Adrenal Fatigue

Many people question me about the term, “adrenal fatigue.” They’ve encountered it online and recognize their own symptoms among those associated with this phenomenon. And they wonder if this is a real condition.

AKA mild adrenocortical deficiency

While it is not a diagnosis considered by conventionally trained physicians, “adrenal fatigue” describes a condition frequently observed in clinical practice by naturopathic doctors and integrative physicians. Some clinicians prefer to use a more specific term, such as mild adrenocortical deficiency (MAD).

In brief, the term adrenal fatigue, or MAD, refers to a condition in which an individual is unable to produce adequate amounts of cortisol, due to repeated exposure to stressful events or circumstances that have depleted the individual’s adaptive mechanisms.

Under normal circumstances, the hypothalamus-pituitary-adrenal (HPA) axis is responsible for sensing and responding to stressors through a variety of mechanisms, especially signalling for the production of cortisol by the adrenal cortex. When, after exposure of prolonged or severe stress, this mechanism becomes depleted or “burned out,” the ability to produce adequate cortisol can become impaired.

Common symptoms

• unexplained fatigue
• weakness
• poor concentration and memory
• nervousness
• depression
• insomnia
• fainting
• sleep disturbances
• poor tolerance to physical or psychological stressors

Other symptoms can include salt or sweet cravings, hypoglycemia, low blood pressure, poor immunity and frequent upper respiratory tract infections, poor cold tolerance, and hair loss.

It should be noted that in MAD, the degree of cortisol deficiency is mild, hence it is distinguished from Addison’s disease, an autoimmune condition characterized by severe, potentially life threatening cortisol deficiency requiring long-term glucocorticoid replacement therapy.

Cortisol’s role in other conditions

MAD may have a role in several other conditions, such as chronic fatigue syndrome, fibromyalgia, depression, and autoimmune conditions including rheumatoid arthritis. Several studies of patients with chronic fatigue syndrome, for instance, have shown that these patients have lower HPA-axis function and levels of cortisol compared to healthy controls.

A meta-analysis of 19 studies showed that, compared to healthy controls, patients with chronic fatigue have lower levels of morning cortisol, the time point when cortisol is supposed to peak. Experimental models of chronic fatigue syndrome also display reduced HPA-axis reactivity. Similar disturbances of HPA activity have been documented in patients with rheumatoid arthritis and depression.

Natural strategies

A thorough examination should first rule out any underlying disease state affecting adrenal function. Once these are ruled out, natural strategies for MAD include B vitamins, vitamin C, adaptogenic herbs, acupuncture, and stress reduction techniques.