The term “Adrenal Fatigue” is all the rage these days. Everyone from holistic doctors to massage therapists to yoga instructors seem 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 “physiologic steroids” or adrenal supplements. We beg to differ.
We by no means wish to cast judgement 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 specialized Endocrinologists (doctors of medicine who specialize in glands and hormones including the adrenal gland). Perhaps this is because it is in fact not a medically sound diagnosis.
Adrenal fatigue is however based on some 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 its potential malfunctions. We will also explain how the phenomenon of “adrenal fatigue” may in fact often be explained by some vitamin deficiencies and other conditions and treated accordingly.
The truth about you what your adrenals do
The adrenal glands are small glands that sit on top of your kidneys. They pack a big punch for organs the size of your thumbs. The adrenals produce many hormones that are vital to our body functioning properly. Specifically they produce steroid hormones and adrenaline type hormones. DHEA (sometimes mentioned in reference to energy and 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. The cortisol is what 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 up (since it is likely to drop if you are starving or bleeding) and it helps keep your blood sugar up for similar reasons. Cortisol is in fact the reason why most normal people do not actually get drops in blood sugar when they are hungry (even if they experience the symptoms associated with low sugar– which is usually due to actual hunger or dehydration).
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 high school science class? These are the ones that make your heart beat fast 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 wack one way or the other, you’ve got problems. If your adrenals are overactive (typically caused by a tumor of some kind) you get lots of these stress type hormones circulating, and predictably you get the symptoms of feeling stressed even when you shouldn’t be—fast heart rate, high blood pressure, sometimes a flushing reaction and in the case of cortisol you can have sugars that are too high, gain weight and lose hair. This can be called either Cushing’s Disease or Pheochromcytoma, 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 gland or due to the long term use of oral steroids (like prednisone) for other condition, which essentially causes your glands to forget how to work 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 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 literally almost rise from the near dead with a dose of steroids). The protocols for treatment typically consist of intravenous steroids in the emergent situation followed by life long oral steroids (such as prednisone). People with adrenal insufficiency should also wear Medalert 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.
So Do I have Adrenal Insufficiency if I think I have Adrenal Fatigue?
What we have just described is Adrenal Insufficiency. The much more commonly referred to term in the lay media is 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, a series of blood tests before and after being given a dose of a steroid that should stimulate the adrenal to work).
Various questionnaires to see if you have Adrenal Fatigue tend to ask about amounts of stress and fatigue that one experiences. Some practitioners do blood, urine or salivary testing that they claim correlates with adrenal fatigue but it is far from accurate or standardised. With a vague definition and unclear means of diagnosing this entity it is not surprising that there are a wide variety of recommendations for treating Adrenal Fatigue. A huge selection of supplements are touted for its use, including everything from standard vitamins, heavy metals to glandular preparations (i.e. things made from ground up animal glands). Some include DHEA. Some do not. We are not advocates of the use of DHEA supplements for any condition because its use has been associated with higher rates of breast cancer and has little proven benefit.
The bottom line is we are tired of Adrenal Fatigue. It seems to be something we could all say we have. We are tired, we are stressed, we have moments of feeling poorly. However, when there is no objective way to diagnose or treat a condition, it’s hard to accept it is as valid. This was perhaps best stated by Dr. Todd B Nippoldt on the Mayo Clinic website. “It’s frustrating to have persistent symptoms your doctor can’t readily explain. But accepting a medically unrecognised diagnosis from an unqualified practitioner could be worse.”
We are highly skeptical of this diagnosis. Rather, we believe the symptoms that may lead one to consider it are certainly real and certainly should be addressed. (See our previous blogs on energy, muscle aches, electrolytes to learn more). Of the many patients over the years who have come to us on various regimens for Adrenal Fatigue most have been on a host of glandular preparations and a few on actual prednisone or other prescription steroids, few with any legitimate testing to justify their use. Many have have had side effects from the “treatment” they were taking which they attributed to their underlying condition– weight gain, hair loss, a rush of energy and anxiety followed by profound fatigue, high blood sugars and more. Sometimes it is hard to even know with what problem they actually started.
After ruling out other medical conditions it has been our experience that people actually suffer from classic vitamin deficiencies, typically those that cause fatigue and lack of energy. It can take months to see the effects of the other treatments wear off and to adequately replete iron, vitamin D, various B vitamins and magnesium. In the end most people end up feeling much better once they have simplified their vitamin regimen and gotten back to a normal sleep , diet and exercise regimen.
If only a vitamin for stress could make you feel better…
The concept of adrenal fatigue is so appealing. So many of us have extreme stress and feel poorly in a number of ways and it is some how reassuring to think that there is a quick fix for this. Certainly, there are solutions to symptoms caused by stress and fatigue. There is no doubt that stress and “burning the candle at both ends” takes its toll on our bodies and this must be addressed. It is true that stress causes cortisol levels to rise and this is not good for you for many many reasons (it contributes to obesity, poor sleep, etc).
However, 99% of us have fully functional adrenal glands despite major stressors. Those of us whose adrenals fail do not have this problem because of stress and do need a legitimate endocrinologic evaluation by a certified Endocrinologist. The rest of us need to take a step back and first of all try to trouble shoot the sources of our anxiety.
We can not always change external circumstances but we can do our part to change how we handle them. We can teach ourselves techniques such as mindfulness and meditation and even consider individual therapy to work through some of our issues and decompress by sharing our perspective with an objective outsider (rather than a friend or family member). We can take care of ourselves in addition to others by allowing ourselves the time to sleep, exercise and eat properly. These are the backbones of a healthy and lower stress existence.
We can also replenish our nutritional needs with proper vitamin supplementation based on our individual needs (take our brief survey to get your Vous Vitamin Personalised Multivitamin). Taking ground up adrenal glands from an animal is no way to address your own symptoms associated with stress and exhaustion. Your symptoms should be examined carefully and treated with thought and care by an experienced practitioner in combination with the above mentioned lifestyle changes as well as a safe and thoughtful vitamin regimen.
What’s new in 2022?
Adrenal Fatigue is still not a real entity. In fact, more and more true medical experts are speaking out against its misclassification and the potential dangerous proposed treatments. Stress certainly hasn’t gone away in recent times, so self care and appropriately addressing symptoms with the right approach has become increasingly important. Personalised vitamins have become more and more popular, given their individualised approach to addressing nutritional needs in a medically sound way.
Romy Block specialises in Endocrinology and Metabolism and is mother to three active adolescent boys. Arielle Levitan is a Doctor of Internal Medicine with a special interest in Preventive Medicine and Women’s Health. She is a mother of three teen agers. As professional women with active family lives, they recognise that people often neglect their own health needs and are uncertain about what vitamins to take. Each person is different in her diet, exercise and health history, and will benefit from different nutrients. After years of advising their patients about the proper vitamins to take, Drs. Block and Levitan created Vous Vitamin® to provide people everywhere with quality vitamins that are suited to their individual needs. They are authors of the award winning The Vitamin Solution: Two Doctors Clear Confusion About Vitamins and Your Health (She Writes Press, 2015). Take your vitamin survey now to get exactly the right vitamins for your needs.
The statements made in this article have not been evaluated by the Food and Drug Administration. The products offered by Vous Vitamin® are not intended to diagnose, treat, cure, or prevent any disease.
Nothing contained herein is intended to be a diagnosis or constitute medical advice. The symptoms described in this Blog may be a result of a serious medical condition which requires medical treatment. You should consult with your doctor if you are experiencing any of the symptoms mentioned in this Blog and before beginning any vitamin or supplement regimen.