Adrenal Fatigue Myths: Today, we explore the myth of adrenal burnout and how this common diagnosis may actually harm more than it helps. We dive into how the human stress response operates, highlight a more accurate diagnosis of HPA-axis dysfunction, and highlight a few ways to fortify your metabolic reserve and naturally calm down the nervous system.
What is “Adrenal Fatigue”?
Adrenal burnout diagnosis is on the rise, particularly in the realm of functional or holistic medicine. While it may be well-intentioned in principle, the more significant issue is that it is not backed by science, nor does it actually diagnose anything specific. At its core, the adrenal fatigue diagnosis generally implies that the adrenals have become so drained that they cannot produce more cortisol.
The symptoms on which adrenal fatigue is generally being diagnosed include:
- Body aches
- Weight loss
- Weight gain
- Joint pain
- Brain fog
- — and just about every other symptom that you can think of.
The problem with such a massive list of symptoms is that they can describe every disease or illness, but does it have scientific links to the body’s experiences during chronic stress?
Adrenal Fatigue Myths: Can Your Adrenals Really Fatigue?
Undoubtedly, stress plays a significant role in influencing the body, and chronic stress impacts an array of disease models.1 The theory of adrenal fatigue as the root of the symptoms is not based on science. Studies are trying to prove adrenal fatigue is not real.2
The basis of adrenal fatigue is that insulin sensitivity is dulled to the point where people can no longer produce cortisol. The issue is that most people don’t have low cortisol levels. Since lab testing for cortisol levels is quite complicated (factoring things like salivary cortisol vs. blood cortisol and which time of day the tests are done), most of the results aren’t accurate.
During times when tests accurately detect low cortisol levels, it is rarely due to adrenal depletion. The condition that depletes adrenals to the point of low to no cortisol production is called Addison’s disease, which is an autoimmune disease worsened by but not caused by stress.3
Some of the possibilities for low cortisol (without actually having “fatigued adrenals”) include cortisol resistance and downregulation of the HPA axis. The first is a loss of sensitivity to cortisol receptors due to chronically elevated levels.4 The second is a protective mechanism in the brain that occurs due to chronically elevated stress levels. Neither has anything to do with adrenals “burning out.”5
Ancestral Stress-Response and the Modern Dilemma
Two main parts make up the human stress response. The sympathoadrenal medullary system (SAS) is the key player in managing short-term stress, and the hypothalamic-pituitary-adrenal axis (HPA axis) deals with medium to long-term stress.6
The stress response induced by the SAS and the HPA axis is crucial in keeping us alive.
In the fight-or-flight response, for example, our perceived fear is met by a release of stress hormones like cortisol, which promote alertness, strength, and speed. This cortisol release gives the body the energy and reaction time needed to escape a potentially life-threatening situation. The trade-off for the increased heart rate, blood sugar, and blood pressure is that the digestive and reproductive systems take a back seat.7 The body goes into ‘self-preservation mode’ and focuses solely on getting you back to safety, at which time less-important functions like digestion and reproduction can resume.
The problem with the modern western lifestyle is that this ancestral stress response is no longer relevant to how humans perceive and experience stress. Modern lifestyles experience chemical, emotional, and physical stress in ways our ancestors did not. Most of us spend most, if not all, day experiencing one, two, or all three of these types of stress. Whereas our ancestors experienced short bouts of fear, we in modern times tend to spend most of the day in varying degrees of fight or flight.8
Being in a constant fight-or-flight state depletes our metabolic reserve, making us less resilient and more vulnerable to our environment and physiological shortcomings. These two concepts essentially refer to our capacity to withstand short- and long-term stress.
Adrenal Fatigue Myths: Short-Term and Chronic Stress
The body’s resilience is essentially your ability to withstand external stress. Ultimately, your resilience over time depends on how much metabolic reserve you have to back up the ‘withdraws’ you make due to periods of stress. Over time, you become more prone to various diseases and illnesses if you do not replenish and fortify your metabolic reserve.
A depleted metabolic reserve is linked to depression, obesity, PTSD, asthma, eczema, thyroid issues, obsessive-compulsive disorder, and diabetes.9-12
Over time, as we have explored, the body can experience an array of adaptations that can lead to cortisol resistance or downregulation in the HPA axis. Although symptoms can be similar, addressing the situation with this different diagnosis can lead to drastically different solutions.
A More Accurate Diagnosis: HPA Axis Dysfunction
Instead of treating patients for ‘adrenal burnout’ (under the presumption of low cortisol levels caused by chronic stress), a more likely accurate diagnosis would be HPA axis dysfunction. It may seem like a niggly difference (just calling it something else), but the reality is that it leads to a completely different healing method.
There are four leading causes of HPA axis dysfunction:13
Anything that causes inflammation can trigger HPA dysregulation. Some causes include an inflammatory diet, too much (or too little) exercise, parasites, bacterial infections, or an injury.
Stress, be it ‘positive’ or ‘negative,’ can lead to HPA dysfunction when it is chronic and elevated. Although some stress is considered positive, like cold showers, exercise, or sauna– it is compounded by the effects of negative stress, which are highly prevalent in modern times. These negative stressors include chemical stressors (like toxins in body care products or tap water) and emotional stressors from complicated relationships, family, health, job, or financial situations.
Light plays a crucial role in HPA axis health, namely the exposure to natural light and enough of it. Modern lifestyles promote high exposure to artificial light, particularly during times when daylight is no longer available. Not enough natural light interferes with circadian health (your regular ‘sleep-wake’ cycles), which burdens your HPA axis regulation.
High or low blood sugar
How your body responds to sugar in the blood impacts hormone signaling for leptin and insulin, which can play a negative role in HPA axis regulation over time. Keeping blood sugar stable is the key.
Adrenal Fatigue Myths: How to Fortify your Metabolic Reserve
Building up your metabolic reserve, thus making you more resilient to stress, is a lifestyle. Nothing here should be a significant surprise; your metabolic reserve is cultivated over time in every decision you make. Some of the key players include:
- High-quality sleep
- Enough quantity of sleep
- Eating a low-inflammatory diet
- An appropriate amount of exercise (not too much, not too little)
- Avoid exposure to artificial light after sundown
- Get enough exposure to daylight during light hours
- Keep balanced blood sugar levels
- Finding a balance between sympathetic and parasympathetic nervous systems
Ways to Activate the Parasympathetic Nervous System (and Relax!)
Despite not being a real diagnosis of illness, it is clear that mitigating chronic stress is a good thing for promoting health and longevity. Although adrenal fatigue is not a scientifically accurate depiction of what is going on, it should not deter you from managing your stress.
Relaxing deeply, thus activating the parasympathetic nervous system (“rest and digest”), doesn’t have to be complicated. There are various ways to calm your nervous system, but ultimately you will also need to reduce the stressful inputs. Remember: stress comes in chemical, emotional, and physical forms. These include exposure to toxins, being in unhealthy relationships (friends, family, or work), emotional or physical abuse/ trauma, exercising too much or too little, and even transgenerational toxins and trauma.
While working on removing the abundance of stressors from your life, you can also implement various stress-reducing techniques, including:
- Gentle yoga
- Time in nature
- Qi Gong
- Tai Chi
- Walking barefoot in nature
- Breathwork (pranayama)
- Human touch (hugs, massage)
- Gratitude Journal
Despite being one of the most commonly diagnosed illnesses, adrenal fatigue (or adrenal burnout) does not exist according to our current understanding of human physiology and science. This matters because addressing the illness’s root cause is the only way to devise an effective treatment and heal from it in the long term. Fortifying your metabolic reserve is undoubtedly a pivotal way to promote resilience; this includes lifestyle choices like good sleep quality and quantity, a low-inflammatory diet, and adequate exercise.
Although not the root cause of the symptoms typically associated with the ‘adrenal burnout’ diagnosis, managing stress can also be useful to promote healing. They include habits like meditation, being barefoot in nature, human touch, yoga, and a gratitude practice.
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- Cadegiani, Flavio A., and Claudio E. Kater. “Adrenal Fatigue Does Not Exist: a Systematic Review.” BMC Endocrine Disorders, vol. 16, no. 1, 2016, doi:10.1186/s12902-016-0128-4.
- Zelissen, Pierre M.j., et al. “Associated Autoimmunity in Addisons Disease.” Journal of Autoimmunity, vol. 8, no. 1, 1995, pp. 121–130., doi:10.1006/jaut.1995.0009.
- Chrousos, G P, et al. “Primary Cortisol Resistance in Man. A Glucocorticoid Receptor-Mediated Disease.” Journal of Clinical Investigation, vol. 69, no. 6, 1982, pp. 1261–1269., doi:10.1172/jci110565.
- Björntorp, P, and R Rosmond. “[Low Cortisol Production in Chronic Stress. The Connection Stress-Somatic Disease Is a Challenge for Future Research].” Europe PMC, vol. 97, no. 38, 1 Sept. 2000, pp. 4120–4124., europepmc.org/article/med/11068377.
- Vanitallie, Theodore B. “Stress: A Risk Factor for Serious Illness.” Metabolism, vol. 51, no. 6, 2002, pp. 40–45., doi:10.1053/meta.2002.33191.
- Hjortskov, Nis, et al. “The Effect of Mental Stress on Heart Rate Variability and Blood Pressure during Computer Work.” European Journal of Applied Physiology, vol. 92, no. 1-2, 2004, pp. 84–89., doi:10.1007/s00421-004-1055-z.
- Boer, Margarethe M Bosma-Den, et al. “Chronic Inflammatory Diseases Are Stimulated by Current Lifestyle: How Diet, Stress Levels and Medication Prevent Our Body from Recovering.” Nutrition & Metabolism, vol. 9, no. 1, 2012, p. 32., doi:10.1186/1743-7075-9-32.
- Stranahan, Alexis M., and Mark P. Mattson. “Metabolic Reserve as a Determinant of Cognitive Aging.” Journal of Alzheimers Disease, vol. 30, no. s2, 2012, doi:10.3233/jad-2011-110899.
- Neglia, Danilo, et al. “Impaired Myocardial Metabolic Reserve and Substrate Selection Flexibility during Stress in Patients with Idiopathic Dilated Cardiomyopathy.” American Journal of Physiology-Heart and Circulatory Physiology, vol. 293, no. 6, 2007, doi:10.1152/ajpheart.00887.2007.
- Strauer, Bodo-Eckehard. “Myocardial Oxygen Consumption in Chronic Heart Disease: Role of Wall Stress, Hypertrophy and Coronary Reserve.” The American Journal of Cardiology, vol. 44, no. 4, 1979, pp. 730–740., doi:10.1016/0002-9149(79)90295-9.
- Staub, Jean-Jacques, et al. “Spectrum of Subclinical and Overt Hypothyroidism: Effect on Thyrotropin, Prolactin, and Thyroid Reserve, and Metabolic Impact on Peripheral Target Tissues.” The American Journal of Medicine, vol. 92, no. 6, 1992, pp. 631–642., doi:10.1016/0002-9343(92)90782-7.
- Fink, George. Stress: Concepts, Cognition, Emotion, and Behavior. Academic Press, an Imprint of Elsevier, 2016.