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Adrenal Fatigue and Laboratory Testing
By: Michael Lam, MD, MPH and Dorine Lam, RD, MS, MPH

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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.

Routine Laboratory Tests

The most common presenting complaints of Adrenal Fatigue are lack of energy, lethargy, dizziness, insomnia, hypoglycemia, low blood pressure, and anxiety. Routine conventional medicine workup for these in an otherwise healthy person commonly include:

  • Hematology (full blood count (CBC) - red cells, white cells and platelets to make sure patient is not anemic.

  • Biochemistry (liver and kidney function) to rule out systemic organ damage.

  • Inflamation in the blood - ESR, C reactive protein, plasma viscosity to rule out autoimmune diseases, among others.
  • Cancer markers for early detection of cancer.

  • Blood Sugar level to rule out diabetes mellitus.

  • Urine testing to rule out infection or kidney damage.

  • Fecal occult blood to rule out bleeding from the gut and cancer screen.

  • Electrolyte panel to assess kidney function.

  • Thyroid stimulating hormone to rule out primary thyroid failure.

These tests are good in detecting macroscopic pathology such as major organ failure including anemia, heart disease, metabolic dysfunction, cancer, liver failure, kidney failure, thyroid diseases.

Unfortunately, these routine tests do not detect organ dysfunction at the sub-clinical level such as those afflicted with sub-clinical hypothyroidism, Adrenal Fatigue, mild liver dysfunction, imbalanced electrolyte function, minor hormonal imbalance, estrogen dominance, and suboptimal detoxification capacity.

In addition, little if any attention is paid to laboratory values that lie close to or just outside of normal range. Low normal or high normal values are generally passed over as insignificant until the result is much higher or much lower than normal range.

Modern medicine has also ushered in a wide array of standardized protocols of testing in addition to the number of tests. These well-intended tracks are meant to efficiently and effectively handle most common medical problems with accuracy and speed. They are by definition fitting for the masses. Those whose response falls within the statistical norm but physically symptomatic will be inadvertently ignored as they will be considered normal when they are not. In these cases, conventional medicine has little to offer. Instead, normal laboratory values are used to justify why patients are sent home to self-navigate, and that nothing is wrong when the body continues to suffer.

Unusual and convoluted clinical states such as those suffering from chronic fatigue syndrome, Adrenal Fatigue syndrome, tension myositis syndrome, and estrogen dominance are difficult to diagnose to start. Conventional physicians usually dismiss these conditions because routine test values are invariably within the standard laboratory reference range. This is why it is most frustrating to the patient—when they are told there is nothing wrong while they feel physically tired and lethargic.

Prior to the advent of modern medical laboratory tests, the astute physician had to rely on a detailed history and physical examination to assess the clinical state. Laboratory values are used only in case of doubt, or as a confirmatory tool. Unfortunately, this is fast becoming a lost art in the clinical practice of medicine. The failure of conventional medicine to be on alert and to recognize that a person can be ill but have normal laboratory blood test results is alarming. Many sufferers are sent home to self-navigate and are abandoned by the very health professionals who are supposed to help them recover.

To make matters worse, most conventional physicians are not nutritionally oriented or trained. Even if laboratory tests come back abnormal, they are at a loss on how to correlate it with clinical findings when the presentation is overwhelmingly convoluted as one sees commonly in Adrenal Fatigue.

When Normal is Not Normal

To illustrate how a normal laboratory test can be present in a body that is not well, let us consider the following:

  • Most Adrenal Fatigue sufferers have low immune function present with frequent infections but normal white cell count. Low or low normal white cell count can be a sign of poor immune function. Nutritional deficiencies, such as low zinc, low magnesium, low B vitamins, and low essential fatty acids can contribute to this. Normal white cell count does not rule out these problems at the sub-clinical level.

  • Normal platelet count does not rule out stealth viruses or a residual bacterial infection, such as that seen in post-acute Epstein-Barr virus infection. Low or low normal platelet count can be a sign of toxic stress from viral or emotional forces.

  • Borderline or high mean cell volume (MCV) suggests B12 deficiency, folic acid deficiency, or hypothyroidism. Normal MCV can occur with sub-clinical B12 deficiency in those who are constitutionally weak or sensitive.

  • A normal fasting blood sugar in absolute terms associated with clinical hypoglycemia is common in advanced stages of Adrenal Fatigue.

  • Normal electrolyte levels do not rule out the presence of debilitating sub-clinical dilutional hyponatremia seen in advanced Adrenal Fatigue.

  • A normal thyroid Free T3 and Free T4 do not rule out secondary subclinical hypothyroidism due to pituitary or adrenal dysfunction.

  • Normal aldosterone level with salt craving and low blood pressure is commonly found in Adrenal Fatigue. Both serum aldosterone and sodium levels are usually within normal range.

  • Normal potassium level does not rule out the need to reduce internal potassium load. In Adrenal Fatigue, sodium depletion is common, leading to a relative (and not absolute) potassium overload that is still within normal laboratory range on testing.

  • High normal liver enzymes usually suggest liver dysfunction, typically from chemicals such as medications, or poor nutritional status. Normal liver enzymes are commonly associated with poor clearance of metabolites in Adrenal Fatigue as the body slows down to conserve energy.

  • High normal or high total cholesterol could mean low levels of vitamin D or hypothyroidism commonly seen in Adrenal Fatigue and does not necessitate the administration of statin medications to normalize lipid level.

  • A normal TSH can be present in those with clinical hypothyroidism. In other words, you can be suffering from hypothyroidism but have normal TSH levels.

As you can see from the above, just because laboratory test results are within normal range does not necessarily mean a person is free of illness. Many chronic illnesses, including Adrenal Fatigue, progress over time slowly. Sole reliance on routine blood serum laboratory tests for definitive assessment is a grossly incomplete approach to start in the case of Adrenal Fatigue.


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 www.DrLam.com 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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