Overview
Adrenaline is the emergency compensation for low energy. When blood sugar falls, the body releases adrenaline to pull glucose out of the liver. A hypothyroid person living on this compensation can produce 20 to 40 times the normal daily output of adrenaline, which doctors then often misread as hyperthyroidism. Chronic high adrenaline drives cortisol production and triggers an inflammatory cascade every time a person experiences a stressor, even if it's small.
Key Points
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Adrenaline rises to compensate for hypothyroidism. A hypothyroid person's adrenaline can often be 20, 30, or 40 times higher than normal. These people can seem hyperthyroid with high blood pressure and a fast pulse, but they have very little T3 production or very high reverse T3 blocking it. The adrenaline is keeping their body temperature normal and their heart rate up in place of a functional thyroid.
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A surge of adrenaline releases fatty acids, and if those fats are polyunsaturated, it turns the stress reaction into inflammation. Once glycogen is used up, adrenaline starts pulling free fatty acids out of fat cells and phospholipids in other tissues. PUFA released this way interferes with sugar metabolism, signals for more stress hormone production, and forms spontaneous prostaglandin-like molecules that cause inflammation and degeneration. Saturated fats released the same way are anti-inflammatory and turn off the stress hormones, so the same adrenaline surge is either self-limiting or self-amplifying depending on what is stored in the tissues.
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The sequence under stress is adrenaline first, then cortisol. When blood sugar falls, adrenaline comes up first and mobilises glycogen out of the liver and muscles. If glycogen runs out and blood sugar keeps falling, ACTH rises and cortisol follows. Cortisol produces glucose by breaking down tissue protein (starting with the thymus and the muscles), because the body has no protein storage. A surge of adrenaline is a warning that you need more efficient sugar metabolism or more carbohydrates in the diet.
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Adrenaline rises the moment the lights go out, not just when blood sugar is already low. In one experiment, people had a tube put in their veins to sample blood every 15 minutes, and as soon as the lights went out, adrenaline levels increased within 15 minutes. This happened whether the person stayed awake or fell asleep quickly. The darkness itself is the major driver of the nocturnal stress cycle that leads to high cortisol by morning, and it is worse in late winter when vitamin D is also lowest.
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Salt and sugar are the two most direct ways to lower adrenaline. Stirring a little salt into a glass of orange juice can help lower anxiety. Salt inhibits aldosterone, which otherwise interferes with mitochondrial energy production and mimics hypothyroidism. Sugar raises blood glucose and turns off the signal calling for adrenaline in the first place. A bowl of very salty chicken broth works as a bedtime sleep inducer for the same reasons.
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The classic hypothyroid morning pattern is low temperature with a fast pulse, because adrenaline is running ahead of cortisol. During the night, adrenaline is the first thing to rise when glycogen gets used up, and cortisol comes up behind it by dawn. Some hypothyroid people wake with a very fast pulse but a low temperature because the adrenaline is driving the heart but cortisol has not yet caught up enough to slow it down. The pulse should fall after breakfast when carbohydrates bring the adrenaline down.
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Adrenaline constricts peripheral blood vessels, which is why hypothyroid people have cold hands and feet with a warm core. The vasoconstriction keeps heat in the brain and heart at the expense of the skin. Cortisol running high destroys tissue fast enough to make heat, so a very high core temperature with cold extremities, a fast pulse, and a temperature that falls after eating is the pattern of someone running on adrenaline and cortisol rather than thyroid.
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When a high-adrenaline person first supplements thyroid, they may temporarily become more sensitive to adrenaline spikes. Thyroid makes tissues sensitive to adrenaline, so someone with 30 or 40 times the normal daily output who takes even a small dose of thyroid will suddenly feel that excess adrenaline as a racing heart. It takes a week or two of slow increases, sometimes longer, for the autonomic nervous system to quiet down and let thyroid take over. A 30 milligram dose can cause heart pains and coronary spasms if intracellular magnesium is low, which it almost always is in the hypothyroid state.
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Chronic adrenaline is one of the primary drivers of cardiovascular disease. Even minor, short-term elevations calcify blood vessels and raise blood pressure. Adrenaline is also negatively ionotropic, meaning it impairs the heart's ability to contract properly. This is why beta blockers like propranolol, which block adrenaline at the receptor, are among the first-line drugs for high blood pressure and are now being trialed for cancer with promising results in conditions like glioblastoma.
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Progesterone is the most powerful over-the-counter anti-adrenaline intervention. Progesterone increases the oxidation of adrenaline, which deactivates it, and acts as an alpha-2 adrenergic receptor agonist, the same mechanism as the drug clonidine (not an endorsement of clonidine).
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Adrenaline releases endorphins, which is why stress becomes self-reinforcing. Whenever cortisol and adrenaline rise, endorphins (the body's natural opioids, chemically similar to heroin or oxycodone) are released alongside them. This is the mechanism behind the "adrenaline junkie" phenomenon: the pursuit is really for the endorphin high, which is why people can become behaviorally addicted to a chronically stressful lifestyle.
Notable Quotes
"Adrenaline is the emergency compensation for low energy."
[Ray Peat — KMUD: Thyroid and Polyunsaturated Fatty Acids]
"I've seen many low thyroid people who in a day produced 30 or 40 times more adrenaline than normal and adrenaline tends to lead immediately to cortisone production depending on how efficient your adrenals are."
[Ray Peat — Gary Null: Thyroid Function NPR Interview]
"Salt and sugar are great ways to lower adrenaline. I recommend that to people who are performing and they're anxious before they perform. Tell them, stir in a little salt in a glass of orange juice. It works great."
[Sarah Murray — KMUD: Exploring Alternatives]
"Adrenaline has the nasty effect of calcifying your blood vessels, raising your blood pressure"
[Georgi Dinkov — Why Some Sugar is Actually Good For You, & Methylene Blue too w/ Georgi Dinkov]
Important Things To Consider
Do not suppress adrenaline directly without first having sugar and salt in place. Since adrenaline is compensating in many ways, for example by keeping blood sugar up, opposing it with a drug like clonidine, for example, can sometimes trigger asthma or hypoglycemia when things swing the other way. If you lower adrenaline down without raising glucose (by eating enough carbohydrates), cortisol can actually rise to fill the gap.
Eggs without carbohydrate can trigger an adrenaline surge. If you already tend toward hypoglycemia, eating eggs (or any other high protein, low carbohydrate food) stimulates insulin secretion, which drops blood sugar further, and causes a surge of adrenaline. The shakiness that follows is the adrenaline. If you want eggs, have them with fruit or juice.
Caffeine on an empty stomach in a hypothyroid person drives adrenaline and cortisol into a frenzy. Black coffee on an empty stomach is what causes the terrible reactions people blame caffeine for. The fix is coffee with cream/milk and with food, never alone, because cream/milk slows caffeine absorption and food keeps blood sugar up. Coffee con leche after a meal has none of the harmful effects.
Insomnia and waking in the early hours is usually an adrenaline problem. If someone is waking repeatedly or cannot stay asleep, their liver usually doesn't have enough stored glycogen - thyroid is the limiting factor for how fast glycogen can be synthesised. Sucrose provides fructose, which is especially good at converting to glycogen, so sugar from fruit late in the day helps more than starch. Setting an alarm to wake slightly before the expected waking point and eating carbohydrate, milk, juice, or even a cracker, every hour for a week can break the cycle in severe cases.
Chronic high adrenaline ages a person the same way chronic high cortisol does. Adrenaline in chronic excess is itself highly stressful, and the organism will keep cortisol elevated alongside it. Nocturnal adrenaline and cortisone rise in everyone during fasting sleep, but in the old and hypothyroid they rise much higher, which is why people in their 70s and 80s often wake up after five or six hours and cannot get back to sleep.
Acute adrenaline is physiological; chronic adrenaline is pathological. Brief, intense adrenaline bursts during a real stressor are a normal response and are not especially harmful. The problem is the modern low-grade stress state that keeps adrenaline elevated for most of waking hours. The distinction is not adrenaline itself but its persistence.
Low-carb and fasting protocols chronically elevate adrenaline. Depleting glycogen forces the body into the stress pathway. People who sustain low-carb, ketogenic or chronic fasting approaches end up with chronically elevated cortisol and adrenaline, which is why many develop insomnia, anxiety, muscle loss, and over time a metabolic state where they cannot tolerate sugar when they try to reintroduce it.