Adrenal Fatigue – Where are we at?

“I have adrenal fatigue”

This is one of the most common reasons why people contact me. They have either

(a) read about this condition and realised they have many of the symptoms,

(b) been told by a practitioner they likely have the condition, or,

(c) have been tested and been told they have this condition.

Did you know that many researchers/scientists/practitioners don’t believe it exists? At least not using the typical definition. Often we are told that the stress we have been under has ‘burnt out’ the adrenal gland itself. It is far more likely the ‘adrenal fatigue’ you are experiencing, and perhaps seeing on test results, is due to a much deeper and complex issue.

If you are one of those people who has been told you have adrenal fatigue based on a test showing you have low levels of cortisol in the blood, we may need to re-assess the situation. Why? Because we can’t use this information in isolation! You could go as far as saying we can’t even view the entire hormonal system in isolation. It is intimately connected to many other bodily systems, in particular the immune and neurological systems. But the digestive system may also be able to influence hormonal health (remember, over 60% of the immune system is located here after all!).

With quotes from the research like “what matters may be how the target tissue responds to cortisol, rather than the levels of the hormone per se”, we have to wonder if there is any use in testing cortisol in isolation?

The fact that thyroid hormones and sex hormones can influence the HPA axis (which controls cortisol production) suggests that if we want to consider cortisol, we also need to test for these hormones also (among many, many other factors that influence the HPA axis).

On top of this, did you know there are theories suggesting that low cortisol may be an adaptive response offering some protection in certain circumstances? Many forget to mention that cortisol is the  most potent anti-inflammatory hormone in the body. If you were to test cortisol levels you may see them elevated during infections for example. However, if those infections are chronic, you may also find low cortisol levels – or ‘adrenal fatigue’. The take away message here is: “context is key” and the answer to many health questions is “it depends”. Broad sweeping generalised statements, in my opinion, oversimplify things.

Using supplements aimed at supporting the adrenal gland will be of little use in this sort of situation. And in fact, if low cortisol can be a protective response to help clear the infection (low cortisol will allow the immune system ‘to do it’s thing’) do we want to be messing with that process? More importantly, we may want to support the immune system deal with the infection. This way, we are dealing with the downstream effect of low cortisol by treating upstream. It’s like the comic book sketch with the janitor mopping the floor before turning off the tap!

The body is incredibly complex, and very intelligent. There are numerous mechanisms in place to modulate hormone activity at many levels, meaning that cortisol sensitivity (like insulin sensitivity) varies between different tissues of the same individual and and between individuals generally.

We have mechanisms in place, such as enzymes within the cell, that can regenerate cortisol from cortisone. The enzyme that does this, 11B-HSD1 has been shown to be up-regulated in inflamed tissues. The body has naturally adapted to help deal with the situation.

So in fact, systemic levels of cortisol (measured often via saliva samples or blood) may not always provide an accurate indication of what is going on within a tissue or cell type. Cortisol sensitivity can differ between cell types and different tissues (liver tissue or fat tissue as an example).

We could go on and on about the complexity of the human body. But essentially the take away message is ‘adrenal fatigue’ many not exist as many of us have been led to believe. After all the concept is old, and science moves forward….quickly!

I truly wish I could provide an easy succinct answer on this topic but it isn’t possible. We need to treat the individual, not the disease.  We need to treat the upstream cause, not the downstream effects.

I would love to hear from you if this resonates at all. Knowledge is power when it comes to health. I really hope I can help educate people (my clients aid my journey every day), help empower people, so they can take control of their health and destiny. So don’t be shy, I would love to hear from you!

 

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