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Interview with Dr. Leslie Churchill on Adrenal Fatigue

1) How do women get diagnosed properly with adrenal fatigue? Reason I ask is that a lot of medical doctor say they don’t believe in adrenal fatigue?

To start, the term “adrenal fatigue” is more aptly described as hypothalamic pituitary axis dysfunction or HPA-D.  It is really a misnomer because it is very uncommon for the adrenal glands to actually be “fatigued” and not be able to produce the cortisol hormone; rather, in studies when total cortisol was measured it was more commonly too high versus too low. Even when total cortisol is too low, it is rarely because the adrenal glands are fatigued. Instead, it has been found that the problem is more often in the brain and central nervous system, as well as related to different tissue-specific mechanisms for regulating cortisol that lead to the symptoms that we know as “adrenal fatigue“.

A thorough discussion of a person’s symptoms combined with appropriate testing using dried urine testing for complete hormones (DUTCH) is the most comprehensive way to evaluate the function of the HPA axis.

2) What do you see is women’s biggest challenge with adrenal fatigue?

I would say that the biggest challenge is the time and energy it can take to heal, as the lifestyle patterns that have led us to the state of HPA – D that we are currently in have got to change. This includes prioritizing our sleep, dealing with and minimizing stress, emphasizing a work/pleasure balance, dedication to good nutrition and self-care, as well as changes to our lifestyle such as blue light exposure throughout the day, getting adequate sunlight exposure in the morning or mid day hours, and controlling our blood sugar and overall inflammation which all have major roles in affecting the hypothalamic pituitary axis.

3) I know I did the DUTCH test to see what exactly my cortisol was doing but can you explain more about the DUTCH test and why it’s such a valuable test?

The DUTCH test measures not only free cortisol like is commonly tested in salivary cortisol testing, but also total cortisol metabolites, which is essential to avoid confusion when the body’s clearance of cortisol to cortisone is abnormally high or low. The test shows the ability of the body to produce cortisol and whether total production is high or low or out appropriate levels. This is essential for properly evaluating HPA axis function and for appropriate treatment. For example, different problems are going on if cortisol is too high or too low; which salivary testing can easily miss or misconstrue because it only looks at free cortisol levels which is only 3-5% of total cortisol throughout the body. For example, free cortisol levels can be normal while total cortisol metabolites can be too low or too high (which would not be seen on salivary testing because only free cortisol is shown). On the other hand, free cortisol can be low or high if clearance of cortisol isn’t at an appropriate level and total cortisol production itself can be fine, leading to inappropriate treatment and harm on behalf of the patient.
Another problem with salivary cortisol testing that the DUTCH test has overcome is there are often falsely low levels of cortisol shown by salivary testing (especially in the morning) if the person has what is called a low cortisol awakening response or CAR.

4) What are the most difficult symptoms you see from adrenal fatigue?

HPA – D often results in fatigue, sleep disruption, poor exercise tolerance and/or recovery, low libido, brain fog, decrease in immune function, and reduced stress tolerance. Every cell and tissue in the body can be affected which is why it’s very important for everyone with chronic disease to be evaluated to allow for complete body healing.

5) Do you have advice for women who have adrenal fatigue or think they suffer from any of the symptoms and how to get help?

I would advise any person struggling with the symptoms mentioned in the question before, or those who are dealing with a chronic disease state, to consider DUTCH testing. It is only one day of dried urine sampling collected 4 to 5 times throughout the day at specific times.  It is very noninvasive and can give the most comprehensive evaluation of the HPA system and therefore lead to the most effective treatments.
More information can be found at for those interested. I have the test kits available at my office and you simply pick the kid up and take it home and mail it in when you are ready. The results come back within two weeks and we can sit down and develop an appropriate plan of action.


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