What is Adrenal Fatigue Syndrome?

The effects of stress do not simply impact one’s mental health. It is well documented that stress also has an influence on physical well-being. If you search the evidence-based medical literature you will find studies on stress as a contributing factor for heart disease and decreased immune response going back several years. More recently, adrenal fatigue syndrome is an area where increased understanding has emerged regarding the body’s response to chronic stress. Although this phenomenon is not recognized by all medical practitioners, there is compelling information that contributes to the body of work being done in this area that may explain a confluence of symptoms experienced by growing number of individuals and point toward a specific diagnosis.

Adrenal fatigue syndrome (adrenal fatigue syndrome) is a term utilized to describe a condition in which the adrenal glands do not function at optimal levels. Normally, the adrenal glands respond to stress by producing cortisol, a hormone that assists the body in managing increased levels of stress, and adrenaline, which is more commonly associated with the “fight-or-flight” response. The release of cortisol is dependent upon a negative-feedback loop in the body that involves the hypothalamic-pituitary-adrenal (HPA) axis. When stress rises, the hypothalamus senses the circulating cortisol levels and determines the need for additional secretion of cortisol in order for the body to adequately manage the stressful environment. If needed, the hypothalamus will signal the adrenal gland via the pituitary gland to produce additional cortisol in order to maintain homeostasis or balance in the body systems in response to stress.

It is important to point out that stress comes in many forms. There’s physical stress, like the demands of a hard workout, illness, or malnutrition; emotional stress, like the loss of a loved one or depression; work-related stress, like starting a new job, the loss of a job, or excessive work volume; spiritual stress, like the loss of sense of self or purposelessness; and relationship stress, like divorce or strained family relations, to name a few. So, stress is a perception as much as it is a physical feeling.

In adrenal fatigue syndrome, it is thought that chronic stress creates a continual need for the adrenal gland to increase cortisol production, thereby causing a condition in which the adrenal gland becomes overworked and is unable to keep up with the demands created. Because this hormone has an impact on the brain, some symptoms of adrenal fatigue can be attributed to changes in the mood and motivation centers.

The controversy regarding whether or not adrenal fatigue syndrome is a legitimate diagnosis exists primarily in the lack of a consistent diagnostic indicator or single reliable test. In a systematic review of the literature, Cadegiani and Kater (2016) concluded that adrenal fatigue syndrome does not exist based upon the endocrinologists’ perspective because there is no definitive test that has been identified through clinical trials for adrenal fatigue syndrome. On the other hand, integrative-medicine specialists contend that not only does adrenal fatigue syndrome exist, but because of its complex clinical picture it goes largely unrecognized or underdiagnosed. This is due to the fact that many patients report fatigue as a symptom, which is also a hallmark symptom for adrenal fatigue syndrome.

James Wilson (2014) submits in his article Clinical perspective on stress, cortisol and adrenal fatigue that symptoms associated with adrenal fatigue syndrome have a unique fatigue pattern. According to the author, these symptoms include:

  • Early-morning fatigue even with what would be considered a full night’s sleep
  • The need for caffeine or other stimulants to feel awake
  • Mid-morning low, often compensated with caffeine or sugar
  • Afternoon low between 2 p.m. and 5 p.m., lasting from 2 to 5 hours and ranging from the need to slow down or to lie down
  • Improved energy after 6 p.m.
  • A “second wind” around 11 p.m. if still awake that may last until 2 a.m.

Associated symptoms may also include (Wilson, 2014):

  • Decreased stamina, productivity, resilience, and libido
  • Craving salt or salty foods
  • Low blood sugar, especially when under stress
  • Increased severity or incidence of respiratory infections
  • Difficulty concentrating
  • Irritability
  • Feeling overwhelmed
  • Mild depression

Considering the causes of adrenal fatigue syndrome, it is easy to imagine how busy indoor cycling instructors could be at risk for developing this condition. The day-to-day demands of teaching, schedule changes, subbing classes, and fitting in your own training can be stressful. Add to that the everyday demands of family life, work life, and trying to manage healthy eating patterns, and it’s difficult to find life balance. It is not surprising that adrenal fatigue syndrome is getting so much attention in the literature with a fast-paced world full of cell phones, email, and communication applications that bombard our lives, leaving very little time for decompression.

As previously mentioned, it is important to keep in mind that stress takes many forms. Taking care of your clients is obviously a professional goal, but taking care of yourself is paramount to being able to maintain a healthy professional practice. Ask yourself: Do I practice what I preach? The physical demands and pressure from other areas of life create an environment for stress that can set you up for adrenal fatigue.

Regardless of the argument among practitioners regarding the diagnostic indicators of adrenal fatigue syndrome, the impact of stress for those who have experienced it is real. Ruling out a specific root cause that may contribute to these symptoms is important because the symptoms of adrenal fatigue syndrome can be vague or inconsistent. Managing the effects of stress that may trigger adrenal fatigue syndrome is the target of the treatment. These strategies may seem fairly obvious and familiar, but nonetheless they are the tools described to decrease the effects of chronic stress that trigger adrenal fatigue syndrome.

Lifestyle modification

This includes but is not limited to decreasing stress by minimizing responsibilities and demands on your time and energy. That might be carving out time in your day to “decompress” or taking all non-essential tasks or time-consuming activities off your plate. Taking time to relax is also important. Do focused meditation, participating in a mind-body class like yoga, and get adequate rest every night by establishing bedtime routines, including a “no-screen time” leading up to bedtime. Be honest about relationships that exhaust your energy and spend your time in healthy relationships that bring you joy. Exercise at moderate intensity on most days of the week (remember, high-intensity exercise can be a source of stress).

Dietary balance

A healthy diet is part of any balanced lifestyle. It is particularly important in restoring well-being when recovering from adrenal fatigue syndrome (Wilson, 2014). This includes adequate intake of fruits and vegetables, avoiding fruit in the morning. Be sure to eat before 10 a.m., again before noon, and at regular times during the day (Wilson, 2014). Stay well hydrated. Combine unrefined carbohydrates and whole grains, proteins, and a good-quality fat at every meal and snack (Wilson, 2014). All these are tenets of good nutrition.

Dietary supplements

There is no specific scientific evidence available supporting the successful use of vitamin supplements, but anecdotal information suggests that supplementation can help until the symptoms of adrenal fatigue syndrome are diminished. Wilson (2014) suggests a combination of Vitamins B, C, and E as well as magnesium, digestive aids, and herbal tinctures to promote sleep.

Adrenal fatigue syndrome is a complex condition. The vague nature of the symptoms can also be related to other conditions or factors, making it more difficult for medical professionals to come to agreement on the true nature of a syndrome brought on by chronic stress. Seek evaluation for symptoms like overwhelming fatigue, sleeplessness, and hypoglycemia—these are important signals that your body is out of balance and they should be heeded. Integrative specialists suggest that lifestyle modifications, diet, and dietary supplements are a safe pathway that can promote health by decreasing stress; however, they emphasize that the positive effects may take months or longer to appreciate depending upon the degree of symptoms (Wilson, 2014). Most importantly, the guidelines for improving health and reducing stress can be supported by all areas of practice and can help relieve symptoms of chronic stress.


Cadegiani F, Kater C. Adrenal fatigue does not exist: a systematic review. BMC Endocrine Disorders

[serial online]. August 24, 2016;16:1-16. Available from: CINAHL Complete, Ipswich, MA.

Accessed March 8, 2018

Wilson, J. L. (2014). Clinical perspective on stress, cortisol and adrenal fatigue. Advances In Integrative Medicine, 193-96. doi:10.1016/j.aimed.2014.05.002



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