IIf there are two words that Dr. James Findling, an endocrinologist at the Medical College of Wisconsin, most likely it is “adrenal fatigue.”
Some of his patients recount a claim they read on social media: that adrenal fatigue occurs when the adrenal glands, which produce the stress hormone cortisol, can’t keep up with the amount of stress they’re facing and underperform, resulting in a long list of symptoms. But the mainstream medical community disagrees. “Adrenal fatigue is an illogical and illegitimate diagnosis that has no scientific basis,” Findling said, and endocrinologists are “disgusted” that the idea won’t go away.
The Endocrine Society, of which Findling is a member, agrees that adrenal fatigue is not a valid medical diagnosis, and researchers have debunked the concept in studies. But the term persists on social media and among some alternative medicine practitioners, so people continue to think they have it. “It takes a lot of time and a lot of explanations…to prove their adrenals are OK,” Dr. Anat Ben-Shlomo, an endocrinologist at Cedars-Sinai in Los Angeles.
How the adrenal glands work
It’s hard to blame patients for thinking they have adrenal fatigue, as the symptoms associated with this condition are so common. These symptoms include difficulty waking up in the morning and then feeling tired most of the day, relying on caffeine for energy, craving salt or sugar, experiencing brain fog, feeling hopeless or hopeless, and reporting a low sex drive. And that’s the short list. “Almost all the symptoms,” says Dr. Rashmi Mullur, endocrinologist and integrative medicine specialist at UCLA Health.
These symptoms are real, says Mullur, and may indeed be related to chronic stress—but they’re not because your adrenal glands are weakened. “Even though you may feel emotionally and mentally exhausted, your adrenals can’t actually burn out,” he says. “They will continue to function even under conditions of chronic stress.”
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The adrenal glands, located above the kidneys, produce and release various hormones, including cortisol and adrenaline. During stressful situations, the domino effect that begins in the brain eventually signals the adrenals that it is time to start pumping out these hormones, which triggers a series of physiological effects intended to help the body respond to the stressor. When there is enough cortisol in the bloodstream, the brain receives the message and regulates its production.
The ability of the adrenals to carry out this process “seems limitless,” Ben-Shlomo said, unless a person actually has adrenal dysfunction. There are some rare conditions that cause the adrenal glands to produce small or large amounts of hormones—Addison’s disease and Cushing’s syndrome, respectively—but these conditions are usually caused by autoimmune conditions, tumors, infections, long-term drug use, or other medical problems. not routine stress. (Damage to the pituitary gland, which is located at the base of the brain, can also interfere with the hormone production process.) And, unlike adrenal fatigue, there are validated tests that doctors use to diagnose Addison’s disease and Cushing’s syndrome, Ben-Shlomo says.
The myth of adrenal fatigue
If this is not an accepted diagnosis, where does the idea of adrenal fatigue come from? This is often attributed to James Wilson, a chiropractor and naturopath who in 2001 published the book Adrenal Fatigue: A Stress Syndrome of the 21st Century. In an interview with TIME, Wilson said he coined the term in the late 1990s after seeing many clients who had similar energy and mood problems, which he attributed to problems with their adrenal glands.
Although he says it is “doubtful” that mainstream medicine will accept adrenal fatigue, Wilson argues that there is a state between adrenal failure and normal function, and that doctors are missing it because they are not using the right diagnostic tests. Wilson believes saliva tests are more appropriate than blood tests for measuring cortisol levels. The US National Institutes of Health says blood tests are the gold standard for diagnosing adrenal insufficiency, but a 2023 study from researchers in the UK found that saliva tests are no less accurate.
The medical system is not motivated to take adrenal fatigue seriously, Wilson said, because it is “pointless” without a prescription drug to treat it. (Wilson sells a variety of supplements that claim to improve adrenal health.)
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The problem with people who believe they have adrenal fatigue, Ben-Shlomo says, is that they may self-diagnose and seek unproven and potentially dangerous treatments. He once saw a patient who took so many steroid-containing supplements that they actually damaged his adrenal glands—the opposite of what they promised.
Additionally, people who think they have adrenal fatigue may actually have another medical problem causing their symptoms, which could also be missed if the patient self-diagnoses.
Treat stress, not symptoms
What about people who experience all the symptoms caused by adrenal fatigue, but test results are normal at the doctor’s office? Mullur can empathize. As the parent of a child with disabilities, she has faced extreme stress and experienced many of the symptoms of adrenal fatigue herself, which inspired her to do more for patients experiencing the same thing. “I knew my adrenals were functioning, but I was feeling all the symptoms: not being able to sleep, eating too much, being tired all day, gaining weight, losing hair, irritability, and so on,” he said.
For others facing this problem, he says the solution is often to manage chronic stress—because, while it won’t damage the adrenal glands, chronic stress will be bad for health. Can has a big impact on overall health, Mullur says.
Read more: Can Food Really Change Your Hormones?
In the short term, the body’s response to stress can save lives and improve health. But when someone lives with unrelenting stress, they can experience a variety of impacts that contribute to health problems ranging from cardiovascular problems to immune and nervous system dysfunction. Research also shows that chronic stress can disrupt circadian rhythms, possibly impacting everything from sleep to digestion.
Mullur said people should focus on managing their stress through a “back to basics” approach such as movement, nutrition, mindfulness practices and social connection. Seeing a mental health doctor or other healthcare practitioner may also help, if possible.
Over time, Mullur says, these practices will improve the symptoms people are experiencing, which is valid and worth treating—even if those symptoms aren’t related to an adrenal problem. “We needed a different name,” Mullur said. “It’s about treating chronic stress. That’s the main problem.”
