Adrenal Fatigue: The 21st Century Stress Syndrome

by Lara Pizzorno, MDiv, MA, LMT

In Adrenal Fatigue, Dr. James Wilson combines a researcher’s grasp of the latest scientific insights into the causes of adrenal dysfunction with an experienced clinician’s practical understanding of its real life impact on patients. The result is a book that successfully bridges the gap between the therapeutic lifestyle changes the research shows must occur to restore adrenal function and the support clinicians can provide to enable patients to actually make these changes. 

Adrenal Fatigue is a condition in which the adrenals, due to chronic over stimulation, begin to fail and produce lower levels of cortisol even when stimulated by higher levels of ACTH (as in an ACTH stimulation test.) Wilson makes a very strong case that adrenal fatigue is an increasingly prevalent yet unrecognized response to the hyper-stress characteristic of the 21st century. Stressors – physical, emotional, psychological, environmental, and infectious – all contribute to adrenal fatigue. The adrenals respond to all types of stress in the same way. And the load is cumulative – if many smaller stresses occur simultaneously, accumulate or become chronic, and the adrenals have no opportunity to recover, adrenal fatigue is all too often the result.

Although adrenal fatigue (aka non-Addison’s or subclinical hypoadrenia) has been described in medical texts since the 1800s, few physicians have recognized the presence of this increasingly widespread problem. Why? Because the “normal” range for adrenal function on standard blood and urine tests includes all but the most severe cases of adrenal malfunction: Addison’s disease (extreme low cortisol and cortisone) and Cushing’s syndrome (extreme high cortisol and cortisone).  And patients whose triggering complaint is actually adrenal fatigue typically present with a host of other diseases and syndromes, whose only apparent similarity is that fatigue is a primary symptom.

This diversity is not surprising since the hormones secreted by the adrenals influence all major physiological processes in the body, closely affecting utilization of carbohydrates and fats, conversion of fats and proteins into ATP, fluid and electrolyte balance, the distribution of fat (fat stored as visceral adipose tissue and along the sides of the face is an indication of dysfunctional adrenals), blood sugar regulation, cardiovascular and gastrointestinal function.

In addition, some hormones secreted by the adrenals have anti-inflammatory and anti-oxidant protective activity and also help control allergic and other adverse reactions to alcohol, drugs, foods and environmental allergens. Furthermore, the adrenals become the major source of sex hormones after mid-life (in men as well as women, although andropause occurs a bit later and the decline in hormone production is more gradual.) And, as every athlete knows, muscular strength and stamina are acutely affected by adrenal hormones, i.e., steroids.  Lastly, susceptibility to certain types of diseases and ability to respond to chronic illness is significantly influenced by the adrenals. The more chronic the illness, the more critical adequate adrenal response becomes.

The many diverse manifestations of adrenal fatigue

The diverse roles played by adrenal hormones explain why adrenal fatigue can be the underlying cause of such a wide range of symptoms and conditions, including:

•    Fatigue—the hallmark symptom
•    Decreased immunity
•    Functional hypoglycemia
•    Weight gain – the temporary increase in cortisol levels produced by driving the adrenals with fast food and caffeine causes people with chronically low cortisol to put on weight since even a temporary excess of cortisol causes visceral fat deposition
•    Food and environmental sensitivities and allergies
•    Rheumatoid arthritis
•    Premenstrual tension
•    Menopausal symptoms
•    Mental disturbances – increased anxiety, depression, difficulty concentrating, less acute memory recall
•    Insomnia
•    Frequent respiratory infections – chronic and recurrent bronchitis, pneumonia and other chronic lung and bronchial diseases typically have an adrenal fatigue component. Adrenal fatigue is often precipitated by recurring bouts of bronchitis, pneumonia, asthma, sinusitis, or other respiratory infections. The more severe the infection, the more frequently it occurs or the longer it lasts, the more likely the adrenals are involved. If there are other concurrent stresses, like an unhappy marriage, poor diet or stressful job, the downhill slide is steeper and faster.
•    Extended recovery period --longer than normal recovery period with decreased stamina and excess fatigue is a strong indication of adrenal fatigue.
•    Asthma
•    Fibromyalgia & Chronic Fatigue Syndrome -- using recently developed polymerase chain reaction tests, infectious microorganisms have been identified as contributing factors.   These pathogens exert a tremendous drain on adrenal resources.
•    Type 2 Diabetes
•    Auto-immune disorders
•    Alcoholism –the hypoglycemia that results from adrenal fatigue predisposes to a compulsive desire for alcohol


The many diverse causes of adrenal fatigue


Some professions, notably the medical profession, are harder on the adrenal glands. Insurance company actuarial tables show that physicians, on average, die approximately 10 years earlier, have higher rates of alcoholism and several times the drug addiction rates of the “normal” population. If Wilson’s enumeration of key lifestyle factors that promote adrenal fatigue –immediately following – rings too many bells, please read this book!    

•    Insufficient sleep
•    Using food and drink stimulants when tired
•    Staying up late when fatigued
•    Constantly driving yourself
•    Trying to be perfect
•    Lack of enjoyable and rejuvenating activities
•    Poor food choices
•    Staying in no-win situations over time

Other professionals at increased risk include the police, secretaries and teachers, and middle executives, all of whom live in the middle, taking the blame when things go wrong but lacking the control to make them go right. Those “in the middle” often present with Syndrome X (glucose intolerance, high triglycerides, low HDL cholesterol, insulin resistance, hypertension, central obesity, accelerated atherosclerosis). All these symptoms reflect the effects of chronic stress that produces elevated cortisol levels. And there are also congenital differences in adrenal resiliency. Children born to mothers suffering from adrenal fatigue or who experience severe stress in the womb typically have lower adrenal function.

The many diverse signs adrenal fatigue

If any of your patients are suffering from a chronic disease and morning fatigue is one of their symptoms, the adrenals are probably involved. If a patient presents with three or more of the following signs and symptoms, adrenal fatigue is highly likely:

•    Difficulty getting up in the morning
•    Continuing fatigue not relieved by sleep
•    Craving for salt or salty foods
•    Lethargy
•    Increased effort to do everyday tasks
•    Decreased sex drive
•    Decreased ability to handle stress
•    Increased time to recover from illness, injury or trauma
•    Light-headed when standing up quickly
•    Mild depression
•    Less enjoyment or happiness with life
•    Increased PMS
•    Symptoms increase if meals are skipped or inadequate
•    Rely on caffeine and sugar to keep going
•    Thoughts less focused, more fuzzy
•    Memory less accurate
•    Decreased tolerance
•    Don’t really wake up until 10am
•    Afternoon low between 3:00 and 4:00 pm
•    Feel better after evening meal
•    Decreased productivity

While Wilson’s focus in Adrenal Fatigue is non-Addison’s or subclinical hypoadrenia, this book could have been marketed as a treasure trove of tools to enable identification of the specific underlying causes of an individual patient’s physiological dysfunctions and the establishment of a targeted curative lifestyle.  A self-help manual for the person suffering from adrenal fatigue – both in diagnosing and treating the condition -- the book is arranged sequentially, each part preparing the reader for what follows.

Organizational structure of the book

Part I provides an overview of adrenal fatigue: what it is, what causes it, who is likely to suffer from it, how it progresses and why medicine has not yet recognized it as a syndrome.

Part II contains a questionnaire (available free on-line at http://www.smart-publications.com/take-the-adrenal-fatigue-questionnaire/) and other tactics, such as a Health History Timeline and iris contraction and postural low blood pressure tests, which will help identify whether adrenal fatigue is present, its degree of severity, and what might be causing it. In this section, Wilson also provides an excellent review of laboratory tests for adrenal fatigue discussing not only his preferred option, saliva hormone testing, but problems with the interpretation of standard laboratory tests and ways to still get useful information from these tests.

Part III is an unbelievably comprehensive guide to restoring healthy adrenal function. It identifies virtually every possible hidden source of stress that can drain the adrenals, gives a very detailed description of effective therapeutic options, including a number of stress management techniques; a full dietary program; dietary and botanical supplements; and replacement hormones -- and ends with a Q&A section responding fully to patients’ frequently asked questions. And more – it’s just too much to list here.

Wilson’s discussion of the connection between adrenal fatigue and low blood sugar, exemplifies the thoroughness of his approach. This section includes not just an explanation of why high cortisol levels induce weight gain, what –and what not -- to eat and drink, and why, but also when to eat, key nutrients in foods, the glycemic index, and a handy summary listing patients can print out for a quick reminder.

Part III also includes a section on food allergies and sensitivities that provides the most complete and useful write up of how to track and identify hidden food allergies and sensitivities I have yet to read in my 30+ years as a medical editor. Adrenal Fatigue is well worth a spot on your office reference shelf just for this section.

Part IV is an overview – in patient-friendly English – of the impact of the adrenal glands on physiological function that clearly explains why even mildly impaired adrenal function can have such widespread and dramatic repercussions.


Adrenal Fatigue: The 21st Century Stress Syndrome is a classic. It will serve as an invaluable resource for both patients and clinicians alike.

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