Low Adrenal Function /
Adrenal Insufficiency
  Adrenal Function Low
 Signs and symptoms
 Conditions that suggest it
 Contributing risk factors
 Conditions suggested by it
 What else it can lead to
 Treatment
 



Low Adrenal Function / Adrenal Insufficiency: Overview
The adrenal glands, located above the kidney, often become 'exhausted' as a result of the constant demands placed upon them. An individual with adrenal exhaustion will usually suffer from chronic fatigue, may complain of feeling stressed-out or anxious, and will typically have a reduced resistance to allergies and infection. The adrenal glands secrete several important hormones that help maintain the balance of many body functions. Stress, fasting, temperature changes, infections, drugs, and exercise all stimulate the adrenals to release their hormones. When the adrenals release too few or too many hormones, the body responds differently to the everyday stresses of life.

The adrenal cortex is involved in the production of glucocorticoids (such as cortisol i.e. hydrocortisone), mineralocorticoids (aldosterone) and androgens such as androstenedione and DHEA. A mild to moderate adrenocortical deficiency can substantially reduce your quality of life, yet this condition is not recognized by most doctors, who only think of the adrenal gland's condition as being at either extreme - normal or in overt failure (Addison's disease).

Treatment and Prevention
For those concerned about taking a hormone (cortisol) - perhaps for life - a more natural approach to strengthening the adrenal gland can be tried. This may include vitamin C, PABA, adrenal glandulars, ACE (Adreno-Cortico-Extracts) injections, licorice root, ginsengs, TMG (tri-methyl-glycine) and DHEA among other possibilities.


Signs, symptoms & indicators of Low Adrenal Function / Adrenal Insufficiency:
Lab Values - CommonLow systolic blood pressure is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Low systolic blood pressure
Low diastolic blood pressure is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Low diastolic blood pressure

Symptoms - Allergy
Allergies to certain foods may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Allergies to certain foods

Symptoms - Environment
Poor tolerance of cold may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Poor tolerance of cold
Poor tolerance of heat may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Poor tolerance of heat

Symptoms - Female
Male characteristics may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Male characteristics

Symptoms - Food - Beverages
Constant/frequent thirst may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Constant/frequent thirst

Symptoms - Food - General
Weak appetite may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Weak appetite

Counter-indicators:
Normal eating frequency may contraindicate Low Adrenal Function / Adrenal Insufficiency  Normal eating frequency
Regular, healthy eating habits support adrenal function.

Symptoms - Food - Preferences
Sugar/sweet craving is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Sugar/sweet craving
Craving for salt may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Craving for salt

Symptoms - Gas-Int - General
Meal-related bloating may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Meal-related bloating

Symptoms - General
Fatigue that worsens during the day is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Fatigue that worsens during the day
Chronic fatigue for over 3 months is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Chronic fatigue for over 3 months
Constant fatigue is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Constant fatigue
Fatigue induced by light exertion is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Fatigue induced by light exertion
Dizziness when standing up is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Dizziness when standing up
Having a CFS diagnosis is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Having a CFS diagnosis or history of CFS diagnosis
Slow recovery from colds may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Slow recovery from colds

Counter-indicators:
No fatigue induced by light exertion often contraindicates Low Adrenal Function / Adrenal Insufficiency  No fatigue induced by light exertion
Chronic fatigue now resolved often contraindicates Low Adrenal Function / Adrenal Insufficiency  Chronic fatigue now resolved
No/past history of being fatigued often contraindicates Low Adrenal Function / Adrenal Insufficiency  No/past history of being fatigued
Absence of worsening fatigue often contraindicates Low Adrenal Function / Adrenal Insufficiency  Absence of worsening fatigue

Symptoms - Hair
Balding lower legs may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Balding lower legs

Symptoms - Head - Eyes/Ocular
Vision disturbances may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Vision disturbances
(High) sensitivity to bright light may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  (High) sensitivity to bright light

Symptoms - Head - Nose
Allergic rhinitis may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Allergic rhinitis

Symptoms - Immune System
History of infections may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  History of infections
Postviral syndrome may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Postviral syndrome

Symptoms - Metabolic
Low energy/stamina is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Low energy/stamina
Low body temperature may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Low body temperature
Frequent colds/flus may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Frequent colds/flus
Being severely affected by flus may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Being severely affected by flus

Symptoms - Mind - Emotional
Adverse reaction to stress is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Adverse reaction to stress
Inability to work under pressure is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Inability to work under pressure

Symptoms - Muscular
Tender muscles may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Tender muscles

Symptoms - Reproductive - Female Cycle
Hot flashes during period is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Hot flashes during period
Adrenal estrogen seems to be necessary to avoid hot flashes during normal menses when the ovarian production of estrogen drops. Hot flashes during menses may be a symptom of mild adrenal cortex deficiency.

Irregular menstrual cycles may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Irregular menstrual cycles
Unexplained missed periods may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Unexplained missed periods
Menopausal arthritis may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Menopausal arthritis
Breast soreness during cycle may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Breast soreness during cycle

Symptoms - Reproductive - General
Morning sickness is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Morning sickness
Probable miscarriage may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Early/late term miscarriage or probable miscarriage
Difficulty conceiving children may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Difficulty conceiving children

Symptoms - Respiratory
Frequent/occasional/regular sore throats may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Frequent/occasional/regular sore throats

Symptoms - Skin - Conditions
Acne worse during period may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Acne worse during period
History of adult acne may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  History of adult acne

Symptoms - Skin - General
Darker/redder skin color is often a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Darker/redder skin color
Diminished perspiration may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Diminished perspiration
Red palms/fingertips may be a sign or symptom of Low Adrenal Function / Adrenal Insufficiency  Red palms/fingertips

Symptoms - Sleep
Counter-indicators:
Being a deep sleeper may contraindicate Low Adrenal Function / Adrenal Insufficiency  Being a deep sleeper
Regular good sleep habits (non-wakeful rest during the night, not snoring, waking refreshed) tend to contraindicate adrenal stress.

Conditions that suggest Low Adrenal Function / Adrenal Insufficiency:
AutoimmuneAddisons Disease (confirmed) strongly suggests Low Adrenal Function / Adrenal Insufficiency  Addison's Disease (confirmed)
Lupus, SLE often suggests Low Adrenal Function / Adrenal Insufficiency  Lupus, SLE (Systemic Lupus Erythromatosis)
Lupus is one of the auto-immune diseases, caused by a hyperactive ("hypervigilant") immune system that attacks a person's own protein as if it were foreign matter. One reason for this is poor adrenal function. Adrenal steroids modulate (slow down) the immune system: when there is not enough of these steroids the immune system goes berserk.

Chronic Thyroiditis may suggest Low Adrenal Function / Adrenal Insufficiency  Chronic Thyroiditis
Crohns Disease may suggest Low Adrenal Function / Adrenal Insufficiency  Crohn's Disease
Ulcerative Colitis may suggest Low Adrenal Function / Adrenal Insufficiency  Ulcerative Colitis

Counter-indicators:
Addisons Disease often contraindicates Low Adrenal Function / Adrenal Insufficiency  Addison's Disease

Circulation
Counter-indicators:
Anemia (Iron deficiency) often contraindicates Low Adrenal Function / Adrenal Insufficiency  Anemia (Iron deficiency)
If anemia is identified as a problem then the likelihood of low adrenal function is reduced. Therefore, it is wise to rule out anemia first, because both can contribute to similar symptomology. Of course, it is not impossible for both to occur simultaneously, but this is less likely.

Hormones
Progesterone Low or Estrogen Dominance often suggests Low Adrenal Function / Adrenal Insufficiency  Progesterone Low or Estrogen Dominance
The inner most layer of an adrenal gland is the zona reticularis which produces small amounts of sex hormones. Specifically, it produces androgen, estrogen and progesterone. Adrenal exhaustion can therefore cause hormone deficiencies.

Hypothyroidism often suggests Low Adrenal Function / Adrenal Insufficiency  Hypothyroidism
A suggestive but unresolved issue is the connection between the thyroid and the adrenal glands. An altered sensitivity of tissues to thyroid hormone may take place when there is a reduction in adrenal hormones.

Hirsutism may suggest Low Adrenal Function / Adrenal Insufficiency  Hirsutism
Hyperthyroidism may suggest Low Adrenal Function / Adrenal Insufficiency  Hyperthyroidism

Immunity
HIV/AIDS often suggests Low Adrenal Function / Adrenal Insufficiency  HIV/AIDS
Adrenal insufficiency is considerably less common than hypogonadism in people with HIV, but its incidence increases in advanced cases.

Weakened Immune System may suggest Low Adrenal Function / Adrenal Insufficiency  Weakened Immune System
Adrenal insufficiency can lead to a host of problems, including a weakened immune response, anxiety and panic attacks.

Infections
Shingles (Herpes Zoster) may suggest Low Adrenal Function / Adrenal Insufficiency  Shingles (Herpes Zoster)
Sinusitis may suggest Low Adrenal Function / Adrenal Insufficiency  Sinusitis

Inflammation
Chronic Inflammation often suggests Low Adrenal Function / Adrenal Insufficiency  Chronic Inflammation
The adrenal glands produce hydrocortisol, the major natural anti-inflammatory steroid in the body. Without enough circulating cortisol there may be a tendency to become easily inflamed.

Lab Values
A Low IgM Level may suggest Low Adrenal Function / Adrenal Insufficiency  A Low IgM Level

Mental
Anxiety may suggest Low Adrenal Function / Adrenal Insufficiency  Anxiety
Adrenal insufficiency can lead to a host of problems, including a weakened immune response, anxiety and panic attacks.

Metabolic
Hypoglycemia often suggests Low Adrenal Function / Adrenal Insufficiency  Hypoglycemia
Migraine/Tension Headaches may suggest Low Adrenal Function / Adrenal Insufficiency  Migraine/Tension Headaches

Musculo-Skeletal
Rheumatoid Arthritis often suggests Low Adrenal Function / Adrenal Insufficiency  Rheumatoid Arthritis

Nervous System
Exhaustion Caused By Emotional Upsets may suggest Low Adrenal Function / Adrenal Insufficiency  Exhaustion Caused By Emotional Upsets

Organ Health
Diabetes Type II may suggest Low Adrenal Function / Adrenal Insufficiency  Diabetes Type II

Respiratory
Asthma may suggest Low Adrenal Function / Adrenal Insufficiency  Asthma

Skin-Hair-Nails
Dry skin may suggest Low Adrenal Function / Adrenal Insufficiency  Dry skin
Hives may suggest Low Adrenal Function / Adrenal Insufficiency  Hives
Cold Hands and Feet may suggest Low Adrenal Function / Adrenal Insufficiency  Cold Hands and Feet
Adult Acne may suggest Low Adrenal Function / Adrenal Insufficiency  Adult Acne

Uro-Genital
Fibrocystic Breast Disease often suggests Low Adrenal Function / Adrenal Insufficiency  Fibrocystic Breast Disease
[The Safe Uses of Cortisol, William Mck. Jefferies, MD 1996, p.156]

Erectile Dysfunction (ED, Impotence) often suggests Low Adrenal Function / Adrenal Insufficiency  Erectile Dysfunction (ED, Impotence)
Painful Menstruation (Dysmenorrhea) may suggest Low Adrenal Function / Adrenal Insufficiency  Painful Menstruation (Dysmenorrhea)
Dysmenorrhea caused by ovarian dysfunction may disappear when low doses of cortisol are used to improve adrenal influence on ovarian function. [The Safe Uses of Cortisol, William Mck. Jefferies, MD 1996, p.157]

Metrorrhagia may suggest Low Adrenal Function / Adrenal Insufficiency  Metrorrhagia

Risk factors for Low Adrenal Function / Adrenal Insufficiency:
Childhood(Severe) sexual abuse during childhood often increases risk of Low Adrenal Function / Adrenal Insufficiency  (Severe) sexual abuse during childhood
Females who have been abused are more sensitive to life's stresses many years after the original abuse event(s). This elevated stress response can lead to adrenal exhaustion.

Rapid growth but short stature may increase risk of Low Adrenal Function / Adrenal Insufficiency  Rapid growth but short stature

Diet
Counter-indicators:
A Healthy Diet often decreases risk of Low Adrenal Function / Adrenal Insufficiency  A Healthy Diet
Healthy and regular eating habits support adrenal function.

Habits
Counter-indicators:
A Good Aerobic Exercise Level often decreases risk of Low Adrenal Function / Adrenal Insufficiency  A Good Aerobic Exercise Level
Those regularly engaged in exercise and hobbies are less likely to suffer from adrenal problems.

Hormones
Hypopituitarism increases risk of Low Adrenal Function / Adrenal Insufficiency  Hypopituitarism

Nutrients
Counter-indicators:
A Good Supplementation Level may decrease risk of Low Adrenal Function / Adrenal Insufficiency  A Good Supplementation Level

Personal Background
Counter-indicators:
Being in a good relationship may decrease risk of Low Adrenal Function / Adrenal Insufficiency  Being in a good relationship
Happy and fulfilling relationships tend to contraindicate adrenal compromise.

Supplements and Medications
History of cortisol use increases risk of Low Adrenal Function / Adrenal Insufficiency  Short-term/long-term/history of cortisol use
Antihistamine use may increase risk of Low Adrenal Function / Adrenal Insufficiency  Antihistamine use
Prednisone use may increase risk of Low Adrenal Function / Adrenal Insufficiency  Prednisone use
Long-term use of prednisone can lead to adrenal suppression, possibly resulting in depression, euphoria, hypertension, nausea, anorexia, high blood sugar levels, or increased susceptibility to infection.

Symptoms - Allergy
History of adult allergies may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of adult allergies

Symptoms - Food - Beverages
(High) coffee consumption may increase risk of Low Adrenal Function / Adrenal Insufficiency  (High) coffee consumption
Caffeine raises adrenaline levels and heavy coffee consumption can lead to a state of adrenal gland exhaustion, where the adrenal glands are no longer able to adequately respond to stress by releasing enough adrenaline.

Symptoms - Glandular
History of hypoglycemia may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of hypoglycemia
History of hypothyroidism may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of hypothyroidism
A suggestive but unresolved issue is the connection between the thyroid and the adrenal glands. An altered sensitivity of tissues to thyroid hormone may take place when there is a reduction in adrenal hormones.

History of hyperthyroidism may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of hyperthyroidism

Symptoms - Head - Nose
History of sinusitis may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of sinusitis

Symptoms - Immune System
History of postviral syndrome may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of postviral syndrome
History of shingles may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of shingles
History of chronic thyroiditis may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of chronic thyroiditis

Symptoms - Mind - Emotional
History of baby blues often increases risk of Low Adrenal Function / Adrenal Insufficiency  History of postpartum depression or history of 'baby blues'
A high-stress lifestyle often increases risk of Low Adrenal Function / Adrenal Insufficiency  An average-stress/a high-stress lifestyle

Counter-indicators:
A low-stress lifestyle often decreases risk of Low Adrenal Function / Adrenal Insufficiency  A low-stress lifestyle
A slow-paced lifestyle would tend to contraindicate adrenal compromise.

Symptoms - Muscular
History of tender muscles may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of tender muscles

Symptoms - Respiratory
History of asthma may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of asthma

Symptoms - Skin - Conditions
History of adolescent acne may increase risk of Low Adrenal Function / Adrenal Insufficiency  History of adolescent acne

Low Adrenal Function / Adrenal Insufficiency suggests the following may be present:
HormonesLow Adrenal Function / Adrenal Insufficiency often suggests Hypopituitarism  Hypopituitarism

Immunity
Low Adrenal Function / Adrenal Insufficiency may suggest HIV/AIDS  HIV/AIDS
Adrenal insufficiency is considerably less common than hypogonadism in people with HIV, but its incidence increases in advanced cases.

Low Adrenal Function / Adrenal Insufficiency can lead to:
AutoimmuneLow Adrenal Function / Adrenal Insufficiency sometimes leads to Lupus, SLE  Lupus, SLE (Systemic Lupus Erythromatosis)
Lupus is one of the auto-immune diseases, caused by a hyperactive ("hypervigilant") immune system that attacks a person's own protein as if it were foreign matter. One reason for this is poor adrenal function. Adrenal steroids modulate (slow down) the immune system: when there is not enough of these steroids the immune system goes berserk.

Recommendations and treatments for Low Adrenal Function / Adrenal Insufficiency:
BotanicalLicorice Root is highly recommended for Low Adrenal Function / Adrenal Insufficiency  Licorice Root
Licorice root is a specific herb that has been used for centuries to support these glands. If cortisol levels are low, one of the ways to sustain more normal levels is to slow or inhibit its breakdown. This can be accomplished naturally.

The only known readily available inhibitors of the enzyme that deactivates cortisol (11 beta-HSD) are glycyrrhizic acid (found in licorice root extract), progesterone, and flavonoids (in grapefruit). The concept of extending cortisol bioactivity via 11 beta-HSD inhibition is well established, but the manner in which progesterone alters 11 beta-HSD is not currently clear. You could eat 10 to 15 grapefruits or take licorice root extract to sustain cortisol levels. However, licorice root used regularly in large doses can produce high blood pressure, water retention, potassium wasting, and breast enlargement in men. A Naturopathic Doctor should be able to guide you in using licorice root alone or in combination with other adrenal agents.

Korean Ginseng may help with Low Adrenal Function / Adrenal Insufficiency  Korean Ginseng
Both Chinese ginseng (Panax ginseng) and Siberian ginseng (Eleutherococcus senticosus) are known to exert beneficial effects on adrenal function and enhance resistance to stress.

Ginseng may prove especially effective for the restoration of normal adrenal function and prevention of adrenal atrophy associated with corticosteroid administration. In rats, ginseng has been found to inhibit cortisone-induced adrenal and thymic atrophy. Ginseng could be combined with other botanicals with adrenal enhancing activity in the treatment of adrenal atrophy.

Diet
Caffeine/Coffee Avoidance often helps with Low Adrenal Function / Adrenal Insufficiency  Caffeine/Coffee Avoidance
Caffeine raises adrenaline levels and heavy coffee consumption can lead to a state of adrenal gland exhaustion, where the adrenal glands are no longer able to adequately respond to stress by releasing enough adrenaline.

Hormone
Hydrocortisone is highly recommended for Low Adrenal Function / Adrenal Insufficiency  Hydrocortisone
Physiologic replacement doses of oral cortisol can make a dramatic difference in cases of adrenal exhaustion. Because of side-effects induced by larger doses, many doctors are reluctant to use it and many patients are thus deprived of a valuable and needed therapy. Physiologic doses of cortisol (5-25mg per day) are safe. Lab testing can confirm the diagnosis of mild adrenocortical deficiency. A doctor experienced with cortisol use should be consulted; a typical prescription is 5mg four times per day, with an emphasis on early morning use if later doses keep you up at night, or if fewer doses are taken.

DHEA may help with Low Adrenal Function / Adrenal Insufficiency  DHEA

Lab Tests/Rule-Outs
Test Adrenal Function is highly recommended for Low Adrenal Function / Adrenal Insufficiency  Test Adrenal Function
Adrenal function can be evaluated in several ways by blood, saliva, and/or urine testing. Your doctor should know the best test to use depending on the suspected severity of the condition.

Mineral
Increased Salt Consumption often helps with Low Adrenal Function / Adrenal Insufficiency  Increased Salt Consumption
Sea salt should be included in the diet, unless contraindicated for other reasons, as it benefits adrenal gland function. When seasoning foods, use as much salt as tastes good to you.

Magnesium may help with Low Adrenal Function / Adrenal Insufficiency  Magnesium
Zinc may help with Low Adrenal Function / Adrenal Insufficiency  Zinc

Nutrient
TMG (Tri-methyl-glycine) may help with Low Adrenal Function / Adrenal Insufficiency  TMG (Tri-methyl-glycine)
The adrenal gland uses nutrients such as TMG (betaine), tyrosine, vitamins B5, B6 and C to maintain function and produce its hormones.

Vitamins
Vitamin B5 (Pantothenic Acid) often helps with Low Adrenal Function / Adrenal Insufficiency  Vitamin B5 (Pantothenic Acid)
Key nutrients to aid adrenal function include vitamin C, B5 (pantothenic acid), vitamin B6, zinc, and magnesium. These nutrients not only play a critical role in the health of the adrenal gland, but also in the manufacture of adrenal hormones.

Vitamin A may help with Low Adrenal Function / Adrenal Insufficiency  Vitamin A
The adrenals need lots of vitamin A, C, and B-complex.

Vitamin B6 (Pyridoxine) may help with Low Adrenal Function / Adrenal Insufficiency  Vitamin B6 (Pyridoxine)
Vitamin C (Ascorbic Acid) may help with Low Adrenal Function / Adrenal Insufficiency  Vitamin C (Ascorbic Acid)
Taking 1-3gm of mineral ascorbates up to 3 times daily is supportive of adrenal gland function.

Vitamin Paba may help with Low Adrenal Function / Adrenal Insufficiency  Vitamin Paba
PABA potentiates the hormone cortisol. When cortisol is being supplemented, the dosage of PABA may need to be reduced.


KEY
Weak or unproven link: may be a sign or symptom of; may suggest; may increase risk of; sometimes leads toWeak or unproven link: may be a sign or symptom of; may suggest; may increase risk of; sometimes leads to
Strong or generally accepted link: is often a sign or symptom of; often suggests; often increases risk ofStrong or generally accepted link: is often a sign or symptom of; often suggests; often increases risk of
Definite or direct link: strongly suggests; increases risk ofDefinite or direct link: strongly suggests; increases risk of
Weakly counter-indicative: may contraindicate; may decrease risk ofWeakly counter-indicative: may contraindicate; may decrease risk of
Strong counter-indication: often contraindicates; often decreases risk ofStrong counter-indication: often contraindicates; often decreases risk of
May be useful: may help withMay be useful: may help with
Moderately useful: often helps withModerately useful: often helps with
Very useful: is highly recommended forVery useful: is highly recommended for




Last updated: Apr 08, 2012