Is It Adrenal Fatigue or Are You Really Tired?
Do you ever have that super-fun combination of high-level stress and absolutely no energy? Though you might be feeling stressed and tired from the litany of horrors in the news or just a super-obnoxious Facebook feed, there could also be an adrenal imbalance exacerbating your symptoms. That said, your adrenals might not have anything to do with it. Adrenal fatigue has become a hot diagnosis from naturopaths and alternative medicine practitioners, but the traditional medical community is not jumping on the fatigue bandwagon.
Before you start to worry about your hormonal balance, here's everything you need to know about adrenal fatigue, the controversy around the disease, and what to do if you're experiencing symptoms.
What Are the Adrenals?
The adrenal glands are responsible for regulating a number of hormones that affect your metabolism, blood pressure, and immune system response. But the real star of the adrenal show is stress.
Both cortisol and adrenaline are regulated by the adrenal glands. Adrenaline (and its close cousin noradrenaline) gets involved during high-stress times when your body sets off the "fight-or-flight response." You know, that feeling when you see an absolutely horrible tweet and you're not sure if you should spend your day dismantling the troll or go hide under a blanket for a few hours.
For lower-level stress, cortisol takes control. The hormone is raised in stressful situations and causes your heart rate to increase, helps you metabolize sugar more quickly, and generally gets things moving to respond to non-relaxing situations.
What Is Adrenal Fatigue?
In 1998, James Wilson, DC, Ph.D., coined the term "adrenal fatigue," which is also called adrenal stress, adrenal exhaustion, hypoadrenalism, or "that thing where you're tired all the time and I think it's stress or something" if you're talking to your mom's friend who saw something about adrenal fatigue in a magazine in the checkout line at Whole Foods.
Adrenal fatigue doesn't mean you have sleepy little glands sitting on top of your kidneys. Some doctors believe it is caused by overworking the adrenal glands. When your body is exposed to long-term stress and your adrenals keep pumping out hormones to cope, eventually they get tired out. The adrenals can't produce enough of the necessary hormones to handle the chronic stress.
Once the glands are fatigued, Wilson says you can experience an array of symptoms, like:
- Weight gain/inability to lose weight
- Brain fog
- Feeling run down or overwhelmed
- Craving salty or sweet snacks
- Trouble bouncing back from stress
Adrenal fatigue is different from Addison's disease or adrenal insufficiency. For those disorders, the adrenal gland is physically damaged (often from auto-immune issues) and cannot produce the proper hormones. For adrenal fatigue, the adrenals are physically intact, they just aren't working properly.
Basically, it's a medical condition caused by too much stress, and Wilson claims this disease is brought on by all the added stress of the modern world. Though we may have fewer true "fight-or-flight" moments than our ancestors did, we are barraged by low-level stressors at almost all hours of the day. Sure, early humans had to build their own homes out of hard-to-work materials and ward off bear attacks, but they weren't checking their phones at 1 a.m. to make sure their boss wasn't mad at them.
But Is Adrenal Fatigue Real?
In "Adrenal Fatigue Does Not Exist: A Systematic Review," scientists at the Federal University of Sao Paulo say that adrenal fatigue is definitely real. Just kidding! The title pretty much gives it away. When these professionals searched through 3,470 studies on PubMed about adrenal fatigue, they found no substantial proof that it's a real disease. Previous studies that supported adrenal fatigue didn't properly measure the patient's stress hormones, and there were few scientifically sound studies of the disease to begin with.
The Endocrine News stated that most of the symptoms of adrenal fatigue don't match symptoms of adrenal insufficiency, the scientifically proven disease. With insufficiency, you'll see weight loss, vomiting, diarrhea, nausea, fatigue, and low blood pressure. With fatigue, people complain of feeling tired, not wanting to get out of bed, craving junk food, and weight gain. Though both disorders make you tired, it doesn't make sense that adrenal insufficiency (caused by physically damaged glands) would produce such different symptoms from an adrenal gland that's just too tuckered out to make enough hormones.
To add fuel to the "adrenal fatigue is a myth" fire, the Endocrine Society does not recognize it as a real disorder, and Google is littered with articles like "Adrenal Fatigue: A Fake Disease" from qualified medical professionals. In short, the medical community thinks adrenal fatigue is completely made up.
If Adrenal Fatigue Is Fake, Why Am I Hearing About It So Much?
When Wilson coined the term "adrenal fatigue," he gave a name to a host of symptoms that plagued many patients. Even today, he still uses this questionnaire as a primary diagnostic tool. Here's some sample questions where you rate each answer on a scale from 0 (never) to 3 (intense or frequent):
- My ability to handle stress or pressure has decreased.
- My thinking is confused or hurried under pressure.
- My muscles sometimes feel weaker than they should.
- I often become hungry, confused, shaky, or somewhat paralyzed under stress.
- I have difficulty getting up in the morning.
- I need coffee or another stimulant to get me up in the morning.
How did you do on the quiz? You probably got quite a few 2s and 3s, right? Of course! Every time I look at the quiz, I think, Oh crap, I probably have this because it presents a lot of symptoms that are incredibly common. To be fair, the full quiz is much longer than this and some of the questions are fairly specific ("I get pain in the muscles on the side of my neck" and "My best, most refreshing sleep comes at 7-9 a.m."). But most of the question are vague and apply to a wide swath of people.
Wilson published his theory of adrenal fatigue with a version of this quiz in his book, Adrenal Fatigue: The 21st Century Stress Syndrome. That book was recognized by a few medical societies, though none of them were supported by any official American board of medicine, according to Cedar-Sinai.
Since the symptoms are so common and adrenal fatigue seemed to finally give people an answer to the "Why am I tired all the time, can't lose weight, and feel foggy" question, a lot of people supported (and still support) this diagnosis. "Adrenal fatigue can have debilitating symptoms on the body," says Suzanne Demers, DC, and doctor of functional medicine. "Many people will gain weight and will not be able to get the weight off, and may also feel mild depression or a decrease in their ability to handle stress."
Demers isn't alone, as many naturopaths and doctors of alternative medicine believe in adrenal fatigue. Most will claim that conventional medicine hasn't caught up with their knowledge of the disease (like Dr. Wilson does on his site).
Though the evidence doesn't support adrenal fatigue, it doesn't 100 percent prove that it doesn't exist. In 1981, Barry Marshall, M.D., discovered that most ulcers were caused by a specific bacteria, but the medical community balked at his hypothesis. His ideas didn't start gaining traction until he drank the bacteria, gave himself an ulcer, and solved the whole thing with simple antibiotics. In 2005, he was awarded a Nobel Prize for his scientific breakthrough.
Now, this one story doesn't prove that scientists are always wrong. It simply shows that discoveries can happen that the medical community doesn't automatically agree with. In the case of adrenal fatigue, it's very unlikely that the medical community is incorrect. But naturopaths and people seeking alternative treatments have enough doubt to keep their faith in fatigue.
But I Have Adrenal Fatigue Symptoms—What Can I Do?
Here's the thing. Even if adrenal fatigue isn't real, your symptoms are. Feeling tired all the time, moody, cranky, crave-y, stressed, and depressed are all real things, and you shouldn't have to feel that way. With these persistent symptoms, it's best to tell your doctor to try to get a more specific diagnosis. If you've already seen the doctor, or your symptoms are mild and you want to figure it out on your own, there are a few major potential culprits for your adrenal fatigue symptoms.
If It's Not Adrenal Fatigue, What Is It?
Though studies show that stress doesn't wear out your adrenal gland, that doesn't mean that stress doesn't have consequences on your body. A paper from the University of Miami found that chronic stress directly led to high blood pressure and decreased immune response. When stress hormones stayed high, patients recovered more slowly from disease and got sick more easily. The paper also found that symptoms usually associated with getting sick (fatigue, malaise, no appetite) weren't caused by the illness but by the body's attempt to get better. Basically, the stress of fighting a cold is what causes all the crappy feelings, not the actual cold itself.
A study from University College London found a positive link between chronically high cortisol and obesity. This doesn't prove that stress causes weight gain but shows that high-stress hormones may be part of the cause. Even if high cortisol isn't the main cause, stress has a clear impact on weight since most people turn to food or alcohol when they're stress levels get out of hand. If you constantly feel stressed and repeatedly turn to ice cream and nachos to calm you down, weight gain is fairly likely. At the very least, that's exactly what I did a time of great stress, and boy, howdy, did I gain weight! Obviously, not everyone responds to stress with eating, but it certainly happens.
So, stress can cause fatigue, malaise, no appetite, more appetite, high blood pressure, decreased immune response, and weight gain—almost all the symptoms of adrenal fatigue.
If you really don't think stress is the problem, it might be depression. Now, depression sounds very scary and bad, but it's common and treatable. About 16 million Americans have major depressive disorder, while 6.8 million adults have generalized anxiety disorder, according to the Anxiety and Depression Association of America (ADAA).
Before you think, no way, I'm definitely not depressed, here are some of the major symptoms (via the ADAA):
- Persistent sad, anxious, or empty mood
- Decreased energy or increased fatigue
- Insomnia, waking at odd hours, or oversleeping
- Weight gain
- Weight loss
- Headaches, digestive disorders, and pain that doesn't seem to have any other cause and doesn't respond to treatment
Sounds a lot like the adrenal fatigue symptoms, huh? Depression isn't just feeling sad, it can also manifest in complex physical and emotional ways. Using myself as an example, I had horrible pains in my stomach that no one could figure out (even after $4,000 worth of testing. Thanks, crappy insurance!) But when I finally got help for my full-out major depressive disorder, those pains went away.
Now, hearing "it's just stress or maybe depression" might not be very comforting. But there's a lot you can do to fight the symptoms of general stress, even without seeing a doctor. However, if you think it might be depression, it's definitely worth seeing a mental health professional for a full diagnosis and options for treatment.
Alternatively, you may have hypothalamic-pituitary axis dysfunction (try saying that five times fast). Either way, you should get checked out—if you've been experiencing a lot of the symptoms associated with adrenal fatigue, your doctor is almost certainly going to want you to get a full workup for fatigue in general.
How to Feel Better
Many of the suggestions of how to combat adrenal fatigue are also helpful for stress or mild mood disorders. They aren't always easy, but the suggested dietary and lifestyle changes could ease your symptoms.
The most important thing to do for your symptoms is to reduce stress, and one good way to do that is to get more sleep. Have you ever started crying over something because you were just too tired to deal? I have! By simply getting enough sleep, you can immediately relieve some of the symptoms associated with adrenal fatigue.
"Stay on a regular sleep schedule of 8-10 hours per night," Demers says. This will increase mental clarity, improve your mood, and make it easier to deal with stressful situations. Getting 8-10 (10!) a night is easier said than done, especially if you have kids. Demers recommends going to bed at the same time every night and getting in some activity (even walking) during the day. The combo of routine and moving your body will help you relax at night and get to Snooze Town a little faster.
Change Your Diet
Foods you should eat more of tend to contain high levels of omega-3 fatty acids, which help reduce inflammation. Omega-3s are vital to fighting the symptoms of adrenal fatigue, according to Barry Sears, Ph.D., founder of the Inflammation Research Foundation and author of The Zone Diet. He recommends taking fish oil supplements to get a high, concentrated dose of omega-3s. "When you increase the intake of omega-3 fatty acids, you reduce the production of pro-inflammatory hormones (eicosanoids)," Sears says. This helps counteract the effects of chronic stress on the body. As inflammation recedes, people usually feel more energetic and experience weight loss.
This dietary approach does not work overnight, but you should see some change in symptoms after 4-6 weeks. If, after a few months, this dietary change does nothing but make you angry about all the coffee you can't drink, it might be time to see a doctor and reevaluate your symptoms.
Just Straight Up Lower Your Stress
The top way to fight the symptoms of adrenal fatigue is to lower your stress. Easy, right? Nothing's more soothing than someone telling you, "Relax! Relax right now, or your health will suffer forever!"
You can't expect stress to disappear immediately, but you can find ways to relax. First, to continue to overcome your stressors, you have to identify them. Take a few minutes to list out everything that causes you stress. It doesn't matter if it's a huge thing like debt or something small like a cubicle mate who plays games on their phone with the volume turned up—write it down. Then, see if there are any stressors you can get rid of. Sure, you can't magically erase major stressors, but taking away some of the small things can make a big difference.
"Most importantly, schedule time for yourself each week or every other week," Demers says. Take at least two hours a week to spend totally alone, doing whatever you want. No thinking about work or planning your trip to the grocery store. Instead, use those two hours to quietly read, get a massage, or go sit in the park. Honestly, you could stare at a wall or binge Real Housewives—just do anything that feels soothing to you. And no matter how busy you are, put this "me time" in the calendar and stick to it.
I Still Think It Might Be an Adrenal Problem
If you're concerned that you may have Addison's disease or adrenal insufficiency, it's best to get ACTH stimulation blood tests. You give a little blood, then get a shot of adrenocorticotropic hormone (ACTH), and give blood again. Essentially, this shows how your body reacts to the cue to give cortisol. This test won't confirm adrenal fatigue but will help diagnose even more serious adrenal disorders.
If you or a doctor still believe it might be adrenal fatigue, you can ask for a saliva test. The cortisol/DHEAS saliva test measures the stress hormones in your spit and how they change throughout the day. If your results show low adrenal function, you can talk to your doctor (or make some of the dietary and lifestyle changes suggested in this very article). Now, this test is not recognized as a proper test for cortisol levels and was shown to be faulty in 61 percent of patients, according to the Harvard Health Blog. But if you're curious about your hormone levels throughout the day, this test could give you some insight into what's going on in your body.
Adrenal fatigue may or may not be real, but that doesn't mean your symptoms are "made up" or "all in your head." More likely, general stress is the cause, and it's screwing with your body in a variety of ways. If your symptoms are severe, please see a doctor and a mental health professional; and in the meantime, you can take note of your symptoms or try some of the dietary changes and see if they make a difference. But most of all, try to reduce your stress. No matter the official diagnosis, added relaxation is medicine we all should be taking.
Amber Petty is an L.A.-based writer and a regular contributor to Greatist. Follow along as she shares her weight-loss journey in her new bi-monthly column, Slim Chance. Take singing lessons from her via Sing a Different Tune and follow her on Instagram @ambernpetty.