Is adrenal fatigue fact or fiction?

Is adrenal fatigue fact or fiction?

There have been two burnout periods in my life. Once in college and the second while in naturopathic school. The second time wasn’t quite as severe as the first, but it also included a terrible relationship and 14 hour school days. I went from thriving to feeling like I was barely keeping afloat amidst the stress. I remember, distinctly, coming home many nights at 9 PM from a long day in classes and going from the door to bed. Exhausted and done. No energy to eat dinner, brush my teeth, or officially get into pyjamas.

It was a pretty classic episode of adrenal fatigue--that darling diagnosis of the natural health community. I was overwhelmed and exhausted, had constant headaches, would cry spontaneously, my period was irregular and debilitatingly painful and anxiety permeated everyday.

To even hint that adrenal fatigue isn’t real seems a little crazy considering this experience, but I want to break it down because I do think there are some myths in this term.

To be clear, adrenal fatigue is not an accepted medical diagnosis and in August 2016, an endocrine journal published a review titled “Adrenal fatigue does not exist: a systematic review.” In my experience, if patients take the term to their primary care doc, it’s quickly discounted as not real.

Where conventional practitioners take issue with the term adrenal fatigue is that it’s used to  describe a situation where constant stress has led to the adrenal glands being worn down and producing less cortisol and this isn’t supported in the literature. Second, they worry that this broad and nonspecific diagnosis may lead to overlooking another true cause of a person’s symptoms.

However, we do know that the stress response is implicated in a whole host of chronic diseases and that constant triggering of the fight-or-flight is detrimental to our health. But the whole mechanism is much more nuanced than one term. The HPA (hypothalamus-pituitary-adrenal) axis is in charge of setting off a cascade of events that help the body respond to stress. For our purpose, cortisol will be excreted to save us in the short term, but as the exposure to stress becomes more constant or unrelenting the system will start to dysfunction and affect our health, resulting in a range of symptoms from fatigue, to feeling like you can’t shut off, to weight gain, blood sugar issues, hypertension, Hashimoto’s, or depression (to name a few).

Essentially, if there’s a mismatch between the stressor and our ability to cope with it, this will create wear and tear on the system and contribute to disease/imbalance. This formula will be different for each person and the things that are considered “stress” will also be unique.

In the end, does it matter what we call it?

Where the tension around terminology becomes frustrating is that, in the absence of true pathology like Addison’s or Cushing’s, symptoms like fatigue and low energy, for the most part, are not investigated further. An eye roll from your doctor around “adrenal fatigue” can translate into a dismissal of your symptoms. And those are real and the role of stress is real too.

This is where a naturopathic and functional approach can really shine. An adept practitioner will see that the HPA axis is being affected and ask where is this stress coming from or how is it manifesting in your life?

Examples of potential stress could include:

  • Poor food choices
  • Leaky gut
  • Exposure to toxins
  • Hidden infections
  • Medications
  • Inflammation
  • Inefficient detoxification pathways
  • Negative self talk
  • Financial worry
  • Caregiving
  • Poor sleep
  • Malabsorption
  • Anemia

This complexity is what adrenal fatigue is pointing towards. Begging us to investigate where things are misaligned and where our stress response is becoming less resilient and having an effect on mind and body.  

Testing for adrenal dysfunction

Symptoms go far in showing a pattern of how the body is adapting to stress. I usually think of two broad categories: is stress causing overwhelm (are you running on adrenaline and living the ethos “can’t stop, won’t stop”) or is it next-level exhaustion? Saliva testing is useful, too, to chart out your cortisol pattern. The Adrenal Stress Index can be ordered by a functional medicine practitioner.

In conclusion

Feeling overwhelmed, exhausted and on alert are all signals from the body for some attention. They can be an opportunity to recalibrate and invite more pause and restoration in order to avoid stress contributing or exacerbating a chronic condition. You want to rule out a true diagnosis of adrenal insufficiency, but we should all be talking about the reality of modern life and where this mismatches with our nervous systems.

I think this sums it up nicely:

“Inhabiting a human nervous system is kind of like living in a house where the doorbell and burglar alarm make the same sound.”

--Ethan Nichtern from The Road Home

Pair this discussion, with the symptoms pointing to an adrenal imbalance and on embracing being along with doing.