In Part 1 of this Q&A, Richard Shames, MD commented on the controversy. Dr. Shames is a graduate of both Harvard and the University of Pennsylvania, and trained extensively with the National Institutes of Health. He is a well-respected integrative physician and hormone expert in private practice for more than three decades. Dr. Shames is also co-author of the books ThyroidPower, and Fat Fuzzy and Frazzled.
Mary Shomon: Many of my readers were glad to catch the recent Q&A refuting the Endocrine Society's position statement that "adrenal fatigue is not a real diagnosis." I promised to pass along questions from thyroid-adrenal sufferers about the topic. First: why does mainstream medicine refuse to recognize the idea that adrenal function may be subpar -- and take a very black or white attitude, recognizing only Addison's or Cushing's?
Richard Shames, MD: There are several revealing reasons that immediately occur to me, and none of them are acceptable from the patient perspective. First is that I believe their stance comes from a place of overly rigid and closed-minded thinking.
Adrenal problems are some of the most complex and difficult of all medical problems to decipher and treat correctly. As for the adrenal glands, let's clarify. True Addison's disease is severe and often life-threatening low adrenal function. True Cushing's disease is severe and often life-threatening high adrenal function.
It's much easier to imagine the adrenal gland always functioning smoothly and up to par, except of course for a couple of obvious, easy-to-understand gross abnormalities. Thus, a busy medical doctor now has only two adrenal problems of concern. Rule them out with a quick black and white blood test, and get on with your hectic day.
Mary Shomon: What other reasons have you identified?
Richard Shames, MD: I feel that the issue of medical exclusiveness is important. It has many forms, but boils down to something that I can paraphrase, but I myself do not believe. It goes like this: "Medical doctors are really the only true scientific healers. Peer-reviewed journals (oddly, supported by drug ads and drug industry research grants) are the only true source for the advancement of scientific medical knowledge. 'Adrenal fatigue' is a term used by chiropractors, naturopaths and nutritionists. In addition to the iron-clad fact that these so-called health practitioners are not true medical doctors, they also have obviously not published scientific studies in our scientific medical journals. Therefore, what they have to say about so-called adrenal fatigue must not be medically, scientifically valuable."
Mary Shomon: So until such a time that more "mainstream" medicine starts to identify, study and publish about "adrenal fatigue," it remains an idea that doesn't fit with the current medical practice. Is there a parallel to the mainstream medicine's very slow recognition that elevated but "normal" glucose levels were indicative of "pre-diabetes" and their slow/bedgrudging acceptance of the idea that treating these pre-diabetic glucose levels may prevent full type 2 diabetes?
Richard Shames, MD: Absolutely! If the Endocrine Society persists in its unfortunate exclusive stance that mild adrenal illness -- what we're calling adrenal fatigue -- does not warrant risk assessment and early intervention, then everyone loses. Why does it have to take so long each time for a good preventive idea to become accepted? Have they forgotten again that preventive medicine is a true and valuable, yet under-utilized, medical specialty?
Mary Shomon: What benefit is there for mainstream medicine to completely ignore a category of illness that many integrative physicians have recognized and treated for years? This has happened with chronic fatigue syndrome and fibromylagia, and now they seem to want to apply this "It doesn't exist, it's made up" label to adrenal fatigue/adrenal insufficiency. Do you have any idea why?
Richard Shames, MD: I don't. It's like being stuck back way back in the 19th century, when Dr. Addison and Dr. Cushing were just formulating their very basic ideas of adrenal under-function and over-function, respectively. Can't we doctors now "stand on the shoulders of giants" the way Isaac Newton spoke of being spurred to breakthrough thinking, by studying Galileo, Copernicus, and Kepler? I'm sure that both Dr. Addison and Dr. Cushing would have wanted modern medical doctors to explore the many confusing shades of gray, between the two 19th century black and white adrenal extremes.
Mary Shomon: Can you explain the integrative perspective regarding adrenal fatigue, how it is demonstrable on tests, and treatable, in contrast to the Hormone Foundation's perspective?
Richard Shames, MD: Absolutely. Adrenal fatigue is very real. Illnesses, described by the words 'adrenal insufficiency' or 'hypo-adrenalism' or 'low adrenal function' or 'hypo-adrenia' are already definitely accepted by the scientific and medical community as being a real conditions. People can have and indeed do have MILD forms of this condition. It's just as real as having a mild form of any other true illness.
It can be evaluated using tests. People without any signs, symptoms, related illness, or family history of adrenal insufficiency most always have normal results on their adrenal saliva tests. On the other hand, people with signs, symptoms, related illness, or family history of adrenal insufficiency most always have abnormal results on their adrenal saliva tests.
And it is definitely treatable. In my face-to-face office visits, as well as my telephone lifestyle coaching sessions, I explain to people the particulars of many useful interventions. They range from vitamins, to minerals, to herbal medicines, to glandulars, to over-the-counter pro-hormones as pills or creams. I have been doing all of this for well over 20 years, generally with very satisfying success. A large number of other like-minded medical doctors are similarly working in this way, with similarly good results.
Mary Shomon: We already have many people struggling/suffering, and we know that if there is underlying adrenal issue, this makes it even more difficult for the thyroid to be addressed/managed? If the mainstream doctors are going all out on a campaign against the idea of adrenal problems, what does this mean for thyroid patients?
Richard Shames, MD: It means that things are going to change in their favor soon. This Endocrine Society/Hormone Foundation position paper denouncement of adrenal fatigue is merely the first desperate and obviously off-balance punch in a 10 - round eventual victory for better adrenal care. We have seen it many times before that an idea whose time has come does eventually get accepted and later embraced by standard medical care.
Read more about the science behind adrenal fatigue, and what patients can do.
- More information on Richard Shames, MD
- Adrenal Fatigue / Adrenal Exhaustion
- Successful Thyroid/Adrenal Care