Podcast 18 - Adrenal Fatigue

Transcription

Chad: This is Dr. Chad Edwards and you are listening to Podcast number 18 of Against the Grain. Are you tired and fatigued? Are you frustrated with doctors because they don’t seem to listen? Do you want to fix your pain without surgery? If you answered yes to any of these questions, then we are the clinic for you. We offer Tulsa Prolotherapy, PRP and stem cell injections, IV nutritional therapies, bioidentical hormone replacement therapy, and functional medicine to help you get back on track to optimal health. Call us clinic at 9-1-8-9-3-5-3-6-3-6 or visit our website at www.revolutionhealth.org to schedule your appointment today.

 

Male: Welcome to Against the Grain podcast, with Dr. Chad Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready, because we are about to go Against the Grain.

 

Chad: Welcome back, so glad you are back to hear what we had to say today. This is Dr. Chad Edwards and I am here with Marshall and we’re going to talk about some good stuff today.

 

Marshall: Yes, I’m pumped. This is this is pretty educational for.

 

Chad: Number one, I’m pretty passionate about this topic. I’ve experienced this issue myself. Number two, you talk about controversy, you go take this to your standard Inside the Box primary care physician and say, “Hey, I have adrenal fatigue”, and you might get laughed at. One of the things that just gets me totally fired up and I just want to slap people and say, “Why in the world don’t you understand that this can actually happen when it works?” We discuss this with the pancreas when it comes to diabetes because it gets fatigued and it quits working. We see this with the testicles and testosterone, we see this with thyroid. Why on Earth can’t it happen also to the adrenal glands? The thing is we think so black and white and we look so much at disease instead of health. Tulsa Prolotherapy

 

This is one of the things that makes functional and integrative medicine so much different, is we are looking at the nuances –I view the human body when it’s functioning well like a NASCAR, a highly-tuned professional NASCAR driver on the track and that’s the way we want to function. When your car is blowing blue smoke and it’s knocking and all that kind of good stuff, that’s a diseased car. Think about the car that is sputtering into the gas station and almost passing out before it gets there. You got that on one end and then you have the NASCAR on the other end. Unless you have the engine that’s knocking and is getting ready to blow up, what I see is like with tradition medicine, we just don’t get it. So many people aren’t a NASCAR and they are one of those little jalopies that is getting ready to blow up. Tulsa Prolotherapy

 

Marshall: Both are outliers.

 

Chad: Exactly. But it shouldn’t be, we should be NASCARs. In traditional medicine we’re dealing with the outlier end of, “Do you have a disease or not?” Forgive me, but it’s just bull crap to say we have a Health Care System. We do not have a Healthcare System in this country, we have sick care. We have three international classifications of diseases ICD-10, we don’t have the international classification of Health. Nobody cares if you’re healthy, they care if you’re sick. Insurance doesn’t pay for health, they pay for sick. It’s just nonsense. Tulsa Prolotherapy

 

Marshall: I was just going to say, now I think our listeners are understanding why this is controversial.

 

Chad: Exactly. We will take something like the adrenals and you can feel tired and fatigued and all these kinds of things. When you go to your doctor and they say, “I think I’ve got “adrenal fatigue.” A lot of information out there about adrenal fatigue and what I see in my clinic is more and more people being proactive and reading and learning on their own, because their doctor aren’t doing it. Now, I’m not necessarily blaming their doctor, they’re a function of the system which makes me think of that Saturday Night Live skit with Adam Samberg. Tulsa Prolotherapy

 

Marshall: Yes, Adam Samberg.

 

Chad: The song ‘I’m not a part of this system’, I love that one, I think we should play that, it’s awesome. “I’m not part of the system.” With the adrenals, If you’re tired and fatigued the last time you go to your regular doctor and you say, “I think it’s this,” if they don’t laugh you are out of the exam room, then they might get a cortisol level, it’s one of the hormones that we’re going to talk about in this episode. They might check a cortisol level, if they’re on it, they’ll bring you back for a first thing in the morning serum cortisol, serum meaning blood, serum cortisol level if they’re like on again, or they might just send you to endocrinologist, whatever. That’s not what you need. The adrenals, there’s a lot to them and we got to assess them. Tulsa Prolotherapy

 

What is this adrenal fatigue thing? I get a lot of patients, they come in and see us and they say, “I’m tired, I got brain fog,” there’s a whole Litany of symptoms that can go along with adrenal fatigue. You can run down a whole list of symptoms that are pretty common, you guys can look them up on your own, I won’t waste the time here talk about these different symptoms. It can be really vague, it’s just like, “Something is just not right.” I don’t test everybody that comes into my clinic, that says, “I’m just not right,” with some of the adrenal fatigue testing but we consider it. I will talk to you some of that. If you have fatigue, it’s possible that you have adrenal fatigue. There is a whole bunch of things that can cause fatigue.

 

I see often in men, testicular hypofunction; that would be the medical term for it, but low testosterone. Got all these low testosterone clinics are popping up all over the country and you got the Low T Center in the Men’s Clinic and this and that, and they’re all dealing with testosterone. Well, and I see a lot of tests on testosterone. One of my issues is when you have a 31 year old guy that comes in because he’s got low testosterone, yes, you can treat their testosterone but why in the world is their testosterone low? That’s not normal. They’re not 75, why does a 31 year old have low testosterone?

 

If we address testosterone without considering why their testosterone is low to begin with, we have done a serious disservice to that patient. It is against the Paradigm of functional medicine where another thing going off on a little bit of a tangent. We talk about functional and integrative medicine, a lot of times testosterone replacement, bioidentical hormone replacement therapy, some of these things that a lot of a standard traditional doctors don’t really engage in. We’ll say we put ourselves in the Function Medicine Room. The reality is, we could use those therapies but that doesn’t necessarily make us any better than the traditional medicine route where, “Here’s your problem here’s your pill.” You have a hormone deficiency and we just replace the deficiency, what’s the difference in doing that and just giving you bioidentical pill for your blood pressure?

 

Not that there’s bioidentical a pill for blood pressure, but we have to address, “Why is this?” Literally, I’ve seen a 21 year olds with testosterone in the double-digits. Normal range of testosterone depending on the lab, roughly around 300 to 1000. I’ve seen 75 in a 21-year-old. Why in the world is that going on? Now, traditional medicine and certainly we have to do complete and due diligence to make sure that we look into the whole thing. We have to make sure that the anatomy is appropriate. These systems are controlled by the brain in the pituitary gland and they send these hormones that will tell these glands to make testosterone, to make this, and make that, all those kinds of things. Certainly those can be problems but that’s not what I see most of the time, there’s a functional reason for this and stress is a major player in this adrenal fatigue component.

 

When we start talking about adrenals, I think it’s important to understand what are the adrenal glands? We have normal anatomy, we two adrenal glands and they used to be called — another name for them would be the Supra-Renal glands. Renal s the kidney, so ‘Supra’ meaning ‘Above.’ Above the kidneys are these little triangular shaped little bit glands that are absolutely critical for life, you can’t survive without them. There are two different sections of them, there’s the Adrenal Cortex and Adrenal Medulla. The Adrenal Medulla is the middle section and it produces Catecholamines like epinephrine, norepinephrine, those kinds of things. You can have adrenal tumor that can cause high blood pressure and it causes high levels of those Catecholamines.

 

The adrenal cortex is going to be the focus of what we talked about today and the adrenal cortex has three different layers to it and each layer produces a different type or category of hormones. That adrenal cortex is controlled by a number of factors but influenced in large part by the brain. We have this thing called the hypothalamic pituitary adrenal axis. The hypothalamus is a section of the brain, communicates intimately with the pituitary gland and the pituitary gland also in the brain, and it secrets a number of hormones and in this case ACTH, adrenal cortical tropic hormone. It’s when your brain tells you to make more cortisol, it sends out ACTH which goes to the adrenal cortex and it stimulates the production of cortisol. There is a bunch of other factors that go into it also.

 

I remember when I was medical school, we had to memorize this hormone pathway, this adrenal hormone pathway. I remember looking at this thing and it’s nuanced, you talk about a lot of stuff in it. I looked at this pathway and I said, “Okay, I’m going to memorize this for the test and totally flash that toilet. When am going to use this? I’m not going to be an endocrinologist.” How ironic it is that I use that exact diagram, only I would consider that diagram condensed to what I use today. I use it almost every day and it’s showing the cholesterol is the precursor to all these hormones, it’s one of the reasons that cholesterol is absolutely essential for life, not this horrible villain that has been popularized. That cholesterol is the cause of death and the scourge of mankind, it’s absolutely essential for your health.

 

If you doubt that statement lookup up Smith-Lemli-Opitz syndrome. In fact if you are homozygote, meaning have both genetic copies of Smith-Lemli-Opitz syndrome, it’s compatible with life. Most of those are spontaneous miscarriages. You have to have cholesterol, so cholesterol becomes Pregnenolone, which goes through this whole hormone cascade and through the different layers of the adrenal cortex. You make aldosterone and progesterone and a number of precursors, and then in the middle layer, you primarily make cortisol. Then in the inner layer you make some of your 17 Keto steroids, which would be like DHEA, androstenedione and androstenediol and testosterone and those kind of things.

 

Marshall: It sounds alike to me just breaking this down. It starts up in the brain and your brain sends signal you the adrenal glands. Then there’s a whole host of different hormones that are produced by these adrenal glands that can be responsible for either keeping your body in balance —

 

Male: HIPAA, Health Insurance Portability and Accountability Act.

 

Chad: That was a good one.

 

Marshall: That was awesome. Responsible for a whole host of balance or imbalance in the body.

 

Spekear1: That’s correct

 

Marshall: Okay.

 

Chad: Basically with this hypothalamic pituitary adrenal axis. We’ve got this what’s called the negative feedback system. We have constant levels of some of these hormones and they may be low but the brain senses that and says, “Okay, this is appropriate.” It’s like the guy just sits there and monitoring everything and, “Okay, that’ good, that’s good, that’s good. Nope, not enough raise that up. That’s too high, lower that down.” When you at with the adrenal, one of the — I hesitate to say one of the primary, because all of this are primary and they are big deals. When it comes to things like stress and the implications of stress, the cortisol levels play a big role in this. If you think about this from a fighter flight kind of perspective, I like to think about it as – I’m not an evolutionist but if you think about it from an evolutionary kind of perspective, if you’re a cave man and running away from a saber tooth tiger, then you need the fighter flight component.

 

This is major stressor, fighter flight piece comes, your Catecholamines, which we just discussed from the adrenal medulla, go rushing up, your blood pressure goes up, your heart rate goes up, breathing rate goes up, muscle metabolisms starts to going up, so that you can start run away from the saber tooth tiger. Or you can fight the bad guy or you can do any other number of other things that you would need to do. On the back side of that, you’ve ramped up everything up, you need something to mitigate some of that. That’s one of the ways that cortisol comes in and it’s more of what we call a Sub-Acute. You have the acute phase where you’ve got to run away from the bad guy, and then we have the Sub-Acute where we have to deal with some of the consequences of some of that.

 

Cortisol is one of the things that does that, and certainly we need it in the acute stressors as well. Cortisol levels will kick in and help with those systems. The problem comes in when, if you get chased by a bad guy, a saber tooth tiger or whatever it is once and then you get away from that, then everything can slowly return to what we call homeostasis, can go back to normal. It might take a couple of days for that to go back. The more relaxed we are, the better off. The problem is that our current modern day society where physiologically getting chased by a saber tooth tigers every day. I don’t mean we are stressed out emotionally on that level, but what is the definition of stress? I would argue that stress is anything that upsets homeostasis.

 

We have this homeostasis meaning just kind of a normal where everything is kind of in balance and something comes along and tips that that card over and it messed stuff up, that’s a stressor. Psycho emotional stress is certainly one of those, that’s the, “Shoot, I am going through divorce. My parents kicked me out of the house. I have finals, I’m failing at school, I lost my job,” any number of those kind of things are psycho emotional stressors, that we would all often think of is, “Okay, yes, that is a stressful situation”. Then you also have physiologic stressors, and physiologic stressors would be things like low blood sugar. Cortisol is one of the hormones that kicks in when your blood sugar drops. It doesn’t have to drop to 40, normal blood sugar range will be roughly like 70 to 90 somewhere in there.

 

We try to keep a fairly tight control on your blood sugar levels, and your blood sugar will go up and certain hormones like insulin will kick in and do its thing. When it starts to drop and maybe it drops to 69 or wherever, you begin to see cortisol levels rise just a little bit. We see so many nutritional problems in a lot of our patients that cortisol levels often respond because of low blood sugar. A lot of people come in with “Hypoglycemic episodes,” usually those hypoglycemic episodes are because their insulin levels went up because high glycemic index, high carb meal. Their insulin levels go up and then when the insulin level go up, blood sugar levels go down, and so the blood sugar levels come crashing down and the insulin level would come down also. There’s this period what we called a natter where the blood sugar levels drop a little bit too low. Then all these other hormones kick in like cortisol, glucagon, epinephrine, these different things will kick in to raise blood sugar levels back up. We have this constant process to keep thing in this homeostatic control thing.

 

Now, if your blood sugar are always crashing because you are on medicines, because you are stressed, because you have hypoglycemia, because of poor dietary things, then you tend to have bit more cortisol. Now, if you are stressed and you have blood sugar problems, now we got two reasons. Then you can have inflammation, there’s just a whole host of reasons that you can have too much cortisol, all of those things are stressors on the adrenal glands. When you think about human physiology and how the body works. The body gets tired of certain things, it’s almost like a teenager or, the nagged spouse, and when you are constantly nagged, nagged, nagged you just quit to listening. The adrenal glands just like with insulin resistance, so I’m alluded to in the beginning how with diabetes we have some physiology mechanisms.

 

This is how diabetes can play into this because we get insulin resistance. We end up having so much insulin because we have crappy diet and we have all this other issues. We can’t process blood sugar and insulin because we become resistant to it. Lots of things cause that or go into why we get insulin resistance. The same thing can happen with cortisol, and the same thing can happen with the adrenal glands when they are constantly bombarded over and over again, make more cortisol they become resistant to it, so it messes up that hypothalamic pituitary adrenal axis. Again, it can be from psycho emotional stressors, tissue damage, inflammation, pain, blood sugar problem, all kinds of things can cause this issue with the adrenals.

 

There’s been studies where they’ve looked at the immune response in a nurturing situation and the immune response and specifically IGA levels. It’s one of the antibodies that that we produce. In a nurturing situations or where everything’s good like you get big warm hugs and stuff. I don’t remember what they exactly did in the study, but it’s like really comfortable nurturing situation, versus a very stressful situation. I do remember that one on the study, it was walking across a bridge in using people that were afraid of heights to walk across a high bridge and they measure their salivary IGA levels at the beginning and halfway across, and there was a dramatic difference. These are stressors that impair the immune function that if you’re constantly stressed like that, eventually you can lead to adrenal fatigue.

 

If you’re tired of fatigued, you go to your doctor, they check the cortisol levels and they say, “Your cortisol levels maybe on the low end of normal or on the high end of normal but it’s not outside the normal range, it’s not that engine that smoking and clanking and about to die.” They’ll say, “Well, your labs are normal.” How many times have we talked about, “Your labs are normal but you are not that NASCAR.” This is where most of our patients come in and that there’s something wrong. It did meet criteria as a disease as evaluated by the number of physicians they’ve been to, but there’s something not right. This is where adrenal fatigue comes in. How do we evaluate for adrenal fatigue? Before we go into this, should we go ahead and like pay a bill?

 

Marshall Yes. Let’s take a quick break.

 

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We’re back talking about adrenal fatigue and what causes it and how we can evaluate for it and ultimately what we can do about it. Again, traditional medicine we’re going to do like this single blood test, sometimes we do some provoked testing but it’s a serum test. You got to understand that there is a circadian rhythm. Circadian rhythm, meaning that your cortisol levels are going to change throughout the day. That’s why at the beginning of the podcast I said, if your physicians are on top that, you come in for your first morning level. It’s very inconvenient for a patient to come into the lab four times in a day, especially have them come in between 10 and midnight at night, so 10:00 PM to 12:00 PM and so 12:00 AM I guess. That’s next to impossible.

 

We will often use a four point cortisol saliva test, and so we send our patients home with a kit, they fill up these little vials with spit and we send it off and get it tested. I wasn’t taught this in traditional medicine. I never asked because I didn’t even know but I’ve heard some physicians that will say, “I don’t believe in that four point cortisol test.” I did a little looking, well, I’ve actually been to conferences and things like that and the four point cortisol saliva test is considered the gold standard test looking at saliva or looking at cortisol levels. It is very well accepted and there is a lot of evidence showing its effectiveness. This is something that’s very easy to do, you don’t have to get your blood drawn, we give you the kit. A lot of insurance companies don’t pay for it so there’s a cost with it.

 

You’re looking at anywhere from depending on the lab, I think the cheapest one I know was like $120 all the way up to a couple hundred dollars depending on which lab, what on you’re getting tested, those kinds of things. Sometimes we’ll test hormones in conjunction with the saliva test. Some people will think that that saliva test is no good. I’ll have patients that will ask me for a cortisol like a blood level, and one of the things that I’ll tell them is because of the circadian rhythm, we should have high levels of cortisol in the morning. It should be like really definitely on the high side. Then at noon, they should drop quite a bit, a plateau in the afternoon and then they drop off just a little bit at night. We have this rhythm to it and again all controlled by the brain in this hypothalamic pituitary adrenal or HPA axis.

 

I can get a serum cortisol level and it will be 100% normal at that time, but given the circadian rhythm it might be completely jacked up across the board. We really need to see what that rhythm looks like to understand how this whole system is working. I did a little bit of looking and was looking for a good validation or whatever, and Andrew Weil MD and on his website he had a statement, and this says, “Saliva test for cortisol, the adrenal hormone that mediates stress responses are now considered highly reliable and that a growing body of evidence suggest the saliva test can also accurately determine levels of testosterone and DHEA.” There’s more and more evidence that the saliva testing is the way to go and certainly convenient and easier for the patient.

 

We’ll get this saliva test and we’ll evaluate what do these levels look like. I won’t go to the interpretation of those tests because it really is very individual, and there’s a little bit of an art to it. If your cortisol levels are low across the board, the brain is not stimulating the adrenal gland to make cortisol at the appropriate times. Maybe it is stimulating and the adrenal just can’t respond. The brain may be even screaming, you know it’s sending out a lot of ACTH and the adrenal glands are have just said, “Enough, I’m not listening, I can’t do it.” Any of those factors can certainly play a role and it’s important to delve into why is this happening?

 

When we talked about the layers of the adrenal cortex, you had the aldosterone mineral corticoid layer and then you have the glucocorticoid layer which is the cortisol piece. Then that inner layer is the 7 Keto steroid layer and you are making DHEA and testosterone, there’s some role with testosterone. It’s not uncommon to see low testosterone levels and you do a saliva test and their adrenals are short. I can’t prove and say, “This definitely caused this,” but these guys go together so much and when you fix the adrenals a lot of times their testosterone levels improve dramatically. I think it’s very important when you’re considering why are their testosterone levels low? You got to look at their adrenals.

 

Again, this is really important to make sure that we are checking full comprehensive why our testosterone levels is low. Also cortisol levels, cortisol steroids, hydrocortisone and things like that often make people feel better. I’ve even seen cancer patients feel better when they were placed on steroids. I had a late 30s competitive CrossFit athlete come in to see me and this was a really interesting case. I guess this is my HIPAA Compliant story. He came in to see me and he was really tired and he is a CrossFit gym owner, a competitive athlete. All of his labs look fantastic, like his testosterone levels looked great. Everything looked really good but his progesterone level was really low and progesterone is one of those and that’s aldosterone pathway in the outer layer of the adrenal cortex.

 

There was something else on his lab, I can’t remember what it was. I looked at this and I was like, “My gosh, he’s not making any cortisol.” We did a number of things, ended up putting him on hydrocortisone, which is a bioidentical cortisol basically. He liked dramatic improvement in how he felt overall and his testosterone level was normal. We’ve been working on trying to fix it where he doesn’t need the hydrocortisone, but he clearly had adrenal fatigue. Now, he made me criteria for something like Addison’s disease where he just — it’s a problem in the adrenal gland where you can have a primary or secondary problem. Primary meaning that the brain’s not making it and then secondary meaning that the adrenal glands aren’t responding to it. It’s a very, very interesting case.

 

When we see this abnormal adrenal pattern, we say, “Yes, you got adrenal fatigue.” For our listeners and they’re thinking they’ve got adrenal fatigue, what do you do about this? “I think I’ve got this. I’ve got all this brain fog, I’ve got fatigue, I’ve got blah, blah, blah. What do I do?” Well, the first thing I think is to get tested. There are a number places that you can get tested. Go find a functional medicine doc, get some saliva testing and have them evaluate your adrenals. Certainly, there are other things like actually you check thyroid hormones and inflammation markers and blood sugar. There’s a lot of things that go with this. Certainly get tested, but in that rhythm, that cortisol rhythm, have that circadian rhythm, is going to dictate how to optimize your therapy.

 

There are some things that we will often use. There are some supplements that we use. Some herbal, what are called Adaptogens. These herbal Adaptogens are generally plants that are grown in a hospitable environment or a hostile environment. There are some question about some heat shock proteins that there’s just an adaptation that those plants have undergone in order to be able to survive in that environment. They think that these plants confer some of that adaptability to us by these heat shock proteins and those kinds of things. Ashwagandha’s one has been around forever. There is things like Schisandra. There’s a number of some other ginsengs are very good. That a lot of herbal Adaptogens, Rhodiola, Cordyceps are very good at helping to cushion the adrenal gland, so they are just not get bombarded nearly as much.

 

There’s some herbal more things that you can do. There are some other supplements. You can use what are called Glandulars, which are like natural desiccated thyroid. You can have natural desiccated adrenal gland and which gives some of the precursors and some of the nutrition the adrenal glands will need. Sometimes you can use progesterone or pregnenolone, which are both hormones and you need a prescription for those. Well, I get the pregnenolone compound from a compounding pharmacy. You may be able to find it as a supplement. I would use some caution, and if you haven’t read my book it’s available on my website revolutionhealth.org under supplements and you can download that free e-book.

 

That will explain the supplement quality and some of the really cool stuff that’s out there because there’s a lot of scary stuff out there. I would encourage you to go get that e-book and I read through that. Some of the glands, the natural desiccated glands that you can use. Then also fundamentally going with that functional medicine role, you’ve got to consider why did this happen to begin with? When you look at the adrenals and all those things that can cause them to go out of work. That the blood sugar problems, the chronic stress, the psycho emotional stress, the tissue damage inflammation pain, those kinds of things. You have to fix all of those things too. Because if you don’t, it’s a really uphill battle trying to fix the adrenals when they’re still getting falcon punched all day long. You got to quit getting punched and kicked.

 

Marshall: Which one would you recommend fixing first?

 

Chad: Well, you’ve got to fix the underlying problem. For example, if you are getting poisoned, the first step is quit getting poisoned. You get carbon monoxide exposure, the first treatment is get them out of the carbon monoxide. Remove the stressors, remove the blood sugar irregularities and make sure we’ve got a nice stable blood sugar. You fix that baseline stuff first. You’ve got to do that. Then I like starting with, we’ll go with the least risky most cost-effective. I think some of the herbal stuff especially when you get a true pharmaceutical grade supplement. Like something that you would get from zymogen. Really high quality stuff, that’s what I would recommend as [sic] an herbal and then I would go to the glandular as next. If we’re still not getting anywhere, then I would look at adding a hydrocortisone kind of thing.

 

When you take that comprehensive approach, we see some really fantastic results with that adrenal fatigue and most of the time we can turn this around. The last thing I’ll say is that fixing this problem is not an overnight solution. You don’t start therapy and tomorrow morning you wake up a new man, a new woman. This takes months. It takes a long time to fix this. With diligent effort on fixing a lifestyle, optimizing sleep, optimizing stable blood sugar levels, removing those stressors and then adding some herbals and Adaptogens and medications when needed. Then we see some really good results but it takes consistent effort over time.

 

Marshall: I think this is hugely valuable because it really applies to everyone whether you’re a college student dealing with the stresses of being in college. Maybe you’re in a relationship and there are emotional stressors that come along with that. Or maybe you have some imbalance chemically with the hormones in your body. Maybe you are getting good sleep and you’re on top of everything at work but for whatever reason you still experience that fatigue. Really this has a lot of application for all the listeners out there.

 

Chad: Absolutely, and there’s always a cart and the horse issues. You mentioned when we talked about hormones and things like that, and even young. You can have hormone issues that could contribute to adrenal fatigue and you can have adrenal fatigue that contributes to hormone problems. It requires a thorough comprehensive evaluation and that’s what a good functional medicine, integrative medicine physician, a nurse practitioner clinic is going to provide you. Is that comprehensive evaluation and you’re never going to get it in a 15-minute office visit with your primary care physician.

 

Marshall: Let’s go to that side of the fence real quick because you were trained from the traditional perspective, the traditional medicine perspective. How will most doctors or what is the stigma at least of how most doctors might treat something like this?

 

Chad: Well, first of all you’ve got to look at most of the time we look at evidence based medicine. We’re going to say, “What’s the study that proves this?” If something like adrenal fatigue is so nuanced that you cannot control all of the variables that would be required to control in order to get a randomized placebo-controlled double-blinded study. Because the adrenal glands can be off because of thyroid, can be off because of hormones, can be off because of blah, blah, blah, blah. You’ve got to make a homogeneous group. You’ve got to make it where everybody has the same problem. Well, number one, we don’t identify in tradition standard medicine. We don’t say, “Okay, all these people have adrenal fatigue.” We don’t do that. Much less why do they have adrenal fatigue?

 

You’re never going to get a study, well, not anytime soon anyway, on adrenal fatigue and why and what is it and all those things. Because there’s no randomized placebo-controlled double-blinded study, it’s not going to make its way into JAMA, i*t’s not going to make its way to the New England Journal. If it’s not in some of these peer-reviewed journals, I have a strong suspicion that many of my colleagues will say, “Oh, there’s no evidence for that,” and they’ll just completely dismiss it. They’re looking for that clunker car that’s getting ready to blow its engine and they’re not looking for, “Where do we need to fine-tune?” You may not meet disease criteria. There’s not a diagnosis code for adrenal fatigue and not a classic in our definition so to speak.

 

You have to use one of the other codes so to speak because it’s like an unspecified disorder of the adrenal gland kind of thing. Which doesn’t really describe what we’re talking about, but does kind of. It’s just not widely accepted that this is a problem to begin with, and then if there is a problem Ashwagandha doesn’t have a pharmaceutical company promoting it, so there’s no studies on ashwagandha for anything much less adrenal fatigue. I guess there’s probably some studies on safety in some observational kinds of data but no randomized placebo-controlled double-blinded studies that many of my colleagues want understandably for, “There’s evidence that this works, let’s do that.”

 

Marshall: A hugely controversial subject on A, how do you diagnose it? B, how to treat it? C, if you should even treat it. Is it bad enough that you should be doing something about it? Now, this has been hugely helpful for myself and I’m sure all the listeners as well.

 

Chad: Awesome. It’s just it’s a big topic, affects a lot of people but there’s a lot of things that we can do for it.

 

Marshall: All right. Well, thank you very much, I appreciate it Dr. Edwards.

 

Chad: Thanks so much for your time. Thank you guys for listening, we look forward to seeing you next time where we’re going to go continue –

 

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