Laboratory Testing For Adrenal Fatigue Syndrome

By: Michael Lam, MD, MPH; Dorine Lam, RDN, MS, MPH


Adrenal Fatigue Syndrome (AFS)

Any time stress afflicts the body, the response is the same. The hypothalamic-pituitary-adrenal (HPA) axis is activated, ending in the adrenal glands secreting cortisol, the stress-fighting hormone. As stress continues, the adrenals become less and less able to produce this hormone. Eventually, adrenal fatigue sets in and the vague symptoms of AFS begin. Due to the vagueness of the symptoms, they prove hard to evaluate clinically. If not assessed and addressed adequately, these symptoms will grow to the point of rendering the person suffering from them bedridden. Routine laboratory tests are not designed to pick up these vague symptoms.

Routine Laboratory Testing

Laboratory testing is common when diagnosing Adrenal FatigueThe most common presenting complaints of Adrenal Fatigue are lack of energy, lethargy, dizziness, insomnia, hypoglycemia, low blood pressure, and anxiety. Routine conventional medicine laboratory testing for these in an otherwise healthy person commonly include:

  • Hematology (full blood count (CBC) – red cells, white cells and platelets to make sure patient is not anemic.
  • Biochemistry (liver and kidney function) to rule out systemic organ damage.
  • Inflammation in the blood – ESR, C reactive protein, plasma viscosity to rule out autoimmune diseases, among others.
  • Cancer markers for early detection of cancer.
  • Blood Sugar level to rule out diabetes mellitus.
  • Urine testing to rule out infection or kidney damage.
  • Fecal occult blood to rule out bleeding from the gut and cancer screen.
  • Electrolyte panel to assess kidney function.
  • Thyroid stimulating hormone to rule out primary thyroid failure.

These tests are good in detecting macroscopic pathology such as major organ failure including anemia, heart disease, metabolic dysfunction, cancer, liver failure, kidney failure, thyroid diseases.

Unfortunately, these routine laboratory testing procedures do not detect organ dysfunction at the sub-clinical level such as those afflicted with sub-clinical hypothyroidism, Adrenal Fatigue, mild liver dysfunction, imbalanced electrolyte function, minor hormonal imbalance, estrogen dominance, and suboptimal detoxification capacity.

In addition, little if any attention is paid to laboratory values that lie close to or just outside of normal range. Low normal or high normal values are generally passed over as insignificant until the result is much higher or much lower than normal range.

Modern medicine has also ushered in a wide array of standardized protocols of testing in addition to the number of tests. These well-intended tracks are meant to efficiently and effectively handle most common medical problems with accuracy and speed. They are by definition fitting for the masses. Those whose response falls within the statistical norm but physically symptomatic will be inadvertently ignored as they will be considered normal when they are not. In these cases, conventional medicine has little to offer. Instead, normal laboratory values are used to justify why patients are sent home to self-navigate, and that nothing is wrong when the body continues to suffer.

Unusual and convoluted clinical states such as those suffering from chronic fatigue syndrome, Adrenal Fatigue Syndrome, tension myositis syndrome, and estrogen dominance are difficult to diagnose to start. Conventional physicians usually dismiss these conditions because routine test values are invariably within the standard laboratory reference range. This is why it is most frustrating to the patient—when they are told there is nothing wrong while they feel physically tired and lethargic.

Doctors rely on detailed medical history and laboratory testing for diagnosisPrior to the advent of modern medical laboratory tests, the astute physician had to rely on a detailed history and physical examination to assess the clinical state. Laboratory values are used only in case of doubt, or as a confirmatory tool. Unfortunately, this is fast becoming a lost art in the clinical practice of medicine. The failure of conventional medicine to be on alert and to recognize that a person can be ill but have normal laboratory blood test results is alarming. Many sufferers are sent home to self-navigate and are abandoned by the very health professionals who are supposed to help them recover.

To make matters worse, most conventional physicians are not nutritionally oriented or trained. Even if laboratory tests come back abnormal, they are at a loss on how to correlate it with clinical findings when the presentation is overwhelmingly convoluted as one sees commonly in Adrenal Fatigue.

NeuroEndoMetabolic (NEM) Model

In order to comprehensively understand and assess conditions like AFS, a different approach must be undertaken by healthcare professionals. Two major factors of the body’s response to stress must be combined: the typical neuroendocrine factor and the functional metabolic factor. Incorporating the systemic metabolic component with the organ specific neuroendocrine component allows the healthcare professional to get to the root cause of symptoms and develop adequate remediation efforts. In this model, there are six circuits that all work interdependently in dealing with stress. These six circuits include the metabolic, detoxification, inflammation, cardionomic, neuroaffective, and hormone response circuits.

When Normal is Not Normal with Laboratory Testing

To illustrate how a normal laboratory test can be present in a body that is not well, let us consider the following:

  • Most Adrenal Fatigue sufferers have low immune function present with frequent infections but normal white cell count. Low or low normal white cell count can be a sign of poor immune function. Nutritional deficiencies, such as low zinc, low magnesium,low B vitamins, and low essential fatty acids can contribute to this. Normal white cell count does not rule out these problems at the sub-clinical level.
  • Normal platelet count does not rule out stealth viruses or a residual bacterial infection, such as that seen in post-acute Epstein-Barr virus infection. Low or low normal platelet count can be a sign of toxic stress from viral or emotional forces.
  • Borderline or high mean cell volume (MCV) suggests B12 deficiency, folic acid deficiency, or hypothyroidism. Normal MCV can occur with sub-clinical B12 deficiency in those who are constitutionally weak or sensitive.
  • Low white blood cell count is common in laboratory testing for Adrenal FatigueA normal fasting blood sugar in absolute terms associated with clinical hypoglycemia is common in advanced stages of Adrenal Fatigue.
  • Normal electrolyte levels do not rule out the presence of debilitating sub-clinical dilutional hyponatremia seen in advanced Adrenal Fatigue.
  • A normal thyroid Free T3 and Free T4 do not rule out secondary subclinical hypothyroidism due to pituitary or adrenal dysfunction.
  • Normal aldosterone level with salt craving and low blood pressure is commonly found in Adrenal Fatigue. Both serum aldosterone and sodium levels are usually within normal range.
  • Normal potassium level does not rule out the need to reduce internal potassium load. In Adrenal Fatigue, sodium depletion is common, leading to a relative (and not absolute) potassium overload that is still within normal laboratory range on testing.
  • High normal liver enzymes usually suggest liver dysfunction, typically from chemicals such as medications, or poor nutritional status. Normal liver enzymes are commonly associated with poor clearance of metabolites in Adrenal Fatigue as the body slows down to conserve energy.
  • High normal or high total cholesterol could mean low levels of vitamin D or hypothyroidism commonly seen in Adrenal Fatigue and does not necessitate the administration of statin medications to normalize lipid level.
  • A normal TSH can be present in those with clinical hypothyroidism. In other words, you can be suffering from hypothyroidism but have normal TSH levels.

Laboratory testing plays an important and significant part of assessing bodily function. It should not be disregarded. However, as you can see from the above, just because laboratory testing results are within normal range does not necessarily mean a person is free of illness. Many chronic illnesses, including Adrenal Fatigue, progress over time slowly. Sole reliance on routine blood serum laboratory tests for definitive assessment is a grossly incomplete approach to start in the case of Adrenal Fatigue.

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

Laboratory testing is common when diagnosing Adrenal Fatigue

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Thank you very much, Dr. Lam, for your reply to my question. Just wanted to say that I’ve been following your guideline diet completely, word by word, and I have lost rapidly weight, from 85 kg to 68 kg. I feel much better since I stopped eating meat. I occasionally eat some chicken breast, but most times fish and soy products. Definitely, there is a health improvement.