If you start digging through medical journals with the keywords “adrenal fatigue” you aren’t going to unearth a lot of data, but rather a conversation about how it doesn’t really exist. In fact, the multi-complexed and fatiguing health concern of “adrenal fatigue” has very little to do with the actual adrenal glands.

My clients often present me with a wide-range of symptoms that fall under the adrenal fatigue complex ranging from unexplained autoimmune and hormonal issues involving cortisol and insulin imbalances, anemia, sleep disturbances, varying degrees of chronic fatigue, depression, weight gain and loss, and lifestyle stress.

Adrenal fatigue has become such a ubiquitously thrown around description, that experts at Harvard’s School of Medicine felt compelled to respond from an evidence-based perspective suggesting the same thing I discuss with both the health providers and clients who adopt it — why would your adrenals be drained? Harvard’s correspondent, Dr. Marcelo Campos stresses the importance of taking a closer look at what types of stress might be affecting you.

As observed for nearly two decades in my clinical practice, most adrenal fatigue symptoms can be traced to dysregulation of the hypothalamic-pituitary-adrenocortical complex that has been influenced by varying epigenetic factors over the years. Holistic practitioners who understand the nuances of underlying constitutional fatigue realize this, as well as conventional providers who can be quick to make superficial, compartmentalized diagnoses. Simplified, the HPA axis regulates neuroendocrine and immune function responsible for digestion, overall immunity, sexual health, and energy expenditure.

It may be obvious that an evidence-based gap exists between much of holistic health practices and more conventional models. Holistic health practitioners are often far superior to conventional models at tuning into their patient’s and client’s personal health concerns at a very necessary, deep constitutional level, yet sometimes lack the scientific evidence or lab-testing know-how to bring the greater picture together. To guide people toward personalized testing and a more unified, evidence-based language that bridges these gaps in the health professions is both overdue and essential.


If you’re a health practitioner of any kind, you no doubt have had patients and clients say “but I’m still so tired, I don’t get it.” What eventually became evident to me was that when clients held back from openly admitting to lifestyle stress and really dealing with their deeper emotional concerns, the “but I’m still so tired” issue remained — one of the defining symptoms of so-called adrenal fatigue.

Pollution, pesticides, and poor diets do a real number on our genomic and microbiomic expression when left unmitigated, but add lifestyle and emotional stress and this same epigenetic variable exacerbates all of the other more physiologically overt issues. I always remind my clients that while participating in a pristine diet, targeted nutraceuticals, and a personalized movement/fitness routine will certainly optimize wellness, if we’re not addressing lifestyle stress and the sources of it, the underlying cause will gradually appear, flipping those genetic switches on, and causing inflammation and cascading health concerns.

Mitigating stress by addressing the HPA axis from an integrative perspective eases the whole-human healing picture into place because it addresses multi-systemic health concerns simultaneously, both subjectively and objectively. This is why I recommend my clients work side-by-side with epigenetic, integrative specialists and manifestation and neurolinguistic psychologists and practitioners who specialize at unearthing the roots of stress to advance healing. Our perspective on stress, health, and lifestyle dictates everything.


When stress activates the HPA axis, a flood of catecholamines or stress hormones is activated (including the hormones and neurotransmitters: epinephrine, norepinephrine, and cortisol). This neuroendocrine activation leads to major ongoing physiological distress that influences central wellness — metabolism is often left sluggish, our immune systems compromised, fatigue sets in, and labeled health concerns arise.

Now imagine you’ve learned your cortisol levels are off and you have adrenal fatigue. Maybe you have a little more data such as DHEA, epinephrine, and melatonin. If you have had genetic testing performed, you may also have discovered polymorphisms in certain genes such as COMT, MAO-A, MTHFR, and BHMT, potentially leading to even more significant impacts from environmental and lifestyle stress. These genetic variations coupled with the neuroendocrine findings described above are all evidence that the HPA axis needs help.

Let’s say you stopped testing short at cortisol and started using cortisol-mitigating nutraceuticals. And, unbeknownst to you at the time, you also experienced fluctuations in other neuroendocrine hormones and genomic polymorphisms. By stopping at the adrenal fatigue diagnosis and only addressing cortisol levels, you could be causing further distress to the body by throwing off unknown biochemical imbalances. I’ve seen many people have the very health concerns they set out to treat worsen by failing to include the bigger picture criteria for nutraceutical implementation. The bottom line is to trust your intuition when something feels off and investigate the issue as comprehensively as possible.


Work with an integrative practitioner —

Find an integrative practitioner who specializes in the big picture: lifestyle, epigenetic, and functional medicine.

Mitigate stress — 

Inner child and shadow work are powerful methods of accessing our beliefs and addressing stress at its root. Research suggests that HPA axis dysregulation begins with early life stress exposure. Check out this research in Frontiers in Cellular Neuroscience to learn about how stress can influence key developmental stages in life.

If you need more guidance, practitioners like Lucia Pinizotti and James Cervelloni of Mindopoly Center for Change, Lacy Phillips of Free and Native, and Dr. Adi Jaffe of IGNTD are excellent resources to help you “go there” to that inner child and core belief level.

Christine Dionese, co-founder of flavor ID is an integrative health and food therapy specialist and wellness, lifestyle, and food journalist. She has dedicated her career to helping others understand the science of happiness and its powerful effects on everyday human health by harnessing the power of the epigenetic landscape. Christine lives, works, and plays in Southern California with her husband and daughter.

Illustration Credit: Youheum Son.

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