I think that the biggest misconception in regards to the adrenal fatigue syndrome and cortisol, in general, is that most people believe stress to be only psychological or emotional (e.g. work stress, relationships or financial stresses). An important concept to understand when looking at successfully treating the HPA axis dysregulation (more commonly known as adrenal fatigue), is that anything that taxes the body over a prolonged period of time is a potential stressor to the system e.g. chronic illness, chronic inflammation, excessive exercise or chronically disrupted blood sugar regulation caused by poor dietary choices over a long period of time can contribute to the development of cortisol issues. That’s why a holistic lifestyle approach to treatment is crucial. It is easy to miss or even ignore the issue for a long time until things really get out of hand because we live in a culture which glorifies being super busy. “I’ll sleep when I’m dead” we often say with pride. We wear lack of sleep as a badge of honour, our common cultural attitudes are that stressed, always busy and exhausted is admirable, a sign of hard work, our worth and ambition. We start believing that the state of exhaustion is the norm and forget that it is not normal at all, but we can’t remember the last time we got up in the morning feeling energetic so we feel no urgency to adjust our lifestyle, we blame low energy levels on passing years or intense work schedules and slowly develop habits that have very detrimental effects on our health in the long run. Sadly most people don’t often seek help until the health issue is severe. Symptoms of adrenal fatigue are numerous and can include:However, adrenal fatigue is not a clearly defined syndrome and symptoms alone are not reliable as a sole method of diagnosis and can be very non-specific, meaning high or low cortisol can often share similar symptoms, that’s why testing is so important. Testing for cortisol/adrenal fatigue syndrome includes:Cortisol serum test (very timing dependent and not enough as a sole method of diagnosis); saliva test (scientific literature suggests its high accuracy); and 24 hour urine testing (most accurate method for establishing total cortisol levels); there is also a new testing method now available – DUTCH test (dried urine test for comprehensive hormones) which gives a better overall picture of individual’s specific cortisol issue and adrenal function. Stress management is critical- Diet alone is not enough. Identifying negative habits of thought, learning to say “no”, taking time out and allowing for adequate rest is all part of stress management. There is a lot of research on mindfulness and meditation being very powerful tools of recovery and preventing relapse of the condition. Time in nature, fun, laughter and play, as well as meaningful social connections, are also found very helpful. A nutrient dense diet- A high protein breakfast in the morning to stabilise blood sugar throughout the day, which in turn helps to keep your HPA axis functioning appropriately. Plenty of protein has stabilizing effects on sugar. Moderate, quality carbohydrates tend to work best for adrenal fatigue and making sure not to go too long without eating. Always combining carbohydrates with protein and fats in meals to help slow absorption and stabilize blood sugar. A popular dietary practice includes intermitted fasting, although having some great health benefits, is not appropriate for those suffering from adrenal fatigue. Reduction or avoidance of stimulants is strongly recommended - In addition, prolonged stress depletes the body of vital nutrients so nutrient supplementation under the care of qualified health practitioner to support depleted adrenals and provide nutrients necessary for energy production is essential, B vitamins, vitamin C, Mg and Coenzyme Q10 to name just a few, should be included in the treatment protocol.Sleep - plenty of rest is essential, no less than 7-8 hours a night. Appropriate exercise- Physical activity is an integral part of recovery as our bodies are geared for action, especially when under stress when cortisol soars our body turns on the ‘fight or flight’ and exercise is a powerful way to bring the hormones of stress back to balance. However, in adrenal fatigue gentle approach is key. Intense exercise will only deplete the body further and add to the problem. Gentle walking and swimming, stretching, gentle yoga, tai chi and Qigong and various breathing exercises are the best options, building the energy stores up rather than depleting them.I strongly believe that integrated, multi-disciplinary approach is always the most beneficial for the patient. If I was to choose only one thing I would seek advice on stress management first. It is a critical first step towards recovery. Step two would be nutrition and then naturopathic treatments.No, I have never experienced it personally but it is a common condition in clinical practice.