Catabolic VS Anabolic: The Road to Recovery from Adrenal Fatigue

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

Read Part 1 | Part 2 | Part 3

Water and the Extracellular Matrix

The network of non-living tissues in our body, called the extracellular matrix, relies on water to function properly and is essential to catabolic vs anabolic statesWhat is  a catabolic vs anabolic state and what is the potential impact on your health? Keep reading to learn more about catabolic vs anabolic, and how you can transition from a catabolic vs anabolic state. The extracellular matrix (ECM) is a network of non-living tissues that are located outside the cells of our body, hence the term extracellular. The ECM provides structural support to the cells, as well as cell adhesion, migration and proliferation. Essentially, the ECM provides the physical scaffolding for our seventy trillion internal cells to roam and thrive, connecting all the spaces within the body; without its proper functioning our body suffers. When the ECM begins to break down health can be severely threatened, as it may eventually lead to depletion of the body’s nutritional reserves, putting the body into a catabolic vs anabolic state, which can result in cellular dysfunction and organ failure. In contrast, rehabilitation of the ECM can vastly improve the outcome of chronic diseases as it is within the ECM that healing begins. ECM can be unpolluted and cleansed by an increase in water consumption. Water plays a major role in affecting the ECM, as fluid intake carries the toxins to the kidneys and liver for processing and excretion. It is important to balance the extra fluid intake with electrolytes, especially sodium and potassium for those suffering from Adrenal Fatigue Syndrome to avoid any imbalance. The ideal water to drink is room temperature spring water; avoid cold water, sugary drinks and caffeinated beverages.

Cooked food is much more gentle on the body than raw foods and serves the body well at this stage. Beef, pork or chicken is cooked for approximately six hours, so the meat is extremely tender and is eaten along with the broth for a good source of protein.

Frequent Meals. Eat frequent five to six small meals a day. Eating breakfast is critical because during sleep, much energy is expended for repair and rebuilding of damaged muscle tissue. By the time you wake up, your body needs a fresh supply of nutrients.

Frequent Snacks. Avoid any symptoms of hypoglycemia by snacking frequently with healthy snacks such as whole apples or nuts.  So what does all of the above have to do with catabolic vs anabolic states?  Continue reading to find out.

Catabolic State Exercises

Exercise should be very carefully programmed to allow body parts to be strengthened at the core without worsening the catabolic state. The gentle Adrenal Restorative Exercise as well as circulation exercises should be started first, followed by Adrenal Yoga Exercise to rebuild the internal core strength. Aggressive weight, aerobic, or flexibility training should be curtailed until body weight and muscle mass have stabilized and the adrenals are well on their way to recovery. It is encouraged not to be in a catabolic vs anabolic state but do to ailments this can occasionally be unavoidable.

For those who are bed-bound or lack mobility, electromyostimulation can be useful. This electrical muscle stimulation method entails stimulating the contraction of muscle with low levels of electrical impulses by placing electrodes on the skin at strategic points.

Another way of increasing muscle mass and strength in those for whom normal exercise is difficult is by using whole-body vibration (WBV) techniques. With WBV, oscillations are created using vibrating platforms and these are transmitted up through the body vertically, starting with the feet. This recently devised training method has shown results in achieving stronger muscles and overall strength in people who are healthy and can improve gait and balance in older individuals.

Exercising and a catabolic vs anabolic stateFor those who are very ill, exercising regularly may be impossible. But nonetheless they should try to move around if they can, even if it is only sitting up and walking a short way to the bathroom. When someone older is on complete bed rest the synthesis of protein in his or her body is impaired. We suggest starting with Adrenal Restorative Exercise and Adrenal Cardiac Exercise first as a foundation. Advance towards the Adrenal Yoga exercise series slowly and systematically. Use the Adrenal Breathing technique throughout. Always take time to allow the body to rest and heal. The body should feel calm and relaxed after each exercise session for four continuous hours. A liquid nutritional cocktail of protein, collagen, and amino acids are important before and after exercise.

Micro Nutrition Program

Earlier we mentioned that testosterone, growth hormone and DHEA seldom works but in fact often worsens an already advanced state of AFS with catabolism present. Glandular and herbs carry similar risks. They should not be considered until the metabolic cycle is stabalized.

Fortunately, other options are available. Each nutrient has pros and cons. If properly titrated, they can be very useful provided the delivery system and dosage matches the body’s catabolic state at every step of the recovery process. Blindly taking any of these could easily make matters worse given the fragile state of the body by the time one is catabolic with advanced AFS.

Protein Supplementation—Whey and Pea

Consuming meals with protein and amino acids in food and supplement form is more effective if the supplements are provided in doses of at minimum 20 g-30 g per meal, with at least three, maybe more, meals a day rather than having one or two large meals containing protein a day. The synthesis of protein goes down when there is less than approximately 20 g of protein a meal being consumed by an older adult of average size. But, when huge quantities of protein are consumed in one meal it does not really seem to increase the synthesis of protein in the body. A research study using young and older adult subjects with good health showed that muscle protein synthesis did not increase for individuals ingesting a meal of ¾ lb. of lean beef (90 g of protein) compared to subjects ingesting ¼ lb. of lean beef (30 g of protein). For many in a catabolic state, the body has multiple digestive issues that make protein overload problematic. In such cases, protein supplementation should be considered. The two most common are whey and pea protein.

Pea protein supplementation may be needed for catabolic vs anabolic stateWhey is left over when milk is coagulated during the process of cheese production, and contains everything that is soluble from milk. Whey protein is the collection of globular proteins isolated from whey. The protein in cow’s milk is 20 percent whey protein and 80 percent casein protein. Whey protein is thought to have one of the best profiles of amino acids of any naturally occurring protein. It is a rich source of many of the amino acids key to building muscle tissue, including the chain of amino acids valine, isoleucine, and leucine. Several studies show that supplementing with whey protein can significantly increase protein synthesis and the increase is more than the increase obtained from supplementing with casein (milk curd) or from soy protein. It is widely available and heavily used by those in the body building industry to promote increase in muscle mass. Because many in advanced AFS and catabolic state have digestion issue especially with diary products and their derivatives, whey protein may be too harsh for the body. It is not recommended unless there is no other choice.

Pea protein provides a delicious alternative source of protein for anyone but especially for vegetarians, vegans or those following restricted diets. It is entirely gluten-free, soy-free and dairy-free. This is the preferred source.

Yellow peas supply a wide range of essential and non essential amino acids, the building blocks of bodily tissue and muscles. Its high lysine and arginine content is key to combat catabolism. Lysine cannot be made in the body and must therefore be consumed through the diet. It is also the precursor of carnitine, the molecule responsible for converting fatty acids into energy and helping to lower cholesterol. Lysine, along with proline and vitamin C, plays a critical role in the synthesis of collagen—the building block of connective tissue such as cartilage, skin, tendons, and bone. With lysine, the estimated average requirement for a 155 lb. human ranges between 1000 mg-3000 mg/day.

Alert: Protein powder can cause energy spikes that may be too much for a weak body to handle, trigger anxiety, insomnia, and panic attacks. It can also lead to constipation. Always take enzymes and or magnesium with protein power to ensure smooth bowel movements.

Amino Acids

Amino acids are basic building blocks of protein. It would seem logical that any catabolic reversal program incorporates amino acids in its recovery arsenal. This is true, however, for those who are young or in early stages of AFS. Like anabolic hormones, there is a significant risk of overstimulation, especially at high doses and for those who are in a state of hypersensitivity or have a history or sensitivity to nutritional supplements, including paradoxical reactions. The more advanced the AFS, the higher the risk. Do not be surprised if the body cannot tolerate amino acids even at the low end of the dosage range.
Taking several different amino acid supplements seems more beneficial than just taking a single amino acid. Several supplements play vital roles in the prevention and treatment of muscle wasting:

  1. Glutamine: 1,000-14,000 mg daily
  2. Arginine: 1,000-10,000 mg daily
  3. Lysine: 300-1,000 mg daily
  4. Proline: 500-2,000 mg daily

Side effects of amino acids include adrenal crashes, heart palpitations, anxiety, insomnia, constipation, a sense of being wired, and POTS like symptoms.

Due to the high risk of overstimulation, proceed with amino acid replacement only under close clinical supervision and when the adrenals are well healed.


L-Carnitine and a catabolic vs anabolic stateL-carnitine is an amino acid derivative, which is found in meat. Small amounts of it can be synthesized in the body. Carnitine has a critical role to play in the production of energy in two aspects:

  1. Carnitine compounds move fats through the mitochondrial membrane so they can be burned to produce energy.
  2. Carnitine regulates a number of energy-producing activities.

Fatigue frequently accompanies cancer patients, and a significant amount of fatigue presents itself in 60 percent to 90 percent of patients undergoing chemotherapy or radiotherapy. There have been several studies published that show that many patients with cancer-related cachexia are low in carnitine.

Recommended Dosage: 2g-6 g of carnitine a day is linked with relieving fatigue and an increase in lean body mass. Much less is needed if advanced AFS is present. This may not be suitable for those with heart palpitations.


Creatine is a compound, which behaves like an amino acid. It is often used by bodybuilders and may very well be helpful in treating people with muscle wasting. Creatine exists in meat and fish, and the body naturally produces approximately 1 g to 2 g every day from amino acids, arginine, methionine and glycine. There are quite a few studies showing muscle creatine levels are higher in younger than older adults. Older healthy adults have been able to increase muscle creatine levels significantly with daily supplements of 5 g to 20 g of creatine.

Recommended Dosage: 1 g-3 g daily for those with AFS. Those in advanced stages may not tolerate creatine or can only tolerate a very small dose.

Vitamin C

Vitamin C is essential for strengthening the immune system. It also makes a significant contribution in maintaining an anabolic state by being a foundational building block of collagen. Collagen is the main structural protein of the various connective tissues in animals, making up from 25 percent to 35 percent of the whole-body protein content. It constitutes one to two percent of muscle tissue, and accounts for 6 percent of the weight of strong, tendinous muscles. Collagen provides the key scaffolding in maintaining extracellular matrix integrity. Without adequate collagen, our vascular wall deteriorates.

Vitamin C therefore helps prevent deterioration of the catabolic state. Unfortunately, many in advanced AFS cannot tolerate vitamin C for a variety of reasons. At the same time, the amount of vitamin C contained in whole fruits is very limited. An orange, for example, only provides 65 mg of vitamin C. That is sufficient to prevent the vitamin C deficiency called scurvy, but not enough to help the body built collagen to reverse the catabolic state.

Fortunately, for those who are sensitive or unable to tolerate vitamin C, new delivery systems and forms are available. Vitamin C is best taken in a blend consisting of fat-soluble vitamin C, mineral ascorbates, and liposomal vitamin C (such as LipoNano C to ensure consistent and steady cellular availability of this important nutrient).

Recommended Dosage: 1 g-8 g daily for those with AFS. Those in advanced stages may not tolerate vitamin C at all or can only tolerate a very small dose. Those taking liposomal C only need to take a small fraction of recommended dose due to the excellent bioavailability properties.

Omega-3 Fatty Acids

Omega-3 fatty acids and catabolic vs anabolic stateTaking adequate amounts of omega-3 fatty acids can help in the prevention of and in treating catabolic wasting. Omega-3 fatty acids are highly concentrated in certain fatty fish and fish oil as well as flaxseed and flaxseed oil. A study was done on sixteen older adults who were healthy. This study showed that 4 g a day of an omega-3 fatty acid supplement that contained 1.86 g EPA plus 1.5 g DHA for eight weeks straight was linked with significantly higher rates of protein synthesis compared with the control subjects who were given placebos of 4 g of corn oil a day.

Recommended Dosage: 3 g-10 g of DHA/EPA per day. Blood thinning can occur at high dosage. For best result, consider the purest liquid form molecularly distilled in an amber glass bottle with nitrogen packing to reduce oxidative degeneration.

Vitamin D3 in Liposomal Form

Vitamin D is a vital nutrient for maintaining a strong immune system. It is also essential for growing and maintaining healthy muscle and bone tissue.

D3, also called cholecalciferol, it is the most active form of the vitamin in the intestines and blood. It is converted to the active hormone of vitamin D more than other forms of vitamin D. It has proven to increase muscle strength, and for elderly adults, doses of 700–1200 IU a day can significantly decrease fall rates. For optimum health it is recommended that most people maintain 25-hydroxyvitamin D between 50 and 80 ng/mL blood levels. It is best absorbed when encapsulated in a fat soluble liposome.

Recommended Dosage: LipoNano vitamin D3 2,000-10,000 IU daily.

Hydrolyzed Collagen

Collagen is a major body protein. There are many forms of collagen, and it accounts for almost 20 percent of the total protein in our body. In addition to its critical role in forming support structures of the skin, it is also the main constituent of the extracellular matrix.

Collagen is characterized by its high proline content, which constitutes about one third of the amino acid. Its triple helix, rope-like structure contains protein organized in bundles that are anchored to each together at right angles and held in place by inter-fiber cross linkages.

The spatial arrangement of the collagen network also depends on the presence of supporting macromolecules known as proteoglycans and glycosaminoglycans (GAGs). Collagen is a much better support structure than GAGs. GAGs are a water-saturated gel in which water soluble molecules, hormones, peptides, and ions circulate. Cortisol breaks down collagen. During catabolism and aging, the diminished amount of collagen is gradually replaced by the weaker GAGs. This reduction in the quantity of collagen and replacement with alternative but weaker macromolecules results in skin that is less thin and less elastic. With age, this gel, due to its weak support structure, tends to sag, and cellular metabolism and mitosis is compromised. Furthermore, if water intake is insufficient, the links in the collagen network, like those of a net cast into the sea, collapse as the net is only kept open in the presence of water and collapses upon itself in a dehydrated environment.

The extracellular matrix may need additional collagen to reach catabolic vs anabolic states due to stresses of Adrenal FatigueThe foundational constituents of collagen are vitamin C, lysine and proline in high doses. Unfortunately, this is often not well tolerated by those in advanced AFS and catabolic state. A better alternative is to supplement directly with hydrolyzed collagen in powdered form.

Recommended Dosage: 5 g-10 g of hydrolyzed collagen Types 1 and 3, along with co-factors D-Ribose, L-lysine, L-proline, Coenzyme Q10, and L-carnitine works best. Many will report a boost in energy as well. Excessive collagen can cause constipation.

Additional Nutrients Worth Consideration

  • Melatonin, 5-HTP, and niacin for sleep
  • Natural progesterone cream
  • GABA, taurine, and theanine for calming
  • Glutathione to reduce oxidative damage extracellularly
  • D-Ribose for energy
  • Activated charcoal or clay by mouth to help clear the GI track
  • Marine phytoplankton and minerals
  • Iodine
  • Carbon and germanium garments to detoxify the extracellular matrix
  • High resistance water to decongest internal body fluids
  • Chromium and soluble fiber to assist metabolic and sugar stabilization
  • Magnesium for constipation and muscle relaxation
  • Quercetin and bromelain to combat excessive histamine and reduce food sensitivity and inflammation
  • Fermented milk thistle to help liver congestion
  • Digestive enzymes to help breakdown food and lessen the catabolic load
  • Probiotics can be helpful provided they do not worsen constipation.

Anabolic Hormones—Use for Step 3

Once the body’s metabolic cycle is stable in the neutral state and AFS well healed, consideration to move toward a more aggressive anabolic approach using drugs and stimulating natural compounds can be given. Usual treatments include encouraging the patient to ingest more food, fluids, prescribing medication, and prescriptions of anabolic hormones such as testosterone, DHEA, bio-identical and growth hormone. These treatments should accompany the proper conventional treatment for whatever the underlying cause of the catabolism is, such as adrenal fatigue, HIV/AIDS, cancer, infection, and kidney or respiratory failure. If the cancer can be treated successfully, then cachexia is more likely resolved as well.


Testosterone plays a vital roll in building muscle, and a lot of patients with wasted muscle tissue (women and men) have a testosterone deficiency. One research study showed that over 70 percent of men with cancer cachexia were deficient in testosterone. In cancer patients with cachexia total levels of testosterone were lower when compared to cancer patients without cachexia. Several research studies have shown that treating with testosterone has been helpful in boosting lean weight gain for those with HIV/AIDS or cachexia related to COPD.

A Texas research study treated men aged sixty to eighty-five who were healthy but had low testosterone levels (

Testosterone is a prescription medication. Always start with a very small dose to gauge the body’s response. Be aware that not everyone can tolerate testosterone replacement therapy.


DHEA is a powerful hormone and a precursor to many of the other vital hormones including estrogen and testosterone. Older adults commonly have low levels of DHEA and this is linked to cardiovascular disease, depression, increased risk of osteoporosis and bone fractures, lower muscle mass and strength, and sexual dysfunction.

DHEA in a catabolic vs anabolic state and improvements to bone densityThere have been studies published that show when DHEA is given (a typical dose is 25 mg-50 mg a day) to osteoporosis patients it is linked with higher bone densities. These benefits seem to especially affect women more than men. Studies also indicate that supplementing with DHEA may enhance cognition or overall mental abilities, mood, sexual function and help cardiovascular disease.

Recommended Dosage: 15 mg-50 mg daily for women and 25 mg-75 mg daily for men followed by blood tests in 3-6 weeks; consider starting at a lower dose and increase as indicated. Stop if you find it too stimulating. Side effects include acne, hair loss, oily skin, and irritability. Adrenal crashes can be triggered.

Growth Hormone

Growth hormone, commonly called by their brand names Serostim®, Genotropin®, Saizen®, Humatrope®, Nutropin and Norditropin® won approval by the Food and Drug Administration as a treatment for HIV/AIDS-related wasting. As with many approved drugs it is occasionally used off-label as a treatment for other catabolic wasting conditions. The pituitary gland produces growth hormone and the body’s natural production normally declines significantly as people grow older or when they have a severe, chronic illness like cancer or AIDS.

Some of the adverse side effects that are more commonly seen in patients being treated with growth hormone than in patients in the control group are diarrhea, edema, and joint pain. Growth hormone is sometimes used to treat older adults suffering from age-related sarcopenia. In analyzing the studies, which used 220 older adults as subjects, they showed that by treating them with growth hormone for a period of two weeks or longer there was an association made to an average of 4.6 lb. gain in lean weight without any significant difference in bone density. But the older subjects who were treated with growth hormone did experience problems with their health in significantly higher numbers when compared to subjects in the control groups. These problems included carpel tunnel syndrome, edema, and joint pain. They were also a little more likely to develop the onset of type 2 diabetes.  So, how does this realate to catabolic vs anabolic state?

Alert: Any one of these three hormones can be considered under professional guidance for those who are young, healthy and in early stages of AFS, where fatigue is mild and not incapacitating but in a catabolic wasting state for other reasons, such as after a major accident or surgery. Each hormone has its pros and cons. For example, those with cancer should be very careful because of the anabolic effect that may encourage cancer cells to grow. This helps us to recognize that to be in a catabolic vs anabolic is relative to each individual person.  To be in a catabolic vs anabolic can be helpful or less so depending on the overall condition of the person.

Other Stimulatory Compounds

In taking a look at catabolic vs anabolic physical states, not the following. Supplements composed of natural compounds with intrinsic stimulatory properties such as thyroid replacement, iodine, zinc, copper, vitamin B12, pituitary and adrenal cortex glandular, herbs such as rhodiola, ashwagandha, maca, ginseng, and green tea can be considered at this time, provided they are given with close supervision.

It is not unusual for the body to have a surge of energy with these as well as with anabolic hormones. Be on the look out as over time, anxiety and fatigue may resurface and become more prominent, followed by an adrenal crash.  It is important to avoid this as adrenal crashes induce catabolic vs anabolic states.

Summary: Catabolic vs Anabolic

So, what is catabolic vs anabolic and how can it impact your health? Most people in advanced stages of Adrenal Fatigue Syndrome are in a state of catabolism, clinically or subclinically. It’s a process moving from a catabolic vs anabolic state. Recovery from a catabolic state requires a three step approach. Step one is to stabilize the metabolic cycle by gentling reversing the catabolic state. Step two is shifting the body’s metabolic balance to neutral from net negative energy drain. Step three is to prepare the body and engineer a soft and gentle anabolic liftoff with anabolic hormones and the like. These steps help to aline the body transferring it from a catabolic vs anabolic state. Step 1 is best accomplished by a combination of macro nutrition with whole foods, following the catabolic state dietary principals, consistent nurturing exercises with rest, and a properly dosed and delivered micro nutritional cocktail. The process of moving from catabolic vs anabolic must be slow to avoid adrenal crashes and patience is required. Once the body is stable, a more aggressive micro-nutritional approach is started to return the body to a neutral catabolic cycle achieve step 2. Lastly, anabolic hormones such as growth hormone, testosterone, and DHEA may be considered for step 3.

When directly comparing catabolic vs anabolic states, it is not always healthy to reside in a catabolic vs anabolic state. If you think that you are in, or have symptoms of catabolic state and suffer from Adrenal Fatigue Syndrome, recovery needs to be personalized. An improper approach to recovery can complicate, deter, or even exacerbate your current state. So, make sure you communicate with your health professional concerning your transition from a catabolic vs anabolic state and what is best for you.

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

Catabolic vs anabolic
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