Adrenal Fatigue?

"It's something made up by naturopathic doctors; endocrinologists won't recognize it as a real condition."
"Naturopaths have it wrong. 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."
"Aldosterone is often under-appreciated or unrecognized by naturopaths. You can have varying levels of cortisol deficiency, aldosterone deficiency or both."
"It's the concept of the adrenals burning out that doesn't make sense."
"The naturopathic approach can be dangerous if cortisol or ground adrenals are prescribed. People often feel better on cortisol, but side-effects include osteoporosis, weight gain and diabetes. It shouldn't be prescribed lightly."
Dr.Theodore C. Friedman, endocrinologist, Charles R.Drew University

"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."
"If someone is feeling tired and under some sort of stress, their adrenal function is probably not optimal, and it may be OK to try taking some supplements for the adrenals."
Saul Marcus, naturopath, Connecticut

"Fatigue is probably the No.1 complaint among new patients in my practice."
"For some reason, doctors think that either your adrenal glands are perfectly fine or else they have ceased to function."
Leila Kirdani, family physician, Rochester, N.Y.

Adrenal insufficiency is a disorder where the adrenal glands fail to produce sufficient hormones for bodily health, and this condition is recognized by doctors. The function of the adrenal glands is to produce two hormones: cortisol and aldosterone, and low aldosterone causes salt to be lost in urine, leading to fuzzy brains where you feel dizzy when you stand up, or unwell after exercise. Dr. Friedman stresses that those with low aldosterone should be seen for diagnosis by an endocrinologist who will prescribe appropriate treatment.

It is, he points out, a  hormone that is frequently overlooked in alternative medicine and as a result represents one adrenal issue a naturopath may fail to test for. As for cortisol, people can have a low cortisol condition resulting from the pituitary gland producing insufficient hormone of a type that stimulates release of cortisol from the adrenals. Additionally, a small proportion of patients have Addison's disease, where adrenal glands have been attacked by antibodies. This is an urgent condition requiring an endocrinologist's diagnosis and cortisol prescription.

Holistic nutritionists and naturopaths and others in alternative medicine feel that adrenal fatigue represents a condition characterized by the adrenals under-producing cortisol, a hormone whose purpose is to aid in the management of stress and regulation of metabolism, sleep, blood sugar, and inflammation. The theory is that too much stress strains the adrenal glands and they fail to produce sufficient cortisol for the body to feel energized, despite little evidence to support the theory. As such, it is a condition that has no recognition among endocrinologists, or endocrinology societies in view of a lack of evidence in the scientific literature for the very existence of adrenal fatigue.

On the other hand, people with adrenal insufficiency do feel the fallout of fatigue, so their adrenal glands should be examined. Naturopaths test cortisol levels in saliva and make their diagnoses as well on presentation symptoms. Saliva tests are unreliable however, according to Dr. Friedman, who stresses that the best way to measure cortisol is through a blood test which measures electrolytes along with several hormones. The end result renders an accurate idea which hormones present out of the normal range and therefore what could be the cause of certain issues.

"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. If you do have an adrenal issue, it needs to be treated as soon as possible", cautions Dr. Friedman.

Is there such a thing as adrenal fatigue?

Answers from Todd B. Nippoldt, M.D.

Adrenal fatigue is a term applied to a collection of nonspecific symptoms, such as body aches, fatigue, nervousness, sleep disturbances and digestive problems. The term often shows up in popular health books and on alternative medicine websites, but it isn't an accepted medical diagnosis.
Your adrenal glands produce a variety of hormones that are essential to life. The medical term adrenal insufficiency (Addison's disease) refers to inadequate production of one or more of these hormones as a result of an underlying disease.
Signs and symptoms of adrenal insufficiency may include:

• Fatigue
• Body aches
• Unexplained weight loss
• Low blood pressure
• Lightheadedness
• Loss of body hair
• Skin discoloration (hyperpigmentation)

Adrenal insufficiency can be diagnosed by blood tests and special stimulation tests that show inadequate levels of adrenal hormones.
Proponents of the adrenal fatigue diagnosis claim this is a mild form of adrenal insufficiency caused by chronic stress. The unproven theory behind adrenal fatigue is that your adrenal glands are unable to keep pace with the demands of perpetual fight-or-flight arousal. As a result, they can't produce quite enough of the hormones you need to feel good. Existing blood tests, according to this theory, aren't sensitive enough to detect such a small decline in adrenal function — but your body is.
It's frustrating to have persistent symptoms your doctor can't readily explain. But accepting a medically unrecognized diagnosis from an unqualified practitioner could be worse. Unproven remedies for so-called adrenal fatigue may leave you feeling sicker, while the real cause — such as depression or fibromyalgia — continues to take its toll.