Is adrenal fatigue “real”?

Low energy and tiredness are among the most common reasons patients seek help from a doctor. Despite being so common, it is often challenging to come up with a diagnosis, as many medical problems can cause fatigue. Doctors engage in detective work, obtaining a medical history, doing a physical exam, and doing blood tests. The results often yield no explanations. It can be frustrating for clinicians and patients when a clear-cut diagnosis remains elusive. An attractive theory, called adrenal fatigue, links stress exposure to adrenal exhaustion as a possible cause of this lack of energy.

But is adrenal fatigue a real disease?

The adrenals are two small glands that sit on top of the kidneys and produce several hormones, among them, cortisol. When under stress, we produce and release short bursts of cortisol into the bloodstream. The adrenal fatigue theory suggests that prolonged exposure to stress could drain the adrenals leading to a low cortisol state. The adrenal depletion would cause brain fog, low energy, depressive mood, salt and sweet cravings, lightheadedness, and other vague symptoms.

Numerous websites mention how to diagnose and treat adrenal fatigue. However, the Endocrinology Society and all the other medical specialties do not recognize this condition. The Endocrinologists are categorical: “no scientific proof exists to support adrenal fatigue as a true medical condition.” This disconnect between conventional and complementary medicine adds to the frustration.

A recent review of 58 studies concluded that there is no scientific basis to associate adrenal impairment as a cause of fatigue. The authors report the studies had some limitations. The research included used many different biological markers and questionnaires to detect adrenal fatigue. For example, salivary cortisol is one of the most common ordered tests used to make a diagnosis. The cortisol level, when checked four times in a 24-hour period, was no different between fatigued and healthy patients in 61.5% of the studies. The review raises questions around what should get tested (blood, urine, and/or saliva), the best time, how often, what ranges are considered normal, and how reliable the tests are, to name a few. In summary, there is no formal criteria to define and diagnose adrenal fatigue.

But what if I have symptoms of adrenal fatigue?

If you have tiredness, brain fog, lack of motivation, among other symptoms, you should first have a thorough evaluation with a medical doctor. Anemia, sleep apnea, autoimmune diseases, infections, other hormonal impairments, mental illnesses, heart and lung problems, and kidney and liver diseases are just some among many medical conditions that could cause similar symptoms. If the workup from your medical professional turns out normal and you believe you might have adrenal fatigue, I would recommend you consider a fundamental question: Why would your adrenals be drained? Take a better look at what types of stress might be affecting you. For many, the hectic pace of modern life is to blame.

The lack of a biological explanation can be disappointing. To make things worse, it’s not unusual for doctors to say “there is nothing wrong with you” or “this is all in your head.” The overwhelming amount of information on the Internet that recommends many types of treatment causes even more stress. Mental health conditions, such as depression or anxiety, may have symptoms similar to adrenal fatigue and may not respond well to antidepressants and counseling. And some patients do not believe that a mental health concern is the primary cause of their symptoms and many refuse medications due to concerns about their side effects.

So what’s a person to do?

Navigating this ocean of uncertainty is not an easy task. Symptoms associated with adrenal fatigue probably have multiple causes. Frequent follow-up visits and a strong patient-clinician partnership are critical elements for success. Alternative and complementary clinicians often have better results, because the appointments tend to last longer and they view patients through a more holistic lens. An important word of caution: some medical professionals prescribe cortisol analogs to treat adrenal fatigue. Cortisol replacement can be dangerous even in small doses. Unintended consequences can include osteoporosis, diabetes, weight gain, and heart disease.

Regardless of what we call it, there are millions of people suffering from similar symptoms, and a personalized plan that involves counseling, medications, supplements, lifestyle change, among others could work for many. Improvement following these programs is slow, and the evidence is weak, but I hope advances in big data, genomics, and its relationship with the environment and the microbiome, may shine a light on how to better help people who suffer from these ailments.

The adrenal fatigue theory may fit like a glove to explain your symptoms, which are very real. But before buying expensive protocols over the Internet to treat something we’re not even sure exists, take a deep dive and reexamine your lifestyle. The path to feeling better may be closer than you think.

Related Information: Boosting Your Energy

Comments:

  1. Scott

    What does that silly Harvard trained medical specialist know, anyways. You do YOU, Anne. Treat your adrenal fatigue and live life to the fullest.

  2. Che

    Hi Anne,

    Who was your naturopathic doc? I would love to know. I have similar issues and need help…badly!

  3. Anne

    I had a horrifically stressful past two years with job changes and a death in the family and identified with the symptoms described above and more. After seeing regular doctors and a psychiatrist, I finally found a naturopath doctor who had me thoroughly tested. My DHEA-S level was below normal range and the 4x/day saliva test showed my cortisol level dropping over 90% from the mid-range of normal in the morning to the very bottom of the range by noon and lower the rest of the day. She called the pattern “flat lining.” So this is clearly not normal, but it’s also not a “recognized condition”? I’ve been taking two thyroid medications for nearly 30 years – including Armour Thyroid, which most doctors don’t know how to prescribe – and have now added an adrenal supplement. Once we got the right dosage I started to feel better within a few days. I can finally sleep and have more energy throughout the day. I don’t care if you think adrenal fatigue doesn’t exist. I am proof that it does, and that it can be treated.

    • Abdulmalik Koya

      Mrs. Anne, your narrative is fascinating. You just mentioned you’ve been on thyroid medication for 30years, is it for low thyroid levels (hypothyroidism) or abnormally high thyroid level (hyperthyroidism)?

    • Joann Hnat

      I was diagnosed with secondary adrenal insufficiency in 2005, and see a very good endocrinologist for treatment. She says that cortisol levels do not remain constant, and normally fall throughout the day.

  4. Maria Galvão

    I AM 87 years old and all the symtoms descrived I have in my BODY . But mentally and emotionally I am another person : very healthy , active , excellent mood , ready thinking … Is this split natural ? Is one part of me dying and the other just watching ?

  5. Sam Tschudin

    I think adrenal fatigue is real and could be the symptom of other illnesses. When your cortisol level is low for whatever reasons your blood pressure is bound to be low resulting in lethargy and general weakness. People who complain of tiredness should be checked thoroughly by endocrinologists to ensure that they are not suffering from serious illnesses such as Addison ‘s disease for example.

  6. Deborah Daw Heffernan

    I am lucky to have lived now for 12 years with a heart transplant, requiring that I take myriad drugs to suppress my immune system and manage inflammation, as is the normal course. With a suppressed immune system, one is vulnerable to infections and I have been no exception. Every winter I am sick sick sick with colds and bronchial infections verging on pneumonia. But not this year. My PCP wondered if my adrenals had become “lazy” from prednisone doing their work for them. This fall we tried a daily dose of 1,000 mg of B12. The boost of energy was immediately noticeable. Most importantly, I fought off a cold, unheard of for the past 12 years—even during a very stressful period over Christmas in which my husband was suddenly diagnosed with cancer (in remission already!). Despite all the stress of caring for him and being with him in the hospital, exposed to pathogens for weeks during flu season, I remain astonishingly vigorous and well. I would recommend that heart transplant patients and others with suppressed immune systems explore this solution with their clinicians. I am only a short-term case-study of one, but the difference has been astonishing—and right at the moment I needed the wellness to save my husband’s life.

  7. Dr.Puneet

    As I belong the forensic medicine branch and my observation is first rule out metabolic disorders, endocrinal disturbance , systematic diseases and any one defiantly find out the cause if they are not responsible then the fatigue is psychological if this is also not responsible than it is left for various environmental factors such as age, sex, life style, eating habits etc etc.

  8. Arthur Burns

    My guess? It is lack of B vitamins. To start with!
    The Art of it!

  9. Holly Hart

    I have all these symptoms but I also know that my lifestyle is the cause of a lot of it. I agree that people do not seek the best treatment for many conditions. Taking a pill is the easy way and that is what people want. Continue my unhealthy lifestyle but take a pill to conteract the effects of it. That does not work.

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