Is Adrenal Fatigue a Real Thing?

Adrenal fatigue

In this blog post, we dig a little deeper into the part that your adrenal glands play in stress chemistry. (If you’re already a little lost, this is a continuation to a series on stress that starts here!)

So is adrenal fatigue a real thing?

No. The term “adrenal fatigue” was coined by Dr. James Wilson in 1998, and it’s been popular ever since within the alternative medicine space. However it’s not an actual clinical entity, and the term is misleading.

Move over adrenal fatigue

Yup, adrenal fatigue is not a real medical condition. Chronic or acute stress can’t actually exhaust your adrenal glands. Your adrenal glands are not intelligent on their own. They simply make hormones when instructed by your brain to do so. The entire stress response involves much more than your adrenals, however. It first starts in your brain and goes like this:

In your brain:

  • You first perceive fear in the amygdala.
  • Then your hypothalamus gland makes CRH (corticotropin-releasing hormone).
  • Next, your pituitary gland makes ACTH (adrenocorticotropic hormone).

ACTH travels to your adrenals to activate a stress response:

  • Norepinephrine and epinephrine (part of the catecholamine neurotransmitters) are released from stores inside your adrenal.
  • Cortisol is made on demand in the mitochondria, after about 10 minutes of sustained stress.

In your body cells and tissues:

  • These adrenal hormones bind to receptors on your cells so they can get inside and do their work.
  • Then they break down (metabolize).

If the stress trigger continues, the process begins all over again.

Rinse, lather, and repeat!

Brain stress, adrenal glands, stress response, anatomy

Meet HPA-D, the real clinical entity

HPA-D stands for hypothalamus-pituitary-adrenal axis dysfunction. This more accurately portrays the breakdown of the whole stress response. Unlike “adrenal fatigue,” this condition is a real thing, and it’s written about extensively in medical literature. However, your conventional doctor or endocrinologist has not been trained in this. They only recognize severe HPA-D disruption in terms of extreme cortisol levels:

  • Addison’s disease is abnormally low production of cortisol (and aldosterone, an adrenal hormone that regulates salt and water).
  • Cushing’s syndrome is abnormally high cortisol production.

If your HPA-D is not at either extreme end of the cortisol spectrum, you’re deemed “normal” and may get an eye roll or two if you bring up “adrenal fatigue” to your regular doctor.

In functional medicine, we assess and treat the whole HPA-D spectrum between Addison’s and Cushing’s. Like many other conditions, we are concerned with the entire range of problems – not just when you’re at the far end and really sick. We want to prevent that from happening. We assess the health of your HPA axis, and we can also assess other things involved with the stress response, such as:

  • The flexibility of your amygdala – is it overactive? Are you a “highly sensitive person?”
  • Your mitochondrial function (where cortisol is made)
  • The cofactors your adrenals need to make hormones, such as vitamins B5, B6, and C, and the mineral magnesium
  • How cortisol and catecholamines metabolize, which is affected by liver and thyroid health, inflammation, insulin, and specific genetic SNPs like COMT

How do we test the HPA axis?

We do this by testing cortisol! However, a single cortisol blood test reading doesn’t tell you much. Cortisol in your bloodstream is bound to carrier proteins, so it doesn’t reflect the level of cortisol that is free and available. We test free cortisol through urine or saliva samples.

It’s also important to test your cortisol levels throughout the day and night, as it fluctuates a great deal. This means taking free cortisol measurements at least four times in a 24-hour time frame. You can do this at home with a kit. We use the Dutch adrenal urine test or the ZRT saliva test in our clinic. You can learn more and order these on your own here:

Lab testing, adrenal, cortisol

Why is it important to test?

HPA axis dysregulation appears in 3 different patterns: chronically high cortisol, chronically low cortisol, and mixed-up cortisol levels. Mixed-up levels mean cortisol is high at the wrong time and/or low at the wrong time. It’s possible to gauge an individual’s pattern based on symptoms; however, getting the lab results helps us to be more accurate.

These different patterns require different treatments. For example, a person with high cortisol during the day needs to focus on interventions that down-regulate the HPA axis. A person with overall low cortisol, especially in the morning, requires strategies that up-regulate the HPA axis. With mixed-up cortisol patterns, the interventions become more nuanced.

We cover the different treatment plans for different patterns in our course called Fix Your Adrenals. The next blog post discusses a lifestyle approach to healing HPA-D so head over there to learn more. 

Feel free to add any comments or questions below.

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