Catabolic State and Adrenal Fatigue Syndrome – Full Version

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.

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 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:

  • Break down of adipose fat stores to form fatty acids
  • Cycle of citric acid
  • Process of glycolosis
  • Break down 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. With 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

A man rundown from the Catabolic StateExcessive 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.

Obviously, 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.

Catabolic 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

A catabolic state will tire you outThis 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

It 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.

Catabolic State Consequences

Adrenal Fatigue causes a catabolic process condition, or breakdown, of the bodyPatients suffering from catabolic state, depending on the level of severity, are at increased risk of:

  • Diminished quality of life in general with loss of vitality
  • Falls due to frailty
  • Infection as the immune system lacks the nutrient to be optimized
  • Much lower capacity for exercise due to lack of muscle mass
  • Poor and/or slower healing of wounds
  • Significantly lower breathing capacity as intercostal muscle function declines
  • Death

Consequences of a catabolic state, whether clinical or subclinical, include:

  • Worsening of the underlying condition, such as Adrenal Fatigue Syndrome
  • Gradual loss of muscle mass that easily leads to frailty causing adverse effects on a number of medical outcomes
  • Compromising various bodily organs, including cardiac and respiratory function
  • Continued weight loss, although unintended
  • Ultimately death

Stress and Catabolic State

Glucocorticoids, primarily cortisol, are steroidal hormones produced by the adrenal glands in response to stress. With chronic stress, the adrenal glands become weakened after its effort to compensate by increasing anti-stress hormone cortisol fails. Cortisol output there varies as AFS progresses. It is usually high in stages 1 and 2 of adrenal fatigue. As adrenal fatigue progresses, cortisol output is often pushed to its limit. A chronically high cortisol output can lead to a state of catabolism because cortisol causes the breakdown of proteins in order to generate energy over time. As AFS enters Stage 3 and beyond, cortisol levels tend to stay low as AFS advances further.

This metabolic cycle is deranged when under stress with AFS. The emergency mobilization of quick nutritional resources, cortisol release, norepinephrine, epinephrine prepares the body for the fight-or-flight alarm response. It is a way to ensure that our energy needs are covered when survival is perceived to be at risk. At the same time this mobilization is handled under stress, the levels or cortisol and adrenaline go up while the levels of DHEA and testosterone go down. The net effect is in favor of catabolism if all else is equal.

In advanced stages of adrenal fatigue, the rebuilding process, normally carried out by testosterone, estrogen, DHEA, and pregnenolone, is overwhelmed by the amount of catabolic hormone damage. While laboratory tests may show low cortisol at this time, the vicious cycle of catabolism is well entrenched with its downward decompensatory cascade reinforced by a destabilizing positive feedback loop. Therefore, the rebuilding process will be exceedingly slow and sluggish.

In other words, the catabolic mode is self-driven once entered. Less muscle mass means reduced exercise capacity. This further reduces the incentive to exercise as frustration and fatigue sets in. Fatigue drives further inactivity. Muscle mass loss is exaggerated with disuse. The vicious cycle continues. Furthermore, muscles torn from normal wear and tear are not adequately repaired on a timely basis. Collagen is broken down without significant compensatory replenishment. Outwardly, wrinkles start to develop as premature aging sets in. Internally, organs and muscle breakdown leads to chronic muscle and joint pain of unknown origin, especially after strenuous exercise or heavy lifting. Reduced muscle mass can lead to chronic pain syndrome, joint pain, chronic fatigue, and fibromyalgia.

As the collagen structures of internal organs break down, their functions are compromised. Gastrointestinal tract motility and contraction forces are reduced. Adrenal fatigue is often associated with the poor ability to digest proteins and common symptoms include indigestion and irritable bowel syndrome. The amount of acid production in the body may not be sufficient to help break down the digested foods, resulting in further improper digestion. Clearly, the root pathophysiology is a body in catabolic state of the metabolic cycle. Unless reversed, the health consequences can be devastating.

Laboratory Tests for Catabolic State

The basic normal laboratory workup for diagnosing catabolism includes a complete blood count, IGF-1 (a surrogate marker for growth hormone); cytokine panel, CRP, CBC, chemistry panel, sedimentary rate, chemistry panel, liver panel, thyroid function, free testosterone, DHEA-S and electrolytes. Those with advanced AFS should also have a 24-hour 4-point cortisol saliva test.

The following are good markers of catabolic state:

  • BUN-to-creatinine ratio with normal creatinine

    Urea is the final breakdown product of the protein and amino acid metabolism. This is the most important catabolic pathway for eliminating excess nitrogen from within. This test is frequently accompanied by serum creatinine testing. Clinicians frequently calculate the urea nitrogen/creatinine ratio: serum bun in mg/dL/serum creatinine in mg/dL. For a normal healthy individual on a standard diet, the normal ratio ranges between 12 and 20. A low BUN: Cr ratio suggests inadequate protein intake, reduced urea synthesis as in advanced liver disease, and increased creatinine production as in rhabdomyolysis. High ratio with normal creatine is noted with a catabolic state of tissue breakdown.

  • Free testosterone

    When the body spends excessive amounts of time in a catabolic state, injuries, illness and reduced performance levels are typical symptoms. In addition to high cortisol and low DHEA, testosterone levels tend to be low in both men and women. This is often accompanied by reduced exercise performance, low libido, and poor memory. The normal level for a male is 50-210 pg/ml (174-729 pmol/L) and 1.0-8.5 pg/ml (3.5-29.5 pmol/L) for a female.

    Note: Lab results can be skewed to the low side if one is on a low fat diet because testosterone is manufactured from much needed cholesterol in the body. A low testosterone level in men can also be caused by some inherited diseases (such as Klinefelter syndrome or Down syndrome), liver cirrhosis, prostate gland cancer treatment, chronic alcohol use, obesity, and chronic pain. In women, a low level of testosterone may be caused by an underactive pituitary gland, loss of ovary function through disease or surgery, Addison’s disease, and some medicines (such as corticosteroids or estrogen).

  • Cortisol and DHEA ratio

    Two key hormones regulating the metabolic cycle are cortisol and Dehydroepiandrosterone (DHEA). Cortisol is a hormone secreted by the adrenal glands to help the body in times of stress. It performs a number of functions including the breakdown of muscle proteins, which causes an increase in glucose in the bloodstream to help the body attain the energy it needs in times of stress. Cortisol generally has a catabolic effect. DHEA usually has the opposite effect, since it’s an anabolic hormone and anabolism is the process that occurs when food converts into living tissue. When you are under chronic stress an imbalance occurs because the production of cortisol is increased and DHEA production slows down. This results in your body going into a catabolic state. The net result is cortisol dominance.

    Both cortisol and DHEA (present in blood as DHEA-S) can be measured by routine laboratory testing. A blood cortisol/DHEA-S ratio of greater than 6 is an alert sign of catabolic state.

    Raised ratios of cortisol to DHEA cause an increase in fat deposits, predominately in the midsection. This is the commonly referred to muffin top we see in people under stress or middle-aged people that are sedentary. It also impairs skin regeneration, which can cause wrinkles to develop. Protein breakdown due to stress can also accelerate the development of osteoarthritis and the bone loss that goes with it. It also extends the time it takes for someone to heal from an injury or trauma. Other physical conditions, which are related to a rise in cortisol to DHEA ratios, include depression, hypertension, ischemic heart disease and various types of cancer.

Unfortunately, the clinical correlation between laboratory tests of catabolic state markers is neither linear nor absolute. There is considerable personal variance as well as changes as the catabolism progresses. The absolute cortisol level, whether by blood or saliva, cannot be relied on as the sole indicator of catabolic state. Catabolic markers are helpful and serve as a reference point. They are best used in the context of close clinical correlation. For example, loss of body weight and muscle mass usually occurs gradually in patients with chronic conditions such as Adrenal Fatigue Syndrome. One can be in a catabolic state but the cortisol/DHEA ratio is under 6, for example. Again, a careful history and clinical symptoms remain the best tools in identifying catabolic state early on.

Anabolic Hormones—Wait a Minute

Once the catabolic state is suspected, the conventional approach is to start immediately on anabolic hormones. This is especially true if the blood testosterone and DHEA are low. Unfortunately, this is one of the most common clinical mistakes one can make if advanced AFS is present.

Clinically, we see that the more advanced the AFS backdrop, the less such anabolic hormonal approaches will be tolerated. Some feel more energized, but only for a short time. Others may in fact feel jittery and anxious from the get go. Heart palpitations and panic attacks are common while adrenal crashes are triggered in others. This creates an atmosphere of the weaker the adrenals the higher the risk of a backfire.

The deranged autonomic nervous system (ANS) associated with advanced AFS may be a strong contributing factor to treatment failure. Those with advanced AFS typically are in a state of ANS overdrive. The sympathetic nervous system, along with its stimulatory hormone epinephrine (also called adrenaline) is typically in overdrive as an autonomic compensatory response by the body when it enters a flight-or-fight mode in its fight for survival brought on by perceived stress. The body is on full alert. Receptor sites are hypersensitized. The extracellular matrix is congested from cellular metabolites overload, while the liver is overburdened with resulting slow clearance. The result is a body saturated with unwanted metabolite that causes inflammation. Any anabolic agent that has intrinsic metabolic stimulatory properties tends to make the internal terrain even more hostile. These agents, while constructive for those who are not in advanced AFS, tend to behave paradoxically. Anxiety, panic attacks, jitteriness, a sense of wired and tired, insomnia, heart palpitations, and POTS-like symptoms are frequently reported. Adrenal fatigue may worsen as adrenal crashes are triggered by such anabolic therapeutic agents in a setting of catabolic state and concurrent advanced AFS.

Agents to be avoided unless clinically critical and conducted under supervision include testosterone, DHEA, pregnenolone, growth hormone, estrogen, thyroid, glandular such as adrenal cortex, and herbs such as rhodiola, ashwagandha, maca, ginseng, and green tea. Even vitamin C may not be tolerated.

Challenges of Catabolism Reversal in the Presence of Advanced AFS

A body in catabolic state with concurrent advanced AFS is usually not able to accept natural or synthetic anabolic compounds that have stimulatory properties. Use of any nutritional supplementation, even though intrinsically gentle by nature, needs to be carefully titrated to match the body’s state of function to be gently nurturing and supportive without triggering any crash. This is easier said than done because the AFS sufferer, when accompanied by catabolism, is typically in a fragile state, with little reserve remaining to cushion any change, whether it be good or bad. Many are already house bound and unable to work or maintain a normal social life. Adrenal crashes can be easily triggered.

Adrenal Fatigue and the catabolic process can make it difficult for the sufferer to stay warmLaboratory tests only give at best a rough picture and are neither specific nor sensitive enough to be relied upon heavily for day-to-day clinical decision-making. A detailed history by an experienced clinician is key. Yet, tremendous challenges face the clinician when designing a catabolism/AFS recovery program. The sufferers are typically:

  • Too weak to digest and tolerate any normal food
  • Too fragile to accept any anabolic hormone
  • Too prone to paradoxical reaction with supplements of any kind
  • Their receptor sites are too sensitive and dosage becomes problematic
  • Their liver is too congested, resulting in a high internal toxic load due to sluggish metabolic breakdown
  • Their extracellular matrix is too polluted, resulting in a heightened sensitivity to food, drugs, and nutritional supplements
  • Their reactive hypoglycemia makes dietary choices limited and difficult
  • They have too much adrenaline flooding the body, leading to a lower threshold for adrenal crashes, heart palpations, and adrenergic POTS
  • They have a sluggish assimilation rate across their GI tract, with reduced absorption and thus bioavailability of nutrients
  • They are too weak to exercise, further worsening muscle wasting during inactivity
  • They are too socially withdrawn to solicit emotional support and break the negative attitude cycle.
  • Their thinking process is too slow often aggravated by brain fog.
  • They are too weak to hold a full-time job, leading to financial hardship
  • They are eager to get well, but have failed multiple times and lost patience, resulting in pent up frustration and anger towards health professionals

Given the above constraints, stabilizing and reverting the metabolic cycle from catabolism to neutral is a very challenging endeavor.

3 Step Recovery Approach

When in an advanced AFS 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 AFS, 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 AFS 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.

Therefore, 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 AFS 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 Metabolic Catabolism 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 AFS.

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 blue print 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.

As 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 Principals and Approaches

The major problem for those with AFS 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; AFS 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

The 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 AFS 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.

If 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.

Water and the Extracellular Matrix

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, 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.

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.
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.
For 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 stabilized.

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 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.

Whey 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

L-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

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 availably 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

Taking 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 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

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 (<500 ng/dL). Some subjects were given injections of testosterone and others were given a placebo. After fives months had passed, the men treated with testosterone put on an average of 6.9 lbs. of lean mass while losing an average of 2.7 lbs. of fat. The subjects who were given the placebo injections lost on average 2.4 lbs. of lean mass and put on an average of 2.6 lbs. of fat. Research studies have shown that testosterone treatments can improve the synthesis of protein and the development of muscle mass in older women. 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

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.

There 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.

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.

Other Stimulatory Compounds

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.

Summary

Most people in advanced stages of Adrenal Fatigue Syndrome are in a state of catabolism, clinically or subclinically. 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. 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 is necessarily 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.

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.

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