Do you ever experience any of the following;
- Tired for no reason?
- Having trouble getting up in the morning?
- Need coffee, cola, salty or sweet snacks to keep going?
- Feeling run down and stressed?
- Crave salty or sweet snacks?
- Struggling to keep up with life’s daily demands?
- Can’t bounce back from stress or illness?
- Not having fun anymore?
- Decreased sex drive?
If you answered yes to any of these vague collection of symptoms then you might have what an increasing number of people are calling “adrenal fatigue.” The reality of being a nearly graduated doctor is that friends and family often contact me for medical advice. Lately, there has been a rise in the number of people asking about adrenal fatigue or adrenal dysfunction, and I’m noticing more and more people sharing articles on Facebook with titles like “everything you need to know about adrenal fatigue.” As someone who is both endurance and medically minded, I wanted to put all my thoughts in one place to share what I know about this subject so far. I will continue to update it as learn more, so please feel free to leave any comments or questions at the bottom.
The adrenal glands
Your adrenal glands are small glands that sit on top of your kidneys and produce hormones including cortisol, aldosterone and androgens (that become sex hormones). When people speak about adrenal fatigue they often refer to cortisol as one of the primary trouble makers and symptom causers.
Is cortisol the problem?
Normally, cortisol has potent metabolic effects on a range of different tissues in the body, and the amount of cortisol in the blood varies across the day according to circadian rhythm. It tells the liver to produce more glucose and contributes to the breakdown of muscle tissue (thereby increasing your blood sugar). Cortisol also inhibits the formation of new bone and and decreases calcium absorption from the gut. In normal amounts this is ok, but in high amounts (such as Cushing’s disease or in people taking steroid medications) it can contribute to osteoporosis. Cortisol also has a range of effects on the heart, helping to sustain normal blood pressure and heart muscle function; and in the brain, by altering the firing of some neurons and even influencing mood and behaviour of some people. So as you can see, it is conceivable to think that any symptoms at all might be attributable to some kind of cortisol or adrenal gland problem.
Certainly, people do get problems with their adrenal glands such as adrenal insufficiency, which is a proper diagnosis. One form of this is Addison’s disease, a condition where your glands stop producing cortisol. It can be caused by the body’s immune system attacking the adrenal glands, cancer growth or an infection in the glands. It leads to very low blood pressure and heart problems, and can be a medical emergency. This disease affects approximately 4 per 100,000 people.
Could stress cause your adrenal glands be fatigued?
Cortisol is often referred to as the “stress hormone” – so it makes sense that people who feel stressed and burnt out like the idea that they have run their glands out of the hormone. It makes sense. It lines up with our desire to be tougher than everyone else, to glorify being busier than the next guy. “Look how hard I train and work, I’m so much more busy and stressed than you that I’ve used up all my cortisol.”
So why has someone told you that you might have adrenal fatigue or dysfunction? Maybe you do have some of the quoted symptoms, you’re not coping with your usual daily tasks and you’re noticing that your mood and physical energy are beyond low. What they might actually be referring to is the General Adaptation Syndrome (GAS) that describes the body’s physiological response to a stressor of any kind (physical/emotional) over time. The key stages are as follows:
1. Alarm stage: the fight or flight response, increase in cortisol and adrenaline, heart pumping, ready to fight or run.
2. Resistance stage: Maintained high secretion of cortisol with catabolic effects, depletion of body resources. This stage can go on for a long time, but is not sustainable.
3. Exhaustion stage: The body’s resources are used up and it can no longer maintain function at such high levels of stress, immune system suffers, resting heart rate increases, feelings of exhaustion and low mood dominate, fatigue levels are high- all the hallmark symptoms of what is now called “adrenal fatigue.” It is not your glands that are tired and giving up, but the lack of available fuel for your body to continue to function at a level that the adrenal hormones are asking for.
(Original paper on the general adaptation syndrome published here)
In addition to this, the overtraining syndrome that occurs in endurance athletes can have negative effects on the function of the hypothalamic-pituitary-adrenal axis (HPA-axis). There have been papers describing an Addison-type overtraining syndrome where the adrenal glands are no longer able to maintain proper hormone levels and athletic performance is severely compromised. A review of this information and research can be found here.
Looking into the diagnosis and workup of adrenal fatigue
The label of ‘adrenal fatigue’ is a made up disease with no basis in human physiology. It appeals to peoples need for a medical name for their symptoms, and takes advantage of those who do not have much medical knowledge. It is irresponsible to diagnose a patient with something by using a vague list of symptoms with zero clinical scoring system, and lab tests that are not meaningful and whose values do not correlate with underlying pathology. It is akin to diagnosing anyone who is short of breath with having asthma, when in fact they might be having a heart attack, or have a serious pneumonia.
The term “adrenal fatigue” was invented by a chiropractor (NB: Not a medical degree = not a medical doctor) / naturopath in 1998. Those questions listed at the top are part of his way of diagnosing the disease, which could also be used to indicate something like diabetes, infection, sleep apnoea, depression, cancer or any other chronic disease.
Chances are, if you see a naturopath or alternative practitioner they will tell you that adrenal fatigue is something that cannot be formally diagnosed, and doctors either haven’t “discovered it yet” or “are in denial” that it exists. The portrayal of medicine in these circles is one of non-listening, non-caring, pill pushing robots who are years behind the natural practitioners. This is misleading and hurtful, but it serves the purpose of discrediting the very people who have devoted their lives to the healing of others.
Sometimes naturopaths will test your cortisol levels, which in these circumstances is unreliable because it cannot definitively diagnose or exclude anything. They will likely charge you a large fee and put you on a confusing end elaborate diet, complete with expensive supplements that they conveniently sell from their clinic. Ultimately, people will undoubtedly feel better if they eat healthy, unprocessed foods, cut out caffeine/alcohol/wheat etc, engage in relaxation techniques and prioritise sleep, but you probably don’t need a $200 consult to tell you that. At best, taking supplements you don’t need may mean you’ll pee out some expensive urine. However, you can inadvertently disrupt the balance of other hormone and metabolic systems by taking a handful of unnecessary supplements.
Supplements available to treat “mild adrenal fatigue” that you can diagnose yourself with based on an online quiz on their homepage. Moderate and severe adrenal fatigue can also be diagnosed like this… seems legit.
Your symptoms are real, but your diagnosis is probably not
Yes, these symptoms are definitely real and should always be checked by your GP to rule out underlying illness (a real adrenal insufficiency) or some kind of deficiency (i.e ferritin- female athletes I’m looking at you!) This is probably the most worrying part for me as a future doc- that people with real medical conditions and diseases are being told they have this made up one, and as a result are not getting the help they really need.
Contrary to what many alternative health practitioners say, the first place a good doctor will always look for answers is in your lifestyle and diet, as well as ruling out any serious conditions that might be responsible. Sometimes it is simply a case of reducing stress in your life and eating better, and these take both time and effort on your behalf- not pills and magic herbs. But in the off chance that something is really wrong, we can quickly open up a path to appropriate treatment. Yes, it can be very unsatisfying to leave a consult with no immediate medical label to explain your symptoms, but surely that’s far better than being treated for a pretend illness by an unqualified (and expensive) quack.