What is Adrenal Fatigue?

Dear Doctor,

I ran a test from a self-service lab that showed I had low levels of cortisol and it put me in the category of maladaptive adrenal function. I am tired all the time, have a hard time recovering after activity and am wondering if this is what everyone means when they say they have adrenal fatigue. My doctor said it is all rubbish – there is no such thing as adrenal fatigue. Can you offer some perspective on this from a Naturopathic Medicine point of view?

Janine, West Palm Beach, FL


Thank you for your question, Janine. 

Certain criteria must be met before a diagnosis with an ICD-9 code is given. These criteria are often based on labs and other objective diagnostic tests, such as imaging and/or physical exam, and compliance with the code criteria is necessary for insurance billing. Otherwise, a medical professional may face accusations of insurance fraud.

It is the opinion of some medical professionals that if labs and other diagnostic tests are not sufficiently out of range to merit an ICD-9 diagnosis, then there is no problem at all.

This point of view has its drawbacks. One is that some healthy patients may have lab values that fall outside of the reference range despite the absence of pathology. An example is an elite athlete whose blood chemistry may appear abnormal due to adaptations that accommodate increased oxygen transport. The other drawback is that some patients may be on the spectrum of disease which does not YET meet the criteria for ICD-9 diagnosis, and yet a problem exists. Waiting until that patient meets diagnostic criteria before beginning a treatment plan forgoes the opportunity for early intervention.

To say that something is rubbish because it does not meet diagnostic criteria is a form of denying the patient’s experience. Furthermore, it does not take into account that the model itself may be flawed or limited.

As Naturopaths, we are taught to treat the whole person. Beyond that, we are taught to treat THE person, not JUST the lab, the image, the physical exam finding. If you are experiencing extreme fatigue and difficulty recovering after activity, this merits investigation by an experienced professional who will listen and assist you in uncovering the underlying cause of your symptoms.

To more specifically answer your question about the Naturopathic perspective on Adrenal Fatigue, the best answer may be that it varies from physician to physician. Many Naturopathic Doctors use the term Adrenal Fatigue loosely to describe the symptoms that a person experiences as their cortisol and other adrenal hormones become depleted through stress, over-stimulation, or other factors that continuously tax the adrenal glands. A person with “Adrenal Fatigue” by definition, does not meet the criteria for Adrenal Insufficiency, but their adrenal output is measurably below optimal levels and their symptom picture corresponds. Another consideration is that Naturopathic Doctors are trained to treat the cause, and “Adrenal Fatigue” is considered by many to be a symptom.  To address it, one must investigate the factors that have over-taxed the adrenals and make changes there.


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