Catabolic State: Adrenal Health and Healing

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



Read Part 1 | Part 2 | Part 4

3 Step Recovery Approach for Adrenal Fatigue

Performing gentle exercise can help slow down the catabolic state, but be careful to not over do itWhen in an advanced Adrenal Fatigue Syndrome and catabolic state, stabilizing and reversing the catabolic state must progress in stages for maximum success.

Step 1. First, we need to prevent the catabolic state from becoming worse. This is best accomplished with a combination of macro-nutritional, lifestyle modalities and, micro-nutritional at the foundational level.

Step 2. Once catabolism has arrested, we need to initiate a return of the metabolic cycle to neutral from catabolism bias while supporting positive adrenal function without over stimulating the adrenal glands. At the same time, we need to be vigilant to make nutritional adjustments as the body changes to avoid any risk of adrenal crashing. This is a difficult balancing act to say the least. The return to neutral catabolism cycle must be systemic but slow by design so as not to affect too many changes at any point in time that might make matters worse. This is best accomplished by aggressive micro-nutrient therapy that is gentle and matching to the body’s state of weakness and catabolic cycle each step of the way.

Step 3. Lastly, after the body is in a stable state, anabolic hormones and the like can be considered.

This three-step approach process has to be carried out in sequence. It will take some time, as the process cannot be hurried without significant risk. Yet, we cannot allow the body to be in catabolic wasting for too long without organ injury, such as kidney damage, that can be very serious. Continuous close monitoring is therefore required. In extreme cases, hospitalization may be required. Most of the time, however, reversal of the catabolic state can be accomplished in an outpatient setting, slowly but surely.

Not following the 3 steps in sequence is a common reason for recovery failure. The most common mistake is the premature and or aggressive use of anabolic hormones and compounds that are stimulatory when the body is not ready. This can trigger adrenal crashes and worsen the overall condition over time.

How About Calories?

In addition to the common error of trying to use anabolic hormones to reverse the catabolic cycle prematurely (when the body is still in catabolism and yet to stabilize), programs that focus primarily on aggressive increase in caloric intake also fails frequently. Remember that in advanced Adrenal Fatigue Syndrome, the body is trying to slow down in order to conserve energy because it perceives danger and a threat to survival. Forcing more food into the body requires the body to expend energy to carry out the necessary digestion and metabolite breakdown.

A weak and fragile body in advanced Adrenal Fatigue Syndrome simply does not have enough energy reserve to carry this out properly. So forcing more food into a catabolic state, while making sense in theory is contrary to what the body is trying to do—to conserve energy by slowing down organs and downregulating the food assimilation process as a survival tool.

A common mistake is to increase calorie intake to halt the catabolic state for those with Adrenal FatigueTherefore, when faced with forced extra caloric intake when it is not ready, the body, if able, will simply slow down further. Food becomes poorly digested and largely unabsorbed when it goes through the bowel. Stools can contain undigested food. Much energy is expanded in this process, draining the body further of limited energy reserves. The result is continued catabolism and weight loss despite increase in caloric intake. Sufferers and clinicians will likely fail in their efforts to reverse the catabolic state with this approach.

When advanced Adrenal Fatigue Syndrome is present, anabolic hormones and aggressively forced increase in caloric intake are likely to backfire and make matters worse over time. The combined one-two punch when both are employed can easily trigger adrenal crashes and worsen the overall condition.

Simply forcing calories or food into a body that is not adequately prepared is like forcing milk into a baby when it is sick, causing the baby to throw up most of the milk as an autonomic self-preservation response, resulting in possible aspiration and collateral damage.

Progression from a Catabolic State to Neutrality

As mentioned above, a comprehensive program needs to be formulated and priority established with great care for those in a fragile state who have catabolism and are in advanced stages of Adrenal Fatigue Syndrome.

The stabilization (step 1) and return to catabolic neutrality (step 2) process includes:

  • Stabilize vital signs and fluid balance, especially blood pressure, electrolytes, and heart rate, prior to commencing.
  • Reduction of the external energy demands while allowing the body’s circulation to be optimized to carry nutrients.
  • Reduction of the overall sympathetic tone with the Adrenal Breathing Exercise so that both the digestive system and gastrointestinal tract can relax and return to normal operations.
  • Supporting the body’s extracellular matrix to assure it is free of pollution and metabolites and free flowing to reduce internal toxic load.
  • Decongest the liver to optimize metabolic clearance capabilities.
  • Correct sleep defects to allow cellular rejuvenation and cortisol rebalance at night. Sleep medication and aids may be required.
  • Avoiding any further degeneration of the musculoskeletal system caused by lack of use. The Adrenal Restorative and Adrenal Yoga exercises can be instituted as tolerated.
  • Reducing mood swings that might trigger exaggerated neurotransmitter responses and adrenal crashes.
  • Starting with easy to digest whole food macronutrients before embarking on aggressive micronutrients (nutritional supplements) therapy
  • Do not embark on aggressive cleanses, detoxification, and antibiotic therapy unless absolutely necessary.

An individualized blueprint for recovery is absolutely critical. Both step 1 and 2 overlaps each other, and rightfully so.

Blindly embarking on a program without considering each person’s constitution sensitivities, and state of weakness is a sure recipe for failure. Close follow up is mandatory, as the body will invariably react in unexpected ways once change is instituted.

Remember the body is already entrenched in its processes, and any change, no matter good or bad, will be perceived as stressful to the body. Sometimes the body will cooperate, but more often than not, resistance will surface, and a series of adjustments with setbacks will be needed, even in the best of hands. Changes cannot be forced onto the body without collateral damage. Many self-navigations fail due to the lack of consideration and respect of this important physiological principal.

Recovering from a catabolic stateAs the body returns to a metabolic neutral state, a sense of stability returns while weight stabilizes and muscle mass regains its integrity. Many will also report a sense of balance and calm, as if someone has lifted a heavy backpack off their shoulders. Bowel movements become more regular, anxiety reduces, bloating less problematic, digestion improves, skin tone becomes more vibrant, and skin pigmentation reduces. Many report a lighter feeling as a result. Adrenal crashes should reduce. Adrenaline rushes and reactive hypoglycemia resolve. Sleep improves. Muscle mass volume stabilizes and continued weight lost stops. These are signs that the body’s metabolic cycle has returned to the neutral state, the way nature intended it to be.

This can take a few months or longer. During this time, it is imperative that the body is closely followed by an experienced clinician. The use of any nutritional supplements must proceed with care, no matter how good they claim to be. Hospitalization may be required if in home therapy fails.

Catabolic State Dietary Principles and Approaches

The major problem for those with Adrenal Fatigue Syndrome and catabolic state is how to deliver enough calories into the body without aggravating the already fragile body. By the time, the body enters clinically symptomatic catabolism; Adrenal Fatigue Syndrome is usually in the advanced stages. Many are bedridden or housebound. The body’s catabolic and flight-or-fight hormones are in full throttle, along with a hypersensitive nervous system as the body is flooded in a sea of stimulatory hormones such as norepinephrine and epinephrine.

As a compensatory response to overwhelmingly perceived stress over time, the body has typically entered a system-wide slow down, which includes the liver, GI, and respiratory systems to conserve energy. This cycle is self-reinforcing. For example, if the GI tract is not bought slowly back to the neutral state, it is likely to gradually go into gastric shut down, where only a small amount of food will be accepted at one time. A regular meal can last hours because the body needs frequent breaks. Similarly, brain fog due to metabolic byproduct accumulation becomes intoxicating as thinking slows. Gut assimilation decelerates when nutrients that are unable to be absorbed pass the GI tract into the body, resulting in bloating and gastric distention. Constipation becomes the norm that may require enemas for bowel movements. Food intolerance, delayed food sensitivity becomes common. Pain of unknown origin in muscles and joints becomes prevalent. Sleep becomes almost impossible.
The body is literally being starved and wasting away as it refuses to allow nutrients into the cells, which is its only known protective mechanism. Weight loss and fatigue continues with no end in sight. Electrolytes and fluid imbalance become triggers for a vicious downward decompensating cascade that ends in collapse. This can be the final fatal blow.

A catabolic state diet is really a group of dietary guidelines that best fit this state. A one size fits all dietary plan is not possible because of great individual variance. It is important to match food intake to the degree of food assimilation permitted by the body at every step. Proper GI rest is also important. Both are necessary to first stabilize and then turn the body around from a catabolic state to a metabolically neutral one.

The emphasis is on preventing further muscle mass loss, maintaining internal homeostasis, reducing excitatory neurotransmitter flow, avoiding hypoglycemia, and keeping the body well hydrated. A metabolic neutral body will allow adequate energy flow for normal daily activities with stable mass and weight.

Meal plans must be customized not only based on nutritional needs but also the degree of digestion and assimilation permitted by the body. Food choices are usually quite limited and therefore require carefully selection, and if necessary, rotation.

The following are especially important considerations of a catabolic state diet.

Soups, Smoothies, Stews and Broths

Chicken soup or broth is a great source of nutrients for those in a catabolic stateThe diet at this stage should consist of foods that are simple and easily digested so as not to place an extra burden on the body’s digestive system.

Smoothies, soups, stews and broths are extremely nourishing for those in this state, especially when advanced Adrenal Fatigue Syndrome is present. Not only are these foods simpler to cook for those that have very little energy reserves and cannot labor in the kitchen for a prolonged amount of time, they are also easier to digest and therefore create less strain on the digestive tract.

Smoothies can provide much needed enzymes as the ingredients are raw and have not been exposed to the cooking process whereby enzymes can be destroyed due to heat. The ingredients used in these smoothies should ideally be organic and made up of non-hormone components, especially for dairy products. Yogurt may be added into the smoothies if you are able to tolerate dairy products. Unfortunately, those in severe catabolism may not be able to tolerate too much raw food so a personalized program matching the body’s need and the state of catabolism is critical for successful recovery.

If you prefer, you may blend the entire contents of the soup and drink as a thick broth or pureed soup. The soup should be taken at warmer than room temperature, but not above 120° F as prolonged consumption of extremely hot soup may lead to esophageal cancer.

While drinking soups and smoothies, it is important to continue the chewing action as this activates the saliva enzymes, which will lighten the burden of digesting the food on the gastrointestinal tract.

In order to deliver healthy fats into the body at this stage, it is a good idea to add extra virgin olive oil to the soups and smoothies. Other alternatives can include avocado oil, flax seed oil, or expeller pressed coconut oil, which does not contain the strong coconut flavor—use these different oils on a rotation and observe how your body reacts to them.

Soup and broth preparation tips

Bone broths using only the bone, no meat attached, are great for anti-aging and calcium replenishment. In order for the calcium and other minerals to leach from the bones into the broth, add 1 tablespoon of apple cider vinegar to the pot of water and bones and let sit for thirty minutes before cooking.

Fish broth does not need to be cooked as long as the other meats. The omega-3 in the fish will greatly assist those with respiratory illness such as asthma and bronchitis. Cooking fish in broth for thirty minutes will be sufficient.

Chicken broth is infamous for helping with colds and flus. Adding kelp or mushroom to the broth while cooking will help improve thyroid function.

Lamb or mutton soup is good for the winter months as it is considered an internally hot/hearty soup, according to traditional Chinese medicine, and should not be used when you are very weak. Lamp soup can help with circulation for those with cold extremities, such as the hands and feet.

Vegetable broth for a catabolic stateIf you are vegetarian, fresh vegetable broths have great detoxing properties and can be used instead of meat broths. For added protein, blending in soaked cashews, almonds, or tofu can create a creamy texture. If you can tolerate dairy, you may add organic cheese or cream.

Meat broths (not including bone only broths) should not be cooked for longer than six hours as the nutritional value of the meat and protein can be destroyed.

Generally, when making meat or bone broth, you should add lots of green, dark leafy vegetable alkaline foods to offset the acidic meat proteins. Root vegetables can be added in at the same time as the meat, but for leafy greens, it is generally best added in the final cooking stage to preserve the nutrients. Salt should be added at the end of the cooking process as well, because as the soup reduces in liquid it may become too salty if added during the initial stages.

Read Part 1 | Part 2 | Part 4

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


Dr. Lam’s Key Question

It is better to eat food that is easily digested and assimilated. Whey protein and eggs offer the best source of bioavailable protein. You also need to get to the cause of catabolism, further investigation by professionals. The key is to eat enough calories whether it is through fats, protein or carbohydrates to prevent the catabolism.


Catabolic state

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9 Comments

  • Steven says:

    Dr. Lam,

    I have a huge muscle wasting problem..

    Before AF, I use to be muscular …

    Now when I lift weights, my muscles actually get smaller now..And when I go to sleep, the next morning, I can see my muscles got smaller just from sleeping…Very strange!

    I do have a small case of sleep apnea that is untreated..

    Can these symptoms be caused by AF or sleep apnea?

    These symptoms have been going on for 7 years! 🙁

    • Dr.Lam says:

      The catabolic state can be very devastating for you if you are wasting muscle. Do not try to self navigate if you are at this point. Try to find a professional who knows AFS in depth to reverse this.

      Dr Lam

      • Steven says:

        Do you think you can help? I have tried many things..I am to the point I am super sensitive to almost any kind of supplement..I can not even use hair spray without it causing my muscle wasting to worsen..very confused.

  • Margaret M says:

    Dr. Lam, first of all thank you for the work you do. You and your work are life savers because, as you have researched, AFS is life threatening and most doctors don’t recognize it as a real condition.
    I am not sure what stage of AFS I am in. I feel fatigued all the time, have a hard time falling asleep most nights, and everynight I wake up after three hours of sleep and I am awake ususally 2-4 hours, and then I fall asleep for another 1.5 to three hours. When I try to exercise like I used to – weight lifting and or aerobics, I am tired for 3-4 days afterward. Lately I have become aware that I have POTS, after standing for ten minutes, my heart rate was going from resting rate of 70 to 150-160. I have to say I have been doing your adrenal breathing exercises for two months, and my heart rate only goes up 30-40 beats from resting whether I am just standing or walking while shopping. This is a great improvement for me, and I expect to reach my goal of being cured of the POTS symptoms. Based on this info, in what stage of AFS do you think I could possibly be and what is the estimated length of time of recovery? Many Many Thanks. Margaret

    • Dr.Lam says:

      I cannot tell you without more detailed history as too many variables. The fact that my adrenal breathing exercise helps points to underly sympathethic nervous system overtone. My book has multiple chapters that go into this. That would be a good read for you as there is much you can do to help yourself.

      Dr Lam

  • Noah says:

    Canabolic

  • Noah says:

    Dr lam can the can abolished state still be reversed if you are on hydrocortisone?

    • Dr.Lam says:

      Catabolic state and hydrocortisone are two seperate issues though some can be present with both. Reversal depends on how advance the situation is.

      Dr Lam