Is Adrenal Fatigue Real?

Have you tried to discuss your symptoms with your doctor only to be told that 'it's all in your head' or that 'there's no such thing as adrenal fatigue'?

Fatigue is one of the most common reasons that people visit their GP, and it’s also one of the most common reasons people come into my clinic. Many people are familiar with the term ‘adrenal fatigue’ or adrenal exhaustion’ and it is often used to describe the collection of symptoms that are often associated with chronic, ongoing fatigue such as:

  1. Sleep disturbances

  2. Waking unrefreshed from sleep

  3. Poor exercise tolerance

  4. Poor immune function and frequent infections

  5. Brain fog and poor concentration

  6. Low libido

  7. Low mood

The rationale behind the ‘adrenal fatigue’ explanation is that these symptoms are caused by low cortisol being produced by the adrenal glands. This argument does not stand up to scientific scrutiny with testing of many patients revealing ‘normal’ salivary cortisol levels.

But it’s not good enough to brush off these symptoms as being psychological and leaving people continuing to feel unwell and powerless.

There has to be a better explanation, and there is. To comprehend what is going on and why you may be feeling tired all the time, with no energy to carry out day-to-day activities, you need to understand the sophisticated interplay between your brain, your adrenal glands and your nervous system. Although ‘adrenal fatigue’ doesn’t exist, the feedback loop that manages cortisol release from your adrenal glands as a result of stimulus from your nervous system has become compromised leading to a loss of the normal diurnal rhythm - and that's why you're experiencing symptoms like those listed above.

Modern lifestyle contains so many triggers for your nervous system and can leave you permanently in a state of ‘fight or flight’. Many people work extremely long hours with early starts and late finishes. We are available on our phones and computers at all hours of the day and night and often don’t allow ourselves any time to wind down and relax. Even exercise has become a high intensity activity for many people and done at times of the day when our body would probably prefer to be resting. These things all activate your Hypothalamic-pituitary-adrenal (HPA) axis and cause the release of cortisol and neurotransmitters such as noradrenaline and adrenaline.

This ongoing response has a really negative effect on your immune system and your metabolism and can lead to some of the symptoms I mentioned earlier like the frequent infections. Many people who experience chronic fatigue also report difficulty maintaining a healthy weight. Also, because the ‘normal’ cortisol rhythm often becomes disturbed, sleep disorders become common and this becomes another ‘stressor’ and trigger of the HPA axis – perpetuating the cycle.

Your diet also plays a large role in triggering your HPA axis, especially the typical western diet that is high in refined carbohydrates and saturated fats. These foods trigger an pro-inflammatory response and the release of chemicals that are neuroinflammatory such as interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-alpha). These chemicals are associated with symptoms such as brain fog and low mood. Pro-inflammatory foods also cause a change in the microbial species that reside in your gut and increase the proliferation of species such as e.coli that are associated with chronic fatigue. In fact, scientists have found that many people with chronic fatigue are also deficient in some species of beneficial bacteria such as Lactabacillus casei and Bifidobacterium infantis and often experience an improvement in symptoms such as muscle aches and pain when supplemented with probiotics containing these species.

There are also other underlying factors that may contribute to your chronic fatigue, including thyroid dysfunction, anaemia and undiagnosed infections (bacterial and viral). As I just mentioned, your gastrointestinal microbiome plays a huge role in your health and any dysbiosis can cause symptoms including fatigue. It’s not just your microbiome though, your entire gastrointestinal system must be functioning well for you to experience good health.

This begins in your stomach and small intestines where food is broken down and absorbed and includes your liver, gallbladder and pancreas where digestive enzymes and other cofactors of digestion are produced. If your digestion is not working properly, you can’t absorb nutrients from your diet including protein and minerals such as magnesium and calcium needed for all body functions. It is important to address these factors as part of any treatment for chronic fatigue.

Sympathetic nervous system dominance associated with increased cortisol production is also associated with low levels of GABA (gamma-aminobutyric acid), an inhibitory neurotransmitter that balances the excitatory effects of cortisol and is important for sleep. Activities that can impact your GABA levels include using your computer or other electrical devices late in the evening and doing high intensity exercise at night. Low levels of GABA can cause symptoms such as:

  1. Insomnia and other sleep problems

  2. Anxiety

  3. Low mood and depression

  4. Increased perception and tolerance to pain

  5. Brain fog

  6. Fatigue

Many women who experience chronic fatigue also report symptoms associated with their menstrual cycle including PMS. Increased cortisol production has a negative effect on the balance between estrogen and progesterone needed for a healthy menstrual cycle with progesterone essentially competing with cortisol. Progesterone is important for sleep because it interacts with GABA and also reduces anxiety by upregulating the enzyme that breaks down histamine, another excitatory neurotransmitter. It also helps to regulate your energy production by stimulating thyroid function. The increased cortisol production is associated with high blood glucose levels and a relative estrogen dominance. This can lead to increased production of inflammatory chemicals called prostaglandins around the time of your period leading to irritability, anxiety, heavy bleeding and pain.

How does naturopathic treatment work?

Taking a holistic view is the cornerstone of naturopathy and chronic fatigue is no different. Treatment must begin with an assessment of all the contributing factors and most importantly diet and lifestyle because they play such a vital role in inflammation and the activation of the HPA axis.

Diet can be healing though, and by introducing foods that counteract inflammation such as those high in antioxidants and omega-3 fatty acids, the HPA axis can be dialled down. The avoidance of proinflammatory foods such as refined sugar, flour and saturated fats and replacing them with whole grains and fresh vegetables not only provides the essential nutrients needed by your body, but it also helps to restore a more beneficial gastrointestinal microbiome through their prebiotic activity.

Herbal medicine is ideally suited to supporting HPA axis function with herbs such as Passiflora incarnata (Passionflower) and Piper methysticum (Kava) improving GABA production and reducing cortisol dysfunction. Herbs such as Matricaria chamomilla (Chamomile) and Melissa officianalis (Lemon Balm) are wonderful for gastrointestinal upsets that are associated with anxiety. For short term energy improvement, herbs such Rhodiola rosea (Rhodiola) and Eleutherococcus senticosus (Siberian ginseng) can be really useful; especially for people experiencing frequent bouts of illness.

So there really is help at hand if you are experiencing chronic fatigue. The most important thing is to address all the factors that are contributing to your symptoms and treat them in a holistic way.

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