“The fatigue doesn’t come overnight,” the founder of Open Heart Solution, a coaching practice that specializes in healing codependency, tells HealthyWay. “Instead, I lost vitality by inches over the course of several months.” Gaines chalked her worsening symptoms up to getting older. Then she started getting headaches at the base of her skull. Trying to eat became a nauseating ordeal. This was not a natural decline, she realized. “The fatigue was so bad, I couldn’t get out of bed for more than a few hours at a time,” she says. “Even though I was exhausted, I couldn’t sleep. Weight loss. Irritability came next. Then, sensitivity to light. For a month or two, all I could do was lie in bed, staring at the ceiling.” At the time, Gaines was living with an acupuncturist. Her roommate tracked her symptoms and issued a confident diagnosis: adrenal fatigue. Gaines felt that she had found her problem. She was ready to address it. To her dismay, though, her doctors dismissed her concerns. “Of course I talked to doctors, and they were like, ‘Adrenal fatigue is not a real thing,’” Gaines says. “And then we go to the functional medicine community and they say, ‘Yeah, medical doctors say it’s not a real thing because there’s no pill for it. There’s no code for it in insurance. There’s not a prescription for it…’ So adrenal fatigue will never be a diagnosis in the Western medical community.” Healthcare, like everything else, is rife with cultural conflict. But what some call adrenal fatigue could become an ideological town square in which all patient-centered service providers—the scientists and the intuitionists alike—might find common ground. And even a mislabeled affliction can lead to lifestyle changes that are healthy for everyone. That said, it’s important to understand the medical consensus on this cluster of symptoms, which ranges from apathy to light sensitivity. Regardless of your view of institutionalized medicine, this is what you should know before you go to your primary care physician—or your acupuncturist—about the very real difficulties that are often associated with adrenal fatigue.
What is adrenal fatigue?
As far as we can tell, the adrenal fatigue diagnosis debuted in 1998 when chiropractor James L. Wilson, DC, ND, PhD, coined the term. His definition of adrenal fatigue? “A collection of signs and symptoms, known as a syndrome, that results when the adrenal glands function below the necessary level.” That definition comes from his website, where Wilson sells an array of herbal products, including an Adrenal Fatigue Quartet, which was listed at $183.44 at the time of this writing. Like many vitamin and supplement websites, Wilson’s site, AdrenalFatigue.org, is dotted with asterisks that point to the small print at the base of the page: “This statement has not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.” The problem with Wilson’s definition of adrenal fatigue is that it can just as easily refer to an existing and scientifically verified diagnosis: adrenal insufficiency, which results from damage to the adrenal glands or the glands that send chemical signals to the adrenals. So how does the endocrine system work (or stop working) and why do people use different terms to identify issues that are seemingly the same?
The Endocrine System and Its Discontents
Broadly stated, the endocrine system is a self-regulating network of chemical-producing tissues and their targets within the human body. Target organs, including other endocrine glands, absorb these chemicals: aka hormones. Suffice it to say that, just as certain neurotransmitters like serotonin and dopamine bind to receptors in your brain, certain hormones zero in on tissues and organs within your body. These hormones change the behavior of those tissues and organs, powering unconscious physical processes and experienced sensations alike. In the experiential act of being, your brain is just one part of the equation. Hormones and other organs also play significant roles, making it complex to say the least. So let’s talk adrenal glands. These two small hormone-producing entities sit just atop your kidneys. They produce a number of hormones—from the stress hormone cortisol to aldosterone, epinephrine, and precursors to the sex steroids androgen and estrogen. Don’t worry if you don’t know what those things are. We didn’t either, so we had to ask a doctor. Take just one of these substances—cortisol, for example. “We need cortisol to live,” says Shirisha Avadhanula, MD, a senior fellow physician in the department of endocrinology, diabetes, and metabolism at Georgetown University Hospital. “We need it for normal human physiological functioning. This hormone, among many of its functions, orchestrates our body’s response to stress in such ways as regulating our blood pressure, for example. It coordinates our immune response and it also regulates our metabolism.” Point being, adrenal insufficiency is a medically recognized condition in which damaged endocrine glands fail to produce enough hormones to maintain homeostasis, the delicate thermo-electrochemical balancing act by which our bodies and minds remain stable and healthy. Adrenal fatigue, on the other hand, has grown from Wilson’s dubious hypothesis to a full-fledged cottage industry. We live stressful lives, say the believers. Our lives are so stressful that our adrenal glands essentially run out of cortisol. According to endocrinologists, though, this argument doesn’t make physiological sense. “Basically, the whole concept is that constant stress causes your adrenal glands to burn out and release—eventually—low levels of adrenal hormones, especially cortisol. That’s the whole concept behind adrenal fatigue,” Avadhanula says. “But, physiologically speaking, under periods of stress, your adrenal glands actually work harder, and they make more cortisol. Even under stressful conditions, our adrenal glands don’t fatigue out. They continue to maintain their role. They’re really not so easily subverted.” But that in no way discounts the symptoms associated with the term, Avadhanula stresses. The doctors we spoke with focused on three main points they’d like to spread in the interest of public health.
The 3 Things Endocrinologists Want You To Know About Adrenal Fatigue
The consensus of the Endocrine Society, the professional association of endocrinologists, is that adrenal fatigue as it’s defined by Wilson and many others does not exist. But when a patient can’t get out of bed for more than a few hours a day, clearly something has gone awry. Here’s what endocrinologists want you to know if you think you or a loved one are experiencing something that sounds like adrenal fatigue. [sol title=”“Nobody’s disputing the symptoms.”” subheader=”A good doctor listens and investigates symptomatology.”] “The first point I want to get across is: Nobody’s disputing the symptoms,” Avadhanula says. When a patient comes to her complaining of overwhelming tiredness, brain fog, and unexplained weight changes, she urges them to avoid the term adrenal fatigue because it’s not a legitimate diagnosis according to Endocrine Society consensus. But she knows that something is causing these symptoms. “We need to listen to our patients, and we need to investigate their symptomatology,” Avadhanula says. As she makes these points, she speaks slowly and methodically, enunciating each syllable and clearly conveying her emphasis. So that’s the first thing: If you fear that you have adrenal fatigue, no good doctor is going to discount your symptoms. On the contrary, they’ll look for the true cause to help you get back to health. [sol title=”The term “adrenal fatigue” should be eradicated.” subheader=”The wrong label can prevent the right diagnosis.”] “The second thing, of course, is that we encourage patients and other practitioners and other physicians to stop using this terminology,” Avadhanula says, referring to the term adrenal fatigue. “It can cloud an underlying diagnosis, and that’s when things become concerning.” Joshua Miller, MD, MPH, is the medical director of diabetes care for Stony Brook Medicine and an assistant professor of endocrinology and metabolism in the school’s department of medicine. He’s certified in internal medicine and endocrinology, diabetes, and metabolism. And he shares Avadhanula’s concerns. “It’s unfortunate, because you know full well there’s this information all over the internet, and if a patient has something, God forbid, more serious going on, but they themselves are convinced it’s adrenal fatigue, well, they’re going to miss getting that other issue addressed. And we have seen that happen before.” [sol title=”The Dark Side to the Spread of Misinformation” subheader=”Someone’s profiting.”] “As is the case in any industry, there are many health care practitioners out there, some of whom are physicians, some of whom are not, who will take advantage of patients who are convinced of their diagnosis of adrenal fatigue, and will try to sell them something,” Miller says. “And we’ve encountered this many times, my partners and I.” Wilson, the inventor of the term adrenal fatigue, and many others who use it are in the business of selling herbal supplements, which can’t be a coincidence. And unregulated supplements may not address an underlying health issue that’s actually causing your symptoms. Miller describes the problematic scenario:
A patient will come and see me, and they’re taking a supplement that they bought from another doctor who they saw—and I use the term doctor loosely for some of these folks. And it’s a concoction of vitamins and herbs and this and that, that, one, probably costs hundreds of dollars, and two, is not helping, and three, has the potential to harm. So the first question, literally the first question I’ll ask patients when they come in with that story, is “Do you feel better taking the supplement than you did before you took it?” And most patients have never really asked themselves that question before. And when they do, many of them will sit back and say, “You know, Dr. Miller, I really don’t feel any different since starting this herb or starting this supplement.”
So what happens next? The endocrinologist will recommend that you stop taking the supplements. “The problem is that these supplements are not regulated, nor are they approved by the FDA,” says Avadhanula. “We don’t really know what’s in them. There’s no way to know. The expert consensus is that you’d recommend the patient stop taking them.”
Adrenal Fatigue Symptoms According to the Internet
The Hormone Health Network, which is operated by Endocrine Society, lists the symptoms that have been associated with the term adrenal fatigue. They include:
- Severe tiredness and lethargy
- Sleep problems
- Difficulty getting out of bed in the morning
- Cravings for sugar or salt
- Over-reliance on caffeine
The trouble is that these symptoms are nonspecific; they can be caused by any number of factors. For many busy, stressed-out adults, they’re realities of daily life. One person’s adrenal fatigue could be another’s daily grind. That’s not to say that you should simply accept a stressful lifestyle. Chronic stress is associated with a multitude of negative health effects, from musculoskeletal disorders to high cholesterol. Stress absolutely can produce the symptoms that some associate with adrenal fatigue. It’s just that the science doesn’t back up the adrenal-fatigue theory of how stress leads to poor health outcomes. Still, many patients self-diagnose adrenal fatigue, which could be costing them the opportunity for a legitimate diagnosis and better treatment.
Evidence-Based Medical Disorders That Can Be Confused With Adrenal Fatigue
So if these symptoms aren’t caused by a burnt-out endocrine system, what is causing them? While the phenomena associated with adrenal fatigue are nonspecific and could be caused individually by many different conditions, there are a few illnesses that share symptomatology. Most notably, these include:
“Per Endocrine Society consensus, adrenal fatigue is not a recognized medical entity,” says Avadhanula. “The reason I think patients have a lot of questions and come to me with queries about this diagnosis is that the symptomatology that adrenal fatigue describes consists of a lot of really nonspecific symptoms.” Of course, these symptoms do “match up with stress,” says Avadhanula. Tiredness and confusion and caffeine addiction may not come from an illness, per se. They might just be the result of lives lived out of balance.
Self-Care for People Who Experience Symptoms Associated With Adrenal Fatigue
Gaines’ symptoms began to ease when she put herself on a wellness regimen of her own creation. “I started really simply,” she says. “I started by getting up in the morning and making some tea, and going outside and drinking it for 10 minutes, with no sunglasses, and just looking, allowing the light to come into my eyes.” That simple time carved out for herself—a quiet moment first thing in the morning—set Gaines on her path to a more balanced, peaceful lifestyle. But it was just the first step. “I started walking around the park that was at the back of my house,” Gaines says. “I have the luxury of working at home, so sometimes I would take conference calls and do them while walking around the park.” Gaines also began to take advantage of a major lifestyle change. She had moved from a tumultuous life in New York City to a slower pace in Texas. That made it easier for her to incorporate self-care behaviors like exercising in the great outdoors into her everyday routine. “I live in a place where there’s plenty of sunlight, and plenty of places to walk, and plenty of places to breathe fresh air, and there’s plenty of places to put the phone away and just listen to the river running and not worrying about the text messages coming in,” she says. “If I didn’t have that, I don’t know where I would be right now.” The thing is, the recommended lifestyle-based treatments for the symptomatology some call adrenal fatigue are commonly recommended treatments for chronic stress. You would be hard pressed to find a doctor who would caution you against practicing good sleep hygiene, exercising regularly, pursuing mindfulness, or spending time in nature. What they do have a problem with, however, are untested supplements and wellness programs that take advantage of suffering patients by charging hefty fees that insurance companies won’t cover. “As in many parts of health care, people get taken advantage of,” Miller says. That’s a shame, when “some of the simplest interventions [for these symptoms] are exercise, good sleep hygiene, keeping screens out of the bedroom, eating a wholesome diet, not eating processed and fast foods, not drinking a lot of caffeine, avoiding a ton of alcohol, and not smoking. And you’ll feel better. You don’t have adrenal fatigue, you’re just living a healthier life.” While the science behind the idea of adrenal fatigue doesn’t hold up, the lifestyle changes said to cure the condition will actually make most people feel better. In that sense, the shamans and the scientists are on the same page. Go outside. Listen to the real birds, not your Twitter notifications. Adrenal issue or no, managing stress is good for your overall health. “You are born to be vital and alive,” says Gaines. “And there’s nothing in the world that should take you away from that.” Say what you want about adrenal fatigue. Who can argue with that sentiment?