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You Do NOT Have Adrenal Fatigue – So What Is It?

Maria Claps, Contributor
Thyroid Nation

You Do NOT Have Adrenal Fatigue

There are too many people walking around thinking that they have adrenal fatigue. This diagnosis was handed to them after a saliva test and a visit to a holistic clinician. I admit, I used to use this method of testing. I’ve ordered saliva tests on my clients and have coached them in recovering from the maladies of modern day lifestyles, and at that time, I too called it adrenal fatigue

Many of them got better, because when we get adequate rest, deal with our stressors, eat nutrient dense food and take high quality supplements, our bodies usually respond well. But this didn’t mean that they had adrenal fatigue.

So if you don’t have adrenal fatigue, what do you have?

Most likely, you are experiencing a mismatch between your biology and your lifestyle. This shows up in two main ways. The first is nutrition. For the vast majority of our time on earth, we’ve consumed wild game, fish, vegetables, starchy tubers, nuts, seeds and fruit in season. Nowadays, the 6 most common foods in the modern diet are pizza, sugar sweetened beverages, beer, bread, grain based desserts, and fried chicken. This type of diet is inflammatory and is a factor in our modern day chronic un-wellness.

The second, lesser known, mismatch between our bodies and our lifestyle is the activation of our stress response system. Our stress response system has two components, the sympathoadrenomedulary system (SAS) which is responsible for our immediate or short term stress response and their HPA axis, which is responsible for our intermediate or long term stress response. The HPA axis consists of the hypothalamus and pituitary glands (in the brain) and the adrenal glands (in the mid back). It helps us process threats to the body (whether those threats are a car accident or refined, nutrient poor food that you’ve just eaten)

Both of these stress response systems exist for our own good. But the protective mechanisms they produce can become harmful over the long term if continually called upon.

Here’s the perfect scenario for understanding this: Imagine you’re a hunter-gatherer out for a walk on the savannah in the middday sun and all of a sudden a wild boar charges you. Its a good thing that your heart rate, blood pressure and blood sugar increases. It is a very crucial part of your physiology meant to ensure your survival. But while these survival mechanisms increase, your digestion and sex hormone production plummet. This is the way it is supposed to be. But its a problem when it never calms down.

Enter the modern lifestyle….traffic, work deadlines, inflammatory food, over-exercise, or its opposite, couch potato syndrome: smoking, OTC drug abuse, lack of rejuvenating activities. The list goes on…I’m sure you get it.

The constant activation of the stress response via the SAS and HPA pathways erodes resilience and induces metabolic breakdown.

The loss of resilience is associated with the modern day disease epidemic and  is why stress contributes to so many conditions.


A Partial List of Conditions Associated with Chronic HPA Axis Stimulation

  • Depression
  • Fibromyalgia
  • Excessive exercise
  • Diabetes
  • Central obesity
  • Asthma
  • Rheumatoid arthritis
  • Eczema
  • PMS
  • Thyroid disease

If you’ve gone to a holistically minded doctor and you’ve got any number of these problems and a saliva test, you’ve probably been handed an adrenal fatigue diagnosis.

The adrenal fatigue model is loosely based on the work of Hans Selye and his General Adaptation Syndrome. Selye explained that there was a progression of stress over time: Those 3 stages are:

  1. Alarm

  2. Resistance

  3. Exhaustion

The adrenal fatigue model with the three stages of adrenal burnout is loosely based on this model. Stage 1 of adrenal fatigue is high cortisol with DHEA on its way down. Stage 2 of adrenal fatigue is falling cortisol (which is sometimes in the normal range) and decreasing levels of DHEA and stage 3 is even lower cortisol and lower DHEA.

True adrenal fatigue, if the term is to be used at all, should be reserved for those who have… Click To Tweet

But is the adrenal fatigue concept really accurate?

No, it’s not. Consider the 2 primary problems with the adrenal fatigue diagnosis:

  1. Most people with “adrenal fatigue” don’t have low cortisol levels. The assessment of adrenal fatigue has relied on saliva measurement of cortisol taken at 4 distinct points throughout the day. This type of cortisol measured in a saliva test is unbound and has cell signalling effects but it’s only 2-5% of our total cortisol production. The vast majority (around 70%) of our cortisol is excreted in urine. This measurement is called metabolized cortisol. Free (salivary) cortisol is NOT the best marker for cortisol production.

This would not matter if free and metabolized cortisol was the same. But often, they are quite different.

It’s possible to have low free cortisol and high metabolized cortisol.


Conditions with associated with low free cortisol and high total cortisol:

  • Obesity
  • CFS
  • Insulin resistance


  • Active stress response
  • Long term glucocorticoid use

Also, it is possible to have high free cortisol and low metabolized cortisol. This is commonly seen in liver damage and hypothyroidism.

***Special note for hypothyroid sufferers: If you get a DUTCH test and it shows up as the opposite of what I describe above, you might be getting overdosed on your thyroid medication***

Therefore, a saliva test is an incomplete picture of true cortisol production.

  1. Even when total cortisol is low, its rarely because the adrenals are tired and unable to produce it. The control mechanisms for cortisol production reside in the brain and central nervous system. The HPA axis governs circadian rhythm and stress signals in the brain and cortisol output through negative feedback loop.

The adrenals produce cortisol but the regulatory mechanisms are primarily outside the adrenal glands. Therefore we should not be calling the problem of low cortisol adrenal fatigue, but instead it should be called  “low cortisol mechanisms”.

Here are two low cortisol mechanisms:

1). Down regulation of the HPA axis – when we are exposed to stress for a long time or intent dressed like PTSD we see a down regulation in cortisol receptor sensitivity. This is the body’s wise attempt to protect itself from the effects of chronically high cortisol levels. But the problem is that it actually ends up with using the body’s ability to produce cortisol. This is an Adaptive short term mechanism that becomes maladaptive in the long-term.

2). Impaired cortisol signaling – High cortisol levels will lead to cortisol resistance. This can be caused by a decrease in cortisol receptor sensitivity and/or a decrease in cortisol receptor expression.

Along with many others in the functional health community, I now know that adrenal fatigue is really a misnomer.

And that’s ok. Max Planck, brilliant late physicist, said

“science progresses one funeral at a time”

Progression in science is a good thing and with the advent of the DUTCH method of testing, which tests both free and metabolized cortisol, we have a greater understanding of the health of the adrenal glands.

Nourish&FlourishTrue adrenal fatigue, if the term is to be used at all, should be reserved for those who have Addison’s, an autoimmune inability to produce cortisol.

But for most, it is simply miscommunication between the brain and the adrenals which is exacerbated by a mismatch between how we were designed to live (nutrient dense food, infrequent activation of the stress response, exposure to sunlight) and how we actually live (too much exposure to electronic screens, nutrient poor food and  go-go-go lifestyles.

So what’s a woman to do?

You can get your adrenal hormones and your sex hormones tested by an accurate test and this is called the DUTCH test. DUTCH stands for dried urine total complete hormones and it uses dried urine to measure hormone levels. Precision Analytical laboratory in Oregon is the maker of this test.

I am offering women an opportunity to do this test and receive a customized lifestyle protocol in my online group program “Balance Your Hormones, Love Your Life” which starts on May 2nd.

You can find out more information and enroll right here.

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About the Author

Maria-ClappsMaria Claps is a Certified Holistic Health Coach, Functional Diagnostic Nutrition Practitioner and is trained in the Gottfried Protocol for helping women balance their hormones. She coaches clients in her central NJ office and all over the country. She’s also a mom to four grown children. Please check out Nourish & Flourish with Maria at her website, Let her knowledge of health, nutrition and hormones help you by making a personal consult appointment with her, HERE. Be sure to follow her on Twitter and tune-in to her wonderful scopes on Periscope. Check out her new course to help balance hormones!

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 Questions or anything to ask Maria about adrenal fatigue? We’d love your thoughts. Your comment might just help someone else in need, too!


1 Comment

  1. What if you’ve been hypothyroid along time, never had good blood levels, have high bp,kidney problems and had a very stressfull life, and have a mass on my Left adrenal gland
    And feel like I haven’t an ounce of energy or emotion.

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