The answer to this question depends on who you ask it to.  Most medical doctors in Canada (probably the US as well) will say that there is no such thing as adrenal fatigue.  Most naturopathic doctors in Canada (and the US) will say that it does exist and many of their patients ‘suffer’ from it.

In a purely semantic sense I would suggest that the medical doctors are more correct.  If you do or see a lot of adrenal stimulation test results you will see that most of them come back negative for Addison’s disease (adrenal glands inability to create sufficient cortisol on stimulation with ACTH).  This means that the adrenal gland is able to produce enough cortisol when stimulated by ACTH.  This is the way that medical doctors test for adrenal dysfunction, and the test will invariably come back negative when they have a patient that they have tested after the naturopathic doctor has diagnosed adrenal fatigue.  They would then come to the conclusion that the naturopathic doctor had misdiagnosed the patient, thinking that ‘adrenal fatigue’ would be synonymous with Addison’s disease.

Yes, you could argue that the test uses too much ACTH, and the cortisol did not go high enough, suggesting weak adrenal function, but I would argue this is not generally the case.  The problem is that, when tested, the cortisol is much lower than optimal (not according to lab ranges for normal but on hormone experts views on optimal levels).  Is this not adrenal fatigue?  No, this not a fatigued, or dysfunctional, adrenal gland.  This was proven with the ACTH stimulation test.  When stimulated enough, it will produce enough.  But the cortisol was too low, correct?  Yes the cortisol was too low, but with enough stimulation it went to more normal levels.  This means that the adrenals are not being stimulated enough normally.  This will be missed in the adrenal stimulation test and the medical doctors will then eliminate the adrenals as an issue.  Then in their minds they eliminate cortisol as an issue, which is a mistake.  If they would only have done a baseline ACTH with the cortisol, then they may have seen the problem.  Low stimulation for cortisol due to low ACTH, resulting in low cortisol, resulting in all the symptoms of (what the naturopathic doctors would call) adrenal fatigue.

Now, if you believe that adrenal fatigue just means low cortisol, then the naturopathic doctors are more correct (remember, you have to know the optimal levels for cortisol, not just the labs ‘normal’ range).  But the word suggests that the adrenal gland has somehow become fatigued, which is probably not the case as suggested above.  The actual description of what has occurred, and where the problem lies, is not so simple.  The cause of the low cortisol is, as is generally described in adrenal fatigue, starts with long term high stress.  This long term high stress (resulting in long term high cortisol production) does not cause the adrenal gland to become fatigued, it causes damaging effects on the body.  This is not to be confused with short term high stress (resulting in short term high cortisol).  Some suggest that short term is less than a week.  Initially, when cortisol goes high, it is to protect you during the stressful event.  This includes stimulating the immune system.  High cortisol over longer terms starts to cause damaging effects, including suppressing the immune system.  What people may tend to forget is that the brain controls the hormones (for the most part).  The brain controls cortisol with the release of ACTH from the pituitary.  There are some steps before this but I will not discuss them here.  The brain makes decisions on how much cortisol to stimulate based on inputs it receives.  These inputs include the amount of cortisol circulating in the blood stream and how much cortisol the body needs (the negative feedback loop).  If the brain gets inputs that say the cortisol is now causing some damaging effects it will take this in to account when deciding to stimulate more or less cortisol (in this case less).  The brain starts releasing less ACTH so the adrenal gland produces less cortisol.  This may not be enough to help you deal with the stress properly but the brain had to drop it based on the damaging effects.

The brain is doing the best it can with the situation.  The problem is the aftermath.  This is what some would call adrenal fatigue.  But the adrenals are not fatigued.  The brain is not really fatigued either, it was doing its job to protect you (by protecting itself because without a functioning brain you are dead) by dropping cortisol when it started causing damage.  The problem is the brain brain has reset the cortisol to lower levels than optimal (lower during stress and even lower when the stress goes away) and does not seem to want to allow the adrenal gland back to its ‘normal’ levels of cortisol when the stress is over.  Its almost as if it does not want to put itself back in the position it was in, so it keeps the cortisol suppressed.  This is when someone will start seeing the symptoms of low cortisol:  fatigue (especially in the afternoon), light headedness and/or irritability if misses meals and light headedness at other times, foggy headedness, waking during the night and having troubles getting back to sleep, hair loss, allergies, asthma, skin rashes, muscle aches or tender points from increased inflammation (fibromyalgia or polymyalgia rheumatica), getting sick more frequently and lasting longer, and signs such as low blood pressure (hypotension) and low blood sugar (hypoglycemia).

The key now is the brain and its connection to the adrenals, what is called the HPA axis (the hypothalamic-pituitary-adrenal axis).  The trick is the complexity of the brain and how to treat it.  Most herbals that are credited for treating ‘adrenal fatigue’ are more likely to be treating at the brain level (herbs such as the adaptogens) as are many of the supplements that we use for the adrenals (such as phosphatidyl serine).  Understanding the brain’s part in the creation of low cortisol and understanding the value of cortisol are the keys to treating the condition we may know as ‘adrenal fatigue’.

Note:  Cortisol is truly one of the most important, if not the most important, hormone in the body.  When doctors (medical or naturopathic) or pharmacists call cortisol a ‘dangerous hormone’ they show a complete ignorance of cortisols role in the body and the research that has been done on cortisol (not to be confused with prednisone and dexamethasone that are generally used in very high ‘supra physiologic’ doses).  Cortisol is, in fact, one of the few hormones we cannot live without, and (as far as I know) the only one that studies suggest will cause our death within about 4 hours of not having it.  More on this in a later blog.