Is Adrenal Fatigue Real???

Many people are showing up at their primary care provider's office after self-diagnosing on “Dr Google or other web searches, wanting relief for their adrenal fatigue...but is it real???

Adrenal glands and their function

The adrenals, aka suprarenal glands, are located on top of both kidneys and produce hormones that help regulate

• metabolism
• immune system
• BP
• response to stress.

The adrenals are composed of an outer region, the cortex, which has three zones, the zona fasciculata, zona glomerulosa and zona reticularis, and the center or medulla.

• Zona fasciculata produces the glucocorticoid hormone cortisol, which helps control the body’s use of fats, proteins and carbohydrates, regulates BP, increases blood sugar, suppresses inflammation and can decrease bone formation.
• zona glomerulosa produces the mineralocorticoid aldosterone, which regulates BP and blood pH by controlling the levels of electrolytes in the blood
• zona reticularis produces DHEA and androgenic steroids; precursor hormones converted to estrogen in ovaries and androgens in testes
• medulla produces epinephrine and norepinephrine, which initiates the fight or flight response of increased heart rate and force of heart contractions, increased blood flow to muscles and brain and relaxation of airway and other smooth muscles, assists in glucose metabolism, controls vasoconstriction and helps maintain BP

A question asked on the Search Mayo Clinic site was,

“Is there such a thing as adrenal fatigue?"

Dr Ann Keams responded that “adrenal fatigue isn’t an accepted medical diagnosis” but a lay term purported to be “a mild form of adrenal insufficiency caused by chronic stress with nonspecific symptoms” as fatigue, sleep disturbances, digestive problems, irritability, salt and sugar cravings and use of stimulants like caffeine for alertness.

The Endocrine Society’s Patient Resource page, updated on January 25, 2022, made a point in “Dispelling the Myth” of adrenal fatigue that proponents of adrenal fatigue may advise lifestyle changes (no smoking, drinking, drugs), exercise, healthy diet and adequate sleep, but that regardless of diagnosis, these changes would make anyone feel better. Vitamins and supplements may also be suggested. Allen Loyd V Jr, in his article on “Adrenal Fatigue” published in The International Journal of Pharmaceutical Compounding (Jan/Feb 2013 – Vol 17, No 1), stated, “compounding pharmacists can prepare formulations to assist the patient who is suffering from this syndrome”. The warning, though is that these symptoms may also be an indication of depression, obstructive sleep apnea, adrenal insufficiency or other health problems. The Endocrine Society also cautioned that “if you take adrenal hormone supplements when you don’t need them, your adrenal glands may stop working and become unable to make the hormones you need when you are under physical stress. When these supplements are stopped, a person’s adrenal glands can remain ‘asleep’ for months”, which could put this person at risk for adrenal crisis.

“We are tired of ‘adrenal fatigue’” is the statement paper published in SAMJ (Sept 2018, Vol 108, No 9) by I L Ross, J Jones and M Blockman. While the internet and mostly non-medical publications assert that adrenal fatigue is often dismissed by doctors, the author's belief is that “as physicians, our responsibility is to determine whether a true medical disorder exists and whether an underlying sinister condition is being overlooked...there are no confirmed diagnostic and special investigations on how to screen for adrenal fatigue, and there is no ICD-10 code delineating it as a recognized clinical disorder.” The authors also referenced
the work of Flavio A Cadegiani and Claudio E Kater (BMC Endocrine Disorders 2016; 16:48, https://doi.org/10.1186/s12902-016-0128-4 ), “Adrenal fatigue does not exist: a systematic review”. This review included 3,470 articles from PubMed, Medline and Cochrane databases with “systematic finding of conflicting results derived from most of the studies methods utilized, regardless of the validation and the quality of performed tests. Their conclusion? “...there is no substantiation that ‘adrenal fatigue’ is an actual medical condition. Therefore, adrenal fatigue is still a myth.”

So there you have it! As nurses, we educate both ourselves and our patients to better advocate for them. As the Endocrine Society of the USA has warned, if patient fatigue exists, true hypoadrenalism should be excluded due to the high mortality of Addison’s disease, and patients should be appropriately investigated and managed for their symptoms.

More appropriate are the terms “adrenal insufficiency” and “HPA axis dysfunction”, both medical diagnoses, and they have scientific backing...but that’s a blog for another day

Recipe for Adrenal Support

Ingredients:

• 1 head of Lacinato kale or curly kale, stems removed
• 1 red bell pepper , diced
• ¼ red onion, diced
• 1 cup shitake mushrooms
• 1 clove garlic, crushed
• ¼ cup sunflower seeds (pine nuts may be used but are expensive)
• ½ cup cherry tomatoes, quartered
• ¼ tsp unrefined sea salt
• ½ cut cauliflower, sliced thin

 Marinade:

• 3 tbs lemon juice
• 1 tbs olive oil
• ¼ - ½ tsp unrefined sea salt
• 1tsp Italian seasoning
• 1tsp dried oregano
• ¼ tsp cayenne pepper
• 1tsp cumin powder
• ¼ tsp black pepper

 NOTE: bolded ingredients indicate food support for adrenals

 Directions:

1. Stack 3-4 kale leaves at a time. Slice crosswise into thin ribbon strips, using a down and thru motion, keeping the tip of the knife on the cutting board.
2. Pour marinade over the cut kale.
3. Add the crushed garlic and salt
4. Use your hands to massage the marinade into the kale. The kale will wilt and become soft, taking on a “cooked-like” appearance.
5. Taste the kale. If there is still bitterness, add additional salt and/or lemon juice to balance
6. Gently toss with tomato quarters, cauliflower, red pepper and sunflower seeds.

ENJOY!!!

Author - HI, my name is Ginger Montgomery APRN, FNP-BC. I recently retired from my nursing career of 35 years and am now committed to providing next-level healthcare as an integrative nutritional practitioner to a needy population hungry to achieve real and lasting symptom relief and optimal health so they can experience and enjoy the fullness of life to the maximum.

“It is not how much you do, but how much love you put in the doing”, Mother Theresa