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Adrenal Fatigue Overtraining in

the Athlete: a Nutritional

Perspective on Pathology and

Treatment of Overtraining

Syndrome: an “exhaustive” review

By Matt Lovell, BA (Hons) Dip ION NTCC CNHC MBANT

Although the term adrenal fatigue is used frequently these days the term adrenal

insufficiency is more accurate as complete adrenal fatigue is a very serious condition which

would need immediate medical attention. The only difference between adrenal fatigue and

over-training syndrome in an athlete is the root cause of the condition. In essence we are

talking about exactly the same state w ith a different series of causal factors.

Many athletes I see exhibit symptoms of adrenal insufficiency and over training although few go on to

develop over training syndrome or adrenal fatigue requiring medical intervention – it is nonetheless a very debilitating experience. The failure of the adaptive mechanisms means progression andadaptation take a back seat whilst rest and recuperation are the order of the day.

In the accompanying case study I have suggested interventions which can help an athlete recoverquickly whilst still maintaining performance. This is not always the case though, and left unchecked without adequate support and infrastructure some athletes will take up to a year to recover orpersistently dip in and out of over-training and as a result never quite make the grade in terms ofperformance improvement.

Overtraining has been described as an imbalance between training and recovery which, in turn, leads

to decreases in performance1. There is no single biochemical or physiological definition of

overtraining, although many different criteria are used to assess the level to which an athlete hascompromised their physical and psychological abilities to adapt to training stimuli. ChronicOvertraining Syndrome can be differentiated from the transient state of “overreaching” which may bealleviated with rest. Over-trained individuals often take far longer to recover and usually displayassociated hormonal, biochemical and inflammatory imbalances and psychological impairments thatmay take months to correct. These imbalances have a nutritional underpinning allowing thepossibility of a nutritional approach to treatment.

An initial consultation aims to:

• Conduct a full assessment and screening process with the athlete

• Withdraw and lower trigger factors

• Increase supporting factors

Two very useful spreadsheets I’ve used include adrenal stress causes (view online) and adrenal stressindicators (view online) – when these are combined with an adrenal stress index test properevaluation can be made and then an intervention plan adjusted to the individual’s requirements



Adrenal Fatigue & Overtraining in the Athlete Matt Lovell

Figure 1: Stages of Fatigue, taken from Matt Lovell Adrenal Fatigue Presentation 2006

RESISTANCE STAGE 1

Cortisol raised DHEA normal

ALARM STAGE

Cortisol raised DHEA

high

Rested Stage; Peak of super compensation

Cortisol Normal DHEA high

EXHAUSTION

Cortisol low /

DHEA in it’s boots

RESISTANCE STAGE 3

Cortisol normal / low DHEA very low

Cortisol raised DHEA low

RESISTANCE STAGE 2

NERVOUS BREAKDOWN

Typically, overtraining is associated with symptoms of performance incompetence, immune

suppression, glycogen depletion, high perceptions of fatigue and negative impacts on mood2. The

profile of mood states questionnaire (POMS), a scoring system, is also a valid method of assessing themental state which may lead to or may be a symptom of the hormonal and neurotransmitter changes which result from over training. It is a state of dysregulation between anabolic and catabolicprocesses, which has been associated with chronically decreased circulating levels of testosterone,

growth hormone, follicle secreting hormone (FSH), luteinising hormone (LH), as well as decreasedneuromuscular activity

3,4. Hormonal dysregulation is a unifying factor in most documented cases of

overtraining, although the specific nature of such impairment can vary from case to case dependingon the overtraining subcategory, demands of the sport and stage of overtraining.

Two subcategories have been defined, being the sympathetic and the parasympathetic types of

overtraining5. These are usually exemplified by explosive-type athletes and endurance-type athletes

respectively, although this categorisation is far from consistent. Many other factors involved inovertraining serve to complicate attempts at simplification and classification. In theory at least, asympathetic dysregulation in over trained individuals is manifested as restlessness andhyperexcitability, with anxiousness also contributing to performance incompetency and inadequate

recovery. This is by far the rarest subtype1. Parasympathetic overtraining would be typified by

decreased sympathetic activity, such as impaired adrenal function6. However, not only are theassociations between athletic types and overtraining category inconsistent, but the symptomdescribed as “impaired adrenal function” may describe both increased levels, or decreased levels of

hormones as seen in the phases of over training listed in Figure 1. Deficits may occur in hormonelevels as well as at the receptor level (insensitivity despite high hormone concentrations), or due toother, related metabolic processes.

The Catecholamine Response and pre cursor therapy

This review will focus mainly on what could be described as the “parasympathetic type” ofovertraining, also referred to as “adrenal fatigue” or “adrenal insufficiency”. Essentially, this is a stateof impaired sympathetic function due to decreased circulating levels of stress hormones, or perhaps

more frequently, decreased sensitivity to them7. This has been supposed to be a defence mechanism

against the catabolic and deleterious effects of training and stress-hormone release8. The fact that




noradrenaline (NE) at submaximal exercise intensities, can be reconciled by considering the effects,rather than the volumes, of catecholamine release . In addition, one must consider whether theindividual is in the early, or advanced, stages of overtraining. It is now thought that early stages ofovertraining are typified by an increased catecholamine release in response to exercise, coupled with a

decreased biological sensitivity to their effects. This may be coupled with decreased resting levels7,9

.However, reductions in circulating catecholamine levels are exhibited in the later stages of

overtraining.10

In an athlete struggling with higher levels of body fat this can often become a vicious cycle of overtraining in order to achieve weight or skinfold targets. The increased training exacerbates the adrenalissues and compounds the problems – in addition thyroid activity will lower in medium to longer termover training and excess exposure to stressors. The tendency in this case can be to administer thyroidhormone replacement therapy, which may worsen the adrenal fatigue as the whole system is pushedfurther by upregulating thyroid activity, when in reality the body’s defensive mechanisms are slowingthe whole process down. Furthermore, supplementation with stimulant fat burning supplements willcompound this problem and if taken with excess carnitine can down regulate thyroid activity in

receptors.37

Whilst decreased circulating levels of NE have been reported in male footballers following weeks ofovertraining11, as well as in female endurance athletes7, elevated submaximal catecholamine release isin fact a consistent observation in overtrained athletes. Male swimmers who displayed significantlyreduced maximal performance following 4 weeks of overtraining however, actually showed increased

resting levels of NE12

, while increased nocturnal E levels were seen following overtraining resulting

from resistance exercise4. The unifying factor in these pathologies is a lack of catecholamine

sensitivity. Combined with a chronic rather than acute release of stress hormones, in essence theindividual is becoming catecholamine resistant.

Not only have such increased E levels been seen to coincide with decreased density of β-receptors at

the neuromuscular junction4,13

, but a decrease in submaximal heart-rate (HR) is frequently observed

to accompany such hormonal elevation14

. This reduction in HR is in marked contrast to appropriateendurance training adaptations, as it is not accompanied by a reduction in resting HR, and isassociated with decreased performance. Decreased maximal HR is also a symptom of overtraining

that may be explained by ineffective sympathetic tone14

. Decreased sympathetic activity is thereforelikely to be induced by a reduction in β -receptor density. This would explain not only observations ofsubmaximal bradycardia (HR reduction), but lower levels of neuromuscular excitability (NME) shownfrom EEG measurements following overtraining.

Such desensitisation to catecholamines in resistance trained athletes has been explained by some as apossible defence mechanism in response to undertaking high-intensity loads and is associated with

frequency of maximal efforts4. Thus an athlete becoming desensitised to catecholamines may

represent a biological fail-safe whereby the body attempts to prevent further excessive exertion whichcould lead to damage.

The coach who doesn’t understand his athletes within a team environment where there is less time forindividual contact and coaching than in individual based sports could see this situation as a player‘lacking drive’ becoming ‘lazy’ and generally not pushing themselves as hard. Monitoring processesneed to be in place to assess daily levels of energy, sleep patterns and how this relates to performancein fitness and power as well as field based sessions.

Late stages of overtraining have been proposed to coincide with reduced exercise-inducedcatecholamine release at all intensities. Some have proposed that this may be to do with adrenalfatigue, or depletion in endogenous levels, while others would argue against this logic. It could beargued unlikely that catecholamine precursors could become depleted when one considers thattumour induced hormonal elevations are often tenfold higher and sustained for decades in cancer

patients15

, and that no other protein synthesis processes are overtly impaired by amino-aciddeficiency in overtraining. That other impaired metabolic processes may be aided by supplementary






In this state, where the stress system cannot manufacture enough cortisol, profound tiredness will bea symptom with difficulty waking and getting out of bed. The best nutrient for this situation isliquorice, a potent substance which can prolong the half life of cortisol.

Possible roles of Serotonin

The central-fatigue theory postulates that serotonin (5HT) may exert a determinant role in instillingfeelings of exhaustion from exercise. The theory goes that serotonin synthesis and release in certainareas of the brain is associated with feelings of tiredness. Indeed, a chronic imbalance inneurotransmitter levels has been reported in overtrained marathon runners, which may not only

highlight a role for 5HT, but also its interaction with catecholamines and acetylcholine in

overtraining22. This serves to demonstrate the complexity of neurotransmitter relationships, andargues against the over-simplified definition of overtraining as simply being

hormonal/neurotransmitter deficiency. In animal studies, levels of 5HT were seen to be elevated inthe midbrain, unchanged in the striatum and decreased in the hippocampus compared to rest at the

onset of fatigue23

. It is rather dysregulation then, as opposed to a specific deficiency, which may linkneurotransmitter biochemistry with overtraining. This may reflect impairments in metabolic

processes, as well as deficits in endogenous hormones/neurotransmitter precursors.

Other factors that may affect these metabolic pathways include the presence of circulating fatty-acids

and amino acids. 5HT is synthesised from the amino acid tryptophan. Lipolysis is stimulated byexercise, and competition from fatty acids for albumin-binding, causes an increase in circulating freetryptophan. Simultaneously, branched chain amino acids (BCAAs) are taken up for use as fuel bymuscle cells. This decreases circulating levels. The circulating tryptophan/BCAA ratio has been seen

to be affected by dietary fat and exercise17

. Following this line of reasoning, normalising levels of fats,BCAAs and tryptophan, and supporting the proper function of involved metabolic processes may aidthe treatment of overtraining. In addition, supplementation with BCAAs during exercise will bluntthe cortisol response, potentially increasing the effectiveness of anabolic hormones on the adaptivemechanisms.

The Cytokine Theory of Overtraining

Another, and not necessarily unrelated, theory of overtraining puts cytokine activity at the centre ofthe problem. Overtraining is described as primarily an inflammatory disorder whereby trauma tomuscle tissue causes an increase in circulating inflammatory mediators. These would stem from both

immune-cells, as well as muscle cells themselves24

. Like the theories regarding a hormonal basis toovertraining, the cytokine hypothesis can also go some way to explain the psychological impairmentsthat accompany physical symptoms. Cytokines are known to be able to cross the blood-brain barrier

and impact on behaviour, being frequently associated with depression25-26

. Indeed, many similarities between the psychological aspects of overtraining and depression can be seen. Behaviours such as withdrawing from social contact, and lethargy, are often described as “sickness behaviour” and are

believed to be linked to the physiological phenomenon of systemic inflammation27

. The hypothalamo-pituitary/adrenal-fatigue theory of overtraining would explain psychological impacts as resulting fromdysregulation of endocrine hormones which also act as neurotransmitters, thus affecting behaviour.Resting elevations in the proinflammatory cytokines IL1 b, IL-6 and TNFα are a common symptom in

overtrained athletes27

. Such proinflammatory environments cause muscle-wasting and are also

associated with catabolic hormonal environments28

. Yet more links and similarities with the hormonaltheory of overtraining can be seen when one considers the elevations in resting cortisol seen inovertraining. Acute post-exercise cortisol responses of the magnitude that would decreaseinflammation by negative feedback are reduced however. Rather than subscribing to one or the othertheory of overtraining, it is perhaps more useful to think of overtraining as a great number ofinterrelated and integrated pathologies, which affect many physiological and psychological processes.

Dietary nutritional strategies and supplementation protocols




As we outline the various pathological processes involved in overtraining, potential strategiesregarding nutritional intervention become apparent. The problem can be tackled from one of severalangles:

1. Supporting recovery processes around training sessions through the use of amino acids, herbsand macronutrient selection.

2. Supporting HPA axis through the use and rotation of certain adaptogenic compounds.3. Supporting neurotransmitter/endocrine metabolism by ensuring adequate levels of dietary

precursors.

4. Supporting neurotransmitter metabolism indirectly (e.g. cofactors/competitors in synthesis).

5. Addressing inflammation from a nutritional perspective.

BCAAs

BCAAs compete with tryptophan for the same transport proteins in order to cross the blood-brain

barrier. The BCAA/free-tryptophan ratio has been seen to impact upon 5HT synthesis23

. Therefore branched chain supplementation has been theorised to offer relief from central fatigue and

overtraining.26,29

Tyrosine

Tyrosine supplementation has been proposed as a method of regulating and maintaining adequatecatecholamine levels. Supplementation may have an impact on mood regulation by aiding the

synthesis of dopamine (DA), noradrenalin and adrenalin.30

Omega-3 Fatty Acids

Omega-3 fatty acids are the precursors for the series 3 prostanoids and series 5 leukotrienes, as well asresolvins. Prostanoids are inflammatory mediators, while resolvins help mediate their inflammatory

action. The series 3 prostanoids and series 5 leukotrienes are less inflammatory than their omega-6

derived counterparts, the series 2 prostanoids and series 4 leukotrienes. By skewing the precursorsupply to favour omega-3 derived inflammatory-mediators and resolvins, omega-3 supplementationhas been seen to exert anti-inflammatory effects. Supplementation two grams per day or more of EPAhas been observed to decrease inflammatory aspects of overtraining in swimmers and aid exerciseinduced broncho-constriction, while their anti-catabolic properties have shown encouraging results in

preventing muscle-wasting28

. From a psychological standpoint, supplementation has also been seen to

be effective in the treatment of depression31

, supporting cognitive function32

, and increasing measures

of emotional well-being.33,34

Adaptogens

Adoptogen is the name given to a wide and unrelated collection of herbal preparations that seemingly

have the ability to “adapt” in treating a great many different ailments. This has been put down to thefact that these herbs commonly contain a great many different active components which can addressdifferent deficits depending on the condition. Valerian is one such adaptogenic plant which in

addition to accepted anti-oxidant and immuno-stimulatory properties35,36

has been used for treatment

of overtraining-like symptoms, making use of its regulation of sympathetic neural activity.30

Summary

Overtraining can have severe detrimental effects, impacting upon the physiological and psychological workings of the body and mind.

Top Adrenal Supporting Factors:

1. Balance systemic factors

2. Remove ‘Trigger factors’

3. Support mental health through cognitive therapy




5. Increase CNS supporting amino pre cursors

6. Supporting HPA – adaptogen cycling and glandulars

Case Study of an Elite Rugby Player – “Player 1”

Symptom Presentation

• Fatigue – especially in the afternoon

• Difficulty sleeping

• Under-recovery following training sessions

• Excess body fat despite following a strict dietary regime

• A number of psychological symptoms including low grade depression

In his words he was just not ‘feeling right’.

Ragland’s sign was positive, 120/80 – followed by 103/70, as was pupil dilation test. Player 1 alsoreported feeling dizzy on standing. (Ragland’s sign is an abnormal drop in systolic blood pressure

when a person arises from a lying to a standing position. There should be a rise of 8–10 mm in thesystolic number. A drop or failure to rise is indicative of adrenal fatigue.)

Adrenal stress index test showed low afternoon cortisol levels reflecting fatigue based symptoms –initial stages of over-training were apparent.

Player 1’s diet was as follows:

Table 1: Lifestyle and daily diet on presentation, player 1

Player Supplementation: ‘green drinks’ (Jarrow green defence, multi nutrients, and omegacomplete) taken in a sporadic and unplanned manner.

Family history: both parents overweight, father had significant problems with cholesterol and was

taking statin medication.

Hypothesis and Nutritional Interventions

The initial hypothesis centred around a likely case of over training combined with an inadequate

intake of quality carbohydrates in sufficient amounts to allow full muscle recovery and protein

synthesis.

Strategy

Time 7-8am 8-9am 12-1pm 2-4pm 4.30-7pm 7-9pm 10pm

Action Training

(cardio/weights)

Post

TrainingRecovery

Lunch Rugby

Skills/MetabolicSession

Nap Uncontrolled

“grazing”

Dinner

Intake Nil BCAAs +Protein-shake

Meat + Vegetables(no starch)

ProteinShake(during/post)

Nil High GI CHO(Cereals, breadsetc)

High GI CHO(potatoes)with meat anvegetables.Possibly dese(bakeryproduct)




The key elements were feeding little and often to reduce insulin drive. Whole protein foods were

therefore advocated instead of whey shakes, incorporating good fats, fibrous vegetables, and starchy

wholegrain foods and root vegetables in measured amounts to support carbohydrate requirements for

training. The interventions stressed the importance of taking in nutrients prior to morning training

sessions (table below).

Symptom Hypothesis Intervention Rationale

Fatigue – especially inthe afternoon

Adrenal optimiser(2 on rising with b/fast)

Precursors supportadrenal function

Difficulty sleeping ZMA (4 capsules withsupper) – combinationof Zinc l-methionine,zinc aspartate andmagnesium aspartate,B-6

Supportingmetabolism involvedin neurotransmitter-regulated sleepingpatterns

Multi nutrients (2 witheach main meal)

Address potentialshortfall in B vitaminstatus

Address blood-sugar/insulin withfrequent small meals

Glucose optimiser

Assists with properblood glucoseregulation

Under-recovery followingtraining sessions

Challenge to HPA systemthrough intensive, fasted,training sessions - possibleB-vitamin need, mineralneed, and blood-sugardysregulation

Possible impaired proteinabsorption/metabolism

Amino acidsupplementationchanged to PRE-training as opposed topost-training

Support proteinsynthesis/repair

Omega plus EFAs (3capsules with eachmain meal)

Regulates fatty acidmetabolism

Excess body fat despitefollowing a strict dietaryregime

Mis-timing nutrientintake/overconsumption anddysregulated fatty acidmetabolism Green tea extract (1

capsule with breakfast)

Support antioxidantstatus and fatmetabolism

A number ofpsychological symptomsincluding low gradedepression

Challenge to HPA systemand possible mineral needsimpacting onneurotransmitter function.Under-recovery influencing

mental well-being

All above As above

Table 2: Strategy for intervention, player 1

Lifestyle Interventions

Psychological and habitual strategies included

1. Eating earlier in the evening ideally finish eating 3 hours before bed time

2. Introducing raw vegetables – celery, peppers, etc

3. Having a broth based soup before the main meal

4. Eating protein foods and cooked vegetables first

5. Eat chosen sources of starch only if still hungry6. Stopping eating if more thirsty than hungry and return to finish leftovers if desired




About the Author Matt Lovell is director of Perform and Function Ltd. From a

personal training background, he graduated from ION and ran a personal training

company in the City of London where he gained wide experience in body

composition change and physical preparation for general and elite level sports. This

has led to specialisation in performance based nutrition and diet applications for

elite athletes, female hormonal health and body composition management.Currently Matt’s day to day work includes elite rugby players, footballers and

professional boxers. He holds monthly clinics for the general public to maintain a

broader spectrum of applied clinical nutrition. This includes female hormonal health

and weight management. He is the author of several ebooks;

In essence what presented here in the athlete was not at all uncommon – a high degree of impact based and resistance training complemented by an inadequate intake of nutrients. Body compositiontargets were being met through calorie restriction in and around exercise exactly when a higher intakeof nutrients is required. The body’s defence mechanism – excess stress hormone production – willeventually deplete the adrenals and result in insufficient adrenal hormone production. The provision

of blood glucose stabilising nutrients and frequent feeds suppresses cortisol production and allows theadrenals to begin restoring. This combined with adrenal nutrients pantothine, cycling adaptogens andnon stimulant based fat burners allows the athlete to remain lean whilst increasing calories in and

around training. As I continue to work with player 1 we now pay more attention to cyclingsupplementation and to supplementing according to test results as opposed to what we feel a clientmay need.

Overall I learnt that the simple things normally work the best – eating slowly, proper digestion, sleep

and taking time to relax as an athlete are critical to success. Without these even the most

comprehensive supplementation and testing protocols will not assist performance or help with an

athlete’s health and wellness.

For the full unedited version of the case study please email [email protected]

References

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2. Kreider, R.B.F., A.C.; O'Toole, M.L., Overtraining in Sport. 1 ed. 1998: Human Kinetics.

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8. Meeusen, R., et al., Brain neurotransmitters in fatigue and overtraining. Appl Physiol Nutr Metab, 2007. 32(5): p.857 64




9. Uusitalo, A.L., Overtraining: making a difficult diagnosis and implementing targeted treatment. Phys Sportsmed,2001. 29(5): p. 35-50.

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11. Lehman, M.F., C; Netzer, N, Chapter 2; Physiological responses to short and long term training in endurance athletes,in Overtraining in sport, R.B.F. Kreider, A.C.; O'Toole, M.L., Editor. 1998, Human Kinetics. p. 19.

12. Hooper, S.L., et al., Hormonal responses of elite swimmers to overtraining. Med Sci Sports Exerc, 1993. 25(6): p.

741-7.

13. Kraemer, W.J., et al., Acute hormonal responses to a single bout of heavy resistance exercise in trained power lifters

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15. Thoren, M. and M. Anniko, Glucocorticoid incubation of human ACTH-producing pituitary tumours in vitro. A studyon ACTH secretion and cell morphology. Arch Otorhinolaryngol, 1986. 243(2): p. 96-101.

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21. Wittert, G.A., et al., Adaptation of the hypothalamopituitary adrenal axis to chronic exercise stress in humans. MedSci Sports Exerc, 1996. 28(8): p. 1015-9.

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marathon runners. Int J Sports Med, 1992. 13 Suppl 1: p. S141-2.23. Chaouloff, F., D. Laude, and J.L. Elghozi, PHysical exercise: evidence for differential consequences of tryptophan on

5-HT synthesis and metabolism in central serotonergic cell bodies and terminals. J Neural Transm, 1989. 78(2): p.121-30.

24. Pedersen, B.K., et al., Role of myokines in exercise and metabolism. J Appl Physiol, 2007. 103(3): p. 1093-8.

25. Pedersen, B.K., The diseasome of physical inactivity--and the role of myokines in muscle--fat cross talk. J Physiol,2009. 587(Pt 23): p. 5559-68.

26. Armstrong, L.E. and J.L. VanHeest, The unknown mechanism of the overtraining syndrome: clues from depressionand psychoneuroimmunology. Sports Med, 2002. 32(3): p. 185-209.

27. Smith, L.L., Cytokine hypothesis of overtraining: a physiological adaptation to excessive stress? Med Sci SportsExerc, 2000. 32(2): p. 317-31.

28. Fearon, K.C., et al., Double-blind, placebo-controlled, randomized study of eicosapentaenoic acid diester in patients

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30. Balch, J., Balch, P., Prescription for Nutritional Healing 2nd ed ed. 1997, NY: Avery Publishing Group.

31. Hallahan, B., et al., Omega-3 fatty acid supplementation in patients with recurrent self-harm. Single-centre double- blind randomised controlled trial. Br.J.Psychiatry, 2007. 190: p. 118-122.

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35. Neill, M. and P.S. Dixon, Effects of a preincisional 14-day course of valerian on natural killer cell activity in Sprague-Dawley male rats undergoing abdominal surgery. Holist Nurs Pract, 2007. 21(4): p. 187-93.

36. Zaffani, S., L. Cuzzolin, and G. Benoni, Herbal products: behaviors and beliefs among Italian women.Pharmacoepidemiol Drug Saf, 2006. 15(5): p. 354-9.

37. (Jeffrey Bland) The 14th International Symposium on Functional Medicine, 21st Century

Endocrinology: Thyroid and Adrenal as Sentinel Organs 2008.



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4th Test 3rd Test 2nd Test NOW PAST MENTAL / EMOTIONAL NOTES & COMMENTS

acute stress or crisis

anger often

anxiety often

autism

bi-polar disorder

chronic, unrelenting stress

depression often

despair or hopeless often

don’t take enough time for myself

experienced long periods of stress that effected my well-being

experienced one or more stressful events or traumas that effected my well-being

fearful often

financial stresses prevalent

grief feelings oftenguilt feelings often

impatience often

irritable often

mental strain for prolonged period(s)

nervous often

no or too little down time

often exercise to exhaustion

often work until I’m exhausted

overwork, work long hours

panic attacks

post traumatic distress syndrome

push too hard until exhaustion

relationship conflict or stress (family, work, romantic, friendship, marriage, etc.)

sad often, no apparent reason

type “A” personality

went through a major mental or emotional trauma in last 5 years (death in family,

divorce, lost job, lost home, moved, etc.)

work stress (unhappy, boss problems, co-worker disputes, deadline pressures, etc.)

work too much, I’m a workaholic

worry about things too much (money, future, relationships, kids, world affairs,

health, etc.)0 0 0 0 0 MENTAL / EMOTIONAL

4th Test 3rd Test 2nd Test NOW PAST ENVIRONMENTAL NOTES & COMMENTS

air pollution exposure

chemical exposures

electromagnetic fields (computers, etc.)

geo-physical stressors

heavy metal accumulation in hair

metal fillings in teeth

mold exposure at work or home

noise pollution

non-organic foods

processed foods and drink

radiation (airplanes, computers, x-rays)

root canals in teeth

smoking or second hand smoke exposure

toxic exposures in air (smog)

water pollution

wear a dental splint on teeth

wear braces on teeth0 0 0 0 0 ENVIRONMENTAL

4th Test 3rd Test 2nd Test NOW PAST LIFESTYLE NOTES & COMMENTSdieting (calorie restriction)

excessive exercise

lack of exercise

late hours (not in bed before 10 p.m.)

light cycle disruption (“grave yard” shift)

long work commutes

overscheduled life

overwork (physical strain)

physical injury, trauma, accident

poor diet

serious falls or blows to the head

sleep deprivation - insufficient quality or duration (less than 8 hours per night)

surgery

temperature extremes

too much to do, not enough time

whiplash0 0 0 0 0 LIFESTYLE

Hit "<Ctrl>Shift X" to SORT tables by NOW column

Hit "<Ctrl>Shift Y" to SORT tables by Symptoms

Adrenal St ress Causes ( ASC )

ADRENAL CAUSES TOTALS

METABOLISM SUB-TOTAL

MENTAL / EMOTIONAL SUB-TOTAL

ENVIRONMENTAL SUB-TOTAL

LIFESTYLE SUB-TOTAL

KEY: Red numbers indicate worsening since last test. Green numbers indicate improvement.

Please rate any condition that applies to you NOW and in the PAST, using the following scale:

5 = Severe 4 = Strong 3 = Moderate 2 = Mild 1 = Weak 0 = Not Present

• Start by going through and marking in the NOW column only the symptoms that apply to you currently

• Then go back and respond in the PAST column to the symptoms you marked in the NOW column

• Rate your response in the PAST column based on how you felt when the symptoms were at their WORST

ASC 1 of 2



4th Test 3rd Test 2nd Test NOW PAST METABOLISM NOTES & COMMENTS

acute infections

alcohol abuse

antibiotic use often

bacterial infections

bacterial infections-bacteroides fragilis

bacterial infections-clostridium perfringens

bacterial infections-E. coli

bacterial infections-E. enterococcus

bacterial infections-helicobacter pylori

birth control pills

caffeine abuse

candidiasis, candida overgrowth

chronic fatigue (CFS)

chronic illness

chronic indigestion

chronic infectionschronic inflammation

chronic pain

colitis, mucous

colitis, ulcerative

diagnosed degenerative condition/disease

drug abuse

environmental sensitivities

food allergies, reactivities, sensitivities

fungal infections

gingivitis

gluten intolerance

GSE – Gluten Sensitive Enteropathy

GSE-celiac disease, sprue

GSE-dermatitis herpetiformis

hyperthyroid

hypothyroid

inhalant allergies

injury to head, neck, or back

insulin resistance

kidney problems

lactose intolerance

liver toxicity or other problems

low blood sugar (hypoglycemia)

lung or respiratory problems

mal-absorption

mal-digestion

nutritional deficiencies

oxidative stress - high free radicals revealed in lab tests

parasites protozoa, flatworms, roundworms

parasites-cryptosporidium parvum

parasites-entamoeba histolytica

parasites-giardia lamblia

parasites-toxoplasma gondii

protein digestion insufficiency

pyorrhea

structural problems, misalignments

sucrose intolerance

TMJ stress

viral infections (ebv, cmv, herpes)

yeast infections0 0 0 0 0 METABOLISM

Please list any use of Presciption Drugs:

Please list any use of Over-the-Counter drugs:

ASC 2 of 2



NAME: HEIGHT: SEX:

TEST WEIGHT AGE DATE TEMP * What is your Main Health Complaint?

1st Test How often does this bother/affect you?

2nd Test How long has it been present?

3rd Test What have you tried that has NOT worked?

4th Test What does it prevent you from doing that you love to do?

5th Test On a 1-10 scale, what is your level of commitment to getting well?

6th Test Females Only - What is your menstrual status


0 0 0 0 0


0 0 0 0 0


0 0 0 0 0


0 0 0 0 0


0 0 0 0 0


0 0 0 0 0


0 0 0 0 0


0 0 0 0 0

4th Test 3rd Test 2nd Test NOW PAST ENDOCRINE FUNCTION

asthma

bright light/sunlight bothers me

bruise easily

chronic illness

cold often

crave salt

decreased ability to handle cold

diarrhea

diminished sex drive, low libido

dizzy or light-headed upon standing

dry skin

edema, fluid retention (around ankles, under eyes, etc.)

endometriosis

energy low

excessive facial or body hair

exercise exhausts, makes me feel worse

fatigue easily

fatigue not relieved by sleep

fibrocystic breastshair brittle

hair loss

hay fever

headaches

heart arrhythmia

heart palpitations

heartburn, reflux, or GERD

hot flashes

hyperthyroid (medically diagnosed)

hypothyroid (medically diagnosed)

impotence

increased effort to perform daily tasks

indigestion when stressed or tense

low blood pressure

Mentruating? Perimenopausal? Menopausal?

Please rate any condition that applies to you NOW and in the PAST, using the following scale:

Hit "<Ctrl>Shift S" to SORT tables by Symptoms

• Start by going through and marking in the NOW column only the symptoms that apply to you currently

• Then go back and respond in the PAST column to the symptoms you marked in the NOW column

ENDOCRINE FUNCTION SUB-TOTAL

NEURAL TISSUE HEALTH SUB-TOTAL

5 = Severe 4 = Strong 3 = Moderate 2 = Mild 1 = Weak 0 = Not Present

* TEMP - Take your Oral Temperature upon awakening before getting o ut of bed for 5 days (not necessarily c onsecutive). Add them up. Divi de by 5. Enter your result.

MUSCULO-SKELETAL SUB-TOTAL

DETOXIFICATION SUB-TOTAL

• Rate your response in the PAST column based on how you felt when the symptoms were at their WORST

Adrenal Stress Ind icators ( ASI )

KEY: Red numbers indicate worsening since last test. Green numbers indicate improv ement.

FAT & PROTEIN SUB-TOTAL

NOTES & COMMENTS

ADRENAL INDICATORS TOTALS

Hit "<Ctrl>Shift N" to SORT tables by NOW column Ratings

CARBOHYDRATE SUB-TOTAL

EICOSANOID MODULATION SUB-TOTAL

Copyright © 2008 Healthexcel and Functional Diagnosti c Nutriti on

Version 1.4

ASI 1 of 5



low body temperature (below 98 degrees orally)

menstrual irregularities/problems

migraines

nails brittle, break easily

nausea

need my daily coffee, tea, or cola (caffeine)

need to wear sunglasses in bright sunlight

night sweats

no energy to exercise

often awake between 2-3 a.m. (not because I’m hungry)

oily skin

PMS (cramps, nausea, headaches, irritability, etc.)

rashes, dermatitis, itching skin, or hives often

sleepy, drowsy during the day

slow to get going in a.m. and/or like to sleep late

sodium retention (medically diagnosed)

spider veins

swelling or puffiness under eyes

tender breasts

thin or delicate skin

thyroid disorders (medically diagnosed)

tire easily, low stamina/endurance

tired/low energy, especially in afternoon

unable to get pregnant

unable to maintain pregnancy

urinate frequently

uterine fibroids

vaginal drynesswake up feeling tired or unrested

0 0 0 0 0 ENDOCRINE SUB-TOTAL

4th Test 3rd Test 2nd Test NOW PAST NEURAL TISSUE HEALTH

absentminded

ADD/ADHD

angry often

anxiety, anxiousness (can be for no apparent reason)

apathetic

avoid emotional confrontations or situations

best sleep often between 7 – 9 a.m.

can’t think clearly

concentration difficult

decreased ability to handle stress or pressure

decreased tolerance of others

depression, sadness, melancholy

despair

emotionally stressed

fearful (can be for no apparent reason)

feel best in the evenings

feel overwhelmed often

feel unwell often

foggy thinking

forgetful

get confused often

hard to do tasks quickly

hard to get out of bed or get going in a.m.

hard to think or act quickly

have little control over how I spend my time

hopelessness feelings

inability to calm downinsomnia - hard to fall asleep

insomnia - wake up & can’t go back to sleep

irritability

just don’t feel right, not myself

lack drive, motivation

learning is difficult

less productive than in the past

loud noises bother

memorization difficult

memory poor

mentally stressed

mood swings, emotional ups and downs

must force myself to keep going

nervous breakdowns

NOTES & COMMENTS

ASI 2 of 5



nervousness

panic attacks

procrastinate often

shake or feel nervous under pressure

sleeping pills needed for sleep

spacey, hard to focus

startle easily

stress or pressure causes me to lie down and rest

suddenly run out of energy

tearful, could cry easily

thinking gets confused when under pressure

thinking not as clearly as in the past

thoughts too many, too rapid

timid, overly cautious

upset easily

work best late at night

worry

0 0 0 0 0 NEURAL TISSUE SUB-TOTAL

4th Test 3rd Test 2nd Test NOW PAST MUSCULO-SKELETAL HEALTH

arthritis, osteo

arthritis, rheumatoid

circulation poor

difficulty building muscle

losing muscle mass

low back pain

muscle weakness

osteopeniaosteoporosis

pain in jaw (TMJ)

pain in joints (not due to injury)

pain in low back area

pain in lower neck

pain in sciatica

pain in shoulders

pain in upper back

sprains or strains occur easily or often

stiffness or achiness, especially in morning

0 0 0 0 0 MUSCULO-SKELETAL HEALTH SUB-TOTAL

4th Test 3rd Test 2nd Test NOW PAST CARBOHYDRATE METABOLISM

alcohol intolerance

anger, irritability relieved by eating

craving for sweets

diabetes, Type I

diabetes, Type II

excessive hunger

feel faint often

feel weak

hyperglycemia–high blood sugar

hypoglycemia–low blood sugar

insulin resistance

light-headed often

nausea, eating relieves

often awake between 2-3 a.m. and need to eat something

shakiness, nervousness relieved by eating

0 0 0 0 0 CARBOHYDRATE METABOLISM SUB-TOTAL

4th Test 3rd Test 2nd Test NOW PAST EICOSANOID MODULATIONallergies - food

allergies – other inhalants

allergies – seasonal (hay fever)

allergies are worsening (severity, frequency, or to more things)

autoimmune diseases-ALS

autoimmune diseases-Crohn’s

autoimmune diseases-Graves’

autoimmune diseases-Hashimoto’s

autoimmune diseases-Lupus

autoimmune diseases-MS

autoimmune diseases-Other

bacterial infections

cancer

cardiovascular disease

NOTES & COMMENTS

NOTES & COMMENTS

NOTES & COMMENTS

ASI 3 of 5



catch colds easily

CFS-chronic fatigue syndrome

chemical sensitivities

coughs or colds usually last for several weeks

environmentally sensitive, reactive

food intolerances, reactivities, or allergies

fungal infections

get sick easily or often

gum infections (gingivitis)

headaches

immune deficiency

inflammation (not due to injury)

often get colds or flu

pain (not due to injury)

parasite infections

sensitive to odors, flowers, or chemicals

sick more often, takes longer to get well

sinus problems

tooth infections (pyorrhea)

urinary tract infections

viral infections (cmv)

viral infections (ebv)

viral infections (herpes)

yeast infections (candida)

0 0 0 0 0 EICOSANOID MODULATION SUB-TOTAL

4th Test 3rd Test 2nd Test NOW PAST DETOXIFICATION CAPACITY

acnealternating constipation and diarrhea

aversion to certain foods

bloating

burping or belching

constipation (b.m. less than once a day)

dark circles under eyes

diarrhea

exposure to environmental toxins

heavy metal accumulation

intestinal gas

irritable bowel

kidney disorders

leaky gut

liver disorders

loss of appetite

lung disorders

often have nightmares

rashes, hives often

skin problems, bad skin, bad coloring

strong body odor

sweat burns my skin

0 0 0 0 0 DETOXIFICATION CAPACITY SUB-TOTAL

4th Test 3rd Test 2nd Test NOW PAST FAT & PROTEIN METABOLISM

digestive disorders

mucosal surface integrity problems (ulcers)

slow healing

sweat has an ammonia odor

unable to lose weight

weight gain - waist, hips, thighs

weight loss0 0 0 0 0 FAT & PROTEIN METABOLISM SUB-TOTAL

NOTES & COMMENTS

NOTES & COMMENTS

Documents

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