Perhaps this sounds familiar. you feel tired, so tired. just about all the time. you pump in caffeine, maybe sugar, too, to get through the day.

The doctor looks at your labs and finds nothing wrong. yet, you don’t feel right.

A little Googling or a chat with a naturopath or chiropractor may have made you curious about adrenal fatigue. yet a little more investigation shows that there’s debate about whether the condition even exists.

Dr. Pierre Brunschwig of Helios Integrated Medicine says adrenal fatigue is something he sees frequently in his practice.

As a medical doctor who embraces holistic and complementary medicine, as well, he sees patients who have not found the help they were seeking in western medicine, and also patients who have not had their needs met by complementary medicine alone.

Brunschwig defines adrenal fatigue like this: “Somebody whose stressors are such that they have overwhelmed and depleted the adrenalin gland’s ability to continue to make important stress hormones, especially cortisol.”

He adds: “They end up in a low energy well.”

Brunschwig says the stressors may by physiologic conditions such as sleep apnea or an undiagnosed chronic infection. or they may be psychological. Sometimes the two interact, intensifying the condition.

His first step is a long interview, followed by lab work and sometimes other tests, to deduce what is going on with the person.

“You have to be quite comprehensive to capture the majority of the stressors,” he says.

He says most people come in saying they’re tired.

“The first, second and third thing is fatigue,” Brunschwig says.

However, he probes to find out when they are the most tired, if it’s after meals or later in the day, for example.

“The way that they’re tired is a very important clue as to how much adrenal function they have left,” he says.

“Someone who can’t get out of bed all day obviously has a big issue. somebody who’s only tired between 3 and 5 o’clock in the afternoon, we’d expect their adrenal function to be mostly intact.”

Brunschwig has patients use a take-home saliva test to measure cortisol. rather that the typical blood test, often taken in the morning, he says the saliva test, which is taken four times in a day, gives a more complete picture.

The Hormone Foundation, a group devoted to hormone research and the clinical practice of endocrinology, says in a fact sheet that no test exists for adrenal fatigue, a condition it says it not a real medical condition.

It recognizes adrenal insufficiency, a near total failure of the adrenal glands that is a function of Addison’s Disease, but says there is no medical evidence for adrenal fatigue, which often has vague symptoms that could be caused by a variety of conditions.

Brunschwig says that most of the medical community only recognizes Addison’s, which is a complete loss of adrenal function.

“What we’re saying is that (some) people don’t lose all of their function. They’re limping along badly but manage to produce a little cortisol,” Brunschwig says. “What I’m saying is they don’t feel good and can barely function.”

Lynn Smith, a dietitian and life coach, says she sees many clients with adrenal fatigue, especially since one of her specialties is people with alcohol and drug problems.

“It’s why diet is so fundamental to feeling good in recovery,” she says. “People come in. They’re wiped out. They’re using sugar and caffeine to satisfy cravings. It keeps them in an up and down cycle.”

Smith also sees clients with the more common stressors such as demanding work, a challenging family life and not enough time in the day.

“The diet becomes a valve for all that stress,” she says.

Perhaps ironically with the complexity of life for many people, the long-term remedy for adrenal fatigue is simple, if not always easy to implement, Smith says.

“The more you stay in balance, the more adrenals don’t get called into action,” she says.

That means paying attention to the basics: eating a varied, healthful diet, getting plenty of sleep and exercising moderately.

She also suggests finding ways to calm down such as meditation or yoga.

Smith recommends taking supplements under the supervision of an alternative practitioner or doctor. She says having your cortisol levels tested is key.

Indeed, one of the warnings of the Hormone Society is that people may self-diagnose adrenal fatigue and take supplements on their own, some of which may be dangerous.

Brunschwig says diagnosing and treating underlying conditions is the first step. he then says it’s key for patients to realize that they may be in an unconscious cycle in which they create emergencies in their lives to tap into cortisol’s cousin adrenaline as a way to regain their energy.

“Helping people understand how they’ve done this and helping them to back out of this is an important step in recovering adrenal health,” he says.

Then, depending on what testing and interviews show, Brunschwig suggests supplements, some of them intravenous. Magnesium often can play a big role in recovery, he says. he uses nutrient support and adrenals to help bring back function.

However, he says, “You can’t heal the body if you have emergencies going on all day. to a certain extent, that’s part of the lesson.”