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Dec 1, 2018


by Dr. Dan Kalish

STAGE 3 Adrenal Exhaustion

This packet will explain these findings. It will let you know which supplements you should be taking based on those results and recommend diet and lifestyle considerations that will improve your overall health. If you follow the recommended supplement protocol as well as the diet and lifestyle information in this packet you should see a noticeable improvement in your health.

Explanation of Test Results

Your recent testing indicates that you are in Stage 3 Adrenal Exhaustion.

What do my adrenal test results mean?

Your cortisol and DHEA levels provide an accurate assessment of how well your adrenal glands are functioning. Healthy, properly functioning adrenal glands are imperative for vibrant, optimal health. When the adrenal glands become fatigued due to chronic stress, many health consequences can result.

What is chronic stress?

Adrenal exhaustion begins to occur when stresses become chronic in nature, meaning that they are present day after day. The causes of the chronic stress range from skipping breakfast every day and only eating a salad for lunch to having exposures to mercury to infections in the digestive tract to conducting life at a frenzied pace each day. It is extremely important to address whatever is causing your chronic stress so that the treatment protocol that you have been given can successful restore proper function to your adrenal glands.

What do the stages of adrenal exhaustion mean?

Although the decline in adrenal function occurs in a progressive fashion, three “stages” of adrenal exhaustion are commonly used to describe a patient’s condition. As the adrenal glands first come under chronic stress, the outer part of the adrenal gland called the adrenal cortex begins to produce and secrete a greater quantity of cortisol, the “stress hormone.” This increased cortisol production “steals” pregnenolone, the hormone needed to produce other hormones in the adrenal cortex, most notably DHEA. In Stage 1 of adrenal exhaustion, daily cortisol output is elevated and DHEA levels begin to decline. Since DHEA metabolizes into sex hormones, specifically estrogens and testosterone, imbalances in these critical hormones can occur. In women progesterone levels are often impacted to a greater degree by chronic stress than estrogen levels, leaving them “estrogen dominant.” As chronic stress continues unabated, the adrenal glands can no longer maintain the daily high levels of cortisol output. In Stage 2 of adrenal exhaustion, daily cortisol output falls back to “normal” levels, and DHEA levels decline even further. Low or borderline low morning, noon or afternoon cortisol levels and normal nighttime cortisol levels are often seen in Stage 2 of adrenal exhaustion. As chronic stress continues to weaken the adrenal glands, daily cortisol levels fall even farther. In Stage 3 of adrenal exhaustion, cortisol levels are low and DHEA levels fall even lower. There is an increased probability of low nighttime cortisol levels as well as low readings throughout the day. In Stage 3 adrenal exhaustion, a patient is subject to serious hormonal imbalances, resulting in profound fatigue or depression. Chapter four in my book, Your Guide to Healthy Hormones, offers a detailed discussion of the adrenal hormones and the various stages of adrenal exhaustion.

What are the consequences of adrenal exhaustion?

In all stages of adrenal exhaustion (even Stage 3), cortisol levels are elevated relative to DHEA levels. There are many health consequences associated with a high ratio of cortisol to DHEA that affect your:
  • Blood Sugar Control
  • Immune Function
  • Detoxification Capabilities
  • Tissue Health
  • Hormone Balance

Supplement Protocol Recommendations

The protocol for Stage 3 Adrenal Exhaustion is essential to improving your current state of health as you will see by the supplement descriptions.


DHEA reverses immune suppression caused by excess cortisol levels, thereby improving resistance against viruses, bacteria and Candida albicans, parasites, allergies, and cancer. It increases muscle mass and decreases percentage of body fat. It prevents osteoporosis, heart attacks, while improving energy, vitality, sleep quality, premenstrual symptoms and mental clarity. Additionally, it accelerates recovery from any kind of acute stress, for example insufficient sleep, excessive exercise, mental strain, etc.


As is the case with DHEA, pregnenolone levels decline with age. Many physicians and scientists believe that replacement of pregnenolone to youthful levels is an important step in the treatment of aging and symptoms of aging. Other benefits of pregnenolone include stress reduction and increased resistance to effects of stress, improvement of mood and energy, reduced symptoms of PMS and menopause, improved immunity, and repair of myelin sheaths.

The Kalish Diet

The Kalish Diet is designed to improve the health of everyone, regardless of their health complaints. By following my diet, you will feel better physically, have more energy, eliminate cravings, improve sleep quality, and lose weight. In my experience, there are three “musts” for each of us to attain our optimum health through diet. We must (1) determine the balance of macronutrients (proteins, carbohydrates, and fats) right for us and only choose the highest-quality food available; (2) eliminate gluten, soy, and pasteurized dairy for two months, and (3) maintain stable blood sugar.

Macronutrient Ratios

There are three variables when considering proper macronutrient ratios: 1) genetics, 2) how damaged your metabolism is, and 3) energy requirements. It is important to keep in mind that activity level on a given day can require adjustments to your macronutrient ratio.

Genetic predisposition is an important factor, given the variation in what our ancestors ate, based on their physical environments and the types of food available. This work has been clearly explained in The Metabolic Typing Diet by William Wolcott and The Nutritional Solution by Dr. Harold Kristal and James Haig. Simply put, some people require high-carbohydrate diets to be healthy, while others require largerthan-averageamounts of protein and fat.

If your metabolism is damaged, you will need to adjust your macronutrient ratios. For example, if you have chronic health problems, you will need to consume more high quality raw fats and proteins while you are healing. These nutrients provide the raw ingredients that aid in structural repair of damaged cells. Carbohydrates are used primarily as fuel, not for structural repair, although it is always important to have the right amount of starchy carbohydrates in your diet. If you eliminate all carbohydrates, your cortisol level will be affected, which could lead to a hormonal imbalance.

Your individual energy level also will dictate your macronutrient ratio. If you are like many Americans and lead a sedentary life (thanks to modern conveniences such as computers and televisions), you will want to be sure to eat fewer carbohydrates. These serve as fuel to the body, and if you are eating more than you are burning, you will push your insulin level up which will lead to unstable blood sugar and a host of health problems. If, on the contrary, you are an active person who exercises several hours a day, you will need to eat more carbohydrates to fuel your body.

Dr. Dan Kalish

Dr. Dan Kalish

Founder of the Kalish Institute
Dan Kalish, DC, IFMCP, is founder of the Kalish Institute, an online practice implementation training program dedicated to building Integrative and Functional Medicine practices through clinical and business courses.