The hotly debated term ‘adrenal fatigue’ has evolved over the past two decades to signify a condition whereby the adrenal glands lose their ability to produce stress hormones, mainly cortisol, under the duress of chronic stress. The individual posting claim to coining the term ‘adrenal fatigue’ claims:

“Adrenal fatigue is produced when your adrenal glands cannot adequately meet the demands of stress….It is a collection of signs and symptoms, known as a “syndrome,” that results when the adrenal glands function, but not at their optimal level. During adrenal fatigue your adrenal glands function, but not well enough to maintain optimal homeostasis because their output of regulatory hormones has been diminished – usually by over-stimulation.”

Over one century of scientific research has never corroborated the above statements. For this reason, it is important for the millions of people suffering from states of low cortisol (more correctly termed ‘hypocortisolism’) to learn and understand the true reasons underlying their condition.

Thanks to the advances offered by modern medical technology, the true causes behind stress induced low cortisol states has shown that the process through which stress induced low cortisol states occur is sophisticated and complex. The adrenal glands are just one of many organs and structures involved in the stress response system. And as members of a system, they cannot and do not act independently. Other extremely influential factors are command centers in the brain, other hormones, the immune system, genetics, and a person’s individuality (personality type, early life experiences, perception of stress, etc.). To promote the adrenal gland as being an independently functioning, central component of the stress response system is not only inaccurate but also diminishes the true complexity of the neuroendocrinological system.

When a person discovers they have low cortisol, the most important question to ask is why. The reason will never be ‘exhausted adrenals’.

The hotly debated term ‘adrenal exhaustion’ has evolved over the past two decades to signify a condition whereby the adrenal glands lose their ability to produce stress hormones, mainly cortisol, under the duress of chronic stress. The result is complete ‘exhaustion’ of the adrenals. One avid proponent of the term ‘adrenal exhaustion’ states:

WARNING: ADRENAL EXHAUSTION AND INSUFFICIENCY ARE NOT RECOGNIZED MEDICAL DIAGNOSES

“The medical profession is far behind when it comes to understanding adrenal gland problems. In 2011, they still do not recognize adrenal insufficiency, adrenal exhaustion or adrenal burnout as real health conditions. This is very sad, as the situation is so common.”

Over one century of scientific research has never found ‘exhaustion of the adrenal glands’ to be the cause of low cortisol. For this reason, it is important for the millions of people suffering from states of low cortisol (more correctly termed ‘hypocortisolism’) to learn and understand the true reasons underlying their condition.
Thanks to the advances offered by modern medical technology, the true causes behind stress induced low cortisol states has shown that the process through which stress induced low cortisol states occur is sophisticated and complex. The adrenal glands are just one of many organs and structures involved in the stress response system. And as members of a system, they cannot and do not act independently. Other extremely influential factors are command centers in the brain, other hormones, the immune system, genetics, toxic exposures, nutrient deficiencies, and a person’s individuality (personality type, early life experiences, perception of stress, etc.). To promote the adrenal gland as being an independently functioning, central component of the stress response system is not only inaccurate but also diminishes the true complexity of our stress response systems.
For those who truly believe they suffer from ‘adrenal exhaustion’, the future is bleak since one proponent of this concept claims, “Most people never recover from burnout”.

According to proponents of ‘adrenal burnout syndrome’, “Adrenal burnout syndrome is basically a mild form of Addison’s disease. It is a low functioning or underactivity of the adrenal glands. It may also be termed adrenal insufficiency or adrenal exhaustion.” Indeed the adrenal glands are of paramount importance in our stress response system because they produce the essential hormone cortisol without which we could not live. However, there is much more to this story than you may realize.

When your body is subjected to stress, whether psychological, environmental, nutritional, or otherwise, a complex chain of events occurs which involves every organ system in your body…not just your adrenal glands. The type of stressors, how you perceive the stress, your genetic makeup, your development in the womb, and numerous other factors profoundly affect the type of stress response your body will generate.

Over one century of scientific research has never shown that the adrenal glands ‘burn out’ in response to chronic stress. Low cortisol states absolutely exist and have been shown to be responsible for up to 25 % of all cases of stress related bodily disorders such as chronic fatigue syndrome, fibromyalgia, and PTSD. However, the process through which low cortisol states evolve is often initiated in the brain. You see, there are three very important structures in the brain that regulate the release of cortisol: the hypothalamus, the pituitary gland, and the hippocampus. The adrenal glands cannot make cortisol if they do not receive the message to do so, and research shows that this, by far, is the most common cause of low cortisol. Other causes include:

• Cortisol message is generated by the cells don’t hear it
• Adrenals can’t make cortisol because they are diseased, damaged, or lack an important ingredient for cortisol production
• The command centers in the brain don’t talk to each other
• The cortisol message gets all the way to the cell, but the door to cortisol wont open
•
The list of additional causes is enormous but ‘adrenal burnout syndrome’ is not one of them. For the proponents of this condition, I say show me the evidence!

Normally, the stress hormone cortisol is released in a typical ‘diurnal’ or circadian pattern. It peaks in the early morning hours, gradually declines throughout the day, and reaches its lowest levels during the first few hours of sleep. Low cortisol, medically known as ‘hypocortisolism’ is defined as either an abnormally low (or ‘blunted’) daytime cortisol levels, an inappropriate rise in cortisol after exposure to a stressor, or both.

Hypocortisolism and Chronic Fatigue Syndrome

Hypocortisolism has been found in up to 25% of patients with chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, posttraumatic stress disorder, ‘burn-out’ and chronic pain syndromes.

Low Cortisol and Adrenal Fatigue

Is low cortisol the same thing as adrenal fatigue? Yes and no. Proponents of adrenal fatigue claim that low cortisol occurs because the adrenal glands cannot keep up with the ongoing demand placed upon them by chronic stress. The end result is low cortisol and the symptoms thereof (fatigue, depressed mood, etc).

There is unequivocal evidence that low cortisol states occur and are clinically relevant. However, no medical evidence exists confirming that low cortisol states occur as a consequence of failing adrenal glands or ‘adrenal exhaustion’. Rather, most evidence points to a breakdown in the sophisticated communication circuits between areas in the brain (the hypothalamus and the pituitary gland) and the adrenal glands. Some other reasons include:

• The cortisol message is there but the cells of the body do not respond.
• The adrenal glands cannot make cortisol because they are damaged (i.e. heavy metal toxicity), diseased (i.e. autoimmune disease) or lack an important factor in cortisol production (i.e. vitamin C deficiency)

It is important to understand that low cortisol states are an indication of other underlying problems which must be identified and treated. Assuming the adrenals simply ‘no longer work’ is inaccurate and potentially dangerous if the true underlying cause is not determined.

Many of us have come to know the hormone cortisol as the hormone that goes up when we are ‘stressed’ and the hormone that promotes the development of belly fat. However, even though cortisol has gotten a ‘bad rap’ when it comes to the waistline, it is an extremely important hormone that is the only hormone your body could not live without.

Although other hormones, such as adrenaline, are released when you are in a stressful situation, cortisol is the body’s primary survival or ‘fight or flight’ hormone. For instance, when you narrowly escape the crosswalk as a hurried car speeds past you, adrenaline is the hormone that prompts you to get out of the way, but it is cortisol that allows you to keep running. Its sole purpose is to divert all your bodily resources away from unimportant things (reproduction, sleep, digestion, etc) to ensure your survival. Cortisol causes a rise in blood sugar, pulse, and blood pressure, a decrease in bowel and immune system function, and a reduction in the activity and effectiveness of all other hormones in your body.

High Cortisol Symptoms

Unlike all the other hormones produced by your body, cortisol is a ‘catabolic’ or wear and tear hormone. As such, it is important that all hormones are properly balanced to prevent excessive tissue breakdown. If a balance does not exist, high cortisol states can ultimately lead to such diseases as diabetes, high blood pressure, high cholesterol, obesity, immune system abnormalities, and even cancer.

Low cortisol states (hypocortisolism) always represent an underlying problem. Therefore, accurate diagnosis and directed treatment is the rule. However, during the process of discovery, there are some natural supplements available to help improve some of the symptoms often encountered in hypocortisolism such as fatigue and chronic pain. All are made by a company far more knowledgeable and sophisticated than any modern day pharmaceutical company. The company name? Mother Nature.

Supplements for Low Cortisol

Perhaps the most beneficial supplements in treating low cortisol are known as ‘adaptogens’. There are nearly 50 plant derived adaptogens, and as their name implies, they assist the stress response system in ‘adapting’ to stress. Commonly used adaptogens include Ginseng (Siberian, Korean, and Panax), Rhodiola, Ashwaganda, Bacopa, Holy Basil, and Licorice root.

Over 2000 years ago, Chinese and Ayurvedic medicine began using adaptogens to promote physiological resistance to stress, fatigue, trauma, and anxiety. Medical research on adaptogens began in the 1940’s. Rhodiola and Siberian Ginseng have been studied most extensively. Research has found that adaptogens improve mental concentration, productivity, and stamina under conditions of stress and aid in promoting resistance to the harmful effects of stress.

Fibromyalgia (FM) is one of the most common chronic pain conditions and affects approximately 10 million people in the U.S. alone. Although patients of all ages, genders, and ethnicities can be affected, up to 90 percent are women. The risk of acquiring FM increases with age. In fact, approximately eight percent of adults meet the American College of Rheumatology classification of FM.

It may come as no surprise that many of the symptoms that characterize hypocortisol states and chronic fatigue syndrome are also seen in fibromyalgia. They include:
• Widespread, chronic muscle pain
• Increased sensitivity to touch
• Fatigue
• Sleep disturbances
• Morning stiffness
Patients with FM also experience more depression, anxiety, and psychosocial stress. FM often coexists with CFS, probably because the mechanisms through which both conditions arise are in parallel. However, in addition to being deficient in cortisol, FM patients may also have low levels of androgens (testosterone and DHEA), thyroid hormone, growth hormone, and catecholamines (epinephrine and norepinephrine).

Symptoms of Fibromyalgia

Numerous studies on patients with FM have identified several important predisposing factors. They include:

• Emotional neglect
• Victimization
• Problems with school or vocation
• Hereditary predisposition
• Temperament
• Early pain or disease experiences

These factors, coupled with family or job stress and a lack of ability to cope, can leave an individual especially vulnerable to developing FM.

Mirroring the findings in studies of patients with chronic fatigue syndrome, patients with FM display low daytime cortisol levels, inappropriate rises to cortisol in response to stressors, and dysfunction in the stress response system (‘HPA axis dysfunction’). There have been no studies confirming that primary ‘adrenal fatigue’ is the cause of low cortisol states in FM patients or other patients with hypocortisolism.

Chronic fatigue syndrome (CFS) has become a pervasive medical problem affecting up to 5 percent of patients, primarily women. There is no effective treatment for this condition, perhaps because in nearly all cases, there is an underlying cause that has not been properly identified.

What is Chronic Fatigue Syndrome?
Symptoms of Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is defined as clinically unexplained, persistent, or relapsing fatigue of at least six month’s duration and the presence of at least four of these symptoms:

• Sore throat
• Tender, enlarged lymph nodes in neck or under arm region
• Muscle pain
• Pain in multiple joints
• Fatigue after exercise
• Non-refreshing sleep
• Headaches
• Impaired memory/concentration

You may find it interesting to know that all of the symptoms of chronic fatigue syndrome are also symptoms of hypocortisolism! And again, the key question to ask is WHY? Some key causes of chronic fatigue syndrome AND low cortisol include: sleep disorders, immune system dysfunction, chronic infections, gastrointestinal problems, and abnormal function of the mitochondria (power houses of our cells).

Numerous studies have confirmed that patients with CFS have:
• Reduced baseline HPA (hypothalamus-pituitary-adrenal) axis function
• Decreased function or abnormal regulation of HPA axis
• Flattened daytime cortisol levels
• Inappropriately low cortisol levels upon exposure to a known stressor
• Excessive inflammation

And yet again, the majority of the medical evidence does not find primary adrenal gland failure to be the cause of low cortisol in CFS patients. A 2008 issue of the Journal of Chronic Fatigue Syndrome published an evidence based review of CFS and fibromyalgia which specifically states:
“… A more important fact is that a multitude of studies have demonstrated the HPA axis dysfunction in these conditions [CFS and fibromyalgia] is central (hypothalamic or pituitary), not a primary adrenal insufficiency.”