Adrenal insufficiency, or adrenal fatigue, is a condition in which the adrenal glands fail to produce a sufficient amount of steroid hormones to sustain the body during illness. The adrenal glands may produce the wrong amounts of hormones —either over or under-producing them due to “fatigue” and hypothalamic-pituitary-adrenals (HPA) dysfunction. Adrenal fatigue is real, and it’s common in Lyme disease regardless of whether you use herbal antimicrobials , medications, or a combination of treatment approaches.
Adrenal Fatigue Symptoms
Adrenal fatigue symptoms mimic those of Lyme, and can therefore be difficult to differentiate from symptoms of other processes caused by Lyme. Common signs of advanced, severe adrenal fatigue, which is prevalent in many with chronic Lyme, include:
- Fatigue , especially in the morning
- Feeling easily anxious or depressed
- Low stamina
- Feeling “wired and tired”
- Digestive problems 
- An inability to stand for a long time, POTS
- Brain fog
- Weight loss or gain
- Blood sugar regulation problems
- Low blood pressure
The Best Way to Test for Adrenal Fatigue
However, these symptoms are also caused by other dysfunctional processes in the body that are created by Lyme. The best way to test for adrenal fatigue is to do a saliva cortisol test, although even that will only tell you so much, as some people have near-normal cortisol levels and yet exhibit symptoms of adrenal fatigue. So combining this test with a clinical analysis and symptom evaluation is the best way to diagnose adrenal fatigue.
In any case, if you have symptoms of the above, chances are, you are battling adrenal fatigue. It is nearly universal in people with late-stage chronic Lyme, so the more important question is probably, to what degree do your adrenals need support?
Natural Remedies for Adrenal Fatigue
In cases of mild or moderate fatigue (determined again by your saliva cortisol levels and degree of symptoms), many healthcare practitioners have found all of the following natural remedies to support the adrenals (note: this list is not all-inclusive):
- Vitamin C
- Pantethine (or pantothenic acid)
- Licorice root
The first two listed here are nutrients that are generally considered to be safe for most. The adrenals use up a remarkably large percentage of the body’s Vitamin C, so if you have adrenal fatigue, you may find that you need dosages of anywhere from 5-50 grams daily. Note that I did not say milligrams!
The USDA’s recommended daily allowance (RDA) of Vitamin C, at 500 mg, is very low, and considered to be sufficient only to prevent rickets- never mind support a person with chronic illness going through Lyme disease treatment. Liposomal and non-corn derived forms of vitamin C may be more beneficial than those made from corn and/or plain ascorbic acid.
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Pantethine, a bioavailable derivative of pantothenic acid, is also highly utilized by the adrenals, especially under times of stress. Like vitamin C, dosages of pantethine can vary widely. Because vitamin C and pantethine are both water-soluble, overdosing isn’t usually a concern, but consulting with your doctor to find out how much you may need is always a good idea.
Adaptogenic herbs, such as ashwaghanda and rhodiola, are also commonly used by practitioners to balance their patients’ adrenal function in those with mild to moderate adrenal fatigue. Other herbs, such as Siberian Ginseng, can also be helpful, but Siberian Ginseng is stimulatory and may wear out already exhausted adrenals if used long-term.
Licorice root is an especially useful herb for adrenal fatigue, especially if the adrenal fatigue is advanced (as characterized by low saliva cortisol levels and more severe symptoms). Licorice root causes the body to retain cortisol, so it can help to boost cortisol levels in people who are deficient in this life-giving hormone. However, it raises blood pressure and long term use can cause potassium depletion, so it’s a good idea to use it judiciously and only under the care of a qualified healthcare practitioner.
For more advanced cases of adrenal fatigue, which is, as I noted, characterized by low morning cortisol levels or an inverted cortisol pattern on test results (where cortisol levels are low in the morning and high at night), and more severe symptoms, bio-identical hormone replacement therapy may also be necessary.
One practitioner that I interviewed for book, New Paradigms in Lyme Disease Treatment: 10 Top Doctors Reveal Healing Strategies that Work, David Minkoff, MD, shares that many of his patients with chronic Lyme disease battle adrenal fatigue that is severe enough to warrant bio-identical hormone replacement therapy. This involves giving the body the hormones that it isn’t properly producing- in supplement form- to make up for deficiencies.
These hormones can include: pregnenolone, progesterone, estriol, DHEA, and in cases of severe adrenal fatigue—hydrocortisone.
Some doctors have cautioned against using hydrocortisone, a powerful steroid hormone supplement that the body uses to replace deficient levels of cortisol. They contend that it can cause Lyme symptoms to flare, but other practitioners believe that it is useful and essential for some people’s recovery.
Cortisol regulates inflammation in the body, and in truth, too low levels are just as bad as when levels are too high. Without enough cortisol, the body may not mount an effective immune response against infections, and supplementation can therefore sometimes be appropriate. Too high levels can cause infections to flare, so working with a practitioner is essential if you are have advanced adrenal fatigue and are considering this type of therapy.
Finally, adrenal glandulars, which are adrenal supplements that contain adrenal (and other endocrine tissue) from animals such as sheep and cows, and which may or may not contain adrenal hormones, can also be helpful for supporting the adrenals in advanced adrenal fatigue, but they are powerful and should also be used under the guidance of a qualified healthcare practitioner. Still, they can be very helpful for giving the adrenals a rest and helping them to recover while battling chronic illness.
In the end, the adrenal glands play an important role in the body’s immune response, so supporting them with supplements and lifestyle modifications during Lyme disease treatment can be essential during recovery. Not all doctors who treat Lyme understand adrenal support or how to balance the endocrine, or hormonal system. It is a complicated art that requires skill and experience. The good news is, increasingly greater numbers of practitioners are realizing that supporting their patients’ adrenals is an important component of Lyme treatment, and are endeavoring to help their patients in this area.
This article was first published on ProHealth.com on September 19 2016 and was updated on June 23, 2019.
Connie Strasheim is the author, co-author or ghostwriter of 10 wellness books, including four on Lyme disease, and the just-released New Paradigms in Lyme Disease Treatment: 10 Top Doctors Real Healing Strategies that Work . She is also a medical copywriter and Editor of Pro Health’s Lyme disease page, as well as Editor of the Alternative Cancer Research Institute. Her passion is to help people with complex chronic illnesses find freedom from disease and soul-spirit sickness using whole body medicine and prayer, and she collaborates with some of the world’s best integrative doctors to do this. In addition to Lyme disease, Connie’s books focus on cancer, nutrition, detoxification and spiritual healing. You can learn more about her work at: www.ConnieStrasheim.org .