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“Adrenal Fatigue” is a term used for many years by alternative medicine practitioners but does it exist? This is certainly a term that I have used for some time but not in the way that most practitioners use it. I will use terms at times that are widely searched for on the internet so that I can spread the science behind these terms but it doesn’t necessarily mean that I endorse the term or subscribe to the existence of a condition.
There are a few published papers that tackle this very issue that I’ll cover in this article on “adrenal fatigue”.
What does the research show about “adrenal fatigue”?
The first paper I’d like to mention is entitled, “We are tired of ‘adrenal fatigue’” by Ross et al. The title of this paper quickly gives you the underlying frustration of the authors about this term. This paper is a position statement and not a clinical trial, review, or analysis of any kind. The authors begin by outlining the adrenal fatigue theory and that is doesn’t exist as a defined medical condition.
The authors do point out a valid adrenal disorder called adrenal insufficiency which is characterized by insufficient cortisol production after an adrenocorticotropic (ACTH) hormone stimulation test. They also mention Addison’s disease which is true adrenal failure.
Interestingly, those who suffer from fatigue actually showed a greater rise in cortisol with an ACTH stimulation test which indicates excessive cortisol production not insufficient cortisol production in those with adrenal insufficiency.
And another study actually found no difference in salivary cortisol levels taken throughout the day in two-thirds of healthy subjects compared to those who suffered from fatigue.
Dehydroepiandrosterone sulphate (DHEA-S) has also been used as a marker for adrenal fatigue but research has shown this to be unreliable.
The most recent systematic review of adrenal fatigue is entitled, “Adrenal fatigue does not exist: a systematic review” by Cadegiani and Kater. The authors searched 3,470 published papers but only 58 of them fulfilled proper criteria for evaluation. Of the 58 studies, only 10 actually used the term “adrenal fatigue” but none of them did any kind of testing to validate this false condition. Some studies tried to use the term “burnout” instead of “adrenal fatigue” but no scientific evidence was presented in these papers.
None of the studies in the above review were able to validate any of the functional tests used to assess adrenal hormone production including cortisol and DHEA. Additionally, no valid information was found in these tests to assess HPA axis dysfunction which is one of the hallmarks of “adrenal fatigue”.
The authors rightly point out that anytime there is a suspected issue of HPA axis dysfunction, the following must be ruled out as a cause of this dysfunction:
1. Sleep apnea
2. Adrenal insufficiency
3. Mental illness
5. Night-shift workers
6. Other hormonal imbalances
7. Liver and kidney dysfunction
8. Heart conditions
9. Lung disease
10. Autoimmune disease
Some alternative practitioners are not adequately assessing each patient for the above list of potential issues and jumping into treatment of “adrenal fatigue”.
The authors conclude that there is no demonstrated evidence that “adrenal fatigue” is a real condition. Their two final statements are:
1. “The results of previous studies were contradictory using all the methods for assessing fatigue and the HPA axis.”
2. “The most appropriate methods to assess the HPA axis were not used to evaluate fatigue.”
It is clear from reviewing the above paper that the methodology in all the studies reviewed was very poor and did not provide any valid scientific support of “adrenal fatigue”.
What about corticosteroids?
Many integrative practitioners are prescribing oral corticosteroids to treat adrenal fatigue which can have many negative consequences. Corticosteroids will immediately improve one’s sense of well-being no matter what condition they have thereby giving the false impression that this treatment was necessary for the patient.
Corticosteroids can lead to osteoporosis, glaucoma, myopathy, insomnia, psychiatric disorders, cardiovascular disease, and metabolic disorders. It can be difficult to come off of corticosteroids the longer someone has been taking them which can be a long and arduous process. This overuse of corticosteroids is a major problem in integrative medicine today.
Dr. Hedberg’s Comments on “adrenal fatigue”
Unfortunately, I see many patients who believe they have “adrenal fatigue” either because another practitioner told them they have it or they read something on the internet that lead them to believe they have it.
There is no doubt that HPA axis dysfunction exists but the majority of the time this doesn’t lead to adrenal glands that aren’t producing enough hormones as claimed in “adrenal fatigue”. Adrenal insufficiency or Addison’s disease as noted above are two real conditions that lead to very low levels of adrenal hormone production. These require specific testing to diagnose and must be treated through conventional medical therapies.
Adrenal hormone testing through combined urine and saliva such as the DUTCH test by Precision Analytical can be useful to determine if the patient has adrenal insufficiency or to investigate further for Addison’s disease. The interpretation of the DUTCH test can also help to determine inflammation and insulin resistance depending on the patterns found on this test.
If you do have HPA axis dysfunction then it can be useful to take adrenal adaptogens as outlined in my article on the best adrenal adaptogens.
I rarely do testing for adrenal hormones because this is rarely the primary issue with each patient as most of the issues that cause adrenal hormone imbalances are addressed through my treatment plans. These include things like trauma history, gut health, insulin resistance, thyroid health, metabolic acidosis, dietary factors such as protein and carbohydrate ratios, insomnia, too much or too little exercise etc. which can all stress the body and the HPA axis.
It is unhealthy to cling to a label of any condition but it is even worse when that condition doesn’t exist. If you have been told you have “adrenal fatigue” or believe that you have it, the best thing you could do for health is to let go of this label and move on to figuring out why you aren’t feeling well.
This is why it’s important to work with a functional medicine practitioner who takes a science-based approach to health so you’re not paying for unnecessary tests or supplements. You can now enjoy a new lease on life by letting go of this label and continue to focus on what is really going to help you get well.