It’s dark and it’s late. You’re coming out of a club in the city heading back to your car, which is parked on a poorly lit side street. About 50 yards from your car door, you notice a man crossing the street toward you. Nobody is on the street.

Your heart is racing, and your muscles tighten. You are on red alert. Should you run? Prepare to fight? Your keys are already in your hand – you could use them to defend yourself. Your fingers clench so tightly around the keys that you feel them digging into your palm. You recognize this feeling. It’s terror.

Now closer to you, you hear the man’s footsteps stop and from the corner of your eye you catch light coming from an open apartment building door. You hear laughter. You turn your head slightly and see a woman step out of the building. She embraces that man. More laughter…

Your shoulders drop, your breathing relaxes after a huge exhale accompanied by a nervous and relieved chuckle. You release the grip on those keys clenched in your hand. You’re safe.

Threat, Perceived Threat, and The HPA Axis

This man never was an actual threat to you. But your nervous system’s fight or flight response, the primitive survival mechanisms that start in your brain and quickly extend into your entire hormonal system through the hypothalamic-pituitary-adrenal axis (simply say HPA axis and you’ll still sound wicked smart!) didn’t know this. Your brain is so exquisitely tuned to protecting you that it just responds to your perception of danger and there you go – fasten your seat belt because you’re going on a stress-hormone ride!

This HPA axis is incredibly effective at mobilizing the energy you do need to run – or fight. Sugar is pumped into your bloodstream in rapid fire. Your body even breaks down fat and muscle to create extra sugar in case it’s needed. Insulin is pumped out to regulate the sugar. Your blood vessels constrict, causing your blood pressure to go up. Your body directs energy away from any functions that aren’t needed in the face of danger – like digestion and reproduction, affecting your gut and your hormone balance.

When the danger is done, your body is designed to quickly recover without any lasting damage. The extra blood sugar gets swept up into your cells by the insulin, your blood vessels relax, and blood flow returns to your gut and reproductive hormones once again get released in normal amounts. All of the numerous changes caused by the activation of the HPA axis return to normal.

Thankfully, most of us do not find ourselves on dark roads thinking we’re being followed too often. However, most of us do experience more minor levels of stress on a day-to-day basis that keep us in survival mode. And if we’ve had past trauma of any magnitude, even relatively small, we are more primed to perceive situations as threatening.

Chronic Survival Mode

Here are just a handful of situations that keep us in chronic survival mode. I’m sure you can probably relate to one or more:

  • A periodically or chronically stressful work environment/boss/co-workers
  • A stressful home situation or relationship
  • Financial stress
  • Illness in yourself or a family member
  • Episodes of low blood sugar because you’ve been too busy to eat much more than a cup of coffee and a muffin, or you’ve skipped meals all together
  • Poor sleep making you feel irritable, crave sugar, and feel at the end of your rope
  • Being overwhelmed by things to do, and feeling like you’re never going to get them done
  • Getting stuck in traffic on your way to a meeting or to pick your kids up at school
  • Running late and getting stressed out about it
  • Having to get your taxes in and your bills paid

These are all real stressors that activate the HPA axis – and are even more activating if you’ve been fired from a job, experienced a relationship trauma as a child or adult, been exposed to vulnerability due to severe financial stress, or any other stressful past trauma, or perceived potential disaster, because then your perception of each incident as a possible threatening trigger is even higher.

When chronically activated, the HPA axis puts us in a state of on-going survival mode, and this can have a huge impact on numerous aspects of our health, leading to:

  • Overweight, especially around the middle, and difficult or near impossible weight loss
  • Difficultly falling asleep, poor sleep, or waking up tired even after a full night of sleep
  • Poor immunity, getting sick a lot
  • Chronic exhaustion, overwhelm, poor emotional, mental or physical resilience
  • Irritability, anxiety, feeling tired and wired, depression, hopelessness
  • Sugar, caffeine, and other food cravings
  • Episodes of low blood sugar
  • Insulin resistance, metabolic syndrome, high blood pressure, high cholesterol
  • Poor mental function, concentration, or memory problems
  • Hormonal problems from irregular periods to fibroids to infertility to PCOS to hypothyroid

For this blog, I want to emphasize the connection between being stuck in survival mode, and its effect on thyroid function, and offer you tools to heal both.

The Adrenal-Thyroid Connection

Your thyroid gland, the butterfly shaped small organ at the front of your neck, performs literally hundreds, if not thousands, of essential functions related to growth, metabolism, hormonal control, and utilizing and conserving energy depending on what your body needs moment to moment. Your adrenal glands, two tiny triangular glands (I mean you blinked you missed them small!) sitting atop your kidneys, control the hormones and nervous system chemicals that regulate your stress response, immunity, blood pressure, your reproductive hormones, and much more.

When you are under prolonged chronic stress your adrenal system tells your body to conserve, rather than spend too much energy. Your thyroid slows down, too. It’s like a warning system that protects you from over-drafting on your energy bank account.

Further, chronic adrenal stress has a major impact on your immunity – over time increasing your risk of developing chronic inflammation and autoimmunity.

These are the two primary gateways that lead from the chronic overdrive of your survival mechanisms – your adrenal function – leading to Hashimoto’s thyroiditis, or autoimmune hypothyroidism which is responsible for about 90% of all thyroid dysfunction in the US.

When you are under stress, immune system chemicals called inflammatory cytokines (which have names like IL-1 beta, IL-6 and TNF-alpha) are released. These “down regulate” (medical speak for decrease) the production of the key thyroid related hormones TSH, T3, and T4, make the thyroid less sensitive to TSH which stimulates the function of thyroid hormone production, and decreases the conversion of the inactive form of the thyroid hormone T4 to the active form, Free T 3. Acute stress can do this for days; chronic stress can make this a more regular state and in time, lead to thyroid suppression – or hypothyroidism. Chronic inflammation also makes the thyroid hormone receptors on your cells less sensitive to the active form of thyroid hormone, such that thyroid hormone can’t do its job. This is called thyroid hormone resistance.

Remember how I also said that chronic stress diverts energy away from important functions like your gut and your reproductive hormones? These can also have an impact on your thyroid function.

When you are under stress, blood flow gets directed away from the lining of your gut, and also, the chemical environment of stress has a direct impact on your gut flora leading to overgrowth of the more harmful species at the expense of the good guys. Both of these gut changes can lead to a condition called leaky gut which makes you more susceptible to all manner of food triggers and harmful gut bug triggers from gluten to dairy to numerous other foods, and to developing a condition called “endotoxemia,” all of which in turn can lead to inflammation in your body significant enough to ultimately lead to autoimmune conditions. Cutting out food triggers as part of reducing the stress your body is under is an important part of healing the adrenal-thyroid connection. An elimination diet and 4R program can help you to identify food triggers, heal your gut lining, and improve your gut flora.

Hashimoto’s thyroiditis is the most common autoimmune disease in the US, affecting far more women than men, and rates are on the increase along with our stress levels! It’s also a vicious cycle, because the more our body perceives stress due to inflammation, the more the stress response system gets triggered. We pump out more cortisol, one of our key stress and inflammation protection hormones, which in turn causes us to gain more weight, break down muscle for fuel, and store extra fuel as harmful forms of cholesterol.

Cortisol reduces our ability to clear estrogen from our system through our liver. Increased estrogen up regulates (medical speak for increases) the production of a carrier protein called thyroid binding globulin (TBG) which does exactly what it sounds like – binds onto thyroid hormone. Bound forms of thyroid hormone are not very active – so your thyroid function goes down even when your thyroid is pumping out the stuff like it’s supposed to. The active free form just doesn’t get to your cells where it’s supposed to do its good work.

The problem gets even more complex, because it’s part of the role of the thyroid to metabolize cholesterol – so not only is your overworked or now exhausted adrenal stress system causing you to produce more cholesterol, inefficient thyroid functioning is preventing you from using it up. BOING: you end up with high cholesterol even if your diet seems pristine!

Not to mention, you’ve either got the symptoms of hypothyroidism: fatigue, weight gain, dry skin, constipation, thinning hair, irregular hormone function and menstrual or gynecologic problems, and more, or you’ve actually developed Hashimoto’s!

The Adrenal-Thyroid Cure

You can nip these vicious cycles of the stress-adrenal-thyroid connection in the bud – or kick them in the butt! Here’s what you’ve gotta’ do:

  1. Become familiar with your signs of stress response, or “being stuck in survival mode.” Once you learn to recognize them, you can learn to respond quickly with a relaxation response, rather than react with a prolonged stress response. See # 3 below for relaxation response techniques.
  2. Identify those areas of your life that need attention so that you can get out of survival mode and into a life that you love living. This might mean saying no to some things you’ve taken on, rethinking how you approach your work:life ratio, take more time for self care so you can have the resilience to cope with what’s on your plate, rethink your economics to want less of what you don’t really need and earn more so you can have what you do need, reaching out to friends (oxytocin, the love hormone gets released when we connect with peeps we love, and this is a counterbalancing hormone to the stress system).
  3. Develop a regular “stress decompression” practice. We all need tools for on the spot stress reduction, and also regular self-care habits that keep our nervous system well fueled for meeting life’s invetiable stresses. My favorite exercise for traffic jams, the sudden urge to quit your job or throw something at your boss is called “the quickie.” Here’s how to do it:  Center yourself wherever you are, sitting or standing or lying down, feeling the parts of your body touching the ground…just feel that grounding with the earth. Breathe naturally at first, then after a few breaths, inhale for 4 counts while saying I am in your mind. Then exhale for 4 counts while saying at peace to yourself. Repeat this I am…at peace cycle at least 4 times.
  4. Keep your blood sugar balanced. You’re feeling shaky, in a hot or cold sweat, and losing your concentration. Maybe you’re a little nauseated or even faint. You realize you haven’t eating since this morning and it’s already mid-afternoon. Ok you’ve eaten at little bit, but just coffee and a Danish – not real food! Most of us gals know the feeling – we’ve been there at one time or another. The blood sugar crash, or “food emergency,” is super common – and it takes a major toll on the adrenal stress system. You see, your brain is DEPENDENT on a steady supply of sugar to keep it happily humming. Low blood sugar is a brain emergency of the highest magnitude. So you’ve got to’ feed your head. Regularly. With protein, good quality fats, and carbs from whole grains and veggies. My top tips for keeping your blood sugar steady are: eat protein at breakfast, don’t skip meals, graze on high protein snacks if your blood sugar tends to tank, and keep a healthy emergency food stash within reach. You can read more here.
  5. Use adaptogens to support your adrenal stress response and cool down your immune-inflammatory reactions. Adaptogens are a special class of herbal medicines that have been used in Traditional Chinese and Ayurvedic medicines for centuries to promote a sense of well being. In those systems, these herbs are considered the “Kings” and “Queens” of herbal medicines for restoring health, vitality, immunity, stamina, and promoting longevity. The term adaptogen refers to the unique ability of these herbs to help you adapt to the stress in your life. They do this by “normalizing” or “regulating” the adrenal stress response.

Order My New Book!

Let’s Take Back Your Thyroid Health…Starting Now

Adaptogens help your body to cope more effectively with the demands of everyday life. They provide a sustained sense of calm, and while they increase energy, with the exception of Chinese ginseng, they are non-stimulating. In addition to their effects on stress adaptation, adaptogens have profound antioxidant and anti-inflammatory effects that protect your cells from damage from a variety of chemical exposures. Also, one of the definitions of adaptogens is that they are non-toxic, even with long-term use. You can rely on these herbs to be safe and gentle. My “Top Five” are Tupac, Nas, Lauren Hill…I mean, Holy Basil, Ashwagandha, Rhodiola, American Ginseng, and Reishi. Click here to read more about these herbs and their specific benefits.

Taking care of your stress system will help quiet down your inflammatory responses, allowing your thyroid to more effectively produce thyroid hormones and revert Hashimoto’s antibodies (I’ve seen this happen many times!), and allow your cells to convert and use those thyroid hormones. In the process, you’ll find yourself more energetic, resting better, losing those love handles you just don’t love and couldn’t get a handle on, your cravings will fade, and life will seem so much easier!

To your fabulous health!

Dr. Aviva


Get the first chapter of my new book The Adrenal Thyroid Revolution, FREE right here.

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    • I have purchased your book on Is there any way to access the diet/information in printed form?
      Excellent by the way.

      • Hi Shana!
        I am the nurse practitioner in Dr Romm’s practice, and I often hop in to answer comments and questions since Dr Romm doesn’t always have time to get to them all!
        Send an email to [email protected] – Megan may be able to help you with printed content.
        Thanks for purchasing Dr Romm’s book! We hope you love it!

  1. I needed to read this today. I have been dealing with adrenal issues for several years now and really thought I had a handle on them. The last two months I really pushed my self physically causing too much stress, and I can tell that I have undone much of my progress. Back to being a kind steward to this body and spirit.
    Thank you Aviva for being such a wonderful guide. Your books were with me during childbirth and postpartum and now as I raise up my big babies. Might there be a book on menopause in the works? Fingers crossed;)

    • Thank you Eden! LOL — the next book is on overwhelm and women’s health. When I’m done with that, I’ll likely be in menopause myself — so that’s likely when that book will emerge! <3 Aviva

  2. Aviva,
    What a very informative , and helpful article . I thank you for such great information and tips for us to do. I suffer from hypothyroidism and have gained weight . As now I feel so uncomfortable and don’t know what yo do, I will try your tips. Thanks! Love your website.

    • Hi Aviva,
      Been reading some of your articles and was very impressed.I was wondering if you have any info on pcos.Know s/o trying to get pregnant for 2yrs ,diagnosed with pcos put on letrozole but its not working.Any advice.Another issue is a nose polyp,how to shrink it while pregnant.waiting to hear from u.thank u in advance.Sar

  3. You have done it again! Thoughtful, informative, and real strategies for living a healthful life, no gimmicks or hyperbole. When I have health concerns for myself or family I always turn to you, and this is why. Thank you so much Aviva!

  4. Dr. Romm:
    Ashwagandha was recommended to me by a therapist I am seeing. However, I had a thyroidectomy three years ago and am on Synthroid. In my research to find if it would be safe to take Ashwagandha while on Synthroid, I got various answers. The company that makes Synthroid couldn’t advise one way or the other, but I came across information on one website that said you should not take it if on Synthroid. Any comments on this? Thanks, June

    • There is a small amount of data that suggests some interference with ashwagandha and thyroid medication. You could try all of the other approaches and choose any of the other adaptogens, or ask your doctor to monitor TSH and adjust thyroid medication appropriately if you choose to use abhwagandha. Great question! Aviva

  5. So much more information than my endocrinologist has ever given me. I have tried for years to get help treating Hashimoto’s naturally… unfortunately, medicine is much more of a simple answer for most doctors. I’m going to continue trying to find my natural path. Thanks Aviva!

  6. What about hyperthyroid. I had my thyroid removed 6 years ago due to Graves disease and I have always thought this likely came about because I had a very stressful job and have a nature, like many women, to try and “fix” the problems of all my loved ones. So many aspects of life were stressful.

  7. Hi Aviva! This article is so timely for me, as I’ve been struggling with my adrenals. I’m on a supplement to support adrenal health that has some of the herbs you listed. Is it safe to be trying to conceive a child while taking these herbs? I know you’ve said to steer clear of herbs in the first trimester, but are they safe up until I get a positive pregnancy test? Thank you so much!!

  8. When I was 15 years old, I was diagnosed with Adrenal Hyperplasia. The year was 1968 and I had male pattern hair growth and had experienced only one period at age 11. I have often wondered if my diagnosis was correct. I’ve also wondered if my symptoms could have been caused by a very stressful childhood. The symptoms haunted me and made me feel like a freak. Do you have any possible answers?

  9. Thank you so very much. Although I’m not diagnosed with thyroid issues I know that I’ve lived in constant survivals mode since childhood. I have taken adorable support in the past and found it wonderful. I stopped as we were trying for babe number two, who is now 10.5 months. And idea about these herbs and breastfeeding?

    I’m not sure how and in what quantities to take thaws herbs. Amy help would be greatly appreciated!

  10. We’re fortunate to have such a caring person to share her wealth of knowledge for the betterment of all who need it. Thank you. Saw you on Dr. Oz today and smiled. Great job.

  11. Hi! Thank you for this article. Are any of the adaptogen herbs safe while breastfeeding? I had my second child 4 months ago, have Hashimotos and Celiac and am crazy inflamed. Trying to figure this all out.

  12. Hi Dr Romm, I love your articles. My adrenals are completely fatigued and I’ve gained a ton of belly weight recently. My energy levels are so low that I crash after exercise, and in turn my mood plummets. I’m stuck in a vicious cycle. My ND prescribed a cortisol support containing many of the adaptogens you listed. My question is that I take an anti depressant and I’ve read that ashwaganda can cause serotonin syndrome. What are your thoughts on this? Thank you!

  13. I truly appreciate all the wonderful information and effort you put into your articles and wish I could find a practitioner like you where I live! I would really like to try an elimination diet for my family. I am hypothyroid, chronically anemic in iron and b12 and have allergies. One daughter has sensory processing and anxiety disorders and the other has had chronic constipation since she was small so I think it could be extremely helpful for all of us. I find the thought of planning the meals for myself (while breastfeeding my 9 month old baby), reluctant husband and 2 picky school aged kids (who I would also be packing school lunches for) quite overwhelming. Do you know of any good 3-6 week elimination diet plans that would have all the meals planned out with recipes to help make it a little simpler?

  14. Really well explained thank you! I’m going to forward on to some of my patients (I’m a physical therapist) and this explain a lot of what we discuss, very well!

  15. this was a fabulous piece of reading! As a weight loss consultant dealing with thyroid and stress issues several times a day, I could not agree more as to how the essence of hormones have been captured so precisely and fluently! I read tons on hormones but I can easily say .. you are my favourite author and I literally look forward to your emails… absolute quality information! and very happily recommend you to everyone!! you are amazing at what you do – a role model!

  16. I have all of the triggers and symptoms. I have thought I had an adrenal problem for years, I also have a pituitary adenoma, and have recently had a positive ANA. I have visited Dr. after Dr. Trying to find someone who will listen to me and help. A Rheumatolgist dismissed the positive ANA and said don’t worry about it. I have a good diet and exercise, but can not loose weight. Been feeling hopeless and thinking that I just have to accept that this is my life. I am happy to read this article, maybe there is some hope.

  17. Dr. Romm,
    Thank you for such a great article! This describes me to the T! This gave me peace of mind, and made me realize it’s time to move forward and remove some of the stress factors from my life. I had an MRI (on my back) and the surgeon said I had a mass on my adrenals, I went to my PCP and she poo-pooed it of and said “everyone does” yet year after year I have always had to have 2nd and 3rd blood tests for thyroid “issues” yet everything in the end comes back “ok”. Thank you for clearing up the connection. So thrilled I found your website!! Thank you!!!!!!

  18. We love your work!! I needed this gentle reminder to continue my healing path. Synthroid was never effective for my hypothyroid. Nutritional changes helped & so did Armour thyroid supplement. But since we do not live in a perfectly balanced environment…. Things changed & was stuck. Read your wonderful article on adaptogens a while back. And though I was using Ashwaganda, I found that a combo was needed. Energy returning and getting back to center. Thank you

  19. Reading this gives the impression that all hypothyroid problems are due to stress, and people not managing their stress well – basically something that people are doing wrong. Isn’t it possible that thyroid issues are genetic and happen for other reasons unrelated to people’s stress level? In short, I feel guilty, like I did something wrong, after reading your article, because I have Hashimotos…..

    • Hi FC
      So sorry you felt this way. This is certainly not my meaning nor my intention. First of all, stress isn’t something we necessarily do to ourselves — it’s a major part of life for most people. Stress is the biggest preventable contributor to disease, along with diet, but we’re not taught how to manage our stress as kids – and most of us as adults are just buried by it. Of course, there are many contributors to Hashimoto’s — for example, environmental toxins and allergens that can interfere with thyroid function at many levels. But this articles is specifically about stress and thyroid – that’s why the focus on it. Hypothyroid is potentially caused by a genetic susceptibility, but there usually has to be a trigger that sets it off. A viral infection, a major stress like a serious event in someone’s life, etc. The point of this article — and all of my articles — is not to feel blame or shame but to be able to be empowered to identify those things we can change, and do so, so we are not victims of the stresses of our society or anything else. Be well! Aviva

    • I agree. I have hypo thyroid, genetic predisposition. I am not going to feel guilty about this orone more thing ican’tcontrol

  20. This is very intriguing reading. I am a 34yo sahm, and for a while now (since leaving the full-time work force 7 years ago) I have wondered about my own thyroid function. I have many of these symptoms listed esp. sugar cravings, fatigue, difficulty losing weight around middle, etc. My problem is, I have four kids, ranging in age from 5years to 10 weeks (not kidding), all boys. Seriously, is it even possible to know if I have the imbalances described here or if the constant cycle of pregnancy/nursing/mothering/repeat jut has me spinning at the moment?! I was a high-octane professional before being a mom, and I have fought these symptoms for a while. Thank you!

  21. Thanks for the great empowering information! I am currently pregnant (32 weeks) with my baby #3. Every pregnancy and postpartum period puts me in the this spin of stress and therefore I end up with major adrenal/thyroid issues that take a couple years to resolve (or in my case, just in time to have another baby). It’s so hard to find quality and accurate information on thyroid/adrenal health during pregnancy. I know my thyroid issues are a result of stressful pregnancies and the postpartum period. Despite what I try to do to stay calm and nourish my body, my body goes into fight or flight mode. Do you have any resources for dealing with this during pregnancy and nursing? I have read mixed reports on adaptagenic herbs during pregnancy.

    • Hi Cori,

      This is Megan from Dr. Aviva’s team. So sorry for the delay, Dr. Aviva gets hundreds of comments and she is working on getting caught up. By now you have most likely had your baby and I wanted to point you to an article that Aviva wrote on adaptogens. It’s incredibly helpful and loaded with wonderful supportive information, especially for new mamas.

      Megan- Dr. Aviva Romm Nutritionist

  22. I have not been diagnosed with anything but this all is what I experience on a regular basis. What kind of doctor do I go to so that I can begin the road to health and have proper bloodwork, testing, etc.

    • Hi Korrine,

      An appointment with an integrative or functional medicine doctor would be most helpful. If you are having a hard time finding one in your area or near you, The Institute for Functional Medicine is a really great resource for finding a practitioner in your community.

      Megan- Dr. Aviva Romm Nutritionist

  23. Thank you so muh for laying this out so clearly. This whole episode just happened to me and I’m sending this article to my husband so he can fully understand what’s going on!

  24. I was diagnosed with the beginnings of Hashimotos a couple of years ago, and because of a misdiagnosed parathyroid adenoma, had my thyroid removed. Now when I read all of the information about thyroid health, I don’t know what to think of it and how it applies to me. I generally try to eat real foods and manage my stress, but I wonder about about a few things, like foods that are supposed to make thyroids sluggish . . . would they also make my thyroid meds less effective? Are there foods I should avoid or eat more of to help with my thyroid med processes? Also, I wonder if the auto-immune process could be attacking some other part of my body, like my pancreas, since I am the only person in my family with diabetes, and I was not very overweight at time of diagnosis (not at all now), had low-normal blood pressure, and good cholesterol. Do you have any insight to offer with these things?

    • Hi Wendy,

      This is Megan from Dr. Aviva’s team. Please check out Aviva’s new free Thyroid Insights Ebook — you can download it from her website — hopefully you can find some good supportive info that will be helpful for you.

      Megan- Dr. Aviva Romm Nutritionist

  25. As a midwife, doula and someone with Hashimotos, I’m trying to find a way to do the job I love with the stress of the on-call lifestyle and interrupted and lack of sleep that are probably keeping me in chronic survival mode.

  26. Thank you so much for a fabulous and insightful article explained to us in terms non-medical people can understand. My mother was diagnosed years ago with a thyroid condition and has had various procedures done and is taking the Armour thyroid medication. I seem to have many symptoms of hypothyroidism but have never had the tests. I also recognize that I need to manage my stress and I actually use your breathing technique especially at night. I think I will use it more to manage on the spot situations. I recently purchased some of the adaptogenic herbs and Dr. Hyman’s 10 day detox book. Now I’m going to develop an action plan and follow through with an appt to an endocrologist to determine a diagnosis. I have your list of tests I’m going to ask for too! Either way food, herbs, and managing my stress are now a priority. Lastly, I will be looking for your next book on Overwhelm and Women’s Health! Thank Youx100!

  27. Excellent Job ! . Thank you for simplifying the complex “HPA axis ” for a wider audience . I am sure your article will serve a great reading for thousands of people enduring stress every day .and unknowingly becoming chronically ill..
    Thank you

  28. Adaptogens can have negative counterintuitive effects on people with severe adrenal fatigue. Ashwagandha and rhodiola can have a very stressful and wired effect on those people, making adrenals worse. Look it up.

    Things that have helped me most with my adrenal fatigue? Giving up caffeine and strenuous exercise, meditation, lots of sleep, Celtic sea salt on everything, and high dose Vitamin C.

  29. wow. what an eye opener. I’m having autoimmune and thyroid issues. Love to discover that there is something I can do to help my body heal naturally. Thanks a bunch!
    I am …At peace… just tried my first one!

  30. Great article! I wish I could find an answer for me. I had Thyroid cancer & had all my thyroid removed 16 years ago. I am on synthroid everyday but still get a lot of the symptoms. I try to get tested about every 6 months & the dosage is adjusted.

  31. This is the most focused and excellent information that I have ever read on the HPA axis. It is also very encouraging as I have all the symptoms of hypothyroidism, adrenal fatigue and leaky gut, although my thyroid tests keep on coming back as ”normal”. I suffer(ed) from adrenal fatigue and battled to get out of it being in a system where I was told that there is no such as thing as adrenal fatigue Iam just a difficult person ! You also learn to monitor your stress resilience which is much weaker in the process of healing than before adrenal fatigue. Aswaghanda and more recently the elimination diet has added so much energy and more resilience to my system. I also have a thyroid which caused me hair loss, anxiety, irritability, cold sensitive, and belly weight gain and heart palpitations. I also have high levels of estrogen and I have a sensitivity to medication especially conventional hormone treatments and some antibiotics. I also have wheat and lactose intolerance for many years and I can trace back the years of long term stress and use of conventional medication which did not correlate with my system, which cause havoc in your system. I now pace my exercise and look what I eat and take my vitamins and probiotics on a daily basis and it really helps and also concentrate to engage with people that are not discouraging. This is a journey not for the weak and you discover more about yourself and your body every day ! What i can see now is to NEVER underestimate the effects of long term stress on your body, never think it will not catch up with you later, it does ! Never believe anyone that tells you that that is life, as it is not, they are lying, life is health and happiness. I have learnt to walk away from negative and draining situations which makes you feel helpless and that you will never ”get” there and also to look at those situations and people differently, disconnecting myself from them where I can and while in certain case still being involved but in a disconnected way, being able to see them for who they are. Concentrating more on the things that build my energy the feeling good things and also to make more time for myself. I have also learnt that people who identify a problem and project it onto you, actually own the problem themselves and instead of feeling guilty bad and despondent etc, i can now see it for what it is and save my energy for the good stuff and that is very empowering and also helped my system to cope much better. I can also feel that sauna, swim and yoga and rest when Iam tired and good friendships have added much balance to my system lately. This article has encouraged me to continue and to strengthen my healing journey. Thank you for this !

  32. Amazing and helpful article! Would Triphala fall under one of the great adaptogens? (It has worked wonders for me and I believe it’s an adaptogen)?

    • I don’t consider it an adaptogen per se, but it is a traditional tonic and digestive remedy. Glad you’ve found it super helpful!

  33. I have been living with this for years. I’ve been working to heal it though diet and herbal support for about 2 years. As a result of my leaky gut I ended up with a nasty candida overgrowth. It is a challenge and I am sometimes discouraged. Thank you for the article. It’s comforting to see it all out together in one article.

  34. My sister suffered from Addison’s Disease. A horrible stress disease that put her body through everything your article talked about. The one thing she would want people to know about the body’s hormones is how amazing prednisone is to help all hormone health issues. All the doctors did was put her body through 20years of harmful medicines. Its wonderful to read such helpful information for people suffering.

  35. Amazing article! I think that this my biggest issue with both pcos and my thyroid resistance. I’ll work on incorporating your advice. It can be oh so complicated.

  36. Hi Aviva!
    Well, I feel as though you have just diagnosed “issues” I’ve been experiencing most of my adult life….. As though the article was written about me! Thank you so much. About to click on all the links in this article to increase my knowledge and understanding of what’s going on and what I can do about it. I’m turning fifty this year, and want to feel how I ought to have at 25. Bring it!

  37. Dear Dr. Romm, I almost cried when I saw your site this morning. As a patient with long standing pituitary and subsequently thyroid and adrenal problems, I have been frustrated with the medical community who just treats the symptoms of these. When I did a naturopathic physical, emotional, intellectual and social history, it was very clear to me how this was all related to the HPA axis. It took me 28 years to find a physician – a naturopath – who listened to my theory of pituitary and thyroid problems being a secondary problem to the hypothalamis effect. Even as a critical care and legal nurse, familiar with evidence based research and finding appropriate research, I was unable to have these conversations with my physicians. Answers to what caused my pituitary and thyroid problems and why I have to take thyroid medication “forever” was consistently met with – “you just do”. One naturopath finally listened and watched me draw out my full history and my theory to the primary and secondary problems, and actually said, “I agree with you”. I just cried. The frustrating part is, even with the adaptagens and sugar control, I have yet to be able to reverse most of the problems. I look forward to reading your work and seeing if you have more answers. Thank you! for thinking outside the box and seeing the body as a whole instead of the usual western medicine compartmentalized view. I applaud you! Audrey Friedman RN

  38. Thank you for this article. I have been suffering in silence for years with Thyroid/ Adrenal issues. I’m currently taking medicine which works part of the time. I get to that point I’m in survival mode. when I crash and burn and can barely get it together, I get so frustrated.

  39. I just found your website through FM and am in love. Thank you for this lovely article! I suffer from hypothyroidism, which was discovered in the first trimester of my first pregnancy. It has been going up and down since then (3 children later) and am now on Eltroxin 50 mikrogr/100 mikrogr. I really don’t like the thought of having to do synthetic hormones for the rest of my life. It is there for a reason and I am sure I must be able to heal it too. I don’t feel especially good, even taking the Eltroxin. Recently discovered that my hormone spiral is probably not adding any good to the situation (will be removed next week). All in all, I am on a mission to help my body cure itself and read about adaptogens in your article. Adaptogens, that will support my body in recovering. Do you recommend specific adaptogens for hypothyroidism (you mention a few); do I pick what I think is best of should I opt for the whole list? Thank you so much, am staying on your page!

    • That would require a very long blog (will eventually do) or even a book! I do like what both Christiane Northrup and Marcelle Pick have to say — but in general I take a conservative approach, using mostly only topical forms of estrogen for patients, and sometimes oral progesterone troches if symptoms are severe in spite of other natural approached.

  40. I am full time nursing my 3.5 month old baby, and I feel as if I suffer from most of the ailments on the list. Which of the adaptogens are safe for lactation?

    • There are no contraindications to the adaptogens while BF’ing, however, I have seen ginseng overstimulate babies when mom is taking it.

  41. Thank you for writing an article on the relationship between adrenal & thyroid function that everyone can follow. After many years working in a high stress job I was finally able to resign. Unfortunately the stress has taken a tole on my health. I had a hormone panel done which confirmed my adrenals are exhausted. The path of healing is not short or easy but with support of my primary care (who gets it!) and my husband I am feeling better one day at a time.

  42. Thanks for a great article Aviva! I have adrenal fatigue and have been struggling with insomnia and almost constant fatigue because of it…I am wondering if it is okay to take all 5 of your top adaptogens at once or if more is not necessarily better? Or if they even make supplements with a combination of the recommended adaptogens together in one pill?


    • Hi Angie! Yes, it is okay, actually, and many combination products do use this many….but you can also start simpler and see what works more specifically for you.

      • I have panhypopituitarism. My adrenal nor any of my glands work. I have times when I am strong and feeling so well, and other times I am so week I can barley function. Thank you for the information.

  43. Hello! First – your musical adaptogen list made me smile… GOOD CHOICES that I often turn to myself =]

    Second – I’m having a total thyroidectomy in exactly two weeks and I’m scared pantsless. Never had surgery (39yo), and am concerned about medication and other issues that will arise due to the loss of my thyroid (always tested within normal range (lower end) but never medicated. Having procedure done due to 50% compression on my trachea from a large 7 hormone-producing multinodular goiter.

    Do you have any advice for questions I should ask my Endo and surgeon before I go under? I’m also gluten sensitive (makes my thyroid blow up), but do I have to be as concerned once it’s removed? I’ve also heard about T2+T3+T4 replacement therapies being better than just Synthroid, et al. Your opinion on that?

    THANKS so much for all of the info you provide!

  44. Thank you so much Dr. Aviva for your posts, including this one, for Healthy MD Radio, for Healthy Kids All Year around course, Reset your Gut Program and so much more! I am enjoying all of the above so much and still hoping to finally hop on regular studies in Herbal Medicine for Women and Children. I was trying to find the link to pre-order the book on Thyroid and Adrenal Revlution, and silly enough cannot find it 🙂 Could you please share it if you find this place appropriate. Thank you in advance, Anna T.

    • Hi Anna,

      Thank you for all the kind words!! Aviva sees every message. If you would like to pre-order the book please follow this link. Also, make sure to keep your receipt or proof of purchase as there will be some awesome bonuses available VERY soon!

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant & Functional Health Coach

  45. There is a lot of talk of weight gain, but I have all the symptoms but with decent weight loss which I didn’t need. Had shingles earlier this year and seem to be in fight flight ever since… am with naturopath taking supplements but my acupuncturist wants me to take kidney/liver chinese medicine. I’m stressed about taking them though as dr says they can be dangerous to the liver… (more stress and indecision).

  46. I bought your book but am finding the meal plans confusing. I have hypothyroidism and am on synthroid. The reboot plan has recipes with nuts but advice elsewhere is the book says “no nuts”. Same question for chickpeas: on the no list for reboot but hummus is a mainstay.

    • Hi Laurel, Yes, my apologies – there were last minute editorial changes made at the publisher’s end that led to confusion in the week 1 meal plan. Bottom line is to take legumes and nuts out for just one week and see if this helps – if not add them back in. Also, if you don’t have any joint pain, the nuts may be no problem for you at all and you can leave them in. 🙂

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