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Is Adrenal Fatigue Real? And What To Do About It

Publication date: 11 March 2016

The concept of "adrenal fatigue" is something of a staple in the world of complementary and alternative health. Yet doctors mostly don't take it seriously - they didn't learn about it in medical school so they assume it's not real. Certainly they don't test for it or treat it, at least in the UK's NHS, to my knowledge. But that doesn't mean we can't take a scientific approach to it.

My view is that adrenal fatigue is real, but it's a stress condition, not a medical condition. It's characterised by two main symptoms: anxiety (or at least poor stress tolerance) and fatigue.

In most cases there's nothing wrong with the adrenal glands (in a medical sense) - the problem is a breakdown of communication in the systems controlling adrenal output. I prefer to call it adrenal dysregulation rather than adrenal fatigue. I think the idea that the glands themselves get "exhausted" is probably wrong in most cases.

The adrenal glands are known for producing stress hormones. Adrenalin is the best know, cortisol is perhaps the most important stress hormone. Actually the adrenals produce many other hormones besides, but we can say that adrenalin and cortisol are stress hormones because they are produced in response to stress and they help us deal with stress (by mobilising energy and resources, etc.).

Cortisol is regulated by the so-called HPA axis, which is a pathway starting in an area of the brain called the hypothalamus (very important to body regulation generally), and running via the pituitary gland to the adrenal glands.

There are stages of "adrenal fatigue" or adrenal dysregulation. In stage 1, there is too much cortisol around. The system is designed for bursts of cortisol, to help you deal with stress, like encountering a sabre-toothed tiger. When the stress is over, cortisol drops down again, and there's no problem. But modern stress tends to be chronic and unremitting, and so cortisol gets stuck at elevated levels, which is a problem (it causes damage). Stage 1 is characterised by feeling wired, or anxious, or tired but unable to slow down. There's often difficulty getting off to sleep (sleep onset insomnia).

Stage 3 comes months or even years later. It's the "burn-out" stage. Cortisol levels drop low - it looks like the adrenal glands get exhausted but more likely they are being told not to produce much cortisol. The main symptom of this stage is fatigue, especially mid to late afternoon, and also early hours wakefulness. And cortisol is unresponsive, meaning it's not there when you need it (under stress) - so your stress tolerance tends to be lost to some degree.

So the major cause of adrenal dysregulation is stress, and particularly unremitting stress (e.g. working long hours, not sleeping enough, etc.). It can be mental or physical stress. Physical stress might mean training for a marathon or it might be having a gut health problem such as IBS. The adrenals have to respond to physical stress just the same.

Whilst there are many supplements available for adrenal fatigue, the key thing for recovery is to address the underlying causes. Adaptogenic herbs and the like don't address causes (though I'm sure they can be helpful in giving relief and helping to re-regulate the HPA axis). But you're not going to get lasting benefits unless you reduce the stress, whatever the source.

Nowadays we're pretty much all under stress. Stress is not the same as anxiety - don't make the mistake of thinking stress is for wimps. Stress is anything that demands an adaptive response, emotional or otherwise. It doesn't mean you can't cope, but coping with too much saps your resources. I think there is such a thing as good stress, but stress tends to be damaging when it is ever-present (e.g. having deadlines to meet) even if it's low-level.

In my practice I see a lot of clients with adrenal fatigue. I do use adrenal testing (I'm planning to write more about this in my next blog post) and I do recommend supplements, but my emphasis is always on lifestyle change. That includes diet change but also learning stress management skills. Biofeedback is an ideal tool. For example I find that most people who are adrenally dysregulated also have dysregulated breathing patterns (namely, over-breathing). I think there's no substitute for optimal breathing training using biofeedback. Here's a short video describing it.

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