Some people who are chronically tired relate to the idea that stress has exhausted their adrenal glands, leading to a condition known as adrenal fatigue, which is promoted and popularized by some health enthusiasts both on TikTok and in numerous websites.
We asked Lynette Nieman, MD, senior research scientist at the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), to talk about adrenal fatigue. Dr. Nieman is also a past president of the Endocrine Society. Here’s her expert take on this social media health advice phenomenon.
Doctor’s Ask: Adrenal fatigue is a trending topic on TikTok, with more than 500 million views of videos on its signs, symptoms and treatments. Is this really such a serious health problem?
Lynette Niemann: Adrenal fatigue is not a recognized medical condition. And yet there is a lot of information about him online other than just on social media apps.
EH: Interesting. So if it’s not an actual health condition, what symptoms are these viewers experiencing that lead them to believe they have a health problem called adrenal fatigue?
LN: The main symptoms are feeling tired, especially on waking, and then feeling more energetic later in the day. It also includes consuming too many stimulants such as coffee, craving salty or sweet foods, difficulty coping with stress, and feeling tired or overwhelmed.
EH: A lot of people feel that way. What other medical conditions might you have if you experience this collection of symptoms?
LN: The list is quite extensive. It could be prolonged COVID, obstructive sleep apnea, anemia, psychiatric problems (such as depression and anxiety), executive function impairment (which includes attention deficits, cognitive deficits, or memory deficits), or excessive physical exertion. It can also be the result of non-medical conditions, such as poor eating habits, eating because you’re feeling anxious, or poor sleep hygiene.
EH: Why do you think this misinformation is being spread that adrenal fatigue is an actual medical condition? Do people just want an easy answer to their constant exhaustion?
LN: One of the reasons I see this happening is that many people have been adversely affected by the COVID-19 pandemic and their resilience is being tested. And it may even be the COVID itself that is causing the fatigue and brain fog. Research on this issue is emerging. Studies have shown that some post-COVID patients have permanent impairment in attention and processing speed, as well as increased self-reported fatigue. However, these findings are recent and may not have reached the general public. As a result, people are looking for answers to their symptoms.
EH: What treatments do health advocates (experts) promote the concept of adrenal fatigue?
LN: Very few medical professionals believe that adrenal fatigue is a real entity. Most of us proceed as usual: we look at the differential diagnosis for each patient’s individual symptoms and try to determine if there is a medical condition that can be treated, including true adrenal insufficiency. Sometimes the person needs psychological support (especially cognitive behavioral therapy, CBT) or lifestyle support, such as personal trainers, nutritionists, and ADHD coaches.
However, some practitioners recommend various “supplements” that supposedly “support” adrenal function. And some of them contain powerful cortisol-like drugs. These substances can, in high doses, cause Cushing’s syndrome, which is associated with hypertension, diabetes, increased risk of stroke, pulmonary embolism, and opportunistic infections, and also suppress the pituitary’s normal ability to produce [the hormone] ACTH, leading to true adrenal insufficiency.
By the way, some of the adrenal fatigue treatment advice online is really excellent common sense – get enough sleep, eat healthy and find ways to de-stress.
EH: Are there any potential ill effects from these supplements?
LN: One of the worst bad effects is not on the body, but on the pocket! These supplements are very expensive and not covered by insurance. However, supplements that contain cortisol-like compounds (glucocorticoids) can mimic the effects of too much cortisol, leading to an increased risk of infection, weak immunity, abnormal menstrual patterns, weight gain, mood and memory problems, loss of bone or fractures, diabetes and hypertension.
EH: It’s a long list. So if you’re experiencing a set of symptoms that are misclassified as a medical condition that doesn’t exist, what type of doctor should you see?
LN: If you have physical symptoms, you should see an internist or family doctor. You can explain your symptoms and let the doctor run some tests to determine if you have a treatable medical condition.
The Endocrine Society’s physician listing site is a good site for finding a physician and also has a lot of excellent information on various endocrine diseases and concepts, including a discussion of adrenal fatigue. NIDDK, one of the NIH institutes, is also a good resource.
If the symptoms are more psychological, you should seek the help of a psychologist, licensed social worker or psychiatrist. Unfortunately, many of these healthcare workers are overwhelmed by the high demand for their services in the post-Covid era, and it can be difficult to get an appointment quickly.
If the emotional problems are severe, such as wanting to hurt yourself, you can call a three-digit hotline such as 988 Lifeline for Suicide and Crisis, which also has options for Spanish speakers. You can also contact the crisis text line (text HELLO to 741741). Both services provide 24-hour confidential support to anyone in a suicidal crisis or emotional distress. Other options are to talk to a religious leader of your faith.
EH: What else do you recommend to people if they’re feeling down and out?
LN: My advice to all patients, including doctors who are patients, is that it is dangerous to self-diagnose. Please consider that you may have an alternative, treatable problem and simply talk to a health professional to explain your symptoms. Licensed physicians will not be able to treat adrenal fatigue if they do not believe it exists, so it is not helpful to the patient or physician or provider to require this diagnosis and treatment. However, these doctors will work to find the cause of your symptoms, whether they are physical, emotional or lifestyle related.
This interview has been lightly edited for clarity.