There is no such thing as Adrenal Fatigue. Or is there?

According to US News, the complaints “I just don’t feel good” and “I’m tired”  are two of the top reasons that patients see their primary care doctor.  A 2002 study revealed that fatigue was a primary complaint of 25% of patients who saw their doctor.1

It’s hard to quantify but something seems off.  Your gut tells you to get it checked out but you hesitate to make the appointment. You’re getting by, it just takes more effort to do so.  You worry that something may be seriously wrong. 

 

Eventually, you schedule. During the appointment you tell your doctor how you’ve been feeling. The doctor taps away on the laptop as you describe your symptoms. Then she does a quick exam, orders some blood work, says “we’ll let you know” and is off.  She doesn’t seem overly concerned, which provides  little reassurance.  

 

A few days later, the nurse calls and says the doctor reviewed your labs and everything is normal.  She’ll see you next year for your physical.  You politely say thank you and hang up the phone. Whew!  Thank goodness it’s not my heart or cancer.  

 

You feel relief.  

 

Then a few minutes later you think–” if everything is normal, why in the world do I feel so tired?” Of course, you didn’t think to ask the nurse this question. But now after the adrenaline has settled you wonder what the next step is.  Surely something more can be done.  You’ve got a couple of choices:

 

1. You can call the nurse back and ask what to do next
2. You can make another appointment with the same or different doctor asking her to look deeper
3. Or, you can accept that this is the way life is at (INSERT YOUR CURRENT AGE HERE).  Maybe the best years have passed you by.  

 

I know what you’re going through.

 

I saw patients like you every day during my 15 years as a family practice doctor.  I believed you!  I felt for you.  I just didn’t have the tools to help you.  

 

One day, early in my career my sister-in-law asked me what I thought about adrenal fatigue.  I told her flippantly, “In my 11 years of training I’ve never heard of it.  What’s adrenal fatigue?”  Surely, if it was a valid diagnosis, I’d know about it.  She sent me an article to read and when I did, it made perfect sense.  

 

The article pointed out that people are under a tremendous amount of stress and that stress takes a toll on the body. Our bodies were designed to handle intermittent acute stress.  Think: chased by a tiger out in the wilderness and you are trying to survive.  Thankfully,  most of us have never been chased by a tiger.  However, in today’s modern world, we experience a different type of stress.  Chronic stress.  This stress isn’t as intense but it is unremitting.  It’s constant.  Our bodies handle it for a while but eventually, it becomes too much.  

 

I think our ability to handle chronic stress is like a bucket.  Each stressor fills the bucket a little bit.  Unless you are actively doing things to mitigate this stress eventually the bucket overflows and adrenal fatigue results.  

 

What are the stressors? 

 

Well, it really is whatever is stressful for you.  Emotional stress can be as simple as dishes, laundry, dental appointments, and birthday parties.  Or it can be more serious such as death, divorce, discord in relationships, or trauma.  Likely it’s both. Both the little stressors and the big stressors pour into your stress bucket.  The stress bucket is how I like to view all the stress that our body can handle without shifting into survival mode.  It isn’t always the biggest stressor that causes the bucket to spill over.  Sometimes it’s just the next small stressor on top of all the other ones.  In addition to the emotional stress everyone experiences, we are all exposed to hidden stressors which come from our gut and our toxic burden. More on this later.  

 

The article my sister-in-law sent blew my mind.  I had to put my western medical training “we know everything” ego aside. Yes! This is what my patients have.   I have an answer and I can help them. The article concluded by saying the treatment was to decrease stress.  

 

UGH! Easier said than done, right?  I didn’t know how to decrease my own stress let alone how to teach patients to do so in a 15-minute visit.  I looked to the literature to see if there were other ways I could help people with this seemingly common problem.  I couldn’t find anything in the literature about it.  I did find a lot about a rare condition I had learned about in medical school called adrenal insufficiency or Addison’s disease.  According to the NIH, adrenal insufficiency affects between 100-280 per 1 million people.  Super rare.  I was seeing people with fatigue and normal labs all of the time.  I checked them for adrenal insufficiency and found zero cases.  

 

According to Dr. Anat Ben Shiomo at Cedar-Sinai hospital “Adrenal Fatigue is the notion that our adrenal glands get overworked by stress and stop producing the hormones we need, including cortisol. It’s a medical myth.”  

 

So I trusted my training.  For 15 years I told the dozens of patients I saw each week that they were fine.  

 

I had nothing to offer them.  

 

If they insisted on treatment I’d give them Prozac. That’s what the medical literature said to do. 2

According to my conventional training, I was following science and being a good doctor.  

 

Intuitively, they knew we were missing something.  Intuitively, I agreed.  But the system I was trained in didn’t.  A 1990 journal article in the Archives of Internal Medicine also agreed that because of the prevalence of fatigue and the lack of treatment options, there is a need for a search for effective therapy.  3 However 30 years later, I’ve seen no new innovative treatments for this in my conventional training.  

 

Then one day, it happened to me. It was gradual, but I didn’t feel right.  Surely something was off.  Like my patients, I was told my labs were normal and I was fine.  Early in my career, I trusted my conventional medical education thoroughly.  But after a decade in, I was having serious doubts.  

 

What if adrenal fatigue was real? By now I’d seen thousands of patients with these symptoms with nothing to offer them.  They couldn’t possibly all be making it up.  People have better things to do than go to doctors’ appointments and complain about things that aren’t truly affecting their lives.  I began to shift my training from conventional medicine to functional medicine.  Functional medicine does accept adrenal fatigue as a real diagnosis.  Well, to be more accurate it is more appropriately called HPA axis dysfunction, but same thing!  

 

I learned how to diagnose and treat it and began helping 100s of patients live a better life.  I always listened to and believed my patients before, but now I have solutions that actually make a difference.

 

Your body is designed to feel amazing and when it doesn’t there is a reason. 

 

You won’t die from adrenal fatigue but you won’t live your most full abundant life either.  

 

Even though conventional medicine still says there is no such thing as adrenal fatigue. I know differently.  I know because I had it. I fixed it for myself and I now know how to fix it for my patients.  Conventional medicine knows a lot, but it doesn’t know everything. 

 

There is no such thing as adrenal fatigue. Another lie I learned in medical school that I no longer believe. 

 

 

1. Cullen W, Kearney Y, Bury G. Prevalence of fatigue in general practice. Ir J Med Sci 2002; 171:10.
2. Chen MK. The epidemiology of self-perceived fatigue among adults. Prev Med 1986; 15:74.
3. Kroenke K, Arrington ME, Mangelsdorff AD. The prevalence of symptoms in medical outpatients and the adequacy of therapy. Arch Intern Med 1990; 150:1685.