"Tired, stressed, and having trouble sleeping every day? You may chalk it up to the demands of life and self-diagnose burnout (thanks, hustle culture). But go down the rabbit hole of health anxiety that is WebMD, and you’ll likely come across a myriad of overlapping conditions before discovering that your persistent fatigue, stress intolerance, and sleep issues could be signs of adrenal fatigue.
The caveat: While the World Health Organization classified adrenal fatigue as an official illness in 2010, many general practitioners will neither test for nor diagnose it (we dive into the adrenal fatigue controversy among medical communities and what you need to know). So, is adrenal fatigue the answer to the symptoms so many of us experience or a medical myth? We asked experts to explain what adrenal fatigue actually is, its causes and symptoms, and what to do about it.
What Is Adrenal Fatigue?
Naturopathic doctor Dr. James L. Wilson, ND, DC, PhD introduced the term in 1998. In his book Adrenal Fatigue The 21st Century Stress Syndrome, he described adrenal fatigue as “a group of related signs and symptoms (a syndrome) that results when the adrenal glands function below the necessary level.” Dr. Wilson used the term to explain a series of common and difficult-to-diagnose symptoms such as chronic fatigue, digestive problems, difficulty sleeping, low sex drive, and cravings due to high stress levels.
What’s the theory behind adrenal fatigue? “The adrenal glands produce hormones like cortisol, which play a crucial role in regulating metabolism, immune function, and the body’s response to stress,” explained Dr. Mark Hyman, M.D., a leading physician, best-selling author, and co-founder of Function Health. “When the body detects stress, the adrenal glands produce and release stress hormones into your bloodstream.” When we experience chronic stress—be it physical, emotional, psychological (i.e., trauma), social, or environmental—we may overtax the adrenal glands and disrupt adrenal gland function. “Because the adrenal glands produce stress hormones, it becomes exhausted (or fatigued) when overloaded,” Dr. Hyman said. And because cortisol is essential for life (it also aids in maintaining your blood pressure, heart function, and blood glucose levels), health problems can arise.
What Causes It?
Adrenal glands are intended to cope with stress (i.e., when we need cortisol and our “fight-or-flight” response to kick in to run away from or fight a tiger), but adrenal glands are not meant for chronic stress (sustained spiked cortisol over a long period). For many of us today, our stress response is triggered more by daily deadlines, traffic, and fights with our significant others rather than running from a tiger, meaning many of us are dealing with chronic stress and, therefore, over-fatiguing the adrenal glands. “Prolonged exposure to stress, whether from work, relationships, financial worries, or more, can chronically activate the body’s stress response system,” Dr. Hyman explained. “This constant activation can lead to wear and tear on the adrenal glands, disrupting their ability to produce hormones in the appropriate amounts and at the right times.”
While it’s the main culprit of adrenal fatigue, chronic stress isn’t all to blame. Dr. Hyman cited that a diet high in processed foods and refined sugars can contribute to inflammation and oxidative stress in the body, placing additional strain on the adrenal glands. Another offender is sleep deprivation or poor sleep quality which affects the body’s cortisol production via the circadian rhythm, further exacerbating adrenal dysfunction. Toxin exposure to heavy metals, pesticides, and pollutants can also increase stress in the body, as well as health conditions, chronic infections, or autoimmune disorders. Integrative nutritionist, Emily Brown, also cited lesser-known triggers such as hormonal imbalances or excess adipose (fat) tissue: “These biochemical disruptions produce and perpetuate an internal cycle of stress, inflammation, to more stress, more inflammation, and more disruption.”
What Are the Symptoms?
Because every body is unique, adrenal fatigue symptoms are diverse and can vary from person to person. “While most symptoms are nonspecific and can overlap with those of other health conditions, they often reflect disruptions in the body’s stress response system and hormonal imbalances,” Dr. Hyman attested. So, what are the likely signs of adrenal fatigue? Fatigue, stress intolerance, sleep issues, brain fog, mood swings, anxiety, palpitations, changes in weight, digestive issues, low libido, and muscle aches or weakness. “These symptoms are often attributed to various underlying health conditions, so adrenal fatigue often goes undiagnosed.” Dr. Wilson agreed: “Adrenal fatigue causes you to feel ‘gray,’ and you have chronic fatigue that doesn’t get better with sleep.”
The main symptoms of adrenal fatigue are chronic stress accompanied by exhaustion (which doesn’t get better with more sleep) or feeling tired all day and unable to sleep at night. But many other symptoms from poor digestion to cravings can be related to adrenal fatigue.
Explaining the Controversy
Many experts (typically in conventional medicine) deem adrenal fatigue a “medical myth,” while others (typically in functional medicine) like Dr. Hyman cite it as one of the most common undiagnosed problems today. The controversy comes down to the amount of research. Dr. Florence Comite, MD, an innovator in Precision Medicine specializing in Endocrinology, explained that organizations like the Endocrine Society assert there is insufficient clinical evidence to support adrenal fatigue’s existence. “Research, including a study in the journal BMC Endocrine Disorders, reviewed the scientific literature on adrenal fatigue, concluding it lacks scientific basis and emphasizing the importance of further research into fatigue and stress-related symptoms,” Dr. Comite shared. “Further research into its symptoms and their causes may lead to the recognition of adrenal fatigue as a syndrome.”
While the conventional medical community maintains there isn’t enough research, functional medicine practitioners—from naturopaths to chiropractors—widely recognize and diagnose patients with adrenal fatigue. “Mainstream medicine tends to reject the concept of adrenal fatigue primarily because of the lack of robust scientific evidence supporting it as a distinct medical condition,” Dr. Hyman explained. “Nevertheless, adrenal fatigue can significantly impact a person’s quality of life.”
Functional medicine holds that adrenal fatigue is a reaction to chronic stress, and chronic stress is linked to many illnesses. “No matter what we call it, the fact that our adrenal function and our stress response can become impaired as a result of chronic stress is a reality, and it should be taken seriously,” conveyed Marcelle Pick, an OB/GYN nurse practitioner and functional medicine practitioner. “The point is, our adrenals are real. Our stress response is real. Our stressors are real. Your symptoms are real. And in functional medicine, we want to get to the root cause of your symptoms and what affects your stress response.”
In summary, there is still a divide among medical communities over whether adrenal fatigue is a practical diagnosis or needs more evidence to prove its worth recognition. From the experts we interviewed, we can conclude this: chronic stress can absolutely wreak havoc on your health and may cause a wide range of symptoms–whether it has to do with fatigue of the adrenals or the overall effect of stress on the body comes down to semantics. If you do believe you have adrenal fatigue or stress-related symptoms, get a wide range of opinions from various doctors or experts, prioritize finding the root cause of any symptom, and always listen to your gut.
What To Do About It
Work with a functional doctor individually
If you believe you may be experiencing adrenal fatigue, seek out a doctor or healthcare professional trained in functional medicine. Because adrenal cases can vary, it’s important to do testing and make an individualized plan with your doctor. “It’s vital to individually test to figure out where stress is coming from and what stage of adrenal stress they are at so that you don’t misdiagnose medications, supplements, or adaptogens,” Brown recommended. Dr. Hyman suggested measuring your adrenal function by checking cortisol and DHEA-S, which can provide insight into your levels of stress or burnout.
Reduce triggers to the nervous system
The #1 goal: Lower stress, which reduces the load on the adrenals. “Our hyperstimulated environment fosters an overstimulated nervous system, which informs and impacts our endocrine (hormone) system directly,” Brown explained. “So we can’t address and heal the adrenals and other aspects of our endocrine system without understanding the root causes and triggers to calm the nervous system.” “It’s best to manage your personal stressors and stress response,” Dr. Hyman agreed. “If you focus on mitigating stress and the stress response, the symptoms will often ease.” In addition to mindfulness, breathwork, and meditation, Brown recommended parasympathetic and vagus nerve activation in the morning. But her best tips for reducing stress? “My favorite advice for nervous and endocrine system nourishment: find a hobby that brings you joy, lean into your social circle, and cultivate a strong sense of safety for yourself.”
Increase nutrition (and prioritize breakfast)
You can also support the health of your adrenal glands with better food choices. Prioritize a diet rich in whole, nutrient-dense foods, like leafy greens, nuts, seeds, legumes, fiber, and protein. “It’s so important to help your body help you, and if your body is working hard to combat stressors from food, then it’s only exacerbating the problem,” Dr. Hyman said. Additional nutritional support can come from supplementation, too, like magnesium and B vitamins for their energy production ability and direct adrenal support. According to Brown, glandular supplements and vitamin C can help restore adrenal health, while a potent multivitamin can support the effects of chronic stress at the mitochondrial level, the source of our energy and vitality.
Brown’s recipe for promoting adrenal fatigue management? “Eat three solid, substantial (protein, fat, and fiber) meals, with small snacks if needed. We should prioritize breakfast and supporting the energy and adrenal demand of the day first thing in the morning when cortisol production is naturally peaking.”
Optimize your circadian rhythm
A vital component in easing adrenal fatigue is getting adequate rest. Brown recommended starting your day with circadian rhythm support by getting three to five minutes of sunlight without sunglasses. Dr. Hyman prescribed creating a relaxing bedtime routine to signal to your body that it’s time to wind down, which may include dimming the lights, avoiding screens, and engaging in calming activities, like reading or taking a warm bath. Then, maintain a consistent sleep schedule that allows you to go to bed and wake up around the same time each day to regulate your body’s internal clock and improve sleep quality.
Find balance in your workout routine
When you’re chronically fatigued, exercising may seem counterintuitive. But incorporating simple, low-intensity movement into your day can reduce mental stress. For example, when you pair a soft workout, like stretching, Pilates, or walking around the neighborhood, with intentional breathing, you can reset the nervous system to get out of “fight-or-flight” mode. Regularly engaging in these types of activities can lead to improved mood, better sleep quality, and an overall sense of well-being.
It’s also important to check in with your body and monitor how you feel throughout your workouts. When you’re recovering from adrenal fatigue, exercise should enhance your energy without overwhelming the body. Because physical activity stresses the body, it’s important to be in tune with your body and beware of overtraining. If you are experiencing symptoms of adrenal fatigue, gentle exercise like walking or yoga helps relieve stress, but you also may need to tone down the intensity, length of time, or frequency of workouts.
Please consult a doctor or a mental health professional before beginning or stopping any treatments, supplements, or medications. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical or mental health condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.