By Ginevra Liptan, MD
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Adrenal burnout is common in fibromyalgia and can really worsen fatigue and fog. Adrenal burnout (also referred to as adrenal fatigue) stems from overworked adrenal glands. The hyperactive stress response in fibromyalgia causes the adrenal glands to work hard—all the time. The continual bombardment of stress response on the adrenals in fibromyalgia forces them to try to pump out cortisol at a high rate continuously. This results in overworked adrenal glands that never get a “rest” period until they “burn out” and start secreting cortisol in abnormal patterns.

There are two ways to diagnose adrenal burnout. One is to look at symptoms. If you have many of the symptoms listed above, especially the highlighted ones, this is a strong indication that adrenal burnout may be an issue for you.

Symptoms of Adrenal Burnout
Brain Fog
Low blood pressure/dizziness
Feeling faint when standing up quickly
Severe anxiety
Feeling shaky/irritable when you are hungry
Frequent thirst
Salt cravings
Low libido
Dark circles under eye
Multiple food or environmental sensitivities

Click image to enlarge.

Click image to enlarge.

The more scientific way to assess the function of the adrenal glands is to look at the pattern of cortisol secretion by measuring saliva levels four times in a day, at around 7am, 11am, 5pm, 10pm.  Any deviation from the normal cycle indicates strain on the adrenals.

Most fibromyalgia patients show mild adrenal burnout with a flattening of the usual curve of hormonal release throughout the day. Several studies have shown this “blunting” of the normal pattern of cortisol secretion in fibromyalgia patients (studies here, here, and here).

My treatment approach to adrenal burnout
I treat adrenal burnout with a combination of supplements for at least three months. Several vitamins and minerals are used heavily by the adrenal glands and may need to be supplemented for adrenal support. These include vitamins C, B5 and B6, and folic acid. Folic acid can be hard for some people to utilize, so I recommend an activated form of folic acid called L-5MTHF. Magnesium is the most important mineral for adrenal function, along with zinc and copper. There are also several important herbs that have balancing effects on the adrenals, including panax ginseng, rhodiola, ashwaganda.  CBD or cannabidiol is also very supportive for the adrenals, and can be useful to add in to any adrenal support protocol, especially if symptoms of anxiety are a big issue for you, with dosing of CBD tincture of 5-20mg up to four times daily.

Don’t expect instant results—it usually takes at least a month before your fatigue will lessen. I tell my patients to think of their adrenals as a bowl that they are trying to fill with sand- but they can only put in a pinch of sand at a time, so the supportive nutrients must be given to your adrenals multiple times a day in small amounts. Cases of severe adrenal dysfunction may require six months to a year of this extra support.

In addition to supplements there are other important actions to take for adrenal burnout:

  • Nutritionally, we can support adrenal glands by eating well and emphasizing protein with every meal, and by limiting stimulants like caffeine, sugar, and alcohol.

  • Drinking plenty of water, and increase salt, especially sea salt. I like to add ¼ teaspoon sea salt to 16 oz. of water twice daily (it should be dilute enough that it doesn’t taste salty). This sea-salt water help increase blood pressure by keeping more fluid in your bloodstream and supplies needed minerals to the adrenal glands. Drinking it is useful to stop the “peeing all the time and still feeling thirsty” feeling that is so common in fibromyalgia. If you don’t want to drink dilute sea-salt water, you can also liberally add sea salt to your food along with increasing water consumption. Don’t add sea salt if you have high blood pressure, however.

  • Reducing stress by activating your own relaxation response with deep breathing, gentle stretching and doing things that give you joy.

  • Get as much high quality sleep as you can.

Here is the approach I use at The Frida Center for Fibromyalgia. Keep in mind a few things with this. This is just a general guide and must be adapted to your own personal health situation. It is always best to consult with a health care provider before starting any new treatments. (Click on supplement names for my recommended product.)

Supplement Breakfast Lunch Dinner Bedtime

SR-Adrenal 2 capsules 2 capsules —- —-

L-5MTHF —- —- 1 capsule —-
(Folate 1000mcg)

Magnesium Glycinate 1 capsule 1 capsule 2 capsules 3–4 caps
(120mg capsule)

Ascorbic Acid 1 capsule 1 capsule 1 capsule —-
(1000mg capsule)

Sea-salt Water ¼ tsp sea salt in 16 oz. water, twice daily

Optional: If ascorbic acid bothers your stomach, use less acidic form in Ester-C instead. If magnesium gives you loose stools, take as much as you can tolerate orally and then apply magnesium cream topically.

Author Bio: Ginevra Liptan, MD, developed fibromyalgia while in medical school. She is a graduate of Tufts University School of Medicine and board-certified in internal medicine. Dr. Liptan is the founder and medical director of The Frida Center for Fibromyalgia and the author of The FibroManual: A Complete Fibromyalgia Treatment Guide For You…And Your Doctor and The Fibro Food Formula: A Real-Life Approach to Fibromyalgia Relief.