What Is Adrenal Fatigue? The Facts About This Controversial Medical Condition

It seems like everyone’s talking about adrenal fatigue, and it’s pretty easy to see why. The condition’s extremely-common-yet hard-to-pin-down symptoms include fatigue, body aches, trouble sleeping, and dark under-eye circles, and adrenal fatigue wraps them up in a tidy diagnosis that can supposedly be treated with a cocktail of supplements.

Thing is, there’s no scientific evidence this condition actually exists.

An alternative medicine specialist named James L. Wilson first introduced the concept of adrenal fatigue with his 1998 book, Adrenal Fatigue: The 21^st Century Stress Syndrome. The condition, as he explained it, is a group of non-specific symptoms associated with “below optimal adrenal function resulting from stress.” When the adrenals (small glands that sit on top of the kidneys and produce vital hormones and help the body to regulate metabolism and respond to stress) are overtaxed, he argued, we can suffer from everything from “‘gray’ feelings” to the inability to leave bed for more than a few hours. Wilson offered “unique dietary supplements” as the remedy.

Nearly two decades later, there’s still no way to test for the condition. What’s more, researchers have uncovered no concrete evidence that stress actually does drain the adrenal glands. The Endocrine Society, a group representing more than 18,000 physicians and scientists around the world, doesn’t mince words in its fact sheet: “'Adrenal fatigue’ is not a real medical condition. There are no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands and causes many common symptoms.”

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“The symptoms people experience [when they believe they have adrenal fatigue] are very real, and sometimes it’s difficult to have symptoms and not have a diagnosis, so that could be where the persistent myth of 'adrenal fatigue’ syndrome comes from,” says Salila Kurra, MD, co-director of the Columbia Adrenal Center and assistant professor of medicine at Columbia University Medical Center in New York City.

There really is harm in believing that myth and “waiting for the research to catch up," as some people put it, says Marilyn Tan, MD, an endocrinologist with Stanford Health Care and clinical assistant professor of medicine at Stanford School of Medicine in California. "Symptoms of fatigue, body aches, trouble sleeping, indigestion, and nervousness are non-specific and could be due to a variety of other diseases, including sleep disorders, depression, irritable bowel syndrome, and thyroid disease,” she explains. “To attribute all symptoms to a single diagnosis of 'adrenal fatigue’ risks missing the detection of other treatable underlying diseases.”

Confusing matters, there is a similarly-named condition that’s widely accepted in the medical community, with research supporting its existence: adrenal insufficiency.

Primary adrenal insufficiency, also known as Addison’s disease, occurs when the adrenal glands are damaged and can no longer produce enough cortisol, a hormone that plays a role in bone growth, blood pressure control, immune system function, metabolism, nervous system function, and stress response. It’s very rare, affecting 110 to 144 of every 1 million people in developed countries. Autoimmune disorders cause about 80% of cases. Secondary adrenal insufficiency, on the other hand, is much more common, and occurs when the pituitary gland won’t produce enough of a hormone that stimulates the adrenal gland to produce cortisol. It can be brought on by long-term glucocorticoid (steroid) use, pituitary disease, radiation, or other causes.

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Both types of adrenal insufficiency can be detected with lab tests, and patients suspected of having it might receive, for example, a morning blood test to measure their production of cortisol. “The reason you check cortisol levels in the morning to look for whether or not someone is making enough is because that’s when it should be the highest,” Dr. Kurra explains. “Most people with a normal sleep/wake cycle should have a spike of cortisol around 8 a.m.” Adrenal insufficiency is a serious condition treated with hormone substitution and replacement, and people diagnosed with it are urged to carry medical identification so that they can receive appropriate help in the event of a crisis.

If your adrenal glands aren’t working properly, your primary-care physician will likely refer you to a specialist. And take note: Although proponents of “adrenal fatigue” suggest treating yourself with over-the-counter supplements that promise “adrenal support” or “thyroid support,” you absolutely should not do this to treat potential adrenal concerns of any kind. “If you take a supplement that has thyroid extract or adrenal extract, it could cause the symptoms of having too much of those hormones,” Dr. Kurra says. “Supplements can also make your own glands—especially the adrenal glands, if you’re taking some derivative of cortisol—stop working. Then, if you stop taking the supplement all of a sudden, your adrenal glands may not work; it takes time for them to 'wake up’ again.”

Plus, supplements have other drawbacks. “Most supplements are not only costly and not covered by insurance, but they are not FDA regulated,” says Dr. Tan. “We do not have a full understanding of all of the effects of various supplements. Even though components of the supplements may be 'natural,’ that does not mean they will not affect the body in adverse ways.” They can also make it trickier for your doctor to help you: “Supplements make testing [for hormone levels] really difficult,” Dr. Kurra adds. “We don’t really know the active ingredients; there can actually be something in a supplement that gives false positive or false negative results.” This is especially true when it comes to herbal remedies and multi-ingredient supplements; mega-doses of vitamins can have their own drawbacks, of course, but they are less likely to cause harm.

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If you’re experiencing symptoms that may have led you to believe you have adrenal fatigue, it’s time to reach out to your primary care doctor, says Dr. Kurra. “A primary-care physician can help guide you in the direction of your treatment and, if you need to, help you find a subspecialist.” Dr. Tan concurs: “This provider is the one who will be coordinating all your care between various other providers. Since the symptoms attributed to 'adrenal fatigue’ can be non-specific, it is best to speak with your primary care provider so that he or she can better assess whether there is another obvious underlying cause.” You’ve got all the background you need; now, make that call.

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How Your Cube Mate Can Improve Your Concentration

It may not be an epidemic yet, but concentration appears to be contagious, according to new research.

This could help explain why some of us (think coffee shop worker bees, and fans of the open-office floor plan) are more productive around other people—at least other people who aren’t slacking off.

“Our findings might also suggest that we will copy low effort too, so it’s not as simple as ‘studying together is better,’” lead author Kobe Desender, a doctoral researcher in the cognitive psychology group of the Faculty of Psychology and Educational Sciences at Vrije Universiteit Brussel in Belgium, told Health in an e-mail. “But working in the vicinity of highly motivated people might be wise.”

Research had already shown that having another person nearby can affect how well you perform. But does what the other person is doing have any influence? To find out, Desender and his co-authors conducted two experiments.

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In the first, 38 volunteers sat side by side in pairs, each duo sharing a computer and a keyboard. They were asked to respond to certain colors appearing on the screen by hitting pre-specified buttons on the keyboard. The task became more difficult for participant A but stayed the same for participant B. Regardless, participant B tended to match his or her effort to participant A even though B’s task remained the same.

The second experiment was the same as the first, except this time a cardboard wall divided the computer screen in half. That way participants could not see what their matched pair was doing, and the researchers could determine that Participant B’s improved performance was due to mental effort, and not just seeing the partner’s tasks.

Either way, the result was the same—and not too different from the findings of other “social contagion” studies which have suggested, for instance, that obesity may be contagious.

When one person in a group gains or loses weight, friends tend to follow suit. “How your partner, friend, or Weight Watchers [buddy] is engaging with the world, the task that they’re doing is going to have some impact on you and your behavior,” Aaron Heller, PhD, assistant professor of psychology at the University of Miami Miller School of Medicine, told Health. (Heller wasn’t involved in the current study.)

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There’s no good explanation for why mental effort may be contagious, at least not yet. It’s possible that we pick up on scent cues emanating from our neighbors, or even their body posture. “Some postures are indicative of increased effort,” says Desender. “But [this is] very speculative." 

Who knows—there may even be an evolutionary perk to matching the level of exertion of the person in the next cave, er, cube. "If my co-worker exerts quite some effort in a task, it makes sense to do the same, this might be a good cue with a high evolutionary advantage. If she or he has access to more information then you, mirroring her or his effort might be adaptive,” says Desender.

“Future research should examine how we detect effort in other persons,” says Desender. It would also be interesting to note how individual differences play into the dynamic, Heller notes, for example, in people who are depressed and withdrawn.

For now, though, all we know is that focused effort seemed to spread between volunteers in a university experiment. We don’t know if this will be the same in a library, coffee shop, or office setting. But it does seem to matter who your friends are.   

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Are You Too Hard on Yourself? This Study Explains Why

When you screw up—think misplaced keys, missed deadline, missed opportunity—do you accept it as a misstep and move on? Or do you beat yourself up for not being on top of your game?

A team of psychologists recently published findings in the journal Self and Identity that help explain why some of us are prone to do the latter.

For the study, 161 adults between the ages of 17 and 34 completed a questionnaire that measured their capacity for self-compassion. They also filled out a survey about their values, including what they wanted out of life, and the behaviors or traits they believed were necessary to achieve those things.

Finally, the participants were asked to imagine themselves in two scenarios: One in which they acted with self-compassion, and another in which they were self-critical. Then they described how they would feel about themselves after each scenario.

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The researchers found that across the board, the study participants recognized that self-compassion is generally a good thing—but not necessarily for themselves.

Participants who were less self-compassionate thought that practicing self-care would negatively impact their performance. They said being kind to themselves after a failure, rejection, or loss would make them feel less conscientious, less ambitious, and less motivated. They also saw self-criticism as “a sign of strength and responsibility.” In other words, they believed being tough on themselves made them tougher, better, and more driven.

But those folks might want to start cutting themselves some slack: The researchers note that people who are rich in self-compassion typically possess better emotional health. They benefit from higher life satisfaction, and a lower risk of depression and anxiety. They also tend to have a sunnier outlook, and to cope better when crap (inevitably) happens.  

If you’re in the habit of treating yourself harshly, try shifting your perspective on what self-criticism actually does for you, suggests Ashwini Nadkarni, MD, a psychiatrist at Brigham and Women’s Hospital who was not involved in the study. “You might think [being self-critical is] motivating, and in the short term, it can be. But in the long run, the things that you tell yourself—I should be a better mother, I should have a better job—are demoralizing,” she explains. Over time, that type of self-flagellation can lead to burn out, and keep you from reaching the goals you were pushing so hard to achieve in the first place.

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Below, Dr. Nadkarni offers her four-step plan for practicing more self-kindness and understanding:

Be aware. In order to change a behavior, first you need to be convinced it’s a problem. So for one week, write down any self-critical thoughts you notice. 

Talk to yourself like you’d talk to a friend. You are more likely to be kind and empathetic to a loved one. Try treating yourself with the same level of respect. 

Be mindful. Observe your feelings, but don’t judge them. When a self-critical thought pops into your head, recognize it; then refocus your attention to something neutral, like your breath.

Start a journal. When something upsetting happens, write down the most self-compassionate things you can think to say. Ideally, the words will express that you accept yourself exactly as you are, imperfections and all.

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