"Adrenal Fatigue" Is The New "Detox"
Dec 13, 2010 | Comments Off 
I don't know about you, but I get a chill down my spine whenever I hear the word "detox." Maybe it was the Master Cleanse, or the fact that my friends truly believe that they have ancient poop in their colons, but the word has lost all meaning.
Similarly, "adrenal fatigue" is another medical condition that has me rolling my eyes whenever I hear it.
I still remember the first time I ever came across the concept. It was at the now defunct Stop The Thyroid Madness Forums where members would regularly suggest adding "support for the adrenals" in the form of cortisol to compliment their thyroid medication.
The conversation went down like this:
"I just got a prescription for 17 grains a day of Armour Thyroid, what else should I do?"
"Better support those durn adrenals!" the forum members would say.
For those of you that have no clue what I'm talking about, the adrenals are two star shaped endocrine glands that sit on top of your kidneys. They are often referred to as "the stress glands" and are responsible for secreting cortisol, testosterone, aldosterone, and DHEA.
"Adrenal fatigue" is said to be when the adrenals have become "stressed" from constantly being called upon to release the hormone cortisol.
Dr. Bryan Walsh, who I first heard about on Jimmy Moore's Livin La Vida Low Carb Podcast, wrote a great piece for T-Nation that explains the conventional wisdom behind adrenal fatigue:
Unfortunately, the adrenal gland model many alternative practitioners follow today is completely outdated. It basically says that the adrenal glands go through a progressive stress response like this:
1. Alarm reaction — This is the body's initial response to stress. It's typically characterized by elevated cortisol levels.
2. Resistance — If stress is prolonged, the adrenal glands will start to become more "fatigued" and therefore will use other hormones (i.e. pregnenolone) to help make cortisol. Cortisol levels may be normal or high during this phase, but DHEA levels may be low, which can negatively impact Testosterone levels.
3. Exhaustion — This final stage is typically characterized by low adrenal function, with low cortisol and DHEA levels. This phase is what most people refer to as "adrenal fatigue."
Dr. Walsh goes on to explain the updated "functional" model:
There's a branch of medicine called neuroendocrineimmunology, which basically states that the nervous system, the endocrine system, and the immune system have an intimate connection with one another, and that it's impossible to talk about one system without considering the others.
The adrenal glands are really nothing more than manufacturing plants that release hormones based on inputs from other areas of the body. In other words, if someone is having symptoms of low cortisol, perhaps it's not the adrenal glands that need help, but rather something in the body is actually telling the adrenal glands to produce less cortisol.
Dr. Walsh's functional model starts making even more sense when you compare those with "adrenal fatigue" to those with type II diabetes. The "adrenal fatigue" sufferer claims that there adrenals are "burned out" and the only way to "get them back on line" is to give them rest by supplying the body with cortisol, so their adrenal glands don't have to produce it.
The type II diabetic is in a similar conundrum. Instead of their adrenal glands being called upon to secrete excessive amounts of cortisol, the diabetic's pancreas is called upon to secrete insulin. Should the diabetic "rest the pancreas" by supplying insulin? No! Of course not, that would be crazy. Instead, they should investigate whether low body temperature, autoimmunity, inflammation or environmental factors are the culprits of their decreased ability to metabolize glucose.
Organs just don't get stressed out for no reason, the adrenal glands, just like any other bodily system, are simply acting appropriately to the stimuli they receive.
Reader Comments (17)
I can vouch for what you are saying with some anecdotal data. I had severe adrenal fatigue so bad I could barely get out of bed, massive yeast infection and at certain points I had to go to the hospital emergency room with mild adrenal collapse.
I think it has more to do with the liver's ability to manufacture pregnenolone from cholesterol. Previously my cholesterol was low(around 115) even on a high fat zero carb diet. It's always been low. Morning cortisol of 14.(pretty low for morning cortisol) ACTH of 6(range 10-50) Progesterone of .2(range .2-1.4) Pregnenolone of <20(range <140) This was right on the edge of an actual mainstream diagnosis of secondary adrenal insufficiency, especially since I failed an ACTH stim test(my cortisol did not double after an injection of ACTH). Slowing working my way up to 30mg/day of hydrocortisone saved my life and allowed me to function, but if I went without it, I would collapse be unable to get out of bed and start shaking involuntarily.
After supplementing with 50mg/day OLM pregnenolone(and zero HC) for a couple months. My morning cortisol is now 21, progesterone 1.2, ACTH 27, and pregnenolone is 76.
Now I haven't even taken any pregnenolone in over a month and my levels are still the same.
Thanks for commenting Richard,
Amazing.
I would suggest that most would probably just stay on Cortef for the rest of their lives.
I've been through a horrifying adrenal fatigue, and it truly is no joke for those who are afflicted. Entire face feels like it's being both run over and shot at the same time.
"Organs just don't get stressed out for no reason, the adrenal glands, just like any other bodily system, are simply acting appropriately to the stimuli they receive"
Couldn't agree more with that...
Thanks for commenting James,
Can you explain more?
Other than self-diagnosis or a confirmed stimuli causing the adrenals to act erratic, adrenal fatigue seems to carry the same weight as "detox."
I felt a post like this coming. "Detox", "Candida", "Adrenal Fatigue"... this are all really vague health diagnosis' that seem to be attributed to just about every ill health symptom in the book. When people actually dig deeper and look closer at the state of their health, these things are narrowed down into more specific catergories... ie "Candida" is usally SIBO, or sometimes thyroid, "Detox" is often a dietary stressor or vitamin defiencey, and "adrenal fatigue" can really be anything.
Not discounting any of these, but I feel like so many people just tag themselves with this ailments and fall for some of the bunk science and supplements that go along with them.
what I love about your blog and philosophy Danny, is that you preach diet before anything else. People should always always play with diet and lifestyle before supplements. People should ask if they are eating enough, sleeping enough, getting outside and moving enough, relaxing enough, eating in macronutrient ratios that work for them. How is their digestion, gut flora, Vitamin D levels, etc etc.
"Adrenal Fatigue" and "Candida" have always seemed like cash-ins to me. It is really sad with "Candida", a problem that is usually with gut flora, and people spend most their time attempting to kill their "Candida" with high doses of antifungals/antibacterials like oil of oregano, super low carb diets and the like, which is actually further worsening their problem. The problem is never the bacteria/fungi, it is the terrain and the population. Weed for a tiny bit but mostly seed my friends, seed those good fellas in your gut with raw milk, raw milk kefir, lacto-fermented foods, dirty raw garden veggies, boiled sweet potatoes and root veggies and drop some of your hygiene, go play in the dirt or something.
Off on another rant again, apologies Danny.
There's definitely some voodoo in the blogosphere surrounding adrenal fatigue, but having seen results in the reversal of my own adrenal problems via supplementing isocort, pregnenalone, DHEA, ADB5+ etc, I feel pretty comfortable saying that this is an effective treatment. There are some processes in the body where supplementing causes a down-regulation of your natural production, but there are others where supplementing has a "priming the pump" effect. This seems to be the case with digestive enzymes, for example. It could also explain why treating adrenal fatigue with supplements is quite effective while treating type II diabetes with insulin is not.
There almost certainly is a point where the adrenals just get "burnt out" as a result of prolonged exposure to a stressor, and the removal of that stressor is insufficient in reversing this burnout. I went through stages 1 and 2 in college, and distinctly remember the inability to sleep at night/wake up in the morning etc. Of course, I was also dealing with systemic scleroderma. Then at 21 I had a heart transplant, which is likely the major stressor that pushed me over the edge into stage 3.
Three years later, despite a full year of cyclic low carb paleo eating (including overeating in an effort to gain weight), my adrenal stress index showed my cortisol at 6.7, 4.9, 2.9, 2.5 in morning, noon, afternoon, nighttime respectively. It's funny because I should have felt like dogshit, but I never did, my energy has always been high and constant, at least since I went paleo and including when I had those numbers measured. Anyway, it's something that I've been working with a biosignature guy with, and while I haven't had my adrenal stress index taken since that first measurement, there has most likely been improvements, as determined by improvements in skin fold ratios and a relatively substantial lean mass gain in only a few months (as compared to very little if any gain despite intelligent lifting for the last year).
Danny,
AMAZING post! U CR*CK ME UP. Identifying root causes is key. 'Organs just don't get stressed out for no reason, the adrenal glands, just like any other bodily system, are simply acting appropriately to the stimuli they receive.' Your assessments are GOLD.
Geoff,
Did you say you had a heart transplant? I have little evidence but I am pretty certain that many of our mainstream drugs cause adrenal dysfunction just as soy may affect/kill the thyroid, pancreas and adrenals... Were you on corticosteroids for immunesuppression and prevention of organ rejection? Being synthetic hormones, these shut down endogenous cortisol synthesis. I had a problem with both a cracked (therefore mildly infectious) tooth for ~2yrs and a synthetic birth control hormone. Both f*cked up my bodily systems including adrenals...
I think the adrenals, pancreas and thyroid are more 'susceptible' to dysfunction because they are employed 24/7 except during meditation and the great majority of sleep. The liver? IT IS HUGE -- more to go around. These are tiny organs in comparison.
-G
Hey Danny, not sure the exact mechanisms behind why I personally am going through adrenal fatigue but beyond throwing supplement at myself (not my preferred method of achieving anything at all) getting rid of metal load really took care of it. I'm experimenting again soon with getting rid of oxidized metals and mercury which has obviously been a problem for me, as well Candida and a few other things, the GI issues having more than enough research behind it to tie with metals.
Wouldn't have thought this if not for personal experience with a trial and error approach, and again anything that causes extra stress on the body could cause adrenal burnout, metals being probably the most common.
LOL had to laugh at that post. "Better support those durn adrenals!" hahaha.
Thanks for commenting Bill,
Your rants are always welcome, especially when they encapsulate what I'm trying to say so well.
Thanks for commenting Geoff,
Having a heart transplant at such a young age pushes you out of the self-diagnosing soccer mom camp. I'm definitely not channeling you in this post!
Thanks G!
Hey James,
I apologize if I've already probed, but how do you know you have a heavy metal burden?
Thanks for commenting T.D.
:)
Hey Danny, it's alright.
Besides the fact that all of us have some amount of metal burden (unless your really really lucky. Really lucky) it's been a long process of trial and error, I've tried a lot of different things and the only thing which has ever given me relief of certain symptoms I'm having along with hair loss was chelating, it made me go from feeling like I was a walking corpse to feeling like a rockstar. No supplement, food, etc has every done that for me, the intense pain my temples / face / eyes went away and I could think much more clearly. I understand you're a musician Danny, I am as well, I play psychedelic Jazz and it was pointed out to me that the before and after jams were of no comparison when it came to keeping syncopated timings and whatnot, mathematics became a lot easier as well. Go figure, It was the last thing I thought about... Metals? what metals?
What a relief to hear this from someone else! Incidentally it was "adrenal fatigue" that got me to where I am today. CW/SAD was making me frustrated and I couldn't lose weight, so I talked to a friend studying functional medicine or holistics or whatever and he "diagnosed" me with adrenal fatigue, and recommended that I pay hundreds of dollars for lab tests, bioidentical hormones, and a metabolic typing test. I smelled snake oil but I was desperate, and was actually considering trying to come up with the money until I stumbled upon Mark Sisson while googling around about adrenal fatigue and metabolic typing. Now I'm your standard success story (30 lb weight loss in 5 months, better energy, focus, libido etc). In retrospect the whole functional medicine thing seems like BS--it just seems completely backwards/crazy to me that our bodies would require us to consume hormone supplements to function properly, but apparently it works for some people... Anyway, I just found your blog last night and it's been a great read so far, thanks!
Interesting stuff James. Cutler mentions how big of an impact specific metals have on cognitive function.
Thanks for commenting Heather,
Your story is awesome. It's unfortunate that some of us go through the ringer before figuring it out.
Hi Danny!
I've been puzzling over an idea in Chapter 8 of your excellent book.
You wrote: "If you choose to go low-carb, it might be wise to plan on periodically carb loading (low fat, low protein, high carb) to avoid any thyroid down- regulation."
Here's what I'm wondering about:
* Does a Zero Carb diet tend to result in thyroid down-regulation?
* What's the least amount of carbs a Zero Carb'er would need to add, in order to to stop thyroid down-regulation?
Thanks again!
Barnabas
Hey Barnabas,
There is some data that suggests that restricting carbohydrates too aggressively will down-regulate the thyroid.
Having said that, I know a couple of zero-carbers who exhibit no signs of low thyroid.
Taking all of this into account, if you do better on a low-carbohydrate diet, it might be wise to periodically "carb-load" to restore leptin and thyroid signaling.
All of this is heavily dependent on the person and their current metabolic state.
Sorry for being so vague Barnabas, this is kind of a gray area.
any suggestions?? by taking a hair mineral analysis I've discovered that I am in the exhaustion stage of adrenal fatigue. (10 year ex-cocaine user and 5 year ex-bulimic/anorexic/compulsive exerciser). It's also been brought to my attention that I have high levels of aluminum in me....my dilemma is this....should i detox the metal first or just treat the adrenal issues first. I've read contradicting information on the web and my hair analysis recommendations are unclear in this matter. any help would be greatly appreciated!
Thanks for commenting Donna,
You won't find any clear information on the internet in regards to what to do about aluminum. I'm no expert, but check out Andy Cutler for information regarding heavy metals.
http://www.carnivorehealth.com/main/2010/11/1/mercury-chelation-it-aint-so-easy.html
Matt Stone has a great post on anorexia that might be of use:
http://180degreehealth.blogspot.com/2010/07/anorexia-rehab.html