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 a mismatch between your biology and your lifestyle. This shows up in two main ways. The first is nutrition. For the vast majority of our time on earth, we’ve 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, sugar sweetened beverages, beer, bread, grain based desserts, and fried chicken. This type of diet is inflammatory and is a factor in our modern day chronic unwellness.
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 process threats to the body (whether those threats are a car accident or refined, nutrient poor food.)
Both of these stress response systems exist for our good. But the protective mechanisms they produce can become harmful over the long term if continually called upon.
Here’s the perfect scenario for understanding this: Imagine you're a hunter gatherer out for a walk on the savannah and all of a sudden a wild boar charges you. It's a good thing that your heart rate, blood pressure increase. It’s a crucial part of your physiology meant to ensure your escape and this your survival. But at the same time these survival mechanisms activate, your digestion and sex hormone production plummet. This is how it’s supposed to be, but it’s a problem when it rarely or never calms down.
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 with the modern day disease epidemic and is why stress contributes to so many conditions.
SOME CONDITIONS ASSOCIATED WITH CHRONIC HPA AXIS STIMULATION:
- Excessive exercise
- Central obesity
- Rheumatoid arthritis
- Thyroid disease
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 loosely 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 LOOSELY 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.
Not really. Consider two 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.
This would not matter if free and metabolized cortisol was the same. But often, they are quite different.
It’s possible to have low free cortisol and high metabolized cortisol.
Some conditions with associated with low free cortisol and high total (aka metabolized) cortisol:
- Chronic Fatigue Syndrome
- Insulin resistance
- Active stress response
- Long term glucocorticoid use
Also, it is possible to have high free cortisol and low metabolized cortisol. This is commonly seen in liver damage and hypothyroidism.
***Special note for hypothyroid sufferers: If you get a DUTCH test and it shows up as high free cortisol and low total (aka metabolized) cortisol, you might be getting overdosed on your thyroid medication***
Therefore, a saliva test is an incomplete picture of true cortisol production.
Even when total cortisol is low, it's rarely because the adrenals are tired and unable to produce it. The control mechanisms for cortisol production reside in the brain and central nervous system, not the adrenal glands themselves. 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 simply be called “low cortisol mechanisms”.
Here are two reasons why cortisol production can 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 an adaptive short term mechanism that becomes harmful in the long-term.
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.
With the DUTCH (Dried Urine Test for Comprehensive 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 estrogen metabolite breakdown.)
True adrenal fatigue, if the term is to be used at all, should be reserved for those who have Addison’s disease, an autoimmune inability 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.
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