- Tired for no reason?
- Having trouble getting up in the morning?
- Struggling to keep up with life’s daily demands?
- Not having fun anymore?
- Craving salty or sweet snacks or caffeine?
- Do you have unexplained fears/anxiety?
- Do you have asthma, arthritis, or fibromyalgia?
Then you might be suffering from adrenal fatigue!, or so says the internet along with a host of self-stylized heath gurus, but what does adrenal fatigue really mean and does it even exist? As a integrative & functional nutritionist, I get this question a lot.
What is adrenal fatigue?
Before we can tackle adrenal ‘fatigue’, we have to review some basic physiology. The adrenals are two little endocrine glands (meaning they produce hormones) found on top of the kidneys; the main hormones of interest where adrenal fatigue is concerned are adrenaline and cortisol, a.k.a. the ‘stress hormones’.
According to some practitioners, adrenal fatigue is nothing more than a case of exhausted adrenal glands; exhausted because they have been chronically stimulated to release adrenaline and cortisol in response to prolonged stress – as a result, they’re unable (have exhausted their ability) to produce enough hormones, mostly cortisol, and a tsunami of health problems follow.
The consensus is that adrenal fatigue was coined by James Wilson in 1998 perhaps as a way to make complicated biology simpler for ease of communicating. I for one value clear communication but think there’s a way to do it without compromising facts. The problem is, the adrenals glands are more than capable of producing cortisol on demand; they don’t run out of cortisol nor do they stop producing it because they’re too tired to do so. If fact, chronic stress can cause adrenal glands to get larger and increase their capacity to respond to stress; i.e. adaptation.
Adrenal fatigue should not be confused with Addison’s disease, an autoimmune disease that causes adrenal insufficiency (too little cortisol) or Cushing’s syndrome (where there’s too much cortisol) – not even close.
What about those salivary tests?
These tests involve collecting saliva anywhere from 1 to 4 times a day; typically at least one in the morning upon rising. The test measures the levels of cortisol in your saliva; if several samples are collected, the test is said to provide an evaluation of how cortisol levels fluctuate throughout the day which supposedly measures adrenal function/response.
The problem with these tests is that they’ve never been adequately validated, or the extent to which a test measures what it is supposed to measure. Testing cortisol levels in saliva hasn’t been shown to be reliable either; a measure is said to have a high reliability if it produces similar results under consistent conditions regardless of who’s doing it. The unreliability of salivary cortisol tests isn’t surprising since it’s well-known that many factors (prolonged & intense exercise, long commutes, moderate alcohol consumption, smoking, stress) can influence cortisol levels – in short, it’s a crap shoot.
The other consideration is that most people don’t have low cortisol levels and the amount measured in saliva only represents 3-5% of the total body cortisol; hardy representative.
In the absence of Addison’s disease, a person may have low cortisol levels it’s true but not because the adrenals aren’t able to produce it; other reasons can explain low cortisol but they have nothing to do with the adrenals’ ability to produce it.
Cortisol levels can drop with prolonged stress because the body will try to protect itself. Without going into too much details, the part of the brain that triggers our response to stress will effectively ‘turn down the volume’ and tell the adrenals to produce less because being over-stimulated isn’t a good thing. But the adrenals are not fatigued, they’re simply following orders.
Also, the body’s tissues will start to protect themselves by increasing their resistance to cortisol; it’s like as if there were to put in earplugs and ignore cortisol when it’s knocking at the cells’ door.
If it’s not the adrenals, what’s causing all my symptoms?
The symptoms attributed to adrenal fatigue are broad and not specific. There are many disorders, diseases and syndromes that can produce similar symptoms so be sure not to ignore them and seek medical attention if they become problematic, but for most of us, the generalized symptoms of fatigue, intolerance to cold, cravings, low mood & motivation, decreased/increased appetite, anxiety, poor attention, poor sleep or decreased sex drive can often be traced back to the side effects of prolonged, untreated stress: inflammation & oxidative stress.
Lifestyle, diet and supplements can all be leveraged to lower inflammation and ultimately temper the stress response and balance adrenaline & cortisol levels. In fact, the traditional ‘adrenal support’ supplements include several of the vitamins and minerals used by the adrenal glands to produce stress hormones, as well as, herbs that have been shown to lower both inflammation and oxidative stress, and by extension cortisol. They do not ‘boost’ fatigued adrenals to produce more.
See my post Adaptogens. Can they really help to reduce stress?
A better term for adrenal fatigue might be something along the lines of stress-related adrenal dysregulation since stress can influence cortisol output by the adrenals in response to the hypothalamus’s role in overseeing stress regulation. Anyone presenting with some of the symptoms above needs to see their doctor and start addressing some of the lower hanging fruit were stress management is concerned such as:
- good sleep hygiene
- stress management
- routine blood work for anemia, thyroid function, perhaps androgen testing (testosterone, estrogen, pregnenolone)
- medications that interfere with sleep/side effects
- routine disease screening like diabetes/insulin resistance, kidney disease, blood pressure
- getting moderate amounts of activity/exercise
Along with this, seeing a nutrition professional can help since nutrition-related issues can produce similar symptoms like un-diagnosed food allergies, intolerances & sensitivities, histamine/sulphite intolerance/reactions, unhealthy use of caffeine and alcohol, or even functional nutrient deficiencies can negatively impact our stress response. Assessing the intake of brain-specific nutrients is crucial and addressing any underlying gut issues is also paramount since the gut and brain are intimately linked and a ‘bad gut’ can show up with brain/mood related symptoms.
Be sure to get checked out from head to toe