Question: Is adrenal fatigue real?

Probably not, but there are real issues that can cause the symptoms people associate with it.

Like many coaches, I once believed in adrenal fatigue. The theory went as follows:

When you're constantly under stress, your adrenal glands work overtime and are forced to produce more stress hormones than they're "supposed to." Over time they become fatigued, or incapable of producing stress hormone anymore. This, according to the theory, makes the body ill equipped at facing stressful situations and leads to a state where you become chronically fatigued.

The problem? It's pseudoscientific, has never been proven, and is unlikely to really happen.

That doesn't mean people are lying about their symptoms. Those are real and can be caused by excessive stress, abuse of stimulants, and other lifestyle issues that increase the production of stress hormones. However, they're not due to a "fatigue" of the adrenal glands.

What are the symptoms, anyway? Here's what people generally experience when they suspect they have adrenal fatigue:

• Drop in motivation
• Low energy
• Decrease in willpower/discipline
• Anhedonia (lack of pleasure)
• Mood swings
• Disrupted sleep patterns
• Not feeling rested after a full night of sleep
• Decrease in physical and mental performance

The most likely causes are:

1. Dopamine depletion
2. Dopaminergic receptor desensitization
3. Adrenergic receptor desensitization
4. Noradrenaline depletion

Any of these situations will lead to the symptoms we associate with adrenal fatigue. And all of these can occur when you're chronically under stress or over-challenging your nervous system.

Depending on your brain chemistry, some are more likely to happen to you than others. For example, someone who's very sensitive to dopamine is more likely to have dopamine depletion or dopaminergic receptors desensitization. Why? Because he's naturally super sensitive to it, but doesn't produce a high level of dopamine.

Someone who's more sensitive to adrenaline is more at risk of adrenergic resistance and noradrenaline depletion. This is more common. Around 14-20% of the population is dopamine dominant.

Still confused? Here's what you need to understand: Adrenaline and dopamine are neurotransmitters – chemicals that control your brain. They work by attaching to and activating receptors. The receptors can be more or less sensitive. The more sensitive they are, the more strongly they respond to the neurotransmitter.

Dopamine and adrenaline are activating neurotransmitters. They turn on the nervous system, increasing motivation, willpower, drive, competitiveness, and physical and mental performance. They also have their own impact depending on the part of the brain they work on. For example, dopamine is the "pleasure" neurotransmitter.

Both are tightly connected because adrenaline is ultimately fabricated from dopamine. Dopamine can be converted to noradrenaline which can itself be converted into adrenaline.

So the more adrenaline you need to produce, the more dopamine you use up. If you don't produce a lot of dopamine, and you use a lot of it to produce adrenaline, you run the risk of depleting dopamine stores. Let's talk about that.

People with low dopamine production will run the risk of depleting their dopamine when they're asking their body to pump out too much adrenaline by putting themselves in stressful situations. Several training variables will increase adrenaline:

• Pace: Faster training creates the highest amount of adrenaline production.
• Volume: More volume means more adrenaline.
• Mental Stress: A max lift (or psyching yourself up) can also increase adrenaline.

If someone has naturally low dopamine and he trains fast with a large volume and constantly goes balls-out, the risk of dopamine depletion is real.

Another possibility is making the dopaminergic receptors less sensitive. In that case, the effect is similar to dopamine depletion: you have plenty of dopamine, but the receptors simply aren't responding to it.

This is a lot less common. It likely won't happen to a regular Joe living a normal life and training hard. It's more likely to happen to people who abuse substances/drugs that directly target the dopamine receptors.

What kind of drugs can make your dopaminergic receptors less sensitive? These are the most common:

• Cocaine
• Amphetamines
• Ritalin
• Methamphetamine
• Nicotine

Use of these drugs can create a huge stimulus on the dopaminergic receptors. The receptors will adapt by becoming less responsive to avoid being constantly over-stimulated. If someone takes these drugs regularly, he can easily make himself resistant to his own dopamine and will exhibit the symptoms we saw earlier.

Note: As we saw in Question of Strength 50, some anabolic steroids also stimulate the dopaminergic receptors, which can be the reason behind the depression associated with the use of steroids.

The other possibility, and it's much more frequent, is either adrenergic receptor desensitization or noradrenaline depletion.

The adrenergic receptors are the most easy to get desensitized. Ask a bodybuilder who has taken clenbuterol in the past. The first day or two he'll get super amped up, have jitters, monster energy, etc. Same as if he were on speed.

After 2-3 days the effects become very subtle. And after a week he doesn't feel it anymore. That's because his receptors "down-regulated" or became desensitized.

The problem is, when your own adrenergic receptors become desensitized you stop responding to your own adrenaline. And that's what causes low energy, no motivation, no discipline, a drop in self-esteem, bad performance, etc.

You don't need take clenbuterol to get your adrenergic receptors desensitized. These receptors are like the NO2 in your race car: they're meant to give you a short time boost in a do-or-die situation. They aren't meant to stay activated all the time.

If you're constantly under stress and pumping out adrenaline, you can easily make your receptors resistant. THIS is the most common cause of what we erroneously call "adrenal fatigue."

A last possibility is a depletion of noradrenaline. This can be caused by a chronic and excessive cortisol elevation. See, cortisol, on top of being an enemy for muscle growth, is what increases the conversion of noradrenaline to adrenaline. The more cortisol you produce, the more you convert noradrenaline to adrenaline.

Symptoms of noradrenaline depletion include:

• Low energy
• Lack of focus
• Problems concentrating
• Disorganization
• Low blood sugar

The take-home message? Excessive chronic cortisol levels can lead to what we think is "adrenal fatigue" by either depleting noradrenaline (easier to fix) or desensitization of the adrenergic receptors (harder to fix).

Besides blood tests, you need to rely mostly on behavioral observations. But there's one test that can narrow it down.

Take 7 grams of tyrosine on an empty stomach in the morning, wait 30 minutes, and assess how you feel. Compare it to how you feel normally on most mornings.

• If after 30 minutes of taking tyrosine you feel awesome, much better and more energetic than normal, the problem is likely dopamine depletion (tyrosine is used to make dopamine).
• If you feel good, but not to the point of feeling like you just found the magic bullet, it's likely noradrenaline depletion. In that case it might take 45 minutes to start feeling a bit better. That's because tyrosine will make dopamine which will then increase noradrenaline.
• If you still feel like crap after 30-45 minutes, and there's no difference, then it's more than likely adrenergic desensitization.

The first two cases share the same basic solution: increase dopamine levels. I recommend Brain Candy®, which has the most bioactive form of tyrosine as well as the bioavailable form of B6 which is necessary for the production of dopamine, combined with Rhodiola Rosea which extends the life of dopamine.

If your problem is noradrenaline depletion, you might also want to reduce cortisol levels by taking 3-5 grams of glycine and a dose of magnesium (500 mg) post-workout and in the evening. Glycine is a neurological inhibitor which will decrease cortisol production due to over-activation, and magnesium can dislocate the adrenaline from the adrenergic receptors.

If your problem is adrenergic desensitization, taking doses of magnesium 3-4 times a day (500 mg) to prevent excessive binding of adrenaline to the receptors will help. So will increasing meal frequency and carb intake.

A higher meal frequency and more frequent carb feedings will decrease adrenaline production both directly and by decreasing cortisol, which will decrease noradrenaline to adrenaline conversion.

If you're a carbo-phobe you might think, "Yeah, but I'm gonna get fat!" Maybe you'll add one or two pounds of fat in the process. But that's nothing compared to the long-term damage of keeping your receptors resistant.

As for training, all of these situations require that you decrease volume by around 40-50%, decrease frequency (do three or four weekly workouts only), increase rest intervals, and stay away from intensity techniques until the problem is solved.

I consulted with an international CrossFit athlete who had this exact problem. He made those adjustments for three weeks and was back in full form. Settling down a bit for a couple weeks (even up to five) is nothing in a training life.

Question: Should you hit the gym when you're sick?

Funny you should ask...

Question: If you can increase the weight on an exercise, but you stop feeling the target muscle working with that load increase, is it better to go up in weight or to stay at the same weight and feel that mind-muscle connection? My main goal is hypertrophy.

That's a great question. And it really depends on the exercise and the purpose of that exercise.

Your main goal is hypertrophy, so maintaining a proper mind-muscle connection with the target muscle is more important than someone training for strength, for whom the main goal is moving more weight from point A to point B.

Training for Strength

Even in the case of someone training for strength, not feeling it in the right muscle might be a sign of compensation and not using the right muscles to do the work.

When I'm training someone for strength, I'm normally more permissive on the main lift of the session (allowing them to feel it a little less), BUT if the lifter feels it more in the joints than in the muscles, I decrease the weight.

On the assistance work, I won't increase the weight if the feeling is lost because the purpose of the assistance work is to fix a weakness. Losing the feeling is normally a sign of compensation which means the exercise won't optimally target the weakness I'm trying to fix.

Training for Size

When training for hypertrophy, feeling it in the right muscle is even more important. A study by T Nation authors Dr. Brad Schoenfeld and Dr. Bret Contreras has recently shown that the hypertrophy response is greater when the mind-muscle connection is better. (1)

However, I want to mention one caveat. Dr. Nick Winkelman, who's the head of Athletic Performance & Science for the Irish Rugby Football Union and one of the world's best experts on cueing, has shown that when it comes to performance and complex movements, external cues and focus is better than internal cues and focus.

This means that when doing a multi-joint lift (bench press, squat, deadlift, Olympic lifts, military press, pull-ups, etc.) it's best to have an external focus. External focus is when you put your body in relation to the surroundings to have the whole body do the right thing. For example...

For the Romanian Deadlift

• Don't think about loading the hamstrings (internal focus).
• Do think about bringing your glutes to the wall behind you (external focus).

For the Power Clean

• Don't think about contracting your calves and traps (internal focus).
• Do think about pushing the floor away explosively (external focus). Or think about hitting the ceiling with your head.

For the Bench Press

• Don't think about squeezing your shoulder blades together (internal focus).
• Do think about spreading the bar apart or about pushing yourself into the bench (external focuses).

For the Squat

• Don't think about pushing your knees out (internal focus).
• Do think about screwing your feet into the floor (external focus).

On isolation movements and machine exercises you should have an internal focus, think about squeezing the target muscle. But on multi-joint free weight exercises you should have an external focus.

In a squat, bench, or RDL, feeling the exercise properly will come from focusing on optimal lifting mechanics – perfect technique. If you stop feeling the big lift properly (you start to feel it in your joints or you feel unstable) then the weight is too heavy for your level of technical mastery.

"Feeling" an isolation exercise or machine movement is not the same as "feeling" a multi-joint free weight lift. Feeling an isolation exercise is all about maximizing the mind-muscle connection with a single muscle.

In a multi-joint movement, it's all about spreading the load over the muscles in the best way possible. You might not feel the same direct tension in one muscle, but the lift just "feels good."

• On isolation and machine exercises, if you lose some mind-muscle connection, decrease the weight.
• On multi-joint free weight lifts, decrease the weight only if the technique feels off or you start to feel the weight more in the joints than in the muscles.

1. Schoenfeld BJ et al. Attentional focus for maximizing muscle development. Strength & Conditioning Journal. 2016 Feb;38(1):27-29.