By Dr. Mercola
Your adrenal glands are each no bigger than a walnut and weigh less than a grape, yet are responsible for one of the most important functions in your body: managing your stress.
When your adrenal glands are overtaxed, a condition known as adrenal fatigue or adrenal exhaustion sets in, which in turn can set a cascade of disease processes into motion. One tell-tale sign of adrenal burnout is feeling chronically fatigued.
It's estimated that up to 80 percent of adults experience adrenal fatigue during their lifetimes, yet it remains one of the most under-diagnosed illnesses in the United States.
The Kalish Method1, designed and taught by Dr. Daniel Kalish, integrates scientific testing with natural health solutions to heal your adrenals and restore their normal function.
I first met Dr. Kalish about 17 years ago when he first started using and perfecting this process, which originated with Dr. Timmins, who has since passed away.
Unfortunately, while many conventional health practitioners have started testing adrenal function, many are still unaware of the protocols for solving adrenal dysfunction. Dr. Kalish is passionate about getting the message out that such protocols do exist, and are profoundly effective—capable of restoring health in most individuals in as little as six to 12 months.
The basis of adrenal fatigue or burnout is stress, which over time can tax your adrenal glands to the point of causing other health problems, such as:
- Sleep disorders
- Weight gain
The precipitating event for most people is a period of intense emotional stress. According to Dr. Kalish, approximately 95 percent of his patients report having experienced major emotional stress around the time their health began to falter.
How to Test Your Adrenal Function
Conventionally, you'd see an endocrinologist who would evaluate your adrenal glands, or perhaps a doctor of internal medicine. Unfortunately, they tend to primarily test for specific diseases like Addison's disease or Cushing's disease, both of which are relatively rare.
As stated by Dr. Kalish:
"In the conventional medical context, when they think about the adrenal glands, they really only think about these extreme medical conditions that are not going to be what most suffer from. They do a conventional medical test [to] determine whether you have one of these rare endocrine disorders or not.
In the conventional medical world, they're really not aware of the kinds of lab tests called a functional adrenal stress profile. It means that we're not worried about the disease processes as an endocrinologist would be, but we're really looking at functional problems.
Those are problems that are not going to send people to the hospital, but are more of disrupting your day-to-day life. These would be fatigue, depression, problems with weight gain, and problems with sleep.
Those types of issues – the functional adrenal problems – that aren't severe disease processes, are determined better by either salivary testing, or some doctors also use urine samples."
The Kalish Method calls for testing your adrenal function by taking four saliva (or urine) samples over the course of a day. This maps out your circadian rhythm, showing how your cortisol levels rise and fall throughout your day. Saliva is collected at approximately four-hour intervals: first thing in the morning upon waking, then at noon, late afternoon, and again at night before going to bed. The first video in this playlist explains why testing your hormones might be a good idea. The second video reviews the differences between urine and saliva testing.
How the Kalish Method Helps Normalize Dysfunctional Adrenals
The Kalish Method is aimed at normalizing dysfunctional adrenals and restoring normal adrenal function. It's a clinically validated method that's been used for a long time, yet most physicians are still not aware of it.
"What we find is that if we just restore what's missing in the person for a period of six months or maybe at the most 12 months, the adrenal glands and the internal production of these hormones comes back," Dr. Kalish explains. "So, we're actually restoring the normal production of these hormones in the body. The treatments, therefore, are relatively short-term; six months to a year. The only way we've found to do this real repair process is to use these really low dosages of DHEA and pregnenolone over a period of time."
Another helpful test that can be used is hair analysis. A nutritionist friend of mine has been using this for many years through a company called Trace Elements. According to the theory on hair analysis, the ratio of certain minerals can also be strongly suggestive of adrenal function, specifically the sodium to magnesium ratio. It's similar to a glycohemoglobin test and it's measured over three months.
According to Dr. Kalish, this makes sense as your adrenal glands control so many different body functions, some of which involve minerals. Calcium and magnesium can have an impact on your adrenal function as stress tends to make your body use these minerals up at a higher rate, for example. This is also true for sodium and potassium.
"These are like general indicators of how much stress a person is under, which is a great screening tool," Dr. Kalish says. "And then you can get more specific with the four-times-a-day testing, so you can see exactly what's happening on a given day."
The Three Stages of Adrenal Fatigue
In the Kalish Method, adrenal issues are divided into three general categories: stage one, stage two, and stage three. In a stage one pattern, your cortisol levels are very high, and you're under a lot of stress. But it's usually an enjoyable type of stress. Perhaps you're a student or a new parent, which is stressful, yet you're enjoying yourself and you feel more charged and alive than anything else. You need that excitement. Your body requires it. It's somewhat like exercise. But the key is to have the adaptability and the resiliency to absorb that stress, enjoy it, benefit from it, and then dissipate it.
If you don't sufficiently rest and recharge, your adrenals will get overtaxed, causing your cortisol levels to drop, and this is where most people notice there's a problem. Dr. Kalish explains:
"If you stay in this high-cortisol state for long enough – at stage one – you eventually go to stage two. Stage two means that the cortisol levels are now starting to fail. This is when people start to gain weight. This is when people start to not be able to sleep. This is when your sex drive starts to go away. This is when people just know that there's some health problem."
If you stay at stage two long enough, and you fail to change your lifestyle to address your failing adrenals such as not eating right, not resting, and not exercising, you eventually enter stage three. Here, your adrenals are actually burned out and your cortisol levels are low all the time, causing you to feel chronically fatigued and unable to recover your energy despite resting.
Dr. Kalish suggests thinking about cortisol like units of energy. In the morning, you're supposed to wake up with around 20 units of energy. When you go to bed, it should be down around two. That normal fall of cortisol is what creates that feeling of a "normal" day that ends restfully. But many are waking up with reduced cortisol levels, which translates to feeling exhausted despite having just slept. And many are going to bed with dramatically elevated cortisol levels, making it virtually impossible to shut down your brain and fall asleep.
"This natural rhythm you're hardwired for is based on your exposure to light and day. When the sun comes up, cortisol goes up. When the sun is down, cortisol is low... You pretty much have to fall in line with this rhythm in order to be healthy... Now, when we do the labs, we're analyzing where you're at and then restoring you back to this normal rhythm. That's the point of the testing," Dr. Kalish says.
Four Causes of Adrenal Dysfunction
There are three main reasons for adrenal fatigue and dysfunction:
- Emotional stress, typically related to grief or loss
- Poor diet: Eating too many carbs can disrupt cortisol and a certain group of corticosteroids (a blood pressure-stabilizing hormone), and the Standard American Diet is "a perfect recipe for destroying your adrenal glands," Dr. Kalish warns.
One of the most important things that cortisol does is regulating secretory IgA in your gut. What this means is that the immune response in your gut is controlled by cortisol. Hence, if you're stressed, the immune response in your gut suffers, the gut tissue becomes damaged, and good bacteria give way to bad bacteria, causing immune dysregulation that is centered in and around your gut.
Two important components to address this problem are to 1) regularly eat fermented foods, which will dramatically increase the beneficial bacteria in your body (which automatically will help decrease pathogenic bacteria), and 2) to eat a diet low in sugars and carbs, as that will also promote a healthy gut flora.
- Chronic inflammation in your body: Inflammation is the hallmark of virtually every disease you can think of, from diabetes to cancer, and when chronic, it stresses your system, including your adrenals.
One little-known strategy to counter inflammation is grounding or earthing, which requires nothing more than taking off your shoes and walking barefoot outside, ideally on dewy grass or on the beach. Connecting your soles to the earth will massively increase the influx of free electrons into your body, which helps dissipate inflammation due to their potent anti-inflammatory action.
Another common hormonal cause of adrenal fatigue is hypothyroidism or underactive thyroid. Thyroid function is diagnosed by a blood test, but there's some controversy over what is normal and what's not. Many alternative doctors feel the conventional reference ranges are far too broad, and opt to treat people exhibiting sub-clinical thyroid symptoms.
"What's interesting about the thyroid and the adrenals is that as the cortisol levels go up, one of the normal body mechanisms is to downregulate thyroid," Dr. Kalish says. "So, most everybody with high cortisol is going to have lower than ideal thyroid hormone levels. At that point, it becomes a decision as to if you want to work on the adrenals, work on thyroid, or work on both together...
More than 90 percent of the time, the adrenal program is enough to restore thyroid function. The biggest reason [for doing] the adrenals first is that when you start taking thyroid hormones your internal production of thyroid hormones drop. With the adrenal glands, it's the opposite. When you start to take these adrenal-support products, your internal production of adrenal hormones comes back. If you can restore adrenal function, you can save the person from having to be on thyroid medications potentially for the rest of their life."
Intermittent Fasting Is Contraindicated if You Have Adrenal Fatigue
One of the most powerful interventions I've ever encountered for controlling your weight and optimizing your insulin and leptin levels is to intermittently fast by skipping breakfast. However, Dr. Kalish brings up an important caveat to this strategy... The reason why intermittent fasting works so well is this: There are two fuels your body can burn for energy: sugar and fat. And you have about six to eight hours of stored sugar as glycogen in your muscles and in your liver.
Once you exhaust that, then you're out of fuel for the most part, unless your enzymes are adapted to burning fat. Most people have plenty of fat to burn. The problem is when that when you keep your glycogen stores consistently replenished by eating every six to eight hours, then the enzymes that are adapted to burn the fat get impaired, preventing your body from burning the fat.
So you get into a vicious cycle, which I think is exacerbated by having breakfast, as this doesn't allow your body to enter that fat-burning zone. You need that 12-hour window (or more) where you're not eating any food, which upregulates your enzymes to burn fat, downregulates the enzymes to burn the carbs, and shifts your body into fat-burning mode as your primary way of supplying energy. There are three major benefits to this:
- Your hunger for junk food and sugars disappears. It's the closest thing to magic I've ever seen with respect to diet
- You're able to normalize your body fat, and
- Your weight typically goes down, unless you're very muscular (as it doesn't decrease your muscle mass)
All of that said, Dr. Kalish brings up a very important point, and that is that you need to be reasonably healthy before your body can properly adjust to an intermittent fasting schedule. He explains:
"A lot of the people that we work with have inconsistent blood sugar stability. They need to work into [intermittent fasting]. This is actually the way that I eat every day myself. But sometimes if you try that too early in the process where a patient is sick, it can backfire. But the healthier you get, the easier it is to do.
... The other thing that is tricky about this topic in general is that a lot of people have used skipping breakfast as a way to lose weight. But the rest of their diet was really unhealthy. What we try to do at the Kalish Method is to get the healthy diet going, get the regular meals going, and then introduce [intermittent fasting] when they're more advanced...
It's very hard for a person to have normal energy and to burn fat when their metabolism is basically broken. The more dysfunctional your cortisol is, in a sense, the more damaged your metabolism is... Through these adrenal tests and the 6-12 month protocol, we can work to reset their normal production of these hormones."
So, to summarize, if you are suffering from adrenal fatigue, keep in mind that intermittent fasting may not be such a good idea. You need to be relatively healthy and your adrenals have to be functioning normally in order to allow the hormonal shift to occur that will take you from sugar- to fat-burning mode.
The Crisis of Adrenal Fatigue Among Today's Youth
Shockingly, Dr. Kalish is now seeing increasing numbers of "tweens," teens, and young adults with adrenal fatigue. In one recent month, at least a dozen women in their early 20s had levels of sex hormones that were almost identical to women in their 80s and 90s!
"We had... a 12-year-old and a 15-year-old with stage three adrenal burnout... I'm seeing this trend now, which is really alarming," he says. "I just want to make people aware that kids are under a lot of stress now. It's not normal for a 15-year-old boy or girl to be in adrenal burnout. And it's really not normal for an 18- 22-year-old woman to have burned out adrenals and sex hormone levels that are the same as her grandmother's. I think that it's something we need to be aware of.
This younger generation is under a lot of pressure right now. We need to support them. I don't know what all the factors are but I'm sure some of it is toxins in the environment and [improper] diet, [and] emotional pressure. They're clearly not getting enough rest and downtime anymore."
Finding a Clinician Trained in the Kalish Method
"I have a sense of urgency to get the word out and get a lot of practitioners trained, so that the public can have access to these safe, low-dose protocols. They really work. They've been tested for decades. I just want to make sure that we get the word out, so that people can have access to them," he says.
As of last year, there were about 500 clinicians trained in the Kalish Method, from all around the globe, including Bahrain, Egypt, Singapore, Australia, New Zealand, and all across the US. Fortunately, many of them do telemedicine, providing consultations over the phone. Whether you're a health practitioner or a potential patient, you can learn more on Dr. Kalish's website: kalishinstitute.com3.
Again, the Kalish Method simply calls for a basic adrenal test, where you spit in a test tube four different times over the course of a day. If it is determined that your cortisol levels are too low, you are then given a program of various vitamins, minerals, and low-dose adrenal hormone supports that will help your body to begin producing more on its own. Other hormones, such as testosterone and pregnenolone levels may also be checked, and if necessary addressed with supplements.
"What the most important part is the test also reveals the level of stress that you're under and how much you need to focus on the lifestyle changes. The more advanced the adrenal exhaustion is, the more meticulous and careful you have to be about sleep, exercise, diet, and stress management," Dr. Kalish says.