Approaching Adrenal Insufficiency

By: Michael Lam, MD, MPH

Our Approach to Adrenal Fatigue

An informed medical professional is needed with adrenal insufficiency

We are frequently asked how our approach to Adrenal Fatigue is unique. Our approach involves the total body in the following ways.

First, we place great emphasis on helping the whole individual, factoring in each person's unique history, constitution, environment, emotions, values, nutritional states, as well as on his/her physical symptoms. Our approach is to take the time to know the body first, and then to nurture and support the body naturally so it will heal itself. Why? Because we believe that is the best permanent solution from our experience.

Second, our primary focus is long term sustainable recovery without crashes rather than symptoms suppression which is seldom successful long term. Many symptoms of adrenal insufficiency such as insomnia, hypotension and hypoglycemia tend to improve when the adrenals are healthy. We try to separate the smoke from the fire, so to say, and direct our attention at putting out the fire instead of tending to the smoke.

Third, we focus on helping each person understand the kind of body they have to live with, and how to listen and interpret the signs of their body. This is important because our goal is to get each person to take care of himself/herself in time and eventually take control of their health and properly self-navigate. This is the ultimate solution because conventional medicine is unlikely to be of much help for many years to come in regards to this condition. To see how these three focuses are involved in our approach, let us consider the following questions from a reader and our responses.


I understand that stress causes excess cortisol production, which depletes Vitamin C in the adrenal gland. At the same time, Vitamin C supplementation reduces excess cortisol. So how can Vitamin C help increase cortisol and at the same time reduce it?


One of the things Vitamin C does is to help cortisol production. Cortisol, however, is NOT the total answer to Adrenal Fatigue. That is very important to understand, though it holds the key to many symptoms. Vitamin C's mechanism of action touches many very important and different pathways within the body in addition to helping cortisol production. The basic science of Vitamin C involves redox pathways and how the body transfers electrons and deals with oxidation. This is highly technical and falls within a discipline called oxidative medicine.

Vitamin C does not reduce cortisol production directly. Cortisol itself has a negative feedback loop once the body perceives it has an adequate supply at any point in time, even though lab measured cortisol may be low and one may still have symptoms of adrenal insufficiency. (That is why lab results are sometimes NOT very reliable indicators, among many other reasons, especially in those with advanced Adrenal Fatigue). Ultimately, by facilitating better cortisol balance and regulation, Vitamin C helps play a part in cortisol normalization. So you see that multiple pathways are at work.

Our linear thought process does not work well with understanding Adrenal Fatigue because things are much more complicated than what meets the eye. This is compounded by an ever-changing body and our lack of understanding of the underlying physiology and thus we are prone to making false assumptions. This is the common pitfalls of modern medicine in Adrenal Fatigue - the application of a single-focus symptoms suppression strategy in a multi-factorial ever-changing environment. You can see this clearly in the case of Vitamin C. Once you understand how Vitamin C works within a multi-pathway scenario, the picture becomes clear. Both the body and Vitamin C behave logically.

The above question was asked because of the lack of understanding of Vitamin C and how the body works. Without an understanding of how the body works in a holistic way, it is not possible to have an effective Adrenal Fatigue recovery program. We will take some time now to expand on this here as well because it serves to make it more clear why we approach Adrenal Fatigue the way we do.

Our Approach to Adrenal Fatigue

First, most people in advanced Adrenal Fatigue have multiple convoluted and concurrent issues involving many other organs such as the thyroid and neurological systems. Cortisol is one of the key connecting points, but seldom the only one. One cannot explain ALL symptoms of adrenal insufficiency by cortisol dysregulation alone in most cases. That is why the Adrenal Fatigue toolbox needs many different tools in addition to Vitamin C to approach different pathways ranging from metabolic to neurological. Vitamin C alone is not a panacea that works for all situations. In some people it can have backfiring effects, and these may not be related to cortisol at all. Each nutrient works through multiple direct and indirect pathways, and each is important. This is very different from drugs where predictable single pathways are the predominant mode of action in most situations.

Second, each nutrient has its own positive and negative balance as it relates to the body. That is why Vitamin C and cortisol work better for some than others. You have to look at the root issue to really understand. The recovery process is like trying to cross a river with lots of rapids and when you are blind-folded. You have to feel your way through, slowly and carefully. As strange as it may sound in modern medicine, this approach was actually the norm for centuries and now is an endangered and missing art. In fact, being overly dependent on laboratory results is a common mistake in modern medicine, when it comes to internal medicine, due to many shortcomings associated with laboratory testing. The most astute health practitioners will use laboratory results as a supporting tool and make recommendations based on their experience. In the case of Adrenal Fatigue, this is even more important where our understanding is still in its infancy and laboratory results are not very reliable.

Third, the body changes all the time, especially when it is not stable. That is why Adrenal Fatigue recovery is so challenging. The deployment of any nutrient, diet, exercise, or lifestyle change requires personalization for optimum recovery. To effectively shape the best recovery from Adrenal Fatigue over time, gradually, and without crashes, (which is a hallmark of clinical excellence), we need to assess the situation on a real time basis, consistently and systematically, using nutrients and various challenges.

Fourth. To understand the role of any single component of a recovery program, whether it be nutrition or diet, we really need to look at the whole person's intrinsic root weakness as the starting point. Each person is unique, and Adrenal Fatigue may just be a symptom of underlying root dysfunction. It takes some time to sort it out properly. For example, some people have overwhelming ovarian weakness expressing as Adrenal Fatigue. While Vitamin C and cortisol may support the adrenals and reduce fatigue, the ovarian issues can continue to haunt the sufferer for years thereafter. Fatigue may improve, but brain fog, anxiety, estrogen issues etc. persist. Adrenal Fatigue therefore may be an indicator of internal dysfunction and we are always on alert for that - to figure out the root cause.

Recover from adrenal insufficiency takes time

If you understand the above points, then you will understand why our approach as a result is very much holistic and not simply symptoms driven. We see this as the only effective long term solution from our experience. Those who want a quick fix will find our approach disappointing, even though it is already faster when compared to other approaches and far more gentle. But expectations are hard to manage because each person has a different timeline. I tend to say goodbye to those I find who are too focused on quick fixes, because while it is relatively easy for me to stimulate them to enhance energy, it is likely to eventually backfire.

Most people don't realize that I can affect their recovery only as fast as their body will permit to effect long term sustained recovery, and each everybody is different. I can only facilitate, and not mandate what the body does. Some do well in a short time, others may take a long preparation period to get the body to kick in, so to say. Those who are older or constitutionally weaker face the biggest challenges. If the desired result is not achieved, there is usually a very good reason behind it. No amount of water can put out a fire if oil is being added on the side, and for those in this category, it takes a systematic approach to figure things out, one step at a time. If you look deep enough, you can usually find an underlying reason. Those who focus on understanding their body will likely find it, and we try to educate and facilitate that process.

Those who are primarily interested in finding fixes (as conventional medicine has somewhat conditioned us to do) will eventually give up because their body will rebel and not cooperate. The source of the problem is within, and nutrients are used as a support to sculpt long term internal changes. That is our primary focus - long term, sustainable recovery. That is why we ask each client to keep a journal and we try to teach them what their body is telling them each day and with each crash. It is a learning process. Those who are good students will find recovery a process that is enjoyable despite what appears to be stagnation and crashes from time to time.

We try to explain many of these important concepts in the various articles in my site, especially the one called Adrenal Crash and Recovery Cycle. It is common for many who are persistent but see little dramatic initial results to thank me four to six months later for their permanent improvement which can only be grossly evident when they look back after that amount of time. That is the beauty of allowing the body to heal itself. However, for some, it takes longer than their patience allows.

A few months is a short time to repair a body that has decades of harm done to it, not to mention a strong component of personality traits that may be involved. So the issue of cortisol and Vitamin C posed in the question, while important as it relates to adrenal function, must be put in proper perspective.

To effectively ensure a safe and gentle recovery, our approach starts with making sure the body is stabilized first. We follow this with qualitative challenges to understand each person's internal workings. We start by looking at the big picture and slowly hone down to the specifics, step by step. We avoid a symptoms management approach, which can make one lose sight of the big picture. Rushing into resolving the symptoms can give temporary relief, but seldom a sustained and total recovery from Adrenal Fatigue from our experience.

Most people with Adrenal Fatigue are inquisitive and rightfully looking for scientifically based answers. Those who are looking for a simple linear explanation and extrapolations will be disappointed because Adrenal Fatigue is anything but simple. We have spent years studying and are still constantly amazed at the many "exceptions" that come our way.

Focusing on trying to explain every single symptom or physiological pathway may be good psychological exercise for the ego, but often increases anxiety, drains the body of limited reserves, and retards recovery. All are undesirable. There is a gap between basic science for academic purposes and the clinical reality on the front lines, as exemplified by Vitamin C and cortisol in the context of Adrenal Fatigue. Those that recover fastest are generally those who follow instructions to a T and spend their energy doing what they enjoy in life.

Follow Up Question:

I am recovering well under your program, but have liver dysfunction as well. Is that common in Adrenal Fatigue and does that affect my recovery process?


Sub-optimal liver function is a common finding in AF; however, many have perfectly normal lab results. Interestingly, many get that way not only because only of constitutionally weak livers (often times but not always, there is a family history of liver problems, but this is hard because so many people have liver problems and not know it) but many with the best intention have over the years embarked on various cleanses to detox which may compound the problem without knowing it. Detoxing can increase energy and make one feel better if they are in good health, and detoxing is a noble endeavor. However, if the body is not quite ready, it can have a stealthy and silent slow backfire effect that few pick up on if not astute and already looking for it. This is because the liver is a big organ with lots of reserves (you can survive very well with a large part removed surgically, for example), so you don't feel it until the very end, so to say.

If this is the case, the key is to give time for the problems to be worked out, and this can mean months and letting the body become ready. The focus is not about stimulating the detox pathways (as most people do) which may increase the liver's work load and can become counterproductive. The better approach then is to allow the cells to heal themselves. That takes time. In the meantime, we continue the rebuilding processes and stay focused on the ortho-molecular level. We do not lose our focus. In most cases the body will reward you eventually by resetting itself positively, and when that happens, the improvement can be quite dramatic. Those in this situation will find our approach very slow but it is for a purpose. They may get discouraged. From time to time, we will challenge the body and see if any progress has been made. It's like restoring an old building; it is a lot of work but without a lot to show until the very end when things all come together.

Cases like this require patience which many people do have. However, those who do not have patience, and those who crash because they do too much as soon as they feel better, will have setbacks. This happens frequently for those who are self navigating, as they don't have a resource to go to when crashing to minimize it, and eventually they get confused and give up. That is the sad part because they will then jump to another approach and start the same cycle again.

The key is to figure the body out as we go and learn from the body's signals, since the body is always right. That is the gold standard. The problem is most of the time we don't know how to interpret the signals or interpret them wrongly if inexperienced. Even with experience, some trial and error is normal due to poorly understood pathways. Most of the time, the body leaves us clues if we look hard enough. Those who do very well in terms of recovery, especially if they are older and no longer young and strong, are invariably the patients and good students that follow instructions to a T.

The worst thing one can do is to try to figure out every detail and second guess the body's responses or get disappointed when the body does not respond the way we like. This negativity will only worsen and weaken the already fragile adrenals. Leave the why and how to the professionals and concentrating on following instructions is the smartest action for most who are not scientifically minded. This is better than wasting precious energy to figure it out and still not getting the answer because no amount of science can factor in each person's unique environment and unpredictable responses that so commonly occur in advanced Adrenal Fatigue.

The best use of current resources in this time is to get the mind totally off the Adrenal Fatigue and focus on something else. Have a life, as some say. Give the mind and the body a rest. The more time and energy wasted on figuring out why things are not working and getting all wound up, the slower the recovery will be. Eventually, some give up, blaming nutrients or something else. That is why sometimes I do not connect with those in this that situation for a few months because I don't think their body is ready for recovery at that point.


Our philosophical approach to Adrenal Fatigue is unique because we focus on the whole person by understanding its internal workings first. Then we support and nurture it back to health with a systematic and personalized program of natural compounds, dietary, exercise and lifestyle suggestions. Our experience shows us that the body in most cases is capable of healing itself if given the right tools. We try not to rush in and embark on a symptoms suppression program without consideration of the deeper root pathology involved, because the body is constantly changing, our approach calls for consistent monitoring and the use of numerous qualitative challenges to assess the body's state constantly, so recommendations are made on a real time basis. Laboratory testing is used when needed. Just as important in our goal is to teach you how to listen to your body, how to live with it post recovery, and how to prevent recurrence in the future.


© 2005  Michael Lam, M.D. All Rights Reserved.

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