Why Conventional Medicine Rejects Adrenal Fatigue – Part 1

By: Michael Lam, MD, MPH

Conventional Medicine Rejects Adrenal FatigueAdrenal Fatigue is a term applied to a collection of nonspecific symptoms such as fatigue, anxiety, joint pain, insomnia, hypoglycemia, depression, nervousness, sleep disturbances and digestive problems presenting in an otherwise healthy person with normal laboratory test results. Over 50 percent of adults suffer from Adrenal Fatigue at one point or another in their adult life. Most recover without knowing they had Adrenal Fatigue Syndrome, but a minority fail to recover, and a smaller number continue to only get worse. In its worst form, a person can be bedridden and incapacitated. The term often shows up in popular health books and on alternative medicine websites. An Internet search of the words “Adrenal Fatigue” yield over 2.4 million results, with search threads ranging from the Mayo Clinic to the Hormone Foundation and alternative health forums. What is clear is that to the vast majority of conventional medicine physicians, other than the forward-thinking ones, this condition does not exist and is not real. Yet to the vast majority of sufferers, this condition is very real and indeed, can be quite debilitating.

How is it possible that such a widespread dysfunction that generates so much ongoing interest among the public be rebuked by many of the world’s most brilliant and well-trained physicians? How does one explain the cognitive dissonance among most conventional medicine physicians’ assessment that Adrenal Fatigue does not exist, while the real experience of many sufferers is that of incapacitation and the inability to hold down a job?

Clinical vs. Subclinical States of Illness

Eighty percent of the most common causes of death in age related illness results from cardiovascular disease, stroke, and cancer. These degenerative diseases gain a head start years before outward symptoms are detectable. For example, the average cancer takes over a decade to develop before a lump is felt or clinically detectable.

A lifetime of poor nutrition, stress, and environmental pollution erodes cellular protection, repair, and replacement—the very foundation of health. While outwardly one may appear normal and healthy by traditional standards, inward cellular damage and insult is taking place daily from pollution, stress, and the cellular oxidative process, coupled with endogenous and exogenous free radical attacks from a young age. By age 50, free radical attacks damage as much as 30 percent of our cellular protein. Fortunately, the body has endogenous self-repair mechanisms. However, this repair mechanism is not 100 percent efficient. Damage that escaped repair can lead to cellular mutation and ultimately organ dysfunction. Adrenal Fatigue may be the result of such continuous insult over time.

Modern laboratory and detection methods are far from perfect and lack the sensitivity to pick up signs early enough to warn us of impending danger. Modern medicine with its many tests are of tremendous value when symptoms turn catastrophic and gross system failure is obvious—when chest pain occurs, or brain function fails, or a lump appears. Conventional Medicine and Laboratory TestingUntil then, normal current testing results simply reinforce our denial that most adults who appear healthy have, in reality, already entered into a sub-clinical state of aging with multiple diseases well in place but undetectable by physical examination or laboratory tests. These progressive sub-clinical disease states include borderline hypertension, sub-optimal adrenal function and hormonal imbalance, reduced liver detoxification capacity, reduced gastric assimilation potential, metabolic imbalances, and sugar intolerance. They are mostly foreign to conventionally trained western physicians who are taught to think in terms of demonstrable pathology to define disease.

The Disease Continuum

It is not unusual to be seriously ill and symptom-free yet have normal laboratory values. Autopsy studies of those who died of sudden death from cardiac arrest have repeatedly shown a large proportion with clean coronary vessels and perfectly normal laboratory tests.

Health, in reality, comprises a full spectrum of wellness; a continuum that ranges from severe sickness at one end to optimum health at the other end. Each chronic disease exhibits a similar continuum. Conventional medicine tends to label a person as sick once they cross the threshold of normal laboratory reference based on data derived from general population statistics. Until one crosses the threshold, they are considered normal. This is an all-or-nothing approach. The body is not a light switch that flips from normal one day to become abnormal the next. Unfortunately, all that is in between is universally ignored. The advancement of preventive medicine as a medical specialty strives to arrest disease at its sub-clinical state and address these sub-clinical conditions well before they become serious.

Adrenal Insufficiency (Addison’s Disease)

Conventional medicine and its view of Adrenal Fatigue as largely a myth has foundational validity. From their perspective, there is only one disease state when it comes to adrenal weakness, and it is called adrenal insufficiency, or Addison’s disease.

Both conventional medicine and natural medicine physicians recognize adrenal insufficiency as a real disease diagnosed through blood tests. Addison’s disease afflicts 4 out of 100,000 people. Life-long steroid replacement therapy is usually required. Diagnosis is relatively straight forward with well defined protocols.

Mild Adrenal Insufficiency — Is It Real?

Adrenal Fatigue is advanced by natural medicine professionals to denote a mild form of adrenal insufficiency where regular laboratory tests are normal but a person is symptomatic. It is also called by a variety of other names, including mild non-Addison’s adrenal insufficiency.

Modern medical practice relies heavily on laboratory tests and other diagnostic procedures in mechanized fashion to confirm the presence or absence of disease. Any other approach is considered unscientific. The importance of taking a detailed history and recognizing the uniqueness of each body as the key foundation of arriving at any diagnosis is quickly becoming a lost art, replaced by the over-reliance on laboratory tests. This works rather well for acute illness, because the clinical presentation is dramatic. For chronic conditions, this laboratory reliance model is less than ideal. Most, if not all, chronic conditions evolve through a sub-clinical state as mentioned above. In this state, symptoms are present but all relevant laboratory results are within normal limits.

Conventional Medicine and Assessing Clinical HistoryAt best, laboratory results serve to help physicians assess the clinical states. It was never designed to replace a detailed history and good clinical skills. Within the current medical framework of thinking, normal simply means the absence of detectable illness as evidenced by laboratory test results within a statistical range defined mathematically. The threshold of what is considered normal or abnormal is determined by man. It is therefore an imperfect science.

This approach to medicine is grossly incomplete in chronic conditions, to say the least. The problem is obvious. Sole reliance on laboratory testing as the definitive diagnostic tool is a flawed model. On one hand, many are not well but have normal test results. They are told nothing is wrong and sent home. On the other hand, by the time testing detects illness it may be too late. The result is the same: patients suffer unnecessarily.

The Adrenal Fatigue Debate

Let us examine the foundational premise advanced by naturally oriented physicians to support their thesis that Adrenal Fatigue is real.

The adrenal glands, like any other organ system, are subject to dysfunction due to intrinsic weakness or external insult anytime during our life. It secretes over fifty hormones and is largely responsible for helping the body deal with stress. Most of these hormones decrease after reaching a peak in our 20s. The gradual decline in hormonal health is first unnoticeable, especially in the adrenal glands. According to natural medicine physicians, fatigue is usually slight in the early stages of Adrenal Fatigue. A good night’s rest or a cup of coffee is usually all that is required to regain lost energy.

If physical or emotional stress remains high, and the body is not allowed rest and recuperation, the pace of adrenal deterioration picks up. Sagging skin, irregular menstrual cycles, low libido, hypoglycemia, low blood pressure, insomnia, and lethargy are signs of internal systems breakdown at the sub-clinical level. The gradual decline of thyroid hormone leads to hypothyroidism; dysfunction in sugar regulatory hormones, such as insulin, leads to metabolic imbalance; imbalanced estrogen leads to a myriad of hormonally sensitive conditions including endometriosis, PCOS & fibrocystic breast disease; decline of cortisol leads to low immune function and frequent illness, worsening hypoglycemia, low blood pressure, insomnia, fatigue, and anxiety.

Because the adrenal glands constitute one of the main hormonal regulation centers of the body, it comes as no surprise that those with intrinsic adrenal weakness are most affected. Those who have severe childhood emotional trauma, excessive physical exertion, major surgery, and repeated pregnancies are particularly vulnerable.

Every chronic illness including hypertension, hypothyroidism, and diabetes progresses through a continuum from normal to severe in a graded state over time. Based on common sense alone, mild dysfunction of the adrenal glands is likely to exist regardless of the name it is given.

It is important to note, however, that while Adrenal Fatigue can explain may of the presenting symptoms, it often cannot fully explain ALL the symptoms presented by sufferers. There may be other conditions that clinically present itself with fatigue but the underlying root cause is NOT adrenal weakness.

Causes of Adrenal Fatigue from a Natural Medicine Perspective

Natural Medicine and Conventional MedicineAccording to natural medicine physicians, Adrenal Fatigue is largely caused by stress, either emotionally or physically.The theory is that your adrenal glands are unable to keep pace with the demands of perpetual fight-or-flight arousal and hormonal demands due to stressors. As a result, insufficient hormones are produced and fatigue is the result. Conventional medicine sees no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands, leading to the common symptoms of fatigue and lethargy.

Conventional medicine acknowledges that symptoms of fatigue are real, but does not maintain that the adrenal system dysfunction plays a role as long as a test for Addison’s disease is negative. In other words, they believe the symptoms as reported by sufferers are accurate, but the cause lies outside the adrenal glands. Thus the diagnosis of Adrenal Fatigue is invalid and not real. Instead, they turn their attention to other syndromes that have similar clinical presentations, such as depression, chronic fatigue syndrome, and fibromyalgia. Adrenal Fatigue is rejected as a possibility. What is interesting is that these other diagnoses were themselves being considered invalid by conventional medicine.

Why Conventional Medicine Rejects Adrenal Fatigue

The basis of conventional medicine’s thesis that Adrenal Fatigue is not real revolves around two critical questions.

First, whether it can be proven that stress can lead to a physical imbalance of adrenal hormone output that can be quantified, and thus, considered as evidence. Second, whether this quantifiable imbalance is the root cause for symptoms of fatigue and lethargy.

Let us look more closely at each of these.

The advent of brain imaging and neuroscience research has proven without a doubt that a network of hormones connects the mind and body. Physical or emotional stress has been demonstrated and proven to be a strong trigger of quantifiable hormone release in the adrenal glands, including adrenaline and cortisol. Laboratory measurements of these hormones show varying results, depending on the state of the person and the stress level. Research has proven that in times of acute stress, our adrenaline (the hormone responsible for the fight-or-flight response) level rises quickly. At time of rest, it falls gradually. The degree of rise and fall, however, varies from one person to another. Some people under stress can release a large amount of adrenaline. In others, the rise is much more muted. When stress is chronic in nature, acute elevation does not occur. Often times, the change is hardly noticeable, perhaps because the body has other compensatory mechanisms in place. In other words, while we can say that there is a definite hormonal connection, the exact degree at this sub-clinical state has yet to be perfectly quantifiable with pinpoint accuracy. A general picture of hormonal imbalance can be seen.

To conventional medicine physicians, this does not meet the threshold of what they consider scientific evidence. To naturally oriented physicians, this is the best we can do given the current technology. We choose to accept it.

Brain Imaging and Conventional MedicineNext is the evaluation of sub-clinical hormone imbalance and the question as to whether or not this leads to clinical symptoms of fatigue and lethargy. The results are not perfectly clear. One can have high adrenaline levels and not feel fatigued, while others can be tired but have normal adrenaline blood levels. Again, presently there is no quantitative test of any kind that provides a direct and absolute correlation between the levels of any single adrenal hormonal to symptoms of fatigue with 100 percent accuracy.

Based on the above, we can surmise three possible deductions:

First, that the current laboratory test is incapable of measuring sub-clinical states. In other words, laboratory studies are not useful for this situation at all and therefore should be discarded.

Second, the current test is good, but the reference range lacks sensitivity to correlate to the sub-clinical state. What is needed is to redefine the reference ranges, or lower the threshold. This is not uncommon in the medical world.

Lastly, we can surmise that such sub-clinical states do not exist because current laboratory tests are accurate enough to cover the entire spectrum of adrenal health. There is no change necessary.

Unfortunately, the medical science relied on by conventional medicine has not yet advanced to a state where one can definitively argue for and defend any one of the above three scenarios to the complete exclusion of the others. Adrenal Fatigue is not the first condition to face this challenge. Many illnesses considered invalid in the past have subsequently become validated if one examines the history of medicine. In fact, this is the norm and not the exception. Most chronic diseases, if traced to their root history, experience resistance and rejection by the mainstream medical community of that era when first introduced. This is the norm. Their full acceptance into the medical community only comes decades later. Not many decades ago, depression, fibromyalgia, irritable bowel syndrome, and chronic fatigue were also considered invalid diagnoses by conventional medicine. Today, they are accepted illnesses.

Depression: Diagnosis Without Using Laboratory Tests

Let us take depression as an example. To qualify for a diagnosis of major depression, for example, one only has to, within a two-week period, have any five of the following symptoms that represent a change from previous function:

  • Depressed mood most of the day, by subjective account or observation
  • Insomnia nearly every day
  • Fatigue or loss of energy nearly every day
  • Feeling of worthlessness
  • Diminished ability to think or concentrate
  • Recurrent thoughts of death (not simply afraid of dying)
  • Significant weight loss or weight gain when not dieting
  • Psychomotor agitation as observed by others

Conventional Medicine and DepressionClearly none of the above nine criteria are laboratory driven or quantitative in nature. They are all subjective. Once a person has five of the symptoms, depression is diagnosed, and that becomes a medical fact. Your updated medical records will be with you for the rest of your life. Until they reach this diagnosis, a person is not considered depressed.

The obvious question then is what diagnosis is given to a person who has four out of the nine criteria? Is that person normal and thus unworthy of treatment? Borderline depression would be a logical diagnosis, but this does not exist. However, not all conditions face this problem. Borderline hypertension is a valid diagnosis, and so is borderline diabetes.

Indeed the medical world is full of idiosyncrasies.

Read Part 2 Now!

© Copyright 2015 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Questions

They are good treatments but make sure you consult your coach before starting.

The use of birth control forces menstrual regularity and allows conventional doctors to regulate the flow and timing that is often disrupted by PCOS.

Most doctors are trained to improve symptoms the fastest way. They are not trained to build the body up from the foundation. Using glandular and adaptogen herbs, in my opinion, is not helping to improve the foundation of your body but patchwork. They do have their function at the proper time and place, but priority should always be to allow the body to self-heal first. Herbs and glandulars can help short term, but can potentially have long term issues.

You should read and learn about your condition. Print and give your doctor my article on OAT axis imbalance.

Conventional medicine

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Hello Dr.Lam
Thank you for enlightening traditional MDs like myself to understand something so common yet poorly understood in our conventional Medical practice. Once well, I hope to become your apprentice some day.
Dr. Brian L.