What's Really Going On With Adrenal Fatigue?

Are you convinced your adrenals are fatigued?

But what exactly does a fatigued adrenal even mean?

And more importantly, is adrenal fatigue even a real condition?

You may have read an article regarding adrenal fatigue and felt that the listed symptoms described you perfectly:

Difficulty getting out of bed each morning, even after a restful, 8-hour sleep;
High levels of fatigue throughout the day;
Inability or decreased tolerance to handle stress;
Cravings for salty or sweet foods;
Increased energy levels before bed;
Dependence and overuse of stimulants like caffeine and sugar;
Weakened immune system.

These are the basic symptoms of adrenal fatigue. Additional symptoms may include:

Low blood sugar;
Low blood pressure;
Weight gain;
Feelings of dizziness when transitioning from seated to standing positions;
Increased fatigue after exercise.

Chances are you recognize at least one of these symptoms as they describe many of us in our busy world. They’re so commonplace and non-specific that one might argue they’re not a disease state at all, they’re normal.

Let me be the first to tell you that these symptoms are not normal. They’re early warning signs that your body is under stress. When that stress lasts for too long or, is too intense, more serious symptoms arise.

Your body on stress

The term adrenal fatigue is misleading as your body’s stress response involves much more than just the adrenal glands. The Hypothalamic – Pituitary – Adrenal (HPA) axis plays a pivotal role in managing energy balance, food selection, and satiety (feeling full after eating). Whenever you’re under stress, your HPA axis will help you better deal with that event.

The celebrity hormone in the world of stress is cortisol. Cortisol is a steroid hormone that the HPA axis releases in response to stress and to maintain blood sugar levels. You may know it as the stress hormone. Or, as the hormone that stops you from losing weight.

When your body experiences stress, your HPA axis is the mechanism used to respond to the event. According to The Role Of Stress And The HPA Axis In Chronic Disease Management by Thomas G. Guilliams, there are three stages that illustrate the way stress affects the body:

Stage 1: Acute HPA axis activation

During the initial exposure to stress, your HPA axis responds by producing increased levels of cortisol. Ideally, the source of stress is removed and the HPA axis returns to normal. If the stressor is not removed, the body enters the second stage of stress maladaptation.

Stage 2: Stress maladaptation

If your stressors have been present for a long period of time your body reacts to the ongoing high levels of cortisol by instructing the adrenal glands to lower cortisol levels inappropriately.

Stage 3: Adrenal Fatigue

If the stress is still unable to be removed, your body creates a state of low cortisol which prevents it from removing inflammation. This is commonly known as adrenal fatigue. But as you’ll soon learn, adrenal fatigue is much more a problem of your brain than of your adrenal glands.

Are there actually 3 stages to the adrenal fatigue syndrome?

These stages are better thought of as descriptors than actual medical conditions. They’re a model. Like most models, the 3-stage theory of adrenal fatigue helps you to understand the way adrenal fatigue could progress. In reality, it is not so neat and tidy. You can fluctuate between stages and sometimes skip entire stages completely.

When your body has been exposed to stress too intensely, too often, or for too long, your HPA axis becomes less able to respond to the stressor. Adrenal fatigue or more accurately hypothalamic-pituitary-axis dysfunction (HPA-D) occurs when your body is no longer able to respond to a stressor in a healthy manner.

Here lies one of the main reasons the term adrenal fatigue faces resistance from the medical community:

Adrenal fatigue a simplified explanation for a very complex network of events that take place within your body during a stressful event.

The adrenal fatigue model was a basic understanding of how your body responds to stress. Today, there is a more robust and current understanding of how your body responds to stress. Enter hypothalamic-pituitary-adrenal axis dysfunction (HPA-D).

HPA-D is version 2.0 of adrenal fatigue. HPA-D brings to light a more detailed medical knowledge of your body’s reaction to stress. It illustrates that this is not simply an adrenal issue, but a much more complex central nervous system response that has many moving parts.

HPA-D is a brain problem. Not an adrenal problem.

Can your adrenal glands really fatigue?

Part of the reason adrenal fatigue is frowned upon by the medical community is that there is no evidence suggesting the adrenal glands fatigue. That is, outside of serious medical conditions like Addison’s Disease, your adrenal glands do not tire out, fatigue, or stop producing cortisol. It’s a common misconception.

Adrenal fatigue is actually more of a miscommunication in the brain than it is an adrenal problem.

This is why most mainstream medical doctors do not acknowledge that adrenal fatigue exists. But that doesn’t mean your symptoms are just in your head. Your doctor does not believe in adrenal fatigue because, in the medical literature, there is no evidence of its existence.

Low cortisol may very well be the outcome of chronic stress, but the mechanism that causes this to occur is not a fatiguing of the adrenal glands. Instead, low cortisol levels come about through your brain’s efforts to ensure your body’s tissues do not have high levels of cortisol.

I’ll admit that adrenal fatigue is much nicer to pronounce than HPA-D. But if you want your doctor on your side, I’d encourage you to adopt HPA-D in place of adrenal fatigue. But since you’re probably much more familiar with the term adrenal fatigue, I’ll refer to the condition as such throughout the remainder of this post.

How do you (properly) diagnose adrenal fatigue?

Surely you or someone you know feels tired after 8 hours of sleep or becomes fatigued in the afternoon. With the symptoms of adrenal fatigue being so commonplace, a diagnosis based on symptoms is likely to result in an error. Not to mention, there are so many conditions that cause fatigue. Think of low iron levels or low thyroid levels – both of which can mimic the symptoms of adrenal fatigue.

To ensure an accurate diagnosis, laboratory tests need to be done. This way, an effective treatment plan can be crafted. Another reason why laboratory testing for adrenal fatigue is crucial is that symptoms for elevated and deficient levels of cortisol can be identical, and yet the treatment plans are very different.

Historically, cortisol levels have been measured in one of two ways:

Blood test
Saliva test

Blood test

Cortisol measurements done by your medical doctor are taken via the blood. This reading is done at an arbitrary time – whatever time you book your lab test. While this test may tell you if you have elevated or suppressed cortisol levels at that particular time of day, it does not provide the larger context needed to create an effective diagnosis or treatment plan.

You see, cortisol has something called a diurnal rhythm. Meaning that your cortisol levels rise and fall with the light-dark cycle of your environment. Shortly after waking, you’ll experience a surge of cortisol. When it’s close to bedtime, your cortisol levels should be quite low.

In order to accurately gauge a weighted average of cortisol production, you should be taking readings throughout an entire day. Simply taking one reading (at an arbitrary time) will not accurately assess your cortisol levels.

Saliva test

Alternative practitioners have traditionally used saliva to measure cortisol. Saliva measurements of cortisol provide a great reading of cortisol’s diurnal rhythm. However, what a saliva test fails to show is how quickly cortisol is metabolized.

A saliva test measures something called free cortisol. Free cortisol is the quantity of the cortisol hormone freely circulating in your body. Free cortisol represents only 1% of the total amount of cortisol in your body. (1) The other 99% of cortisol is called metabolized cortisol. Metabolized cortisol is bound to other proteins. This is why it is not considered free.

When a saliva test is performed, it measures free cortisol and does not consider metabolized cortisol levels. This means it ignores the levels of 99% of the cortisol in our body. In order to get an accurate reading, a proper diagnosis, and thus an effective treatment plan for adrenal fatigue, precise testing is essential.

How should adrenal fatigue be treated?

In conclusion, adrenal fatigue can be incredibly challenging to properly diagnose. The generalized symptom of fatigue can be caused by many other illnesses such as low thyroid, iron deficiency, and insomnia. Fatigue can even be a side-effect of medications, food intolerances, or other diseases.

Thus, proper testing is essential. The diagnosis of adrenal fatigue cannot be based on symptoms alone as low levels of cortisol may not be the only cause of your low energy levels. I always recommend working with a knowledgeable Functional Medicine practitioner. Functional Medicine practitioners are able to explore the many different reasons why you may be fatigued and help you take steps to recover your health.

What’s causing your adrenal fatigue?

When you think of stress, what likely comes to mind is the usual work, financial, or relationship stresses that affect us all. However, there are a number of hidden stresses that tend to affect your system much more than the typical stresses found in daily life.

These hidden stresses include:

Blood sugar irregularities

Both high and low blood sugar can wreak havoc on your body’s stress-management system. Perhaps most alarming, this can occur without any obvious symptoms.

Sleep disturbances

Don’t underestimate just how important sleep is in the maintenance of health. It’s so significant that when altered, lack of sleep can be the sole cause of adrenal fatigue. Night shift workers – heed this warning!

Hidden sources inflammation

Inflammation is your body’s response to harmful stimuli. It’s unlikely your sprained ankle will cause adrenal fatigue. But did you know that the food you eat could secretly be keeping you fatigued?

You can read more about the real causes of adrenal fatigue, and steps you can take to get them under control, in the following blog posts:

Now, I want to hear from you!

What do you think, is adrenal fatigue a real condition? Leave your responses in the comments section below!

Looking for more information about fatigue? Check out our other writings on how to achieve a fatigue-free body!

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Is Adrenal Fatigue A Real Syndrome?