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Adrenal Fatigue and Body Types
By: Michael Lam, MD, MPH and Dorine Lam, RD, MS, MPH

Table of Contents

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Information presented here is for general educational purposes only. Each one of us is biochemically and metabolically different. If you have a specific health concern and wish my personalized nutritional recommendation, write to me by clicking here.

Body Type/Constitution

Commonly, body type refers to the appearance of a person as it relates to physical shape or contour of the body. Some may refer to it as the degree of athletic ability or performance. In the context of holistic healing, body type, also known as biological constitution refers to the inner makeup and the resulting ability to deal with illness.

Regardless of the outward appearance, we each have a unique inner body type or biological constitution we were born with. It is the subtle part that eludes routine laboratory test and physical examination by conventional western medicine. Yet it plays an important role in our everyday living, affecting how our body metabolizes nutrients, processes food, thinks, plays, works, and sleeps. For this article, the words "constitution" and "body type" are used interchangeably.

Adrenal Fatigue has eluded medical investigation for decades because the clinical presentation is not uniform. The wide variation of possible responses to the same stressor and the resulting level of Adrenal Fatigue varies greatly and often defies medical logic. Some people can be under severe stress and perform well, while others will crash when placed upon the slightest stress. Some with Adrenal Fatigue progress steadily, getting worse over time (from Stage 1 to Stage 3 slowly), while others quickly deteriorate and never fully recover. A large part of this is due to each person's unique constitution.

Constitution and Genes

Each of us is born with a certain genetic makeup. This genome determines our body elements from obvious anatomical composition such as blood, muscle, and organs to subtle internal hormonal and metabolic systems. Under normal circumstances, this genome determines who gets cancer and who does not. You must have heard stories of a life-long chain smoker who does not develop lung cancer while another non-smoker in perfect health dies of sudden death. None of us has perfect biological constitutions. There are always some weak parts somewhere within. Some of us have more weak parts, and others less. Some of us have weaker immune systems and tend to get sick easily. Others might have metabolic weakness, with weight management being the main issue. Unfortunately, you cannot decide your body's constitution or body type. You can however, nurture the weak parts of your body and try to restore and strengthen them as much as possible.

Recent genetic research has also shed light on this matter. It is currently believed that while our basic genome does not change over time, its expression does. In other words, as you age, your genes do not change, but your epigenome changes dramatically. Epigeneticism is now emerging as a primary influence factor. This centers on the notion that environmental factors such as diet, lifestyle, and stress influence the expression of your genes.

It is the expression of your genes -- NOT the genes themselves -- that dictate whether you develop certain diseases and, in the case of the adrenal glands, the degree of weakness. Examples of these factors that can amplify the adrenal's constitutional weakness includes aging, obesity, excessive childhood illness, prolong stress, excessive use of prescription antibiotics, emotional trauma such as death of a loved one, physical trauma such as a car accident, relational difficulties such as divorce, and psychosomatic illnesses.

For example, if you have weak adrenal glands at birth due to a weak biological constitution and elude any detection by conventional western medicine, your weakness might be expressed when stressed and thereafter lead to Adrenal Fatigue. The absence of stress, on the other hand, can delay the expression of this weakness for an indefinite period of time. It is influenced by physical and emotional stresses -- how you respond to everything that happens in your environment, from climate change to marriage to final exams to childhood abuse that will ultimately affect your epigenome. Thus, someone who is born with strong adrenal glands constitutionally might not develop Adrenal Fatigue despite severe stress. Others who have weak adrenal functions might start having symptoms as a teenager when exposed to stress.

Our genome, along with the epigenome, ultimately decides our body's weakest link and expression of illness throughout our lives.

East vs. West

The concept of the body constitution is not well understood by western medicine, which tends to treat all bodies alike. In eastern medical philosophy, heavy emphasis is placed on the forces of nature that govern the human body and are responsible for regulating all systemic, endocrine, metabolic and functional changes in the body. They are the five vital elements - air (the vital force behind all functions), fire (source of energy and heat and responsible for transformation, such as metabolism, hormones, saliva), earth (the element of strength and anabolism, such as collagen, and ligaments, and muscles), water (that which binds structures together such as urine, sweat, and gastric enzymes), and space (where all factors exist, such as oral cavity, respiratory system and reproductive system). The sum total of the above five elements has to be in perfect balance for the body to feel good and function normally.

In Ayurveda, the biological constitution or the genetic makeup of an individual, which remains constant throughout one's life, is called Prakruthi. The Prakruthi of an individual manifests as the physical attributes and physiological and psychological responses. For centuries, the universal laws have remained a mystery to human intellect. Western medical advances employing scientific methodology is only scratching the surface in the exploration of different planes of knowledge on the overall scheme of things. The constitution of the universe rules the formation, existence and destruction of all the objects in a space and time continuum of consciousness. Every individual is a unique entity with a constitution of his/her own. This is called Prakruthi. This Prakruthi or the biological judiciary controls the physical and mental faculties of an individual.

What is apparent in Adrenal Fatigue is that the body's ultimate response to the stressors and subsequent recovery pattern depends largely on the body's biological constitution, regardless of whether one looks at it from the Eastern or Western medical perspective. Those who have strong adrenal constitutions do recover faster and have longer sustained recovery compared to those who have weak adrenals. Those with weak adrenals never fully recover after crashes but continue a downward path of decompensation.

Unfortunately, there is no routine laboratory test to determine the body's constitution. The best determinant is a good history carried by an astute clinician. As Adrenal Fatigue usually develops through the years, the body often sends out many signals over a long period of time. Most of us do not pay enough attention to these signals throughout the years and tend to ignore them. When Adrenal Fatigue finally triggers crashes and the body fails to recover, we are at a lost as to the reason why.

The more advanced the Adrenal Fatigue, the more important the body constitution plays a role in determining the ultimate natural progression of the condition. Knowing whether you have a strong, normal or weak body constitution plays an important role in adrenal recovery because the pattern of recovery and the kind of nutrients required differ depending on the type of body constitution.

Your Constitution

The best gauge of constitution health from a western medical perspective is a detailed past history with qualitative determination based on general principals of well being in the presence and absence of exposure to traumatic events.

A body's constitution can range from very strong to very weak. The distribution resembles that of a bell-curve, it can be generally surmised that 68% of the general population fall within the normal range, 2% are very weak, 14% are weak, 2% are very strong, and 14% are strong. The ranges are by no means absolute. This is shown below.

Those who are constitutionally very weak in general health tend to get minor illnesses frequently, which also takes a long time to get well. They often get seasonal rhinitis or sensitivity to pollen during the spring, heat intolerance during the summer, rolling colds and flu during the fall, and intolerance to cold in the winter. They have multiple food sensitivities, especially for wheat, dairy and corn products. They are highly sensitive to over-the-counter or prescription medications. Their gastric system seems to be sensitive to the environment, being more susceptible to travelers' gastroenteritis compared to normal travelers. Yet all routine laboratory tests look normal. They frequently visit physicians for one ailment or another, and always seem to be struggling to stay healthy.

On the opposite end of the spectrum, those who are constitutionally very strong never get sick even for one day. They are "strong as an ox". For some reason, they stand up better to viruses and stay healthy when others fall prey. Routine laboratory test are also within the normal range.

Most adults, if they look back at their life, can surmise their overall constitutional status. The majority of us fall into the normal range, with our fair share of common cold, stress and strain.

Interestingly, many who are weak in constitution overall can have strong adrenals. The opposite is also true. In other words, aside from the general biological constitution of the body, each organ has its own constitution as well. Determination of the final biological constitution of the adrenal glands therefore depends on a host of factors, many of which are still not known. They include the adrenal's intrinsic constitution and constitution of other closely related organ systems such as the thyroid and ovarian systems, both of which can affect the final outcome.

However, some general clinical observations are evident. When it comes to Adrenal Fatigue, knowing your constitution is important. Those who have strong overall constitutions are less likely to suffer Adrenal Fatigue. If they do, the progression tends to be slower, with less intense adrenal crashes, and a faster recovery process that can be sustained. Those with weak constitutions have higher propensities to develop Adrenal Fatigue even under normal daily living. Their chances of deteriorating to advanced stages are higher. Adrenal crashes tend to be more intense, with delayed and protracted recoveries that are difficult to sustain.

Nowhere is the constitution's effect on Adrenal Fatigue recovery more prominent than in Stage 3C, the state of disequilibrium. Here, there are often concurrent ovarian, thyroid, and adrenal dysfunction (OAT axis imbalance) along with dysregulation of hormones such as cortisol, adrenaline, thyroid, insulin, and estrogen. Symptoms include hypoglycemia, moderate to severe fatigue, low blood pressure, anxiety, insomnia, adrenaline rush, heart palpitations, low libido, POTS, PMS, hypothyroidism, and menstrual irregularities.

This is the time when the emergency backup system is activated to maintain homeostasis. The autonomic nervous system is on full alert. The body can be flooded in a sea of adrenaline. For many, this is a wake-up call that their adrenal glands are in deep trouble, with rapidly declining adrenal function, as shown below:

Knowing the body's constitution and using that parameter to design an optimized recovery program for Stage 3C is a sign of clinical excellence because the weaker the constitution, the faster the decline and the slower the recovery. Not factoring this in is a common mistake, and might delay or worsen the recovery outcome.

The following graph illustrates how the body's constitution affects the recovery phase of Stage 3C Adrenal Fatigue recovery.

It is evident from the above that the degree and speed of recovery varies greatly, depending on one's constitution. Let us now examine each recovery pattern in relation to the constitution in detail.

Very Weak Constitution

While only a small percent of the general population is constitution very weak, they are the most desperate when afflicted with Adrenal Fatigue. The following diagram shows why:

After an adrenal crash, there is no noticeable recovery. The body may go through a period of stabilization, but even this is marred with multiple minor crashes along with intermittent major ones, where energy drops 30% or more compared to the immediate pre-crash level.

Severe symptoms such as hypoglycemia, low blood pressure, and insomnia continue to persist and get worse over time. Normal daily activities are severely disrupted. It is not unusual to spend much of one's time in bed or on the couch. Many are bedridden after a long time. Not only has recovery failed, but also the energy level continues on a sloping downhill path. Ultimately there will be some form of crash that pushes the key adrenal hormones and functions below that which is necessary for basic normal adrenal function. The time frame varies, but this is usually a matter of months if no attention is given to nurture the adrenals back to health quickly. The body then enters into a state of emergency that keeps only the most basic functions going while the rest (like gastrointestinal, reproductive function) are compromised. Any use of stimulatory natural compounds or prescription drugs may result in a brief sense of well being at best, but this quickly backfires and makes the situation even worse unless under expert professional guidance is solicited.

Weak Constitution

Those with weak constitutions are likely to experience a noticeable but mild recovery after a major crash into Stage 3C. The graph below shows the general recovery pattern.

There might be a sustained period of gradual improvement, but progress is generally slow. Minor crashes and setbacks are expected along the way. After a while, a plateau is reached. The body does not seem to be able to do any better and more rest does not seem to increase the energy level of the body. Normal daily activities may be carried out on good days, but bad days are common and rest is needed. The body is marginally functional at best. When a new stressor hits, there will be inevitable follow-up crashes, lowering the adrenal functions along the way, like series of small steps going down. With each crash, there is a period of stabilization. These periods of stabilization may be accompanied by a slow gradual reduction in energy level, or at best, maintain the same energy level. Follow-up crashes tend to be more and more intense and severe, with longer recovery times each time. Invariably, the body will experience a major crash and enter into Adrenal Fatigue Stage 3D. After a brief pause and declining stabilization period, adrenal failure may ensue. Compare to those with very weak constitution, those here can consider themselves fortunate as the natural progression of the condition is somewhat slower with intermittent periods of functionality. Unfortunately, there is no escape from the ultimate outcome if nothing is done to help the recovery process.

Normal Constitution

Most people fall into this category. Adrenal Fatigue comes on slowly and gradually over years or decades. Most are not aware that they have Adrenal Fatigue until they enter Stage 3. If a crash does occur, they are likely to be able to mount a reasonable and moderate level of recovery over time. Unfortunately, this cannot be sustained, as shown below:

This recovery pattern after a major crash into Stage 3C is characterized by significant improvement in energy over time. Rest is welcomed but sometimes not required as the body's biological constitution is strong enough to sustain some setbacks. Minor crashes surface periodically, but are still manageable to handle. The setbacks tend to be rhythmic in nature. Taking afternoon naps and sleeping early helps tremendously. A full recovery back to the asymptomatic level above the Adrenal Symptoms Threshold (AST) is usually not possible, though it could be close. They remain symptomatic below the AST, but are far better than they were at the peak of the crash. There is always some discomfort, though the unpleasantness can be reduced with proper rest and lifestyle adjustments.

The body needs frequent rest to cope with fatigue, but is not permitted to because these people, with normal constitutions, are used to full and active lifestyles. Most of them are usually in denial for a extended period of time that the body is in trouble. As compared to those who has been constitutionally weak all their life and used to slowing down and taking naps during the day, these are fully productive individuals and are not used to giving the body rest other than at the end of the day.

Balancing between work and rest becomes a constant struggle. Compliance becomes a major issue even when under professional care. With insufficient time spent nurturing the body back to health; this is a set up for inevitable crashes to follow. With each crash, the body tries to mount a recovery effort. At first the recovery effort brings relief, but over time as the adrenals get weaker with continued crashes, the recovery curve tends to be stable at best. Ultimately, the many crashes followed by the flat stabilizations resemble stairs going down. This process can last for months and even years. Eventually, the body's reserve is so low that it crashes and enters into Stage 3D Adrenal Fatigue. After a final stabilization period, adrenal failure risk becomes high.

Strong Constitution

Those with a strong adrenal constitution usually are able to mount a significant recovery steadily from Stage 3C. The recovery curve is smoother than those with normal constitution because the body is better able to absorb setbacks. Eventually, the body is able to return to the level of function above the adrenal threshold level (AST) and become asymptomatic. Those who are fortunate will have a sustained period of symptom free. Ultimately, however, this fails with time, as shown below:

Compared to those with weaker constitution, those here do recover on their own to a point that normal daily function is uninterrupted. This asymptomatic period may be sustained for years. On the outside, they appear cured and totally normal. On the inside, the body is struggling to stay asymptomatic as it stays marginally above the Adrenal Symptoms Threshold.

There may be occasional minor crashes but recovery is relatively fast. During these crashes, symptoms are unpleasant, but tolerable. They may be able to continue full time employment. This can go on for decades. Some try to self-administer natural compounds to stimulate energy production when fatigued. Because the symptoms are marginal, they do not see a need to visit their physician for help until quite late.

Eventually, with aging, and if stressors are not removed, a major stress event may come, such as the death of a loved one. Due to the lack of preparation, this normally comes as a surprise. Sufferers tend to push themselves more when this happen as they deny Adrenal Fatigue exists. The fact that conventional western medicine does not recognize this condition complicates the matter further. Sufferers lose valuable time that should be used to nurture the body to rebuild the adrenal reserve that is slowly but surely dwindling. Eventually, crashes become more frequent and intense. Recovery becomes less successful, and the inability to stay asymptomatic after a crash eventually becomes the standard. Eventually, the body crashes into Adrenal Fatigue Stage 3D and ultimately ends in adrenal failure.

Message from Dr. Lam

I hope you have enjoyed reading this article. If you have areas you don't understand,
or if you have a specific health concern, feel free to write to me by clicking here.

About The Authors

Michael Lam, M.D., M.P.H., A.B.A.A.M., is a western trained physician specializing in nutritional and anti-aging medicine. Dr. Lam received his Bachelor of Science degree from Oregon State University, and his Doctor of Medicine degree from the Loma Linda University School of Medicine in California. He also holds a Master’s degree in Public Health. He is board certified by the American Board of Anti-Aging Medicine where he has also served as a board examiner. Dr. Lam is a pioneer in using nontoxic, natural compounds to promote the healing of many age-related degenerative conditions. He utilizes optimum blends of nutritional supplementation that manipulate food, vitamins, natural hormones, herbs, enzymes, and minerals into specific protocols to rejuvenate cellular function.

Dr. Lam was first to coin the term, ovarian-adrenal-thyroid (OAT) hormone axis, and to describe its imbalances. He was first to scientifically tie in Adrenal Fatigue Syndrome (AFS) as part of the overall neuroendocrine stress response continuum of the body. He systematized the clinical significance and coined the various phases of Adrenal Exhaustion. He has written five books: Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs, The Five Proven Secrets to Longevity, Beating Cancer with Natural Medicine (Free PDF version), How to Stay Young and Live Longer, and Estrogen Dominance. In 2001, Dr. Lam established as a free, educational website on evidence-based alternative medicine for the public and for health professionals. It featured the world’s most comprehensive library on AFS. Provided free as a public service, he has answered countless questions through the website on alternative health and AFS. His personal, telephone-based nutritional coaching services have enabled many around the world to regain control of their health using natural therapies.

Dorine Lam, R.D., M.S., M.P.H., is a registered dietitian and holistic clinical nutritionist specializing in Adrenal Fatigue Syndrome and natural hormonal balancing. She received her Bachelor of Science degree in Dietetics, holds a Master’s Degree in Public Health in Nutrition, and a Master of Science degree in Nutrition from Loma Linda University, in Loma Linda, California. She is also a board-certified, Anti-Aging Health Practitioner by the American Academy of Anti-Aging Medicine. She coauthored with Michael Lam, M.D., the books Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs and Estrogen Dominance and numerous articles on Adrenal Fatigue Syndrome. Her personal research and writing focuses on the metabolic aspect of Adrenal Fatigue Syndrome. She is married to Michael Lam and is an integral part of the telephone-based nutritional coaching team helping people overcome Adrenal Fatigue Syndrome.

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