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October 26, 2020 16 min
“Adrenal Fatigue” is a term used for many years by alternative medicine practitioners but does it exist? This is certainly a term that I have used for some time but not in the way that most practitioners use it. I will use terms at times that are widely searched for on the internet so that I can spread the science behind these terms but it doesn’t necessarily mean that I endorse the term or subscribe to the existence of a condition. There are a few published papers that tackle this very issue that I’ll cover in this article on “adrenal fatigue”. What does the research show about "adrenal fatigue"? The first paper I’d like to mention is entitled, “We are tired of ‘adrenal fatigue’” by Ross et al. The title of this paper quickly gives you the underlying frustration of the authors about this term. This paper is a position statement and not a clinical trial, review, or analysis of any kind. The authors begin by outlining the adrenal fatigue theory and that is doesn’t exist as a defined medical condition. The authors do point out a valid adrenal disorder called adrenal insufficiency which is characterized by insufficient cortisol production after an adrenocorticotropic (ACTH) hormone stimulation test. They also mention Addison’s disease which is true adrenal failure. Interestingly, those who suffer from fatigue actually showed a greater rise in cortisol with an ACTH stimulation test which indicates excessive cortisol production not insufficient cortisol production in those with adrenal insufficiency. And another study actually found no difference in salivary cortisol levels taken throughout the day in two-thirds of healthy subjects compared to those who suffered from fatigue. Dehydroepiandrosterone sulphate (DHEA-S) has also been used as a marker for adrenal fatigue but research has shown this to be unreliable. The most recent systematic review of adrenal fatigue is entitled, “Adrenal fatigue does not exist: a systematic review” by Cadegiani and Kater. The authors searched 3,470 published papers but only 58 of them fulfilled proper criteria for evaluation. Of the 58 studies, only 10 actually used the term “adrenal fatigue” but none of them did any kind of testing to validate this false condition. Some studies tried to use the term “burnout” instead of “adrenal fatigue” but no scientific evidence was presented in these papers. None of the studies in the above review were able to validate any of the functional tests used to assess adrenal hormone production including cortisol and DHEA. Additionally, no valid information was found in these tests to assess HPA axis dysfunction which is one of the hallmarks of “adrenal fatigue”. The authors rightly point out that anytime there is a suspected issue of HPA axis dysfunction, the following must be ruled out as a cause of this dysfunction: 1. Sleep apnea 2. Adrenal insufficiency 3. Mental illness 4. Overwork 5. Night-shift workers 6. Other hormonal imbalances 7. Liver and kidney dysfunction 8. Heart conditions 9. Lung disease 10. Autoimmune disease Some alternative practitioners are not adequately assessing each patient for the above list of potential issues and jumping into treatment of “adrenal fatigue”. The authors conclude that there is no demonstrated evidence that “adrenal fatigue” is a real condition. Their two final statements are: 1. “The results of previous studies were contradictory using all the methods for assessing fatigue and the HPA axis.” 2. “The most appropriate methods to assess the HPA axis were not used to evaluate fatigue.” It is clear from reviewing the above paper that the methodology in all the studies reviewed was very poor and did not provide any valid scientific support of “adrenal fatigue”. What about corticosteroids? Many integrative practitioners are prescribing oral corticosteroids to treat adrenal fatigue which can have many negative consequences.
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