Saskatoon StarPhoenix


Forget the label and treat the stress

- CHRISTY BRISSETTE The Washington Post

Who isn’t tired these days? But what if you’re so fatigued that even getting more sleep doesn’t seem to help?

According to naturopath­s, holistic nutritioni­sts and others, adrenal fatigue is a condition where the adrenals don’t produce enough cortisol. Cortisol is a hormone that helps manage stress and regulate metabolism, sleep, blood sugar and inflammati­on.

“Fatigue is probably the No. 1 complaint among new patients in my practice,” says Leila Kirdani, a family physician.

Basically, the theory goes that too much stress wears out our adrenal glands, so they get tired and don’t produce enough cortisol for us to feel energized. But there is very little in terms of evidenceba­sed dietary advice to help these individual­s. This raises several issues.


It isn’t recognized by endocrinol­ogy societies or endocrinol­ogists. A recent review of the scientific literature found no evidence for the existence of adrenal fatigue.

Theodore C. Friedman, an endocrinol­ogist at Charles R. Drew University, says he is open to complement­ary medicine. Like many doctors, he says adrenal fatigue doesn’t exist: “It’s something made up by naturopath­ic doctors; endocrinol­ogists don’t recognize it as a real condition.”

Saul Marcus, a naturopath in Connecticu­t, says: “Convention­al medicine insists it doesn’t exist. However, adrenal fatigue is essentiall­y a stress reaction, and stress is very well understood as a cause of illness.”

Somewhere in the middle is the idea that adrenal fatigue is a term that encompasse­s a wide range of general symptoms rather than a discrete medical problem. Does the label matter?


“For some reason, doctors think that either your adrenal glands are perfectly fine or else they have ceased to function,” Kirdani says.

“Naturopath­s have it wrong,” Friedman explains. “They describe adrenal fatigue as a stress-induced condition where your adrenal glands don’t produce enough cortisol. In fact, when you’re stressed out, your adrenal glands make more cortisol.”

Doctors do recognize adrenal insufficie­ncy, a disorder where the adrenals don’t produce enough hormones. The adrenal glands make two hormones: cortisol and aldosteron­e. According to Friedman, “Aldosteron­e is often underappre­ciated or unrecogniz­ed by naturopath­s. You can have varying levels of cortisol deficiency, aldosteron­e deficiency or both.”

Having low aldosteron­e causes salt to be lost in the urine, which leads to brain fog, feeling worse after exercise or feeling dizzy when you stand up.

Friedman says people with low aldosteron­e can be diagnosed by an endocrinol­ogist and treated with synthetic aldosteron­e, extra salt or licorice root.

Because aldosteron­e is often ignored by alternativ­e medicine, this is one adrenal issue your naturopath may not test for.

Where cortisol is concerned, people can have low cortisol as a result of their pituitary gland not producing enough of a hormone that stimulates the release of cortisol from the adrenals.

A smaller portion of people have Addison’s disease, where the adrenal glands are attacked by antibodies. Friedman says these patients need to see an endocrinol­ogist and get on cortisol right away.

As Friedman puts it, people with adrenal insufficie­ncy do have fatigue, so it makes sense to examine their adrenal glands. “It’s the concept of the adrenals burning out that doesn’t make sense.”


Marcus says adrenal fatigue can be diagnosed in several ways. Many naturopath­s test cortisol levels in saliva, but it can also be diagnosed based on symptoms.

“If someone is feeling tired and under some sort of stress, their adrenal function is probably not optimal, and it may be OK to try taking some supplement­s for the adrenals.”

Friedman calls the saliva test unreliable and says a blood test is a far better way to measure cortisol.

The blood test measures electrolyt­es (including sodium), as well as several hormones. This gives a picture of which hormones are out of the normal range and what could be causing issues.


Google “adrenal fatigue diet” and you’ll find eliminatin­g everything from dairy to grains and beans. But there isn’t any evidence to show any of this will help you manage stress or feel more energized.

I recommend eating whole foods, plenty of vegetables, heart-healthy fats and lean protein, limiting highly processed foods and added sugars, as well as cutting down on caffeine and alcohol, which can negatively affect sleep.

Go for slow-burning carbohydra­tes such as sweet potatoes, barley, quinoa and rolled oats, and always combine them with a protein such as beans or lentils, chicken, fish or lean meat.

Get healthy fats from oily fish, olive oil, avocado, nuts or seeds at each meal and snack, and chances are you’ll feel more energized.

Friedman doesn’t have a problem with people taking certain supplement­s as long as they don’t interact with other medication­s or supplement­s.

Marcus and Kirdani recommend supplement­ing with sea salt, B vitamins and herbs such as rhodiola or lemon balm. (Please see a medical profession­al before taking supplement­s or herbs to make sure they’re safe for you.)

Friedman warns: “The naturopath­ic approach can be dangerous if cortisol or ground adrenals are prescribed. People often feel better on cortisol, but side-effects include osteoporos­is, weight gain and diabetes. It shouldn’t be prescribed lightly.”


Everyone seems to agree that managing stress makes sense.

So does eating well and treating vitamin or mineral deficienci­es, as well as getting regular physical activity and enough sleep.

What does matter is if treating so-called adrenal fatigue ends up preventing the diagnosis of a serious medical problem.

Friedman’s take-home message is clear: “If you’re experienci­ng fatigue, you need to see an endocrinol­ogist to make sure you’re getting at the real issue and not masking fatigue that’s being caused by another health problem. If you do have an adrenal issue, it needs to be treated as soon as possible.”

 ?? GETTY IMAGES/ISTOCKPHOT­O ?? Cutting down on booze, making time for exercise and getting enough sleep are important for good health, but if fatigue persists, visit an endocrinol­ogist.
GETTY IMAGES/ISTOCKPHOT­O Cutting down on booze, making time for exercise and getting enough sleep are important for good health, but if fatigue persists, visit an endocrinol­ogist.

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