Burnout Part 3: Diagnosis Tips

Richmondchironeu • August 19, 2019

Hello once again everyone:

So now we go into the lab tests to diagnose adrenal status, but before we do, we need to cover the two primary types of adrenal problems.

Rarely, are the adrenal glands over active. This is called Cushing’s Disease and is suspected when you have high cortisol and blood pressure unresponsive to medication and other physical signs, such as a round or moon shaped face that you did not have before. Lab tests that confirm high cortisol then lead to the next step, which is undertaken with an endocrinologist to establish the possible cause. One possible cause is an adrenal or pituitary adenoma, and imaging studies may be ordered along with other lab tests to find out if this is a primary (an adrenal tumor) or secondary issue (a pituitary tumor).

Mild increases of cortisol seen on blood and/or saliva tests without moon face or blood pressure concerns raise the concept of stress induced cortisol elevations. This is not Cushing’s Disease, but happens when long periods of high stress force the HPA axis to be elevated. In Cushing’s or stress induced hypercortisolemia, it can be very helpful to run a salivary cortisol test where cortisol is measured in 4 saliva samples taken over the course of the day, usually at 8:00 AM, Noon, 4 to 6 PM and a final one at 11:00 PM. In this case, we are looking at the cortisol rhythm which is where we are checking to see if the normal diurnal changes in the cortisol levels occur.

Normally, the cortisol is highest on arising, and slowly goes down over the course of the day. This normal rhythm can be disturbed in many ways and gives us a clue to whether or not this is a functional issue or a pathological concern. For example, a high morning cortisol, with normal cortisol the rest of the day will lend toward a diagnosis of high stress/anxiety states. A high evening cortisol raises the suspicion of Cushing’s, but if the cortisol is normal or low all day and just high at night, then that is more of a functional issue.

The cortisol salivary rhythm test can also spot adrenal insufficiency, where you have low cortisol all day. When cortisol is low all day, then an autoimmune condition can be suspected and further lab tests for antibodies to the adrenal glands can be ordered. Low cortisol is called Addison’s disease, and both Cushing’s or Addison’s can be life threatening and require the expert care of an endocrinologist experienced in treating these cases.

It is very often frustrating to have your primary care physician state that your tests are all normal and that no such thing as adrenal fatigue has been substantiated in the literature, even when your symptoms fit that adrenal fatigue description exactly. Standard medical care does not recognize adrenal fatigue as a legitimate condition, stating that there is no scientific evidence or formal criteria to either define or diagnose adrenal fatigue. In the next newsletter, we will get into this in more detail, but for now my opinion is that both sides are correct. Please read this link and get ready for next week’s newsletter where we dismantle the controversy.

Bottom Line:  When you read the proposed definitions of burnout and adrenal fatigue, it becomes apparent that these conditions are actually MULTI-SYSTEM disorders and no single test will diagnose such a condition. The controversy arises when we try to look at things through the lens of disease as opposed to organ fatigue or organ reserve (lack or function or just abnormal function from chronic overuse). In multi-system functional disorders (such as burnout and adrenal fatigue), it is often more useful to look at lab tests from both a pathological viewpoint as well as a functional viewpoint. Stay tuned for what this looks like!!

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Health News Update: Pesticides, Cancer & Why Go Organic

By Mark Smith • June 29, 2026
Health News Update: Pesticides, Cancer & Why Go Organic 6.29.26 Hello everyone: Slowly but surely, despite the health and food industries downplaying the risks, evidence is emerging that the long-term consumption of trace amounts of toxic chemicals can add up to some serious health consequences. “Our process-based model, encompassing 31 key pesticide active ingredients, together with an innovative stratification of cancer cases by developmental lineage, reveals a robust spatial association between environmental pesticide exposure risk and cancer incidence. In pesticide-associated cancer hotspots, exposomic profiling of liver tissue—a primary target of chemical carcinogens—uncovers a distinct transcriptomic signature of pesticide exposure, implicating a non-genotoxic mode of action that disrupts core regulatory circuitries sustaining cell identity. Collectively, these findings strongly support a mechanistic link between pesticide exposure and cancer, challenging assumptions of human non-carcinogenicity derived from reductionist experimental models. This study redefines the exposome as a lineage-conditioned, mechanistically tractable framework and shows how complex pesticide mixtures can contribute to carcinogenic trajectories, with profound and far-reaching implications for global health policy and socio-ecological equity.” https://www.nature.com/articles/s44360-026-00087-0 pesticide exposure & cancer risks Bottom Line: Whenever possible, purchase your food from organic sources including local farmers that use regenerative and organic practices. Not all foods need to be organic, and to decide which ones absolutely need to be, you can access the Environmental Working Group’s yearly list of the Dirty Dozen foods that are the highest in pesticide residues. This will also include the Clean 15 foods that do not need to be organic as they are usually grown without or with very low pesticide levels. https://www.ewg.org/foodnews/dirty-dozen.php dirty dozen food guide Additionally, high quality nutrients support the natural detox processes our bodies use to get rid of any and all toxins. When we consume the Standard American Diet or Westernized Diet, we are low in the nutrients and co-factors needed to support optimal detox cleansing. So always start with food upgrades as they will carry your upgrade the farthest. Remember that most chronic health conditions start 20 years before you even notice them creeping up or becoming diagnosed. What you do now is creating your future. It used to be said that you are what you eat. Another way to say that is we become what we eat…so please take good care and make sure you always put high grade fuel into your Temple.

Health news Update: High Fat Diets Promote Inflammation and Illness

By Mark Smith • June 22, 2026
Health news Update: High Fat Diets Promote Inflammation and Illness 6.22.26 Hello again: This news has been slow to surface with the popularity of keto and paleo dietary trends, but the following information is what is known about the typical Standard American Diet, also known as the Western Diet. “Conclusion : HFD-associated low-grade inflammation results from overlapping effects of dysbiosis and high fat intake, with crosstalk between microbiota and fat-driven inflammatory processes independent of gut flora involving multiple mechanisms. For this reason, it is difficult to determine what occurs first, thus, HFD-driven dysbiosis and HFD-related inflammation should be considered partially independent but closely correlated mechanisms.” https://pmc.ncbi.nlm.nih.gov/articles/PMC8619527/ High fat promotes inflammation Bottom Line: As you all know by now, inflammation will cause, perpetuate, and/or aggravate every known illness or condition, including aging. The next logical question is what to eat? The answer is the Green Mediterranean food plan…which essentially going vegan but allowing some animal-based foods no more than 3 times per week. This takes some planning but is most easily achieved by using a ‘crowding out’ method. This is simply accomplished by including more and more unprocessed, whole plant-based foods in place of processed or fatty foods and naturally reducing those less than healthy items. Below is some more information to help you make the switch…knowing that you can improve your day-to-day nutrition by making small consistent upgraded choices is critical. Upgrades to improve your health path do not usually arise from one big resolution but from those small individual choices made every day…and these add up to some major improvements over several months and longer. “The gut microbiota is responsible for recovering energy from food, providing hosts with vitamins, and providing a barrier function against exogenous pathogens. In addition, it is involved in maintaining the integrity of the intestinal epithelial barrier, crucial for the functional maturation of the gut immune system. The Western diet (WD)—an unhealthy diet with high consumption of fats—can be broadly characterized by overeating, frequent snacking, and a prolonged postprandial state. The term WD is commonly known and intuitively understood. However, the strict digital expression of nutrient ratios is not precisely defined. Based on the US data for 1908–1989, the calory intake available from fats increased from 32% to 45%. Besides the metabolic aspects (hyperinsulinemia, insulin resistance, dyslipidemia, sympathetic nervous system and renin-angiotensin system overstimulation, and oxidative stress), the consequences of excessive fat consumption (high-fat diet—HFD) comprise dysbiosis, gut barrier dysfunction, increased intestinal permeability, and leakage of toxic bacterial metabolites into the circulation. These can strongly contribute to the development of low-grade systemic inflammation.”

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By Mark Smith • June 15, 2026
Health News Update: Meal Timing Makes a Significant Difference 6.15.26 Hey there everyone: There are more and more papers coming out about meal timing and they pretty much all point to the same conclusion: “These study results are observational, so not proof of causation, but it fits broader chrononutrition science showing that aligning meals with daytime circadian biology supports metabolic and overall health.” — Monique Richard, MS, RDN, LDN https://www.medicalnewstoday.com/articles/eating-breakfast-late-linked-biological-aging-depression-oral-health?utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=sundaysupplement&utm_content=2025-09-14&apid=32362300&rvid=24561ae4b347411c6ae1874dad579a0aedec4a5e471e9b3b5a21dc0826faa6b9#Eating-breakfast-later-in-the-day-linked-to-several-health-issues eating breakfast important for long term health Bottom Line: To achieve a meal timing pattern that is in harmony with your circadian clock, consider what the authors provided: Anchor the Day Early: Aim to eat breakfast within one to two hours of waking, most days. A simple pattern like breakfast: 7–8 a.m., lunch: noon–1 p.m., dinner: 5–7 p.m. works for many families and individuals, allowing for possible snacks as necessary, keeping a consistent window of sleep and fasting open ~10–12 hours, and try to avoid snacking two to three hours before bed. Front-Load Protein: Target ~25–30 g protein at breakfast (e.g., Greek yogurt + nuts + berries ; eggs + beans + veg; protein-fortified oatmeal ). Distributing protein across meals supports muscle function, brain health, satiation, and numerous other functions. Eat Early and Evenly: A protein-strong breakfast, a steady midday meal, and a light, timely dinner, hydration in between, coupled with laughter and loved ones. This schedule pretty much is defined as eTRF, or early Time Restricted Feeding, which is known to have multiple benefits including weight loss and management, blood sugar balancing, improving sleep, and more.

Health News Update: How to Use Red Light Therapy to Heal/Recover

By Mark Smith • June 8, 2026
Health News Update: How to Use Red Light Therapy to Heal/Recover 6.8.26 Hello everyone: Recently I was able to use red-light therapy to overcome some chronic pain issues that were not responding to nutritional support, anti-inflammatory supplements, massage therapy, acupuncture, and chiropractic treatments. What actually turned the corner for me what something that I learned while researching red-light therapy that no one has ever mentioned before…and it is not included anywhere that I can find on the sales information for any red-light device. The answer to make red light optimally effective is simply to use it every other day. So, what’s up with that? Some basics: Red- light therapy is also called, Low Level Light Therapy (LLLT), or Photobiomodulation. It has been well established that certain frequencies in the infra-red spectrum can stimulate biological mechanisms that promote increased cellular function and thus push forward a healing response. The most effective researched wavelengths are 660 nm. and 850 nm. and used together can be a powerful way to advance repair and reduce pain. Most devices that are currently available on the internet have those frequencies, a built-in timer, and intensity controls. They come in all shapes and sizes, from ones that fit shoulders, hands, feet, the face, the back, the entire body, hips, knees, and even the head/skull. It has even been used for dry eyes, but in that application, I recommend that you consult an eye specialist. These units vary in price from a reasonable amount, depending on the size of the array, to a ridiculous amount. As far as I can tell, if they have the right wavelengths and adequate power (which is in Watts, such as 12 Watts), most of the mid-range priced ones can be reasonably assumed to be adequate. And what could you consider the use of red-light therapy for: · Joint pain · Lower inflammation · Enhance immune functions · Headaches · Arthritis · Strain/sprain injury recovery · Acne · Wrinkles · Scars · Hair loss · Eczema · Psoriasis · Wound recovery · Chronic pain · Improve energy Bottom Line: There is considerably more to the science that I am not covering, but one thing about the science that is critical to know is that in order to get the best results there is something called the bi-phasic response. It goes something like this: low levels of light stimulation enhances physiologic healing and cellular function(s), while higher or excessive dosages can inhibit healing and cellular functions. This biological response is called the Arndt-Schultz law…which is also known as a ‘hormetic’ response. The best way to take advantage of this science is to just use any red-light therapy device every other day. You could, for example use LLLT on your left knee and shoulder today, and tomorrow on another body part but not the same area 2 days in a row. This has proved rather miraculous for me, and I wanted to pass this along. One last tidbit: keep the red-light source close to or on bare skin, not more than an inch away. It can takes weeks to months to reach full benefit, so don’t give up too early. https://link.springer.com/article/10.1186/s12967-025-07466-3 Using light to heal.
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