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What Exactly Is Adrenal Fatigue?

Causes, signs, symptoms, treatments, and controversy

With James L. Wilson, PhD

Excess stress causes the adrenal glands to increase cortisol production.

If you're feeling tired and fried, chances are you've probably heard of adrenal fatigue and wondered if it may be the source of your constant exhaustion. But what exactly is it, and how do you know if it's what's causing your lack of oomph? Let's investigate.

Adrenal fatigue is an increasingly common yet sometimes controversial diagnosis used to indicate depletion of the adrenal glands. Cortisol is a hormone released by the adrenals for use in the regulation of blood pressure. In response to stress, the adrenals release greater amounts of cortisol. Adrenal fatigue is thought to occur when the adrenals have become overtaxed by excess cortisol release and can no longer produce levels of cortisol necessary for optimal body function.

James L. Wilson, PhD, who coined the term adrenal fatigue in his book Adrenal Fatigue: The 21st Century Syndrome, describes the adrenals as “two little glands that sit over your kidneys and are about the size of two large grapes and weigh about five-to-eight grams.”

According to Wilson, “The adrenals put out over fifty hormones. We often only hear about DHA and cortisol, but forty percent of women’s estrogen or progesterone are made in the adrenal glands and about forty percent of testosterone in males is made in the adrenal glands.”

Practitioners who treat adrenal fatigue consider the expansive function of these glands and the range of deficiencies that may occur when the adrenals aren’t functioning optimally. “They have a very profound effect on the entire body,” says Dr. Wilson. “They’re the glands that first respond to stress, but also the first to suffer as a result of stress.”

Symptoms

Common symptoms of adrenal fatigue are thought to include:

  • fatigue, particularly upon waking, with intermittent “crashes” throughout the day
  • poor stress response and mood regulation
  • cognitive issues or “brain fog”
  • increased energy levels in the evenings 
  • cravings for salty and sweet foods 
  • overuse of caffeine and other stimulants 
  • a compromised immune system

Less common symptoms are believed to include:

  • insomnia
  • frequent urination
  • loss of muscle tone
  • poor circulation
  • depression
  • weight gain 
  • decreased libido

Causes

Any kind of excess stress causes the adrenals to increase cortisol production. Adrenal fatigue is thought to occur when the adrenals have been overworked to a degree that they can no longer secrete levels of cortisol that are adequate for optimal function.

Potential stressors include environmental and dietary influences, as well as anxiety and emotional stresses. Experiences such as grief, trauma, and autoimmune conditions are considered to have a possible chronic negative impact on adrenal function. An overuse of antibiotics is also believed to possibly have detrimental effects on cortisol production.

Distinction from Addison’s Disease

Adrenal fatigue is closely related to, but not to be confused with, Addison’s Disease, a disorder characterized by insufficient cortisol production due either to a pathology directly affecting the adrenals or a disruption of signaling between the brain and the adrenals. While symptoms of Addison’s Disease are similar to adrenal fatigue, the primary difference is that adrenal fatigue is considered a possible result of the overuse of otherwise healthy adrenal glands due to stress.

“The adrenals are necessary to have gluconeogenesis to take place in the liver, as well as the glycogen storage where it stimulates the production of blood glucose,” says Dr. Wilson. “So, most of the major symptoms of either adrenal fatigue or Addison’s Disease are a result of either a lack of cortisol or a lack of blood glucose and the many effects that it has systematically throughout the body.”

He theorizes, “Unlike Addison’s, adrenal fatigue doesn’t have a pathological origin, with the exception of the overuse of antibiotics which may partially shut down the use of the adrenal glands. So, you do get different symptoms with Addison’s Disease versus adrenal fatigue, because you’re talking about the difference between a body that can’t secrete cortisol versus a body that isn’t secreting sufficient cortisol.”

Controversy

Some studies argue against adrenal fatigue as a diagnostic category. Symptoms related to adrenal dysfunction are also referred to as “adrenal disorder” or “adrenal insufficiency.” Some researchers maintain that adrenal fatigue does not exist.

A 2016 review published in the medical journal BMC Endocrine Disorders examined fifty recent studies and concluded that there is no statistically verifiable relationship between adrenal deficiency and fatigue.

Practitioners such as Dr. Wilson, however, disagree. “The research for this goes back years. Henry Harrower, one of the original editors of The Journal of Endocrinology, wrote quite a bit about low adrenal function. It was known by different names such as hypocortisolism and Minor Addison’s Disease,” says Wilson.

A 2011 evidence-based review published in Integrative Medicine states, “Studies have shown a correlation between hypocortisolism and numerous disease states, such as metabolic syndrome and fibromyalgia, as well as chronic pain syndromes, cardiometabolic disease, mood disorders, autoimmune diseases, and malignancies.”

Adrenal fatigue has become increasingly recognized by naturopaths, homeopaths, and doctors of functional medicine. However, many traditional medicine doctors uphold that it isn’t a viable medical condition, in part due to how generalized its alleged symptoms are and the fact that they can apply to many other causes such as depression or hypothyroidism.

Diagnosis

Some of the recent scientific debate about adrenal fatigue has to do with diagnostic methods. Previously, adrenal health was often assessed using blood tests designed for Addison’s Disease and Cushing’s Syndrome—tests which some practitioners say are insufficient for measuring the complex cycles of cortisol levels.

Doctors who test specifically for adrenal fatigue most often do so using urine or saliva tests to measure cortisol levels. “You also have to get an idea about the stress in people’s life,” states Dr. Wilson. “You can have a patient who has normal cortisol levels but who’s exhausted and working fourteen hour days. They’re worried about their mortgage, so there’s clearly a problem there—they need more cortisol than normal, so there’s going to be a crash.”

Because cortisol levels vary throughout the day, doctors treating adrenal fatigue suggest that it is important to administer comprehensive tests as well as to understand a patient’s daily energy patterns in order to better assess the way cortisol production cycles over the course of a day.

It’s not a disease

“It’s not a disease,” says Dr. Wilson. “It’s a syndrome that results from being stressed to a point at which the body can’t respond in an optimal way.” He draws connections between adrenal fatigue and nearly all autoimmune diseases, since the mental and physical stresses accompanying such conditions also affect the adrenals.

Doctors who treat adrenal fatigue also suggest that conditions such as clinical depression and PTSD often tax the adrenals in ways that can cause chronic deficiency.

“About twenty-five percent of what’s considered clinical depression also involves low cortisol while about seventy-five percent of clinical depression also involves high cortisol,” says Dr. Wilson. “So, it’s pervasive, with the adrenal having so much to do with proper immune function, proper blood sugar balance, and with brain function. There’s thousands of cortisol receptors in every part of the brain, and they work in conjunction with each other and with the other neurotransmitters.”

Treatments

Presently, there is no pharmaceutical treatment for adrenal fatigue, which some naturopaths and doctors of osteopathy consider to be a factor in traditional medicine’s view of the condition. Suggested natural remedies include lifestyle changes such as a low-sugar/low-caffeine diet, avoidance of junk food, a healthy sleep schedule, and nutritional supplementation.

Supplements thought to help ease adrenal fatigue include:

  • Vitamin C
  • Magnesium
  • B vitamins
  • Coenzyme Q10
  • Ashwagandha
  • Rhodiola
  • Licorice Root

Other healthy routines such as adequate daily hydration, managing blood sugar through a balanced eating schedule, and meditation are also believed to have positive effects on restoring the adrenal glands to optimal function.

 

 

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