I recently worked with a client who had been put on a ketogenic diet for adrenal burnout. Whilst it had helped symptoms initially, it was life limiting and was no longer helping her energy. It prompted me to write this blog as it is something I've consistently worked with in my clinic. It's a subject riddled with misinformation, leading clients down endless rabbit holes. If you or someone close to you is suffering, I hope this helps.
Adrenal fatigue isn't an accepted medical diagnosis. However, it is a widely used term so it is important to understand it. Google “adrenal fatigue” or “adrenal burnout diet” and you’ll find websites recommending everything from eliminating dairy to following a paleo diet. However, in reality, “adrenal fatigue’ is a lay term applied to a collection of nonspecific symptoms, such as body aches, fatigue, sleep disturbances and digestive problems.
The general consensus among health practitioners is that adrenal fatigue is a condition where the adrenals, the glands that sit above the kidneys, don’t produce enough cortisol. Cortisol is a hormone that plays a role in managing stress and regulating metabolism, sleep, blood sugar and inflammation. Basically, the theory goes that too much stress wears out our adrenal glands — they get tired and don’t produce enough cortisol for us to feel energized. However, as medical doctors and endocrinologists point out, in fact, when you’re stressed out, your adrenal glands make more cortisol.
However, whilst the label can be misleading, the symptoms are real. Moreover, people with a medical diagnosis of adrenal insufficiency do have fatigue. The medical term "adrenal insufficiency" refers to inadequate production of one or more of these hormones as a result of an underlying disease or surgery. Signs and symptoms of adrenal insufficiency may include:
- Body aches
- Unexplained weight loss
- Low blood pressure
- Loss of body hair
- Skin discoloration (hyperpigmentation)
Adrenal insufficiency can be diagnosed by blood tests and special stimulation tests that show inadequate levels of adrenal hormones. Low cortisol can result because the pituitary gland not producing enough of a hormone that stimulates the release of cortisol from the adrenals. Addison’s disease is a condition where the adrenal glands are attacked by antibodies. As a result, the adrenals won’t produce enough cortisol.
However, for most people with burnout or fatigue, this medical diagnosis doesn’t fit the bill. Instead, they are left with a wide range of frustrating and often debilitating symptoms rather than a specific condition.
Then there's the burnout that seems to appear right on cue as soon as you take a break or a holiday, so called "leisure sickness." Once fight or flight stress hormones wane, so does the shot in the arm to the immune system. Adrenaline can also mask some of the daily niggles and aches and pains. As a result, once stress subsides, the body is left more vulnerable for an infection to strike or for those symptoms to be noticed. It's an ancient survival strategy that 'reads' the threat of a wild animal or the stress of home-schooling children whilst trying to hold down a job in exactly the same way. When your body perceives that a threat is over, it can hunker down and use your energy to fight an infection instead. And yes, I fully expect this to happen to many of us post Covid 19.
So, what's the best approach?
In my clinic the initial work is to ensure the client has eliminated other medical causes of fatigue, such as anaemia or thyroid problems. Next, it’s a case of looking at broader triggers of fatigue and burnout such as (but not limited to) stress, peri-menopause or menopause, sleep issues, poor digestive health or depression. In other words, locate the stressor and work on the root cause(s), not just the symptoms.
So, while the worlds of conventional and alternative medicine are divided on adrenal fatigue as a condition, everyone agrees that managing stress and fatigue makes perfect sense.
For this, a holistic approach is always best, combining eating well, treating any vitamin, mineral or essential fatty acid deficiencies, improving digestive wellness, ensuring regular physical activity and enough sleep. Foods that are lower on the glycemic index help stabilise blood sugar, and as a result can help manage energy levels and mood. Some people do better on a low-carb diet, others need a different approach.
Above all else, every time someone asks for help with burnout and fatigue it is vital to remember that the path that got them to that point will be utterly unique to them - thus, the advice should always be personalised.