Adrenal exhaustion. I learned about it in my hormone training in 2012. The story sounded very logical: the stress hormone cortisol is produced in your adrenal glands. If you are under a lot of stress, you need extra energy; cortisol gives you this extra energy. If your adrenal glands work overtime for a long time and therefore have to produce a lot of cortisol, they would become fatigued and eventually exhausted: adrenal exhaustion. The true story, however, turns out to be a bit more complex. New insights show that adrenal exhaustion does not exist. That it’s a huge understatement about what’s really going on.
The fact that women, in particular, sometimes struggle for years with their energy levels after a long period of stress or a burnout, is because the real causes are not addressed.
Your body is doing everything it can to protect you
Everyone produces cortisol every day. Cortisol is the hormone that peaks in the morning around 7 a.m. and wakes you up as a result. It gradually decreases during the day. This is why many people are more productive and sharper in the morning than in the afternoon. In the course of the evening it decreases further and you get tired: time to rest and prepare for sleep.
Cortisol is the hormone that causes you to wake up early in the morning.
Cortisol is also called the stress hormone, but it is actually an anti-stress hormone. It is created to protect you against stress. Stress always requires extra energy; your body will do everything it can to protect you from a threat. Fighting or fleeing against this requires energy. Cortisol provides this extra energy.
When stressed, your adrenal glands produce extra cortisol to ensure that your chances of survival are as high as possible.
The concept of adrenal exhaustion
The concept of adrenal fatigue was introduced in 1998 by James L. Wilson in his book Adrenal Fatigue. In Dutch it appeared under the title Adrenal exhaustion.
His theory is that prolonged stress (both physical, mental and/or emotional) depletes the adrenal glands that produce cortisol. As a result, they produce less and less cortisol over time, which makes us feel dead tired after a while. The side effects of adrenal exhaustion are very diverse: from sleeping problems and intestinal complaints to anxiety disorders and depression.
A burnout would be the situation where someone feels burned out because too little cortisol, ie energy, is produced in the exhausted adrenal glands.
Does prolonged stress lead to less production of cortisol?
The crucial question that several researchers have asked themselves in recent years is whether chronic stress does indeed ultimately lead to significantly lower levels of cortisol. And herein lies the problem. This does not appear to be the case.
More than 30 studies show that during prolonged stress there are varying cortisol levels: sometimes normal, sometimes lower, but often higher.
One of the best studies to investigate this, published in the magazine Psychoneuroendocrinology, concluded that, in line with other studies, more cortisol is often produced in the case of chronic stress (1). Researchers consistently see a slightly higher level of cortisol in the morning in people with chronic stress, not a lower level.
Long-term stress does not affect the production of cortisol
Many studies have been done with participants with various types of long-term stress. Chronic stress from unemployment (2) , chronic stress from overwork (3) , chronic stress from overtraining in athletes (4) , chronic stress in women with chronic pain (5). Time and again it turns out that the production of cortisol actually remains fairly normal and is more likely to be slightly higher than too low.
Research shows that long-term stress does not ultimately lead to a lower level of cortisol.
Scientific research does not support the theory that chronic stress, in any form, ultimately leads to lower cortisol levels and thus to adrenal fatigue.
You may think that this is because these people are not yet in a burnout and their adrenal glands are not yet exhausted. I thought this too at first. It is striking, however, that studies do not even show a remarkable difference in cortisol levels between people who are burned out or have chronic stress, and people who are vital and healthy!
Feelings of stress and production of cortisol are separate from each other
It gets even more interesting! One of the most exciting studies I’ve come across was studying a group of nurses. This research was published in the magazine Stress and Health (8).
The researchers wanted to test whether the nurses with extremely high or extremely low cortisol levels were more likely to suffer from stress-related problems such as fatigue and sleep or mental problems. They naturally assumed that this would be the case. Based on their cortisol levels, the nurses were classified into 3 groups: extremely high, normal, and extremely low. What turned out? Nurses with extremely high or extremely low cortisol levels did not differ in stress-related complaints from the group with normal cortisol levels.
In other words, the cortisol level turned out to say nothing about or the degree of stress and stress symptoms experienced by the nurses!
The right cortisol level for you is very personal
How remarkable is this! So this tells us that our cortisol level is a very poor indicator of whether someone is under too much stress or overtired or not. In other words, someone with extreme fatigue from prolonged stress may have high, low, or normal cortisol levels. And also: someone who feels healthy and energetic may also have a high, low or normal cortol level.
Someone can feel fine with an extremely high or extremely low cortisol level
Yet there are hundreds of therapists who have the cortisol level of their (extremely) tired and stressed clients tested to see if they are heading for adrenal exhaustion. If the level is too high, they often conclude that the adrenal glands are still working overtime, but that you have to watch out for adrenal exhaustion. Too low a level of cortisol would mean that your adrenal glands would be exhausted.
I hope to have shown above that this conclusion is incorrect. Do you still have doubts about this? Have you had your cortisol levels tested? Then read on.
Interpretation of cortisol levels is very difficult
Did you know that there are large variations in the ‘normal values’ for cortisol between labs? For one lab, 80 nmol/l is a lower limit and you get the conclusion that your cortisol is extremely low, in another lab this is 150 nmol/l. That’s almost double! The result depends very much on where you are tested.
- What is high for you and what is low if you have never had your personal normal values tested while you were feeling fine? As you have read, this can vary greatly from person to person. A level of cortisol that is too high or too low may be very normal for you and not a signal at all that something is wrong. Your fatigue then comes from something completely different than tired adrenal glands. Read below what it could be.
- You can have normal cortisol levels while having all the symptoms of exhaustion. How frustrating is that? It may then be that the ‘normal values’ of the laboratory are too low or much too high for you personally.
- A single measurement of cortisol does not say much. If you slept poorly the night before the saliva test, your cortisol level in the morning may already be significantly lower than normal. Healthy ‘night owls’, people who have more energy in the evening than in the morning, usually start the day with a low cortisol level.
- There are many drugs that suppress cortisol production, such as antidepressants, pain relievers, low blood pressure drugs, and aspirin.
- Pregnancy, obesity, a lack of nutrients and diseases can also have a major influence on cortisol levels. This is usually not taken into account in measurements.
In short: a cortisol level that is too high or too low does not clarify whether something is wrong with you and it certainly says nothing about the health of your adrenal glands.
Adrenal Fatigue Has Never Been Recognized by Mainstream Medicine
If you try to find scientific research on the phenomenon of ‘adrenal fatigue’, you will find virtually nothing. The first thing you come across is a comparative study of several studies that actually concludes that there is no evidence for adrenal exhaustion (6).
The Endocrine Society has published a fact sheet about it that says:
“In mainstream medicine, the concept of adrenal exhaustion is not recognized as a condition. There is no scientific evidence whatsoever for the concept of adrenal exhaustion under the influence of persistent stress stimuli.”
There are also no validated diagnostic tests to demonstrate adrenal exhaustion such as in adrenal insufficiency due to Addison’s disease.
We also don’t know pancreatic exhaustion, liver exhaustion or thyroid exhaustion. Organs do not become ‘exhausted’. There is always a combination of various factors when something in our body no longer functions properly.
Adrenal exhaustion does not exist
Let me make it clear that the consequences of chronic stress definitely have a huge impact on our health! Complaints attributed to adrenal exhaustion such as (extreme) fatigue, need for sweets or salt, binge eating, poor sleep, low libido, panic attacks, mood swings, lack of concentration, not being able to think clearly, mild forms of depression: they are all real .
The point is, however, that they are not caused by exhaustion of the adrenal glands!
The above complaints can have many underlying causes and are part of many diagnoses made by doctors. From a malfunctioning thyroid gland to insulin resistance and from fibromyalgia to chronic fatigue syndrome.
What matters is that we find out the real cause or causes of various exhaustion symptoms not to blame our adrenal glands. Otherwise, recovery can take a long time.
Exhaustion as a result of prolonged stress does exist!
What actually happens in your body when you experience too much stress for a long time? As we have seen, the hormone cortisol is then (among other things) produced again and again to give us extra energy and to ensure that our chances of survival are as high as possible. Stress hormones then rush through your body and brain.
The production of these stress hormones, including cortisol, always precedes the production of all kinds of other hormones that we also need. And therein lies the problem. Cortisol is a dominant hormone that displaces other hormones, reducing their production. This disrupts the hormone balance in a body. Watch:
- Cortisol and progesterone are both made from pregnenolone. In the event of too much stress, pregnenolone is converted to cortisol and progesterone loses out. This is precisely the hormone that ensures relaxation and rest.
- Too little progesterone can lead to estrogen dominance; a situation that causes a range of women’s complaints.
- Cortisol hinders the production of melatonin, the hormone that ensures healthy sleep. Stress and sleep do not go well together.
- Cortisol also robs you of growth hormone and DHEA; two hormones that ensure cell repair and that prevent aging.
- Too little DHEA causes less production of thyroid hormones: thyroid problems often arise after a long period of stress.
- Dopamine and serotonin are also chased away by cortisol, which can cause depressive symptoms and anxiety disorders.
- Cortisol gives the body energy like sugar does: by raising your blood glucose. As a result, insulin must always be produced. Too much and too often insulin is bad for the body; it promotes chronic inflammation and weakens your immune system.
Disrupting the female hormone balance through stress will lead to a wide range of complaints.
The term adrenal exhaustion is a huge understatement
Excessive and prolonged stress constantly causes extra cortisol production in the body (so this says nothing about your normal values), resulting in a disruption of your hormone balance. This is also the reason why menopausal women, between the ages of 40 and 55, are extra sensitive to this; their hormone balance is then in any case more vulnerable due to the hormone fluctuations that take place during that period.
All the building and healing ‘repair’ hormones in your body are dominated by the hormone cortisol and pushed aside.
No wonder that the (first) symptoms of a burnout can be very diverse; every person is unique and has a weak spot. For some it starts with fatigue, migraine or digestive problems, for others with poor sleep, depressed feelings or gaining weight and not being able to lose weight anymore.
Burnout is a dramatic disruption of our hormone balance and other processes in our body. The term adrenal exhaustion is therefore a huge understatement: prolonged stress has effects on many more areas than just the adrenal glands.
A holistic approach; hormone balance…
There is a lively trade in (expensive) supplements to boost the adrenal glands. I hope it’s clear to you by now that these can be counterproductive and even harm your health.
Supplements that ‘boost’ your adrenal glands can cause extra fatigue if they overload your thyroid.
As described above, the hormone cortisol drives out other hormones that are responsible for cell repair and repair in the body. Ensuring less stress, and therefore less production of cortisol, is therefore the only solution. However, building more relaxation into your life is often insufficient.
Remember that your body also gets stress from an excess of sugars, carbohydrates, processed food, toxic substances, a leaky gut, chronic inflammation, lack of daylight, infections, lack of nutrients and too little exercise and pleasure in your life. This also puts an extra burden on your hormone balance. This can also reduce your stress.
Treat a burnout or extreme fatigue as a result of stress as broadly as possible!
…and don’t forget your mitochondria!
Finally, it is good to know that energy in your body is not only produced in your adrenal glands, but in your mitochondria which are located in almost all your body cells. It is the mitochondria of your adrenal glands that, through a complex process, convert cholesterol into cortisol. You need a lot of vital mitochondria to make enough cortisol.
Your mitochondria also cannot cope well with toxic substances, processed food (preservatives in particular are bad for them), lack of nutrients, chronic inflammation, lack of exercise and a disturbed day and night pattern.
You can boost your mitochondria by making the switch to getting energy from fats instead of primarily from glucose. Your mitochondria can make twice as much energy from a fat molecule as from a glucose molecule.
This is especially important at times of stress and can really give you more energy.
If you want to know more about this, follow my Energy Boost program, click here (temporarily in November with a 40% discount!)
“I ate myself out of my burnout”
I know what it is like to be burned out and I know what it feels like to be completely exhausted. But when I changed my diet, quite radically, during my burnout, I felt better after 6 months than I had at least ten years before. I ate myself out of my burnout I say ever since.
I only now understand how this is possible: I cut out all sweets, dairy, gluten and processed food and started eating a lot more plants and healthy fats. In addition, I (among other things) went for a brisk walk every morning before breakfast and regularly went to the sauna. Unnoticed, I reduced the hidden inflammation in my body, I balanced my hormones and gave my mitochondria the fuel to produce plenty of energy for me again.
1. Genetic factors, perceived chronic stress, and the free cortisol response to awakening, Stefan Wüst ea
3. https:/ /www.ncbi.nlm.nih.gov/pubmed/24312516
5. https://www.sciencedirect.com/science/ article/abs/pii/S0306453011001831
8. https ://onlinelibrary.wiley.com/doi/abs/10.1002/smi.1004