchecked in the body, prevents healing, and causes the
person to be sluggish for most of the day.

I recommend the Adrenal Stress Profile from ZRT. I have found it to be the most accurate for
adrenal testing. However, the lab recently redefined their reference ranges, resulting in labs
I would have previously classified as dysfunctional to be misread as normal by the untrained
eye. If you’re going to go down the road of adrenal saliva testing, I recommend working with
a practitioner trained in interpreting these labs, preferably one who has been interpreting
them for at least 4-5 years.

ABCs of Adrenals | Izabella Wentz, PharmD 3

 WHAT CAUSES ADRENAL FATIGUE?
In most cases of adrenal fatigue, the problems generally originate in a communication break-
down that occurs within the hypothalamic-pituitary-adrenal axis, otherwise known as the
HPA axis. The HPA axis describes the interactive feedback loop that takes place between
these three endocrine glands.

The hypothalamus is like the CEO of our body’s production of hormones. It scans messages
from our environment and other endocrine glands, as well as checks the body’s overall
hormonal status before passing on the order for more hormones to the pituitary gland. The
pituitary gland then acts as a project manager and will pull together individual workers (like
the thyroid gland, the adrenal gland, and the gonads) to do their jobs. The pituitary will also
make sure the workers have adequate resources to do their jobs by managing growth (and
repair), and electrolyte/water balance.

The HPA axis works in response to two types of stress: immediate stress and chronic stress.
Let’s see how the responses to each type differ.

In cases of immediate stress, the hypothalamus senses stress and sets off a hormone cas-
cade that leads to the activation of our fight or flight response. As part of this response, the
adrenals pump out extra hormones and our bodies go from a state of relaxing, digesting and
healing, to a survival state.

Your body’s energy is shifted from activities not essential to survival like growing beauti-
ful hair, metabolizing nutrients into energy, making hormones, digesting and repairing
itself, to instead focusing its resources to meet the great, stress-induced demand for
cortisol and adrenaline.

Then, once you’ve escaped from the threatening bear or gotten out of the way of the oncom-
ing car, the demand for emergency levels of hormones settles down and the focus once
again turns to parasympathetic response, focused on body maintenance and upkeep.

In cases of chronic stress, the never-ending presence of stressful, yet non-life-threatening

situations, can lead to the constant activation of the stress response.

To help meet the demand for cortisol, your body will decrease the production of other hor-
mones normally produced by the adrenals, such as progesterone, DHEA, and testosterone.

Eventually, with enough chronic stress, the HPA axis becomes overwhelmed and desensi-
tized to the usual feedback loop and stops sending messages to the adrenals to produce
more hormones or less hormones, no matter what’s happening. Additionally, a person may
run out of nutrients that are required for proper adrenal function.

ABCs of Adrenals | Izabella Wentz, PharmD 4

One of the most common causes of adrenal fatigue is stress, which creates an intense de-
mand for stress hormones such as cortisol and adrenaline. There are four main types of
stress to consider:
1. Sleep disorders
2. Mental/emotional stress
3. Metabolic/glycemic dysregulation
4. Chronic inflammation

Sleep Disorders
One of the fastest ways to induce adrenal dysfunction is through sleep deprivation. In fact,
sleep deprivation is used in lab animals to suppress the hypothalamic-pituitary and adrenal
(HPA) axis. Sleep deprivation can be caused by insomnia, sleep apnea, and shift work.

Mental Stress
Feelings such as grief, guilt, fear, anxiety, excitement and embarrassment can be classified
as stress. This stress is based on our perception, not on the nature of the individual stress. For
example, public speaking may cause plenty of mental stress for someone with social anxi-
ety, but another person who enjoys speaking in front of others may perceive the experience
as pleasurable. Situations that are new, unpredictable, and threaten the ego, or that involve
feeling a loss of control, are perceived as stressful.

Glycemic Dysregulation
Researchers in Poland have found that up to 50 percent of patients with Hashimoto’s have
an impaired tolerance to carbohydrates. This means that after consuming carbohydrate-rich
foods, their blood sugar levels would spike up very high, causing a great amount of insulin
release. The role of insulin is to clear blood sugar out of our bloodstream and store it in our
cells, so a large insulin release is followed by a rapid drop of blood sugar (hypoglycemia).
Symptoms of hypoglycemia are very unpleasant and may include irritability, fainting, light-
headedness or tremors. Hypoglycemia necessitates the release of cortisol to help maintain
the glucose supply to the brain and counteracts insulin, causing insulin resistance. (This is
also linked to the Type 2 diabetes epidemic).

Inflammation
Chronic inflammation may occur from joint pain, obesity, toxic burden, inflammation in the
GI tract from irritable bowel disorders, pathogens, or food sensitivities. These conditions will
signal cortisol for its anti-inflammatory effect.

ABCs of Adrenals | Izabella Wentz, PharmD 5

 THE CONVENTIONAL APPROACH TO ADRENAL FATIGUE
The adrenals are a source of disagreement between conventional medical doctors and natu-
ral practitioners. Conventional medical doctors only recognize Addison’s disease as an adre-
nal insufficiency disorder, but do not recognize “adrenal fatigue” as a medical diagnosis.

When my integrative doctor first suggested that I get tested for adrenal fatigue, I “Googled”
the term and found a “reputable source” claiming that adrenal fatigue was a made up disor-
der and did not exist.

Being a skeptical pharmacist, I put-off testing my adrenals — I had just ventured into the
world of alternative medicine, and was always afraid of people trying to take advantage of
me and take my money, not realizing that they were simply trying to help.

But then I got to a point where I was just so exhausted and irritable, despite taking thyroid
medications and following a gluten free diet.

I started talking to Carter Black, RPh, my compounding pharmacist, about the symptoms I
was experiencing; and he suggested that I have my adrenals tested. Mr. Black had special-
ized in hormones for many years and told me that the interventions for adrenal fatigue did
indeed work well for many of his patients.

Finally, it stuck: maybe it was hearing it from a fellow pharmacist, or maybe because he
didn’t have any adrenal test kits to sell to me, that I decided to try it out.

Sure enough, I had an advanced stage of adrenal fatigue, and the recommended treatments
for the adrenal fatigue helped me feel tremendously better!

I now recommend the adrenal saliva test to all of my clients with Hashimoto’s, and have
found that 90 percent of my clients (who do the test) have some degree of adrenal fatigue.
So trust me, adrenal fatigue does exist!

RECOVERING FROM ADRENAL FATIGUE

The key to recovering from the above symptoms is focused on supporting the adrenals. We
can do so by resting, balancing blood sugar, destressing, reducing inflammation, and build-
ing resilience with supportive supplements.

Rest
Sleep is the reset button for the adrenals. When we sleep, our body releases human growth
hormone and repairs itself. Make sure to get at least 7 hours of sleep each night and go to
sleep before 10pm. If you can pull it off, I actually recommend getting 10-12 hours of sleep
per night for 1 month in my adrenal-focused recovery protocols. Be sure to read my article on

ABCs of Adrenals | Izabella Wentz, PharmD 6

the sleep apnea and Hashimoto’s connection if you have unrefreshed sleep, snoring and/or
a scalloped tongue.

Balancing Blood Sugar

Stabilizing your blood sugar through diet is a crucial step in overcoming adrenal fatigue and
thyroid conditions. Balancing your blood sugar can create noticeable improvements in how
you feel each day.

Aim first and foremost to eat more fats and proteins, and less sugary and starchy carbs. When
consuming carbohydrate-rich foods, your blood sugar goes up too high, too quickly, causing
symptoms such as nervousness, lightheadedness, anxiety, and fatigue. These swings in blood
sugar can weaken your adrenals and cause a spike in your thyroid antibodies.

Check out my article on stabilizing your blood sugar with diet for more information.

Stress Reduction
The most important strategy for combating adrenal fatigue does not involve dieting, supple-
ments, medications, or testing. This strategy, however, is often the hardest to implement.

This strategy is… stress reduction.

Reducing my stress was probably the hardest lifestyle change for me to implement. I only had
two settings, “GO” and “SLEEP”. I did not know how to relax, smell the roses, turn-off, or unwind.

So, I came up with this list of strategies to make myself more relaxed and shift my body into a
state of relaxing, digesting, and healing:
• Do your best to eliminate, simplify, delegate, automate.
• Be more resilient by being more flexible. Bruce Lee once said, “Notice that the stiffest tree
is most easily cracked, while the bamboo or willow survives by bending with the wind.”
• Do the things that you like.
• Avoid burning the candle at both ends.
• Consider massage, acupuncture, meditation or tai chi, which may help get you relaxed.
• Avoid multitasking. Do one thing at a time and keep your full attention on it before you
move on to the next task. Take a small break in between tasks.
• Start a journal and make a list, being mindful of what makes you feel better and what
makes you feel worse.

I hope some of my strategies will resonate with you. But, many of you will want to come up
with your own list. Many of these items may be really difficult to implement, especially for
those of us with responsibilities like jobs, children, or elderly relatives who need our care.
However, somehow, you HAVE to schedule time for yourself.

ABCs of Adrenals | Izabella Wentz, PharmD 7

Reduce Inflammation
Food sensitivities are a common source of inflammation. Gluten, dairy and soy are the most
common reactive foods in Hashimoto’s, and eliminating them will eliminate inflammation in
your body. Elimination diets and food sensitivity testing may help you determine additional
foods that may need to be removed from your diet. I have an article on food sensitivities that
you can read for more information.

Chronic infections are also a common source of inflammation in the body. Common infec-
tions include H. pylori, Blastocystis hominis and Candida, but there are numerous potential
infections that can be root causes as well.

SUPPORTIVE SUPPLEMENTS
To support the adrenals, I recommend starting with what I like to call, the ABCs. Patients with
adrenal issues, at any stage or degree, may benefit from the ABCs of Adrenals protocol that I
developed:

A - Adaptogenic herbs
B - B vitamins
C - Vitamin C

Adaptogenic herbs are natural herb products that supplement the body’s ability to deal with
stressors. In order to be considered an adaptogen, an herb must possess several qualities.
First, the herb must be non-toxic to the patient at normal doses. Secondly, the herb should
help the entire body to cope with stress. Finally, the herb should help the body to return
to “normal” regardless of how stress is currently affecting the person’s functioning. In other
words, an adaptogenic herb needs to be able to both tone down overactive systems and
boost underactive systems in the body. Adaptogens are thought to normalize the hypotha-
lamic-pituitary-adrenal (HPA) axis.

B vitamins become depleted in stressful situations that often precede the development of
autoimmunity. Pantothenic acid (B5) and biotin (B7) deficiency in particular have been linked
to decreased adrenal function in animals and humans.

Vitamin C is essential for proper adrenal function, and is often depleted during high cortisol
production. Additionally, vitamin C has antioxidant properties, and can be very helpful for fight-
ing viral infections (that may contribute to weakened adrenals) such as the Epstein-Barr virus.

While some may wish to obtain these supplements from natural whole food sources, due to
gut issues, people with Hashimoto’s usually have an impaired ability to extract vitamins and
minerals from food.

ABCs of Adrenals | Izabella Wentz, PharmD 8

 RECOMMENDED SUPPLEMENTS

Adrenal Support
A mixture of the adaptogens eleuthero, american ginseng, ash-
wagandha, and rhodiola, which help to support adrenal function.
Adrenal support also contains B and C vitamins to help nourish
the adrenals. This product is designed to promote healthy cortisol
levels, hypothalamic and pituitary function (HPA axis), and cate-
cholamine production (dopa-mine, norepinephrine, and epineph-
rine).
Dose: 1-3 capsules daily (start with 1 and work up to 3)
Precautions: Licorice root extract should not be used by those with
water retention or high blood pressure. Additionally, this product con-
tains ashwagandha, which is a nightshade that can be reactive for some
people with nightshade sensitivities. If pregnant or lactating, consult
your physician before taking this product.

STANDALONE OR ADDITIONAL SUPPORT OPTIONS

Adaptogens

• American ginseng (Panax quinquefolius) • Lycium (Lycium chinense)

• Amla (Emblica officinalis)
• Ashwagandha (Withania somnifera)
• Asian ginseng (Panax ginseng)
• Astragalus (Astragalus membranaceus)
• Chaga mushroom (Inonotus obliquus)
• Cordyceps (Cordyceps sinensis)
• Dang Shen (Codonopsis pilosula)
• Guduchi (Tinospora cordifolia)
• He Shou Wu (Polygonum multiflorum)
• Holy basil (Ocimum sanctum)
• Jiaogulan (Gynostemma pentaphyllum)
• Licorice (Glycyrrhiza glabra)
• Maca (Lepidium meyenii)
• Prince Seng (Pseudostellaria heterophylla)
• Reishi (Ganoderma lucidum)
• Rhaponticum (Rhaponticum carthamoides or
Stemmacantha carthamoides)
• Rhodiola (Rhodiola rosea)
• Schisandra (Schisandra chinensis)
• Scutellaria baicalensis Shatavari (Asparagus
racemosus)
• Shilajit (Asphaltum bitumen)
• Siberian ginseng (Eleutherococcus senticosus)
• Suma (Pfaffia paniculata)

Dose: Please follow the directions from your healthcare provider and/or the directions on the
bottle under the care of your practitioner.

ABCs of Adrenals | Izabella Wentz, PharmD 9

Pure Encapsulations - B Complex Plus
Dose: 1-2 capsule daily, in the morning
Precautions: If pregnant or lactating, consult your physician before taking this product.

NOW - Vitamin C 500 Chewables

Dose: 500-3000 mg daily
Precautions: If you experience diarrhea from taking too much vitamin C, you’ll know that
you’ve reached your threshold. Reduce your dose by 500 mg if you experience diarrhea. If
pregnant or lactating, consult your physician before taking this product.

OTHER HELPFUL SUPPLEMENTS

Magnesium Citrate
Supports healthy DHEA levels (a precursor to our other hormones) and promotes relaxation.
Magnesium is often depleted in stressful situations.
Dose: 1 teaspoon daily, at bedtime
Precautions: Reduce dose or switch to magnesium glycinate if diarrhea occurs.

Thorne Moducare
Plant sterols that normalize cortisol and DHEA as well as balance Th-1 and Th-2 immune
branches, dampening an overactive immune response.
Dose: 1 capsule, three times daily, on an empty stomach
Precautions: Do not take with milk.

ADVANCED PROTOCOLS

Those who do not find relief from symptoms after a few months of ABC support may need
to follow more specific advanced protocols. These advanced protocols may involve targeted
therapies like addressing past traumas, as well as incorporating supplemental hormones and
prescription medications. As such, I recommend doing adrenal saliva testing (like the Adrenal
Stress Profile by ZRT) and working with an experienced practitioner to tailor your treatment
to your individual needs.

ABCs of Adrenals | Izabella Wentz, PharmD 10

Disclaimer: None of the statements in this guide have been evaluated by the FDA, or any
other government body. These products are not intended to diagnose, treat, cure or prevent
any disease.

The opinions expressed, while based on scientific research and experience, are the personal
opinions of Izabella Wentz and may not adhere to current practices.

The following guidelines are not meant to replace your physician’s advice, your personal be-
liefs or your own common sense. Please be sure to consult your physician before taking this
or any other product.

If you have a medical emergency, please call 911.

ABCs of Adrenals | Izabella Wentz, PharmD 11