The term “Adrenal Fatigue” is commonly used when describing feelings of burn-out and includes a broad range of symptoms:

  • Fatigue
  • Stress
  • Poor sleep
  • Low libido
  • Poor exercise tolerance and recovery
  • Weak immune function
  • Brain fog

Now, this may come as a shock to you but there’s really no scientific evidence to support the idea that your adrenals are just sleep-a-Saurus-rexes.  If they were “fatigued” you would have low cortisol and most people don’t have low cortisol.

In fact, many individuals who have low free cortisol levels actually have high total cortisol when tested via the DUTCH test (dried urine test that’s the current gold standard and most accurate available for cortisol and hormone testing).  

This pattern of low free and high total cortisol is common in those who are overweight or have insulin or leptin resistance. If your doc is just doing a saliva test for ‘free’ cortisol, the high cortisol would be missed all together. 

Plus blood and saliva cortisol testing is unreliable for multiple reasons so unless you’re getting a DUTCH test, then I wouldn’t put too much faith in results

Contrary to the idea of adrenal fatigue which proposes the adrenals aren’t producing enough cortisol… high cortisol, cortisol resistance, and disrupted diurnal rhythms (cortisol being low or high at the wrong times) are more common than low cortisol. 

Even in the instances where cortisol levels are low, it’s rarely due to tired adrenals. 

The regulation of cortisol is primarily controlled by the brain, central nervous system (hypothalamus, pituitary, etc.), and local tissues (NOT the adrenals), which are all interconnected through the HPA axis.



The HPA axis, or hypothalamic-pituitary-adrenal axis, is a complex system in the body that regulates our response to stress. 

When we’re faced with a stressful situation, the hypothalamus in our brain sends a signal to the pituitary gland, which then releases hormones that stimulate the adrenal glands to produce cortisol and other stress hormones. 

Cortisol helps us to deal with stress by increasing our heart rate, blood pressure, and blood sugar levels, among other things. However, if the HPA axis becomes dysregulated, it can lead to a range of problems, including fatigue, anxiety, depression, and other issues. 

So, while it might not be as fun to say as “adrenal fatigue”, HPA dysregulation is a more accurate and helpful description as of what’s at play in your stressed-out, wired-but-tired body.

Now I’m not saying that this pattern of symptoms associated with Adrenal Fatigue doesn’t occur…

But for better accuracy and description of what’s really happening within the body, I propose we use a different and more accurate name. 



Now it may seem like I’m just being a nit-picky nerd that’s getting her suspenders in a twist about semantics BUT…

By using a term that aligns with scientific research, it allows us to use data from tests like the DUTCH as evidence to make a concise diagnosis and treatment plan. 

An accurate name helps both practitioners and patients to have a better understanding of the condition, leading to more effective treatment plans and outcomes. 

When we understand the mechanisms behind what’s happening at a physiological level aka Osmosis Jones style, we can better treat the issue at hand.  Adrenal fatigue doesn’t describe what’s actually at play and can cause us to use the wrong treatment and make things worse.

For instance, treating someone as if they have low cortisol (ala the Adrenal Fatigue model) with a cortisol-increasing drug or herb, when in reality they have normal or high cortisol, could worsen their symptoms.

The body is like a Rube-Goldberg mechanism, each part needs to be dialed in and functioning appropriately in order for the others further down the chain-of-command to work. Acknowledging that the system is more complex than just lazy adrenals makes it clear that a successful treatment plan will usually require more than simply consuming adaptogens like ashwagandha or ginseng, to boost adrenal function.

This explains why the symptoms of HPA-D are so diverse and its effects can be so devastating. It’s also why there isn’t a simple pill or trick to fixing the burn-out.



HPA-D (HPA axis dysregulation) is a consequence of our modern lifestyle, where there is a mismatch between our bodies and environment. Our sleep patterns are disrupted by artificial and blue lights, and we spend most of our day sitting at desks or on the commute, exposing ourselves to chronic stressors instead of the occasional acute stressors that our ancestors faced. Additionally, many of us have gut infections and nutrient deficiencies due to processed foods and poor water quality.

To rectify HPA-D, it’s necessary to identify the root cause, as there is rarely just one single factor. 

It requires a holistic approach that involves examining daily habits and making changes to support stress management, sleep, and healthy blood sugar levels. 

Simply supplementing or following a specific diet may provide some relief, but it’s not enough to address the underlying issues.

Wanna learn more?

Check out this blog post How Your ‘Healthy’ Habits are Causing ‘Adrenal Fatigue’ for more info on what else might be contributing to your symptoms of HPA-D.

Or for more personalized help, book a Functional Medicine Initial Consult. They’re virtual so we can work together no matter where you are.