Adrenal Fatigue: When Your Body Says It Has Had Enough
Updated: Mar 24
Without a doubt, we are experiencing more burnout and fatigue today than ever before. In some ways, it's an epidemic in and of itself. Many of us are facing some level of challenges due to social isolation, financial strain, health challenges and increasing mental health struggles. Very likely you, or someone you know, has said more than once, "I'm totally exhausted. No matter what I do, I never feel rested."
Severe and prolonged fatigue can be looked at in two ways: (1) adrenal fatigue and (2) adrenal insufficiency. Adrenal fatigue describes a clinical presentation of symptoms that is not (yet) a medical diagnosis by current standards in conventional medicine. Adrenal insufficiency is a serious, potentially life-threatening medical diagnosis. It's important to understand the job of the adrenal glands in the body.
What Do the Adrenal Glands Do?
The adrenal glands are small organs in the endocrine system that sit on top of the kidneys. The adrenals are part of a system called the HPA axis (hypothalamic-pituitary axis), which is involved in numerous physiological events within the body, most notably the stress response.
Each adrenal gland has two parts: the cortex (outside) and the medulla (inside). Each part secretes different hormones. The medulla, which is a smaller region of the adrenal gland, secretes epinephrine and norepinephrine (catecholamines). Catecholamines are the "fight or flight" hormones that are secreted in response to acute stress. These hormones get your heart racing and palms sweaty.
The cortex is the larger region and it secretes several hormones: cortisol, aldosterone, testosterone, and DHEA (glucocorticoids). Glucocorticoids play a role in regulating blood sugar, metabolism, insulin levels, sexual function, anti-inflammatory responses, and immune system suppression.
When the Mind and Body Recognize Stress
When you perceive something as stressful, the brain makes a decision in nano-seconds as to whether or not that stressor is a real threat to your wellbeing. If it is a threat, your body must decide to fight it, flee from it, or somehow adapt to it. This comes in handy when running away from a bear, in the face of a mental-emotional crisis or even being bombarded by fear-based news. Regardless of the stressor, the HPA axis is engaged, triggering various hormones to be secreted to prepare the body for action. Ideally, once the stressor is removed, the body and mind get feedback that the stress is abating and the goal becomes to restore balance (called homeostasis). However, if the stress persists at a high level for months or even years, the HPA axis thinks it is constantly in "fight or flee mode." When that happens, adrenal dysfunction (fatigue) can occur.
Adrenal Fatigue or Insufficiency: What's the Difference?
Chronic stress affects our vitality in innumerable and sometimes immeasurable ways. For most people, the human body is not so fragile that it is immediately thrust into a state of physiological fatigue so intense that the adrenal glands lose their ability to function. Usually, people progress from health to illness along a spectrum, where dysfunction occurs first and, if not addressed, can become a life-threatening illness such as adrenal insufficiency.
Adrenal insufficiency is also known as Addison's disease, a rare and potentially life-threatening illness. In this condition, the person does not make enough cortisol and other essential hormones to sustain life. Eighty to ninety percent of cases in developed countries are caused by autoimmunity. To test for Addison's disease, a doctor will order specific blood tests that measure cortisol and the other hormones.
Adrenal fatigue is considered a clinical diagnosis that is made when a set of symptoms and / or certain lab values, like dysregulated cortisol patterns, are present. Many of these symptoms are similar to those for Addison's disease and include:
Body aches not explained by other illness or physical exertion
Exhaustion that does not resolve in a reasonable time or occurs in flares
Poor cognitive function and brain fog
Depression, lack of passion and motivation, apathy
Natural Approaches to Restore Balance to Adrenal Function
When we talk about restoring adrenal function, naturopathic doctors always go back to the basics of health. Depending on individual needs, a program to restore balance to the adrenal glands and overall health would incorporate:
Detoxing the body from the physiological impact of emotional, physical and environmental stress
Identifying and addressing nutrient deficiencies
Dietary changes that include removing foods the body is reacting to, such as food sensitivities and sugar, and increasing foods that act as medicine, such as whole foods, dark leafy greens, colorful veggies, lean meats, etc.
Coaching/ counseling to recognize, prevent, and manage stress
Stress reduction techniques (yoga, meditation, mindful movement/walking, breath work)
Enhancing social support
Supporting healing through the use of individualized supplements and botanicals
Therapies such as hydrotherapy and craniosacral
An individualized exercise routine
Life can be challenging. It doesn't have to wear us down. If you understand that chronic stress of any kind eventually takes a toll on the body-- and can even be life threatening if not addressed properly--then you can do something to protect your health and wellbeing.
When it comes to medical conditions in which fatigue is the primary symptom, there are many possible root causes. Naturopathic doctors will work with you to understand why you have these symptoms, find and treat the root cause, and restore balance to the body. This is often a multifaceted approach, as intense fatigue and the toll it takes on many body systems often develops over time and stems from various factors.
Sometimes the solutions can be difficult to see on our own and may be impossible without medical testing and advice. If you are experiencing persistent and ongoing fatigue, talk with your naturopathic doctor.
Wilson JL. Adrenal Fatigue the 21st Century Stress Syndrome. 1st ed. 2001.
Adrenal Insufficiency (Addison's Disease) Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/underactive-adrenal-glands--addisons-disease
Mayo Clinic. "Adrenal Fatigue: What causes it?" https://www.mayoclinic.org/diseases-conditions/addisons-disease/expert-answers/adrenal-fatigue/faq-20057906
Endocrine Society. "The Myth of Adrenal Fatigue." Posted by Eric Seaborg Sep 2017 at https://endocrinenews.endocrine.org/myth-adrenal-fatigue/
Jankord R, Herman JP. "Limbic regulation of hypothalamos-pituitary-adrenocortical function during acute and chronic stress." Ann N Y Acad Sci. (2008 Dec) 1148:64-73. doi: 10.1196/annals.1410.012. PMID: 19120092. https://pubmed.ncbi.nlm.nih.gov/19120092/
Bancos I, et al. "Diagnosis and management of adrenal insufficiency." Lancet Diabetes Endocrinol. (2015 Mar) 3(3):216-26. https://pubmed.ncbi.nlm.nih.gov/25098712/
Cadegiani FA, Kater CE. "Adrenal fatigue does not exist: a systematic review." BMC Endocr Disord. (2016 Aug 24) 16(1):48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997656/
Herman JP, et al. "Regulation of the Hypothalamic-Pituitary-Adrenocortical Stress Response." Compr Physiol. (2016 Mar 15) 6(2):603-21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867107/
The Washington Post (online) "Is adrenal fatigue real? Forget the label and treat the stress." https://www.washingtonpost.com/lifestyle/wellness/is-adrenal-fatigue-real-forget-the-label-and-treat-the-stress/2017/04/04/6952b2b6-1889-11e7-9887-1a5314b56a08_story.html
Ulrich-Lai YM, Figueiredo HF, Ostrander MM, Choi DC, Engeland WC, Herman JP. "Chronic stress induces adrenal hyperplasia and hypertrophy in a subregion-specific manner." Am J Physiol Endocrinol Metab. (2006) 291:E965-973. http://ajpendo.physiology.org/content/291/5/E965.long
Naturopathic Pediatrics: What Is Adrenal Fatigue? https://naturopathicpediatrics.com/2011/10/29/what-is-adrenal-fatigue-2/