Paging Dr. Frischer: Adrenal Fatigue Syndrome

In my practice, one of the most common complaints I hear is fatigue. The difficulty with this symptom is that there are so many possible causes. A diagnosis requires a careful review of a patient’s entire lifestyle, health history, diet history, exercise and sleep habits, etc. Could adrenal fatigue syndrome (AFS) be responsible?

Scientific literature on fatigue includes Addison’s disease (also called adrenal insufficiency). Addison’s is a well-known medical condition, yet I can count on my fingers how many times I have seen it in my rather long career.  In contrast, some sources on adrenal fatigue syndrome claim that it is extremely common.

Adrenal fatigue syndrome is said to include a collection of non-specific symptoms, such as fatigue, body aches, anxiety, inability to handle stress, depression, cravings for salt, difficulty concentrating, changes in digestion, insomnia, inability to lose weight, allergies, and a “weak immune system.” 

AFS appears in numerous alternative medicine sources, but is not accepted as a medical diagnosis by mainstream institutions. Blood tests that are able to diagnose Addison’s disease come back normal for AFS.

In contrast to AFS, Addison’s disease clearly occurs when the adrenal glands stop functioning. Causes include autoimmune disease, having a malfunctioning pituitary gland, longtime use of prednisone, cancer, the use of blood thinners, and having a chronic infection (especially tuberculosis).

When Addison’s disease is present, the adrenal glands don’t produce enough essential hormones. This leads to fatigue, body aches, weakness, nausea, salt craving, unexplained weight loss, low blood pressure, lightheadedness, loss of body hair, and hyperpigmentation. This adrenal insufficiency can be diagnosed by blood tests, as well as by special stimulation tests.

Proponents of the adrenal fatigue diagnosis claim this is actually a mild form of Addison’s adrenal insufficiency, and that it is caused by chronic stress. The theory is that the adrenal glands are unable to keep up with the increased demand of perpetual stress, leading to excess flight-or-fight activity. As a result, the glands can’t produce quite enough of the hormones we need in order to feel good, yet there is enough to show a normal blood test. 

The assertion is that most of us will develop AFS at some point in our life. The diagnosis of AFS is based only on symptoms, and there are indeed some similarities between these symptoms and those of Addison’s disease.

The treatment for Addison’s disease is to replace the missing hormone(s). The proposed treatment for Adrenal Fatigue Syndrome is also logical: it focuses on the purported root causes, including stress and diet.

One thing I have learned through the years is that science does not explain everything, and that when science lacks a reasonable answer for a problem, many will step forward with answers - be they correct or not. I advise that you be extremely careful *not* to accept a diagnosis that is unrecognized by mainstream medicine. I have seen patients hurt by purported treatments for unproven conditions. “Remedies” for so-called adrenal fatigue can leave a patient feeling worse, and encourage him or her to ignore the actual root causes.

Yes, there are conditions that are as yet not understood by mainstream medicine. However, my responsibility is to offer advice that is supported by science. I would suggest that you do the same. As knowledge expands, we will all grow with it.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.