Approximately 25% of Canadians and 33% of Americans report feeling somewhat or extremely stressed most days. (4)(30) While acute (short-term) stress is necessary for protecting the body from immediate threats, unmanaged chronic stress commonly experienced by many adults can result in numerous negative health effects over time. Chronic stress may result in dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and subsequent imbalances in cortisol, the body’s primary stress hormone produced by the adrenal glands. (12)
Certain nutrients, such as vitamin C, magnesium, and dietary supplements known as adaptogens may help support HPA axis function and modulate cortisol levels during times of physical or psychological stress. (21) This article will review the body’s physiological response to stress, outline the signs and symptoms of cortisol dysregulation, and provide an overview of various adrenal support supplements benefits.
The body’s stress response
A stressor is defined as a real (physical) or perceived (psychological/social) threat to an individual’s safety. Examples of stressors include physical pain or injury, work overload, social embarrassment, and financial stress. (12) When an individual perceives a threat, a physiological stress response occurs in the body.
In cases of acute stress, the amygdala, found in the brain’s limbic system, will trigger the first phase of the stress response in the sympathetic nervous system, known as the body’s fight-or-flight reaction. This response is followed by a response in the neuroendocrine system. The first phase involves the release of catecholamines into the bloodstream, which produces a number of effects, such as increased blood pressure, heart rate, respiration, and inflammation. (12)
The second phase of the stress response activates the HPA axis, which initiates a hormonal cascade that stimulates the release of cortisol from the cortex of the adrenal glands. Cortisol decreases inflammation, mobilizes glucose for use as energy, and suppresses non-vital organs. (12) All of these effects assist the body in coping with the stressor and returning to homeostasis, a state of physiological balance in the body.
Top 7 adrenal support supplements
When indicated, adaptogens, a type of herbal dietary supplement, can be used to improve resistance to stress and balance cortisol levels. Adaptogens, such as Withania somnifera, Rhodiola rosea, and Panax ginseng, have been shown to play a role in the regulation of the HPA axis as well as improve mental work capacity and tolerance to mental fatigue during periods of stress. (21) Additionally, certain nutrients, such as vitamin C, and magnesium, may play a role in adrenal health. (3)(25)(27)
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1. Ashwagandha (Withania somnifera)
Derived from a small shrub native to India and Southeast Asia, ashwagandha is a popular medicinal herb and adaptogen commonly used in Ayurvedic medicine. The therapeutic properties of ashwagandha are primarily attributed to the bioactive constituents found in the plant’s roots known as withanolides. (7)
Research suggests that supplementing with ashwagandha safely and effectively improves stress resistance. One study of 64 individuals with a history of chronic stress found that supplementing with ashwagandha for 60 days reduced perceived stress levels and lowered serum cortisol levels compared to the group receiving a placebo. (5) Specific to stress management, ashwagandha has clinical applications for individuals with stress-related nervous exhaustion, insomnia, and debility. (7)
2. Holy basil leaf (Ocimum sanctum)
Another adaptogen, holy basil leaf, sometimes referred to as tulsi, is a plant native to Southeast Asia. It has been found that supplementing with holy basil leaf may improve cognitive function and reduce salivary cortisol levels. (26) Tulsi may also combat psychological stress and normalize blood glucose (blood sugar), blood pressure, and blood lipid levels. (6)(15)
In a double-blind, placebo-controlled trial, subjects supplementing with holy basil for six weeks reported a 39% improvement in general stress symptoms compared to a placebo. (28)
3. Phosphatidylserine (PS)
Phosphatidylserine (PS), a phospholipid found in cell membranes, is primarily sourced from soy for its use in supplements. Research suggests that supplementing with PS may help normalize the HPA axis stress response and maintain normal levels of cortisol in the body. (14) In a six week trial, PS supplementation effectively normalized adrenocorticotropic hormone (ACTH) levels, a hormone produced by the pituitary gland that is responsible for controlling cortisol production. (14)
4. Rhodiola (Rhodiola rosea)
Rhodiola rosea is an adaptogenic herb that has been shown to decrease cortisol levels. The roots and rhizome of the plant contain approximately 140 different active compounds, such as monoterpene alcohols and their glycosides, flavonoids, flavonolignans, proanthocyanidins, and gallic acid derivatives. (22)
In one double-blind, randomized controlled trial, subjects with stress-related fatigue were given two daily doses of Rhodiola rosea for a duration of 28 days. The subjects experienced improved mental performance, concentration, and morning-time cortisol secretion, known as the cortisol awakening response (CAR). (19)
5. Asian ginseng (Panax ginseng)
Panax ginseng, also referred to as Asian or Korean ginseng, is an adaptogenic herb that possesses antioxidant and anti-inflammatory benefits. (18) Ginsenosides, a group of steroid-like saponins, have been identified as the primary active components of the herb. Panax ginseng exerts many therapeutic actions, such as neuroprotective, antioxidant, anti-inflammatory, antiapoptotic (prevents cell death), immunostimulant, and anticancer effects. (31)
Research has shown that supplemental Panax ginseng may improve chronic fatigue and reduce the HPA axis response to stress. (9)(17) In one study, Panax ginseng supplementation reduced circulating cortisol and increased enzymatic and nonspecific antioxidant activity in response to physical stress. (9)
6. Vitamin C
The adrenal glands contain one of the highest concentrations of vitamin C in the body, and research indicates that stress can cause the adrenal glands to secrete vitamin C. (20)(23) A randomized, placebo-controlled trial of 120 participants showed that a high dose of sustained-release vitamin C (ascorbic acid) lowered blood pressure, improved salivary cortisol recovery, and improved subjective psychological stress responses compared to the control group. (3)
7. Magnesium
It is estimated magnesium deficiency affects up to 20% of the global population. (8) Insufficient magnesium levels in the body can lead to low stress tolerance and manifest in a number of ways, including fatigue and depression. (11)(29)
Although human trials are limited, some studies have suggested that supplementing with adequate amounts of magnesium may have anti-anxiety and anti-stress effects. (24)(27)
The bottom line
Supplements such as Withania somnifera, Rhodiola rosea, Panax ginseng, vitamin C, and magnesium have been shown to help the body adjust to stress, balance cortisol levels, and support the function of the HPA axis. If you are a patient, we recommend speaking with your healthcare provider to find out whether these adrenal supplements are right for your wellness plan.
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Try Fullscript for free- Aguilar Cordero, M. J., Sánchez López, A. M., Mur Villar, N., García García, I., & Rodríguez López, M. A. (2014). Salivary cortisol as an indicator of phycological stress in children and adults; a systematic review. Nutr Hosp, 29(5), 960–968.
- Allen, M. J., & Sharma, S. (2019). Physiology, adrenocorticotropic hormone (ACTH). In StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK500031/
- Brody, S., Preut, R., Schommer, K., & Schürmeyer, T. H. (2001). A randomized controlled trial of high dose ascorbic acid for reduction of blood pressure, cortisol, and subjective responses to psychological stress. Psychopharmacology, 159(3), 319–324.
- Canadian Mental Health Association. (2014). Stress. https://cmha.bc.ca/documents/stress/
- Chandrasekhar, K., Kapoor, J., & Anishetty, S. (2012). A prospective, randomized Double-Blind, Placebo-Controlled study of safety and efficacy of a High-Concentration Full-Spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine, 34(3), 255–262.
- Cohen, M. (2014). Tulsi – Ocimum sanctum: A herb for all reasons. Journal of Ayurveda and Integrative Medicine, 5(4), 251.
- Cooley, K., Szczurko, O., Perri, D., Mills, E. J., Bernhardt, B., Zhou, Q., & Seely, D. (2009). Naturopathic care for anxiety: A randomized controlled trial ISRCTN78958974. PLoS ONE, 4(8), e6628.
- DiNicolantonio, J. J., O’Keefe, J. H., & Wilson, W. (2018). Subclinical magnesium deficiency: A principal driver of cardiovascular disease and a public health crisis. Open Heart, 5(1), e000668.
- Flanagan, S. D., DuPont, W. H., Caldwell, L. K., Hardesty, V. H., Barnhart, E. C., Beeler, M. K., Post, E. M., Volek, J. S., & Kraemer, W. J. (2018). The effects of a Korean ginseng, GINST15, on Hypo-Pituitary-Adrenal and oxidative activity induced by intense work stress. Journal of Medicinal Food, 21(1), 104–112.
- Fries, E., Hesse, J., Hellhammer, J., & Hellhammer, D. H. (2005). A new view on hypocortisolism. Psychoneuroendocrinology, 30(10), 1010–1016.
- Gröber, U., Schmidt, J., & Kisters, K. (2015). Magnesium in prevention and therapy. Nutrients, 7(9), 8199–8226.
- Hannibal, K. E., & Bishop, M. D. (2014). Chronic stress, cortisol dysfunction, and pain: A psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical Therapy, 94(12), 1816–1825.
- Hellhammer, J., Schlotz, W., Stone, A. A., Pirke, K. M., & Hellhammer, D. (2004). Allostatic load, perceived stress, and health: A prospective study in two age groups. Annals of the New York Academy of Sciences, 1032(1), 8–13.
- Hellhammer, J., Vogt, D., Franz, N., Freitas, U., & Rutenberg, D. (2014). A soy-based phosphatidylserine/ phosphatidic acid complex (PAS) normalizes the stress reactivity of hypothalamus-pituitary-adrenal-axis in chronically stressed male subjects: A randomized, placebo-controlled study. Lipids in Health and Disease, 13(1), 121.
- Jamshidi, N., & Cohen, M. M. (2017). The clinical efficacy and safety of tulsi in humans: A systematic review of the literature. Evidence-Based Complementary and Alternative Medicine, 2017, 1–13.
- Janssens, K. A., Oldehinkel, A. J., Verhulst, F. C., Hunfeld, J. A., Ormel, J., & Rosmalen, J. G. (2012). Symptom-specific associations between low cortisol responses and functional somatic symptoms: The TRAILS study. Psychoneuroendocrinology, 37(3), 332–340.
- Kim, H. G., Cho, J. H., Yoo, S. R., Lee, J. S., Han, J. M., Lee, N. H., Ahn, Y. C., & Son, C. G. (2013). Antifatigue effects of Panax ginseng C.A. meyer: A randomised, Double-Blind, Placebo-Controlled trial. PLoS ONE, 8(4), e61271.
- Kim, J. H. (2018). Pharmacological and medical applications of Panax ginseng and ginsenosides: A review for use in cardiovascular diseases. Journal of Ginseng Research, 42(3), 264–269.
- Olsson, E., von Schéele, B., & Panossian, A. (2008). A randomised, Double-Blind, Placebo-Controlled, Parallel-Group study of the standardised extract SHR-5 of the roots of Rhodiola rosea in the treatment of subjects with Stress-Related fatigue. Planta Medica, 75(02), 105–112.
- Padayatty, S. J., Doppman, J. L., Chang, R., Wang, Y., Gill, J., Papanicolaou, D. A., & Levine, M. (2007). Human adrenal glands secrete vitamin C in response to adrenocorticotrophic hormone. The American Journal of Clinical Nutrition, 86(1), 145–149.
- Panossian, A., & Wikman, G. (2010). Effects of adaptogens on the central nervous system and the molecular mechanisms associated with their Stress—Protective activity. Pharmaceuticals, 3(1), 188–224.
- Panossian, A., Wikman, G., & Sarris, J. (2010). Rosenroot (Rhodiola rosea): Traditional use, chemical composition, pharmacology and clinical efficacy. Phytomedicine, 17(7), 481–493.
- Patak, P., Willenberg, H. S., & Bornstein, S. R. (2004). Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocrine Research, 30(4), 871–875.
- Poleszak, E., Szewczyk, B., Kędzierska, E., Wlaź, P., Pilc, A., & Nowak, G. (2004). Antidepressant- and anxiolytic-like activity of magnesium in mice. Pharmacology Biochemistry and Behavior, 78(1), 7–12.
- Rolf, L., Damoiseaux, J., Huitinga, I., Kimenai, D., van den Ouweland, J., Hupperts, R., & Smolders, J. (2018). Stress-Axis regulation by vitamin D3 in multiple sclerosis. Frontiers in Neurology, 9, 263.
- Sampath, S., Mahapatra, S. C., Padhi, M. M., Sharma, R., & Talwar, A. (2015). Holy basil (Ocimum sanctum Linn.) leaf extract enhances specific cognitive parameters in healthy adult volunteers: A placebo controlled study. Indian J Physiol Pharmacol, 59(1), 69–77.
- Sartori, S., Whittle, N., Hetzenauer, A., & Singewald, N. (2012a). Magnesium deficiency induces anxiety and HPA axis dysregulation: Modulation by therapeutic drug treatment. Neuropharmacology, 62(1), 304–312.
- Saxena, R. C., Singh, R., Kumar, P., Negi, M. P. S., Saxena, V. S., Geetharani, P., Allan, J. J., & Venkateshwarlu, K. (2012). Efficacy of an extract of Ocimum tenuiflorum (OciBest) in the management of general stress: A Double-Blind, Placebo-Controlled study. Evidence-Based Complementary and Alternative Medicine, 2012, 1–7.
- Schwalfenberg, G. K., & Genuis, S. J. (2017). The importance of magnesium in clinical healthcare. Scientifica, 2017, 1–14.
- The American Institute of Stress. (2019, December 18). What is stress? https://www.stress.org/daily-life
- Xiang, Y. Z., Shang, H. C., Gao, X. M., & Zhang, B. L. (2008). A comparison of the ancient use of ginseng in traditional Chinese medicine with modern pharmacological experiments and clinical trials. Phytotherapy Research, 22(7), 851–858.
I need to correct the writer that Chronic Fatigue is not the same thing as Chronic Fatigue Syndrome. It is also commonly called ME Myalgic Encephalomyelitis . Chronic fatigue is just a symptom that can be from many different causes with the syndrome has very specific diagnostic criteria.
Why do some express the importance of vitamin C in adrenal recovery and others don’t even menchion it ??
Hi Julie, thank you for your comment! We provided this as a suggested supplement due to the research and study sourced from our Integrative Medical Team. You will see a hyperlink within the Vitamin C section that links to this citation if you would like to take a look!
I had my adrenal gland removed due to a tumor in January. It’s the end of July and I am in so much physical pain due to muscle tension and cramping it’s unbelievable. I live in orange county California. If anybody knows any functional medicine doctor that deals with chronic pain due to a lack of an adrenal gland please let me know
Hi, my 8yo is has a cortisol deficiency. The article only talks about Licorie Root to help increase it. Are there any other supplements or foods that I can give her to increase her cortisol levels?
When is the best time to take these supplements?? Morning, or evening?? As I have high cortisol levels in evening, have done saliva test. Do not want to take anything that’s going to keep me up as I have insomnia.
Hi Dedra, thank you for your comment. We sincerely apologize but we are unable to make any individual recommendations. Since every person is unique when it comes to their health needs, speaking to your healthcare provider is the best option as they will be able to tailor your recommendation specifically to you. Wishing you a safe and healthy week ahead!
Hi Adriana, thank you for reaching out. We sincerely apologize, but we are unable to make any individual recommendations. Speaking to your daughter’s healthcare provider is the best option as they will be able to tailor her recommendation specifically to her. Since everyone’s health needs are unique this is the best option to find exactly what she needs. Wishing you a safe and healthy week ahead.
morning and noon preferably 🙂
Dr Preston ND in Sunset Beach, CA
562-794-9027
She will know how to help.
Hello, should i take Phosphatidylserine if i produce too litle cortisol?
Thank you
Hi Rasa, thank you for reaching out. Unfortunately, we are unable to provide any specific medical recommendations. It is always best to speak to your healthcare provider for the best options for your unique health needs. Wishing you a safe and healthy week ahead.
I like Dr. Sunny Raleigh. She’s better than most doctors I’ve seen and takes insurance.
Unfortunately my Dr. says there is no check box on the paperwork for adrenal fatigue for insurance to pay. So basically they dismiss my concerns and don’t test or treat for that.
Hi just curious if you were diagnosed with Cushing’s Syndrome? A friend of mine had a cyst removed from her adrenal gland and was initially diagnosed with adrenal fatigue. She is just now getting back to “normal” she gained a lot of weight (about 40 lbs) just concerned now that she might be in chronic pain.
Lessons Learned The Hard Way
I have a wonderful endocrinologist at Barnes in St. Louis. She has made my life sooo much better. At the age of 42, she correctly diagnosed 3 endocrine diseases/disorders: Adrenal Insufficiency, Type 1 diabetes, and Hypothyroidism after my primary care doctor incorrectly diagnosed me only with Type 2 for all these symptoms. I still felt awful if not worse so I demanded labs for everything, including my endocrine system. However, he only tested my sugars leading to the diagnosis of Type 2 Diabetes because “I was too skinny and old to have Type 1”) If you are not aware, Type 1 and Type 2 are very different and are treated differently. Thanks to his lack of knowledge, I ended up in ICU in a DKA coma, kidney failure, a heart attack and glucose over 1,000 because I needed insulin, not pills. I am lucky to be alive! Then I suffered Adrenal Crisis and failure. A simple injection brought me back which I keep with me at all times now. A blood test would have confirmed Type 1 and Adrenal Insufficiency. I fired him and made an appointment with the ICU endocrinologist. Again, more labs were done. I also had hypothyroidism and many deficiencies; some mentioned above. I was put on an insulin pump, 5 mg prednisone daily for my adrenal replacement, thyroid meds, and replacement supplements for my deficiencies. I cannot tell you how much better I felt afterward, though I still suffer to this day.
Later, every time we’d try to wean off prednisone, I could not get under 3 mg. Later, a pituitary gland MRI showed atrophy; therefore, I will be on prednisone for the rest of my life. Here are some words of caution and advice from my experiences:
1. ONLY USE YOUR PRIMARY CARE DOCTOR RUN LABS.(Remember some doctors do not recognize or treat this debilitating disorder) If the labs are off, remember the Monopoly rule: “Do not pass go, do not collect $200.” Move quickly to an endocrinologist. ASAP! BUT first, have your PCP prescribe DEXAMETHASONE in case you go into Adrenal Crisis. If you have a long wait to see an endocrinologist, and if you can trust him, start a few mg of prednisone. Adrenal crisis can be a death sentence. You need an endocrinologist. It is a precarious condition to diagnose and treat.
It is not wise having regular PCP doctors continue treatment indefinitely. This is difficult to diagnose and treat. Also, there are advanced labs and radiology needed now. They need to trace back in your health to analyze the cause. It can be temporary or can be another disorder or disease, even cancer. However, they must figure out the source. Adrenal Insufficiency has many, many causes. Other diseases can have similar symptoms. In addition, the adrenals may only be a part of what is wrong. It may be a much more serious situation and not just an insufficiency
2. Do NOT take adaptogen herbs without research. Most doctors tell you not to take supplements, especially herbs. However, research, research, research. There are some that may work well for you. REMEMBER, everyone has individual needs! BEWARE: Some of the herbs may actually lower cortisol. You do NOT want this if you have been diagnosed with Adrenal Insufficiency. I learned the hard way. Just because it says “Cortisol…” does NOT mean this type of herb will help your case! It may do the opposite.
3. Only add one vitamin or herb at a time. If you have a side effect or improvement, you will not know which one helped. This means NO blends.
4. Chances are you have insomnia because you are also not producing melatonin. Do not take over 10 mg.
5. Supplements I researched for a long period of time that worked great:
-I took C, and it made a huge difference.
low levels of C can cause iron anemia because you do not absorb it properly.
-P5P is the only B6 that will help with nausea if your nausea is due to certain situations. I had severe nausea for over 5 years. 15 mg and POOF, I could live again.
Do NOT take too much or it will make your digestive problems worse! You may also like Activated Charcoal for digestion
problems ie. gas.
-Potassium helped my blood pressure and water weight
-DHEA ONLY IF LABS SHOW A DEFICIENCY
It is one of the most abundant circulating steroids in humans, in whom it is produced in the adrenal glands, the gonads, and the brain. It enhances libido, promotes weight loss, and bolsters the immune system.
-Vitamin D3. I take 10,000 IU a day.
Be sure it is D3. It helps me feel much better. Many people are deficient because of the few foods that provide it are
unpopular. Thus, breakfast cereals are fortified with D.
-Garlic, black elderberry, and Noni
for weakened immune systems
-Moringa Moringa oleifera is a plant that has been praised for its health benefits for thousands of years.
There are 6 health benefits of Moringa oleifera that are supported by scientific research.
-Majinstha My lymph system was in dire need of detoxification.
Lymph is the seat of the immune system. It is powerful for the arterial and circulatory system. 10 x’s better than red beets. I
felt incredible after taking for a month and continue doing so.
-Magnesium has 10 imperative attribute and many people are deficient.
BUT REMEMBER: too much Magnesium will lower cortisol!!!
-Protein! Dense Carbs! Healthy Fats! Hydration!
Excellent for Adrenal Fatigue. I do not eat many foods with protein, so I take a supplement from bovine and chicken.
Before you try supplementing, research, and get blood tests for the types of vitamins and minerals you shouldn’t take an overload of!
Is stinging on top the kidney area a adrenal gland problem? It eventually leads to a whole body itch and pain not long after it starts stinging. I’m finding even saliva makes it sting because I’m not eating anything first thing in the morning. I’m asking because I’m trying to find the right dr to go to. I’m really baffled right now.
You can do a search for functional Medicine doctors in your area on the internet as well as there’s a database for functional Medicine doctors on the internet.
Is the guidance on PS backwards?
I was having 3am insomnia. When I was out of Seriphos (phosphorylated serine) I tried varying doses of phosphatidylserine in place of Seriphos. I zipped through a bottle with maybe 1-3 nights of sleep but otherwise no noticeable benefit.
When I got back onto Seriphos, it took down my excess cortisol during the day if I needed it to, and 1-3 before bed stopped the 3am awakenings (along with eating an Extend bar for glucose support, which I was also supporting during PS).
In short, Seriphos works for me where PS had no effect.
I also use glycine, which I believe is a precursor of each, to soothe my nervous system sometimes.
Hi Timothy,
Thank you for sharing your experience! Though this list of supplements can be typically found in an adrenal support protocol, they are not always suitable for everyone. We highly recommend talking to your doctor about adrenal fatigue and adrenal support supplements that would be suitable for your individual health needs.
Hi Roxanne, thank you very much for reaching out! We really appreciate you sharing your experience. In this case, we do recommend speaking with your healthcare practitioner who would be able to best support your individual needs. Wishing you a healthy and enjoyable day ahead!
Dear Kelly,
My mother has secondary adrenal Insufficiency from long term dexamethasone treatment 4mgr, which herbs according yours research and personal experience (for your case ) will help to adrenals to produce cortisol again ?
I know that adaptogens lowers the amount of cortisol that adrenals produce, which is your opinion about panax ginseng?
Kostas
Hi Kostas, thank you for your comment! In this case, we’d recommend that they check in with their healthcare practitioner about what they’d recommend.
Very good article! Keep up the good writing.
You ought to be a part of a contest for one of the highest quality blogs on the internet.
I’m going to recommend this blog!