Adrenal fatigue

One of the things which really should make us proud of Western society is our medicine. I am alive today because of Western medicine, and I would wager that you are too. We have vaccines which have all but abolished some of the worst diseases we have faced as a species. We have drugs which can make once-fatal illnesses nothing more than a trip to the doctor. Death during childbirth is a shocking and terrible tragedy, rather than a relatively common and unfortunate occurrence.

We can now remove and replace a faulty heart, for goodness sake.

Western medicine which is developed using the scientific method is, in my opinion, one of the greatest achievements we have. It’s not flawless, not by a long shot, but it’s absolutely incredible.

Alongside Western medicine, however, we have alternative medicine which I’m using as a catch-all to encompass a lot - including naturopathy, Chinese medicine, homeopathy, functional medicine, Reiki and various other practices that are sometimes also referred to as complimentary medicine or similar. 

I’m not going to go into Alternative Medicine today in any great detail because it’s not necessary for the discussion at hand (and a kettle of fish all of its own). All I’m going to say in an effort to provide some kind of background for this article is this: 

Western Medicine is created using the scientific method, that is a body of current knowledge and evidence is used to do something; and while all other variables are controlled a given outcome is then tested for. The knowledge gained from doing this is then used for future experimentation, until we have something which we can claim with a significant amount of confidence will do what we expect it to. Things are tested, re-tested, altered and tested again until the outcome becomes predictable, and until we know that a treatment will do what we want or expect it to in a given situation.

Alternative medicine is created by people who do a very similar thing, but the variables are not controlled. A therapy is applied and if the person feels better, it’s considered to have worked. For various reasons including the placebo effect, regression towards the mean, improvements in lifestyle factors (we’ll come back to this) and decreased side effects caused by stopping other conventional drugs, this is not a reliable manner of assessing the efficacy of a treatment.

If I put lavender on your feet to cure a headache and you wake up the next day without a headache, did the lavender help, or do headaches only last a couple of hours?

When I charge you £300 and tell you to stop eating X, and you do, do you feel better because X was ‘bad’, or do you feel better because I’m in a position of authority and you have emotional and financial interest in my ‘cure’ working?

When these therapies are tested using the scientific method with other things controlled (as happens a lot, the US government has put over $2.5billion in to it alone), we can learn the real state of affairs. Either the natural/alternative things work and are studied further – aspirin comes from tree bark, for example – or they are found not to work and are rejected. Most Alternative Medicine practitioners are therefore promoting therapies, treatments and remedies which have been demonstrated to not work. That should make you highly sceptical of them from the get-go. 

*Quick note before we continue. This is important. There is a big difference between different alternative medicine practitioners in a few rare cases. We have quacks who peddle the bunk supplement which are the point of this piece, and then we have people who use current research to form genuinely beneficial lifestyle interventions in order to help people before taking the medical route. To namedrop in order to give an example, Dr.Spencer Nadolsky is a licenced and practicing bariatric physician who utilises lifestyle interventions before he offers surgery – his recommendations are evidence based nutritional improvements and exercise. Similarly, there can be no question that various lifestyle improvements and practices can help some illnesses or even put them in remission, especially if that issue was caused by lifestyle factors in the first place.

I’m not stating that complimentary lifestyle interventions can’t help some ailments. If you have IBS you can indeed improve this by looking at your diet and potentially your gut microbiome. If you suffer from extreme stress you COULD find benefit from meditation. What I am stating, however, is that an alternative medicine practitioner who asks you to supplement with herbs based on an aura, or asks you to undergo an elimination diet thanks to applied kinesiology, or who tells you to cleans, detox or use cannabis oil instead of chemotherapy in spite of the current evidence should be viewed with extreme scepticism.

Even if you were to use an alternative medical approach to ‘cure’ something, the placebo effect, confirmation bias and other factors are far too powerful to trust your gut instincts, and when tested – this is confirmed. Applied Kinesiology, for example, has been described in the literature as being no better than ‘random guessing’ (1).

Anyway, to the point.

One thing that alternative medicine practitioners are very good at is ‘diagnosing’ you with things which only they can cure. There is a laundry list of ‘fake illnesses’ out there, but the one which I am asked about most regularly, 3 times this week for example, and therefore the one which I am going to write about today, is Adrenal Fatigue. 

I’m writing about this not as some kind of ‘rant’ or ‘debunking’, but simply so that there is somewhere to point the people who ask me about this issue. Those who believe they have Adrenal Fatigue DO need to change something, and it’s my hopes that this article will point them in the right direction.

Is it real? Do you have it? What is it? All these questions and more will be answered, and if you have been diagnosed with or cured of Adrenal fatigue at any point in your life and you now feel better, please read the whole article before you judge what I’m going to say; I don’t think for a second you’re making anything up.

Let’s get to it.

What is adrenal fatigue?

Adrenal fatigue is a term coined originally by Dr James Wilson in a book published in 1988. To explain it I’m just going to give you a massively oversimplified overview on what cortisol is.

Cortisol is a hormone produced by your adrenal glands (alongside some other hormones associated with stress responses including epinephrine, cortisone and norepinephrine). The adrenal glands are little bean-shaped glands which sit on top (ad-) of your kidneys (-renals) and they start pumping out their secretions when they sense that you’re stressed. Cortisol is used for a bunch of functions including waking you up, but in the context here it’s used during periods of stress to release energy from your body’s stores for use. Adrenaline makes your vascular system send more blood to your working muscles, and cortisol fills that blood with delicious energy-rich substrates, and you manage to outrun a bear.

Simple.

The theory behind Adrenal Fatigue goes like so:

• You’re stressed all the time (note, stress is mental, psychological, physical etc)
• You produce cortisol all the time
• Your adrenal glands get worn out and stop producing cortisol as needed
• Your cortisol levels end up chronically low, which causes a laundry list of symptoms

Proponents of this condition point to our modern lifestyle and assert that due to increased workloads, reduced free time, poor levels of exercise, poor nutrition and generally high stress existences we are taxing our poor adrenal glands so much that they simply can’t keep up. Like a car that’s driven at 100 miles per hour every day, they eventually just pack up and stop working properly. 

“Cures” for adrenal fatigue consist of some amount of lifestyle intervention (improve nutrition, look at sleep, etc) alongside various supplements – and it is these supplements which I am taking exception to today, because in almost every email I get asking questions about adrenal fatigue, the person asks me what supplements they should take, or whether X,Y and Z supplements will help as much as their ‘practitioner’ says they will.

Supplements recommended include various salts and minerals, but may also include some powerful extracts. This may seem harmless (if a waste of money), but supplements bought from an alternative practitioner are NOT regulated to nearly the same extent as drugs bought at a chemist – doses are unreliable and may not even be stated, while at the same time you are being given them by someone who is diagnosing you of a disease which is not supported by endocrinologists or ANY literature – a red flag if I ever did see one.

Because they aren’t considered ‘drugs’, we are often tricked into thinking that a supplement or natural remedy cannot be harmful but this is a long way from the truth. Overdosing on vitamins and minerals is probably harmless as it’s unlikely you’ll take a HUGE dose, but done long-term this can indeed cause some major issues and even in the short term some amount of GI distress is likely.

Far more deadly, some extracts or supplements can interact with other drugs which you may be using and either stop them working or create a harmful combination – then we have to consider that taking a compound which actually does interact with your adrenal glands or the hormones they produce can cause them to ACTUALLY stop working for some time, leading to medical conditions down the road such as ‘adrenal crisis’.

What typically happens is a practitioner tells you that you have adrenal fatigue, gives you a bunch of lifestyle interventions to implement and sells you supplements. The lifestyle interventions make you feel better, and the supplements pay your practitioner’s rent.

And here’s the rub – a search on Pubmed for Adrenal Fatigue comes up with just about no papers relative to it, other than a few descriptive pieces which don’t provide any kind of evidence for a mechanism, and the top result is the aptly titled and well written review paper “Adrenal fatigue does not exist: a systematic review” created by a team of endocrinologists. 

In fact, hormone.org (a public facing website by a large American society of practicing, licensed endocrinologists) released a statement about this condition which contained the following line: “Adrenal fatigue” is not a real medical condition. There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms. (2)”

This is, in my opinion, a big problem.

Why is this a problem?

This is a big problem for three very key reasons. The first, and least critical, is that it’s going to cost you money. While alternative practitioners often demonise ‘conventional medicine’ as being run by ‘Big Pharma’ who only care about profits, it’s no secret that alternative medicine practice appointments are exorbitantly expensive, and the supplements or treatments they recommend are equally extravagantly priced. These people don’t run charities. 

Secondly, there are genuine medical issues which can arise from adrenal gland malfunction. Addisons disease, known as Primary Adrenal Insufficiency is a condition caused by a reduction in cortisol production due to issues with the glands themselves. This is a serious condition, and if alternative medicine practitioners are diagnosing and ‘treating’ adrenal fatigue, they run the risk of giving someone with Addisons, or similar, a false diagnosis which gets in the way of them seeking proper, effective medical treatment. There are other potential clinical causes, too. 

There is secondary adrenal insufficiency - Your adrenal glands ‘work’ when they are told to do so by the pituitary gland: a small area in your brain which produces a corticotropin called ACTH amongst other things. If you have pituitary issues (caused by a ton of things from genetic factors, tumours and trauma to autoimmune disorders and opiate usage) then this chemical is not produced as it should be, and therefore the adrenal glands don’t get a signal. Various interventions can be done in order to treat this issue, but they need to be chosen due to the specific issues that you have.

Then there is tertiary adrenal insufficiency – The pituitary does it’s job of producing ACTH when it gets a signal in the form of CRH from the hypothalamus. If your hypothalamus is impaired (such as in Cushing’s disease recovery patients, or those who have abruptly stopped taking high dose glucocorticoid drugs, like synthetic cortisol - hydrocortisone). (6)

My advice is this: if you have been diagnosed with “adrenal fatigue” because a test has shown that your cortisol levels are too low – then GO TO A DOCTOR. A qualified and registered clinical endocrinologist will be able to identify, over time, what exactly the problem is and will be able to create a plan around it. Lifestyle interventions such as reducing stress, improving nutrition and exercising appropriately are great, too, but you knew that anyway, didn’t you?

Finally, one of the biggest issues I have with this is that it’s exploitative. The diagnosis of adrenal fatigue is often given to people who are suffering from symptoms which are very, very real. If you or someone you know have ever been told they have Adrenal fatigue, I have the upmost sympathy because it’s potentially a label slapped on a pretty sad state of affairs. 

Symptoms which proponents claim are key signs of adrenal fatigue are:

1. Tired for no reason?
2. Having trouble getting up in the morning?
3. Need coffee, cola, salty or sweet snacks to keep going?
4. Feeling run down and stressed?
5. Crave salty or sweet snacks?
6. Struggling to keep up with life’s daily demands?
7. Can’t bounce back from stress or illness?
8. Not having fun anymore?
9. Decreased sex drive?

(adrenalfatigue.org)

So we have someone who is exhausted, craving foods (therefore probably overweight and/or struggling to lose weight), struggling to sleep, having difficulty keeping up with the demands they have placed on them, getting ill regularly, without libido and – more than likely – at least mildly depressed. This could be due to lifestyle factors, but on top of all of this it closely resembles serious medically recognised issues like Chronic Fatigue Syndrome. That’s not a place I’d like to be in, and if I was told by someone wearing the guise of someone who cares about me that I have a condition which they can cure with the supplements they sell, then I’d be all over it too.

It’s exploitation of people who are in a place of vulnerability by those who are in a position of perceived authority. That, my friends, is not cool.

But where do the symptoms come from?

To be clear – if you are chronically stressed your adrenal glands don’t stop producing cortisol.

If anything, they actually get bigger and start producing more so that they can keep up with the increased demand. If you were tested, your cortisol would either be a little high, or right where it needs to be.

In almost every case, though, Adrenal Fatigue is not tested for. Adrenal Fatigue is almost exclusively diagnosed due to symptoms alone, and though the previously mentioned medical issues are very, very real and those who suspect they have hormonal issues should always see a doctor, generally speaking a vague set of symptoms similar to the above 9 point list is used. 

That, or it’s assumed that a highly stressed person is putting strain on their adrenal glands, therefore a highly stressed person is ipso facto told that adrenal fatigue is their problem. After all, they DO meet the criteria, right?

Well, lets’ look at this objectively, and let’s lean on the current body of evidence. If you meet the above criteria and are concerned, in just about every case you can ‘solve’ the issue with lifestyle adjustment. So before you seek a homeopathic practitioner or chiropracter’s help – take a look at the below.

1. Tired for no reason

It’s no secret that we don’t sleep as much as we used to. One (admittedly not peer reviewed) UK survey of over 15,000 people found that over 60% of those who responded being unhappy with how they sleep, and only 8% recording that they ‘always’ wake feeling refreshed. (3)

I don’t think I really needed to give a citation here, though. It’s almost a commonly known fact that people are finding more and more reasons to stay up late, and by Friday just about everyone in an office looks dishevelled, like they are hanging on by a thread until they get their weekend lie-ins.

And the ‘no reason’ part? Well, what’s interesting is that sleep debt is cumulative meaning that it builds over time and can often be hard to ‘pay back’ (4). If you sleep poorly during the week, as a hectic schedule is likely to cause (not to mention the stress that we’ll come back to) then you aren’t likely to be able to pay that back by sleeping in an extra hour at the weekend. Over the weeks you get more and more sleep deprived, and because it happens so slowly you don’t really notice it.

2. Having trouble waking up in the morning?

Sleep works in cycles of roughly 90-120 minutes. During this we go through multiple stages of progressively deeper sleep (called NREM sleep stages 1-3) then finally, REM or rapid eye movement sleep so called because, spoiler alert, your eyes move rapidly behind your eyelids.

If you wake up in the middle of one of these cycles, you are still in deep sleep, which causes a sensation called sleep inertia. If you’ve ever taken a nap and felt worse afterwards, that’s what that is.

If you are sleeping poorly, have poor sleep hygiene, or are sleeping between two times which coincide with the breaking of a sleep cycle, you’re going to feel tired in the morning. The best way to change this is to improve your sleep quality by ensuring your room is dark, your mind is at ease, you aren’t surrounded by electronics, you reduce caffeine intake in the latter stages of the day and you keep your sheets clean. A smart alarm such as that on a lot of fitness trackers, or a Lumie alarm designed to gradually wake you up isn’t a bad investment if the above tips don’t seem to have the desired effect.

3. Need coffee, cola, salty or sweet snacks to keep going?

If you need certain energy dense foods to keep you going, then there are two probable issues – your diet is not providing you with steady energy throughout the day, or you just have poor energy because of stress/lack of sleep/lack of exercise and this is a pick-me-up. Unfortunately there really isn’t a way around this. Over time, you need to work on improving your nutritional intake, and over time you need to improve your lifestyle in general. Regular exercise, good sleep and a lot of fruit and vegetables are needed here, rather than herbal supplements.

4. Feeling run down and stressed

I think you’re starting to get the gist here. Ultimately if you are feeling run down and stressed, then you are probably just a bit run down and stressed. This is such a vague ‘symptom’ that it could be caused by anything from too little sleep, to too much exercise, to too much work, to too little exercise, to poor time management.

There are other articles on stress management, so I won’t explain much more here, but suffice it to say that the ONLY way to stop feeling run down and stressed is to take a break, and work on ways to reduce the things causing you stress (both external, at the source, and internal, in the way that you respond to stressors). 

Stress can be harmful in and of itself. It increases your blood pressure, impairs your ability to recover from training, reduces sleep quality and much more. It’s crucial that you manage stress, because it can ruin your life.

What it does not do, however, is stop your adrenal glands working, meaning that supplement aren’t the answer.

5. Crave salty or sweet snacks?

This is a complex one, but it can also be simplified a lot. Cravings come for a variety of reasons, not least of all an imbalanced diet or a diet which is not satisfying due to being too restrictive or repetitive etc. With that said, cravings also come about due to emotional reasons or food associations.

Essentially, the only two things you actually enjoy and crave are serotonin and dopamine. These are the two chemicals released in your brain to make you ‘feel good’ as a reward for a certain action. You have evolved to ‘like’ certain things because they manage, in some way, to help you pass on your genes.

You enjoy winning things, because that raises you higher in the dominance hierarchy – something which is sexually selected by the opposite sex. Winning increases ‘happy chemicals’ in your brain, to make you enjoy winning and want to win again.

You enjoy exercise, because it helps regulate a bunch of your body’s systems and keeps you alive longer while also increasing sexual appeal

You enjoy feeling clean, because hygiene is a good way to not die of disease so often

And you enjoy sweet, fatty or salty foods because they are high in calories, meaning high in energy, which is important when food isn’t abundant (salt is also important for bodily functions, so you get a little reward for eating it) 

So what this tells us is that when we are sad, stressed, depressed or similar we are much more likely to seek out these rewards to make us feel better – ESPECIALLY if doing so has become habitual. Habitual exercisers habitually exercise because they crave a reward. Well, habitual Dorito eaters are the same. 

This doesn’t mean you’re broken, it probably means you need to manage the cause(s) of your poor mood/stress, and potentially also seek an alternative means of getting your daily dopamine fix.

6. Struggling to keep up with life’s daily demands?

Honestly I’m not even sure what this one means, and I think it’s obvious that the issue is a combination of having too much to do and being unable to ‘get your head’ around what you do have to do.

What your adrenals have to do with that, I have no idea. 

7. Can’t bounce back from stress or illness?

This is an interesting one. 

When you have a significant amount of cortisol ‘floating about’ in your system due to prolonged stress, it binds to receptors on cells in such abundance that it actually interferes with a protein complex known as NF-kB. NF-kB isn’t something you need to remember or know about, but it’s inhibition affects the way that your cells produce cytokine-producing immune cells. At the same time, catecholamines like epinephrine and norepinephrine which are also released from the adrenal glands during a stress response bind to adrenergic receptors, activating a certain protein called cAMP, which in turn affects certain gene expressions in cells which are involved in immune cell production.

In short, having too many ‘stress hormones’ in your system for a prolonged period inhibits your body’s ability to mount an immune response (7) and defend you against illness – this is why marathon runners are especially susceptible to colds.

That doesn’t mean your adrenal glands are suffering, though, it means you need to chill out more. 

8. Not having fun anymore?

This is similar to 6 in that I’m not sure why this is even in here. This seems to describe either extreme apathy or some kind of clinical depression, both of which would be best dealt with by a psychologist or therapist. Selling someone herbs because they report ‘not having fun anymore’ is exploitation in my book.

9. Decreased sex drive? 

And finally, another vague symptom which could be due to anything. Relationship problems are a big one, but lets assume for a minute that the obvious stuff is fine – does stress cause impaired libido? 

Damn right it does. 

For a start, those who are mentally preoccupied by life, work, school or other pressures are not exactly easy to ‘get in the mood’. Movies have us believing that a stressed person need only be distracted by a lover to make them feel better, and that might be true for some short-term or minor frustrations, but someone who is struggling to pay their mortgage or a person who is facing unemployment isn’t going to be ‘cured’ by knockin’ boots. 

But it goes beyond that. One of the primary causes of a higher sex drive in both men and women is, well, sex hormone levels. I’m making it sound far more straightforward than it is because the ratio between testosterone, oestrogen and other hormones, and the interplay between yet more hormones makes a big difference, but in this context a little reductionism is a good way to make a point.

During a stress response, production of sex hormones is severely reduced. This is because the moment you are running away from a lion is not the moment to procreate, and on a much more realistic level, times of war, of famine or of general strife are also not a great time to be ‘burdened’ (think in terms of ancient primates, I’m not being sexist here) by a pregnant female or a child is not a great idea.

That makes sense, but if that stress never goes away such as is the case for someone who has poor work/life balance, then libido can be all but eradicated. Depression and the drugs which treat it can also impair libido, giving another tangible reason for your sex drive to plummet during stressful times.

So again – think smaller and think simple. Lack of sex drive during times of stress is not a sign that your adrenal glands are fatigued. If anything, it’s a sign they’re doing their job properly.

Final thoughts

My main point here, in fact the key take home from just about everything I write, is this:

Simple stuff done well works, almost every time. Sure, some strategic training principles, some nuanced nutritional protocols and some clever supplementation regimes can eek out the last 2-3% of progress (however you measure it). On top of that, there are OBVIOUSLY some medical or clinical conditions which need closer attention to be paid to them (for the final time, this article is NOT aimed at those who have been tested in a research-based manner and shown to have issues with hormone production – those guys need to see an endocrinologist) but in general, just about everything that we face boils down to the basics. 

Not losing weight? You’re probably eating too much.

Not gaining weight? Not eating enough

Gaining weight, but not getting stronger or more muscular, just fatter? Your training probably sucks. That, or you’re expecting more than is realistic.

Poor concentration? Are you hydrated? Are you sleeping well? Does ‘the thing’ actually seem interesting to you? 

Tired? Recover and sleep more 

Overly stressed? Work on stress management, time management, prioritisation and goal setting

Hungry? Eat more protein, or fibre, or both. Try hydrating more, maybe adjust your deficit, sleep better, manage stress.

Poor training recovery? See number 3, or eat a little more

It’s simple, it’s basic, but it’s what works and there’s no way around it. Once the simple stuff is in place, and ONLY when the simple stuff is in place, should you look for other areas to explore. 

If you think you need to revisit the basics, consider taking a peek at the BTN Foundation Academy which you can start at any time. For those starting out in coaching, or those who are looking to help themselves and their family, it might be just the ticket. 

You can find some more information on it here.

And until next time, thanks for reading.

References

1. http://www.whprsfiles.com/pdf/Applied%20Kinesiology%20whprs%20rating.pdf
2. http://www.hormone.org/hormones-and-health/myth-vs-fact/adrenal-fatigue
3. http://www.dreams.co.uk/sleep-matters-club/sleep-survey-uk-2016/
4. http://www.health.harvard.edu/staying-healthy/repaying-your-sleep-debt
5. Han, KS, Kim, L, and Shim, I. “Stress and Sleep Disorder” Exp Neurobiol. 2012 Dec; 21(4): 141–150. Published online 2012 Dec 26. doi: 10.5607/en.2012.21.4.141
6. http://cursoenarm.net/UPTODATE/contents/mobipreview.htm?12/1/12319
7. Padget, DA and Glaser, R. “How Stress Influences The Immune Response” TRENDS in Immunology Vol.24 No.8 August 2003