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John Owens, D.O. ATSU-KCOM, Class of 2005 Board Certified, Family Medicine/OMT Diplomate, American College of Osteopathic Family Physicians Physician/Endoscopist, Utica Park Clinic Adjunct Clinical Faculty, OSU-CHS, Dept of OMM
www.facebook.com/DrJohnOwens
May 2, 2015
What is Adrenal Fatigue? -Not a recognized syndrome in the United States -Recognized in its most severe form: Addison’s Disease
HPA Axis:
What is Adrenal Fatigue? -hypoadrenism “Any doctor worth his/her salt understands that the term “adrenal fatigue” means mild adrenal insufficiency. The Hormone Foundation statement readily admits that adrenal insufficiency IS a real diagnosis. To me, they seem to be denying the possibility that some people might have a mild form of a real diagnosis. That’s short-sighted and excessively arbitrary.” – Richard Shames, MD
Normal Function
Addison’s Disease Adrenal Fatigue
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How common is Adrenal Fatigue? • Addison’s Disease: 1 in 23,000 • Adrenal Fatigue/Insufficiency: unknown, although might affect the majority of the population at some point in their lives Estimated 16% of population severe (1969) Estimated 66% of population any level of AF (1969) • Fatigue: Top 50 most commonly used diagnoses (#43)
What are the Symptoms of Adrenal Fatigue? You feel tired for no reason. You have trouble getting up in the morning, even when you go to bed at a reasonable hour. You are feeling rundown or overwhelmed. You have difficulty bouncing back from stress or illness. You crave salty and sweet snacks. You feel more awake, alert and energetic after 6PM than you do all day.
Conditions Associated with Adrenal Fatigue • • • • • • • • • •
Anxiety Asthenia - lack of/loss of strength, generalized weakness Asthma Autoimmune problems Bronchitis - recurrent, chronic or slow recovery Burnout Chemical Sensitivity Chronic fatigue syndrome (CFS) Chronic infections Chronically run down - with early morning fatigue and low blood pressure • Chronic mental and/or physical exhaustion • Cravings for carbohydrates, sweets or salt
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Conditions Associated with Adrenal Fatigue • • • • • • • • • • • •
Depression Fatigue - severe, disabling early morning fatigue Feeling tired despite sufficient hours of sleep Fibromyalgia Hair loss Hypoglycemia Immune System dysfunction - frequent illnesses Insomnia - or non-restful sleep Low Blood Pressure Nervous breakdown (nervous exhaustion) Pneumonia Respiratory infections - recurrent, chronic or slow recovery
Conditions Associated with Adrenal Fatigue • Rheumatoid arthritis • Reliance on stimulants like caffeine • Slow recovery following acute infectious diseases, especially influenza, pneumonia, or other respiratory infections • Weight gain
How do you Diagnose Adrenal Fatigue? Physical Examination: Pupil dilation (2 min provocation) Unstable Pupil Orthostatic Hypotension Sergent’s White Line Test Laboratory Analysis: Cortisol (urine/serum/saliva) ACTH ACTH Stimulation TSH/fT3/fT4/Reverse T3
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Treatment Options Osteopathic Concepts 1. The human body has a natural tendency towards health, as well as the capacity to resist disease and heal itself. 2. The body’s musculoskeletal system is central to the patient’s health and self-expression. 3. Palpation (touch) and manipulation of the body are essential to gaining patient confidence, as aids to the diagnosis and treatment of disease, and for reestablishing and developing health. 4. Preventative medicine, such as proper nutrition, exercise, and reducing health risks, is essential.
Treatment Options Adrenal Fatigue Diet Avoid: Caffeine Sugar/Sweeteners Processed Foods Hydrogenated Oils Include: Coconut Avocado Fatty fish, e.g. wild-caught salmon Chicken and turkey Nuts, such as walnuts and almonds Cruciferous vegetables (cauliflower, broccoli, brussel sprouts)
Treatment Options Nutritional Supplements • Magnesium • Fish oil (EPA/DHA) • Vitamin B5 • Vitamin B12 • Vitamin C • Vitamin D3 • Zinc
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Treatment Options Stress Reduction • Rest when you feel tired, as much as possible. • Sleep 8-10 hours a night • Avoid staying up late and stay on a regular sleep cycle. Ideally, in bed before 10p • Laugh and do something fun every day • Minimize work and relational stress • Eat on a regular food cycle and and reduce sugar and caffeine • Exercise (even moderate exercise and walking can help) • Avoid negative people and self talk • Take time for yourself (do something relaxing) • Seek counsel or support for any traumatic experiences
Treatment Options OMT
Osteopathy in the Cranial Field (CV4) Cervical/Suboccipital Techniques T8-10 (Sympathetic System) Rib Raising
Osteopathic Manipulative Treatment
Treatment Options
Videos: http://www.acofp.org/apps/OMT/index.html
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OMT for Pituitary Function Osteopathy in the Cranial Field
CV4 Technique Normalizes sympathetic function In 1992, Gitlin and Wolf demonstrated stimulation of uterine contraction in 100% of limited-size sample (6 subjects) with CV4 technique, with mean time to first contraction 17 minutes and longest 34 minutes.
Inducing the Still Point
OMT for Fatigue/Stress/Depression Osteopathic Manipulative Treatment for Self-Reported Fatigue, Stress, and Depression in First-Year Osteopathic Medical Students Sarah Wiegand, OMS IV, MSc; William Bianchi, OMS IV, MSc; Thomas A. Quinn, DO; Mark Best, MD, MBA, MPH, MS; and Thomas Fotopoulos, DO The Journal of the American Osteopathic Association February 2015 | Vol 115 | No. 2 ---------------4 minutes of rib raising, 3 minutes of anterior cervical fascia release, 7 minutes of sternocleidomastoid inhibition, 3 minutes of levator scapulae inhibition, and 3 minutes of occipitoatlantal release. Performed weekly for 4 weeks.
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OMT for Fatigue/Stress/Depression
Rib Raising
Sternocleidomastoid/ Levator Scapulae Release
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Suboccipital Release Place pads of fingers inferior to the occipital ridge and allow the weight of the head to rest on the fulcrum created by your fingers.
You have completed the technique once the occiput rests in your palms, indicating relaxation of the suboccipital musculature.
OccipitoAtlantal Release
Techniques: Articulatory Still Technique Indirect/BLT Muscle Energy HVLA
T8-10 Sympathetic Innervation Techniques: Muscle Energy HVLA Still Technique Indirect/BLT
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Osteopathic Coding
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References Cited http://adrenalfatiguesolution.com/hpa-axis/ https://www.adrenalfatigue.org/what-is-adrenal-fatigue#how-common https://books.google.com/books?id=q7MeBgAAQBAJ&pg=PA114&lpg=PA114&dq=icd9+780.7+how+common&source=bl&ots=zMq74J9C7c&sig=7yyJ2l1YsqIs9TCILp16_FkKzjQ&hl=e n&sa=X&ei=NBs8VaO7LMzOsAX4noDgBg&ved=0CC4Q6AEwAzgK#v=onepage&q=icd9%20780.7%20how%20common&f=false http://www.adrenalfatiguerecovery.com/adrenal-function-tests.html
http://www.drdach.com/Adrenal_Fatigue.html http://draxe.com/3-steps-to-heal-adrenal-fatigue/ http://www.ncbi.nlm.nih.gov/pubmed/25637614 http://www.ncbi.nlm.nih.gov/pubmed/12033756
References Cited http://wisdom-magazine.com/Article.aspx/328/
https://clinicaltrials.gov/ct2/show/NCT01332864 http://www.cranialacademy.org/researchCLINICAL.html Giles PD. Effects of cervical manipulation on autonomic control. Unpublished Master’s Thesis University of North Texas Health Science Center, Fort Worth, TX 2006. [ Giles PD, Smith M, Hensel K. Effects of cervical manipulation on autonomic control. Submitted for publication, J Compl Altern Med.]
Cutler MJ, Holland BS, Stupinski BA, et al. Cranial manipulation can alter sleep latency and sympathetic nerve activity in humans: a pilot study. J Altern Complement Med. 2005;11(1):103-108. Gitlin RS, Wolf DL. Uterine contractions following osteopathic cranial manipulation. J Am Osteopath Assoc. 1992;92(9):1183 [Abst]
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References Cited Magoun HI. Osteopathy in the cranial field, 2e. Kirksville, MO: Journal Publishing Company; 1966:112-113. J Am Osteopath Assoc. 2015 Feb;115(2):84-93. doi: 10.7556/jaoa.2015.019. http://www.acofp.org/apps/OMT/index.html http://jaoa.org/article.aspx?articleid=2094539 http://jaoa.org/article.aspx?articleid=2093282 http://www.prohealth.com/library/showarticle.cfm?libid=8134
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