Catabolic State and Adrenal Fatigue Syndrome – Part 1

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Dorine Lam, RDN, MS, MPH


Catabolic state makes you lose muscleCatabolism is the general term for a combination of metabolic activities that break down large molecules, such as lipids and proteins into much smaller molecules like nucleotides, amino acids, and fatty acids. By doing so, catabolism provides energy for all cells to maintain their function and grow starting from the time food is ingested. Anabolism is exactly the opposite. Together, catabolism and anabolism are integral and opposite parts of the metabolic cycle that require perfect balance to maintain a strong body, healthy weight, and stable muscle mass. If these activities are not in balance, the body can be in a catabolic state.

Adrenal Fatigue Syndrome (AFS) is a neuroendocrine condition induced by stress and characterized by fatigue. There are four stages, with symptoms ranging from mild to severe. In the advanced stages, one can be incapacitated and unable to work or lead a normal social life due to lack of energy. Symptoms of advanced AFS include reactive hypoglycemia, heart palpitations, lightheadedness or dizziness on arising, insomnia, fatigue, salt cravings, brain fog, low blood pressure, loss of muscle mass, GI disturbances, belatedness, and weight loss. These symptoms are very similar to those suffering from advanced catabolic state. Indeed most sufferers of AFS in advanced stages are in a clinical or sub-clinical catabolic state with many negative consequences.

Let us first take a step back and examine the physiology of catabolism.

Metabolic Cycle

The human metabolic cycle has two different components, anabolism, which is named after the Greek word for building up, and catabolism, which means breaking down. The processes involved in anabolism consist of the synthesizing of proteins, which is the building of complex physiological structures, such as muscle tissue, from more basic structures like amino acids. Hormones, such as testosterone, human growth and insulin, usually stimulate the process. When your body is in an anabolic state it is rebuilding and repairing your bodily tissues by reconstructing their structure cell by cell. This consumes energy, and the energy comes from the process of catabolism.

By breaking down food to generate energy, catabolism assists the body in providing fuel needed to function on a day to day basis. Extra energy is used for anabolism. Catabolism is therefore part of normal daily living. Some of the known catabolic processes include:

  • Breakdown of adipose fat stores to form fatty acids
  • Cycle of citric acid
  • Process of glycolosis
  • Breakdown of muscle protein for gluconeogenesis

Catabolism followed by anabolism completes the metabolic cycle. Growing children have a heavy bias towards anabolism until they reach adulthood. Throughout our young and mid-adult years, the cycle is balanced with catabolism offsetting anabolism and vice versa. Food ingested turns to energy for daily living and cellular repair. Our metabolic cycle is balanced, and our body is in optimum health. With intake of energy equally distributed, our adult weight usually remains steady and muscle mass is maintained. Sedentary lifestyles and the catabolic stateWith excessive food intake, sedentary lifestyle, severe stress, chronic illness, etc., the metabolic cycle can be thrown off balance. Also, as we get older, the metabolic cycle bias starts to shift slightly towards catabolism as we lose about 14 percent of our muscle mass for every decade in our adult life. To maintain muscle mass and tone, the elderly need to incorporate weight training into their daily exercise program to avoid the loss of protein and muscle mass that is part of the normal aging process.

In times of emergency, catabolism can be a life saver in providing much needed quick energy. For example, when you are in the midst of an intense workout, your body is breaking down complex sugars and converting them into glucose, and the glucose is then converted into adenosine triphosphate (ATP). This is the basic energy needed for fueling the workout.

Typically we get 60 percent of our calories from consuming carbohydrates, we get 30 percent from consuming fat, and just 5 percent to 10 percent from the proteins we eat. The balance of the protein we consume is utilized by our body for protein synthesis in an anabolic process that replenishes what is lost.

Excessive Catabolism

Excessive or prolonged catabolism without adequate compensating anabolism, however, has negative consequences. Muscle tissue along with essential fat deposits throughout the body can become depleted. Without sufficient anabolic replenishment, the process of growing and repairing tissue cannot take place fast enough. The body enters a net negative energy state. The key clinical sign of catabolic state is gradual weight loss with reduction of muscle mass and subcutaneous fat. Overall weight may not be substantially reduced in early stages. Fatigue is often associated as less energy means a reduction in vitality.

If not reversed in timely fashion, chronic catabolism results. This is called the catabolic state. The metabolic cycle is now firmly entrenched in favor of catabolism. The body is in a state of low energy. Fatigue, exercise intolerance, and inability to handle stress are typical symptoms.

AFS sufferers in advanced stages are often in a clinical or subclinical catabolic state. There may not be any obvious signs of weight loss if it is subclinical. In fact, one can be gaining weight part of the time in a catabolic state as the body is cannibalizing muscle for energy when muscle is available. Needless to say, this cannot be ongoing as there is only limited muscle to be sacrificed for energy before internal organs are affected negatively. Weight is an important indicator but not the only parameter of catabolism in the early stages.

A man rundown from the Catabolic StateObviously, a catabolic state is undesirable. If not reversed, the body enters a more severe state called catabolic wasting or cachexia, where central fat persists but peripheral fat and muscle mass diminishes rapidly, resulting in persistent weight loss or an inability to gain weight. Catabolic wasting or cachexia is characterized by at least a 5 percent loss of the patient’s overall, normal body weight. Most of the time, it is up to a 20 percent loss.

Causes of Catabolic State

There are usually a variety of factors that contribute and cause catabolic wasting. A state of subclinical malnutrition exists that is not caused by insufficient food but rather inadequate absorption of nutrient assimilation across the gut from where it really counts at the cellular level. This often happens in the late stages of a chronic illness or cancer, both causes a marked loss of fat stores and muscle tissue. Although a reduced appetite usually accompanies cachexia, an increase in the intake of food alone hardly ever helps.

Common causes include:

  • Aggressive detoxification when the body is not ready
  • Major surgery leading to muscle trauma and loss of collagen
  • Major accident leading to systemic inflammation and muscle breakdown
  • Chronic infection, such as Lyme disease or H. Pylori
  • Cancer in advanced stages as cancer cells overtake normal cells and their metabolic activities, draining the body of nutritional reserves.
  • Chronic liver disease leading to slow down in metabolic processing and increased internal toxic load which in turn breaks down protein
  • Antibiotic use in a body not prepared
  • Chronic stress (one of the most frequently overlooked triggers of subclinical catabolism)
  • Dehydration
  • Excessive exercise uses the body’s store of glycogen and glucose. When this happens, it can start to breakdown muscle and connective tissue for energy.
  • Prolonged fasting forces the body to catabolize muscle for energy
  • Advanced Adrenal Fatigue Syndrome, where the body enters a catabolic state as a compensatory mechanism to generate energy from internal sources.

Inflammation is the common pathway of catabolism and muscle mass deterioration. Chronic and acute illnesses can result in major increases in inflammatory cell-signaling molecules known as cytokines. Major surgeries, severe accidents and infections are some frequent contributors. They trigger massive inflammatory responses, which result in reduced synthesis of muscle protein and raise its breakdown rate. Cytokines also trigger the release of neurotransmitters called catecholamines and the adrenal hormone cortisol, creating a vicious positive cycle of catabolism. Both of these can increase catabolic wasting because they disrupt the metabolism of muscle cells and change the basal metabolic rate.

Catabolic State

A catabolic state, depending on whether it is clinical or subclinical, is characterized biochemically by an imbalance in catabolic hormones such as cortisol in various degrees as catabolism progresses.

A catabolic state will tire you outCatabolic hormones help generate energy for the body’s needs by way of producing ATP. ATP allows your cells to use the energy that is released in the process of catabolism to fuel its immediate cellular needs for proper function. So, even when your body is in a state of catabolism, it is attempting to take care of what would be best in terms of your overall health. Along with catabolism is increased oxidative damage, high levels of systemic inflammation and lower levels of anabolic hormones such as testosterone and growth hormone. Cortisol may be high at the start of catabolism, but ultimately becomes low, as the body is unable to put out more when the catabolic state becomes severe.

Symptoms of Catabolic State

This may not seem like much of a problem on the surface, but imagine the damage that could be done if you remained in a continuous state of depletion for a long time. When the healthy muscle tissue is enduring long stretches of time in a catabolic state, the tissue ends up eating away at itself. This is due to it seeking a stored-up source of energy. Muscle mass begins to reduce, metabolites of muscle breakdown can congest the liver and damage the kidneys, just to mention a few negative consequences. As the weight goes further down, the immune system becomes affected, brain fog surges, balance can be problematic, and respiratory function compromised due to reduced muscular tone to expand the chest cage. Fatigue increases with shortness of breath and reduced oxygen intake. In their last days, most advanced cancer sufferers are in a catabolic state suffering from cachexia.

Symptoms alert for catabolic state:

  • Lack of exercise tolerance
  • Low baseline energy state
  • Fatigue easily on exertion
  • Failure to gain weight despite excessive caloric intake
  • Unexplained weight loss that is not part of a weight management program
  • Symptoms of gastrointestinal tract slow down, such as bloating, constipation, food sensitivities, and allergies
  • Inability to tolerate or increased sensitivities to certain kinds of food, such as tomatoes, almonds, diary, gluten, and wheat
  • Lack of energy on one seating to complete a regular meal, requiring one to two hours to complete a meal
  • Brain fog as toxic metabolites build up
  • Insomnia
  • Liver area discomfort or pain
  • Muscle cramps
  • Shortness of breath and inability to take deep respiration
  • Weak urinary stream
  • Visible loss of muscle mass, especially at the biceps, triceps, chest, and gluteus muscles
  • Increased skin pigmentation and age spots
  • Increased wrinkles around the eyes and forehead
  • Low body temperature and sensitivity to cold
  • Dizziness or lightheadedness especially on arising
  • Low blood pressure
  • Hypoglycemia
  • Inability to tolerate raw foods
  • Onset of weight loss after antibiotics
  • Reduced gastric acid secretion
  • Gastric shutdown increases so that only a few bite size portions of food are tolerated at a time
  • Electrolyte imbalance, especially potassium and sodium
  • Low libido and low semen volume

Muscle cramping and soreness and a catabolic stateIt is important to note that the body can be in a state of catabolism for a long time, in what is called a subclinical state without obvious clinical symptoms until it is well entrenched. Normal daily living is unaffected. Signs and symptoms are subtle at best. These may include a gradual reduction of exercise capacity, reduced hand grip strength, greying of hair, onset of wrinkles especially around the eyes, less toned tricep muscles, persistent central fat around the abdomen that refuses to go away with exercise or diet, an increase in flu frequency as well as other infections, and GI bloat and indigestion.

Unless one is on the alert, most sufferers do not notice the gradual internal breakdown characterized by subclinical catabolism until it is too late. This is because the body has a compensatory mechanism, which is activated automatically. Unfortunately, an unresolved subclinical state of catabolism will advance towards a state of catabolic wasting if it is not reversed but allowed to continue unabated. The key to detecting subclinical catabolism is to see the overall big picture clinically from afar—one of a body slowing down, loosing vitality and muscle, trying to hang on to what it has nutritionally. The body has various degrees of slow down modes as it tries to conserve energy, with resulting loss of vibrancy and vitality.

It comes as no surprise that the catabolic state, either clinical or subclinical, is strongly associated with those suffering from cancer, chronic infection, and severe stress. Other conditions, such as irritable bowel disease, heart, liver and lung disease, rheumatoid arthritis and various conditions presenting with fatigue as their primary symptom including chronic fatigue syndrome and Adrenal Fatigue Syndrome are also frequently associated with a catabolic state. Once entered, the catabolic state is self-propelling in a downward vicious physiological cycle that is detrimental to quality of life and in most cases causes the underlying medical condition to worsen.

Read Part 2 | Part 3 | Part 4

© Copyright 2016 Michael Lam, M.D. All Rights Reserved.


Dr. Lam’s Key Questions

A catabolic state is when your body’s breakdown process exceed that of built up. Weight loss and fatigue ensue.

Research has shown the use of cryotherapy can reduce inflammation.

A man rundown from the Catabolic State

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