Adrenal Fatigue Treatment: Overcoming the Obstacles
Laboratory Testing—is it Really Necessary?
Returning to the issue of laboratory testing, it is almost a foregone conclusion that some form of laboratory test is needed to make a diagnosis among the medical community. This hypothesis itself needs to be examined. Not all conditions in medicine are quantified before they are accepted. Hundreds of accepted medical diagnoses exist and are used everyday without laboratory tests. Examples include depression, irritable bowel syndrome, tension myositis syndrome, chronic fatigue syndrome, and fibromyalgia syndrome. How are Adrenal Fatigue and Adrenal Fatigue Treatment any different?
Because of the gross failure of serum laboratory studies in assessing adrenal function accurately at the sub-clinical state, many naturally oriented physicians advocate the use of 24-hour saliva cortisol tests as an alternative evaluation tool. In this case, one takes four saliva samples throughout the day to plot a cortisol curve. This curve is compared to that of a normal person. In most cases of severe fatigue, the cortisol curve is flat throughout the day. In other words, it does not follow the rhythmic pattern you find in normal people. However, some people can have a flat curve and be totally normal. There is currently no quantitative test with pinpoint accuracy to correlate the hormonal level against fatigue. All tests available give us only a birds-eye view at best. While this approach has some merit, it is not perfect.
Other naturally oriented physicians place their faith on a detailed and accurate history alone. To them, learning to listen to the body and its signals is a far more accurate tool in assessing adrenal health than serum or saliva laboratory testing at this time. This is not without clinical foundation. Many with weak adrenals clinically present with normal serum and saliva tests, while others can have abnormal laboratory values but be clinically asymptomatic. They have no fatigue or lethargy. Lastly, there are problems with current laboratory reference range errors, delayed sensitivity problems, and hard to reconcile clinical correlations that are built into the imperfection of current laboratory testing methodology. Until laboratory technologies improve, reliance on laboratory tests can be confusing and sometimes misleading.
Conventional medicine disagrees. According to them, the current laboratory standard is acceptable to detect all forms of adrenal illness. No test is needed specifically for mild forms of Addison’s disease because such forms do not exist.
This debate gets even more complicated the more one dwells upon the details. Within the natural medicine camp, some feel a single snapshot of saliva cortisol, if done over a 24-hour period, is sufficient. Others are of the view that saliva testing needs to be implemented serially in order to have any value, and even then, it is not absolute. The reason is simple—many people in the early stages of Adrenal Fatigue have normal saliva test results. Only by repeating the test at close intervals can clinical symptoms be correlated well with laboratory testing.
Conventional medicine’s thesis is that because of the lack of definitive tests to diagnose Adrenal Fatigue absolutely, this condition is not real and does not exist. There seems to be a parallel for patients who have classic signs of hypothyroidism clinically but their laboratory tests are normal.
TSH is the most common test used to rule out hypothyroidism. The higher the number, the more likely hypothyroidism is present. For many decades up until late 2002, the normal range was around 0.5–5.0. This high threshold meant that many who might have been suffering from hypothyroidism clinically with normal TSH levels under 5.0 were not being treated and thus suffered unnecessarily. That range changed to 0.3–3.0 as of early 2003. Many whose results fall between 3.0 and 5.0 are now considered hypothyroid while they were considered normal before this change.
For decades, doctors told these patients all was normal and they were sent home without treatment. Such borderline hypothyroidism was at the time discarded as a valid diagnosis until recent years. The justification used is that their TSH test was normal.
Not too long ago, many endocrinologists were in fact denying mild hypothyroidism as a true diagnosis. The same may be happening to Adrenal Fatigue as a mild form of adrenal insufficiency. The similarity is striking. It took years of mounting patient complaints and failures of traditional clinical approaches before the scientific community admitted they were well behind the ball in diagnosing hypothyroid. Such may be the case with Adrenal Fatigue.
Even with the lowering of the TSH threshold, many forward thinking physicians start medical treatment for hypothyroidism if one’s TSH level is above 2 as long as clinical symptoms are present. They are basing their decision on evaluating the entire clinical presentation, and less on laboratory tests.
The Road to Acceptance
The core difference between how conventional medicine and naturally oriented physicians see adrenal weakness comes down to how the same two separate camps of professionals interpret the data. Naturally oriented physicians tend to place more weight on clinical presentation. Hard clinical observation together with soft laboratory test results is sufficient to make the case as far as they are concerned.
Conventional medicine, on the other hand relies more on testing than on clinical presentation. Because test results do not technically meet man-made standards, Adrenal Fatigue as a diagnosis is rejected.
Both camps have the best intention at heart to do what is right. The difference lies in the lens they wear when looking at the same clinical presentation and laboratory data. Both are correct in their perspective.
All scientific endeavors evolve through a systematic process. It all starts with unanswered questions that lead to discoveries of alternative answers. From this a new theory is developed and a thesis advanced. Through research and clinical studies, such a thesis is scrutinized over time as the evidence is examined. Debate within the medical community is therefore a healthy process and a constructive one. Through this process, a faulty thesis is rejected, and a sound thesis advances. Accepted theories eventually become medical facts, which set the standard. As medical science progresses, new facts will ultimately emerge that may displace previous facts.
It usually takes several decades for new discoveries and theories to be absorbed into mainstream medicine with successful passage of clinical trials and studies. Then it is taught to medical students, and more time elapses before students mature into respected physicians and disseminate this information to the general population.
Take the free radical theory for example. First advanced by Nobel Laureate Dr. Linus Pauling in the mid 1950s, it was not accepted by the mainstream medical community. In fact, it was outright rejected and ridiculed. The required technology to prove Dr. Pauling correct would only come 40 years later. That is when the traditional medical community started to take it seriously.
Only forty years ago, the concept that inflammation caused heart disease was a laughable concept. The thesis that a bacteria can be the most common cause of gastric ulcer, the idea that borderline diabetes is a serious condition requiring intervention early on, the thought that hormones can come in a gas form (nitric oxide) were all rejected when first presented to the scientific community. Yet today, they are universally accepted facts.
From a nutritional perspective, none is more dramatic than the abrupt reversal of vitamin D as an important vitamin after decades of fear. Until the year 2010, prescribing vitamin D in excess of the RDA (recommended daily allowance was 400 IU per day for adults between 50-70 years of age and 200 IU for adults under 50) was considered dangerous. Today, the RDA is increased to 600 IU. Most conventional physicians, however, routinely prescribe 1000 IU or more per day, well above the RDA. Those who are naturally oriented prescribe even more.
Medical knowledge is an evolving science. As knowledge explodes, what was considered fiction yesterday might well become a fact today. The good news is that with time, the truth eventually surfaces. Borderline sugar intolerance or hyperglycemia was once considered inconsequential, but is now a proven serious precursor to diabetes. Borderline hypothyroidism was once ignored, but is now recognized as clinically important enough to warrant early medical intervention. Borderline hypertension now is considered a serious risk factor for stroke and heart disease if the family history is positive. Modern science has indeed dispelled previous assumptions that these sub-clinical states are normal with no treatment required. Clearly we need to increase our sensitivity to all chronic debilitating conditions for optimum health. These need to be treated very early on at first sign of any problem instead of waiting until the full-blown diseased state occurs.
Adrenal Fatigue Treatment?
According to conventional physicians, because Adrenal Fatigue is not real, supplements and vitamins for Adrenal Fatigue treatment are therefore useless, and may not be safe.
Some of the most popular supplements for Adrenal Fatigue treatment contain extracts of human adrenal, hypothalamus (a part of the brain that produces hormones), and pituitary gland. These could be harmful if not properly supervised. Taking adrenal hormone supplements when unnecessary can lead the adrenal glands to reduce output and thus prove unable to produce hormones when under stress, according to conventional physicians.
Most experienced natural medicine physicians believe that the proper use of natural supplementation is important in the recovery process, but that process should be professionally supervised for optimal results. Indeed, few would disagree that improper use of nutritional supplements can cause harm to the body, regardless of whether a person has Adrenal Fatigue or not.
The Practical Approach to Adrenal Fatigue Treatment
Separating Adrenal Fatigue from other syndromes with overlapping symptoms is not easy. Chronic fatigue, depression, fibromyalgia are all present with certain degrees of lethargy and loss of energy. Laboratory tests are not perfect. Wide-spread misinformation is prevalent.
Time is the ultimate revealer of the truth. Unfortunately, it will take decades of further research for conventional medicine to accept Adrenal Fatigue treatment.
Those of us on the front lines who deal with patients coming in with fatigue know that the debate will eventually end. Our body is always right. As the final arbitrator, we need to learn to listen to our body, regardless of what our scientific mind tells us, or what doctors tell us. No one can argue with the body. It is always right. Whatever approach we take, we are likely to be on the right track if fatigue reduces over time clinically and a sense of calm and vibrancy returns. Likewise, we need to admit failure if clinically the condition gets worse. Generally speaking, those who learn to listen to the body when it comes to sub-clinical states will often be well rewarded.
Adrenal glands and fatigue are so intertwined and more often than not inseparable clinically and by laboratory tests, therefore, advising the patient on Adrenal Fatigue treatment is not easy. What patients need is a practical approach to improve, not theoretical discussion.
The fastest and most practical way to improve is actually quite simple. Rather than spending a lot of energy on extensive tests and debates about what the diagnosis should be, those with unexplained fatigue associated to what appears to be adrenal dysregulation clinically can undergo a trial course of natural Adrenal Fatigue treatment. While this approach may not appear scientific on the surface, it is actually a common practice in conventional medicine. For example, it is an accepted standard of care to start a trial course of antibiotic for gastric pain if one suspects gastric ulcer because the vast majority of gastric ulcers are due to bacterial infection. If this fails to bring relief, further workup can be initiated.
The key to success in this trial adrenal support approach is to employ only gentle natural compounds along with dietary and lifestyle adjustments under proper professional supervision. Bear in mind that improper supplement use can actually make things worse over time. The overall results will guide us. If one feels better with the adrenal oriented support program, the root cause logically arose from or close to adrenal dysfunction unless other factors are at play. If one does not improve, alternative root causes need to be investigated. Under proper care, the body speaks to us, one way or another, within a short time. Engaging in academic debates is great for the ego but does little to relieve pain and suffering – the ultimate mandate of the health professional. Risk and harm need to be factored into the recovery plan, and constantly monitored for feedback and clinical results.
Conclusion on Adrenal Fatigue Treatment
The traditional medical approach to diagnosing chronic disease does not take into consideration their sub-clinical stages, which have reached epidemic proportions worldwide. These include borderline hypothyroidism, borderline hypertension, and borderline diabetes.
In the case of Adrenal Fatigue treatment, clearly the threshold of science has not been reached according to conventional medicine. Current laboratory tools are considered sufficient. Symptoms tied to adrenal weakness are assigned to other syndromes with similar and overlapping clinical pictures, including depression, fibromyalgia, and chronic fatigue.
Let us draw a parallel between the current rejections of Adrenal Fatigue by the same mindset insisting that fibromyalgia or chronic fatigue syndrome is not a real medical condition not too long ago. The similarity is striking. Elevating the man made arbitrary bar of what is considered science to a point that modern laboratories are unable to reach with current technology can be dangerously inept. Using this as justification to reject a condition with such overwhelmingly widespread physical debilitating symptoms only makes matters worse for the very people who need care and attention.
Theory and debate is great for the academic mind and the ego, but does little for those who suffer. Technical debate should not stand in the way of healing those in need. Simple logic points to the existence of a sub-clinical state of adrenal weakness, regardless of whether laboratory testing is currently sensitive enough to detect it. The debate of whether to call this sub-clinical state Adrenal Fatigue, adrenal burnout, adrenal exhaustion, mild adrenal insufficiency, non-Addison’s hypoadrenia, decompensatory syndrome, mind-body syndrome, or tension syndrome becomes insignificant if one focuses on the big picture: healing the patient. For the time being, we call it Adrenal Fatigue because that is the most logical name due to the close association of our understanding of adrenal function.
Regardless of the name assigned to this condition, one needs to be practical when it comes to Adrenal Fatigue treatment. One consideration is to embark on a trial course of natural adrenal support, and let the clinical results guide us forward.
© Copyright 2015 Michael Lam, M.D. All Rights Reserved.