Why ‘How To Heal Adrenal Fatigue’ Isn’t the Right Question

Written by Dr. Michael Ruscio, DC on February 12, 2021

Written by Dr. Michael Ruscio, DC on February 12, 2021 — Reviewed by Robert Abbott

How To Improve Your Energy Levels, Chronic Fatigue, and Stress Levels

Adrenal Fatigue|
Causes of Fatigue|
How To Heal Fatigue|
Medical Assessment|
Improve Gut Health|
Heal the Thyroid|
Anemia|
Diet|
Stress Relief|
Supplements|
The Bottom Line|
Recommended Products|

When it comes to how to heal adrenal fatigue, we need to take a few steps back. Though your fatigue is real, adrenal fatigue is not recognized as a medical condition and is even being questioned by many in alternative medicine.

Instead of talking about how to heal “adrenal fatigue”, we need to discuss what may really be causing your fatigue symptoms.

Treat the cause, not the symptom. The truth is that your gut health, thyroid function, iron levels, blood sugar levels, food sensitivities, and stress tolerance are more likely to be underlying causes of your fatigue. Diagnosing and treating the true cause of your fatigue is the key to getting your energy back.

In this article, we’ll explain the theory of adrenal fatigue and why many experts don’t consider it valid. We’ll explore other possible root causes of fatigue symptoms and how to improve fatigue with research-backed solutions.

What Is Adrenal Fatigue?

Adrenal fatigue is a theoretical health condition where your adrenal glands are no longer able to produce an appropriate hormonal response to stress.

Normally, when you experience stress, your adrenal glands produce hormones — cortisol, adrenaline, and aldosterone — for the “fight or flight” response.

The adrenal fatigue theory proposes that prolonged chronic stress levels can “fatigue” your adrenal function, leaving them less able to muster the hormones needed for a stress response.

Purported Symptoms of Adrenal Fatigue and Adrenal Health Dysfunction

When people think of adrenal fatigue, they associate it with the following symptoms:

Chronic fatigue or ongoing low energy levels
Low blood pressure
Weight gain or weight loss
Lightheadedness or brain fog
Low sex drive
Low immune system function (frequent colds or illnesses)
Hormone imbalances (like hypothyroidism)

However, there is not yet clear evidence that adrenal fatigue exists as a medical condition.

According to a systematic review of research on adrenal fatigue, cortisol levels on saliva tests and blood tests don’t correlate with fatigue symptoms 50-80% of the time [1].

Other studies suggest a similar conclusion. A systematic review of post-traumatic stress disorder (PTSD) patients found they had similar cortisol levels to healthy individuals [2]. An additional systematic review and meta-analysis showed that neither trauma nor PTSD affected cortisol levels [3].

Addison’s disease — an autoimmune disease characterized by very low cortisol (adrenal insufficiency) — is a real medical condition. However it’s extremely rare, affecting only .01% of Americans [4].

Even though Endocrinologists don’t recognize adrenal fatigue as a real condition, fatigue is definitely a real and troublesome symptom that can be caused by many health issues.

A Better Response To ‘How To Heal Adrenal Fatigue‘

There are many other, very common reasons for fatigue that have nothing to do with your adrenal glands and adrenal fatigue.

Fatigue symptoms are most often caused by:

Gut dysfunction
Thyroid imbalances (hypothyroidism)
Iron deficiency anemia
Low blood sugar
Inflammation from food sensitivities or autoimmune conditions
Sleep problems like sleep apnea
Other physiological effects of stress

To effectively heal your fatigue symptoms, make sure you are focusing on the right causes.

Address the Root Causes of Your Fatigue

Overcoming your fatigue is about addressing the true underlying causes. You may need some help figuring out what these are. Once you know where your fatigue is coming from, focusing on your digestion, your thyroid health, your iron levels, your diet, or your unique stressors can have you feeling energetic again in no time.

Get a Good Medical Assessment

Understanding what’s causing your fatigue is vitally important to forming the best treatment plan. For example, if your fatigue is due to gut dysbiosis, taking iron may not improve your fatigue.

Patients may feel their concerns about fatigue are disregarded by some medical practitioners. Other practitioners broadly label all fatigue as adrenal fatigue, an inaccurate diagnosis that does not help you restore your energy levels. The right health practitioner will take your fatigue seriously and can help you accurately assess your root causes. If you need help, consider applying to become a patient at our clinic.

Improve Your Gut Health

If you have digestive imbalances or conditions like IBS, SIBO, and IBD, your fatigue may be coming from your gut [5]. In a meta-analysis of 24 studies, more than 50% of Irritable Bowel Syndrome (IBS) patients were found to have fatigue [6]. Fatigue is also associated with leaky gut, and repairing leaky gut has been shown to reduce fatigue [7, 8, 9].

Studies have found that using probiotics [10, 5, 6] can improve fatigue. This is likely because probiotics reduce gut inflammation, crowd out bad bacteria, and improve leaky gut [11, 12, 13, 14]. To learn more about how to use probiotics, see our Probiotics Starter Guide.

Address Any Underlying Thyroid Dysfunction

Fatigue is one of the main symptoms of hypothyroidism (underactive thyroid). If you have hypothyroid symptoms, including fatigue, hair loss, weight gain, and dry skin, reach out to your medical provider for evaluation.

If you are hypothyroid, treatment with thyroid medication may significantly help your fatigue. However, some people don’t experience adequate fatigue improvement with thyroid medication. That’s because there is a strong connection between thyroid health and gut health. Thyroid patients usually benefit a lot from improving gut health.

Probiotics have been shown to improve the absorption of thyroid medication and to reduce fatigue in hypothyroid patients [15].
Treating gut dysbiosis has also been shown to improve thyroid lab markers [16, 17, 18] and thyroid antibodies [19].

In short, you may experience fatigue relief by improving your thyroid health along with your gut health.

Assess and Restore Your Iron Levels

Iron deficiency anemia is one of the most common causes of fatigue. Your doctor can test your iron levels with a simple iron or ferritin blood test. If you are low in iron, taking an iron supplement may help improve your fatigue [20].

Adequate stomach acid is necessary to absorb iron well, so low stomach acid can contribute to fatigue [21]. Supplemental betaine hydrochloride (HCL) may help you increase your iron levels and improve your fatigue [22, 23].

Avoid taking iron unless you know you are deficient, as excess iron can cause other problems.

Eat for Blood Sugar Balance

Low blood sugar levels can be a cause of fatigue, yawning, sleepiness, and brain fog. Eating a diet that minimizes blood sugar swings can help.

To keep your blood sugar stable, aim to eat a diet low in processed carbohydrates like bread, pasta, crackers, and chips. Eat more whole foods, such as high-quality proteins, healthy fats, and complex, slow-burning carbs, like fruits, vegetables, nuts, whole grains, and seeds.

The paleo diet is a low-carb diet that helps keep blood sugar steady [24, 25].

If you need help changing your diet, reach out to our clinic to learn more about meeting with our health coach.

Avoid Your Food Sensitivities

Food sensitivities can also be a cause of fatigue. For example, 64% of patients with non-celiac gluten sensitivity reported fatigue when they ate gluten [26].

Eating a diet low in common inflammatory foods, like gluten, dairy, or fermentable carbohydrates may minimize foods that can cause immune reactions and fatigue [27, 28].

The low FODMAP diet has specifically been shown to improve fatigue for people with IBS and fibromyalgia [29, 30]. A gluten-free diet like the paleo diet or a low histamine diet are other options that may help, if appropriate for you.

Increase Your Stress Tolerance

Though stress doesn’t fatigue your adrenal glands, it does have documented effects on your mental wellness, memory, immune system, digestion, sleep, and hormones, and can absolutely cause fatigue [31].

Adaptogens are herbs that help your body tolerate stress better and support good energy levels. Rhodiola (Rhodiola rosea), Eleuthero (Eleutherococcus senticosus), and Ginseng (Panax ginseng) have been shown to help reduce fatigue, stress, and exhaustion [32, 33, 34, 35, 36, 37, 38]. Licorice root is commonly recommended to help with fatigue, but there is virtually no research to confirm this.

Lifestyle changes to increase your sleep, and to manage your stress can help you feel less overwhelmed and fatigued by day-to-day stress. Going to bed early, handling sleep problems like sleep apnea, and practicing stress reduction activities like yoga, meditation, exercise, and time in nature can help too.

Supplements to Improve Fatigue

Magnesium [39, 40], B vitamins [40], and vitamin C [41, 42] have been shown to benefit fatigue. Supplementing daily for a short while may improve your fatigue.

Low blood levels of vitamin D have been proposed as a contributor to fatigue in a number of autoimmune health conditions, including lupus [43], rheumatoid arthritis [44], and multiple sclerosis [45]. However, there are few studies that confirm the relationship. So, though there are numerous reasons to take vitamin D, fatigue isn’t one of them.

The Bottom Line

Adrenal fatigue isn’t a real condition, but that doesn’t mean that your fatigue doesn’t need attention.

Healing fatigue is about choosing a strategy that is right for your individual underlying causes. A gut imbalance, anemia, a high stress load, or a poor diet are just a few possible things to consider.

Dr. Michael Ruscio is a DC, natural health provider, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

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