Adrenal Fatigue… real or fake?

This week is International Stress Awareness Week. The World Health Organization is calling ‘stress’ the health epidemic of the 21st Century.   And yet, the medical profession is slow to recognize or treat ‘adrenal fatigue’ or ‘burn out’ as a real condition.


Persistent fatigue and tiredness are some of the most common symptoms that drive people to seek the help of a doctor.  Often the doctor finds it hard to come up with a diagnosis.  She may take your medical history, carry out a physical exam and do some blood tests.  Often this yields no explanation.    To complicate things further for the doctor, fatigue may be linked to thyroid dysfunction, anaemia, fibromyalgia, M.E. and various other conditions.  If he is testing solely for adrenal dysfunction, he’ll be looking for the extremely low ‘hypo’ or extremely high ‘hyper’ production of cortisol, for a diagnosis of Addison’s disease or Cushing’s Syndome, but anywhere outside of these ranges will not deliver a diagnosis.  Neither do the Endocrinology Society and other medical specialties recognize this condition.  Your doctor is in a bit of a dilemma.  At best, he may not think you are neurotic and may accept that your symptoms are real.   At worse, the doctor thinks you are depressed or neurotic and if so you may walk away with a prescription for anti-depressants.  This now becomes your dilemma because with no diagnosis there is no treatment.  But what if you do have adrenal fatigue, you are not depressed and there is another way?  We place so much of our trust and hope in our doctors, often they are in a position to help us and just as often they are not.  But here’s the good news, that doctor may not yet be aware that in other streams of medical practice namely ‘functional and complimentary medicine’, adrenal dysfunction is recognized and it can be tested and treated as a real condition.

So is it real or not?

If you google ‘adrenal fatigue’ you will find no end of controversy about whether it is a real or fake condition.  Here’s the answer!  It depends on who you are asking.  In general, conventional medicine does not accept a condition called ‘adrenal fatigue’.  If it were accepted it would then require a corresponding pill.  In alternative or complimentary medicine, chronic stress leading to adrenal fatigue, has traditionally been recognized as real and treated with the practice of that modality.  For example, an acupuncturist may use needles to stimulate and return balance to the glands and a nutritional therapist may use therapeutic foods to support adrenal function.   Both would likely recommend stress reduction and other dietary or lifestyle practices as part of a recovery programme.  So you see, there exists a real disconnect between conventional and complimentary medicine to add to your confusion.  Functional medicine, however, is like the meeting of these two opposing worlds.  Cortisol levels can be tested and can show whether the adrenals are functioning optimally.  Although you are not likely to be offered this test within the conventional medicine model of practice in Ireland, it is available privately or through a functional medicine practitioner, functional medicine certified clinician or nutritional therapist.

Help is on the way!

On the one hand it is deflating and a little soul destroying to go along to your doctor when you are feeling exhausted and vulnerable and come away without any hint of a solution.   You may begin to wonder if you are in fact, neurotic!  Even that may be more satisfying than dealing with a grey fog of nothingness.  Or, if you could see it from where I’m standing, this may actually be a better outcome in the long run than a misdiagnosis and a pill.

Functional medicine is about looking for the underlying causes of disease.  The symptoms of adrenal fatigue are loud and clear messages from your body telling you to take care of yourself and manage your stress levels.  For a lasting recovery, the treatment needs to be holistic and needs to address the underlying cause of chronic stress levels.

No patient that was ever diagnosed with type II diabetes got the corresponding pill from the doctor until they hit the diagnostic number on the HbA1c blood test.  The same holds true for cholesterol, thyroid, adrenal dysfunction and most other diseases.  By then you’ve earned that pill but do you really want a disease?

This is what is happening – conventional medicine focuses on pathology [disease].  Tests do not facilitate treatment until disease is present and test results identify a single cause.

Functional medicine testing focuses on sub-optimal functioning.  Tests are useful before disease can be identified and results can identify the interrelationships among the causes.

Source: Google Images

Applied to ‘adrenal fatigue’ this means that if your cortisol levels are unbalanced but you are not yet in a disease state, functional testing will show this imbalance.  Ideally cortisol is higher in the morning and decreases by late evening so you are ready to sleep. An imbalance may have you sleepy in the morning and awake at night.  You will in any case be experiencing the symptoms associated with this dysfunction and these are very real.   In contrast to conventional medicine, the functional medicine clinician is guided mainly by your symptoms.  Testing is secondary to this and is used to gauge current health status and as a means to chart progress. Testing is not used in functional medicine simply as a diagnostic tool.

These different approaches often require a giant leap in perception from a client when they first come in contact with a practitioner trained in the functional medicine model.   Q. “Why do you just believe what I’m saying, don’t you doubt me”?   A. “Of course I believe you, why would you make it up, why would you be looking for help if there was no problem”?  With an ‘Adreno-Cortex-Stress Hormone Saliva test’ you will at least know if cortisol imbalance is present.  Working with a nutritional therapist or functional medicine clinician is not a quick fix option.  You are likely to be offered as a treatment, a range of dietary, lifestyle and sometimes supplement recommendations to promote adrenal recovery.

I know from my own experience that adrenal fatigue is very real and I know the best approach to recovery is a holistic one.  I have learned to be mindful of my own stress levels, observing what triggers my stress responses and working to adapt to, manage or eliminate these triggers.  With time and patience, recovery is a realistic outcome, helped also by diet and exercise.  In the end it becomes less about managing a labelled condition and more about taking control of your health your mind and sometimes your life choices.

Superman…. real or fake?

In truth, I don’t think there is a doctor alive that would argue that reducing your stress levels with mindfulness, yoga, relaxation, meditation, good sleeping habits, good nutrition, exercise and a large injection of fun, would promote healthy adrenal function.  Doctors are not super human although they are expected to be.  Some doctors might agree with this and others might prefer the superhuman tag.  Truth is, they are as likely as anyone, if not more so, to suffer from adrenal fatigue.  And, if they sat down and really thought about it fully and logically, it might be concluded that they are not really arguing the existence of ‘adrenal fatigue’, considering that chronic long-term stress is cited in medical literature as a risk factor for most chronic diseases.  It’s more of a case that, collectively as a profession, they have not decided that ‘adrenal fatigue’ is a disease.   You see it’s not all the way there, it’s not bad enough to earn the title disease.  Let’s frame it with a not so similar but clear example…. you’re a pregnant woman, you feel nauseated 24/7, you are undoubtedly feeling symptoms of sickness, your hormones are all over the place, throughout the pregnancy you may experience many physical and emotional symptoms and at some point you may face the off the scale physical pain of childbirth.   People have even died giving birth.  The point – pregnancy is not an illness!  We agree, of course, it is not an illness but we don’t dismiss the very real symptoms and health risks associated with pregnancy and child birth.  This is just how the medical system works.  Adrenal fatigue is [currently] not a ‘diagnosed condition’.  There is no assigned pill as there is for blood pressure or high cholesterol.  But this does not mean the symptoms are not real, nor does it mean the adrenal glands are not under functioning.

If you have adrenal fatigue – is a diagnosis and a pill really what you want or need?  Maybe not after all?   It would be very helpful, of course, to be reassured it’s not all in your head.  And it’s not!   There is a lot you can do for yourself to prevent a crash!

Another way to view this is that conventional medical practice is strictly controlled and legislated and anything outside of this control may be viewed with suspicion.  In fairness, you do need to use critical thinking when you place your trust in the hands of any practitioner but also bear in mind that YOU are ultimately responsible for your own health.  Huge organizations are slow to change.   Even in the face of mounting evidence to the contrary, change of established beliefs can mean a loss of control and can be met with huge resistance.

Instead of trying to decide whether adrenal fatigue is real or fake medical professionals should ask … “Is there anyone alive today that would not benefit from improved adrenal function”?  The answer is no!  So then we can put our energy and resources into achieving this instead of trying to win an argument.

  • Sapolsky, R.M., Why Zebras Don’t Get Ulcers (2004). St. Martin’s Griffin: New York
  • Wilson, J.L., Adrenal Fatigue (2001). Smart Publications:  Petaluma, CA

Contact:  Look for a Functional Medicine Practitioner or a Nutritional Therapist trained in the functional medical model

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