It’s Q&A time! You can ask your own question here for a chance to have it answered in an upcoming edition.
Today’s question has two parts. The first part is available to all subscribers (about so-called adrenal fatigue in general), and the second part is for paid subscribers (about the “adrenal body type”).
I know you’ve spoken to guests about adrenal fatigue before, but I didn’t see this question addressed anywhere, so apologies if it’s a repeat. A chiropractor mentioned to me in session that my (fat and disabled) body feels like “years of cortisol is stored up.” While I think it was a well-intended comment, I looked up this phrase and was immediately hit with a lot of diet-culture-steeped stuff about an “adrenal body type.” Is this just diet/wellness-culture BS, or is there any legitimacy to this label?
Thank you for the wealth of information and resources you share! My therapist pointed me to your original podcast, and I have been grateful ever since.
Just a reminder that these answers are for educational and informational purposes only, aren’t a substitute for medical or mental-health advice, and don’t constitute a provider-patient relationship.
I did a deep dive into the concept of adrenal fatigue in my second book, The Wellness Trap, which I’d recommend checking out for the full story (including interviews with people who’ve received this dubious diagnosis). I’ll share a bit of that info here for context, and then I’ll answer your specific question about the so-called “adrenal body type.”
First, let’s talk about adrenal fatigue in general. The TL;DR is that adrenal fatigue isn’t a real condition, but the signs and symptoms misattributed to it are real, and they can be explained by other causes—in some cases including the normal functioning of the human body.
The term “adrenal fatigue” was coined in 1998 by a naturopath and chiropractor named James Wilson, who subsequently wrote a 2001 book outlining the supposed diagnosis and his method of treatment. The adrenal glands are small, triangle‐shaped organs that sit on top of each kidney and produce hormones that help regulate the body’s metabolism, immune system, blood pressure, stress response, and more. Wilson’s theory, which is unsupported by scientific evidence, is that the adrenal glands get overworked by excessive stress and stop making enough of the hormones our bodies need, particularly cortisol.
Excessive stress is certainly a problem, and it’s associated with many different health issues—but it doesn’t make your adrenal glands tired. “Stress can have an impact on our health, but it doesn’t affect your adrenals this way,” said Anat Ben‐Shlomo, an endocrinologist at the Cedars‐Sinai Adrenal Program, in a 2018 interview. “When you’re stressed, the adrenal glands actually produce more of the cortisol and other hormones you need. They will give you all that’s necessary.”1
A 2016 review of the scientific literature, published in a reputable journal of endocrine disorders, had a title that was notably frank for a scientific study: “Adrenal Fatigue Does Not Exist: A Systematic Review.” It looked at the results of 58 studies with more than 12,000 total participants spanning two decades and found that none of the studies supported the concept of adrenal fatigue; none of them even used appropriate methods to test whether there was any correlation between participant‐reported fatigue and adrenal function. The Endocrine Society, a group of physicians and researchers specializing in hormone health, wrote in 2022: “No scientific proof exists to support adrenal fatigue as a true medical condition. […] Doctors urge you not to waste precious time accepting an unproven diagnosis such as adrenal fatigue if you feel tired, weak, or depressed.”
Even Wilson seems to acknowledge that there’s no real scientific evidence behind the adrenal-fatigue label. As the official version of his questionnaire cautions, “No formal reliability or validity tests have been completed to confirm its accuracy, and the author assumes no responsibility for its use or accuracy.”
Unfortunately, many alternative‐, integrative-, and functional-medicine practitioners still use this questionnaire (or some variation on it) to “diagnose” adrenal fatigue.
The survey has dozens of questions related to symptoms that could easily be explained by genuine medical or mental-health conditions, like digestive disorders, allergies, anxiety, and more (all of which I have). It even treats the existence of real diseases as evidence of supposed adrenal fatigue: Checking “I have low blood pressure,” “I have rheumatoid arthritis,” or “I suffer from asthma” counts toward the points needed to make a “diagnosis” of adrenal fatigue (26 points for men and 32 for women).
Worse, many questions just describe normal experiences of living in a human body: “I tend to shake or am nervous when under pressure,” “I get low energy, moody or foggy if I do not eat regularly,” “I get colds and/or other respiratory illness […] two or more times per year,” “I get pain in the muscles on the sides of my neck,” “I feel worse if I miss or skip a meal.” (It’s striking how many of these questions imply that people should be able to go long periods of time without food.)
Between the benign complaints and the genuine symptoms of my chronic conditions, I racked up 91 points on the questionnaire.
The idea that there’s one underlying cause for a vast number of common symptoms (or just normal human characteristics) is a common framing in wellness culture, and it can easily lead us astray. Of course it would be amazing if we could explain everything that’s ailing us with one diagnosis and treat it in one fell swoop. That’s unfortunately not how these things work in most cases, but it’s understandable to wish it were—especially when we’re struggling to get a proper diagnosis and treatment. Adrenal fatigue and many other dubious diagnoses are built on that wish, which can easily give rise to the belief that all of our aches and pains have the same “root cause.”
That goes for emotional pains, too—including the body-image distress that often accompanies not meeting our culture’s impossible beauty standards. And this is where the so-called adrenal body type comes in. The notion of an adrenal body type harnesses our culture’s pre-existing anti-fat bias and ageism to sell the dubious diagnosis of adrenal fatigue and its unproven cures.
