There are too many people walking around thinking that they have adrenal fatigue. This diagnosis was handed to them after a saliva test and a visit to a holistic clinician. I admit, I used to use this method of testing. I’ve ordered saliva tests on my clients and have coached them in recovering from the maladies of modern day lifestyles, and at that time I too called it adrenal fatigue. It was a good way to learn and it had some value, but the science of lab work is changing.
Many of my clients got better, because when we get adequate rest, deal with our stressors, eat nutrient dense food and take high quality supplements, our bodies usually respond well. But this didn’t mean that they had adrenal fatigue.
So if you don’t have adrenal fatigue, what do you have?
Most likely, you are experiencing dissonance between the optimal living and the way you actually live. This shows up in two main ways. The first is food. Our ancestors consumed wild game, fish, vegetables, starchy tubers, nuts, seeds and fruit in season. Nowadays, the 6 most common foods in the modern diet are pizza, sweet drinks, beer, bread, grain based desserts, and fried chicken.
The second, lesser known, mismatch between our bodies and our lifestyle is the activation of our stress response system. Our stress response system has two components, the sympathoadrenomedulary system (SAS) which is responsible for our immediate or short term stress response and the HPA axis, which is responsible for our intermediate or long term stress response. The HPA axis consists of the hypothalamus and pituitary glands (in the brain) and the adrenal glands (in the mid back). It helps us interpret threats to the body (whether those threats are a car accident, sitting in traffic or refined, nutrient poor food)
Both of these stress response systems exist for our benefit, yet can become harmful over the long term if over-utilized.
Here’s the perfect scenario for understanding this: Imagine you are living in the Paleolithic Era and are out for a walk on the savannah and all of a sudden a wild boar charges you. Its a good thing that your heart rate and blood pressure increase. It’s a crucial part of your physiology meant to ensure your escape and thus your survival. But at the same time these survival mechanisms go to work for you, your digestion and sex hormone production plummet. This is how it’s supposed to be, but it’s a problem when it is always on.
Enter the modern lifestyle….traffic, work deadlines, inflammatory food, over-exercise, or its opposite, couch potato syndrome, smoking, OTC drug abuse, lack of rejuvenating activities. The list goes on…I’m sure you get it.
The constant activation of the stress response via the SAS and HPA pathways erodes resilience and paves the way for metabolic breakdown.
The loss of resilience is associated why we are surrounded by so many sick people. Stress contributes to so many conditions.
Some Conditions Associated with Chronic HPA Axis Stimulation:
If you’ve gone to a holistically minded doctor and you’ve got any number of these problems and a saliva test, you’ve probably been handed an adrenal fatigue diagnosis.
The adrenal fatigue model is based on the work of Hans Selye and his general adaptation syndrome theory. Selye explained the progression of stress over time in 3 stages: alarm, resistance and exhaustion.
The adrenal fatigue model with the three stages of adrenal burnout is based on this model:
- Stage 1 of adrenal fatigue is high cortisol with DHEA on its way down.
- Stage 2 of adrenal fatigue is falling cortisol (which is sometimes in the normal range) and decreasing levels of DHEA
- Stage 3 is even lower cortisol and lower DHEA.
But is the adrenal fatigue concept really sound?
I don’t think so. Consider 2 problems with the “adrenal fatigue” diagnosis:
Most people with “adrenal fatigue” don’t have low cortisol levels. The assessment of adrenal fatigue has depended on saliva measurement of cortisol taken at 4 distinct points throughout the day. Cortisol measured in saliva is only 2-5% of our total cortisol production. The vast majority (around 70%) of our cortisol is excreted in urine. This measurement is called metabolized cortisol. Free (salivary) cortisol is NOT the best marker for cortisol production. Metabolized cortisol, however, is a good marker for overall cortisol production.
It’s possible to have low free cortisol and high metabolized cortisol. Remember, the “free” cortisol reading is the measurement you get with a saliva test (2-5%). The total cortisol is not a value you get from salivary testing. It is important to have both values.
Some conditions with associated with low free cortisol and high total (aka metabolized) cortisol:
Long term glucocorticoid use
Also, it is possible to have high free cortisol and low metabolized cortisol. The # 1 reason for this presentation on the DUTCH test is hypothyroidism.
Therefore, a saliva test is an incomplete picture of true cortisol production.
Even when total cortisol is low, its rarely because the adrenals are tired and unable to churn it out. The brain and central nervous system direct the production of cortiso, not the adrenal glands. The adrenals produce cortisol but the regulatory mechanisms are primarily outside the adrenal glands. Therefore we should not be calling the problem of low cortisol “adrenal fatigue”, but instead it should be called “low cortisol”.
So Why Does Cortisol Drop?
1)Down regulation of the HPA axis – when we are exposed to stress for a long time, there can be a down regulation in cortisol receptor sensitivity. This is the body’s attempt to protect itself from the damaging effects of chronically high cortisol levels. The problem with this is that it actually ends up hampering the body’s ability to produce cortisol. This is something that should be short term. It’s harmful when it becomes the way the body does business.
2) Impaired cortisol signaling – High cortisol levels will lead to cortisol resistance. This can be caused by a decrease in cortisol receptor sensitivity and/or a decrease in cortisol receptor expression.
Wiith the DUTCH (dried urine total complete hormones) method of testing, which tests both free and metabolized cortisol, we have a greater understanding of the health of the adrenal glands. (We also get to look at sex hormone production and estorgen metabolite breakdown.)
True adrenal fatigue, if the term is to be used at all, should be reserved for those who have Addisons, an autoimmune inablity to produce cortisol.
But for the vast majority of us, our “adrenal fatigue” is simply a miscommunication between the brain/adrenals exacerbated by how we were designed to live (nutrient dense food, infrequent activation of the stress response, plenty of exposure to sunlight, connection with nature) and how many of us actually live (too much exposure to electronic screens, nutrient poor food and go-go-go lifestyles).
So what’s a woman to do?
You can get your adrenal hormones accurately (key word here!) and this is called the DUTCH test. This test uses dried urine to measure hormone levels. Precision Analytical laboratory in Oregon is the maker of this test.
I have done over 50 tests in the last 6 months and have yet to find someone with BOTH low free and low metabolized cortisol. In fact, 75% of my ladies have an overactive HPA axis which shows up as high free cortisol and high total cortisol.
The science of lab testing has taken a huge leap forward. Its time to move away from the diagnosis of adrenal fatigue and really find out what’s going on in your body. The DUTCH test can be a great first step.