Adrenal Fatigue: Separating Fact from Fiction
In my journey to find a doctor to help me with my autoimmune disease Hashimoto’s Thyroiditis, I have seen conventional medical practitioners, endocrinologists, iridologist, homeopath and a functional doctor (which is a conventional medical practitioner who have also been trained in functional medicine – who focuses on finding and treating the root cause, not just treating the symptoms).
Somewhere along this journey I got introduced to the term “adrenal fatigue”. As I am curious by nature, I went online to search more about it. What is it? What happens in my body? Can this be treated? So, I started doing my own research, as I believe as a patient, I am my own best advocate and I want to be able to make informed decisions about my health.
What I found was very interesting. There seems to be huge debate in the medical field about the validity of an adrenal fatigue diagnosis. There are those who believe it is a real condition and provide numerous treatment options (just search online for the term adrenal fatigue and you will find many sites with advice, recommendations and selling products in the form of herbs, vitamins and minerals). Then, there are those who do not support it as a valid medical diagnosis, as there is no research that can conclusively confirm that it exists, nor any medication that can be prescribed for it.
I believe in having the information available (to a level that I can understand it since I am not a doctor) so that I can make informed decisions about my health and my body. With that in mind, I am sharing the information here so you too can make an informed decision about your health.
In this article, I will look at the following:
- What are the adrenal glands?
- The role of the adrenal glands in the body’s stress response.
- Disorders affecting the adrenal glands.
- The theory of adrenal fatigue.
- What does the research say about adrenal fatigue?
- And what about burnout?
- A word of caution.
- But what if you have the symptoms of adrenal fatigue?
What are the adrenal glands?
The adrenal glands are part of the body’s hormonal system. These glands sit on top of your kidneys. The glands consist of an outer part called the adrenal cortex and an inner part, called the inner adrenal medulla.
The adrenal gland produces hormones that impact other parts of the body. The hormones secreted by the adrenal cortex are:
- Glucocorticoids, also known as hydrocortisone or cortisol. Cortisol plays an important role in metabolism, in that it stimulates glucose production and helping to release energy from fat and muscles. Cortisol also has anti-inflammatory effects.
- Mineralocorticoids, the most important of which is aldosterone, which helps to main the body’s salt and water levels, which in turn, regulates blood pressure.
- Small amounts of adrenal androgens, which are male sex hormones, mainly DHEA (dehydroepiandrosterone) and testosterone.
The hormones that are secreted by the adrenal medulla are catecholamines, which includes epinephrine (also known as adrenaline), norepinephrine (also known as noradrenaline) and small amounts of dopamine. These are the flight-or-fight hormones.
Now that we know which hormones are made by the adrenal glands, next we look at the role of the adrenal glands in the body’s stress response.
The role of the adrenal glands in the body’s stress response
When we talk about the body’s response to stress, Professor Robert Sapolsky (specialty in neuroscience in the The Great Courses: Stress and the Body, and author of the book Why Zebras Don’t Get Ulcers) from Stanford University explained it well. The body seeks homeostasis. It always works to be in balance with the ideal pressure, temperature, level of glucose in the bloodstream and so on. Sapolsky defines stress as anything that disrupts the homeostatic balance of the body.
With that in mind, we can start to understand the impact of stress on the body.
While the stress-response is great and adaptive to save your life when you are facing a life-threating event, is also very damaging to your health, especially if you are stressed so often that it becomes chronic.
One of the systems in your body is the hormonal system. Hormones come from glands and impact various parts of the body. When you are stressed, the brain activates the stress response and in doing so, the hypothalamus in the brain instructs the pituitary gland to release hormones which instructs various glands to release other hormones. One of these glands are the adrenal glands.
The adrenal glands release an important hormone, called called glucocorticoids (mainly cortisol). This hormone helps to get energy into the body to the muscles so that you can react, quickly!
As part of the process to get energy to the muscles quickly, the glucocorticoids work with two other hormones epinephrine (also secreted by the adrenal glands and better known as adrenalin) and glucagon (a hormone released from the pancreas during stress to help mobilize energy from storage) to shut down the secretion of insulin so that no nutrients are stored in the body. Your blood sugar spikes (as more glucose is placed in the blood) and your heart rate increases (so that the glucose is delivered faster to the muscles and brain). All of this is focused on getting energy to your muscles so you can run for your life or fight for your life!
The glucocorticoids have another function in the body as well: it stimulates the appetite so that you can replace the energy after you have been running or fighting for your life! As soon as the stress is over, and you are now safe, it takes a few minutes for the glucocorticoids (cortisol) levels to return to normal and now you are hungry. This is the recovery phase of the stress response, and the reason why we eat more during periods of stress, especially those exact foods which are high in energy: starches, sugars and fatty foods!
So that is the reason why most people eat more when they are stressed!
Disorders affecting the adrenal glands
Next, let us get into the details of diseases that affect the functioning of the adrenal glands. There are genuine recognized disorders that affect the adrenal glands and that impact the health of patients.
When the adrenal glands cannot produce enough glucocorticoids (cortisol), it is called adrenal insufficiency. Adrenal tumors can also affect the adrenal glands. Cushing’s Syndrome is when the adrenal glands produce too much cortisol. Another disorder is a genetic disorder called congenital adrenal hyperplasia, characterized by low levels of cortisol (people with congenital adrenal hyperplasia often have additional hormone problems).
As I am investigating adrenal fatigue, I am just going to review adrenal insufficiency, and not look at adrenal tumors, Cushing’s Syndrome or congenital adrenal hyperplasia.
Understanding adrenal insufficiency
There are three levels of adrenal insufficiency:
- Primary adrenal insufficiency or Addison’s Disease is caused by underactive or damaged adrenal glands, which then affect the cortisol and aldosterone levels in the blood. This disease is rare, affecting about 1 person in 100 000 in the United States. Addison’s Disease is classified as an autoimmune disease, as it is the immune system’s antibodies that attack and damage the adrenal glands, causing lower hormones over time.
- Secondary adrenal insufficiency is caused by a decrease in the production of another hormone that the pituitary gland secretes, ACTH or adrenocorticotropic hormone. This hormone tells the adrenal glands to produce cortisol. So when the pituitary gland produces less ACTH, the adrenal glands produce less hormones. Secondary adrenal insufficiency can also happen if you have been prescribed corticosteroid therapy (for example prednisone to relieve inflammation or high dose inhaled steroids to treat asthma) and you suddenly halt the treatment. These treatments suppress natural cortisol production and it can take time, weeks to months, for levels to normalise.
- Tertiary adrenal insufficiency happens when the hormone that instructs the pituitary gland to produce ACTH, is not enough, leading to the pituitary gland producing less ACTH which leads to lower hormones secreted by the adrenal glands.
How do you know if you may have adrenal insufficiency? This is not an easy diagnosis, and the symptoms may develop slowly. The most common signs and symptoms include:
- Fatigue or extreme weakness
- Unexplained weight loss
- Muscle aches and weakness
- Dizziness and fainting
- Changes in blood pressure or heart rate
- Abdominal pain
- Nausea and/or vomiting
- Diarrhea or constipation
- Decreased body hair
- Low blood sugar
- Salt craving (with Addison disease)
- Dehydration (with Addison disease)
Now that we understand how the adrenal glands work when the body’s stress response is activated and adrenal insufficiency, let us look at the theory of adrenal fatigue.
Diagnosing adrenal insufficiency
Adrenal insufficiency can be diagnosed by blood tests and special simulation tests that will show inadequate levels of adrenal hormones.
The theory of adrenal fatigue
The term “adrenal fatigue” made its debut in 1998 by chiropractor and naturopath James Wilson, who also published a book by the same name.
The premise is based on the idea that the adrenals can work so hard when you are experiencing severe chronic distress that it can go into overdrive, become tired and then it cannot produce the stress hormones cortisol and adrenalin anymore, thereby becoming “fatigued”.
Symptoms of adrenal fatigue
The adrenal depletion would then cause brain fog, low energy, depressive mood, salt and sweet cravings, light-headedness, unexplained weight loss, reliance on stimulants such as coffee, trouble to fall asleep and waking up, and nonspecific digestive problems.
How is adrenal fatigue diagnosed?
There is currently no test that detects adrenal fatigue. Many practitioners test the cortisol levels in saliva or by doing a blood test, or just based on the symptoms a patient presents. The blood test measures the levels of electrolytes and hormones, giving a better picture of which hormones may be out of range and could be causing the symptoms.
What does the research say about adrenal fatigue?
The symptoms of adrenal fatigue are relatively generic, and that is exactly where the problem is. Because the symptoms are so vague, there could be a variety of reasons that someone is experiencing these symptoms. These may include nothing more than a busy lifestyle and a lack of sleep, a caffeine addiction or poor nutrition. It could also be symptoms of a serious underlying medical condition, and a misdiagnosis (being diagnosed with adrenal fatigue when you may actually have an underlying condition) could impact your health negatively. But more about this later.
For now, I want to look at the scientific research. Many supporters of the adrenal fatigue theory state that the scientific evidence still need to catch up, but in the many years since the term was introduced, research have not been able to confirm it as a legitimate medical condition.
A review of 58 studies was done, where the authors of the review investigated the suggestion that chronic stress could potentially lead to “overuse” of the adrenal glands and that the adrenal glands could as a result, fail. What did the authors of the study conclude? To quote directly from the study: “This systematic review proves that there is no substantiation that “adrenal fatigue” is an actual medical condition. Therefore, adrenal fatigue is still a myth.”
The Endocrine Society also released an official statement: “No scientific proof exists to support adrenal fatigue as a true medical condition. Doctors are concerned that if you are told you have this condition, the real cause of your symptoms may not be found and treated correctly. Also, treatment for adrenal fatigue may be expensive, since insurance companies are unlikely to cover the costs.”
And what about burnout?
The term burnout is also not a recognized medical diagnosis. Burnout is recognized as an “organizational syndrome” by the World Health Organization on 28 May 2019. It is chronic workplace stress.
Researchers in burnout, Dr. Christina Maslach, identified three dimensions of burnout:
- An overwhelming exhaustion,
- Feelings of cynicism and detachment from the job, and
- A sense of ineffectiveness and lack of accomplishment.
I mention this here because I want to highlight that burnout is something that happens in the workplace. The impact of this however, is very real, and I believe it can create stress, which is a known risk factor for developing chronic disease and autoimmune diseases.
So, while burnout is officially something that happens in the workplace, the impact on a person can lead to various stress-related illnesses.
A word of caution
While adrenal fatigue is not considered an official medical condition, the symptoms that many people feel are very real. As I also mentioned, if you experience any of these symptoms, you should have a thorough evaluation done by your medical doctor. There could be other causes of your symptoms, for example anemia, sleep apnea, autoimmune diseases, hormonal imbalances, mental illnesses like anxiety and depression, or heart and lunch problems to name a few.
Another concern that has been published is when a patient has been diagnosed with adrenal fatigue, the patient is often prescribed and treated with corticosteroids (synthetical steroid hormones, for example prednisone), regardless of the cause. We must remember that when a patient starts using corticosteroids, the patient will experience a (usually temporary) sense of wellbeing, regardless of the patient’s condition. But no drug comes without risks and side-effects. Using corticosteroids increases the risk of infections, psychiatric disorders, osteoporosis, glaucoma, sleep disturbances, metabolic disorders (including weight gain and diabetes) and cardiovascular disease.
When supplementing with vitamins and minerals, always take care, as this is an industry that is not regulated. You don’t want to end up doing more harm to yourself than good. Most vitamins are not a problem, except for the fat-soluble vitamin D and vitamin B1 (specifically benfotiamine).
I have also seen recommended herbs like ashwagandha (Indian ginseng), rhodiola (golden root), and licorice root to relieve symptoms. These herbs are great at lowering cortisol, but if you are struggling with low cortisol levels, you could be making yourself feel worse by taking these. Always work with a person who is trained in these herbs so that you take it correctly.
Adrenal hormone supplements like an adrenal glandular (an extract made up from ground-up adrenal glands, usually from pigs or cows), can also create problems. The main active ingredient is hydrocortisone. If you take adrenal extracts when you don’t really need it, you increase the risk that your adrenal glands may stop working altogether (which could lead to adrenal crisis, which is life-threatening), and it could take months for your adrenal glands to start working correctly again once you have stopped the supplement. Also, these pills are not regulated, so there is no guarantee that what is on the label matches the content of the pills.
But what if you have the symptoms of adrenal fatigue?
The theory of adrenal fatigue seems such an easy fit for so many very real symptoms. And herein lies the problem.
Stress has a huge impact on your body. Start first by asking this fundamental question: what am I doing that is causing all these symptoms? What is the source of the stress? Pressure at work or at home or the hectic pace of your life may be to blame. There are few things you can do:
- Implement stress management strategies like mindfulness, meditation and exercise.
- Review your priorities and implement strategies to reduce your to-do list by considering delegation, automation, outsourcing, avoiding and removal of tasks.
- Manage your blood sugar. Blood sugar that is too high or too low can be the cause of some of these symptoms, so good nutrition is key. Also, have a medical doctor check your blood sugar levels.
- Implement sleep hygiene. Getting enough sleep is crucial for your mental health. Implement a sleep routine and regular sleep time and wake up time, reduce your intake of caffeine and have your last cup of coffee by 14h00, and in the evenings reduce your exposure to blue light (television, computer and cell phone lights).
Then, check your mental state. Mental health conditions, such as depression and anxiety, may have very similar symptoms to adrenal fatigue. Get these sorted
Also, there could be an underlying medical condition that is the root cause of your symptoms. Have a thorough evaluation by a medical doctor. There are so many medical conditions that could cause the symptoms, including sleep disorders, thyroid conditions, infections, autoimmune diseases, other hormonal impairments and heart and lunch problems to name a few.
What is the point I am trying to make here?
- Do not diagnose yourself.
- There are several disorders that do affect the adrenal glands, including the autoimmune Addison’s disease, secondary and tertiary adrenal insufficiency, Cushing’s syndrome and congenital adrenal hyperplasia.
- While medical research has made huge strides and research breakthroughs are published regularly, take note that the current research found no substantiation that “adrenal fatigue” is an actual medical condition
- If the symptoms of adrenal fatigue fit you like a glove, speak with your functional medical doctor to do a full evaluation to check for any underlying medical conditions. Check that you do not have an undiagnosed mental health condition like anxiety or depression that could be adding to your symptoms. Take some time to reexamine your lifestyle and what you can change to reduce the impact of stress.
- Be careful when you consider taking any supplements specially formulated for adrenal support. You could be doing more harm than good.
Ps. If any medical doctor is telling you that your symptoms are in your head (known as medical gaslighting), and they “treat the paper and not the patient” (meaning that your blood lab results are all normal and therefore there is nothing wrong with you), it is time to fire your doctor and change to another qualified doctor who wants to help you.
SEE ALSO: Link to another article
Sources and References
- Adrenal fatigue. Hormone Health Network. Irina Bancos, M.D., Melanie Schorr Haines, M.D., Jason Wexler, M.D. Last updated May 2020. https://www.hormone.org/diseases-and-conditions/adrenal-fatigue
- Adrenal fatigue does not exist: a systematic review. NCBI. Published online 24 Aug 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997656/
- Adrenal fatigue: A fake disease (updated). Scott Gavura, 29 Jun 2017. Science-Based Medicine. https://sciencebasedmedicine.org/adrenal-fatigue-a-fake-disease/
- Adrenal glands: Functions and related disorders. 10 Dec 2019. Jennifer Berry, reviewed by Marina Basina, MD. https://www.medicalnewstoday.com/articles/adrenal-gland
- An Overview of the Adrenal Glands. Robert M. Sargis, MD, PhD. https://www.endocrineweb.com/endocrinology/overview-adrenal-glands
- Adrenal glands. https://www.yourhormones.info/glands/adrenal-glands/
- Is adrenal fatigue “real”?. 28 Feb 2018. Marcelo Campos, MD. Harvard Medical School. https://www.health.harvard.edu/blog/is-adrenal-fatigue-real-2018022813344
- Corticosteroid Adverse Effects. Updated 4 July 2020. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK531462/
- Why You Should Avoid Adrenal Extract. Rebecca Morris. Updated 17 Sept 2018. https://www.healthline.com/health/why-you-should-avoid-adrenal-extract
- Is adrenal fatigue a real condition? Tim Newman. 27 Jun 2018. Medical News Today. https://www.medicalnewstoday.com/articles/245810