If adrenal fatigue is ‘fictitious’, why are we so tired?
After six months of feeling “weird” Aimie Rigas went to her GP.
She told him she exercised “really well”, slept for eight or nine hours a night but still felt “really tired” and was putting on weight.
Regardless of the label, addressing sleep and stress is important.Credit:Stocksy
He took blood tests to check her thyroid function, her blood glucose levels and “all sorts of things”.
“Everything was fine except my cortisol was really low,” says the 30-year-old Melburnian.
Rigas’ doctor had expected her levels to be higher given she had recently left a job where she working long hours and had been struggling to switch off.
“My boyfriend was saying you’re really stressy, you’re really snappy but when you’re in it it’s hard to see,” she recalls, adding that in retrospect, she was “definitely stressed”.
Her doctor thought adrenal fatigue was “possibly the cause” explaining that if your cortisol is too high for too long, your adrenals stop producing it.
“It’s a common problem,” says Eta Brand, the president of the Australian Naturopathic Practitioners Association.
Brand estimates “every second person” who walks into her clinic in Queensland’s Nambour is experiencing issues related to stress and fatigue. To assess the root of the problem Brand says naturopaths take a “comprehensive approach” that explores diet, stress levels, stress management techniques, sleep, hormonal issues, nutrient deficiencies and energy levels: “We will take a very good naturopathic case history.”
Two in three Australians turn to complementary medicines when they are unwell. In recent years, the gap between complementary and conventional medicines has narrowed as more GPs acknowledge that certain therapies are effective and even choose to train in and “integrate” complementary medicines as part of their practice.
Brand estimates “every second person” who walks into her clinic is experiencing issues related to stress and fatigue.
But there remains a stand-off over certain practices that lack evidence, like homeopathy, chiropractic and the diagnosis of adrenal fatigue.
Traditional Chinese medicine regards adrenal fatigue as a deficiency in the kidneys, but the term was popularised among some western practitioners following James L. Wilson’s 1998 book, Adrenal Fatigue.
Wilson, who is a chiropractor and naturopath, sells his own line of supplements marketed as the “solution” to adrenal fatigue. The small print on his supplements range notes that “these products are not intended to diagnose, treat, cure or prevent any disease”.
In his book, he explains adrenal fatigue as a “deficiency in adrenal gland functioning that can result in debilitating symptoms ranging from lethargy to lowered sex drive to weight gain”.
The medical community however is adamant it is not a real condition but a term used to describe a vague cluster of symptoms that could be caused by any number of things.
“Adrenal fatigue is a 'fictitious' condition which does not exist,” says Associate Professor Warrick Inder, an endocrinologist from the University of Queensland. On the other hand, he says adrenal insufficiency is “a potentially life threatening condition which we take very seriously and usually needs life long treatment”. Adrenal insufficiency has very different symptoms to those ascribed to adrenal fatigue, which Inder says, is an “umbrella term” used to describe people feeling stressed and tired: “It's got nothing to do with the adrenals.”
Professor Chris Dayas, from the University of Newcastle's School of Biomedical Sciences and Pharmacy, adds that a diagnosis off a single blood test is challenging as “cortisol secretion varies over the day”.
“There are no pre samples or controls to compare to,” he says. “I would say that the stress is still a possible culprit but that the concept of adrenal fatigue is not supported by any literature.”
Chronic stress can cause physiological and behavioural changes, Dayas explains. These include weight gain, fatigue, feeling “flat”, having frequent infections and irritability as well as increasing the risk of high blood pressure, autoimmune diseases, anxiety, diabetes and heart disease.
One concern specialists express is that other potential health problems, like mild anaemia, thyroid problems, growth hormone deficiency, or menopausal issues, may be overlooked if the symptoms are lumped under “adrenal fatigue”.
So getting checked by a GP is important. Sometimes however, the real issue is not physical and we need to focus on stress and sleep. “I think people like to have a physical diagnosis,” says Inder. “But there's a whole science of mind-body interaction and don't forget that getting the mind healthy is really important.”
Seeking the advice of a naturopath to explore improving energy levels from a different perspective can prove helpful in this instance regardless of the label.
“There are definitely naturopathic solutions,” Brand insists.
Rigas says she is still “very much on the journey to discovering what's up”.
So desperate is she for answers, she admits “kind of hoping something is wrong to explain the way I'm feeling, so I can start fixing it”.
In the meantime, she has taken her doctor’s advice to address her stress levels, by cutting down on intense exercise, swapping it for walking and pilates and trying to get more sleep.
“[My doctor] said it wouldn’t hurt to meditate and sleep more and take it easy,” she says, and adrenal fatigue or not, it’s wise advice for us all.
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