Adrenal Fatigue: another fake diagnosis
No, 80% of people are not secretly suffering from this mythical ailment
Adrenal fatigue is the false belief that our adrenal glands become “worn out” as a result of prolonged, repetitive stress – and the output of key regulatory hormones, like the 'master stress hormone' cortisol, is diminished. Let’s be clear: adrenal fatigue is not a true medical condition.
Just like many pseudoscience claims and diagnoses, the notion of adrenal fatigue is based on a nugget of truth.
That nugget? There are legitimate medical issues related to adrenal gland and cortisol dysfunction. These including Cushing’s syndrome and Adrenal insufficiency (including Addison’s disease). Contrary to what wellness influencers claim though, adrenal fatigue is NOT a ‘mild’ version of adrenal dysfunction.
There is an entire industry around adrenal fatigue. Self-proclaimed “specialists” claim that 80% of Americans experience adrenal fatigue. It’s important to note that the true specialists of our adrenal glands are endocrinologists, and it’s probably obvious that they are not the “specialists” I am referring to here.
To a person who isn’t trained to understand what these terms mean– adrenal fatigue sounds scary.
The “adrenal fatigue” chunk of the multi-billion dollar supplement industry is substantial. While the term was coined in 1998 by James Wilson, a naturopath and ‘alternative practitioner’, it has really taken off as a ‘diagnosis’ since Gwyneth Paltrow announced that she was suffering from adrenal fatigue about 5 years ago.
Gwyneth said she had been suffering from a lack of energy, brain fog, and dark under eye circles. She and her doctor Alejandro Junger (important to note, NOT an endocrinologist) created a whole supplement plan for adrenal fatigue and she launched Goop Wellness, a supplement line with single-portioned packs that combines more conventional supplements, like vitamin D, with alternative remedies, like adaptogenic herbs.
The adrenal fatigue treatment lineup, called Why Am I So Effing Tired, includes a blend of phytonutrients, good fats, ashwagandha, and holy basil—both “adaptogens” that help the body deal with stress—and glycerated licorice, which proponents claim give the adrenals a boost.
Adaptogens are another ‘faux’ term that are given to a whole array of various supplements that claim to help your body ‘adapt to stress’ - more on that later!
If you’ve read my previous piece on supplements, you’ll recall that dietary supplements, particularly blended ones, lack data on efficacy and safety. Additionally, adrenal fatigue is not a legitimate medical diagnosis, so its unclear what these supplements are trying to cure.
Obviously, Gwyneth is not remotely a scientific or medical expert, but she preys on her fans to sell them unproven and potentially dangerous products.
The adrenals are two small glands that sit on top of the kidneys and produce several hormones, including cortisol.
When under stress, we produce and release cortisol into the bloodstream.
Cortisol is a glucocorticoid hormone (a type of steroid hormone) synthesized from cholesterol and can act on nearly every tissue in the body. As such, cortisol has broad effects on the nervous system, immune system, cardiovascular, respiratory, reproductive, musculoskeletal, and integumentary systems. Cortisol production is regulated by the pituitary gland in the brain.
Because cortisol has so many functions, it makes it a target to become a scapegoat for pseudoscience diagnoses. Cortisol:
helps the body to manage stress
converts protein into glucose to boost flagging blood sugar levels
works in tandem with the hormone insulin to maintain constant blood sugar levels
reduces inflammation
contributes to the maintenance of constant blood pressure
contributes to the workings of the immune system
The stress response is very complex and tightly regulated:
In times of stress, the sympathetic nervous system (SNS) gets activated: this is our fight or flight response, which leads to a cascade of hormonal and physiological responses in the body.
The amygdala in the brain processes fear, arousal, and emotional stimuli to determine the appropriate response. The amygdala then sends a stress signal to the hypothalamus. The hypothalamus subsequently activates the SNS, and the adrenal glands release a surge of catecholamine hormones, such as epinephrine (aka adrenaline). This results in effects such as increased heart rate and respiratory rate.
As the body continues to perceive the stimuli as a threat, the hypothalamus activates the hypothalamic-pituitary-adrenal (HPA) axis. Cortisol is released from the adrenal cortex and allows the body to continue to stay on high alert. Acutely, cortisol plays a role in catabolism (breaking down molecules) to provide energy to the body for that fight-or-flight response.
Cortisol acts on the liver, muscle, adipose tissue, and pancreas and is involved in protein and glucose metabolism, including increasing availability of blood glucose to the brain.
Cortisol increases gluconeogenesis which is the production of glucose from amino acids or fatty acids and decreases glycogen synthesis in the liver. Gluconeogenesis becomes active when the body needs energy. In the presence of cortisol, muscle cells decrease glucose uptake and consumption and increase protein degradation to supply amino acids for gluconeogenesis.
In adipose tissue, cortisol increases lipolysis, a catabolic process that results in the release of glycerol and free fatty acids. These fatty acids can also be used as an energy source for other cells as they continue to produce glucose.
Cortisol acts on the pancreas to decrease insulin and increase glucagon. Glucagon is a peptide hormone secreted by the pancreatic alpha cells to increase liver glycogenolysis, liver gluconeogenesis, liver ketogenesis, lipolysis, as well as decrease lipogenesis. Cortisol enhances the activity of glucagon, epinephrine, and other catecholamines.
Cortisol and adrenal gland signaling has a broad array of physiological effects, but is also tightly regulated by feedback signaling. So why did this become the target of yet another pseudoscience diagnosis?
30% of adults report chronic pain or fatigue: this is the target demographic for the adrenal fatigue diagnosis.
Fatigue, chronic pain, and lethargy among the most common reasons patients seek help from a doctor. However, as you can imagine, it can be challenging to come up with a diagnosis based on those symptoms alone. Countless medical and non-medical issues can cause fatigue and pain. Everything from poor sleep quality, anxiety, depression, infectious disease, autoimmune disorders, cancer, and physical injuries can cause these symptoms.
This is the same situation with other pseudoscience diagnoses, including chronic Lyme disease, leaky gut syndrome, and food sensitivities, all topics I’ve covered.
People want a name to put to their symptoms. Enter, adrenal fatigue.
Adrenal fatigue is the false notion that chronic stress leads to the adrenals producing too much cortisol which eventually ‘drains them’ of their energy.
This fatigue then causes generic and nonspecific symptoms such as brain fog, low energy, depressive mood, salt and sweet cravings, lightheadedness, and other vague symptoms.
The term “adrenal fatigue” was coined in 1998 by James Wilson, a naturopath and ‘alternative practitioner’. He claimed it describes a group of related signs and symptoms that occur when the adrenal glands function below the necessary level, causing the syndrome adrenal fatigue. Essentially, he fabricated a medical condition in which your adrenal glands become tired. (if it wasn’t clear, this is not a thing).
He stated that it is associated with “intense stress” on the body and occurs following acute infections like bronchitis, flu, or pneumonia. If you read my piece on Huberman’s false claims related to exercise, stress, and cortisol, you likely have some fundamental understanding on why this is nonsense - because your body is quite good at regulating itself.
While roughly 5% of individuals experience symptoms lasting after viral or bacterial infections (think long COVID or post-treatment Lyme disease syndrome), these are post-acute sequelae of infection. These symptoms are related to damage caused by the pathogen itself during the course of infection and as a result of the rebound of the immune response, and have nothing to do with your adrenals being fatigued.
Wilson sells his diagnosis more: you might not have ANY physical signs of illness but still may feel tired, "gray," and have fatigue that doesn’t get better with sleep, and you might crave salty snacks. Sounds totally legit.
Just like other pseudoscience diagnoses, these symptoms are vague, generic, and mislead people into a manufactured illness that these practitioners can then exploit.
Adrenal fatigue is an increasingly common diagnosis among naturopaths and other alternative practitioners.
These individuals are not medically trained, but position themselves as experts and prey on vulnerable individuals.
Typically, they use fraudulent methods to ‘diagnose’ someone with adrenal fatigue, such as monitoring cortisol levels and claiming that fluctuations (which are supposed to happen) mean the adrenals are getting fatigued, and then prescribe expensive supplements to treat it. Does this pattern sound familiar yet?
These supplements often include things like IV vitamin therapies, extremely restrictive diets, and “targeted nutritional supplementation” that includes vitamins and minerals like vitamins B5, B6, and B12, Vitamin C, and magnesium.
Adrenal health supplements are often adulterated with undisclosed hormones that can be dangerous.
Many supplements sold as treatments for adrenal fatigue can be seriously harmful. Because of the lack of regulation of dietary supplements, many “adrenal support” supplements sold online as energy boosters may contain thyroid hormones and steroids that aren’t listed on the labels and can cause dangerous side effects.
Researchers from the Mayo Clinic purchased the 12 most popular dietary supplements for enhancing metabolism, promoting energy, easing so-called adrenal fatigue, or providing “adrenal support.” Lab tests of the supplements found they all contained thyroid hormone and most had at least one steroid hormone.
Seven of the supplements contained at least one adrenal or steroid hormone. The most commonly detected hormone was pregnenolone, which was in five supplements.
None of the products tested mentioned any thyroid or steroid hormones on their labels or on ingredient lists included with packaging materials.
Every supplement in the study contained a small amount of a thyroid hormone known as triiodothyronine (T3).
It is a serious risk to take hormonal supplements when they do not have a true hormonal issue.
Taking too much thyroid hormone can lead to life-threating heart problems, bone damage, excessive weight loss, tremors and agitation.
People who accidentally take adrenal or steroid hormone may experience symptoms like weight gain, hair loss, osteoporosis and other bone issues, high blood pressure, diabetes, depression, acne, and stretch marks as well as a potentially life-threating shutdown of the adrenal glands, called adrenal crisis. This is because again, cortisol and other hormones, are tightly regulated in our body, and are produced only when needed. Taking supplements that include these things can cause serious issues.
Whether you took unnecessary hormonal supplements because you were prescribed them by an unqualified practitioner or because you inadvertently took an adulterated supplement, the risk is the same. This may cause actual adrenal dysfunction and lead to adrenal crisis, which is very serious.
Supplements sold as ‘natural,’ ‘organic,’ ‘herbal,’ ‘plant-based,’ may not be safe, may give patients false reassurance, and prey on the appeal to nature fallacy.
Most Americans who take dietary supplements buy them online or in stores without consulting their doctor, and often rely on product labels or promotional materials on websites to decide what to take. Roughly half of older adults take dietary supplements, often while taking prescription medications that might interact with supplements and cause serious or even fatal side effects. Unfortunately, those labels and marketing materials are frequently not accurate. Toxicity as a result of taking unregulated supplements is a common cause of liver injury and emergency room visits.
Legitimate medical issues related to adrenal gland dysfunction are exploited to sell this faux diagnosis.
Cushing’s Syndrome is a rare condition which leads to overproduction of cortisol (hypercortisolism) in the body. Cushing’s occurs in about 10-15 per million people every year. The most common cause is a small tumor on the pituitary gland called a pituitary adenoma, which account for more than 70 percent of cases in adults and about 60-70 percent of cases in children and adolescents. Cushing’s occurs most commonly adults between 20 and 50 years of age, and women account for more than 70 percent of cases.
Adrenal insufficiency, sometimes called Addison’s Disease is a rare condition that occurs when the adrenal glands do not produce enough cortisol (hypocortisolism). Adrenal insufficiency affects between 40 - 60 people per million of the general population. The most common cause of this is autoimmunity that leads to the destruction of the adrenal cortex, the region of the adrenal gland that produces cortisol.
To diagnose these real medical issues, there are validated diagnostic tools that endocrinologists - hormonal experts - will use in combination with a thorough and detailed medical history.
For Cushing’s syndrome, these may include:
Cortisol-free urine testing
Salivary cortisol testing
Low-Dose Dexamethasone Suppression Test
ACTH (Adrenocorticotropic Hormone) Levels
CRH (corticotropin-releasing hormone) stimulation test
imaging studies of the adrenal glands
For adrenal insufficiency, these may include:
Morning serum cortisol levels.
ACTH (Adrenocorticotropic Hormone) Levels
Insulin tolerance test
Electrolyte panels
Plasma Renin Activity and Aldosterone Levels
imaging studies of the adrenal glands
These tests allow a comprehensive and dynamic assessment of how the adrenal glands are functioning using clinically-validated methods. Combined with a thorough medical history and symptom assessment, a trained endocrinologist uses these to make a diagnosis.
If you have symptoms such as those described under the pseudoscience umbrella of adrenal fatigue, it doesn’t mean that your symptoms are fake. There may be a very real reason you are experiencing symptoms, but it is not due to adrenal fatigue.
Please, don’t fall prey to pop culture pseudoscience diagnoses. These fraudulent medical conditions, tests, and treatments may cause far more harm than you realize.
Thanks for joining in the fight for science!
Thank you for supporting evidence-based science communication. With outbreaks of preventable diseases, refusal of evidence-based medical interventions, propagation of pseudoscience by prominent public “personalities”, it’s needed now more than ever.
Stay skeptical,
Andrea
“ImmunoLogic” is written by Dr. Andrea Love, PhD - immunologist and microbiologist. She works full-time in life sciences biotech and has had a lifelong passion for closing the science literacy gap and combating pseudoscience and health misinformation as far back as her childhood. This newsletter and her science communication on her social media pages are born from that passion. Feel free to follow on Instagram, Threads, Twitter, and Facebook, or support the newsletter by subscribing below:
As a retired RN who this year is celebrating 50 years since graduation, I am grateful for your articles. I frequently find myself arguing with TV, Internet or social media ads spewing information about diseases that don’t exist to market useless, expensive and the worst, dangerous, “supplements”. (yelling at a TV screen is not a good look for a 70 year old if caught by family) You give me the real information to factually explain to friends who may buy into these marketing schemes and lies. Thank you.
THIS! How many times in 21 years of Yoga teaching did I hear a yoga teacher "diagnose" a student with this?! Too many times! This is rampant in the New Age "yoga" World!