Is Adrenal Fatigue Real? (and what Is REALLY causing the fatigue)

Written by Tim Skwiat

Adrenal Fatigue Myth

Are you feeling run down and stressed? Do you feel tired but wired? Do you have trouble falling asleep or staying asleep? Do you have trouble waking in the morning, feeling like you got hit by a truck?

Do you lack energy and feel lethargic? Do you often lack focus, struggle concentrating, and feel like it’s impossible to navigate through the dense brain fog?

Do you feel like you need coffee, an energy drink, or other stimulants just to get through the day? Do you find yourself reaching for sugary—or maybe even salty—junk food to give you a much-needed boost?

Does any of that sound like you?

If you’ve played doctor detective on the Internet, maybe you’ve read about adrenal fatigue. Maybe someone has told you your adrenal glands have been worked to exhaustion. Maybe that’s the reason you’re so tired.

Maybe NOT.

The Myth of Adrenal Fatigue

Many health books, alternative medicine websites, and the general media have popularized the term “adrenal fatigue” as an explanation for a wide array of symptoms supposedly set off by long-term mental, emotional, or physical stress. Supporters theorize that too much life stress overworks and exhausts our adrenal glands, which help us deal with stress by producing hormones like cortisol.

And when we’re constantly in the throes of stress, our adrenal glands simply can’t keep up, which is when the laundry list of symptoms covered under the umbrella of adrenal fatigue begins to appear:

  • • Tiredness and fatigue
  • • Trouble falling asleep at night
  • • Difficulty getting up in the morning
  • • Salt and sugar cravings
  • • Needing stimulants (e.g., caffeine) to get through the day
  • • Feeling blue
  • • Weight loss or weight gain
  • • Low libido

As you can tell, these are very common and non-specific, and they can even occur as part of a normal, busy life. No wonder adrenal fatigue has become so popular.

Fortunately, science is not a popularity contest (although it sometimes feels that way), and the current body of scientific evidence indicates that adrenal fatigue “does not exist” and it’s “still a myth.”1 The Endocrine Society does not recognize adrenal fatigue as a medical condition, bluntly stating, “the adrenal glands cannot be ‘fatigued.’”2

Then What IS It?

Regardless of whether adrenal fatigue is real or not, what you’re feeling IS real. And that’s the most important thing. But if we can’t chalk it up to your adrenals being run ragged, what’s the culprit?

That’s the million-dollar question. Actually, it’s probably worth a lot more than that considering people are making millions and millions “selling” adrenal fatigue as the explanation for virtually every problem under the sun.

Be that as it may, if you’re feeling tired, weak, or depressed, there is a chance you do have a serious health problem. In other words, these can be symptoms of real medical conditions, such as adrenal insufficiency, depression, obstructive sleep apnea, or other health issues. Getting a real diagnosis from a real doctor can be critical to help you feel better and overcome your health problem. In other words, if you think you’ve got a problem, get help from a doctor.

That being said, there are several lifestyle factors that also may be playing a role, and along those lines, it’s a very good idea to take a thorough inventory of the following:

Stress

Obviously, if you think your adrenals are fried, there’s a strong possibility you’re feeling stress, which can come from many angles and forms: social, physical, financial, emotional, psycho-spiritual, environmental, mental, and cultural.

Stress isn’t bad; in fact, just like the Goldilocks Principle tells us, we need just the right amount to thrive. Too little can be just as harmful and impairing as too much.

However, since most people have too much on their plates (even if it’s just a matter of perception), stress management tactics like the following are priceless for protecting your limited, valuable resources:

Set boundaries. Learn to say “NO.” As hard as it can be, you may be spreading yourself too thin by aiming to please others and taking on more than you can handle. Do what is right and don’t make apologies.

Practice yoga. Yoga has been shown to reduce cortisol and exert powerful “anti-stress” effects.3,4

Meditate. Mindfulness meditation, which is a form of meditation where you focus your awareness on your breathing and body in the present moment, has been shown to lower both stress and cortisol levels.5

Take a walk. Taking a leisurely walk in nature, also known as Shinrin-yoku or “forest bathing,” can help reduce stress, lower cortisol, and activate the body’s “rest and digest” branch of the nervous system (parasympathetic).6,7

Breathe deeply and slowly. Start with a long exhale, blowing out all the air in your lungs over the course of about 5 seconds. Hold your breath for a second, then take a deep, 5-second breath in through your belly, holding for a second. This type of breathing activates the vagus nerve, which reduces the body’s “fight or flight” response and increases its parasympathetic activity.8

Exercise. There’s no question that exercise can be effective for helping manage stress, and according to an article published in the American College of Sports Medicine’s Health & Fitness Journal, “all types of exercise can be beneficial for stress management.”9 That said, be careful about doing too much high-intensity exercise (such as high-intensity resistance training and high-intensity interval training), which can induce a pretty substantial adrenal/stress response and promote burnout.10 In fact, many female clients I’ve worked with have greatly benefited from reducing their volume of high-intensity exercise, instead including a bit more low- to moderate-intensity activity (e.g., walking, yoga).

Restorative Sleep and Circadian Rhythms

If you’re not consistently getting high-quality, restorative sleep, chances are you’re going to feel many of the issues typically associated with adrenal fatigue. Sleep is intricately tied to our circadian rhythms, which basically refers to the body’s 24-hour internal clock and is often called the sleep/wake cycle.

Believe it or not, there are circadian clocks in various organs of the body, including the adrenal glands.11 For example, under normal circumstances, cortisol should be lowest at nighttime when we go to bed (and melatonin levels should be high), and they should peak in the early morning, facilitating wakefulness. You know the ol’ tired and wired feeling you’re used to? There’s a good chance your circadian rhythms are jacked up, throwing off your cortisol output (i.e., low in the morning, high in the evening).

Disturbances in our natural circadian rhythms—due to shift work, jet lag, sleep disruption, feeding behavior, and light/dark exposure—can have potentially profound negative effects on body weight, carbohydrate metabolism, a variety of hormones, and more.12

According to renowned sleep researcher Dr. Dan Pardi, there are three components that determine the restorative quality of sleep:

1. Timing: The human body prefers a consistent bedtime and wake time. If you normally are in bed from 10 pm to 6 am, sleeping from 2 am to 10 am will not be as restorative—despite sleeping the same number of hours. Two additional notes on timing:

a. Know your chronotype. Are you a morning lark or a night owl? According to Clinical Psychologist and renowned sleep doctor Michael Breus, “Not every person’s biological clock keeps the same time”; “your body has been programmed to function much better at certain times of the day than others.” Along those lines, your preferred timing of sleep and activity is known as your chronotype. And knowing your chronotype, which is genetically determined, can be tremendously important for setting the best bedtime for yourself. For instance, if you’re naturally a morning person who tends to stay up too late or a night owl who has to get up early, your circadian rhythms can be disrupted.13

b. Respect the sleep cycle. Generally speaking, the average sleep cycle lasts about 90 minutes (although this can vary across individuals). Along those lines, you are likely to experience the most wakefulness if you get up at the end of a sleep cycle—instead of in the middle. Maybe you’ve had an experience like this before when you slept for 8 hours (5 1/3 sleep cycles) but still felt dog-tired. On the other hand, maybe you’ve slept for 6 hours (4 sleep cycles) and felt bright-eyed and bushy-tailed. Along these lines, it’s a good idea to make sure you give yourself enough time in bed to ideally get 5 – 6 sleep cycles, letting yourself wake up naturally when your body is ready.

2. Duration: Make sure you’re in bed enough time to get a full night’s sleep. In other words, you cannot get 8 hours of sleep if you’re only in bed for 6 hours. Since you have less control over when you have to get up, set an appropriate target bedtime.

3. Intensity: This refers to the depth of sleep, and although you have less control over this than you do timing or duration, according to Dr. Pardi, there are several things you can do to improve your sleep hygiene and establish a healthy, consistent sleep/wake cycle, which are crucial to optimal sleep intensity.

Recommendations for Sleep Hygiene and Circadian Rhythms

Time in bed. Make sure you are setting yourself up for success by being in bed for 7 to 9 hours per night.

Routine. Work on going to bed and getting up at the same time every day. My personal solution? Have a baby. Our daughter doesn’t know the difference between Tuesday and Friday. She’s up at the same time EVERY day.

Be active. Being physically and mentally active during the day can help you sleep better at night. In general, regular exercise improves sleep quality; however, some may find that intense exercise close to bedtime may have a negative effect on sleep. Regular exercise also seems to help regulate circadian rhythms, and there is some evidence that suggests the benefits of exercise may be maximized when it’s done in the afternoon or early evening.14

Block blue light in the evening. Arguably one of the biggest factors disrupting circadian rhythms in today’s society is our exposure to blue light, which is ubiquitous in the forms of fluorescent lightbulbs, cell phones, tablets, computer monitors, TV screens, and more.15 Blue light suppresses melatonin production, delaying feelings of sleepiness and the onset of our nighttime cycle, disrupting circadian rhythms and sleep. Try the following strategies 2 to 3 hours before bed:

o Avoid TV and computer screens
o Use the app f.lux if you must use your computer
o Use a similar app if you must use your smartphone (i.e., Night Shift for iPhones)
o Dim your lights
o Use amber-tinted light bulbs
o Wear amber-tinted glasses

Bright outdoor light in the morning. On the other side of the coin, getting sunlight exposure first thing the morning can have a substantial effect on setting your circadian clock to help you feel more awake during the day. In fact, a lack of sunlight exposure may be even more to blame for circadian disturbances than excess artificial blue light exposure at night. While you’re at it, you might as well kill two birds with one stone and take a walk!

• Blackout your room. At night, make your room as dark as possible, using dark curtains and removing all sources of artificial light.

Chill out. The ideal bedroom temperature range, between 60 and 67 degrees, can help your body naturally cool, which helps facilitate sleep.

Watch what you drink. Research shows that drinking caffeine-containing beverages even 6 hours before bedtime can have important disruptive effects on sleep.16 Thus, it’s best to cut off caffeine more than 6 hours before bedtime. And while alcohol may help you fall asleep, it disrupts sleep quality and reduces REM sleep in a dose-dependent manner.17 In other words, the more you drink, the worse you sleep.

Watch what you eat. Obviously, you don’t want to go to bed too hungry or too full. Generally speaking, it’s best to avoid large mixed meals within a couple hours of bedtime. If you need to eat something after that, a small, healthy snack (~150 calories), such as a protein shake, a piece of fruit, or a handful of nuts, can be beneficial for weight management, appetite control, and body composition.18 (More on nutrition below.)

Take a dump. A “brain dump” that is. If you’re the type of person whose wheels start turning uncontrollably as soon as your head hits the pillow, have a notepad handy on your nightstand. Write down ideas, important thoughts, etc. This can help quiet your mind, and you can also take an honest look to see if there’s anything you HAVE to do at that very moment.

How Much, What, & When You Eat

Surprise, surprise! What, when, and how you eat can also be playing a substantial role, and to feel your best, you need an optimal mix of calories, amino acids (i.e., protein), fats, carbs, vitamins, and minerals. Unfortunately, there’s no one-size-fits-all recommendation for everyone; however, here are some helpful starting points:

Track your food intake. Tracking your food intake can be a very useful tool to get a good understanding of how much and what you’re eating. Ideally, you should use an app (such as MyFitnessPal) that tracks calories, macronutrients (proteins, fats, carbs), and micronutrients (vitamins, minerals). You don’t have to do this long-term; the goal is just to get a better understanding of where you are right now.

Track your water intake. Pretty much everyone knows that drinking plenty of clean water and properly hydrating is essential for feeling your best. However, up 75% of Americans don’t get enough water, and even minor dehydration can lead you to feel tired and lethargic.19

Make sure you’re eating enough. Dieting is a surefire way to zap your energy levels. In fact, reducing energy levels and caloric expenditure is one of the body’s primal metabolic adaptations to a reduced-calorie diet.20

Make sure you’re eating enough carbs. Cutting carbs is all the rage these days, and while it can be an effective, highly useful tool for many people, there are some folks who are especially sensitive to reductions in carb intake. For these people, low-carb diets can trigger the adrenals to go on overdrive. Also, most people make the mistake of severely dropping calories when they cut carbs, and as mentioned above, that can be a problem.

Dietary restraint. Preoccupation with body weight, food, and dieting—which is referred to as “dietary restraint”—can be a “subtle but chronic psychological stressor.”21 Sure enough, numerous studies have shown that dietary restraint is associated with higher levels of cortisol.22,23 In other words, if you’re the type of person who’s fixated on the number on the scale, every morsel of food you put into your body, or both, you may be placing a serious strain on yourself.

Limit processed foods, added sugar, etc. When is the last time someone told you to eat more ultra-processed junk food? Probably never. You’d be well-advised to limit your intake of these highly refined “foods,” which can lead to disturbances in normal, healthy levels of inflammation and trigger the body’s stress response.24

Watch when you eat. According to a recent study published in the American Journal of Physiology Endocrinology and Metabolism, “It is not only what you eat and how much you eat, but also when you eat.”25 You see, timing of food intake can have meaningful effects the body’s circadian clocks. In fact, according to Dr. Satchin Panda, “Meal times have more effect on circadian rhythm than dark and light cycles.” On the other hand, circadian rhythms can have a substantial effect on how you metabolize the food you eat. For instance, research on circadian biology shows us that carb tolerance and insulin sensitivity are greatest in the morning and then decline over the course of the day.26,27 Research has also shown that eating closer to bedtime (such as a late dinner or late-night snack) had a negative effect on sleep quality.28 According to time-restricted feeding research conducted by Dr. Panda and others, it seems best to limit your “feeding window” to less than 12 hours each day with most—if not all—of your food intake during daylight hours (e.g., before 8pm).14,29

Your Struggle is REAL

Whew! That’s a lot. But that’s the point. If you’re feeling tired, lethargic, or any of the other laundry list of symptoms covered under the umbrella of adrenal fatigue, there’s a pretty good chance your lifestyle may be the culprit, and it’s quite possible your circadian rhythms are disrupted. And even though adrenal fatigue may be a myth, your struggle is REAL. While there’s no quick fix, there are several actionable steps you can begin taking immediately.

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References

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