What is Adrenal Fatigue?

adrenal fatigue

Adrenal fatigue seems to be one of the new, popular health terms lately, but exactly what is it? And more importantly, do you have it?

You may have read an article regarding adrenal fatigue and felt that the listed symptoms described you perfectly:

  • Difficulty getting out of bed each morning, even after a restful, 8-hour sleep;
  • High levels of fatigue throughout the day;
  • Inability or decreased tolerance to handle stress;
  • Cravings for salty or sweet foods;
  • Increased energy levels before bed;
  • Dependence and overuse of stimulants like caffeine and sugar;
  • Weakened immune system.

These are the basic symptoms of adrenal fatigue. Additional symptoms may include:

  • Low blood sugar;
  • Low blood pressure;
  • Weight gain;
  • Feelings of dizziness when transitioning from seated to standing positions;
  • Increased fatigue after exercise.

Chances are you recognize at least one of these symptoms as they describe many of us in the industrialized world. They’re so commonplace and non-specific that one might argue they’re not a disease state at all, they’re normal.

This is why determining whether you do or do not have adrenal fatigue can be a challenging endeavor.

What causes adrenal fatigue?

The term ‘adrenal fatigue’ is misleading as our body’s stress response involves much more than just the adrenal glands.

The Hypothalamic — Pituitary — Adrenal (HPA) axis plays a pivotal role in managing energy balance, food selection, and satiety (feeling full after eating). The HPA axis is a set of glands that work together to control reactions to stress and regulate many body processes including digestion and the immune system.

Cortisol is a steroid hormone that the HPA axis releases in response to stress and to maintain blood sugar levels. You may know it as the “stress hormone.”

When the body experiences stress, the HPA axis is the mechanism the body uses to respond. According to The Role Of Stress And The HPA Axis In Chronic Disease Management by Thomas G. Guilliams, there are three stages that illustrate the way stress affects the body:

  • Acute HPA axis activation.
  • During the initial exposure to a stress the HPA axis responds by producing increased levels of cortisol. Ideally the source of stress is removed and the HPA axis returns to normal. If the stressor is not removed, the body enters the stage of stress maladaptation.
  • Stress maladaptation.
  • If stressors have been present for a long period of time the body reacts to the ongoing high levels of cortisol by instructing the adrenal glands to lower cortisol levels inappropriately.
  1. Adrenal Fatigue.
  • The body creates a state of low cortisol which prevents it from removing inflammation. Normalizing cortisol levels is required in order to overcome the injury/illness.

These stages are better thought of as descriptors than actual medical conditions. Like most models, the 3-stage theory of adrenal fatigue helps to conceptualize the way adrenal fatigue “could” progress. In reality, it is not so neat and tidy. We can fluctuate between stages and sometimes skip entire stages completely.

When our body has been exposed to stress too intensely, too often, or for too long, the HPA axis becomes less able to respond to the stressor. Adrenal fatigue, or more accurately hypothalamic-pituitary-axis dysfunction (HPA-D) occurs when our body is no longer able to respond to a stressor in a healthy manner.

Can our adrenal glands really fatigue?

Part of the reason adrenal fatigue is frowned upon by the medical community is because there is no evidence suggesting the adrenal glands fatigue. That is, outside of serious medical conditions like Addison’s Disease, the adrenal glands do not tire out, fatigue, or stop producing cortisol. It’s a common misconception. Adrenal fatigue is actually more of a miscommunication in the brain than it is an adrenal problem.

This is why most mainstream medical doctors do not acknowledge that adrenal fatigue exists. But that doesn’t mean your symptoms are just in your head. Your doctor does not believe in adrenal fatigue because in medical literature there no evidence of its existence.

Low cortisol may very well be the outcome of chronic stress, but the mechanism that causes this to occur is not the adrenal glands, but our brain’s efforts to ensure the body’s tissues do not have high levels of cortisol.

So while adrenal fatigue is certainly a more convenient term, HPA-D is the correct way to refer to this syndrome. However, as most patients are more familiar with the term ‘adrenal fatigue’, we will continue to refer to it as such throughout the rest of this blog post.

How do you (properly) diagnose adrenal fatigue?

Surely you or someone you know feels tired after 8 hours of sleep, or becomes fatigued in the afternoon. With the symptoms of adrenal fatigue being so commonplace, a diagnosis based on symptoms is likely to result in error. Not to mention, there are so many conditions that cause fatigue. Think of low iron levels or low thyroid levels — both of which can mimic the symptoms of adrenal fatigue.

To ensure an accurate diagnosis, laboratory tests need to be taken. This way, an effective treatment plan can be crafted. Another reason why laboratory testing for adrenal fatigue is crucial is that symptoms for both elevated and insufficient levels of cortisol can be identical, and yet the treatment plans are very different.

Historically, cortisol levels have been measured in two ways:

  1. Blood test
  2. Saliva test

Cortisol measurements done by your medical doctor are taken via the blood. This reading is done at an arbitrary time — whatever time you book your lab test. While this test may tell us if you have elevated or suppressed levels at that particular time of day, it does not provide the larger context needed to create an effective diagnosis or treatment plan. To do this more information regarding the hormone’s diurnal rhythm, or day-night cycle is needed.

Alternative practitioners have traditionally used saliva to measure cortisol. Saliva measurements of cortisol provide a great reading of cortisol’s day-night cycles. However what a saliva test fails to show is how quickly cortisol is metabolised.

A saliva test measures free cortisol which is the quantity of the hormone freely circulating in your body. Free cortisol represents only 1% of the total amount of cortisol in your body. (1) The other 99% of cortisol is called total cortisol. Total cortisol is bound to other proteins. This is why it is not considered “free”.

When the saliva test is performed, it measures free cortisol and does not consider total cortisol levels. This means it ignores the levels of 99% of the cortisol in our body.

In order to get an accurate reading, a proper diagnosis, and thus an effective treatment plan for adrenal fatigue, precise testing is essential.

At the time of this writing, there is only one test that measures both free and total cortisol levels. The DUTCH (Dried Urine Test for Comprehensive Hormones) by Precision Analytics is the gold standard for proper adrenal testing. The DUTCH test can be ordered by Functional Medicine providers and medical doctors.

In conclusion, adrenal fatigue can be incredibly challenging to properly diagnose. The generalized symptom of fatigue can be caused by many other illnesses such as low thyroid, iron deficiency, and insomnia, or, it can be a side-effect of medications, food intolerances, or other diseases.

Thus, proper testing is essential. The diagnosis of adrenal fatigue cannot be based on symptoms alone as low levels of cortisol may not be the only cause of your low energy levels. I always recommend working with a knowledgeable Functional Medicine practitioner. Functional Medicine practitioners are able to explore the many different reasons why you may be fatigued and help you take steps to recover your health.

If you are suffering from adrenal fatigue, the initial stressor that set off the chain reaction leading to your condition must also be dealt with. This is also something Functional Medicine practitioners excel at.

When you think of a stressor, most likely what you think of is the usual work/ finance/ relationship stresses that affect us all. However, there are also a number of ‘hidden’ stressors that can affect your system just as much, if not more than the obvious pressures.

A Functional Medicine practitioner will take a look at the following influences in your lifestyle to determine which are playing a key role in your health concerns:

  1. Blood sugar irregularities. Both high and low blood sugar can wreak havoc on our system, and most alarmingly, both can occur without obvious symptoms.
  2. Sleep. We underestimate just how important sleep is in the maintenance of health. It’s so significant that when altered, lack of sleep can be the sole cause of high stress.
  3. Hidden Inflammation. Inflammation is our body’s response to harmful stimuli which can include illness and injury, but also sensitivities to food and the environment.
  4. Perceived Stress. Stress is felt differently by everyone, and chronically high levels of stress can lead to burnout.

You can read more about the possible causes of adrenal fatigue, and steps you can take to get them under control, in the following blog posts:


Originally published at Flourish Clinic.