Adrenal fatigue – convenient myth or stark reality?

General Healthcare

  8 Minutes

The term ‘adrenal fatigue’ is a group of symptoms which result when we are exposed to stress, either as a very intense single event or an accumulation of chronic stress over time. Essentially, our hormonal stress buffer becomes literally overworked, leading to a reduced stress resilience and ability to adapt to life’s daily stressors.

Hormonal stress physiology 101

Our bodies are very cleverly designed to be able to withstand stress in any form, be it psychological or emotional stressors or physical stressors such as infections or mechanical stress, or even environmental stress such as extreme heat or cold. In response, the body is able to make adjustments to its functioning to adapt accordingly.

One of the major adaptation mechanisms involves our hormonal system known as the endocrine system. A key part of our endocrine system in this context is the Hypothalamus Pituitary Adrenal (HPA) Axis. This is a typical example of how the nervous system is closely linked to the endocrine or hormonal system in our bodies and how these two systems work together to maintain balance.

The Hypothalamus sits deep within the base of the brain (below the thalamus) and although only about the size of an almond and only weighing about 4 grams, this part of the brain plays a vital role in regulating the autonomic nervous system, appetite, body temperature, emotional responses, maintaining daily physiology and importantly controls the actions of the pituitary gland by releasing neuro hormones which activate it under certain circumstances. The other important glandular structure is the pituitary gland, which is attached to the base of the brain – talk about dynamite coming in small packages! Known as ‘the master gland,’ this tiny pea sized gland literally controls almost all the hormones in your entire body!

In circumstances of stress, the hypothalamus releases a hormone called Corticotropin-releasing hormone (CRH), which in turn stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH), which influences the adrenal glands to release cortisol. This interaction is called the Hypothalamus Pituitary Adrenal (HPA) Axis.

The Hypothalamus Pituitary Adrenal (HPA) Axis

As seen in the image above, the pair of adrenal glands sit on top of each kidney. The hormones they produce do a variety of things in our bodies, including regulating metabolism, the immune system, blood pressure, mineral balance and many other essential functions including very importantly helping us to adapt to stress by producing the hormone known as cortisol.

Linking adrenal fatigue and cortisol

Linking adrenal fatigue and cortisol

Cortisol is the major stress adaptation hormone that helps our bodies cope physically and psychologically with stress, and also very importantly acts as a natural anti-inflammatory in the body, kind of like our own homemade cortisone! When the HPA axis stress adaptation process is called upon day in and day out for weeks or months on end, i.e. when under chronic stress, the system begins to weaken eventually, resulting in a situation where the adrenal glands can no longer keep up with the demands to produce cortisol.

So how does this manifest in the body you may ask? Understanding the key functions of cortisol, namely stress adaptation and anti-inflammatory effects, are key to recognising the signs and symptoms when cortisol production is too low:

  • Unexplained fatigue and waking up tired
  • Difficult to get going in the morning
  • Too tired to exercise
  • ‘Depression-like’ symptoms – low mood, disinterest, apathy
  • Poor concentration, focus, mental stamina
  • Feeling overwhelmed and unable to handle stress like before
  • Low libido
  • Cravings for salt, sweets and stimulants
  • Addicted or reliant on coffee or energy drinks to function
  • Blood sugar lows
  • Dizziness on standing or getting up and/or low blood pressure
  • Frequent infections (low resistance)
  • Inflammatory symptoms
  • Fibromyalgia-like symptoms (body pain)
  • New allergies or flaring up of existing allergies e.g. eczema, asthma, hay fever etc.
  • Sensitive to bright light
  • Difficult controlling body temperature.

Adrenal fatigue

The controversy

A simple online search for ‘adrenal fatigue’ will reveal a minefield of information about this hotly debated condition. The orthodox medical profession outright denies the existence of ‘adrenal fatigue’, claiming there simply isn’t sufficient measurable proof of its existence, yet thousands of articles, blogs and patient testimonies state the contrary as do a wide variety of complementary medicine practitioners. Put simply, ‘adrenal fatigue’ doesn’t exist in medical texts nor is it taught at medical schools. Articles in medical journals even go so far as to warn consumers against accepting such a diagnosis.

The medical world does however fully accept and acknowledge a diagnosis of ‘adrenal insufficiency’ (AKA Addison’s disease) as a condition when the adrenal glands don’t make enough of the hormone cortisol. It also curiously recognises ‘burnout’ defined medically as ‘state of vital exhaustion,’ what’s curious is that ‘vitality’ is something highly subjective and certainly difficult to measure objectively with medical tests. So, what is the problem with ‘adrenal fatigue’ then and why is it so vehemently denied?

Healthcare professionals such as integrative doctors and doctors of complementary medicine who do recognise and treat this condition will argue that ‘adrenal fatigue’ needs to be clearly distinguished from the more advanced form thereof known as adrenal insufficiency or Addison’s disease which is in reality, quite rare i.e., affecting less than 1 person per 100 000. Arguably our modern, high-stress, high pace lifestyles often linked with poor diet, lack of exercise, poor sleep and insufficient rest periods are undoubtably likely to place strain on our HPA axis and as a result, potentially lead to a weakened stress response but not necessarily to the degree of adrenal failure or Addison’s disease-like scenario. Symptoms are often referred to as an outward manifestation of an internal problem, kind of like warning lights on the dashboard of your car, it is these warning signs that constitute what is referred to as ‘adrenal fatigue.’

What can be done to support healthy adrenal function?

1. Start with diet

One of the cornerstones of treating adrenal exhaustion is through diet; there are specific food groups that should be avoided (ironically these are often the same foods patients with adrenal exhaustion crave). The table below lists these:


Avoid Introduce
Irregular meals
Foods high in sugar or high GI
Starchy foods
High GI fruits
Stimulants e.g. caffeine
Allergenic foods, gluten, wheat, dairy
Refined foods
Frequent small meals
Bedtime snack – soaked raw almonds
Combine, fat, protein, and whole grains in meals
Good quality proteins
Essential fatty acids – fish, nuts, seeds


2. Lifestyle interventions

A careful stocktake of our lifestyles is necessary in order to identify where and how we can reduce or at least modify our stress loads. A holistic approach to dealing with stress always achieves the best sustainable outcomes. There are various scientifically proven non-medicinal interventions which combat stress, some of these include:

Breathing exercises are quick and easy to apply and can conveniently be practised anywhere and at any time to quickly reduce stress levels, relax the muscles and calm the mind.

  • Sit in a comfortable position with your back straight, relax your shoulders, and keep your head up.
  • Close your eyes.
  • Take in a deep breath in through your nose for 4 seconds – pushing your belly out as the air enters the lungs, hold the breath in for 7 seconds then breathe out through your mouth for 8 seconds and totally empty the lungs.
  • Repeat the process – focus attention on the breathing process (air moving in and out) – make sure you keep your shoulders relaxed and don’t move them up and down but rather expand and contract the belly each time you breathe in and out.

Going for a walk for at least 10 minutes boosts endorphins and clears the mind – ideally, this should be done in a natural environment such as a park or green area. Simply being outdoors and in nature has proven to induce relaxation in addition, when you walk you actually enter a state of meditation called involuntary attention; a situation which holds our attention but also promotes reflection.

Visualisation – make yourself comfortable, close your eyes and imagine and visualise a relaxing setting or situation e.g. a peaceful mountain setting, a white sandy beach or any positive place – this practice is known as guided imagery.

Progressive muscle relaxation is an ideal technique to apply if you become really physically tense when stressed – start with the feet and toes and progressively work your way upwards to the head. Begin by contracting the muscles as tight as you can and then consciously relax them fully, then move upwards to the next set of muscles.

Music therapy is a very powerful way to influence your mood and relax the mind; there is extensive research confirming the therapeutic effects music has on us in various contexts – slow, quiet, classical music is particularly relaxing and scientifically proven to slow down the heart rate, lower blood pressure, and decrease stress hormones. Interestingly, we tend to neglect such activities when we are stressed because we consider them a waste of time when we are under pressure, but they can be a powerful tool to positively influence our emotions.

3. Adaptogens

Adaptogens are a specialised group of herbal medicines which help the body adapt to stress, support healthy metabolic processes, and restore necessary balance. In herbal medicine, they are known to assist us with coping with a variety of types of stressors including emotional, environmental, and physical stress. They do this by helping adrenal glands to respond more effectively and efficiently. The most scientifically researched adaptogens include herbal medicines such as:

  • Astragalus membranaceus (Astragalus)
  • Eleutherococcus senticosus (Siberian ginseng)
  • Glycyrrhiza glabra (Licorice root)
  • Panax ginseng (Asian ginseng)
  • Rhodiola rosea (Rhodiola)
  • Schizandra chinensis (Schizandra)
  • Withania somnifera (Ashwaganda).

For more information and guidance on these, we suggest you see a phototherapeutic doctor.

4. Other supplements and remedies

If you are experiencing high-stress levels and the results thereof consider the following:


Bio-Strath contains 61 of the 100 vital nutrients our bodies need daily, in a unique format that is highly absorbable by the human body. Included in these are 11 vitamins, 19 minerals and trace elements, 20 amino acids and unique to Bio-Strath, 11 building substances. Building substances are special because they are the nutrients our body needs first to make new cells!

Bio-Strath contains plasmolysed herbal yeast providing nutritional support to:

  • Contribute to normal mental performance.
  • Memory and concentration.
  • Assist with focus and attention.
  • Reduce fatigue and stress.
  • Strengthen the immune system.
  • Help restore and maintain natural energy.
  • Increase vitality.
  • Vitality during and after pregnancy.
  • Recover from illness (convalescence).
  • Recover from exercise.
  • Support and contribute to the healthy metabolism of nutrients.
  • Maintain good health.
A.Vogel Neuroforce Formula

A.Vogel Neuroforce is a homeopathic nerve tonic. The ingredients specifically address nervous tension and exhaustion during or after stressful events with hypersensitivity, agitation, and restlessness. Indicated for emotional symptoms such as grief, tearfulness, anger, resentment, irritability, anticipation, fear and depressed mood. It is recommended to support the nervous system during periods of stress, conflict or emotional strain or to use in situations of acute shock and trauma.

A.Vogel Dormeasan

If sleep is negatively affected by stress, A.Vogel Dormeasan is a herbal medicine for the relief of sleep disturbances, stress and anxiety. Ingredients support the nervous system by having a calming action and address symptoms such as restlessness and anxiety and promote restful sleep.

A. Vogel Valeriana

A.Vogel Valeriana contains fresh valerian root extract which is a mild herbal sedative for the supportive treatment of nervous tension, anxiety, restlessness, irritability and sleeplessness.

Pegasus Calming 30c

This remedy takes the edge off stressful situations, helping to calm and steady your nervous system allowing you to focus and cope.

Calming 30C contains many of the elements in herbal remedies such as passiflora and valerian but in homeopathic doses. Calming 30C also contains chamomilla (referred to as the ‘opium of homeopathy’) . The wonderful thing about Calming 30C however, is that it calms and relaxes in a way which still allows you to be mentally sharp and focused when taken in the day time; and only induces ‘sleepiness’ when taken at night with the intention to sleep.

It’s effective even for severe anxiety and panic attacks, is non-habit forming and won’t make you feel drowsy as a side effect. Because homeopathy always strives to heal the underlying cause, patients who suffer panic attacks will find after using the remedy for 2-3 episodes, no longer get the attacks, or if they do, they occur in a much milder form.

Pegasus Sleep 30c

The Pegasus Sleep 30C remedy is useful for all kinds of insomnia whether due to anxiety and worry, over-work, excessive mind-busyness or nervous exhaustion.

Best of all, you won’t wake up groggy and leaden as with many over-the-counter sleep medications.

Pegasus T.R.S 200c (Trauma, Rescue, Shock)

Pegasus T.R.S 200c (Trauma, Rescue, Shock) should be on hand at all times as it is the ideal emergency treatment for any shock situation e.g. accidents, emotional upset and grief.

It assists with the physical trauma and shock, as well as the emotional aspect of being in an accident.

The remedy may be useful as a supportive treatment in drug withdrawal programs e.g. coming off sleeping tablets or quitting smoking where an aspect of grief occurs due to giving up the addictive substance.

  Listen to the podcast here: Adrenal fatigue & burnout


  1. Bone, K. and Mills, S. 2013. Principles and Practice of Phytotherapy. 2nd Edition ed. Edinburgh: Churchill Livingstone.
  2. Wilson, J.L. 2014. Clinical perspective on stress, cortisol and adrenal fatigue. Advances in Integrative Medicine.1(2): p. 93-96.
  3. Winston, D. and Maimes, S. 2019. Adaptogens – Herbs for Strength, Stamina, and Stress Relief. Rochester Vermont: Healing Arts Press.