What Is Adrenal Fatigue—And Is It Even Real?

Maybe it was an Instagram post from your local wellness guru. Or a remark from an acquaintance about her latest naturopath visit. Either way, if you’ve heard of the term adrenal fatigue, it has likely been shrouded with mystique, vagueness and—in some cases—controversy. But adrenal fatigue is not a medical diagnosis.

So what do people mean when they talk about adrenal fatigue?

Your adrenal glands, which sit like two little hats above both your kidneys, produce stress hormones, such as adrenaline, androgens, cortisol and aldosterone. These hormones affect your metabolism, blood pressure, stress responses and immune system.

The adrenal fatigue theory claims that chronic stress can trigger your flight-or-fight response and in turn, over-exhaust your adrenal glands. Symptoms of so-called adrenal fatigue are far ranging and typically include poor sleep and fatigue, weight gain or weight loss, dizziness, headaches, craving salty or sweet foods, body aches and low blood pressure.

Why do doctors reject adrenal fatigue as a diagnosis?

The problem with adrenal fatigue is that its symptoms are too wide-ranging to fit into a unifying diagnosis.

When it comes to adrenal dysfunction, the adrenal glands can either produce too much cortisol or not enough cortisol, according to Dr. Meera Luthra, an endocrinologist at McMaster University in Hamilton, Ont.

If you have too little cortisol, you have what’s called adrenal insufficiency—also known as Addison's disease—which can result in unexpected weight loss, dizziness, lightheadedness, low blood pressure, nausea, stomach pain and loss of appetite.

On the other end of the spectrum, having too much cortisol is known as Cushing syndrome, which presents the opposite symptoms: weight gain in the face and stomach, high blood pressure, purple stretch marks on your abdomen, diabetes and muscle weakness.

Adrenal fatigue conflates the symptoms of having too much and too little cortisol. “This is the first problem,” says Luthra. “There's a mixture of symptoms of both cortisol deficiency and excess, which physiologically doesn't make sense to us in endocrinology.”

Why could you be experiencing symptoms associated with adrenal fatigue?

Adrenal fatigue isn’t real, but the various symptoms commonly associated with it certainly are. It’s tempting to lump all these symptoms together into a single diagnosis, but unfortunately, getting to the various roots of these problems is a more complex process.

Weight gain and fatigue are common concerns among 30- and 40-something women, but Luthra says there are usually a few culprits behind these symptoms, including obstructive sleep apnea and thyroid issues. “[Obstructive] is often associated with patients who are overweight and/or have insulin resistance. And it's largely undiagnosed,” she says. (Diagnosing it requires a sleep study.) Thyroid dysfunction, like hypothyroidism, can also cause weight gain and fatigue, as could a vitamin deficiency or anemia.

“Metabolism in women does slow down leading up to menopause, the average for which is 51. With the changes in hormones and hot flashes and night sweats, disturbed sleep is the number one cause of fatigue as well,” she says. “But once you start treating them with an appropriate hormone replacement, [patients] feel a whole lot better.”

The best way to pinpoint the issue is to exhaust all possibilities through testing with your family doctor, as opposed to a naturopath whose testing methods are not validated by medical standards. But sometimes, even when all objective possibilities are ruled out, symptoms remain unexplained. In these cases, Luthra considers the possibility of mental illness, such as depression, which can also cause fatigue.

“If you keep attributing everything to adrenal fatigue,” says Luthra, “you may miss other diagnoses.”