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Q: What is the difference between chronic fatigue and adrenal fatigue?
And is there a hormone test for DHEA and cortisol that will determine the difference? So would your levels determine adrenal fatigue vs chronic fatigue and where does burn-out come in? Would you say that it occurs more after ongoing untreated chronic fatigue, or also after untreated adrenal fatigue? And I've read recently that you can reach stage 4 adrenal fatigue. Do you agree? What happens after stage 4? L.B.
A: IAN CRAIG REPLIES: Adrenal fatigue and chronic fatigue syndrome (CFS) are two quite separate distinctions within functional medicine. Adrenal fatigue talks very specifically about the adrenal glands, these tiny little glands that sit on the kidneys, but which have an enormous role in our modern society. Adrenal hormones wake us in the morning, get us to work or drop off the kids, assist us through meetings or daily chores, and help us get through our training sessions. The pituitary gland in our head drives output of stress hormones from the adrenal glands and it is this daily occurrence that can gradually depletes these glands of their normal function.
It is when the adrenal glands secrete lower than normal levels of cortisol and DHEA that a person presents with adrenal fatigue. Very flat-line levels of these hormones may lead to a diagnosis of adrenal exhaustion. CFS, on the other hand, is an altogether more complex scenario of imbalanced health. In most cases, adrenal fatigue lies at the heart of the syndrome, but there are many other factors that contribute to CFS. For example, mitochondria produce energy for our cells, so if they under-function, it will mean lower systemic energy levels to the individual.
There are several reasons why our mitochondria may under-function, including: low levels of nutrients including magnesium, Co-Q10, B-vitamins, and iron; additionally, the mitochondrial membranes may be blocked by toxins such as plastics and heavy, or toxic, metals. Like adrenal fatigue, CFS is affected by what I call the three Ps of stress: physical, physiological and psychological. In CFS patients, you may find adrenal fatigue, hypo-thyroidism, and hypothalamus-pituitary under-functioning.
These individuals may be incredibly sensitive to stress, which, over time, results in a scenario of whole body fatigue. Whereas adrenal fatigue may be resolved by rest and active restoration practices, CFS sufferers may require a myriad of therapies, including, nutritional, psychological, emotional, environmental and musculoskeletal (body work). A complex answer to a complex question. In a nutshell, CFS is not a condition that can be neatly diagnosed by a certain set of symptoms — it requires an extreme amount of motivation and hard work from the individual, combined with the input from some particularly skilled practitioners.
In terms of burnout, it is really irrelevant whether we are talking about adrenal fatigue or chronic fatigue. Burnout is a fairly loose term used to simply show that the person is finished energy-wise. This would certainly be the case when adrenal fatigue shifts into exhaustion state, but it could also be used to describe somebody suffering with CFS although if that person was to then obtain a ‘diagnosis’ of CFS, that description would displace that of burnout.
Stage 4 adrenal fatigue is complete exhaustion of the adrenal glands. This is normally the point at which the person will completely rest and take treatment support and gradually reverse through the stages. However, there is a worse clinical picture than stage 4 adrenal fatigue: As noted, CFS is a much more complex clinical picture and a sufferer might have stage 4 adrenal fatigue and other metabolic and hormonal depletions which is a far more difficult case to treat.
IAN CRAIG is an exercise scientist, nutritional therapist and neuro-linguistic programming practitioner. He initially qualified as an exercise physiologist (MSc) and strength and conditioning specialist (CSCS), applying this knowledge to his own middle-distance running career and the care of his personal training clients. Ian’s current focus on nutritional therapy (BSc) includes weight management, digestive health, blood sugar regulation, stress, fatigue and sporting performance. He runs nutrition and exercise clinics in Cape Town and regular workshops on stress, corporate wellness and sports nutrition, is a columnist for SA Squash, Go Multi and Bolander, and writes and presents internationally on the new concept of functional sports nutrition.
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