Are you convinced you have adrenal fatigue?
Or, maybe you did get diagnosed with adrenal fatigue. But whenever you try treating it, you end up feeling worse…
Let’s say you have all the symptoms of adrenal fatigue. You’ll get completely different testing options from a family doctor versus a functional medicine practitioner. And even most tests run by functional medicine practitioners and/or naturopaths are inaccurate!
What to do? How do you properly test for adrenal fatigue?
Adrenal fatigue: a legitimate condition? Or, just a way for naturopaths to sell supplements?
There’s no shortage of confusion surrounding adrenal fatigue. Some say adrenal fatigue is not a real medical condition. Others say it’s epidemic in societies of the 21st century. Holistic practitioners tend to diagnose everyone with adrenal fatigue. Whereas medical doctors won’t recognize adrenal fatigue as a legitimate medical condition.
Why is there so much confusion surrounding this condition?
It comes down to testing. Until recently, there has not been an agreed upon effective methodology for testing adrenal function. Combine poor testing methods with a general misunderstanding of how the human body responds to stress and you’ve got the situation you find adrenal fatigue in today – confusing.
Why grizzly bears are good for your adrenals but city life isn’t
Imagine you’re on a hike in the Canadian wilderness. Your stress levels are super low. As you turn a corner on the trail you make eye contact with a massive female grizzly bear and her two cubs!
Your brain quickly processes the situation… STRESS. It instructs your adrenal glands to release cortisol and adrenaline. Suddenly, your heart is racing, your pupils are dilated, and your palms are sweaty.
But the mother grizzly and her cubs is more interested in the berries on the side of the trail than you and your friend. She leisurely saunters into the bush in search of more berries. You let out a sigh of relief. Wow. That was stressful.
This is the type of stress your body has adapted to cope with. A short, intense bout of stress that returns to a healthy baseline after a short period of time. Unfortunately, life isn’t always this kind.
In stressful situations (like the example above), your body releases stress hormones like cortisol. But when stress continues without reprieve or, is so intense that it overwhelms your body’s capacity to properly handle it, conditions like adrenal fatigue result. Remember, adrenal fatigue is not often caused normal life stresses. Adrenal fatigue is typically caused by hidden stresses.
Let me be very clear that your adrenal glands do not fatigue. This is part of the reason why your family doctor isn’t on your side – there’s really no evidence to support adrenal fatigue. The root cause of adrenal fatigue comes from your brain, not your adrenal glands. The condition in your brain that causes adrenal fatigue is called hypothalamic-pituitary-adrenal axis dysfunction (HPA-D).
These two terms can describe a similar condition – low cortisol. But they suggest different pathways for the way in which it develops. HPA-D has scientific evidence to support its existence. Adrenal fatigue is lacking that evidence. Throughout this article, I’ll refer to HPA-D as adrenal fatigue as the condition is still colloquially known as adrenal fatigue.
Much like its name, the way to best test for adrenal fatigue and/or HPA-D is still a source of great confusion. Until recently there wasn’t a good way to properly assess your body’s response to stress.
Why family doctors test for adrenal fatigue improperly
Visiting your family doctor for adrenal fatigue can be a trying experience. The majority of docs are resigned to the fact that adrenal fatigue is a myth. Cortisol assessments done through conventional medicine will often reveal you to be within normal ranges.
But that doesn’t mean you don’t have a cortisol problem. The real problem is the testing method done through most state-run healthcare systems. The reference ranges used for cortisol blood tests done by your family doctor are calibrated to pick up very high levels of cortisol (Cushings Disease) and very low levels of cortisol (Addison’s Disease). Everything outside of these two diseases will register within normal ranges. Even if you feel anything but normal.
The other inherent problem with blood testing cortisol is the time in which your blood is drawn. Cortisol has something called a diurnal rhythm. Meaning that the levels of cortisol in your body rise and fall throughout a twenty-four hour period. Cortisol should surge to its highest level of the day shortly after you wake up. From there, it’s a slow decrease in cortisol levels as the day progresses. By bedtime, your cortisol should be at its lowest point of the day. While you sleep, your levels rise once again and the cycle starts anew the next morning.
Since cortisol’s levels fluctuate so much throughout a twenty-four hour period, for any cortisol test to be accurate, the test needs to take a weighted average of cortisol production in a 24-hour period. A single blood test checking cortisol is not accurate enough to diagnose adrenal fatigue. A single cortisol blood test will only pick up extreme fluctuations of cortisol; like those found in Cushing’s or Addison’s Disease. This is why your family doc has probably told you that your cortisol levels are fine. And that you don’t have adrenal fatigue.
Is there another way for conventional medicine to assess cortisol levels?
Blood testing cortisol is by far the most common method of testing in conventional healthcare settings. But urine tests can be ordered through most state-funded healthcare systems. Urine tests involve collecting all of your urine for a 24-hour period. The inherent problem with urine collection tests is that people do them improperly. Studies have found that 30-40% of all 24-hour urine collection samples are invalid. (1, 2)
If blood tests are inaccurate and few people do the urine tests properly, how should cortisol levels be measured?
As you’ll soon learn, properly testing for adrenal fatigue is quite nuanced. There are different types of cortisol found within your body. And each has a different effect it exerts on your body’s systems.
Why holistic practitioners test for adrenal fatigue improperly
Ok, so you know that the cortisol test(s) ordered by your GP is not up to the task of accurately determining your cortisol levels. But before you rush out to make an appointment with your naturopath, know that the adrenal fatigue testing methods used by holistic practitioners are not much better.
Naturopaths, acupuncturists, chiropractors, and other holistic practitioners tend to use saliva tests to determine adrenal function. Saliva tests were thought to be the best way to evaluate the adrenal function for a long time. It’s a relatively convenient way to test (you simply spit into a tube) and it’s done at specific time points throughout the day; so you get a good idea of cortisol levels within a 24-hour period.
The rather large downside to salivary testing is that it only measures something called free cortisol. Free cortisol is cortisol hormone that is not bound to any other protein. It’s free. Free cortisol does create the largest effect on your body but it only makes up a small percentage of the total amount of cortisol your body produces.
It’s like the old parable about the group of blind men describing an elephant:
A group of blind men heard that a strange animal, called an elephant, had been brought to the town, but none of them were aware of its shape and form.
Out of curiosity, they said: “We must inspect and know it by touch, of which we are capable”. So, they sought it out, and when they found it they groped about it.
In the case of the first person, whose hand landed on the trunk, said “This being is like a thick snake”.
For another one whose hand reached its ear, it seemed like a kind of fan.
As for another person, whose hand was upon its leg, said, the elephant is a pillar like a tree-trunk.
The blind man who placed his hand upon its side said, “elephant is a wall”.
Another who felt its tail, described it as a rope.
The last felt its tusk, stating the elephant is that which is hard, smooth and like a spear. (3)
When you only look at part of the picture, you tend to make inaccurate conclusions. This is what happens when an adrenal fatigue test only measures free cortisol. It’s only part of the picture. You need to look at your body’s total production of cortisol (not just the levels of free cortisol) in order to make accurate clinical decisions.
I’ll show you why this is so important below!
Most tests for adrenal fatigue are wrong – here’s why
Did you feel worse after getting treated for adrenal fatigue?
This phenomenon is not at all uncommon. It almost always has to do with poor testing methods.
Your adrenal glands are busy synthesizing cholesterol into cortisol on a regular basis. But 80-90% of your body’s cortisol is not readily available. The majority of your cortisol is bound to a protein called cortisol-binding globulin (CBG). (4) The remaining 10-20% of your cortisol is called free cortisol.
Your cortisol gets metabolized (digested) through your kidneys and liver and eventually leaves your body through the urine. If you have high levels of free cortisol (like when you run into a grizzly bear) you should have high levels of metabolized cortisol. This would indicate that your body is digesting and excreting all of its cortisol properly. If you have adrenal fatigue (low levels of free cortisol) you should also see low levels of metabolized cortisol on your test. This indicates that your body has low levels of cortisol and low levels are also being metabolized.
This becomes confusing when your free cortisol levels are dramatically different than your metabolized cortisol. And its why so many testing methods for adrenal fatigue are inaccurate.
For example, a person with obesity will often have high levels of metabolized cortisol when compared to his/her levels of free cortisol. This occurs because adipose tissue pulls cortisol from its binding protein and then excretes it in the urine. If you ran a saliva test on this person, his/her lab results would indicate adrenal fatigue (low cortisol). Remember, saliva tests only measure free cortisol. But in reality, this person has the opposite of adrenal fatigue. He/she has elevated cortisol. The majority of which is being metabolized and then excreted in the urine. (5)
The opposite of this pattern can occur in patients with hypothyroidism. In this scenario, you’ll typically see high levels of free cortisol and low levels of metabolized cortisol. (6) If this patient ran only a salivary cortisol test, they would be told they have hypercortisolism (elevated cortisol). When in reality, they actually have very low levels of cortisol (adrenal fatigue or hypocortisolism).
As you can see, if you don’t run the proper test, you could end up on a treatment plan that will make you feel worse. This is why proper testing for adrenal fatigue is so important. Below, I’ll show you the best way to (properly) test for adrenal fatigue.
How to accurately test for adrenal fatigue
You now know that free cortisol is only a small fraction of total cortisol production. Therefore, testing only free cortisol is not an accurate way to test for adrenal fatigue. Since salivary tests only measure free cortisol, they cannot be included as a recommended test for adrenal fatigue. Blood tests measure total cortisol but they’re only taken at one time of the day. (7) Which makes blood tests just as inaccurate as saliva.
This leaves urine testing remaining. Urine testing allows for labs to measure both metabolized and free cortisol levels. When you add metabolized cortisol with free cortisol you end up with your body’s total cortisol production. To accurately assess adrenal fatigue, you need to know your total cortisol production levels.
Since collecting all of your urine for an entire day is far from convenient, there needs to be a more user-friendly way to accurately asses adrenal function. Enter the DUTCH test. The DUTCH test combines the accuracy of a urine test with the ease of a saliva test. At the time of this writing, it is the best test for adrenal fatigue.
Full disclosure – I use the DUTCH test in my functional medicine practice. But I do not have any sort of financial affiliation with the company. I’ve chosen to use the DUTCH test because they offer the most accurate and most convenient test for assessing HPA axis and adrenal function.
If you and/or your practitioner are suspecting your symptoms are related to adrenal fatigue, make sure you test properly. Opt for a test that measures both free and metabolized cortisol. And make sure that there’s a weighted average in a 24-hour period!
If you tried treating your adrenal fatigue but ended up feeling worse, check the testing method you used. Your worsening of symptoms may be caused by a misdiagnosis!
Now, I want to hear from you!
How did you test for adrenal fatigue? How did the treatment you performed improve your symptoms?
Leave your replies in the comments section below!
Also published on Medium.