How To Talk To Your Doctor About Adrenal Fatigue

Why does the medical profession continue to ignore adrenal fatigue?

Have you asked your doctor to treat your adrenal fatigue? If you have, I reckon you’d have received a skeptical look and a remark that sounded similar to:

Adrenal fatigue is not a real medical condition.

But all your other lab markers come back in normal ranges. And your symptoms fit perfectly with those listed under adrenal fatigue. So, what’s really going on here? Why won’t your doctor recognize and treat adrenal fatigue?

Adrenal Fatigue: A 21st Century Syndrome

Do you know the difference between a syndrome and a disease? A syndrome is a collection of symptoms, whereas a disease has a known cause. IBS is a syndrome – it’s a collection of symptoms related to the gut. Malaria, on the other hand, is a disease. It’s caused by the Plasmodium parasite. This parasite is spread through mosquito bites. I’ve written more on syndromes vs diseases here.

Adrenal fatigue is similar to IBS in that it is a collection of symptoms. But the symptoms of adrenal fatigue are so common that one may even go so far as to call them “normal” in this society. Some of the more common adrenal fatigue symptoms include:

• Fatigue
• Challenges falling and/or staying asleep
• Low blood pressure
• Brain fog
• Weight gain or challenges losing weight
• Difficulty getting out of bed in the morning
• Inability or challenges handling stress
• Decreased immune system

I reckon most readers can identify with at least one of the above-listed symptoms. Not only are they so prevalent in our society, they can also be caused by a number of different conditions. This is one reason why I always advocate for proper testing. Adrenal fatigue should never be diagnosed or treated based on symptoms alone.

This is also one reason why your doctor won’t suggest adrenal fatigue as the cause of your symptoms. There are many other conditions that need to be ruled out first. Some common causes of fatigue include:

• Low thyroid (hypothyroid)
• Low iron (anemia)
• Infection(s)
• Low blood sugar (hypoglycemia)
• Sleep disturbances(s)
• Heart disease
• Fibromyalgia and/or chronic fatigue syndrome
• Depression

Even if you and your doctor have ruled out the above causes for your fatigue, don’t expect a diagnosis of adrenal fatigue. In the medical world, adrenal fatigue does not exist.

Is adrenal fatigue a medical condition? 

The short answer to this question is no, adrenal fatigue is not a medical condition. But let’s explain why that is and what we can do about.

The model behind stress causing disease or illness is not new. In the 1970’s, Dr. Hans Selye was the pioneer of the modern understanding of stress.  The adrenal fatigue model came about through an extrapolation of Dr. Selye’s work. Unfortunately, this theory did not have science behind it.

Adrenal fatigue was thought to occur after our body was exposed to high levels of stress for long periods of time. At this point, it was thought that the adrenal glands “fatigued” and stopped producing cortisol. In turn, the symptoms of fatiguing adrenal glands caused the above list of symptoms.

Thankfully, researchers looked into to this theory. (1) They found that the adrenal glands did not fatigue. Their cortisol production remained consistent. This is why your doctor doesn’t believe in adrenal fatigue. There is no scientific evidence to support its existence.

But there are conditions involving high or low levels of cortisol that are certainly recognized by the medical community.

Cortisol levels and adrenal fatigue

The medical profession is certainly concerned with cortisol levels. Unfortunately, they only consider extremely high or extremely low cortisol levels to be problematic. In the spectrum below you see low cortisol levels to the left and high cortisol levels to the right.

|————————————————–|—————————————————-|

Low Cortisol                                    Normal Cortisol levels                                      High Cortisol

Addison’s disease

Addison’s disease is an autoimmune disease that results in very low levels of cortisol. In the above spectrum, it would be on the very far left end. In Addison’s disease, the body attacks the adrenal cortex. Destruction of the adrenal glands results in extremely low levels of cortisol. Those with Addison’s disease will need to supplement cortisol hormone in order to achieve normal levels.

Cushing’s Disease

On the other end of the spectrum is Cushing’s disease. In the above spectrum, Cushing’s disease would be on the very far right side. Cushing’s disease is often caused by a growth on the pituitary gland. This causes extremely high amounts of cortisol to be created.

In the case of Addison’s disease, doctors are looking for morning cortisol readings to be less than 3 mcg/dL (80 nmol/L). (2, 3) For Cushing’s disease, doctors are looking for evening cortisol readings to be greater than 7.5 mcg/dL (207 nmol/L). (4)

The medical profession will test cortisol levels to ensure you do not have Cushing’s or Addison’s disease. Outside of those conditions, cortisol readings are largely ignored.

But what if your cortisol readings are slightly outside of the range?

Your doctor will likely tell you you’re fine, though I’m confident that you probably don’t feel fine. You may not have Addison’s or Cushing’s disease but you certainly have low or high levels of cortisol. And high or low levels of cortisol cause symptoms.

Even if your blood test results come back well within range, that still doesn’t rule out adrenal fatigue. Cortisol has something called a diurnal rhythm. That means that the amount of cortisol in our body varies depending on the time of day. Exposure to sunlight helps to control this rhythm.

A well-functioning cortisol rhythm is at its peak 20-30 minutes after waking. To ensure this happens, make sure you are exposed to sunlight every morning shortly after waking. As the day progresses, cortisol levels should gradually decrease, reaching their lowest point just before bed. Low cortisol levels help us to fall asleep. As we sleep, cortisol levels start to increase up until morning. The cycle then starts anew the next day.

To accurately test cortisol, samples should be taken at different times throughout the day. This will show whether your cortisol rythm is functioning properly. It’s entirely possible to have normal levels in the morning and irregular levels later in the day. One blood test is not enough information to determine healthy cortisol function.

How to talk to your doctor about adrenal fatigue

The first step is to stop referring to your condition as adrenal fatigue. By all means, use this word when talking about your symptoms with friends and family. But when you visit your doctor, you’re going to need to learn to use medical terminology. Describing your condition as adrenal fatigue is a sure-fire way to get your doctor’s guard up. Remember, there is little to no scientific evidence supporting the adrenal fatigue theory. I go into more detail why that is in this post.

Instead of calling your condition adrenal fatigue, call it hypothalamic-pituitary-adrenal axis dysfunction or HPA-D. HPA-D has a long list of research backing its existence. (5) To summarize, HPA-D explores how our body responds to stress. You likely won’t be surprised to learn that stress can have a negative effect on our health. The HPA-D model explores how this occurs and the hormones involved.

If you know your cortisol readings through testing, you can also refer to low cortisol conditions as hypocortisolism. High cortisol conditions can be referred to as hypercortisolism. Both of these terms will be more likely to get your medical doctor on your side for future treatment.

How do doctors treat adrenal fatigue?

If you do get your conventional doctor on your side, don’t be surprised if he has little to offer in the way of treatment. Adrenal fatigue or HPA-D is still poorly understood by the conventional medical paradigm. At the time of this writing, effective treatment protocols or products have not been developed.

For low levels of cortisol (hypocortisolism), a doctor may recommend small doses of hydrocortisone in the morning. This can help to increase the cortisol awakening response. (6) As cortisol levels are at their highest shortly after waking, an increased cortisol awakening response can lead to increased energy levels throughout the day.

Outside of hydrocortisone treatments, conventional medicine is woefully unequipped to treat adrenal fatigue. Fortunately, there are a number of natural supplements that have been studied for their effect on cortisol levels. I have written extensively about these supplements in this post.

Remember, adrenal fatigue describes a condition of low cortisol levels. But high cortisol levels can create symptoms that are nearly identical to low levels of cortisol. Some supplements have been shown to raise cortisol levels. These products are great for low cortisol levels. Other products have been shown to lower cortisol levels. These products are great for high cortisol levels.

If you take a supplement known to raise cortisol levels and you already have high cortisol levels, it is likely that this supplement will make your condition worse. The same can be said for taking a cortisol lowering supplement when you have hypocortisolism (low cortisol). For this reason, proper testing and treatment are imperative to a successful treatment. I always recommend locating and working with a knowledgeable Functional Medicine practitioner who can help navigate you through treatment.

Ok, now you know the best ways to address adrenal fatigue with your medical doctor.

Now, I want to hear from you!

How have you spoken about adrenal fatigue with your practitioner?

Looking for more information about adrenal fatigue? Check out our other blog posts.