Do you sleep through the night but still wake feeling exhausted? Perhaps you feel tired all day, yet become alert when it is finally time to rest.
You may notice poor concentration, cravings, dizziness on standing or less capacity to cope with everyday demands.
I want to understand what is placing your body under pressure and what it needs to recover.
Stress has several sources
Stress is not only psychological.
Inflammation, infections, blood sugar disturbances, inadequate nutrition, poor sleep and certain environmental exposures can also create physiological stress.
These pressures can overlap. Someone managing illness, disrupted sleep and demanding family or work responsibilities may have several contributors operating at once.
My approach brings together nutrition, mineral assessment, appropriate investigation of cortisol, cellular energy production, liver health and daily habits.
What do the adrenal glands do?
The adrenal glands sit above your kidneys.
They produce hormones including cortisol, which helps regulate the stress response and glucose availability, and aldosterone, which helps regulate sodium, potassium and fluid balance.
Their activity is coordinated through signals from the brain and other systems in the body.
The mitochondrial connection
Mitochondria are structures inside cells that help produce energy. In the adrenal cortex, they also carry out essential steps in making steroid hormones, including cortisol and aldosterone.
This makes healthy mitochondrial function important to adrenal hormone production.
Illness, inflammation, toxic injury and nutritional deficiencies can affect cellular energy systems. However, persistent exhaustion does not establish that adrenal mitochondria are failing or that cortisol production is low.
You may hear the term “adrenal fatigue” used to describe exhaustion associated with prolonged stress. It is not an established medical diagnosis, and mitochondrial dysfunction is not simply another name for it.
The symptoms are real. The task is to investigate their possible causes rather than assume the adrenal glands have become exhausted.
Cortisol patterns and symptoms
Cortisol normally follows a daily rhythm, generally rising towards morning and falling towards night.
Persistently excessive cortisol exposure can be associated with sleep disturbance, anxiety, abdominal weight gain and reduced glucose tolerance.
Insufficient cortisol can be associated with marked fatigue, weakness, poor appetite, low blood pressure and difficulty coping with illness. Salt cravings and dizziness on standing may also be relevant.
Someone may describe sleeping well but waking completely depleted.
These symptoms overlap with many other conditions. They cannot tell us whether cortisol is high, low or normal without an appropriate assessment.
True adrenal insufficiency is a medical condition that requires medical treatment.
Cortisol and blood sugar
Cortisol helps maintain glucose availability, including by encouraging the liver to make new glucose from substances such as amino acids and glycerol.
This is called gluconeogenesis, meaning the production of new glucose.
During stress, this response helps make fuel available. Persistently excessive cortisol can contribute to reduced insulin sensitivity and higher glucose.
In genuine cortisol deficiency, the body may have more difficulty maintaining glucose, particularly during fasting or illness.
Shakiness, brain fog and fatigue when meals are delayed deserve attention, but they do not automatically mean low cortisol.
Meal timing needs to suit you
If you feel unwell when meals are delayed, I would review your overall intake and glucose patterns before encouraging fasting.
For some people, balanced meals or snacks approximately every three hours may be a useful temporary structure.
Others do better with a different pattern. The aim is to provide enough nourishment and reduce disruptive highs and lows, rather than impose a rigid eating schedule.
Fasting should not be pushed through when it repeatedly leaves you dizzy, shaky or exhausted.
Sodium and potassium: the electrical minerals
Sodium and potassium help maintain electrical gradients across cell membranes.
These gradients support nerve signalling, muscle contraction and the transport of substances into and out of cells.
They also contribute to fluid balance and normal heart function.
Aldosterone helps the kidneys retain sodium while increasing potassium excretion. However, mineral balance also depends on kidney function, food intake, fluid losses and medicines.
Stress and mineral changes
Stress, illness and inadequate intake can coincide with changes in mineral requirements or losses.
When the body prioritises sodium retention through aldosterone, more potassium can be lost in urine. Think of the kidneys holding on to sodium to help maintain fluid balance and blood pressure, while allowing more potassium to leave.
Low potassium can contribute to weakness, fatigue, muscle cramps and palpitations. Lightheadedness and low blood pressure may occur alongside fluid or mineral disturbances, but they are not reliable signs of low potassium alone. This is why I assess symptoms alongside blood results.
Magnesium is also relevant to energy production, muscle function and nervous system activity.
Changes in mineral balance are sometimes described as a stress related mineral loss cascade. In practice, there is no fixed sequence that everyone follows, so I would assess the individual rather than assume which mineral has been lost first.
Where boron fits
Boron is sometimes described as a “plug” helping retain magnesium.
It may influence aspects of mineral metabolism, but that analogy should not be taken to mean that everyone losing magnesium needs boron.
Your intake, symptoms, results and existing supplements need to guide any decision.
Why potassium needs care
Potassium supplements and concentrated electrolyte powders are not routine recommendations in my approach.
Too much potassium can affect heart rhythm, particularly when kidney function is impaired or certain medicines are being taken.
Where suitable, I prefer to begin by reviewing food sources such as potatoes, vegetables, beans, avocado and fruit.
Coconut water, orange juice and pomegranate juice can also contribute potassium, but their sugar content, portion size and your glucose response matter.
POTS (Postural Orthostatic Tachycardia Syndrome) and low blood pressure
POTS requires particular attention to fluid balance, symptoms and medicines.
For some people, an individually agreed increase in sodium and fluid helps support blood volume.
With POTS, I would not add large amounts of potassium without assessment. Potassium can help the smooth muscle in blood vessel walls relax, which may lower blood pressure. Extra potassium therefore needs careful consideration if you already experience low blood pressure or dizziness.
This does not mean avoiding potassium in normal foods or that potassium is unsuitable for everyone with POTS.
Your blood results, kidney function, medicines and individual symptoms guide the approach.
I would not advise changing sodium or potassium simply from symptoms or a hair mineral ratio.
The liver and cortisol clearance
The liver helps process cortisol into metabolites and conjugated forms that can be excreted, largely through urine.
Liver disease can alter cortisol metabolism. Nutritional status, medicines and the wider health picture may also be relevant.
Persistently excessive cortisol exposure can affect glucose regulation, insulin sensitivity and liver metabolism.
This is why I consider liver health alongside stress and metabolic symptoms. It does not mean that everyone with chronic stress has impaired detoxification or needs a liver cleanse.
How I assess the picture
I begin with your symptoms, daily routine, food intake, sleep, medicines, blood pressure and previous results.
Blood tests may include serum sodium, potassium, kidney function and glucose markers, alongside other investigations relevant to fatigue.
Cortisol testing
A properly timed morning serum cortisol may be appropriate when adrenal insufficiency is suspected, with further medical testing where indicated.
Salivary cortisol has specific clinical uses, including investigation of excessive cortisol in appropriate circumstances.
A daily salivary profile or a DUTCH test may be discussed in selected situations, but these do not diagnose “adrenal fatigue” or replace medical endocrine assessment.
Hair tissue mineral analysis
If hair tissue mineral analysis is considered, I would discuss its limitations alongside any findings.
Hair results are affected by factors such as external contamination and hair treatments. They are not a reliable standalone measure of mineral stores inside cells, cortisol output or adrenal function.
Possible targeted support
These are examples for discussion, not recommendations to begin taking them.
Phosphatidylserine and holy basil are sometimes considered for stress related symptoms. L theanine may also be discussed for relaxation.
Magnesium, vitamin C and vitamins B5 and B6 may be relevant where intake or an identified need warrants attention.
Adrenal glandular products are also marketed for support, but evidence for benefit is limited. They are not replacements for hormone treatment and need careful scrutiny before use.
Liquorice root requires individual assessment
Liquorice slows cortisol breakdown in certain tissues, prolonging its effects. It is sometimes considered for morning support following assessment, but it is not a replacement for treatment of cortisol deficiency.
It is not suitable for everybody and should not be used by anyone with hypertension. It can raise blood pressure, cause fluid retention and lower potassium, sometimes seriously.
This applies to liquorice tea as well as supplements. Your blood pressure, potassium levels, medicines and medical history need to be considered before use.
Sleep and recovery come first
You cannot out supplement a poor lifestyle.
That is not a criticism of someone who is struggling. It means supplements cannot replace adequate sleep, food, recovery and manageable daily demands.
I prioritise consistent sleep opportunities, regular nourishment and realistic changes that reduce the pressure on your system.
Movement should support recovery
Walking, stretching, gentle yoga, dance and free movement can help you reconnect with your body without turning recovery into another demanding programme.
For someone who is depleted, we begin with small amounts and increase gradually according to the response.
Pushing through repeated crashes is not the aim.
Calming the nervous system
Slow, comfortable breathing, gentle humming, singing or gargling may be ways to practise settling and relaxation.
These are sometimes described as supporting parasympathetic activity, the part of the nervous system associated with rest and digestion.
Time outdoors, grounding practices, enjoyable movement and supportive company may also help you feel calmer. They are supportive habits rather than tests or treatments for adrenal hormone deficiency.
My approach
I bring together your symptoms, mineral intake, appropriate hormone investigations, glucose regulation, liver health and capacity for recovery.
The aim is to identify what needs medical investigation, what can be supported nutritionally and which daily changes are achievable for you.
We start gently, introduce changes gradually and adjust according to your individual response.
If you feel you need support in this area, please reach out and let’s take the next steps together towards improving your overall wellbeing.
Lisa Cahill
Qualified nurse and naturopathic nutritionist
Evolve Female Wellness
lisa@evolvefemalewellness.com
All supplements, herbal preparations and testing options mentioned are included as an educational guide, not individual recommendations. They do not suit everybody. Your symptoms, medical history, medicines and relevant results need assessment before a guided plan is developed.