Adrenal Fatigue and Body Constitution – Part 1

By: Michael Lam, MD, MPH; Dorine Lam, RDN, MS, MPH

What is Body Constitution?

Body constitution determine how Adrenal Fatigue affects a suffererCommonly, body constitution refer to the appearance of a people 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 constitution, 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.

Adrenal Fatigue Syndrome 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.

Body Constitution and Genetics

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. 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 Body Constitution

The best gauge of body 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.

Adrenal Fatigue bell curve of body constitution

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:

Chart of Adrenal Fatigue stages and body function, which can be affected by body constitution

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.

Adrenal Fatigue recovery pattern based on body constitution

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.

Read Part 2 | Part 3

© Copyright 2013 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

The environment temperature does help to warm the body more during the summer. In winter, the environment is colder, and the body needs to increase metabolism to keep warm. If it is unable to do so, as in hypothyroidism, then symptoms of low thyroid tend to be exaggerated.

Body constitution determine how Adrenal Fatigue affects a sufferer
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Hi Dr. Lam, I actually found your website by accident and was thrilled when I did! Seven years ago, I discovered your Tai Chi exercises. I wanted to say thank you for doing your videos, I was going through breast cancer and they calmed me down and gave me needed oxygen in my body. Actually, 14 months after my first cancer, the cancer returned or never left! My doctors urged me to do chemo therapy again, but I refused and cured my own cancer with my diet, exercise, guided imagery and a very positive attitude. It is so true that we must heal our whole body, not just parts of it. Today, I am a partial vegetarian, that does not consume chemicals or preservatives and I eat right for my blood type. I am also thankful for my naturopath and my desire to always keep learning about health and wellness! I am so happy that I am still here to see my children grow up! Thank you for your awesome information, I really appreciate it!


  • Adaline says:

    Great read. I had no idea physical or emotional trauma could amplify the adrenal’s constitutional weakness. It’s interesting how the way you respond to stress can affect your epigenome; never considered that.

  • Kaleb says:

    Thank you for explaining the differences between body types and healing.

  • Lynne says:

    How long does it take to rebuild your body’s constitution?

  • Abreham says:

    Can you restore body constitution through diet and exercise alone?

  • Julie says:

    Dr. Lam, How can I discover my body constitution?

    • Dr.Lam says:

      The best way is by detailed history and challenges. These are qualitative methods as there are no quantitive methods at this time.


  • Stacey says:

    if a mother has adrenal fatigue when she is pregnant, is it almost certainly passed on to the fetus? how would one be able to tell with an infant if there is some type of adrenal issues?

    • Dr.Lam says:

      The body has auto compensation mechanisms. The more advance the AFS, the higher the chances of being inflicted onto the fetus. There is no technology to allow us to identify AFS in infant at this time.


  • Leticia says:

    if your constitution ends up very weak, is it possible to bring it back to very strong?

  • Charit says:

    I’ve always felt i had a very strong constitution. However, about 7 years ago I had a very traumatic experience and ever since then i feel like I am just weak and getting weaker by the day. I can barely tolerate putting anything into my body. this article really makes a lot of sense to me.

  • Janet says:

    can trying to balance out the neurotransmitters cause you to have more fatigue or make the adrenals worse.

  • Kennedy says:

    Wow, this is an interesting article. I had never thought of my body constitution. It puts a different perspective on life. Thanks.

  • Mia says:

    What is the relationship between Stress, Cortisol, and our Immune System. Is it a combination of all 3 that makes us get sicker more often compared to others?

  • Marsha says:

    Do neurotransmitters affect your constitution?

    • Dr.Lam says:

      Imbalance neurotransmitter can weaken you. Most of the time, its the weak consitution that affect neurotransmitter balance.

      Dr Lam

  • Zamfirescu says:

    excellent statement about constitution
    I am a doctor, 80 years, and suffer for years on an adrenal fatigue wich is at the stage of 3c. Since my childhood I have a very weak constitution.
    Your book was a great help for me. Thank you.

  • Missy says:

    I like the graphs! Helps me have a better visual in understanding the body’s constitution in stages of adrenal fatigue!

  • Arletta Sloan says:

    I’m a little confused. Which is mostly due to the fact that I am brain foggy and tired most of the time. I couldn’t finish reading all this right now. But, what you said, the mention of constitutions reminded me of something a doctor told me once.

    He said except for the fact that I get ill a lot, I am supremely healthy. Other things, too, over time, said he – which all amounted to, basically, telling me that there are factors that cause me to be tired and feel ill, but, that I have a body that wants to heal and be strong.

    I think that would count as having a good constitution, yes? Anyway, it sounded a lot like hope.

  • Courtney says:

    are conditions like PCOS and Estrogen dominance major factors in the bodies constitution in adrenal fatigue recovery?

    • Dr.Lam says:

      They are, especially if the body is sensitive. Remember there are always a lot of individual variations.

      Dr Lam

  • Dr. Jeffrey M. Moore, DC says:

    I have not seen any mention of the hypothalamic-adrenal-pituitary axis. Dr. Harrower’s chart shows the connections of the endocrine system in its inhibitory and excitatory influences. I will also mention Dr. Janet Lang and Dr. Annette Shippel, two of the several doctors who have taught seminars on adrenals and the endocrine system

  • Jayna says:

    I must show my friend this article as we have often talked about this, she has had a weight problem since very young but has always ate and exercised extremely well.

  • Faye says:

    Can mental mindset alter the expression of one’s genes?

  • Fred says:

    Great article! it greatly helps as i am more of a visual learner. i can understand now how my body constitution correlated with my recovery time.

  • Secorra says:

    What ways can you help burn body fat, specifically on the stomach?

  • Angel says:

    I had never thought of gauging my body type. This was a good read. Thank you.

  • Jenny says:

    I was prediabetic at age 7 and severely overweight my entire childhood, I was also a very sickly child in and out of the doctors office almost constantly. At age 19 I dropped down from a size 22 to a size 6 over the course of a year. I felt great at first, I didn’t even have a cold for almost a year, but now that I seem to have hit a plateau on my weight two years later, I feel extremely worn out and notice I am beginning to fall ill more often. I continue to maintain a healthy diet and regular exercise, although exercise is having to cut back more and more. I’m not sure what’s going on?

    • Dr.Lam says:

      Too rapid a weight loss can upset the body’s metabolism. those who are weak or have preexisiting weakness can be so severely damaged that it cannot mount a compensatory response to rebalance itself. you need to see a doctor who understand metabolism to really put a handle on this.

      Dr Lam

  • Jared says:

    Wow. The amount of information given on this website is incredible. Kudos to the maker and a special thanks to Dr Lam for all the research you have put in.

  • Nicole says:

    The section on body constitution was fascinating, because it helps me to understand the correlation between your body’s strength and the strength of your adrenal gland.

  • Mel says:

    What’s the best way to determine the body’s constitution?

  • Zerrick says:

    Interesting read Dr. Lam, thank you. Is there a graphical representation of body types available? I’m more of a visual learner. Thanks again!

    • Dr.Lam says:

      There is no graphical representation because when it comes to constitution, we are looking at cellular function at the orthomolecular level. A very detailed history is what is necessary by experienced clinician who knows what to look for. We are not looking at the physical shape of the person

      Dr Lam

  • Mary says:

    Thank you.