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Adrenal Fatigue: Is it Real? The Answer May Surprise You

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A question I hear all the time is this: Is adrenal fatigue real or not?

After writing a guest post for Jen Sinkler, I was somewhat embroiled in a heated discussion about whether or not “adrenal fatigue” really exists.

The argument from the most reasonable critic was this:

Adrenal fatigue is not a real condition. We need to stop perpetuating this term. Here is the problem: You’re tired and someone says you have adrenal fatigue. You take one of those bull— salivary diurnal cortisol tests that you ordered online. You get the results and it says you have adrenal fatigue. OR someone just diagnoses you with adrenal fatigue. All of a sudden you possibly missed a potential real diagnosis (anemia, hypothyroidism, sleep apnea, etc) and you just labeled it with a made of up diagnosis. This is super dangerous and why we cannot go around discussing fake diseases.

I understand what this critic is saying, and to an extent I agree with it. If people are being diagnosed with “adrenal fatigue” when they actually have something more insidious going on, they’ll be in trouble if all they do is take a saliva test, change their diet and lifestyle, and take a handful of supplements.

However, the majority (if not all) of my “adrenal fatigue” clients have already gone to their doctor for help, and after rigorous but inconclusive/negative testing are told “you’re fine” and are often prescribed an antidepressant or Ambien.

The short answer to the question in my headline? No.

“Adrenal fatigue” is not a real diagnosis. But I strongly believe that the condition the term is describing is very much real.

What is Adrenal Fatigue, anyway?

“Adrenal fatigue” is a misnomer – a colloquial term for HPA Axis Dysregulation, which itself is not a “clinical diagnosis” (yet) but certainly exists in the literature and is associated with chronic stressors like overtraining, PTSD, and sleep disruption.

The hypothalamic-pituitary-adrenal axis (HPA axis) is the control center for your body’s stress response. When you get stressed, the concentrations of your HPA axis hormones are increased. The hypothalamus releases corticotropin-releasing hormone (CRH), which is the first of a cascade of hormonal changes that eventually result in the production of cortisol (the “stress hormone”) from the adrenal glands. Elevated cortisol levels direct the distribution of energy to different organs that underlie the stress response, such as the brain, heart, and muscles. This is a normal response and is something your body was designed to do.

Screenshot 2015-08-27 14.52.33
Image Source: Tsigos & Chrousos, 2002

As you can see in the diagram above, the HPA axis has several feedback loops that allow the body to normalize the production of stress hormones such as cortisol.

This prevents your body from becoming overstimulated by a source of stress that is more chronic in nature. This process is called “habituation”, where the body is able to decrease its physiological activation to certain stressors. (1) You might also call this adaptation. It’s normal and healthy, and prevents the negative side effects of chronic HPA activation.

However, certain people are unable to properly habituate to the daily stress they face, particularly if the stress is much more significant than simply a traffic jam on the way to work. Think of stressors like an abusive relationship, a sick family member, or serious financial strain. (I’d consider chronic malnourishment or overtraining at this same level from a physical stress perspective.)

What happens when the HPA Axis gets dysfunctional?

When the HPA axis is no longer able to adapt to daily stressors appropriately, this is when the symptoms of “adrenal fatigue” become an issue.

The typical pattern of adrenal dysfunction is a high level of cortisol to start, then a drop to low cortisol, though some stressful events are traumatic enough to send the HPA axis straight into low cortisol output. Some people also experience a reversal of the circadian rhythm of cortisol output, where their cortisol is low in the morning and high in the evening.

The adrenals don’t get “fatigued” – they eventually produce less cortisol over time as the hypothalamus stops stimulating them appropriately. (Fun fact: This is why many people say “adrenal fatigue” doesn’t exist. Because the name sucks.)

Any level of cortisol disturbance due to chronic HPA axis activation falls into the umbrella term of “adrenal fatigue”. Failure of the HPA axis to respond appropriately to acute stress is another cause of symptoms. Those with HPA axis dysregulation typically have developed a new “normal” of steady state low or high cortisol, and depending on which state they fall into, different symptoms can emerge.

These symptoms can include:

  • Weight gain or loss
  • Frequent illness (e.g. colds, flus)
  • Reduced sex drive
  • Lightheadedness
  • Poor memory
  • Fatigue, lethargy and exhaustion
  • Insomnia
  • Coffee addiction
  • Salt, sugar, and fatty food cravings
  • Worsened PMS
  • Pain in the upper back or neck
  • Mild depression
  • Food allergies
  • Dry and thin skin
  • Hypoglycemia
  • Low body temperature
  • Nervousness and anxiety
  • Heart Palpitations
  • Unexplained hair loss
  • Alternating constipation and diarrhea
  • Heartburn or dyspepsia

One argument from adrenal fatigue critics is that the symptoms list is too diverse and could be related to any number of diagnosable conditions. While this is true, that doesn’t invalidate the fact that chronic HPA axis activation and subsequent dysfunction can cause those symptoms in many individuals as well. These may seem like highly variable, nonspecific symptoms, but that doesn’t mean they’re not primarily due to stress.

In scientific literature, failure of the HPA axis to habituate to chronic stress is associated with a wide range of physical and mental health outcomes, including exhaustion, depression, anxiety, low self esteem, and central fat accumulation (2, 3, 4) Low steady state cortisol is often seen in both PTSD and chronic fatigue syndrome (CFS). (5, 6)

What’s worse, HPA axis dysfunction can affect the regulation of immune and inflammatory processes, which can influence the risk of infectious disease, autoimmunity, heart disease, and even some cancers. (7)

Your ability to respond and adapt appropriately to stress will significantly affect how your body responds to chronic stressors over time. If your body stops responding appropriately, your risk of these conditions rises substantially.

Why do some people react to stress worse than others?

It’s important to realize that not everyone responds and adapts to similar stressors the same way. For example, research shows that people who are prone to “rumination” (i.e. overthinking and focusing on past stressors) have a reduced ability to adapt to repeated stress. (8) Just one night of sleep deprivation has been shown to impact the body’s ability to adapt to stress as well. (9)

This would indicate that certain personality types and/or lifestyle factors may put someone at higher risk for HPA axis dysregulation. And it would explain why certain people seem to be fine when exposed to regular intense stress (professional athletes, military personnel, etc.) while others develop HPA axis dysfunction from seemingly “normal” stress (e.g. doing Crossfit 5 days a week while eating a low calorie diet and sleeping 6 hours a night.)

For those of you suffering from adrenal fatigue syndrome, I’m sure this resonates with you deeply.

Why is it that you can eat a “healthy” diet and exercise regularly, but have crushing fatigue, while your friends or family might eat junk and sit around all day and feel completely fine?

All of us have different levels of response to the same stressors and a lifestyle that might cause HPA axis dysfunction in you might be completely manageable for a friend. That’s why individualization is key when recovering from HPA axis related disorders.

So, is adrenal fatigue “real”?

As you can see, “adrenal fatigue” is not a recognized medical diagnosis, and the term is misrepresenting the processes happening in your body when you are unable to adapt to chronic stress.

However, that doesn’t mean the condition isn’t real.

HPA axis dysregulation is very much a real condition, and it’s important to recognize the importance of healthy lifestyle changes to reduce or eliminate the symptoms associated with chronic HPA axis dysregulation.

If you’ve been to the doctor for any of the symptoms I listed above, gone through multiple diagnostic tests, and have found nothing, you need to take a closer look at your diet and lifestyle  and identify if you’re engaging in behaviors that are causing your body to be under constant stress.

This is an extremely common issue in the Paleo community, particularly for women. I see it all the time with my one-on-one clients – people eating way too little for the amount of exercise their doing, and experiencing severe hormonal disturbances from the HPA axis disruption.

Just look at the experiences Joanna and Ivy had:

Screenshot 2015-08-27 08.48.18

Screenshot 2015-08-27 19.59.05

It frustrates me that there are so many people out there who are harming their HPA axis function in the pursuit of better health and fitness, and when they finally see their doctors about the symptoms, most docs don’t think to look at the person’s diet and lifestyle as a potential cause.

Why did we create Paleo Rehab: Adrenal Fatigue?

Both Kelsey (my business partner) and I have struggled with hormonal issues related to stress, including low cortisol, and that’s why we’re passionate about helping people who are in a similar condition.

In no way would we ever consider what we’re doing “diagnosing and treating” anything. We’re just trying to help people who are driving themselves into the ground with restrictive dieting, overexercising, high levels of stress, and poor sleep.

The reason we created the program is because we had so many clients coming to us on these restrictive diets and 8 million supplements, and the biggest issue was their inadequate diet and overly stressful lifestyle. So we figured we’d create a program to teach the basics to a wider audience.

Most of our students are the ones who went to their doctor(s) for help and were told that there was “nothing wrong with them”. Sure, from a medical perspective there may be nothing treatable, but from a lifestyle perspective there is a huge room for improvement, especially in the psychological part that many of our clients struggle with most prominently.

Ultimately our ideal client is the person with disputed HPA axis function due to their high stress diet and lifestyle choices, and we help them address those basic issues in detail.

For those critics saying that Kelsey and I are using a “made up term” to dupe people into buying a bogus program, I have two things to say. First of all, we’re helping people address HPA axis dysfunction in the program, and if you want to call it that instead, by all means – do it.

But that leads me to my second point: had we called the program “Healing from HPA Axis Dysregulation”, I can guarantee NO ONE would have bought it. Just look at this Google trends analysis for the term “adrenal fatigue” versus “HPA axis”.

Screenshot 2015-08-27 16.27.49
Which name would YOU choose to use for marketing?

While we’re not master marketers trying to manipulate people into buying our program, we’re also not stupid. We had to use the term “adrenal fatigue” because had we not, 95% of our ideal customer base wouldn’t have even known the program was something they’d benefit from.

It’s unfortunate that the term “adrenal fatigue” is so controversial and we wish we could use the scientific term, but it’s kind of like putting toothpaste back in the tube at this point. That’s why we chose to just use the layman’s term and then educate people once they bought the program.

And I bet the term is going to stick around until medical professionals start diagnosing people with HPA Axis Dysfunction, which I doubt is going to happen anytime soon.

When it comes to Paleo Rehab: Adrenal Fatigue, Kelsey and I are really proud of the information and guidance we provide, and the results our students have gotten. I won’t apologize for using a controversial term if it allows me to help the people who need it.

What do YOU think about adrenal fatigue?

I’d love to hear your thoughts – do you think adrenal fatigue is real? Do you think HPA axis dysregulation is real? Have you made any diet or lifestyle changes that improved or eliminated your adrenal fatigue symptoms?

Share your story in the comments below!

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  1. Great article – super informative! Those screenshots above from people on your Facebook page mimic my EXACT story as well. My ND sent me to have a brain MRI and my pituitary came back completely normal. They thought I had a benign tumor as well. I have lower hormone levels and haven’t had a period in 3 years. I have gut dybiosis (which she thinks is a candida overgrowth) and really bad anxiety and stress, due in part to my current schedule and in part to how i’m wired. I found those comments really interesting – it’s great to know i’m not alone! My ND is currently working with me on the candida issue, and i’m taking a few natural supplements to help stimulate my female hormones, but she hasn’t suggested anything to address adrenal. I think we might be taking it one step at a time. Thank you for writing this! I feel much more informed.

  2. YES! Also – I think people think you can get adrenal fatigue like THAT. In my experience and knowledge, it really isn’t that quick. It’s usually a long ACCUMULATION of poor habits that lead to decreased hormonal input and/or dysregulation.

    I only WISH this information was available years ago, when I was on the low carb/low calorie HIIT train. And honestly, I THOUGHT I was being healthy based on what I read from all the “experts”! It took me over TWO YEARS to get my cortisol levels back to normal (I had low morning cortisol, subclinical hypothyroidism [high reverse t3, low free t3, and a poor ratio], plus vitamin D deficiency.) It SUCKED. I was finally able to start exercising again, but then I moved (HUGE stressor!) and started suffering from panic attacks, anxiety, fatigue, heart palpitations. I got on progesterone cream which helped TREMENDOUSLY (I also had estrogen dominance.) Finally, 2.5 years later from when I first got diagnosed, my levels are NORMAL!!!

    I didn’t TRULY start healing until I took a major MENTAL shift. I feel like that is such an invaluable part of the process. It KILLED me that I couldn’t work out as hard, OR that I was instructed to eat more (I was always SUPER bloated all the time since my belly didn’t digest well.) Once I finally just LET GO, and allowed my body to rest, recover, and be NOURISHED, was the point where I finally started coming out on the other side. I still feel like I can’t PUSH it like I used to, but I am gaining back my strength and stamina slowly and carefully. Good luck to ANY of you suffering from HPA dysregulation, it takes a LOT of patience and understanding, but consider it a beautiful learning experience on how to truly take care and love your body, 🙂 xoxo

  3. The problem is misrepresentation of the pathophysiology of the HPA axis maladaptation you speak of. Chicken or the egg. When there is true HPA axis dysfunction as a cause of symptoms/disease, we can generally easily diagnose that. When there is HPA axis adaptation that is subpar for reasons of lifestyle (hard to even diagnose that, as using they salivary cortisols for that are not validated and the assays used by non medics facilities are often frought with wide varieties of inconsistencies), we can exclude adrenal insufficiency fairly easily and if there is adrenal insufficiency, we must diagnose the cause. This is a good look from the Endocrine Society
    -(ps, I’m an endocrinologist so my bias is to finding the true underlying cause of real endocrine pathology and also focusing on lifestyle for conditions you bring up)

    1. Perhaps I’m not understanding your comment – are you saying that you don’t believe chronically stressful lifestyle factors can cause HPA axis maladaptation? Or that a diagnosis of “adrenal fatigue” simply isn’t necessary if no other diagnosis has been found and adrenal insufficiency has been ruled out?

      In the absence of adrenal insufficiency, what kind of diagnoses are you typically seeing in these patients? As I’m not a doctor I don’t diagnose disease, and the majority of my patients who come see me with what I perceive as “lifestyle-induced HPA axis dysfunction” have already seen a doctor and have not identified any medically legitimate diagnosis. (As evidenced by two of the Facebook comments I shared in the post.)

      The link you shared was useful, and I can understand the reasons why diagnosing someone with “adrenal fatigue” is dubious, but I don’t think it adequately explains the hormonal disruption that occurs when a person is under chronic stress and is unable to adapt to it appropriately.

      I do appreciate the opportunity to discuss this with someone who is an expert in the field of endocrinology.

    2. Serum testing for cortisol doesn’t work unless your cortisol is dangerously low. That is the problem with us suffers, we are subclinical, you will never find us in your lab ranges. So instead we are all just depressed, anxious hypochondriacs who should just go on antidepressants. Whatever you call it, it is very real……..

    3. Great point.

      I think what further discredits (and
      Personally throws me off) is when “stages” of adrenal fatigue/exhaustion/ potentially leading to Addisons are used as examples.

      Dr Lam is just one of many prime example using these tactics: Just go to his site. His theme?

      “If you don’t do this, or do that, ‘just right’ your adrenal situation just gets worse and worse”

      Then Read “adrenal crashes” and “adrenal exhaustion” (If you read closely, it’s obvious that he unnecessarily complicates, confuses, and worries readers on the simplest and most common sense of things, makes you hesistant to even do simple things like drink water and salt, and yet repeatedly says, “this should not be taken without the guidance of a professional” )

      All the symptoms listed can be anything from the common cold to an AD. But then again so can “Depression” ; )

  4. Why is it that you can eat a “healthy” diet and exercise regularly, but have crushing fatigue, while your friends or family might eat junk and sit around all day and feel completely fine?

    It’s called #FirstWorldProblems. People getting “AF” from launching podcasts and writing books need to step back and decide if the OMGSoMuchStress is worth it, or if they might be better off using their degrees and talents to help people in more personally rewarding fashion (e.g. in person one-on-one consultations, building tangible businesses) where they interact with humans for reasons other than marketing to them.

    Also, as to Paleo Rehab, I cannot get over the irony and hypocrisy of calling a program what it is, but still advocating paleo. Especially for women. Ancestralize me? Laura, I believe if you delved into the actual literature on ancestral diets, you’d realize why women fare so poorly on any version of “paleo” out there. I have a stack of PDFs here in my Mendeley I’d be happy to share. Learn why, for example, the Kikuyu women were healthier, more fertile, and lactated like badasses — even per Weston A. Price. Yikes! Legumes!!

    Your recommended macro ratios are exceedingly rare in the literature. In other words, there is zero basis for them as a starting point. Again, what is actually written, not what Kresser and Jaminet and other paleo types tell people it says. In almost every culture out there, the women ate more carbs and less fat and protein vs. the men as well. As an RD, don’t you feel any responsibility to ground your recommendations in the science and anthropological literature? In what you learned to get that degree?

    1. Could also be that they care less, thus, worry less, and don’t take things too seriously. They don’t sweat the small stuff and take things in stride. It’s the easy going attitude. Which is not to be confused with lazy.

      Those are the ones I notice that seem to get away with alot more and seem to be happier in general. (Although what never seems to amaze is how I see people in thier 40s, 50s, with more energy, who seem flat out happier, than some of the young. And how I see those who are overweight seem to have more energy than the thin)

      I was like that. Ate what I wanted within reason, had a laid back mindset, didn’t sweat the small stuff, decent build, had plenty of energy.

      Never thought of having plain energy as “adrenals” or “HPA axis” or even worried too much about things that make life worth living like coffee, ice cream, that occasional pizza, or occasionally staying up late, etc etc

      It was when I was hit with far too much over a period of time with practically unavoidable outside family stuff that tore me up. Now I surely know I have hormonal issues because it’s showing up physically. Slowly wore and tore on me, sapped me mentally, And then noticed I had narcoleptic like symptoms, (mentally unalert) with fuzzy brain, very little energy. So I could either let a doctor tell me I’m fine and that the fatigue isn’t real.

  5. ““…when they finally see their doctors about the symptoms, most docs don’t think to look at
    the person’s diet and lifestyle as a potential cause.””

    It’s really frustrating when Paleo advocates like to claim that ‘most’ docs don’t look at lifestyle as a potential cause. What evidence do you have for this? Is this simply from what your clients are telling you? While I agree there are docs that don’t dig deep enough (every profession has this though), the alternative health community seems to think this is the rule rather than the exception. I’m just curious if they can even support this claim. I know the individual who you quote in the beginning of this article is getting tired of hearing this.

    “Our audience is primarily people who have been on a Paleo diet, which tends to be very low

    While I agree to many individuals think Paleo is inherently low carb (it’s usually one of the big critiques of the diet which I think misses the pt.), I also think this is a convenient cover used by some in the Paleo community to really hide what I see is the bigger issue here and that is food restriction. While I realize some have moved to a Paleo ‘framework’ approach where the diet is less restrictive there still is an initial restrictive phase of this diet (30 days usually). While going low carb can be problematic for sure for someone, Paleo proponents seem to have a hard time admitting that the restrictive nature of the diet in general is the real problem. Even if it is only for 30 days, enough psychological damage can be created (or perpetuated if someone has an underlying eating disorder), in this short time frame.

    ““Our diet recommendations are a 20% protein, 30% carbohydrate, and 50% fat diet to
    start out with, and we help people identify their ideal calorie intake based on
    their height/weight/gender/activity l”vels””

    I’ve never counseled my clients to break their diets down into percentages like this. I’m not even aware of any evidence that shows this is the ideal breakdown. But the real issue I think is that this has the very real potential for clients to overthink eating and to truly suck the joy out of it. Counting calories and macro percentages? I think I know better now why so many in the Paleo community have adrenal fatigue. They are overthinking and overanalyzing this stuff and not seeing the big picture.

    “There are optional supplements based on the person’s test results. “

    So along with paying $200 for the program, an additional $100 + for recommended supplements and then the additional testing (I really don’t want to know how much that costs) how is this even cost effective for the avg. person? I have a hard time believing Paleo isn’t just some nutrition program for middle and upper class white people. I’m not being sarcastic here. I imagine most Paleo conferences are are about the least diverse nutritional conferences you can go to. Considering that obesity disproportionately affects the poor who are disproportionately non-white, Kresser is completely out in left field by claiming that paleo is ‘taking the world by storm.’ It’s taking the white, middle and upper class world by storm and leaving the rest to fend for themselves.

    1. Hi Brent,

      The “evidence” I have for the claim that most doctors don’t look at diet and lifestyle as a cause of a patient’s symptoms is the experience of my clients and fellow dietitians, stories from lifestyle-minded med students, and my experience going through 9 months of internships in conventional care facilities. While there are a lot of great doctors out there that take the whole patient into consideration, the med school training and appointment structure that the average doctor has been confined to does not allow for great lifestyle counseling even if the doctor has taken a special interest in lifestyle beyond the handful of hours they might have been taught in medical school. I have a friend who is going through his med school and residency training who is routinely appalled at the lack of knowledge most of his professors and superiors have about the role of diet and lifestyle in preventing and treating disease.

      Perhaps I’m biased because the bulk of clients coming to see an RD haven’t gotten adequate lifestyle education from their physician (after all they wouldn’t need an RD if they had), but just because there are many doctors who do take a holistic approach, doesn’t mean that the vast majority aren’t still primarily using pharmaceuticals to address lifestyle issues. Trust me, I know how Dr. S feels because I get enough flak from people saying that dietitians are just mindless women with eating disorders pushing the food pyramid.

      I’m curious what type of clients you work with, and what makes you believe that specific food restriction is universally dangerous? I agree that excessive restriction is dangerous and that’s why part of our program actually teaches students how to re-evaluate the foods they avoid and identify whether they have a solid reason to – e.g. they avoid gluten because they get major digestive distress from it, but they avoid legumes simply because its “not Paleo”. The name of the program being “Paleo Rehab” is actually indicating that we’re trying to move people away from an overly restrictive Paleo diet as much as possible. One of our meal plans includes dairy, legumes, and gluten-free grains.

      People in the Paleo community don’t “admit that the restrictive nature of the diet in general is the real problem” because many of them themselves have specific food sensitivities that were causing them severe health issues until they went Paleo. And many of my clients have had incredible results from going Paleo, including and especially remission of autoimmune disease. It sounds like you’re trying to throw the baby out with the bathwater simply because some of the loudest Paleo proponents often promote arbitrary restriction of whole foods like dairy, legumes, potatoes, and grains.

      “I’ve never counseled my clients to break their diets down into percentages like this.” – We use these macro percentages to get people moving towards a more macronutrient balanced diet, and then teach them to adjust up or down in carbs vs. fat as necessary. A 20% protein diet is pretty standard, and the 30% CHO vs 50% fat is a lower carb but not VLC approach that serves as a starting point for the person to adjust accordingly. Do you believe that there is evidence specifically supporting the 50% carbohydrate diet that we are taught in our dietetics program to promote? (Note: I’m not saying that 50% CHO is bad, I’m just saying that evidence for any macronutrient percentage as being optimal is usually based on epidemiological data and not rigorous long term RCTs.)

      The ultimate goal of teaching the calorie and macro needs is to make sure these students are getting enough food to meet their activity levels and getting a balanced macro diet, since many of them are eating too little carbs and sometimes even not enough protein at each meal. Once they’re used to the amount of food they need, we recommend that they move away from tracking and use more intuitive methods (which we also teach).

      As far as the cost is concerned, I’m not sure what to say to that, considering that the most anyone would spend on the program is $700-800 if they bought every single optional supplement and a cortisol test, and many of our students only buy the $197 program and skip the testing and supplements altogether (which we tell them is totally fine, BTW.) If they choose to spend their money that way, and receive significant health benefits in return, I don’t see why the cost is something to be scoffed at. People spend more money on cell phones.

      Your concern about Paleo being a “white, middle and upper class” problem is just as much of an oversimplified claim as mine was that “most docs don’t counsel on lifestyle” – it sounds like you have just as many biases as I do, which is fine (and human!) but you should acknowledge that you’re not coming at this from a completely unbiased perspective.

      Yes, most people who are interested in health and nutrition beyond just eating every day are middle class or wealthier – not just in the Paleo-sphere. I’ve worked with poor, underprivileged communities in a variety of settings, including WIC as well as a local food pantry that taught cooking classes to underserved community groups. Many of them had health issues that could be at least improved if not solved by eating healthier and exercising more but beyond just the educational barriers, the environmental barriers to doing this are appalling.

      Many of them don’t have access to fresh food (let alone grass fed, organic, etc.) and certainly can’t afford a gym membership, and many live in unsafe neighborhoods where walking outside is unappealing for good reasons. And even when presented with alternative options for food and exercise, many of these people don’t have the motivation to make these changes. As you know, they have bigger problems to worry about.

      So yes, health, nutrition, and fitness are an “upper class” concern (though I don’t think race should be included in that distinction), but unfortunately in lower socioeconomic tiers, most public health evidence shows that the only way to address these problems is to change the environment itself PLUS educate the population. And I would hope that as the upper/middle class becomes more aware of proper nutrition and lifestyle changes, the more these trends will trickle down to the rest of society.

      I would never say that I know the ultimate solution to the problem of poor health in underserved communities, and my experience working with those groups was depressing because I felt helpless. At least in my current line of work I can see that the efforts I’m putting in are affecting people’s lives.

      Do you honestly believe that the Paleo trend is negatively impacting the underserved communities’ health? Or are you just irritated that the Paleo movement seems to be leaving out those who can’t afford to eat grass fed beef and organic broccoli and go to a gym? Do you have a proposed solution for the problem, considering that scientists haven’t even truly pinned down the most treatable underlying causes of obesity?

  6. Thank you for this. When people say it’s not real, those of us suffering feel even worse.

    What do you recommend for the afternoon “crash”? Mine starts around 2pm and last until 6ish. This even happens when I have a h carb at lunch.

  7. Laura,
    Tell me what you think of this….
    There’s a concept in neurology called the central integrative state, which basically states that the net output of a neurological structure is a summation of the excitatory inputs versus the inhibitory inputs. In other words, if a combination of stimulus from neurotransmitters, hormones, and cytokines all result in an excitatory state, the result will be an elevation of cortisol. And inside the H of the HPA axis, the hypothalamus, there resides the PVN, the paraventricular nucleus where all those stimulus meet.
    So, all these inputs from: Cytokines from the immune system, neurotransmitters from the nervous system, input from the limbic system (emotions), and hormones from the endocrine system… They are received inside the PVN and that’s how your HPA axis knows what to tell the adrenal glands to do.. Either suppress cortisol or increase output. So really, the adrenals don’t get “fatigued” but are being suppressed by inhibition type inputs into the hypothalamus. So, if this line of thinking by neuroendocrineimmunogy field leaders is right, simply increasing sleep and carbs can help but it’s only part of the solution.. Carb timing might be more important, to eat considering the cortisol curve… perhaps eating low carb in the am (when cortisol is already the highest) to help keep blood sugar stable, then a slightly higher carb lunch and an even higher carb supper would help. But that’s just one part.. Addressing how a person deals with stress is big (to impact the limbic system inputs) and addressing cytokines from the immune system which is a very technical thing really. What toxins,heavy metals, sugars or other inflammatory foods can influence your immune system and what cytokines it’s inputting into the PVN. Of course some supplements can actually shift the overactive side of the immune system (th1 or th2) that is over-reacting. that needs to be in conjunction with detoxing toxins/metals and eating an anti-inflammatory diet. I apologize if your course is doing exactly all this but I do think that all these things need to be considered. On another note.. The way you broke down the macros.. Some people (depending on body type: mesomorph, endomorph) might do better with fewer carbs 25% and higher protein 30-35%) and definitely people need to eat more carbs when they are doing crossfit like exercising 2-5 times per week. Especially after each workout.

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  9. Doesn’t really matter to me what it is called, it is a very really set of symptoms and a few more. Conventional medicine totally ignores any of it as they usually do with anything they know nothing about. I believe just about any disease is going to have a HPA disregulation attached to it. Cortisol is a major player, how could it ever be left out of the equation. The biggest and best thing I have done for my adrenal fatigue (oops there’s that bad word again) is getting all forms of caffeine out of my diet, I believe caffeine and other stessors over a lifetime created this problem, damage done!! I still have a whole host of symptoms and add going through menopause to the mix. I have to wonder about people who have adrenal fatigue, how they can do any sort of exercise, extreme or not, I find it very hard some days to just walk across the room. I do believe there is such a thing as being born with low function, we are not all the same and we all have different stressors that trigger adrenal fatigue, it’s certainly not always about being on paleo and over exercising. Look at your parents and see what they are made of, then look at your whole life from the time you were born, we are all products of our environments, this just didn’t happen overnight, and it won’t go away overnight. All that being said don’t let anyone disregard how you feel, it is real……..

  10. People should do some research to find out what method works for them, it can vary allot. For me what worked was meditation, it may not work for you but thats what did for me.I have a super active mind which would sometimes distract me while I’m painting. Meditation has helped me to be present and focus while I paint. It’s an amazing feeling to let your ego go while you paint and just flow through each movement.