Adrenal Fatigue manifests itself in tiredness, exhaustion, and trouble sleeping. From the point of view of conventional medicine, there is no such thing as adrenal fatigue. We explain how it behaves and what you can do if you have the corresponding symptoms.
Conventional medicine: There is no such thing as adrenal fatigue.
Anyone who is stressed, sleeps poorly, is chronically tired and exhausted, cannot lose weight despite dieting and cannot get through the day without coffee has been receiving the diagnosis of adrenal fatigue for some time, especially from alternative practitioners and naturopathically oriented doctors. The therapy that follows is intended to get the adrenal glands going again.
However, the vast majority of conventional medical doctors say that adrenal fatigue does not exist. It is a fashionable diagnosis ( 3 ) – similar to Leaky Gut Syndrome, which, from the point of view of conventional medical fact-checkers, should also not exist ( 1 ). However, the latter is now also included in the therapy by many doctors.
Because although it is repeatedly claimed that there is no correct definition, let alone a specific diagnostic procedure for Leaky Gut Syndrome, both have long existed, as we explain in the previous link. And the number of scientific reports in which Leaky Gut Syndrome is discussed has been growing continuously since 2011. In 2020 alone, 113 papers were published in the PubMed database, and in 2021 there are already another 117 ( 2 ).
What about adrenal fatigue then? From a conventional medical point of view, there is adrenal insufficiency, but not adrenal fatigue.
In order to be able to understand the difference between adrenal insufficiency and adrenal fatigue, let’s briefly clarify what the adrenal glands are and what tasks they perform:
The adrenal glands and their functions
The adrenal glands are small endocrine glands (about 3 cm by 1.5 cm) that lie above the kidneys (hence the term “adrenal glands”). Everyone has two adrenal glands, which produce around 40 different hormones and consist of the adrenal cortex and the adrenal medulla.
The adrenal medulla
In particular, the adrenal medulla produces the two stress hormones adrenaline and noradrenaline.
The adrenal cortex
The adrenal cortex produces, among other things, the stress hormone cortisol, but also aldosterone (which regulates blood pressure) and androgens (the so-called male hormones, such as testosterone and DHEA). The adrenal cortex does not act independently. The hormone glands in the brain (hypophysis and hypothalamus) tell it when to produce how much of which hormone.
DHEA stands for dehydroepiandrosterone. It is a precursor hormone that can be converted into both testosterone and estrogen.
The role of cortisol
In the case of adrenal insufficiency, the adrenal cortex is usually particularly affected and cortisol formation is impaired. Cortisol affects different parts of the metabolism. It makes the body fit to react adequately in stressful situations (“fight or flight”).
In addition, cortisol increases blood pressure and causes the liver to produce new sugar. It breaks down fat and protein (to provide even more energy), inhibits inflammatory processes, and suppresses the immune system (because in fight or flight, there is neither time nor energy to take care of infections; that has to wait until the threat has been overcome).
Overactive and underactive adrenal glands
While the terms under-function and over-function have long been known for the thyroid gland, this is not yet the case for the adrenal glands. But here, too, there are both. The overactive adrenal cortex is called Cushing’s disease (pronounced Kushing), and underactive is called Addison’s disease or adrenal insufficiency (named after the doctors who first described the diseases).
Overactive adrenal glands: Cushing’s disease
In Cushing’s disease, the adrenal cortex produces too much cortisol. Symptoms appear that also occur when someone has to take high-dose cortisone preparations over a long period of time: full moon face, accumulation of fat on the neck and stomach, but at the same time thin arms and legs (cortisol has a muscle-depleting effect), thin skin and a tendency to diabetes, high blood pressure, osteoporosis and acne. Cushing’s disease is rare (1 new case per year per 100,000 inhabitants).
Underactive adrenal glands: Addison’s disease or adrenal insufficiency
In Addison’s disease or adrenal insufficiency, there is a cortisol deficiency. Here the adrenal cortex can no longer produce enough cortisol, e.g. because tumors or autoimmune processes destroy the hormone-producing cells. Since the adrenal cortex is controlled by the pituitary gland and hypothalamus, tumors or other diseases of these two glands can also lead to adrenal insufficiency. Adrenal insufficiency is also rare (2 – 4 new cases per 100,000 inhabitants per year).
Adrenal insufficiency: the symptoms
The symptoms of adrenal insufficiency are:
- tiredness and listlessness
- weight loss
- Low blood pressure
- loss of appetite and nausea
- stomach pain
- muscle and joint pain
- menstrual bleeding stops
However, it is also possible that those affected hardly have any symptoms in everyday life. Only in stressful situations – when the organism needs more cortisol – do threatening circulatory disorders with drops in blood pressure, hypoglycemia or even diarrhea and vomiting suddenly appear. In this case, one speaks of the so-called Addison crisis. In the case of adrenal insufficiency, therefore, cortisol must be taken as a drug to correct the deficiency. Adrenal insufficiency generally does not lead to a life-threatening crisis.
Adrenal Fatigue: The Symptoms
While adrenal insufficiency is rather rare, many people are currently being diagnosed with adrenal fatigue or diagnosing it themselves based on the descriptions in books or on the Internet. Because the following symptoms are anything but rare due to our stressful age:
- Exhaustion and tiredness (you wake up without enough sleep and are exhausted)
- Everyday life can hardly be mastered without caffeine
- Irritability and mood swings to the point of depression
- Cravings for sweet and/or salty foods
- Losing weight is no longer possible (neither with sport nor with diets)
- No desire for sex
- Energy slump in the afternoon, but then you suddenly wake up again shortly before going to bed and cannot fall asleep – and if you do, the sleep is not restful
- Sleep disorders
- Dizziness when standing up quickly
- Headache in the afternoon
- Blood sugar problems
- Chronic inflammatory diseases
- Brittle fingernails and brittle hair
What’s behind it
In healthy people, the cortisol level rises in the morning, guaranteeing a fresh awakening and a happy start to the day. As the day progresses, the cortisol level drops again. In the evening, the pick-me-up hormone cortisol is replaced by the calming “sleep hormone” melatonin. When melatonin levels drop in the morning, cortisol levels rise again.
If there is adrenal fatigue, there is an imbalance (at least that is the explanation). Cortisol levels are low in the morning (when they should be high) and high in the evening (when they should be low), which is why you can’t fall asleep.
However, from the information above, you know that the adrenal cortex receives its instructions from the brain. One speaks of the hypothalamus-pituitary-adrenal axis, or HHN axis for short. This describes a very complex regulatory circuit between the hormone glands of the brain (hypothalamus and pituitary gland) and the adrenal cortex. In the case of adrenal fatigue, this control circuit is said to be disturbed. Apparently, the communication between the brain and the adrenal glands no longer works properly.
Adrenal Fatigue: The Causes
Chronic stress is said to be the main cause of adrenal fatigue. Normally, the hormonal balance levels off after the end of a short-term stressful situation. The cortisol level, which has shot up, sinks again, and the person calms down.
But if life remains stressful and strenuous, then there is a constantly increased daily cortisol level until the adrenal glands are finally exhausted and can no longer keep the cortisol level high. Long-term stress would therefore lead to a cortisol deficiency.
However, this deficiency is of course not as pronounced as in Addison’s disease. On the other hand, it is a mild form of adrenal insufficiency, which now leads to the symptoms mentioned, such as tiredness, lack of drive, etc. Other possible causes of adrenal fatigue are said to be the following:
- viral or bacterial infections
- autoimmune diseases
- emotional stress
- too much sport (physical stress)
- food intolerance
- intestinal flora disorders (dysbioses)
- toxins (poisons)
The diagnosis of adrenal fatigue
Even with the possible symptoms listed, you certainly noticed that these are very unspecific and could indicate all sorts of other diseases/problems, e.g. depression, fibromyalgia, some autoimmune diseases, hypothyroidism, cardiovascular problems, burnout syndrome, KPU, chronic fatigue syndrome, a lack of vital substances or the typical menopausal symptoms.
So if you have the symptoms mentioned, you will eventually see your doctor, who will do the usual tests and analyses, so that some things can be ruled out. However, those tests that are recommended for the diagnosis of adrenal fatigue will not be carried out by a doctor who is oriented toward conventional medicine. These tests include the following:
Saliva Test for Daily Cortisol Profile: Collect saliva samples throughout the day to see how cortisol levels change throughout the day. A test kit can also be ordered online. You take the saliva samples yourself, send them to the laboratory, and receive an evaluation by e-mail with recommendations for further action.
Saliva or blood test of the DHEA level: Since DHEA (dehydroepiandrosterone) is also a hormone that is produced by the adrenal cortex, this hormone level test could also provide information about the functionality of the adrenal cortex.
Intestinal flora check: Many alternative medicine practitioners also recommend checking the intestinal flora for any health problem. Because if there is a disorder here, it can also have a detrimental effect on the brain and hormone system and thus increase adrenal insufficiency. If you want to heal these, possible disorders in the digestive system should first be eliminated (leaky gut syndrome, candida infestation, small intestine overgrowth, etc.).
Questionnaire for self-diagnosis: In the book Diagnosis: Adrenal Fatigue by Julia Tulipan and Nadja Polzin, which covers the topic of adrenal fatigue very comprehensively, you will find a questionnaire to help with the diagnosis. Various areas are queried:
- Vulnerable factors, e.g. whether you often suffer from respiratory infections, whether you gain weight quickly, whether you are already chronically ill, whether you are diabetic, etc.
- Signs and symptoms, e.g. whether you are still productive at work, whether you are easily confused when things get stressful, whether you have a sensitive stomach when stressed, whether you are sensitive to cold, whether you have small dark brown spots on your face, etc.
- energy pattern, e.g. how you feel after lunch, how food generally affects your energy balance, when you are fit during the day, when you feel exhausted, etc.
- eating habits, e.g. how you feel after fatty foods, whether you like to eat salty foods, how you feel when you skip meals, etc.
Pupil test: The pupil test, which anyone can do at home, is also presented in the above-mentioned book. If the test is positive, this is an indication of a low aldosterone level. As you know from above, aldosterone is a hormone produced in the adrenal cortex. If the level of aldosterone is low, then it is moderate to severe adrenal fatigue.
In short, the test goes like this: Take a flashlight and go into a completely dark room with a mirror. Stand in front of the mirror. Wait a few seconds, then shine the flashlight into one eye from the side and observe your pupil in the mirror. Normally, the pupil narrows and stays narrow. However, with a low aldosterone level, the pupil should first narrow, but then open again, narrow, open, etc.
The longer the phases of pupillary opening, the more serious the adrenal insufficiency. You can use this test at home to check your healing process. Because with increasing improvement, the phases of the pupil opening would have to shorten further and further.
Blood pressure measurement and skin test: In the book mentioned above, two more tests for home use are described, which we do not want to anticipate here.
The diagnosis of adrenal insufficiency
Now, some conventional physicians fear that real adrenal insufficiency could possibly be overlooked if instead adrenal fatigue is looked up and you start treating it with naturopathic remedies.
So if you want to rule out having adrenal insufficiency to be on the safe side, ask your doctor for the appropriate tests. For this purpose, the following values are checked in the blood: sodium, potassium, cortisol and ACTH. ACTH is the abbreviation for Adrenocorticotropic Hormone. This hormone is made by the pituitary gland in the brain. It tells the adrenal cortex to make cortisol. If ACTH is high, then the problem is in the adrenal gland, if ACTH is low, something seems to be wrong with the pituitary gland.
A so-called ACTH stimulation test and antibody tests (to rule out an autoimmune disease) can also be carried out, but you can ask your doctor about this.
Naturopathic therapy for adrenal fatigue
Now that you’ve been diagnosed with Adrenal Fatigue, what do you do? The list of necessary measures will disappoint you. No matter which book or article you read on the subject on the internet, the usual measures are listed that are necessary for every health problem from a holistic point of view.
That means it doesn’t matter whether you have adrenal fatigue or not. If you are suffering from the symptoms that are associated with adrenal fatigue (and your doctor cannot find an underlying disease), you can easily implement the usual measures that follow the main naturopathic rule, which is: Banish everything harmful from life, put everything beneficial in life!
Below we repeat these measures again:
1. Stress management
Find those points in your life that cause you stress and organize your everyday life in such a way that you no longer allow yourself to be so stressed. Surround yourself with people who don’t stress you! If someone comes into your life who is stressing you out, talk to them or, if possible, leave them behind. Find a stress management technique (e.g. The Work by Byron Katie, breathing exercises, Jacobson’s progressive muscle relaxation, Tai Chi, etc.).
2. Anti-inflammatory measures
When cortisol levels drop, chronic inflammatory processes can develop more easily. So it is important to take anti-inflammatory measures. This includes an anti-inflammatory plant-based diet high in fruits, salads, vegetables, whole grains, legumes, nuts, and healthy fats and oils.
A low-carb diet is often recommended because blood sugar fluctuations should be avoided at all costs. But this can also be achieved with a wholesome diet.
It is important that no isolated carbohydrates are eaten, i.e. no white flour products (white bread, pastries, cakes, biscuits, white flour pasta, etc.) and no products that contain sugar or other isolated sweeteners.
Of course, you shouldn’t live mainly from whole grain products now, but focus your attention on plenty of vegetables and salads, plus a high-quality protein source (tofu, tempeh, legumes) and high-quality fats and oils. Whole carbohydrates are only a small side dish, e.g. Brown rice, wholemeal pasta, cereal patties or similar.
In addition, a dietary supplement with anti-inflammatory substances (e.g. curcumin, OPC, omega-3 fatty acids, etc.) should be taken.
Not to forget: lots of exercises and enough sleep (regular sleeping times!).
3. Correct possible nutrient deficiencies
Have it checked to see if you might have a vitamin or mineral deficiency. On the one hand, a deficiency makes you susceptible to stress and illness and, on the other hand, it can lead to symptoms that are said to be adrenal insufficiency. Don’t just think of vitamins (vitamin D, vitamin C), but also zinc, magnesium and selenium. Magnesium, for example, relaxes the mind and body, improves sleep, and even promotes healthy adrenal function.
Vitamin B12 and folic acid are directly involved in regulating the melatonin-cortisol cycle and should also be checked.
4. Take adaptogens
Adaptogens are plants that can protect you from the harmful effects of stress. These plants include ashwagandha and Rhodiola. Ashwagandha, for example, can be taken wonderfully in the form of an Ayurvedic sleeping drink. Here is the recipe for the Ashwagandha drink:
- 1 tsp ashwagandha powder
- 2 pinches of turmeric powder
- 2 pinches of cardamom powder
- 1 pinch of cumin powder
- 1 pinch of clove powder
- 1 pinch of cinnamon powder
- 1 pinch of nutmeg powder
- 250 ml oat milk
- 1 tsp yacon syrup
The drink ensures a good night’s sleep and makes you wake up refreshed.
Treat Adrenal Fatigue holistically
So you can see that you can save yourself the complicated (alleged) diagnosis of adrenal insufficiency. Because whether you have adrenal fatigue, are on the verge of burnout, or have any other stress-related condition, the actions to take are ALWAYS pretty much the same.
So stay calm, and don’t stress yourself out with a doctor’s odyssey hoping to find a doctor who might be able to treat your adrenal fatigue. Focus on yourself, your life and your body. Give it what it needs (exercise, sleep, vital substances, healthy food, relaxation) and take away what harms it (stress, anger, fast food, stimulants (caffeine, nicotine, etc.), lack of exercise, irregular sleeping times).