Heal Your Adrenals Using the A.P.A.R.T. System

Adapted from Chapter Seventeen of How to Heal Hashimoto’s: An Integrative Road Map to Remissionpublished 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.

1. A = Ask and Asses

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.

Signs and Symptoms of Adrenal Fatigue

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

Testing the Adrenals

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:

3 Stages of Adrenal Dysfunction

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.

How to Test your Adrenals at Home

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.

A Second Adrenal Test

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.

Adrenal Lab Tests

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.

Adrenal Testing Recap

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.

2. P = Prioritize and Plan

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.

3. A = Act and Adapt

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:


American gensing

Ashwaghanda (this plant is a nightshade and may cause a reaction)




He shou wu (also excellent for helping promote hair growth)

Holy Basil

Jiaogulan (also excellent for reducing cholesterol)



Panax gensing



Herbs that influence ACTH:

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:


Panax ginseng


ACTH Reducing:




Suggestions for Different Stages of Adrenal Fatigue/Exhaustion

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.

Here are some food sources of B Vitamins.

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

4. R= Reassess and Readjust

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.

5. T = Try and Try Again

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.

About the Author Marc Ryan

So now, not only is it my profession, it’s my passion, and it’s personal. I’ve been joking with people lately saying it’s a blessing and a curse. A blessing because I really get it, and a curse because I really got it! ?

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