Notes and Thoughts from:

by Karen Mann

Picture of Book Cover for Adrenal Transformation Protocol

Adrenal Transformation Protocol

By Izabella Wentz, PharmD, FASCP

Available on Amazon: Click Here To Purchase

  • The term “adrenal fatigue” was initially introduced in the 1990s by a chiropractor with the intention of using it for marketing purposes. Western medicine does not recognize it as an actual disease; rather, true adrenal insufficiency can cause life-threatening symptoms and needs to be appropriately managed with steroid supplementation.
  • That being said, the case for adrenal dysfunction is defended in the book Adrenal Transformation Protocol by Izabella Wentz. However, she refers to it as “HPA axis dysfunction” or “impaired stress response.” HPA refers to the sequence of glands in the body that are responsible for the production of cortisol: the hypothalamus, the pituitary, and the adrenals. 
  • Reverse T3 is believed to be a measure of adrenal dysfunction because of the interaction between the thyroid and the adrenal glands, with RT3 being a potential blockade to the use of T3, the active form of thyroid hormone. So, while T3 may be normal, its action may be blocked by RT3. However, in mainstream medicine, RT3 is known to be metabolically inactive and only a useful test for extremely sick patients when there is concern about thyroid function. It’s not a part of the normal labwork your regular PCP would ever order. 
  • Wentz has measured cortisol in patients with the symptoms characteristic of “adrenal dysfunction” and has found that the curve one would see with normal cortisol production is slightly off in these patients. In normal people, cortisol is higher in the morning and decreases as we approach bedtime. In patients with adrenal dysfunction, the levels are higher or lower than average. The problem with this is that the levels are still within normal range and should be able to regulate all physiologic functions in the body. The belief is that because the levels are slightly higher or lower than normal, a whole range of symptoms are created, from fatigue to brain fog to cravings to headaches. The list goes on to include almost every symptom a person with inflammation or metabolic dysfunction would experience, essentially accounting for 88% of our population.
  • Wentz puts forth a protocol to help the people she believes are suffering from adrenal dysfunction. I am including the basics of the protocol. However, I want to clarify that you could apply this protocol to anyone with any physical complaint and see improvement. The audience she is speaking to is the overworked, overstressed, underappreciated, disconnected American population, all of whom would benefit from lifestyle changes. These changes aren’t specific to the rehabilitation of the adrenals. These changes would help anyone with any condition resulting from inflammation, which is ultimately the downstream manifestation of stress. 

Four main causes of stress:

  • Inflammation
  • Circadian Rhythm Imbalances (sleep disturbances)
  • Nutritional Imbalances
  • Psychological Stress

There are three stages of adrenal dysfunction:

Stage 1 = High Cortisol Stage – constant, unmanaged stress

Stage 2 = Cortisol “Roller-Coaster” Stage – levels go up and down throughout the day

Stage 3 = Cortisol Deficiency Stage – the adrenals can no longer keep up with the demand

The book provides a symptom tracker to determine which stage you’re in.

She states, “Diet and lifestyle are key to recovering from adrenal dysfunction.” I think diet and lifestyle are crucial to health, regardless of your specific diagnosis.

She promotes a dietary strategy that is essentially a strict elimination diet (more stringent than Whole30), a series of supplements, removal of caffeine, emphasis on quality sleep, and various tools for stress management, emotional regulation, and trauma recovery.

Excluded Foods:




High glycemic vegetables

High glycemic fruits




Spicey Peppers


This diet is supposed to balance blood sugar and reduce inflammation. (this is true; it will do that).

Bone broth, fermented foods, and fiber are encouraged.


Saccharomycese boulardi – a yeast used in Western medicine in kids with diarrhea and used in this protocol for reducing gut inflammation.  

Carnitine (improves fatigue)

Magnesium (citrate, although I prefer glycinate at bedtime)

Myo-Inositol (this is used for insulin resistance in PCOS patients)

Electrolytes (sodium, potassium, chloride, magnesium, Vitamin C, Quercetin, taurine, D-ribose)

Protein shakes are encouraged. Eat six times a day; breakfast is also encouraged. Hydrate.

Aerobic exercise is better for those in Stage I, and strength training is better for those with more advanced stage dysfunction. 

For mood disturbances, she recommends the following tests:

Thyroid panel

Copper toxicity

Food Sensitivity testing

Nutrient Panel

Female Hormones

Mold panel

Gut infection panel

Organic Acids Test

Functional medicine adrenal testing

Adrenal hormones


Pyroluria (not currently supported as being causative by Western Medicine)

For emotional regulation, utilize trigger awareness and mindset management associated with therapy and coaching, as well as:


Warmth (including baths with Epsom salt)









Being in Nature


Light therapy

Positive thinking

Pleasureable activities.

While I personally do not have any of the symptoms associated with adrenal dysfunction, I read this book for a friend who did, and for all my patients wtih similar concerns. I do not advocate for or against this protocol, but I wanted to share its basics for people curious to try it. Most Western Doctors will only do this workup if specifically asked, but you can order the labs yourself. This workup and treatment protocol align more with the tool kit of a Functional Medicine Provider.

Have you tried her protocol and had success? Let me know! 

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