Role of Adrenal Exhaustion and Cortisol in CFIDS/Lyme

One of the apparent results of my long-term chronic infection is adrenal exhaustion. This is a complicated problem that must be addressed in order for more complete healing to take place. The primary symptom of exhausted adrenals for me is that energy ‘runs out’ early in the day (say, around 12-2 PM), I feel horrible when I get an ordinary virus – like I might die, and any stress at all saps so much energy that I must lay down. Also, sleep problems and chronic kidney-area pain or lower back pain whenever I lay down and relax. There are others but I would say these are primary. Here are some of the things I have learned about the adrenals and treating this problem.


When adrenals are exhausted they have actually lost some of their capacity, and therefore a person with exhausted adrenals is living with a condition that is basically a sub-clinical form of Addison’s Disease. I believe that a LOT of late stage Lymies have this and do not realize that it is an actual injury to the adrenals that should be addressed separately.

Also, one of the most telling symptoms is to lose all body hair from the lower legs, and eventually the upper legs as well. This is a strong indicator of adrenal exhaustion, but it reverses when the adrenals heal. BTW, my adrenals are slowly healing on salt/c, but I still have to treat them, and I must support them well during bad herx cycles.

There are several tests, the most useful is the Adrenal Stress Index (ASI), which is a very simple saliva test you take at home and send to the lab. You take several samples over a 24-hour period. This shows the levels of many adrenal hormones, and compares them to normal. A typical person with adrenal exhaustion has levels about half of normal, although sometimes there are reverse levels also (one time of day the cortisol is too high, another time of day it is too low), which show general regulation problems from chronic infection load. Most doctors who are ‘into’ natural medicine know about this test.

Cortisol is a hormone that is involved in adrenaline production, it is a safe supplement to take, but if a person takes too much the body may become dependent. However, there was controversy over this drug early on because its over-use caused problems. Then a Dr. Jeffries proved a number of years ago that a level not exceeding half the biological dose is safe and will not alter the body’s metabolism in any negative way. Taking too much is a problem because when we have high adrenal levels the immune system is depressed. There was a lot of misinformation about this about 20-30 years ago, and that still persists in the minds of many medical practitioners.

One interesting study showed that people with chronic fatigue syndrome may have adrenal glands that are half the size they should be based on body mass. I don’t think the reason is clear yet, either atrophy or genetics, but it was a surprise to learn this. Some people just seem to have low adrenal capacity. And as adrenals are taxed heavily with chronic infections, this is a big issue. (reference: Psychoneuroendocrinology 1999 Oct 24(7):759-68, Small adrenal glands in chronic fatigue syndrome: a preliminary computer tomography study. Scott L V, Teh J, Reznek R, Martin A, Sohaib A, Dinan T G [8 patients tested] )

There are other ways to boost the adrenals, such as licorice root and salt. Because I have chronically exhausted adrenals and probably have lost some adrenal function (For now anyway) I must take adrenal support every day. On days when I go off salt (I try to take a day off now and then to rest the kidneys), I must take cortisol (Cortef) or a lot of licorice. The typical healthy adrenal gland makes 40mg of cortisol per day. I usually take 5-10mg of cortisol on days off salt, or days with high stress. Many people take 20mg daily, and for some this has completely reversed their health problem (usually chronic fatigue type issues).

Historically, licorice was the natural treatment for Addison’s, because it acts as a re-uptake inhibitor for adrenaline. Some people treat only with licorice and adrenal extracts. I use very small amounts of licorice only because large quantities of licorice increase estrogen and lower testosterone levels. But in small quantities it does not seem to be a problem.

There are many other herbs that can be helpful in treating adrenal exhaustion. If you are serious about this topic I would recommend reading the book 'Adrenal Fatigue' by James Wilson (he is unique, he is an ND and DC with a PhD in nutrition). There are dozens of books on the subject but this one seems to be one of the most highly regarded, and his program does help many people, without using cortisol.

A good place to get the ASI test based on a phone consultation is www.chronicfatigue.org – they have reasonable rates and are a non-profit treatment center for adrenal-related issues.