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Doctor Detective with Bryan Walsh


In this week’s case study, meet a woman who’s tired, struggling to lose weight, and on a blood sugar roller coaster. It seems like an open-and-shut case of “adrenal fatigue”. But what happens when the conventional protocols to treat “tired adrenals” don’t work? Our Dr. Detective team comes up with another explanation.

Eat less and exercise more. It’s generally a great prescription for improving health and improving body composition. However, it doesn’t always work.

Even with an awesome exercise plan and a rock-solid diet, some people suffer from mysterious symptoms and complaints that seem puzzling, given how much effort they put into their fitness and health.

When we meet clients who have problems that exercise and nutrition — not to mention their own doctors — can’t seem to solve, we know there are only a few experts on the planet to turn to. One of them is Bryan Walsh.

Dr. Walsh has a sharp mind, a fitness background, a degree in naturopathic medicine, and extensive additional training and certifications. His wife is a naturopath too. (We bet his kids are the healthiest on the planet.)

When tough cases arise, Dr. Walsh turns from mild-mannered dad and husband into forensic physiologist. He pulls out his microscope, analyzes blood, saliva, urine, lifestyle – whatever he has to, in order to solve the medical mystery.

When Dr. Walsh volunteered to work on a regular case study feature with us, we jumped at the chance. By following along with these fascinating cases, you’ll see exactly how a talented practitioner thinks. You’ll also learn how to improve your own health.

In today’s case, we meet a woman who struggles with her weight and energy levels. Find out how Dr. Detective solves her problems and develops a new theory of adrenal dysfunction.

“Adrenal fatigue” is a popular topic in the alternative medicine world today. Unfortunately, many practitioners follow an obsolete, outdated model of treatment, which often leaves people feeling just as bad as before.

I used to have many of the same assumptions. Here’s the case that changed my mind and taught me some key lessons about adrenal fatigue… and about my own process of scientific investigation.

The client

Jessica, a 31 year old woman, came to our office looking help with weight loss, hormones, and constant fatigue.

“I’m tired all the time,” she said. “I have no energy to do anything, I gain weight at the drop of a hat, and I can’t lose it.”

Understandably, she was pretty discouraged. She was stuck at 250 lb, despite trying desperately to lose weight. In fact, she said, she’d been overweight since childhood. In addition, her periods had been irregular since age 12.

Because of apparent blood sugar and hormonal issues, she had been prescribed Metformin (an antidiabetic drug) and birth control pills, which she was currently taking.

The client’s signs and symptoms

As always, I started with careful observation of the client’s signs and symptoms, jotting down my initial insights as well.

Signs / Symptoms My thoughts – potential issues
Irregular periods Female hormone imbalances, possibly elevated testosterone
Inability to lose weight Poor diet & exercise habits, blood sugar dysregulation, sex hormone imbalances
Fatigue Anemia, thyroid, adrenal, sex hormones, blood sugar dysregulation

These are common symptoms nowadays. Unfortunately, there are many potential causes.  So examination alone didn’t provide much insight into her case. We needed to order some lab testing to dig deeper.

Luckily, Jessica had some useful paperwork in the form of several lab reports from work that she’d had done over the years. (Note to potential patients: Be sure to save your medical documentation over the years. It can provide us health care practitioners with some useful clues!)

Based on her symptoms, we decided to start with a basic blood chemistry panel as well as a salivary hormone panel.

The test results

Blood chemistry panel

Overall, Jessica’s blood chemistry panel did not reveal anything terribly significant:

Marker Result Lab Reference Range Thoughts
Fasting glucose 79 mg/dL 65-99 Borderline low – possible reactive hypoglycemia
LDH 128 IU/L 100-250 Borderline low – possible blood sugar fluctuations
Vitamin D 29.8 ng/mL 32-100 Low – cause unknown

Her salivary hormone panel also indicated low secretory immunoglobulin A (IgA), an antibody present in mucosal tissues, which is often used to look for autoimmune disorders. This result suggested that Jessica had  sub-optimal digestive function, a possible sensitivity to gluten, and slightly elevated testosterone.

Salivary cortisol

What was more interesting about Jessica’s case, however, was her salivary cortisol panel.

According to this test, Jessica produced very low levels of cortisol during the day. This helped to explain many of her other symptoms.

People with low cortisol will often suffer from what feels like hypoglycemia, including feeling lightheaded, shaky and irritable between meals. When they feel this way, they might say, “My blood sugar is low.” In fact, something else is going on.

As a glucocorticoid, cortisol helps regulate blood sugar, including during periods of fasting (e.g. if we miss a meal, or overnight while we sleep). When cortisol is low, the body can’t free up blood sugar effectively when needed.

So the brain goes to Plan B: activating the sympathetic nervous system (SNS) to stimulate the release of epinephrine (aka adrenaline). Result: symptoms such as shakiness. It feels like “low blood sugar” but often, what people  are actually describing are the effects of the adrenaline shot.

Here’s another key to understanding: the adrenal glands, which sit atop the kidneys, produce both cortisol and epinephrine (adrenaline). So, cortisol and adrenaline are related in both their mechanism of action and site of production. This is why cortisol problems are often described in terms of the adrenals, and low cortisol is sometimes called “adrenal fatigue”.

It seems logical: The adrenals get “tired” as they work overtime to produce important chemicals. But as you’ll see, I realized I had to reconsider the concept of “fatigue”.

The prescription

Based on Jessica’s symptoms, lab results, and our previous experience helping women with hormone irregularities, these were our recommendations:

Step 1 – Diet

The gastrointestinal tract is a central system in the body — tied to immunity, metabolic regulation, and a wide variety of physiological systems. Digestive health is paramount — even when symptoms don’t seem to be “digestive”.

So we started Jessica on an elimination diet. This may seem too simple. But because of the GI tract’s crucial role in nearly every other physiological process, elimination diets get better results than nearly anything else we do!

Elimination diets have another benefit: They can significantly improve people’s overall nutrition. After cutting out foods systematically, many people begin to realize that they don’t really need some of the less healthy foods they used to eat. They feel so much better, they don’t miss junk food!

Along with asking Jessica to try an elimination diet, we suggested that she follow the eating guidelines found in Gourmet Nutrition.

Step 2 – Liver support

Speaking of the GI tract, the liver is another big player in metabolic and overall health. In physiological terms, the liver is the Body’s Glorious Factory: it detoxifies, transforms, regulates, processes, and/or synthesizes nearly everything our body uses, including sex hormones.

While Jessica didn’t have any overt signs of liver dysfunction in her blood chemistry, we’ve seen many women improve their hormone irregularities by improving biotransformation pathways in their liver.

Specifically, we gave her Amino-D-Tox (Designs for Health), LV/GB (Designs for Health), and OptiCleanse shakes (Xymogen) for 30 days along with the elimination diet.

Step 3 – Adrenal support

Of course, we also tackled the adrenal issue directly. As any good alternative practitioner would suggest in cases of low cortisol (aka “adrenal fatigue”), we put Jessica on a variety of adrenal supplements in order to help repair the adrenal glands and increase her cortisol levels.  This included:

  1. Adaptocrine (Apex Energetics) – an adaptogenic formula designed to support adrenal function
  2. AdrenaStim (Apex Energetics) – a topical licorice root extract preparation designed to increase the half-life of cortisol (thus, cortisol would take longer to clear from the blood), thereby increasing cortisol levels.

The outcome

In the first 30 days of following her new diet, Jessica lost 30 pounds. While 30 pounds sounds like a lot, keep in mind that she began the protocol weighing 250 pounds and therefore had quite a bit to lose.  Since her previous attempts to lose weight had been unsuccessful, Jessica was happy with this result.

Besides helping her lose weight, the elimination diet also gave us another clue to her underlying problems.  When she reintroduced dairy, she reported feeling tired and having a headache all day. This suggested a possible food sensitivity.

Being good detectives, we also followed up with some more testing. And here we made an interesting discovery. Despite carefully following our instructions along with losing weight, Jessica’s adrenal glands did not seem to be recovering.

Her afternoon cortisol readings looked a little better, but the morning output still wasn’t that strong.  So — assuming that she might need a little more time to respond — we continued with the supplements and her program.

Fast forward another  30 days. Still underwhelming: just a slight improvement in the morning.

Obviously, we weren’t making any progress.  Ever mindful of JB’s golden question: “How’s that working for you?” , it was time to reconsider our action plan.

So we hit the books and burned some midnight oil to learn more.

A new concept of “adrenal fatigue”

Adrenal fatigue is normally said to occur when the adrenal glands are so exhausted that they cannot produce sufficient cortisol.

While this may be true in some people, I suspect that, more often, the adrenal glands are completely capable of producing cortisol, but certain influences in the body are stopping them from doing so.  Instead of being too depleted to perform their function, they are blocked from performing it.

Based on this hunch, we decided to stop trying to support Jessica’s adrenal glands directly, as we had been doing, and to start addressing things that might be inhibiting them, such as the immune system.

The result? After only 30 days of immune support, including substances such as Echinacea, astragalus, maitake mushroom, and Melissa officianalis, we ran some tests and got good news.

Finally. Jessica slept better, had more energy, and generally felt better overall.

Not only that, but for us, this was a huge learning experience, prompting us to question our previous assumptions about adrenal fatigue.

Incidentally, follow-up blood chemistry test revealed an improvement in the previous markers, most notably higher lactic acid dehydrogenase (LDH) which to us indicated better blood sugar management.

Marker Result Lab Reference Range Thoughts
Fasting glucose 80 mg/dL 65-99 Improved – within reference range
LDH 154 IU/L 100-250 Improved – within reference range
Vitamin D 67.2 ng/mL 32-100 Improved – within reference range

Jessica’s main goals were to lose 100 pounds and to get pregnant.  After a year of eating right, exercising, and taking the right supplements, she ended up losing 70 pounds— and she is now the proud mother of a little baby boy.


What can we take away from Jessica’s story?

  1. While much can be gleaned from historical theories and methods, modern scientific research offers us new and improved understandings of how the body works.  We must be willing to modify our theories when scientific advancements are made, which sometimes means admitting we don’t know everything there is to know about the body.
  2. In science and medicine, language can shape the way we think about concepts and phenomena we observe. It’s important to be precise about what, exactly, we’re seeing and describing. “Fatigue” implies that the adrenals are just… “tired”. Our research, instead, suggested that “inhibited” might have been a better term. Had we not questioned this concept, we might still be wondering why adrenal glands are so “lazy”!
  3. Thus, hypocortisolism (low cortisol) exists, but it may not be due to “fatigued” adrenals.  Rather, other physiological mechanisms may prevent or slow the adrenal glands’ production.
  4. Improving digestive system function through an elimination diet can produce dramatic results. Not everyone will lose weight as fast as Jessica did, but most folks will feel better.

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