For treatment of my patients, I utilize a version of the naturopathic hierarchy of therapeutics pyramid-shaped model, shown above, when working with each patient. This acts as a guide, so that I am sure they’re being treated on all levels, not merely superficially or symptomatically.
Starting at the very bottom or base of the naturopathic treatment pyramid, I work to assist the patient in identifying and understanding the nature of the various stressors and create a plan to eliminate or mitigate these stressors to the best of our ability.
There are hundreds of lifestyle and personality types who suffer from Adrenal Fatigue: an anxiety-ridden, exhausted parent of young children who is trying to manage a household but also needs to work outside the home; a hypertensive, pre-diabetic, fast-food eating executive who has sacrificed everything to succeed in a career or the perfectionist teenager with a terrible diet, insomnia, and low blood sugar, who has not yet learned the essentials of balance.
What needs to happen for each of these three individuals to regain health? Identify, eliminate, or modify as many stressors as possible to reduce a total load of stress. Remember, the body cares little where the stress comes from, whether it be mental, emotional, physical, or social. Everything counts: poor nutrition, not enough “down time,” grief, unhealthy sleep hygiene. It all ends up in the same bucket, contributing to the same total load.
A level up from Lifestyle, Diet is the next foundation of naturopathic treatment. A hypoglycemic diet (low-sugar diet) controls the amount and release of sugar, or glucose, in the bloodstream. It is important to control blood sugar because it is the main job of the adrenal glands and cortisol to raise your blood sugar when it gets too low. Hence, if we can prevent it from dropping, we can take one major, daily stress away from the adrenal glands.
Ideally, when we eat, we want to elevate blood sugar slowly and have a prolonged elevation until the sugar gradually comes down, at which point we are ready to eat again. Intake of protein, fat, and fiber slows the elevation of glucose in the blood, while intake of sugar and carbohydrates tends to spike glucose more quickly.
After we’ve worked on the foundation of the pyramid with lifestyle and diet modification, the third level in the pyramid is balance. This level is purposefully ambiguous and open-ended, as you are the only one who knows what needs balancing in your life.
Balance must exist in the physical realm. Chiropractic treatment to balance the structural integrity of the skeletal system is appropriate. Massage of the muscles in the body can assist the metabolism by clearing metabolic byproducts or by relieving certain detrimental muscular imbalances developed over time and through poor habits or posture.
For some, acupuncture can bring balance through the manipulation of our meridian systems and through the balancing of yin and yang. Yoga, Tai Chi, and Qigong are also useful tools in bringing balance into our beings on all levels, but especially to our muscles, tendons, and even on our inner organs.
The next level of treatment is that of general support. This support is geared toward the overall well-being of the patient from a supplemental point of view. Typically, this involves supporting the body through a high-quality, easily-absorbed multivitamin to supply nutrients where our less-than-perfect diet may leave holes in our nutritional status.
The brand of vitamins used is extremely important, as different companies have different quality control standards. I have found that many products are inferior and thus produce inferior results.
Antioxidants are also important in the treatment due to the increased oxidative stress (free radicals) that results from chronic activation of the stress response. This increase in free radicals places more demand on your antioxidant status, and thus needs to be replenished.
The final level of general support is essential fatty acids. Essential fatty acids (EFAs) make up the majority of your cell membranes and help with communication of one cell to another. The efficiency of this process is crucial to ensure adequate healing. EFAs exist in many forms; however, from my research and experience, the primary EFA deficiency is in that of the omega 3 fatty acids, which exists primarily in fish, although there are other sources. The omega 3 oils in fish oils are more bioavailable to us than the omega 3s in plant sources, such as flaxseed oil.
The next level of the therapeutic pyramid is the support of bodily systems. This support must be individualized for each patient, because each patient is unique in their presentation, group of symptoms, genetics, and biochemistry.
Typical systems that require support or strengthening in patients with Adrenal Dysfunction are the stress response system (brain/limbic nerve, ANS, hormone, HPA, and adrenal), as well as the digestive and immune systems, and perhaps the reproductive system and thyroid. We may also treat issues within the cardiovascular or nervous systems, or those pertaining to metabolism.
As mentioned previously, some of these dysfunctions are secondary but may need to be addressed in order to reduce the total stress load on the body. I support these systems in the most natural yet effective way, so as not to further offset the balance of the body.
Symptoms must be handled with care in my patients. Symptoms are merely messages from the body of underlying dysfunction. Our job is to listen to these messages and interpret them properly.
If you were to shut off the message, for example, with an analgesic like Tylenol for a headache, you can then no longer assess the intervention for the headache and will have a difficult time determining the underlying cause. It may have been low blood sugar or dehydration, but we cannot assess it if we keep masking it.
This is not to say that I would allow a headache or any other symptom to fester uncontrolled if I had a way to fix it; only that you want to use the most gentle most targeted of intervention, so that the feedback obtained from therapeutic success or failure provides information for overall healing.
In addition, by masking the symptoms, we may have fixed one problem, but you may have created another. Certain symptoms must warrant some attention for the person with Adrenal Dysfunction to have a chance at healing.
Symptoms like insomnia and anxiety are a good example of this. These symptoms often are the result of the same underlying problem: an up-regulated or “trigger-happy” stress response with an output of stress hormone that is often excessive and released at inopportune times.
This up-regulated stress response system must be quieted, otherwise it’s like trying to repair the engine of a car while you’re driving it down the road. It’s much easier if you shut off the engine and put it up on blocks somewhere safe in a garage. At that time, you can grab a few of the right tools and, with a little know-how from experience and study, you can make the appropriate repairs.
Bio-identical Hormone Replacement Therapy (BioHRT)
Bioidentical hormone replacement therapy (BioHRT or BHRT) involves the use of hormones that are the same as (or bio-identical to) your body’s own substances. Doses are typically used to replace a deficiency in a certain hormone. Hormones vary in their strength and function. Even with replacement doses, we can be gentle yet effective, which greatly reduces the risk of side effects as well as the risk of suppression of the individual gland targeted.
General treatment of the adrenal glands can support the system in such a way that makes BioHRT of other, somewhat stronger hormones unnecessary. This allows us to treat your system on a deeper level, working to repair the problem, not simply to replace what is missing without paying any attention to why it’s missing.
Research gives us clues as to how much hormone to use in some situations, but these protocols must be individualized and specific to each patient. The protocols have been refined over many years of my experience and through the use on thousands of patients.
Prescription drugs and surgery
At the very top of our pyramid—the tiniest piece—are the tools of our current conventional model to medicine. Quite often, I do not have to reach the top and treat at this level. I spend so much effort emphasizing the bottom levels, which effect change and healing at a deeper level.
While I am not against the use of pharmaceutical drugs and surgery–certainly these methods have been life-saving, and we are fortunate to have many of them–I am against the overuse and misuse of these medications and methods. When the use of a drug will worsen the overall condition, although may allow for temporary relief of a symptom, it is counter-intuitive to the overall healing process.
The paradigm for the use of drugs and surgery as treatment modalities works primarily for acute injury and trauma care, and at that it works quite well. These modalities do little good, however, and yet have much potential for harm in cases of chronic disease.
A final note regarding the treatment hierarchy described may be helpful to put it all into perspective: The higher you move up the levels of the pyramid, the more interventions become increasingly specific and targeted. They are also typically more expensive, come with more risk, and are more invasive. They require much less responsibility and personal investment from the patient, which makes them somewhat easier to employ.
When you treat from the bottom up, we ultimately save time, money, and energy and effect change for the long term.