Ask the Doc: Is Adrenal Fatigue a Myth? Plus: Tips for Athletes with Graves Disease, Overcoming Hay Fever and Histamine Intolerance, Clearing up HBA1C Readings, and More

April 19, 2017
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On this episode, Dr. Tommy Wood of Nourish Balance Thrive is back! Sign up for Tommy’s weekly highlight emails here.

Adrenal Fatigue

  • Tommy’s take on a recent systematic review looking more deeply into adrenal fatigue as a medical condition.
    • 58 articles
    • Terminology and methodology need to be normalized
    • Not able to find studies in which there’s a gold standard test for assessing the integrity and functionality of the HPA axis—one test is the insulin tolerance test (ITT).
    • Cortisol tests – The results of our review indicate that the three major tests (CAR, DAC and SCR) used to identify the underlying causes of the fatigue/exhaustion state failed to do so, since they were unable to demonstrate significant differences or proper causality.
      for further prospective studies aiming to correlate fatigue, exhaustion, or burnout status with impairment of the HPA axis, an ITT or a 250 μg CST should be performed to evaluate the adrenocortical ability to release cortisol, measurements of ACTH, DHEA-S, and corticosterone (an intermediate steroid product that is impaired earlier than cortisol [127]), the adoption of the most validated questionnaires, particularly Maslach Burnout Inventory, the Chalder Fatigue Scale, SF-36 or the General Fatigue Scale of the Multidimensional Fatigue Inventor, and considering different study populations…
  • Keeping it relevant to athletes: we are often told we are at a high risk or have adrenal fatigue, but a PCP may call BS, saying “that doesn’t exist.” What’s one to think? What’s the bottom line?

HbA1C vs. Glucose Readings

  • Once on EP we discussed that it is possible that an HBA1C measurement can be incorrect possibly due to having increased red blood cell lifespan, therefore leading to a higher reading since the measurement assumes a 8-12 week RBC lifespan. Is there some test that can be performed to see if one’s RBC are causing this effect?
  • What could it mean when fasting blood glucose is regularly in the 70’s, postprandial 60-90 minutes is usually less than 100, and waking and pre-meal is low 90’s, but HBA1c comes back somewhat high at 5.6-5.7% for years now? Are there any other possible causes for this issue?

Thyroid Conditions and/or Grave’s Disease

  • Athletes living with Graves Disease and still training; how to navigate life and thrive given the condition?
  • How to be a more efficient T4 to T3 converter? Are there common causes to poor conversion? Is there an optimal time of day to take the levothyroxine, ie: morning vs. bedtime vs. the middle of night/early morning? What role does cortisol play in T4 to T3 conversion?
  • Helpful supplements:
    • Anti-inflammatories (for gut etc.)
    • Liposomal Curcumin
    • Liposomal GTH
    • CBD oil
    • Gut tonics – slippery elm
    • GI revive
    • Gaia Turmeric sport
  • Some with Graves may find that breathing is more labored due to paralyzed vocal cord, even at an easier effort, so my perceived level of exertion feels harder than “normal” people at any given effort. Any thoughts on how to maximize training while dealing with this higher than normal RPE?
  • Training adaptations and recovery take much longer due to Graves – just accept this and deal or is there something we can do?
  • Athletes who have or complain of chronic hay fever when they train and resorting to antihistamine every 12 hours so would be interested to know if anyone else has complained of the same symptoms and found a way to manage them.

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