Your adrenals aren't fatigued - YOU are (part 2).

Adrenal fatigue: the idea that our adrenal glands get overworked by stress and stop producing the hormones we need, including cortisol.

There is no such thing as “adrenal fatigue”

(Disclaimer: Unless you have Addison’s disease, which I REALLY doubt you do, because it is quite rare and quite severe. Nope, don’t bother googling it until you read all the way to the bottom of this article. Just don’t.)   

Let’s get right to it. There are several problems with the diagnosis of “adrenal fatigue.” They basically fall into 2 categories: that’s just not how the body works & the testing used to justify the diagnosis is deeply flawed. Let’s discuss the second thing first. 

People usually get diagnosed with “adrenal fatigue” via a salivary cortisol test coming back saying they have low cortisol levels. Which is, frankly, a crappy and disingenuous way to try and legitimate a non-existent diagnosis. 

Why? Because salivary cortisol only measures free or “unbound” cortisol, which represents but a teeny fraction (3-5%) of your body’s overall levels!  In short: the test most commonly used to diagnose someone with “adrenal fatigue” is a very poor representation of where cortisol levels are at in the body. Like, abysmal. 

In short: the test most commonly used to diagnose someone with “adrenal fatigue” is a very poor representation of where cortisol levels are at in the body. Like, abysmal. 

Studies that looked at total cortisol (all the types, including free cortisol) found that there’s little to no correlation between having low free cortisol and low total cortisol. It’s actually more common for those folks to have normal, or even HIGH total cortisol! Another thing to note: the low free cortisol + high total cortisol combo is a very common pattern in obesity. 

The second problem with the testing used to diagnose “adrenal fatigue” is this: People are frequently being tested at the wrong time of day - cortisol is at its peak in the 15 to 30 minutes after you wake up. It’s called the cortisol awakening response and it can account for HALF (50%) of all the cortisol you crank out in a day. If you’re not tested within that window, your results could appear to be lower than they actually are. 

But the shoddy testing is not even the biggest problem I have with the “adrenal fatigue.” 

I could (almost) care less about that, since questionable testing methodology is…not unheard of in the alternative health world (candida, allergen testing, heavy metals, fucking muscle testing- give me a break). 

The absolute biggest problem is that YOUR ADRENALS DON’T GET FATIGUED. 


Your adrenals.

Don’t.


Get. 


Fatigued.


Period. Your body is way more elegantly designed than that. Here’s what I mean: your stress response keeps you alive. That’s its job. It enables you to react and respond to potential danger. It helps you run away from the bear. Now, it would not be a very good survival adaptation if one of your key stress hormone pumper-outers just decided to stop working because too many bears kept chasing you (but also, find a cave without so many bears, dude. jeez). The adrenals are always ready to work, to provide the cortisol/adrenaline the drives the stress response. 



Buuuuuuut (there’s always a but, and this one is a big juicy booty): 


Something IS happening. 


Your adrenals are fine, but that doesn’t mean that your fatigue and other symptoms aren’t real. THEY ARE. And they are very poorly served by an allopathic medical system that will send you home empty-handed and discouraged if you don’t meet the criteria for a medical diagnosis. 
If you are a human in the world, you are probably chronically stressed. That’s a real thing that you are experiencing, with all the associated fatigue, insomnia, brain fog, achey joints, low libido, etc. But it’s not because your adrenals are failing. And the solution is CERTAINLY not to pump yourself full of stimulating adaptogens. 

Your adrenals are fine, but that doesn’t mean that your fatigue and other symptoms aren’t real.

THEY ARE.

And they are very poorly served by an allopathic medical system that will send you home empty-handed and discouraged if you don’t meet the criteria for a medical diagnosis. 

So here’s what might be actually happening (in VERY broad strokes):

All that cortisol from all that stress keeps pounding away at you week after week, month after month. High stress hormones over a long period of time get are rough on your body. So, if it goes on for too long, your body will, as a protective mechanism, seek to buffer this wear-and-tear in a couple of ways. Let’s go over 2 of them extremely briefly. 


One is cortisol resistance, which is a similar concept to insulin resistance. The body tells the cortisol receptors to become less sensitive (i.e., insensitive or resistant) to try and protect you from the negative impacts of too much cortisol over too long a period of time. It also decreases the number of receptors, period. This can look like low cortisol, but has nothing to do with the adrenals. 


Another is downregulation of the HPA axis. Your hypothalamic-pituitary-adrenal axis is the conductor of the stress orchestra, in short. HPA axis stuff gets pretty hairy pretty quickly, so suffice to say that your brain turns down the volume on the obo section (aka decreases the sensitivity of some receptors involved in the pathway). The conductor is trying to protect you, but now you can’t hear the oboes very well (decreased ability to stimulate production of cortisol). 


Important to note here is that the brain is doing this, not the adrenals. And it has nothing to do with the adrenals being unable to produce cortisol. 

So instead of calling it “adrenal fatigue,” a better term might be “HPA Axis Dysfunction” (though I actually prefer Chris Kresser’s term, “HPA axis maladaptation.”) 


Although, tbh, I also kind of hate both because they’re both a little “well the problem is your nervous system, m’am. Why are you, as an individual, so incapable of adapting positively to the super fucked up world we live in, huh?!” But in the interest of clinical accuracy (and therefore correct and safe treatment), they’re both a big step up from “adrenal fatigue.”


Stress absolutely impacts our health. Like, duh. I’m writing this on Election Day 2020, ffs. My resting heart rate today has been like…95. A plethora of chronic diseases have been strongly linked with stress. My point is that stress doesn’t affect the adrenals the way the term “adrenal fatigue” strongly implies it does.


IN SUMMARY: your adrenals aren’t fatigued, but your fatigue is real. don’t take “adaptogens” to try to correct this, because that wouldn’t work even if the problem WERE your adrenals (see part 1 - “adaptogens” don’t increase adrenal function). Fix the real problem(s). There are no shortcuts to robust energy levels. 



What those “adaptogens” should be used for instead


The name of the game with “adaptogens” is thus: in the hands of a skilled, judicious practitioner (like yours truly), as short-term tonics in small doses, within the context of deep rest, these plants can really be magical for helping the depleted individual. Here are some examples: 

  • To support recovery from a nasty acute illness (like COVID19), alongside lots of rest.

  • To TEMPORARILY help with the fatigue that often comes along with making positive lifestyle changes (caffeine withdrawal, cutting out sugar, etc)

  • To improve the quality-of-life and reduce the fatigue of a serious disease such as cancer


This is in line with the way plants like ginseng, rhodiola and eleuthro have traditionally been deployed by healers for many, many years. That and, you know, waging war on the neighboring clan or pillaging the English countryside. Which brings me to my last point:


Sometimes you need to push performance short-term. That’s fine. Know that you’ll have to sleep for like a month afterwards.


There are times when we must temporarily become superhuman. Relief efforts after a natural disaster. Conquering English farmland on a Viking conquest. Organizing for justice in a pivotal moment in US history. Finals week. 

It happens, and no one is saying never take stimulating adaptogens. 

Do what you must, but do it from an informed place.

Sources:

ArticlesAlyssa Dalosadrenal fatigue, adrenal burnout, adaptogen, ginseng, rhodiolaComment