The Enigma of Adrenal Fatigue and Chronic Stress

In our age of burnout, a controversial diagnosis might offer an avenue to recovery

Our bodies are designed to recover from occasional bouts of stress, but when we go too hard for too long, we eventually break down. Yuris Alhumaydy/Unsplash

Do you have more stress than energy? Are you dragging all day, yet can’t fall asleep at night? Do you depend on stimulants to make it through life? Then you may be suffering from adrenal fatigue.

Adrenal fatigue is a new name for a very old diagnosis. It’s the idea that too much stress and not enough rest wears us down, accelerating the aging process, and draining us of the energy we once relied upon to get things done.

Adrenal fatigue covers a wide range of symptoms, such as weakness, fat accumulation, exhaustion, insomnia, inflammation, you name it. Virtually every system in the body can be impacted by this condition, but at the root are the adrenal glands—two small organs that sit atop each kidney.

Adrenal glands function like the body’s battery, pumping out stress hormones that get you revved up and focused to meet daily challenges. When you face imminent danger or some other high-stress situation, this battery switches into high gear, resulting in a fight-or-flight response.

Over Activated

Our resilient bodies are designed to react and recover from occasional bouts of stress, but when we go too hard for too long, we eventually break down. The theory behind adrenal fatigue is that our battery starts to lose power, triggering malfunction and fatigue.

Chinese medicine, Ayurveda, and other ancient healing traditions describe patterns very similar to adrenal fatigue, but this theory is extremely controversial in modern medicine. Conventional physicians say the condition doesn’t actually exist at all. A 2016 systematic review published in the British Medical Journal finds no hard evidence for adrenal fatigue. The review cites a “poor quality assessment of fatigue,” and “the use of an unsubstantiated methodology” as proof that the condition is a myth.

The only official diagnoses regarding adrenal health are rare examples of extreme underproduction and overproduction of hormones. However, for those who support the adrenal fatigue theory, the vast majority of adrenal malfunction goes largely unrecognized. A growing number of doctors believe that, in our high-stress modern world, adrenal fatigue has become so common that it amounts to a hidden epidemic.

If there really are widespread cases of adrenal fatigue, it wouldn’t be the first time conventional medicine dismissed a real problem. Back in the 1990s, fibromyalgia and chronic fatigue syndrome were both thought to be nothing more than psychosomatic symptoms of otherwise healthy patients. However, with enough patient complaints and doctors willing to consider the evidence, both ailments have gained much more credibility.

Underestimated

So how can some doctors see a problem that most don’t? According to Dr. Nisha Jackson, a specialist in gynecology and functional medicine in Medford, Oregon, the conventional medicine paradigm doesn’t acknowledge adrenal fatigue because it lacks the perspective, tools, and treatment model necessary to address such a complex condition.

“Medicine today likes to treat people as efficiently as possible because that’s what it’s forced to do, and it has to treat it with medication,” Jackson said. “Adrenal fatigue is more about a lifestyle that you have to change, and I think that is just not something that is talked about in the medical office.”

Even if doctors don’t recognize adrenal fatigue, they certainly encounter its symptoms. As much as 90 percent of doctor visits are related to stress. These visits typically translate into prescriptions for anxiety, insomnia, depression, or some other problem that can be identified and paired with a drug in under 10 minutes.

But Jackson believes taking a deeper, more holistic view of a patient, where such symptoms can be linked to the same underlying cause, will result in a more meaningful solution.

“When you’re under-producing cortisol, and this is a very simplistic way of explaining it, but you don’t have it what it takes to get through your day,” Jackson said. “You don’t have what it takes to manage stress. You start having anxiety attacks, you’re not stable emotionally, and the worst thing is you’re exhausted. When you’re exhausted, you start eating things you don’t normally eat because you’re depressed.”

Rarely Tested

One huge reason doctors don’t see evidence for chronically underperforming adrenals is that they rarely, if ever, test for it. For doctors that do, it’s a different story. Jackson’s medical practices see thousands of patients a month, and most test positive for adrenal insufficiency.

Jackson’s perspective may be unconventional, but it comes from almost 30 years practicing medicine. When she was an OB-GYN nurse practitioner, she saw women who suffered the symptoms that she would later understand as adrenal fatigue. These patients didn’t see any relief from conventional treatment options, so Jackson began looking for answers elsewhere: acupuncture, mind-body therapies, herbs, and other nonstandard forms of medicine.

Jackson also gained valuable insights through her own experience with stress. A self-described workaholic trying to both start her own practice and raise a family, Jackson says her insatiable drive and not taking enough care of her own health eventually burned her out.

In her new book, “Brilliant Burnout,” Jackson describes how she got her energy back and how she has helped many of her patients recover, too.

The book is primarily aimed at women, but Jackson says that overstressed men can be just as susceptible to this condition, resulting in symptoms such as hair loss, belly fat, and low sex drive.

“The men that we see in our medical practices are very sick. They feel terrible. They feel depressed. They’ve lost a lot of their enthusiasm for life. Their testosterone levels are in the tank,” she said. “All of a sudden we’re seeing 30-year-old men with 80-year-old testosterone levels. That’s directly related to the adrenals. There’s no other explanation for it.”

Adrenal Effects

It’s called adrenal fatigue, but the condition can cause hormonal havoc throughout the body. Thyroid and sex hormones are often impacted, as well neurochemistry, leading to even more symptoms, and leaving you even more stressed out.

The condition doesn’t hit everyone the same way. Some people seem to be able to run on overdrive for years without any visible consequences, while others may see a decline following a few episodes of emotional upheaval that push them over the edge.

But no matter how much stress we can tolerate, Jackson believes everybody has a breaking point—a level of stress where the adrenal glands are forced to reduce hormone production in an act of self-preservation.

“At some point, their adrenal glands are going to say, ‘We can’t do this anymore. We can’t keep up with you. So in order for us to go into preservation mode, we are now going to underproduce cortisol,”’ she said.

Reenergized

Doctors who specialize in treating adrenal insufficiency say it’s rarely an easy fix. And the more severe the case, the longer it can take to fix it. This isn’t the kind of condition where one pill makes everything better. Lots of issues often have to be addressed over a period of time in order to turn the situation around.

When people read about adrenal fatigue online, they’re often tempted to tackle the problem by supplementing with the hormones they believe they lack. But this strategy runs a real risk of harm, and may even make for worse problems.

Jackson does prescribe bio-identical hormones made from yams with dosages based on regular blood serum tests. But she says the most important and profound recovery comes from patients learning how to manage the stress that got them sick in the first place, and by learning how to care for their body so it can better handle the stress they must face.

“Sometimes your hormone levels just rebalance themselves once you start changing your lifestyle habits,” she said.

Ideally, people who suffer from adrenal fatigue need to cut back on their hectic schedules, but that’s not always realistic when there are bills to pay and obligations to meet. However, Jackson said if you can focus on the basics of good health—sleep, diet, and reducing emotional distress—your body will be able to handle your must-do list much easier.

Sleep

At the top of the adrenal recovery program list is sleep. No matter how busy our lives become, we can’t replenish our energy without a good rest.

It’s important to make time for bed, but what if we still can’t sleep once we get there? Jackson says this likely due to a backward cortisol rhythm.

Ideally, adrenals produce the most cortisol during the day to give us energy, stamina, and focus so we can deal with the stress that comes our way. Cortisol is supposed to drop at night so we can fall asleep and sleep deeply. But Jackson says that, for many, this rhythm is flipped.

“You will be exhausted during the day, but wired and tired at night,” she said. “It’s a huge problem.”

This flipped rhythm comes as a result of years of routinely pushing yourself when your body is begging for rest. Yet instead of slowing down, many of us reach for stimulants to get us through the day, eking out a little more energy that our adrenals don’t naturally want to give.

When we finally give our exhausted adrenals a break at the end of the day, they get a chance to recover, so they switch on again right before bed—at exactly the wrong time for sleep.

One supplement Jackson uses to help with a flipped cortisol rhythm is phosphorylated serine. When taken before bed, this safe amino acid helps lower cortisol levels so your brain can power down and allow you to sleep.

One thing to avoid is drinking alcohol before bed. It may help knock you out, but alcohol actually creates more sleep problems by interfering with restorative rest.

Diet

Food is the second major factor when it comes to our energy level. And if we’re dragging through our days, we often look to sugar for energy. However, a high sugar diet actually costs us energy in the long term.

Jackson says the key to adrenal recovery is to keep glucose levels steady. Eat regularly, mostly vegetables, protein, and good healthy fats like nuts and seeds. Weed out the sugar and simple carbs.

“Protein is the nutrient that helps stabilize your blood sugar longer, and that’s probably the most important thing in adrenal fatigue,” Jackson said. “Big peaks and troughs in your glucose levels is a disaster because it calls for more cortisol to be made to help you deal with the blood sugar imbalance.”

Another important nutrient to make sure you’re getting enough of is vitamin C—a substance vital for making cortisol.

Mental Downtime

Our body needs mental rest just as much as physical rest. Jackson recommends adopting a meditation practice, but if this seems daunting, just find a quiet space (even if you have to go into the restroom), and concentrate on your breath and releasing your anxiety and worry. Instead of always scrolling through your phone when you take a break, develop a habit of giving your overfilled brain a moment of clarity.

Exercise

Rather than depending on stimulants for energy, try exercise. It may sound counterintuitive, but not working out can cause fatigue. Exercise is one of the best ways to help your body better adapt to stress. It increases oxygen flow to your brain and muscles to help sustain your energy throughout the day.

Adaptogen Herbs

In ancient times, doctors treated symptoms like weakness, premature aging, and fatigue with herbs. These same herbs today are used to treat adrenal fatigue. They are known as adaptogens because they help the body better adapt to stress. They help elevate or lower your hormones according to your own individual needs. Some of the best adaptogens for adrenal fatigue include Korean ginseng and ashwagandha.

Boundaries

Another important aspect of recovery is learning to say “no.” Avoid people who drain your energy. And don’t agree to things you don’t have the energy to do.

“I’m constantly weeding people out who drag on my energy,” Jackson said. “While that sounds kind of harsh, it’s a very important thing to do, because there is only so much energy that you can emit in one day.”

Of course, better management of relationships has the potential to resolve some of these problems without attrition.

Avoid Relapse

The recovery plan for adrenal fatigue really just boils down to the same factors that have always been at the heart of a healthy life: adequate rest, a good diet, and a calm mind.

However, once you feel better, it’s tempting to return to your old ways. When we get our energy back, the to-do list starts to grow again, and we forget about maintaining the basics of good health and self-care. Soon, we end up right back where we started.

Jackson says relapse is very common, so she encourages her patients to take note when they feel their best, and remember what it took to get there.

“I’ve learned that I have to do the basic things every day or I’m not going to be able to do what I really want to do in life,” she said. “I love being plugged in. I love helping people. And I know that if I’m not doing those basic things I’m going to hit the wall at some point.”