Is Adrenal Fatigue Real?

There has been increasing interest in a condition known as Adrenal Fatigue, particularly by proponents of natural medicine and naturopathy. However, most mainstream medical practitioners view it as a mythical disease designed to sell more supplements and drum up business for natural practitioners. These medical practitioners argue that there is no evidence for such a condition.

So what does the research say about a condition known as Adrenal Fatigue?

Is it argued that Adrenal Fatigue is a condition caused by a dysfunction in the production of hormones produced by the adrenal glands. In particular, it is argued that chronic stress (either physical or mental) can ‘exhaust’ the adrenals, eventually leading to a lowered production of the stress hormone, cortisol (plus several other hormones). This reduced cortisol production can lead to the following symptoms:

• Excessive fatigue and exhaustion, chronic fatigue
• Non-refreshing sleep
• Sleep disturbance, insomnia
• Feeling overwhelmed or unable to cope
• Craving salty and/or sweet foods
• Sensitivity to light
• Low stamina and slow to recover from exercise
• Slow to recover from injury or illness
• Difficulty concentrating, brain fog
• Poor digestion

Adrenal Fatigue is different to a medical condition known as Addison’s disease which is a rare endocrine disease where the adrenal glands are significantly impaired (and destroyed) to the point that they cannot produce the necessary hormones to maintain bodily functions. The treatment requires lifelong administration of cortisol and other relevant drugs. In people with Adrenal Fatigue it is argued that people can still produce hormones to maintain everyday activities, however, levels are suboptimal.

With Addison’s disease, a blood test for cortisol shows that levels are well below ‘normal.’ However, in people with Adrenal Fatigue, blood tests for cortisol usually come back normal. Salivary tests for cortisol are usually done to diagnose Adrenal Fatigue, where a generally flattened cortisol profile is found (healthy cortisol secretion should vary throughout the day).

While there is intense debate about the existence of Adrenal Fatigue, the reality is there is partial support for such a condition. As shown below, the adrenal glands are controlled by two areas of the brain, the hypothalamus and pituitary gland. Along with the adrenal glands, they are collectively known as the HPA axis (Hypothalamus-Pituitary-Adrenal axis), and there is evidence that a dysfunction in the HPA axis is associated with many mental and physical health conditions.

For some people, the HPA axis is too sensitive thereby producing too much cortisol, whereas for others the HPA axis is not sensitive enough, thereby producing too little cortisol. So while the adrenals are highlighted as the problem in Adrenal Fatigue, it is actually the steps associated with the HPA axis that is dysfunctional. Many argue that the brain regions (i.e., the hypothalamus and pituitary gland) are the problem, not the adrenals. However, wherever the problem lies, low cortisol continues to be the issue.

In a paper published by an expert in stress research, Professor George Chrousos [1], it was concluded that low cortisol output is associated with the following conditions/ diseases:

• Atypical/seasonal depression
• Chronic fatigue syndrome
• Fibromyalgia
• Premenstrual tension syndrome
• Nicotine withdrawal
• Following chronic stress
• Postpartum period
• Adult post-traumatic stress disorder
• Hypothyroidism
• Rheumatoid arthritis
• Asthma, eczema

So while there continues to be debate about Adrenal Fatigue and the mechanisms associated with it, the reality is that low cortisol is definitely a problem for many people. It also seems that chronic stress is a major cause of the problem which then causes a disruption in the whole HPA axis. The solution is, therefore, to reduce physical, mental and environmental stresses so the whole HPA process has time to heal and repair itself (if possible).

This involves improving physical health through good sleep, healthy eating, and moderate exercise. Learning relaxation, engaging in pleasant/ engaging activities, and taking regular timeouts are also extremely important. Often psychological therapy can be helpful for people struggling with anxiety and chronic stress. Psychological therapy such as cognitive-behaviour therapy (CBT) can help people modify unhelpful thoughts and coping responses.

There are also several herbs and nutrients that can help reduce stress levels. These herbs are termed ‘adaptogens’. Ashwagandha, Rhodiola Rosea, and Licorice Root are examples of adaptogenic herbs that may help moderate the stress response (but only use high-quality, clinically-supported extracts).

References

1. Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009 Jul;5(7):374-81.  link to paper
2. Panossian A and Wikman G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol. 2009 Sep;4(3):198-219.  link to paper