IS ADRENAL FATIGUE REAL?
Forget the label and treat the stress
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.
IS ADRENAL FATIGUE REAL?
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?
WHAT’S REALLY GOING ON WITH YOUR ADRENAL GLANDS?
“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.”
HOW DO YOU GET TESTED FOR ADRENAL FATIGUE OR ADRENAL INSUFFICIENCY?
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.
TAKING CARE OF YOUR ADRENALS
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.”
DOES IT MATTER WHAT WE CALL IT?
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.”