3 overtrainingformatted4 ic ml3
TRANSCRIPT
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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
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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
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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
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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
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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
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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)
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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
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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]
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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
with cancer cachexia. J.Clin.Oncol., 2006. 24(21): p. 3401-3407.
29. Gastmann, U.A. and M.J. Lehmann, Overtraining and the BCAA hypothesis. Med Sci Sports Exerc, 1998. 30(7): p.1173-8.
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.
32. Helland, I.B., et al., Effect of supplementing pregnant and lactating mothers with n-3 very-long-chain fatty acids on
children's IQ and body mass index at 7 years of age. Pediatrics, 2008. 122(2): p. e472-e479.
33. Lucas, M., et al., Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in
middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Am.J.Clin.Nutr., 2009. 89(2): p.641-651.
34. van de, R.O., et al., Effect of fish-oil supplementation on mental well-being in older subjects: a randomized, double- blind, placebo-controlled trial. Am.J.Clin.Nutr., 2008. 88(3): p. 706-713.
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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
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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:
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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
4th Test 3rd Test 2nd Test NOW PAST
0 0 0 0 0
4th Test 3rd Test 2nd Test NOW PAST
0 0 0 0 0
4th Test 3rd Test 2nd Test NOW PAST
0 0 0 0 0
4th Test 3rd Test 2nd Test NOW PAST
0 0 0 0 0
4th Test 3rd Test 2nd Test NOW PAST
0 0 0 0 0
4th Test 3rd Test 2nd Test NOW PAST
0 0 0 0 0
4th Test 3rd Test 2nd Test NOW PAST
0 0 0 0 0
4th Test 3rd Test 2nd Test NOW PAST
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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
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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
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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
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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