Matt Perryman Matt Perryman

A New Explanation for Adrenal Fatigue and Metabolic Damage?

If you’ve read some of my older rantings, you’ve seen that I don’t terribly care for the phrase “adrenal fatigue”. A survey of medical literature just doesn’t agree with the idea of an adrenal dysfunction. Yet, many people have complained of having the symptoms. The same goes for the “damaged” [sic] metabolism. This has a little more evidence in the literature, yet it’s often used as a catch-all term for a certain set of symptoms.

In the past, I’ve considered this to be a function of simply too much stress and little to no attention paid to recovery. For example, the people most often complaining of both of these symptoms are usually doing the Standard Female Fitness Regimen – 2-3 hours of cardio every day, an equally stressful weight-training plan (if any at all), and a diet that might add up to 900 calories of chicken and broccoli – combined with the normal stresses of life. Some will exhibit signs of thyroid disease and either hyper- or hypocortisolemia (which are actually pathological conditions, mind you, that should be diagnosed by a medical doctor).

My personal research into the subject has led me to a few conclusions:

  1. Most of this is brought about by training with the Standard Female Fitness Regimen, too much stress and too little attention to recovery. Note that this extends past exercise and diet into “regular life” too. Stress is cumulative.

  2. For those that do exhibit pathological symptoms, there’s probably a very real cause – perhaps an undiagnosed disorder or infection.

  3. People buy into quack diagnoses and “treat the wrong causes” if you will.

In short, there ain’t no magic in this world – only things that haven’t been explained. My logical-minded brain tends to see things as a problem to be solved, breaking things down into the most straightforward approach. Not everyone does that. While the metabolic damage and adrenal fatigue “diagnoses” as most people understand them may be a BS, that doesn’t mean there’s not an explainable phenomenon at work.

Well, along these lines, I found a new study that’s worth a look.

Wyller VB, Eriksen HR, Malterud K.
Can sustained arousal explain the Chronic Fatigue Syndrome?
Behav Brain Funct. 2009 Feb 23;5(1):10. [Epub ahead of print]

ABSTRACT: We present an integrative model of disease mechanisms in the Chronic Fatigue Syndrome (CFS), unifying empirical findings from different research traditions. Based upon the Cognitive activation theory of stress (CATS), we argue that new data on cardiovascular and thermoregulatory regulation indicate a state of permanent arousal responses – sustained arousal – in this condition. We suggest that sustained arousal can originate from different precipitating factors (infections, psychosocial challenges) interacting with predisposing factors (genetic traits, personality) and learned expectancies (classical and operant conditioning). Furthermore, sustained arousal may explain documented alterations by establishing vicious circles within immunology (Th2 (humoral) vs Th1 (cellular) predominance), endocrinology (attenuated HPA axis), skeletal muscle function (attenuated cortical activation, increased oxidative stress) and cognition (impaired memory and information processing). Finally, we propose a causal link between sustained arousal and the experience of fatigue. The model of sustained arousal embraces all main findings concerning CFS disease mechanisms within one theoretical framework.

I got the full paper and had a look. I think these guys may be on to something. Consider the following:

Personality traits such as perfectionism, conscientiousness and internalization may have an impact, as do illness perceptions such as a poor sense of personal control over symptoms and a strong focus on bodily sensations. In many patients, firm evidence supports a relation to long-lasting infection caused by different microorganisms, such as Epstein-Barr virus, enteroviruses, and Coxiella burnetii. In addition, CFS may be initiated by critical life events or perceived chronic difficulties.

They go on to list several other symptoms, including dysfunction of the HPA axis, increased SNS output (the part of the nervous system responsible for stress response and “fight or flight” activity), and decreased muscle function (likely due to a combination of stress-related effects). Sounds an awful lot like what people are reporting as symptoms – and even the right kind of people reporting said symptoms.

The paper focuses around what they call the sustained arousal model of Chronic Fatigue Syndrome (CFS). This is based on the cognitive activation theory of stress – basically, when something stresses you out, your body responds by increasing its state of arousal. This involves changes in brain activity and hormonal function in order to cope with the stress. When the stress goes away, so does this arousal. Importantly, if the stress doesn’t go away, then the arousal never turns off. Normally this arousal response is healthy, but if it becomes sustained it may contribute to disease.

The authors have a look at the symptoms of CFS, which could be summed up as a constant state of stress. Signals to the heart/cardiovascular system and adrenal glands are all elevated, causing increases in blood pressure and epinephrine levels. Signals to the sweat glands, blood flow to the skin, and the skeletal muscles were associated with altered body temperature. These are all the symptoms of being stressed out, in other words, but persisting even at rest.

In terms of causes, they suggest that undiagnosed infections along with “critical life events and perceived chronic difficulties” are likely culprits. The common characteristics are the long-lasting nature, which may create a similarly long-lasting arousal response. This is where it gets shaky: apparently this initial response may not be enough to stop the stress; apparently certain personality types are prone to worrying and thus making the problem worse when they don’t see the symptoms improving. Additionally, there do seem to be some genetic predispositions towards neurological and endocrine dysfunctions. So you get a perfect storm situation, where all the factors seem to come together to cause the CFS.

With regards to the altered cortisol levels:

An arousal response has profound endocrine consequences, mainly influencing plasma levels of adrenal hormones. Whereas short-lasting arousal activates the HPA axis and increases levels of glucocorticoids, sustained arousal might have the opposite effect. Similar endocrine changes have been documented in CFS, and thus seem coherent with our postulate of sustained arousal.

The on-going stress appears to work at the central level, affecting serotonin levels in the brain, along with a reduction of the hormone that signals cortisol release in the hypothalamus. If that’s the case, then there wouldn’t be any “adrenal fatigue” at all – the bottleneck would be at the central level, in the brain. Compounding it further, exercise-related cytokines (some of which are responsible for the actual overtraining syndrome, by the way) seem to be elevated during the stress response and may also contribute to this sustained arousal.

In other words, short-term stress leads to an elevation, while sustained arousal might well burn you out. Which pretty neatly figures in to what I’ve said in the past regarding “adrenal fatigue”: this is not so much a disease-state as much as it is a manner of chronic stress. However, given light of this information, I’m willing to concede that there may well be a physiological basis that transcends simply being “over stressed” – even though it’s more of a self-induced stress disorder than a full-blown disease state. There seems to be a vicious circle that can easily get out of hand, and CFS seems a very likely candidate.

As stated in the past, my beef with the “adrenal fatigue” diagnosis is that it’s mostly used to play on fears; in the worst case scenario, it could lead to people treating the wrong causes. CFS on the other hand looks to have clearly-defined causes, and further, be a treatable condition. If it’s a matter of infection and psychological traits leading to stress leading to burn-out, well, that can be addressed. It doesn’t require sending $99.99 to the guy you found on Google. Further, since this seems to be a central response, not a dysfunction of the adrenal glands…well, you see where I’m going.

And then, of course, some people are probably just pushing themselves too damn hard and not resting enough. The litmus test would be recovery time – if you spend a few weeks out of the gym and feel better, well, don’t go back to your old habits. It’s only when symptoms persist that I’d consider this an option.