Adrenal fatigue is a term that has been circulating around the wellness world for years. It’s especially common in the realm of functional and integrative medicine. Perhaps you’ve heard of the term while browsing the internet or reading a book. Or maybe you were diagnosed by a healthcare professional with adrenal fatigue yourself. Some people say adrenal fatigue is a real diagnosis and some say it isn’t. So, is adrenal fatigue real? Is it an actual diagnosis that can be treated?
What is “adrenal fatigue?”
The adrenal glands are the last part of our hypothalamic pituitary adrenal (HPA) axis. Your HPA axis is responsible for your stress response aka your fight or flight response. (Here’s a 2 minute video explaining the HPA axis.) These two small glands sit on top of the kidneys and produce a variety of hormones. One of these hormones is cortisol. When our bodies experience stress, the adrenals produce and release small amounts of cortisol into the bloodstream. Cortisol does many things. It helps regulate blood sugar levels and metabolism, reduces inflammation, and regulates memory formation. In times of stress, cortisol increases heart rate, blood glucose, respiration and muscle tension. Cortisol also shuts down the body’s systems that aren’t necessary in times of crisis. We need cortisol to survive.
The term adrenal fatigue is used often in the media and by functional medicine clinicians to describe a condition in which someone experiences chronic, repeated exposure to stressful conditions. The repeated exposure of stress over time causes overstimulation of the adrenal glands. Eventually, the adrenal glands fail to function like they should.
What are the symptoms of “adrenal fatigue?”
The two most common symptoms associated with adrenal fatigue are tiredness and low energy. Other symptoms include brain fog, lack of motivation, depressed mood, and having trouble getting out of bed even after getting an adequate amount of sleep.
The problem is that fatigue and low energy are such general symptoms and many, many people go to their health care provider (HCP) with these symptoms seeking help. These generalized symptoms are associated with many medical problems, making it challenging to nail down a specific diagnosis. Anemia, autoimmune diseases, thyroid problems, mood disorders, problems with major organs, infections, sleep disorders, etc. are associated with low energy and fatigue.
When you go see your HCP, they get a thorough history, perform a physical exam and order diagnostic tests to help nail down a diagnoses. With general symptoms like fatigue, low energy, lack of motivation (symptoms associated with “adrenal fatigue”) the workup often isn’t helpful and lends few, if any, answers. Physical exam is normal. Blood work is normal. This can be perplexing and frustrating for you, the patient, but also the health care provider because there is no clear cut answer for the symptoms you’re experiencing. It can be really enticing to tell someone they have “adrenal fatigue” to explain their generalized symptoms of fatigue and low energy. Or maybe you’ve heard, “There’s nothing wrong with you.” or “It’s all in your head.” That can be really frustrating and invalidating as a patient too.
How is an adrenal fatigue diagnosis made and is it valid?
Practitioners diagnosing this phenomenon use a patient’s reported history and symptoms along with laboratory tests to make a diagnosis. This is problematic in many ways. These symptoms are so incredibly general. As far as the research goes, there is no validated symptom score to assess these symptoms. In contrast, the PHQ-9 and PHQ-2 are well researched and valid assessment tools used in primary care and mental health settings to evaluate mental health. There is no such tool for assessing adrenal fatigue. There are also lab tests used in naturopathic/functional medicine settings and tests marketed on the internet to detect adrenal fatigue. Unfortunately, there is no compelling data to validate these tests. The same goes for hormonal tests and food allergy tests marketed on the internet and used in these clinical settings. Just because a test is offered, doesn’t mean it’s valid.
I think it’s important to note that adrenal fatigue and adrenal insufficiency are not the same. Adrenal insufficiency is a well researched and legitimate medical condition that has defined symptoms and can be diagnosed with laboratory tests.
What the research says
There was a systematic review published in 2016 exploring the validity of adrenal fatigue. Systematic reviews are the cream of the crop when it comes to research. They give us the highest quality evidence. The review published included 58 studies and found no evidence for the diagnosis of adrenal fatigue. As of now, we have no formal criteria to define what adrenal fatigue is nor do we have criteria to diagnose adrenal fatigue. If you want to geek out, you can read the full review here.
The symptoms are real, adrenal fatigue is not
While it can be really frustrating to have these symptoms and be told it’s all in your head, know this: Your symptoms are real. What you feel is real. It’s just that adrenal fatigue is not a real diagnosis. Not having a biological explanation for symptoms can be frustrating, disappointing and emotionally draining. Mental health diagnoses like anxiety and depression can manifest symptoms similar to those associated with adrenal fatigue. Especially in today’s fast paced society, feeling anxious and/or depressed is not uncommon and you are not alone. Know that! If you feel like you are experiencing symptoms that are attributed to “adrenal fatigue” I’d encourage you to take a step back and do some reflecting. What are the stressors in your life? How is your sleep hygiene? How is your mental health? Your emotional health? Is the exercise you engage in helping you live a less stressful or more stressful life?
Recommendations to “treat” adrenal fatigue have the potential to do more harm than good
Although getting a diagnosis for a medical condition that doesn’t actually exist isn’t good medicine, it’s the recommendations to follow that have the potential to be quite harmful. If you google adrenal fatigue you will find pages and pages of information that I think actually cause more psychological distress and confusion.
If you’re feeling tired and stressed, the last thing you need is more things to do and fix. The recommendations for adrenal fatigue are cloaked in diet culture. The primary recommendation is to cut out a bunch of foods from your diet – to essentially go on an elimination diet. The nutrition prescription is to eliminate all processed foods, sugar, dairy, gluten and starchy carbs. Dieting is one of THE most stressful things to put your body through – emotionally, mentally and physically. There is also a slew of supplements to take and other alternative therapies to embark upon. I’m more stressed just typing that.
My concern is not only the lack of evidence to support these extreme recommendations. I also worry about the high potential for these “adrenal fatigue” treatment recommendations to perpetuate disordered eating habits and more stress. Of course, high levels of stress isn’t a good thing for our long term health. High levels of stress can, and likely will, negatively impact our health. Wrapping all of these general symptoms up into a illegitimate diagnosis and then “treating” the condition with elimination diets among other recommendations that have no scientific evidence is a problem. It’s oversimplifying a bigger problem and giving people a “protocol” to fix an issue that is far more complex. Controlling food does seem really enticing when other parts of your life feel out of control. Following guidelines and steps is really comforting when we feel overly stressed and aren’t sure where to go next.
What you can do instead
These recommendations aren’t black and white. They aren’t a protocol. If you sat these recommendations next to the “adrenal fatigue solution” book, you’d sell more copies of the “solution” because it’s far more appealing to people. Diets do sell. They just don’t work.
- Sit down and figure what you actually need to do in your life versus what you think you need to do.
- Prioritize your sleep – get at least 7-8 hours every night.
- Set boundaries in your life. What things are you saying yes to? That list should be incredibly small. Protect your yeses!
- Nourish your body with a variety of foods at regular intervals throughout the day. If you don’t eat 3 meals a day, start there. If you don’t get hunger cues, eating 3 meals and ~3 snacks a day (so you’re eating every 4ish hours) is a good place to start.
- Drink your morning coffee, but choose something other than caffeine after lunchtime. Caffeine later in the day can make it hard to fall and stay asleep. If you rely on coffee to “make it through the day” take a step back and figure out what you need to do in order to not rely on caffeine.
- Drink water! At least 64 oz. Sounds elementary, but there have been so many times when hydration has been the key to alleviating a symptom.
- Spend time with people that make you feel good. Surrounding yourself with people who add to your life (not take away) can move mountains when it comes to our mental and emotional health.
- Re-evaluate your exercise routine. Do you use exercise as punishment? Is exercise something you feel obligated to do or something you view as a “should do?” Are you exhausted before or after working out? If any of these resonate, I’d really encourage you to take a step back from intentional exercise. Walk. Play with your kids or your dog. Do some relaxing yoga. Here’s a post on healing your relationship with exercise.
- Start a mindfulness practice. That might sound woo-woo, I get it. I don’t resonate with the word “mindfulness” as much as I do “chill out.” Stretch on the floor for 10 minutes before bed, take a morning stroll without your phone, or deep breath for 60 seconds.
- Unplug from devices and screens. Technology is awesome, but it can also clutter our brains because it keeps us constantly stimulated.
Stress is real. It certainly affects our health. Your symptoms are also real. Although the above list is not exhaustive and everyone’s journey will be different, I hope this post and these tips give you a starting point. Remember, slow baby steps. Change in and of itself is stressful. Start with one change and implement it over the course of a week or two. When you’re ready, move on to something else that feels manageable. Over time, all these small changes will help you live a healthier, happier and more authentic life that aligns with your values.
If you’d like, you can sign up here for my free mini email course on healing hormones – it gives you some starting points and practical steps so you feel your best physically, mentally and emotionally.