A question that I often get asked on my instagram account and other social media platforms is:
Are Adrenal Fatigue, Burnout and Chronic Fatigue Syndrome the same thing?
To answer this question I would like to unpack each of these three separately, but if you would like the short answer, it goes as follows:
Burnout out and / or adrenal dysfunction may be part of the picture of Chronic Fatigue Syndrome but I would not consider them to be the same thing.
The long answer starts by understanding each of these individually…
Chronic Fatigue Syndrome
The National Institute of Health and Care Excellence (NICE) guidelines for Chronic Fatigue Syndrome (CFS) define CFS as fatigue or tiredness that…
- started recently, has lasted a long time (usually several month) or keeps coming back
- means you cannot do the things you used to do
- gets worse after activity or gentle exercise, such as a short walk (Post Exertional Malaise)
You must also have some of these symptoms:
- problems sleeping, such as insomnia
- muscle or joint pain
- headaches
- a sore throat or sore glands that are not swollen
- problems thinking, remembering or concentrating
- flu-like symptoms
- feeling dizzy or sick
- fast or irregular heartbeats (heart palpitations)
- doing exercise or concentrating makes your symptoms worse
Although not an official symptom of CFS, also have clients who experience:
- Sensitivity to light, sound, chemicals and smells
- Foggy brain or feeling hungover
- Neurological symptoms like numbness and tingling
- Anxiety and depression
- Hypervigilance and difficulty calming down
- Poor temperature regulation (too hot or too cold)
- Feeling unrefreshed even after a good nights sleep
Those of us who have been diagnosed with CFS or experience these symptoms will know that a CFS diagnosis is a clinical diagnosis which means there is no specific test for CFS but rather the diagnosis is used when there is no other attributable cause for fatigue.
However, this is based on the traditional medical model which is looking for disease rather than imbalance. When I consider the clinical picture of my clients in my practise they may be experiencing any combination of the following:
- Chronic stress
- Nervous System Dysregulation where the nervous system is stuck “on” in fight or flight or stuck “off” in freeze or shut down
- Mold mycotoxins
- Digestive imbalances such as dysbiosis, bacteria or parasite infections
- Nutrient deficiencies
- Sub-optimal red blood cell health (important for transporting oxygen required for energy)
- Blood sugar imbalances
- Histamine Intolerance / Mast Cell Activation Syndrome (MCAS)
- Hormone imbalances, including adrenal hormone output which can be high or low
- And many others…
All of which collectively and individually could be responsible for symptoms of fatigue. The role I play as practitioner is to help my clients investigate and address these imbalances using a combination of taking a comprehensive health history, reviewing blood work through a narrower set of reference ranges known as “Functional Reference Ranges”, recommending Functional Tests and recommending diet and lifestyle changes and complimentary supplements while tracking progress or lack thereof.
Each client will have their own unique combination of imbalances but generally speaking these are the main causes of fatigue that we’ll want to prioritise:
- Infections (Bacteria, Virus, Yeast and / or Parasites
- Toxic Load (Heavy Metals, Mycotoxins, Environmental Toxins)
- Chronic Stress and Trauma
You’ll notice here that I did not mention the adrenal glands although in some cases, there may be adrenal dysfunction BUT this may be a secondary imbalance as a result of the factors listed above.
Adrenal Fatigue
You may have heard the term “Adrenal Fatigue” and you might be wondering if this is something that might be contributing to your low energy, brain fog, burnout or chronic fatigue syndrome (CFS).
Let’s begin by understanding that “Adrenal Fatigue” is not a medically accepted term and therefore, the concept doesn’t actually exist. The more preferred term is “Adrenal Dysfunction” which I also feel can be misleading.
The term Adrenal Dysfunction implies that the adrenal glands are not functioning optimally when I would be tempted to argue that the adrenal glands are actually responding appropriately to the level of stimulation the nervous system may be experiencing.
Let’s break this down further…
The adrenal glands are small glands that sit on top of the kidneys. They are responsible for releasing the stress hormones like cortisol, adrenalin and noradrenalin, hormones that regulate blood pressure and electrolytes, such as aldosterone as well as DHEA and small amounts of sex hormones like oestrogen and progesterone.
Cortisol and DHEA are the main hormones that I want to focus on as it is often low levels of these hormones that are blamed for “adrenal fatigue”.
A healthy person has a daily rhythm of these hormones. Cortisol specifically should peak within 30 minutes of waking – this is our get up and go to start the day when we should feel energised and ready to go. It gradually declines across the day so that it is low at night when we want to sleep.
If we experience a lot of stress in the day, cortisol and DHEA will be higher than normal and this can continue for weeks or even months. This is what is often referred to as the Alarm Stage of adrenal dysfunction. But really, it is not dysfunctional at all, it is an appropriate response to stress, the body however, is just being exposed to ongoing threat for too long.
This means that to cope with the extended threat the body must compensate. What begins to happen is cortisol resistance. This means that the cells of the body become less sensitive to cortisol so the body needs to produce more cortisol to have the same effect. At the same time, DHEA is declining. This can cause the tired but wired feeling, difficulty sleeping, energy crashes throughout the day, carbohydrate cravings and weight gain.
If the threat or stress still remains, eventually the body reaches what is known as the exhaustion stage which is what is often referred to as “Adrenal Fatigue”. This stage is characterised by ongoing fatigue, an excessive need to rest, low mood and excessive exercise tolerance.
The term adrenal fatigue suggests that the adrenal glands cannot produce any cortisol. If this was the case, you would likely have an autoimmune condition known as Addison’s disease.
What is more likely happening in this scenario is that the brain is applying the breaks on the body. When stress has been continuing for too long and the body needs to enforce rest, it may decrease signalling from the brain to the adrenal glands to reduce cortisol production. This is an intelligent and self protective attempt to help the body find balance.
In clinical practise I see a variety of adrenal tests from different clients all diagnosed with CFS. The adrenal output of these clients varies from what would be referred to as “Alarm” to “Resistance” to “Fatigue or Exhaustion” and yet all these clients have CFS.
Therefore, changes in adrenal function may be an adaptation of the body as it aims to cope with the burden of stress on the body, yet how this looks for each person, may be different.
Burnout
Burnout is the final piece of the puzzle. Burnout is a syndrome of emotional, physical and mental exhaustion. This happens when the body has been operating from a place of survival (fight or flight) for too long and the “vagal brake” (which helps to regulate the system), loses its tone.
We can use the analogy of riding a bicycle downhill. If you’ve ever ridden a bicycle you will probably have the experience of keeping slight pressure on the brakes when riding down a steep hill. Failure to do so likely results in going too fast, a speed wobble and potential crash.
When the vagus nerve – the critical nerve that supplies information to the parasympathetic nervous system responsible for “rest and digest” – loses its tone, the sympathetic nervous system can operate out of balance. The sympathetic nervous system essentially is the bicycle having the speed wobble down the steep hill.
When someone has poor vagal tone, this means that even small things that normally wouldn’t feel too stressful, can feel very stressful. The body uses a huge amount of energy to deal with day to day stressors. This can leave the body exhausted as it burns through huge amounts of energy to do mundane things. When the nervous system feels particularly overwhelmed it can enter a freeze state, which is a parasympathetic state, and this results in shut down and exhaustion. There could also be a reduced cortisol output as the body compensates for the “faulty brakes” – but not always.
When the sympathetic nervous system is more active there can be an increased cortisol response but this doesn’t always mean that a freeze state is associated with a low cortisol response or “adrenal fatigue”.
The body enters freeze when the level of stimulation to the nervous system is overwhelming. This means the body travels through flight or flight into freeze.
The analogy that I find helpful here is to think of the sympathetic nervous system like a rocket ship taking off with huge amounts of energy. The freeze state is a parachute, trying to contain the rocket ship and pull it back down to earth. It takes tremendous energy to contain the energy of the rocket ship and therefore, underneath freeze, there is a large amount of activation. This may or may not result in an increase in cortisol.
Finally, it is normal to move through different states of activation as we experience different levels of stimulation or stress throughout the day. Nervous systems can move from regulation, into fight or flight into freeze and back again moment to moment. Getting stuck in a particular state is more likely to be responsible for ongoing imbalances and yet, we all have a certain degree of flexibility in our systems even when they are more dysregulated. It is the loss of vagal tone that reduces our flexibility and therefore this is what we want to address and recover and in doing so, widen the window of tolerance we have for stress. This ultimately means we can maintain an optimal level of arousal in day to day life without experiencing hypo- or hyper-arousal.
When I work somatically with CFS clients, the loss of vagal tone is evident but week after week there is evidence of improvement and yet these clients may have normal, heightened or reduced cortisol levels and be at different stages of “adrenal dysfunction”.
Conclusion
From the discussion above my conclusion and approach in practice is to consider each client’s nervous system and biochemistry as unique to their case.
I have found cortisol saliva tests for adrenal function less and less useful clinically and I find my somatic training to track the nervous system states of my clients much more insightful – which is why I created the Nurturing Resilience Group Program.
Additionally, when we work around supporting the main threats to the body that could be placing stress on the system, my clients experience the greatest increases in wellbeing, irrespective of what their saliva tests may say.
What next?
Whether you consider yourself to have Chronic Fatigue Syndrome, Adrenal Fatigue or Burnout, help is just around the corner.
I know first hand how low energy can impact every aspect of your life. If you are looking to recover your lost energy, health and aliveness, I would love to support you.
You can find out more about how you can work with me here.
