Adrenal Fatigue, Adrenal Burnout or Adrenal Imbalance?

As one of few practitioners that specialise in adrenal health, it comes as no surprise that my mailbox often contains enquires from individuals who think they may have adrenal problems. They are usually right. While the wording used by various people makes no odds to me, the different phrases employed demonstrate the lack of agreement in medical circles as to what these adrenal problems really are.

Adrenal Fatigue is a phrase first coined by Dr James Wilson, a US physician who noticed the connection between a range of symptoms and lowered adrenal output. Since then, it has become an accepted phrase within the alternative medical community but has met resistance from those in ‘conventional’ circles. Such doctors reject the label and refuse to discuss adrenal fatigue, as it is not a diagnosis listed in the Physician’s Desk Reference, it does not have an insurance code attached to it and was not covered at medical school.

The nomenclature is also relevant. Both adrenal ‘fatigue’ and adrenal ‘burnout’ are inclusive terms that the layman can instantly make sense of. However, in the overspecialised climate of 21st-century medicine, esoterica is the name of the game and anything that sounds remotely ‘unscientific’ can expect immediate and unconditional rejection. It is interesting how I can normally gain co-operation with various specialists on mutual patients on the basis of the vocabulary used. If I send a letter to a specialist recommending that a mutual patient include certain foods or nutraceuticals and undertake infra-red saunas to ‘detox’, I know that my suggestions will be ignored. However, if I avoid the D-word and explain that I have ordered a assay of chemical adducts attached to translocator proteins on mitochondrial membranes and found raised levels of toxic metals blocking the movement of ATP compounds, then we may get somewhere. After all, I am now part of the ‘club’. In Western medicine, words are very important.

Adrenal insufficiency is a ‘medical’ word. So is hypoadrenia. These terms are used less by patients and holistic practitioners, but often by endocrinologists who have received back the blood tests of patients and found the cortisol to be low (obviously, ‘low cortisol’ is a frightfully simple phrase and not a good medical term). However, despite the mainstream recognition these words enjoy, I am not suggesting that these are better terms to use for adrenal dysfunction.

Adrenal dysfunction may often see cortisol levels fall independently from DHEA. As such, DHEA levels may remain firmly within the desirable range while cortisol levels bottom out. Sometimes DHEA levels rise in some of the compensation patterns that occur as the hypothalamic-pituitary-adrenal axis struggles in vain to maintain some sort of normality. DHEA can also plummet without the cortisol levels being affected. Thus, “adrenal insufficiency” is often too generic to be an accurate term. It is certainly inappropriate when it is used without having measured both cortisol and DHEA.

Additionally, having an endocrinologist admit that your test shows ‘adrenal insuffiency’ does not mean you will receive any treatment. The NHS textbooks (still used today) state that there are only three ‘flavours’ of adrenal function: high (“Cushing’s Disease”), normal and low (“Addison’s Disease”). Many endocrinologists have been trained to believe this and, confronted with results they do not understand, prefer to dismiss the patient than accept the limitations of their (very limited) education. This is where patients get told that ‘adrenal fatigue is not a medical diagnosis’. Sadly, for all the hullabaloo made by doctors about the need for ‘evidence-based practice’, the way specialists deal with patients depends a lot more on their individual dogma than the test results or symptoms exhibited.

When I work with individuals that may be suffering from adrenal issues, I am never attempting to find a label, or a diagnosis, or a name to give the problem. In all cases, I seek to understand what imbalance we are dealing with and establish the underlying causes. This is the only way we can then provide the specific support required while facilitating the changes in the background that allow the body to heal itself.. In clinic, I will tend to use whichever term carries most meaning with the individual in question. Failing that, ‘adrenal imbalance’ is my choice term until an adrenal stress index test establishes the exact situation.

Although the medical world is built around certain words to establish and maintain exclusivity, the words used are irrelevant. Your adrenal glands will respond exactly the same to specific nutrients whether the suggestions were made in English, Spanish or sign language.

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