I am sometimes asked by patients – often after they have been spending hours looking at Dr Google – whether they might be suffering from 'adrenal fatigue'. This is a term coined some years ago by some doctors and the general media to describe a condition purported to be due to chronic exposure to stressful situations, and is said to be linked to the adrenal glands.
According to the theory of adrenal fatigue, chronic stress can potentially lead to 'overuse' of the adrenal glands, eventually causing depletion of essential hormones in the body and so triggering symptoms such as exhaustion, frequent infections and low mood.
The adrenal glands
The adrenal glands are two walnut-sized glands that sit just above our kidneys, and which are responsible for producing the hormone cortisol which helps our body deal with stress and which also helps in the regulation of our body's natural hormonal rhythms.
A number of endocrine diseases are caused by dysfunction of the adrenal gland. Overproduction of cortisol leads to Cushing's syndrome, whereas insufficient production is associated with Addison's disease (the American President John F Kennedy suffered from this condition). A variety of tumours can also arise from adrenal tissue and are commonly found in medical imaging almost by chance when searching for other diseases.
Modern life is rubbish?
Proponents of adrenal fatigue say that because modern life is so stressful, and that we are in effect under a state of constant stress, our adrenal glands eventually are unable to produce the levels of cortisol and similar hormones required for our bodies to remain healthy and so leave us unable to respond effectively to stressful situations. This in turn can trigger a variety of random and sometimes seemingly unrelated symptoms such as frequent infections, chronic fatigue, low mood, dizziness, early morning headaches and 'fogginess' and skin problems.
However – and this is where many doctors have a problem with this theory – the usual symptoms reported to be linked to adrenal fatigue tend to be the non-specific ones that most of us have at some point, and which are much more commonly linked to other problems such as depression or anxiety, thyroid problems, irritable bowel syndrome and fibromyalgia.
When you test the body's ability to make cortisol by using a blood test called the synacthen test, it is extremely rare to find that cortisol is not being manufactured by the body. In fact most people who believe they have adrenal fatigue still make normal levels of cortisol.
On the back of the adrenal fatigue theory, a whole industry has built up ranging from retreats and 'de-stress weekends' to spas and people saying they to be able to cure adrenal burnout using anything from nutrition to counselling. Websites have sprung up claiming to be able to provide cures for adrenal fatigue using supplements (invariably expensive and 'exclusive') often said to be derived from the adrenal glands of cows and pigs. What is often lacking here – apart from any medical evidence – is common sense where people suffering from fatigue are given proper lifestyle advice including sleep hygiene, nutrition and exercise guidance and stress advice.
Does adrenal fatigue exist?
Now I know that there are people who believe that adrenal fatigue exists, that they suffer from it and that they know how to treat it. I also know that people also believe in homeopathy and astrology but anecdotal beliefs are not science. So let's look at the evidence:
A 2016 Endocrine Disorders systematic review of almost 3,500 endocrine articles on fatigue and cortisol found there was no substantiation whatsoever that 'adrenal fatigue' is an actual medical condition, and the authors concluded that this purported condition is actually a myth.
In over 30 years as a doctor I have never seen a case of adrenal fatigue, and although some people will vehemently disagree with my view I am above all else a scientist and am guided by what science tells me and not anecdote and personal views.
We are all tired – I am, you are and my dog looks pretty shattered too thinking about it. But life does that to us and we need to learn how to deal with it. The great satirist Swift once said that the three best doctors in the world were 'Dr Diet, Dr Quiet and Dr Merryman'. He was right then and he's still right now.