Adrenal Fatigue on Keto — Or Just Low Sodium?

"Adrenal fatigue" isn't a real medical diagnosis, but the symptom cluster people label it with — exhausted-but-wired, 3am wakeups, salt cravings, dizzy on standing, afternoon crash — is very real. On keto, it's almost always low sodium wearing an adrenal costume. Here's how to tell.

The overlap is almost total

Cortisol and aldosterone (the sodium-regulating hormone) are both made in the adrenal gland and both track together. Low sodium sends aldosterone up, which drags cortisol up with it — so you end up with adrenal-shaped symptoms without any adrenal pathology at all. The keto sodium-flush is the fastest way to create this pattern in a healthy body.

The 3-day sodium test

Before you spend $400 on adaptogens, cortisol saliva panels, or licorice root, run this:

1. Days 1–3: 5,000 mg sodium spread across the day (¾ tsp salt in the morning, ½ tsp mid-afternoon, pinch at bedtime). Add 1,500 mg potassium chloride and 300 mg magnesium glycinate.
2. Track: morning energy, 3pm crash, 3am wakeups, dizziness on standing. Score each 1–10.

If the scores improve by 50%+ in 72 hours, it was electrolytes. That's the vast majority of cases. If nothing shifts, that's the point to look at cortisol timing with an actual clinician.

Why this matters

The adrenal-fatigue industry is enormous and expensive. Ruling out the $8 fix first is not a shortcut — it's the correct order of operations. Fix the mineral floor. Then, and only then, ask whether something else is going on.