The term “adrenal fatigue” is all the rage these days. Everyone from holistic doctors to massage therapists to yoga instructors seems to throw it around like crazy. According to many, it explains why people feel poorly and can be simply remedied with a dose of either DHEA and/or certain “physiological steroids.” We beg to differ.
We by no means wish to cast judgment on the above-mentioned practitioners. We are simply noting that this diagnosis seems to be made by a litany of people, yet by very few (if any) legitimately trained, board-certified endocrinologists (doctors of medicine who specialize in glands and hormones, including the adrenal gland). Perhaps this is because it is not actually a medically sound diagnosis. Adrenal fatigue is, however, based on some legitimate medical concepts, and it is perhaps loosely related to the very real condition of adrenal insufficiency. We will first explain what the adrenal gland is and does, then delve into these malfunctions of it. We will also explain how the phenomenon of “adrenal fatigue” may be explained by some vitamin deficiencies and other conditions, and how to treat it accordingly.
The adrenal glands are small organs that sit on top of your kidneys. They pack a big punch for glands the size of your thumbs. The adrenals produce many hormones that are vital to our bodies functioning properly. Specifically they produce steroid hormones and adrenaline-type hormones. DHEA (mentioned previously in reference to libido) is one of the steroid-hormone precursors (building blocks). The steroid hormones consist of aldosterone, testosterone, and cortisol. Aldosterone and testosterone regulate blood pressure and sex drive. Cortisol is considered a “stress hormone.” This very important hormone is secreted by your adrenals during times of stress and, accordingly, it helps sustain various parts of your metabolism at those times—i.e., it helps keep blood pressure and blood sugar up (since they are likely to drop if you are starving or bleeding). Cortisol is in fact the reason why most people do not actually get drops in blood sugar when they are hungry (even if they experience the symptoms associated with low sugar). Our naturally produced steroid hormones are some of our best defenses against illness and injury.
The adrenaline hormones are also used in times of stress. Remember that whole fight-or-flight thing from science class? These are the hormones that make your heart beat faster when a bear is about to attack you. These hormones also go crazy when you are riled up.
Clearly if the adrenals are out of whack one way or the other, you’ve got problems. If your adrenals are overactive (typically caused by a tumor of some kind) and you get lots of these stress-type hormones circulating, predictably, you get the symptoms of feeling stressed—fast heart rate, high blood pressure, sometimes a flushing reaction—even when you shouldn’t be. In the case of cortisol, you can experience sugars that are too high, weight gain, hair loss, and even anxiety and/or depression. This can be called either Cushing’s syndrome or pheochromocytoma, depending on which part of the gland is overproducing (complicated stuff that’s kind of beyond our scope here). Needless to say, this is not an enjoyable state of affairs; and these are serious, but exceedingly rare, conditions.
If your adrenals are underactive, you have different issues. In the medical community this is referred to as adrenal insufficiency, and it typically occurs due to an autoimmune condition where your body actually makes antibodies against your adrenal glands or due to long-term use of oral steroids (like prednisone) for other conditions, which essentially stops your glands from working on their own. There
are other very rare causes such as bleeding into the glands or tumors that replace the glands. All of these are very unusual but potentially life-threatening conditions, because, as we explained previously, your body relies on these glands during times of stress. And stress is a relative term; it can even refer to having a cold or a low-grade fever. If the adrenals are not making aldosterone and cortisol, your blood pressure can drop as a result and you can pass out, or even worse.
This is a medical emergency. People who have true (or suspected) adrenal insufficiency need medical evaluation and treatment. These patients respond dramatically (within minutes to hours to adrenal replacement—they nearly rise from the dead with a dose of steroids). The protocols for treatment typically consist of intravenous steroids in the emergent situation followed by lifelong oral steroids (such as prednisone).
People with adrenal insufficiency should also wear medical alert bracelets so that in case of an emergency, providers know to dose them with IV steroids. This can be very scary stuff to be sure. What we have just described is adrenal insufficiency. In contrast, the lay media makes common reference to the term adrenal fatigue. The theory behind adrenal fatigue is that if we have lots of stress we “use up” all of the stress hormones that our adrenals make and they somehow wear out. Sounds plausible, but yet it does not bear out scientifically. This term has been used to explain a whole host of symptoms from fatigue to irritability to GI symptoms, body aches, and more. It is unclear to us how it is diagnosed since there are no gold standard or data-proven tests (true adrenal insufficiency is diagnosed with what’s called a stimulation test). Various online questionnaires to see if you have adrenal fatigue tend to ask about amounts of stress and fatigue that one experiences. Some practitioners tout saliva, blood, and urine testing, but they do not use the medically proven diagnostic test that includes giving a dose of hormone to stimulate the adrenals and then testing their response.
The adrenal glands are complex and it is important to get tested if you think you might have an issue. But, many people confuse fatigue symptoms with an adrenal problem. One way to rule out whether fatigue may be due to vitamin deficiencies is to go through a personalized vitamin assessment and take a targeted formula to see if your energy starts to improve. Mass market vitamins solutions are often too low-dosed to make an impact on energy, so taking a personalized vitamin is a good starting place.
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