Doctors Are Missing Adrenal Fatigue in Chronic Fatigue Syndrome

Some of the patients I have treated for chronic fatigue have consulted multiple doctors before the underlying cause of their chronic fatigue was finally correctly diagnosed and treated.  Here’s an account of one of those patients:

Two months after my baby was born, I began to feel tired all the time.  Even though I had 8 hours of sleep at night, I woke up still tired and found it hard to get up in the morning.  Sometimes, I woke up with some pain on both hands, knees, ankles, or feet.  I saw 5 doctors, including an internist, an endocrinologist and a rheumatologist.  I had numerous lab tests, but none of them found anything conclusive.  The rheumatologist in Redwood City thought I should wait for 6 months for my body to normalize and readjust from the hormonal changes from pregnancy and the stress of caring for an infant.  The internist referred me to a psychiatrist.  I perceived it as a polite way of saying “it’s all in your head”.  I refused to see a shrink.  After 6 months with no improvement, I went to see a holistic doctor in Palo Alto.  He recommended nutritional supplements for energy and brain function, but I saw little improvement.  I finally consulted Dr Husbands who not only properly diagnosed chronic fatigue syndrome, but also addressed the underlying causes.

Signs and Symptoms

Whether you can relate to these patients who have consulted multiple doctors, or you suspect you are suffering from chronic fatigue, proper diagnosis and treatment are what you need.  There are several underlying causes of chronic fatigue, one of them is adrenal fatigue.  This is not recognized by many conventional doctors.  Here’s a list of signs and symptoms of adrenal fatigue-associated chronic fatigue syndrome (CFS).

  • Difficulty getting to sleep at night
  • Waking up at 2 or 3 AM for no apparent reason with difficulty going back to sleep
  • Difficulty waking up by 7 or 8 AM even though you’ve gone to bed by about 10 PM
  • Your deepest sleep being 1-2 hours before you wake up in the morning
  • Not feeling rested when you wake
  • Just feeling awake at about 10 AM even though you’ve been up for 3 hours
  • Inability to exercise without feeling “wiped out” for the next 2 to 3 days
  • Lack of stamina
  • Multiple areas of muscle tenderness and pain
  • Salivary adrenal tests show low total cortisol output and low DHEA-sulphate (DHEA-S)

Diagnosis

CFS is a common manifestation of adrenal fatigue.  My approach for diagnosis and treatment is based on a functional medicine and clinical nutrition perspective.  My diagnostic process includes:

  • salivary cortisol testing
  • salivary DHEA-S testing
  • functional medicine examination
  • conventional evaluation of medical history and examination established for CFS

Typically, these doctors that were consulted by these patients did not test salivary cortisol and DHEA-S levels.   If they did, they used the blood or urine cortisol and DHEA testing methods.  In research studies and in my clinical experience, I found salivary testing is the most accurate and reliable.   Since cortisol levels change significantly depending on the time of day, we should find out your cortisol levels at certain times of the day.  The normal daily range of cortisol output at specific times of the day is known.  Since morning cortisol levels should be at their highest after we wake up, with a dramatic drop by noon, and a gradual decrease until midnight, it is best to take 4 saliva samples during a normal day to ascertain each individuals output.  I often see altered cortisol response and DHEA-S levels which often correlate very closely with each individual’s signs and symptoms.  On the other hand, if cortisol is measured by one blood or urine test, only the cortisol for one time of the day will be reflected.  This is simply unreliable.

Last but not the least, here’s an excerpt from an article in my blog about adrenal fatigue:

It is very important to determine if someone is presently in an elevated cortisol pattern or if someone is in a stage of relative adrenal exhaustion because the treatment for each stage is quite different.  If you treated someone in the stage of adrenal exhaustion as if they were in an elevated cortisol pattern, you could significantly harm the person by further suppressing cortisol output.  Likewise, if you treated someone “locked” into an elevated set point of cortisol output as if they were in the stage of adrenal exhaustion, you could induce high blood pressure and other significant problems in that individual.  For this reason, salivary laboratory testing  of cortisol and DHEA-S is often essential.

Let me know what you think by posting a comment below.  If you have any questions about this post, post it as a comment or contact me through our contact form above.

To get notified of future blog posts Follow Dr Husbands on Twitter or Like Holistic Health Bay Area on Facebook