Adapted from Chapter Seventeen of How to Heal Hashimoto’s: An Integrative Road Map to Remission, published by Hay House. 
In this post, I will show you how to use the A.P.A.R.T. System to heal the adrenals.
Not sure what that means? Click here to learn about the A.P.A.R.T. System.
Open your journal (keeping a food/behavior/reaction journal is an absolute necessity, in my opinion, if you are serious about healing your Hashimoto’s) and try to figure out which symptoms of problems with the adrenals you have (see below for a list).
Note what they are, then create a plan for addressing them.
After that take inventory of what you did. Look at what worked and what didn’t. Both will provide valuable information.
Double down on what worked, change what didn’t. Keep at it.
But don’t wait to deal with stress and heal the adrenals. They are just too important to wait.
Symptoms of Low Cortisol (Adrenal Exhaustion Phase)
Cannot stay asleep
Crave salt
Slow starter in the morning
Afternoon fatigue
Dizziness when standing up quickly
Afternoon headaches
Headaches with exertion or stress
Weak nails
Symptoms of High Cortisol (Adrenal Resistance /Alarm Stages)
Cannot fall asleep
Perspire easily
Under high amount of stress
Weight gain when under stress
Wake up tired even after 6 or more hours of sleep
Excessive perspiration or perspiration with little or no activity
In this section let’s take a look at some testing we can do for the adrenals and also to talk about the 3 stages of adrenal burnout.
Ok, so like virtually everything in our body, things don’t usually happen overnight. They develop over time and progress from ok, to sort of bad to really bad if you do’t do anything to stop that progression.
We saw this with the progression to type 2 diabetes. It goes from dysglycemia to insulin resistance to metabolic syndrome to full blown diabetes.
The same is true with autoimmune disease. It goes from silent autoimmunity to reactive autoimmunity to full blown autoimmune disease.
The adrenals are no exception. Adrenal problems also go through a progression as well.
It looks like this:
1. Alarm reaction: This happens in normal life. The adrenal glands become hyperactive to increase cortisol levels to adapt to the demands of stress.
2. The second stage is the Resistance stage: This occurs in response to prolonged stress as the body steals pregnenolone from cholesterol to make cortisol- also known as the pregnenolone steal.
When this happens, hormonal imbalances arise because there isn’t enough cholesterol to make them. It can cause PMS, infertility, male menopause, and polycystic ovarian syndrome (PCOS).
3. The third stage is the Exhaustion stage: At the point the adrenals are saying “Uncle” and they can no longer adapt to stress.
The cofactors needed to make cortisol become depleted and cortisol levels drop too low. Because the adrenals no longer produce sufficient cortisol, the pregnenolone steal cycle also stops.
Basically, let me give you a quick run down of what they are.
The first is to test your blood pressure in 2 different positions: sitting or lying down and standing.
Firstly, Take and compare two blood pressure readings—one while lying down or sitting and one while standing. Rest for five minutes in a relaxed position before taking the reading.
Stand up and immediately check your blood pressure again. If the blood pressure is lower after standing, then you may have reduced adrenal gland function, and more specifically, an aldosterone issue–(Aldosterone is an adrenal hormone and hypothyroidism can lead to low levels of aldosterone in the blood.)
(Normal adrenal function will elevate your BP on the standing reading in order to push blood to the brain.)
It’s also a good idea to do this test both in the morning and in the evening, because you can appear normal one time, and not another.
The second test you can do is to check your pupils. This is called the Pupil Test and it also tests levels of aldosterone.
You need to be in a dark room with a mirror. From the side (not the front), shine a bright light like a flashlight or penlight towards your pupils and hold it for about a minute. Carefully observe what happens to your pupil.
With healthy adrenals (and specifically, healthy levels of aldosterone),your pupils will constrict, and will stay small the entire time you shine the light from the side.
The light causes them to constrict, it’s a natural response to having light shone in your eye.
In adrenal fatigue, the pupil will get small, but within 30 seconds, it will soon get larger again again or obviously start to flutter as it tries to stay small.
Why does this happen?
Because when you have adrenal insufficiency you can also have low aldosterone, which can cause an imbalance in sodium and potassium (too little sodium and too much potassium).
This imbalance is what causes the sphincter muscles of your eye to be weak and to dilate in response to light.
So the fluttering struggle to keep the pupil small may mean you have adrenal challenges.
In terms of laboratory tests, there are a couple ASI or Adrenal Salivary Index and the DUTCH or Dried Urine Test for Comprohensive Hormones. These provide the most accurate, useful and comprehensive test for the adrenals.
One important thing to understand about this test; (and this is true of a number of different tests) The most important test is the second or even third test.
One test is useless, because we are establishing a baseline and then we are going to take action. And we need to know if what we are doing is helping.
The second and third tests give us that information. We must always reassess and readjust.
And the adrenals generally respond to treatment pretty well. If they don’t you need to look for something deeper. A parasite or heavy metal toxicity, a chronic viral infection or some food intolerance.
Some times you have to be a detective and examine, step by step, all of these things.
The ASI tells us how a person’s adrenals are working throughout the day. Its a 24 hour test. Cortisol is secreted in a specific pattern over a 24 hour day and by measuring saliva at different intervals throughout the day, we can chart the cortisol levels.
Being in a chronic state of alarm or prolonged stress will mess with this rhythm. One example of this is people who are night owls, or have trouble falling, staying asleep or they wake up really tired after getting enough sleep.
Their rhythm has been disrupted.
The ASI shows abnormalities in this circadian rhythm, charts key hormone levels and pinpoints where problems arise along the way. It can be a really valuable test.
The DUTCH test, which uses dried urine, is innovative in a number of respects, and offers several benefits over older hormone tests.
For example, a conventional (liquid sample) urine test gives you metabolites you simply can’t get in a blood or saliva test, but the collection method can be quite messy and inconvenient.
One of the biggest problems with hormone testing is that some hormones fluctuate throughout the day. Cortisol, for example, rises as soon as you get out of bed and then declines as the day wears on.
If your diurnal pattern is dysfunctional, meaning you’re low in the morning and high at night, you have a serious problem. But a 24-hour urine test cannot show you this.
That’s really the advantage of a saliva test, which is done several times over the course of a day. By taking multiple samples throughout the day, you can get a more accurate measure of your cortisol pattern. The drawback is the collection method, which can be time consuming and tedious.
The DUTCH test, on the other hand, captures all of that information and more in one simple test. Simply urinate on the filter paper on the collection device and let it dry.
Those test strips are then used to give you a complete hormone panel, including metabolites, (which can’t be measured in blood or saliva), effectively replacing multiple testing methods.
Both of these tests can be useful tools for determining your next steps and identifying the type of adrenal problem that you have.
If we want to heal out Hashimoto’s, we absolutely have to heal our adrenals.
And the reality is that this whole process of healing these multiple systems is, without question going to take longer than it takes you to read this book.
I am teaching you about what is going on. Correcting it takes time, patience, vigilance and devotion.
But it is so worth it, people.
Some of the tests that you can do for the adrenals are:
1. The blood pressure test. Take 2 measurements, one seated or lying downand one standing. Compare them. If there is a big difference, this may point to adrenal problems.
2. The pupil test. Point a light at your pupils. Watch it constrict, then watch it return to normal. If it gets small and quickly goes back to normal or flutters, then, “Houston, we’ve got a problem”.
3. Lastly, the best laboratory test is the ASI or Adrenal Salivary Index. This takes multiple saliva tests throughout the day and tracks your circadian rhythm. It can be very helpful, not only for identifying the problem but also for tracking your progress in fixing it.
Not everything has the same level importance. This is what 80/20 teaches us. Some things are having more of an impact than others. Figure out which they are (the positive feedback loops) and then make a plan to fix them.
What does that mean when it comes to the adrenals? Check kidney and adrenal function. Adrenal health is very important if you are taking? thyroid replacement hormone.
The warning label for Synthroid states:
“Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium.
Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone.”
What this means, in plain English, is that in cases of hypothyroidism, the adrenals need to be evaluated before putting patients on thyroid replacement hormone. And if they aren’t and you give them thyroid hormone anyway, this may cause an acute adrenal crisis. Not good.
How many people with Hashimoto’s and hypothyroidism do you think have adrenal insufficiency? A lot.
And how many were tested for adrenal insufficiency before they were put on thyroid hormone? Very few.
Clearly, evaluating and treating the adrenals, if necessary, is a major priority.
Once you have evaluated your adrenals, and you’ve established a plan, the you need to act on that plan. Here’s a some of the actions you can take.
Adaptogenic Herbs:
There are quite a few herbs that have adaptogenic properties, meaning that they help your body adapt to stress.
But as with everything, there is a risk/benefit analysis that must be done with them, especially when autoimmunity is involved. You must be cautious about stimulating the immune system when taking adaptogenic herbs.
Here’s a list of herbs that can be helpful, it may be best to introduce them one at a time rather than in a mixed formula. That way, if you have a reaction, you’ll know which herb was responsible:
Acanthopanax
American gensing
Ashwaghanda (this plant is a nightshade and may cause a reaction)
Cordyceps
Codonopsis
Eleuthrococcus
He shou wu (also excellent for helping promote hair growth)
Holy Basil
Jiaogulan (also excellent for reducing cholesterol)
Licorice
Maca
Panax gensing
Rhodiola
Schizandra
ACTH is to the adrenals what TSH is to the thyroid. It regulates cortisol production. High ACTH may mean the adrenals aren’t producing enough cortisol. Low ACTH may mean the pituitary isn’t producing enough adrenal hormones.
ACTH Increasing:
Ginko
Panax ginseng
Tripterygium
ACTH Reducing:
Acanthopanax
Hypercium
Licorice
Earlier, we looked at symptoms for the different stages of adrenal issues. Figure out which stage you are in and try the supplements below.
1. Alarm Stage:
Balance blood sugar and support healthy response to insulin resistance: alpha lipoic acid, biotin, chromium, gynemma sylvestre, inositol, magnesium, zinc
Adaptogens: See above
Essential fatty acids: fish oil, evening primrose oil
2. Resistance Stage:
Balance blood sugar and support healthy response to insulin resistance: alpha lipoic acid, biotin, chromium, gynemma sylvestre, inositol, magnesium, zinc
Adaptogens: See above
Essential fatty acids: fish oil, evening primrose oil
Add licorice, and B vitamins (see food sources below)
3. Adrenal Exhaustion:
1. Chromium, adrenal, pancreas glands, choline bitartrate, co-enzyme Q 10, inositol, rubidium chelate, vanadium.
Adaptogens: See above
Essential fatty acids: fish oil, evening primrose oil
Add licorice, and B vitamins (see food sources below)
In cases of extreme exhaustion, consider consulting a physician or practitioner. You may benefit by adding pregnenolone and/or DHEA.
VITAMIN B1: rice bran, pinto bean, peas, millet, lentils, almonds, turnip greens, collard greens, kale, asparagus
VITAMIN B2: salmon, trout, cod, mackerel, perch, oysters, mushrooms, almonds, hijiki
VITAMIN B3: rice bran, red pepper, wild rice, kelp, sesame seed, peaches, brown rice, mushrooms, barley, almonds, apricot
VITAMIN B5 (PANTOTHENIC ACID): beef, chicken, salmon, mackerel, sardines, barley, rice, avocado, plums, raisins, almonds, dates
VITAMIN B6: banana, barley, brewer’s yeast, molasses, brown rice, liver, beef, cabbage, carrots, potato, yams
VITAMIN B12: beef liver, beef kidney, ham, sole, scallops, eggs, oats, pickles, amasake, algae, spirulina and chlorella, brewer’s yeast
FOLIC ACID: liver, asparagus, lima beans, spinach, swiss chard, kale, cabbage, sweet corn
Retest, Reassess and ask all over again. Figure out what worked and what didn’t. Double down on what worked and either eliminate or recreate a plan for what didn’t.
Try some things and reassess.
Retest your adrenals, Reorder the ASI (Adrenal Salivary Index) and see if what you did helped.
Keep doing it, keep refining, keep building on the positive results and keep looking for the remaining positive feedback loops that are causing vicious cycles.
The adrenals are a critically important part of the puzzle and given their importance for whether or not you can take thyroid hormone, it makes sense to make healing them your top priority.
Looking for help in assessing your adrenals? Do a consultation with Marc. Click here to learn more.
This post is an excerpt from my book, How to Heal Hashimoto’s: An Integrative Roadmap to Remission.
One of the things I sought to do in writing the book was to teach you how to evaluate and treat yourself so that you can get some successes and then build on them to create positive healing momentum.
That’s what the A.P.A.R.T. System is and I’ve broken it down for your here.
Remission is a journey.
It involves taking responsibility for your life and circumstances and doing whatever is necessary to change that life and those circumstances.
The road to your remission should be ever evolving and growing, and it should be a process that you continue to improve upon and refine.
So it is not a destination. Getting there is just half the battle.
Staying there is the other half. And the only way you can stay there is to be committed for the long haul.
Measurable goals should be:
These goals are just that. They are meant to be targets. You may not reach them 100%.
And that’s ok, not reaching them 100% does not mean you will have failed or that you should give up and quit trying.
These are just numbers and numbers in isolation are never a complete measure of success or failure.
One important thing to remember about laboratory tests is that they are not meaningful outside the context of what you are experiencing in your own body.
So you must always be aware of what is happening in your body, of how you feel and also of what factors led up to that. Try to pay attention to both the good and the bad.
What you feel is clinically relevant and diagnostically important. And, really everything you do and try is just a test. What happens as a result is data that we can use; it provides us with clues and valuable information.
In addition, one should never keep forcing a solution when the evidence before you plainly shows you that it isn’t working.
You must change your plan when that happens.
This can be tricky, but it is possible to do it if you have a system.
Unfortunately, this is usually not part of the mainstream approach. With conventional medicine, medication is often the first treatment option, diet and lifestyle changes are ignored or dismissed and the experiences that you have within your body are not given the importance that they deserve.
To address this problem and offer an alternative way of approaching healing that does take important factors like diet, lifestyle, physical, emotional and spiritual experiences into account, I’ve created a simple system for you to use.
It’s called The A.P.A.R.T. System, because this approach stands apart and so will your results if you use it.
This is a simple, easy-to-remember acronym for getting better results that aren’t based on protocols, dogma, or preconceived ideas.
It goes like this:
Each letter has two ideas that are associated with it.
Data has healing power, if you know what data to collect and analyze and you know what to do with that information. (Both are big “ifs.”)
You need to ask what the symptoms are and assess the different systems of the body to find out where these symptoms are coming from.
And every bodily system and lifestyle practice needs to be a suspect. Don’t exclude something because you’re attached to it, feel like you can’t dowithout it or have decided that it isn’t a problem.
Everything in your life should be evaluated with equal scrutiny and if it isn’t working to make you better, it may have to be eliminated.
This includes people, places, and things like your favorite foods and drinks.
Not everything has the same level of importance. This is what 80/20 teaches us (20 per cent of your issues cause 80 per cent of your symptoms – I’ve described in more detail in the Introduction).
Some things are having more of an impact than others. Figure out which they are (the positive feedback loops – or the things that are repeated and reinforced in your body and mind) and focus on those first, then make a plan to fix them.
I have created a Cheat Sheet in the back of the book that contains what I think are the most common 20 percent issues that cause 80 percent of our problems.
Act and put your plan into motion. Then observe what the results are. Double down on what works and change what doesn’t. And results should be apparent relatively quickly.
If they aren’t, you need to make changes.
The common practice of a doctor or practitioner prescribing something and then telling the patient to come back in three to six months is not the best approach, in my opinion. That’s way too long, especially if it isn’t working.
Retest, reassess and ask all over again. Figure out what worked and what didn’t. Double down on what worked and either eliminate or recreate a plan for what didn’t.
It sounds obvious, but it is often overlooked or forgotten. Testing and reevaluating what you have done to see the result of your treatment is essential for good care.
Quick side note here: In my opinion, what I have learned over many years of practice is that you need to trust what the data is telling you. In most cases, when you make the right choice, you start feeling better.
Things like a “healing crisis,” a “die off,” or a “detox reaction” sometimes occur, but they can also be a cover for incompetence. The right decision should result in a positive result relatively quickly.
If you are doing something and you aren’t getting better or you continue to feel worse, or it causes more discomfort, pain, and adverse symptoms, then you need to question whether that is the best course of action.
Eliminate it, reduce variables, and find out which part of what you are doing is causing that reaction or set of symptoms.
And all of this should not be done on the basis of lab tests alone. With Hashimoto’s it must include a thorough examination of the signs and symptoms as well.
Remember, what you feel is diagnostically important and clinically relevant.
Keep doing it, keep refining, keep building on the positive results and keep looking for the remaining positive feedback loops that are causing vicious cycles.
People sometimes give up before giving a certain approach a chance. Or they get some good results and then slide back to their old ways of doing things. When you find something that works, keep doing it. Don’t quit and don’t give up.
Lab work and symptoms should all confirm that this has taken place.
Again, lab tests must always be viewed in context to how you feel. It is the combination of these two factors that determine success or failure.
In addition, you must create realistic goals that are small enough to achieve and then build upon them. Acknowledge and celebrate your small victories.
You can’t go from sick to perfect in a couple of weeks.
As I said, remission is a journey. It is measured by how you feel, by your lab tests and by your quality of life.
In other words, this journey is all about creating a lifestyle that will sustain and foster ongoing success.
Would you like to read the whole book? It chock full of great information and is available at all major book retailers.