If you’ve been around the paleosphere for any significant amount of time, you’ve probably heard of Adrenal Fatigue.
In Adrenal Fatigue, so the theory goes, chronic stress causes the adrenal glands — the part of the body responsible for managing stress — to weaken over time.
People who experience Adrenal Fatigue are said to suffer from chronic fatigue, intense sugar and salt cravings, irritability, a run-down immune system, difficulty waking up in the morning, and an inability to copy with daily tasks despite seemingly adequate sleep.
Now in the paleosphere, adrenal fatigue is sort of taken as a given. Like, of course it’s real. But there are a lot of people in the world who beg to differ.
After digging deep into both sides of the issue, I have come to the conclusion that while there are very real ways in which the adrenal glands can malfunction, weaked adrenals simply isn’t one of them.
So what I bring to you today is why I believe the Official Concept of Adrenal Fatigue As People Talk About It probably doesn’t exist.
The history
The term “Adrenal Fatigue” was coined as recently as 1998 by Dr. James Wilson. According to Wilson, if you experience any of the following symptoms, “you may have adrenal fatigue”:
- Tired for no reason?
- Having trouble getting up in the morning?
- Need coffee, cola, salty or sweet snacks to keep going?
- Feeling run down and stressed?
- Crave salty or sweet snacks?
- Struggling to keep up with life’s daily demands?
- Can’t bounce back from stress or illness?
- Not having fun anymore?
- Decreased sex drive?
Now – is it just me, or might just about everybody on the planet experience this from time to time?
Of course that could be because everyone in the world suffers from adrenal fatigue. It could also be because there are literally dozens of medical conditions that cause these symptoms.
The medical community refuses to recognize adrenal fatigue as a real problem. Why? Some proponents of Adrenal Fatigue Theory believe that this is because of inadequate testing. For example, the range of acceptable cortisol levels according to the medical literature is too broad, they say. This is a fair critique! The “acceptable range” for cortisol levels in the afternoon according to standard medical procedures is .01-.33. That’s a 3000% percent difference. I’ll say it again: that’s a fair critique! Perhaps the medical community needs to become more sensitive to small changes in cortisol levels.
I find this to be the best critique out there. Nevertheless, even abnormal cortisol levels does not prove that adrenal fatigue is the cause of it.
In fact, the medical community recognizes many conditions that can cause low cortisol levels. One is Addison’s disease, which is an autoimmune condition that attacks the adrenal glands. Another is called “adrenal insufficiency” which happens when the pitiutary stimuli to the adrenals decreases for one reason or another. Official “Adrenal Insufficiency” diagnoses are relatively rare, but it is diagnosed. Adrenal Fatigue doesn’t make the cut as an adrenal disorder because there is still just about zero reason to believe it is a real, clinical thing.
The burden of proof
This is my main problem with adrenal fatigue:
So far as I can tell, in the 17 years since Wilson proposed the Adrenal Fatigue Hypothesis, there has been not one shred of evidence that Adrenal Fatigue is real.
More than anything, what I would love to see is a specific pathology or biochemical explanation of what occurs during adrenal fatigue. How do the adrenal glands “stop functioning”? What is the biochemical cause? Is there physical damage to the adrenal glands that we can see and test for? Why do the adrenal glands stop being able to work very well?
Every hypothesis is saddled with the burden of proof. That’s just how science works. If you have a hypothesis, it’s your job to back it up. I just don’t see it happening with adrenal fatigue. Now, I do of coruse recognize that there are a few ways in which adrenal function may suffer… of course there are. But it’s not because the adrenal glands stop working.
Confusing Adrenal Dysregulation with Brokenness
Before going any further, it’s important to recognize that adrenal dysfunction is a real thing we see happen all the time.
By “dysfunction,” I mean, the adrenals work at the wrong time of the day.
Most of us know what this is like from personal experience. We need a crane to get us out of bed in the morning, for example, but lay awake in bed wide-eyed for hours before we feel tired enough to fall asleep.
When you are under a lot of stress, when your diet is poor, or when your sleep is insufficient or delayed, then your adrenal glands may get off schedule.
This will cause you to feel very fatigued at some times when you ordinarily wouldn’t, and very alert at times when you ordinarily wouldn’t, either.
This is a real problem. The way to fix it is to treat yourself as lovingly as possible, and with as regular a schedule as possible. It does not mean that the adrenal glands are broken. It only means that they need to be ushered back on track.
My two hypotheses for what actually happens in “Adrenal Fatigue”
Glands in the body don’t “get tired.” That’s like saying that your heart is going to beat more slowly from now on because it beat too fast for the last year. Or maybe a better analogy is that the pituitary gland would stop working because “its tired” (is there such a thing as too much sex?!).
That doesn’t seem very feasible to me. But other things to me seem biochemically feasible. Here they are:
1. Cortisol Resistance
Cortisol is a hormone. It seems entirely plausible to me that the body’s cortisol receptors can become resistant to cortisol signals due to inflammation, stress, and chronic cortisol abuse.
In the event of inflammation, stress, and chronically elevated insulin levels, cells simply stop being able to receive the cortisol signal as easily as they did before.
If this is in fact a real thing, then cortisol, and maybe even adrenalrine will be produced in higher and higher amounts in order to try and convince the stress signal to go through. That’s not an awesome thing, and would in theory lead to alternating periods of very high and very low energy.
The solution to this is simple stress reduction. You can also support your adrenals with all the vitamins it needs. I discuss these below. Yet the problem of excess cortisol production (and timing dysregulation) will never go away if the stressful stimulus is not dealt with. Period.!
2. Insufficient adrenal support
This is my personal favorite hypothesis of what “adrenal fatigue” really is – it’s what I think is probably one of the major players if not the major player in adrenal problems that people experience.
The adrenal glands need the proper vitamins and minerals to work right. They also need healthfully functioning pituitary and thyroid glands, as well as a vital set of kidneys and a healthy liver. The adrenal glands will not work if the tools it needs to get the job done are not available.
These are the vitamins you need to have in spades:
Vitamin C – Vitamin C is absolutely necessary for the creation of cortisol, adrenaline, and dopamine – and the synthesis of testosterone, cortisol, and aldosterone. It helps moderate these levels, too, if they’re too high.
B vitamins, particularly 5 (pantothenic acid), 6 (pyroxidine), and 12 (a great B complex here) – B5 helps to produce co-enzyme A, which contributes to cellular respiration and the breakdown of fats, proteins and carbohydrates. B6 acts in several of the pathways that are used to create adrenal hormones. And B12 helps with energy production, cell repair and the maintenance of our red blood cells. The amounts that you need of each are quite different, for example you should be aiming for 1000mg of B5, 50mg of B6 and 100mcg of B12 as a good starting dose.
Magnesium – Magnesium is responsible for opening channels on cell walls, which means that it both helps your body ramp up and is necessary to cool down.
Cod Liver Oil – inflammation can cause the adrenal glands to act up. Cod liver oil is great for counter-acting that – perhaps the best supplement for that of all.
Zinc – zinc not only supports the immune system, but also helps with insulin resistance. Blood sugar swings cause the adrenal glands to panic, so zinc can really help with this. Chromium and copper are also thought to help with this. (As it magnesium!)
CoQ10 – CoQ10 is necessary for producing energy and growing and maintaining your cells. Good food sources include beef, sardines and various organ meats, but if you are not getting enough from food then this is a good supplement.
Alternative causes of Adrenal Fatigue Symptoms
Even while I have those two hypotheses I just shared about adrenal health, it’s still important to remember that the symptoms of adrenal fatigue can be caused by many other things! Remember the list of symptoms? Fatigue? Craving sugar and salt?
Here is a list of what I think are the most common causes of fatigue:
–Stress causes hypothyroidism in many different ways. For one, it cuses the pituitary gland to decrease production of Thyroid Stimulating Hormone, which inhibits thyroid activity. For another, stress causes the liver to decrease conversion of thyroid hormone T4 to T3, which also radically reduces energy levels. Finally, stress causes inflammation, which causes thyroid hormone resistance. With decreased thyroid functionality you will definitely experience fatigue.
–Adrenal and circadian rhythm disruption causes REM sleep and deep sleep quality to be disturbed, which causes reduced energy during the day, sugar and salt cravings, irritability, and depression and other and mood disorders.
-Stress can both increase urinary excretion as well as disrupt electrolyte levels in the blood, which can lead to rapid heart beat, pounding heart beat, and high blood pressure, as well as decreased heart beat and decreased blood pressure.
–Low iron and iron-deficiency anemia may cause extreme fatigue
–Low intake of B vitamins may cause anemia and fatigue
–Inadequate sun exposure and low vitamin D levels causes fatigue, mood disorders and cravings
–An imbalance of neurotransmitters, particularly of serotonin, dopamine, and GABA, will cause fatigue, mood disorders, cravings, and just about every symptom under the sun.
–Severe testosterone, estrogen, or progesterone insufficiency such as may be experienced in a hysterectomy, in severe menopause, or in other radical hormone imbalances can cause adrenal fatigue symptoms.
–Estrogen dominance decreases thyroid hormone efficacy, which induces fatigue and related symptoms. It can also act on serotonin and dopamine to create mood disorders.
–Leaky gut can cause neurotransmitter insufficiency as well as inflammation, two things that hurt the stress response and can cause adrenal fatigue symptoms.
–Caffeine and alcohol, Q.E.D.
In Conclusion!
Okay so this has been one monster of a post! But we have covered so many things! Here they are, in sum:
1. “Adrenal fatigue” as it is classically described probably doesn’t exist.
2. It is possible that inadequate nutrition is being supplied to the adrenal glands, so in addition to reducing stress the best thing you can do for your adrenals is to nourish them as best as possible with bountiful:
vitamin C (sustained release!),
B5,
B6,
B12,
(THIS is an awesome B complex designed specifically for adrenal support with B5 6 and 12)
magnesium (my favorite), and
omega 3s (the extremely potent fermented cod liver oil)
CoQ10 (a high absorption one I once used)
and probiotics.
3. There are many potential causes of fatigue. Even while the adrenals are super important to support, don’t forget that there are other parts of the body that absolutely must be nourished to feel energetic and happy, too!
What is your experience? Agree with me? Think I’m crazy? I’d love to hear what you think!! Please feel free to open and change my mind!
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Really this post just comes down to semantics. Adrenal fatigue / adrenal malfunction. Really I take it to mean the entire system/cascade is fatigued and ceases to work as it should, usually as a result of the system “over-operating” for too long due to lifestyle factors. Whatever you call it, it’s a real thing. Your adrenal glands don’t ever STOP working, and anyone who thinks they do simply doesn’t understand how they or the body work (which is ok – it’s complicated! and there are still many mysteries we do not understand) or is just throwing out the latest buzzwords. If you want the proof of this condition, read The Adrenal Reset Diet by Dr. Alan Christianson and work your way through his references.
Oh Stefani, I absolutely agree with you. In fact I am dealing with a couple of clients right now that claim that they have adrenal fatigue but like you, I have always been skeptical of that diagnosis. I know for a fact that one is extremely low in testosterone and has leaky gut. So I am addressing those issues first.
Thank you for being such a stand apart rebel of the paleo world. You just saved me a bunch of time, confirming what I already suspected.
Beth I would love to know how you’d suggest increasing Testosterone naturally? Mine is extremely lo…
Exercise is critical, however, I do not feel comfortable giving any other specifics as I do not know enough about your situation. You can reach me just check out this page http://www.hookedonhealth.co/coaching/
The first session is free.
GIRL, yet again another amazing post. thanks for always giving me the WHY behind everything. i am so into the SCIENCE of everything, which is why your blog = my fav ever
Isn’t that kinda just semantics ? All syndromes are just a collection of symptoms caused by usually hard to figure out causes . I agree with everything g you suggested to help the symptoms . I think it may be a good idea to have some kind of name for this but I don’t know what ! I use adrenal supportive herbs as well as everything you suggested . I wish there was a simple cure .
THANK YOU!!! My husband is an internal medicine doctor, and I am a physical therapist. We are both sick and tired of this junk term being thrown around!!
Love this article Stefani! I’m especially interested in Adrenal and circadian rhythm disruption. Do you have simple tips on how to address this? (nutraceuticals and lifestyle)
Cheers from Australia,
Agnes x
The fact is, Steph, that most of us women in the western world are struggling with health issues. We have been to so many doctors who want to dismiss us with antidepressants or some such thing, and we know that is only ‘paste’.
I think I’ve been thru a bit more life than you as I’m just about to celebrate my 70th Bthday! I went thru a difficult puberty where I developed a white patch in my hair, (first sign of auto immunity), but told I had been quote – ‘hit on the head’! Then the heavy and painful periods, the difficulty getting pregnant, the miscarriages, the fatigue, glandular fever, mumps/encephalitis and paralysis at 30, then the trials of being a mother to teenage children, the birth of grandchildren, and the miserable deaths of parents to cancer and motor neurones. This is the reality of life and there are possibly millions of women who have similar stories. Some do go down the line of regular medicine, and I’ve seen some terrible things done and said to my friends. Long ago, possibly before you were born, I went on a Gluten Free diet. I was poo pooed by the medical profession at the time, because I also put my children on it…….oh no!!!…HOW will they grow properly, I was told. I then had tests for insulin problems,……result?…I went on a sugar free diet. “Then I found my allergy to dairy milk, so I eliminated that also. So for approximately 40 years, I have lived on a gluten free, dairy free and sugar free diet.
About 5 years ago, I refined this again. I’m now almost grain free, and live on organic, and where poss., home grown fruit and veggies, with organic grass/fed, straight from the farm, beef about twice a week, and organic chicken and fresh Tasmanian salmon about once a week. I’ve removed all the plastic I can from my life, and eliminated all the chemical based soaps and cleaners. I still care for a large home, garden & family, so whilst I don’t go to gym, I’m for ever active and ‘on my feet’.
I searched for an Integrative Doctor, and am reasonably happy now in that regard, but I’m getting tired of all the conflicting information I receive on a daily basis on the Net.
I have NEVER, with all my efforts, been able to turn around my gut issues.
I even ferment my own veggies. My Hashimotos has certainly improved, but I still suffer fatigue, cramps, (sudden, esp. at night), poor sleep, and excess urination, ..once again, esp. at night. My muscles are constantly fatigued and every bone and joint is painful. I’ve tried naltrexone 6 times now,….even dividing the lowest dose into thirds, but still I end up with nausea and violent migraine.
I’m on progesterone cream, cortisone cream (which I stopped for 3 months and was put back on), adrenal glandulars, liver glandular, amino acids, the ‘new’ Vit C which is supposed to bypass the stomach and go straight to the cells,….Multi B, Mineral Pdr. Chlorella, Cod Liver Oil, Salmon Oil, Ubiquinol (Q10) and Astaxanthin.
It’s frustrating beyond measure, and expensive beyond the pockets of most.
I don’t look my age, and my hair is still its natural colour. I am a good weight, and tho I have vitiligo,my skin is in good condition.
The point is this. I agree to never give up! But when the body turns on itself, for whatever reason, genes, stress, illness etc., it is VERY difficult to get it to ‘behave’ itself again, and tho there have been exceptional people doing exceptional work lately, for which we are all most sincerely grateful, the ‘nut’ hasn’t really been cracked.
I forgot to mention. I take copious amounts of magnesium! I wouldn’t even publish how much I take!! I also rub the oil into my legs, and I stand on a vibrating machine to stimulate my circulation before going to bed.
Yes, it all helps,…but it doesn’t stop the problem. Life shouldn’t be such a constant battle.
So to answer your question about adrenal fatigue. Yes, I do believe there is such a thing, but by the time you know you have it, you probably have thyroid and sex hormone issues as well. The ‘three legged stool’ certainly exists. Problem is, you can’t treat just ONE hormone. You have to try to balance them all, and that does take time, patience, diet, stress control, exercise, and a really good Integrative Doctor who is willing to work WITH you, I went to an endocrinologist for 11 yrs. who refused to listen, calling adrenal fatigue ‘bull………t’! By the time I had the brains to move on, my bloods showed I was one step away from Addisons. I believe it is foolish to ignore someone who feel they might have a problem. But they need to be checked thoroughly for the cause.
Hope that helps. Enjoy your travels and being young!
I’m curious, Jed, how you found that naltrexone was causing your migraines. As far as I can tell, that is not listed as one of the possible side effects. I’ve been taking it for RA and it has dramatically decreased my joint pain, but I’ve also had many, many more migraines since taking it (I went from about 2-3 migraines per year to practically every day). But I cannot find anything anywhere that suggests LDN could cause migraines. In fact, I’ve heard it can help with migraines, if anything. So curious where you learned about this? Any info is much appreciated!
I’d argue that this is a bit like saying IBS doesn’t exist.
Does IBS describe a single, particular pathology and etiology? No. But does it describe a linked group of observable symptoms? Sure. Can many people with that group of symptoms be helped by the same or similar interventions/tactics? Yep. I feel like adrenal fatigue is the same way.
Don’t you think the term “adrenal fatigue” could still be useful, until the medical community comes up with some more specific way to acknowledge that many people experience major illness related to their messed-up cortisol sensitivity/adrenal function/various precursors to adrenal function?
Any thoughts why supplementing desiccated adrenal gland would help the symptoms of so called “Adrenal Fatigue”? I’ve had two saliva adrenal panel tests, about 6 months apart. After the first test revealed an abnormal adrenal pattern, it was recommended by my natural health practitioner that I take the glandular supplement (by Standard Process) and within a few days it helped my constant nervous feeling that caused me to jump out of my skin when the doorbell rang, for example. The second test revealed a much more normal adrenal pattern.
I’ve got to agree with Scooter. I don’t think it’s fair to dismiss this condition altogether just because it’s been annoyingly oversimplified by the Paleo community. Simplifying it too far in the other direction (“It doesn’t exist!”) is just as troubling. I mean, look at where other extreme claims have gotten us — e.g., demonizing carbohydrates.
I think the term “adrenal fatigue” is thrown around broadly and people don’t have a true grasp on the condition. It’s much more complicated than your adrenals “pooping out” or “being shot.” My understanding of it is a systematic dysfunction, which many people (such as Chris Kresser) refer to as HPA (hypothalamus, pituitary, adrenal) axis dysregulation. It’s MORE than just the adrenals, but unfortunately, the name “adrenal fatigue” makes people think it’s ALL about the adrenals. I am currently working with a functional medicine specialist for stage II adrenal fatigue, and he takes into account everything you list under “Alternative Causes for Adrenal Fatigue Syndrome.” Why? Because all of those things can get janky when the HPA axis is out of whack. They’re not all alternative causes; many of these can be part of the systemic issue.
Demonizing carbohydrates hasn’t done anything. It’s the ignorance that people have about what a carbohydrate is and how much they are needed, and how little they understand fat metabolism that is actually getting us into trouble.
I’m tired of people saying it’s “cutting out all carbohydrates” when you eschew grains and starches but still eat veggies. Veggies are carbs!
I’m tired of people complaining they “need” starch to function in athletics when they never took the time to get fat-adapted!
There’s lots of science pointing to the fact that carb is the least necessary micronutrient to eat (you pretty much only NEED it if you’re type 1 diabetic, and then only sometimes) and causes the most physical damage in anyone but people with kidney disease, who also need to watch their protein. But oh let’s call it demonization. Science is superstition now. Nice.
Carbohydrates are macronutrients, not micronutrients.
For more information on carbohydrates and health (especially female health), see here: https://www.healthtoempower.com/carbohydrates-for-fertility-and-health/
There is not a black-and-white way to eat for anybody.
Dana if you think needing starch to function in athletics is bogus then you’re probably not much of an athlete or only doing non-glycolytic sports. I finally got tired of people always telling me my problem was that I just wasn’t fat adapted even though I always felt terrible no matter how hard I tried and accepted that carbs are pretty helpful. Anti-carb folks have this religious conviction they call “science” but then don’t have a good explanation for why most of the actual scientists don’t agree with them…
Hi, Really enjoyed your post. Thanks for the thoughtful questions.
I’m not sure how to send you a private email, and I really would like to recommend an article (which you have probably already seen, but here it is anyway): Great! Another Thing to Hate About Ourselves | The New York Times by Jennifer Weiner.
I apologise if I am being pushy here (and please feel free to ignore my comment), but I would be very interested to hear your thoughts on the topic. I am unaware whether there is research out there about the ‘necessity’ and or health benefits of pubic hair, and would be good to hear a ‘primal’ perspective. Many thanks.
Oh yeah I’ve already read it. I dont’ think there’s any sort of health risk with removing pubic hair (beyond the standard in-grown hairs and infections if razor burn is bad, etc) – so no worries about that. Whatever you do beyond that is your choice – not an easy one to make, regarding the pressures to conform to certain standards and desire to please partners, etc – so I really have no judgments or recommendations to make on the matter
Regardless of what term you want to use for it, I can personally attest that adrenal fatigue/dysfunction absolutely does exist, can be measured effectively with 12 hour cortisol saliva testing and can be effectively treated. After being diagnosed with leaky gut 5 years ago my saliva cortisol levels were at all the wrong points. With adrenal supplements and gut healing my levels continue to be in range and all symptoms are gone. I’ve recommended this same testing to many people suffering the same conditions with the same results. It’s very hard for people to find information on this adrenal condition regardless of what you would like to name it but it absolutely should not be dismissed. You may want to work with doctors/labs who practice the saliva tests and treatments and get more information around this.
I think a number of people have missed the point. Stefani isn’t arguing semantics. Adrenal Fatigue isn’t described as a syndrome as some suggest it is said to occur from an identifiable cause ie the adrenals have been overused and hence stopped producing cortisol effectively. As Stefani states there is absolutely no evidence for this mechanism of action. I think the points Stefani makes are spot on, the problem is very real, the symptoms are very real, the suffering is very real but the biology/physiology etc behind these symptoms isn’t adrenal fatigue. It may be a functional problem with the adrenal glands in the same way that IBS is a functional problem with the digestive tract and fibromyalgia is a functional problem with the autonomic nervous system (nervous system is stuck in fight or flight mode) or it may be a combination of other health concerns that are not being addressed because a person is too busy insisting they have adrenal fatigue. There is also another damaging side to insisting that you have adrenal fatigue especially with a conventional doctor. They know that science does not demonstrate adrenal fatigue and therefor will simply dismiss you as being irrational and once that happens you’ve lost the battle. Work with your conventional doctor to rule out the diseases/syndromes etc that conventional medicine is able to identify and treat and work with your natural medical practitioner to address nutrition/stress management and everything else that will need to be addressed in order to support healing. That way you give yourself the best possible chance of overcoming what ever is causing the horrible effects.
THANK YOU!
Good points, but most articles proclaiming that adrenal fatigue doesn’t exist invalidate people’s authentic experiences and put them down for being weak of character or hypochondriacs. I certainly don’t think Stefani is doing this, but there is a prior history of this attitude in the medical field. Not many people read 100% of every article they look at, so a quick perusal would have you thinking she shared the sentiment.
Thank you! As a NP and someone who has gone through a barrage of repetitive saliva tests, blood tests, and head MRI’s, to be diagnosed with secondary Adrenal Insufficiency by a board-certified endocrinologist at a world-renowned hospital, I am SICK of hearing about adrenal fatigue. I can treat my body as wonderfully, healthfully, and as well as I possibly can. I can feed myself herbs, do yoga, avoid caffeine, sugar, pollution, noise, and late bedtimes, but I STILL need prednisone every single day. And I always will. Or I will die. I absolutely agree with you that myriad things can and do cause the symptoms of “adrenal fatigue”. And I agree that your hypothesis that something is improperly functioning has weight to it. There is a lot we have yet to discover about the body. But I DO NOT believe that our adrenals get tired and thus stop working. There is absolutely zero evidence to support this, it makes zero sense from a bio-chemical standpoint, and I think your heart analogy is perfect. Thanks again for posting this.
The problem with this article is that it is approaching a Naturopathic syndrome, Allopathically. These are different healing philosophies. The problem with approaching this topic this way is that in Natupropathic Philosophy there is only 1 disease and 1 cause of disease. (Allopathy has 30,000 diseases and that grows annually when they update their PDR.) So by definition the article is correct that the DISEASE of Adrenal Fatigue does not exist. However, the SYMPTOM PICTURE a.k.a. a syndrome that is called Adrenal Fatigue sure does! I have worked with MD’s & DO’s and although they will not diagnose a case of sub-clinical hypoadrenia, they are always surprised when that patient with a case of Chronic Fatigue or that “irreversible” hypothyroidism returns to their practice with their symptoms reversed. The problem is that people fail to treat the whole person and instead look to palliate the symptoms. Focus on building health through detoxification (fasting), reducing stress, and correcting malabsorption of minerals and the symptom picture resolves.
“No problem can be solved from the same level of consciousness that created it.” – Albert Einstein
You are not the first clueless health blogger to posit that Adrenal Fatigue is not real. (See: the genius of Kaleo). But as someone with severely dis-regulated cortisol (as evidenced by a salvia cortisol test), I will tell you AF is VERY REAL. Your article is helpful to YOU in that using the term “Adrenal Fatigue” in the title of a post brings you lots of traffic. But it is EXTREMELY harmful to those of us suffering with an invisible illness for you to try to de-legitimize the problem. People can bicker whether it’s a signaling problem with the HPA Axis or the adrenals themselves that are damaged, but the cause doesn’t make the suffering any less real, or any less related to the adrenal glands, which produce the cortisol!
I beg of you, stick to what you know (acne, body image), and leave the pontificating about Adrenal Fatigue to those who are actually knowledgable on subject. I pray that you and others like you who feel the need to weigh in on the subject you know nothing about never actually have to experience the suffering of dis-regulated cortisol yourself.
I’m sure that since you read the article, you see that I acknowledge that adrenal dysregulation exists, and I even offer several explanations for why I believe that happens. But I do not believe adrenal fatigue is the right way to label or to think or talk about it, since there is no biochemical evidence so far as I can tell that the adrenal gland itself actually slows down after working too hard.
You believe that Adrenal dis-regulation exists, but not Adrenal Fatigue? You don’t seem to appreciate how hard it is already to be suffering from an illness that many in the mainstream medical community dismisses as imaginary. Perhaps you could follow the example of others in a the Paleo community who work to be helpful to those suffering with this illness (e.g., Diane Sanfillippo, Chris Kresser, Robb Wolf), rather then writing an article designed to generate traffic and teach nothing.
Comparing AF to being “really wiped out,” is really a slap in the face to those of us who’ve had to file for disability and/or are bedridden from having dis-regulated cortisol.
Can you imagine titling an article “Why Multiple Sclerosis Doesn’t Exist?” if you disagreed with the precise language used in the disease’s name? No, I didn’t think so.
On behalf of lots of us suffering with AF, please reconsider your title, if not the entire article.
Thanks for the article!
Just wondering at what times of the day do you usually take your zinc, stress b-complex and vitamin c?
I just bought those.
Disclaimer: this is out of curiosity, I am not looking for medical advice or anything similar! 🙂
Thank you xo
I agree with Anne- this is not a helpful post, and as far as I can see you are not even qualified to write such a post, so this article completely lacks credibility. Yes you have done research into your own PCOS, as I have spent years trying to figure out what was ‘wrong’ with me, so I began studying Naturopathic nutrition (now about to begin my final year) and have gone down many different paths to get where I am now- I can assure you adrenal fatigue does exist- as you are not any kind of practitioner, you would not have come across the salivary cortisol test? I had four ‘low’ readings indicating hypo cortisol which therefore explains my chronic fatigue- at last, I can begin to get well by taking the relevant nutrients and working on lifestyle factors to reduce/manage stressful situations. It’s certainly not helpful for writers like you with your unqualified opinions and little understanding of a condition (often misdiagnosed) that affects thousands of people… Who are, just like you were trying to find answers for your own health, endeavouring to get themselves to a place of wellness.
Stephanie,
I agree with the content of the article, but the title seems a bit callously worded. I won’t harp about it because there are plenty of other comments to that effect.
The reason I’m commenting is that I was having the same problem as you believing the usual explanation of adrenal fatigue— the adrenal glands get “tired” or excessive stress “wears the adrenals out.” I certainly believe that something can go wrong functionally with the adrenals and the HPA axis as a whole. I have very low cortisol levels myself, to the point where I’m bedridden for most of the day, but ever since being diagnosed with adrenal fatigue I’ve been hesitant to use that term. I usually tell people that I have very low hormone levels or that my hormones are messed up because I can’t justify using the term adrenal fatigue when I don’t think that my adrenals are “fatigued.”
Before I even saw this article I researched how the body produces cortisol, because I’m a nerd, and the key nutrients seem to be cholesterol, Acetyl coenzyme A, and vitamin B5. I came to the conclusion that the mechanism that causes low cortisol levels after a long period of stress is that there are not enough nutrients to continue making cortisol at the high level that the stressed out HPA axis demands. If the adrenal glands don’t have access to all of the nutrients they need to make cortisol, they will not be able to make as much cortisol as the body needs, and levels will begin to fall and continue to fall as long as stress levels are high and nutrient levels are inadequate. This explanation, while not rigorously scientific, jives with my experience. I ate a nutrient-poor diet before going paleo, and I think the lack of access to necessary nutrients and chronic stress together caused my cortisol levels to decrease.
Thank you for raising this point, that we in the paleo community should not settle on using a term for a syndrome that inaccurately describes the underlying cause of that syndrome and causes a collective eye roll from physicians and endocrinologists everywhere. Perhaps it would be better to use the term HPA axis dysfunction. I was hoping that Dr. Sarah Ballantyne would make a post about this very topic, where she explains the underlying cause of adrenal fatigue in explicit and scientific detail. She hasn’t blogged about it yet (she’s probably waiting for the research), but in the meantime I’m glad you’ve written this post.
Potentially damaging and upsetting article for believers and those battling what ever it is going on in their bodies. The evidence is in the testing. I have the test rests to show my adrenals struggle to function correctly.
Stands to reason a medical doctor and physical therapist say it bogus! And that’s what we are up against all the time! I’m a nurse but believe it to be true. Ibs, CFs and fybromyaligia were also thought to be bogus diagnosis which left hundreds of people if not thousands struggling to cope with no way of knowing the way forward.
There is a massive amount of evidence for AF. And like the other lady says. Stick to what you do know, not what you speculate on.
This article is the most disgraceful and dangerous article I have ever come across on the Internet. This is my first comment on any site it is just so arrogant and upsetting and is obviously just click bait with it’s title. Some people have ridiciculously low levels of cortisol bordering on Addison’s disease. It is indeed very real and very harmful symptoms if not treated properly by a health professional. .”Adrenal Fatigue” You have chosen semantically to see label as saying the adrenal are fatigued, which could be silly if read it that way. You could just as easy read it as meaning the PERSON is fatigued and its causes are related to adrenal dysfunction of some sort. As you say this adrenal dysfunction is indeed very complex in it’s root causes, but who is saying they’re not? You seriously need to do some scientific research on low cortisol before you write such a harmful article, as Anita above writes there is plentiful scientific evidence. It may not be the best term but it’s a popular one. Adrenal insufficiency is probably better but not used as widely used. The terminology problem has been by people like yourself clumping together other all unidentified fatigue based problems as being the same as people with scientifically tested low cortisol levels( true adrenal fatigue/adrenal insufficiency)
This article is a disservice to women.
Adrenal Fatigue is REAL – Often caused by Birth Control – Copper IUD. Copper Toxicity and heavy metal overload is one of the most common causes of adrenal fatigue.
Because the medical community is ignorant and for profit (in the USA), they would rather hand a woman anti depressant pharmaceuticals rather than heal adrenal glands.
I am an athletic woman and suffered greatly from copper toxicity caused by an IUD which compromised my adrenal glands. It’s been 2 years and I am getting better.
Women deserve advocates, not 1940’s doctor rhetoric ‘its all your imagination’!
Sorry for chiming in so late on this, but there is much more than semantics involved and even much more than is eluded to in the original article related to the oversimplification of stress-related phenomena when it is labeled (incorrectly) as adrenal fatigue. It matters because other (real) things are occurring- usually in the brain, to alter the stress-response. We have posted a few blogs on this topic recently (also about the false idea of pregnenolone steal- purported to explain why cortisol causes DHEA to drop), and have recently even published a book to help clinicians understand the complexities of the stress-response.
Clinically, it can be important to understand that down-regulation of the stress-response may be a protective mechanism against chronically high levels of cortisol and re-adapting the body by addressing the root causes of stress (in the hypothalamus) is a critical first step. It is true that some supplements (vitamins, minerals, herbs, or even DHEA) can help, but these are almost always working in the brain or other target tissue and have limited direct “adrenal” support. When we oversimplify something as complex as the HPA axis/Stress response by using “Adrenal Fatigue” we miss both the root causes and the potential solutions for long-term healing. Thanks for opening the topic in the first place- brave!
For a look at our take on this topic: http://www.pointinstitute.org/is-it-really-adrenal-fatigue-or-hpa-axis-dysfunction/
I think that is fine in saying a better term is needed and such terms should in fact be promoted more widely so that conditions such hpa axis dysfunction and true adrenal insufficiency are not ignored and misunderstood. But the fact is at the moment in history they are ignored and misunderstood. You like the term adrenal dysfunction better than adrenal fatigue, awesome, use that as your title. You want people to get more clearer about it’s causes , that is fantastic, use that in the headline somehow.. But to say adrenal fatigue doesn’t exist as a headline when another more suitable term is simply Not universally accepted as yet, is counterproductive to increasing western medicine’s understanding and interest in hpa dysfunction and how it may happen. Surely you would want to increase people’s understanding and interest not encourage them to be dismissive of It. Your title cruelly promotes the idea that adrenal dysfunction, a term and conditon you accept as being real and true as also not existing, because in reality the average doctor/ reader has not yet become familiar with your accepted term at this point in time, they just read ‘adrenal’and ‘doesn’t exist’ together.. So sad that someone who has made a career in supposedly being interested in people’s health so willingly turns to sensationalist headlines instead of positively promoting an area that desparately needs better investigation. Words are powerful use them with integrity and responsibility if you are truly interested in improving the health of your fellow humans. Rather than dangerously putting words “doesn’t exist” into the public arena, when adrenal functioning is already so misunderstood!
Sometimes the adrenals give too much cortisol and adrenaline and cause problems and dysfunction also. After my second daughter was born, I was flooded with adrenaline and couldn’t sleep for several days and nights. I have struggled with insomnia since her birth (7 years ago) and I have learned a lot on how to manage this excessive and sensitive stress response. I’ve learned to cycle my cortisol–if I feel stress, get rid of it through movement. I do best when I’m exercising nearly every day as I feel my body needs it and refueling with nutrient dense foods and many of the supplements you listed above. When I was in the depths of this illness, I truly felt like I was losing my mind with a newborn baby and I was told it was “just postpartum depression”. I cried with relief when I found out there was such a thing as adrenal fatigue and it wasn’t all in my head. I like the term adrenal dysfunction rather adrenal fatigue but it certainly is real and life altering. Thank you for continuing to discuss this topic as it does effect many women.
I just had to reply to your comment. I had EXACTLY the same thing when I gave birth 11 months ago. Thought I would end up getting sectioned! Much better now but still have trouble sleeping sometimes, agree that exercise is a huge part of feeling better.
I just feel bad for everyone out there who has fallen for this and is spending money on treatments that don’t work because it’s not a real disease. I’m a licensed mental health counselor and can tell you that in many cases it’s a combination of mental health issues and physical issues. But mostly, it’s depression and anxiety.
Lol!
I feel that although there are many good points in this article, it overall does a disservice, because it basically invalidates the enormous suffering of many people based on semantics. It’s a shame that people have used the story of the adrenal glands getting tired out, but this is why it’s more correct to say HPA axis dysfunction, which does indeed exist. It’s odd to me that you wrote another article all about HPA axis dysfunction in 2012, so you do agree that it exists. Instead of saying adrenal fatigue doesn’t exist, it would have been more helpful to suggest simply that people use the correct term. Many respectable paleo experts, such as Robb Wolfe and Chris Kresser refer to “adrenal fatigue,” simply because that’s what people are familiar with. They know the adrenal glands aren’t getting tired out, and they take the time to explain that.
I have been dealing with “adrenal fatigue” or HPA axis dysfunction for much of my life. It is exacerbated or improved by diet, lifestyle, and thyroid status, but it is a frailty that will probably always exist in me. I have had help from many doctors and done countless lab tests (most including 4 saliva samples a day). Cortisol is always wonky with me, no matter what. It’s just a matter of degree. Yes, stress-reduction and eating well helps, but it is much more of a serious and tenacious condition than that for many people. I am convinced there is a genetic component, and it is also tied in with thyroid disease in many cases. Some people live highly active lives that most people would find enormously stressful, yet they never experience the symptoms of HPA dysfunction. The only way for me to be well all the time would be to live on an organic farm in the wilderness with no electricity. Personally I would like to accomplish some things in life that require that I not withdraw from society, so it’s going to be an ongoing challenge.
By the way, I am pretty sure that the term “Adrenal Fatigue” never meant to imply that the adrenals were fatigued. The condition is one of fatigue, and the specific nature of this fatigue is adrenal. I suspect this is where the confusion started.
Michelle said, “Your adrenal glands don’t ever STOP working, and anyone who thinks they do simply doesn’t understand how they or the body work (which is ok – it’s complicated!”
Yes Michelle, it is complicated, and you might want to research Addison’s disease before you put it out there that you Know how the adrenals and body work. I have Addison’s disease, and my adrenal glands do not work..period. They have stopped working. I have to take steroids every day to keep me alive because my adrenals don’t work. I don’t know if adrenal fatigue is real or not. I lean toward not. I do know that it makes me angry that the term is thrown around so much. It also makes me mad when it is compared with Adsison’s and people confuse my adrenal insufficiency with adrenal fatigue. i know what I have is real and life threatening. Heck…I wish I had adrenal fatigue. It also Really makes me mad reading someone classifying it as an “invisible illness”. Addison’s is an invisible illness. I don’t feel that AF deserves that title. So while you treat your AF with herbs, minerals, vitamins, yoga, and a healthy diet, I will continue to take my 7 pills a day with terrible side effects that keep me alive while I still feel terrible and can’t hardly get out of bed every day. I have been in adrenal crisis numerous times and almost died twice. I’m sorry, but I just feel like telling people who claim to have AF to quit whining!
“If you have a hypothesis, it’s your job to back it up. I just don’t see it happening with adrenal fatigue.”
And since the medical field refuses to recognize adrenal fatigue, they refuse to test for it — and so, *OF COURSE* they have never found it! There has been no medical testing/results/determination whether or not “it exists.” Just like the 9/11 Commission determined beforehand that there were no explosions and therefore they had no reason whatsoever to look for or test or consider the possibility of explosives, and therefore they FOUND NO PROOF! Well, DUH!) If “investigators” decide, a priori, that a thing does not exist, then they do not look for it or test for it, and (duh) they do not FIND it! (Sheesh!)
Your “research” into alllll the standard medical field(s) resulted in not finding anyone who l00ked for adrenal fatigue, and therefore you conclude that it doesn’t exist? The absence of evidence s NOT evidence of absence!
IF treating a person who matches all the ‘adrenal fatigue’ symptoms (with the “anecdotally” worked out things that work for others, since the medical field refuses to actually DO the clinical testing) RESULTS in that person (those people) getting WAY better — then are you going to join the herd insisting that it was: “all in their minds; here have an antidepressant”?!
“Glands in the body don’t “get tired.”” Pancreas? Thyroid? Ovaries? Hello?! If you do not like the word “tired” — which is certainly a great accurate description, even if not a medical diagnosis — then maybe get some research going, and find a better word/word you like for the actual real physiological effects people have — and then recover from when treated — according to the anecdotal experience of thousands of people who HAVE dealt with ‘adrenal fatigue.’
“then cortisol, and maybe even adrenaline will be produced in higher and higher amounts ” — and this relates to LOW cortisol just how?
“The adrenal glands will not work if the tools it needs to get the job done are not available.” Wait wait! YOu JUST wrote a few paras above that:
And in the comments you actually write:
“But I do not believe adrenal fatigue is the right way to label or to think or talk about it, since there is no biochemical evidence so far as I can tell that the adrenal gland itself actually slows down after working too hard.”
So, this whole post, denigrating MANY people’s experiences, telling them they are fools for describing their collection of horrible symptoms with a useful and descriptively if not medically accurate term, is just you objecting to the term? You headline is absolute link bait; followed by negative comments about what people feel and invalidating their experiences and descriptions is just you trying to get people to use a term you prefer? And then, way down in the comments, you finally ‘fess up to: “I don’t like the term y’all are using.” Way to be supportive. NOT!
This is sad to me – I have been suffering from adrenal fatigue for two years after a major major burn out from many factors. It nearly killed me. And my doctor and many others, diagnosed me with adrenal fatigue. My body does not have the ability to handle stress on any level without ring hospitalized. After living 26 years as an avid body builder and rock climber. I can’t even do a yoga class without a major system failure, measurable on paper.
I’m sorry, but this article is just vastly misinformed and it’s unfortunate to those who are actually suffering from it.
What an insulting, useless, and contradictory article…
States that “adrenal fatigue doesn’t exist,” then that it’s probably due to insufficient adrenal support and that “the adrenal glands will not work if the tools it needs to get the job done are not available”.
Yeah sunshine, that’s the definition of adrenal fatigue.
Maybe I’ll write an article about how diabetes doesn’t exist, and what people are really dealing with is an inability to produce insulin.
My Doctor is leading me down this adrenal fatigue path. But it doesn’t explain how I went from being able to exercise at a high level, to having myoclonic seizures all day long. I had a quite a bit of stress in my past but I resolved issues, and went through intense counseling, and became more spiritual and that worked. I’m stressed more NOW than I was before because I can’t work in my current condition. I think since insurance companies don’t want to pay to test for rare treatable conditions, doctors want to blame everything on stress. Or pharmaceutical companies have remedies for problems but not enough people have the problem so they can’t make money. All these “other” theories sound like ways for people and doctors to sell books. I pray I’m wrong but so far it all seems like money rules health care. A response is appreciated. 🙂
I would personally keep investigating. Stress can have real and powerful effects on our health, but we can also have health conditions that shouldn’t go ignored. I would only believe the stress hypothesis if 1) there seemed to be a significant amount of stress, 2) i had ruled out all other options, or 3) medical testing of some sort supported the stress hypothesis. Otherwise I would keep looking for other potential causes from the seizures
I hope this helps, at least some <3
So you post an article with an inflammatory title, without justifying it? Ok, here’s a comment with actual justification: PaleoForWomen.com is a site whose owners cannot even read real studies on Pub Med regarding Adrenal Fatigue and hypothalamus pituitary adrenal disfunction. There are links to such studies at the end of my comment.
And if PaleoForWomen hid some “gotcha, we really didn’t mean it” text somewhere in this “article”? Well, then you deserve to have to screen more comments. Try not using titles that are either incorrect or don’t fit your article.
https://www.ncbi.nlm.nih.gov/pubmed/26311923
https://www.ncbi.nlm.nih.gov/pubmed/19594222
https://europa.unibas.ch/fileadmin/psycho/redaktion/Abteilungen/Klinische_Psychologie_und_Psychotherapie/Gaab_et_al.__2002_PSM_DEX.pdf