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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