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PAGE 2 / The Complete ADRENAL Health Program
Kevin: Welcome everyone. My name is Kevin Gianni from The Complete Adrenal Health Program. Today we are
going to give you the goods on your adrenals. We’re going to be talking about how your adrenals work, the
role they play in your health and how to help them health naturally. My expert guest is Dr. J.E. Williams,
who has been in practice for 30 years and has had over 100,000 patient visits. Today in module one we’re
going to get familiar with the adrenal system. So Dr. Williams, welcome.
Dr. Williams: Thank you for having me on the program. I look forward to educating and hopefully enlightening our
Kevin: We talked about blood tests and we talked about the thyroid in our previous programs . Today we have
one of the most common issues, because of the amount of stress that we have on a regular basis. It’s adrenal
burnout and the adrenals being overworked. So why don’t we start with explaining what the adrenals are
and how we’re going to work through this specific program.
Dr. Williams: I’d be happy to do that. I want to remind our listeners that hormones, and this is what we’re mainly
looking at when we talk about any of the endocrine glands, adrenals being one of the primary ones, are
sophisticated chemical messengers that provide information and help the processing of that information
between all body cells, all body systems, and the environment outside that includes stressors, chemical,
psychological and physical, like colder weather or exercise or diet, as well as the stresses of daily events,
whether you like your boss or don’t like your boss, whether you’re stuck in traffic in LA or not. They also
regulate biochemical information so that your body functions properly but also they control the life-
sustaining processes. So when we look at hormones we’re going to divide them into the key, major ones.
The major ones definitely fall into the adrenal gland category. That’s going to be adrenaline and cortisol
and also another one that’s made by the pancreas, insulin, which interacts a lot with the adrenal gland. So
when the intracellular communication process falters, when there’s too much or too little of the hormone,
in this case talking about adrenal glands, then we have imbalance, first of all. The body is very capable of
hiding itself and not allowing the boat to tip over. Even if it does, like a sailboat you have the right ballast
and the keel and it will come all the way back up, a little worse for the wear and shaken and sorry but it will
normalize itself. However, over time breakdown will occur and then system-wide dysfunction can happen.
So the adrenal gland and it’s hormones are key to life, to health and to happiness as well, in terms of how
health and happiness are related to hormones.
With that said, the adrenal glands, also called the supra-adrenal, renal meaning kidney and supra meaning
on top of, are two triangular-shaped structures that sit directly on top as caps to the kidneys. There’s one on
each side of the body. They are more or less just below the bottom of your lowest ribs, towards your back.
They have two parts. There’s an inner and outer part. The outer part is called the cortex, like the bark of a
tree. The inner part is called the medulla. Each secretes different groups of hormones. They both perform
different functions. They secrete large numbers of hormones into two main classes. Those are steroids and
catacholines. The outer part, which is the adrenal cortex, secretes hormone that have an effect on the body’s
metabolism, the chemistry in your blood and on your body morphology. That’s how your body looks, it’s
characteristics, it’s shape, including where you pattern your body fat. So when we look at what people
look like, we’ll talk more about that later in the program, when they have adrenal problems a trained eye
can tell if you have too much or too little of adrenal stress hormones going on, just by the way your body
looks. When people are trying to lose weight, control appetite and so forth, there is a significant role that
is played by adrenal hormones and the way the body patterns its fat.
Transcripts Module 1 / PAGE 3
The main hormones that the adrenal cortex secretes are the steroid hormones, that includes corticosteroids
and androgens, which are the male hormones. They are secreted directly into the bloodstream, on demand.
They flow during the day time and they also are released when necessary, and quite rapidly. The main hor-
mones that the adrenal cortex secretes are cortisol, which is going to play the key role in the adrenal fatigue
phenomenon, aldosterone, testosterone and DHEA.
Inside the glands--remember, these are very small. They’re less than the size of your palm. But they do a
phenomenal amount of work. This inner part, the adrenal medulla, is necessary for the immediate stress
response. This is where adrenaline, technically called epinephrine, is secreted. That increases heart rate,
the force of the contractions of the heart muscle, blood flow to the muscles and to the brain and also is
associated not only with contraction but relaxation and very importantly, the conversion of glycogen into
glucose, which is the storage molecule in the liver and muscles needed upon demand during exercise and
The other is norepinephrine or noradrenaline and that has effects on smooth muscle, metabolic processes
and cardio output and causes vasoconstriction and is related to blood pressure.
That’s the basic gland and its hormones. There’s so much more to the adrenal gland and that is where we
take a look at its relationships into the connection, not just the downstream effect into the bloodstream
and out to the cells into the muscles and to energy but also upstream, which is the connection between
the hypothalamus and the pituitary. This is called the HPA or the hypothalamic-pituitary-adrenal axis. It’s
well-studied over several decades and its relationship to stress and overall health and disease. Mainly we’re
going to be look at it in terms of adrenal health, how it controls and how cortisol interacts back to the
pituitary and of course how it relates to the other stress hormones. But the main thing is we’re going to be
looking at cortisol.
This system acts as an energy regulator in the body. It controls virtually all hormones but has a very close
relationship with the adrenal hormones and very interconnected with the nervous system and also with
energy expenditure. That again has to do with weight-loss and weight-gain, as well as exercise, and very
importantly, modulates the entire immune system.
My area of main interest is immunology. So I’m always looking at the effect of cortisol and drugs that are
chemical mimickers of that, like Prednisone, on the immune system and on the whole body. Keep in mind
that these hormones, like cortisol, hydrocortisone and their pharmaceutical cousin Prednisone, have pro-
found effects on all systems of the body all the way down to your bone and up to your skin. When we’re
looking at the HPA axis a little bit closer we’re going to find that there’s a feedback loop between the hypo-
thalamus, pituitary and the adrenal glands. The main hormones that activate this are called corticotrophin
releasing factors, CRF, arginine vasopressin, AVP, and adrenal corticotropin hormone, ACTH. That’s the
big one. The action of cortisol is to directly affect the hypothalamus and pituitary, completing the loop and
then all other processes in between.
If we have too much cortisol we suppress immune function and we suppress the activity of the HPA axis
and prevents release of neurotransmitters. Then you go into kind of a quiescent mode and then when the
cortisol goes down it should trigger a resetting of that mechanism and we go back engaged again. That
should happen at nighttime. It should be more quiescent. In the morning your cortisol should start to
come up again and it should activate the system and become engaged. If you have a lot of stress it becomes
highly engaged and then after the stress the cortisol level goes down and then you go into rest mode, al-
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most into kind of a crash mode where you will literally pass out into a deep sleep and some people repeat
sleeping 9, 12, 17, sometimes 20 hours straight and then they wake up, disoriented a little bit and then
refreshed and their system reboots itself.
The problem with the adrenal stress related HP axis dysfunction disorders is that this system is not regulat-
ing itself effectively anymore. There’s imbalances throughout the system. It’s either too high or too low or
appropriate release of the stress hormones, predominantly cortisol. Then you have either an overly active
or under active chronic problem.
Kevin: I want to talk about some of the ways the adrenals relate to other systems in the body. But first I want to
ask, because the adrenal glands sit right on top of the kidneys, what’s the relation between the two?
Dr. Williams: Other than structural positioning there’s no direct connection into the kidneys in terms of Western ana-
tomical and physiological view. There are a few hormones that, predominantly aldosterone, that have an
influence on some of the functions of the kidney, but that’s indirect. The hormone, in other words, doesn’t
have the direct pipeline into the kidney. It goes into the bloodstream and then influences the kidneys in-
Where it becomes confusing is the cultural view between east and west. In Chinese medicine, the eastern
view, they talk about the kidneys being the most important organ in the body. All health, including what
you’re born with, your innate or genetic essence, is going to be influenced by the kidney ching or the es-
sence of the kidney, the inherited essence. That’s going to dictate how strong bones are, how robust you are,
how adaptable you are to the environment, how good an athlete you are, how long you live, how sexually
active you are. As you go through your life they clearly define a balance between what they call the kidney
yin and the kidney yang. Any deficiency in either the kidney yin or yang or the kidney ching systems is
going to cause fatigue.
So it matches or parallels or mirrors the symptoms that occur from the adrenal gland. When we look closer,
we drill a little bit deeper, we find that anatomically Chinese medicine didn’t separate off this little cap,
the supra-adrenal structure on top of the kidney and the kidney as a filtration system for water and its
connection to the bladder in terms of urination. They grouped it all together. So you might say that the
kidney yin in Chinese medicine is the actual organ of the kidney and the urinary function and the kidney
yang is connected to something also called the gate of fire or the ming mung, which is more of the adrenal
It’s kind of the downstream effect where you hear one thing and then somebody says it distorted a little
bit, somebody says it again, like the parlor game of describing and elephant. Pretty soon you start off
describing an elephant and as you’ve gone around the room you’re talking about the cotton balls in your
Kevin: So let’s talk about how the adrenals and the hormones directly relate to other systems of the body.
Dr. Williams: They relate to all systems of the body. That’s highly important to start off with. First of all, let’s take a broad
brushstroke. They’re going to relate to the higher centers, the pituitary, the hypothalamus, and that’s going
to affect every other hormone. So adrenals go off, thyroid can go off. Adrenals go off and your gonadotro-
phic hormones and your androgenic hormones, testosterone and DHEA, go off. So the endocrine connec-
tion through the hypothalamic-pituitary axis is first and foremost.
Transcripts Module 1 / PAGE 5
Secondly, they also relate to metabolism, how you burn and transform sugar, glucose in the body. That’s
going to directly relate to diet, what you eat, when you eat, how much you eat and how you process that
and what type of foods you eat and what type of foods you are going to crave. Salt, for example, is neces-
sary for good adrenal function. So craving salt if you have one the patterns that we look for in terms of the
minor symptoms or the tip-offs for adrenal weakness, adrenal fatigue, is the craving for salt. Same thing
with sugar, although sugar is not directly related to the function of the function of the adrenal gland. It’s
related to the function of the pancreas, which is anatomically very close to the adrenal glands. It sits in
between the middle there, a little closer towards the front of the body. Even when you exercise, it’s a form
of physiologic stress. So your body is going to need more insulin. It’s going to need more sugar to get into
the muscles so it’s going to activate the muscles, the liver and whatever you’ve eaten that’s in reserve or that
you’re craving in reserve. So sugar cravings can also play a role in the metabolism on the backend and then
into weight issues. So you see a person with dysfunctional adrenal gland, they’re going to be underweight,
difficult to gain weight. Sometimes they think, “My metabolism is so great.” Their adrenal may be going
out of balance. Or people who can’t lose weight, even if they start to diet a little bit. They have low energy
and they maybe lose a little bit, lose some of the water that’s accumulated in the body but they can’t lose
weight. They get stuck at kind of a set point.
Then if it gets worse you’re going to go into an imbalance between the salt and sugar cravings and you’re
going to be holding water and you’re going to be holding fat. If it gets worse then you’re going to hold a
lot of fat around the middle of your body, so you lose your waist and you collect fat around the sides and
the upper back, not just belly fat or the tire around the middle but all the way up to under the ribs, to
women up under the breasts, then you become chunkier or more square in the center of your body and
in the periphery where your big muscles are you become weaker. The arms and legs become thin and the
so-called apple shape body or the fruit of the loom look.
That, of course, relates to cardiovascular. It’s going to influence your blood pressure. One of the ways we
check for adrenal fatigue is to take your blood pressure sitting down, or lying down, and then stand up
quickly but not too quickly and then take it immediately again. If you have a drop in blood pressure by 10
points that’s usually a good indicator that your adrenal hormones are not regulating your cardiovascular
function well. So you have this postural hypertension. People who get up from a chair and feel dizzy or
light-headed often have that phenomenon. That’s also associated with adrenal.
Then lastly, the nervous system is very connected to the autonomic nervous system and people who have
imbalances in their parasympathetic and sympathetic responses. One clue is going to be easily sweating,
particularly on your palms and bottom of your feet. People have that, they’re not doing anything, maybe
just lying down, but they’re autonomic nervous system is ramped up on one side and not balancing on the
other. That also directly has a connection to the adrenal gland.
One of the tip-offs for that with adrenal fatigue phenomena is that not only are the people tired and fa-
tigued and lethargic but they can also be irritable. So they go from kind of snapping out behavior to very
tired or crashing behavior. Any little thing kind of sets them off. Sometimes maybe loud noises. It’s not
loud to you but they think that you’re making too much noise. Or everybody shivers when chalk goes
across the blackboard, right? These folks have that type of response when there’s nothing happening other
than normal sounds or somebody asking a question.
There’s lots of little keys. We’ll talk about them more in the next modules. The main thing is to understand
how profound the adrenal glands, even though they’re very small, are in relationship to all body systems.
PAGE 6 / The Complete ADRENAL Health Program
Lastly I want to mention skin and bones. Two much cortisol, or if you take too much Prednisone, and as
you get older you’ll also see this phenomena where adrenal function part of it is too little and part of it may
be too much for the tissue to handle. The skin becomes thinner. That’s a problem. If you have too much
cortisol it will shut down your hypothalamus and the hypothalamus will actually atrophy. You won’t func-
tion as well because other systems of the body need the hypothalamus to be working. If you have to much
cortisol you’ll have weaker bones. You will have osteoporosis. Same thing if you take too much Prednisone.
If you’re using that product for say, controlling asthma, the pharmaceutical effect is an anti-inflammatory
but it also suppresses immune function and creates thinning skin and weaker bones.
Then, of course, there’s the immune function. Too much cortisol suppresses the immune system. You’re
more susceptible to all types of infection, both bacterial and viral, including common cold and flu.
Kevin: When you talk about cortisol and its role in bone health, is the cortisol directly affecting the degradation
of the bone or is it more of an acidic environment in the body or do we know?
Dr. Williams: It’s the cortisol. The cortisol directly is doing that. Acid/alkaline balance have little to do with direct ad-
renal hormone function. Aldosterone is another hormone secreted by the adrenal which influences the
mineral balance in your body and your urination. If you have low aldosterone you’ll have a tendency to uri-
nate frequently without having an urge, like when there’s an infection. The urine is usually more clear and
you’re more thirsty. You drink more water and you have the urge to urinate. These people are constantly
going back and forth to the bathroom that do not have urinary tract irritation, inflammation or infection
can have also adrenal issues with the aldosterone. If that gets too imbalanced then you can alter the acid/
alkaline balance. Usually though, it shifts towards the alkaline side rather than the acid side.
Kevin: How do these imbalances directly cause poor health?
Dr. Williams: Let me answer that question by taking a step back. One of the things that we have a tendency to do is
people, doctors are people too, is we tend to look at things in black and white and direct cause and effect.
Like a mosquito bite makes you itch. But it took a long time to figure that mosquitoes were carrying yel-
low fever and malaria. Only about 100 years ago we discovered that. Then we got rid of the mosquitoes
and the incidence of infections were less, but it was not until the middle of the last century when we really
started to understand much about how those viruses and those parasites that the mosquitoes carried affect
the cells in the body. I think we’re kind of at that same level now, with adrenal health. There are mainly
indirect but profound indirect effects.
They’re so interconnected to everything in the body that it’s not going to be like a mosquito bite or a bruise
or a break or a toxin or something like that. They’re going to be indirectly interlinked into a vastly com-
plicated system that includes the neurotransmitters, that includes neuropeptides, that include immune
molecules, cytokines and so forth and then the hormones themselves.
The most direct relationship between adrenal hormones is due to stress. The adrenal medulla secretes
adrenaline. When the stress is there, there’s a--it’s not instantaneous. It takes a few seconds up to a few min-
utes but it’s very quick that the levels will increase very rapidly and then you’re going to see immediately
increasing heart rate. The force of the heart contractions becomes stronger. Blood flow goes away from the
stomach and out into the muscles, pushes up into the brain so you become very alert and your muscles
become stronger. They become filled with blood. It pulls sugar out of the liver, in the form of glycogen.
Your body becomes, in a sense, superhuman. That’s where you hear about the mother lifting the car off of
Transcripts Module 1 / PAGE 7
the infant and things like that. People can actually do those things, but for very short periods of time.
Then on the backend there’s a relaxation process. The cardiac output goes down as the hormones go down.
The rest of it that relates to the fatigue phenomenon and the burnout phenomenon and the bone and skin
thinning is a very gradual, very slow, indirect process.
Kevin: Let’s talk about some of the major health concerns, particularly starting with the clinical concerns and then
talking about some of these more sub clinical issues that most people are probably experiencing.
Dr. Williams: The first is the clinical concerns. There’s two of those in classical western medicine. When you have too
much or too little cortisol. When you have too little you have a condition called Addison’s Syndrome.
When you have too much you have Cushing’s Syndrome. Basically you’re going to look at this as Addison’s
people tend to be very thin and very weak and very droopy. Cushing’s Syndrome people tend to be over-
weight, almost like they have no neck. The fat develops around their neck, particularly on the back of the
bottom part of their neck. They get a rounder look to their face called a moon face. They have difficulty
losing weight. So those are the two clinical syndromes that are related to adrenal disease.
There’s also tumors of the adrenal gland, but that’s a different aspect of our program.
There’s a third part of it, which is Syndrome X. There’s an ICD9 diagnostic code for it, also called Meta-
bolic Syndrome, where you have disruption significantly enough between the adrenal hormones and the
pancreas, so between cortisol and insulin. Now you have a combination of fat and thin. Here you have the
fat around the middle and maybe around the neck and maybe rounding more in the face and thin around
the extremities. That’s the Metabolic Syndrome, or Syndrome X.
The other types are not classified as diseases yet and that is what we talk about as the adrenal fatigue or the
adrenal burnout or the adrenal insufficiency. It’s a continuum. It’s not just you go from optimally healthy
to totally fatigued. It tends to come and go. It tends to occur gradually. The system attempts to self-regulate
itself. The factors that influence that are the amount of stress and how much stress and how often the stress
is and the severity of the stress, how close to home it is to you. The other is your genetic propensity, if you
have strong or normal or weaker adrenals to start with and then how the rest of your body is working, all
these other systems, your cardiovascular system, your pancreas and insulin. All of those factors play a role
in the balance or imbalance, the decline or rebuilding of your adrenal glands.
Stress, diet and exercise are the three components that the individual is going to be most faced with and
have some degree of control over.
Kevin: I want to talk a little bit about the role of stress and adrenal burnout and how stress actually causes some
of these health challenges.
Dr. Williams: That’s the key, Kevin. Your endocrine response to stress, particularly adrenal and specific the HPA axis. So
any stress, physical or psychological, including exercise--remember, stressors can be positive or negative.
Some exercise is a positive stressor to the body and your body responds at a moderate level, your adrenal
glands in this case specifically, to exercise just as it would to a stress as if you were being chased by a lion or
you walked into your kitchen in Arizona and there was a rattlesnake curled up in the middle of the floor.
The problem is that your body has mechanisms to respond and then normalize after the exercise or after
the stresses that would be caused by say an accident, a slip and fall injury, falling off your ladder when
PAGE 8 / The Complete ADRENAL Health Program
you’re fixing your roof or when there’s a rattlesnake on your kitchen floor. It doesn’t seem to be that good at
modulating or restructuring, rebalancing, when you have chronic levels of stress, the modern maladaptive
syndrome. That has been thought to have three phases.
Cortisol secretion occurs in response to stress, as does some epinephrine and nor epinephrine. But it’s the
cortisol that tracks up through the bloodstream to the hypothalamus and the pituitary gland, causes those
glands to release more hormone and to start to self-regulate. If there’s too much cortisol, as I mentioned,
it’s going to cause the hypothalamus to atrophy and over time, if it’s consistent like that, the hypothalamus
is not going to respond as well so the whole HP axis is going to breakdown. You’re going to have a sustained
release of cortisol from the adrenal cortex. Prolonged release of ACT, adrenal corticotrophin hormone,
from the pituitary causes an increase in size of the adrenal cortex and long-term release of ACTH causes
it to shrink. So now you’re going to have change in size of the structures, both the hypothalamus and the
adrenal. Eventually it’s not able to self-regulate so the HP axis is wobbling, if not going dysfunctional.
Finally the adrenal cortex itself will be unable to produce sufficient amount of cortisol and now the whole
body system starts to breakdown. Normally the HPA axis, the hypothalamus would kick in, but because of
the previous long-term cortisol release it’s now atrophied and it’s not able to respond to the lower. So now
you have, not a complete shutdown, of course, but a reduced function ability of both the adrenal cortex
and the hypothalamus and the pituitary doesn’t know what to do. It’s kind of stuck in the middle and may
or may not be releasing properly. Now your rhythms of the cortisol release and the pattern of that during
the day and night are completely off. Then behind that comes your other hormones, your other cortisol
hormones and then behind that, for women, ovarian hormones, for men their gonado-hormones like
testosterone. Then the kind of paired hormone to cortisol, DHEA, will also become affected so you have
imbalances. We’ll talk about this in detail in the program on testing, between cortisol and DHEA. So you
have too much cortisol and not enough DHEA or you have the opposite, too much DHEA and lower
cortisol, which is more favorable.
So if your DHEA is strong, which is what you want, but in my clinical practice, I think this is so impor-
tant to offer our listeners is that hundreds and hundreds of patients that I’ve seen and tested and what we
find, what my colleagues find in the testing is that normally you should have strong DHEA production
and you should have moderate amounts of cortisol, not low, not high. That’s going to create loving, caring,
kind, appreciative person who is joyful and their immune system is working strong and they sleep well and
their appetite is good and their body weight is normal. When the cortisol is too high and your DHEA is
now low, you have a frustrated, angry, irritable person who fluctuates back and forth between despair and
depression and agitation. They’re fatigued and push themselves, drive themselves with coffee and green tea
and ginseng. That leads to further breakdown of the system. Rest is the key to solving this. Then finally
you have cortisol and DHEA both going down. So you have low cortisol and low DHEA.
You normally find, testing people, they are somewhere in between. They’re not at full burnout phenomena.
They might not even be quite into adrenal fatigue. They’re into first level of HPA axis imbalance. What
they have is normal cortisol in blood testing and very low DHEA. They’re moving towards imbalance in
the ratio of cortisol and DHEA. So they have kind of a low performance syndrome where they’re tired
some of the time. Rest seems to help them. Exercise seems to be OK but if they over-exercise their recovery
is not great. They’re not as sharp. Their memory is not as good. This is also going to occur in 20-some-
things, not just older folks. The younger people are sort of experiencing what natural aging process might
show up. They just don’t know quite what’s wrong with them. The rest on the weekend, they feel better
and then they go back into the stressful environment and the whole process in a few days or weeks starts
Transcripts Module 1 / PAGE 9
Kevin: So in cases of adrenal burnout, how long does it take from someone to go from constant stress to cortisol
being produced regularly, the hypothalamus shrinking and then cortisol being unable to be produced?
How long does that process take?
Dr. Williams: It usually takes years. The old way of looking at it was developed by Hans Selye decades ago in what he
called General Adaptation Syndrome, GAS Theory of stress. He put it into three stages. We know that
that’s basically true now, but it’s a lot more complicated than that. There’s at least five stages, interrelated
stages. But in Dr. Selye’s three stages he clearly classified the alarm stage or phase of the adrenal cortex reac-
tion, which discharges hormones focused mainly on cortisol, directly into the bloodstream and you have
direct affects on the hypothalamus and pituitary. If that continues over a period of time, weeks, months,
years, then there’s going to be resistance stage where the adrenal cortex continues to put out not abnor-
mally high levels but just higher than normal levels of cortisol. The cells become resistant. They don’t want
to deal with that cortisol in the body and the person has more difficulty dealing with stress. That’s when
they start to typically drink more coffee, engage in stronger green tea, taking ginseng. They try to balance
it with different food, maybe more salty or sugary foods or both, fatty foods sometimes or a combination
of all three. Exercise junkies that might push themselves with exercise. They feel better during the exercise,
particularly high-impact aerobics, because the adrenaline is up. Then the adrenaline goes down and finally
they reach this third stage of exhaustion where the system just cannot adapt anymore. There’s an inability
to cope with stress. The person is in bed or they don’t want to come out of their home and they have all of
the other phenomena that starts to go along with that. We look at it as a continuum rather than a direct
relationship between stress and adrenal fatigue. It’s a wearing out of the system. It’s like repetitive stress,
carpal tunnel. It doesn’t usually happen the first day you start typing but weeks after weeks after months it
will get worse and worse until it becomes carpal tunnel syndrome. If you have propensity to have narrow
wrists or exercise and you collect fluid a lot in your body then you’ll be more susceptible to carpal tunnel
over time. People are the same way with adrenal fatigue. They will be more susceptible if they genetically
don’t have strong adrenal function or if the stressors are particularly insidious and particularly strong, or
importantly, if they have stress their entire life, if they had a stressful childhood. For example, they may go
into the teenage years already under stress so by the time they’re in their 20s they go to college, they start
working, now they’re at burnout phase at 23 or 26.
Kevin: I want to go back to Addison’s and Cushing’s, as well as talk a little bit about adrenal burnout. The biggest
question I have is, are these clinical issues reversible and then is something like burnout completely revers-
Dr. Williams: The clinical issues, they are manageable. To little cortisol and Addison’s can be treated with hydrocorti-
sone or pharmaceutical grade cortisol and patients feel better and they can be normalized with that. Of
course in natural medicine we’re going to look at the bigger picture and try to kind of restructure the whole
HPA axis and all of the endocrine system and the cardiovascular and nervous system, as well.
Too much cortisol being produced by an abnormally-functioning gland, both of these are organ-related
problems and that’s more difficult to reverse. There’s actually no drug that reduces the amount of cortisol
or neutralizes cortisol in the body. We’re looking at different ones that have an effect on too much cortisol
but when you’re all the way into Cushing’s Syndrome there’s nothing that directly inhibits the cortisol.
The third clinical entity is the Metabolic Syndrome, which is kind of a combination of that too fat, too
thin at the same time, with disruption to the pancreas and insulin and glucose. That can be remedied
through lifestyle changes and modulating the cortisol, which can be done, and regulating exercise and diet.
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We can restructure that pretty much 100 percent of the time. Adrenal fatigue continuum, which goes all
the way to the burnout phenomena, we might want to take a look at that extreme phenomena in a little
more detail, what happens in the body and this cascade of events that cause the crashing. In some people
they will crash, but not crash and burn. In some cases they go to the full so-called burnout. I don’t use that
term in my clinical practice, in my office, with my patients. It’s very dramatic. It sounds like a Hollywood
movie with the car crashing and all that stuff. It’s dramatic and gets your attention but it doesn’t serve the
patients. I like to look at it as more of a continuum and how we can restructure and use bio-identical hy-
drocortisone and cortisol. I’ll use adrenal glandulars with low levels of natural cortisol. We’ll use nutrients
What’s also important here in terms of restructuring all of this is that the adrenal hormones are built from
two molecules. One is cholesterol and two is tyrosine. Tyrosine, as you remember, was the molecule that
built the thyroid hormone. Tyrosine also is the precursor to adrenaline and noradrenaline. So you need
enough tyrosine in the body to help rebuild that. Second is all of the adrenal hormones, from the adrenal
cortex, start with cholesterol. The first one that’s built, in all cases, in the three zones inside the adrenal cor-
tex, but all three zones use cholesterol to build the first precursor molecule which is pregnenolone. When
you look at blood studies on patients in pregnenolone you’ll see even younger people with unusually low
levels of pregnenolone. That already tells us that they’re not producing, the adrenal gland is not producing
enough of the main grandmother of all adrenal hormones, pregnenolone. We can supplement them with
You also want to look at, particularly your extreme vegans and raw foodists, no fats and very little carbo-
hydrates and you have a system that is dependent on cholesterol and you’ll often find that these folks have
too little cholesterol. The cholesterol that the hormones are built from are the low-density so-called bad
LDL cholesterol. Too much is not good but too little you cannot build enough adrenal hormones. So over
time, over years, you’ll get weaker and weaker. You will build hormones but not enough.
The next level is progesterone. Progesterone is a key hormone, stress hormone. In the early days of pro-
gesterone prescribing and over-the-counter use of wild yam creams and so forth is that progesterone en-
docrine converts into cortisol so if there’s too much stress and a woman is producing sufficient amount of
progesterone the body may rob that and put it back into cortisol or vice versa. Now you have imbalance
between progesterone and estrogen. Now you have three layers of problems, your stress-related adrenal
HPA axis issue, too little or too much cortisol. You have increasing premenstrual syndrome and irritability.
And you have problems with blood sugar, insulin, weight and so forth. So those are highly important.
The next one, the father of all hormones, is DHEA. That’s built directly from pregnenolone and from
DHEA you have another few steps in between of other hormones that the body is making, the adrenal is
making. Then from there you have testosterone. Not all of testosterone is produced in the male gonads. A
lot of it is produced in the adrenal. Women, if they have strong testosterone levels in their blood, you can
tell that their adrenals are working pretty well. If you add DHEA and their DHEA is low you often will
see that they can produce more testosterone from the supplemental DHEA. It gives the adrenal glands a
chance to rest and sometimes recoup and recover.
Kevin: Before we end this module I want to ask, what are some of the truths about adrenal function and some of
the fiction. I know that a lot of people can get online and go to google MD and search all these different
ideas about the adrenal. What’s true and what’s not?
Transcripts Module 1 / PAGE 11
Dr. Williams: The facts are that the adrenal produces major hormones that are key to your survival, your ability to adapt
to your environment, including all types of stressors, physical and physiological and to the functioning of
their entire bodies. That’s fact.
Also fact is that too much or too little in the extreme produces adrenal gland disease. That’s Addison’s and
Also fact is that serious imbalance produces Syndrome X or Metabolic Syndrome, and everything that’s
associated with that.
Also fact is that they interplay on a daily basis between adrenal hormones, primarily cortisol and DHEA.
It influences your mood, your energy, your sex drive, your sleep, your appetite. The relationship between
insulin and pancreas function, adrenal function, is very important and also the connection between the
liver and the liver’s ability to convert glycogen into glucose in response to adrenal hormones, also very
So those are some of the facts.
The other is that too much cortisol, even if it’s not Cushing’s Disease, in other words if you’re taking Pred-
nisone or even bio-identical hydrocortisone, too much of that, and/or stress producing too much cortisol,
it will cause more deterioration of your bones and thinning of your skin and/or accelerated, more rapid
So those are the main facts.
The fiction part is the confusion between the complexity of this very important gland and its hormones in
the rest of the body. There’s direct links. The only direct link which is fact is that stress releases adrenaline
immediately. A boxer in the ring has to have enough adrenaline but they have to control their adrenaline
so they don’t get overly aggressive. They have to meter out how they work with stress. Their blood pressure
can’t go too high. Same thing with a soldier in the battlefield. There’s going to be a lot of adrenaline going
but if they get too much they’re likely to go into the fight or flight effect and they’re going to flee or they’re
going to overly engage, shoot off too many rounds, jump the fence and attack their opponent too aggres-
sively. Those are also facts.
What’s fiction here is that, for example, exercise is a form of stress but it’s a positive stress. If you over-
exercise or if you’re not prepared for exercise and your body is not attuned to that and you don’t know
how to control that in a smooth fashion, for example classical yoga starts off with and ends with rest. You
start off standing straight and relaxing and tuning in to your body and training your system and then you
go into slow moving, flowing, upward/downward dog postures and then as you start to get going into
more and more aggressive postures, more intense poses, and then in the end you slow down and reverse
the process and you lie down and go into integration. That’s the way it’s meant to be. What we do is we
think that exercise is good. We jump in and stimulate the adrenaline. We think we’re doing really good but
adrenaline now isn’t balancing insulin. People start to crave the sugary drinks so they can exercise more.
They’re drinking Gatorade, for example, and then if they get tired, if the adrenals are low, they’re going to
drink Red Bull or caffeine before they exercise or caffeine in ephedra tablets and now they’re driving their
adrenal system into fatigue syndrome.
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I think the fact versus fiction is very important in terms of exercise. It’s important in terms of when you get
treatment and how you get treated. The level of adrenal fatigue that you are, it’s not all or nothing. It’s a
continuum and an interrelationship and good, clear diagnosis is very important and the intervention and
the supplementation and the hormone replacement needs to be individualized.
Kevin: Great. This is the end of module one. In module two we’re going to be talking about how to identify and
how to test your adrenal health using medical testing as well as self-tests from home. This is Kevin Gianni
and Dr. Williams. Thank you so much.
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Kevin: Welcome everyone. This is Kevin Gianni from The Complete Adrenal Health Program. Today is module
two. In module two we’re going to be talking about the things you can do at home or with a health
practitioner to help you identify what is going on with your adrenals. We are with Dr. J.E. Williams and
he is going to be your guide today. Dr. Williams, welcome.
Dr. Williams: Thank you for working with me on this important program on adrenal health.
Kevin: We covered a lot of information in module one about how the adrenals work. Now we’re really going to
get into what you can do to help identify what’s going on with your adrenals. Why don’t you give us a little
bit of an outline of what we’re going to cover today.
Dr. Williams: This is the module for evaluating health. We’re going to be looking at the adrenal fatigue continuum. We’re
going to go over clues that you can do yourself, you can evaluate or look at yourself, but please keep in
mind that those are clues only and they, like medical students, every time you read anything in the book
you think you have the disease. By the end of medical school you have gone through about 1,475 diseases
and in fact you didn’t have any of them. So everything has to be put into context.
Then we’re going to look at conditions that relate to or play roles in the adrenal fatigue as well as conditions
that can kind of overlap and confuse the evaluation, even from experienced doctors. And then we’re going
to really focus on the testing, what are the best tests. We’re going to look at blood, saliva and urine and
which hormones are best tested. Then finally finish up with the actual numbers of the testing so you have
a good idea when you do your own self-testing what to look for, the laboratory ranges and based on my
clinical experience what are my optimal ranges.
Kevin: Let’s start with adrenal fatigue and then we’ll move deeper into some of the other issues. Let’s identify some
of the things that someone could experience that may be clues to having this issue.
Dr. Williams: The first thing I want to mention is just go down a bullet list of some of the take-away topics from
module one. That is, how important the adrenal gland is. It secretes hormones that are key to life itself, to
sustaining your life. The three major hormones in the body, two of those are adrenal hormones, cortisol
and adrenaline, and the other is insulin, which comes from the pancreas. There’s a relationship, and that
will become more and more clear and evident as we go through each module. So the adrenal gland supports
life and it’s also necessary for our energy in the body, for managing normal weight and body shape. It is
strongly related to exercise, mood and of course stress. The most important hormones and where we’re
going to be focusing on mainly today are going to be hormones from the adrenal cortex. That’s primarily
cortisol. The other two are DHEA and pregnenolone.
The adrenal fatigue phenomena is closely related to cortisol and DHEA and their relationship to insulin
and all of those hormone’s relationship to neurotransmitters, to enzyme reactions, to how glucose is
released from the liver and the muscles and blood flow and blood pressure. It’s just one of those amazingly
wonderful, complex paintings that goes on inside the body every day, in fact every minute of every day
including while you’re sleeping at nighttime.
When the adrenal goes wrong it starts to show imbalance, not just in the gland itself, not just in deficiency
or excess of hormone. We talked about the Cushing’s and Addison’s disease yesterday, which are the western
allopathic paradigm of more than 100 years ago, which is too much or too little of any hormone causes any
disease. That’s absolutely correct. Very well done. Good job guys. But the fact is that it’s highly complex
Transcripts Module 2 / PAGE 15
system and interrelated and so many intercommunications that the old paradigm just doesn’t work in the
fatigue continuum. Number one, there’s an HPA, a hypothalamic-pituitary-adrenal axis imbalance. I’d
like to talk about that in more detail in another module, because that’s the crux of the issue really. When
that starts to go off, you don’t feel well. You feel tired. Your energy is off. Your glucose and blood sugar
metabolism are off. You have more PMS for women. Your sleep is off.
If you regulate that through lifestyle changes, then you normalize your adrenal gland and you come back
to balance and everything is fine. If that goes on too long or the system, your body and genetics, are more
susceptible, or the stressors or the dietary choices that you make are too out of balance then you’ll end up
into a fatigue syndrome where you’re constantly tired and associated with fibromyalgia and chronic fatigue
syndrome and stuff, immune system disruption and that becomes a chronic condition. That’s still fixable.
We can still treat that. We can still bring the person back to balance.
The next level, if that continues, is the hormone insufficiency. So now you have the HPA axis imbalance.
You’ll have the actual adrenal fatigue issue with hormones that are up and down or disrupted ratios,
cortisol to DHEA, and then finally the adrenal becomes too tired and it becomes unable to produce
enough hormone and now you’re into kind of a permanent state of deficiency and fatigue. Still fixable, if
done right. You may have to replace the cortisol with bio-identical hydrocortisone and it will take more
complex therapy. It will take more time. It will take supportive therapies like acupuncture, massage and a
lot of rest.
Then finally you go into the full-blown so-called burnout. I’d like to, at another module, talk about that
in much more detail. Not only is the balance tipped but the whole seesaw is broken itself. That’s really a
problematic and very difficult, or perhaps sometimes impossible to completely fix.
Kevin: What are the specific clues so we don’t get that far?
Dr. Williams: Exactly. The first thing you want to keep in mind is that the adrenal is a tough organ. So are the kidneys
upon which it sits. They can take a lot of abuse. But that’s not the goal, to see how far you can push them.
The idea is to moderate your system as you go. Think of it as flying in a high-efficiency, high-altitude
airplane and you’re the pilot. You can do a lot of things to that plane and that engine. You can turn it to
this side and that side, upside down. You can go straight up and straight down. As long as you’re in the
air you’re still fine. But if you overdo the systems or you get careless with your own maneuvering, then
you’ll crash and burn. During the process of flying, or living, you have to moderate all the time all the
instruments and all of the systems that give you feedback. In other words, you have to be looking at all the
Here are the clues. These are the dials you want to look at. Number one, fatigue. Now keeping this in
mind throughout the entire program, the number one symptom in these cases is fatigue. It’s not just being
tired after hard work or after exercise, you sit down, you rest a bit and have a good night’s sleep and you
feel better. This is the type of fatigue that you don’t feel better in the morning, you don’t feel completely
rested. You rest up another couple days or a weekend and you’re still tired. It’s that type of fatigue. It’s a
chronic fatigue. It’s a persistent fatigue. If that fatigue goes away and you say, “I guess I’m OK,” but then
it returns again next week or returns again next month, now you want to use that as one of your evaluation
mechanisms that some system is off and you need to make adjustments. When it gets worse you’re going
to be not only fatigued but you’re also going to be very tired and weak. So when you feel not just fatigued,
fatigue meaning after stress, after exercise, after a long day, but now you’re really tired. You just want to
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sit down. Sometimes you feel like you have to lay down. You also feel muscle weakness. Some people say
at the most extreme it’s hard to even hold a pencil in their fingers. A pencil will just fall out of their hand,
they feel so weak. So tiredness and weakness are sure clues that you’re getting adrenal fatigue scenario.
Finally, that goes all the way to exhaustion. That’s not where we want to get.
The second clue is blood pressure. If you have a tendency to run low blood pressure on a normal basis
you could also have some adrenal hormone issues. The key to blood pressure is when you’re lying down or
sitting up and your blood pressure is taken, you leave the cuff on or ask the nurse or doctor where you’re
doing it to leave the cuff on, and then stand up, don’t jump up, but stand up quickly and immediately
take your blood pressure again. If the numbers are ten or more points lower than when you were lying
or sitting, that’s one of the give-aways for adrenal fatigue. The hormones are not controlling your blood
The third one is dark circles under the eyes. That’s also related to allergies but allergies are very closely
related to adrenal fatigue. If you have persistent and recurring dark circles, not just the little bit that go
away from being tired or not getting enough sleep or you had a long drive across the country or something
like that, that’s not what I’m talking about. The very dark, almost kind of raccoon looking color at
the bottom of the eyes and even sometimes on the eyelids themselves. That’s a clue. Also so are your pupils.
People who have dilated pupils even in strong light typically will have adrenal fatigue. When I shine the
exam light on to their pupils they don’t respond as well. When you shine the light the pupils should shrink
and then when you take the light off they should open up and dilate again. If they stay dilated, even in
strong light, that’s typically a problem with the adrenals.
The fourth one is slow morning and afternoon slumps. You wake up tired and you’re slow to start. The
people who need the coffee, they don’t get started 10 o’clock, you can’t talk to them in the morning, they’re
grouchy, they’re irritated, they don’t really come alive until 10 or 11. That’s typically trouble with the
adrenal glands. They’re not regulating properly during the nighttime. Then those people who crash in the
afternoon, they’re having the hypoglycemic combined with adrenal slump. That usually occurs between
two and four. They can almost clock it. Then in the evening, especially after they eat, they re-regulate their
blood sugar, their insulin responds OK and now they’re awake. Sometimes feeling quite good later in the
evening. Of course then they’re going to stay up till 11 or midnight or one o’clock or later because they’re
feeling pretty good. They’re getting stuff done that they couldn’t get done during the day. Now they’re
tired, their sleep is off at that point and the cycle all starts again.
The fifth is salt and sugar cravings. Certainly people with low adrenal and low blood pressure have a
tendency to crave salt, which is necessary to thicken the blood and increase the blood pressure. Of course,
if you have high blood pressure you shouldn’t be using salt at all. But it’s also related to some of the adrenal
hormones and how it regulates sodium and potassium in the body. So the tendency towards salt cravings,
eating salty foods, always asking for extra salt on your food, can be a tip-off. Also, sugar cravings. That
would be the adrenal hormone, principally cortisol, relationship to the pancreatic hormone insulin and
The sixth is increased appetite and the need for carbohydrate drinks when you’re exercising. If you’re
working a lot, if you’re using a lot of mental energy, 90 percent of glucose is burned up in the brain so if
you’re a create person, a writer for example, you’re going to feel very exhausted because you’ve used up so
much glucose in the brain and you’re going to crave some food or some sugary treat in order to feel better.
That normally is self-regulating. But if your appetite tends to be increased without any reason and you can’t
Transcripts Module 2 / PAGE 17
control your appetite, often the stress hormone cortisol has gone too high. It’s driving appetite. Of cause,
that’s going to make you gain weight if you’re not exercising it off.
The other is the need for carbohydrate drinks when exercising. Here’s a similar thing where you feel good
when you exercise but you start to slump during the middle of your workout so you go over and get a
Gatorade or people are bringing carbohydrate drinks, even drinking honey and water and herbal teas with
honey and water while exercising. Then they feel better and they can continue the exercise. That tells you
that your cortisol and other adrenal hormones are not working efficiently enough to extract the glycogen
out of your liver and you’re not getting their right metabolism into the muscle tissue and you’re getting
fatigued during exercise. You should be able to move through exercise with some fluid replacement but
not this significant craving for carbohydrate sports drinks and then when you do drink them you feel a lot
better. That’s another tip-off something is wrong.
The seventh one is after exercise you don’t recover well. Remember, the best thing to do after exercise,
and yoga has it already built-in traditionally, you lay down for 10-20 minutes, sometimes longer, in the
corpse pose and you integrate all of your body and your hormones and your blood flow and your mind
settles down. That’s where you get all the benefits. So after exercise, you go to the gym and have a shower,
relax, have a sauna, relax, even lay down for a little bit and then you should come up and feel quite good.
Those people who don’t feel good after exercise, they feel even more tired, more burnt-out, they pushed
themselves, they struggled through and it takes them not hours but days to recover from exercise, is a tip-
off for adrenal problems.
The eighth one is if you can’t lose weight or if you gain weight too easily. That’s often an adrenal imbalance
that’s influencing how your body patterns fat, how it relates to insulin and that insulin is the key to putting
fat in and out of the adipose cells.
The ninth one is skin. If your skin is thinning, more so than you expect, and of course it naturally thins
somewhat during aging, then you may have too much cortisol going on in the body. But if it’s becoming
dry, flaky and there’s a persistent dermatitis, itching and scaliness, dandruff, that also may give you a clue
that you’re having trouble with your adrenal.
The tenth one is body hair. If you have low amounts of body hair or you had normal amounts when you
were younger and you find that it’s thinning, which happens somewhat with aging, then we find that it’s
thinning and there’s less of it, including underarm hair and lower arms and lower legs, or there’s patches
where you find that there’s no hair, this is body hair, not head hair, then that’s also a tip-off that there’s
trouble with the adrenal gland.
Kevin: A couple of questions inside of all this. Some of these symptoms seem the same as thyroid. How do we
know which ones are which? How do we separate it?
Dr. Williams: They interrelate. We have HPA, meaning hypothalamus-pituitary-adrenal axis, and we have an HPT
axis, hypothalamus-pituitary-thyroid axis. And then they overlap so we have an HPTA, hypothalamus-
pituitary-thyroid-adrenal axis. They will cross over. Your thyroid, as you remember, produces hormones
that help our body utilize oxygen in the cells. The thyroxin inside the cell is necessary for the synthesis of
steroid hormones, which are produced by the adrenal glands. They play key interactive and overlapping
roles. The way we find out which is which is through the testing.
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Kevin: With the blood pressure, do both numbers drop?
Dr. Williams: Both numbers tend to drop equally, but if the bottom number drops more than ten then you know for
sure that there’s a very likelihood of adrenal fatigue.
Kevin: When I was experiencing some of my adrenal issues I had some cramping in my muscles. Is that regular
too, or is that maybe something different?
Dr. Williams: You can have cramping and pain, muscle pain and joint pain that doesn’t go away. You’ll have lean muscle
loss with increased body fat. So you have abnormal too much fat to lower muscle ratio. Even if people are
eating pretty lean foods they’ll still have an abnormal ratio. You have brain fog and of course, irritability,
difficulty sleeping, the food cravings, the increased appetite that I mentioned. But you can also have the
neck and shoulder and back pain, muscle aches and pains and joint pains that kind of continuously don’t
Kevin: Great. What other clinical conditions play a part in advancing adrenal fatigue?
Dr. Williams: The first one, like we talked about, is thyroid. There’s an important relationship to both of those. If you
don’t catch that, if there’s say one more off than the other, say the adrenal is weaker than the thyroid or
the thyroid is weaker than the adrenal, they will tend to compensate for each other. If you treat just the
adrenal or just the thyroid in some of these cases then you’ll make the other problem considerably worse.
It’s important for the clinician to understand both of these conditions very well.
PMS is another one, premenstrual syndrome. It’s associated with hypoglycemia, which is another clinical
condition that overlaps and plays a strong part in adrenal fatigue, often misdiagnosed, if you’re looking at
it just from the western allopathic model where you’re only looking at one disease at a time. PMS is where
there’s increased irritability and a lot of fatigue and food craving, the hypoglycemic pattern that parallels
often with PMS.
Depression is a mood disorder but sometimes it’s 100 percent endocrine hormone disorder. Regulating the
hormones fixes the problem. When we look at the ratio between DHEA and cortisol we find many clues
for people who are suffering from depression. In other words, they come in and they say, “I’m tired. I’m
not feeling well. I’ve been diagnosed with depression. I’m taking these antidepressants. They’re helping a
little bit. They’re helping somewhat with my mood but I’m still very fatigued.” It’s not really addressing the
adrenal aspect of that. As I just mentioned, low back pain, neck and shoulder pain, muscle tightness and
stiffness that’s chronic and persistent. You can get treated by the chiropractor. You can get acupuncture and
massage. It might feel a little bit better afterwards but it just keeps coming back and you keep going and
going. You need to look a little bit deeper and see if you have signs of adrenal fatigue going on.
Allergies I mentioned already, all types of allergies including seasonal allergies and those people with
elevated eosinophil levels that have real classic type sensitivity can also have adrenal fatigue underlying
that. But clearly those people who don’t have classic type one sensitivity like hay fever type allergies and
developed allergies as an adult and they seem to get worse and they seem to be related a lot to foods, often
have adrenal fatigue as an underpinning problem. Then of course there’s the hypoglycemia and other
strange phenomena that happen around insulin either too low or too high and its relationship to cortisol
either too low or too high. Adrenal fatigue doesn’t tend to push towards diabetes or hyperglycemia it tends
to manifest as hypoglycemia. If you have hypoglycemia you also want to evaluate your adrenal problem,
Transcripts Module 2 / PAGE 19
particularly if you treat it effectively and you’re on the hypoglycemic diet and you feel a little bit better but
not completely resolved. The next step would be to look at the adrenal glands.
Kevin: Let’s get into the testing. What are some of the ways to medically test to make sure you’re dealing with the
Dr. Williams: The testing is really interesting. We know a lot about the testing now, much more so than we did 10 or 20
years. The quality of tests are quite good. There’s going to be three types. There’s going to be blood testing,
urine testing and saliva testing. All three are very useful but they have their particular purposes. When we
ask which test is best, really they’re all good for their use. However, the bottom line is that if you’re looking
for general evaluation of adrenal fatigue then the saliva test is the one you want to go for. Let’s take a look
at each of these in a little more detail.
The fasting blood test we’re going to be looking at three hormones - cortisol, DHEA and pregnenolone.
The two precursor hormones are pregnenolone first and then DHEA. So it’s important to make sure that
the adrenal gland is producing enough of these hormones. Then we’re going to look at the DHEA to
cortisol ratio. When we do blood testing it’s important to keep this in mind, that you’re going to have to
do it in the morning before nine o’clock. Closer to seven is better. So between seven and nine. That’s when
your cortisol should be coming up. That’s when your adrenal gland should be kicking in and the number
should be rising nicely. However, it’s a circulating level of the cortisol and is not the available level. It’s not
a tissue level. It’s not the free cortisol. It’s just a general marker. It’s very good for evaluating Addison’s and
Cushing’s disease. It’s very good at giving you an idea of where your stress is pushing your cortisol and
where it might have been during the nighttime. However, it’s a snapshot of a large landscape. Anybody
who says that it’s not good at all is not correct. That’s another fact and fiction issue. It is important. I test
it always on all patients all of the time when we’re looking at general hormone evaluation, aging evaluation
and of course adrenal evaluation. But the testing doesn’t end there.
In terms of serum cortisol tested in the morning, the lab ranges are in very small amounts, micrograms
per deciliter and the lab ranges are on average between 6 and 20. What we want is a tighter range. If your
fasting cortisol level is over 15, pushing up to 17 for example, you likely are getting a little bit stress-
induced cortisol. That’s a little bit too much. If you just had come out of the gym, you went into the
morning and exercised, that likely should be a little bit higher. The idea is to go in in the morning, fasting,
don’t eat any breakfast, don’t drink any orange juice, water is OK, no exercise, just drive yourself to the lab
and get your blood tested. That’s a better measurement. So more desirable is going to be less than 15 and
even better is less than 12. You want it in the optimal range to be kind of in the middle of the laboratory
range. I always look for between 8 and 12, sometimes even less than 10, even tighter between 8 and 10. If
it starts to get on the low end of the range, meaning between 6 and 8 then it could be normal or we could
be getting some suspicion of low adrenal gland function. So the take-home points here are if it’s at the
low normal within two points of the lower end of the range or within two points at the higher end of the
range but still within range then that’s a clue that we need to test a little bit further. If it’s in the middle it’s
probably OK and I usually don’t test any further than that.
A couple of other things to look at in your general laboratory testing for adrenal insufficiency is low or
below normal sodium or higher than normal potassium. Then you look at some of the kidney functions,
blood uronitrogen, if that’s high or on the high end of the normal range you might suspect that you’re
having some adrenal hormone issues, even if the cortisol is tracking within the laboratory normal ranges.
Then, if you have high or high normal eosinophils, which is the white blood cell that is related allergies.
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On the DHEA, that’s your dehydroepiandrosterone, we’re going to look at DHEA sulfate or DHEA-s.
It’s a serum study in the blood. It’s an age and gender-matched range. It’s a good, solid test and I use it
all the time. For adults between the ages of 45 and 65 the range can vary from approximately 50 pushing
up towards 300 for males. For females it’s a little bit less. At the lower end approximately 30 pushing
up towards 250. However, at the low normal, for both male and female, if it’s under 100 we’re already
starting to see a little bit of low adrenal function, not producing enough DHEA. If you want more optimal
numbers and you want to optimize your adrenal then you’re going to look for adult ranges for the men to
be 250-300 and for women 150-250.
The last, third one, is pregnenolone. We’re measuring 17-hydroxy pregnenolone, also in the serum. The
adult range, for both men and women, not an age-matched range, is approximately from 350. Here’s
where I see a lot of problems, even in younger people. Young adults should have very strong pregnenolone
levels, 300, 350, even higher to 400. As you age it goes down gradually, almost to nothing. What I find is
that even young adults will have low levels of pregnenolone, sometimes 150, sometimes 100, sometimes
35. Older adults still should have reasonably strong levels of pregnenolone. Sometimes they have 10 or less.
That gives you a strong clue that pregnenolone is not being produced. That’s your precursor molecule. If
you don’t have enough pregnenolone you can’t make DHEA and you can’t make any of the other steroid
hormones in the body. Pregnenolone, optimally from my clinical experience, needs to be at least 100 and
I prefer to have it between 150-350 in both men and women in the adult age group.
Kevin: What other tests are there for cortisol and DHEA? Which ones are the ones you should take?
Dr. Williams: The next tests are the urinary tests. Those are usually 24-hour. You have to capture every drop of urine
that you excrete over 24 hours, collect it in a large container that the lab gives you and then siphon off a
small amount and bring it back to the lab and then they measure that for that. It’s used to help confirm
diagnosis of Cushing’s Disease where you have hypersecreteion of cortisol. Sometimes when you’re doing
the blood test you just don’t the high levels. As I said, it’s like a snap shot. So you’d have to do serial testing
of blood throughout the day. That’s only practical if you’re in the hospital or if you want to sit in the lab
all day or come and go. Usually people don’t have that amount of time so they do the 24-hour testing. We
don’t usually do that for standard clinical studies of cortisol. We’ll go right from blood testing to saliva.
However, the 24-hour urinary test for catecholamines produced by the adrenal medulla is very useful and
we do that all the time when we’re looking for deficiency, adrenaline, for example, or other hormones that
are not related to cortisol. However, healthy, normal people, even with adrenal fatigue, typically don’t have
significant abnormalities in their catecholamines. I’ve tested them many, many times and even with severe
adrenal fatigue that’s based on the hormones from the adrenal cortex, primarily cortisol and DHEA, we
don’t see abnormals in the 24-hour urine catecholamine. So we don’t test that that much.
The most important one is going to be your saliva testing. You’re going to do multiple samples over a 24-
hour period, usually four but sometimes up to six levels of testing. Typically four is enough. What you’re
measuring inside the saliva is a bioavailable form of cortisol and it reflects or mirrors the tissue levels
that would be in your body and your body’s cells. It’s a very good test and quite accepted now by even
traditional MDs and many of the national labs now also offer salivary cortisol testing. The labs will chart
out the levels of the cortisol within the saliva on the times that you test it. Then they will give you a curve
or a graph and then you can evaluate if you are in the normal or if you have imbalances. For example, you
may start off in the morning just fine, then slump down in the afternoon and then in the middle of the
night you’re back to normal. So that would be more of a stage one or the adrenal imbalance phenomena.
Even though you may have some fatigue it’s not significant in terms of cortisol output.
Transcripts Module 2 / PAGE 21
Then you might see other forms of imbalance would include maybe too much cortisol in the morning.
So you’re wired but say you didn’t sleep well at nighttime so you have the wired-tired phenomena, too
much cortisol, which means that your adrenal is putting out cortisol but it’s putting out too much in an
imbalanced response to obviously no stress if you’re sleeping or just getting up in the morning but your
body is kind of in a state, an imbalanced state like, “God, I have to get up. I have something to do,” and
yet because that was likely higher during the nighttime your sleep hasn’t been good so now you’re also tired.
That may normalize out the rest of the day.
Another type of imbalance would be in the morning where it’s low-normal or too low in the morning.
Those are the slow-to-start people. What people tend to do is they tend to drink coffee or strong green tea
in the morning or they push themselves to exercise. They get adrenaline going and feel a little bit better
but then they crash an hour later. Instead of in the afternoon they have a morning slump, usually between
11am and 1pm. They eat something and either feel better or feel very sleepy. If they eat and feel better then
you know that they’re still having adrenal slump but their insulin is working well, their glucose is likely
working well. Don’t forget, on the lab testing, you have to check also glucose and insulin to compare those
two. Or a good clinician would be doing that. If they eat something and then feel sleepy afterwards or have
to take a nap afterwards now the clues are strong that you have adrenal deficiency and hypoglycemia.
If your testing is all the way at the low-normal even though it’s in the right curve if it’s at the low-normal
or below normal anywhere along the testing line then you’re in full adrenal fatigue syndrome.
What I want to mention is that in the morning the levels will be higher. In the middle of the day they’re
going to be considerably lower, pretty much to about half of the morning levels. That’s a normal curve. The
afternoon they should go down again and then gradually move towards fairly quiescence state during the
middle of the night. So by 10pm, 11pm, midnight there should be very low levels of cortisol in your body.
That allows you to sleep. If they’re too low or too high at nighttime then you’re going to have insomnia or
you’re going to wake up after you fall asleep, about an hour or two afterwards. Or if they’re too low to begin
with, say at six or seven in the evening, then you’re going to crash and fall asleep on the couch. That means
that you’re extremely sleepy regardless of how much activity you put out during the day. If you worked
hard, if you were building a new house and you were putting up the roof and framing and everything like
that of course you should be exhausted by the end of the day. This is just normal activity and exhaustion
following it, no output.
Kevin: Can you mention some of the values for urine and saliva? You mentioned them for the blood testing.
Dr. Williams: The values on the urine are going to stay pretty consistent but on the saliva they’re going to vary from lab
to lab. For the 24-hour urine cortisol for adults the range is going to all the way down to zero up to 50
micrograms per 24 hours. So we’re not looking for deficiency here. You could get some clues if it’s on the
very, very low end, close to zero. But maybe we’re looking to see if it’s too high, above 50.
On the salivary testing the results vary from lab to lab. Genova Diagnostics that I use, they use micrograms
per deciliter and some of the labs use picograms per deciliter. All of the salivary labs are going to measure
DHEA. They’re not going to track the DHEA as they do the cortisol, most of them won’t. They’re going
to look at the morning DHEA. The morning salivary DHEA is in picograms per milliliter with Genova
Diagnostics, the lab that I use. It’s going to be 71-640 picograms per milliliter. That’s a very, very large
range. In the middle of the range is where you want. In other words, probably the average would be
between 200 and 400. That’s quite acceptable. If you’re way down, below 100, down below normal, then
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I’d still suggest that your DHEA is too low. More importantly is the relationship between the DHEA
and the cortisol. As we look at many lab tests, not just adrenal hormones but even cholesterol and LDL
ratios, LDL to HDL ratios and triglycerides to HDL ratios, we find that it’s in the relationship between
different numbers, between different functions in the body, between different levels of hormones, that you
really start to get better clues for these syndromes that are not classical diseases. In the cortisol to DHEA
relationship the ratio is going to be based on DHEA to cortisol. What you’re looking for here is that if
you have high levels of DHEA and low levels of cortisol that’s closer to normal. If it’s reversed, where you
have low DHEA and high cortisol, now we have usually aging phenomena occurring or accelerated aging
or early aging and certainly have some form of adrenal imbalance going on. The ratio, as I mentioned, of
DHEA to cortisol, is critical during aging and many diseases. This high cortisol to low DHEA ratio in
conjunction with stress in your life is a strong predictor of depression.
The third ratio to look at would be low DHEA and low cortisol. Now we have both of the main hormones
in the burnout phase of adrenal deficiency and that’s really in your late stage of the condition. So even
if you’re, on your salivary testing, if your cortisol level is say in the mid to low-normal range and it has a
normal curvature, if the DHEA is very low then the ratio will be out of balance and that is a predictive
marker for adrenal health, suggesting low adrenal function.
The DHEA and pregnenolone can also be tested in the saliva. Blood testing is very good for DHEA and
pregnenolone. So I typically will look at blood testing for cortisol, DHEA and pregnenolone and if I
find clues there I’ll look at the saliva testing for cortisol and DHEA and sometimes we’ll extend it out to
saliva, pregnenolone. Also sometimes we look at testosterone, particularly in women because most of their
testosterone is being produced by the adrenal gland. You add them all together, factor them all together.
You look at the ratios and then you come up with the answer, clinical answer, and whether that’s suggestive
of adrenal fatigue.
Kevin: If someone at home wanted to either suggest to a practitioner what kind of test they should take or they
wanted to do it themselves, what would be the best protocol? Where would they start? What exactly would
they do? How would they move forward?
Dr. Williams: You start with blood testing and you do fasting cortisol, DHEA and 17-hydroxy pregnenolone. Then you
also do the saliva test. They usually are called adrenal stress index or something like that, depending on the
lab where they measure salivary cortisol and DHEA and provide you a ratio and provide you with a graph.
I know that many holistically-oriented practitioners go right to the saliva test now. I don’t agree with that.
There’s a lot of reasons why you want to look at it from a couple different angles and make sure that you’re
cross-checking and cross-referencing. However, for the average person they can order their own salivary
test kit and use that as a starting point and if there’s abnormals don’t jump to conclusions but then get the
blood testing. That would also be a good way to do it.
Kevin: When does urine fit in?
Dr. Williams: Urine doesn’t really fit in. As I said, we’re testing for catecholamines and looking for high cortisol that we’re
not picking up in a snapshot in the blood. But for adrenal fatigue phenomena blood, cortisol, DHEA,
pregnenolone and salivary cortisol and DHEA with ratios and with an index, is the way to go.
Kevin: Great. What are some of the issues that could mask or cause an adrenal misdiagnosis?
Transcripts Module 2 / PAGE 23
Dr. Williams: Those include anemia, chronic infection and chronic liver disease. Also, as we mentioned, hypothyroidism.
So low thyroid gland function or imbalances or trouble with thyroid hormone conversion can also mask
or cause a misdiagnosis. Now, here’s where fact, fiction and some of my clinical disagreement would come
in with holistic practitioners. One of the things that sets me apart is that I have more than 30 years of
clinical experience. I’ve been doing this and only this for a long time. Sometimes there’s some rare cases
that I haven’t seen yet or have seen only one or two. But adrenal fatigue, chronic fatigue, fibromyalgia,
I’ve seen thousands of cases of each. They overlap. So I’ve done hundreds and hundreds and hundreds if
not thousands of cases of testing. So I have a very good idea of what works and what doesn’t work, what
provides the advantage. This is what we want people to do.
Here’s where the problem comes in for a lot of holistic practitioners. They start with the salivary testing.
The patient comes in with fatigue, hard to get up in the morning, aches and pains. They say, “You must
have adrenal fatigue syndrome. Let’s do salivary testing.” The numbers look a little bit below normal and
they say, “Ah, look, here we go.” They haven’t looked at the blood count. Fatigue can be caused by anemia.
It can be caused by low thyroid function, infections going on, chronic low-grade infections from Lyme
disease to more exotic and less exotic diseases. They can cause all the same phenomena. Many chronic liver
diseases will have fatigue as a factor. So fatigue itself should not be the only criteria to start testing for and
then coming up an isolated diagnosis of adrenal gland weakness. Keep in mind that the most common
symptom of adrenal fatigue, all the way to Addison’s Disease, is weakness. 100 percent of the people have
weakness. But also 100 percent of anemic people, 100 percent of hypothyroid people, 100 percent of liver
disease people, 100 percent of chronic infection people also have fatigue. The difference is with the adrenal
fatigue people they will often say they feel like they’re coming down with the flu but they don’t have a fever
and they don’t have the achiness and so forth. So we sometimes say it’s flu-like fatigue. It’s associated with
weakness, just like when you’re coming down flu you feel very weak. So you’re tired and weak at the same
time. With those other conditions you may be just simply tired but not have the weakness.
The other thing is that there’s an overlap between Metabolic Disease or Syndrome X and fatigue syndrome.
With Addison’s Disease 100 percent of the people lose weight, can’t gain weight and they keep on losing
weight and they’re losing muscle strength as well. With adrenal fatigue sometimes people are underweight,
sometimes they’re overweight. Many of them are in-between. They have a mixture of too much cortisol
with too little DHEA. Sometimes too little cortisol and sometimes it combines with too little DHEA,
depending on the day, the time of today and so forth. But in the end they end up with more chunkiness
and more fat around the middle of their body that they can’t lose. So they’re tired and they have this other
phenomena. The postural hypotension is only about 25 percent of the people have that with complete
Addison’s Disease. So adrenal fatiguers, almost 70 percent of them don’t have postural hypotension or low
blood pressure. With Addison’s Disease 95 percent of the people have low appetite but with adrenal fatigue
people they first start off with increased appetite. There’s a lot of overlap with adrenal fatigue and also with
nausea and abdominal pain. Chronic fatigue people also often have an adrenal fatigue layer and they often
have Irritable Bowel Syndrome at the same time.
The three or four main conditions other than anemia, hypothyroid, chronic infection and chronic liver
disease, that are associated with adrenal fatigue are Chronic Fatigue Syndrome and Chronic Fatigue Immune
Deficiency Syndrome, Fibromyalgia and a wide range of immune deficiency syndromes including HIV.
Also, they’re going to overlap and there’s going to be multi-layers with headache phenomena, Irritable
Bowel Syndrome, chronic nausea. If you look at other conditions that are associated with that, alcoholism,
a craving for alcohol, is strongly associated with adrenal hormone deficiency. Some heart diseases are. Blood
pressure diseases, low and/or high, hypoglycemia I already mentioned, rheumatoid arthritis and several of
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the other autoimmune diseases, including MS, can be associated with adrenal hormone deficiency. Then
asthma and allergies. Asthma is particularly strongly related.
Kevin: Great. We’re going to be talking more about some of these associations in module three, as well as start to
talk about some of the things that you can do to help yourself get better.
Dr. Williams, thank you so much.
Dr. Williams: You’re very welcome.
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Kevin: Welcome everyone. This is Kevin Gianni from The Complete Adrenal Health Program. Today we have
module three for you. In module three we’re going to be talking about vitamin deficiencies. We’re going
to be talking about major factors in adrenal health imbalance and we’re going to be talking about diet
and many other things you can do to help rebuild your adrenals. We’re here with Dr. J.E. Williams. Dr.
Dr. Williams: Thank you.
Kevin: Let’s get started. Let’s do a little bit of review of what we talked about in module two, cause of adrenal
fatigue, burnout, some of these modern lifestyle diseases.
Dr. Williams: It’s very important to understand that this is a stress and lifestyle disease. That’s 90 percent of what people
experience related to chronic fatigue, depression, anxiety and sleep disorders. It’s rare that you find an
adrenal organic disease, which is Addison’s and Cushing’s Syndrome. It’s so important that I’ll repeat
myself. It’s a stress and lifestyle disease. It’s predominantly modern and European and North American.
The logical, aggressive, stressed cultures. You rarely see anything like this in Latin America or India where
people take it easy, where they rest more, where they have a lot more support in their family. They do a
lot of limbic brain movement like dancing. That’s part of the cure, by the way, limbic moving including
dancing and tai chi and yoga. You also see it primarily in the temperate northern climates and less in the
warmer, tropical climates. It’s a condition that’s found in China and it’s been long understood in it’s way
of diagnosing kidney yin and yang and kidney ching deficiency disorders.
It’s also a continuum. It’s not just a simple disorder. It’s a band or a progressive condition that can be
paused, halted. It can start and stop. It becomes more and more complicated the worse it gets. You begin
with the adrenal fatigue, which can be chronic, at low-level and progresses to an HPA axis imbalance.
There’s good evidence now that hypo-function or lower function of the HPA axis is in the high percentage
of patients with chronic fatigue syndrome and that the mild, low levels of cortisol and this blunted adrenal
corticotrophin response through the HPA axis in response to stressors and environment and psychologically,
and also things that you cause yourself, all the worries and anxieties, induce a negative feedback sensitivity.
Then you have disruption of the glucocorticoid hormones. That’s the mid-stage of this continuum and
much more difficult to re-regulate.
If it continues you push all the way into what we’ve been terming as adrenal burnout, which is really
a neuro-endocrine-immune dysfunction. That’s the highly-complex, very difficult to re-regulate with
immune system blunting or dampening of the T cell and B cell responses, interaction between cytokines,
which are messenger molecules like hormones but that regulate the immune system and disruption of the
balance between T-lymphocyte helper cells and variations in rhythms that day and nighttime, as well as in
response to stressors. So that’s the final edge of the continuum.
Then you start to see layering into that, chronic infections like Epstein Barr, like Lyme Disease and so
forth. I’m not talking about acute infections, I’m talking about the chronic ones.
Then there’s a long list of conditions that are associated with adrenal fatigue, including these hard to
diagnosis and kind of soft and amorphic conditions. The main ones, as you may recall, are Addison’s and
Cushing’s. The third aspect is Syndrome X and metabolic diseases. Then we talked about hypoglycemia,
PMS, rheumatoid arthritis and other autoimmune conditions like Hashimoto’s hypothyroidism, of
course, Chronic Fatigue Syndrome and it’s immune disorder cousin, Fibromyalgia, depression and anxiety
Transcripts Module 3 / PAGE 27
disorders, panic disorders and then very importantly, post traumatic stress syndrome and Gulf War
Syndrome. They all fall under and are associated with adrenal fatigue.
Kevin: Let’s move into some of the major factors in lifestyle that are causing some of this adrenal stress, adrenal
Dr. Williams: The number one factor is stress. We talked about that in module one so I won’t dwell on that here because
we’re going to look at daily lifestyle factors in this module. Stress is the cause. That can be acute, overwhelming
stress like happens in a fire, during war-time or an acute worry, you’re losing your home, you’re losing
your mortgage, your stock portfolio has gone down or the daily grind of work, of an incompatible work
relationship, an unhappy marriage and the constant pressure that we put on ourselves and that we live
under in the modern, western world. So stressors of all types create that. The amount that we see, almost
an epidemic, of this problem, is really due to modern, western living and is lifestyle-based and is stress-
induced, for sure.
Kevin: Why don’t we talk about something people probably don’t want to hear about but the role that stimulants
play, as well.
Dr. Williams: As soon as you start to feel fatigued the natural response is to rest. When you override that response or the
stress gets so severe that the hormones are kind of taking over that natural response then the first thing we
do is we reach for something that’s going to give us more energy. Typically we’re going to reach for legal
substances that are widely available in your local supermarket. That’s caffeine-containing sodas of all types
including natural sodas and of course, coffee and also chocolate. The cacao that chocolate is made from has
caffeine. Some types like Venezuela dark chocolate have more caffeine than others. And green tea. If you
abuse any of the three of those you’re going to push your caffeine level up. You actually will feel better and
I’d like to in a few minuets talk a little more about caffeine, what it does to cortisol. You do feel better. You
feel balanced again. By 11 o’clock you’re already fatiguing and people will push more and more coffee. By
the evening they can’t sleep. So typically what they do is they push the coffee in the morning and then they
take the alcohol in the afternoon and evening. They start off with their happy hour and then they’re trying
to calm themselves down. It doesn’t work very well because both the caffeine and the alcohol cause sleep
disruption and the cycle not only starts all over but it worsens over time. So caffeine is a major disruptor.
I’m not saying caffeine is bad for you. It’s actually, in small dosages when you don’t have adrenal fatigue, it’s a
very useful and healthy substance. It’s been used by people in the middle east and Africa and Mediterranean
for thousands of years.
Chocolate has low levels of caffeine compared to coffee, but some are stronger than others, and the amount
that you eat is going to add more caffeine. But it has two other things in it that feed this type of addiction,
that stimulates brain neurochemistry similar to what caffeine does. That’s the high sugar content and the
high fat content. So now you have caffeine, sugar and fat and it becomes a very addictive substance. Even
a healthy, organic chocolate is going to have these same properties if used too much.
If you find yourself needing more coffee, needing more chocolate, craving these, you’re likely to have
adrenal fatigue problems. Green tea also has caffeine in it, as does yerba mate from Argentina. If you’re
using those you’re doing yourself a favor, you actually are getting anti-cancer benefits and other great
polyphenol substances in green tea but over-using it is also one of those tip-offs, if you need to keep that
going all day long. Traditional cultures use small amounts of coffee and small amounts of green tea in
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concentrated doses, but very small amounts, almost down to a thimble-full they may take every few hours.
So they modulate that, regulate their intake throughout the day. Europeans and Americans tend to push
maximum amounts in the morning and then they keep it going for the rest of the day, including with
caffeine-containing carbonated beverages. Everyone knows the two top favorites.
The other substance that acts as a stimulant is ephedra, which is the Chinese herb ma-huang. It contains
ephedrine and pseudo-ephedrine, which are naturally-occurring substances also made as pharmaceutical
drugs and are found predominantly in over-the-counter decongestants. They have a stimulant effect.
They suppress appetite, improve your concentration, increase your blood pressure, if you have low blood
pressure and are suffering from adrenal fatigue and they’re a great decongestant. They open up your nose
and head. As I mentioned, people with adrenal fatigue often have allergies and congestive problems. Their
immune system is off. They often have chronic sinus problems as well. You can get hooked onto these over-
the-counter decongestants containing ephedrine and pseudo-ephedrine. However, some people are going
to use the natural one, the ma-huang, the ground-up Chinese herb concentrated into capsules. Sometimes
they make tea from that. They can stay up all night working on projects. They can study better. They’re
more alert. Over time you have stress combined with stimulant use, chronic stimulant use, and you’re
going to make your adrenals much, much worse.
Guess what. When you’re looking for a natural diet pill it’s going to contain caffeine from a variety of
sources including colonot [?] and guarana from Brazil and/or green tea substances and ma-huang, which
contains the ephedrine and pseudo-epinephrine, in relatively high dosages. It definitely works. Speeds you
up. Increases your heart rate. Lowers your appetite. It’s not good for people with high blood pressure and
eventually will contribute to destroying your adrenal health.
Then I want to mention ginseng. We’re going to talk about it in module four, in some detail, along with
other adaptogenic herbs that help regulate the body’s response to stress. In small amounts ginseng is quite
helpful. But when you abuse ginseng, when you take too much of it, it acts as a stimulant and it can disrupt
adrenal health. For women particularly, it can cause heavy menstrual bleeding. For both men and women
it can cause agitation, anxiety and sleeplessness, which of course further disrupts the HPA axis. Sometimes
you see the LA Syndrome. You see people abusing ginseng and drinking too much coffee and taking green
tea and popping ephedra pills during the day and night. When you add illegal drugs like cocaine on top
of it now you’re not heading for adrenal burnout, you’re diving off the diving board into a swimming pool
with no water.
It’s important to take a closer look at caffeine. Caffeine increases cortisol secretion. So when you’re
undergoing stress, as we mentioned, it’s going to stimulate your HPA axis. It’s going to up-regulate the
communication between the hypothalamus and the pituitary and the adrenal gland. Your body is going to
produce more cortisol, if it’s acute stress. During exercise your body responds to it like acute physiologic
stress, adrenaline. So you’re going to feel better. You’re going to feel more alert. Your heart is going to
pump more blood. That should be balanced with rest and the natural dipping down of the cortisol and the
adrenal gland preparing again to release higher levels. It also releases diurnal on a daily basis, more cortisol
in the morning and it dips down through the day until it’s very quiescent at night.
However, caffeine stimulates cortisol secretion whether you’re undergoing stress or whether you’re at rest
or before exercise. If you’re already, number one, having too much cortisol, even in the high normal ranges
as I mentioned yesterday, above 15 but still less than 20, that’s within the upper normal range, you’re
probably secreting too much cortisol on a regular basis and that’s a response to stress. Adrenal glands are
Transcripts Module 3 / PAGE 29
still working well enough to produce that but if you add on top of that caffeine you’re going to produce
more cortisol. You may be pushing that number after you drink caffeine, this is in blood tests, above 20,
maybe 21, 22, 24. That’s too much chronically and that’s going to lead to atrophy of that hypothalamus
gland and eventually will contribute to the burnout.
So caffeine does increase cortisol secretion in the level in the blood. It also creates more wakefulness,
stimulates the nervous system and also increases dopamine, which is a neurotransmitter and related to
another adrenal hormone, L-dopa. Caffeine up-regulates the stress access and stimulates both corticoids
and catecholamines. It increases blood pressure. If you have high blood pressure caffeine you shouldn’t take
much or any of it. It helps to dis-regulate further that HPA axis and the cortisol levels in the body. So one
needs to be careful about caffeine use. When you’re in severe disruption you can’t have any at all.
Kevin: Let’s move on to some of the other vitamin deficiencies and nutrient deficiencies.
Dr. Williams: There’s three main nutrients that we need to replace, we need to take a closer look at in the adrenal gland.
Vitamin C is one. Second is vitamin B5 and the third is the amino acid L-tyrosine.
Let’s look at vitamin C first. Vitamin C occurs throughout all cells and tissues in the body. It’s actually
part of the collagen, which is like the mortar between the bricks that provides structure to your entire
body. So vitamin C is critical and has numerous other functions. Some organs have higher concentrations
of vitamins than others. That usually gives us a tip-off that that organ is largely dependent and not just
supportive but dependent on that nutrient. The adrenal gland has the highest concentration of vitamin C
in the body. That gives us the tip-off that vitamin C is critical for adrenal health.
One of the things that I’ve found with my patients is that if they’re suffering from adrenal deficiency and
you give them vitamin C you have to increase it gradually, gradually, gradually upward because the body
can only absorb 50-100 milligrams of vitamin C at a time. The rest is excreted through large intestine as
well as through the kidney. That’s not a bad things. Sometimes you need more vitamin C to be pushed
through those organs. But you really want most of it into the blood and into these higher levels. The best
way to take it is three times a day. You’re only going to get a certain percentage absorbed in some of the pills
you take. So even though you can only assimilate 50-100 milligrams at a time some people need to take
500 or up to 1500 milligrams just to get that small amount out of there into their bloodstream, at least
three times a day. So what I found is that even though 500 to 1500 milligrams is your basic starting dose,
people under stress and with adrenal deficiency syndromes need more vitamin C, they need it on a regular
basis and they need to re-saturate that adrenal gland slowly and gradually over a period of time. As you
give them their vitamin C you’ll find that as they move upward towards 1,000, 2,000, 3,000, 4,500, 5,000,
5,500, 6,000, in that upper range all of a sudden they feel a lot better. That’s my tip-off that we’re reaching
saturation, the adrenal gland is absorbing the vitamin C. Their mood is up. Their energy is up and they’re
feeling a lot better. Not like a stimulant like a caffeine-high, but the well-being that it gives for those people
is significant. We measure that and, “OK, you need to be on this dosage, 4500 or 6,000.” That’s a total
amount per day, divided into three equal amounts. Sometimes people have to break that down into six or
more times a day because they can’t handle the acidic component. Of course, as you know, vitamin C is
ascorbic acid. So those people may have to take a buffered form and keep it modulated equally throughout
The third one is vitamin B5. Very important. A key nutrient for adrenal health. Vitamin B5 is called
pantothenic acid and it’s essential to all forms of life. It’s found in all the living cells of your body, in a
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very special form called co-enzyme A. Often you find that in advanced adrenal fatigue patients that they
have two other things going on. One, they have enzyme deficits. I’m not talking about the enzymes that
found in foods like papayas and pineapples or the ones that health food practitioners claim are found
in raw foods and juices. These are enzymes that are made in your body and drinking more juice does
not supply these type of co-factor nutrients in large enough amounts to amount to anything. These are
necessary for all cycles in all cells, including building hormones. Every step in the building from cholesterol
to pregnenolone to DHEA all the way down to cortisol require enzymatic reactions between each of the
many, many steps. Some of these are nutrient derived and then manufacture rebuilt chemically through
the biochemical process in your body, co-enzyme-A being one of them. You may see it in the pantothenic
acid, vitamin B5 or co-enzyme-A, which is a more refined form of that, more of a nutraceutical form. It’s
absolutely necessary for adrenal health and for appropriate protection of cell division and DNA replication
as well as transcription. So we always give pantothenic acid along with vitamin C.
We know which foods contain vitamin C, citrus fruits and vegetables and mostly plant-based foods.
Pantothenic acid, on the other hand, is mainly found in organ meats like liver and kidney, also egg yolk,
fish and shellfish, chicken, milk, yogurt. But in the plant-based it’s in mushrooms, avocados, sweet potatoes
and yeast. Nutritional yeast is a good source, or whole grains like brown rice and whole grain wheat if
you’re not sensitive.
In terms of supplements you often find pantothenic acid made from, in terms of food-based supplements,
made from yeast.
The dosages that are required are relatively high compared to the amount that’s used in the body. I typically
will use 150-250 milligrams three times a day, again prescribing multiple times throughout the day. It’s
not good enough to just take it once. That’s several hundred milligrams up to about 1,000 milligrams a
day. Sometimes we even have to push that higher, usually the co-enzyme-A nutraceutical form, up to 1500
milligrams a day, that’s 500 milligrams three times a day, or even higher.
Then the last one is L-tyrosine. Tyrosine is an amino acid. The dosage is typically 250-500 milligrams
three times a day. You may recall that it’s the building block for adrenaline and it’s also the building block
for thyroid hormone. So very important molecule. It comes from dietary sources and is synthesized for
phenoalanine. You have to have the enzyme processes to break phenoalanine down. Stress tends to disrupt
phenoalanine metabolic cycle so tyrosine can become deficient or poorly metabolized from phenoalanine.
It’s found in high-protein foods. Of course, it’s an amino acid. Soy, in terms of plant-based foods. So tofu
is useful. It’s also found in all of your meats, like chicken, turkey, fish, primarily. And then other plant-
based sources would be nuts like raw almonds, avocadoes, legumes, lima beans, pumpkin seeds and sesame
seeds. And it’s found in cheeses and milk and yogurt. To be most effective we use it in supplemental form
250-500 milligrams three times a day.
One more is important, sodium. I know that it’s kind of classical for people with low blood pressure and
borderline low adrenal gland for their MD or their naturopathic doctor to tell them to include more salt
but I don’t recommend that because some people can be sodium-sensitive. They can go from low blood
pressure to seriously high blood pressure in a matter of weeks to months. If they’re not measuring that
they won’t catch it and it can cause some harm and cardiovascular risk. It’s also not necessary to over-
supplement sodium. There’s ways to get extra salt in the diet. Drink more vegetable juices, particularly
adding celery in there. It’s better for you and it’s processed better. There are also some salty special foods the
Asian cultures have developed. The umeboshi plums in Japanese cuisine are salted, a special nutritive sour
Transcripts Module 3 / PAGE 31
plum. Also, Chinese dry them. They cure them in salt and they have kind of a bittersweet, quite sour flavor
to them. One or two of those a day are typically what I recommend in terms of diet, not adding more salt
to your food or drinking a glass of salt water.
If people do need more sodium I recommend they take it in a tri-salt form, so they’re balancing sodium
with potassium and magnesium and even calcium. They’re getting all of those minerals and electrolytes in
a balanced form all at the same time. Watch their sodium/potassium levels in their bloodstream and watch
their blood pressure.
Kevin: Let me ask you a few questions about this here. When you’re taking vitamin C are you talking about a
straight vitamin C or can you take camu camu extract or acerola cherry?
Dr. Williams: With vitamin C I’m talking about the nutraceutical form, the pure ascorbic acid. The same ting with the
vitamin B5. I’m talking about either pantothenic acid or the co-enzyme-A form. The same thing with
L-tyrosine, the pharmaceutical-grade form. You can use food-based forms and the dosage, the amount of
vitamin C you get out of there will be less typically per dosage but it’s going to work the same way in the
body as long as it can be taken up in the body and you take it over time. I prefer plant-based forms, if they
work, or supplementing plant-based forms with pharmaceutical-grade forms. Of course, I’m a clinician
so people pay me to get results. I need to get them getting feeling better quite quickly in order to have
confidence in my work. I know that the pharmaceutical-grade vitamins work. They raise the blood levels.
I know that from testing case after case. I also know that over time short-term and long-term they work.
Perhaps when you’re just preventing or you’re treating lower-grade levels or as a supplement the food-based
ones would be great, including yeast-based forms of these vitamins, B5 and tyrosine.
Kevin: When you talk about pantothenic acid, do you get that from a B-complex? Is the amount in a B-complex
Dr. Williams: B-complex is important to take in addition to isolated B vitamins. So in order not to disrupt the relationship
of the entire B family. I’m very strong on that, that you’re taking a multivitamin which includes a B-complex
or a B-complex along with higher dosages of individual vitamins, in this case B5. In the B-complex,
especially if it’s food-based, you’re going to have very low levels. Nutritional levels are like one to five
milligrams. Therapeutic levels needs to go up into the hundreds of milligrams or higher.
Kevin: With salt, is there ever a time when sea salt is good?
Dr. Williams: Sea salt is quite useful because it has a number of other minerals. Some of these specialty salts, like
Himalayan salt, have other minerals with it besides sodium. Adding those to food or water is quite useful.
Some naturopathic doctors believe that you wake up in the morning, your cortisol is low, your adrenal
is low, instead of going for your cup of coffee or your green tea you mix sea salt in a glass of warm water
and drink that down and that helps to nourish your adrenal glands. I don’t think people should do that
on a daily basis without knowing what their blood pressure is, without monitoring their blood pressure,
without knowing what their sodium levels and potassium levels in their blood are, as well as magnesium
and calcium. It’s the sensitive individuals that could really disrupt the whole balance and add another
dimension of problems. I prefer that they take their vitamins in the morning and that they keep their green
tea moderate and that if they’re using coffee at all that it’s moderate. The very ill patients can’t have any
green tea or any coffee. They just need to focus on the supplements and keep their salt intake moderate.
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Sometimes in Asia what they do is they use very mild green tea, low-caffeine forms, and they add umeboshi
plums to that. That’s a good morning drink. Also they will take ginseng soup. It’s a mild amount of ginseng
that’s been cooked in fish or chicken, like in a slow cooker, and they’re just going to drink the broth off of
When you’re in recovery that’s what it is. It’s not, “How do I stimulate my adrenals more? How do I
jumpstart them? How do I get supplemental extra cortisol in a crash system?” But, “How do I recover?
How do I support recovery? How do I nourish myself and my adrenal glands?”
Kevin: Let’s talk a little bit more about diet and how diet plays a role with adrenal health.
Dr. Williams: Modern western diet is a [indecipherable] to adrenal health. You have three things. One, stress. Chronic,
unrelenting and sometimes acute stress, along with chronic stress. Two, you have abuse of stimulants
like caffeine primarily. And three you have a diet that doesn’t support good health. We all know that. It
contributes to chronic disease like cardiovascular disease, but also creates more dependence on food and
moves the entire system towards metabolic disorders. Those include high refined carbohydrates so your
white flour products, your sugary sports drinks, your high-fructose syrup, sodas, even you have to watch
many of the natural sodas have fructose in them. So not only now do you have low nutrient density in
your foods but you have this high carbohydrate that is easily broken down to sugars in your body and now
you’re creating serious imbalance stressors onto the system. Refined carbohydrates, sugar and of course
alcohol are the three, besides stimulants, substances in the diet that have to go if you want to recover your
Kevin: Is there anything in the vegan diet or anything missing from the vegan diet that maybe should be considered
for someone who is going down that path?
Dr. Williams: Yes. In the vegan diet you have one serious omission. You’re going to have a very low to no cholesterol diet.
Over time vegans, particularly raw food vegans, when I test their blood they’re going to find that their
cholesterol is below 130. Keeping your cholesterol in the normal range is highly important. You can’t build
adrenal hormones from that. So what they’re going to do in the beginning is they’re going to lose weight,
moving towards underweight. They’re going to feel relatively good for months to maybe a year or so,
because they’re getting high nutrient density foods that are normalizing their weight and their metabolism
and they’re completely off of all the processed and preserved and high trans fats and high refined sugar
foods. However, over time they’re going to deplete the system significantly. We all know about vitamin
B12 and iron and the importance of those and the low levels found particularly in vegans but many strict
vegetarians as well. One of the things that they consistently overlook is the cholesterol. You need enough
cholesterol and you need enough of the LDL, low density, as well as the HDL. Those are the two that
these adrenal hormones are built from, the adrenal cortico hormones. So check your lipids and make sure
you’re getting enough, that your cholesterol is high enough. If you’re vegan for six months to two years and
cholesterol is looking good, the range is 135-165, that’s the optimal ideal range, don’t stop there. You need
to check it every year, every six months to make sure it’s not dipping down. Eventually it will go down.
It’s important that vegans have enough of healthy oils in their diet. They may need to supplement with flax
oil, with omega-3 from sacha inchi oil from the Amazon and some of these healthier vegan sources.
Let’s talk about what to do on a daily basis. How do we recover? How do we manage? How do we balance
and how do we restore our adrenal function? Because it’s a lifestyle and stress-induced disease, number one
Transcripts Module 3 / PAGE 33
we have to somehow either develop better coping skills with our stress mechanisms or we need to eliminate
stress from our lives as much as possible. Number two, we need to change our diet away from the modern
western American diet to a healthier balanced diet. Number three, we need to move away from stimulants
like coffee, strong green tea and then the extra things we might be needing for weight loss like ma-huang,
which contains ephedrine and pseudo-ephedrine.
The main hormone that we’re going to look at is cortisol. The two others are DHEA and pregnenolone.
We’ll talk about that in module four. To manage cortisol we start as soon as we get up with breakfast, not
with a glass of salt water. Morning is when your cortisol levels should come up. Deficient cortisol and
adrenal fatigue people are going to be slow to start in the morning and they need to get their body going.
Typically they also will be borderline hypoglycemic. So we start with breakfast. Breakfast is the meal of
champions. We all know that. But it’s not highly-refined carbohydrate cereal with lots of sugar on it.
Breakfast is the most important meal for adrenal fatigue and hypoglycemic patients. You need to eat your
breakfast. Adrenal people don’t want to eat breakfast. They want coffee. They want green tea. They want
their glass of salt water. They want their supplements. They tend to not feel good with breakfast. When
they do eat a high-protein breakfast they do a lot better through the entire morning. They have to avoid
the big, sugary breakfasts, the stimulants and then move towards a slow-burning fuel with low glycemic
index carbohydrates or a combination of high protein. They also may need a little more oil or fat in their
diet. If they’re vegan they’re going to have to go for the plant-based forms. If they’re vegetarian but
not completely vegan they can use a little bit of unsalted butter. You’re going to eat in the morning
relatively early, between seven and nine and really no later than ten. Almost in all cases people feel much,
much better with a high-protein breakfast.
Kevin: And then moving throughout the day?
Dr. Williams: As we go along throughout the day you want to look at your exercise. If you can move in the morning
and you can do exercise twice a day it’s much better than doing a serious gym workout where you’re
exhausted and you’re pushing your adrenaline and cortisol. Exercise should be regular and should be
balanced between your work and your rest and your eating.
Here’s a standard routine for adrenal recovery. Go to bed early. Set a regular schedule. 10 o’clock, 11
maximum, you should be in bed, every single night. Sometimes I put patients to bed at 9 or 9:30. You
should also get up early, 7 o’clock to 9 o’clock. No later than that. Often adrenal fatiguers start to wake up
after 9 at night and get a lot done and then have a terrible day the next day. That contributes to the cycle.
You need to go through kind of a withdrawal phase of a week or two by getting yourself into a regular
schedule. But don’t oversleep. You need seven to nine hours for chronic fatigue and for adrenal burnout
people, but sometimes even 11 or 12. But not 11 or 12 every day. Do not over sleep. It will disrupt your
What’s important is the last two hours of sleep that can come normally for healthy people in the early
hours of the morning between four, five, six and seven. For adrenal fatigue patients they usually have sleep
disruption during the night and they may not get that last two hours of restorative sleep until the morning,
between six and eight or seven and nine, even sometimes between eight and ten. If you have to get up in
the morning and go to work you’re just going to continue more and more stress. Now you’re putting non-
restorative sleep pattern in and you’re going to have sleep disruption. Eventually it’s going to complicate
and make the whole process worse.
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When you get up in the morning, eat your high-protein breakfast with a little bit of complex carbohydrate
like whole grain bread or oatmeal. If you can use a little bit of butter or plant-based oils or fats you need
to add that at that time, like flax oil.
Throughout the day you need to eat like a hypoglycemic. You need to eat small meals, high protein and
frequently. If you can’t do that then you need to eat regular meals, two or three, and you need to eat high
protein snacks including plant-based protein like a handful of almonds, every few hours. Make sure that
you also get your healthy oils a few times a day.
Avoid caffeine and alcohol. You may struggle through withdrawals for several days or even weeks but
eventually you will feel a lot better. Avoid your stimulating herbs and don’t take decongestants containing
Moderate your work routine. Try to get some exercise in, as I mentioned, in the morning and in the
afternoon or evening. As many times as you can during the week work in your garden. Take that walk in
the park. There’s plenty of evidence--in my blog I even have an article on it, Japanese call it Forest Walking
or Green Zone Walking, in Europe they call it, and how it improves the immune chemistry in your body
and your T cells recover better. It’s amazing what the living green color and the plants, how they make us
feel. I watched the Avatar movie last night for about the 20th time and the interconnection of the Nave
people with the forest and the plants and their planet. That’s really what it’s all about.
You have to set up your own almost kind of recovery spa. This is going to take weeks. It’s going to take
months. It’s going to take years. Other natural therapies that you can fit into your schedule during the week
include acupuncture, massage and other forms of bodywork, and meditation practice. Acupuncture once
a week or once a month is fine. It’s the premier therapy for balancing the adrenal system. It will not, on its
own, serve to fix or to cure advanced adrenal deficiency syndrome. But it up-regulates and down-regulates
the entire HPA axis and the immune system. Acupuncture done in the hands of a skilled practitioner is
excellent if you have access to it. Massage and bodywork help de-stress you, give you a relaxing zone. Also,
meditation helps you to develop better coping mechanisms.
In terms of exercise you want to make sure that it’s regular, gentle. My recommendation is tai chi, number
one. It’s a limbic, moving exercise like dancing. That’s also good. It gives you enough exercise but it never
tires you out. It re-regulates your entire autonomic nervous system as well as HPA axis.
If you wanted to totally recover you could probably do it just with diet, with Chinese herbs and tai chi.
They’ve done it for thousands of years in China. We could do it now but they usually go to the temple for
a few months and have no stress. So that helps, too.
Walking is great. Do it every day. Don’t do power walking or speed walking or walk in the hot sun in the
middle of the day on the beach. Do gentle, normal walking. Don’t drag yourself. If you feel so tired that
you have to drag yourself out it’s better to rest. Even if you have to push yourself a little bit until that walk
feels good during the walk and afterwards. Swimming is good, excellent, but pace yourself. Bicycling,
leisurely not long-distance, is also good. All of those activate limbic and rhythmic systems in the body.
Restorative yoga is excellent. Avoid the aggressive forms of yoga. There’s many of them but two of the most
available are Bikram’s yoga or any forms of hot yoga, and classical Ashtanga yoga series one and series two.
They are excellent forms. I practice them myself and I’m a great proponent of them however for adrenal
Transcripts Module 3 / PAGE 35
fatigue people you want to focus on restorative, gentle yoga. Not so gentle that it puts you to sleep. But
rhythmic, regular like gentle Vinyasa, is outstanding to restore and recover from adrenal deficiency, adrenal
insufficiency and the adrenal fatigue in its entire spectrum.
When you were talking about diet you didn’t mention fruit in the morning. Is that something to avoid or
is it something you can eat with some protein or some fat?
Dr. Williams: Fruit in the morning is out for adrenal fatigue people. Number one, it’s high sugar. Number two, these are
not natural heritage fruits. These are genetically-modified, highly-hybridized packages of water and sugar.
Even if there’s organic they’re still high sugar.
What you see for adrenal fatigue patients, chronic fatigue patients, stress people, a lot of the vegans, their
energy is very low. They’ve gone hypoglycemic at nighttime and their cortisol is not coming up. So they
go for the natural fruit juices and the fruit salads and the fruit smoothies. They’re going to feel a little bit
better afterwards and over a long period of time they’re going to be much worse.
Let me add a couple of breakfast tips, if I can. The four breakfast tips for adrenal recovery and cortisol
balancing are number one, eat light. Don’t eat a heavy protein. Eat light. If you’re a fast-burner, if your
metabolism is strong and you’re a lean person then you’re going to need more protein for breakfast. If
you’re a slow-burner you’re going to need a low-glycemic index complex carbohydrate to break down
slowly over the morning. Keep that in mind. The fourth one is avoid sweets including fruits.
Kevin: Great. Thank you. This is the end of module three. In module four we’ll be diving a little bit deeper into
some of the herbs and some of the other things that you can do to help bring your adrenals back into great
Dr. Williams, thank you.
Dr. Williams: You’re welcome.
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Kevin: Welcome everyone. This is Kevin Gianni from RenegadeHealth.com. I want to personally thank you for
taking an interest in your health and investing in this special program. The Complete Adrenal Health
Program will teach you the cutting edge natural approaches to adrenal treatment. First, before we start,
I‘d like to introduce our special guest, Dr. James Williams. Dr. Williams is a pioneer in the field of
integrative medicine and longevity and quality of life. He’s the author of five acclaimed books including
“Viral Immunity” and “Prolonging Health.” With more than 25 years clinical experience treating chronic
disease he brings his experience with over 100,000 patient visits directly to you. In this program I’ll be your
host while Dr. Williams shares this important information with you.
Before we start I want to share this important disclaimer with you. The information in this course is
intended to for educational purposes only. It does not replace the evaluation and advice of a qualified,
licensed healthcare professional. For detailed information about your adrenal health, please consult with
So let’s get started on this module.
Welcome everyone. This is Kevin Gianni from The Complete Adrenal Health Program. Today what we’re
going to be doing is going through the holistic treatment that Dr. Williams has used on his patients with
great success. We’re going to be running over some of the things that we talked about in module three
but we’re also going to be expanding on some of the other things that you can do that actually with your
adrenals, particularly herbs.
Dr. Williams, welcome.
Dr. Williams: Thank you for having me on the program. I’m looking forward to helping our listeners and solving one of
the major crisis in health in the modern world.
Kevin: Let’s talk about the principals that are based around healing the adrenals. Let’s go through the steps and
then we’ll go into detail and drill down the very specifics.
Dr. Williams: The most important thing to remember is that this is really a maladaption syndrome and not to stay
focused on the adrenal gland, particularly if cortisol, as we mentioned, is too low, and how to fill that up.
I call that the bucket theory of natural health and if the bucket’s half empty fill it half way up and you’ve
got a full bucket. If it’s empty all the way fill it all the way up. In this case we’ve got a bucket with a hole.
But the real problem is the garden. We carry water to the garden back and forth from the stream. It’s a real
big environmental issue. It’s a maladaptive syndrome of how the human body and the environment inter
and co-relate within the body with all these higher and lower centers, hypothalamic-pituitary and adrenal
and other axes. The three main reasons for that, of course, are stress, over-use of stimulants and high sugar,
high fat, high salt diet, the Standard American diet.
The first thing is you have to have a plan. Then you make your lifestyle adaptations and then you support
your adrenal health with nutrients and correct diet. You sure up some of the precursor hormones like
DHEA and pregnenolone. Then you take your adaptogenic herbs, like ginseng, and give it replacement of
cortisol. And finally you have to give it time. It takes months, years of time to restore adrenal health.
Kevin: In the previous modules we put together a lot of information. Now I want to wrap it all up in a systematic
way. I’m a big advocate of making plans. What are the steps? Let’s walk someone through this particular
Transcripts Module 4 / PAGE 39
plan so they can get their adrenals back into great health.
Dr. Williams: We’re going to go through it step by step in a lot of detail. I’ll go as clearly as possible. This is exactly how
I work with my patients in my clinic. I’ve teased out the most important points for people to do self-
assessment. Remember, self-assessment is always subjective, even for doctors themselves. As I say, doctors
make the worst patients because they have the information and they’re still very subjective about their
view. In other words, it’s kind of backed up with emotions and you can’t see things so clearly when they’re
right in front of your face. It’s a good starting point, however. Then we’ll bridge into when you need help
along the way.
The first step is to get a sense of where you are on the adrenal fatigue continuum. There’s two aspects of
that. Part A is to make sure that you’re not high cortisol or the early stages of adrenal imbalance, moving
towards fatigue, if you do have high cortisol. That’s important because if you have high cortisol and you
treat it as if you have low cortisol, you’re just making the entire problem considerably worse and you may
feel a little bit better but you’ll certainly feel more imbalanced in the process if your doctor doesn’t catch
early. Many holistic practitioners out there make this mistake, too.
The first thing is to separate out high cortisol from low cortisol, getting clues and tips in the beginning
and then focus on the low cortisol, which is the adrenal fatigue syndrome, where you fit on the fatigue
continuum. There’s three aspects of that. The first is your symptoms. We went over those in detail in the
previous module. What I want to be clear about now is that first, both high and low cortisol have fatigue
as a symptom. Adrenal fatigue syndrome is not just being tired, it’s feeling weak and tired. People say that
they feel exhausted. They feel so tired they can’t get out of bed in the morning, so tired that they have to
nap in the afternoon. And they are also weak. It’s difficult for them to exercise. Exercise often makes them
worse. That’s the adrenal fatigue with low cortisol.
The adrenal fatigue imbalance with high cortisol or early stages of disruption of the adrenal and HPA axis
will also be fatigue. So both high and low have fatigue as a symptom but with high cortisol you’re going to
be irritable. There’s going to be increased PMS symptoms. You’ll be snappy and anxious and easily angered.
That’s typically high cortisol. Sometimes there’s adrenal imbalance to the point where the adrenaline is also
jerking up. People still exercise. They still feel better when they exercise. They’re not that tired but they’re
still fatigued. The fatigue tends to come and go where advanced adrenal fatigue is there all the time.
The other thing with high cortisol is you usually have increased appetite, without having exercise, without
having done a lot of yard work or where you would expect to have it. These people are hungry all the time.
They have increased appetite and of course they gain weight. So they easily gain weight and it’s hard to
lose weight. The pattern is central obesity where the center of the body and abdomen below the breasts in
women and up under the ribs in men and down to the waist becomes very chunky. This is not just belly
fat. It’s an increasing amount of fat, usually evenly distributed throughout the entire waist. We look at the
waist to hip ratio. When you see your waist becoming wider than your hips than that’s usually associated
with the problem of high cortisol. That is because it’s associated with insulin resistance syndrome and the
phenomena that goes with that of getting fat locked into the adipose cells and imbalance in insulin.
So first of all look at your symptoms and see if you can get an idea whether you’re high or low cortisol.
Questionnaires help. They give you a list of symptoms and assessments. There’s a variety of those on the
Internet and other places. Make sure you’re looking at a good one. You might take one or two and along
with your own assessment of symptoms will give you a closer idea if you have this problem and remember
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high or low cortisol, where do you fall in the beginning and then if it’s low an idea of where you fall in that
adrenal fatigue continuum.
Third is self-assessments. Those are the things we went over where you do your blood pressure sitting
or lying and then standing up quickly and if you get dizzy that tells you right away that you’re having
postural hypotension. It should give you a clue that you’re having trouble with your adrenal glands and
hormones related to that. Even if you’re not dizzy and your blood pressure numbers, upper and lower,
drop by ten points then you’re pretty sure that you’re having adrenal hormone problems. Looking at
your pupil index and looking at your body shape and type, those are other self-assessments. That’s part A
Part B is medical assessment. That’s where the doctor is looking at you and asking you questions, doing the
exam. We do other things like table testing, so that you don’t actually have to lie. We put you on a special
table that tips up and down. Sleep assessments are important as well.
The next step is to get tested. We’re going to do two types of testing, blood testing and saliva testing. Those
are the basics. Don’t skip the blood testing. I know many holistic practitioners jump right into the saliva
testing. Make sure your practitioner knows what they’re doing. Make sure they’re licensed and make sure
that they have privileges to order lab tests because in many states you have all types of holistic people and
they can’t order blood tests. A saliva test anybody can order. They’re not FDA approved, even though
they’re a very well understood test and the equipment has been used, most of it comes from Germany for
decades. These are really good, established tests for cortisol and DHEA. But they have not been approved
by the FDA as medical tests for this specific problem so that means that pretty much anybody can order
those over the Internet. You need to work with a good lab, however.
Let’s look at blood tests first. You’re going to do three basic tests. Fasting, always between seven and nine in
the morning. You’re going to look at cortisol, circulating levels, DHEA-S, that’s DHEA sulfate not plain
DHEA. Total DHEA fluctuates throughout the day and is based on stress and eating or not eating. But
DHEA sulfate, a precursor of DHEA, is much more stable. It’s what we use to test in anti-aging medicine
and adrenal health issues and also many other medical testing. So use DHEA-S. The third is pregnenolone.
That’s your 117-hydroxy pregnenolone, also a metabolite of prenenolone that is more stable. So the three
are fasting cortisol, DHEA-S and prenenolone.
You also want to look at testosterone. Women of all ages should measure total testosterone level and men
over 40 when their testosterone levels produced by their gonads starts to decline their adrenal gland will
produce some and in some cases much of their testosterone. If you’re finding a lower level of testosterone in
women of any age and men over 40 then you can also get a clue that their adrenal gland is not functioning
The next test is saliva testing, your adrenal stress index. Depending on the lab you’re going to do four to
six samples over a 24-hour period. They’re also going to measure DHEA. In the salivary testing it’s going
to be free-tissue levels of cortisol and DHEA. Then they’re going to plop that on a curve so you don’t
really need to know all of these small numbers that go with all these different levels. When you look at
the graph of the cortisol it should match to the higher in the morning and mid-range during the day and
lower at nighttime. Also, when you do the salivary test you can’t have any bleeding gums. Even microscopic
bleeding will cause an abnormal sample because they’ll be measuring both saliva and blood in the sample.
The good labs will wash the saliva, filter out the blood. But if you have bleeding gums it’s better to not take
Transcripts Module 4 / PAGE 41
the salivary test until you’ve solved that problem. That’s correctable by getting your teeth cleaned, taking
away any irritants that are on your teeth like hard plaque cutting into your gums, reducing inflammation,
flossing and taking high dosages of vitamin C with bioflavonoids, typically will solve that in a few weeks
and then you can do your saliva test.
Third step. Once you have a sense of where you are on the adrenal fatigue continuum, you’ve looked at
high and low cortisol symptoms, you’ve taken questionnaires and you’ve looked at self-assessment and
perhaps medical assessment, now you have your blood results and your salivary results. At that point we
want to evaluate the state of your condition. We’re going to look at three different aspects of that.
The first is, do you have normal cortisol and normal DHEA, both blood and saliva? First let’s talk mainly
about blood testing. You want to look at your fasting cortisol and your fasting DHEA-S. If they are falling
in the normal ranges, mid-normal ranges, you probably don’t have a problem. It’s likely coming from
somewhere else. If they are in the low-normal ranges then you might have a problem. The first step is to
see normal cortisol, normal DHEA-sulfate, probably not an adrenal problem.
You’re also measuring prenenolone. Low pregnenolone can be the first sign of a faltering adrenal gland.
Typically what we’ll see is very low normal levels. Pregnenolone numbers go down so close to zero, especially
as you get older, that it’s hard to find one that’s below the normal level. But if it’s in the very low normal
levels, below 100 for example, then that’s a tip-off that you’re probably starting to show some deficiency of
the adrenal cortex, even if you’re normal cortisol and normal DHEA-s. In that case you would supplement
with pregnenolone and you would make lifestyle adjustments.
Second part of evaluating your blood test. You’re going to have normal, high-normal or even high cortisol.
This is important to remember. If you have high cortisol, above 20, then you’re either very stressed or
you’re moving towards Cushing’s Syndrome or you’re taking Prednisone or other medication causing that
level to be elevated or you’re having imbalances in your cortisol. In other words, you may be slightly high
in the morning but normal during the rest of the day. Your salivary test can tease that out. If high cortisol
is a red flag you need to see your doctor right away. Normally what we’re going to see is normal cortisol
values in the mid range or high-normal range, 15-17, and at the same time we’re going to see low levels
of DHEA-sulfate. Now you know that your ratio is off. The low DHEA makes the body respond like low
The treatment for that would be to supplement your DHEA and pregnenolone and make lifestyle
The third is that you’d have low cortisol or very low normal cortisol, closer to five, six, seven, eight. We like
cortisol to be in the mid-range, around 10, 11, 12 even down to 8 or 9 and the DHEA to be very, very
strong and the pregnenolone to be normal. But if you have low levels of cortisol with low levels of DHEA-
sulfate and pregnenolone then you have true adrenal deficiency syndrome.
On your salivary testing if you have one or more times during the day when your cortisol is either low or
high, you’re certainly having imbalances in the way the adrenal is functioning. If you look at the adrenal
index you’ll find that the DHEA to cortisol ratio is off and when you compare to your blood testing you’ll
also see some slight abnormals in there.
In summary, adrenal fatigue phenomena and maladaptation syndrome is typically an imbalance between
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cortisol, DHEA-sulfate and pregnenolone, as well as other adrenally-produced hormones like testosterone,
as well as influenced by insulin-like growth factor, produced in the liver that reflects growth hormone and
Kevin: Let’s talk about these lifestyle adaptations.
Dr. Williams: That’s the first step. This is not an up-regulation of your lifestyle. This is not your January 1st program
where you say, “I’m going to go to the gym three times a week.” If you have adrenal fatigue you can’t go to
the gym and get benefit from that. You won’t keep up your January 1st promises. You won’t be able to get
on a healthier diet or watch your sweets and salt and fat intake because your adrenal glands are imbalanced
and the cravings are too strong. So don’t make any promises that you can’t keep.
You need to restore balance. You need to make adaptations to diet, little by little. Make changes. Don’t
go to full extremes if you have adrenal fatigue. Make small, consistent, easy steps. First of all in your diet.
Lower the sugar. Cut out the stimulants. Reduce or eliminate alcohol.
The next is rest and sleep. Typically adrenal health people need a nap in the afternoon, but don’t oversleep.
It will disturb your sleep cycle at night. 20-30 minutes is more than enough. Set your alarm on you cell
phone so you don’t sleep an hour or two in the afternoon. If you wake up refreshed, you’re on the right
track. If you wake up drowsy, groggy, you’re not. Nighttime sleep, we’ve talked about that, seven to nine
hours of good sleep. You must try your best to restore your sleep. If you fall asleep easily but wake up wide
awake at two, three or four in the morning, then you’re having nighttime hypoglycemia. So your cortisol
is going up and your blood sugar is going down. You need to have a light carbohydrate snack before bed.
Honey and chamomile tea is fine. A little bit of natural, organic yogurt with some granola on it is fine.
Not too sugary, though. No fruits and certainly no stimulants. That often will help prevent nighttime
hypoglycemia. However, if you do wake up like that and you’re wide awake the best thing to do is get out
of bed and have a snack, a chamomile tea with honey or even half a teaspoon of raw, organic honey in
warm water. Within 30 minutes or so your blood sugar will be stabilizing and you’ll be able to go back to
Make sure you get that restorative sleep. You need at least two hours of deep, restorative sleep. That usually
comes at the end of your sleep cycle because these adrenal stress people have disturbed sleep and they don’t
start getting into the restorative cycle until after four in the morning, often not until five, six or even seven.
But do not oversleep.
Try to balance your workplace. The amount of work that you do should be regular and balanced so that
you don’t have to take any long vacations. Your immune system becomes poor functioning in this adaptive
syndrome of adrenal fatigue and you’re more susceptible to infection. You’ll be on and off work with cold
and flu. That’s not what you want. You want to balance it out. Talk to your employer and find out if you
can do things at home. Take work home. Keep it up regularly and don’t overwork, if possible.
Stress. You have to manage stress better. You have to learn coping skills. Talk to your counselor, your coach.
Many personal trainers and massage therapists are excellent at helping with that. Psychologists are well-
trained in coping and adapting to this type of syndrome.
Exercise. You must exercise, every day if possible. But you cannot over-exercise. A full gym workout,
strength training, is not possible. You’ll make yourself worse. Look at tai chi. Look at restorative, gentle
Transcripts Module 4 / PAGE 43
flow, Vinyasa yoga. If you’re in an area of the country like California or New York City, Austin, Texas
where they have excellent yoga teachers who have studied in India and have more than 10, 20 even 30
years experience, like I do, then get some personal training, some coaching directly so that they can adapt
you a yoga practice that you can do at home every day. Maybe you can get to class once or twice a week.
And look at light weight training. If you can’t get yourself to the gym, walk. If you can’t walk because of
traffic or you have to drive to a park and it’s too much stress then invest in a treadmill or other exercise
equipment where you can get some mild exercise.
Lastly, consider acupuncture. It is premier therapy for re-regulating the HPA axis. In the beginning you
need to go once a week. Then you can go twice a week and then once a month and then every three or four
Kevin: Let’s talk about some of the supplements that you can take to add nutrition to your diet that you might
not get from food.
Dr. Williams: The next step is taking foundational support, nutritional supplements. These are not curative medications.
These are the substances that your body needs, particularly your adrenal gland and adrenal hormones,
to build and balance. Remember, it’s all about adaptation, restoring and recovering. This is what adrenal
health is, retraining your body to adapt to the stresses of the modern world, including what you impose on
Two, it’s about recovery from an abnormal, imbalanced lifestyle with addiction and poor diet and over-
working and not sleeping right and recovering the essence of your body’s health, particularly in the adrenal
and the HPA axis. It’s about restoring the strength and the normal function of your adrenal gland.
These are the supplements that you need to take. Vitamin C. You can take it as a buffer, ascorbic acid or
ascorbic palmitate. 500 - 1500 milligrams a day is enough to start. That would be 500 milligrams three
times a day. Then gradually every few days increase that amount, moving upwards towards 4500 - 6,000. If
you find that you all of a sudden feel better, like a weight’s been lifted off your back, then that means that
your adrenal gland is likely not getting enough of its main nutrient which is vitamin C and you need to
take higher dosages. Remember, if you take too much and the body is not absorbing it, it will pass through
the kidneys and the intestinal tract and you’ll have gas and bloating and possibly diarrhea and you’ll urinate
more. That would be getting to much vitamin C. Don’t keep pushing it up to 10 or 12 or 20 grams. Keep
it at somewhere between 4500 and 6,000 milligrams. That’s 4.5 - 6 grams a day, spread out throughout
the day, at least three times, sometimes four or five times is better. It’s taken away from food. Ascorbic
palmitate is an oil-based form and it’s taken with food. I usually recommend a combination because you
need to take vitamin C multiple times throughout the day to get the best absorption. So buffered ascorbic
acid between meals and ascorbic palmitate with meals.
The next is vitamin B5. You take that as calcium paltothenate or in the co-enzyme form as co-enzyme-A.
The dosage is 500-1500 milligrams a day. Sometimes you need to take more, but that’s the standard spread
out three times a day. You also need to take it with a B-complex or multivitamin and mineral with a
B-complex embedded in the formula. This is very important. Any time you take high dosages of any single
B vitamin you want to take a B-complex with it to keep it balanced in your body so you don’t deplete any
of the other B vitamins. People who are at the far end of the fatigue spectrum should take a B-complex
with nutrient co-factors. Those are all the co-factor and co-enzyme forms of the B vitamins.
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Lastly is L-tyrosine amino acid. That’s necessary to build the adrenal medulla hormones, adrenaline and
nor-adrenaline, also called epinephrine and nor-epinephrine. You also need that to build your thyroid
molecules. 500-1500 milligrams a day is more than enough.
Consider electrolyte replacement, sodium, potassium and magnesium. I recommend not taking extra salt,
even though it sometimes makes people feel better who are adrenal fatigued. Sometimes salt craving is a
sign of adrenal fatigue. Drinking salt water in the morning, adding sea salt to your food in excess only will
cause additional problems later. If you do need extra sodium make sure it’s taken in a balanced form called
tri-salts. That’s sodium, potassium and magnesium together. Once a day in the morning.
Kevin: What about some of the adaptogenic herbs? I know that there’s a few that are very effective for adrenal
health. We haven’t talked about these yet so I’m kind of excited to get into them.
Dr. Williams: There’s two groups of the herbs. This is an area that is my specialty. I’ve been working with these for 35 plus
years, with my background in Chinese medicine in particular. These herbs come from Asia and the far east
and often from the colder climates, Korea, North China, western China, Siberia and the Ural Mountains.
That gives you a clue that this is usually a problem of the northern hemisphere.
The other category is licorice root. We’ll talk about that separately. First of all, let’s talk about adaptogenic
herbs. Adaptogen means something that helps you cope with stress, helps your body mechanisms,
principally the homeostatic mechanisms like your blood pressure, your heart rate, your kidney function
and your electrolytes that keep your body alive, that slow down the aging process, and that make the
human body machine run well. Stress disrupts it. We have great mechanisms and functions that help
us return to balance after being stimulated by stress. Yet when stress is ongoing, if it’s too strong and it’s
chronic, like in modern living, then adaptogenic herbs become very important to help us adapt to stress
and aging. As we age adrenal function tends to decline. In a healthy older person it will still be strong. But
on the average person it tends to decline. That’s why you see these herbs being used mainly in Asia with
older people, because they’re not as able to cope with the stresses of daily life. You don’t want a grouchy old
man. You want a wise older person not a grouchy person.
There’s a list of about ten of them. We’re going to talk about five or six of these. The first and king of them
all is ginseng. There are several different types of ginseng. There’s an American version and there’s an Asian
version. The Asian version is panax ginseng. That’s the one that has the adaptogenic properties that tend to
boost or help the people with severe fatigue and older people. The american version of panax gingofolia [?]
has similar properties but that one is better for people who have insomnia, who have more of the agitation,
a little bit of the wired/tired feeling. Typically I recommend panax ginseng in extract form, 250 milligrams
per capsule. That’s standardized to contain 15 percent of ginsenocides.
There are many active components of ginseng. They’re grouped under a large family called ginsenocides.
With these extracts you’re going to get more of the active ingredient. Remember, you need to take moderate
to small amounts on a regular basis. Do not use these as stimulants. The dosage is 250 milligrams,
maximum 500 milligrams, three times a day.
The next one is rhodiola. Rhodiola is from the Ural Mountains. It’s typically my first choice for the
imbalance of the HPA axis. It’s Latin name is rhodiola rosea. I recommend standardized extract with 100
milligrams that contains at least three percent total rosavins [?]. Those are the active components that give
the adaptogenic effect. You’re going to take 100 - 250 milligrams three times a day.
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Eleutherococcus or so-called Siberian Ginseng is the third one. It’s latin name is eleutherococcus senticocus.
It’s an outstanding adaptive and you might call it the prince of the adaptogenic adrenal support world,
ginseng being the king, rhodiola the queen and eleutherococcus the prince. We’ll get down to the princesses
in a moment. I also recommend using it in an extract form, standardized to contain at least 0.8 percent of
eleutherocides. Typically it comes in a 250 milligram capsule and you’re going to take one or two of those,
250-500 milligrams, three times a day.
The two princesses are schisandra, a Chinese herb and Romania. Romania is the princess who becomes
the queen or the step-sister who becomes the princess of the ball. In Chinese medicine Romania is the
centerpiece of restoring kidney and adrenal function. For maladaptive syndrome we’re going to take
100 milligrams of the concentrated extract at least five to one. I like to use up to seven or eight to one
concentration. Schisandra is another Chinese herb, a small hard berry that’s very useful for chronic fatigue
and adrenal syndrome. It also has antiviral and anti-inflammatory properties. We use it a lot in chronic
fatigue patients with adrenal deficiency and chronic virus conditions. I also recommend it in an extract
form that contains at least nine percent of the schisandrans and is taken in 100 milligram capsule up to
400 milligrams three times a day.
Now, you don’t take all of these all at the same time. Sometimes we do see the specialized adrenal support
supplements that have several of these in. When they’re combined together they’re used in very low dosages.
Typically I would recommend to patients one of these adaptogens in these moderate to higher dosages like
I described, taken every day, based on their condition, along with an adrenal support combination of these
different herbs and lower dosages. Then see how they do with that. If there’s positive effects or no effect,
adjust dosage or adjust the herbs that they’re taking.
The second aspect of herbal support is licorice root. This is a very important substance for regulating
aldosterone. Aldosterone is another adrenal hormone . Sometimes when you’re looking at, less than 20 and
maybe even less than 10 percent in my patient population, when you’re looking at adrenal health and you
do all the measurements that I do and patients are still not improving, then we look at aldosterone levels
in blood and urine and if those are low then they need to be improved. Aldosterone affects blood pressure,
how the kidneys process and excrete water and urine from the body. So a very important hormone. If it’s
very low it can cause extreme fatigue. These people typically feel better lying down. They’re the folks that
fall asleep when they’re sitting down, no matter what’s going on around them. These are the folks that are
so tired they need to lie down. They don’t need to take a nap they just need to stabilize their blood pressure
by lying completely prone for five or ten minutes. They feel much better and get up again and they re-
establish their balance. So aldosterone and blood pressure go together.
Licorice root is often contained in the general adrenal fatigue supplements. I don’t recommend taking those
for this reason. It’s a highly-active substance containing glycyrrhizinic acid. If you don’t have aldosterone
deficiency you can over stimulate the aldosterone even in the presence of low cortisol and you’ll raise your
blood pressure. You’ll hold water in your body. It’s well-documented that there’s licorice abuse syndrome
and toxic in high dosages. The condition just gets worse and worse and the blood pressure keeps going up
and up. The solution is to stop taking the licorice.
However, it can be an important component of restoring adrenal health. It’s standardized to 12 percent
glycyrrhizinic acid. You can take from 10 gradually working your way upwards to 150 milligrams a
day. In Chinese medicine they use licorice in every formula for kidney adrenal deficiency, every formula.
However they use it in very small dosages. It’s in a prepared form so that it’s been steamed. Some of these
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active components that cause a raise in blood pressure have been removed. So they use it in very small
amounts, consistently on a daily basis over a long period of time. Do not use licorice root in high dosages
to stimulate your adrenal gland. It can cause significant problems.
Kevin: Let me ask you about Holy Basil. Holy Basil has been effective for me. What are some of your thoughts on
Dr. Williams: Holy Basil is basically just basil leaf that you use in cooking but they call it Holy Basil when it comes from
India. A little more medicinal in its properties. It’s very mild and a good balancer. If you’re having mild
to light amounts of disruption of the HP axis, stress-induced, then basil is a nice regulator. There’s a few
other ones. They’re not going to restore severe adrenal fatigue and they’re not strong adaptogens in terms
of helping your body resist stress while you’re trying to restore.
Kevin: Let’s move on into medical types of treatments, things like glandular extracts and possibly even hormones.
Dr. Williams: The next level of restoring adrenal health--remember, this is for adrenal fatigue low cortisol patients. You
can now add on adrenal glandular extract. Most of those that are made in the United States are required
to have the cortisol removed. There’s still a few that are produced because they’ve been in production
since the 30s and 40s when we didn’t have medical pharmaceutical hormones and there was a lot of
glandulars, active and very good medicines used at that time by medical doctors. They got picked up by
the naturopathic doctors. Many of those have lost their licensing over time. There was only a few left and
naturopathic doctors and holistic Mds would know how to access those. Most of the ones you get over-
the-counter are going to be glandular extracts of the adrenal cortex or whole adrenal that have no hormone
in them. They do not help very much.
The products from New Zealand, on the other hand, are whole adrenal extract from organic herds. You
want to make sure that they’re New Zealand bovine or porcine, from cattle or pig sources, and that you’re
using either whole adrenal tissue or better, adrenal cortex, because that’s where the cortisol comes from. In
those cases you may be getting perhaps 1-2.5 milligrams of natural cortisol and all of the other hormones
that go with that in your adrenal glandular extract from New Zealand. Typically I start with 100 milligrams
of the adrenal cortex in the freeze-dried New Zealand bovine source, taken several times a day. Between
meals is best. And see if that helps improve the fatigue and reset the set point for the cortisol. You’ve got to
follow your labs as we get into these more medical-based testing and see if the numbers are improving.
The next is a multi-glandular formula, or a hypothalamus glandular for the pituitary and hypothalamic
deficiency or imbalance. As you know, if you have too much cortisol you’re going to shut down your
hypothalamus and atrophy your hypothalamus. Adding a multi-glandular formula or hypothalamus
glandular, again New Zealand bovine source is best, or hypothalamus and pituitary glandulars, are very
helpful for these patients.
Medical testing, we’re also going to look at FSH and LH and TSH. Those are pituitary-stimulating
hormones. They tend to be on the low side and the cortisol and thyroid are on the low side then we know
that it’s really more of a central deficiency phenomena like an HP axis phenomena. Then we need to restore
the entire system and these multi-glandulars are helpful.
The next is kind of the star of the show or the rest are the acts that lead up to the main show. This is to
replace your precursor hormones, DHEA and pregnenolone. First of all I want to mention melatonin.
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Melatonin is the premier rebalancing hormone in the body. It resets the biological clock and it serves to
reset the HPA axis. In aging, in menopausal syndrome, in HPA axis and adrenal problems we want to
make sure that you’re also getting melatonin. That’s taken just before you go to bed at night. Start off with
a low dose, 0.5 milligrams. No more than three milligrams. Don’t think of it as a sleep aid. It’s marketed
as that. That’s not what it’s for. It does help sometimes but a lot of times it doesn’t help. What you want
to take melatonin for is no symptom improvement and not focusing on sleep but just to help reset that
biological clock. Then you add DHEA and pregnenolone. Looking at your blood testing and your salivary
testing, evaluate how low or how moderately low you are and then supplement accordingly. I use dosages
in DHEA that go from 5, 10, 25, 50, 100 milligrams, sometimes more. The average starting dose for
men is 25 milligrams twice a day with food in the morning and evening and for women the average
starting dose is 10 milligrams twice a day with food, morning and evening. You always want to take it with
pregnenolone. It’s very easy to get the DHEA levels in the blood up. It’s very hard to get pregnenolone
levels up. Starting dose is either 10 or 30 milligrams for both men and women, taken twice a day with
food. Often we need to push the pregnenolone level up to 100 or 200 twice a day to see any movement in
the laboratory testing.
Remember, your kidneys excrete cortisol, DHEA, pregnenolone, all these hormones. So kidney function
is important. If you’re drinking too much water, if you’re drinking diuretic juices like watermelon juice for
example, you’re going to increase the amount of urine you output. You’re going to excrete more of these
hormones and losing some of their benefit because the turnover is too high.
Another way when you have mild imbalance or during aging when your DHEA and pregnenolone are
going down is to take your DHEA dose with your evening meal and your pregnenolone in the morning.
It tends to help regulate the body’s rhythms throughout the day and your sleep at night. So take a low to
moderate dose of DHEA at night with dinner, 5, 10, 20, no more than 25 milligrams. Pregnenolone in
the morning, 10 or 30 milligrams, with breakfast. Then your melatonin, 0.5-1 milligram at night.
The next step for adrenal health, particularly with true cortisol deficiency is bio-identical replacement. This
is prescription hormone and you’ll use bio-identical cortisol, also called hydrocortisone. Dr. Jeffries, an
MD, is the father of this type of therapy for borderline adrenal deficiency. Also he treated lots of Addison’s
Disease patients. His book is called “Safe Uses of Cortisol” and is kind of the bible of holistic physicians
and naturopathic doctors like myself who use it as a guideline for cortisol replacement. Now remember,
this is for true replacement when cortisol levels are very deficient and the body is not able to make its
own. You’ve already done all of your lifestyle adjustments. You’ve already taken your adaptogenic herbs
and replaced your DHEA and pregnenolone. The dosages are 2.5-5.0 milligrams two to four times a day.
Dr. Jeffries likes to take an even amount throughout the day. I often will adjust that based on your salivary
rhythms of cortisol. If they’re low in the morning you take cortisol in the morning. If they’re high cortisol
in the morning then we’ll skip that dosage and we take that between 11 and 1 in the afternoon, again later
in the day and then skip the one before bed if you’re having sleep problems. If you’re low throughout the
entire day, below normal, kind of a flat line curve, then you want to take it four times a day, before meals,
and the last dose at bedtime with your melatonin. If you’re going to take it throughout the day typically
we’ll use 2.5 milligrams four times a day. If you’re severely deficient or require more, 5.0 milligrams two
to four times a day. Keep in mind that the dosage should stay preferably at no more than 10 milligrams a
day and never more than 20 milligrams total per day. If you’ve added DHEA and pregnenolone and New
Zealand adrenal extracts you may be getting more than total of 20 milligrams a day and need to make
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A couple things to keep in mind. The amount of your daily cortisol production is between 15 and 30
milligrams per day. Your blood testing shows at any one time particularly in the morning, upwards to
20 milligrams. The morning physiologic level at its higher end is 15-20 milligrams. Usually we say that
if you’re having 17, 19, 20 milligrams in the morning you may be producing too much cortisol. Look at
your salivary testing and see how that compares. If you’re making 35-40 milligrams a day that’s enough, if
you’re under chronic stress, that’s enough to suppress adrenal production down to zero. Then that’s going
to cause that collapse syndrome. A normal person then would collapse down, would rest and their adrenal
gland would restart itself and re-regulate itself. However, most of the time it doesn’t. You’re on that yo-yo
effect. Finally you move towards burnout. The body can produce up to 300 milligrams at a burst when
there’s strong stress. That’s going to give you the strength to lift cars and leap buildings in a single bound.
However, even Superman has his weaknesses. The body knows that and will re-regulate and you’ll have
kind of a crashing phenomena after severe stress. You’ll just completely pass out, fall asleep for hours or
even more than a day and then your body kind of re-regulates itself.
Cortisol and these other hormones are excreted by the kidneys. So if you’re taking watermelon juice, for
example, as a cleansing program or to misguidedly tonify your kidneys and you’re overdoing it, it’s also
diuretic so you’re going to urinate more and you’re going to excrete the hormones that you’re putting
into your body or that your adrenal is trying to produce. Make sure that urinary output is normal, you’re
drinking sufficient amount of water and you’re not taking any unnecessary diuretics including carrot juice,
watermelon juice and peaches, which are all strong diuretics.
Lastly, if you’re modulating and self-treating, partnering with a holistic physician and you’re doing a lot
of work by yourself, make sure you’re testing in the first year, regularly, every three to four months, so you
know the objective data, if you’re making progress or not. Evaluate your symptoms. Evaluate your quality
of life. Are you happier? Is your energy better? Is it sustained? How’s your sleep? Do you have less food
cravings for sugar and salt? That gives you an idea that you’re making progress.
Kevin: I have just a few questions here. In terms of the glandular extract, is there any way to get those same type
of compounds in a vegan source?
Dr. Williams: There’s no such thing as a vegan source of a glandular extract because they all come from animals. What
you have to do is you have to use pharmaceutical grade DHEA, pregnenolone and cortisol. Remember,
on over-the-counter most states have DHEA and pregnenolone available but a lot of those the quality is
not that good, they don’t work that well. You need a pharmaceutical grade, micronized form of DHEA
and pregnenolone as well as cortisol. Those are designed to mimic and match the body’s molecules of the
hormones. Therefore they’re called bio-identical and they have no animal product in them.
Kevin: So let’s run over, very briefly if you can, the difference in this plan between someone who had high cortisol
and someone who had low cortisol, just in case someone misunderstood.
Dr. Williams: The plan that I outlined is for low cortisol people or for the imbalances of the adrenal fatigue continuum. If
you have high cortisol then you’re going to focus on just the opposite. You’re going to promote regulation
of the system, of there HPA axis and your homeostatic system, blood pressure, kidney function. You’re
going to modulate your exercise so you’re not pushing too much where your adrenaline is going up and
your cortisol is always going up. You’re also going to have to cut back if not eliminate all of your stimulants.
So much of it is the same in terms of lifestyle.
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But there’s some differences. Let me go over the things that are the same first and then talk about the
differences. Your foundation support supplements will be the same - vitamin C, B5, L-tyrosine, B-complex,
electrolyte replacement as necessary depending on your exercise level and amount that you sweat. You
are going to have to do more stress reduction, more resting, because typically these people have more
sympathetic nervous system imbalance. Their hands can be sweating. They can be irritated, agitated,
talking too much and overly responsive, hyper alert. They sleep lightly and wake up with a start. So lots of
stress reduction. Lots of meditation. Lots of tai chi.
The adaptogenic herbs are still useful but you would not use the ones that tend towards stimulation. So
ginseng is out. You would focus on rhodiola and eleuptocococus. Licorice is also out. Glandular extracts
are out. Anything that possibly may add extra hormone, extra cortisol, you shouldn’t take.
Pregnenolone is in. It’s a more calming and quieting hormone. Remember that progesterone and cortisol
interrelate and women particularly often need to look at balancing and regulating progesterone, not just
DHEA and pregnenolone and testosterone, all male hormones, but progesterone as well. Some doctors
also advice men to use progesterone. I’m not of that camp and tend to prefer to regulate for men the
hormones that are necessary for men and not add pregnancy hormones. But for women, particularly PMS
or pre-menopausal, progesterone becomes very important for re-regulating HPA axis, particularly for the
stress phenomena and if they have higher cortisol.
You would never take cortisol replacement therapy. So no bio-identical hydrocortisone. You would do the
same exact lab testing as you would for low cortisol. Supplements and re-regulation is different. Here’s the
crux of the matter. It’s easier to raise cortisol levels artificially than it is to lower them. There’s no drug or
nutrient or vitamin that lowers cortisol. This is where Holy Basil comes in and these mild regulators can
be useful to down-regulate cortisol. So Holy Basil would be a good choice. Ashwaganda would be a good
choice, an Indian herb. Gotocola would be a good choice. Phosphatidylserine is a specialized nutraceutical
that can be helpful, 100 -150 milligrams a couple of times a day to down-regulate cortisol. It doesn’t work
that well but sometimes it’s useful. The last one, which I use regularly, is gerovital, originally developed
in Romania in the 60s and still used and being studied by scientists as a new medicine for stress and to
lower cortisol. You can obtain it in pills and tablets over the Internet, however the injection form is by
far better and it’s how I use it in my practice. It’s called gerovital or GH3. In Europe they do a retreat of
five to ten days. You bring a person in to the spa center. They inject five to ten milligrams a day and they
get a massage and they get good food. It’s a good recovery method. For busy, modern people I give them
phosphyltidylserine, Holy Basil and have them practice yoga on a regular basis, tai chi on a regular basis,
avoid the strong gym workouts, avoid any type of athletic training where they’re going into say training to
run a marathon, anything that stimulates cortisol production like caffeine of course, and adrenaline. Then
do regular therapy with GH3.
Kevin: Great. This is the end of module four. This has been the complete adrenal health program with Dr. J.E.
Williams. Dr. Williams, thank you so much.
Dr. Williams: You’re very welcome. My pleasure.
Kevin: Thanks for listening to this module. For more information please be sure to review the course materials you
received with this program and start taking action on what you’re heard today. If you have any questions,
please visit our website at www.adrenalhealthprogram.com.