Adrenal Fatigue: Fact or Fiction?

Adrenal Fatigue: Fact or Fiction?

By Stephen Brenna, Pn1

The human endocrine system is responsible for the regulation of all bodily hormones and thousands of corresponding processes they influence. As such, issues related to hormones and this system can be particularly difficult to pin down and identify. Oftentimes, symptoms of hormonal dysfunction are ambiguous, overlap with other possible causes, or are easily overlooked by the sufferer.

Health issues stemming from the adrenal glands and the hormones they produce are no exception to this story. In fact, even within the medical field there is controversy surrounding what constitutes adrenal dysfunction and its diagnosis. Much of this debate surrounds what is known as "adrenal fatigue", a condition that some practitioners claim is very real, that others believe does not exist.

In order to grasp the major influence the adrenal glands have on overall wellness, and to identify who might benefit from a closer look at their adrenal function, we first must understand what the adrenal glands are and what they do. 

The adrenal glands are two thumb-sized glands that sit atop each of the kidneys. Due to their position at the top of the kidneys (aka the renal system), the adrenal glands are also referred to as the suprarenal glands. They are responsible for producing a number of major hormones that affect metabolism, blood pressure, blood sugar, macronutrient absorption, sex hormone balance, stress response, and immune response. Key hormones produced by the adrenal glands include:

  • Cortisol: Controls macronutrient absorption, suppresses inflammation, regulates blood pressure, increases blood sugar, and controls sleep/wake cycle
  • Aldosterone: Affects blood pressure and blood pH via regulation of sodium and potassium in the blood
  • DHEA and androgenic steroids: "Parent" hormones that are converted into estrogens in the ovaries and androgens in the testes
  • Epinephrine and norepinephrine: AKA adrenaline and noradrenaline, "fight or flight" hormones that increase heart rate, push blood into muscles and assist in glucose metabolism

As one can see, the impact adrenal hormones can have on a number of different bodily functions is far-reaching. As a result, symptoms related to adrenal issues can appear very similar to those of other conditions. Symptoms may include: brain fog, depression, skin issues, weight gain, irritability, poor sleep, and cravings for sweet or salty foods, among others.

In some cases, adrenal conditions can be serious or even life-threatening. One example is Addison's disease, also known as "primary adrenal insufficiency". This is an autoimmune condition characterized by insufficient production of cortisol and aldosterone by the adrenal glands, leading to extreme fatigue, dramatic weight loss, and low blood pressure. Another potentially life-threatening adrenal condition is Cushing's syndrome, where the adrenal glands produce too much cortisol. If left untreated it can cause deadly infections, blood clots, or heart attack.

Ok, that all sounds very serious. But what about the plain old adrenal fatigue we often hear mentioned by naturopathic doctors and other functional medicine practitioners? Adrenal fatigue, aka 'hypoadrenia" was proposed as a new condition in 1998 by James Wilson, a naturopath and chiropractor. His claim was that chronic overstimulation of the adrenals could lead to an inconsistent level of cortisol and the parent hormone DHEA in the bloodstream. This inconsistent hormone production was characterized by wildly fluctuating energy levels throughout the day, with peaks and valleys that were out of sync with a healthy cortisol cycle.

Many doctors and endocrinologists, including the international Endocrine Society, dispute the validity of Wilson's claims. In fact, to date adrenal fatigue is not an officially recognized medical diagnosis, with many endocrinologists stating the adrenal glands cannot become "fatigued". Their contention is true adrenal dysfunction is only the result of diseases like Addison's or Cushing's, or direct damage to the adrenal glands.

So who's right? Unfortunately it's difficult to say, as many symptoms linked to adrenal fatigue could be related to multiple other health concerns. As a result, many functional medicine practitioners state that the treatments recommended for adrenal fatigue are beneficial regardless of an official diagnosis. These treatments include improving diet, managing stress, and prioritizing sleep. Where the bulk of controversy comes in is the use of hormone treatments like the steroids prednisone and hydrocortisone, as well as adrenal support supplements.

Mainstream medical professionals claim these steroid treatments could lead to dangerous increases in cortisol levels in people who don't need them. It is the opinion of this writer that such treatments be thought through very carefully prior to use.

As for the use of supplements, common ingredients in adrenal support products include adaptogenic herbs like ashwagandha, rhodiola, and holy basil. In addition, they may include vitamins and minerals like B5, B6, vitamin C, vitamin D, magnesium and selenium. With the exception of selenium, there is little risk of overdose with these ingredients. That said, it is always important to consider medications one may already be taking, as well as other supplements to avoid unnecessary overlap or excessive dosing.

If you are experiencing any of the symptoms of adrenal fatigue listed above, the best remedies are usually the most obvious. Clean up the diet, sleep better, stop slamming so much caffeine and utilize stress management techniques to take the edge off. Adrenal support supplements may be beneficial to support overall wellness, but are never a panacea.