"Adrenal fatigue" is the sort of diagnosis that might hit home during a late-night Internet search. Do you, for example, have trouble waking up in the morning without caffeine? Do you crave salty foods? Do people seem a lot more irritating than in the past?
If so, it could mean your adrenal glands are underperforming because of illness or constant emotional or physical stress, according to some medical practitioners who suggest patients make dietary and lifestyle changes in response — as well as take supplements they frequently sell.
But those who diagnose adrenal fatigue or exhaustion are fighting an uphill battle for legitimacy, even as the terms gain traction in alternative health circles and among Americans seeking a solution for chronic and unexplained fatigue, depression, weight gain and malaise.
The disorder is not recognized by most conventional endocrinologists or internists, major medical associations and even integrative medicine pioneers such as Dr. Andrew Weil, who reject the idea that excessive stress weakens the adrenals and causes health issues.
"Adrenal fatigue is a worthless diagnosis, and lavish testimonials and anecdotal claims of marked improvement following some intervention are most likely fraudulent or transient placebo effects," said Dr. Paul Rosch, president of the American Institute of Stress and a clinical professor of medicine and psychiatry at New York Medical College.
Other critics say there is room for further study. Endocrinologist Seymour Reichlin, an expert on the brain-endocrine system and stress, doesn't believe in adrenal fatigue but says "it's not unreasonable to carry out lab tests because the symptoms of adrenal fatigue overlap with true adrenal insufficiency."
According to the adrenal fatigue theory, modern life is so relentlessly stressful that the walnut-size adrenal glands, which produce hormones needed to cope with stress, get overworked and peter out. If you're tired for no reason, get lightheaded when you stand up quickly, can't shake colds or infections and feel as if you're constantly walking uphill, you may have something going on at the adrenal level, proponents say.
Supporters say the condition differs from adrenal failure (or adrenal insufficiency) and from extremely low adrenal function (Addison's disease), which are usually caused by an autoimmune reaction, a tumor, cancer or an infection such as tuberculosis.
"The adrenals aren't failing, as in Addison's. They aren't destroyed as in an autoimmune issue. They simply can't keep up with the demands placed on them," said James Wilson, an Arizona-based naturopath and chiropractor who coined the term in 1998 and has written what some call the definitive guide for patients. "We know all organs do that," Wilson said. "But for some reason, medicine has resisted the same concept with adrenals."
Skeptics say it's true that prolonged stress can enlarge the adrenals and disrupt almost all the body's processes because of the constant flood of adrenaline and cortisol coursing through the body. But they say there's no gray area on adrenal function — the glands either work or they don't.
They say evidence has not shown that prolonged stress results in the adrenals producing less cortisol. Moreover, many symptoms linked to adrenal fatigue, including feeling tired, depressed, irritable or unable to concentrate, could be caused by dozens of things, including stress, fractured sleep, poor nutrition and a lack of exercise.
And they say doctors who sell supplements to treat adrenal fatigue should raise a red flag for patients.
"Is adrenal fatigue real? Yes and no," said Dr. Brent Bauer, director of the complementary and integrative medicine program at Mayo Clinic. "Like many things in this arena, it's a grain of truth surrounded by a lot of hype and peddlers of quick fixes."
Adrenal fatigue proponents say the condition can affect anyone but is often triggered by a serious illness or injury, allergies, poor nutrition or intense social, emotional or physical pressure. Perfectionists and those who feel trapped or helpless, don't get enough rest or have a stressful job are especially vulnerable, they say.
Kathy Hart, a co-host of the popular Eric & Kathy radio show on WTMX-FM, was diagnosed with adrenal fatigue about four years ago after she began having panic attacks, feeling unusually lethargic and experiencing numb and tingly arms. Normally, Hart bounded out of bed at 3:15 a.m. to get ready for work. But during the show's 10th anniversary in 2006, she often had engagements that kept her out late.
"I didn't want to complain," said Hart, who has three children. "It was like, 'Yeah, I'm tired,' but who isn't? Any woman with kids and a hectic job feels like this. You just complain to your husband and do it."
Hart's doctor prescribed anti-anxiety drugs and antidepressants, but Hart felt the medication made things worse and sought a holistic physician who diagnosed her with adrenal fatigue. Hart changed her diet, began meditating and started taking supplements the doctor sold.
It took a year, but today Hart credits the supplements and lifestyle changes with helping to restore her health. "I think poor nutrition and (a lack of) exercise had a lot to do with it," said Hart, who started the "Healthy With Hart" Web site to educate others about adrenal fatigue.
Hart said saliva testing showed she had low cortisol levels, but testing for adrenal fatigue is controversial. True adrenal insufficiency is usually diagnosed by measuring cortisol levels in blood as well as saliva. But adrenal fatigue proponents say blood tests are inaccurate because the values are too broad and don't catch the early-stage symptoms.
Saliva tests, they argue, are more precise because they measure the amount of cortisol available to the tissues. But there's no agreement on what constitutes low levels on these tests.
"Many people are told they have adrenal fatigue, and they take a homeopathic remedy, but their baseline cortisol testing is completely normal," said endocrinologist Adrian Vella, a specialist in adrenal disorders at Mayo Clinic.
Testing can tell how much of a hormone the adrenals are releasing but doesn't necessarily indicate how well things are working because people have different numbers of cortisol receptors, among other factors, said Dr. Daniel Clauw, director of the Chronic Pain and Research Center at the University of Michigan.
"There's no question that fatigue is at least partly due to the interactions between the brain and the adrenal glands," he said. But it's a "gross oversimplification" of the origins of fatigue, he said, to imply that the adrenals are a major cause.
For Chicago Pilates teacher Jenna Wilayto, hearing about adrenal fatigue was what prompted her to seek additional testing and care for chronic health issues.
Shortly after the ceiling of her new business collapsed, Wilayto, 33, suffered from chronic sinus infections and troubling fatigue. Her skin broke out, she ached and she couldn't sleep despite feeling exhausted. When conventional doctors couldn't help, she turned to a holistic physician, who ran blood tests and told her she was anemic and vitamin-deficient, and that her adrenals were working overtime to regulate her body.
Along with learning some relaxation techniques, Wilayto began following an anti-inflammatory diet; removed caffeine, alcohol, gluten, dairy and citrus fruits; and started taking several supplements, including iron, ubiquinol, vitamin C, vitamin D, fish oil and B complex.
"What I needed was someone who was willing to look outside of the box," said Wilayto, director of the Helios Center for Movement. "The other answers I had gotten were 'Go home and drink wine,' and 'Take a day off; you work too hard.'"
Dr. Melinda Ring, medical director of the Center for Integrative Medicine at Northwestern Memorial Hospital, says it's worth looking into adrenal-related disorders, especially since similar syndromes were described — and discredited — as "rheumatism" in the 16th century.
"I realize 'adrenal stress' and 'fatigue' are trendy terms, but I do believe there are real symptoms that result from true physical manifestations of chronic stress," she said. "Only recently have disturbances in the central nervous system and neurotransmitters been defined by science and accepted by Western medicine and pharmaceutical companies."
If you decide to investigate a possible diagnosis of adrenal fatigue, keep the following factors in mind:
•Get multiple blood or saliva tests. Single blood or cortisol tests are useless because cortisol levels peak around 8 a.m. and fluctuate widely during the day. The tricky part is reducing stress while you're in the doctor's office. "You have to be very careful as there can be false positives and negatives," said Dr. Esther Sternberg, chief of the section on neuroendocrine immunology and behavior at the National Institute of Mental Health. Simply getting a needle stick can raise cortisol levels.
•Don't take extracts of bovine adrenal cortex. "These are absolutely ineffective because the hormones are present in extremely low concentration and, as they occur in nature, cannot be absorbed from the gastrointestinal tract," said Dr. Seymour Reichlin of Tufts University School of Medicine.
•Consider supplements from a class called adaptogens. "Adaptogens (ashwagandha, rhodiola, licorice root, ginseng, schizandra and maca) help support adrenal function, but use them under the guidance of a trained integrative provider," said Dr. Melinda Ring of Northwestern Memorial Hospital.Copyright © 2015, The Baltimore Sun