Do you really have adrenal fatigue? Or is your fatigue caused by another condition?
The only way to determine this is to rule out all other conditions that can be mistaken for adrenal fatigue. The following are conditions whose symptoms are most likely to mimic adrenal fatigue. Before running a test for adrenal fatigue, I recommend you visit your family doctor to rule out the following five conditions:
- Hypothyroidism (low thyroid hormone)
- Anemia (low iron)
- Chronic fatigue syndrome
- Sleep disorders
1. Low thyroid (hypothyroid) and adrenal fatigue
In Canada, there almost 800,000 people who have been diagnosed with hypothyroidism and up to 10% of adults whose thyroid levels are low but still fall in a normal range. That’s up to as many as 3.7 million Canadians with below average thyroid levels.(1)
This often occurs in a condition called Hashimoto’s thyroiditis. Hashimoto’s is the autoimmune form of low thyroid and it’s thought that up to 80% of low thyroid cases are actually Hashimoto’s. (2)
Hypothyroidism is five to eight times more common in women than men and more common in women with small body size. (3)
The symptoms of hypothyroidism are highly variable, depending upon the age at onset and the duration and severity of thyroid hormone deficiency. Common symptoms of low thyroid include:
- Cold intolerance
- Weight gain
- Dry skin
- Muscle pain
- Menstrual irregularities
Did you notice how so many of the low thyroid symptoms mirror the symptoms of adrenal fatigue?
The adrenals and thyroid glands are connected through an axis that connects your brain to your adrenals glands, thyroid glands, and sex hormones. If you have hypothyroidism, it’s not uncommon that you may also have adrenal fatigue. The same is true in reverse.
Therefore, it is of utmost importance to rule in or out low thyroid before starting an adrenal treatment protocol. You can perform a quick survey here to determine your risk of developing a thyroid-related illness.
2. Low iron (anemia) and adrenal fatigue
There are two different types of anemia. Iron deficiency anemia is what you’re most likely familiar with. Iron deficiency anemia comes about when one has low levels of iron, making it difficult for your body to make red blood cells. Anemia of chronic disease (ACD) is the less common version. In ACD, the anemia is developed in response to a chronic illness. For example, anemia of chronic disease occurs in up to 60% of patients with rheumatoid arthritis. (4)
Classic iron deficiency anemia is more common than ACD. For this post, I’ll focus on anemia caused by iron deficiency.
Classic iron deficiency affects more than 12% of the world’s population, especially women of childbearing age, children, and individuals living in low- and middle-income countries. It’s the single most prevalent nutritional deficiency worldwide. In the United States, iron deficiency was present in approximately 10% of females of adolescent and/or childbearing age. (5)
The most obvious cause of iron deficiency is blood loss. This can come about through excessive blood donations, trauma, or heavy bleeding during the menstrual cycle. Other causes of iron deficiency include GI problems like infections and celiac disease.
The common symptoms of iron deficiency include:
- Exercise intolerance
- Shortness of breath (Exertional dyspnea )
- Chest pain (Angina pectoris)
Again, the symptoms of iron deficiency look remarkably similar to that of adrenal fatigue. With upwards of 10% of the population suffering from iron deficiency, having your blood levels checked regularly is of utmost importance. Ruling in or out an iron deficiency should occur before treatment and diagnosis of adrenal fatigue.
3. Depression & adrenal fatigue
Depression and adrenal fatigue share many similar symptoms, so much so that it can be incredibly challenging to tell them apart. Unlike hypothyroidism or anemia, there is no laboratory test for depression.
How do you go about differentiating adrenal fatigue from depression?
The Diagnostic and Statistical Manual of Mental Health Disorders has created robust diagnostic criteria for the proper diagnosis of clinical depression. Called the DSM-V, it uses the following criteria for diagnosing depression: (6)
- Two to four of the following symptoms have been present during the same two-week period:
- Depressed mood most of the day, nearly every day (Dysphoria)
- Markedly diminished interest or pleasure most of the day, nearly every day (Anhedonia)
- Significant appetite or weight change
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation (observable by others)
- Anergia – Fatigue nearly every day
- Thoughts of worthlessness or inappropriate guilt nearly every day
- Impaired concentration or memory nearly every day
- Recurrent thoughts of death or suicide, or suicide attempt
- At least one of the symptoms include dysphoria (depressed mood) or anhedonia (diminished interest or pleasure).
- The symptoms cause clinically significant distress of psychosocial impairment.
- The symptoms are not due to to the physiologic effects of a substance, medication, or general medical condition.
- Persistent depressive disorder (dysthymia) and cyclothymic disorder are not present.
- The mood disorder does not occur exclusively during a psychotic disorder.
Adrenal fatigue will often contribute to insomnia/hypersomnia, appetite changes, fatigue, and an impaired ability to concentrate. However, adrenal fatigue does not commonly contribute to a marked decrease in pleasure throughout the day, suicidal thoughts, or a depressed mood. These alone can help to differentiate depression from adrenal fatigue.
It is important to note that the connection between adrenal fatigue and depression is not a concrete boundary. I recommend thinking about the two as a spectrum. Adrenal fatigue can present as mild depression. If it remains untreated for a long period of time, this can result in clinical depression.
In fact, a 2016 article in the Journal of psychiatric research stated that adrenal fatigue is widely accepted as a significant part of a major depressive disorder.(7)
In this particular study, it was found that those going through a major depressive disorder had low morning cortisol and low ACTH (two common findings in adrenal fatigue). (8) Even more important, it was found that the daughters of the women going through a major depressive disorder had nearly identical low cortisol levels meaning the daughters of the women studied also had adrenal fatigue. (9) It is hypothesized that this may be what predisposes depression among family members (especially through the maternal line).
Functional Medicine clinicians can run proper adrenal testing to determine whether your adrenal function is contributing to depression. I can’t recommend this step strongly enough.
4. Chronic fatigue syndrome and adrenal fatigue
Chronic fatigue syndrome (CFS) is now also known as systemic exertion intolerance disease (SEID). There is no specific lab test used to diagnose chronic fatigue syndrome. Therefore, proper diagnosis can be incredibly challenging. In 2015, the Institute of Medicine (IOM) revised the diagnostic criteria for chronic fatigue syndrome.
In order to be diagnosed with chronic fatigue syndrome, you must present with the following three symptoms: (10)
- A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than six months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest;
- Fatigue after exertion (Post-exertional malaise)
- Unrefreshing sleep (sleep does not alleviate the fatigue)
In addition to the above, at least one of the following two manifestations also must occur concurrently:
- Cognitive impairment
- Symptoms are worse while upright and improve when lying down (Orthostatic intolerance)
Because the diagnostic criteria for chronic fatigue are still being discussed, the prevalence of chronic fatigue is currently unknown. Current estimations put the prevalence somewhere between 1-2% of the population. (11) There is no data showing a connection between chronic fatigue syndrome and adrenal fatigue. With that said, in my clinical experience, I often see adrenal fatigue as a contributing factor to chronic fatigue syndrome.
5. Insomnia and adrenal fatigue
Insomnia is a sleep disorder that affects your ability to either fall asleep, stay asleep, or sleep in. In order for insomnia to be diagnosed, these impairments in sleep need to exist despite you giving yourself adequate time to sleep each night and the lack of sleep must affect your daytime functioning.
Diagnostically, there are two different types of insomnia. Short-term insomnia is diagnosed when the sleep issues have been occurring for less than three months. Short-term insomnia is often triggered by a stressful event. In this condition, it is expected that sleep improves after the stress has decreased.
Chronic insomnia is the second type of insomnia. Chronic insomnia is diagnosed if the condition has been occurring at least three times per week for a minimum period of three months. (12)
It is estimated that chronic insomnia causing daytime fatigue affects more than 10% of the population. (13) Those with a family history of insomnia are at greater risk. Common symptoms of insomnia include increased fatigue, sleepiness, confusion, tension, anxiety, and depression. (14)
I explained the effect sleep (or lack of it) can have on adrenal fatigue in this post. It is more likely that insomnia is a cause of adrenal fatigue than a misdiagnosis. Nevertheless, sleep disorders need to be ruled in/out before diagnosing or treating adrenal fatigue as they can be a causal factor.
There are other sleep disorders such as restless leg syndrome (RLS), circadian rhythm abnormalities (shift work), sleep apnea, and narcolepsy. The main symptom of each is daytime fatigue. In general, sleep disorders tend to be a cause of adrenal fatigue. Therefore, proper treatment of your sleep is essential in overcoming adrenal fatigue.
Ok, now you know the most common conditions that mimic adrenal fatigue! Click here for more of our writings on adrenal fatigue.
Also published on Medium.