The Truth About Adrenal Fatigue

Have you ever been to the doctor to ask about the health symptoms you’re experiencing—like fatigue, anxiety, weight gain, cravings, hair loss, hormonal imbalances, thyroid symptoms—only to be told, “You’re fine, there’s nothing wrong with you”?

Or have you gone to the doctor and said, “I think I have adrenal fatigue. Can you check me out?” and gotten an eye roll? Worse, you might have even been asked if you got your MD from Google University. I know that sounds terrible, but I’ve actually had patients have things like that said to them.

So why is the medical establishment dismissing a whole host of symptoms that are not only very real, but can be harbingers of down-the-road medical problems, including obesity, high blood pressure, chronic fatigue, diabetes, insulin resistance, high cholesterol, or thyroid problems like Hashimoto’s?

Is adrenal fatigue a real thing?

You’re probably not going to expect me to tell you this, but here it is: There is no such thing as adrenal fatigue. That’s the truth. But hold on—I will explain why and what actually is happening in your body and brain that’s causing your symptoms.

There are two reasons that adrenal fatigue gets dismissed by doctors. First, there is no recognized medical condition called adrenal fatigue. Adrenal fatigue is a made-up alternative medicine term, and—second, and it’s a big thing—the adrenal glands don’t actually get fatigued. So unless you have Addison’s disease, which is a medical condition in which the adrenals stop producing cortisol, or one of the other true adrenal diseases, then you can’t be classified as having a medical condition of the adrenals. In conventional medicine, you’re either healthy or you’re sick. There’s no gray area. If you don’t meet the medical criteria for a disease diagnosis, you’re basically told that you’re fine, go home and deal with it, or you may be prescribed an antidepressant or anxiety medication. The symptoms you’re experiencing exist in that medical gray zone.

Also—and this goes even deeper into problems with the well-documented problem of medical bias against women—many of the symptoms that accompany what we call adrenal fatigue are the very same symptoms that are most likely to be brushed off as “in our heads,” “just stress,” anxiety, or depression.

But hold on—that doesn’t mean that something very real isn’t happening to you. It undoubtedly is.

When it comes to new conditions, medicine lags behind (or if they can’t measure it, they don’t believe it).

Twenty-five years ago, a new set of symptoms cropped up, largely, though not exclusively, in women. It was commonly called Chronic Fatigue Syndrome. As with adrenal fatigue, women were dismissed by the medical community, who thought they were hypochondriacs or had mental health problems. Since there were no lab findings to “prove” that they were having these symptoms or that something “real” was going on, they were told they were fine. Or depressed. Or anxious. Because in medicine, if you can’t measure it, it isn’t happening.

We now know that this Chronic Fatigue Syndrome is very real and has a solid medical explanation. It’s now called ME (myalgic encephalomyelitis) and is due to a complex array of inflammatory responses. It’s recognized as a formal medical diagnosis—though in reality, the problem of women with it getting dismissed still persists. Some 30 percent of doctors still don’t know it’s a real thing,  and only 70 percent even learn about it in medical school.

The same exact thing happened with what we now know to be a legitimate medical diagnosis of fibromyalgia. Women who came into their doctor’s office 20 and even 10 years ago, saying that they thought they might have something wrong, or perhaps even called it fibromyalgia, were typically given the eye roll. Most of this was before Dr. Google, so they couldn’t be told to stay off the Internet, but they were dismissed and often given antidepressants, anti-anxiety medications, pain medications, and/or a referral for psychotherapy or psychoanalysis.

So what is going on?

The symptoms that bring women to a doctor’s office wondering whether she has adrenal fatigue, or that land her this “alternative diagnosis” include:

  • Fatigue
  • Sleep problems
  • Irritability, anxiety, feeling blue
  • Sugar/carbs, fat, caffeine, or salt cravings
  • Tiredness around 3:00 or 4:00 most afternoons,
  • Weight gain, especially around your middle
  • Getting sick more often than you used to
  • Hormonal problems
  • Brain fog, forgetfulness
  • Digestive problems
  • Hashimoto’s symptoms or another autoimmune condition.

In general, “adrenal fatigue” symptoms include a range of feeling tired, overwhelmed, and stressed, all the way to feeling really fried and burnt out into deeply exhausted. Sound familiar? You’re not alone. There are millions of women going to the doctor’s office every day with symptoms that they can’t explain. I’m seeing women in their 30s and 40s in my own medical practice with pre-diabetes, insulin resistance, high blood pressure, sleep problems, hormone problems, fertility problems, polycystic ovarian syndrome (PCOS), chronic aches and pains, and autoimmune diseases—which are significantly on the rise, and one of the top eight killers of women. These women are being told, “You’re fine. Your labs are normal. Go home.” It’s not okay. It’s not just that women are uncomfortable and suffering, which is bad enough, but women’s lives are at stake.

I’m here to tell you: Your symptoms are not only in your head. You’re not crazy. And something very real—and new, that doctors don’t yet recognize—is going on. Which brings us back to this thing called “adrenal fatigue.”

Allostatic Load

What we erroneously call “adrenal fatigue” is a phenomenon properly called allostatic load. Allostasis means that humans have an incredible ability to adapt to our environments and stay well. However, when the environment we live in starts to exceed our capacity to keep up—as is happening with the major stress we’re all under, the load of environmental toxins on our systems, the electronic overstimulation that keeps up from getting enough sleep at night, the impact of modern diets and childhood and adult exposure to antibiotics on our microbiome, our diets causing chronic inflammation—a few things start to happen. Allostatic load is the wear and tear on your body that happens when you’re chronically exposed to an activated stress response.

Most notably, our stress response system—which does include the adrenal glands—initially gets kicked into high gear and sometimes overdrive. Our adrenals start pumping out a hormone called cortisol and a chemical called adrenaline, and we end up in chronic “fight or flight”—anxiety, agitation, and insomnia are hallmarks of this. But for some people, it shows up in other ways. Chronic cortisol exposure causes us to pack weight around our waist; can make our brains feel foggy; makes us crave sugar, salt, or fatty foods; and can make us have a lot of negative, stressed-out thoughts. It jacks up our blood sugar and messes with our insulin. It can wreak havoc on our hormone balance, tank our sex drive, and suppress our thyroid function.

That weight around our middle—called visceral abdominal fat—is also inflammatory. It’s a communication signaling center to your brain that tells you to enjoy sugar and carbs more. It tricks your body into thinking that you need to eat more, and more, and more. Why? Because eating those things temporarily quiets down that stress reaction. Then it just pops its head back up again.

Your immune system gets activated to fight an infection. All these things that are meant to protect us start to backfire. It also affects your reproductive hormones, because it’s diverting hormones away from making estrogen, progesterone, and testosterone into making more cortisol. What happens is, at first, when you’re under this chronic influence, you often feel really amped up.

Adrenaline causes our blood vessels to constrict, makes us feel chronically anxious, and affects our digestion. You can get chronic gas, bloating, digestive discomfort, and irritable bowel syndrome. You can get problems in your gut lining that lead to inflammation and leaky gut. You can get problems with your microbiome.

But your body can only sustain these changes for so long before real problems start to happen, so your brain eventually tells your adrenals that enough is enough and, in turn, your adrenals dial back on the cortisol and adrenaline production.

Under the Influence for Too Long

Allostatic load is the wear and tear on your body that happens when you’re chronically exposed to this activated stress response. In an effort to protect you from this wear and tear, your dialed-back adrenals now produce lower levels of cortisol and adrenaline.

When your body dials it down, you’re not fighting inflammation quite as well anymore, and you may feel more aches and pains. Sleep may still be hard to come by, and now, with low cortisol, no matter how many hours of sleep you’ve gotten, you feel like you just can’t wake up in the morning. Or you’re crashing mid-afternoon. Or all day long. You may find that you have worsening digestive problems and worsening stress and anxiety overall. Again, it’s not your adrenals that are exhausted. You’re exhausted, and your adrenals are responding to that chronic state of stress.

When you’re in this state long enough, you can develop conditions like diabetes, high blood pressure, and high cholesterol. It can be impossible to take that weight off your middle no matter how much you diet or exercise. You might develop Hashimoto’s or other autoimmune conditions associated with allostatic load. Your periods, fertility, or sex drive might be gone. You can go into early menopause or, if you’re in menopause, your symptoms might be worse. And depression, anxiety, or low motivation can derail your happiness and success.  

As a doctor, I’m seeing women in their 30s, 40s, and 50s already on several medications for symptoms and conditions that are a result of allostatic load. I don’t want that to happen to you. Furthermore, most of these are reversible, especially if you catch them in time!

It would be my joy to work myself out of a medical job because every woman in this country knows how to take care of her own health.

Aviva Romm teaches the Adrenal Thyroid Revolution at Kripalu.

This article was originally published on Aviva’s website.

Aviva Romm, MD, a Yale-trained physician, uses functional medicine to help women heal their bodies and minds, and transform their lives and their families’ health.

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