Are you tired and worn out all the time? Are you always feeling tense and anxious? Do you crave salty foods? Then you could have adrenal fatigue. Well, that is to say, you could have it if it were recognised as a legitimate medical condition. In this post, I’ll explain what your adrenal glands do, look closer at the alternative health diagnosis of ‘adrenal fatigue’ and compare that to known medical conditions that do affect your adrenal glands.
Adrenal fatigue is a solution to a problem in giving a name to a shopping list of chronic health problems. All caused by exposure to stress, poor lifestyle habits and lack of sleep. Don’t go looking for it in any medical textbooks though; it is a disease label that is most prominent in the complementary and alternative health world. Adrenal fatigue is not recognised by any endocrinology societies around the world as they rightly claim that there is little evidence for the existence of this syndrome.
The term adrenal fatigue was coined (or should that be invented) in 1998 by James Wilson, a chiropractor and naturopath. It describes a group of related signs and symptoms that happen when the adrenal glands function below the necessary level.
Now, too much stress is certainly not good for us, but can it really overwork and wear out our adrenal glands?
What our adrenal glands do
First things first with a bit of a physiology recap. Your adrenals are two small glands that sit on top of your kidneys. They produce several important hormones. Among them, the key stress hormone cortisol. Cortisol plays a key role in several areas such as managing how your body uses carbohydrates, fats and proteins. Cortisol is also central to reducing inflammation, regulating blood pressure and raising your blood sugar.
The adrenal fatigue theory says that prolonged exposure to stress and poor sleep can drain the adrenals. This leads to a low cortisol state. The result: the classic ‘adrenal fatigue’ symptoms of fatigue, brain fog, low energy, insomnia, joint pain, depressive mood, salt and sweet cravings, light-headedness and a bunch of other vague symptoms. Many of these symptoms are so general that they can apply to a whole bunch of diseases and conditions. Or they could just stem from the normal stresses of everyday life.
Depression, fibromyalgia and hypothyroidism all have a lot of overlap with the purported symptoms of adrenal fatigue. So first key point: you can’t diagnose adrenal fatigue by ticking off boxes on a symptom checklist.
And just to pull in a bit more science here, a systematic review of 58 studies aimed to verify if there was any medical evidence for the substantiation of adrenal fatigue as a disease. And the finding? The literature was full of conflicting results with little proof that the condition exists. In fact, the review authors put the onus of proof back on those promoting adrenal fatigue as a disease.
A real case of adrenal disease
Let’s take a detour now into a very real disease of the adrenal glands that you can read about in every medical and endocrinology textbook in the world. It’s called Addison’s disease. Addison’s disease is a rare but serious adrenal gland disorder in which the body can’t produce enough of two critical hormones: cortisol and aldosterone. Cortisol I’ve already covered while the other guy aldosterone regulates the balance of sodium and potassium in the blood. This in turn controls the amount of fluid the kidneys remove as urine, which affects blood volume and blood pressure.
Addison’s disease is also called primary adrenal insufficiency. A related disorder, secondary adrenal insufficiency, occurs when the pituitary gland in the brain does not secrete enough of a hormone called ACTH. ACTH activates the adrenal glands to produce cortisol.
Note that adrenal insufficiency is very different from ‘adrenal fatigue’. The cause of the adrenal insufficiency in Addison’s disease can be from damage to the adrenal glands, from an autoimmune response as well as from infection. Addison’s disease occurs in all age groups and both sexes, and it can be life-threatening.
Addison’s disease symptoms usually develop slowly, often over several months. Signs and symptoms may include extreme fatigue, weight loss and decreased appetite, craving salty food (which is related to the function of aldosterone regulating blood sodium), darkening of the skin, low blood pressure, abdominal pain, muscle or joint pains and depression.
Adrenal fatigue vs Addison’s disease
So yes, there are quite a lot of symptoms of Addison’s disease that overlap with those put forward for adrenal fatigue. So, does that make adrenal fatigue a real thing? No. And here is why. Addison’s disease has robust diagnostic methods to test for it such as blood tests for sodium, potassium, cortisol and ACTH as well as diagnostic imaging. ACTH can also be given to the person as a challenge to measure how much cortisol is produced. Treatment of Addison’s disease usually requires hormone replacement – possibly for life.
Compare that to adrenal fatigue which has no valid diagnostic tests – usually just questionnaires and some not-very-accurate tests such as salivary cortisol. Although proponents of the adrenal fatigue theory claim that because it is a mild form of adrenal insufficiency caused by chronic stress, existing blood tests aren’t sensitive enough to detect such a small decline in adrenal function — but your body is. Hmmm, so how do you know it exists then if you can’t test for it?
Treatment of adrenal fatigue usually involves lifestyle changes to reduce stress as well as advice on eating better. All good things to do. But none of them can cure or treat Addison’s disease. So, it is a big stretch to say that any improvement in symptoms of adrenal fatigue are from ‘healing your adrenals’. You’re just making some positive lifestyle changes – that’s all.
But back to those general symptoms of tiredness, brain fog, fatigue and others. These should be checked out by a doctor first. Anaemia, sleep apnoea, autoimmune diseases, infections, other hormonal diseases, mental health problems, heart and lung problems, and kidney and liver diseases are just some of many medical conditions that could cause similar symptoms.
You can see why how giving someone a label of ‘adrenal fatigue’ can misdirect them from addressing a potentially real and serious underlying condition.
What it all means
The truth is your adrenal glands don’t get tired and they’re perfectly capable of keeping up with your busy stressful life without wearing out. Most of us could do with more sleep, taking the time to eat better and taking a step back at times from our connected world. That doesn’t mean that you’re killing your adrenals if you aren’t doing those things. The solution here is to make some positive lifestyle changes, not buy expensive supplements and pay for worthless tests because you’ve been told you have adrenal fatigue.