Is adrenal fatigue "real"?

Low energy and tiredness are among the most common reasons patients seek help from a doctor. Despite being so common, it is often challenging to come up with a diagnosis, as many medical problems can cause fatigue. Doctors engage in detective work, obtaining a medical history, doing a physical exam, and doing blood tests. The results often yield no explanations. It can be frustrating for clinicians and patients when a clear-cut diagnosis remains elusive. An attractive theory, called adrenal fatigue, links stress exposure to adrenal exhaustion as a possible cause of this lack of energy.

But is adrenal fatigue a real disease?

The adrenals are two small glands that sit on top of the kidneys and produce several hormones, among them, cortisol. When under stress, we produce and release short bursts of cortisol into the bloodstream. The adrenal fatigue theory suggests that prolonged exposure to stress could drain the adrenals leading to a low cortisol state. The adrenal depletion would cause brain fog, low energy, depressive mood, salt and sweet cravings, lightheadedness, and other vague symptoms.

Numerous websites mention how to diagnose and treat adrenal fatigue. However, the Endocrinology Society and all the other medical specialties do not recognize this condition. The Endocrinologists are categorical: "no scientific proof exists to support adrenal fatigue as a true medical condition." This disconnect between conventional and complementary medicine adds to the frustration.

A recent review of 58 studies concluded that there is no scientific basis to associate adrenal impairment as a cause of fatigue. The authors report the studies had some limitations. The research included used many different biological markers and questionnaires to detect adrenal fatigue. For example, salivary cortisol is one of the most common ordered tests used to make a diagnosis. The cortisol level, when checked four times in a 24-hour period, was no different between fatigued and healthy patients in 61.5% of the studies. The review raises questions around what should get tested (blood, urine, and/or saliva), the best time, how often, what ranges are considered normal, and how reliable the tests are, to name a few. In summary, there is no formal criteria to define and diagnose adrenal fatigue.

But what if I have symptoms of adrenal fatigue?

If you have tiredness, brain fog, lack of motivation, among other symptoms, you should first have a thorough evaluation with a medical doctor. Anemia, sleep apnea, autoimmune diseases, infections, other hormonal impairments, mental illnesses, heart and lung problems, and kidney and liver diseases are just some among many medical conditions that could cause similar symptoms. If the workup from your medical professional turns out normal and you believe you might have adrenal fatigue, I would recommend you consider a fundamental question: Why would your adrenals be drained? Take a better look at what types of stress might be affecting you. For many, the hectic pace of modern life is to blame.

The lack of a biological explanation can be disappointing. To make things worse, it's not unusual for doctors to say "there is nothing wrong with you" or "this is all in your head." The overwhelming amount of information on the Internet that recommends many types of treatment causes even more stress. Mental health conditions, such as depression or anxiety, may have symptoms similar to adrenal fatigue and may not respond well to antidepressants and counseling. And some patients do not believe that a mental health concern is the primary cause of their symptoms and many refuse medications due to concerns about their side effects.

So what's a person to do?

Navigating this ocean of uncertainty is not an easy task. Symptoms associated with adrenal fatigue probably have multiple causes. Frequent follow-up visits and a strong patient-clinician partnership are critical elements for success. Alternative and complementary clinicians often have better results, because the appointments tend to last longer and they view patients through a more holistic lens. An important word of caution: some medical professionals prescribe cortisol analogs to treat adrenal fatigue. Cortisol replacement can be dangerous even in small doses. Unintended consequences can include osteoporosis, diabetes, weight gain, and heart disease.

Regardless of what we call it, there are millions of people suffering from similar symptoms, and a personalized plan that involves counseling, medications, supplements, lifestyle change, among others could work for many. Improvement following these programs is slow, and the evidence is weak, but I hope advances in big data, genomics, and its relationship with the environment and the microbiome, may shine a light on how to better help people who suffer from these ailments.

The adrenal fatigue theory may fit like a glove to explain your symptoms, which are very real. But before buying expensive protocols over the Internet to treat something we're not even sure exists, take a deep dive and reexamine your lifestyle. The path to feeling better may be closer than you think.