Updated: Apr 26, 2019
The Hormone Health Network states on their website that “No scientific proof exists to support adrenal fatigue as a medical diagnosis.”[1] A blog on the Mayo Clinic website warns patients, “Unproven remedies for so-called adrenal fatigue may leave you feeling sicker, while the real cause—such as depression or fibromyalgia—continues to take its toll.”[2] And a review of studies was recently published in a medical journal that concluded, “there is no substantiation that ‘adrenal fatigue’ is an actual medical condition. Therefore adrenal fatigue is still a myth.”[3]
Referring to health trends as “myths” is common in the medical community. I compare the current controversy over adrenal fatigue to the recent controversy over gluten sensitivity. For years, medical societies claimed that gluten sensitivity did not exist—simply because it was difficult to test for it. But the facts cannot be denied: celiac disease has jumped from a rate of 1 in 3000 in the 1980s to a rate of 1 in 100 today. Sometimes we need to delve deeper into issues before jumping to conclusions. So for adrenal fatigue—is this the end of the story? Is it true that adrenal fatigue does not exist?
I am a Medical Doctor, and I understand the importance of an accurate diagnosis. I certainly do not want to put any of my patients at risk by treating them for a condition that is just a myth. It is true that “adrenal fatigue” is not a true diagnosis, and I cannot submit a code to insurance companies for treating it as a disease. I would argue, however, that the opposition to “adrenal fatigue” as a diagnosis is a battle over terms.
Adrenal fatigue is a term that has been used for decades by naturopathic doctors, functional medicine doctors, and other integrative physicians. It is sometimes called adrenal burnout or adrenal exhaustion.
Adrenal fatigue refers to a condition where the body has become so depleted by chronic exposure to stressful situations that it can no longer appropriately respond to stress. One of the symptoms might be unexplained fatigue—hence the name.
So does this really happen?
Yes, but that is not the whole story. The concept of “adrenal fatigue” is only one thing that can happen when the body is exposed to ongoing stress. When researchers search for just a single pattern in patients with fatigue, they do not find it—and they conclude it is a “myth.” In reality, patients with fatigue might have one of several different patterns of adrenal dysfunction or other hormonal disruption.
I am going to walk you through the physiology of stress and what can happen over time. I will then propose that “adrenal fatigue” is just one of many patterns of stress-related disruption in the body. A broader view of how stress can impact the body might help overcome the controversy that now surrounds “adrenal fatigue.”
The Physiology of Stress
The body responds to perceived stress with a hormonal response that is coordinated by the hypothalamus and pituitary in the brain and the adrenal glands, which sit right above each kidney. Together these 3 organs are referred to as the hypothalamic-pituitary-adrenal axis, or the HPA axis.
The immediate response to stress results in production of adrenaline (also called epinephrine) from the adrenal glands. With ongoing exposure to stress, the body begins to produce elevated levels of cortisol, also from the adrenal glands.
Slightly elevated levels of cortisol can be detected on a salivary hormone test. Slightly elevated cortisol is not sufficient to diagnose a specific disease, but it can contribute to symptoms in the body. Whereas cortisol serves an important purpose to mobilize energy in the short term, in the long term it can contribute to things like blood sugar imbalance, abdominal weight gain, and anxiety.
Another pattern of cortisol production that is quite common in people exposed to ongoing stress is low production in the morning and elevated production at night. This is the exact reverse of what the normal daily cortisol pattern should be. Remember that cortisol mobilizes energy. If it is low in the morning, you will be dragging out of bed feeling tired. If it is high at night, you will be feeling wired and unable to fall asleep.
Just as we can see elevated cortisol levels or disrupted patterns on a salivary test, we sometimes see low levels of cortisol. When a person experiences physical or psychological stress, the body reacts by producing elevated levels of cortisol. This persists through chronic stress, but over time can lead to depleted levels. Low cortisol production is more commonly seen after years of chronic stress—after the exposure to stress has been more prolonged. This is the stage of the stress response that would correspond most closely to what many refer to as “adrenal fatigue.” The body is no longer able to mobilize energy for the stress response.
People who are feeling a lack of energy in daily life (fatigue) could have any of these patterns of cortisol production from their adrenal glands. The researchers who wrote the most recent review concluding that adrenal fatigue is a “myth” were searching for just one single pattern. It is not surprising that they did not find it.
A Broader View
To say that “adrenal fatigue” does not exist ignores the reality that stress influences health and disease. Chronic exposure to stress increases the risk of irritable bowel syndrome (IBS), heart disease, diabetes, depression, and even periodontal disease. [4] [5] [6] [7] [8]
Science is beginning to unravel the multitude of ways that stress and its associated hormones, like adrenaline and cortisol, affect the body. For example, elevated cortisol may promote increased intestinal permeability, alter intestinal microflora, and affect gut motility.[9] [10] It is not uncommon to see patients who develop digestive disorders after stressful situations or whose digestive symptoms worsen from stress.
The body is not a patchwork of isolated body systems. Our brains, our glands, our intestines, and even our bones all communicate with one another. Emotional stress translates into physical reality, and stress affects disease.
What Can You Do?
Discuss with your functional medicine provider about tests to help understand the underlying biochemistry of the body. Sometimes those tests include an evaluation of cortisol levels or the HPA axis.
Consider the use of nutrition, dietary supplements, and sometimes medications to balance the body’s stress response. Sometimes returning to wellness involves stress reduction therapies or nutrients to support a more healthy stress response.
Related Products:
If you struggle with stress, you might want to try a dietary supplement to support adrenal health. With adrenal support, we are able to respond to and deal with stress in a way that is less damaging to our body. Here are some products to consider:
- Adrenal Manager™ includes a combination of glandulars, nutrients, and herbs to support a more balanced stress response.
- Cortisolv® helps your body resist and recover from the effects of everyday stress.
Resources:
[1] The Endocrine Society. Adrenal Fatigue. Hormone Health Network Web site. http://www.hormone.org/diseases-and-conditions/adrenal/adrenal-fatigue. Accessed June 12, 2017.
[2] Nippoldt T. Adrenal fatigue: What causes it? Mayo Clinic Web site. http://www.mayoclinic.org/diseases-conditions/addisons-disease/expert-answers/adrenal-fatigue/faq-20057906. Updated April 12, 2017. Accessed June 12, 2017.
[3] Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016;16(1):48.
[4] Lee SP, Sung IK, Kim JH, Lee SY, Park HS, Shim CS. The effect of emotional stress and depression on the prevalence of digestive diseases. J Neurogastroenterol Motil. 2015;21(2):273-282.
[5] Lagraauw HM, Kuiper J, Bot I. Acute and chronic psychological stress as risk factors for cardiovascular disease: Insights gained from epidemiological, clinical and experimental studies. Brain Behav Immun. 2015;5018-30.
[6] Tamashiro KL, Sakai RR, Shively CA, Karatsoreos IN, Reagan LP. Chronic stress, metabolism, and metabolic syndrome. Stress. 2011;14(5):468-474.
[7] Vinkers CH, Joëls M, Milaneschi Y, Kahn RS, Penninx BW, Boks MP. Stress exposure across the life span cumulatively increases depression risk and is moderated by neuroticism. Depress Anxiety. 2014;31(9):737-745.
[8] Warren KR, Postolache TT, Groer ME, Pinjari O, Kelly DL, Reynolds MA. Role of chronic stress and depression in periodontal diseases. Periodontol 2000. 2014;64(1):127-138.
[9] Zheng G, Wu SP, Hu Y, Smith DE, Wiley JW, Hong S. Corticosterone mediates stress-related increased intestinal permeability in a region-specific manner. Neurogastroenterol Motil. 2013;25(2):e127-39.
[10] Chang YM, El-Zaatari M, Kao JY. Does stress induce bowel dysfunction. Expert Rev Gastroenterol Hepatol. 2014;8(6):583-585.