Thompson consulted her GP, who ordered multiple tests, including for HIV, cancer, tuberculosis and lung disease. They all came back negative. The doctor deduced that her symptoms were stress-related and that she had what is commonly known as burnout, or “adrenal fatigue”.
In 60-year-old publishing lecturer Colleen Dawson’s case, she could hardly get her head off the pillow on some mornings, and “no matter how well I slept, I’d be tired all day long”.
“When I developed a boil in my groin area, I decided to do something about it, because my immune system was obviously very low.”
Dawson chose to see a homeopath, who diagnosed adrenal fatigue. She was prescribed homeopathic treatment for her boil and was referred to a psychologist.
“The first thing the psychologist told me was to stop working. It had been a hectic year, during which I’d done a difficult part-time degree on top of working full-time. Towards the end of that year, I broke my arm, but rushed back to work as soon as I was able.”
Adrenal fatigue is a modern-day syndrome that, in essence, means your adrenal glands are “exhausted” or functioning below optimum levels due to prolonged or intense stress.
The adrenal glands, walnut-size glands that sit on top of your kidneys, are responsible for your body’s response to stress, be it physical, emotional, or psychological, through hormones (namely cortisol, adrenaline and noradrenaline) that regulate energy, immune function, heart rate, muscle tone and other processes that enable you to cope with stress.
Under prolonged stress, which may be induced by working too hard, chronic pain or by persistent feelings of anger, depression, fear or guilt, cortisol, involved in the “fight or flight” response, remains elevated, causing an array of symptoms, from fatigue, dizziness, edginess, aches and pains to weight loss and digestive problems.
However, due to the lack of clinical trial evidence, many conventional doctors don’t recognise it as a distinct syndrome, and a call to the Centre for Diabetes and Endocrinology in Joburg confirmed this, as the endocrinologists present were not prepared to entertain a discussion of what they doubt even exists. Their case is advanced by the fact that the cluster of symptoms associated with adrenal fatigue is also associated with many other disorders.
“Adrenal fatigue isn’t widely recognised as a diagnostic term. In medical circles, adrenal insufficiency is known as hypoadrenalism, and in chronic cases, Addison’s Disease, both of which are rare and not necessarily stress-related,” explains Tshwane endocrinologist Dr Pierre van der Walt.
He does, however, accept adrenal fatigue as a phenomenon and says it is probably underdiagnosed, or misdiagnosed.
In diagnosing adrenal fatigue, levels of electrolytes and cortisol in the blood are tested. If levels are notably low, another blood test needs to be done, as the cortisol level may return to normal after being stimulated.
“If the cortisol increases after a stimulation test is done, it is not adrenal fatigue, and it is important to eliminate other illnesses or stress-related conditions,” says Van der Walt.
The persistent stress caused by today’s workplace, especially in the corporate world, is one of the main causes of adrenal fatigue.
“Many people are facing high levels of stress that force the adrenal glands to work overtime. This causes a gradual decline in adrenal function,” says Dr Sindeep Bhana, an endocrinologist at the Centre for Medical Excellence at Melrose Arch, who specialises in stress-related disorders.
Dawson says constant work stress defined her life before she was diagnosed six years ago. Taking the psychologist’s advice, she stopped working for four months.
“Luckily my husband was earning, but I still felt terrible. I stuck to the homeopath’s instructions and started eating sensibly, stopped drinking coffee and did some aerobic exercise.
“I went for psychotherapy sessions weekly for six months to work out the underlying stresses. It took ages to feel my energy and drive returning, but it gradually did.
“Last year I started taking hormone replacement and I’ve found that my focus is back. I’ve learnt to recognise when the symptoms of adrenal fatigue are coming on, and I’m careful not to take on too much work.”
Thompson’s doctor prescribed antidepressants, a common treatment for stress-related conditions.
Dr Simone Silver, a GP at the Integrative Medical Centre in Bryanston, says adrenal fatigue is often misdiagnosed as depression, anxiety, stress, hypochondriasis, low or high blood pressure, or a chronic viral infection.
“Health-care practitioners should appreciate that health and disease are not the only two states of physical and emotional being,” she says.
“There are stages of dysfunction between health and disease. It is important to view health in a multidimensional way, taking into account the complexity of the human body and mind, and how various environmental and personal factors interact to perpetuate loss of vitality and well-being.”
Thompson, rather than taking antidepressants, decided to see a homeopath, who prescribed a detox diet and a variety of supplements.
“I did yoga every day, and ate simple things like veggies and soups. I stopped caffeine. Within about three months I felt a lot better, and in six months I was back to normal.”
Medical practitioners warn that diet and nutritional supplements alone will generally not fix the problem, however. To address underlying stressors, patients often have to make lifestyle changes and learn stress management techniques.
“Cortisol replacement in the form of pills (such as hydrocortisone or dexamethasone) is sometimes prescribed, but the more conservative treatment is another hormone, the building block for cortisol, known as DHEA (dehydroepiandrosterone), which you can buy over the counter at pharmacies (7-Keto DHEA by Solal, for instance),” says Van der Walt.
Physical exercise is also important, as part from being a destressor, it is one of the best ways to maintain and balance hormones.
If adrenal fatigue has progressed to exhaustion, however, physical exercise should be mild and not a vigorous gym workout, warns health-care consultant and nutritionist Sharon Levin, who suffered adrenal fatigue in the wake of fibromyalgia (defined by widespread pain and tenderness).
“Type A-type personalities are prone to adrenal fatigue because they tend to work or exercise excessively,” says Levin. “To treat the condition effectively, bed rest is essential. Eating correctly and resetting your parameters so you are not continually overdoing things are also critical to recovery.”
Dietary recommendations usually include eating plenty of vegetables, and foods containing omega-3 (fish and nut oils) and omega-6 (vegetable oils), and decreasing or eliminating salt, sugar, caffeine and red meat.
“You can use herbs to add taste to food. In addition, you can take super colostrum, which supports the immune system, and chromium polynicotinate, which assists with insulin and cortisol balancing,” Levin adds.
Supplements recommended include calcium, magnesium, and vitamins C, B1, B6 and B12.
In essence, adrenal fatigue is a red alert from your body that you need to slow down or take a break.
“Your recovery time depends on how far it has progressed. It can take many months to feel normal again,” says Levin, who says she’s learnt to recognise when it’s “coming on” and how best to stave it off.
“It’s about learning to take proper care of yourself.” - Pretoria News
l Dr Pierre van der Walt: 012 804 7856
l Dr Simone Silver: 011 463 0036
l Dr Sindeep Bhana: 011 684 0917
l Sharon Levin: 011 485 5848