Download Is adrenal fatigue real? Forget the label and treat the

Is adrenal fatigue real? Forget the label and treat the stress. - The Washington Post
4/7/17, 9(23 AM
Wellness
Is adrenal fatigue real? Forget
the label and treat the stress.
By Christy Brissette April 5
Who isn’t tired these days? We’re constantly on call for work, family and
friends, and often forget to take time for ourselves. Most of us recognize that
chronic stress can take its toll on our health and well-being. But what if
you’re so fatigued that even getting more sleep doesn’t seem to help?
Complementary and alternative medicine provide an explanation for stressinduced fatigue that offers hope to the chronically tired. According to
naturopathic doctors, holistic nutritionists and others, adrenal fatigue is a
condition where the adrenals, glands that sit above the kidneys, don’t
produce enough cortisol. Cortisol is a hormone that plays a role in managing
stress and regulating metabolism, sleep, blood sugar and inflammation.
“Fatigue is probably the number one complaint among new patients in my
practice,” says Leila Kirdani, a family physician specializing in functional
medicine. “Anyone with prolonged fatigue, with difficulty sleeping, who feels
‘burned-out’ or lack of enjoyment in life, may be suffering from adrenal
fatigue.”
Basically, the theory goes that too much stress wears out our adrenal glands
— they get tired and don’t produce enough cortisol for us to feel energized.
So why aren’t our family doctors telling us about this?
As a registered dietitian in private practice, I often get new clients who have
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Is adrenal fatigue real? Forget the label and treat the stress. - The Washington Post
4/7/17, 9(23 AM
been told by their naturopathic doctors that they have adrenal fatigue and
need to follow a special diet and a regimen of supplements and herbs. Hours
of searching the scientific literature has led to very little in terms of
evidence-based dietary advice to help these individuals. Which raises the
question . . .
Is adrenal fatigue real?
The very existence of adrenal fatigue is a contentious issue. It isn’t
recognized by any endocrinology societies or endocrinologists, medical
doctors who specialize in hormone-related health problems. A recent
systematic review of the scientific literature found that there was no
evidence for the existence of adrenal fatigue as a medical condition.
Theodore C. Friedman is an endocrinologist at Charles R. Drew University of
Medicine and Science who describes himself as being open to
complementary medicine. Like many medical doctors, he says adrenal
fatigue doesn’t exist: “It’s something made up by naturopathic doctors;
endocrinologists don’t recognize it as a real condition.”
Saul Marcus is a naturopathic doctor in Connecticut. “When it comes to
adrenal fatigue, conventional medicine insists it doesn’t exist. However,
adrenal fatigue is essentially a stress reaction, and stress is very well
understood as a cause of illness.”
And so we see the bipolar worlds of conventional medicine and
complementary and alternative medicine are firmly divided into two camps:
adrenal fatigue doesn’t exist vs. adrenal fatigue is an important medical
issue.
Somewhere in the middle is the idea that adrenal fatigue is a term that
encompasses a wide range of general symptoms rather than a discrete
medical problem. Does the label matter?
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Is adrenal fatigue real? Forget the label and treat the stress. - The Washington Post
4/7/17, 9(23 AM
What’s really going on with your adrenal glands?
According to Kirdani, “There is a distinct bias in the medical community
when it comes to adrenal fatigue. For some reason, doctors think that either
your adrenal glands are perfectly fine, or else they have ceased to function.”
“Naturopaths have it wrong,” Friedman explains. “They describe adrenal
fatigue as a stress-induced condition where your adrenal glands don’t
produce enough cortisol. In fact, when you’re stressed out, your adrenal
glands make more cortisol.”
What endocrinologists and other medical doctors do recognize is adrenal
insufficiency, a disorder where the adrenals don’t produce enough
hormones. The adrenal glands make two hormones: cortisol and
aldosterone. According to Friedman, “Aldosterone is often underappreciated
or unrecognized by naturopaths.” He also says that adrenal insufficiency is
on a gradient: “You can have varying levels of cortisol deficiency, aldosterone
deficiency or both.”
Having low aldosterone causes salt to be lost in the urine, which leads to
symptoms such as brain fog, feeling worse after exercise or feeling dizzy
when you stand up. Friedman says that people with low aldosterone can be
diagnosed by an endocrinologist and then can be treated with synthetic
aldosterone, extra salt or licorice root. Because the role of aldosterone is
often ignored by alternative medicine, this is one adrenal issue that your
naturopath may not test for. (Marcus, the naturopathic doctor, says one
reason naturopaths may not test for aldosterone is because it requires a
blood test, and in some states they are not licensed to order bloodwork.)
Where cortisol is concerned, people can have low cortisol as a result of their
pituitary gland not producing enough of a hormone that stimulates the
release of cortisol from the adrenals. A smaller portion of people have
Addison’s disease, where the adrenal glands are attacked by antibodies. As a
result, the adrenals won’t produce enough cortisol. Friedman says that these
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Is adrenal fatigue real? Forget the label and treat the stress. - The Washington Post
4/7/17, 9(23 AM
patients need to see an endocrinologist and get on cortisol right away.
As Friedman puts it, people with adrenal insufficiency do have fatigue, so it
makes sense to examine their adrenal glands. “It’s the concept of the
adrenals burning out that doesn’t make sense.”
How do you get tested for adrenal fatigue or adrenal
insufficiency?
Marcus says adrenal fatigue can be diagnosed in several ways. Many
practitioners test cortisol levels in saliva, but these also can be diagnosed
based on symptoms. “If someone is feeling tired and under some sort of
stress, their adrenal function is probably not optimal, and it may be okay to
try taking some supplements for the adrenals.”
Friedman calls the saliva test used by natural-health practitioners unreliable
and says a blood test is a far better way to measure cortisol levels.
The blood test measures levels of electrolytes (including sodium) as well as
several hormones. This gives a picture of which hormones are out of the
normal range and what could be causing issues.
Taking care of your adrenals
Google “adrenal fatigue diet” and you’ll find websites recommending
everything from eliminating dairy to following a paleo diet that also vetoes
grains and beans. At this point, there isn’t any evidence to show that any of
this will help you manage stress or feel more energized.
When my clients are dealing with stress and fatigue, I recommend eating
whole foods, plenty of vegetables, heart-healthy fats and lean protein,
limiting highly processed foods and added sugars, as well as cutting down on
caffeine and alcohol, which can negatively affect sleep.
Choosing foods that stabilize your blood sugar and are lower on the glycemic
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Is adrenal fatigue real? Forget the label and treat the stress. - The Washington Post
4/7/17, 9(23 AM
index is also important, as your energy levels and mood are closely related to
blood sugar. Go for slow-burning carbohydrates such as sweet potatoes,
barley, quinoa and rolled oats, and always combine them with a protein such
as beans or lentils, chicken, fish or lean meat. Get healthy fats from oily fish,
olive oil, avocado, nuts or seeds at each meal and snack, and chances are
you’ll feel more energized.
Marcus, Kirdani and Friedman all say that whether you’re dealing with
stress or adrenal fatigue, taking care of your overall health helps.
Friedman feels that the naturopathic approach can be valuable, as talking to
someone about stress and ways to cope can help. He also doesn’t have a
problem with people taking certain supplements that boost their immune
system and energy levels, as long as those don’t interact with other
medications or supplements.
Marcus and Kirdani recommend supplementing with sea salt, B vitamins
and herbs such as rhodiola or lemon balm. (Please see a medical professional
before taking supplements or herbs to make sure they’re safe for you.)
Patients also may use an adrenal glandular, essentially ground-up adrenal
glands (usually from pigs or cows), other tissues or extracts.
Friedman warns: “The naturopathic approach can be dangerous if cortisol or
ground-up adrenals are prescribed. People often feel better on cortisol, but
side effects include osteoporosis, weight gain and diabetes. As such, it
shouldn’t be prescribed lightly.”
Does it matter what we call it?
While the worlds of conventional and alternative medicine are divided on
adrenal fatigue as a condition, everyone seems to agree that managing stress
makes sense. So does eating well and treating any vitamin or mineral
deficiencies, as well as getting regular physical activity and enough sleep.
Working on all of these areas will help you boost energy, reduce fatigue and
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Is adrenal fatigue real? Forget the label and treat the stress. - The Washington Post
4/7/17, 9(23 AM
make you healthier. Whether these positive lifestyle changes are improving
stress levels or healing adrenal fatigue is irrelevant.
What does matter is if treating so-called adrenal fatigue ends up preventing
the diagnosis of a serious medical problem.
Friedman’s take-home message is clear. “If you’re experiencing fatigue, you
need to see an endocrinologist to make sure you’re getting at the real issue
and not masking fatigue that’s being caused by another health problem,” he
said. “If you do have an adrenal issue, it needs to be treated as soon as
possible.”
Christy Brissette is a dietitian, foodie and president of
80TwentyNutrition.com. Follow her on Twitter @80twentyrule.
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