[SPEAKER_00]: Now, here's the question.
[SPEAKER_00]: The person writes, 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.
[SPEAKER_00]: A chiropractor mentioned to me in session that my fat and disabled body feels like, quote, years of cortisol is stored up on quote.
[SPEAKER_00]: 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 a quote unquote adrenal body type.
[SPEAKER_00]: Is this just diet and wellness culture BS or is there any legitimacy to this label?
[SPEAKER_00]: Thank you for the wealth of information and resources you share.
[SPEAKER_00]: My therapist pointed me to your original podcast and I've been grateful ever since.
[SPEAKER_00]: Thanks so much for that great question and that nice feedback.
[SPEAKER_00]: And before I answer just a reminder that these answers and this podcast in general are for educational and informational purposes only, aren't just substitute for individual medical or mental health advice and don't constitute a provider patient relationship.
[SPEAKER_00]: So I did a deep dive into the concept of adrenal fatigue in my second book, The Wellness Trap, and I'd recommend checking that out for the full story, including interviews with people who've received this dubious diagnosis.
[SPEAKER_00]: 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.
[SPEAKER_00]: First, let's talk about adrenal fatigue in general.
[SPEAKER_00]: The TLDR here 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.
[SPEAKER_00]: In some cases, including the normal functioning of the human body.
[SPEAKER_00]: The term adrenal fatigue was coined in 1998 by a natural path in chiropractor named James Wilson, who subsequently wrote a 2001 book outlining this pose of diagnosis and his method of treatment.
[SPEAKER_00]: 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.
[SPEAKER_00]: 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.
[SPEAKER_00]: Excessive stress is certainly a problem, and it's associated with many different health issues, but it doesn't make your adrenal glands tired.
[SPEAKER_00]: Quote stress can have an impact on our health, but it doesn't affect your adrenals this way.
[SPEAKER_00]: Set a nap, bench, lomo, and endocrinologist at the Cedar Sinai adrenal program in a 2018 interview.
[SPEAKER_00]: When you're stressed, the adrenal glands actually produce more of the cortisol and other hormones you need.
[SPEAKER_00]: They will give you all that is necessary.
[SPEAKER_00]: End quote.
[SPEAKER_00]: Now, there is a caveat here that some people do have a rare condition called adrenal insufficiency in which the adrenal glands don't produce enough of the hormones they should, including cortisol and aldosterone, but the difference is that adrenal insufficiency doesn't happen because you've quote unquote overtaxed your adrenals, it's actually a legitimate medical condition and it has a specific cause or causes that we'll talk about more in a footnote in these show notes.
[SPEAKER_00]: If you click through to the full show notes, you can check that out.
[SPEAKER_00]: in the footnotes.
[SPEAKER_00]: But getting back to the main text of this Q&A, a 2016 review of the scientific literature, which was published in a reputable journal of endocrine disorders, had a title that was notably frank for a scientific study.
[SPEAKER_00]: Adrenal fatigue does not exist, a systematic review.
[SPEAKER_00]: 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.
[SPEAKER_00]: None of them even used appropriate methods to test whether there was any correlation between participant reported fatigue and adrenal function.
[SPEAKER_00]: The endocrine society, a group of physicians and researchers specializing in hormone health, wrote in 2022, quote, no scientific proof exists to support adrenal fatigue as a true medical condition.
[SPEAKER_00]: Doctors urge you not to waste precious time accepting an unproven diagnosis such as adrenal fatigue if you feel tired, weak, or depressed.
[SPEAKER_00]: Even Wilson, the creator of the term adrenal fatigue, seems to acknowledge that there's no real scientific evidence behind the adrenal fatigue label.
[SPEAKER_00]: As the official version of his questionnaire cautions, quote, no formal reliability or validity tests have been completed to confirm its accuracy, and the author assumes no responsibility for its use or accuracy, and quote.
[SPEAKER_00]: Unfortunately, many alternative integrative and functional medicine practitioners still use this questionnaire or some variation on it to quote unquote diagnose adrenal fatigue.
[SPEAKER_00]: 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 happen to have.
[SPEAKER_00]: It even treats the existence of real diseases as evidence of supposed adrenal fatigue.
[SPEAKER_00]: Checking the box next to, I have low blood pressure, I have rheumatoid arthritis, or eye suffer from asthma, counts towards the points needed to make a quote-unquote diagnosis of adrenal fatigue, which is 26 points for men and 32 for women.
[SPEAKER_00]: What's worse is that many questions just describe normal experiences of living in a human body.
[SPEAKER_00]: Quote, I tend to shake or I'm nervous when under pressure.
[SPEAKER_00]: I get low energy, moody, or foggy if I do not eat regularly.
[SPEAKER_00]: I get colds and or other respiratory illness two or more times per year.
[SPEAKER_00]: I get pain in the muscles on the sides of my neck.
[SPEAKER_00]: I feel worse if I miss or skip a meal and quote.
[SPEAKER_00]: It's striking how many of these questions imply that people should be able to go long periods of time without food, by the way.
[SPEAKER_00]: Between the benign complaints and the genuine symptoms of micronach conditions, I racked up 91 points on the questionnaire.
[SPEAKER_00]: The idea that there's one underlying cause for a vast number of common symptoms, or just normal human characteristics, is a common framing and wellness culture, and it can easily lead us astray.
[SPEAKER_00]: Of course, it would be amazing if we could explain everything that's telling us with one diagnosis and treat it in one fell swoop.
[SPEAKER_00]: 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.
[SPEAKER_00]: 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 quote-unquote root cause.
[SPEAKER_00]: That goes for emotional pains, too, including the body image distress that often accompanies not meeting our cultures and possible beauty standards.
[SPEAKER_00]: And this is where the so-called adrenal body type comes in.
[SPEAKER_00]: The notion of an adrenal body type harnesses our culture's pre-existing anti-fat bias and agism to sell the dubious diagnosis of adrenal fatigue and its unproven cures.
[SPEAKER_00]: The quote unquote adrenal body is ostensibly characterized by belly fat, weight gain or difficulty losing weight, a very round face, a double chin, all things that this weight stigmatizing culture has conditioned us to view as flaws.
[SPEAKER_00]: Once again, there's a small grain of truth at the center of this misinformation popcorn, in the sense that there is a rare condition called cushing syndrome that's caused by high levels of cortisol and may produce some of these symptoms such as abdominal weight gain and facial roundness.
[SPEAKER_00]: But pushing syndrome can be caused by a tumor on the adrenal or protoutary gland, or by the long-term use of corticosteroid medications, including the ones prescribed by some functional medicine practitioners for quote-unquote adrenal fatigue, which, again, is not a real diagnosis.
[SPEAKER_00]: Other supposed hallmarks of the adrenal body type include wrinkles, under eye circles, sagging skin, and other typical signs of aging, which we've also been trained to see as defects by industries that profit when we feel bad about our bodies.
[SPEAKER_00]: It's incredibly useful for marketers to make people believe that all the things they've been told to hate about their appearance are actually signs of a single underlying condition and that they can all be quote unquote fixed by curing the supposed problem with special protocols of diets and supplements.
[SPEAKER_00]: and make no mistake, the inventors of the quote unquote adrenal body are definitely marketing diets and supplements.
[SPEAKER_00]: The notion of an adrenal body type dates back to the 1980s, with a publication of a pseudoscientific diet book that claimed to help readers quote, achieve your ideal body shape, target your trouble spots, and eliminate food cravings forever and quote, among other things.
[SPEAKER_00]: Standard diet culture fair that capitalizes on cultural
[SPEAKER_00]: More recently, a chiropractor with a popular YouTube channel revived the concept of the adrenal body, again without scientific evidence, and connected it to so-called adrenal fatigue.
[SPEAKER_00]: He also sells diet books that promote keto and intermittent fasting, which is problematic, along with a package of quote-unquote adrenal body type supplements, which, like all supplements in the US, are untested for safety or efficacy before going to market, and may not contain what their label claims.
[SPEAKER_00]: We've got some more reading on that for you in the show notes if you click through.
[SPEAKER_00]: Various other alternative medicine practitioners have now taken up his definition of the adrenal body, selling supplements, detoxes, and other diets as supposed cures.
[SPEAKER_00]: I'm not going to link to any of those people to avoid giving them traffic, but I imagine that the person who asked the question came across some of them in their Google searches.
[SPEAKER_00]: Creating a problem so that you can sell the solution is a page out of the classic advertising playbook.
[SPEAKER_00]: As former brand strategist Jessica Elefante told me in her episode, quote, I had learned in marketing 101 to provide a solution to a problem, but working at an ad agency, I learned that the problem could be completely made up and quote.
[SPEAKER_00]: And this approach is a classic because it works.
[SPEAKER_00]: The wellness and beauty industries have captured trillions in market share by continually inventing
[SPEAKER_00]: Of course, there's a big difference between inventing problems to sales spurious cures and responding to genuine health problems with evidence-based solutions as millions of medical doctors and other health care professionals do.
[SPEAKER_00]: But an MD credential is not always a guarantee of credibility.
[SPEAKER_00]: Some MDs promote questionable products and protocols based on fringe theories rather than solid interpretations of scientific evidence.
[SPEAKER_00]: But still, statistically, you're probably much more likely to find dubious diagnoses and other false claims in the realms of alternative, integrative, and functional medicine, which are largely if not entirely unregulated.
[SPEAKER_00]: As Dr. Jen Gunter wrote in a recent post, alternative therapies would be better described as, quote, understudied and unstudied therapies, unquote, that sound like a good idea, but often don't work in practice.
[SPEAKER_00]: Chiropractors fall into the alternative medicine category, though some also identify as integrative or functional medicine practitioners.
[SPEAKER_00]: Chiropractors aren't medical doctors, so they're not technically practicing medicine at all, though they do graduate with a doctor of chiropractic degree from chiropractic schools.
[SPEAKER_00]: They might use the term doctor in their title as the modern day popularizer of the quote-unquote adrenal body type does, but this can be somewhat misleading to people looking for actual medical care.
[SPEAKER_00]: This brings me to a question that I'd invite you to consider, which is, what drew you to see a chiropractor in the first place.
[SPEAKER_00]: Many people, myself included, years ago, are attracted to alternative medicine because they feel unheard and un-served by the conventional healthcare system.
[SPEAKER_00]: Did you have bad experiences with doctors that made a chiropractor seem safer?
[SPEAKER_00]: Or were you simply looking for help with managing back and neck pain?
[SPEAKER_00]: Or is it some combination of those things?
[SPEAKER_00]: It might be helpful to know that chiropractors aren't qualified to diagnose or treat hormonal issues.
[SPEAKER_00]: That's the province of endocrinologists such as our guest on this week's episode about hormone myths.
[SPEAKER_00]: and even when it comes to things like treating back pain, which chiropractors are trained in, the evidence is fairly uncertain.
[SPEAKER_00]: A 2019 systematic review and meta-analysis, which will link to in the full show notes, found that spinal manipulation, which is a core chiropractic method, was not statistically better than recommended interventions for low back pain or quote-unquote back specific functional status, at either the one month or one year mark, and those recommended interventions included pain meds and exercises.
[SPEAKER_00]: Additionally, the study found that, quote unquote, true spinal manipulation was no better than sham spinal manipulation for pain or functional status at six months or one year, though the evidence was a very low quality.
[SPEAKER_00]: The study was led by a researcher with financial ties to the chiropractic industry and the abstracting conclusions been the findings in a positive light.
[SPEAKER_00]: Quote, spinal manipulation produces similar effects to recommended therapies for chronic low back pain, unquote.
[SPEAKER_00]: But that similarity may just be because of the placebo effect, given that fake spinal manipulation may produce roughly the same outcomes.
[SPEAKER_00]: Results for neck pain are similarly uncertain.
[SPEAKER_00]: Chiropractic manipulations also are not without risk.
[SPEAKER_00]: In rare cases, they may cause severe problems like artery issues that increase the risk of strokes.
[SPEAKER_00]: I say all of this not to make you feel bad about going to a chiropractor, but to help you think more critically about whether it's really useful for you going forward, especially in light of the misinformation you encountered there.
[SPEAKER_00]: You may still feel that there are benefits to working with this chiropractor, maybe their empathetic overall, not with standing this particular comment, right?
[SPEAKER_00]: And I know that that can feel precious and hard to find in a conventional healthcare
[SPEAKER_00]: It's just worth considering whether the benefits of continuing to work with a chiropractor outweigh the risks, and whether there are other ways perhaps to get your needs met that don't put you in the path of so much misinformation.
[SPEAKER_00]: Thanks so much for this question.
[SPEAKER_00]: I hope it was helpful, and everyone listening can ask a question of your own by going to christiharis.com slash questions or click the link in the show notes.