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Chronic Fatigue Syndrome and Morning Cortisol Levels

Medical professionals would do well to look at their fatigued patients in terms of their morning cortisol levels. By allowing their patient’s adrenal glands to function at optimal levels, cortisol levels become normalized, allowing their bodies to more effectively regulate blood sugar levels optimizing not only energy production, but optimizing health and wellness in general. Dr. Wilson, the “stress” doctor and world authority on fatigue, stress and adrenal function actually coined the phrase “adrenal fatigue” in 1998. Dr. Wilson found through his extensive research spanning over 30 years that there is almost no part of the body which is not affected to some degree by cortisol. The following study highlights the importance of salivary cortisol testing correlating with fatigue and appeared in the March 2008 issue of JCEM, Journal of Clinical Endocrinology & Metabolism, one of the four journals published by The Endocrine Society.

People who suffer from chronic fatigue syndrome (CFS) often endure months of persistent fatigue, muscle pain, and impaired memory and concentration. Understanding the physiological changes that accompany CFS, however, has been difficult, but a new study accepted for publication in the Journal of Clinical Endocrinology & Metabolism (JCEM) reveals that abnormally low morning concentrations of the hormone cortisol produced by the adrenal glands, may be correlated with more severe fatigue in CFS patients, especially in women.

“We’re learning more and more about the complexities of the illness that is chronic fatigue syndrome,” said William C. Reeves, M.D., with the Centers for Disease Control and Prevention in Atlanta, Georgia, and lead author of the study. “This research helps us draw a clearer picture in regards to how CFS affects people, which ultimately will lead to more effective management of patients with CFS.”

For their study, the researchers screened 19,381 residents of Georgia, selecting 292 people who had CFS, 268 who were considered chronically unwell, and 163 who were considered well to participate. The researchers then measured free cortisol concentrations in saliva, which was collected on regular workdays, immediately upon awaking and 30 minutes and 60 minutes after awakening. The data indicated different profiles of cortisol concentrations over time among the groups, with the CFS group showing an attenuated morning cortisol profile.

Study participants were purposely screened and enrolled from the community, rather than from volunteers identified at a specialty referral clinic. The purpose of this study design was to provide results that would be more generalized to the population suffering from CFS. In this study, women with CFS exhibited significantly lower morning cortisol profiles when compared with well women.

This study confirms previous research indicating that CFS is related to an imbalance in the normal interactions among the various systems of the body that work together to manage stress. “People with CFS have reduced overall cortisol output within the first hour after they wake up in the morning, which is actually one of the most stressful times for the body,” Dr. Reeves said. “We need further studies to better understand the relationship between morning cortisol levels and functional status of a patient suffering from CFS.”

Founded in 1916, The Endocrine Society is the world’s oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. To learn more about the Society, and the field of endocrinology, visit www.endo-society.org.

If the Endocrine Society takes salivary cortisol and CFS seriously enough to publish these results in their prestigious journal, why does the medical profession (and particularly the endocrinologists) not take note and finally regard that low morning cortisol is linked with fatigue, with adrenal fatigue to be more precise?

About the Author

Dr Eric Bakker, NZ naturopathic physicianEric Bakker B.H.Sc. (Comp.Med), N.D, R.Hom. is a highly experienced naturopathic physician who has been in clinical practice for 25 years. Eric is passionate about improving people’s lives through proven wellness and lifestyle principles, natural medicine practice as well as public and professional practitioner education. Eric specialises in candida yeast infections, as well as adrenal fatigue, and thyroid disorders. Dr. Bakker has written one of the most comprehensive books on yeast infections called Candida Crusher. Website:  candidacrusher.com  You can complete his online survey to determine if you have a yeast infection here, or link through to his many You Tube videos: www.yeastinfection.org  Dr. Bakker’s Blog:  www.ericbakker.com

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16 Responses to Chronic Fatigue Syndrome and Morning Cortisol Levels

  1. Hello, thanks for the post. One question: If it’s really true and CFS is connected with cortisol level, is it possible in future to use this knowledge to treat CFS?

  2. I learned in your book that not sleeping in long enough and actually sleeping in past 9am was a good thing. I was taught to be up early and to work hard so this one took a while for me to come to terms with. Thanks again!

  3. Thanks for the great information, didn’t know much about this adrenal fatigue. I remember years ago no one knew much about it and Doctors dismissed it.

  4. CMP says:

    A year and a half ago my conventional doctor told me I had Chronic Fatigue. I was like, yeah I already know that! When I asked what was causing it you could literally hear crickets… Then he told me I was depressed and needed to take some pills! Needless to say I haven’t gone back…

  5. avis says:

    i went to my doctor and had a cortisol test done… its the blood test not saliva test which is said to be inaccurate…and it came back normal but i do feel all the symptoms of adrenal fatigue…could it be possible that the test is not right? if i take vitamin bcomplex i do notice a signicant improvement in energy, focus and metabolism….would i be able to take your supplement still without confirmation of adrenal fatigue… and if yes which one should i take? the rebuikder or the super?

    • adrenalfatigue says:

      Hi Avis,

      There are differences between the blood and salivary tests; you can read about that here: http://www.adrenalfatigue.org/saliva-testing-for-adrenal-hormones. You can take Dr. Wilson’s supplements without testing and without the direction of a healthcare professional. If you are not dealing with adrenal fatigue, you probably won’t see much benefit from the supplements, but they will not work against you. The four supplements in Dr. Wilson’s adrenal fatigue quartet are meant to be taken together for comprehensive support, but several factors may decide which ones you should take. You can find out more about the four supplements here http://www.drwilsons.com/all-products-1/adrenal-quartet, and feel free to call our customer service department with any questions about the supplements. Thanks for your question!

      Dr. Wilson’s Adrenal Fatigue Team

  6. Teresa says:

    Help! Someone please help me! I have been debilitated with this for 4 Yrs. I haven’t been able to find a Dr to help me & I have spent almost all of my savings/retirement trying to get well & paying my bills for the last 4 yrs. This happened to me when my marriage of 21 yrs ended with infidelity and a lifetime of other stressors. I was determined this was s new chance for ME at life and now this has happened. I am 53 years old a want the next part of my life to just have peace…now I fear homelessness. I went to work 2 days a week in October and it set me back. I have literally been in my bed/bedroom asleep ever since. I was unable to celebrate Christmas & nobody seems to understand. I fear I’m not going to survive this severe fatigue that turns to pain if I push to hard. I have kept a positive attitude but I’m starting to feel hopeless. Any support would be appreciated!

    • adrenalfatigue says:

      Hi Teresa,

      Have you checked our healthcare practitioner database on our website? You can search for practitioners helping people with adrenal fatigue and related conditions. Check out the list here: http://www.adrenalfatigue.org/find-a-healthcare-provider. Keep in mind that adrenal fatigue is something that you can help, and you have full reason to be hopeful. Make 2012 a year for your you and your health. Best of luck – hope this helps!

      Dr. Wilson’s Adrenal Fatigue Team

  7. Teresa says:

    I did a saliva test & it shied that my morning cotisol level was low. My Dr. diagnosed me with Chronic Fatigue & Chrnic Pain last week and said there was nothing he could do. He tol me to sign up for Social Security. I called SS & they said I couldn’t draw anthing. My ex-husband had a business that I worked very hard in for 20 yrs but the CPA pit it under his SS#. There were some years that shows mine was paid in too but SS says I don’t have enough quarters paid in.

  8. Teresa says:

    I have always had the most positive attitude all of my life but this thing has just worn me down. Any encouragement or hope from anyone who has been through to this degree? Or help?

  9. Kelly says:


    Since you don’t qualify for SSI you should apply for SSDI, which you should qualify for. You will receive less per month, but it’s better than nothing. I went through the same thing.

  10. Yvonne says:

    My new doctor just put me on Prednisone (artificial cortisol) and I feel terrific!!!!! Pain gone!. Brain fog cleared! Some fatigue still there though but much better. I’m going to be looking in to possible low dosage ongoing…..lots of study now on net about this. God check it out all.

    Good luck, I’ve had this thing on and off for 36 years.


  11. Yvonne says:

    PS: I’ve been diagnosed with CFS and some FIBROMIALGIA. Was never tested for my cortislol levels, but now I sure will.!!!

  12. Sarah says:

    I have adrenal fatigue and CFS and I have read Dr Wilson’s excellent book. I have a dilema. My GP is suggesting I take 10mg of DHEA daily (I have very low levels) but Dr Wilson suggests women don’t do well on DHEA and should consider progesterone cream instead. I am very unsure as to what to do. Could you advise please?
    Many, many thanks,

    • Hi Sarah,

      We can’t comment on your GP’s advice, but we can say there are certainly people dealing with adrenal fatigue who also take some sort of hormone treatment. If you are uncertain or uncomfortable with taking DHEA, seek a 2nd (or 3rd) opinion. Unfortunately, some people end up going to several practitioners before finding the right fit. Best of luck Sarah – thank you for your question!

      Dr. Wilson’s Adrenal Fatigue Team

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