Ari Whitten and Josh Trent discuss whether "adrenal fatigue" is a real or useful clinical concept. Ari argues that while HPA-axis dysfunction and dysregulated cortisol do occur, the specific notion of adrenal fatigue as chronic stress causing chronically low cortisol is not supported by the evidence. He cites systematic reviews (e.g., on overtraining) and multiple stressor domains (psychological, metabolic, toxins) showing no reliable link to low cortisol, and highlights circadian/sleep dysregulation—particularly evening chronotype (night owls)—as a common, non-pathological cause of altered cortisol rhythms. Ari also critiques the applicability of Selye's General Adaptation Syndrome (alarm–resistance–exhaustion) to humans, noting animal torture models produce different and less generalizable hormonal effects, and references Robert Sapolsky's critiques.
Chapters
Is it possible to have HPA axis abnormalities or low cortisol or low morning cortisol or dysregulated cortisol? Absolutely. That is a real thing. But it is fundamentally wrong to claim that adrenal fatigue is the cause or the primary cause or even a common cause of fatigue. It's also fundamentally wrong to claim that adrenal fatigue, the chronic stress leading to low, low cortisol levels, is a real thing. That is also incorrect. And the reason I say that is because one of the other layers of analysis that I did is I looked at all of the studies on various kinds of stressors. So psychological stress, different kinds of psychological stress, chronic stress from being overtaxed with work and working a job you hate. Chronic stress from the opposite unemployment, chronic stress from relationship stress, chronic stress from financial stress, metabolic stressors like chronic cigarette smoking or alcohol consumption, chronic over exercise, over training syndrome. There are studies on all of those in relationship to cortisol levels. Is there any indication from any of that research that any of those stressors are reliably linked with low cortisol levels? The answer is no. You can be exposed to those stressors for years or decades and never get low cortisol levels. There's no predictable relationship whatsoever. So, for example, just on overtraining syndrome, there was a 2017 systematic review that looked at cortisol levels in relationship to overtraining from exercise. Four of the six studies found zero relationship between cortisol and overtraining syndrome versus healthy athletes without overtraining syndrome. And then of the other two, one found slightly higher, one found slightly lower. There's no pattern here. So basically, but again, HPA axis dysfunction is a real thing, and it is possible to have dysregulated cortisol. Let me give you an example of one of the most common causes of it. Extremely common cause of it that almost without exception, people who believe in adrenal fatigue are entirely unaware of, and that is being a night owl chronotype. So just the one factor of going to bed late at night, you go to bed at midnight or 1 or 2am instead of 10pm?
Yes.
That one factor alone will dramatically alter cortisol levels. And there's numerous studies on this. And by the way, I'm talking about healthy people, people without fatigue or without symptoms. I'm talking about if you take a group of healthy people who are either morning people or night owls and you look at their cortisol levels and you chart it, those night owls on average will have cortisol levels that would get them diagnosed by someone who believes in adrenal fatigue as having adrenal fatigue. Okay. They would say, you know, adrenal fatigue. Practitioner would say, oh my gosh, you know, your cortisol levels are tanked. Clearly you've had chronic stress that has been taxing your adrenal glands and now you have adrenal fatigue, when in fact that's not at all what's going on. It's just a function of being a night owl chronotype. So that's one factor. But circadian rhythm and sleep dysregulation across the board is the single most common reason for HPA axis dysfunction. And there are a few other reasons. There are prescription drugs that can affect it. There are psychological factors that can affect it. There are toxins that can interfere with enzymes that are involved in cortisol synthesis, oxidative stress, chronic exposure to mycotoxins and inflammatory cytokines. Being at a high level can contribute to cortisol abnormalities. There's a variety of other things, but there is no case to be made for adrenal fatigue being a real thing. And there's certainly no case for it to be made that it's a primary cause or common cause of fatigue.
I'm curious though, because when we look at the gas model, the Hans Selye, where it's like, you have the alarm, you have the resistance, you have the exhaustion. I talk about this in the Breathe, Breath and Wellness program because in my research, when I started to really understand the vagus nerve and the ANS and how it innervates into the enteric nervous system and what's really going on, as if we're all connected, because we are. I mean, there's more things inside of our body from a cellular level than there are stars in the sky. We're pretty damn complicated. So I agree with you. Like, if we try to reductionize science and be like, oh, it's adrenal fatigue, it doesn't always have that kind of a clear cut answer. But I'm really curious, from your perspective, all your research, all your experience, like, how do you contrast Cellier's work? Where there is an alarm phase, there is a reaction phase, and there is this phase where, let's be honest, people flatline. Don't you think in that flatline, the last step of the gas model, they are in a lower cortisol or are they in an elevated cortisol? How do you apply the gas model to adrenal fatigue?
There are a number of ways that Celia's work is outdated and just not accurate. But one of the. I would say the core mistakes is if you take animals, let's say you take a bunch of rats or dogs, you stick them in a little cage and you just shock them repeatedly at random. The floor shocks them, okay? And they've got no way to escape. You get certain phenomenons that reliably arise from that, like learned helplessness. And if you were to do that for days and weeks on end, you would almost certainly see some kind of hormonal changes, probably in lots of different hormones, not just cortisol, but many different things would change. And if you could measure, let's say you could do a full metabolomics panel that could measure the full array of hundreds of biomarkers in that system, you would find not only did cortisol and 10 other hormones change, but probably hundreds of biomarkers were altered by that. It would be wrong to single out any one of those biomarkers and say, this is the reason that that dog has just laid down and whines all day and has given up on life and is super depressed and is whining in pain and sadness all the time. Right? So I think there's a reductionistic component here that's very flawed. But I also think that there's a component of that dog being trapped in a little cage, being shocked at random without any way to escape for days and weeks on end is not analogous to a human living in real life. And whatever hormonal changes that that dog incurs while being tortured for several days or weeks is not what happens to humans while living in the real human world for decades. It's probably analogous to what a prisoner of war experiences when trapped by the enemy and being tortured for several days or weeks, but it's not analogous to what humans experience. And the fact, I have no doubt that a prisoner of war chained up with his hands tied behind his back, being tortured and waterboarded and whatever else by, you know, by the enemy that's captured him would create a very different hormonal response than athletes who are engaged in over training or people who are slightly, you know, stressed for, overstressed from.
Well, their amygdala is not as hijacked. I mean, if you're, if you're getting tortured by the enemy, you're in full primal mode. I mean, there's like hard wiring. Forget about hormone cascades. There's like circuitry that's just being pushed. So I want to go back to this because, like, I love learning and I really respect your work. So how do we even apply the gas model? Or do you just not use it anymore? What is so outdated about Selye's work?
You know, it's been a while since I looked at it, but I know that Robert Sapolsky had some really nice criticisms in his book. Which one? Why Zebras Don't Get Ulcer. I think he also talked about it in Behave basically. Why? What is outdated about Sellye's model? Off the top of my head, I couldn't necessarily tell you beyond what I just told you, but. But I know that the hormonal, the hormonal aspects of things simply don't follow that trajectory with chronic stressors. And I. And I already told you, you know, and I've actually got an article on my site. So looking at here's all the literature on chronic stress from unemployment, chronic stress from relationship stress, chronic stress, cigarette smoking from alcohol consumption, from from overtraining and whatever other stressors, forms of psychological or physical stressors. None of them are reliably linked with any period of cortisol tanking. It doesn't happen. So you can also look at overt diseases. So like from this model where we interpret total allostatics load on the body. You familiar with that term? Sure, like total body stress load. So everything from psychological stress to spiritual stressors to metabolic stressors, toxins, everything could be lumped under this category of total body stress load. And you could look at people with overt diseases, people who unquestionably have had way too much total body stress load from poor nutrition and other poor lifestyle habits for many years or decades. It.
