Is adrenal fatigue real? Dr. Lewis explains

adrenal fatigue

Many people who don’t feel well and are searching for answers to their symptoms want to know: why am I so tired? They stumble across the term adrenal fatigue, and it typically describes most everything they are experiencing. This concept is talked about a lot but it’s actually outdated because the adrenal glands don’t (and are not meant to) give up or stop working. Even though the fatigue and symptoms you’re feeling are very real, tired adrenal glands are not the issue.  

So what is adrenal fatigue really?

The collection of symptoms that’s referred to as adrenal fatigue is real–it’s just the term that’s not accurate. What’s really going on is a communication issue between an area of the brain (the hypothalamus) and the adrenals. When your adrenals aren’t getting the message to work correctly, we call this HPA-axis dysfunction. Your HPA-axis (hypothalamus, pituitary gland, and adrenal glands) is a complex system of feedback loops that all play an important role in how you respond to stress and how much stress hormone is released.

What does normal HPA-axis function look like?

When you get stressed, your hypothalamus signals release of corticotrophin-releasing hormone. This hormone lets your pituitary gland know to send out adrenocorticotropic hormone (ACTH). That ACTH messages your adrenal glands, which sit on top of your kidneys. Your adrenals then are responsible for releasing cortisol, a stress hormone that helps you cope with stressors. (They also release other important hormones, such as the sex hormones estrogen, progesterone, and testosterone.) Once enough or too much cortisol is detected, an optimally functioning HPA-axis communicates to bring cortisol levels back to normal.

What happens when cortisol gets too high and my HPA-axis doesn’t bring it back to normal?

Cortisol (aka the stress hormone) is created by the adrenal glands. It follows a circadian rhythm and should be highest in the morning while gradually decreasing throughout the day. Cortisol plays a role in the stress response and elevates during times of stress (exactly like it should). An increase in cortisol mobilizes your body’s resources to help you cope with whatever you’re experiencing.

A healthy stress response has a nice rise and fall of cortisol. Our body is so smart that it can tell when there is too much cortisol, and it will feedback to say “stop making so much!” When the body wants to slow down due to stress or illness, it can convert cortisol into cortisone (its inactive form). But in unhealthy stress responses, chronic stress, or in other situations, cortisol ends up high for long periods of time. There’s a rise but there’s not a decrease. Cortisol is important, but it’s damaging when it stays elevated. Common symptoms of high cortisol can include:

  • Depression
  • Anxiety
  • Weight gain
  • Sleep problems
  • Thinning skin and hair
  • High blood pressure
  • High blood sugar
  • Low libido
  • Menstrual disorders
  • And more

Why does cortisol eventually become low with HPA-axis dysfunction (or what many people call adrenal fatigue)?

At the stage when cortisol is chronically high, we really need to work on conscious ways to reduce and cope with stress. Eventually, communication between your hypothalamus, pituitary gland, and adrenals become so impaired that your adrenals stop producing the healthy amounts of cortisol that you need. Low cortisol can easily be missed. Common symptoms of low cortisol include:

  • “Chronic Fatigue Syndrome,” or CFS
  • Pain in joints and muscles
  • Low blood pressure
  • Low blood sugar
  • Depression
  • And more

Communication from the brain to the adrenals can be impacted by things. Stress, high body fat percentage, hyperthyroidism, hypothyroidism, inflammation, certain medications, and head injuries can all alter the delicate balance of signals and feedback loops the HPA-axis uses.

Is it possible to heal? What really helps HPA-axis dysfunction?

In order to properly treat the symptoms accompanying HPA-axis dysfunction, we must first understand what could be contributing causes. Then, we can treat the cause. For example, a super interesting fact is that fat tissue makes its own cortisol. Unfortunately, the downstream effect of this cortisol production is to make more fat tissue. Working to control body composition can help decrease this cause of HPA-axis dysfunction. 

Another example is building habits to support your liver. Liver health is important for both adrenal and hormone health! Your liver plays a role in your cortisol levels and can reactivate cortisone (inactive) into cortisol (active). Being able to activate and deactivate cortisol is crucial to keeping your HPA-axis regulated. In cases of fatty liver, diets high in simple carbohydrates, and prolonged elevated stress levels, the liver just can’t do this effectively.

With HPA-axis dysfunction, you can feel better by addressing stress, blood sugar, diet, sleep, and digestion. For my patients, we also implement treatments to control current presenting symptoms at the same time.

Nicole Lewis, ND