Total Body Approach to Adrenal Fatigue

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


Find out your body type and how you should approach Adrenal Fatigue. Our knowledge of Adrenal Fatigue is still in its infancy. Due to a lack of research and medical education, most conventionally trained health care practitioners are not well informed in this area. Many people afflicted with Adrenal Fatigue are left to self-navigate. Few sufferers know their clinical standing in terms of severity. This is compounded by the fact that clinical presentation of Adrenal Fatigue varies greatly, depending on the stage. As a result, there is tremendous confusion on how to help those in need, with no standardized recovery protocol.

Existing recovery approaches among clinicians varies greatly. Each practitioner's approach is primarily derived from his or her own experience. Clinical expertise in Adrenal Fatigue invariably comes from handling many severe cases over a long time. The recovery toolbox contains many tools. It includes a wide variety of medications, hormones, glandular, herbs, vitamins, and combinations thereof. In addition, a host of adjunctive facilitators including lifestyle, diet, detoxification, and exercise regiments may be added. Despite this comprehensive arsenal of recovery tools, complete Adrenal Fatigue recovery remains elusive and unattainable by many, leading to a common misconception and myth that this condition is virtually impossible to overcome once seriously afflicted.

As compared to other well-established health conditions, the philosophical basis of the approach to Adrenal Fatigue recovery is largely under-investigated. In addition to a lack of medical knowledge on this condition, there is a dichotomy of clinical expression to start. Mild Adrenal Fatigue exhibited by those in early stages often goes undetected. Symptoms arise intermittently without clear consistency. Those who are symptomatic usually recover, under the right hands, within a short time. Even some self-navigation effort can be fruitful. The body has more reserve and is able to tolerate more recovery trials and errors without crashes or setbacks. Severe forms of Adrenal Fatigue, on the other hand, can be very incapacitating. Some in advanced states may be house-bound and even bed-ridden in severe cases. Ambulatory assistance may be required. Proper recovery requires extensive clinical experience, patience, and a systematic approach due to the body's depleted reserves and high levels of sensitivity.

Our clinical approach is a fruition of the knowledge from handling many severe cases through the years. Because many come to us as last resort after conventional medicine and traditional naturopathic ways fail, we are exposed to the most severe cases. Over the years, these advanced cases have served to inform us on how to best help those afflicted.

Our philosophical approach involves four foundational principals that are incorporated into a systematic personalized program. This program integrates conventional and holistic strategies to affect a comprehensive natural healing strategy we call the Total Body Approach.

Four Principals of Total Body Approach

First, we believe the body is a closed eco-system capable of self-maintenance and self-healing under normal circumstances. When this internal repair mechanism is overwhelmed by stressors, break down occurs. This is usually the result of excessive and/or chronic stress, either physical or emotional. The body then enters a state of decompensation, and symptoms surface as warning signs to us of internal derangement. Oftentimes, the weakest organ system of the body is the first one to give way. Those with constitutionally weak adrenals relative to other stronger organ systems may manifest as Adrenal Fatigue. Those with cardiac weakness may manifest as heart attack, and those with a weak gastric system manifest as gastric ulcer, just to mention a few examples. This is one reason why some people can have severe stress but no Adrenal Fatigue. They may develop cardiac disease instead, if that is their weakest organ system.

Adrenal fatigue, how does it work within the human body?

Once the downward decompensation cascade of one system is triggered, many other systems become sequentially affected because they are all linked internally via many hormonal axes. It's like a domino-effect. The result is a convolution of symptoms that can be overwhelming, involving many systems of the body concurrently. Thus, it is common to see insomnia, depression, arrhythmia, hypoglycemia, irregular menses, and hypothyroidism simultaneously in advanced Adrenal Fatigue: the weaker the adrenals, the more prevalent the symptoms. While some symptoms such as salt cravings and hypoglycemia are principally due to adrenal dysfunction, many other symptoms such as arrhythmia and depression are due to breakdown of other organ systems that otherwise are normal.

Second, while mild Adrenal Fatigue manifests itself predominantly as lack of physical energy, advanced Adrenal Fatigue usually manifests as a mind-body condition in addition to a pure physical dysfunction. The brain ultimately controls the adrenal function via the hypothalamus-pituitary-adrenal (HPA) axis and a variety of chemical messengers. Dysregulated responses from emotional states have a big impact on the adrenal function. Mind-body reactions as well as certain forms of hormonal imbalances, nutritional deficiencies, or heavy metal toxicity can produce a similar clinical picture. Target deranged systems include neurological, endocrinological, cardiac, psychiatric, and metabolic systems most commonly. Thorough knowledge of these systems from a basic science perspective is required. Each person's unique history, constitution, environment, emotions, mental, and nutritional states in addition to the often convoluted and pressing symptoms on hand are evaluated from the scientific discipline perspective as a whole unit instead of independent parts in order to have a complete picture of the overall clinical state. Ultimately, the best clinical solution needs to incorporate mental health balance in addition to physical support.

Third, symptoms are our friends and not our enemies. Symptoms are the only way the body communicates with us to tell us what it wants us to do. Symptoms in our view should be allowed to manifest in a controlled environment with minimum discomfort. Many symptoms of Adrenal Fatigue such as salt craving, hypotension, palpitation, and adrenaline rush, anxiety and hypoglycemia tend to improve when the adrenals are returned to health. As long as the body is not in acute crisis, it should be gently supported while the body is given a chance to heal itself. We gain insight into the body by observing along the way the body's symptoms during recovery. This does not mean that unpleasant symptoms are allowed to continue unchecked. What it means is that we are conscious to avoid entering a trap of simply focusing on symptoms removal only. We keep our eyes continually on the big picture using symptoms to guide us and support the adrenal's internal healing process so it can become strong on its own and resist future insult.

Recovery plans driven by overzealous strategies that are symptoms-based rather than nurture-based is seldom successful long term, and for good reason. The body is a perfectly balanced closed system. Symptoms are signs of underlying dysfunction. When we suppress symptoms of one system, invariably another system can be affected, often sub-clinically. In other words, suppressing symptoms of one organ system may trigger dysfunction of another system. Soon, symptoms become even more convoluted and overwhelmed when one dysfunction is superimposed with another dysfunction that is the side effect of the recovery effort. We see this commonly in conventional medicine when the side effects from medications are a major problem. The more medications prescribed, the more risk of side effects.

Fourth, we educate ourselves at every opportunity. We monitor very closely the side effects and potential harm that can come because of well-intentioned strategies as each body reacts differently. We recognize that it might be years before conventional medicine is of help to the current sufferer. It is therefore imperative that each of us learns to take control and self navigate properly. We therefore start with focus on educating each person with the type of body they have and what they have to learn to live with. We teach how to listen to and interpret the signs the body gives. We educate each one on how to live harmoniously with their body while taking control of their health. We teach the pros and cons of each tool within the toolbox and the reason for its use and what to look for as negative effects. We spend a great deal of energy educating rather than medicating.

To facilitate the educational process, we encourage sufferers to keep a personal journal. It is an important tool whereby we can interpret the body's signals in detail. It is a learning process. The serious student of our program faces their health issues with respect and finds recovery an steady and enjoyable process. They will also find themselves well prepared for any roadblocks along the way, as trial and error is unavoidable due to unique individual situations.

Educational Focus Case in Point

Let us consider a case in point on how important this educational process is. Mary is a 40-year old housewife who has had fatigue for over 10 years due to excessive emotional and physical stress. She has seen numerous clinicians but received no definitive help. After our evaluation, she was to start on a personalized nutritional, lifestyle, and diet program. She maintained a skeptical attitude, because prior attempts failed, and in fact made her worse. Part of our personalized recommendation asks that she increase her daily vitamin C intake. An inquisitive person, Mary spends considerable amounts of time on the Internet searching for solutions.

Following the research, she poses the following question:

"I understand that stress causes excessive cortisol production, which depletes vitamin C in the adrenal glands. So, I am okay with taking more as you recommended. But, my understanding is that vitamin C supplementation also reduces excessive cortisol. So how can vitamin C help increase cortisol and at the same time reduce it?"

Mary's question is a good one. One of the things vitamin C does is to help cortisol production. Cortisol alone, 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 oxidation-reduction pathways and how the body transfers electrons and deals with oxidation at the cellular level. Its effect within the body is therefore wide and varied. There are many forms of vitamin C and delivery system as well, each with its own unique characteristics and effect. Some are very stimulatory, while others are more gentle. Improper use is a common mistake.

Furthermore, 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. So, if the body's cortisol level is excessive, signals will be sent from the brain to the adrenal glands to reduce cortisol production. This may happen even though the laboratory cortisol level may be low and one can still have symptoms of Adrenal Fatigue. That is one reason why laboratory results are sometimes not very reliable indicators of adrenal function, especially in those with advanced Adrenal Fatigue. Ultimately, by facilitating a better cortisol output when cortisol is needed by the body, and allowing the cortisol negative feedback loop to carry out its own rebalance and regulation, vitamin C plays an important part in cortisol normalization and balance.

On the surface, the logic of science appears convoluted and conflicting. By educating Mary on how vitamin C works holistically and naturally within a multi-pathway scenario in the body, the picture becomes vividly clear. The body does behave logically after all. This is contigent upon receiving the right form in the right dose of the compound. Mary is now more confident about taking the recommendation. We are also educating her about what her body is saying when she reports back to us with her responses. In time, she will know much more about her body, and with that, a faster recovery.

Seven Steps of Total Body Approach

Utilizing the four guiding principals, here are seven specific steps we use to formulate and personalize our Total Body Approach.

  1. Know the Body. We take the time to know the body and its constitutional state in depth. There is no short cut for this most important foundational narrative methodology-- it takes time. This is confirmed qualitatively by a systematic customized plan to gently test and challenge the body while nurturing it. By knowing each body's unique response, we are able to then further personalize a plan specific for that body's needs to facilitate recovery. This is a laborious process, seemingly slow, and very time consuming. In reality it is the fastest way to facilitate overall recovery, as insights gained from this process helps us to avoid the risk of future crashes, which are major setbacks for any recovery program. Overall, total recovery time is therefore shorter and more pleasant.

  2. Determine the Dominant Dysfunction. To fully anticipate the body's reaction to any single component of our Total Body Approach, whether it is nutrient or diet, we identify each person's major intrinsic root weakness. The body as one unit is only as strong as the weakest organ system. The weakest system is also usually the first system to be symptomatic, and thus, the dominant dysfunction. Each person has one weakness that is uniquely more susceptible to insult comparatively speaking. For some, the thyroid may be the weakness, and hypothyroidism may be the first sign of internal weakness. For others, it may be gastric discomfort. Still others, it may be the cardiac system, with hypertension as the first sign. The organ system with the most dominant dysfunction is also the weakest link to the entire recovery effort. Therefore, it is important the dominant root cause be identified.

    It is not unusual for Adrenal Fatigue to represent numerous symptoms of underlying root dysfunction of other organ systems, including certain rare nutritional deficiencies, some forms of heavy metal toxicity, and many mind-body imbalance syndromes as mentioned earlier. This is perhaps why Adrenal Fatigue is so confusing. For example, some women have overwhelming ovarian weakness in addition to Adrenal Fatigue. While nutrients may support adrenal function and reduce this fatigue, the ovarian issues may continue to haunt the sufferer for years thereafter. Fatigue may improve, but brain fog, anxiety, PMS, and other estrogen-related irregularities may persist.

    Mind-body conditions, such as Tension Myositis Syndrome (TMS), can also manifest itself in many symptoms shared by sufferers of Adrenal Fatigue, such as depression, anxiety, energy loss, IBS, reduced immunity and muscle pain. Neuroscientists and mind & body specialists now confirm that the mind's well-being is closely tied to the body's function at both the clinical and sub-clinical level. This powerful connection cannot be underestimated - imagine biting into a chilled pickle, and most people will begin to salivate. Similar and less obvious responses happen inside our body all the time, and they are mediated by numerous chemical messengers which are directed by the mind. Given this understanding of how the mind & body interact, Adrenal Fatigue may be seen as an indication of a wider variety of internal dysfunction, and we remain aware of this in our quest to determine the root cause.

  3. Determine the Clinical Stage. We try our best to assess the body's clinical state of function and thus level of the adrenal weakness . Adrenal Fatigue in its mild form presents very different clinically from its more advanced form. Symptoms of mild and early stage Adrenal Fatigue may include insomnia, lack of energy, irritability, high blood pressure, salt craving, anxiety, and weight gain. Symptoms of advanced Adrenal Fatigue, however, can include hypoglycemia, low blood pressure, heart palpitations, weight loss, severe depression, and menstrual irregularities. Inexperienced selection of recovery tools is a common occurrence as many use the same tools previously successful in mild Adrenal Fatigue and find it backfires as adrenal weakness progresses. The right tools used in early stage Adrenal Fatigue can therefore actually worsen those in more advanced stages.

    Tools are simply facilitators of our goals. Regardless of what tools are used, the underlying governing strategic concept on deployment must be well understood in order for the ultimate goal to be reached effectively. This is seldom studied and emphasized. Yet, without a clear conceptual strategy on how and when to use these tools clinically, they can be easily misused with undesirable results. Knowing the clinical state will help us formulate the kind of tools to use, however, there is no one best tool that works all the time. As the body changes, the choice of tools has to change. Each tool valuable in its own right and the body's unique response varies greatly from person to person. What is beneficial for one person may be toxic for another, and indeed, may even be negative for the same person during the course of recovery as the body changes in its own state of function.

  4. Prioritize. We prioritize and time our moves in accordance with the body's readiness. Most people in advanced Adrenal Fatigue have multiple convoluted issues concurrently involving many other organs. Prioritizing our approach allows us to formulate a plan systematically and not lose sight of what is important at any point in time. We find that the best way to facilitate sustained recovery is to support the body's return to normal function, one step at a time. After each improvement in energy, we allow time for the body to adapt and use the time wisely to prepare for the next move. It is like climbing a set of stairs up, slowly and surely one step at a time. Too aggressive or too quick an improvement may indeed be a danger sign as it is usually followed by subsequent crashes. Our preference is a gradual and enjoyable steady path to recovery rather than one dominated by periods of euphoria followed by setbacks. Such a pattern can worsen the overall condition and retard the entire recovery process.

  5. Challenge. We use qualitative challenges to gain insight into the body's response prior to selecting the tools from the recovery toolbox in order to give the body the most gentle and nurturing nutrient possible.

    Thorough knowledge and understand of each challenge is essential. Both positive as well as negative responses provide valuable information. Proper nutrient selection matching the body's need is critical based on the challenge results. Each nutrient has its own positive and negative characteristics as it relates to each person's specific constitution. The best nutrient in one person can be toxic to another. This is very different from drugs where predictable single pathways are the predominant mode of action in most situations. Even well intentioned experienced clinicians using natural compounds are often blindsided during the recovery process by an ever-changing body. We are mindful of each nutrient's strength, and weakness and are always open-minded and on the lookout for alternative solutions.

    Medications may be needed from time to time to affect this, but in most cases, the body does a lot better with nurturing natural compounds. A major difference between medications and natural compounds is that the later works through many different pathways simultaneously, while prescription drugs tend to be much more direct and focused on select pathways.

  6. Monitor. We carefully monitor the body's reactions by following a listen- focused narrative approach with close follow-up. Due to the lack or objective and quantitative tests in real time to assess adrenal function in its clinical state, the recovery process is best described as trying to cross a river with numerous rapids. You have to feel your way through, slowly and carefully. Our Total Body Approach calls for taking many secured small steps without mishaps, one at a time, to facilitate this. We are constantly evaluating and updating our assessment. We get as close to real-time body reaction as possible by paying attention to the various signs and symptoms the body exhibits every day. We are especially attentive to how a body performs under challenges and reacts under stress.

    This listen-focused, narrative-based approach has been the norm for centuries in medical practice, but is now an endangered art form in modern clinical medicine, which is relying heavily on investigative modalities. The most astute health practitioners today will use many investigative tools, but the final decision is usually based on careful history, clinical insight, and experience. In the case of Adrenal Fatigue, this is even more important where our understanding is still in the infancy stage and laboratory results are not very reliable.

  7. Patience. Biological change takes time. The body is not a light switch that can be mechanically turned on and off at will like a light switch. We use gentle nutrients as a facilitator of internal change at the cellular level that is long term and sustainable without crashes.

Many do show signs of improvement within a reasonable period of time. Three months is usually the minimum amount of time required to fully understand the body in great detail and give the program a chance to work. As long as the body cooperates, most report great improvement, usually within three months or less. Too fast an improvment is often undesirable, as that is commonly followed by crashes. A gradual improvment is best. Sometimes a bit more fatigue can be experienced as the body recovers. If no improvement at all is noted over time, there is often a very good undercover reason. No amount of water can put out a fire if oil is being added on the side quietly. For those in this category, more patience is needed so that a systematic approach is deployed to find out the underlying cause. Most of the time, the hidden reason is clear if one looks deep enough. Those who focus on understanding their body will likely find it, and we try to facilitate that process. We tend to say goodbye to those who are too focused on quick recovery as the primary goal. While it is relatively easy to stimulate the body to enhance energy output, it is likely to eventually backfire and the overall condition can worsen if the root cause is never uncovered and dealt with properly.

If recovery is a race to the finish line in a track meet, our Total Body Approach is akin to running at a steady pace towards the finish line, feeling fresh at the end, while enjoying the race along the way. It is not a sprint to the finish line followed by collapse.

It is not unusual for those with a positive attitude and persistence to see a big difference only four to six months later after a slow start. Our experience informs us that if the focus is on helping the body to heal itself, the body will in time stop punishing and start rewarding in most cases. That is the beauty of allowing the body to heal itself. Sadly for some, this may take longer than patience allow. A few months is a short time to repair a body that has suffered decades of harm, not to mention a strong component of hard to change personality traits that may be involved.

Many with Adrenal Fatigue tend to have Type A personalities, intense, compulsive, and inquisitive in nature. While the desire to understand the physiological and scientific basis of Adrenal Fatigue is a noble one, overly 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 reserve, and retards recovery. All are undesirable. There is a huge gap between the quest of basic science for academic purposes and getting well which is the primary clinical reality. Those that recover fastest are generally those who follow our instructions closely and spend their energy doing what they enjoy in life in a balanced way, stopping to smell the flowers along the way.

Lastly, we are mindful of our limitations. Our Total Body Approach can facilitate, but not mandate what the body does. We can affect recovery only as fast as the body will permit to affect long term sustained return to health, and every body's speed is different. Some do well in short time, others may take a longer preparation period to set the body on a course of feeling better. Those who are older or constitutionally weaker often face the biggest challenges. We therefore are constantly on the lookout and open to alternative methodology.

Summary

Our Total Body Approach integrates the best of conventional and natural healing processes with the single focus of deploying natural compounds that satisfy the body based on the body's cry, rather than mandating the body's response to our wishes without considering the body's state of function through its signs and symptoms. We believe in accommodating the body's request whenever possible. The problem is that most of us do not know how to listen to our body.

Our experience shows us that the body in most cases is capable of its own healing if given the proper tools. We are facilitators of this process. Our Total Body approach to Adrenal Fatigue calls for a focus on the whole person by integrating a holistic approach with a natural bias.

We take an extensive history. At the outset, we strive to understand the body's internal workings and the root cause of dysfunction. We then determine the dominant dysfunction by various qualitative and quantitative tools. We confirm our thesis by using challenges as needed along the way. We then embark on a quest to nurture the adrenals back to health with a systematic and personalized program of natural compounds, diet, exercise, and lifestyle suggestions on a step-by-step basis, watching for the body's responses through its signs and symptoms. We avoid a symptoms suppression approach, which often backfires.

We endeavor to make the sufferer as comfortable as possible without sacrificing our focus on the big picture. We prioritize our strategies to effect a gradual and sustained recovery crash free. Because the body is ever changing, our approach calls for sustained monitoring to assess the body's biological state continuously, so recommendations are made as close to real-time as possible. Laboratory testing is used when needed.

Along with recovery, our goal is to teach each person how to listen to their own body, how to live with it post recovery, and how to prevent recurrence in the future.

Finally, we are patient in our approach to give the body ample time to recover. We do not force the body into functions when it is not prepared.

 

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



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