[PragmaticPulp]

> I’m curious what sort of stresses are thought to cause adrenal issues. Can they be environmental/situational vs. chronic hereditary?

“Adrenal fatigue” is an alternative medicine diagnosis. It’s a seductively simple narrative for people seeking answers to unexplained medical issues, but the theory is very much pseudoscience instead of actual science.

The biggest red flag for the adrenal fatigue theory is the claim that current blood tests are not sensitive enough to detect it. This is a common trick used by alt-medicine practitioners to dodge contrary evidence. We have medical tests to diagnose genuine adrenal insufficiency (Addison’s disease), but it’s an extremely rare disorder. Statistically speaking, you almost certainly do not have adrenal insufficiency.

The truth is that your adrenal glands are part of a larger system of feedback loops in your body. The adrenal glands don’t operate independently as the adrenal fatigue theorists would suggest, but rather they work in concert with your brain’s hypothalamus and pituitary in a feedback loop known as the HPA axis. Wikipedia can shed more light on the details of HPA axis functionality, but the key point is that the adrenal glands depend on inputs from your brain. That brings me to my main point:

> When doctors and specialists can’t figure it out they send you to someone else or suggest psychiatric issues.

Psychiatric issues can and frequently do manifest primarily as physical symptoms: Lack of energy, low stress tolerance, digestive issues, oversleeping or insomnia. These are hallmark symptoms of depressive disorders.

The fact that your symptoms started around the time of high stress at work combined with frequent, intense exercise is probably not a coincidence. It’s extremely common for people to notice the physical symptoms first and assume that their problem must be located outside of the brain. Your resistance to any psychiatric diagnosis is an extremely common response. Frequently, patients are offended by any suggestion that the origin of their problems is “all in their head” because it feels like a dismissal of their genuine physical symptoms.

However, the key thing to remember is that your brain and your body are not separate systems. They’re one in the same. It took me a long time to realize that drawing a line between mind and body is an artificial boundary that isn’t a helpful distinction when your problems almost certainly overlap both systems.

I think “adrenal fatigue” has become a popular alternative medicine diagnosis precisely because the adrenal glands are located outside of the brain. As I mentioned above, the adrenal glands take inputs from core brain structures. Your adrenals will only produce what the brain tells them to produce. Yet, no one wants to admit that their brain is right place to solve these issues, so they over-focus on the one part of the system that lies outside of the brain. Psychiatry and modern medicine has understood for decades that HPA axis abnormalities are intimately linked to depressive disorders, and that successful depression treatment in any form (therapy, medication, combination) normalizes HPA axis function. At this point, the hardest part is convincing patients to accept psychiatric treatment and give it appropriate time to work.

I’m glad to hear you’re feeling better, but I would encourage you to give your doctors a chance when they suggest psychiatric issues. You’re basically a textbook case of stress-related depressive symptomology. Modern psychiatry may not be perfect, but it’s better than years of unaddressed fatigue and suffering.

[wavepruner]

I've spent the last 15 years convincing my doctors, friends, and family that my physical symptoms are not just a manifestation from mental illness. It took me pushing myself to the point where I could no longer stand up. My legs felt like they were being ripped to pieces when I put weight on them.

I had attempted all the psychiatric treatments recommended to me. None of them ameliorated the physical symptoms.

Then I discovered what physical compounds my body was missing, and the physical symptoms AND mental symptoms resolved. So yes, the mind and body are not separate. They are constructed out of the exact same basic building blocks.

[cpncrunch]

You should look at functional movement disorder, and catatonic depression. I'm not making any comment on your own situation, only on your comment that pushing yourself to the point where you couldn't stand up proves it wasn't psychiatric.

Typically people with ME/CFS/FMD get worse if they push themselves. The key to recovery is rest first and foremost. The symptoms of FMD seem to be a protection mechanism by the brain, and pushing through the symptoms just make it worse.

[wavepruner]

I won't. You don't know what you're talking about unless you have this illness and have a minimum of PhD level of understanding of biochemistry and enzymology.

I've cured myself. Who have you cured? No one I'm sure.

[cpncrunch]

Yes I have had it, and am fully recovered now thanks.

[wavepruner]

Then perhaps we are talking about two separate illnesses.

[cpncrunch]

Definitely not. You are just being closed minded, incredibly rude, and dont understand how the brain actually works.

[wavepruner]

But yes, pain is how your brain protects your body. Pain means you need to rest before your tissues literally rip to pieces from a structural failure.

[cpncrunch]

No, pain isnt always due to structural or physical damage. That is what functional pain is. In many ways it is much worse than physical pain.

[wavepruner]

I do not think this hypothesis is correct. What evolutionary purpose would functional pain serve?

To me, it seems it's a theory to compensate for medical imaging technology that has far too low resolution. Doctors hate admitting that they don't know what's wrong, so instead they claim that the patient is crazy in politically correct terminology with an excessive number of syllables.

Structural tissue damage starts at a molecular level that cannot be seen by medical imaging technology. The fascia alone is too thin to be imaged at all, and so is completely ignored.

Biochemists have delineated in explicit detail how tissue breaks down at the molecular level. And they can reverse it. We need to start listening to them more.

[cpncrunch]

There is pretty clear evidence from neuroscience that pain has a significant emotional component. The evolutionary benefit is to having an emotional component is that it makes it less likely that the animal will try to override the pain.

[rubyfan]

Thanks for the perspective. As you said, it’s very tough in the moment to hear from the doctor that it’s in your head. When you’re physically ill and looking for real answers it really feels like a non-answer. To me as a patient that answer feels more like pseudoscience. It might be right or it might not be in my specific case, but when a doctor quickly gives up trying to diagnose a problem and suggests it’s in your head it’s an extremely invalidating experience.

[cpncrunch]

Just to add to the above: the reason that "adrenal fatigue" was coined is because stress does affect the adrenal glands: initially it causes increased release of cortisol and an increase in size in the glands, but chronic stress can result in hypofunction of the HPA axis, resulting in lower cortisol and sometimes shrinking of the adrenal glands. Whether chronic stress results in fatigue and low cortisol depends on the nature of the stressor, the time since onset, personality factors, etc.

http://dx.doi.org/10.1037/0033-2909.133.1.25

Unfortunately the "adrenal fatigue" crowd have taken this little bit of science and completely mangled it, blaming the adrenal glands themselves and pushing dubious supplements that have no scientific basis.

[BirdieNZ]

Just thought I'd add that I was diagnosed with adrenal fatigue by a medical doctor. I was pretty annoyed, after researching it, because it seemed entirely pseudo-scientific.

In reality I had stress-induced depression with a high degree of physical fatigue as one of the symptoms. When I stopped being depressed, my fatigue went away. Adrenal fatigue is nonsense.

[fortran77]

And the "Adrenal Fatigue" alternative medicine folks simply make it harder for a person with an actual adrenal disorder to be diagnosed by a doctor because they are understandably skeptical if a person comes in with a set of vague symptoms and suggests it's related to adrenaline.