Katherine Chubinskaya, MD
Luciano Kolodny, MD
Jason Wexler, MD
Carol Zapalowski, MD, PhD
What is “adrenal fatigue”?
The term “adrenal fatigue” has been used to explain a group of symptoms that are said to occur in people who are under long-term mental, emotional, or physical stress. Supporters of adrenal fatigue say that you may be more likely to develop this condition if, for example, you have a stressful job; are a shift worker, working student, or single parent; or if you abuse alcohol or drugs.
Symptoms said to be due to adrenal fatigue include tiredness, trouble falling asleep at night or waking up in the morning, salt and sugar craving, and needing stimulants like caffeine to get through the day. These symptoms are common and non-specific, meaning they can be found in many diseases. They also can occur as part of a normal, busy life.
No scientific proof exists to support adrenal fatigue as a true medical condition. Doctors are concerned that if you are told you have this condition, the real cause of your symptoms may not be found and treated correctly. Also, treatment for adrenal fatigue may be expensive, since insurance companies are unlikely to cover the costs.
What is the theory behind adrenal fatigue?
Supporters of adrenal fatigue believe the problem begins when many different life stresses become too much for the body to handle. Our adrenal glands—small organs located above the kidneys—usually deal with stress by producing hormones like cortisol. According to the theory of adrenal fatigue, when people are faced with long-term stress, their adrenal glands cannot keep up with the body’s need for these hormones. When this happens, symptoms of “adrenal fatigue” may appear.
What’s the difference between adrenal fatigue and adrenal insufficiency?
While adrenal fatigue is not accepted by most doctors, adrenal insufficiency is a real medical condition that occurs when our adrenal glands cannot produce enough hormones. Adrenal insufficiency is caused by damage to the adrenal glands or a problem with the pituitary gland—a pea-sized gland in the brain that tells the adrenals to produce cortisol.
A person with adrenal insufficiency may be dehydrated, confused, or losing weight. He or she may feel weak, tired, or dizzy, and have low blood pressure. Other symptoms include stomach pain, nausea, vomiting, and diarrhea.
Adrenal insufficiency is diagnosed through blood tests, and can be treated with medications that replace the hormones the adrenals would normally make.
How is adrenal fatigue “diagnosed”?
There is no test that can detect adrenal fatigue. Many times, a person will be told he or she has adrenal fatigue based on symptoms alone. Sometimes, a blood or saliva test may be offered, but tests for adrenal fatigue are not based on scientific facts or supported by good scientific studies, so the results and analysis of these tests may not be correct.
Are treatments for adrenal fatigue helpful or harmful?
Supporters of adrenal fatigue may advise you to improve your lifestyle by giving up smoking, alcohol, and drugs. Starting an exercise program, eating healthy foods, and following a daily routine for sleeping and waking will almost always make you feel better, no matter what the medical diagnosis.
You may also be told to buy special supplements or vitamins. These supplements claim to be made just for adrenal health. While regular vitamins and minerals may be good for your health, doctors are concerned that supplements or vitamins sold as a treatment for adrenal fatigue could hurt you. Many of these supplements have not been tested for safety.
The U.S. Food and Drug Administration (the government agency that oversees most food and medical products) does not oversee nutritional supplements and vitamins. This means there is no guarantee that what's on the label of a supplement is really what's inside the bottle. In some cases, supplements have very few, if any, active ingredients. In other cases, the dose of a particular ingredient may be too high. This is true if you purchase supplements from your local drug store or a specialty pharmacy (sometimes called a compounding pharmacy) where supplements are made directly by the pharmacist.
If you take adrenal hormone supplements when you don’t need them, your adrenal glands may stop working and become unable to make the hormones you need when you are under physical stress. When these supplements are stopped, a person's adrenal glands can remain “asleep” for months. People with this problem may be in danger of developing a life-threatening condition called adrenal crisis.
What should you do if you have been told you have adrenal fatigue?
Doctors urge you not to waste precious time accepting an unproven diagnosis such as “adrenal fatigue” if you feel tired, weak, or depressed. If you have these symptoms, you may have adrenal insufficiency, depression, obstructive sleep apnea, or other health problems. Getting a real diagnosis is very important to help you feel better and overcome your health problem.