Adrenal fatigue

Wilson9-2013Familiarize yourself with the causes and effects of this stress-related condition.

By James L. Wilson, DC, ND, PhD

Adrenal fatigue is a common stress-related health condition that doctors of chiropractic see in their patients everyday, but many skilled practitioners have not had the opportunity to learn about it or its importance to their practice. Although adrenal fatigue has appeared in the medical literature by various names for more than 100 years, its prevalence is just now coming to the forefront.

As a practicing DC, it will benefit you to have clinically relevant information about adrenal fatigue and its diagnosis, treatment, and relationship to other health conditions.


Simply put, adrenal fatigue is the persistent suboptimal functioning of the adrenal glands, especially under stress. A more formal definition was put forth by Charles Sajous (1852–1929), an eminent physician who wrote: “Functional hypoadrenia (adrenal fatigue) is the symptom-complex of deficient activity of the adrenals due to inadequate development, exhaustion by fatigue, senile degeneration, or any other factor which, without provoking organic lesions in the organs or their nerve-paths, is capable of reducing their secretory activity.”1

Adrenal fatigue is not Addison’s disease, which is the virtual failure of the adrenals primarily resulting from either an infection or autoimmune disorder that damages or destroys the glands (referred to above by Sajous as “organic lesions”). Stress rather than pathological damage is the primary cause of adrenal fatigue.

When the amount of stress continually exceeds the capacity of the adrenals to secrete sufficient hormones to make the physiological and biochemical compensations necessary for that level of stress, adrenal fatigue occurs. In adrenal fatigue, the adrenals still function, but not optimally.

Pervasive and common

In a 1974 publication, John Tintera, MD, a specialist in low adrenal function, conservatively estimated that slightly more than 15 percent of the population has a moderate to severe degree of hypocortisolism (adrenal fatigue) with hypoglycemia but, in actuality, the figure would be closer to 70 percent if all the related groups were included.2

Although there has been no rigorous study of the frequency of low adrenal function, Tintera’s higher estimate seems probable, especially in these stressful times. Most relevant for the physician is the knowledge that this health condition is common enough to be seen regularly by every chiropractor. In contrast, the incidence of Addison’s disease is approximately seven cases per 100,000.3

Unique pattern

Although there are many signs and symptoms of adrenal fatigue, there is no single pathognomonic indicator, except possibly its unique pattern of fatigue. This pattern is characterized by early morning fatigue (even with sufficient hours of sleep), accompanied by the need for caffeinated beverages (often multiple servings) in the morning to get going and keep going during the day.

Frequently, there is a mid-morning low and some people with adrenal fatigue do not actually feel fully awake until after their noon meal. This is followed by an afternoon low from 2:30 to 5:00 p.m. that may last for only about 15 minutes but can last up to two hours. The afternoon low may be so mild that the person simply wants to sit at their desk or take it easy for a few minutes, or as severe as having to lie down for 15 minutes up to two hours.

Then, around 6:00 p.m., it is as if a switch is turned on and they feel better than they have felt all day. This usually persists until about 9:30 p.m. when mild fatigue sets in, but they know that if they fight it then at about 11:00 p.m. they will get a second wind and want to do a project, read a book, or watch late-night TV until about 1:30 to 2:00 a.m.

They may also note that if they can sleep in the next morning until approximately 9:00 a.m. or about two hours later than normal, they feel so much more refreshed than they usually do upon rising.

Fatigue is a common complaint heard by physicians; 85 percent of patients complain of fatigue as one of their major symptoms. However there seems to be no other fatigue pattern quite like this.

Common signs of adrenal fatigue:

  • difficulty getting up and getting going
  • mid-morning low
  • feels better after the noon meal
  • afternoon low
  • feels better 6:00 to 9:30 p.m.
  • second wind 11:00 p.m. to 1:30 a.m.
  • feels much better if allowed to sleep in about two hours longer than usual in the morning.4

Other common signs of adrenal fatigue:

  • hypoglycemia, especially under stress
  • craving salt or salty foods
  • difficulty sleeping
  • having low libido
  • taking longer to recover from illness or increased stress
  • having more frequent and severe respiratory illnesses
  • difficulty focusing or concentrating
  • increased irritability and intolerance
  • decreased productivity
  • increased perimenopause or PMS symptoms
  • feeling overwhelmed and mildly depressed

The distinctive pattern of fatigue together with these symptoms forms a syndrome that you can learn to readily recognize.


There are many causes of adrenal fatigue but by far the most common is stress that is chronic, prolonged, or severe. In modern life, there are often multiple stresses occurring in tandem. The patient may be unaware of some of these stresses but their adrenals, being the glands of stress, have to compensate for it whether physical, biochemical, hormonal, thermal, internal, external, emotional, mental, or toxic in origin, including overuse of drugs, alcohol, and sugar.

Through a carefully orchestrated stress-response system of the hypothalamic- pituitary-adrenal (HPA) axis, the body strives to maintain homeostasis in the midst of these ongoing and varied stresses.

Many cases of adrenal fatigue seen clinically are triggered by motor vehicle accidents; severe injuries — especially head injuries and burns; emotional trauma such as divorce; overwork; hyperactivity; poor and irregular eating habits; and chronic lack of sleep.

There are certain groups of people who tend to suffer from adrenal fatigue more frequently because of the constant stress they are under. For example: Caregivers, social workers, police, doctors, nurses, single moms, people working two jobs, lawyers, and the self-employed are often candidates for this syndrome.

Determination of adrenal fatigue is made by using the patient’s case history, current signs and symptoms, clinical indicators, and laboratory tests to confirm the diagnosis.

JamesWilsonJames L. Wilson, DC, PhD, is an internationally recognized authority on stress and its impact on health. His best-selling book, Adrenal Fatigue: The 21st Century Stress Syndrome, has been translated into several languages. The clinical tools he developed to work effectively with stressed patients, including a diagnostic adrenal fatigue questionnaire, are available to healthcare professionals at



1Sajous CE. (1920). The Internal Secretions and the Principles of Medicine. Vol. 1 (10th ed., pg. 83). Philadelphia: F.A. Davis Company.

2Tintera JW. (1974). Hypocortisolism. (8th ed., pg. 17.) Mt. Vernon: Adrenal Metabolic Research Society of the Hypoglycemia Foundation.

3Stewart PM. (2003). “The adrenal cortex.” Williams Textbook of Endocrinology. (10th ed., pg. 507). Philadelphia: Saunders.

4Wilson JL. (2001). Adrenal Fatigue: the 21st Century Stress Syndrome. Petaluma Calif.: Smart Publications.