Are you suffering from adrenal fatigue?

A controversial new diagnosis might account for why you feel so burnt out. But many doctors question whether it's a real medical condition.

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Between playgroups, grocery runs and toilet training, the marathon of parental duties adds up for Brittany Anderson, a mom of three young kids. She assumed her extreme fatigue was normal. “I’m a mom, I’m supposed to feel exhausted,” she laughs. So when her new doctor suggested testing her for a condition called adrenal fatigue, after giving her a clean bill of health otherwise, she didn’t know what to think. “I had no idea what it was,” she says, but her test results revealed she was indeed suffering from this mysterious ailment.

Maybe you’ve heard it mentioned in your mommy group or read about it on Dr. Google. In the last few years, adrenal fatigue has become the affliction du jour, especially among health-conscious women who feel seriously maxed out. But the controversial diagnosis has many physicians crying foul.

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According to alternative-healthcare professionals and medical doctors working within integrative medicine—a field that marries alternative treatment with conventional biomedicine—the symptoms of adrenal fatigue can include everything from chronic exhaustion and general body achiness to brain fogginess and low libido. In a healthy person, the adrenal glands—the two little triangular-shaped organs that sit on top of your kidneys—release hormones (including the stress hormone cortisol) to help us cope during times of pressure. For those with adrenal fatigue, the glands don’t function well because they’ve been overstimulated, either by chronic stress or a shorter period of intense strain.

“We’re burning the candle at both ends,” says Ashley Riskin, a physician and the clinic director of Connect Health, an integrated medical practice in Vancouver. “Our cortisol can become erratic during times of stress. Normally it peaks in the morning, will taper off throughout the day and be lower in the evening. That’s basic biology. But when you’re burning your stress hormones all day, day after day, people will have variations on that curve that can make them feel awful.”

But pretty much everyone feels groggy during that 3 p.m. slump. So does that mean adrenal fatigue is a full on epidemic?

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Tom Elliott, an associate professor in endocrinology at the University of British Columbia, says no. “Adrenal fatigue is a non-disease,” he says. “It’s a convenient label that escapes the truth that we’re tired because our lives aren’t in order: We’re not sleeping well enough or we’re anxious about work or our kids or our marriage. It’s pseudo-science.”

Addison’s disease

Your adrenal glands can fail to produce sufficient cortisol, but Elliot says true hypoadrenalism, (or Addison’s disease, as it’s commonly known) is very rare. There are no absolutely accurate statistics available, but the US Department of Health estimates its prevalence at about four in every 100,000 people. To test for this condition, patients undergo a blood test for serum cortisol levels. If their baseline levels are significantly lower than normal, patients then undergo a second test where they’re injected with synthetic adrenocorticotrophic hormone (ACTH). (ACTH is a hormone that occurs naturally in the body, and is often produced in relation to stress.) Patients then have their blood response measured 30 to 60 minutes later to diagnose Addison’s.

But Riskin maintains this test, considered the gold standard by conventional medicine, isn’t nuanced enough to offer a complete snapshot of your health. “You can do an Addison’s test, and you can be one or two points higher, and all of a sudden you don’t have it, but if you’re one or two points lower, you do,” he explains. Michelle Richea, a Toronto naturopath, concurs: “The mainstream medical world is only going to look at extremes like Addison’s, but patients with adrenal fatigue exist somewhere on the edges of what’s normal, even though they’re still not functioning optimally. Normal isn’t necessarily healthy, it’s just a reflection of what’s statistically the most common.”

Diagnosis

Riskin recognizes that adrenal fatigue can seem like a one-size-fits-all diagnosis. “If you put on your adrenal fatigue hat, everyone who comes into your office has it,” he admits. He first rules out other conditions that can cause fatigue, like thyroid dysfunction or an iron deficiency, which is especially common in new moms.

“I’d also be asking questions about diet and lifestyle,” says Richea. “Are they getting enough sleep? How well are they controlling their blood sugar levels? If all that checks out, then I’d look to adrenal fatigue.”

To diagnose the condition, naturopathic practitioners and integrated physicians rely primarily on a salivary hormone test (though they might also test serum cortisol levels). A patient’s saliva samples are collected throughout the day and then analyzed to determine how well their hormone levels match up to cortisol’s natural rhythm. Richea says this type of testing provides more specific results.

This test can cost up to a few hundred dollars and isn’t covered by provincial or territorial healthcare plans, but that didn’t deter Brittany Anderson. “As parents, it’s the natural reaction to put ourselves on the back burner,” she says. “The kids are the first ones to get their vitamins in the morning and by the time we get to me, it’s like, ‘OK, we’ve got to get on with the day.’ It was time to reprioritize my health.”

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But Elliot is skeptical. “If it’s not covered, then you have a red flag for a bogus test,” he says. But he understands why people are willing to pay. “You go see your medical doctor and he takes your history, examines you, does tests and finds nothing. You need to look at anxiety—that’s ultimately where these sorts of symptoms are found—but established medicine doesn’t deal with that very well. So you go see a naturopath—who’s probably going to be less hurried and more compassionate than a regular doctor might be. You talk to him and he’s kind and calm, and he comes up with a diagnosis and you love it.”

Treatment

So how does the alternative-health community treat the condition they call adrenal fatigue?

“We might turn to supplements,” says Richea. “There’s a family of herbs called adaptogens that can help our body deal with life stressors.” The popular herb Rhodiola Rosea, for example, may be prescribed to help optimize multiple aspects of the body’s stress response, including improving cortisol levels and stimulating the brain’s ability to process serotonin. Riskin says he has recommended a B-vitamin complex, and products that contain the herbs Rhodiola and Ashwagandha (an herb which functions similarly to the former). “But,” he cautions, “I wouldn’t want someone going to buy an herb without talking to a practitioner first, to ensure a correct diagnosis and that the supplement is appropriate.” And you should definitely consult your doctor or midwife before starting supplements if you’re pregnant or nursing.

Joy McCarthy, a Toronto holistic nutritionist and the author of Joyous Health: Eat & Live Well Without Dieting, stresses the importance of diet when it comes to safeguarding your adrenals. Sadly, your daily double-shot latte is the first thing that needs to go.

“Parents, especially, are rundown, so they’re trying to regenerate by drinking more coffee and consuming more sugar,” she says. “But those foods treat your adrenals like a punching bag.” She suggests switching to green tea, which still has caffeine, but also contains a relaxing amino acid called theanine. She also recommends stocking up on colourful fruit and veggies. “When the body is being hit with stress it creates more free radicals, which damage cells. So eating things like apples, red peppers and kale—anything that’s richly coloured is a sign of lots of antioxidants—is going to protect the body.”

Above all, identifying the stressors in your life and adjusting your lifestyle (rethinking, say, your overscheduled weekends or the renovation you can’t afford) will make the biggest difference to your health. “We need to look at stress-management techniques and a person’s sense of community with regards to the support and love in their life,” says Riskin. “Those will go a lot further than any drug or supplement we can prescribe.”

For Anderson, learning about adrenal fatigue has put her more in tune with her energy levels. “The whole experience made me more aware of my body and, with the stage that I’m at in life with three little ones, when to push and when to slow down.”

Elliot agrees that tackling the root causes of stress is paramount for wellness, but he still firmly rebuffs the notion of adrenal fatigue. Richea isn’t too concerned with adrenal fatigue’s outlier status, though.

“It’s not my main preoccupation to get the medical establishment on board,” she says, “it’s to make my patients feel better.”

A version of this story appeared in our July 2014 issue with the headline “Running on empty,” pp.30-31.

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