Perhaps this scenario sounds familiar...
You're feeling stressed and unwell and decide to see your trusted doctor.
Three visits and four prescription drugs later, you still feel like gum on the bottom of a shoe.
Frustration prompts you to take matters into your own hands, and you spend hours surfing the net in an attempt to diagnose and treat yourself.
You ultimately stumble across the words "adrenal fatigue"and realize that the only thing missing from the description is your picture.
Vindication at last! You are not alone.
In fact, the term adrenal fatigue has skyrocketed in popularity garnishing nearly 100,000 Google searches each month.
People are grasping for anything that will explain the symptoms that their pristine lab results cannot corroborate.
The term adrenal fatigue was coined over a decade ago to suggest that in the face of chronic stress, the adrenal glands eventually become exhausted.
This then renders them incapable of producing ample amounts of stress hormones, particularly cortisol, in the face of any ongoing or future stressful assaults.
The unfortunate victim of this condition is then left to suffer from fatigue, depression, and a litany of other symptoms which modern medical testing universally misses and doctors dismiss.
As a conventionally trained internist, I learned about disease, not the 'calm before the storm.
' Disease, of course, is what happens when a patient's symptoms are confirmed by test results which fall outside of the statistically derived normal reference range.
I learned about the extremes in cortisol production, namely Cushing's Disease (cortisol too high) and Addison's Disease (cortisol too low).
Black and white, not gray, are the official colors of conventional medical training.
As such, patients with uncommitted cortisol levels falling somewhere along the bell shaped curve are labeled as being 'normal.
' And so has evolved the term adrenal fatigue.
Unfortunately, nearly every major medical organization and institution considers this to be a mythical diagnosis propagated by fraudulent and perhaps even unethical souls who wish to peddle 'quick fixes.
' As a physician, scientist, and patient, I began my mission to seek the truth five years ago.
I reviewed hundreds of scientific papers and studies in search of the existence of adrenal fatigue.
It came as no surprise that I could not find one shred of evidence that the omnipotent adrenal glands declare defeat under the constraints of chronic stress.
I did, however, find a wealth of information on stress and stress related diseases in the context of low cortisol.
Low cortisol does indeed exist and it can cause a plethora of annoying symptoms and disease states.
In fact, 25% of all stress related bodily disorders, namely conditions such as PTSD, chronic fatigue syndrome, and fibromyalgia, have been associated with low cortisol.
However, in nearly all cases of low cortisol, the adrenal glands are not the guilty party.
Rather, the lack of central command from the brain is most often the reason the adrenal glands do not get the memo to make cortisol.
So why do the semantics matter? Consider my sixty year old male patient who suffered from many symptoms of adrenal fatigue, such as fatigue, chronic pain, sensitivity to stress, and low grade fevers.
He initially sought care from his primary care doctor who found 'nothing wrong.
' The patient then took over his own medical care, found a seemingly legitimate website about adrenal fatigue, and purchased several supplements hoping for a cure.
The patient ultimately came to see me as a patient because his adrenal fatigue was not improving.
Unfortunately, since they 'why' behind the 'what' of his adrenal fatigue was never pursued any further, his lung cancer was too advanced to treat by the time I saw him.
So much for adrenal fatigue.
Does adrenal fatigue exist? Show me the evidence! Does low cortisol exist? YES! And there is always a cause which must be sought.
The evidence that low cortisol states contribute to disease formation is so overwhelming, it will be difficult for my conventionally trained colleagues to ignore it indefinitely.
As the saying goes, all good things must come to an end.
Giving credit where it is due, the term adrenal fatigue has been useful in improving awareness that subtle abnormalities in cortisol levels can wreak havoc even if confined within the normal laboratory reference ranges.
However, it is an outdated and inaccurate term which now only serves as a barrier for patients seeking legitimate diagnosis and treatment.
Although iconic in its time, it is time to put the term to rest.