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Health: Slow down... Are you heading for burnout?; Chronic tiredness, low sex drive, insomnia, constant irritability... If these symptoms sound familiar, you could be suffering from adrenal exhaustion or burnout, according to the natural health lobby. But doctors say this condition doesn't exist. So who's right?

Byline: Michele Kirsch

There's no doubt about it, we're all cream-crackered. According to a health survey of 22,000 people in Britain, 76% considered themselves tired all the time. And to combat that fatigue, we are getting through a billion cups of tea, almost half a billion cups of coffee and caffeinated drinks, six million kilograms of sugar and two million kilos of chocolate a week. All those stimulants - as naturopaths and other practitioners of complementary medicine will tell you - place stress on the adrenals, a pair of tiny glands that sit just over the kidneys.

The adrenal glands produce the hormones adrenalin and cortisol, which help the body cope with short-term and long-term stress, respectively. Abuse the adrenals, the theory goes, and your body copes with stress less efficiently, being either unable to produce the stress hormones in sufficient amounts or unable to utilise the hormones it can produce. This makes you feel tired all the time and generally unwell.

This is called adrenal exhaustion or burnout, a phrase that pops up all over American health websites, and a condition that is often diagnosed here by complementary practitioners. But is adrenal exhaustion a real condition that can be measured and treated or just `tired' rebranded? We asked the experts.

Does adrenal exhaustion exist?

Dr Wendy Denning, a GP who practises integrated medicine (using both conventional and complementary techniques), says, `Yes, definitely. We use a saliva test which identifies abnormalities in the excretion of the hormones cortisol and DHEA, another anti-stress hormone produced in the adrenals. Most traditional doctors don't believe in saliva testing because they have not been trained in it and there is controversy as to what the normal levels should be.' Dr Mike Dixon, also a GP with an integrated approach, says, `About 10% of the population feels tired all the time. But I would ask what the added benefit of calling it adrenal exhaustion is? I am sure that people who are constantly tired have some sort of physiological marker which we have not found yet.' Professor Mike Besser, an endocrinologist (a glands and hormones specialist) at The London Clinic, says, `There is adrenal insufficiency which definitely exists. That is Addison's Disease. I would ask what evidence there is for adrenal exhaustion - the adrenal glands do not wear out from overuse.'

What's the difference between Addison's Disease and adrenal exhaustion?

Addison's Disease occurs when the adrenal glands don't produce enough hormones called corticosteroids because of damage to the glands through either a tumour, an infection like TB or an autoimmune reaction. Symptoms include weakness, tiredness and dizziness when standing up after lying down, darkening of skin, weight loss, muscle aches, nausea, vomiting and diarrhoea. It is diagnosed from a blood test and treated with corticosteroids.

Adrenal exhaustion, in contrast, is not a disease. `It's a disturbance in the body's normal physiology,' says Dr Andrew Wright, an integrated doctor with a special interest in chronic fatigue. It is a condition of burnout which happens after a three phase cycle, consisting of alarm, adaptation and exhaustion, which tracks the release of the stress hormones adrenalin, cortisol and DHEA.

Nutritionist Patrick Holford says, `When we become stuck in the stress response or it becomes chronic, we can't produce the necessary cortisol to respond to stress. DHEA maintains energy and resistance to stress, but in the exhaustion phase, the DHEA levels fall and energy levels plummet.' The symptoms include slowed down metabolism (which can lead to unexplained weight gain), suppressed immune system - so you catch everything going - recurrent headaches, dizziness, insomnia, fatigue, irritability, depression, impaired memory and loss of libido.

So, it's a bit like depression or ME then?

This is where it gets confusing. Adrenal exhaustion often coexists with, or precedes, other conditions. Depression is a common cause of fatigue and other physical symptoms of adrenal exhaustion. Dr Dixon explains, `We have research that shows when people go to their GPs with tiredness, only a third will say they are depressed, but two thirds of doctors will say that the problem is depression.'

It's a matter of point of view. People with thyroid problems can have adrenal problems as well, and adrenal burnout can contribute to ME (see our case study, right) but that does not mean it always leads to ME. Dr Wright says, `People with ME can have high levels of stress hormones, low levels or normal levels. It varies from person to person.' Dr Denning says, `The difference between chronic fatigue and adrenal exhaustion is that the latter is relatively easy to turn around in about six weeks, by doing the right things. With chronic fatigue you are lucky if you can turn it around in a year. The underlying causes of the two are different.'

I've got most of the symptoms of adrenal burnout. What do I have to do to feel better?

You're not going to like this first bit. Both Dr Denning and Patrick Holford say you've got to give up all stimulants. That means no tea, coffee, energy drinks, sugar and chocolate. As for cigarettes, don't even go there. It's a given that you should not smoke. Also, you'll feel worse before you feel better - this is withdrawal, and it's a good sign, honest!

You can minimise withdrawal symptoms by keeping blood sugar levels stable. Dr Denning recommends a high-protein diet. Holford says you should eat little and often, never miss breakfast, avoid refined, sugary and convenience foods, and take a high-strength multivitamin, a gram of Vitamin C and 200 micrograms of chromium daily. He also suggests trying ginseng, Siberian ginseng or Reishi mushrooms. These are all adaptogenic herbs which means they do what the body needs them to do, so if cortisol levels are too high, they'll bring them down, and vice versa.

Dr Denning suggests building a relaxation method like yoga or meditation into your day. In severe cases, she might also prescribe DHEA (available on prescription only).

Where can I find out more?

l Natural Highs by Patrick Holford (pounds 14.99, Piatkus) l Tired of Being Tired by Jesse Lynn Hanley and Nancy De Ville (pounds 9.99, Michael Joseph), out in January l Endless Energy by Fiona Agombar (pounds 6.99, Piatkus), also out in January l For an Adrenocortex saliva stress home-testing kit (about pounds 85), call Health Interlink (01664-810011). l For the latest research on natural stimulants and where to buy them see

Fiona Agombar, 43, author and yoga teacher, says that adrenal exhaustion affected her immune system, which eventually led to her developing ME.

`In my early thirties I was working very, very hard, including weekends. I relied on coffee and chocolate to prop me up, and I would come home at night and drink a bottle of wine to wind down.

`I was always stressed and started to suffer from insomnia and panic attacks.

Then I got an illness which I thought was flu and was forced to take three days off work. After that, I was so tired I couldn't even hold a conversation. I was also getting severe headaches. The doctor did a blood test and she found out that I had glandular fever.

`I couldn't seem to recover from it and after about nine months I was diagnosed with ME. I don't think the adrenal burnout caused the ME, but it was a contributing factor. I had to stop working because I was so ill and I was hospitalised for three months.

`About five years ago I had an adrenal stress saliva test and it found that my adrenalin and cortisol were highest at midnight and lowest at midday. It should be the other way around. They also found that my blood sugar levels were too low. When I started to eat more healthily and include more protein in my diet it helped considerably. The last test showed that my cortisol levels were low so I am on a very low dose of cortisol and DHEA - I feel well if I pace myself. Now I write part-time, teach yoga and am also a trustee for Action for ME.'
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Copyright 2001 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Features
Publication:The Mirror (London, England)
Date:Nov 10, 2001
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